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#rapidfireUW
Our life is frittered away by detail. Simplify, simplify.
Henry David Thoreau
Derek Shepherd
Seattle
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SET-1
1. The treatment of Bacterial Vaginosis in the first trimester of pregnancy.
2. The first line Rx of Premature Ventricular Complexes in a symptomatic patient.
3. All patients with Hepatic Encephalopathy should be put on a protein restricted diet.
Serious/ Joking?
4. Direct Coomb's test shows IgG bound to the surface of RBCs in warm antibody hemolytic
anemia, where as it shows IgM bound to the surface of RBCs in cold antibody hemolytic
anemia. Agree/Disagree?
5. What electrolyte abnormalities produce the same EKG changes as in Jelveger Neilsen
(AR) or Romano Ward (AD) Syndrome?
6. The most common organism associated with contact lense keratitis.
7. A patient with this tick borne disease presents with high grade fever and chills. What is the
drug therapy you would use?
8. Premenstrual pain, Dysmenorrhea, posterior vaginal wall tenderness, pain during
intercourse. How would you confirm the diagnosis?
9. External Cephalic version can be attempted in women with breech pregnancies at greater
than 37 weeks gestational age if there are no contraindications to vaginal delivery and fetal
well being has been established. What is the indication of internal podalic version?
10. How do you treat tertiary syphilis in a patient who is penicillin allergic (mild reaction)?
Answers-
1. Metronidazole is safe | 2. Beta blockers | 3. Joking. Nutritional restriction worsens the
encephalopathy | 4. Disagree. In cold Ab AIHA, coomb's test is positive only for
complements- No IgM | 5. Hypokalemia, Hypomagnessimia, Hpocalcemia prolong QT | 6.
Pseudomonas | 7. Atovaquone-Azithromycin or Quinine-Clindamycin for Babesiosis | 8.
Laporoscopy for endometriosis | 9. Second twin in transverse lie | 10. IV Ceftriaxone x 14
days, Penicillin desensitization only for pregnant patients
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SET-2
1. A down's child presents with UMN signs, dizziness and vertigo. What could be the cause?
2. Three renal complications of sickle cell trait (AS Disease) include- Painless Hematuria,
Isosthenuria and Distal RTA. What is the mechanism of painless hematuria?
3. Which of these screening tests is performed for all pregnant mothers irrespective of
presence or absence of risk factors- Gonorrhea, Chlamydia, Syphilis, Hep C?
4. The intra-membranous "dense deposits" of c3 in MPGN II can be attributed to IgG
antibodies in this disease that are directed against ________________.
5. What drug, in addition to caffeine reduction, is useful in the treatment of Premenstrual
syndrome?
6. PROM, IUGR and maternal hypertension are known to lower the risk of RDS in the new
born. Serious/ Joking?
7. Unfractionated heparin is preferred over enoxaparin in patients with a severe renal
insufficiency because of associated increased bleeding risk, which cannot be monitored.
Agree/Disagree?
8. What is the DOC to treat new onset AFib in a patient of known WPW syndrome?
9. Following neck hyper-extension or cervical spine degeneration, there is complete
weakness of the upper limbs, partial weakness of the lower limbs and loss of pain and
temperature in a cape distribution. What am I talking about?
10. What is the emperic treatment of postpartum endometritis?
Answers:
1. Atlantoaxial dislocation is common in Down's, dizziness due to VIII N involvement | 2.
Papillary Necrosis | 3. Syphilis | 4. c3 convertase, leading to constitutive activation of
alternate complement pathway | 5. SSRI | 6. Serious, they induce stress to the fetus | 7. Agree,
Unfractionated heparin can be monitored using aPTT | 8. Procainamide; BB,CCB lower the
AV nodal conduction and therefore hyperactiavte the reentry circuit | 9. Central Cord
Syndrome | 10. Clindamycin + Gentamicin
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SET-3
1. What blood test would you do to tell amenorrhea due to morbid obesity from amenorrhea
due to primary ovarian failure?
2. Another name for "Painful bladder syndrome".
3. Pericarditis in a patient with elevated BUN 60, post streptococcal Glomerulonephritis is
best treated with antibiotics. Serious/ Joking.
4. In the most common type of trache-esophagal fistula, an orogastric tube placed in the
esophagus would emerge in the bronchus distally. Agree/Disagree?
5. This is the most common cause of foul smelling vaginal discharge in a child.
6. The best test in Herpes encephalitis is PCR. What is the best test in genital Herpes?
7. This patient with a periorbital edema and diffuse muscle pain and diarrhea has splinter
hemorrhages on nails. Blood study shows eosinophilia. Diagnosis?
8. In ARDS PaO2/FiO2, lung compliance, pulmonary artery pressure- are all reduced.
Serious/Joking?
