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Quiz 4 1. older male with anemia, what should you do next colonoscopy 2.

how do you treat the patient in the last Q ORAL iron replacement therapy 3. red flags of back pain 77 year old male, back pain for 10 wks, hx of cancer 4. female comes in tired, CBC is LOW EVERYTHING, mostly fat in bone marrow what is cause aplastic anemia 5. woman from GREECE (so think thalassemia) has anemia but ferritin levels are normal what do you do when she comes back to look at labs hemoglobin electrophoresis 6. which spike is most likely multiple myeloma the only one that looks like an M (on ours it was B, so albumin and gamma are both high) 7. younger male (mr. blacker) is bisexual has unprotected sex, etc. what is greatest risk factor of getting HIV sexually transmitted ulcerated lesions 8. mr. blacker is dxd with HIV, when does seroconversion occur 4-10 wks 9. 5 yrs later mr. blacker presents with thrush, mild weight loss, and LOW CD4 (I think it was 150-160 in the Q) what stage is he at AIDS (because CDC says CD4 < 200 is considered AIDS no matter what) 10. One year later Mr. Blackers wife becomes pregnant what should do? Test for HIV and only start anti-virals if test is positive 11. You get Mrs. Blackers blood, prick yourself, what do you do FIRST wash with SOAP AND WATER 12. Pregnant pt in 3rd trimester comes in she has shortness of breath, orthopnea, bilateral crackles, S3, S4, NO PERIPHERAL EDEMA; urine shows trace protein (DONT PICK PREECLAMPSIA JUST BCZ YOU SEE THIS, HER BP IS NORMAL) what is the cause PERIPARTUM CARDIOMYOPATHY 13. What kind of heart failure is this patient presenting like? LHF 14. 60 year old machine work w/DM 2, HTN, etc. (lots of other stuff) is on a number of different drugs. He presents with HF (bilateral crackles, 2+ tibial edema, etc.) what do you give him next? FUROSEMIDE 15. Younger male pt (may 20s) with DM I has recently been experiencing shortness of breath on walking short distances, woken up at night because of shortness of breath, must sleep with two pillows on his back (orthopnea); what is the most common cause (basically they give you a LHF presentation and ask you most common cause) ISCHEMIC HEART DISEASE d/t coronary artery disease 16. Older patient (maybe 65?) has history of smoking presents with lung cancer (coughing, hemoptysis, etc). High URINE SODIUM CONCENTRATION (on quiz its 50), what is the cause of his hyponatremia SIADH (1. Bcz lung cancer paraneoplastic syndrome, small cell CA secreting ADH 2. Urine sodium concentration >40 [Medscape]) 17. Patient with hypercalcemia, what is the most likely presentation? constipation, BRADYcardia, SHORTENED QT interval 18. Patient with MM what is the best determinant for PROGNOSIS? B2 globulins

19. Patient with back pain or lytic lesions (cant remember sorry), but NO NEUROLOGICAL SYMPTOMS what is the FIRST test you do? RADIOGRAPH Quiz 3 1. What is the best evidence of end organ damage in HTN S4 (theres only one answer with this) 2. There was a Q on fundoscopic exam in HTN pts? I know the answer was NOT neovascularization (which you see ONLY in DM); I THINK it was arteriolar narrowing (to be safe Id look at retinopathies d/t HTN) 3. Question 3-7 were match up of symptoms and diseases (relatively easy) 4. Clopidogrel for after stent 5. Female comes in chest pain, radiates down arm, no signif past history, normal vital signs, what do you do REASSURANCE (implies panic attacks) 6. They show and EKG and ask about how long the pt has had the pathology based off of the ST and T waves, etc. <24hrs (should be the choice with the lowest time passed, because of the hyperacute T-waves) 7. ASPIRIN (was an answer for something I cant remember) 8. Man comes in with 6 mos history of stable angina, everything else seems relatively normal what do you do? The answer involved beta blockers and a list of other drugs (maybe statin and aspirin were included) [pretty sure it was A] (other answer choices were NO drugs lifestyle change only [tempting but not right], put in stent, perform CABG) 9. Know the leads for anterior, lateral, posterior there was a Q (first aid has a good summary) 10. Pt had surgery 3wks or a month ago; now presents with something else can you give tPA? Yes proceed as normal and give pt tPA 11. Middle cerebral artery was an answer I think pt bumps his head and presents a list of symptoms (maybe double vision) 12. curtain coming down over eyes (TIA causing transient vision loss) Amaurosis fugax

