DIP Episode 30 - Comprehensive Medicine Shelf Review Session 2

Medicine Keywords A Some MS4 Introduction -This first review set contains 137 keyword slides. -The goal would be to spend a min or less per slide (some will take < 30s). -Strongly encourage making notes with each slide. Study these notes for your shelf. Writing stuff down will help tremendously with retention. -Designed to be a more comprehensive but HY medicine shelf review. -Make sure you do all 4 practice NBM Es for the medicine shelf. If a topic is completely new to you, spend about 10 mins studying that topic as something similar may be tested on the shelf. -The medicine shelf is surprisingly not a huge departure from a lot of the material tested from the organ systems on Step 1. We will review some of this pertinent stuff. 1 Opening snap with diastolic rumble at left 4th interspace. Tall jugular venous A waves. How can we increase the intensity of this murmur? 2 Elevated AST/ALT, blistering lesions on the dorsum of the hands, severe hirsutism. What is the enzyme deficiency? How is this disease treated? 3 Hypoglycemia, hypoglycemic sxs, resolution with glucose administration. Differentiating 3 big causes of hypoglycemia based on labs. The acute treatment of hypoglycemia.

4 A Diarrhea (Bugs, associations, treatment) Pork consumption, Undercooked shellfish, Severe rice-water stools in a developing country, Bloody diarrhea with a super small inoculum, Bloody diarrhea after consuming eggs/poultry, Watery diarrhea 2 hrs after consuming potato salad, Bloody diarrhea with low plts/unconjugated hyperbilirubinemia/elevated creatinine. 4 B Diarrhea (Bugs, associations, treatment) Diarrhea upon return to the US from Mexico, Foul smelling watery diarrhea after recent treatment for an anaerobic bacterial pneumonia, Crampy abdominal pain after consumption of home canned veggies, Bloody diarrhea with ascending paralysis in a puppy owner, Watery diarrhea after eating fried rice at a Chinese restaurant. 5 Prussian blue staining of a bone marrow smear reveals basophilic inclusions around the nucleus in a 75 yo M that lives in a home built in the 1930s. What are the associated Fe lab values? How is this disease treated (+ potentially helpful vitamin supplementation)? 6 CXR showing diffuse, bilateral, ground glass infiltrates in a febrile patient taking high dose immunosuppressants. What is the bug? Relevant stain? Prophylaxis? Treatment? Who should get concomitant steroids? Diagnostic studies? Classically elevated marker from pulmonary fluid? 7 (Associations/Relevant Bugs/Risk factors) Flank pain with gross hematuria. Envelope shaped? Coffin shaped? Radiolucent? Shaped like a hexagon? What is the best diagnostic testing modality?

How is this presentation treated? 8 24 yo M presents with a painless, palpable bony mass on the left knee. Knee X ray reveals a contiguous mushroom shaped mass. What is the diagnosis? 9 66 yo F is found unconscious at home by her daughter in December. PE is notable for a cherry red appearance of the skin. Next best step in diagnosis? Treatment modalities? Pathophysiology and O2 delivery associations? Classic exam presentation and risk factors? 10 Elevated creatinine 24 hrs after getting a CT scan. How could this have been prevented? Skin fibrosis after getting a brain MRI. Is there a particular DM medication that should be held before getting a CT scan? 11 A common lower extremity side effect associated with hydralazine and Ca channel blockers. What is the pathophysiology? How is this condition treated? What is the pathophysiologic mechanism? 12 HIV patient with a 3 day history of fever presents with targetoid skin lesions, lip/mouth ulcerations, and visual impairment. PE is notable for skin sloughing (8% BSA). Nikolsky sign is +ve. He was placed on Allopurinol 10 days ago for chronic gout. What is your diagnosis? > 30% BSA involvement? 13 30 yo F presents with 3 day hx of polydipsia and polyuria. Blood glucose is 650 mg/dl, Bicarb is 21, pH is 7.35. Diagnosis? Pathophysiology? Risk factors? Treatment? Na balance? K balance? What is your dx if the patient becomes altered/comatose with rapid treatment? 14 49 yo F presents with wheezing and flushing.

