QS BY AN EXAMINEE
GI questions:
- pt c hematemesis, not actively bleeding -> sclerotherapy
- pt had hematochezia and bluish dicoloration of the cecum -> I don’t know I put angiodysplasia
- toxic megacolon, NPO/IVF/NGT wasn’t enough, then more pain and more fever c free air in abdomen ->laparotomy
- kid swallowed some acid, what to do in ER -> esophagoduodenoscopy
- no questions on h.pylori
- easy question to diagnose achalasia
- question on sjogrens what is next step -> SSA/SSB Ab or parotid biopsy
- guy had halitosis -> zenkers
- several questions on gout -> trial of PPIs
- question on esophageal scleroderma -> trial of PPIs
- guy has heartburn well controlled with antacids, used to have trouble swallowing only steaks, now cannot swallow many solids but liquids is ok -> PPIs or EGD
- diagnose esophageal cancer
- diverticulitis -> ct scan
- woman with jaundice, only + result was HAV IgG, what is she at risk for in the future? HAV, HBV, Hemachromatosis, Hepatocellular Ca, etc.
- pt with hepatic encephalopathy and high Cr -> dialysis
- question was very long, said pt had epigastric pain radiating to upper quadrants, fever, no jaundice, labs weren’t that bad (mildy elevated alk phos) what does she have -> cholecystitis, choledochilithiasis, pancreatitis, bla bla bla…
- Cholecystitis -> abdm U/S
- Older woman with h/o CABG and history of A.fib gets diffuse abdm pain after eating, and has abdm bruit, what does she have? Embolis in SMA, abdm aortic aneurysm, polycystic kidney disease?
- Acute pancreatitis question
- Question on malabsorption, pt had steatorrhea… lol I don’t remember the rest
- Guy had bloody stools and passed out on the floor, recent history of aortofemoral bypass -> I put fistula
- Dx pyloric stenosis
- What is the cause of intussuseption of small bowel in a 65yo? Idiopathic, tumor, cancer of small bowel, lymphadenitis?
- Dx meckels
CARDIO
- Question said positional chest pain, showed EKG of diffuse ST elevation -> pericarditis
- Had two heart murmur audio questions
- IVDA and vegetations on the heart -> tricuspid regurge
- Guy with angina and a.fib -> I put ECG stress test
- Which is the greatest risk factor for CAD? LDL-chol ration, HDL chol ratio, triglycerides, lipids
- Murmur got worse with standing and valsalva -> HOCM
- Kid with cyanosis in the 1st 24hrs of life -> transposition
- Diagnose tamponade
- Kid with holosytolic murmur -> left to right shunt (it’s a vsd)
- Diagnose MVP (said mid-systolic click)
- Diagnose ASD (said wide, fixed S2)
- Endocarditis prophylaxis for dental procedure in a kid with h/o reaction to ampicillin -> clinda
- Teenager with cramps in the legs, muscles on top are bulky, weak on the bottom, bad LE pulses -> coarctation
- Hyperaldosteronism -> PRA ratio
- 3 questions on temporal arteritis (2 dx 1tx)
- woman with renal artery stenosis what is elevated? Rennin
- diagnose dissecting aortic aneurysm -> TEE
- pt had low Na, low K, high Cl on thiazides and ACEI what is the reason for the labs? I put thiazide and ACEI reaction, other choices were hyperaldosteronism, hypoaldosteronism, other stuff
SKIN
- picture of some bad bad acne -> proprionobacterium
- HSV
- How do you treat ringworm > clotrimazole, permethrin, hydrocortisone?
- Pt had dermatitis herpetiformis -> gluten free diet
- Pt had optic glioma what will you find on skin -> café au lait
- Guys nose had a pearly looking thing on it -> basal cell
- Mentally retarted kid with seizures and a skin disorder -> tuberous sclerosis
- Acathosis nigrans -> check glucose
- Kid with DIC
- Picture of a hand with DIP inflammation and said his ankle was very tender -> gout
- Kid went into the woods now has itchyness and rash in a linear pattern -> contact dermatitis
- Mom wants to prevent daughter from getting sunburns ->advise not to go out before 2pm
- Contact dermatitis question -> cell-mediated hypersensitivity
ENDOCRINE
- Guy is depressed after his wife died and labs show high tsh, low t4 -> depression due to medical conidition, other choices were MDD, Adjustment disorder
- Graves disease what Abs are after -> TSH receptor
- Guy with A.fib what must you rule out -> hyperthyroid
- SOOO many questions on diabetes I and II soooooo many. Guy with DKA (give fluids and what type of insulin), guy with DM and foot ulcer (angiography or foot amputation), soooo many know your DM inside out
- Health care worker comes in after fainting has sugar of 40, normal c-peptide -> took insulin
- Guy with low insulin and high c-peptide -> insulinoma
- Guy with rash and high sugar -> glucagonoma
- Dx hyperparathyroidism
- Guy on lithium -> nephrogenic DI
- Dx SIADH
- Guy with loss of facial hair, small testes and is infertile -> check pituitary
- Pt cannot lactate after birth, had postpartum hemorrhage, what is deficient? GnRH, inhibin, progesterone?
