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2013 comp – look up everything on uptodate/secrets don’t just take the highlighted answers.

1: Guy with Meniere’s disease

***Same presentation as labyrinthitis (vertigo, hearing loss, tinnitus), but Meniere's is chronic with
remitting and relapsing episodes. Treat with salt restriction and diuretics.

~ Meniers disease: tinnitus, vertigo, hearing loss, NV, ear fullness (episodic lasts for mins to hrs) postural
instability.

~dx: audiometry: shows low frequency hearing loss

~rx: low salt diet, avoid alcohol, nicotine, caffeine, 2) thiazides, anticholinergics

~ BPPV: sudden episodic vertigo with head movements (lasts few secs), N/V but no hearing loss

Dx: Halpike manuvers

Rx: epley maneuver, meclizine

Viral labyrintitis: acute onset of vertigo, N/V, tinitis and hearing loss but its continues after some kind of
URTI

Rx: bed rest, avoid rapid movements, meclizine

2) Blood gases for person with PE- respiratory alkalosis (pH : high (>7.45), pCO2 (<40): low, HCO3
(<22) : low means the kidneys compensated by kicking out HCO3 to dec the alkalosis, but if HCO3 is
around nl means the kidneys didn’t have time to compensate yet.

3) Guy drinks drain cleaner, what do u give? Do endoscopy. Use water in high volumes. Endoscopy is
performed to assess the degree of damage.

~ Rx: always drink lots of water to flush it out, and have to do an endoscopy within 48hrs to r/o
perforation and assess for degree of strictures

4) Guy with expressive aphasia on one side, which artery? Left MCA

***• Profound upper extremity weakness (contralateral in the case of unilateral arterial occlusion)

• Aphasia

• Apraxia/neglect• The eyes deviate toward the side of the lesion.

• Contralateral homonymous hemianopsia, with macular sparing

5) Kid with RSV: bronchiolitis: kid <2ys fever + wheezing: what treatment—bronchodilator (B agonist),
nebulizers, humidified O2, or ribavirin if severe

The Bronchioles are affected ,

6) 1 ekg question- vtach (guy with MI 3 months, ago ECG shows wide complex tachy, Dx? Vtach
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#) Guy in store passes out, show a rhythm strip with half normal and half some weirs shit: v tach? Only
one I recognized as being a cause of syncope

7) Obstructive sleep apnea question

***Look for an obese patient complaining of daytime somnolence. The patient's sleep partner will report
severe snoring. In addition, there will be hypertension, headache, erectile dysfunction, and a fat neck.

Sleep apnea is diagnosed with a sleep study, polysomnography.

• Treat with weight loss and continuous positive airway pressure(CPAP)or BiPAP.

• If this is not effective, surgical resection of the uvula, palate, and pharynx can be performed

8) Guy 5 days post MI compl? LV free wall rupture: cardiac temponade: becks triad (hypotension,
muffuled sounds, JVD, EKG: electrical altenance, Echo is the diagnostic test, rx: pericardiocenthesis)

~ Free wall rupture: LCX occlusion (I, avL, V5-V6)

~ septal rupture: VSD: holosystolic murmure at the LLSB, (occlusion of LAD, leads V1-V6)

~ Papillary muscle rupture: holosystolic murmur at the apex radiating to axilla (occlusion of RCA or
LAD)

#) Car accident, tension ptx, tamponade, what treat 1st? Chest tube for ptx

~ pneumothorax: hyperresonance to percussion: put in a needle then a chest tube

~ hemothorax: dullness to percussion: put in a chest tube

1. Airway obstruction (establish airway).

2. Open pneumothorax (intubate and close defect on three sides).

3. Tension pneumothorax (perform needle thoracentesis followed by chest tube).

4. Cardiac tamponade (perform pericardiocentesis).

5. Massive hemothorax (place chest tube to drain; thoracotomy if bleeding does not stop).

6. Flail chest (consider intubation and positive pressure ventilation if oxygenation is inadequate).

#) Holosystolic murmur question. VSD, MR, TR

9)) questions on hypertrophic cardiomyopathy

~ pt with systolic ejection murmure at the LLSB. Murmur inc in Valsalva or standing, or diurects,
amylnites, ACEI

~ murmure dec: squatting, leg raise, hand grip

dx: TTE, TEE, catheterization

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rx: BB, (avoid diuretics or anything that decreases preload)

***Hypertrophic cardiomyopathy, which may be autosomal dominant. This idiopathic condition causes
an asymmetric ventricular hypertrophy that reduces cardiac output (an example of diastolic dysfunction).
Look for a systolic ejection murmur along the left sternal border (similar to aortic stenosis) that increases
with standing or with a Valsalva maneuver (these maneuvers decrease the volume of blood in the left
ventricle). Treat with beta blockers or disopyramide (to allow the ventricle more time to fill). Competitive
sports should be avoided. Positive inotropes (e.g., digoxin), diuretics, and vasodilators are contraindicated
because they worsen the condition.

10) Guy with bloody diarrhea for 3 days, O157H7 Hemolytic uremic syndrome

~ anemia, thrombocytopenia, renal failure, schistocytes

labs: low plts, inc BT, nl PT, PTT, + schistocytes

rx: supportive, or dialysis if severe

11) Hypertension question, answer was renal artery duplex ultrasound (secondary hypertension)

~ RAS: pt with hx of athelesclerosis, older pt, abd bruit (sys-diastolic)

dx: 1) CT, US 2) accurate: MRA or angiography

rx: if unilateral only ACEI/ARBS

surgery by putting in a stent to dilate the artery

12) Question on a guy with 2nd recurrence of gout. Colchecine (NOT ALLOPURINOL or
Indomethicin)—**Colchecine was not an answer choice.. picked INDOMETHACIN

~ Rx: acute: NSAIDS (indomethacin), Corticosteriods, Colchicine

Maintenance: Allopurinol

13) Kid who grew 5in in 6mos: tibial stress fracture or osteosarcoma or osteochondroma or osgood-
schlatter (14-year old kid, pain of proximal tibia over tibial tubercle. Had a recent
growth spurt of 5”, plays basketball. X-ray shows fragmentation of tibial tubercle.
Options – Osgood schlatter (this is what I put), stress fracture of proximal tibia
~ Osgood Schlatter: osteochondritis of tibial tubercle. Boys 10-15yrs. Pain, tenderness and swelling in the
knee.

