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MTB-IM Live Online Course Book Answers 2013-2014
MTB-IM Live Online Course Book Answers 2013-2014
Case 1:
1. HTN
2. Diabetes
3. Positional, pleuritic, painful
4. D - Atypical pain + EKG normal --> do stress
test
5. when can't read EKG (LBBB, LVH, pacemaker)
6. when can't exercise
7. angiogram
Case 1 continued:
1. B - asthma
2. yes
Case 2:
1. A - aspirin - treat first!
2. B - statin for all (abnormal stress test - RF's
don't matter = CAD, give statins for any LDL!)
3. PAD, DM, aortic stenosis
4. most common AE of statins is liver disease
Case 2 continued:
1. B - <100
2. D - Fibric acid derivatives
Case 3:
1. C - aspirin LOWERS mortality!
2. ASA, tPA, BB/ACE/statin, cath
3. can't use BB, prinzmetal's, cocaine use
4. have arrhythmia now
5. C - myoglobin
6. C - accelerated idioventricular rhythm
7. C - 3 vessels and >70%
Case 3 continued:
1. D - statins
Case 4:
1. A - prasugrel
Case 4 continued:
1. B - transfer for angioplasty
Case 5:
1. A - thrombolytics
2. A retreat with thrombolytics
Case 5 continued:
1. A - propranolol
2. A - diltiazem
3. A - hypertensive
Case 6:
1. C - Low molecular weight heparin
2. C - angiography
Case 7:
1. mitral stenosis
2. echo 1st, cardiac cath best
3. diuretics
4. C - opening snap earlier
5. C - mitral balloon valvotomy now
6. B - increased thoracic pressure decreases
return
Case 1 continued:
1. A - ASD
2. B - mitral stenosis (really bad also peripartum CM, Eisenmenger's)
3. C wide splitting of S2
Case 2:
1. Mitral valve prolapse
2. Echo
3. increase murmur
4. B - verapamil
5. C - nothing
Case 2 continued:
1. D - aortic regurg
2. D - aortic regurg (phenylephrine is same as
hand grip)
Case 3:
1. LVH
2. echo first, cath best
3. valsalva decreases, hand grip decreases, leg
raise increases
4. D - CHF
5. replace valve in aortic stenosis, balloon in
mitral stenosis
6. repeat echo in 6-12 months
7. A - ACE-I
8. no ballooning for aortic stenosis unless refuse
or cannot tolerate surgery
Case 3 continued:
1. B - no viagra with nitrates, no viagra in aortic
stenosis
2. E - LBBB
3. D - angiography
4. E nothing
5. B fix heart
Case 4:
1. HOCM
2. A - dyspnea
3. BB, AICD
4. nothing
Case 4 continued:
1. A - MR
2. A - AICD
3. C - HOCM
Case 5:
1. atrial myxoma
2. echo
3. echo, then surgery to replace/remove
Congenital cardiac anomalies:
Case 1:
1. B can lead to aortic regurgitation
2. A coarctation
Case 1 continued:
1. E - refer for valve replacement
2. A - valve replacement
3. E - previous peripartum cardiomyopathy
4. B - okay to become pregnant
5. C - Selenium
Pericardial disease:
Case 1:
1. Pericarditis
2. Any infection (viral most common), trauma or
cancer near heart, connective tissue disease
(SLE most common)
3. C - PR depression
4. NSAID's
Case 1 continued:
1. D - Kussmaul's sign
2. C - pericardiocentesis
3. A constrictive pericarditis
Case 2:
1. Pericardial tamponade
2. D - decrease of 10 mmHg when inhale
3. C - electrical alternans
4. C -pericardiocentesis
Case 2 continued:
1. E - equalization of diastolic pressures
Rhythm disturbances:
Case 1:
1. Electrical defibrillation
2. Never
3. Never
4. Epinephrine or vasopressin prior to next
attempt at defibrillation
5. E - Beta blockers
Case 1 continued:
1. C - unsynchronized defibrillation
Case 2:
1. AICD
Case 1:
1. E - no further eval
Case 2:
1. C - Atenolol
Case 3:
1. E - no further eval
Case 4:
1. E - no further eval
Case 5:
1.
