AAC 2

Question 1

Tx of acute gout attack

Answer 1

o NSAIDs (indomethacin)
o Glucocorticoids
o Colchicine – stabilizes tubulin to impair leukocyte chemotaxis

Question 2

Tx of chronic gout

Answer 2

o Probenecid – inhibits reabsorption of uric acid in PCT
o Allopurinol – inhibits xanthine oxidase, thus inhibiting uric acid synthesis
o Febuxostat – also xanthine oxidase inhibitor

Question 3

What will you see in x-ray of osteoarthritis

Answer 3

Joint space narrowing, osteophytes, and polishing of the bone

Question 4

What will you see on x-ray os pseudo gout

Answer 4

Chondrocalcinosis - Calcification of joint cartilage

Question 5

What will you see on x-ray of RA

Answer 5

Periarticular osteopenia with erosion of the joint margin

Question 6

Describe skin/MSK findings in Marfan syndrome

Answer 6

Tall, long limbs, arachnodactyly, hyperflexible joints (not skin)

Question 7

Describe cardio findings of Marfan

Answer 7

Aortic dilation, aortic regurg (diastolic murmur), acute aortic dissection

Question 8

Describe pulm findings of Marfan

Answer 8

Spontaneous pneumothorax from apical blebs

Question 9

Describe common findings in Ehlers danlos

Answer 9

♣ Elastic skin
♣ Hypermobility of joints
♣ Increased bleeding tendency
♣ May also be associated with joint dislocation, berry and aortic aneurysm, organ rupture

Question 10

Describe De Quervain tenosynovitis

Answer 10

• Caused by inflammation of the abductor pollicis longus and extensor pollicis brevis as they pass through a fibrous sheath at the radial styloid process
• Tenderness can be elicited with direct palpation of the radial side of the wrist at the base of the hand
• The Finkelstein test, which is conducted by passively stretching the affected tendons by grasping the flexed thumb into the palm with the fingers, elicits pain
• Often affects new mothers who hold their infants with the thumb outstretched (abducted/extended)

Question 11

Describe MEN 1

Answer 11

• Pituitary tumors (prolactin or GH)
• Pancreatic endocrine tumors (Zollinger-Ellison, insulinoma, glucagonoma)
• Parathyroid adenoma

Question 12

Describe MEN 2A

Answer 12

• Medullary thyroid carcinoma (secrete calcitonin - hypocalcemia)
• Pheochromocytoma
• Parathyroid hyperplasia

Question 13

Describe MEN 2B

Answer 13

• Medullary thyroid carcinoma
• Pheochromocytoma
• Mucosal neuromas

Question 14

Tx of seborrheic dermatitis

Answer 14

Topical antifungals or anti-inflammatory (topical steroids)

Question 15

When do you use octreotide in cirrhosis

Answer 15

During active variceal bleeding

Question 16

What are the most common bugs in secondary bacterial pneumonia

Answer 16

Staph aureus, Strep pneumo

• Strep is most common (age >65)
• Secondary bacterial pneumonia is less likely in younger people and more likely to be staph in the young

Question 17

Describe pathogenesis of bronchiectasis

Answer 17

• Chronic infection of the bronchi causes permanent dilation of airways
• Cronchial wall damage and airway dilation due to recurrent cycle of infection, inflammation, and tissue damage

Question 18

Presentation of bronchiectasis

Answer 18

• Cough, dyspnea, foul-smelling sputum
• Rhinosinusitis, hemoptysis
• Crackles, wheezing
• Clinical presentation is similar to that of chronic bronchitis, however sputum production is more prominent in bronchiectasis and exacerbation are typically bacterial and require antibiotics

Question 19

Most common cause of bacterial meningitis

Answer 19

Strep pneumo

Question 20

What might be produced by squamous cell lung cancer

Answer 20

May produce PTH = hypercalcemia

REMEMBER: sCa++mous

Question 21

What might be produced by small cell lung cancer

Answer 21

• ADH = SIADH
• ACTH = Cushings
• Antibodies against pre-synaptic Ca2+ channels = Lambert Eaton

Question 22

Presentation of mycobacterium avium complex (MAC)

Answer 22

• Nonspecific sx (fever, cough, abd pain, diarrhea, night sweats, weight loss)
• splenomegaly
• elevated alk phos

Question 23

Tx of MAC

Answer 23

Azithromycin

Question 24

What are the cut-offs for positive tuberculin PPD skin test

Answer 24

♣ >/5 mm
• HIV+ patients
• Recent contacts of known TB cases
• Nodular or fibrotic changes on CXR consistent with previously healed TB
• Organ transplant recipients or other immunosuppressed

♣ >/= 10 mm
• Recent immigrants (<5 years) from TB-endemic areas
• Injection drug users
• Residents and emplyees of high-risk settings (e.g. prisons, nursing homes, hospitals, homeless shelters)
• Mycobacteriology lab personnel
• Higher risk for TB reactivation (e.g. DM, leukemia, ESRD, chronic malabsorption syndromes)
• Children age <4, or those exposed to adults in high-risk categories

♣ >/= 15 mm
• All of the above plus healthy individuals

Question 25

When with Hep B core antibody be positive

Answer 25

• IgM = acute/recurrent infection • IgG = prior exposure or chronic infection o Will NOT be positive if immunized o Think of HBcAB as a marker of positive history of disease • Positive in window period (when antibodies are binding antigens and neither antigens or antibodies are detectable)

Question 26

what is the triad seen in Felty syndrome

Answer 26

- RA - Neutropenia - Splenomegaly

Question 27

What age group and how often should mammograms happen?