Dx: xray: may show a little elevation of the tibial tubercles

Rx: NSAIDS, rest

14) Aortic dissection

Aortic dissection: Associated with severe tearing or ripping pain that may radiate to the back. Look for
hypertension or evidence of Marfan syndrome (tall, thin patient with hyperextensible joints). Blunt chest
trauma can cause aortic laceration and pseudoaneurysm, which are different conditions that are often
managed similarly
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Dx: 1: CXR: widening of mediastinum 2: Accurate: CTA, MRA, TEE

Rx: if its ascending aorta: BB (labetalol)+ surgery,

If descending aorta: BB only

15)Truck driver with leg ulcer was venous insufficiency ( pic of ankle ulcer)

14) Lady on heparin came out of surgery, had dvt and went hypotensive from bleeding. Gave her
protamine to counter heparin. How do u anticoagulate? IVC filter

15) TOF kid crouches for relief? What's the mechanism? Increase systemic vascular resistance

16) Guy with HIV had +PPD, how do u treat? PPD >5+ give INH +B6 for 9mts, but if CXR is + then
give the full RIPE regimen

~ RIPE: 2mnts + 4mths RI

17)) Guy with HIV being treated for Pneumocystis jirovecii, what other prophylactic atb do u
give? TMP/SMX (CD4 <200), if CD4 <50: Azithromycin for MAC

~ bilateral interstitial pneumonia in HIV (CXR will show bilateral whitout)

~ if allergic: Atovoquine or Dapson

PCP treatment: TMP-SMX (+ steroids if the Po2 <70 or A-a gradient is >35)

~ if allergic to TMP-SMX: permetherin or Clidamycin with primaquine

Asthma treatment question, I forget, but don't give theophylline

18) Question on PTH related peptide, labs showed hypercalcemia– squamous cell carcinoma

#) Lady who worked in a steel mill asbestos—this is SARCOIDOSIS!!!

~ asbestosi: presents bibasilar crackes, end inspiratory crackes,

dx: 1) CXR: you see interstial infiltrates, pleural plagues 2) accurate: CT 3) gold standard: biopsy

DLCO would be dec

Rx: remove the source

3 questions on pleural effusions

Exudate :

Cancer and infection

Protein level high (> 50 percent of serum level)

LDH level high (> 60 percent of serum level)

Transudate :
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Congestive failure

Protein level low (< 50 percent of serum level)

LDH level low(< 60 percent of serum level)

• Best initial test: Chest x-ray. Decubitus films with the patient lying on one side should be done next to
see if the fluid is freely flowing.

• Chest CT may add a little more detail to a chest x-ray.

• Most accurate test: Thoracentesis

Pleural effusion with pH <7.2 suggests empyema and needs chest tube drainage. LDH >60% of
serum (0.6) or protein >50% of serum (0.5) suggest an exudate. Exudates are caused by infection and
cancer.

19) Post op atelectasis do incentive spirometry 

~ mainly after abd surgeries pt presents with hypoxia Po2 dec, inc RR dec Pco2

auscultation: dec BS at the lung bases

dx: CXR

#) Kid with croup, older kid with parainfluenza, barking cough, hoarseness, inspiratory stridor-
Humidified air, nebulized if mild, racemic epi if severe. CXR: shows steeple sign

acute laryngotracheitis-Look for a child 1 to 2 years of age. Croup usually occurs in the fall or winter.
Fifty percent to 75% of cases are caused by infection with parainfluenza virus; the other common
causative agent is influenza virus. The disease begins with symptoms of viral upper respiratory infection
(e.g., rhinorrhea, cough, fever). Roughly 1 to 2 days later patients develop a “barking” cough, hoarseness,
and inspiratory stridor. The “steeple sign” (describes subglottic narrowing of the trachea; Fig. 20-8) is
classic on a frontal radiograph of the chest or neck. Treat with dexamethasone, racemic epinephrine, a
mist tent, and humidified oxygen.

Kid with RSV

Bronchiolitis generally affects children aged 0 to 18 months and usually occurs in the fall or winter. More
than 75% of cases are caused by RSV; other causes are parainfluenza and influenza viruses. Patients first
develop symptoms of viral upper respiratory infection, followed 1 to 2 days later by rapid respirations,
intercostal retractions, and expiratory wheezing. The child may have crackleson auscultation of the chest.
Diffuse hyperinflation of the lungs is classic on chest radiograph; look for flattened diaphragms. Treat
supportively (e.g., oxygen, mist tent, bronchodilators, intravenous fluids). Use ribavirin only in patients
with severe symptoms or who are at high risk (e.g., patients with cyanosis or other chronic health
problems)

20) CF question kid with recurrent infections with different things do: sweat test

~ if SCID: infection with bacteria, virus and fungi

#) 2-3 month old CD4<200 B and T cell LOW, and leukocyte less than 500: SCID
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21) Question asks for dx of achalasia:

***Achalasia presents in a young nonsmoker who has dysphagia to both solids and liquids at the same
time. There may also be regurgitation of food particles and aspiration of previously eaten material
that is regurgitated and falls into the lungs. This can be a progressive form of dysphagia in which the
symptoms get worse over time.

Diagnostic Testing

• Best initial test: Barium swallow

Most accurate test: Esophageal manometer: inc pr of LES

Rx: Pnumatic dilation, or myotomy

22) Question on zenker, guy with bad breath (halitosis), dysphagia

***Look for a patient with dysphagia with horrible bad breath. There is rotting food in the back of the
esophagus from dilation of the posterior pharyngeal constrictor muscles.

The best initial test is a barium study.

Rx: surgery

23) Guy with GERD after Nissin surgery pt keeps eating like a moron, what do u do? Eat slowly …

24) Question about using D-xylose test Celiac disease– (D-xylose testing: old test to distinguish
pancreatitis from bowel wall abnormalities. D-xylose test results are normal in pancreatic disorders.)
~ if D-xylose shows up in the urine means bowel is intact: so its not celiac or any other disease that
messes up the bowel so prob is with pancreas

25) Broad who loves laxatives (factitious diarrhea), what's the electrolyte abnormalities? Metabolic
acidosis Low K, low HCO3, high chloride: metabolic acidosis with hypokalemia

26) UC increased risk of cancer – colon cancer

~ frequent abd pain with bloody diarrhea

27) Crohn's gets calcium oxalate stones

28) 2 questions on SBO—n/v, constipation, hyperactive bowel sounds

***Small bowel obstruction commonly causes bilious vomiting (early symptom), abdominal distention,
constipation, hyperactive bowel sounds (high-pitched, rushing sounds), and usually poorly localized
abdominal pain. Radiographs show multiple air-fluid levels. Patients often have a history of previous
surgery. Start treatment by withholding food, placing a nasogastric tube, and giving IV fluids. If the
obstruction does not resolve or if peritoneal signs develop, laparotomy is usually needed. CT scanning
can confirm an uncertain diagnosis in stable patients and may reveal the underlying cause of obstruction.

