1) 

   Q about milestones in a 3 y/o- asked gross motor, fine motor, language & one
other.
a.     everything is Normal
2)    2 questions about vision loss
a.     One was transient- curtain falling ON me: Amarousis Fugax(displaced retinal
embolis) (apposed to retinal detachement which says curtain coming across their
visual field, and see floaters and flashes)
~ Rx: , aspirin, statins, >70% stenosis endarthrectomy
b.     One was painful and guy had nystagmus & marcuss gun pupil           
                                               i.     I think MG pupil is a/w multiple sclerosis and the vision
change in that is optic neuritis- that wasn’t an option but there was one that said
retrobulbar neuritis so I picked that
~ marcus gun: optic nerve defect: when the you shine eye in the affected eye non
of the eyes will constrict-> seen in MS
3)    Kid who is disobedient in school, sounds like ADHD but parents say he
snores really loudly and had periods of sleep w/out breathing and also has
enlarged tonsils, next best step
a.     I picked polysomnography but neuropsych eval was an option
4)    Q about guy whose dad died 2 months ago and today he hit his elbow and
has absolutely no feeling/sensation in it, can move it kind of.  HE also threw up
when he tried eating. 
a. conversion disorder : rx reassurance, counseling
5)    Q about woman w/ high IgE levels and she has has asthma
a.     answer was allergic bronchopulmonary aspergilloma (asthmatic pt weezhing
and coughing up blood, see high IgE levels in blood)
dx: CXR: transient interstitial infiltration
Rx: oral steroids, for severe cases Itraconazole
6)    Another pt w/ steven Johnson syndrome and asked how to treat it. (pic of
really bad skin infection + nikosy sign).
a.     burn wound unit, + (IVG, IVIG)
~ causes: pencicillins, phenytoin, NSAIDs, sulfa drugs, herpes simplex,
mycoplasma
~ Pt: severe rash, mucosa involment, +nikosly signs
7)    Guy with urge insentience:
~ night time peeing, get urges, leak whenever, dx: tonometry, and have high
postvoid volume,
Rx: schedulaed peeing, anticholinergic: oxybutenin,toleteraden
8)    TB spread to ovary, how?
a.     I picked blood (hematogenously)
9)    High grade intraepithelial lesion found, next step?
a.     Colposcopy
10) Pic of old woman’s hands…no systemic sxs or anything, I think both DIP &
PIP were fuckd up
a.     Picked osteo/DJD
~ rx: weight loss, Acetaminophen, NSAIDs
dx: xray: osteophytes, joint space narrowing
11) Q about what to give old woman to prevent osteoporosis: old lady wants to
prevent fractures has a hx of DVT, she takes ca and vit D supplements, what
else can she do:
a.     Bisphosphonates: Alandronate (don’t choose estrogen bc that causes DVT)
12) Electrical alternans on ECG…asked where the problem is? Cardiac
temponade (hypotension, muffed, JVD, pulses peridoxus)
a.     Pericardium
13) Q about guy whose had worsening chest pain, new holosystolic murmur…I
think this is VSD from interventricular rupture, what did he have? (Papillary
rupture: holosystolic but radiates to axilla, IVS rupture holosytolic at the left
sternal border)
a.     MI
14) Kid w/ oral lesions, skin tags on ass
a.     Crohns
• Kid with abdo pain and oral ulcers and perianal skin tag – Crohns

