Usmle World Test 2

Front 1

Dx. patient with recurrent ulcers, hypercalcemia, hypophosphatemia, young age

Back 1

Patient most likely has MEN 1, with parathyroid hyperplasia.

Front 2

Chi squared test

Back 2

Used to compare teh proportions of a categorized outcome. Association between two outcomes for example.

Front 3

Pt with increased hematocrit and signs of gynecomastia

Back 3

steroid drugs abuse. Erythrocytos is one of the side effects of androgens. Hepatoroxicity, psycho distrubances, dyspipedima, increased coags, and prematuer epiphyseal fusion.

Front 4

Tx for patients with hep C and elevated ALTs, cirrhosis

Back 4

Ribavarin and interferon

Front 5

Mgmt for patient w hereditary spherocytosis who is having acute flare

Back 5

Folate and consider splenectomy.

Front 6

Dx patient w bone pain, anemia, thromobocytopenia, and hepatosplenomegaly, at the age of 16.

Back 6

Gaucher disease. Gaucher cells have eccentric nucleolis and Schiff positive inclusions are diagnosit.

Front 7

Dx patient with loss of appetite, fatigue, weakness, with low BP, tachy. On chronic steroids.

Back 7

Adrenal insufficiency. Aldosterone is not affected.

Front 8

Schilling test

Back 8

IM injection of unlabeled cobalamin and oral radiolabeled cobalamin. If the cause of def. is from malabsorbtion, you will have diminished urinary excretion. If excretion is normal then it suggests a dietary insufficiency.

Front 9

Dx patient with intermittent dysarthria, dysphagia, ptosis, and diplopia

Back 9

Myasthenia gravis

Front 10

Dx. patient with fine, hair like irregular projections from lymphocytes, tartrate resistant acid phosphotase,

Back 10

Hairy Cell Leukemia. Pancytopenia and splenomegaly, 10-20% have a leukocytosis.

Front 11

Dx. patient with reed sternberg cells (owl eyes)

Back 11

Hodgkins Disease

Front 12

Dx. patient with shiny tongue, and pale palmar creases. Patient had a gastrectomy.

Back 12

B12 deficiency, leading to imparied DNA synthesis. Megaloblastic anemia, macrocytis anemia, and neurological changes.

Front 13

Hypercoagulable state fact

Back 13

Can happen in patient w underlying malignancy, so if someone is presenting w recurreing thromboses, it is appropriate to scan them. Elevated pt/ptt, and positive D dimer are also suggestive.

Front 14

Dx patient with hypokalemia, alkalosis, elevated BUN:Creat ration after diuresis

Back 14

Patient was given loop diuretics, which lead to hypokalemia, and an alkalosis that results from increased aldosterone levels (excretion of hydrogen) and increased solute delivery to the periphery, leading to increased hydrogen excretion.

Front 15

Acute renal failure

Back 15

IS usually indicated by a metabolic alkalosis and hyperkalemia.

Front 16

Tx for a patient refractory to ceftriaxone with gram negative bacilli

Back 16

Probably has a pseudomonas infection, which is a gram negative aerobic bacilli, common cause of gram neagtive nosocomial pneumonia. Treat w pip-tazo. Also aztreonam, cipro, genta, tobra, cefepime

Front 17

Pseudodementia

Back 17

MDD can present as pseudodementia, or memory loss. Dex supression test to detet endogenous depression. Can even have slow movements, a criteria in MDD.

Front 18

Pt w recent transplant (2 weeks) presenting with maculopapular rash on palms, soles, and face, intestinal involvement, and liver involvemnt.

Back 18

Graft vs. host disease. What happens is that the donor T cells recognize the host major and minor HLA antigens and start a cell mediated response. Host T cels lead to a depression in myelopoiesis, and neutropenia.

Front 19

Prevention of contrast induced nephropathy

Back 19

Adequate hydration with the use of isotonic bicarb or acetylcystein to minimize contrast induced nephropathy.

Front 20

Empiric treatment for suspected meningitis

Back 20

Ceftriaxone, vanco, and amp

Front 21

Tx for patients after placement of cardiac stent

Back 21

Clopidogrel, for at least 12 months if you had UA/NSTEMI, and for at least 30 days following PCI for metal stents and one year for drug eluting stents.