~ rx: if pt is stable you can wait and observe for a bit but if the pt is unstable go to surgery

#) Ileus from recent surgery:

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~ pt cant pass stool or gas, but bowel sounds will be hypoactive

dx: xray: shows the whole small and large bowel are dilated

rx: get the pt moving and give them liquids diet to get things moving

29) Guy with appendicitis what test (CT scan): LRQ pain, N/V (but if symptoms are obvious go straight
laparoscopy)

#) Ileus from recent surgery

30) Woman with anal fissures, give laxative and topical nitroglycerin: severe pain with defecation, blood
on toilet bowel: Dx: anoscopy, Rx: if typical anal fissure : fiber, sitz bath, topical analgesics, topical
nitroglycerin

~ pts who are constipated should receive a stool softener or laxative also

31) Colon cancer look for CEA

32) Ovarian cancer CA-125  described the vignette and showed lab values.. really high Ca-125 levels
and asked which organ is affected. OVRAY

~ pt presents with adnexal mass, weight loss, ascites, or bowel obstruction

dx: travanginal US and biopsy

rx: surgical resection and chemo (never do an FNA bc it can lead to leakage of malignant cells)

2 questions on pancreatitis

***Patients classically have epigastric abdominal pain that radiates to the back, nausea with vomiting that
fails to relieve the pain, leukocytosis, and elevated amylase and lipase levels. Watch forGrey Turner
sign (blue-black flanks) and Cullen sign (blue-black umbilicus), both of which are because of a
hemorrhagic pancreatic exudate and indicate severe pancreatitis. Perforated ulcers

dx: severe epigastric pain radiating to the back, with elevated enzymes. Or do a CT

rx: IVF, analgesics, NPO

33) Lady taken to hosp for 2 random episodes of hypoglycemia, happened again twice in hosp. Insulin
was high. Question wanted u to pick insulinoma but C-peptide was low so it's factitious insulin 

insulinoma and sulfunlyurea both have high c-peptide

Question on either gilbert/crigler najjar I blanked on this one: elevated unconj bili, urine will have
elevated urobilinogen

Alcoholic liver disease AST/ALT/GGT increased forget the answer

Question on cirrhosis

#) UTI sx in pt who keeps getting them for the past 2 mos. Sounded like some kinda cystitis or whatever,
I dunno
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34) Question on woman who laughs, stress incontinence, urethroplexy something

(Lady makes urine everytime she laughs, now embarrassed to laugh, what the problem? I picked
urethral valve incomptency

#) Gives u sx on guy with BPH – hydronephrosis

***BPH can cause urinary hesitancy, intermittency, terminal dribbling, decreased size and force of the
urinary stream, sensation of incomplete emptying, nocturia, urgency, dysuria, and frequency. It may result
in acute urinary retention, urinary tract infections, hydronephrosis, and even kidney damage or failure in
severe cases.

35)) Questio of guy with enlarged prostate, NOT nodular/irregular, and increased PSA it's still BPH

46)12year old guy with testicular torsion, take for immediate surgery: painful scrotum, absent cremestric
sign, when u elevate the pain does not disappear.

TESTICULAR TORSION EPIDIDYMITIS

Age Younger than 30 yr (usually prepubertal) Older than 30 yr*

Testis may be elevated into the inguinal Swollen testis, overlying erythema, urethral
Appearance
canal; swelling discharge/urethritis, prostatitis

Prehn sign Pain stays the same or worsens Pain decreases with testicular elevation

Immediate surgery to salvage testis;

Treatment Antibiotics*
surgical orchiopexy for both testes

36) Question on woman's temperature and shows graph during cycle. Answer was wrong time for coitus u
idiot

37) Question on thryoid nodule, pt had ab's to TBG and anti-TPO I dunno the rest but it's hashimoto (pts
mom and grandma had hashimotos.. didn’t say hashimotos.. it said autoimmune infiltration)

Go over cushing/conn/Addison

#) Question on guy with non-philadelphia leukemia: CML 9-22, elevated leukocytes but low LAP score,
Rx: Imatinib

~ pt presents with WBC >50, 000, splenomegaly, blast crisis

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1. 38) Baby with hereditary spherocytosis, the problem is in the membrane: (I think it was baby 1
weeks old or 1 month, but on peripheral smear there was spherocytosis, doesn’t give family hx
that some in the family had the same problem, and didn’t say anything about coombs negative
or positive, asked what causes this problem? I was stuck between autoimmune destruction of
the RBC membrane or abnormal RBC membrane. I ended up picked abnormal RBC membrane.
a. Both can be the answer in this situation, but if it said coombs test was positive then it is
autoimmune, if said coombs negative then most likely hereditary spherocytosis, or even
if they had fm hx in a uncle or mother then its hereditary as well. Tricky bastards

smear: spheroctyes, elevated MCHC (>36) , + family history

#) Guy from Bolivia has kid with thalassemia. In what chain is the defect alpha chain

39)Guy with sickle cell trait, gonna bang this broad. Wants to know if kid will get it. Do
electrophoresis ( do electrophoresis on the mother)

#) Guy with sickle cell, IVF first then do exchange transfusion

~ Rx: prophylactic penicillin till age 5 or longer, vaccinate PCV, meningiccoal, h. influence, folate,
hydration, hydroxyurea

crisis: O2, IVF, analgesics, consider transfusion if symptoms are severe (strokes, priapism, acute chest
syndrome)

#) Guy gets stung by a bee, what type of hypersensitivity rxn mechanism? Mast cell degranulation

~ but if the question asks for the cause of angioedema then bradykinin is the answer

40) Kid born at home to a hippie. Comes to dr bc the kid is bleeding, PT, PTT were increased . Kid never
got vit k shot

41) African woman moves to new England. I thought it was either, she had like fevers and stuff malaria
(plasmodium falciparum) . 

42) Kid with Lyme rash, kid had joint pain now but a while ago he had some rash that resolved on its own
what treat? Amoxicillin in preggo and kid .. doxy otherwise (kid < 8y/o—Amoxicillin, >8y/o—Doxy)

Question on polycythemia vera

Go thru AML/ALL/CML/CLL, 2 questions

#) Marathon runner collapses with temp of 105, how do u cool him down? Evaporative cooling or water
immersion

Few car accident questions

43) Car accident guy with pelvic fracture and leg fracture, still staying hypotensive after treatment, where
the fuck is the bleed? It's either occult abdo bleed, occult head bleed, leg artery bleed I forget the rest.

44) Woman gets raped, what drug do u give? Misoprostol, estrogen something, Levogrestrol
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45) Person with anaphylactic shock give: hypotension, wheezing and resp distress: epinephrine SQ

46) Woman giving birth, has worst headache with photophobia and nuchal rigidity. Subarachnoid
Hemorrhage: do LP to confirm ( mcc ant communicating artery)

~ dx: CT then LP

~ rx: 1: nemodipine , do MRA to located the vessels and coil it

***A subarachnoid hemorrhage is bleeding between the arachnoid and pia mater. The most common
cause is trauma, followed by ruptured berry aneurysms. Blood can be seen in the cerebral ventricles and
surrounding the brain or brainstem on a CT scan. Classically, the patient describes the “worst headache of
my life,” although many die or are unconscious before they reach the hospital. Patients who are awake
have signs of meningitis (positive Kernig sign and Brudzinski sign). Remember the association between
polycystic kidney disease and berry aneurysms. CT is the test of choice and should be performed before
performing lumbar puncture (see question 12). A lumbar puncture shows grossly bloody cerebrospinal
fluid (CSF). Treat with support of vital functions, anticonvulsants, and observation. Once the patient is
stable, do a CT or magnetic resonance (MR) angiogram to look for aneurysms or arteriovenous
malforma- tions, which may be treatable with surgical clipping or catheter-directed angiographic
procedures.

