step 3 29

Question 1

treatment resistant depression management

Answer 1

augment antidepressants with second generation antipsychotics (olanzapine)

Question 2

SE’s of second-generation antipsychotics as a class

Answer 2

weight gain, dyslipidemia, hyperglycemia, new diabetes (all are associated but olanzapine associated with greatest risk)

Question 3

hypoplastic left heart syndrome presentation

Answer 3

• neonate with mild cyanosis at birth who develops progressive respiratory distress and shock after closure of ductus arteriosus

Question 4

TOF presentation

Answer 4

• tet spell (episodes of severe cyanosis due to RV outflow obstruction) + systolic ejection murmur (due to RV outflow obstruction)

Question 5

truncus arteriosus presentation

Answer 5

• heart failure due to excessive pulmonary blood flow + systolic ejection murmur

Question 6

Management of mother with positive titer for anti-Rh(D) antibodies

Answer 6

Can’t do anything (only effective if given before alloimmunization has occurred)

Question 7

umbilical hernia in newborn management

Answer 7

• if reducible, asymptomatic, defer surgery until age 5 (usually closes spontaneously during first few years of life)

Question 8

Gaucher disease presentation

Answer 8

anemia, thrombocytopenia, splenomegaly, bony pain, fractures (glucocerebrosidase deficiency)
- can present in late adulthood

Question 9

common complication of severe MR

Answer 9

AF due to LA dilation

Question 10

severe mitral valve regurg management

Answer 10

If primary – surgery

If secondary – medical management

Question 11

artificial tears medical erm

Answer 11

methylcellulose drops

Question 12

white counts in synovial fluid analysis

Answer 12

less than 2,000 = OA
2,000-75,000 = inflammatory (RA and gout)
100,000 = infectious arthritis

Question 13

when infertility workup is indicated

Answer 13

women younger than 35 = after 1 year

women older than 35 = after 6 months

Question 14

other features of GBS

Answer 14

• paresthesias
• autonomic dysfunction (palpitations, orthostasis)
• respiratory muscle weakness/SOB
• weakness in hands too
• dysphagia, facial muscle weakness

Question 15

sequela of cortisol-producing adrenal adenoma

Answer 15

adrenal crisis (remaining cortex becomes atrophied due to negative feedback inhbition)

Question 16

sick sinus syndrome presentation

Answer 16

Rapidly alternating SVT + bradycardia (also called bradycardia-tachycardia syndrome)

Question 17

other important feature of parkinson’s

Answer 17

• unilateral onset + persistent asymmetry (eg asymmetric hand rigidity)

Question 18

difference between parkinson’s and parkinson-plus syndromes

Answer 18

parkinson-plus = rapid progression, early postural instability (falls) (which doesn’t happen until late in PD), dysautonomia, symmetric motor signs, lack of tremor, poor response to dopaminergic therapy

Question 19

lab findings in nephropathy from aortic atheroembolism

Answer 19

elevated serum + urine eosinophils

Question 20

RCC presentation

Answer 20

• flank or abdominal mass that is firm, nontender, and moves with respiration
• hematuria, resulting in anemia
• flank pain

Question 21

gout prophylaxis

Answer 21

allopurinol + colchicine or NSAID during initiation and titration of allopurinol (changes in uric acid level from allopurinol can trigger an acute flare)

Question 22

management of patellofemoral pain syndrome in young women

Answer 22

NSAIDS, stretching and strengthening

Question 23

biggest RF for development of a recurrent stroke

Answer 23

prior stroke or TIA

Question 24

sequeal of tension pneumos

Answer 24

can rapidly lead to CODES

Question 25

acute blood pressure drop while putting in central line?

Answer 25

prob caused a pneumo

Question 26

other findings on CXR that suggest tension pneumo

Answer 26

widened rib spacing | depressed hemidiaphragm

Question 27

where to insert needle for tension pneumo

Answer 27

midclavicular line, second intercostal space

Question 28

human bite wound management

Answer 28

- irrigate as quickly as possible | - augmentin

Question 29

management of vulvovaginal atrophy

Answer 29

first -- vaginal lubricant | second -- topical estrogen

Question 30

postpartum thyroiditis management

Answer 30

betablockers (can't use methimizole because it's from the release of preformed thyroid molecules. Antithyroid drugs inhibit thyroid hormone synthesis.)

Question 31

prognosis of postpartum thyroiditis

Answer 31

Increased risk of persistent goiter + chronic thyroid dysfunction

Question 32

benefit of meta-analysis

Answer 32

with greater statistical power, you can detect a small effect size. This may lead to a significant effect but may be small clinical relevance.

Question 33

signs of sexual abuse

Answer 33

- recurrent UTI with no medical cause | - knowledge of detailed sexual acts

Question 34

caput succedaneum vs. cephalohematoma

Answer 34

cephalohematoma = does not cross suture lines. well-demarcated. Usually from vacuum or forceps-assisted deliveries., and happen within first few hours or days of life. caput succedenaum = crosses suture lines, resolves within days of birth

Question 35

other indication for ECT

Answer 35

- not eating or drinking with VS instability

Question 36

treatment of depression with psychotic features

Answer 36

SSRI + antipsychotic

Question 37

common side effect of nasal glucocorticoids

Answer 37

epistaxis

Question 38

croup features

Answer 38

stridor + barking cough (loud, forceful coughing)

Question 39

confidence interval caveat

Answer 39

if it's 1-1.6, still insignificant since it includes 1

Question 40

ecological study design

Answer 40

disease rates (eg prevalence) and exposure are measured at the population or community level and their association examined

Question 41

interstitial cystitis treatment

Answer 41

NSAIDs | amitriptyline

Question 42

cardiac glycosides

Answer 42

digoxin

Question 43

management of acute decompensation of peripartum cardiomyopathy

Answer 43

hydralazine (arterial dilator to reduce afterload) + long acting nitrate (isosorbide mononitrate) (reduced preload)

Question 44

isosorbide mononitrate as a med

Answer 44

long acting nitrate, used for preload reduction

Question 45

ascertainment bias

Answer 45

- results are distorted by knowledge of which intervention the participants are assigned to (reason for blinding)

Question 46

bloody diarrhea vs. watery suggests..

Answer 46

bloody suggests bacterial

Question 47

first-line therapy in sexually active patients with primary dysmenorrhea

Answer 47

combination oral contraceptives

Question 48

SLE and pregnancy

Answer 48

- increased risk to fetus. Should avoid pregnancy until disease in remission for 6 months. - happens through transplacental passage of maternal anti-SSA and anti-SSB antibodies, that can lead to complete heart block

Question 49

spontaneous pneumomediastinum pathophys

Answer 49

- young males with lung disease or persistent cough or using inhalants - air escapes the alveoli through small tears in bronchovascular sheath

Question 50

spontaneous pneumomediastinum management

Answer 50

- usually resolves sponatenously | - NSAIDs and O2 (speeds up resorption)

Question 51

ADHD presentation

Answer 51

- restlessness, impulsivity, distractibility, irritability - procrastination - in adulthood rash decisions, emotional dysregulation, executive dysfunction

Question 52

side effects of long term stimulants

Answer 52

- small but persistent elevation in blood pressure and heart rate (you can develop tolerance to meds but not heart rate)

Question 53

lifestyle modification of stress urinary incontinence

Answer 53

weight loss, smoking cessation, decreasing caffeine and alcohol intake