- Dx PCOS
Hematology
- 3-4 questions on B12 deficiency
- 3-4 questions on folate deficiency
- what is low in goats milk? folate
- What is low in breast milk? Vit D
- Guy from
- Sickle cell crisis, after analgesia what do you give? Fluids or transfuse?
- 4-5 questions on iron deficiency
- kid eats anything now has low MCV -> lead poisoning
- I had like 4 questions that starts with a pt who had recurrent nosebleeds.
- One said pt c recurrent nosebleeds on lithium, bupropion and valproic acid, lithium levels are too high what to do next? D/c lithium, d/c valproic acid, d/c buproprion, check platelet level, check AST levels?
- Dx Hemophilia A (question said effusion of blood in the knee)
- Dx von Willebrands
- Question said besides the stockings how else can you prevent DVT? LMW heparin, warfarin, aspirin, tPA.
- Question on HUS (said history of recent infection)
- Dx Henosh-schonlein (said palpable purpura)
ID
- Dx otitis media
- Hard question on sinusitis, know how to differentiate chronic s/s from acute.
- Kid with barking cough -> laryngotrachietis
- A lot of wheezing questions in children
- CSF has RBCs -> HSV
- Pt exposed to so many things, one of them was unpasteurized milk, CSF was normal -> listeria
- Ring-enhanced lesion in the brain in an aids pt prophylaxis -> TMP-SMX
- Kid with h/o meningitis what is the diagnosis to the most common sequela -> confused between tympanometry or air-conduction hearing studies (I know the answer was hearing loss)
- Encephalitis question -> HSV
- Kid c wheezing and has tonsillar inflammation and had trouble opening his mouth but uvula was not displaced and it showed a picture of the lateral neck and asked what it was-> peritonsillar abscess or retropharyngeal abscess im not to sure, know the pix
- Dx pharyngitis
- Nurse with pernichila (the finger infection) that gets it drained, warm compress and Abx, what is next? Keep her away from pts, prophylax all pts, treat all the pateints she was exposed to, etc.
- 2 questions on mycoplasma dx (college students)
- 2 questions on aspiration pneumona
- PPD positive next step -> cxr
- Guy with white fluffy things that don’t scrap off, what is next test? HIV
- 3 questions on Lyme disease
- MANY MANY STD questions, all of them like syphilis, chancroid, gonorrhea, chlamydia, trichomonas (like 4), candida (2)…at least 2 on each one
- Guy with everything that seemed like gout, what is next step? Aspirate fluid from joint (treatment wasn’t an option)
- Had maybe 9-10 questions on the immunodefiencies, know them real well.
- Guy with indurated 5cm mass on thigh and fever, what do you do next? Surgical debridement or I&D?
- Pt has on several meds gets hearing loss, what is the cause?
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Rhematology
- How do you treat pseudogout? Indomethacin, hyaluronidase injections, aspirin?