47) Guy who had TIA, carotids <50% stenosed, what do u do? <50%- medical management- asprin

***Manage symptomatic carotid artery stenosis of 70% to 99% with carotid endarterectomy; less than
50% with medical management (e.g., antihypertensive agents, statins, and antiplatelet therapy) and
treatment of atherosclerosis risk factors. For stenosis between 50% and 69%, the data on management is
less clear, and patient-specific factors affect the decision.

48) Question of guy with CN7 issues, what other problem(bells palsy scenario)? Taste problem

49) 1 month old baby with image of gram stain, it's either GBS, listeria, H.influ, Strep Pneumonia:

50) Question about: man and woman coming in for fertility: woman has high prolactin: bromocriptine

3 questions on alzheimers

***Alzheimer dementia is a neurodegenerative disorder primarily affecting older adults and characterized
by memory impairment, particularly memory for facts and events. Memory loss develops insidiously and
progresses slowly over time. Language function, visuospatial skills, and executive function tend to be
affected early in the disease process.

Look for a patient with vascular risk factors (e.g., hypertension, diabetes, dyslipidemia, coronary artery
disease) whose presenting symptoms include a dementia with abrupt onset and a stepwise deterioration.

Frontotemporal dementia is characterized by focal deterioration of the frontal and/or temporal lobes
leading to changes in personality or social behavior, with an eventual progression to dementia. Age of
onset is typically in the 50s or 60s.

Dementia with Lewy bodies is an increasingly recognized clinical entity characterized by dementia plus
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two of the three following distinctive clinical features: visual hallucinations, parkinsonism (bradykinesia,
limb rigidity, and gait disorders), and cognitive fluctuations. In contrast to Alzheimer dementia, the
memory loss in dementia with Lewy bodies presents later in the course of the disease. Early symptoms
include driving difficulties (e.g., getting lost) and impaired job performance. Sleep disorders such as
acting out dreams are common in patients with dementia with Lewy bodies.

51) 2 questions on MS, 1 was demyelinating and the other was something about nerve conduction I think

Multiple sclerosis classically presents with an insidious onset of neurologic symptoms in white women
aged 20 to 40 years with exacerbations and remissions. Common presentations include paresthesias and
numbness, weakness and clumsiness, visual disturbances (decreased vision and pain caused by optic
neuritis, diplopia as a result of cranial nerve involvement), gait disturbances, incontinence and urgency,
and vertigo. Also look for emotional lability or other mental status changes. Internuclear ophthalmoplegia
(a disorder of conjugate gaze in which the affected eye shows impairment of adduction) and scanning
speech (spoken words are broken up into separate syllables separated by a noticeable pause and some-
times with stress on the wrong syllable) are classic; the patient may have a positive Babinski sign.

MRI is the most sensitive diagnostic tool and shows demyelination plaques. Also look for increased
IgG/oligoclonal bands and possibly myelin basic protein in the CSF. Treatment is not highly effective but
includes interferon, glatiramer, mitoxantrone, natalizumab, cyclophosphamide, and methotrexate. Acute
exacerbations are treated with glucocorticoids.

52) Question about guy who bitched out getting a needle in school, vasovagal syncope

~ vasovagal (neurocardiogenic) : after stress or fear.

53)Acute angle closure glaucoma in pt that went to eye dr and got bad reaction to drops put in

~ sudden onset unilateral pain, teary, lacrimation, dilated and hard to palpate eye

dx: tonometry: inc IOP

rx: IV acetazolamind, IV mannitol and etc

#) Kid with disc herniation what is mechanism: impingement if the spinal cord  

~ sudden onset back pain, radiating to the buttocks, + SLR

dx: xray, MRI rx: NSAIDs, and rest

#) 2 questions on SLE, one with a malar rash pic, the other I think was oral ulcer

SLE can cause malar rash, discoid rash, photosensitivity, kidney damage, arthritis, pericarditis and
pleuritis, positive antinuclear antibody (ANA), positive anti-Smith antibody, positive syphilis results
(on the Venereal Disease Research Laboratory and rapid plasmin reagin screening tests), positive lupus
anticoagulant, blood disorders (thrombocytopenia, leukopenia, anemia, or pancytopenia), neurologic
disturbances (depression, psychosis, seizures), and oral ulcers. Any of these may be presenting symptoms.
Use the ANA titer as a screening test, and confirm with the anti-Smith antibody test. Treat with
NSAIDs, hydroxychloroquine, corticosteroids, or immunosuppressive/immunomodulating agents
(methotrexate, cyclophosphamide, cyclosporine, azathioprine, mycophenolate, tacrolimus, leflunomide,
or belimumab).
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54)) Kid with DDH (hip dysplasia) do ultrasound, not xray (can't remember the age of the kid. But if kid
is <6 mos, do US, if >6mos do XR bc more ossification

55) Question on juvenile arthritis high fever and rash and RH0

~ dx: labs: ANA nl

~ Rx: NSAIDS or aspirin, and they need periodic ophthalmologic exams bc of the complication of
iridocyclitis which causes blindness

56)) Question on scabies, look for webs of fingers

~ rx: permethin

What causes scabies? How do you recognize it? Scabies is caused by the mite Sarcoptes scabei, which
tunnels into the skin and leaves visible burrows, classically in the finger web spaces and flexor surface of
the wrists. You should know what these burrows look like. Facial involvement sometimes is seen in
infants. Patients may also have severe pruritus, and scratching can lead to secondary bacterial infection.

How do you diagnose and treat scabies? Diagnose by scraping a mite out of a burrow and viewing it
under a microscope. Treat scabies with permethrin cream applied to the whole body. Treat all
contacts (e.g., the whole family). Do not use lindane unless permethrin is not an option. Lindane used to
be the treatment of choice but can cause neurotoxicity, especially in young children.

57) Question about black kid with white rash on him for 2 mos. Got worse after sun exp. Tinea versicolor

58) Non-healing ulcer on skin I think it was SCC

59) Girl with precocious puberty something about hormones give GnRH agonist; till puberty

girl: <8yrs, boys <9yrs.

