Usmle World 7

Front 1

Cause of an INO (internuclear opthalmoplegia)

Back 1

Is commonly caused in MS, and is due to demyelination of the medial longitudinal fasciculus

Front 2

Dx patient with an eczematous rash on the breast that does not improve with topical treatment

Back 2

Paget's disease, most which have underlying breast adenocarcinoma. Migration of neoplastic cells through the mammary ducts to the nipple surface.

Front 3

Types of agents that are helpful in COPD

Back 3

beta agonist, muscarinic antagonist (anti cholinergics)

Front 4

Tx of choice in a patient with stable angina and hypertension

Back 4

Metoprolol.

Front 5

Dx patient with blurred vision, frontal headaches, and occasional falls, and blurry vision when leaning forward, with BP of 162/95

Back 5

Intracranial htn. Cushings reflex, hypertension and bradychardia is typical. Needs CT or MRI.

Front 6

Indications for excisional biosy

Back 6

Always narrow margins if suspected melanoma, then 1 cm if the lesion is 1 mm deep or less. Need sentinal biopsy if more

Front 7

Characteristics of renal changes in patient with hypertension

Back 7

arterisclerotic lesions of affarent and efferent renal arterioles and glomerular capillary tufts.

Front 8

Characteristics of renal changes in patient w DM

Back 8

increased extracellular matrix, basement membrane thickening, mesangial expansion, and fibrosis.

Front 9

Most common side effect of hydroxychloroquine

Back 9

Retinopathy. Need eye exam every 6 months.

Front 10

Dx pateint with clear KUB but positive US stones, with low urine pH

Back 10

Low urine pH is indicative of hyeruricosuria, and radioluscent stones are more like due Uric acid stones. Need to hydrate first, then alkanization of the urine, with low pruine diet. Give patient potassium citrate to alkalanize the urine.

Front 11

Type of nephropathy associated wtih Hodgkins lymphoma

Back 11

Minimal change disease.

Front 12

Sequence of esophageal studies

Back 12

barium, endo, motility.

Front 13

MGMT of patient found to be HCV positive during pregnancy

Back 13

Vaccinate them to hep A and hep B. Chance of vertical transmission is 2-5%. Breastfeading is fine, do not treat with ribavarin (plus treatment is only for chronic), dont need condoms for sex, incidence is pretty low.

Front 14

MGMT of patient who is vaccinated for rubella and gets vaccinated

Back 14

reassurance. there have been no cases of congenital rubella syndrome.

Front 15

MGMT of amurosis fugax suspicision

Back 15

need to ultrasound the neck, as it is a sign of emboli causing ischemia to the eye, most likely coming from the carotid bifurcation

Front 16

Dx patient with aldosterone secretion adenoma or bilateral adrenal hyperplasia

Back 16

Conns syndrome, present with patient with hypokalemia and hypertension, typically old patients

Front 17

Most common cause of secondary hypertension in kids

Back 17

Is fibromuscular dysplasia. Phys exam shows a hum or bruit at teh costovertebral angle due to well developed collaterals, renal artery is affected, R more than L, and string of beads is seen.

Front 18

Cause of vitiligo

Back 18

From the depigmentation caused by autoimmune destruction of melanocytes. Inherited version is called piebaldism.

Front 19

Tx of choice for trigeminal neuralgia

Back 19

carbamazepine

Front 20

What kind of drug is trihexylphenidyl

Back 20

anticholinergic. Causes dry mouth, constipation, urinary retention, flushing, vision changes, confusion

Front 21

Differentiate patient with heat stroke vs heat exhaustion

Back 21

heat stroke patient will have thermolegulation failure, super high body temp, altered mental status, hypotension, tachycardia. In heat exhaustio, youll be hypotensive, COOL skin, confsion and muscle spasm.

Front 22

Most common cause of adrenal insuficiency in patients with hashimotos

Back 22

Autoimmune adrenalitis.

Front 23

Infections causes of primary adrenal insufficiency

Back 23

CMV, fungal, TB.

Front 24

Congenital cause of adrenal insufficiency

Back 24

adrenoleukodystrophy, can cause AI, seen in young males, and has long chain fatty acids within adrenal glands.

Front 25

Most common mechanism of hypotension in pateint with acute pancreatitis

Back 25

caused by intravascular volume loss secondary to local and systemic enotehilia injury, leading to vascula permeability, leaking lamsa into peritoneum.

Front 26

MRI changes in patient with pseudotumor cerebri

Back 26

Empty sella and slit like ventricles. Other symptoms include headache that is pulsatile in nature, awakens one from sleep, whooshing sound in ears, sluggish pupillary reflexes. LP is indicated after neuroimaging is done. LP is recomended unless there is noncommunication hydrocepalus or space occypying lesion. LP will show increase opening pressure (>20 cm of water). Sixth nerve palsy should be only sign.

Front 27

Dx patient with acute inflmmation of the gallbladder in the absence of stones

Back 27

Usually due to acute acalculous cholecystitis, usually seen in patients after extensive burns, severe trauma, proonged TPN, prolonged fasting, mechanical ventilation.

Front 28

Conditions which would predispose you to amyloidosis

Back 28

Multiple myeloma or a chronic inflammatory disease such as rheumatoid arthritis

Front 29

Type of nephrotic syndrome most common in African Americans, patients with obesity, or heroin use and HIV

Back 29

focal segmental glomerulosclerosis

Front 30

Dx patient with lesion in teh femur, 14, that has onion skin appearance, followed with a moth eaten or mottled appearance and extention into soft tissue

Back 30

Ewings sarcoma. Treat with surgery, radiation and multi drug chemo.

Front 31

X ray showing fusiform defect with scalloping, occuring in fifth decade of life

Back 31

chondrosarcoma

Front 32

Dx patient with severe intermittent pain, tenderness, and sensitivity to touch, found in the subungual region

Back 32

Glomus tumor. is benign, mostly women.

Front 33

Spindle cell neoplasm that shows an osteolytic lesion with ragged edges, presenting as a painful mass

Back 33

fibrosarcoma.

Front 34

Common side effects of tetracyclines

Back 34

Can cause phototoxic drug eruption, which show as exaggerated sun burns. Results from the production of ROS from metabolites reacting to UC radiations.

Front 35

Antiviral therapy for influenza

Back 35

THINK (wizard of) OZ: oseltamivir, and zanamivir.

Front 36

Tx for CMV

Back 36

ganciclovir.

Front 37

Tx strategy for suspected aortic dissection

Back 37

TEE. Aortagrams are not recommended anymore. HTN should be controlled before TEE is attempted.

Front 38

Mechanism of hypocalcemia after blood transfusion

Back 38

Chelation due to the elevated levels of citrate in the stroed blood. Can chelate calcium or magnesium.

Front 39

Dx pateint with drop in PCWP, drop in PA pressure, drop in RA pressure and extremties are warm

Back 39

Septic shock.

Front 40

Dx patient with normal PCWP, super high PA and RA pressures

Back 40

MAssive pE.

Front 41

Damaged tendons in de Quervain tenosynovitis

Back 41

Abductor pollicis longus and extensor pollic brevis

Front 42

MGMT of patient with suspected infective endocarditis

Back 42

Draw blood cultures, treat wtih empiric ABX, and then get a TEE.

Front 43

Treatment of choice for patient w ALS.

Back 43

Riluzole, a glutamate inhibitor.