- 3-4 questions on RA
- 2-3 questions on Gout
- 1-2 questions on OA
- pt c psoriasis what else should you find? Clubbing of the finger
- 3 questions on Kawakaki’s disease (2 to dx, 1 to tx)
- dx polymalgia rheumatic
- tx SLE (prednisone)
- how do you treat fibromyalgia
- dx polymyositis
- dx DMD
- kid with recurrent fractures and blue sclera -> collagen 1 deficiency
- Showed picture of carpal tunnels -> median nerve at wrist
- Dx slipped capitus femoral (fat kid with a limp)
- Dx Osgood shlatter (showed picture of tibial tuberosity)
- Dx developmental hip displasia (said mom heard popping when changing diapers)
- Picture of chondrocalcinosis -> pseudogout
OBGYN
- Almost every other question started with G-P- (my test was A LOT of obgyn)
- Dx and tx ectopic
- 4 questions on mole (2 dx like HTN in 1st TM and enlarged uterus 2 tx)
- pt is 31weeks and gets in a car accident now has vaginal bleeding and uterine tenderness -> abruptio placenta
- pt is 11 weeks and has passage of fetal contents but no fetal parts noted, very high hCG -> 46XX
- Pt with TOA keeps getting worse and fever getting higher -> surgery
- Pt c cyst on labia majora, nowhere else, only on the majora -> labial abcess, bartholins abscess, bartholin cyst
- HSV at 39 weeks c 4min contractions c no breakouts while pregnant but she feels weird and said that usually when she feels weird she breaks out, what do you do? C-section, augmentation of labor, tocolysis
- 10cm dilation and after 10 minutes all you get is a “palpable minimal caput†what do you do next? Vacuum, continue contractions, c-section
- 37yo c breast mass and gets lumpectomy and after it showed noninvasive intraductal cancer without margins, what is next step? Tamoxifen, radiation, chemo, observe, or sentinel node bx
- Woman at 28wks had an amnio before and got RhoGAm what do you do now? Administer rhogam again
- Woman has baby that’s too small for gestation age, stress test shows late decelerations what is the cause of the IUGR? Uteroplacental insufficiency
- Mom is smoker while pregnant? IUGR
- What is high in a pt with gestational DM? HPL
- Mom is 34wks and gets severe preeclampsia what will the child suffer from? Sepsis, pulmonary insufficiency (that’s what I put).
- High AFP on triple screen? Anencephaly (other choices were trisomy 21, 13, 18)
- Tx gbs
- Pt with vaginal discharge, turns out fern+ what is the d/c? PROM
- Pt with postpartum hemorrhage, what do you do? Give oxytocin, give prostaglandin, surgery, artery ligation (massage was not an answer)
- Macrosomic kid whose mom had gestation DM gets seizures -> hypoglycemia, hyperglycemia, hypo or hypercalcemia, kalemia, natremia, etc.
- 3 questions on cervical dysplasia
- woman with PCOS is at risk for -> endometrial cancer
- woman who has BMI 33 is at risk for ->endometrial cancer
- woman with menopause and fracture -> dexa
- 2-3 questions on endometriosis
- 2 questions on fibroids
- 57yo with vaginal pruritis -> vulvar cancer
- 14yo girl has not had menses, all her friends make fun of her, physical exam is completely normal, what is the dx?
- post menopausal bleeding -> endometrial cancer
- obese F with menstrual cycle problems that when you take pap smear what else should you do? Endometrial biopsy
- woman feels bulging from her vagina, she had a total hysterectomy in the past, she has absolutely no other s/s besides the bulging which gets worse when she stands up -> cystole, rectocele, uterine prolapse?
- Guy who gets urge to pee but pisses on himself before he makes it to the bathroom -> detrusor hyperactivity.
- Know how to treat your STDs!!
- Bloody discharge -> intraductal papilloma
- 37yo woman with breast mass -> mammo, FNA, biopsy, sonogram?
- Menopause lady wants to prevent bone fractures that she seen in her sister, takes no HRT, what should she do? Calcium supplements, estrogen replacement, etc.
SURGERY
- Bleeding from urethral meatus ->retrograde urethrogram
- Dx tension ptx
- Stab wound to stomach -> ex lap
- Guy was on motorcycle crashed into truck and now feels abdm pain, VS are stable, what do you do next? DPL, CT, ex-lap
- Picture of a severely displaced radial bone and pt had no pulses, loss of sensation, and pallor. They said the feeling of the forearm was still very soft, what do you do next? ORIF, fasciotomy, angiography, cast.
- Not too much surgery
Growth development/preventative medicine
- 3yo rides a tricycle, still pees in his bed, can say two worded sentences, is he normal delayed (in each field like social, developmental, motor)
- dx separation anxiety
- kid wants to get circumcised, want should you tell him? Need parents consent
- no formula questions (sensitivity, specificity, odds ratio, bla bla bla)
- dx t-test
- what is the best test to measure incidence? Cohort study
- no bias questions
- if an HIV ELISA test is 99% sensitive and 95% specific, what happens to the sensitivity and specifity if you do “another test†(I don’t know if that meant another ELISA test or a western-blot, so I assumed another elisa and put stays the same)
NEURO
- carotid stenosis of 90% in an asymptomatic pt -> CEA
- how to treat cluster headache? Oxygen
- 3 questions on temporal arteritis
- a question about tremor at rest, not with motion or walking, the answer was related to parkinsons
- Showed a picture of the brain and said the pt had no memory problems but had personality changes, frontal area and temporal area looked atrophied -> Picks
- Guy is taking care of his wife (both really old) and she is getting worse, he promised he wont send her to a nursing facility. He cant afford a nursing aid anymore. Now his wife is making sexual advances and hes disgusted by it. What do you do? Put his wife in assisted living, give him sexual therapy, give him SSRI, give her diazepam.
