1.

Pt come in with cluster headache – give oxygen, sumatriptan ppx is verapamil and prednisone
2. Question on giant cell arteritis – pt will have visual disturbance, muscle pain, fatigue and weakness, will also see jaw claudication.
Tenderness of the temporal area, marked with high ESR ad the most accurate test is biopsy. Treatment = predinisone
3. Acid base balance question –pt was vomit and diarrhea know both cases and know what lab values you will see

i. Primary Metabolic Alkalosis

b. initiating events: renal and extrarenal
i. chronic potassium ion depletion (aggressive diuretic therapy, hyperaldosteronism)
ii. protracted vomiting (pyloric obstruction, gastric ulcers) and loss of gastric acids
iii. dehydration and depletion of extracellular fluid volume (contraction alkalosis)
c. resultant effects: [H+] and/or [HCO3-], pH
i. urine pH will be paradoxically low (acidic) if there is chronic depletion of potassium ions
d. compensations: 2� respiratory acidosis 
(with renal participation if possible)
i. CO2 retention via acid drive on ventilation
ii. hypoventilation also PaO2 which may limit compensation (hypoxic drive on breathing)
e. Primary Metabolic Acidosis
f. initiating events: renal and extrarenal
i. diabetes mellitus and ketoacidosis (larger than normal anion gap)
ii. severe shock or heart failure and lactic acidosis (larger than normal anion gap)
iii. diarrhea and loss of bicarbonate ions (normal anion gap)
iv. renal tubular acidosis and retention of hydrogen ions (normal anion gap)
g. resultant effects: [H+] and/or [HCO3-], pH
h. compensations: 2� respiratory alkalosis 
(with renal participation if possible)
i. CO2 elimination via acid drive on ventilation
ii. Kussmaul respiration (characteristic deep labored breathing)
4. Midshaft of humerus – affects the radial nerve
5. Pt had come in with pneumonia and had nausea and vomiting – answer was legionella (severe pneumo/fever, silver stain, tx w
erythromycin)
6. Pt with atypical pneumonia and gram stain was negative – mcc is mycoplasma
7. Pt with acne and creams aren’t working and wants to start oral pill, and the most common pill that is given is contradicted in what
situation – so isoretinoin and so contraindicated with pregnancy
8. Question on breast feeding and what is contraindicated. So you have to remember that you can breast feed with mastitis, smoking,
alcohol and even maternal rubella but not with mother with AIDS
9. Pt had come in with loss of movement and abnormal sensation of bilateral extremities and looses CN VI in left eye, what is
it? Paramedian pontine reticular formation
10. Best initial test when suspecting gall stones – CT abdomen – eve if everything is pointing to it, still have to confirm with CT
abdomen
11. Graves disease is diffuse so it effects the entire thyroid, some questions were making you think it was graves, but it was just a
nodule so it was just a certain part
12. With graves disease – due to exophthalmos and must be wary or corneal abrasions
13. Know that alcohol cessation is the best thing to stop gout. (had it 3 times, 3years ago, 1 year ago and today)
14. Male comes with discharge and slight joint pain, but gram stain is negative – most likely Neisseria
15. Questions on CT fo Abdomen and CXR – be able to read them
16. To treat severe pleural effusions – do a chest tube placement
17. Know all treatment for HIV and all the stages and that you don't start prophylaxis for many opportunitist until you drop below a
CD4 level
18. Treat MAC with azithromycin
19. Treat P. Jiroveci with SMX/TMP
20. Treat Cryptococcus and candida with fluconazole
21. SLE patients likely to get pericarditis
22. Question on acromegaly and what hormone to check – best initial test is I-GF but the most accurate test is glucose suppression test
23. Question on the best way to check for pancreatic cancer – stem already did ct abdomen and other test – so put ERCP, ct for
diagnosis and assessing spread
24. Question asked what changes are seen in elderly that cause HTN – the vasculature looses compliance
25. Treatment for Syphillis – IM penicillin
26. Plethora and splenomegaly – pt most likely had polycythemia vera, asked how to treat it - phlebotomy
27. Pt has a history of abnormal chromosome 22, and asked how to treat, so they were talking about Philadelphia chromosome and thus
CML – so treat with tyrosine kinase inhibitors – Gleevec was an answer choice which imatinib
28. Pt with gum hyperplasia – asking about cyclosporine not phenytoin and remember that tacrolimus works the same as IL-2
