Sajeet Sohis USMLE and Medical Resources High Yield Review My Word is My Bond www.SohiMD.

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Scenario or Question A 45 yr old F has RUQ pain after a fatty meal A 28 yr old Asian M who is a recent immigrant was recently started on a medication for reactivation TB but now has complains of tingling in his fingers A 35 yr old Nurse undergoes a screening blood test to detect her Hep B status. The results indicate: HBsAb(+), HBsAg(-), HBeAg(-), HBV DNA (-), HBcAg (-). What is most likely explanation? If the prevalence of a condition increases what changes should we expect with PPV? A patient is recovering after surgery but the first day after the procedure he experiences hypotension and hypoglycemia. What is the most likely cause? A patient is recovering after surgery but the third day after the procedure he experiences agitated and states something is crawling on him. What is the most likely cause? After being prescribed a new drug for hypertension a patient complains of swelling around the mouth. Which class of medication could be causing this? A 21 yr old F complains of vision problems, urinary incontinence, and pins and needles in arms. After treatment with an antibiotic for syphilis a patient complains of fever, chills, and myalgia A 38 yr old female complains of a non productive cough and new onset painful skin nodules on her shins. A CXR shows bilateral hilar adenopathy. A patient has had hard to control HTN for several years, he has been taking a Answer/High Yield Cholecystitis 4 Fs: Fat Fertile Fourty Fertile INH: Need to supplement with Vit B 6

Immunization with HepB

Increased prevalence = Increased PPV Adrenal crisis due to abrupt withdrawal of corticosteroids

Delirium Tremors

ACEI

MS Jarisch-Herxheimer Sarcoidosis

Clonidine: Hypertension Rebound

medication recently which has controlled the BP. For the past few days he stopped taking it and the BP increased rapidly A 18 yr old African American F complains she has a butterfly rash on her face exacerbated by sunlight, due to her condition she will most likely die from? In an immunocomprised individual who would like to diagnose PCP, what is the best test? This is generally benign capillary malformation in newborns which usually grows but eventually regresses as a child ages A mother of a newborn male complains that he vomits forcefully after each feeding. There palpable mass in his RUQ, which radiological test should be used to dx the condition? A 21 yr old female complains of epigastric but generally unlocalized abdominal pain. She is in no apparent distress the most important immediate laboratory test to order is? During an annual physical exam a 55 yr old man is found to have a positive fecal occult blood test. What is the appropriate next step? A 8 yr old child does not obey commands and is considered a trouble maker by his teacher, but he eventually listens to his parents and teacher. A patient had a CT scan 2 days prior and now his labs indicates that his Cr has increased from 0.9 prior to the procedure to 2.7 today. What is this condition and what could have prevented it? A 3 yr old Caucasian M who has chronic nutritional problems, respiratory distress, and poor growth since birth. A 17 yr old F recently began using OCP and she complains of swelling and pain in her R calf. What is the most likely cause? A patient is diagnosed with pancreatic cancer and is told the case is terminal then he inquires about the outcomes of treatment What is an effective method to prevent

Lupus nephritis

BAL (Bronchoalveolar Lavage) Capillary hemangioma

Pyloric Stenosis: Ultrasound

b-hCG: Always rule out pregnancy in child bearing years

(+) FOBT then a Colonoscopy is required

Oppositional Defiant Disorder

Contrast Induced Nephropathy: Vigorous IV fluids prior to procedure, nacetylcysteine

