high yield review

7/28/2019 High Yield Review

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Sajeet Sohi’s USMLE and Medical Resources High Yield Review

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Scenario or Question Answer/High YieldA 45 yr old F has RUQ pain after a fattymeal

Cholecystitis 4 F’s: Fat Fertile FourtyFertile

A 28 yr old Asian M who is a recentimmigrant was recently started on amedication for reactivation TB but nowhas complains of tingling in his fingers

INH: Need to supplement with Vit B 6

A 35 yr old Nurse undergoes a screeningblood test to detect her Hep B status.

The results indicate: HBsAb(+),HBsAg(-), HBeAg(-), HBV DNA (-), HBcAg(-). What is most likely explanation?

Immunization with HepB

If the prevalence of a condition increaseswhat changes should we expect withPPV?

Increased prevalence = Increased PPV

A patient is recovering after surgery butthe first day after the procedure heexperiences hypotension andhypoglycemia. What is the most likelycause?

Adrenal crisis due to abrupt withdrawalof corticosteroids

A patient is recovering after surgery butthe third day after the procedure heexperiences agitated and statessomething is crawling on him. What isthe most likely cause?

Delirium Tremors

After being prescribed a new drug forhypertension a patient complains of swelling around the mouth. Which classof medication could be causing this?

ACEI

A 21 yr old F complains of visionproblems, urinary incontinence, and pinsand needles in arms.

MS

After treatment with an antibiotic forsyphilis a patient complains of fever,chills, and myalgia

Jarisch-Herxheimer

A 38 yr old female complains of a nonproductive cough and new onset painfulskin nodules on her shins. A CXR showsbilateral hilar adenopathy.

Sarcoidosis

A patient has had hard to control HTN forseveral years, he has been taking a

Clonidine: Hypertension Rebound

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medication recently which has controlledthe BP. For the past few days he stoppedtaking it and the BP increased rapidlyA 18 yr old African American F complainsshe has a butterfly rash on her faceexacerbated by sunlight, due to her

condition she will most likely die from?

Lupus nephritis

In an immunocomprised individual whowould like to diagnose PCP, what is thebest test?

BAL (Bronchoalveolar Lavage)

This is generally benign capillarymalformation in newborns which usuallygrows but eventually regresses as achild ages

Capillary hemangioma

A mother of a newborn male complainsthat he vomits forcefully after eachfeeding. There palpable mass in his RUQ,which radiological test should be used todx the condition?

Pyloric Stenosis: Ultrasound

A 21 yr old female complains of epigastric but generally unlocalizedabdominal pain. She is in no apparentdistress the most important immediatelaboratory test to order is?

b-hCG: Always rule out pregnancy inchild bearing years

During an annual physical exam a 55 yrold man is found to have a positive fecaloccult blood test. What is theappropriate next step?

(+) FOBT then a Colonoscopy is required

A 8 yr old child does not obey commands

and is considered a “trouble maker” byhis teacher, but he eventually listens tohis parents and teacher.

Oppositional Defiant Disorder

A patient had a CT scan 2 days prior andnow his labs indicates that his Cr hasincreased from 0.9 prior to theprocedure to 2.7 today. What is thiscondition and what could haveprevented it?

Contrast Induced Nephropathy: VigorousIV fluids prior to procedure, n-acetylcysteine

A 3 yr old Caucasian M who has chronicnutritional problems, respiratorydistress, and poor growth since birth.

Cystic Fibrosis: Delta F508 mutation

A 17 yr old F recently began using OCPand she complains of swelling and painin her R calf. What is the most likelycause?

OCP use is linked with DVT

A patient is diagnosed with pancreaticcancer and is told the case is terminalthen he inquires about the outcomes of treatment

Intellectualization

What is an effective method to prevent Vaccination against Hep B



Hepatitis D in a patient?A patient is taking Vancomycin and whatwould be the treatment if the patientexperiences red man syndrome?

Antihistamine and lowering the infusionrate

During embryological development therewere defects in the 3rd and 4th pouches.

What would be the expected defect?

DiGeorge Syndrome

A 19 yr old M complains of a headacheand cough which has slowly becomingworse. The CXR revels a significantdiffuse interstitial infiltrate.

Mycoplasma pneumoniae

What diagnostic test should be usedafter placement of a central line?

CXR to make sure proper placement andto rule out a pneumothorax or arterialpuncture

What are the 3 most important clinicaldecisions to determine in an emergencyor trauma situation for the safety of thepatient?

AirwayBreathingCirculation

An otherwise healthy 42 yr old M rapidlydeteriorates and suffers myoclonicseizures with mental decline andunfortunately passes away 3 mths later.