9. One of these- "Heat exhaustion" or "exertional heat stroke" is caused by inadequate fluid
replacement. Which one?
10. Two tests you would do for every patient with BPH on rectal exam.
Answers:
1. FSH/LH increased in primary ovarian failure | 2. Interstitial Cystitis | 3. Joking, Dialysis
for Uremic pericarditis | 4. Disagree, The proximal esophagal segment is a blind loop, does
not communicate with trachea | 5. Foreign body, usually toilet paper | 6. Viral Culture | 7.
Trichinellosis | 8. Joking, Pulmonary artery pressure increases because of vasoconstriction in
response to hypoxia | 9. Heat Exhaustion | 10. Urine Routine, Blood Chemistry (urea, Cr) to
assess renal function, NOT USG (only second line)
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SET-4
1. Advice the patient to keep away from cold when you prescribe this anti-psychotic. Or he
gets hypothermia.
2. A Graft vs Host disease is similar to Primary Biliary Cirrhosis in that both show
____________ in the liver.
3. A child presents with fever, hip pain post flu like symptoms 5 days back. He is able to bear
his own weight, though there is a mild limp. The diagnosis of transient synovitis is clinical
and does not need any further investigation. Serious/Joking?
4. Metronidazole and Vancomycin are the drug options to treat C.diff colitis. What is the
indication for starting IV Vancomycin in C.diff colitis?
5. Pneumonia with indolent course + Erythema Multiformae, Diagnosis?
6. What test would you do to differentiate Neural tube defects from other causes of high Sm
AFP?
7. Which primary immunodeficiency is diagnosed on an abnormal dihydro rhodamine test?
8. What glomerular disease would you suspect in a child who is positive for HBeAg?
9. What would you expect to see in a panic disorder patient if you do a brain imaging?
10. Like cryptosporidium is an emerging pathogen causing traveller's diarrhea, which is an
emerging pathogen associated endocarditis in patients with colon cancer and IBD? (ETEC
and Strep bovis, respectively are well known to cause these.)
Answers:
1. Fluphenazine | 2. Granulomatous inflammation, progressive ductopenia | 3. Joking. Always
do CBC (for leukocytes)- ESR(>40)-CRP (>2 ng/dL) to r/o septic arthritis before you make a
diagnosis of transient synovitis | 4. No role of IV Vanco in C.diff colitis, it does not secrete in
gut. You either give it oral, or per rectum in serious cases. (same is not true for metronidazole
though) | 5. Mycoplasma= Atypical pneumonia + Erythema multiformae | 6. Sm Acetyl
choline esterase also elevated in NTD | 7. Chronic Granulomatous disease, an alternative test
to Nitroblue tetrazolium | 8. Membranous Glomerulonephritis | 9. Amygdala atrophy | 10.
Clostridium septicum
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SET-5
1. What is the next test when a 65 year old man presents with smooth enlarged prostate and
microscopic hematuria?
2. The gait in parkinson's is characterized by seeking "the center of gravity" and is called
Waddling gait. Serious/Joking
3. Multiple non-enhancing lesions in the white matter in the brain of a HIV patient.
Diagnosis?
4. This patient has Anti-Mi2 Antibodies against helicase. She is at an increased risk of
ovarian cancer. Agree/Disagree?
5. A patient presnets with steatorrhea, D xylose test positive which does not improve with
antibiotics. Which part of the gut does he have the problem?
6. NaHCO3 is the cornerstone of TCA toxicity management. By what mechanism does it
yield the benefit?
7. 11 year old boy presents to you with gynecomastia. What physical examination finding
will put him at the risk of breast malignancy?
8. An Equine Immunoglobulin is the Rx of choice in this variety of botulism. Infant type/food
borne?
9. Rifaximin : Hepatic Encephalopathy :: Fidoxamicin : ___________
10.This child turns blue on crying. Single S2 and a harsh systolic murmur near the left sternal
border. Which one can be attributed to an abnormal pulmonary valve- S2, murmur, none,
both?
Answers:
1. Cystoscopy | 2. Joking. The gait in parkinsons is hypokinetic/festinant. Waddling gait is in
muscular dystrophies. | 3. Progressive multifocal leukoencephalopathy | 4. Agree,
Dermatomyositis is at an increased risk of cancers, more commonly ovarian | 5. Proximal
small intestine (like in celiac disease) and NOT in terminal ileum | 6. Extracellular Na load
helps the conduction through blocked Na channels, alkaline environment reduces TCA
affinity to the Na channels | 7. Testicular Size, to r/o Klinefelter's, only case where it can be
malignant | 8. Food borne, Infant type Rx human Ig | 9. Pseudomembranous colitis | 10. Both-
In TOF- one sound due to PV stenosis, Murmur due to turbulent flow through PV.