Cystic Fibrosis: Delta F508 mutation OCP use is linked with DVT

Intellectualization

Vaccination against Hep B

Hepatitis D in a patient? A patient is taking Vancomycin and what would be the treatment if the patient experiences red man syndrome? During embryological development there were defects in the 3rd and 4th pouches. What would be the expected defect? A 19 yr old M complains of a headache and cough which has slowly becoming worse. The CXR revels a significant diffuse interstitial infiltrate. What diagnostic test should be used after placement of a central line? What are the 3 most important clinical decisions to determine in an emergency or trauma situation for the safety of the patient? An otherwise healthy 42 yr old M rapidly deteriorates and suffers myoclonic seizures with mental decline and unfortunately passes away 3 mths later. During the physical exam of a 1 yr old M infant it is noted that he may suffer from mental retardation, anirida, and genitourinary malformations. What could the palpable mass in his R flank be? The BUN of a pt is 60 and the Cr value is 1.3. What type of renal failure is this? A 63 yr old M complains that he has noticed blood in urine. He does not any other complaints and has no abdominal pain. What condition could he have? A 74 yr old M complains of recent onset back pain with mild anemia. His recent lab work indicated new onset renal insufficiency. These three conditions can be explained by which disease? A 77 yr old F complains of mild abd discomfort and her CBC indicated new onset anemia which was not present last year. What is the next appropriate step? In Turners syndrome why is the FSH and LH increased? What is the treatment for the feared complication after a subarachnoid hemorrhage? A 23 yr old F who is at 34 weeks gestation has a blood pressure of 170/100, 3+ proteinuria and 3+ edema.

Antihistamine and lowering the infusion rate DiGeorge Syndrome Mycoplasma pneumoniae

CXR to make sure proper placement and to rule out a pneumothorax or arterial puncture Airway Breathing Circulation CJD

Wilms Tumor Anirida Genitourinary R(Mental/Motor Retardation) Pre-renal. BUN/Cr >20 Painless hematuria > 60 yrs => Bladder Cancer Multiple Myeloma: Eldery, back pain, anemia, renal issues

Colonoscopy to rule out Colon Cancer

Decreased estrogen causes increased levels Nimodipine can prevent the vasospasm Preeclampsia

Which condition does this represent? A 38 yr old F complains of not having her menstrual cycle for the past 4 months. She also states loss of libido and hot flashes. What condition does she most likely have and what would her hormonal levels be? This condition is commonly associated with infertility, severe menstrual pain, and blood filled cysts. This medication is associated with inhibiting cGMP PDE5 with increased NO levels and was originally intended for hypertension but now used for erectile dysfunction What is Virchows triad? A patient inquires what is the most effective treatment for obstructive sleep apnea? What type of pneumoconiosis is classically associated TB? A pt suffers from complications from Crohns Disease and is started on a new medication. 2 months later he has a (+)PPD, CXR confirms. A 34 yr old F complains of infertility for several years. On physical exam you notice that she is overweight, has a short stature, and low set ears. What is the most effective method for fertility? A 25 yr old M for several years has stated that he has periods where he feels he will become the King of The World and not even the almighty himself can stop him and then for a few weeks then he feels lethargic and sad that his world is crumbling apart. His complaint is that recently he has started to urinate more frequently and is more thristy. What does this represent? With the above situation and Li use. Which two laboratory values are commonly followed to determine if there is any toxicity? A 17 yr old African American male who was previously healthy collapsed suddenly during a basketball game with his friends and by the time the

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

Endometriosis Sildenafil (Viagra)

1. Stasis 2. Hypercoagulability 3. Endothelial damage Weight Loss Silicosis Reactivation TB from Infliximab

Turner Syndrome: In-Vitro Fertilization

Bipolar Mania => Lithium => Nephrogenic Diabetes Insipidits

TSH for thyroid related problems Cr for any renal related problems HOCM: Hypertrophic Cardiomyopathy

paramedics came he was pronounced dead. His uncle had a similar unfortunate early death. What does this scenario typically represent? You are looking at the ECG of your patient who is a 80 yr old M with a history of COPD and Diabetes. There seems some irregularities with the ECG as you cannot see any P-waves and the QRS complexes are irregularly spaced. In general in the treatment of Atrial Fibrillation according to the established studies which is more effective rate or rhythm? What is the CHADS2 score and how do you interpret the findings regarding anticoagulation and atrial fibrillation?

Atrial Fibrillation

In general both are equivalent

A 70 yr old M has a recent diagnosis of atrial fibrillation. What should the target INR ratio be between during his treatment with warfarin? A 70 yr old M is recovering after replacement of his aortic valve. What should the target INR ratio be between during his recovery period? A 54 yr old sedentary male complains of pain in his buttocks and legs while walking and of impotence as well. This represents which syndrome? A urine dipstick of a diabetic individual indicates that there is protein in his urine. Which medication could have possibly prevented this complication of diabetes? This condition is considered an adaptive response to selection pressures attributed to malaria. A young female has had recurrent bouts of abdominal pain and she has had an altered level of mental functioning. Treatment with a Heme product seems to make her symptoms better. Which enzyme may be dysfunctional and what condition does this represent? A 30 yr old female states that she has had heavy menstrual periods and also