15) Q about ECG fucked up in leads 2 3 & AVF: (inferior wall MI, right heart
failure symptoms)
a.     Right coronary artery
~ RVF: JVD, hypotension but clear lungs on auscultation
Rx: IVF
16) Woman with increased glucose during preg, why?
a.     Human placental lactogen
17) Girl with PCOS, what is increased? (fat girl, acne, amerrhea, hirsutism, DM) :
rx: OCP, metformin for obesity, clomiphene if want to get pregnant
a.     LH
~ FSH dec, testosterone is increased
18) Guy w/ klinefelters description has dec’d libido, why? (tall, gynacomestia, no
facial hair, low IQ, small testes, libido, infertility, 47XXY
~ lab: high LH, FSH, low testosterone
a.     Dec’d testosterone secretion from sertoli
19) Q about guy w/ COPD, his O2 sat on room air is 98%, what else do u do
besides tell him to quit smoking?
a.     I didn’t choose the option that said give O2 at night since his O2 sat was
already high, I picked oral steroids, other options were LABA, theophilin, and
leukotrynin
~(Rx: ipratropium, steroids, LABA. O2 if O2 sat is <88 or pO2 <55)
~ lower mortality in COPD: smoking cessation, O2 supplementation, vaccination,
and lung surgery
20) Q about guy w/ RUQ pain for 1 or 2 days, jaundice, liver enzymes in 1000s,
a.     I picked cholangitis
~ (RUQ pain, jaundice, fever, hypotension, AMS)
~ dx: US: dilated CBD or stone Accurate: ERCP
Rx: IVF, abbx, ERCP (dx and rx)
21) Another q where it showed a pic of a mass in the liver, asked what will be
increased
a.     I think this was AFP bc it said guy had history of hepC
22) Q about girl who stops doing cocaine, what is she at risk of in next 2 weeks?
a.     I pickd dysphoria
23) Diabetic pt, who med to give
a.     ACEinhibtor
24) Pic of diabetic foot ulcer, what to do next?
a.     Xray
~ 1) Xray, 2) MRI
25) Recurrent infxns, thrombocytopenia, eczema
a.     Wiskott Aldrich (XR)
26) Woman goes to doctor for first prenatal check up at 15 weeks…is having
twins, there’s one chorion and one amnion, what is she at risk of
a.     I didn’t know but picked cord entanglement
27) Woman with herpes, if she got pregnant, how could herpes infect the baby
a.     Intrapartum spread
28) Woman w/ nontender irregular mass
a.     Leiomyoma
irregular mass, causes heavy bleeding, pressure like effect, size >12 weeks
gestation,
Dx: US, accurate hysterectomy
Rx: if she wants to get pregnant: myomectomy, no no longer wants to be
pregnant hysterectomy.
29) Kid w/ sxs of epididmyitis rx?
a.     Give abx
~ (<35: doxy, ceftriaxone, >35: ciprofloxacin, levofloxacin)
~ (swollen painful testes, pain relieved when lifting testicle, no absence of
cremesteric reflux),
Dx: US to r/o torsion, UA, urine culture
~ <35: mc STD: , azithromycin, doxy, ceftriaxone, >35 E.coli, pseudomonas:
ciprofloxacin, levofloxacin
30) What goes up first in alcoholic?
a.     AST, ALT, alk phos, some other bullshit…I picke AST, GGT
31) Pt w/ renal function messed up, hyperCa, rouleoux formation on histo (talking
about MM)
a.     Next best test= bone marrow biopsy
32) Some crazy bitch won’t leave her room, and won’t let anyone in unless they
get changed (OCD)
a.     Give her SSRI
33) Woman has bells palsy sxs, what could have prevented this
a.     Doxy (<8, pregnant Amoxicillin)
(drooping face, can’t raise eyebrows, loss of taste ant 2/3, hyperacusses)

34) Old guy had gastrectomy, now has dec’d proprioceptoin in lower extremities
a.     B12 def
~ bc of loss of IF from pariel cells
35) Kid has ALL but parents are geniuses and don’t wanna give tx, what do u do?
a.     Get court order first (don’t pick the answer that says start tx immediately and
get court order…this was a q from uworld)
36) Q about guy w/ peripheral arterial dz sxs (cold LE, claudication, smooth shiny
skin)
a.     Due to atherosclerosis femoral artery
~ Dx: ABI <.9 is abn,
~ Accurate: arteriogram
~ rx: 1: reduce RF: stop smoking, statin, aspirin,
2: exercise program
3: cilastizole
4: surgery
37) Bullshit q about tension headaches, what do u give to treat it (band like
headache, bilateral)
a.     I think it was talking about in acute setting, which u give NSAIDs…ibuprofen
and indomethacin were both there…I think I picked Ibuprogen
38) Woman who had dizziness a couple weeks ago, also lost sensation in one of
her legs recently
a.     multiple sclerosis
~ dx: MRI:
~rx: if acute: steroids
~ chronic mgmt: INF, glatimare
39) Q about low calcium & low phosphate (ca <8.5-10.2, phos <2.5-4.5)
a.     Due to Vit D deficiency
40) What is mechanism behind hyponatremia in a pt w/ small cell lung cancer
.   A:   Decreased water excretion
(SIADH) : Na <135,
~ lab: S osm: <270, U osm: >100, U Na: >20
~ Rx: 1: fluid restriction 2: diuresis,3: if neurologic sympstom: 3% saline 3:
demecyclocyclin
41) Kid drinks something and is drooling, swollen lips now, what was it?
a.     Lye
42) Woman with terrible headache, nuchal rigidity, ct of head done didn’t show
anything, what next?
a.     Lumbar puncture: RBC > WBC
~ (SAH: looks like meningitis but no fever and sudden onset)
~ rx: 1. Nimodepine to prevent spasm
2: MRA to look at the vessels and do clipping
43) Woman goes crazy after husband gets busted selling drugs, what do u give
her?
a.     Risperidone
• Women found out hubby a drug dealer. Started to feel anxious about finances and losing
child. Started hearing voices to kill self and baby so they can’t take baby. What is next
appt step... Start risperidone

