A 9 year old boy presents with asymptomatic tongue nodules that are firm and rubbery. They do
not disturb his taste or swallowing. He is also very tall for his age and with long fingers and
arms. Dx and increased risk for what? - Answer MEN2B
- increased risk for medullary thyroid cancer and phe...
A 9 year old boy presents with asymptomatic tongue nodules that are firm and rubbery. They do
not disturb his taste or swallowing. He is also very tall for his age and with long fingers and
arms. Dx and increased risk for what? - Answer MEN2B
- increased risk for medullary thyroid cancer and pheo
What is the typical management of MEN2B? - Answer prophylactic thyroidectomy <1
year of age and chronic screening for pheo
How does sepsis affect right atrial and pulmonary capillary wedge pressure? - Answer
peripheral vasodilation -> decreased systemic vascular resistance -> decreased low right
atrial pressure (less blood coming back) and decreased PCWP
What causes bounding peripheral pulses in the setting of sepsis? - Answer decreased
systemic vascular resistance causes and increase in stroke volume, leading to an increased pulse
pressure (difference between systolic and diastolic pressure)
What is Ludwig angina? - Answer rapidly progressive cellulitis of the submandibular and
sublingual spaces most like 2/2 to infection of mandibular molars
What is the most deadly aspect of Ludwig angina? - Answer airway obstruction
39 yo pt with a history of Roux-en-Y gastric bypass presents with 2 mo of 5-6 large volume
greasy-stools/day. She has has macrocytic anemia and evidence of malabsorption. Dx? - Answer
small intestine bacterial overgrowth
What tests can help diagnose small intestine bacterial overgrowth? - Answer carb breath
tests: lactulose, glucose, to measure the hydrogen production of intestinal flora
What is the pathophysiology of Dumping Syndrome? - Answer post-gastric bypass
complication that occurs with high-carb foods rapidly emptied into small bowel -> osmotic shifts
-> diarrhea.
no associated stearhea or vitamin deficiencies
Homeless man presents with CVA tenderness, blood in urine, and calcium oxalate crystals in the
urine. Labs show an AKI. Dx? - Answer Ethylene glycole/antifreeze intoxication
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What is the treatment of ethylene glycol/antifreeze intoxication? - Answer Fomepizole -
competitive inhibitor of alcohol dehydrogenase to prevent further breakdown of ethnalol
hemodialysis may be required
Injestion of what toxic alcohols cause an increased anion gap metabolic acisodid? - Answer
methanol and ethylene glycol/antifreeze ingestion
Homeless man presents with visual symptoms, turns out to be a central scotoma and confusion.
His pupils do not constrict to light. Labs show an increased anion gap metabolic acidosis. Dx? -
Answer Methanol intoxication
Homeless man presents with lethargy and a discongugate gaze. He has an absent ciliary reflex.
Dx? - Answer Isopropyl alcohol intoxication
What risk factor has the strong associated with both ischemic and hemorrhagic stroke? - Answer
HTN (4x the risk)
26 yo with prednisone-controlled lupus presents with 1 wk Hx of fevers, chills, and a dry cough.
Her O2 sat is 86% on RA an her LDH is increased. CXR shows diffuse reticular infiltrates. Dx
and treatment? - Answer Pneumocystis Jiroveci Pneumonia due to immunosuppression.
Tx with Bactrim
What is the treatment of PCP pneumonia? - Answer bactrim
must also assess immune status
39 yo male that returned from a 2 week trip to India presents with 4 days of nausea, loss of
appetite, and mild RUQ pain. Labs show increased total bilirubin and very high transaminases.