PE is +ve for murmurs consistent with tricuspid regurgitation and pulmonic stenosis. Diagnosis? Diagnostic steps? Treatment (pharmacology)? Symptoms by location? Pellagra? 15 61 yo M presents with exertional dyspnea. CBC is notable for a Hct of 27%. What is the next best step in management? What would Fe studies dictate? What is our primary concern? When should transfusion be explored? What would your diagnosis be if the patient had a similar presentation and difficulty swallowing? 16 29 yo F with a recent trip to India (ate local foods). Returned 2 weeks ago and initially had fevers for 1 week. Now presents with severe abdominal pain and distension. PE is notable for salmon colored circular lesions on the trunk. Diagnosis? Treatment? 17 Septic arthritis ->what is the bug? (+most common cause, + in a sickle cell patient, + in a young F with purpuric skin lesions). Diagnostic step? Findings from diagnostic steps? Treatment (2 pronged approach). The Neisseria vs Chlamydia treatment difference. 18 Subconjunctival hemorrhage in a patient with nasty coughing episodes. Diagnosis? Treatment? Prophylaxis for close contacts? What would the next step in management be in a person that recently started Ramipril for the treatment of HTN who has a cough? 19 Reviewing first, second, and third degree AV blocks. Acute management in a symptomatic patient? Contraindicated medications? Who gets a pacemaker??

20 Reduced EF in a patient with coarse facial features and enlarging fingers. Diagnosis? Diagnostic steps (3)? Treatment options? Most common cause of death? 21 Dysphagia to solids and liquids in a patient with thick/thin blood smears (Giemsa) revealing what appears to be motile parasites. Diagnosis? Diagnostic steps (2)? Pathophysiology? Surgical/Non-Surgical treatment options? Potential sequelae of treatment/disease sequelae? 22 Reduced MCV in a patient with a long history of untreated rheumatoid arthritis. Diagnosis? What would the results of a CBC/Fe studies indicate? Pathophysiology? 23 25 yo M with nasal packing presents with a BP of 65/40, elevated Cr, respiratory distress, T of 104, and marginally elevated troponins. Diagnosis? Pathophysiology? Classic bug associations (2)? Treatment strategies? 24 Sequelae of CKD (acid-base anomalies, electrolyte anomalies, hematologic anomalies, Ca and P balance). Consequences of uremia. Management of CKD (drugs, electrolyte/hematologic fixes). How is kidney function preserved in DKD? Indications for dialysis. 25 Rb gene mutations, Paget’s disease, and Teriparatide administration increase risk of what primary bone malignancy? Associated radiological features? 26 Aspirin Exacerbated Respiratory Disease. Potential pathophysiology? Classic presentation? Treatment 27

28 Aspirin Exacerbated Respiratory Disease. Potential pathophysiology? Classic presentation? Treatment 29 Classic EKG presentation of a Supraventricular Tachycardia. Stepwise management of an SVT. What is the next best step in management if a patient has an SVT but is hemodynamically unstable? What is the most common EKG finding in a patient having a pulmonary embolus? 30 18 yo F presents with scaly, erythematous upper extremity lesions. She has a long history of allergic rhinitis. What is your diagnosis? How is this treated? What would your diagnosis be if these lesions also had umbilicated vesicles? How would this be treated? What is the classic CBC finding with these diagnoses? 31 A patient presents with the classic “stones, bones, groans, and psychic overtones”. PE is notable for skin tenting. What is the FIRST step in management? A quick overview of Ca pharmacology. 32 Testing modalities for H. Pylori infection (3). Triple therapy. Classic presentation/risk factors for peptic ulcer disease. 33 Alpha vs Beta Thalassemias. Pathophysiology. Compare and contrast (C/C) beta vs alpha thalassemia minor in terms of Hb electrophoresis results. C/C beta vs alpha thalassemia major in terms of presentation onset and Hb electrophoresis results. What is Hb H disease? What is Hb Barts? What is the classic smear finding in thalassemias? 34 Classic CBC findings in hemolytic anemias. Classic “gallbladder” pathology present in patients with hemolytic anemias.