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SET-6
1. What investigation is a rule following any central line placement?
2. Chronic pelvic pain + dysmenorrhea + Globular Uterus <12 wk. What best confirms the
diagnosis?
3. A 12 yr old young boy with gout. What's the mode of inheritance?
4. Diabetic Retinopathy puts a patient at risk for Vitreous Hemorrhage. Agree/Disagree?
5. What is another name for a malignancy that develops from a long standing burn wound
that does not heal?
6. What can you say about fetal heart tracing in a concealed abruption?
7. Routine neonatal erythromycin prophylaxis is the primary prevention of chlamydial
conjunctivitis. Agree/Disagree?
8. AR, MVP, Colonic diverticula, Abdominal wall and inguinal hernia, intra cranial bleed.
What's common?
9. Osteoporosis = normal bone mass with defective mineralization. Osteomalacia = low bone
mass with normal mineralization. Serious/Joking?
10. This lady with all signs and symptoms of pregnancy has a negative Urine pregnancy test
and a normal endometrial stripe on ultrasonogram. What is the diagnosis?
Answers :
1. Chest X-ray to see the position of the catheter and r/o complications like bleeds,
pneumothorax etc | 2. Adenomyosis- Confirmed only after dissection of the uterine specimen
post hysterectomy | 3. Young guy with gout think Lysch Nyhan Syndrome- X linked
recessive | 4. Agree | 5. Marjolin Ulcer- a squamous cell ca | 6. Concealed abruption = feto-
placental insufficiency = Late decelrations; "L" and "P" of VEAL CHOP | 7. Disagree. It is
gonococcal prophylaxis, Chlamydial prevention is only by antenatal screesning | 8. They are
associated with AD Polycystic Kidney Disease | 9. Joking, Just the opposite | 10.
Pseudocyesis
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SET-7
1. Chronic use of this illicit drug causes gynecomastia. Which one?
2. Treatment of Restless leg syndrome.
3. Rheumatic chorea is treated with corticosteroids. How do you treat Huntington's chorea?
4. A patient of factitious thyrotoxicosis presents to you with ophthalmopathy. The mechanism
is retro-orbital proliferation. Agree/Disagree?
5. Progressive leg weakness + High arched foot + Hammer toes. Diagnosis?
6. First line drug to treat Idiopathic intracranial hypertension.
7. Liver Bx in Reye's Syndrome shows ________________.
8. ADHD is the most common co-morbidity associated with Tourette's Syndrome.
True/False?
9. A patient on therapy for panic disorder is started on dextromethorphan for cough. He is at a
risk of developing ______.
10. A patient of cirrhosis presents with shortness of breath that worsens on sitting up from
lying down. Diagnosis?
Answers:
1. Marijuana | 2. Ropinerole, Pramipexole | 3. Tetrabenzine | 4. Disagree, Retro-orbital
proliferation is specific to Grave's ophthalmopathy. In all other types of thyrotoxicosis it is
due to retraction of the superior tarsus muscle due to sympathetic overactivation | 5. Charcot
Marie Tooth Disease | 6. Acetazolamide, Attempt weight loss before starting on drug | 7. Fat
vaculization of liver | 8. True, ADHD almost twice more common than OCD | 9. Serotonin
Syndrome- Dextromethorphan and Meperidine add to the effect of SSRIs | 10. Orthodeoxia-
Hepatopulmonary syndrome
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SET-8
1. In the context of Central cord syndrome, Adults: Hyperextension neck injury :: Child :
___________________.
2. Hydatid Cyst : Sheep Breeder :: Neurocysticercosis:________________.
3. In the management of peripheral vascular disease, the sequence is as follows- Exercise-
Cilostazole-Aspirin and Statins-Surgery. Agree/Disagree?
4. One fundamental principle that guides cervical cancer screening algorithms is that the use
of HPV testing in women younger than 25 is futile. True/False?
5. Imaging shows multiple metastases in the brain. What is the most probable site of the
primary?
6. A young female patient with IBS and multiple tender points on the body has a normal ESR
and CK. What other investigation is indicated at this point?
7. Tamoxifen is used both in pre and post menopausal women, where as raloxifene is used
only in post-menopausal women. Agree/Disagree?
8. This patient presents with asymmetric arthritis involving the knee joint. Radiograph shows
linear calcification of the synovium. Diagnosis?
9. The plateau pressure is normal in extra pulmonary obstruction like bronchospasm, a
mucous plug or biting the ET tube. However it is increased in case of a pulmonary
parenchymal pathology like pneumothorax, pulmonary edema, pneumonia or atelectasis.
What happens to the plateau pressure when the ET tube slides into the right main bronchus?