~ GnRH agonist to suppress the PHT axis to delay onset of puperty till appropriate age so the can grow at
a normal rate

60) Menopausal woman painful sex use topical estrogen or hormone replacement therapy

(48 YO patient menopause vaginal atrophy, dyspareunia, next step: vaginal cream,
check LH levels? Estrogen cream)
~ atrophic vaginitis: pruritis and dyspaurinia, rx; topical estrogen cream

61) Question on trichomonas vag: itchy, purulent green, frothy secrection, strawberry vagina, wet mount:
motile organisms and

~ Trichomona: green-yellow, frothy, strawberry or red vagina, motile organism, rx pt and partner

~ Gardinella: gray, fish odor, clue cells, no imflammation of the vagina. Only rx pt

~ treat both metronidazole. Ph <5 for both

62) Chick with fibroadenoma: mobile firm mass, non tender: dx: US
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~ palpabale breast mass <30 US, >30 US & memograph if it confirms fibroadenoma f/u with pt on
an interval of 6mts if it stays stable dismiss as benign no need to do a biopsy

~ all other masses: if the US or mammogram suspects malingnancy do core biopsy

~ rx of cancers: lumpectomy + radiation +/- chemo

if multiple foci involmed do mastectomy

Woman with lump, follow up in 6-9 mos

63) Woman with IQ of 70 at 12 weeks has results of baby with + down syndrome. She wants to keep it.
What do u do? Treat like regular prenatal care

64) Maternal UTI (UTI during pregnancy) nitrofurantoin (or Amoxicillin or cephalexin)

65) Maternal crack cocaine/tobacco use abruptio placentae

Peggo's look for bhcg that doubles (if not then ectopic)

#) Woman who had previous transverse c-section, what is risk? Uterine rupture (still can happen with
transverse vs classic)

#)Bipolar pt on a certain 'drug' she doesn't remember, she goes nuts. What drug causes it? I put lithium

#) Student with generalized panic, give buspirone?

1 question on schizo

66) Drunky with delirium tremens give thiamine ~ pt develops tremers, seizures, unstable vitals, fever,
HTN, tachy

2 questions on biostats, 1 about a cohort study, other I can't remember.

67) Woman that cannot bend one of her fingers when she makes a fist: diagnosis? Fascia fibrosis

68) CHF: up/down arrows for preload, (forget), INC afterload

PCWP increases I put preload inc, cardiac contractility dec, afterload inc.
69) Depressed person getting discharged, biggest risk for trying to kill themselves: increased energy
70) DD DI x2 based on labs: I thought one was hypercalcemia, forgot the other
71) Kid who isn't social: pervasive developmental disorder—Autism Probably a second one too where
you have to DX the kid, maybe some kind of mute?
Rx: psychotherapy
72) College kid who drops out and stops talking to his parents when he comes back home, looks
disheveled: schizophrenia ( if >6mt), schizophreneform <6mts, if its just a false misbelieve then its
delusional disorder
73) Svt or afib from over indulging in alcohol: tell him to avoid alcohol
74) Old dude who says, don't let me wake up a vegetable: discuss resuscitation options with the patient
#) Woman who had blurry vision and some other neuro symptoms while straining to push out her baby:
no idea,? SAH
75) Guy with something kind of serious in PMHx came in for routine check up, 62 y/o: give him
pneumovax?
76) Jack hammer worker, dx: carpal tunnel- median nerve entrapment
#) hemorrhoid management: fiber and sitz baths?
 14

#) Guy without spleen is sick: ceftriaxone to cover capsules

77) Veteran who saw a lot of his friends die and is feeling sad: sertraline ( PTSD >1 mt, Acute stress
disorder <1mt) Rx both with SSRI
78) Chick who has anxiety when she goes to class, she didn't even go recently because it has been
bothering her so much: cognitive behavioral therapy? There was no RX option.
~ specific phobia: CBT
~ social phobia: performance only: propranolol, Benzo, generalized type: SSRI, CBT
79) Gay guy's boyfriend got diagnosed with gonorrhea a few days ago, management for him: give
ceftriaxone and doxycycline or w/e
80) Infant who gets IV for something and gets patchy red erythmatous lesions a few hours later, how
could this have been prevented: idk, I said start the iv fluids earlier lol? Sounds like glove allergy or
something. Idk. Glove reaction
81) Sorta sad dude: dysthymia?( >2yrs)
82) Guy found in his apartment on the floor, lethargic with a red tongue, DX? Carbon monoxide?
COULD BE NIACIN DEF (GLOSSITIS)—asked what could have prevented this.. it was a guy who lived
alone.. old man during the winter months.. carbon monoxide.. ventilation in the apartment
83) Exercise effect on cholesterol profile: increase HDL
#) Picture of barium swallow: def not bird beak, was more narrow and diffuse in upper half and well
defined and thicker in lower half, DX? Picked diverticilum : look at barium esophagus pics
84) Possible ectopic preggo or something, next test: ultrasound?
#) Guy with propriception problem: b12 deficiency
#) Dx for skin colored lesion with center indentation: lookup DD for moluscum contagiosum
85) Fluid ressusitation, which fluid/tx should you use: ringers lactate
#) Big red patches covering some white kids face that spared the nasal folds: DX? No idea. SLE
86) Pancreatitis guy comes back a few weeks later, DX? Pseudocyst
~ pt comes back few weeks later with epigastric pain, early satiety,
Dx: CT
Rx: <6weeks, <6cm: observe, >6 weeks, >6cm: drain
87) Guy who seemed like he had major depressive disorder, they wanted the DX, I picked mdd.
~ MDD: anhydodia + 5 of SIGECAPS Rx: SSRI
88) Guy who seemed like he had adjustment disorder, thought that was the answer, know the DD just in
case.
~ rx: psychotherapy
89) Lactose intolerant, diarrhea everything he drank something order: hydrogen breath test
#) Old dude with normal pressure hydrocephalus: do spinal tap or whatever is the similar procedure listed
~ traid: wet, dementia, gait problem
~ dx: CT ( enlarged ventricles) then LP (nl pr 70-80)
~ rx: serial LP, can put a VP shunt
90) Old lady that is a super star in her community but is worried because she forgets names sometimes:
reassure her it is normal
91) Hand washer or someone with impulse control issues: gave em SSRI
92) Old person that progressively developed AMS over like three weeks, DX: I think this was subdural
hematoma because of his old bridging veins, rmr I said dd stroke!
93) Do you need to give anti biotic for a dental procedure to someone with MVP? Now, I don't think u do
for MVP, or whatever the valve issue the pt had. Also, if it isn't a procedure that involves dental bleeding,
I don't think u do either, regardless of their heart condition, but check into these things.
~ only time you ppx: prosthetic valve, previous endocarditis, congenital disease, or heat transplant:
Amoxicillin ( if allergic clindamycin, macrolide)
#) Post op Abdomen Wound is inflamed above and below, next step? I did a ct scan so I can see what's up
down under
 15