These patients are at risk of aplastic crises with what bug? Do thalassemias present as a microcytic, normocytic, or macrocytic anemia? 35 23 yo M who recently returned from Tucson presents with a 2 week history of fever, ankle/knee pain, chest pain, and a painful, erythematous pretibial lesion. Diagnosis? Classic finding on microscopy? Treatment strategy? Classic geographical association. 36 Periorbital edema, hematuria, and HTN in a patient with a recent history of cellulitis. BUN and Cr are elevated. Diagnosis? Pathophysiology? Associated antibodies? This disease reflects what kind of hypersensitivity reaction? 37 11:22 translocation, X-Ray imaging reveals an “onion skin like” periosteal reaction, bone biopsy with histology reveals small, round, blue cells. What is your diagnosis? 38 What is a parapneumonic effusion (PNE)? Describe the following->Uncomplicated PNE, Complicated PNE, Empyema. What are the pH, LDH, glucose, and micro criteria that typify a “high risk” PNE? How do the available treatment modalities help you differentiate between the different parapneumonic effusion types? For Keyword 39 (next slide)

39 What is your diagnosis? How would you describe the rhythm? How would treat this rhythm in a patient that is stable/asymptomatic vs a patient that is hemodynamically unstable vs a patient that lacks a pulse? What is the most common cause of death in the immediate period following an MI? 40 Oral mucosal ulcerations + +ve Nikolsky sign (flaccid skin blisters) in a 45 yo M. Diagnosis? Pathophysiology? Type of hypersensitivity reaction? Diagnostic testing modality (super HY)? Treatment strategy? 41 Lab differentiation between primary and secondary hyperaldosteronism. Screening vs confirmatory testing for Conn Syndrome. Causes of secondary hyperaldosteronism. Treatment strategies with Conn Syndrome. Quick description of nephron physiology. 42 The Rome Criteria for Irritable Bowel Syndrome. Classic patient demographic. Are there lab abnormalities? IBS Classification. 43 Cold vs Warm Agglutinins (classic antibodies, bug associations). Treatment differences b/w warm and cold agglutinin disease. LDH, Bilirubin, and Haptoglobin levels in hemolytic anemia. 44 32 yo Egyptian immigrant presents with a 2 week history of abdominal pain, hepatosplenomegaly, and hematuria. He swam in The Nile 2 months ago. Diagnosis? Bug? Route of transmission? Classic CBC observation? Potential oncologic sequelae? Pharmacological management? 45 Synpharyngitic glomerulonephritis.

Compare and contrast with Post Infectious Glomerulonephritis wrt to->Timeline to onset of symptoms, complement levels, etc. Treatment strategies. Classic urine findings with the nephritic syndromes. 46 70 yo M with leg pain that is worsened by a back held in extension (but better when held in flexion). Diagnosis? Diagnostic testing? Treatment strategies? 47 Opening snap with a diastolic rumble heard best in the 4th intercostal space in the midclavicular line. Diagnosis? #1 risk factor? Diagnostic testing? Treatment strategies? 48 No oral mucosal lesions + Pruritus + Negative Nikolsky sign. Diagnosis? Pathophysiology? Best diagnostic test? Treatment strategies (contrast with initial management of the somewhat analogous Nikolsky +ve disease)? 49 Compare and contrast primary and secondary adrenal insufficiency (by classic cause, skin findings, levels of ACTH/Aldosterone/Renin, Cosyntropin testing, treatment strategy). Key labs/CBC findings in AI. AI with a history of nuchal rigidity and purpuric skin lesions. Discussion of adrenal physiology. Stress Steroid Dosing. 50 69 yo M with fever, leukocytosis, and LLQ pain. Diagnosis? Pathophysiology? Diagnostic testing? Contraindicated initial studies? GI Antibiotic strategies on the NBME (2)? What is your diagnosis if this patient presents weeks later with recurrent UT Is with urinalysis revealing air and fecal material? 51 B12 Metabolism/Biochemistry (cofactor rxns). Causes of B12 deficiency.