inhibitors and calcineurin inhibitors but there is no gum hyperplasia there
29. Pt with achalasia and had it surgically fixed, but now has an esophageal tear – answer was to go back in and surgically fix it
30. What is the best way to reduce chances of OA – loose weight
31. 2 questions on ACEI and adding that to a pt with diabetes.
32. Pt with bulimia
33. Question showing hypersegmented neutrophils and what was messing up – dna synthesis since you don't have the folate
34. Pt with multiple myeloma, - tx w autologous hematopoietic cell transplant, chemo for older symptomatic patients, radiation if not
responding to chemo
35. Pt with hypercalcemia – before correct calcium must give IV fluids to patient ; Patients with calcium
>14 mg/dL (3.5 mmol/L) require more aggressive therapy. Give NS + Bisphosphonates + calcitonin
36. Pt with MI and asked what the best initial step was,- give aspirin (not morphine, or nitro)
37. If patient has a high pulse of 182 – give esmolol to reduce
38. Pt was a shipyard worker – so patient has asbestos
39. Child with retinoblastoma and now complains of knee pain and sunburst appearance - osteosarcoma
40. Pt was ascuba diver and now short of breath, so do a CXR , since it's a pneumothorax
41. Pt is on diuretic but has high calcium, switch form HCTZ to loop
42. Patient with HIT, stop the heparin and switch to direct thrombin inhibitor
43. Pt is on anti-depressants and has trouble peeing – assume that they were on TCA’s – which are anticholinergics which would make
BPH worse
44. Pt had prostate cancer and bone metastasis and has trouble wlaking now and in pain. More worried about sciatica so lumbar MRI is
the best test, a bone scan will only confirm bone metastasis; tx MM w hematopoietic stem and progenitor cells
transplant;
45. Pt is dying and has poor prognosis – send them to hospice
46. Pt has left sided abdominal pain and lots of blood – diverticulosis
47. Pt has low hb with profound bleeding from rectum and goes into cardiogenic shock, question asks what is the mechanism – high
cardiac output failure – have to remember that AV fistula will cause that and it was probably angiodysplasia -
angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise
unexplained gastrointestinal bleeding and anemia. Lesions are often multiple, and frequently
involve the cecum or ascending colon, although they can occur at other places. Angiodysplasia
often occurs with AVM bc the walls are thin, weak, dilated and prone to rupture
48. Remember flu shot is yearly
49. Questions on vaccines
50. Question gives a history and askes what they need. If they are over 21 need a pap smear yearly.
51. If over 65 – need pneumococcal vaccine
52. Question on Hep C is most likely to cause chronic hepatitis
53. Pt with pharyngitis, and looking at toxic, has strep, do a throat swab and culture
54. To treat chlamydia give Zithromax nowadays
55. Pt has an anterior wall MI but has low bp and a cold clammy skin – they have developed cardiac tamponade – do not put MI
a. Post MI complications
i. Bradycardia due to SA insufficiency
ii. AV block
iii. Right ventricular infarct with new inferior wall MI
iv. Tamponade/free wall rupture - several days after, sudden loss of pulse
v. Valve or septal rupture, MR at the axilla
vi. Aneurysm/mural thrombus (detected with echo, give heparin)
vii. Stress before discharge determines if angiography is needed
56. Question on Entameoba histolytica
57. What is the best management for Aortic dissection – B-Blocker
58. Pt is anemic and stool guaic is negative and over 65 – do a colonoscopy
59. hypercalcemia – symptoms. And values – besides IV – what is next step ? bisphosphonates
60. adrenal hypo ale natre an hypotensive - adrenal insufcciency
61. HIV – Cd 4 value – 550 . what is next step prphylacitc – nothing .leave
62. Cd4 less – what is the next step managen – TMP SMX prhylaxis
63. Kidney questions – prerneal, post renal. Na valvue . less than 1 = pre renal . Fna is less than 1
64. Abx – lady with gonnerhea – tx with IV ceftriaxone
65. STD symptoms - lefts died pain . purulent discharge = gonnerhea
66. Cardio - ASD – WIDE FIXED split s2 – answer was ASD
67. mR – radiating to apex – cant breathe and in to axilla.
68. Pt passed out 3 mins – was fine after – TIA - history of uncotrlled htn carotid bruits
69. Headaches – one that has rhinorrhea ? cluster headaches
70. Anatomy – cannot lift arm – intitaing subscapularis
71. Dementia – 72 lady forgetting active and driv e- can remember ropeol alzhimers. Dementia type