#) Person with liver disease needs pain management, what RX? Fentyl (other options were like
acetaminophen)
#) Maybe a rotator cuff like injury, maybe maybe what imaging to order? I think I did an MRI.
~ dx: next best xray, diagnostic MRI
#) Guy with xray mass in lungs, from endemic area for TB, but it wasn't what I expected, home boy may
have had some effusions too, any who, I ordered a ct scan to get a detailed view for suspicious findings,
because i believe he didnt have said mass on previous x-rays, but maybe i am confuzzled.
~ Question that gives u the standard deviation and average, asks which statement is true: answer was like
64% of the values are between average-SD and average+SD.
#) Litium: movement (tremors, ataxia), nephrogenic DI, hypothyroidism, Pregnancy prob (ebstins
anamoly)
~ valporoic acid: tremers, tacy, resp depression, liver dysfunction (elevated LFTs)
94) gram stain: G+ diplococci with meningeal signs I do believe... answer was Strep Pneumo
95) Pre-eclampsia – 140 mild and 3g mild 150 and >5 is severe start Lebatolol

(Pregnant and BP 140/90, 140/90, 150/100 but urine has no proteins whats next?
Labetolol, FU in week?
#) 2 questions on croup – 1 of the question was tx. (If the pt is outpt then treat with fluids and mist…
Mild: give steroids, Moderate and severe (Stridor) give Racemic epinephrine)

95) 2 late Decel on fetus question: 1 asked what causes it (Uteroplacental insufficiency) and other was Tx
(Position change) VEAL CHOP

***Late decelerations (Fig. 25-3) occur when fetal heart rate deceleration comes after uterine
contraction. This pattern signifies uteroplacental insufficiency and is the most worrisome. If it is seen,
first place the mother in the lateral decubitus position; then give oxygen by face mask and stop oxytocin,
if applicable. Next, give a tocolytic (beta2 agonist such as ritodrine or magnesium sulfate) if the mother is
not in active labor and intravenous fluids if the mother is hypotensive. If the late decelerations persist,
measure the fetal oxygen saturation or scalp pH. Consider preparing for operative delivery.

96) Guy keeps falling asleep, and falls asleep in class, and fell asleep while driving once. Sleep study was
done showed he goes into REM sleep instantaneously. Diagnosis? (Narcolepsy): watch out other choice
was OSA bc he was fat also

***Narcolepsy is a sleep disorder characterized by daytime sleepiness in spite of a normal daily sleep
regimen. Patients have decreased latency for rapid-eye-movement (REM) sleep (patients go into REM as
soon as they fall asleep); cataplexy (random loss of muscle tone that causes patients to fall down); and
hallucinations as they awaken (hypnopompic) or fall asleep (hypnagogic). Treat with modafinil(a
nonamphetamine stimulant), methylphenidate, or amphetamines.

#) Baby keeps getting infections and also has oral candidiasis. Dx? (Combined Immunodeficiency)
compare to CF question

***Severe combined immunodeficiency may be autosomal recessive or X-linked. The classic cause is
adenosine deaminase deficiency (autosomal recessive). Patients have B- and T-cell defects and severe
 16

infections in the first few months of life. Other symptoms include cutaneous anergy and absent or
dysplastic thymus and lymph nodes.

97) HIV with +PPD. Next step? (Do nothing) , Because the induration was only 3mm. +PPD in HIV is
more than 5mm.

98) Indian dude recently moved to America he is in his 30s. Massive Pleural effusion on Chest xray (TB)
other choice that might fit was bronchogenic carcinoma. But too young? 25-30% of time TB only shows
Pleural effusion on chest xray.

98) Lady with arm fracture has chronic pain and is on Norco (Acetaminophen + Hydrocodone) now its
not working. What do you do next? (Change to morphine?) Other choices were change the doses.

99) Gave you a lot of risk factors of CAD on a 14 year old obese pt. Asked you what is he most likely
risk factor in 15 years? (CAD)

#) Lady had surgery and 2 days later starts seeing things or saying stuff and asked for which electrolyte is
messed up? (Hyponatremia?)

100) Weird question which showed a rash on elbow and vignette described a 2 year old girl with rash on
elbow and knees and stuff asked how could it be prevented? (I put avoid frequent baths)

~ atopic dermatitis: intensily pruritic erythemathous, weeping, crusting vesicles rash, mainly in flexors, pt
has hx of atopy or FHx of atopy,

Rx: keep moist, and avoid drying soups and use cotton cloths

Topical steroids , if infected use anti staph Abx

#) Described a rash on guy’s forehead. Said it was hyperkeratosis. SCC (actinic keratosis)

(Skin marks high above forehead: actinic keratosis

~ SCC: rough, scaly nodules or non healing ulcers

~ Actinic keratosis: erythematous papules with central scales due to hyperkeratosis (sandpaper like
texture), scaly lesion on sun exposed areas

rx: cryotherapy, topical 5FU, imiquimod, topical retinoic acid

~ Seborrheic keratosis: waxy, greasy, stuck on warty appearance

Rx: remove only for cosmetic reasons

101) Old lady is concerned about her memory loss. She forgets new names, but MMS is 26/30. She is
able to recall 3 words correctly. I put Normal aging. Dementia patients are not aware of their memory
loss. And this lady was in her 70s.
 17

102) Question on a 9 year old girl. Cried every time she had to go to school…separation anxiety disorder
(Young girl 9 years old, afraid of muggers and thinks people are peeking through
her window, afraid when anyone leaves because she thinks they will die in a car
accident. Has missed school due to her worry. Extremely attention seeking when
at home. I put separation anxiety but I’m not sure. Other options – panic d/o with
agoraphobia,
#) Question on a bone age < real age = asked dx : constitutional growth delay ( if the difference is <2yrs)

103) Picture of parvovirus.. red cheeks.. slapped cheek rash and lacy reticular pattern.. ( make sure its not
Kawasaki) Reassurance

~ fever + rash

rx: supportive

~ Kawasaki: fever for 5 days + bilateral conjunctivitis, lymphadopathy, strawberry tongue and cracked
lips, rash everythere,

Rx: IVG + aspirin

#) question on patient having itching everywhere after he showers.. Platelet count was 900,000 and it said
bone marrow doesn’t make iron anymore.. polycythemia vera ( O2 is normal and erythopoitin is low)

secondary erythrocyotsis.(O2 is low and erythropeitin is high). something like that

a. Male with pruritus during warm water baths, headache, blurred

vision, dec iron in bone marrow, inc LAP. I put polycythemia
b. Female with burning of fingers and toes, normal iron in bone
marrow, inc LAP. Had a TIA previously: secondary erythorcytosis
104) guys wife died 7 months ago due to cancer and he still doesn’t enjoy activities.. or playing sports..
although he feels like its not worth living.. major depressive disorder (I was conflicted between this and
normal bereavement (?) ) ( grief has no self worthlessness or suicide thoughts)

105) described symptoms of celiac disease and asked how to diagnose.. i put antiendomysial and anti
transglutaminase antibodies

~ abd pain, steatorrhea

dx: antibodies first, accurate: small bowel biopsy (atropy of villi)

rx: avoid gluten

 18

106) 2 questions on sarcoidosis.. classic presentation.. painful ulcer on the anterior shin.. erythema
nodosum.. and bilateral hilar adenopathy.. one asked diagnosis and the other one asked what lab value
will be abnormal.. HYPERCALCEMIA (pt started getting DI and asked what is the cause of it is)