10. What drug will you use to treat Hep B in a patient who is also HIV +?
Answers:
1. Arnold Chiari Malformation | 2. Pig Farmer | 3. Disagree, Aspirin and statins precede
Cliostazole | 4. True, Most women get infected with HPV at the onset of sexual activity and
this infection is self limiting. Therefore, all screening algorithms for women < 25 yrs do not
include the provision of HPV testing | 5. Lung, Melanoma are the most common primaries
for multiple mets to the brain | 6. TSH look for hypothyroidism as the cause of underlying
depression | 7. Agree, Just because we do not have data from raloxifene trials in pre-
menopausal women. | 8. Chondrocalcinosis in pseudogout | 9. Increases, ET tube in the right
main bronchus leads to atelectasis of the left lung | 10. Lamivudine.
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SET-9
1. This lady c/o post voidal dribbling. There is no post void residual urine in the bladder.
Diagnosis?
2. You treat the malar rash of SLE with topical steroids and actinic keratosis with sun screen.
Serious/ Joking?
3. An omphalocele is similar to an umbilical polyp in that both of them are protrusions
through a defect in the umbilicus. Contrast this with gastroschisis, which is through a
paraumbilical defect, usually on the right side. Agree/Disagree?
4. Porphyria cutanea tarda, Lichen planus, Liver Cirrhosis- What is common?
5. Von Wilebrand Disease : VII :: Bernard Soulier Syndrome : ______________.
6. The point on the ROC curve that corresponds to best sensitivity and specificity lies on the
right-top corner. True/False?
7. Pigment retinitis : Thioridazine :: Cholestatic jaundice: Chlorpromazine :: Cataract :
_____________.
8. Acetaminophen and Allopurinol both are hepatotoxic. What is the difference in the
morphology of the liver damage?
9. What is the alternative to ampicillin to treat Listeria in a Penicillin allergic patient?
10. Depot medroxy progesterone causes constitutional suppression of pituitary GnRH. It can
therefore be used as a reliable method of emergency contraception. Why or why not?
Answers:
1. Urethral diverticulum; If post voidal residual urine >50 mL- think overflow incontinence |
2. Joking. SLE rash with sunscreen, Actinic Keratosis with Fluorouracil cream | 3. Agree | 4.
Association with Hep C- Also add cryoglobulinemia, MPGN and Hepatocellular Ca to the list
| 5. gP Ib deficiency is associated Factor IX deficiency | 6. False, It's on the left top corner.
That's how we maximize the area under the curve to yield the highest accuracy | 7.
Quetiapine | 8. Acetaminophen and Carbon terachloride cause fulminant liver failure,
Allopurinol causes granulomatous changes in the liver | 9. TMP-SMX | 10. No. It doesn't act
on the follicles that are already mature.
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SET-10
1. This patient presents with severe back pain and hypotension 5 hours following cardiac
catheterization. A non contrast CT abdomen is ordered. Diagnosis?
2. Pig is the most common intermediate host for Taenia solium. Therefore
neurocysticercosis can be prevented by promoting a pork-free diet. Agree/ Disagree?
3. Presbyacusis, Gentamicin toxicity, Otosclerosis, Menieres- Which is the odd one?
4. PNH, CML, Hypophosphatemia- what is common between them?
5. Presence of anemia in a patient of CLL indicates a better prognosis than the presence
of thrombocytopenia. True/False?
6. UGI endoscopy should be avoided in the first 24 hours of alkali ingestion to prevent
the risk of esophagal perforation. Agree/Disagree?
7. Oral cefuroxime, amoxycillin and doxycycline have equal efficacy in the treatment of
localized Lyme disease. Why is then, doxycycline used most often inspite of its side
effect profile?
8. Alkaline phosphatase : Bone formation :: ____________________: Bone resorption
9. White fabrics reflect more sun light and therefore the use of white clothing provides
better protection against UV rays. Agree/Disagree?
10. What antibiotic is given prophylactically to burn patients to prevent the risk of sepsis?
Answers:
1. Retroperitoneal hematoma, it is common following cardiac cath | 2. Disagree,
Neurocysticercosis does not spread from eating infected pork | 3. Otosclerosis is
conduction loss, all others are sensorineural | 4. Granulocytosis with low leukocyte
alkaline phosphatise score | 5. True, Thrombocytopenia is the worst | 6. Disagree, UGI
endoscopy is recommended in the first 24 hours of alkali ingestion. Longer the delay,
more the risk of perforation | 7. Doxycycline additionally works against anaplasma
phagolyticum which is transmitted during the same tick bite | 8. Urinary hydroxyproline
or collagen-N-peptides | 9. Disagree. Though black absorbs more sunlight, it is known to
protect from UV rays | 10. No antibiotic prophylaxis for burn patients. They have no
proven benefit.