Biochemical differences b/w B12 and folate deficiency. Similarities and differences in the clinical presentation of B12 and folate deficiency. Treating B12 deficiency. Pathophysiology of pernicious anemia (+ diagnosis). 52 CD4 cutoffs and pharmacologic prophylaxis in HIV+ patients (Pneumocystis Jirovecii, Toxoplasmosis, Mycobacterium Avium Intracellulare, Coccidioides Immitis, Histoplasma Capsulatum). 53 Central vs Nephrogenic DI. The water deprivation test. Common causes of DI. Treatment strategies for normovolemic vs hypovolemic hypernatremia in terms of fluid replacement. Fixing hypernatremia too quickly. 54 Classic Xray description of Osteoarthritis (4). Clinical presentation of OA. Arthrocentesis findings in OA. Stepwise management of OA (first vs second line). Obesity and its relationship to OA and Osteoporosis. 55 Returned from a business conference 1 week ago + Fever + Nonproductive cough + Abdominal pain + Hyponatremia. Bug? Diagnostic testing? Treatment? What are the common causes of atypical PNA? Most common cause? Typical CXR characteristics? HY associations (for C. Psittaci, C. Burnetii, Mycoplasma species). 56 Midsystolic click heard best at the apex. Diagnosis? Risk factors? NBME pathophysiology buzzword? Diagnostic testing? Maneuvers that make the valvular problem “better” or “worse”. Classic patient demographic. 57 Scaly, itchy skin with yellowish crusting in the winter. Diagnosis? Treatment strategies. Classic disease distribution.

58 Classic presentation of a pheochromocytoma. Genetic disease associations (4). Pathophysiology. Stepwise diagnostic testing. Sequential treatment strategies. 59 Most common cause of a LGIB in the elderly. Diagnostic testing. Prevention/prophylaxis strategies. 60 Blood smear findings in macrocytic/megaloblastic anemias. Classic patient demographic with folate deficiency. HY exam points related to folate synthesis inhibitors. Leucovorin. 61 Classic CMV presentations-> esophagitis, colitis, retinitis. Classic CMV patient populations. CNS distribution of calcifications in congenital CMV. Classic histologic findings. Treatment strategies. 62 CD4 < 200 + severe peripheral edema + frothy urine. Diagnosis? Treatment strategies (3)? The high yield side effect of Indinavir. What is your diagnosis given the triad of fever, rash, and eosinophiluria? What is the common drug association? How is this condition treated? 63 Vitamin D metabolism. Common causes of Vitamin D deficiency. Osteomalacia vs Rickets. Treatment strategies. Vit D/Alkaline phosphatase/Ca/P/PTH levels in osteomalacia/rickets. 64 Risk factors for aspiration pneumonia. Common bugs and clinical presentation of aspiration PNA. Treatment strategies. The CURB-65 criteria. Drugs commonly used in PNA treatment. 65 Pharmacological management of pulmonary arterial HTN 66 55 yo F presents with a 5 week history of a rash on her forehead. PE reveals scaly macules with a sandpaper texture. Diagnosis? Treatment?

Possible dangerous sequelae? Most likely disease sequelae? Classic risk factor. 67 Primary vs Secondary vs Tertiary Hyperparathyroidism. Lab values in these disorders. Classic causes. Classic clinical presentation of hypercalcemia. Treatment of hypercalcemia. 68 Periumbilical pain that migrates to the right lower quadrant. Diagnosis? Classic physical exam signs? Imaging modalities by population? Treatment options. 69 Classic drug and viral causes of aplastic anemia. Fanconi anemia and its buzzword pathophysiology. Fanconi anemia vs Fanconi syndrome. Renal effects of fanconi syndrome. 70 CD4 count of 94 + MRI revealing ring enhancing lesions in the cortex. Bug? Treatment? Prophylaxis? Congenital manifestations of disease? Rescue agent in a patient who becomes leukopenic with treatment. Who should get steroids? Classic methods of transmission. 71 Autoantibody most strongly associated with lupus nephritis. Classic “immunologic” description. Treatment strategies. 72 Osteoporosis screening guidelines. Risk factors for osteoporosis. Preventive strategies. Pharmacological management. Classic locations of osteoporotic fractures (2). 73-What is the bug? Red currant jelly sputum. Rust colored sputum. PNA in an alcoholic. Post viral PNA with a cavitary CXR lesion. PNA in a patient that has chronically been on a ventilator. Most common cause of CAP. Pharmacological management of MRSA. Pharmacological management of Pseudomonas.