107) -2 questions on patients with end state metastatic cancer.. one was prostate and one was breast
cancer.. one the pt was receiving oxycodone and was still feeling pain.. asked what would u give them.. I
put MORPHINE. And the other ques patient was not taking any meds and pain was 2/10.. I put
morphine.. but all the codeine class drugs were answer choices ( for the second questions with 2/10 give a
lower drug ( Tylenol)

108) pt had a really high fever and it should the pleural fluid values and pH = 6.2.. I put chest tube
placement for drainage (antibiotics were the other answer choices)

~ empyema: put chest tube drain it and also give antibiotics

109) a 57 year old woman.. health maintenance ques.. no abnormal pap smears in the past and had a
colonoscopy done 4 years ago.. and she had a hysterectomy and salpingo-oophrectomy.. and asked what
screening does this lady need.. I broke it down between (dexa scan and pap smear(?)—shes not 65 so u
don’t technically do a dexa scan.. so check the indications for when a dexa scan should be done earlier
than 65.. what are the exceptions. A) pap smear b) colonoscopy c) dexa scan d)mammograph)

~ starts at 40-50/ 1-2 years

~ dexa is at 65

110) a guy fell from a 15 feet ladder and he comes in with abdominal pain and his AMYLASE levels
were so high.. pancreatitis.. asked how would u diagnose.. I put CT scan

~ pancreatic laceration: epigastric pain can lead to retroperitoneal abcess pt will present with fever,
chills and epigastric pain, or even a pseudocyts

111) another trauma ques and the guy has a left retroperitoneal hematoma and it said the kidney was
being covered.. asked what organ is affected.. I put spleen rupture

~ LUQ pain, radiating to the shoulder, hypotension

- #) 2 really hard ques on urinary retention.. one was a post partum lady.. she had hemorrhage
during delivery and she was transfused with blood and now she had obstruction symptoms (her
BUN creatinine was like 48/ 3.9)—it was a to J answer choice.. the only one that made sense was
Atonic bladder ( ratio is about 12 so has to be an intrinsic renal problem) ( can not be atonic
bladder has to be something with intrinsic so she probably has some kind of ischemic kidney bc
she lost volume so ATN or something)

112) -question on Hodgkins.. classic B symptoms.. fever.. night sweats.. weight loss.. anterior
cervical lymphadenopathy.. medistinal lymphadenopathy.. answer was clonal proliferation of B cells
 19

113) question on byssinosis.. and asked the FEV1/FVC ratio and peak expiratory flow rate.. it was all
normal increased decreased ( restrictive probs: FEV dec, FVC dec, ratio inc or nl, TLC dec, RV dec,
FRC dec)

114) Question on addisions disease.. fatigue.. weight loss.. hyperpigmentation on the palmar crease..
and gave lab values.. (Na was low, and K was really high).. and it asked what gland does this affect..
adrenal gland

~ primary adrenal insufficiency: fatighe, weakness,

labs: low aldo: low Na, high K, high H,: hypotension

low corticol: hypoglycemia, high ACTH: skin pigmentation, high eosinophils

to diffrenitte from secondary have to do the cosyntropin stimulation test: and if cortisol does not
increase means it’s a primary problem

rx: corticosteroid, fludrocortisone

115) guy has worsened hearing loss and he has a sulfa allergy and comes in with pyelonephritis like
symptoms and asked what antibiotic would u give him (a) Amikacin b) levofloxacin c)gentamycin
d)nitofurantoin (?)

~ hearing loss: don’t give an aminoglycoside: so cant give gentamycin or amaikacin

116) gray white vaginal discharge and the girl takes a lot of bubble baths.. and koh preparation
showed some epithelial cells and coccobaccili.. Bacterial infection (I was conflicted between this and
protozoal infection)

117) alcoholic guy comes in with confused.. altered mental status.. and asked what electrolyte will be
abnormal in this pt.. a) hypokalemia b) hypocalcemia c)hypomagnesemia d)hyponatremia (?)

118) - ques said pt was a 23 year old girl had a viral like symptoms for 1 week.. and now comes in
with glomerulonephritis.. rbc casts in the urine.. I put IgA nephropathy (look at the time frame if its 1-2
days after its IgA)

~ IgA: 1-2 days later, nl complements

dx: biopsy: igA in the mesangiam

Rx: cont their HTN by giving ACEI and supportive

~ post strep: 1-3 weeks later,

dx: initial: ASO titers, anti dnas, low complement

accurate: biopsy: but don’t need to do it

rx: antibiotics if still have the infection, or just supportive

 20

119) - ques on a lady with postpartum depression.. it had been 7 weeks after she delievered her baby.. and
still no lactation and she feels sad, depressed affect.. asked for tx :SSRI (sertraline or paroxetine)

120) a guy who is having trouble concentrating and focusing in school since his parents got divorced.. no
suicidal thoughts or changes in sleep or appetite.. (it was < 6 months) I put Adjustment disorder (he was
fine before.. the symptoms started after his parents got divorced)

Rx: psychotherapy

121) question on a guy that was obese his BMI was like 31.. his abdominal waist size was like 51 and his
BP was high >130/80 and gave his triglycerides and HDL and LDL levels.. they were all elevated.. asked
diagnosis.. metabolic syndrome

#) Wide complex tachycardia - ventricular tachycardia

#) Coarctation of Aorta – unequal pulses

122)

~ ans: where the arrow says 100

#) Hep C, past had Hep B, still smokes and drinks alcohol. Possible development of
cirrhosis. now he is developing Cancer, how to prevent: stop smoking, stop
drinking, lamivudine

#) Prostate non tender and smooth, patient difficulty peeing for one day, no
nodularities: BPH not cancer

122) CHF picture, patient has SOB with walking few blocks: TTE

123) Cause of SOB in CHF: Pulm Edema

124) Rheumatic Fever and patient had diastolic murmer: MS

 21

125) What vaccine can you give in asplenic patient: Pneumococcal vaccine

#) STD Q girl is having sex, Chlam no discharge: Doxy and Ceftriaxone

126) Asthma patient arrow with TLC- FEV1/FVC-DECREASED, INCREASED DLCO

#) Numbness in left leg possible herniated disk: spinal cord compression; L5/S1=

#) Jack hammer operator Pain on his thumb, normal sensation, decreases with
NSAIDs and 1 week off work; what is causing this pain: I put median nerve
entrapment; other options - bony spur, vasospasm

127) Patient has weight gain, purple strai, cushing DZ, best initial: 24 hour urine
cortisol

#) Alcoholic patient in middle of alley in hospital very vocal developing tremor:

withdrawal bc tremors

128) 65 YO colonoscopy done 18 months ago, patient complains of rectal bleeding

recently FOBT positive, what do you do: colonoscopy, check hct??

129) Car accident, similar question, BP dropping below 60/40 what test, CT of
Abdo FAST??