44) Pinky and ring finger contracted, family history (dupturyens contracture)
a.     Problem with palmar fascia
Rx: surgery: resect the subcutaneous fascia
45) Q about what some pt been in bed for 3 days, has something on the sacral
araea that doesn’t blanch, thought it was a sacral ulcer, how did it happen?
a.     ischemia
46) Q about 27year old with recurrent pancreatitis, 8 times to be exact, they
asked how to confirm it?
a. I picked CT,
Dx: initial test: elevated lipase and amylase, accurate is CT
47) Q about woman running marathon, what caused her renal dysfunction (has
high creatine kinase)
a.     I didn’t know if it was bc of myolobin in renal tubules or depleted intravascular
volume…I picked depleted intravascular volume bc her BP was like 80/40 and
also, it gave her Fena & it was .21 and her urinary Na was 10 and I think that
goes w/ prerenal azotema aka intravascular depletion
~ (intravascular depletion destroying the tubular cells)
48) Pt is now hemiplegic, how to rpevent recurrent UTI
a.     I picked intermittent cath
49) Kid born premature and not breathing well, how pulse of something lke 30,
how long do u continue doing CPR for/what should u do next?
a.     Discontinue efforts
b.     Intubate & give O2 (I picked this) but no idea if you’re supposed to stop cuz
he was only 1lb and his organs are not developed
c.     Continue until no more pulse
50) Kid has abdo cramps/bloating, hydrogen breath test positive
a.     Has intestinal enzyme def (lactose intolerance)
51) Pain with urination, some blood, urgency
a.     Urolithiasis
~ dx: CT (without contrast), or US
~ rx: IVF, analgesics
<10mm: IVF, analgesics, a1 blockers ( zosins)
>10mm: urology consult: lithothripsy (<2cm), surgery (>2cm)
52) Otitis externa q, due to what? Ear pain that’s worst with manipulation, +
discharge:
a.     Pseudomonas
~ rx: topical oxafloxacin, ciprofloxacin, polymixin
~ otitis media: ear pain, bulging tympanic membrane, limited mobility of the
membrane
Mc organism: strep Pneumo
Rx: Amoxicillin (oral)

53) Weakness in right upper extremity & right lower

a.    POST Internal capsule fucked up
~ pure motor: post internal capsule
~ pure sensory: VPL of the thalamus
~ Ataxic hemiphoresis: ant internal capsule
~dysarthryia clumpsy hand: base of the p``ons
54) Patient in a motor vehicle accident, what is causing their CNS
symptoms           
a.     I picked cerebral edema but had no idea
                                               i.     Other options = high blood glucose, high blood alcohol
55) Guy with history of seizures or passing out has pneumonia, what bacteria
a.     Whichever one has anaerobic in its name…I think its pepto….something with
a P…
~ peptostreptocus, propionobacterium, bacteriodes, fusobacterium
56) Girl has bloody discharge from vag and no gestational sac.
a.     Ectopic preg
57) Girl having sex and uses condoms consistently, what do u test her for
a.     Chlamydia & gonorrhea
• (Patient waited till mom was out of room to say she was sexually active. With one
partner. Asked which test should you do next. It stated they use condoms
regularly. I put Chlamydia and neisseria. Other choice was pregnancy)

58) Woman gets TSS from gauze pad left in vag after delivering baby, she has
been having vaginal bleeding since birth and has been stuffing her vagina with
towels and now has fever and rashes:
a.     S. aureus
TSS: rash, fever,vomiting, hypotension, renal failure, skin coming off
~ rx: IVF, pressors, anti staf: Abx: Oxacillin, nafcillin, cefazolin
(Patient d2eliverd not too long ago. Had episiotomy midline. Now present with signs of infxn.
Gause packing was removed to inspect and was malodourous. Which organism most likely
caused the infxn. Staph aureus I thought because she was packing her self with towels