74 JVD and exercise intolerance in a patient with a recent history of an URI. Diagnosis? Most common cause? Classic drug causes? Classic cause in a patient with recent history of travel to S. America. Potential sequelae. 75 Massive skin sloughing (45% BSA) in a patient that was recently started on a gout medication. Diagnosis? Treatment strategies. 76 Tetany and a prolonged QT interval in a patient with recent surgical treatment of follicular thyroid carcinoma. Recurrent viral infections + QT prolongation + tetany. Trousseau and Chvostek signs. Mg and Ca balance. Electrolyte/drug causes of prolonged QT intervals. Hypoalbuminemia and Ca balance. 77 Classic presentation of acute pancreatitis. Common causes of acute pancreatitis. Diagnostic testing (more sensitive???). Physical exam signs in pancreatitis. General management of pancreatitis. Management of gallstone pancreatitis. What is your diagnosis if the patient becomes severely hypoxic with a CXR revealing a “white out” lung? 78 20 yo M with red urine in the morning + hepatic vein thrombosis + CBC findings of hemolytic anemia. Diagnosis? Pathophysiology (including genetics)? Treatment. Diagnostic testing? Additional microbiological considerations with treatment. 79 Chronic diarrhea and malabsorption in a HIV+ patient + detection of acid fast oocysts in stool. Diagnosis? Best diagnostic test? Treatment? Common route of transmission.

80 Muddy brown casts on urinalysis in a patient with recent CT contrast administration (or Gentamicin administration for a life threatening gram -ve infection). 81 Classic presentation of RA. Associated autoantibodies (which is more specific?). HLA susceptibility. Pathophysiology. Caplan syndrome. Felty syndrome. Classic hand/finger findings/distribution. Xray findings in RA Pharmacological management. Required testing prior to starting treatment. 82 Differentiating Strep pharyngitis from Infectious Mononucleosis (LND distribution, disease onset, organ involvement). The amoxicillin story. CENTOR criteria and treatment decisions. Who gets treated (3)? Treatment options (+ PCN allergic considerations). Potential disease sequelae (which is treatment preventable???) 83 Most common cause of endocarditis. Patient with malar rash and echo showing vegetations on both sides of the mitral valve. R. sided valvular endocarditis. Classic presentation of endocarditis (+vascular and immune phenomena). Diagnostic testing in endocarditis (stepwise). Treatment options for endocarditis. Bugs implicated in culture negative endocarditis. Prosthetic valve endocarditis. Blood cultures in a patient with endocarditis reveal S. Bovis (or S. Gallolyticus bacteremia). Post dental procedure endocarditis. Who needs antibiotic prophylaxis? 84 Erythematous salmon colored patch with silvery scale on the elbows and knees. Diagnosis? Treatment options?

What is your diagnosis if this patient presents with joint pain (especially in the fingers)? 85 T of 104 + tachycardia + new onset Afib in a patient with a history of Graves disease. Diagnosis? Associated thyroid lab values? Pharmacological management. 86 Biopsy revealing tennis racket shaped structures in cells of immune origin. 87 Small bowel obstruction in a HIV patient with purple macules on the face, arms, and lower extremities. Diagnosis? Bug? Treatment strategies. 88 Fever + rash + eosinophiluria 10 days after a patient started an antistaphylococcal penicillin. Diagnosis? Treatment strategies. 89 SOAP BRAIN MD. Type 2 vs 3 HS Rs in lupus. Lupus antibodies. Drug induced lupus. Classic description of lupus nephritis. Antiphospholipid antibody syndrome. False +ve lupus testing. Most common cause of death in lupus patients (treated vs untreated). Endocarditis? Neonatal 3rd degree heart block? Treatment strategies in lupus. 90 Common causes of pulmonary abscesses. Classic exam scenarios. Most common location of aspiration pneumonia. 91 Chest pain worsened by deep inspiration and relieved by sitting up in a patient with a recent MI or elevated creatinine or URI or RA/SLE. Diagnosis? Classic EKG findings? Classic physical exam finding? Treatment strategies. What is the triad of cardiac tamponade? What are the classic EKG findings? How is tamponade treated? 92 Pearly lesion with telangiectasias on the ear in a farmer. Diagnosis?