Peri-op:
1. C - S3 gallop
GI Answers:
Esophageal disease:
1) B
2) B - 10%
3) E
4) E - PPI
5) C - 24 hr pH
6) B - DES/nifedipine
7) A - peptic/Schatzski ring
8) D - manometry/motility
9) B - manometry
10) B - Barrett's esophagus
11) C - fluconoazole
12) C - 24 hr amb pH
13) C - 24 hr pH
14) D - anticholinergics
15) B - endoscopy
16) A - squamous cell
17)
18)
19)
20)
21)
22)
23)
24)
Stomach diseases:
1) B - endoscopy
2) D - both A and C true
3) B - gastrin levels
4) C - lanso, amox, clarith
5) A - secretin stim
6) A - EUS/octreoscan
7) B - duodenal ulcers
8) E - h pylori
9) C - resp failure
10) D - nuclear med scint
Diarrhea:
1) B - norovirus
2) A - norovirus
3) D - c. jejuni
4) E - staph toxin
5) B - vibrio
6) C - e coli
7) C - e. coli
8) A - b. cereus
9) E - yersinia
10) A - celiac
11) E - all
12) B - ischemic colitis
13) D - reassurance
14) D - c. diff
15) D - clear liquids/observation
16) if sxs recur once re-treat with
metronidazole, if sxs occur twice use
vancomycin, if toxic megacolon remove colon
17) prevent c. diff with probiotics
18) D strongyloides (treat with ivermectin or
abendazole)
19) A cryptosporidium (treat with
nitazoxanide)
20) C - e histolytica (treat with metronidazole)
21) strongyloides
22) irritable bowel syndrome, diarrhea use
loperamide, constipation use linaclotide or
lubiprostone
23) laxative use, stop laxatives
24) yersinia, treat with quinolones if needed
(fever + hypotension + tachycardia)
25) bacterial overgrowth syndrome from small
bowel diverticuli, treat with cipro +
metronidazole
26) celiac disease, small bowel biopsy, anti
endomysial ab, anti-tissue transglutaminase
27) bowel wall lymphoma, biopsy,
noncompliance
28) strongyloides, stool for worms
29) whipples disease, PCR, treat with doxy
Colon cancer screening
1) B - colonoscopy every 10 years
2) E - all acceptable
3) E - nothing like colonoscopy
4) C - 3-5 years
5) A - every 5 yrs, start at 40
6) A - colonoscopy every 1-2 yrs
7) C - every 1-2 yrs, starting now
8) B - flex sig at age 12
Inflammatory Bowel Disease:
1) D
2) A
3) B - pyoderma gangrenosum
4) B - mesalamine
5) C - prednisone
6) B - 6-MP
7) B - sclerosing cholangitis
8) A - sclerosing cholangitis
9) E - all of the above
10) A - infliximab
11) B - frequency similar
12) B - iron def anemia
13) C - corticosteroids
14) C - NSAID's
15) A - surveill colonoscopy
Bleeding and Liver:
Case 1:
1) B
2) E - B and D correct
3) A - low risk of rebleeding
4) D - prednisone
5) E - all of the above
6) D discharge
Pancreas
Case 1:
1) C - lab testing
2) B
3) B
4) C
5) A
6) C
7) B
8) B
9) D
10) B
11) B
12) B
14) if painful and > 4 cm drain
Case 2:
1) D
2) A
3) B
Hepatitis:
Case 1: Chronic Hepatitis
2) C
3) C
4) D
5) B
6) A
7) E
8) A
9) B
10) E
11) A
12) A
13) A
14) B
15) B
Case 2: Acute Hepatitis
1) A
2) B
3) A
4) E
Case 2 continued:
1) D
2) A
3) D
4) B
5) E
6) C
7) B
8) B
9) C
10) E
11) E
12) D
13) alcoholic hepatitis, folate/thiamine/vit K,
>32 points on DF start steroids
14) primary biliary cirrhosis, ursodeoxycholic
acid
15) autoimmune hepatitis, steroids +
azathioprine
16) primary sclerosing cholangitis, liver
transplant is only proven treatment
Neuro answers
Case 1:
1) stroke (L MCA)
2) CT (contrast neg)
3) A - Echo, Holter, carotid Doppler
2) triptans
3) if headaches more than 4 times per month
4) propranolol for > 3 months
5) A - foods
6) A pregnancy and cardiac disease
Case 17 continued:
1) oxygen, verapamil
2) C
3) C
4) C - migraine
5) A - migraine
6) C
Case 18:
1) pseudotumor cerebri
2) A - diplopia
3) CT scan (rule out a space-occupying lesion)
3) LP (shows high pressure)
4) weight loss, check for vit A toxicity, stop
OCP's
5) acetazolamide, VP shunt, cut optic nerve
6) when med therapy doesnt work
7) A visual field loss
Case 19:
1) delirium
2) check sodium, oxygen, glucose, calcium,
infections exclude all correctable causes
3) haloperidol NOT benzos
4) C optic neuritis
5) D prednisone and eye lubrication
6) B laser photocoagulation
Case 20
1) somatization
2) reassurance, freq doctor meetings
3) A education and relaxation techniques
4) D
5) C - citalopram
6) C - fluoxetine
7) E - haloperidol
8) A - discontinue clozapine
9) D - fluoxetine
10) A 2 months
11) A - supportive therapy
12) A somatoform disorder
13) B borderline personality disorder
14) A bipolar disorder
Case 21:
1) D
2) C
3) A
4) B - radial nerve palsy
5) F
6) D
7) C
8) E
9) C
10) D
11) D
12) B
13) C
14) A
Endocrine answers
Case 1:
1) B - HCG
2) E - panhypopituitarism
3) C - pituitary adenoma
4) B - Sheehan syndrome
5) D - sarcoidosis
6) acute hemorrhagic necrosis of pituitary