13. embolus from CARDIAC was an answer (I think the vignette was it went up to the brain but no signs of hemorrhage or ischemia; A & B were very similar so be careful, CAROTID embolus was the WRONG ANSWER) 14. pt has holosystolic murmur that was not present before she was admitted, what is the cause PAPILLARY MUSCLE RUPTURE

Prenatal TBL Quiz: 1. #1 prenatal care providers in US: OB/GYN (uptodate reading) 2. Vaginal exam normal for EVERY prenatal visit: FALSE 3. A woman has NONE of her immunizations and has never had chicken pox, she gets pregnant; what is the ACTIVE vaccine you can give her? INFLUENZA(other choices will be PASSIVE and POST-NATAL) 4. What do you NOT have to limit in the pregnant pt that comes in? PROTEINS (all others DO have to be limited) 5. What causes low birth weight in babies SMOKING 6. Pt comes in worrying about safety of wearing seatbelt because shes heard that they could be harmful, what do you tell her OVERALL they provide protection so she should wear them 7. Pt has never had any prenatal care but has FAM HISTORY of neural tube defects, she says something like first trimester is the worst, nothing can happen now or something like that, she comes in during her SECOND trimester, what do you tell her the answer was something along the lines of PRE-CONCEPTION care or precautions to prevent defects is best (answer was A on our quiz) 8. Pregnant woman has tension headaches, normally takes ibuprofen what do you tell her? ACETAMINOPHEN is safest for pregs (dont choose ANY of the ibuprofen answers closes ductus arteriosus) 9. Lady presents in first trimester (I think they list it in weeks but you figure early preg) what will she present with WEIGHT LOSS, NAUSEA & VOMITING, and I think breast tenderness (theres only ONE choice with weight LOSS choose that one) 10. Lady comes in and hasnt had her period her last menstrual period was September 1, 2010 (for us), calculate the date of gestation of the baby [ +7 days, -3 months, +1 year] for us it was JUNE 8, 2011 (but calculate it yourself in case)

QUIZ 2: know the treatments for asthmaand the order youd give them based on severity!! Know treatments for DM and the mechanisms of action 1. exercise induced: B2 agonist 2. chronic bronchitis: give PaO2 slowly and increase to only 60-65 mmHG (if not youll stop the driving force to breathe) 3. chronic bronchitis to decrease risk of mortality: lifelong O2, 15 hrs per day 4. if remove pancreas (pancreactomy) do you get DKA? NO because glucagon makes it slower or something? (something along those lines involving glucagon) 5. one pt had non-hyperosmolar 6. one of the tx: quinolones, methylpredinsone, inhaled beta and inhaled iaptropium (dont pick the one with anti-virals) 7. one answer was IV infusion and saline (not bolus) 8. Metabolic Syndrome is an INCREASED risk for DM (I think that was the answer) 9. Impaired fasting glucose: 100-125 10. Inhaled glucocorticoid 11. They give you a pt, YOU have to figure out the pt has emphysema, then they ask what would the panel look like, choose the one with the NORMAL pH answer should have pH 7.34 (C on our quiz) 12. One Q is about some sort of breathing obstruction, answer is foreign object 13. 20 year old, peeing all the time: autoimmune beta cell destruction 14. macrovascular: SMOKING (Hb1AC is MICROvasc)