72. hemchromatosis – overload iron – brown color – DM, what is the problem – erectile, CHF…….. dysfunction - Hereditary
hemochromatosis (HH) is an autosomal recessive disorder in which mutations in the HFE gene cause increased
intestinal iron absorption. Iron deposition in tissues, especially the liver, heart, pancreas, and pituitary

73. 75 male. Mi – counseling - sex wife died. – do it.. if tired than stop … or take medication ?
74. guy back pain – hip scan found l1 or l2 .. herniated disc but its stable .. what do next.. do nothing? SLR, or MRI, NSAID for
management, regular activity, steroids in area, surgery if focal deficits. Or surgery to remove
75. pt was carrying stuff not able to lift arm – see in scan acromion classification – what do u do… do a rotator cuff bone if it doesn't
rotate it will hit… - options are rotator cuff injury
76. pt diabetic, renal failure, dialysis – end his life – daughter doesn't want it. = Listen to pt
77. two groups – study . how u correct group? How to adjust group
78. skating and fell on arm wound – clean and leave open? Clean and cover? Cover and suture and give abx..
79. HTn – never seek medical attention , reduce mortality – first BB
80. Skating on ice. Hypothermia . after cpr . seizure.. what is reason for – hypocalemia hypokalemia hyponatremia potassium goes to
ECM as body warms, and Inside cell with cold
81. COPD – what is Fev/fev1 = decreased?FVC is DEC!! what is decreased.
82. Pt has admit to hospital. get pneumonia – med to give? Ceftriaxone
83. Lung cancer – sodium is low. What is the cause .. ADH
84. Renal failure and go pericarditis - due to uremia
85. Inspiration sharp pain – pericarditis
86. Mallory Weise syndrome – alcohol - vomit blood - endoscopy, h blocker? - there is no specific therapy , you can give an
injection of epinephrine to stop the bleeding or the use of electrocautery
87. Has thiazide – pain in knee - = gout
88. someone has kidney stones - pain from back to right testicle – what u have to do next… ??? acute tx Is NSAID + CT w/o contrast
89. Lady has painful urination and has sometimes the urine stops.. lower abdominal palpate is tener.. what to do next.. put catheter in
90. SS anemia – has macrocytic anemia – what u give her folic acid
91. Just valve replacement – ater 3 weeks had a fever? What is the common organism – satph aureas
92. MV – dental surgery. ampicillin before surgery ? 24 before?
93. Liver enlargement and jaundice? obstructive, stones, cirrhosis, tumor
94. anaphylaxis ? hypotension ?
95. chemo drug? Allopurinol – preventing something ? xanthine oxidase inhibitor
96. Multiple genital lesions –syphillis
97. Gerd vs MI – EKG – st elevation - has hd it before. Taken for gerd.. pain under the rib. – so answer is MI
98. Review how to correct hypocalcemia ? ca gluconate
99. renal artery stenosis – bp high – give ace I .. and still high but kidney creatinin is high now.. so kidney worse – what is the reason
for kidney getting worse ? – Decrease blood flow to renal vein ; AVOID IN RENAL STENOSIS BC ACE LOWER GFR BY
PREVENTING CONSTRICTION OF EFFERENT ARTERIOLES THERBY INC CREATININE
100.SLE – which test you should do? Ana? What antibody- anti smith (30%), anti dsdna (60%) both are specific only for SLE,
decreased complement
101.Someone has raynauds syndomre. What do u give him .. CCB
102. Remove ilium / chrons disease - only if does not respond to medications, lifelong IM supplementation w resection
103. derm – psoriasis – white scaly – diagnosis
104. male – lymph node tender.. answer : non hodkins llymphoam
a. NHL - multiple, peripheral nodes, noncontiguous
105.lady . excision biopsy - breast cacner – do a excision biopsy
106.Swelling neck and mobile. And TSH is low and thyroid is high. What is next step. Fine needle, or excision or remove or CT
scan with iodine. Nodules > 1 cm must be biopsied FNA
107. picture – circles blood. Not concave. What do u advise him to take or avoid?.. fragility test ?
108.ALP high, gall bladder stone – what to do --> ultrasound, high risk is ERCP, medium risk is MRCP, and low risk is
cholecystectomy; only do if patient is symptomatic
a. Acute cholecystitis - if murphy sign is + then ultrasound, HIDA if uncertainty remains,