CJD

During the physical exam of a 1 yr old Minfant it is noted that he may suffer frommental retardation, anirida, andgenitourinary malformations. What couldthe palpable mass in his R flank be?

Wilms TumorAniridaGenitourinaryR(Mental/Motor Retardation)

The BUN of a pt is 60 and the Cr value is1.3. What type of renal failure is this?

Pre-renal. BUN/Cr >20

A 63 yr old M complains that he hasnoticed blood in urine. He does not anyother complaints and has no abdominalpain. What condition could he have?

Painless hematuria > 60 yrs => BladderCancer

A 74 yr old M complains of recent onsetback pain with mild anemia. His recentlab work indicated new onset renalinsufficiency. These three conditions canbe explained by which disease?

Multiple Myeloma: Eldery, back pain,anemia, renal issues

A 77 yr old F complains of mild abddiscomfort and her CBC indicated newonset anemia which was not present last

year. What is the next appropriate step?

Colonoscopy to rule out Colon Cancer

In Turner’s syndrome why is the FSH andLH increased?

Decreased estrogen causes increasedlevels

What is the treatment for the fearedcomplication after a subarachnoidhemorrhage?

Nimodipine can prevent the vasospasm

A 23 yr old F who is at 34 weeksgestation has a blood pressure of 170/100, 3+ proteinuria and 3+ edema.

Preeclampsia



Which condition does this represent?A 38 yr old F complains of not having hermenstrual cycle for the past 4 months.She also states loss of libido and hotflashes. What condition does she mostlikely have and what would her hormonal

levels be?

Premature ovarian failure.Low: Estrogen High: FSH, LH

This condition is commonly associatedwith infertility, severe menstrual pain,and blood filled cysts.

Endometriosis

This medication is associated withinhibiting cGMP PDE5 with increased NOlevels and was originally intended forhypertension but now used for erectiledysfunction

Sildenafil (Viagra)

What is Virchow’s triad? 1. Stasis2. Hypercoagulability3. Endothelial damage

A patient inquires what is the mosteffective treatment for obstructive sleepapnea?

Weight Loss

What type of pneumoconiosis isclassically associated TB?

Silicosis

A pt suffers from complications fromCrohns Disease and is started on a newmedication. 2 months later he has a(+)PPD, CXR confirms.

Reactivation TB from Infliximab

A 34 yr old F complains of infertility forseveral years. On physical exam you

notice that she is overweight, has ashort stature, and low set ears. What isthe most effective method for fertility?

Turner Syndrome: In-Vitro Fertilization

A 25 yr old M for several years hasstated that he has periods where hefeels he will become the “King of TheWorld” and not even the almightyhimself can stop him and then for a fewweeks then he feels lethargic and sadthat his world is crumbling apart. Hiscomplaint is that recently he has startedto urinate more frequently and is more

thristy. What does this represent?

Bipolar Mania => Lithium =>Nephrogenic Diabetes Insipidits

With the above situation and Li use.Which two laboratory values arecommonly followed to determine if thereis any toxicity?

TSH for thyroid related problemsCr for any renal related problems

A 17 yr old African American male whowas previously healthy collapsedsuddenly during a basketball game withhis friends and by the time the

HOCM: Hypertrophic Cardiomyopathy



paramedics came he was pronounceddead. His uncle had a similar unfortunateearly death. What does this scenariotypically represent?

You are looking at the ECG of yourpatient who is a 80 yr old M with a

history of COPD and Diabetes. Thereseems some irregularities with the ECGas you cannot see any P-waves and theQRS complexes are irregularly spaced.

Atrial Fibrillation

In general in the treatment of AtrialFibrillation according to the establishedstudies which is more effective rate orrhythm?

In general both are equivalent

What is the CHADS2 score and how doyou interpret the findings regardinganticoagulation and atrial fibrillation?

CHF (1 point)HTN (>140/90 or on meds) (1 point)Age >75 (1 point)Diabetes (1 point)Stroke (2 points)0: Daily ASA 1: ASA or Warfarin 2:Warfarin

A 70 yr old M has a recent diagnosis of atrial fibrillation. What should the targetINR ratio be between during histreatment with warfarin?

INR: 2.0 – 3.0

A 70 yr old M is recovering afterreplacement of his aortic valve. Whatshould the target INR ratio be betweenduring his recovery period?

INR: 2.5 – 3.5

A 54 yr old sedentary male complains of pain in his buttocks and legs whilewalking and of impotence as well. Thisrepresents which syndrome?

Leriche syndrome (Aortoiliac occlusion)

A urine dipstick of a diabetic individualindicates that there is protein in hisurine. Which medication could havepossibly prevented this complication of diabetes?