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 INR: 2.0 3.0

INR: 2.5 3.5

Leriche syndrome (Aortoiliac occlusion)

ACEI: Recommend to prevent diabetic nephropathy

Sickle cell trait Delta ALA Synthase: Acute Intermittent Porphyra

von Willebrand disease

she had several nose bleeds as a child. Her CBC indicates that she has a low MCV and Hb. What bleeding disorder does she most likely have? A young male is found to have progressive dyspnea and chest discomfort. On CXR it reveals a mediastinal mass. A peripheral blood smear reveals many immature cells. If a patient has a protein C deficiency and is started on warfarin. Which complication should you be aware of? A patient has a myriad of symptoms including a hemolytic anemia, a thrombus identified during imaging, ad decreased WBC and platelets The laboratory results of an individual reveals that her reticulocyte is low, the WBC count is low, and so is the platelet count If a patient is prescribed a LMWH such as enoxaparin you should first investigate whither the patient has what type of condition? A 19 yr old African American female has a history of sickle cell anemia and which common drug for this condition increases HbF? In a patient with sepsis there is bleeding at her venipuncture sites. What does this represent? A 4 yr old boy experiences bleeding after a tooth extraction he also has a history of nosebleeds. His uncle had a similar problem. Which vitamin must be given to an infant at birth to prevent a complication which could lead to a neonatal mortality? Hematological association with SLE What endocrine abnormally can commonly present as depression and must be investigated in the work up of the individual? In the elderly which condition mimics Alzheimer and can confound the diagnosis? In septic arthritis what is the dx test of choice? Name all the factors/proteins that have reduced synthesis in Vitamin K

ALL

Warfarin induced skin necrosis Paroxysmal Noctural Hemoglobinura

Aplastic anemia

Renal disease such as ESRD as the dosing is modified Hydroxyurea

DIC Hemophilia A

Vitamin K to prevent Hemorhagic Disease of The Newborn ITP Hypothyroidism

Pseudo-depression Arthrocentesis Factors: II, VII, IX, X Protein: C + S

deficiency: A patient is discussing his past medical history and states that he once had Hodgkins Disease and was treated with Cyclophosphamide. What medication was given in addition to prevent a common side effect? What are the classic MCV values indicating microcytic hypochromic and macrocytic anemia? A patient is brought into the emergency department and his EKG shows ST segment elevation in Leads II, III, and aVF and he is complaining of chest pain and is diaphoretic. Infusion with which medication reduces clot burden? The most common cause of secondary hyperparathyroidism? Which subtype of Hodgkins lymphoma carries the worst prognosis? Which lab values do you follow for Warfarin and Heparin? The unhappy triad of knee injuries Which medication is used commonly after PTCA and functions by preventing glycoprotein IIb/IIIa expression. This medication also has been attributed to have an interaction with PPIs. A tennis player complains of pain in his elbow as he has been training a lot recently for an upcoming tournament. A 18 yr old football player suffers from a dislocation of his humerus and the next day he complains he has lost sensation over his shoulder. Which nerve has been injured? An eldery female has been dx with polymyalgia rheumatic. Which vasculitis is associated with this condition and must be ruled out? Aspirin is generally contraindicated in children due to the risk of Reyes Syndrome. In which vasculitis is Aspirin part of the treatment? Why do drug eluding stents require 12 months of anticoagulation while bare metal stents require 6 weeks? These types of cells are destroyed in Guillain-Barre syndrome and also involved axonal regeneration.

Mesna/Hydration to prevent hemmorhagic cystitis

Microcytic: MCV < 80 Macrocytic: MCV > 100 tPA

ESRD Lymphocyte depleted Warfarin = PT = Extrinsic Pathway Heparin = PTT = Intrinsic Pathway MCL, ACL, Medial Meniscus Clopidogrel (Plavix)

Tennis Elbow = Lateral Epicondylitis Golf Elbow = Medial Epicondylitis Axillary nerve

Temporal (Giant Cell) Arteritis

Kawasakis Disease

Due to the process of epithelialization Schwann Cells

The drug of choice for trigeminal neuralgia

Carbamazepine