109.psoaris – pt on back
110.picture – buttock – erthyema – reactivated Varcella zoseter. One dermatoem
111.old lady forgetting and cannot write bills. Asking doctor and asking to stay home .. what is next step. No family… answer =
evaluate house and perform
112.cardio - S4 is LVH, atrial kick, LA must push against stiff LV
113.EKG – shows vent tachy and ven fib, wolf Parkinson white syndrome - short PR, Increased QRS, delta wave, slurred QRS, SVT
presents as chest pain dyspnea syncope
114.Guy abduct his shoulder – over 120 – acceroy nerve? Rotatcuff tendonitits
 115. Small mass in lungs – smooth – biopsy? Don't do anything? Chest xray? Ct scan
a. 1st do CXR, < 1 cm leave alone, 1-2 cm sputum cytology, bronchoscopy or transthoracic needle, PET, VATS, > 2
cm resect
116.lung cancer – pthrp
117.hilar mass sarcoidos s 39 AA – answer sarcoidosis
118.dextrameeathosone – no response means primary tumor, response means secondary pit tumor
119.Bilateral.. answer is – RA
120.Tx osteoporosis – If menopause – estrogen . if not menopause if raloxifene
121.chrons disease – rectal sparing, skip lesions, transmural, fistulas, stones, perianal abscess tx 5 asa steroids infliximab ***
122.lymph node painful in groin area – what do u do? Biopsy, remove and drain, incision and drain?
123. Distended jugular vein , 12 cm large liver – back up of blood = right sided heart failure
124.calculation - NNT = 1/ARR, NNH = 1/AR AR Is a/(a+b) - c/(c+d)
125.ATN – = chemical toxicity, ischemia, crush injury; kidneys stop working and become oliguric so tx with diuretics
126.Chlamydia – tx doxycycline
127.Runny nose. otitis media, bronchitis, sinusitis, pale conjunctiva – eye nose ear– = moxerlla cattarhallis
128.Guy cant swallow –bad odour .. upper and lower esophageal sphincter – sclera derma, zerker divier
129. Guy HEB B – vaccination ? alcoholic .. AST increase – alcoholic hepatitits
130.COPD – orthpnea – pulnary edema – what is the dx CHF
131.Guy 37 - dad has same dz in 40s - what is the dx ? Huntington’s – anticipation
132. PTT increased – BT increased .. what is the cause? VWF, bernards
133.cold intolerance, = hypothythoridism, hashimoto,… granves dz – autoimmune
134. HTN – and diabetes and has a kidney problem – increase creatinine – ACE –I