- Woman with alzheimers is getting more crazy (screaming at her son for stupid reasons), what do you do? Tell her son its normal
- A LOT of dementia questions (not that hard)
- Wet wacky wobbly -> normal pressure hydrocephalus
- Woman who is one week ok and one week very bad (demented c loss of motor function), has history of CABG and her BP is still high -> multi-infarct dementia
- Dx MS
- 2 questions on Guillian barre (both diagnosis, one was hard)
- One question was on ALS, where is the problem -> motor neuron
- Dx subarachnoid
- One question asked what is the fastest way to treat high intracranial pressure? Intubation and hyperventilation, manitol, trendelenburg, head elevation
- Dx Narcolepsy
- Construction worker in the sun all day gets an episode of confusion (just confusion), he is otherwise healthy and on no medications, what is the dx? Heat stroke, malignant hyperthermia, some other dumb answers.
- Old pt with long history of DM and HTN gets progressive loss of vision, on physical exam the eye has no hemorrhages, no cotton wool spots, no neovascularization, what is the dx? Glaucoma, DM retinopathy, HTN retinopathy, cataracts
PULM
- Acute asthma attack tx
- Pt with situs inverses, recurrent pneumonia and bronchiectasis (so your thinking CF) but it says sweat-chloride was negative -> nasal scrapings
- Many questions on pneumonia
- No questions on pulmonary effusions
- 2 questions on sarcoidosis
- Dx asbestosis
- Dx chronic bronchitis (really easy)
- One question said what is the pathyphysiology of chronic bronchitis (what happens to the vessel walls, something about elasticity)
- 13month old kid with sudden inspiratory wheezing, CXR shows hyperinflation of just the right lung but no foreign object what is next step? Scope
- Dx Aspiration pneumonia. One question said what is the pneumonia consisting of? Gram + only, gram – only, both, gram + and anaerobes, gram – and anaerobes, etc.
- Dx TB (question even said positive PPD)
- Dx atelectasis (fever a few hours after surgery)
- 2-3 questions on ARDS
- One on neonatal ARDS, what to tx with? Surfactant
- Women suspected of having PE, the V/Q scan was negative what do you do next?
- Pt with PE what do you give? Heparin
RENAL
- I had about 10-15 renal questions, some really hard. 6 of them were in that category where you have a million answers and they give you 2 or 3 questions on the same answers. What else can I say but know your renal!!
- Guy had testicular mass, ultrasound confirms that it is a solid mass, what is the next step? Excisional biopsy or orchiectomy?
- 2 questions on BPH (dx)
- Pathophysiology of post-strep GN? I put destruction of foot processes (they didn’t have fusion)
- Muddy casts -> ATN
- Pt in car accident, CK level is off the roof, what is he at risk of? ATN
PSYCH
- Pt with depression and starts hearing voices for ONE week -> MDD, schizoaffective, schizophrenia, bipolar.
- Guy with narcolepsy, how to treat? I put methylphenidate
- Dx ADHD
- Dx anorexia
- Dx delerium
- Kid wondering the street at 2am, high BP, dilated pupils, combative and paranoid, what drug did he abuse
- Girl is found unconscious, high BP, dilated pupils, what drug?
- Woman is found wondering the streets, not oriented, dilated pupils, question said what should you give her, I put thiamine (other choices were naloxone, flumazenil, etc)
- Guy feels spiders on hit feet when hes trying to fall asleep, and he cant fall asleep because of it, what is the dx? Restless leg syndrome
- Another question on restless leg syndrome, the drug is aimed at what? Dopamine, serotinin, NE, Ach, etc.
- Girl is in love with the TV anchorman, keeps writing him letters, waits at his job, believes they will marry, what is the dx? Delusional
- 2 questions on the adverse effects of phenytoin, one was rash
- dx adjustment disorder
- dx normal bereavement
- Professor gets sweating and nervous when he gets on stage in any other place but his own university – panic disorder
- Dx social phobia
- Person feels like theyre in another place (sounds like depersonalization), but it happened after they were put at gunpoint and robbed. Now she has nightmares and can never go to the same place again, but denies having flashbacks -> PTSD, depersonalization, and other stupid answers
- Dx primary insomnia
- Woman has twins that are 2yo and now she feels loss of interest, cant sleep, hates doing anything, what is the next step? Assess suicide.