ACEI: Recommend to prevent diabeticnephropathy

This condition is considered an adaptiveresponse to selection pressuresattributed to malaria.

Sickle cell trait

A young female has had recurrent boutsof abdominal pain and she has had analtered level of mental functioning.

Treatment with a Heme product seemsto make her symptoms better. Whichenzyme may be dysfunctional and whatcondition does this represent?

Delta ALA Synthase: Acute IntermittentPorphyra

A 30 yr old female states that she hashad heavy menstrual periods and also

von Willebrand disease



she had several nose bleeds as a child.Her CBC indicates that she has a lowMCV and Hb. What bleeding disorderdoes she most likely have?A young male is found to haveprogressive dyspnea and chest

discomfort. On CXR it reveals amediastinal mass. A peripheral bloodsmear reveals many immature cells.

ALL

If a patient has a protein C deficiencyand is started on warfarin. Whichcomplication should you be aware of?

Warfarin induced skin necrosis

A patient has a myriad of symptomsincluding a hemolytic anemia, athrombus identified during imaging, addecreased WBC and platelets

Paroxysmal Noctural Hemoglobinura

The laboratory results of an individualreveals that her reticulocyte is low, theWBC count is low, and so is the plateletcount

Aplastic anemia

If a patient is prescribed a LMWH such asenoxaparin you should first investigatewhither the patient has what type of condition?

Renal disease such as ESRD as thedosing is modified

A 19 yr old African American female hasa history of sickle cell anemia and whichcommon drug for this conditionincreases HbF?

Hydroxyurea

In a patient with sepsis there is bleeding

at her venipuncture sites. What does thisrepresent?

DIC

A 4 yr old boy experiences bleeding aftera tooth extraction he also has a historyof nosebleeds. His uncle had a similarproblem.

Hemophilia A

Which vitamin must be given to an infantat birth to prevent a complication whichcould lead to a neonatal mortality?

Vitamin K to prevent HemorhagicDisease of The Newborn

Hematological association with SLE ITPWhat endocrine abnormally cancommonly present as depression and

must be investigated in the work up of the individual?

Hypothyroidism

In the elderly which condition mimicsAlzheimer and can confound thediagnosis?

Pseudo-depression

In septic arthritis what is the dx test of choice?

Arthrocentesis

Name all the factors/proteins that havereduced synthesis in Vitamin K

Factors: II, VII, IX, XProtein: C + S



deficiency:A patient is discussing his past medicalhistory and states that he once hadHodgkin’s Disease and was treated withCyclophosphamide. What medicationwas given in addition to prevent a

common side effect?

Mesna/Hydration to preventhemmorhagic cystitis

What are the classic MCV valuesindicating microcytic hypochromic andmacrocytic anemia?

Microcytic: MCV < 80Macrocytic: MCV > 100

A patient is brought into the emergencydepartment and his EKG shows STsegment elevation in Leads II, III, andaVF and he is complaining of chest painand is diaphoretic. Infusion with whichmedication reduces clot burden?

tPA

The most common cause of secondaryhyperparathyroidism?

ESRD

Which subtype of Hodgkin’s lymphomacarries the worst prognosis?

Lymphocyte depleted

Which lab values do you follow forWarfarin and Heparin?

Warfarin = PT = Extrinsic PathwayHeparin = PTT = Intrinsic Pathway

The “unhappy triad” of knee injuries MCL, ACL, Medial MeniscusWhich medication is used commonlyafter PTCA and functions by preventingglycoprotein IIb/IIIa expression. Thismedication also has been attributed tohave an interaction with PPIs.

Clopidogrel (Plavix)

A tennis player complains of pain in his

elbow as he has been training a lotrecently for an upcoming tournament.

Tennis Elbow = Lateral Epicondylitis

Golf Elbow = Medial Epicondylitis

A 18 yr old football player suffers from adislocation of his humerus and the nextday he complains he has lost sensationover his shoulder. Which nerve has beeninjured?

Axillary nerve

An eldery female has been dx withpolymyalgia rheumatic. Which vasculitisis associated with this condition andmust be ruled out?

Temporal (Giant Cell) Arteritis

Aspirin is generally contraindicated in

children due to the risk of Reye’sSyndrome. In which vasculitis is Aspirinpart of the treatment?

Kawasaki’s Disease

Why do drug eluding stents require 12months of anticoagulation while baremetal stents require 6 weeks?

Due to the process of epithelialization

These types of cells are destroyed inGuillain-Barre syndrome and alsoinvolved axonal regeneration.

Schwann Cells



The drug of choice for trigeminalneuralgia

Carbamazepine

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