Classical relationship to the lip. Treatment? 93 Cold intolerance in a 35 yo white F. Diagnosis? Most common cause (+ classic findings on histology)? Thyroid studies in these patients. Associated autoantibodies and HLA associations. Treatment. Things to watch out for in the future. 94 Massive hematemesis in a patient with a history of chronic liver disease. Diagnosis? Pathophysiology/anatomical correlates? Acute treatment (4)? Prophylaxis? Other manifestations of elevated portal pressures. Treatment strategy employed in treating cirrhotic coagulopathies. 95 Hemophilia A, B, and C. Bernard Soulier Syndrome. Glanzmann Thrombasthenia. Von Willebrand’s disease. ITP. TTP. HUS. Platelet deficiency vs coagulation factor bleeds. Bleeding time vs PT vs PTT. Why do patients with CKD have a coagulopathy? Exercising caution with transfusion in patients with Bernard Soulier syndrome. 96 Risk factors associated with the development of oropharyngeal candidiasis. Classic microbiological description of C. Albicans. Treatment of oral candidiasis. Treatment of invasive candidiasis. Reducing Amphotericin B toxicity. 97 Pleural effusions. Transudate vs Exudate. Light’s criteria. Transudate vs Exudate pathophysiology. Common causes of transudative vs exudative effusions. Chylothorax. Classic PE findings in pleural effusions (lung exam). Treatment of a pleural effusion. Unique cause of transudative and exudative effusions.

98 Holosystolic murmur heard best at the apex with radiation to the axilla in a patient with a recent MI. Diagnosis? Acute vs Chronic presentations of disease. Diagnostic testing. Why might a wide S2 split be observed with this diagnosis? Maneuvers/meds to increase/decrease murmur intensity. 99 Risk factors for the development of decubitus ulcers. Staging decubitus ulcers (1-4). Treating decubitus ulcers by stage (1-4). 2 “general” treatment strategies for decubitus ulcers. Marjolin’s ulcers. 100 T1 DM. Pathophysiology. Associated antibodies. Diagnosing DM (3 tests). The different kinds of insulin. The 3 HY complications of DM. 3 HY recommendations for chronic DM care. The classic T1 DM insulin regimen. Protecting the kidney in DM. 101-The GI Bleed Algorithm

102 Antiplatelet Pharmacology. 2 causes of an abnormal ristocetin cofactor assay. Ristocetin cofactor assay results in Glanzmann Thrombasthenia. Von Willebrand disease effects on PTT. Treatment of VWD. 103 HSV1 vs HSV2. Classic clinical presentations. Diagnostic testing. HSV encephalitis/meningitis association. Classic CSF profile in HSV encephalitis. HSV pharmacology. Classic side effect profile with acyclovir. 104 Can’t see, can’t pee, can’t climb a tree. Diagnosis? HLA association? Classic bug associations (which is most commonly tested on NBM Es?)? Treatment strategies. Antibiotic coverage and N. Gonorrhea and Chlamydia infections. 105 Hemodynamic parameters in the different kinds of shock (hypovolemic, septic, neurogenic, cardiogenic, extrinsic cardiogenic). General treatment strategies. First line treatment of septic shock and anaphylactic shock. 106 The ABCDE mnemonic with melanomas. Diagnostic strategies. Most important prognostic factor. 107 T1 DM vs T2 DM. DM pharmacology (MO As and HY side effects). Biggest risk of hypoglycemia? Contraindications to the use of Metformin. 108 Differentiating between squamous cell carcinoma and adenocarcinoma of the esophagus (risk factors, location in the esophagus, epidemiology in the US vs worldwide). Clinical presentation. Diagnostic testing. 109 Factor 5 Leiden (+ dx testing). Patient needs super large doses of heparin to record any changes in PTT.