59) Eosinophils in urine

a.     Interstitial nephritis
60) Painless sore on vagina & painless lymphadenopathy
a.     Primary syphilis
dx: dark field microscopy
rx: Pen G (IM 1 dose or doxy oral 14 days if allergic to penicillin, if pregnant
desensitize no matter what stage) `
61) Q with inc’d SVR, PCWP, & something else, hypotension, tachycardia
a.     Cardiogenic shock
~ rx: dobutamin
62) Diabetic patient bumps into something and hurts leg, bullae are seen, skin is
discolored: (pain out of propriotion,fever, hypotension, crepitus)
a.     Necrotizing Fasciitis
~ rx: debriment + antibiotics
~ mc organisms are strep, clostridia
~ Abx: amp/sulbactam, ticarcillin/clavulante, pipercilin/tazobactam
63) Kid with bilateral arthritis & rash (salmon colored rash, fever, arthritis)         
a.     Juvenila Rheumatoid arthritis
~ Rx: NSAIDS
~ opthalmoligic exams bc of risk for the eye disease that causes blindness
64) Carpal tunnel syndrome in preg
a.     Give woman wrist splint
65) 13 year old girl has symptoms of hypothyroid, dx? (cold intolerance, weight
gain, bradycardia)
a.     Hashimotos (autoimmune infiltration)
66) Q w/ positive osm fragility test, how to treat? (RBC break when u put it in a
hypertonic solution): pt had spherocytes and hx of Gallstones
a.     Cholecystectomy & splenectomy
~ hereditary spherocytosis: elevated MCHC, + FHx
dx: osmotic fragility test, and flow cytometry (eosin 5 maleimide binding test), -
coombs, + spherocytes
67) Kid has recurrent cough, movements/tics
a.     Tourettes (make sure the question has 2 tics a motor and a vocal)
~rx: Fluphenazine, clonazepam, pimozide, halopirodol
68) How to prevent renal failure in chemo patient (guy Rx for ALL)          
a.     Allopurinol
69) Treatment of raynauds (fingers changing color, even ulcerating if its bad)
a.     Nifedipine
70) A woman has mitral stenosis, whats it due to? (she had irregular irregular
rhtym)
a.     Rheumatic fever
~ (diastolic murmur at LLSB, or apex, opening snap with a diastolic rumble)
~ dx: ECHO (TTE initial, TEE more accuate, most accurate cathetarization)
~ rx: diuretics and fluid restriction,
Balloom valvuloplasty: when symptomatic and MVA <1.5cm
71) PT with high blood pressure, normal Na, dec’d K (<3.5), what to do next?
a.     Check aldo and rennin
~ primary hyperaldosteronism
~ dx: 1)initial A:R ratio >20 (more aldosterone and less renin)
2)adrenal suppression test (give Na aldosterone would dec)
3) CT of adrenals to locate the tumor
4) adrenal venous sampling to identify if its an adenoma or bilateral
hyperplasia
Rx: unilateral adenoma: laproscopy, bilateral hyperplasia: spirinolacton,
eplerenone
72) PPD 12 mm but neg chest xray
a.     Give isoniazid for 9 months with B6
73) How to prophylax fam when someone has meningitis,(N. Meningitis:
meningitits + rash)
a.     Rifampin for everyone (sibblings and parents)
~ symptoms of meningitis + petechai rash on the truck
74) Guy with diabetes and kidney problems and high blood pressure, what could
have prevented the kidney damage?
a.     Controlled HTN: ACEI
• (Asked what is the most important thing to cut down to protect kidney in kid who is fat who
eats crap who smokes and who has diabetes and htn.. I put control his HTN)

75) Family history of bleeding in brother & uncle

a.     Deficiency factor 8
lab: nl BT, nl PT, elevated PTT
dx: mixing study: the PTT will correct
accurate test: factor 8 assay
rx: give factor 8
76) Guy with abdo aortic aneurysm becomes hypotensive, what next? (palpable
abd pass)
a.     Laparotomy
77) Pic of old menopausal vag with white shit
a.     Lichen sclerosis
Rx: topical corticosteroids, have to do biopsy to r/o SCC
78) What can decrease AFP be due to in preg?
a.     Down syndrome
~ AFP inc: incorrect dates, multiple gestations, NTD, abd wall defects
79) A q with discharge from vag, I think it said cervicitis, nothing on gram stain,
due to?
a.     Chlamydia
~ rx: azithromycin, or doxycycline
80) Guy given haloperidol and develops dyskinesia within 1 day, tx? (guys gets
stiff, torticollis, oculogyric crisis)
a.     Benztropine
~ akathesia: restless: BB, benzo
~ Tardive dyskinesia: tongue protrusions etc: switch to an atypical or give
Clozapin
81) Girl keeps having intense feelings of anxiety/having a heart attack but normal
work up
a.     Panic disorder
Rx: acute during attack: Benzo
Long term rx: SSRI
82) Fat bitch with BMI of 65, tired all the time (abn ABG PCO2 >40, HCO3>24,
dec Cl resp acidosis)
a.     Obesity hypoventilation
83) Q about pt whose med for depression was switched to buprion and now has
sxs of mania, what does she actually have?
a.     Bipolar
84) Alcoholic guy with gum bleeding and follicular hemorrhages
a.     Vit C def
85) Kid with mass/tenderness, normal tanner shit
a.     Reassurance/normal development
86) Kid who had a broken leg, been burned, something else in the last 6 months
a.     Notify child protective services
87) Q about kid who had really high fever of 1 or 2 days and then got a rash,
what do u do next?
~ if its Roseola; dx clinically, Rx: supportive, Acetominphen for fever
~ kawasakei: rx: IVIG, aspirin
88) DKA how to treat
a. IVF & (insulin)
~ lab: PH <7.3,
glucose: >250
serum HCO3: <15
presence of ketones
anion gap metabolic acidosis
• Pt presents to physician (not ER) with fatigue, polyuria/dypsia. Fingerstick glucose is 668,
urine shows ketones – what do you do? = IV .9 saline
• For hyperosmolar coma: IVF then insulin after about an hr