Answer 27

- Women age 50-75 | - Every 2 years

Question 28

Describe pathophysiology of CO poisoning

Answer 28

♣ The affinity of CO for binding hgb is >200x that of O2 | ♣ Once bound to Hb, CO forms carboxyhemoglobin, which impairs O2 delivery to tissue

Question 29

Tx of CO poisoning

Answer 29

♣ High flow 100% oxygen | ♣ Intubation/hypercarbic oxygen therapy

Question 30

What is haptoglobin and what do decreased levels indicate

Answer 30

- Haptoglobin is the protein used to carry free Hgb to the spleen - Haptoglobin will be low in intravascular hemolysis because it will all be bound up to Hgb

Question 31

What acid-base disorder would you expect in Primary adrenal insufficiency

Answer 31

Metabolic acidosis

Question 32

Diagnostic imaging for kidney stones

Answer 32

US or NON-contrast CT

Question 33

What 4 groups of patients would benefit from statin therapy

Answer 33

1. Pts with clinical ASCVD (ACS, h/o MI, stable or unstable angina, stroke, TIA, or PAD) 2. Pts with LDL >190 3. Pts with DM, age 40-75 with LDL of 70-189 4. Pts w/o DM, age 40-75, with ASCVD >/= 7.5%

Question 34

Whats the difference between Cushing Syndrome and Cushing Disease

Answer 34

- Cushing syndrome = cortisol | - Cushing disease = ACTH-secreting pituitary adnoma

Question 35

What is the cause of pancytopenia in lupus

Answer 35

Auto-immune destruction (e.g. peripheral destruction)

Question 36

Next step in management of pt with suspected giant cell arteritis and vision loss

Answer 36

High-dose IV corticosteriods (even before biopsy to make official diagnosis - blindness can be permanent!)

Question 37

Presentation of glucagonoma

Answer 37

- Mild hyperglycemia - Necrolytic migratory erythema - Diarrhea - Weight loss

Question 38

Best method for diagnosis of aortic dissection

Answer 38

♣ Transesophageal echo (TEE) – preferred method in patients with renal insufficiency of hemodynamic instability ♣ CT angiography with contrast – preferred in hemodynamically stable patients; requires contrast so avoid in renal insufficiency ♣ MR angiography – time consuming; avoid in patients with kidney disease

Question 39

What are Wells criteria

Answer 39

♣ Wells Scoring Criteria: • Clinical symptoms of DVT (leg swelling, pain with palpation) = 3 • Other diagnosis less likely than PE = 3 • Heart rate > 100 = 1.5 • Immobilization (>/= 3 days) or surgery in the previous 4 weeks = 1.5 • Previous DVT/PE = 1.5 • Hemoptysis = 1 • Malignancy = 1 Scoring • Wells <2 = low probability = Get D-dimer • Wells >4-6 = high probability = CTA angio

Question 40

Tx of hypertrophic cardiomyopathy

Answer 40

• Beta blockers o Negative inotropes prolong diastole and decrease myocardial contractility, which in turn decreases LVOT obstruction and improves symptoms of angina • Non-dihydropyridine CCBs (e.g. Verapamil) o Used when symptoms persist despite beta blocker therapy

Question 41

Symptoms of lupus

Answer 41

``` R - rash A - arthritis S - serositis (e.g. pleuritic, pericarditis) H - hematologic disorders (anemia, leukopenia, lymphopenia, thrombocytopenia) O - oral ulcers R - renal disease P - photosensitivity A - antinuclear antibody I - immunologic disorder N - neurologic disorders ```

Question 42

Meds used to treat BPH

Answer 42

- Alpha-1 antagonists - 5a-reductase inhibitors - Antimuscarinics (to treat symptoms)

Question 43

How do alpha-1 antagonists work to treat BPH

Answer 43

♣ Relax smooth muscle in bladder neck, prostate capsule and prostatic urethra

Question 44

How do 5a-reductase inhibitors work to treat BPH

Answer 44

♣ Inhibit conversion of testosterone to dihysrotestosterone | ♣ Reduce prostate gland size

Question 45

When do you see bite cells?

Answer 45

o Due to Glucose-6-phosphate dehydrogenase (G6PD) Deficiency ♣ No NADPH created in order to reduce glutathione, which is needed to protect RBCs from oxidative damage o Heinz bodies are precipitated hemoglobin within the RBC o Bite cells are due to the phagocytic removal of bite cells

Question 46

What is the difference between Steven Johnson Syndrome and Toxic Epidermal Necrolysis

Answer 46

SJS involves <10% of skin | TEN involves >30% of skin