35 yo with a hypercoagulable disorder that does not correct with mixing studies. Anaphylaxis in a patient with a long history of Hemophilia A. Skin necrosis with Warfarin. Prothrombin G20210 mutation. 110 Classic presentation of VZV infection. Contraindications to VZV vaccination. Shingles vaccination guidelines. Pharmacological management of VZV infection. Classic microbiological description of HHV 1/2/3 on a Tzanck smear. 111 #1 cause of ESRD in the US. #2 cause of ESRD in the US. Classic histological finding in DKD. BP reduction thresholds in a hypertensive crisis. Renal protective medications in patients with DKD or hypertensive nephropathy. 112 Anemia + Cranial Nerve deficits + Thick bones + Carbonic Anhydrase 2 deficiency + Increased TRAP + Increased Alkaline Phosphatase. Diagnosis? Pathophysiology? Treatment? 113 Clinical diagnostic criteria for Chronic Bronchitis. PFT findings in chronic bronchitis (FEV1, FEV1/FVC ratio, RV, TLC). What is the 1 HY PFT marker that can differentiate CB from Emphysema? Treatment strategies in an acute exacerbation. Preventive strategies. 114 Most important risk factor for Afib. Most common arrhythmia in hyperthyroidism. Most common site of ectopic foci in Afib. Classic EKG description of Afib. Most common location of emboli formation in patients with Afib. Who should be cardioverted back to sinus rhythm (3)? Q on T phenomenon. 115 Pharmacological management of Afib (rate vs rhythm control).

Reducing stroke risk in Afib (CHA2 DS2 VA Sc). Who gets Warfarin only? Who gets Warfarin or some other kind of anticoagulant (like apixaban, dabigatran)? Reversing Warfarin and dabigatran. 116 Potential cancerous sequelae of Actinic Keratosis and a Marjolin’s ulcer. Is this lesion classically below the lower lip or above the upper lip? This lesion is often described as a crusty, scaly, ulcerating lesion with heaped up borders. 117 Hypothermia + hypercapnia + non pitting edema + hyponatremia + HR of 35 + hypotension in a patient with a history of papillary thyroid cancer. Diagnosis? Associated thyroid labs? Treatment strategies. Lipid balance in hypothyroidism. 118 Acute onset “dermatologic” breakout in a patient with a recent history of weight loss and epigastric pain. Diagnosis? Exam worthy lymph node associations? What are mets to the ovaries called? Classic bug associated with this diagnosis. Classic histological finding in the diffuse type of this diagnosis. 119 RB Cs without central pallor + elevated MCHC + anemia. Diagnosis? Pathophysiology (including genetic defects and mode of inheritance)? Intravascular or extravascular hemolysis? Diagnostic testing (3)? Treatment. Post treatment care to prevent life threatening infections. 120 Hemodynamic parameters in septic shock (CO/CI, Mixed venous O2 saturation, afterload/SVR, Pulmonary Capillary Wedge Pressure, lactate).

Pharmacological management of septic shock (first line pressors, antibiotic strategies, fluid replenishment). A quick word on qSOFA (not HY for now). 121 Kidney “labs” in the 3 types of acute renal failure. Common causes. 122 Cor Pulmonale. Most common cause of right heart failure. 123 Papillary thyroid cancer (2 common histological findings). Follicular thyroid cancer (method of spread). Medullary thyroid cancer (Tumor marker, what accumulates in the thyroid?, genetic disease associations + mutation). General diagnostic testing strategies in thyroid cancer. Which has the worst prognosis? Seizures after total thyroidectomy. 124 Epigastric pain + Jaundice + Courvoisier’s sign + Conjugated hyperbilirubinemia in a long term smoker. Diagnosis? Diagnostic testing? Tumor markers? Migratory Thrombophlebitis. Relief of severe jaundice and pain in unresectable disease. 125 What is the one commonly tested vitamin that should be routinely replenished in patients with hemolytic anemia? 126 Classic features of nephritic and nephrotic syndromes. Tram tracks. Subepithelial humps. Kimmelstiel Wilson nodules. Subepithelial spike and dome. Nephrotic Syndrome in a HIV+ patient. Normal appearing glomeruli on light microscopy. Apple Green Birefringence with Congo Red staining. 127 27 yo M was found down by his friend 13 hrs after they left a bar the night before. EKG is notable for peaked T waves. Creatinine is 4.5. Diagnosis? Pathophysiology?

128 Life threatening sinusitis in a patient with a HbA1 C of 9%. Bug? Treatment? 129 25 yo F with a history of T1 DM presents with a history of recurrent abscesses in the axillary and perineal region. Diagnosis? What is the most common cause of skin abscesses (bug)? Treatment options. 130 Total and fT4 levels in pregnancy. Best initial test in a diagnosis of hyperthyroidism. Graves disease (including pathophysiology). RAIU results in Graves vs Toxic Adenoma vs Toxic Multinodular Goiter vs Surreptitious T4 intake. Differentiating between surreptitious T4 use and other hyperthyroid states. Antithyroid pharmacology. 131 Gradations in the neoplastic potential of colonic polyps. Adenoma-Carcinoma sequence. Peutz Jeghers syndrome. 132 Sickle cell disease (pathophysiology). Vaccine strategies (what and why?). Osteomyelitis in a SS patient. Painless hematuria in a SS patient (or SS trait). Aplastic crisis in a SS patient. Classic peripheral smear findings. Treatment strategies. 133 Worst headache of a patient’s life. PE is notable for palpable bilateral flank masses. Diagnosis? Pathophysiology (genetics)? Associations (cardiac, brain, etc). 134 CREST syndrome vs Diffuse scleroderma. Clinical presentation. Associated autoantibodies. Scleroderma renal crisis and treatment. Adjunct treatments. Nephrogenic systemic sclerosis 135 Sudden BP drop to 40/palpable in a patient who was recently placed on a ventilator with a PEEP of 15 cm H20. Diagnosis? Treatment?

Basic ventilator strategies-> Reducing hypercarbia, improving hypoxia. 136-Reviewing AV Blocks (+ common risk factors) First degree/Mobitz 1 blocks generally require no treatment. Mobitz 2/3rd degree blocks often require pacemaker placement. In unstable patients with heart blocks, consider some sort of pacing.

137 HY differences between cellulitis and erysipelas (by causative organisms, by involved layer of skin, by acuity of symptoms, by skin/systemic presentation). Treatment strategies. References -Toronto Notes -AAFP Asthma Management Guidelines

Insulin overdose/hyperinsulinemia, increased glucose utilization (e.g., sepsis), and impaired hepatic gluconeogenesis (e.g., starvation, liver failure).

Pneumonia/Infection (e.g., Pneumocystis jirovecii pneumonia - PCP).

Stones (nephrolithiasis), Bones (osteoporosis/fractures), Groans (abdominal pain/ileus), Psychic Overtones (encephalopathy/confusion). This constellation suggests chronic hypercalcemia.

Hypotension, muffled heart sounds, and elevated JVP (Beck's Triad).

Rose spots or generalized rash.

Staphylococcus aureus (especially on prosthetic valves).

Hypotension, muffled heart sounds, and elevated JVP.

Vibrio species (e.g., Vibrio parahaemolyticus) or other waterborne pathogens.

Netherton syndrome (or related metabolic disorders).

Opening snap followed by a low-pitched, rumbling diastolic murmur heard best at the apex.

Renal artery stenosis (RAS) or bilateral adrenal insufficiency/adrenalectomy.

Post-infectious Glomerulonephritis (PIGN).

Trichomonas vaginalis, protozoa.

Primary AI (Addison's) = Low Cortisol, Low Aldosterone, High ACTH. Secondary AI = Low Cortisol, Low Aldosterone, Low/Normal ACTH.

Pneumonia (often CAP).

Hypotension, muffled heart sounds, and elevated JVP.

Vibrio species (e.g., Vibrio parahaemolyticus) or other waterborne pathogens.

Netherton syndrome (or related metabolic disorders).

Opening snap followed by a low-pitched, rumbling diastolic murmur heard best at the apex.

Renal artery stenosis (RAS) or bilateral adrenal insufficiency/adrenalectomy.

Post-infectious Glomerulonephritis (PIGN).

Trichomonas vaginalis, protozoa.

Primary AI (Addison's) = Low Cortisol, Low Aldosterone, High ACTH. Secondary AI = Low Cortisol, Low Aldosterone, Low/Normal ACTH.

Pneumonia (often CAP).