7) A - histiocytosis X
Case 2:
1) acromegaly
2) B - IGF1
3) 2 hr glucose tolerance test
4) TSH
5) after biochemical confirmation
6) osteoarthritis, HTN, DM, 2x mortality
7) surgical resection
8) B lanreotide (or octreotide)
9) Add on (adjuvant) to somatostatin analogue
10) 3rd line agent
Case 3:
1. Kallman's syndrome (hypogonadotropic
hypogonadism)
2) Testosterone. If fertility is a concern, replace
LH/FSH
Case 4:
1) Prolactinoma
2) Serum prolactin level
3) D - MRI
4) see table p. 222
5) Visual field deficit, osteoporosis,
reproductive concerns, and macroadenoma
6) B - Cabergoline
7) Rarely; in the case of resistance to meds
8) A - repeat prolactin with hemodilution
Case 5:
1) Serum GGT level
2) Paget's disease
3) Bone survey
4) A - Bone scan
5) Bisphosphonates
6) Almost never (used for bone pain only)
7) C - bone biopsy
Case 6:
1) osteoporosis
2) DEXA scan - most accurate test
3) C - vit D and TSH
4) steroids, thyroid, vit D def
5) bisphosphonates
6) Never alone for OA, can be used within 7 yrs
of menopause
7) bisphosphonates
8) SERM - 2nd line agent
9) A - calcitonin (best tx for pain)
10) D - calcium and vit D
11) C - HRT increases fibroid size
12) C - testosterone
13) A - alendronate
14) E - d/c alendronate and start PTH
15) D - Raloxifene
Case 7:
1) E - calcium gluconate
2) calcium, PTH, vitamin D
3) QT prolongation
4) activated vitamin D
5) loop diuretics
6) A - TSH
Case 8:
1) hyperparathyroid, malignancy
2) stones, moans, groans, psychic overtones
(renal stones, hypertension, polyuria, fatigue,
mental status changes, bone pain, osteoporosis,
and pathologic fractures.)
3) B - normal saline
4) hypercalcemia due to malignancy
5) hypercalcemia secondary to granulomatous
disease
6) parathyroid adenoma and hyperplasia, most
common complication of surgery is
hypoparathyroidism
7) C - calcitonin
8) D - check sister's calcium
Case 9:
1) Cushings syndrome
2) ACTH
3) ACTH - to distinguish central vs adrenal vs.
extra-adrenal
4) E - serum and urinary cortisol
5) if adenoma
6) adrenal cancer or resistant cushings
Case 10:
1) B - hyperaldosteronism
2) D - renin and aldo
3) C - aldo supp test
4) CT (if adenoma --> take it out, if bilateral -->
no surgery)
5) A - increased plasma renin activity
6) adrenal vein sampling
7) adenoma only, NOT hyperplasia
8) C spironolactone
9) measuring aldosterone in samples of adrenal
venous blood
Case 11:
1) pheochromocytoma
2) D - urina metanephrines
3) adrenal CT
4) always!
5) preop - to prepare for surgery
6) B - after phenoxybenzamine
7) A - thyroid sonogram
Case 12:
1) A - 24 hr urinary cortisol
2) skip - cut out if functional
3) A - ACTH level
Case 13:
1) primary adrenal insufficiency
2) B - AM cortisol
3) if low AM cortisol
4) when primary insufficiency (tell if it's atrophy
or hemorrhage)
5) secondary adrenal insufficiency
6) hydrocortisone. prednisone
7) E - anti-CYP21 antibodies
Case 14:
1) D - Grave's disease
2) post-viral, tender thyroid
3) beta blockers
4) thyroid storm
5) toxic nodule
6) D - propranolol
7) B - free T4
8) A - factitious hyperthyroidism
9) A - increased uptake
10) B wait three months
Case 15:
1) hyperthyroid --> not FNA and no biopsy
needed, euthyroid --> FNA
2) A - sonogram-guided FNA
Case 16:
1) hypothyroid
2) TSH
3) levothyroxine
4) C - IV glucocorticoids
5) Steroids plus IV T4/T3, sepsis
6) Thyroid lymphoma
7) KI
Case 17:
1) Sick euthyroid syndrome
Case 18:
1) fasting sugar > 126, random 2 hr > 200, A1C >
6.5, impaired glucose tolerance 5.7-6.4
2) HbA1c (only one value needed)
3) C 24-26 weeks gestation
4) always (except if Cr > 1.4)
5) 3rd line
6) add on
7) HbA1c > 9.5
8) D - insulin
9) A
10) A - metformin
11) B diet and exercise
12) A - glipizide (shorter half-life because renal
insufficiency)
Case 19:
1) B - lisinopril
2) cough, hyperkalemia
3) urine microalbumin/cr > 30:1 (yearly)
4) exercise, UTI, menstruation
5) BP control and lipids
6) yearly ophtho checkups
7) quarterly podiatry exams, microfilament
8) D - duloxetine (gabapentin, tricyclics okay
too)
9) DM gastropathy --> add erythromycin
10) erectile dysfuction
11) EKG - because diabetics at increased risk for
the development of coronary artery disease
Case 20:
1) diabetic ketoacidosis
2) IVF + IV insulin
3) C - glucose < 200
4) K+ < 5, monitor PO4- < 1.5
5) 24 hour rate x 0.7 = basal dose = glargine
dose
6) normal AG, very high glucose
7) eliminated (said was stupid question)
8) C - decrease pre-dinner aspartate (somogyi)
9) Increase glargine (not one of the answer
choices, typo here)
10) D - increase pre-breakfast aspartate
Case 21:
1) meds (insulin, sulfonylureas), liver failure,
cachexia, chronic kidney disease, insulinoma
Case 22:
1) high testosterone
2) B - CT scan of adrenal
4) D - metformin
Case 23:
1) Rule out pregnancy with beta-hCG
2) Prolactin and TSH levels
3) C - MRI
4) D - observation
5) B - pelvic US (endometriosis)
6) B - fluoxetine
Case 24:
1) D - testosterone
2) FSH/LH
3) no testosterone indicated
4)
5) SSRIs
6) total testosterone, LH, FSH
7) pump to assist in erection
8) sex without protection 2-3 times per week
9) and 10) sildenafil after 24 hours, tadalafil
after 48 hours
12) adrenal CT scan
Nephro answers:
Acute Renal Failure:
Case 1:
1) E - no clear diagnosis
2) chart
3) if prerenal, give octreotide
4) no test
5) no specific therapy
Case 2:
1) AIN - Allergic Interstitial nephritis
3) Protein:Creatinine Ratio
4) B kidney biopsy
5) Prednisone
Case 3 continued:
1) A -Focal segmental glomerulosclerosis
2) B Berger disease
3) B - Goodpasture's disease
4) C loss of urine carrier protein
Case 4:
1) E - antiretroviral therapy
Case 4 continued:
1) D - light chains
2) D - immediate hemodialysis
3) A - calcium acetate with meals
4) C - decrease efferent arteriolar pressure
5) B - continue
Sodium Disorders:
Case 1:
1) DI (Lithium) or Psychogenic Polydipsia
2) Both
3) Both
4) E - Nocturia
5) Urine Na and Urine osmolarity
6) ADH administration
7) Central - ADH replacement, nephrogenic thiazides, NSAID's
Case 1 continued:
1) C psychogenic polydipsia
Case 2:
1) non-ketotic hyperosmolar syndrome
2) normal saline and insulin
3) 357
Case 3:
1) SIADH
2) Mets, Tumor
3) TB, pneumonia
4) Una and Uosm - both high
5) Hypertonic saline or Saline+Diuretic
6) C - Tolvaptan (V2 receptor antagonist)
7) central pontine myelinosis
Case 4:
1) Nephrogenic DI
2) 8.57
3) High Ca and Low K
4) Thiazides, NSAID's
NSAIDs:
1) D constricts afferent arteriole
2) E - hypokalemia
Potassium disorders:
Case 1:
1) Diarrhea--> vomiting --> inhaled beta
agonists drove potassium into cells
2) Very low: <20 mEq/L
3) EKG - U wave
4) no maximum
5) < 20 mEq/hr
6) B - D5W
7) 5 mg/kg per point increase in potassium
8) Mg
Case 2:
1) Tumor lysis syndrome
2) EKG
3) Calcium chloride or gluconate if peaked T
waves
Phosphate disorders:
1) E Fanconi syndrome
2) E renal failure
Metabolic acidosis:
Case 1:
1) Ethylene glycol causes renal problems,
Methanol causes eye problems
2) All three will
3) All three will
4) UA for ethanol, eye exam for methanol
5) Fomepazole (stops toxic metabolite from
forming)
6) Normal anion gap
Renal tubular acidosis:
Case 1:
1) A - Proximal RTA
2) Bicarb
3) Diuretics
Case 2:
1) B - Distal
2) Give acid
3) Bicarb
Case 3:
1) Type IV
2) Na restriction
3) Fludrocortisone
Continued questions:
1) B low anion gap
2) E chronic renal failure
Metabolic Alkalosis:
Case 1:
1) Licorice
1) Kegel exercises
2) Surgery
Hypertension:
Case 1:
1) Lifestyle modifications
2) Weight loss
3) Relaxation
4) Diuretics - thiazides
5) Add beta blocker, calcium blocker, ACE
inhibitor, or ARB
6) Never minoxidil, methyldopa in pregnancy,
clonidine if opiate/alcohol use
7) Reserpine, then clonidine, then beta blockers
Case 2:
1) Beta blocker
Case 3:
1) Beta blocker
2) <130/80
Case 4:
1) Beta blocker
2) Beta blocker
Case 5:
1) Labetalol, nitroprusside, nicardipine
2) see table
Case 6:
1) Young (<30), told (>60), hard to control HTN
Case 6 continued:
1) B - primary hyperaldo
Case 7:
1) Ultrasound
2) Angiogram
3) Balloon and stent
Case 8:
1) Phenoxybenzamine
2) Alpha blocker
Pulmonary answers:
Case 1:
1) FiO2 x 4-5 = pO2
2) are alveoli healthy & allowing gas exchange
3) B - Guillain-Barre syndrome
4) respiratory acidosis (pH/pCO2/pO2/HCO3)
Case 2:
1) metabolic acidosis
2) additional resp acidosis - Winter's formula
(expected CO2)
3) ignore
4) AG MA - MUDPILES, Non-AG MA - RTA 1 & 2
Case 2 continued:
1) D - dialysis
2) B - measure serum osmolarity
Case 3:
1) metabolic alkalosis
2) no additional resp disorder
3) urine chloride
4) B - Gitelman syndrome
Case 4:
1) metabolic acidosis
2) EtOH
3) 2Na + BUN/2.8 + glucose/18
4) met acidosis of unknown etiology
Case 5:
1) C- normal saline
2) septic shock
3) norepinephrine, dopamine
4)
5) 2D echo
Case 6:
1) ARDS (bilateral infiltrate, Fi02/PO2 < 200,
normal LV normal EF, wedge < 18)
2) D - 2D echo
3) maintain FiO2 < 40%, low TV
4) plateau - pulm tissue and airways, peak large airways
5) A- COPD
6) drops
7) C - bronchodilators
8) reducing tidal volume and thus allowing the
levels of carbon dioxide to rise. By reducing
tidal volume, the amount of barotrauma is
reduced
9) B decrease in BP
10) D - mucus plug
Case 6 continued.....