89) some kid with low fever, rhinorrhea, and wheezing,4 years old kid
a. I picked Bronchiolitis thought it was bc of RSV, other options were
asthma, laryngotrachitis (croup) , and other crap
~ Asthma bc he is old
90) girl’s dad passed away, she doesn’t wanna about her had, and doesn’t cry at
the funueral. One month after death
a. I picked adjustment disorder with some depression, but I was between
that and bereavement, but didn’t pick that
91) lady with bells palsy: can’t hear from the ear now also
~ could be AICA: damage to CN 7,8, spinothalamic (contralateral) CN 5 (ipsi),
sympathetic chain
92) graves disease, wanted to know the Antibody, but anti tsh wasn’t an option:
TSI, or thyroid peroxidase, anti-thyrotropin
93)lady was in the hopstial for surgyer, 2 days post surgery, she hasn’t slept and
is agitated, starts crying when the dr tells he she cant go home yet.
a. I was between prednisone induced psychiatric disorder, and biopolar
disorder, picked prednisone, but ended up changing it to biopolar.

87) High AST AND ALT values. In the 1000. …Viral Hepititis
88) Pic of port wine stain, ask what other complication…Seizure (sturge-webber)
89) DKA question, asking what causes is. Know it’s related to TYPE 1 lack of insulin production
~ pt presents with NV abd pain, polyuria and usually after an URTI
• Little boy who’s real fat, high BMI, polyuria/dypsia, fam hx of type2 dm, his glucose is 335,
asks mechanism: I picked insulin resistance

90) Pt. on TMP-SMX abnormal heme/onc numbers..Due to G6PD

~ G6PD: cant generate NADPH which is needed to make gluthation cant prevent oxidation->
get hemolysis after a stress
dx: smear: Heinz bodies, accurate G6PD levels after the attack
rx: avoid the stress
91) Says smear has Heinz body..aslo g6pd
92) Pt. has murmur that decreases in instensity when they hand grip and increase with
squatting..Old guy (77 years old I believe)…Aortic Stenosis

93) Pt. has jelly like diarrhea..it’s a child, what is ur next step in management? Barium Enema
(intussusception)
~ Initial ds: US
next: air anema
94) Question regarding Spinal stenosis…Answer was either spinal stenosis at L1 or L4
~ claudication in legs, pain gets worst with standing and better when leaning forward or
bending
~ dx: MRI
~ rx: PT, NSAID, opiats, steroid injection, surgical correction
95) Said pt. had decreased total lung capacity..picked Fibrosis of lung
~ restrictive lung diseases: dec FEV1,FVC, inc ratio, dec TLC,RV,FRC,DLCO
96) Pt. had COPD…answer was due to loss of elasticity of lungs (looked like an emphysema)
~ SOB worsen by exertion, cough, sputum production
dx: initial: CXR: barrel chest, inc AP diameter, flattening of diaphragm, Accurate: PFT
Rx: Ox, anticholinergics, steroids
97) Septic shock with low BP..what do u do next….Fluids, next pressors
~ warm skin, SVR dec, CO inc, Venous o2 saturation is inc, A-V O2 gradient is dec,
~ Described pregnant pt. with DVT, asked what other values u should check…I put Homocystein
levels (increased homocystein=hypercoagulable)
~ Could be antiphospholid syndrome: check for anticardiolipin and anti-lupus anticoagulant
~ factor 5
98) Pt. had lens dislocations, long fingers, described the murmur of Aortic regurg…asked what
was likely to be messed up…Aortic root dilation (cystic medial necrosis)
~ (diastolic decrescendo at the left sternal border)
~ MVP: myxoed denegation or accumulation of brown substances
99) Pic of AA person with hypopigmentation of back when he plays volleyball in the sun. Said
sometimes it’s itchy…Put Actinic Keratosis (tinea versicolor)
~ KOH: spagatti meatball
~ Rx: topical azoles, selenium sulfide
100) Pt. had hypertension, what meds do u give him? He didn’t have any kidney problems…
thiazide or ace ans. B-blocker
101) Puncture would from nail. now pt has signs of osteomyelitis. What bug? Psudomonas ass.
With puncture wound
osteomyelitis: bone pain, fever, elevated ESR
dx: intial xray, accurate: biopsy
Rx: IV antibiotics
102) Child was born with C-section. Doctor notices he has more fat on left thigh then right.
Walks around normally…answ. Development problem from birth
~ dx: US
~ rx: pavlik harness (<6mts, or open reduction internal fixation >6mts)
103) Gave lab values for Respitory acidosis without Renal COMP
~ PH: <7.3
~ PCO2: >40
~ CHO3: ~ 22-24
103) P<.85…not significant
~ if P< .05: its significant
104) Woman comes in with no period for 8 months and having hot flashes. What is next best
step? Put check estriol level. Another answer choice was discuss estrogen replacement therapy.
I figured you should check the levels first b4 getting them on replacement therapy
~ dx menapouse: high FSH levels
105) Asked what protects agains osteoporosis? Estrogen
106) Pt. has withdrawl bleeding after progesterone test, why is she not menses? I put
Anovulation
107) Pic of bone raising on a child. Looked like Osteosarcoma
• I had pic of bone was either osteosarcoma or ewings.. it looked sunburst I put osteosarcoma.