Quiz 1 1. Know when to transfuse (>30% blood loss and diaphoretic) vs giving crystalloid (<20% blood loss) 2. First thing you do when a pt comes in with GI bleed start IV drip (fluid and electrolyte rescucitation and restrict intake by mouth) 3. Triple tx for H pylory: PPI + ampicillin + clarithromycin 4. Hyperactive bowel soundsearly in OBSTRUCTION 5. Visceral pain vs parietal pain (I cant remember which was asked; visceral: pt is clammy, restless, doubled over, dull and poorly localized pain; parietal: pt is still and motionless, sharp, steady, severe, and precisely localized pain) 6. Chronic pancreatitis (will see CALCIFICATIONS) most likely d/t chronic alcohol use

7. Know this picture : the first FOUR or FIVE Qs are based off a similar picture, it asks obstruction of which area will cause what (letters placed at sphincter of oddi, cystic duct, common hepatic duct, etc. and you have to match it up with if it causes cholecystitis, pseudocyst, biliary colic, pancreatitis, etc.) [also FYI for this picture you dont have to use up all the letters, but for the LAST page of the quiz where you match up diseases to their associations, you DO use up all the letters) 8. What is the pathology that causes edema in anaphylaxis vascular wall injury 9. One answer was NEPHRITIC syndrome (I think the vignette describes it with hematuria with RBC casts) 10. one test asked the best way to check for nephrotic syndrome I think (cant remember answer, NOT 24 hr test) Single spot collection measure protein to creatine ratio in the single collection. If ratio .2g/g then points to nephrotic

11. the last page had like 4-5 diseases and associations that you had to match upUSE ALL the letters (unlike the first Q) I cant remember them all but I remember a few: a. focal segmental assocd w/ HIV b. membranous assocd w/ malignancy/tumors c. multiple myeloma assocd w/ amyloid deposits d. (everything else was little more straight forward I think on was minimal change being the MC nephropathy in kids; and the other kidney disease or pathology was associated with diabetes) 12. one Q was a kid comes in and I think you suspect nephropathy, the question is what do you do (i.e. do you biopsy or not); I cant remember the exact question but I know I followed this RULE taught to usand got the question right: in adults: when you cant identify a secondary cause to the kidney disease (e.g. DM or SLE) then you biopsy (otherwise treat the primary causethe DM or SLE, etc.); in children: ASSUME its minimal change disease dthink the Q was about a kid so remember corticosteroid FIRST] 13. Best test for pulm embolus SPIRAL CT 14. in PULMONARY EMBOLUS you would see RESP ALKALOSIS (vs. acidosis in COPD), HYPOcapnia (decr CO2 in blood) 15. pt comes in with a clot what do you give them when they are discharged Im pretty sure it was warfarin (you give heparin in the hospital [injections NOT oral] then you start warfarin because it takes longer to workafter 3-5 days STOP heparin; send them home with ICM 5 TBL PEDS Quiz: 1. most common cause of hypertension in kids? INCORRECT MEASURING/CUFF SIZE 2. corneal light reflex and cover/uncover test used to check what? CONJUGATE EYE MOVEMENT 3. musical, midsystolic murmur, L sternal border BENIGN STILL MURMUR 4. kid is comes in with mom, he is 3 years old, what should he be able to do SPEAK IN FULL SENTENCES (this is according to bates but its controversial, ICM profs debating to ALSO accept that the child can dress self WITH supervision [even though bates says cant dress self until youre 5) 5. ear exam for kids INSERT SPECULUM TO OF THE WAY INTO EAR 6. #1 way to rule out pneumonia in kids NO TACHYPNEA 7. best test to show meningitis in 4 year old NUCHAL RIGIDITY TEST 8. age to give child MMR vaccine AFTER 12 MONTHS OF AGE 9. children who are obese due to endocrine cause are usually SHORT 10. kid comes in with pale, boggy, mucous membranes what is it CHRONIC ALLERGIC RHINITIS 11. there are intrinsic and extrinsic causes of teeth staining in kids, an extrinsic cause CAN BE POLISHED OFF (note that they want extrinsic cause not

exogenous so do not pick tetracycline, that is an intrinsic but exogenous cause) 12. obesity in developing countries can lead to DIABETES