1) D - lobar atelectasis
2) C - occluded ET tube
3) D - pulmonary embolism
4) D semi-recumbent position
Pulm function testing:
1) FEV1 low, FVC high, ratio < 80%
2) FEV1 low
Flow Volume Loops:
1) A5, B6, C3, D2, E1, F4
2) A - DLCO
3) D - phrenic nerve paralysis
4) D - pulmonary edema
Case 7:
1) B
2) C
3) yes, cover atypicals (quinolones, azithro)
4) C
5) B - LV failure
6) B - home oxygen
7) E - smoking cessation
8) E - recommend lung resection surgery
Case 8:
1) GERD, post-nasal drip, cough-variant asthma
2) nasal steroids
3) A - methacholine challenge test
4) not necessarily
5) B - fluticasone
6) B - peak flow (FEV1)
7) albuterol, steroids
8) add on to albuterol
9) steroids
10) D - stat MICU consult and intubation
11) find and get rid of trigger
12) add omalizumab
Case 8 continued.....
1) B - chest xray
2) D - inhaled steroid and salmeterol
3) D - skin test for aspergillus
4) C - corticosteroids
5) E - CT scan
6) D - stop aspirin
7) E - short-acting beta agonist
Case 9:
1) B - bronchiectasis
2) chest x-ray
3) CT chest - shows dilated airways
4) obstructive pattern
5) D - alpha-1-antitrypsin
Case 10:
1) sarcoidosis
2) A - lymph node biopsy to look for
noncaseating granulomas of unknown origin
3) serious organ involvement
4) restrictive pattern
Case 11:
1) cough, SOB associated with work
2) fever, increased WBC
3) high neutrophil count in CAP
4) B - pleural biopsy
5) oral steroids
Case 12:
1) chest x-ray (idiopathic pulmonary fibrosis)
2) CT chest
3) biopsy
4) restrictive
5) D - refer for heart-lung transplant
Case 12 additional cases:
1) bronchiolitis obliterans organizing
pneumonia (BOOP)
2) alveolar proteinosis
3) pulmonary lymphangioleiomyomatosis
Case 13:
1) narcolepsy
2) sleep studies (polymsomnography) - see
increased REM sleep
3) stimulants - methylphenidate
Case 14:
1) obstructive sleep apnea
2) nighttime pulse oximetry
3) sleep studies with at least 30 apneic episodes
4) D - CPAP
5) obesity hypoventilation
6) acetazolamide (CA inhibitor)
Case 15:
1) pleural effusion
2) lateral decubitis film
3) if fluid layers > 10 mm thick, order serum to
fluid ratio of LDH > 60%, protein > 50%
4) exudate
5) E - cirrhosis
6) infections, rheumatic, cancers, pancreatitis
7) B - rheumatoid arthritis
8) pleurodesis
9) palliative measures
10) empyema (pH < 7.19, gross pus, or lg WBC),
must insert chest tube
Case 15 continued.....
1) A - open pleural biopsy
2) C - pleurodesis
3) A- antibiotic therapy
4) C - decortication
Case 16:
1) history &radiographic appearance of nodule
2) compare current x-ray with previous ones
3) A
4) popcorn calcifications
5) onion-skin or bulls-eye calcification
6) A
7) D
Case 17:
1) chest x-ray
2) C - mediastinoscopy
3) staging
4) no surgery - chemo and radiation
5) stages 1-3A
6) PFT's
Case 18:
1) pulmonary hypertension
2) A - 2D echo
3) right heart cath with nitrate challenge
4) class I symptoms
5) class IV symptoms
6) if vasculature responds to adenosine,
prostacyclin or nitrous oxide
7) right heart failure on prostacyclin or cannot
tolerate medical therapy
Case 19:
1) pulmonary embolism
2) hemodynamically unstable PE without
contraindications to thrombolytics
3) E - VQ scan (high resolution CT lungs ideal)
4) D - dalteparin (heparin)
5) 6 months (3 months - 1 year)
6) immobility, malignancy, nephrotic syndrome,
oral contraceptives, pregnancy, obesity,
hormone replacement therapy, heart failure
7) B - CT
Case 19 continued.....