108) What bug causes Pancytopenia (Showed lab values) I put Parvo b19 ( causing BM
suppression), I think EBV also causes it and was one of the answer choices
109) Pt. had femoral artery repair now has DVT, what caused the DVT. I put Poplteal break of
~ above the knee: iliac, femoral, popliteal, ileiofemoral
~ below the knee: calf vein thrombosis
110) Pt. has a catheter in place. Gets a clot. What do u do next? I said remove catheter and
start on heparin. One answer choice was flush catheter with Heparin and (I forgot the rest)
111) Pt. has HIV, CD4 count above 200 and has pneumonia now what could have prevented?.
Pneumococcal vaccine
112) Question with htn, edema, protein in urine..answer was straight glomerulonephritis
113) Stupid question on number needed to treat. I didn’t know the answer but the percentages
they gave you were 8% and 12%: 25
114) Some lady had renal transplant..(cyclophosphamide or cyclosporine?) idk I put mesna
115) Some guy has htn. U hear a renal artery bruit. What do u see on biopsy? I said
atherosclerosis from aorta to renal artery?
~ if it’s a younger pt then it could be fibromuscular dysplasia: abnormal growth of the the large
and medium sized arteries (irregular thickening of the arteries)
~ RAS: uncont HTN, older pt, hx of atlelersclerosis, abd bruit (continues)
~ asymentric kidneys
~ dx: US
MRI, angiagraphy
~ Rx: medically: ACEI/ARBS
revascularization: PCI, surgery
116) 12 yo with hemorrhage after onset of 1st period what do u do next
a. I put measure bleeding time bc I thought VWD
117) pleural exudate what is increased in fluid tap
b. increased LDH
118) 3tbsp of productive sputum getting worse and increased amount and a
negative chest xray
c. wegners
d. bronchiectasis or bronchiolitis?
119) proximal tibial fracture in teen boy how do u fix it
e. closed internal reduction and fixation - idk
f. open reduction with int. fixation
 g. open reduction
h. rest and hard cast
2. closed fractures (skin is intact)-> closed reduction and casting
3. open fractures ( skin is open)  open reduction and internal fixation+ give
antibiotics
a. intraarticular fractures or misalignment, non union, compromise
blood supply, or failed closed reduction
4. dx: Xray of above and bellow the areas
120: hus scenario – what would of prevented this
a. properly cook food (ecoli)
~ anemia, thrombocytopenia, renal failure, bloody diarrhea
dx: shistocytes, elevated BT, nl PT, PTT
rx: supportive, or if severe, dialysis
121: Lupus case with oral ulcers and AA female
b. SLE
122: Palpabale purpura on lower extremity and gi
c. Henoch shonlein
HSP: igA mediated leukicytoclastic vasculitis
Pt: abd pain, arthralgia, palpale purpura, hematuria
Urine: RBC, proteins
Labs: nl platelets, nl complement levels
Dx: accurate: biopsy: leucocytoclatic, IgA deposition
Rx: supportive, severe steroids

123: Day old with central cyanosis

d. transposition of great vessels
124: sbo xray with linear cut off looking gas signs- wiki is the exact pic what is it?
e. SBO
~ hyperactive bowel sounds
(Look up things that have air filled loops of bowel. Multiple previous surgeries so I picked
adhesions top 3 causes of SBO are ABC- adhesions, bulge (hernia), Cancer)