135.Dig toxicity - u will get electrolyte changes - hyperkalemia

136.Kerby lines and how it is associatd with the lung - pulm edema
137.Pulmonary embolism and how it presents
138.Pericarditis 0 has diffuse ST elevation, pr depression
139.FEV1/FVC – asthma 0 if u give albulterol it will improve the ratio – answer asthma
a. Obstructive - inc RV, dec FVC, very dec FEV, dec ratio
b. Restrictive - dec FVC, TLC, ratio increase
140.emphysema - enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls, increased compliance
141.asthma
142.wedge pressure – if u have pulmonary hypertension it will increase the resistance of the pulmonary artery
143.silicosis is in the upper lobes – displays egg shell calcification of hilar lymph nodes, impair macrophages more susceptible to TB
144.sarcoidoisis increase ace
145.Increae in indirect bilirubin means hemolysis
a. Unconjugated hyperbilirubinemia can result from increased production, impaired conjugation, or impaired
hepatic uptake of bilirubin, a yellow bile pigment produced from hemoglobin during erythrocyte destruction. It
can also occur naturally in newborns. Unless treated vigorously, most patients with Crigler-Najjar syndrome
type 1, a form of unconjugated hyperbilirubinemia, die in early infancy
b. Conjugated bilirubin – live disease, biliary tract disease, pancreatitis, cholangiocarcinoma
146.Hyponatremic patient – treat with normal saline
147.With hypocalcemia = u will see chevstoks sign

148.Pre renal when bun/cr is >20:1

149. Know the ratio – another question on that
150. muddy brown casts = Acute tubular necrosis
151. pt showing signs and symptoms of RA and ulnar deviation = RA
152. carpal tunnel syndrome – pt was a typist, involves the median nerve, give splints, MTB
a. canal of guyton - Guyon's canal syndrome is an entrapment of the ulnar nerve as it passes through a tunnel in the wrist
called Guyon's canal. This problem is similar to carpal tunnel syndrome but involves a completely different nerve.
Sometimes both conditions can cause a problem in the same hand.
153.additions disease - know the lab findings
154.thyroid issue - nodule felt on the thyroid gland - TSH level normal T4 normal - fine needle aspiration
155.chronic renal failure and anemia - give EPO
156.pericarditis - chest pain gets better when he leans forward
157.pyelonephritis - UA - WBCs - infection

ASH RECALL

1. pt w CD4 > 500 leave him alone

 2. HIV Meds – idinavir gives kidney stones
3. Confused, diarrhea, pneumonia – legionella
4. Diverticulitis tx – metro and Cipro, monotherapy w carbapenem, mono w b-lactam + b-lactam inhib
5. Tx for diverticulosis – fiber
6. Best initial test for acromegaly – IGF-1, most accurate is glucose suppression test. Glucose should
suppress GH
7. Flu shots yearly – preventative medicine
8. PBC vs PSC
a. PBC – extrahepatic biliary obstruction caused by autoimmune reaction, leading to infiltrate +
granulomas, AMA+, increased serum cholesterol
b. PSC – fibrosis of intra and extrahepatic bile ducts, ulcerative colitis,
9. Amenorrhea, hirsutism, weight gain – PCOS, increased LH production leads to anovulation, increased estro
and test, B/L cystic ovaries. Tx with OCPs or medroxyprogesterone (remember also for heavy bleeds)
10. Tx for colitis – I.e. UC – sulfalazine, 5-ASA, steroids for moderate disease; maintain remission with ASA;
colectomy for uncontrolled hemorrhage
11. Buerger’s disease – gangrene, autoamputation of digits, tx is quit smoking
12.Study DM – ACE if BP > 140/90, 150/90 over the age of 60
13. Study GI – everything GERD (first step is lifestyle modifications – weight loss? Then start ppi)
a. Tx of GERD – lose weight, EtOH, nicotine, caffeine, choc, peppermint, elevate head, don’t eat
within 3 hours of sleep
b. Mild symptoms – antacid or H2 blockers,
c. Persistent – PPIs
d. Surgery – nissen fundo
e. Endocinch – suture around LES
f. Local heat or radiation for scarring
14. Correct hypocalcemia with? Ca gluconate (preferred less likely to cause tissue necrosis and fuck up heart);
in a person with renal failure correct vit D and phosphate first
15. Alopecia and rashes? Zinc def
a. Delayed wound healing, hypogonadism, decreased axillary, facial, pubic hair, anosmia

Random Notes:

Octreotide – somatostatin analog, tx for varicies, acromegaly, VIPoma, carcinoid; s/e nausea cramps steatorrhea

HAP – ceph w pseudo coverage – ceftazidme or cefepime

Parapneumonic effusion – thoracocentesis on > 1cm on CXR

TCAs are bad, they have anticholinergic properties. May give way to delirium.