~ if pt was stable do Ct of abd.

#) Lots of abdominal pain put NG tube down throat and patient is constipated and
everything thru NG tube is normal what patient has? SBO

130) Conn’s Syn : Adrenal gland is problem, hyperraldosterone; increased na,

decreased k, hypertention, low renin,

131) Girl gives birth to premature baby and she is pregnant again, she quit
smoking cocaine what is her chance of having another premie? Previous
premature baby

132) Patient having shooting pain down arm comes and goes, blurry vision, 22
year old female: MS
 22

133) Guy weakness in all extremities what test, descending weakness: nerve
conduction studies, other option was CT

134) Wegners coughing blood and renal problem: c-ANCA

~ cough, hemoptysis, sinusitis, hematuria, cANCA

rx: steroids, cyclophosphamide

134) Lady started OCP 6 months ago, but 3 months ago she has 3 visits of HTN
whats next? Change OCP to progesterone only; f/u in 3 months

135) 37 YO guy inc ID bili: Gilberts

#) Croup, SOB, difficult breathing, treatment: EPI or humidifier, steroid

136) Lady taking OCP’s from last 2-3 years and from last couple of cycles her
vaginal bleeding has been less: Reassurance

#) Diabetic pt (I think) who cannot extend ring and pinky finger on one hand.
Cause? I put contraction of palmar fascia

#) Old lady given paroxetine for depression 18mo ago. Now suddenly has manic
symptoms. Options – late onset schizophrenia, drug-induced mood d/o (this is
what I put), alzheimer’s dementia

#) Child born with C-section. Doctor notices more fat on one thigh than the other.
Normal walking. What to do next? Options – x-ray, ultrasound (I picked this. I
think she had congenital dysplasia)

136) Pt with oliguria, given abx (think it was penicillin). Eosinophils in urine. Dx?
Interstitial nephritis

137) Pt with oliguria, pigmented granular casts in urine. I put acute tubular
necrosis.

138) Thalassemia question – inc A2. What’s defect? – dec alpha chain production,
dec beta chain production (I put this one)
 23

139) Pt with CLL, he was there for a routine check up, he had leukocytosis, but no anemia or
thrombocytosis, answer choices were > CT SCAN, Granulocyte factor, chemotherapy, Pneumococcal
vaccine… I picked pneumococcal vaccine, UW says if there is leukocytosis that means that’s GOOD
PROGNOSIS, if thrombocytopenia and anemia is present that is BAD PROGNOSIS.

#) Young pt with Afib or flutter on EKG at one point who ended up going to the
ER. Now his EKG is normal. What to do next? Option – start warfarin, dec caffeine
intake (I picked this)

#) Some kid fell and hit a log while skiing, had pancreatic hemorrhage, amylase level 1500, next to step
to make diagnosis? Two choices CT abdo or endoscopic US, I was dumb and picked endoscopic US
because of bleeding, but it might be CT abdo

140) My first question > pt with 20 years of GERD, now cant swallow food or liquids, I picked esophageal
stricture (this is from uw), other choice was achalasia. >20 years hx of gerd causes barretts and
esophageal stricture, I don’t think barretts was a choice.

141) G2P1, she is RH- , never given RHogam!! , current fetus is dead, autopsy shows ascites,
erythroblastalis hydrops

#) some dude fell outta a 15 story building > Aortic Transection ( theres a xray with an abnormal aortic
contour

142) moms a fatty, baby at 2+ position, cervix ready to go at 10cm, baby is stuck at 3+ , what to do next
have mom flex her knees and take knees to chest (think its called the mcrobertson maneuver)

#) another old lady, also in her 70s, has soft stools, always had diarrhea and soft stools, has been losing
weight, long ass question , I picked do d-xylose test to rule out malabsorption… I think they gave labs
but her mcv was normal.

143) Pregnant lady, smokes crack cocaine and cigs, most likely complication in the pregnancy? Abruption
placentae ( but on the exam it said premature separation of placenta)

#) Dude with ocular weakness, facial weakness, has lung ca, im guessing small cell > how to confirm that
weakness problem? I picked nerve conduction study with repetitive movement, other choice was
skeletal biopsy , suggesting polymyositis which is also associated with Lung Ca, but I think in polymyositis
you don’t get involvement of the eyes or facial muslces. Kinda tricky

144) I hated this one, guy with IVDU, with splinter hemorrhage, he has a diastolic murmur heard on left
of sternum!! Fucking TRICUSPID REGURGE WAS NOT A CHOICE, so I got mad and picked Aortic
insufficiency , in IVDU tricuspid > aortic, but can also have mitral regurge, but where u hear the murmur
counts, and this just was so tricky.
 24

145) Pt with diarrhea and hand tremor, she is bipolar, which of the following meds is she on? Lithium or
valproate, I picked lithium, when u read this q ur gonna wana make vomit on the screen, it’s a long as
question and at first ull be like the fuck!!!

#) some guy running a 7 mile race, faints , brought in to ER, what to do? Evaporation cooling, *this from
UW, but know the diff btwn heat stroke and heat exhaustion

#) Small bowel obstruction question, post op, hasn’t farted, hyperactive abdomen sounds, Xray showed
step ladder pattern with increase bowel sounds and air fluid level  > answer was SBO

#) Young girl with ectopic pregg, no masses felt, but pregnancy test was positive, what to do next? I
picked pelvic US, other choices was laproscopy, but wouldn’t u wana see if there is something first with
US? And then do a lap?

146) guy with leukocytosis, increased blast cells, no other choice made sense but 9-22 translocation

#) 16 yo that falls asleep while driving and in class, snores a lot, explains a bunch of results from
polysomnography goes straight to rem, I ended picking narcolepsy over obstructive sleep apnea , didn’t
say he was fat or anything

#) Old pt with decrease sensation in lower extremities , decreased proprioception > Vit B12

147) A guy with a ST depression on ECG, asks what caused the angina that he is experiencing? I picked
thombosis on a cholesterol plaque, other choices were rupture of coronary artery, emoboli in the
coronary artery, vasospasm of the coronary artery

#) A lady with COPD, asked what is the best tx, oxygen therapy was not a choice, I picked ipratropium,
other choices were albuterol, steroids, etc

#) a patient with splenectomy, what abx do u give? Kinda vague, but I picked ceftriaxone, I guess to
cover SHiN..

#) pt with squamous cell ca of skin on face, said something about dried up patches with ulcerations,
most likely diagnosis? I was between actinic keratosis or SCC, I picked SCC just because of the ulcertation

#) One schizophrenia question, guy drops out of school, he says hes not depressed, but mumbles to
himself, and doesn’t wana go back to school cuz he think professor and other students are out to get
him, I was actually stuck between delusional and schizo, but I picked schizo.

#) Person with anaphylactic shock give epinephrine

#) Described hydrops fetalis (generalized edema) auto immune attack

#) Hx of HTN and diabetes memory and sensory impairment vasc Dementia