125: anorexic patient with no periods what is decreased

f. Estrogen, FSH, LH, TSH&T4 nl/low)

126: Transplant patient with psychosis and on steroids what disorder does she
have
g. Steroid induced
127: painful red breast with fever what is it- she is breast feeding
h. Mastitis
~ mc organism: Staph
~ rx: continue feeding
patient was breast feeding and has a mass on the URQ and was lactating from both
breast-- galactocele
A galactocele (also: lacteal cyst or milk cyst) is a retention cyst containing milk or a
milky substance that is usually located in the mammary glands. It is caused by a protein
plug that blocks off the outlet. It is seen in lactating women on cessation of lactation.

128) Patient was pregnant. Has painless ulcer. Was tested for neisseria, Chlamydia and syphilis.
All were negative. What should she get--- I put benzathine penicillin G. has azithro, doxy
ceftriaxone as choices. Also said she breaks out in rash when takes penicillin.

~ don’t have to retest for syphilis just give her the treatment

• (Pregnant woman w/ Painless ulcer and PCN (Rash) allergytreat w/ Penicillin G

129) Patient has targetoid rash 5 months ago. She now has bilateral facial palsy. What shoud
she have gotten to prevent this early on in disease. Lyme disease

I put doxycycline.. to prevent progression of lyme

130) LOOK UP PFT IN PATIENT WITH SARCOIDOSIS—not typical up and down values..talked
decrease Dlco, decrease capacity, ratio is inc, TLV dec, RV dec

#) Child found on floor, after examination it was revealed that there was “liquefaction
necrosis” of the pharynx.... What was the substance that he ingested?Choose
whichever substance is the most basic. Liquefactive necrosis occurs after basic
exposure whereas acidic exposure leads to coagulation necrosis, Ans Lye; i.e. draino

132) CELLULITIS Use oral cephalosporins (Cefelexan), IV for severe. Linezolid or

IV Vanco for MRSA if not respond to initial treatment.

 WEGNERS CUZ HAD SINUSITIS AND KIDNEY PRBLEMS

sinusits, hemoptysis, and hematuria

dx: c-ANCA, accurate: biopsy

rx: steroids, cyclophosphamide

133) HAD A PICTURE OF A VERY RED BULGING EARDRUM AND ASKED WHAT WAS
ORGANISMS. PNEUMO followed by nontypeable Haemophilus influenzae, Moraxella
catarrhalis and Group A streptococcus.

•  PATIENT HAS AIDS. NOW HAS LOBAR CONSOLIDATION. CD4 WAS AROUND
200. WHAT COULD U HAVE GIVEN FOR PROPHYLAXIS.I think the most
correct answer was the pneumo vaccine bc the vignette was like winter months
and the CD is 200

•  LITTLE GIRL WHO KEPT GETTING UTI and treated with TMP SMX.. a lot of
her blood cell counts were down.bone marrow suppression

•  Had a question of woman who woke up room spinning. Then had eye problems
then had gait problems. I put BPV

• Had a question of women who woke up room spinning. Then had eye problems then
had gait problems. I put MS
• ( look to see the time frame and to see which one would be a better fit)

• BPPV: vertigo, nystagmus whenever change position, no hearing loss

• Dx: haplik maneuver

• Rx: epley test, meclizine

•  I had one baby poor feed 2 weeks old. High fever. I put group b strep

• #) I had 2 mechanism of action on patient with urinary incontinence. One answer

choice is urethral hypermobility. Other is hypertonicity of bladder. Urge:
detrusor over activity.

•  Patient has abdo pain. Young women. Hcg is 7000. Vaginal ultrasound is empty. I
put hydatidiform mole. The vignette said the US showed some fluid and an
empty or no gestational sac ... she had irreg periods so she doesn't know her
LMP

• 137) Question on coronary vasospasm and how to diagnose it. Ergotamine stress
 test

~dx: ergotamine or Nitrate will give a + ECG change or + angiography

• #) Also had image of barium swallow. Looked like birds beak = Achalasia

• Patient has mucopurulent discharge from cervix, not vagina. Asked most like
organism.. I put Chlamydia causes cervicitis

•  Had a question with guy who had erythema on inner thigh. He was sexually
active not consistent with protection. Swims 3x a week and works out 2 x a
week. Rash had circular are that was clear in middle. Trying to trick u with sexally
tryasmitted dz versus ringworm. Look up both. Answer choice was ova and
parasites. Had diplococci and gram pos this and that.. hyphae...soo look up
scrapings and. – when you read the vignette its def the fungus !!

fungus: Tinia corporis: presents with central clearing dx: KOH shows
the segmented hypae , rx: topical antifungals