1) A
2) C
3) D
4) B
Case 20:
1) A - alveolar hemorrhage
2) B - bronchoalveolar lavage
3) A - anti-GBM antibodies
4) A - crack cocaine
Case 21:
1) A - acetazolamide
2) B - descent to lower altitudes
Heme/Onc:
Microcytic anemia:
Case 1:
1) C - reticulocytes
2) B vitamin C
3) C - PPI
Case 1 continued:
1) D
2) C iron deficiency anemia
3) C - hypothyroidism
4) D - colonoscopy
5) A sideroblastic anemia
Case 2:
1) B
2) C peripheral smear
3) D MMA level
4) B12 or folate replacement
5) C - hypokalemia
6) F MMA level
7) E
8) C - both
9) metformin
Hemolysis:
Case 1:
1) D peripheral smear
2) A - hemoglobin electrophoresis
3) A - oxygen, fluids, and analgesics
4) high WBC or fever
5) ceftriaxone, levofloxacin, moxifloxacin
6) C exchange transfusion
7) parvovirus B19
8) B reticulocyte count
9) E PCR for DNA
10) IVIG
11) hydroxyurea
12) D aseptic necrosis
Case 2:
1) normal
2) C - renal involvement
3) more than SS trait, less than SS disease (SC in
middle)
4) A - visual disturbance
2) D cold agglutinin disease
3) B autoimmune, cold IgM antibodies
4) C - parvovirus
Leukemias:
Case 1:
1) myelodysplastic syndrome
2) Pelger-Huet cell, bi-lobed, pancytopenia
3) D - % of blasts
4) A - bleeding and infection
5) C - observation
Case 3 continued:
1) B leukemoid reaction
Plasma cell disorders:
Case 1:
1) Myeloma
2) C - bone marrow biopsy
3) B-J protein, hyperuricemia, increased
ESR, low anion gap, rouleau formation,
suppression of other Ig lines
4) D (auto stem cell can be used up to 70 years
old) (B would have been the most effective
*medication*, but that wasn't the question!)
Case 2:
1) MGUS
2) A - no treatment
Case 3:
1) Waldenstroms Macro IgM
2) B - plasmapheresis
Aplastic Anemia:
Case 1:
1) HIV, EBV, CMV, hepatitis B and C serology,
ANA, B12, folate levels
2) none - diagnosis of exclusion
3) B - allogenic bone marrow transplant
4) C - cyclosporine and antithymocyte globulin
5) D - oral polio
6) A - B12
7) A - cobalamin deficiency
Lymphoma:
Case 1:
1) excisional biopsy
2) chest x-ray, chest/abdomen/pelvic CT scans,
bone marrow biopsy and LDH level
3) A - lymphocyte predominant
4) B - lymphocyte depleted
5) A - radiation therapy
6) B - ABVD chemotherapy
7) B - ABVD chemotherapy
8) D - bone marrow transplant
9) filter out antigens - don't alloimmunize
Case 1 continued.....
1) B - lung cancer
2) C - acute leukemia
Case 2:
1) start treatment; more tests wont change
therapy
2) radiation local, chemo widespread, CHOP
3) CD20 antiboduy
4) add rituximab
5) BM transplant
Transfusion reactions:
Case 1:
1) major blood group ABO incompatibility
2) Stop the transfusion. Recheck the blood type.
Hydrate the patient and consider forced
diuresis with mannitol. Possible use of
bicarbonate.
3) D - filter and irradiated
4) delayed development of jaundice
5) C - hypocalcemia
6) A IgA deficiency reaction (anaphylaxis)
Case 2:
1) C - leukoagglutination
Case 3:
1) D - urticarial reaction
Case 4:
1) B - anaphylaxis
Case 5:
1) A - febrile nonhemolytic reaction
2) E - febrile nonhemolytic reaction
Coagulation:
Case 1:
1) von willebrand's disease
2) superficial
3) A - bleeding time
4) A - desmopressin
5) B - factor VII replacement
6) B Bernard-Soulier syndrome
7) C Glanzmanns
9) post-transfusion purpura, tx with IVIG
Case 2:
1) ITP
2) none
3) steroids
4) splenectomy
Case 3:
1) IVIG
2) D - e. coli O157: H7
Case 4:
1) factor XIII deficiency
2) euglobulin clot lysis time
3) E - fresh frozen plasma
Case 5:
1) factor XI deficiency
2) E - mixing time
1. A perform PSA
2. B - transrectal ultrasound with biopsy
Case 2:
1. local - Gleason scoring (low - do nothing, high
- surgery/radiation)
2. A - radiation or surgery (use flutamide first)
Case 3:
1. flutamide, GnRH agonist
Testicular cancer:
1. B - inguinal orchiectomy
2. A - regular follow up, no chemotherapy
unless it recurs
Breast Cancer:
Case 1:
1. mammogram, pap smear, colonoscopy
2. neg = no axillary dissection
3. positive nodes = chemotherapy
4. ER or PR + = tamoxifene, raloxifine,
5. B - HER2/Neu positive
6. alternative to tamoxifen
7. B - yearly mammogram
Case 1 continued....