Front 22

Dx patient with abdominal pain, watery diarrhea, dyspepsia, weight loss, tetany (hypcalceia due to Vit D def), night blindness due to VIt a def, succussion splash from fluid filled loops of bowel. All of htis in the setting of a billroth procedure.

Back 22

Bacterial overgrowth of bowel. Also have lots of flattulence. Surgery for peptic ulcer disease is the bilroth.

Front 23

Dx. 15 year old patient with nausea, vomiting, headache, excitability, delirium, combativeness, liver failure, and CNS damage. Enlarge liver, levated ammonia levels, PT prolongation, metablic acidosis.

Back 23

Reye syndrome. Also known as fatty liver encephalopathy, younger ids URI with influenza or varicalla 60-80% of cases. Patients given salicylates increase the likelihood of getting it, thus why aspirin is contraindicated in children except for kawasaki disease. Treat with glucose with FFP and mannitol to decrease cerebral edema.

Front 24

Dx patient wi balloon degeneration with polymorphic cellular infiltrates

Back 24

Seen in acute alcoholic hepatitis, accumulation of fat protein adn water causes cellular swelling.

Front 25

Dx patient with panlobular degeneration w polymorphic cellular infiltrates, also seen are Kupffer cells phagocytosing debris. Bridging necrosis

Back 25

Sing of acute viral hepatitis.

Front 26

Dx patient w portal necrosis and or piecemeal necrosis

Back 26

Patient w chronic hepatitis

Front 27

Long term Consequence of patient treated with PTU

Back 27

Most common side effect is allergic reaction in 2% of patients, then there is agranulocytosis in 0.3%. THis is characterized by sore throat and fever. Leukopenia is the lab finding.

Front 28

Dx evaluation of a patient with suspected biliary obstruction.

Back 28

First step is to study liver enzymes, then to do Ultrasound. Second technique is ERCP. This is dubious.

Front 29

Congentical defects of biliary excretion leading to a conjugated hyperbiluribinemia.

Back 29

Dubin johnson or Rotor syndrome. Unconjugated hyperbilirubinemai is gilbert's syndrome.

Front 30

Three main susbstrates in gluconeogenesis

Back 30

Protein (usually alanine which is converted to pyruvate), lactate (from anaerobic glycolysis), and G3P (from TAG in fat).

Front 31

Dx 32 yo patient w CHF w acute onset, after travelling, clear Xray.

Back 31

Usually viral in etiology, viral myocarditis, proably due to the coxsackie B virus. May of may not have a viral prodrome.

Front 32

MGMT of patient with high suspicion for PE with no risk factors

Back 32

Anticoagulate first, then search for the source of PE with CT. Early anticoagulation has a decreased risk of death.

Front 33

Common cause of new onset asthma in patient with red or inflamed oropharynx.

Back 33

GERD is a common cause of new onset asthma, up to 75% of patients, and should be treated with a PPI.

Front 34

First line treatment of acute hyponatremia

Back 34

Hypertonic saline, if this doesnt work, then you can give them demeclocycline, which works by inhibiting the effect of ADH, but it takes a few days to work so not for acute setting. Water restrition for mild cases only.

Front 35

Indication for initiation of statin.

Back 35

High risk (chd equiv) if >100 LDL, mod high risk (2 or more risk factors) >130, moderate risk (>160), low risk (>190). Triglycerides are only used in patients with TGs greater than 200, and you use gemfibrozil.

Front 36

Mechanism of contraction alkalosis

Back 36

As you become volume depleted, you activate Aldosterone, which makes you lose protons, leading to an alkalosis.

Front 37

Drug choice for patient w CF

Back 37

Piptazo w Toby. Cef, azithro, are not effective against pseudomonas, adn you dont use cipro because of fear of ototoxicity.

Front 38

Dx. patient w infection of the lacrimal sac due to obstruction of the nasolacrimal duct

Back 38

dacryocystitis

Front 39

Dx patient w inflammation of the lid margins bilaterally, w crusty discharge clinging form lashes,

Back 39

Blepharitis

Front 40

Therapy for Pt w testicular mass

Back 40

Take it out. Dont even biopsy bc you can spread it. Kill it first.