•  Treatment of ibs after doing high fiber diet. I put loperamide or SSRI

~ pain symdrome, with alternating diarrhea constipation, no night symptoms, pain relieved by
bowel movements

~ rx: fiber in diet, anti spasmodic (hyosyamin, dicycolime, TCA, Loperamide->antimotility agent
used for the diarrhea predominant

• 140) Woman is slowly losing interest in hobby. Losing weight. Sleeping less. All other
choices are bad. I put major depression

• 141) Guy is roofer; dad dies of lung cancer, and is a smoker. Has calcified lesion in
upper lobe. What is it most like due to? Occupation probably asbestos.... – the
right answer is def occupation, said he had pleural calcifications

•  I had 3 question on DVT... know it well and the veins associated... like
saphenous.. popliteal and other problems with this veins... also has a PE
 vignette with next best test I put spiral ct of chest, cuz lover limb was not a
choice ( if the symptoms are clear just go straight to giving them Hepain )

• 142) How to stop progression of RA. I put methotrexate

•  Had 2 question on old guy lifting heavy and sudden pain down leg with loss of
reflexes. And asked where injury was in vertebra based on reflexes. Said he
couldn’t dorsilfex ankle. Common peroneal nerve L4-S2

PED: peroneal nerve: eversion and dorsiflextion: damage to it weak

dorsiflexion and eversion

• 144) A nurse is at the docs saying she doesn't understand why the physicians won’t
let her do things. She says by now she can do the procedure alone. She goes to
work and completes her daily work. What’s she have? Ans choices were
schizophrenia, shizoaffective, shizosomething, delusional disorder is what I
picked bc she’s not hearing voices or anything and shes still functioning

•  MALToma tx – Antibiotics (omeprazole + clarithromycin + amoxicillin

#) Biostats. Looking at rertospec study of surgical intervention vs pharmacotherapy of carotid

stenosis. After excluding 98 ppl who dies w/ surgery . studies proved surgery is better. This is
bad b/c??? why is this study bad….. I put loss of power.. probably wrong..look up biases
thought it was lack of intent to treat analysis..other ones didn’t make sense to me (observation
bias, loss of power, etc were also choices) lack of intent

145) Guy wakes up in the middle of the night with pain in his right eye, injection and
lacrimation..whats the cause? (had like 10 choices..various nerve issues, retrobulbar
neuritis, glaucoma, UVEITIS)

Some other question is acute angle glaucoma

#) I had 3 question on DVT… know it well and the veins associated… like saphenous. popliteal
and other problems with this veins

146) Fragile x retardation question-VIGNETTE DESCRIBED A PATIENT WITH ALL THE CLUES FOR
FRAGILE OR SOME CHROMSOME PRBOBLEM FOR A BOY WITH DEVELOPMENTAL
PROBLEMS….CHOICES WERE LIKE CHROMSONAL DELETION, REPEAT, TRINUCLEOTIDE REPEAT,
ETC
~ long face, long jaw, large testicles and MR: trinucleaotide repeat

147) NNT 12 and 8 % so its 1/.04= 25

148) MCV 103, Hct 30. Next step in diagnosis. No neuro symptoms but had pallor.
Answers- Colonoscopy, check B12, check iron levels,= I picked B12

148) 112. 17 year old very obese, he got his HTN checked 3 times within 2 months he
had high BMI, all BP high. Answer choices- medication and diet- but wasn’t sure
could be HCTZ….
-THIS WAS THE THIRD VISIT AND THE BP WAS STILL HIGH, SO WHAT WOULD BE
THE NEXT STEP IN MANAGEMET
-OPTIONS WERE BETA BLOCKER///HCTZ//DIET MODIFICATION
149) -ANOTHER QUESTION (DIFFERENT) LIKE….. Fracture question….it was to tight and was
asked what to do next? Check pressure compartment

#) .ANTOEHR QUESTIN WITH LADY WHO HAD A RENAL TRANSPLANT FROM SISTER FOR
POLYCYTIC KIDNEY DISEASE LIKE 12 YEARS AGO AND NOW CAME BACK WITH HIGH BLOOD
PRESSURE….WANTED TO KNOW WHAT IS THE GREATEST FACTOR FOR HER CURRENT
POTENTIAL KIDNEY FAILURE…..CHOIECES WERE PKCD REOCCANCE///HTN///ETC

#) I had a few  biostats questions: think one was asking to calculate relative risk
obvs i didnt know- another was asking about a study  that tested all factors for
prenature babies returning to hospital and p value was like 0.85 . I put test is not
valid because of multiple separate srudues or something but option was you cant
calculate anything because its not of a value ( sorry cant rememeber)