1. A - lymph node involvement
2. E - lumpectomy with adjuvant chemotherapy
and local radiation
3. A - radiation followed by tamoxifen and
chemotherapy
Case 2:
1. D - tamoxifen
2. DVT
3. B
4. A
Cervical cancer:
1. D
2. D
3. E
Endometrial cancer:
1. A
2. C
Ovarian cancer:
1. C
General Internal Med answers:
Case 1:
1. gastric lavage
2. caustics
3. never dangerous
4. never
Case 2:
1. narcan, dextrose, thiamine
2. intubate and lavage (empty stomach)
3. never
4. seizures
Case 3:
1. salicylate overdose
2. bicarbonate
Case 3 continued.....
1. B ASA toxicity
Case 4:
1. D - EKG
2. if wide QRS --> give bicarbonate to protect
heart
Case 5:
1. give oxygen
2. myocyte ischemia - EKG
3. normal
hyperbaric oxygen indications - cardiac
problems, metabolic acidosis, pregnancy
Case 5 alternate:
1. C - call an ambulance
Case 6:
1. nerve gas
2. C - atropine
3. pralidoxime
Case 7:
1. gastrointestinal disturbance
2. B
3. vtach
4. EKG
5. low potassium
6. life-threatening dysrhythmias or hypotension
unresponsive to other measures
Case 8:
1. spider bite (black widow spider)
2. C - low calcium
3. calcium, anti-venom antitoxin
Case 9:
1. B - EKG
2. j waves on EKG (look like ST elevation)
Case 10:
1. scurvy
Case 11:
1. vitamin A toxicity
Case 12:
1. high altitude pulmonary edema - B
Case 13:
1. D - >85
2. B - CHF
3. A - urine
Immunology:
Case 1:
1. D desensitization (immunotherapy)
Case 1 continued.....
1. B - stop propranolol
Case 2:
1. enalapril
Case 3:
1. C - glucagon
Case 4:
1. E - encase everything
Complement deficiency:
Case 1:
1. A - C2 deficiency
Case 2:
1. B - C1 inhibitor deficiency
Case 3:
1. A - C2 and C4 levels
Case 4:
1. B - danazol
Case 5:
1. C - decreased C2 and C4 levels
Case 6:
1. A - nasal steroids
Case 7:
1. C pneumococcal sepsis
Selective IgA deficiency:
1. D common variable immunodeficiency
Hyper IgE syndrome:
1.C IVIG
Stats/Ethics:
Stats:
Case 3:
1) B - reassurances
Case 4:
1) A lead-time bias
Case 5:
1) B confounding variable
Case 6:
1) B type 2 error
Case 7:
1) all of the above
Case 8:
1) C 5
Case 9:
1) C - random selection across population
Ethics:
Case 1:
1) tell father
Case 2:
1) dont do it
Case 3:
1) no blood to mom, give blood to kid
Case 4:
1) C
2) A
3) A
4) A
5) B
6) B
7) C
8) A
Preventative medicine:
Case 1:
1) A
2) D ASA with PPI
3) E
4) E
5) B
6) E
7) C
8) A family history
9) C serum cholesterol only
10) D
11) D
12) E
13) E
14) B
15) E
16) B
17) B
18) A
19) E
20) A
21) B
22) C
23) C
24) B
25) C
Rheum answers:
Case 1:
1. E - rheumatoid arthritis
2. E - skin nodules
3. A anti-CCP
4. NSAID's and prednisone
5. A - methotrexate
6. A - liver and lung fibrosis
7. B - anti-TNF
8. E - high RF and most joints involved
9. A dry eye
Case 1 continued.....
1. E - spinal fusion
2. A - anti-CCP or RF
3. C hydroxychloroquine
4. B low glucose
5. D accelerated coronary disease
6. C - cricoarytenoid joint involvement
7.