Most likely Dx? - Answer Hep A
What combination of alcohol and what substances can result in acute erosive gastropathy? -
Answer Alcohol + cocaine (vasoconstriction) and aspiring
What cardiac abnormality can be caused directly due to an implantable pacemaker or
cardioverter-defibrillator? - Answer tricuspid regurgitation because it travels from the
right atrium, through the tricuspid, and into the right ventricle
What is involved in the initial evaluation of lupus? - Answer CBC, renal function studies,
serum complement (C3, C4)
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What is the initial first-order test to assess for lupus? - Answer antinuclear antibody (very
sensitive, but not very specific)
What is a more specific confirmatory test for lupus? - Answer anti-double stranded DNA
What is a more specific confirmatory test for Rheumatoid Arthritis? - Answer Anti-CCP,
anti-cyclic citrullinated peptic antibody
What is a more specific confirmatory test for Drug-induce lupus? - Answer antihistone
What is am ore specific confirmatory test for Diffuse systemic sclerosis? - Answer Anti-
Scl
What is a more specific confirmatory test for Limited Systemic sclerosis? - Answer anti-
centromere
What is a more specific confirmatory test for Polymyositis/dermatomyositis? - Answer
Anti-Jo
What condition is associated with increased Anti-Ro/SSA? - Answer Sjogrens syndrome
What CBC abnormality is seen in fat emobolism? - Answer thrombocytopenia
What is the etiology of Kaposi Sarcoma? - Answer Co-infection of HIV and HHV-8
(human herpesvirus-8)
What is the most common etiology of otitis externa? - Answer Pseudomonase Aeruginose
What is the main ADR to watch out for with Isoniazid therapy? - Answer severe
hepatotoxicity
Pt with active TB is started on RIPE therapy. After 1 mo she feels much better and liver function
panels reveals mildly elevated liver enzymes. Next step? - Answer continue current
therapy, mild hepatitis occurs in 10-20% of pts and will resolve
What is the pathophysiology of Sick Sinus Syndrome? - Answer age-related degeneration
of the cardiac conduction systemic with fibrosis of the sinus node.
What is the main clinical difference between central vs. nephrogenic Diabetes Insipidus? -
Answer Mental: dysfunctional thirst mechanism -> severe hypernatremia
Nephrogenic: intact thirst function, normal/slightly elevated Na
What is the protocol of the water deprivation test? - Answer 1. serum and urine osmolarity
measured
2. abstain from water for 2-3 hours
3. periodically measure serum and urine osmolarity
, 4|Page
Pt with continued dilute urine likely have DI
How is central vs. nephrogenic diabetes insipidus distinguished? - Answer Desmopressin
changes. Central DI response with increase in urine osmolarity and nephrogenic shows no
change (kidneys do not respond)
What is the most important risk factor for bladder cancer? - Answer smoking
What are the risk factors for bladder cancer? - Answer - smoking
- exposures: painters, metal workers
- chronic cystitis
- cyclophosphamide
Pt with poorly controlled HIV and a CD4 count of 50 presents with progressive skin lesions that
started as small reddish/purple lesions to large nodules that are friable and bleed easily with
palpation. Lesions on liver are also seen on U/S. Dx? - Answer Bartonella species co-
infection
- vascular cutaneous lesions and systemic "B" symptoms".
At what CD4 count are HIV+ pts at risk for bartonella systemic infection> - Answer <100
What is the most common cause of congenital adrenal hyperplasia? - Answer 21-
hydroxylase deficiency
60 yo man presents with progressive urinary frequency and urgency, tho multiple U/A have only
shown leukocytes and all cultures have been negative. He also has new-onset primal pain during
ejaculation. DRE shows smooth, slightly enlarged prostate. Dx? - Answer Non-infectious
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
What are the treatment options for Non-infectious chronic prostatitis? - Answer aimed at
improving urinary symptoms: Alpha blockers (tamsuloin), 5-alpha-reductase inhibitors
(finasteride)
68 yo man presents with increasing in falling over the past 6 mo, increase in memory loss, and
multiple episodes of incontinence. On PE he has increased tone and reflexes and a slow, wide-
based gait. MMSE is 21/30. Dx? - Answer Normal pressure Hydrocephalus
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