8. E infective endocarditis
9. Bakers cyst, removal
10. Caplans sydrome
11. C palindromic rheumatism
12. A - better
Case 2:
1. D - parvovirus
2. C decreased reticulocyte count
3. B - duration
4. A - PCR for DNA
5. normal
6. A - anemia
7. NSAID's for joint pain, IVIG for anemia
Case 3:
1. E - Sjogren syndrome
2. B - Schirmer test
3. C - SSA and SSB
4. C - salivary gland biopsy
5. A - ANA
6. A - joint pain
7. C - lymphoma
8. artificial tears and saliva (no steroids),
civemeline, pilocarpine
Case 4:
1. C - CREST syndrome
2. ANA
3. verapamil, nifedipine
4. C - renal and cardiac involvement
5. E - no effective therapy
6. worse with exercise, treated with steroids
7. eosinophiliic myositis, steroids work
8. A - ACE inihibitor
9. A - pulmonary hypertension
10. D - right heart catheterization
Case 5:
1. SLE
2. A - ANA
3. B - dsDNA
4. 4 skin (malar, discoid, photosensitivity,
ulcers), joint, renal, CNS, chronic heme
5. A - hydroxychloroquine
6. acute exaacerbations
7. C - CNA and renal involvement
8. B - antiphospholipid antibodies
9. A - mixing study
10. A - anti-Ro (do EKG on baby for AV block)
11. C anti-Sm abs
Case 5 continued:
1. B - restrictive pulmonary disease
Case 6:
1. Still disease
2. A - ibuprofen
3. D - prednisone
4. C - CBC and ferritin levels
Case 1 p. 434:
1. B - relapsing polychondritis
Case 2 p. 435:
1. A - Behcet syndrome
Case 3- p. 435:
1. D - reflex sympathetic dystrophy
2. A - bone image (scintigraphy)
Case 7 - p. 437:
1. C bursitis
2. trauma
3. fever and increased WBC count
4. A NSAIDs and physical therapy
Case 7 continued.....
1.D - anserine bursitis
2.C prepatellar bursitis
3.A Jumpers knee (patellar tendonitis)
4.B - plantar fasciitis
Case 8:
1.A
2.B
3.C
4.E
5.aortic reg, uveitis
6.bent over test
7.A
8. B clinical symptoms
Case 8 continued:
1.C
2.E
3.A
Case 9:
1.psoriatic arthritis
2.pencil in cup deformity
3. asymmetric, inflammatory arthritis of distal
joints of fingers and axial skeleton
4.E
5.part of the sero negative, enthesitis
6.NSAIDs, Methotrexate
Case 10:
1.D
2.B
3.GI campylobacter, chlamydia .....give
antibiotics
4.NSAIDs, antibiotics if infection
Case 11:
1.C
2.ESR
3.temporal artery biopsy
4.high dose steroids immediately
5.shoulder and hip pain with no temporal artery
symptoms PMR with lower dose steroids
6.thoracic aneurysm
Case 12:
1.C
2.B
3.GI angiogram
4.D
5.D
6.steroids
Case 13:
1.C
2.B
3.Biopsy
4.A
5.E
Case 14:
1.B
2. Linear radiodense calcium deposits
3.A
4.D
5.patients who cannot take an NSAID
6.preventive
7.NSAIDs not working, multiple joints
2. C vibrio vulnificus
Postexposure prophylaxis
Case 1:
1. D - Ig and vaccine
2. E - no treatment, A - 0.3%
3. B - immunoglobulin (VZIG)
4. D - Ig and vaccine
5. C - contact and resp isolation
6. Ig and booster vaccine
7. no
8. TIG only for never vaccinated, Tdap for at
least one booster
Case 1 continued.....
1. C Ig and vaccine
2. D - pneumococcus, meningococcus, etc.
Malaria:
1. prophylaxis - mefloquine,
atovoquone/proguanil
2. treat with atovoquone/proguanil, oral
quinine and doxyclycine, artemisinin
3. quinidine
Sexually transmitted diseases:
Case 1:
1. Urethritis
2. Urethral swab for PCR DNA genetic testing
3. One drug for chlamydia (azithromycin or
doxycycline) and one drug for gonorrhea
(ceftriaxone, cefixime)
4. single-dose therapy with azithromycin
5. check for deficiency of terminal complement
Case 1 continued.....
1. D - treat without parental consent
2. C - chlamydia
3. D - do nothing
4. D blood test
Case 2:
1. urinary wet mount and KOH preparation
Case 2 continued:
1. B - trichomoniasis
Case 3:
1. suppression with fluconazole
Case 4:
1. PID
2. E - laparoscopy
3. pregnancy test
4. high fever and WBC
5. 2 weeks of doxycycline
Case 4 continued.....
Case 5:
1. E - ceftriaxone
Case 6:
1. D renal transplant rejection
Bone and joint infections:
Case 1:
1. A - x-ray
2. A - biopsy
3. staph - ox, naf, MRSA - vanco, linezolid,
dapto, gram neg - cipro
4. to detemine duration of treatment
5. never
Case 2:
1. B - arthrocentesis
2. E - culture of synovial fluid
3. ceftriaxone and vanco
4. D - polyarticular involvement, rash,
tenosynovitis
Case 2 continued:
1. B - itraconazole
2. C - bartonelle henselae
3. F - amoxicillin/clavulinic acid
Lyme disease:
Case 1:
1. D - oral doxycycline
Case 2:
1. A - offer reassurance
2. grab head, NOT body
Case 3:
1. just treat
2. oral (joint, rash, facial)
3. oral (joint, rash, facial), IV ceftriaxone
(cardiac, CNS)
Case 4:
1. C stop the antibiotics
Fever and neutropenia:
Case 1:
1. A - ceftriaxone
2. add vanco, then caspofungin
3. C - add caspofungin
Case 2:
1. E - slow rate of vanco infusion (Red Man
syndrome)
2. A - continue abx and retain catheter
3. C hepatosplenic candidiasis
4. C - voriconazole
Case 3: