Step 3 Showdown

What is a common complication of cardiac catheterization?

(Vascular complications). Localized or retroperitoneal bleeding from arterial access site. Radial artery approach is safer.

What are the contraindications to pertusiss vaccine

1. Anaphylaxis (common to all vaccines) 2. Encephalopathy within 1 week of administration 3. On-going neurologic conditions (You do not want to confuse the diagnosis in case encephalopathy develops)

What are the symptoms of Rosacea?

1. Flushing 2. Papules and pustules 3. Telangiectasia 4. Middle-aged people Precipitated by rapid change (increase) of body temperature - sun, hot drink, emotions. Differentiate from SLE and acne. Treatment is topical metronidazole - for pustules, laser surgery for telangiectasia.

What are the two ways to reduce nursemaid elbow?

1. Hyperpronation (preferred - less painful, more successful) 2. Supination and flexion (more painful, less successful) Listen for pop sound which indicates successful reduction. No NEED for XRAYS

Every 1% of HbA1c is equivalent to?

35mg/dl increase in average blood glucose

What is the minimum time for treatment of single episode of depression?

6 months!

What is an immediate consequence of positive pressure ventilation?

Abrupt increase in intrathoracic pressure which may cause acute reduction in venous return, worsen hypovolaemic shock and cause death. - just like a valsava maneouvre. Also, it may worsen a tension pneumothorax. Thus a chest tube must be placed along side it in suspected cases of lung injury

What is the metabolite of cyclophosphamide that is responsible for haemorrhagic cystitis and bladder cancer?

Acrolein

What is a normal post-operative finding following abdominal surgery?

Air under the diaphragm!

Treatment for enterobiasis

Albendazole or Pyrantel Pamoate (pregnant women). Treat all household contacts.

What is the side effect of methicillin?

Allergic Interstitial Nephritis

What is the difference between amaurosis fugax and retinal detachment?

Amaurosis fugax - curtain falling down, transient Retinal detachment - curtain coming across, permanent without intervention

What are the differences between anaphylaxis and anaphylactoid reaction?

Anaphylactoid reaction is not IgE mediated and does not require prior sensitization

When you see signs of UMN lession in down syndrome suspect what?

Atlantoaxial instability - weakness of posterior transverse ligament which causes increased mobility between C1 and C2 resulting in spinal cord compression. Treatment is surgical fusion of C1 and C2

What is the main predisposing factor for orbital cellulitis?

Bacterial sinusitis

A woman has defeminization signs/symptoms and becomes masculinized. Diagnosis?

Basically a transgender. Exogenous androgen use or Sertoli-leydig cell tumor

What is the first line treatment for trypanosomal disease

Beznidazole

What are the differences between CVID and Bruton's Agammaglobulinaemia?

CVID Normal lymphatic tissues, normal B cell counts, decrease Ig and increased risk for lymphoma XLA Absent lymphatic tissues, absent B cells, absent Ig and no risk for lymphoma (more severe)

Ring/Contrast enhancing lesions in the head can only be what?

Cancer (lymphoma) or infection (toxoplasmosis)/brain abscess

Differences between Candida oesophagitis and viral oesophagitis?

Candida - oral thrush, mild odynophagia, severe dysphagia Viral - no oral thrush, severe odynophagia, mild dysphagia Do UGI Endoscopy + biopsy to be sure Candida - white plaques HSV - vesicles and ulcers CMV- deep linear ulcers

What is the treatment for Trigeminal Neuralgia?

Carbamazepine. If refractive, do Gamma Knife Surgery (Using radiation to cut)

What are the 2 important poisoning following inhalational injury?

Carbon monoxide and cyanide poisoning

What test is very good at detecting trisomies?

Cell-Free Fetal DNA

Where do medulloblastoma arise from?

Cerebellar vermis

DOC for Aspiration Pneumonia

Clindamycin

What is the management of rib fracture?

Conservative - Analgesia!!! So as to allow for breathing and prevent pneumonia

What is the management of acute alcoholic pancreatitis

Conservative - NPO, Anagelsics and IV Fluids

What is the single most common cause of culture negative endocarditis?

Coxiella, followed by Bartonella

What is the sequence of appearance of shingles; Rash then pain or pain then rash?

Either one! When pain precedes rash, the diagnosis may not be obvious!

What is the treatment for SAH

Endovascular coiling or surgical clipping to prevent rebleeding - endovascular coiling is superior

How often should colonoscopy be done?

Every 10 years from 50 years

How often should mamography be done?

Every 2 years as from 40-50 years till 75

How often should pap smear be done?

Every 3 years from 21-65 years. If HPV testing is added, then every 5 years.

What is the prognosis of testicular cancer?

Fantastic!!! Managed by surgery (Inguinal Orchidopexy) followed by radiation for local disease or chemotherapy for metastatic disease. Chemotherapy can cure any degree of metastatic disease!!!!

Sickle cell osteonecrosis commonly affects which bones?

Femur and Humerus

Infantile hypertrophic pyloric stenosis is common in?

First born boys

What is the rare-disease assumption?

For rare diseases, the odds ratio approximates the relative risk

Tick borne paralysis may mimic what?

GBS - but there is no fever and ANS dysfunction. Look for tick. Removal results in magical improvement.

What is the treatment for the various myalgias?

Giant Cell Arteritis - High-dose prednisolone Polymyalgia rheumatica - low-dose prednisolone Fibromyalgia - exercise and aerobic conditioning. If it does not work, give TCAs (Amytryptiline)

A woman is 60 years old and is yet to attain menopause. Her estrogen level is higher than expected. Diagnosis?

Granulosa Cell Tumor. Causes precocious puberty in children, post-menopausal bleeding in elderly. It may mask menopause if it occurs before menopause

What is the difference between lens dislocation in marfan syndrome and homocyctinuria

Homocytinuria - downwards Marfan syndrome - upwards

What is enthesitis?

Inflammation and pain at sites where tendons and ligaments attach to bones. It is common in Ankylosing Sponndylitis and classically involves the heels.

Which 2 vaccines are beneficial for adults?

Influenza and Pneumococcus. Influenza every year. For pnuemococcus, If; < 65 but with chronic disease, give PPSV23 <65 but with serious risk give PCV13, then PPSV23. For every one above 65, give PCV13, then PPSV23 3 months later

What is the MOA of ecallantide?

Inhibits kallikren which is needed to produce badykinin. Useful only for HAE

Wassup with PSA test in prostate cancer?

It has no mortality benefit. A normal test does not mean no cancer. Not routinely done except patients request it. Requests should be denied for all patients 75 years an above.

What is the Kliehauer Betke Test (KB Test)?

It is used to calculate the dose of Rhogham to give. It essentially measures the percentage of fetal cells in maternal blood

Lytic bone lesion in children suggest?

Langerhan Cell Histiocytosis

What is the current preferred surgical management of breast cancer?

Lumpectomy with radiation - equally effective as modified radical masectomy but less deforming.

What 4 common cancers have no screening tests?

Lungs, Ovarian, Pancreas and Prostate

People with CVID are at high risk for?

Lymphoma

What medications cause cholestatis?

Macrolides, Ceftriaxone

What screening test has the greatest mortality benefit?

Mamography over 50 years

What is the biopsy finding in factitious diarrhoea (laxative abuse)

Melanosis coli - brownish discoloration of the colonic epithelium with lymph follicles shinning as pale patches

What is the difference between methanol and ethylene glycol poisoning?

Methanol damages the eyes, ethylene glycol damages the kidneys.

Is steroids useful in hereditary angioedema?

NO!

What is the cause of whistling noise during breathing following a nose job?

Nasal septum perforation usually due to septal hematoma

Do the polyp syndrome require increased frequency of colonoscopy?

No

Is gag reflex present in everybody?

No! 20% of normal people do not have it

Is the GCS used for diagnosing coma?

No! It is used to predict the severity and prognosis of coma

What medications causes hyperkalaemia?

Non-selective Beta-blockers, Digoxin, Trimethoprim, ACE Inhibitors, ARBs, K Sparing diuretics, NSAIDS, Cyclosporine, Heparin, Succinylcholine

What is courvoisier sign?

Non-tender palpable gallbladder in a jaundiced patient - obstructive jaundice

What is the treatment for strawberry hemangiona?

Nothing, they grow rapidly, then spontaneously regress. However, some may require beta-blockers and some, excision if found in sensitive place.

What is the side effect of aromatase inhibitors?

Osteoporosis - Despite this, it is slighty superior to SERMs for hormonal manipulations of breast cancer

What are survivors of sexual assault most at risk for?

PTSD, Depression and Suicidal ideation and attempt

Common side effect of Doxycycline?

Photosensitivity

What is a common complication of dihydropyridine Ca channel blockers?

Pitting Pedal Edema due to vasodilation that causes peripheral pooling of blood and increase hydrostatic pressures in the lower limbs - every other thing will be normal

What is a not so common, but not unexpected complication of passing central venous lines?

Pnuemothorax This is why you MUST do a CXR after passing a central venous line to be sure it is well positioned and there are no complications.

What increases the risk of latex allergy?

Pre-existing atopic dermatitis

What is the greatest risk factor for ectopic pregnancy?

Previous ectopic pregnancy!!

What drugs are useful for anorexia and wasting seen in cancer patients?

Progresterone analogs (Megestrol Acetate, Medroxyprogresterone Acetate) and Corticosteroids. Progesterone analogs are preferred because the have less side effects. Cannabinoid has been shown not to be better than placebo!!!

Grotton papules are similar to what?

Psoriatic arthritis plaques. Psoriasis involves the nails and DIP

What is a differential of cardiac tamponade?

RVMI - be careful with nitrates and diuretics, they can precipitate cardiogenic shock. Also constrictive pericarditis. Echocardiography can differentiate.

Selective IgA deficiency makes one prone to what?

Recurrent mucosal infections and Chronic gardiasis

What causes primary dysmenorrhea?

Release of prostaglandins from the endometrium which causes uterine contractions

What are the two most common causes of metabolic acidosis with a normal anion gap?

Renal Tubular Acidosis (RTA) and Diarrhoea. The Urine Anion Gap (UAG) (Urine Na - Urine Cl) can differentiate the two! This is because RTA has hyperchloremia and hypochloruria, and diarrhea has hypochloremia and hypochlouria. RTA - UAG is positive Diarrhea - UAG is negative

What is a musculoskeletal complication of cocaine intoxication?

Rhabdomyolysis

What is a common complication of endotracheal intubation?

Right Bronchus Intubation. Just move the endotracheal tube 1-2 inches above the carina

Acute onset of back pain and hypotension are concerning for?

Ruptured AAA especially in an elderly person.

What two personality disorders are associated with brief psychotic episodes?

Schizotypal and Borderline personality disorder. It is typically due to stress

What is the most accurate test for diagnosing chronic pancreatitis?

Secretin Stimulation Test

What is a contraindication for Buproprion use in smoking cessation?

Seizure Disorder

All post-transplant patients should receive what medications and immunization?

Septrin against PCP and Toxo, and Ganciclovir against CMV. They should also be vaccinated against Influenza, Pneumococcous and Hepatitis B

A likely malignant colonic polyp will be?

Sessile, villous and > 2.5cm

What kind of anemia is anemia due to alcoholism?

Sideroblastic anemia - which may be microcytic or macrocytic. Sideroblastic anemia can be improved by pyridoxine.

Which prostate cancer treatment modality is more likely to give erectile dysfunction? Surgery or radiation?

Surgery

What 2 things stimulate prolactin production?

TRH and Serotonin

Nasal packing following surgery can lead to?

TSS

What are the differences between tennis elbow and golfer elbow

Tennis Elbow (lateral epicondylitis) Repetitive contraction of extensor muscles. Pain is felt with passive wrist flexion and wrist extension is resisted Golfer Elbow (medial epicondylitis) Repetitive contraction of flexor muscles. Pain is felt with passive wrist extension and flexion is resisted.

What is the best position to situate a subclavian central venous line?

The junction of the SVC and Right Atrium. Problem arises when it enters the heart because it can touch structures: Touches atrial wall - atrial fibrilation Touches tricuspid valve - endocarditis Touches interventricular septum - Bundle Branch Block

How is Lewy Body Dementia different from Parkinsonism

There is early onset of dementia, visual hallucinations and altered mental status

What is the difference between spontaneous pneumothorax and tension pneumothorax?

There is mediastinal shift to the unaffected side in tension pnuemothorax and it is a medical emergency - needs needle thoracotomy asap before chest tube!

What are the signs and symptoms of intrahepatic cholestasis of pregnancy?

Third trimester jaundice, severe itching (of the palms and sole) unresponsive to antihistamine, no rash. Treated with ursodeoxycholic acid. Disappears with delivery.

What is the most common cause of hip pain in children?

Transient synovitis. Usually follows a mild URI and examinations and investigations are essentially normal. it is treated with NSAIDS and rest.

What is the difference between Criggler-Najjar Syndrome type I and II

Type I is more severe and is unresponsive to attempts to induce liver enzymes by phenobarbital. It invariably leads to kernicterus. Type 2 is less severe and can be managed with periodic phenobarbital.

What is a differential for abruptio placentae?

Uterine Rupture

What is a differential for placenta previa?

Vasa previa - fetal vessels are trapped between the baby's head and the internal OS. Is is characterized by painless bleeding which begins upon ROM. Baby is rapidly compromised, mother is spared. Emergency CS is indicated

How does parvovirus B19 infection present in adults?

With athralgias!!! Very similar to RA but with largely normal physical exams and no systemic symptoms! Common among adults who are in close contacts with kids - resolves within 2 months

How often should a patient be turned in order to prevent decubitus ulcer?

every 2 hours

An elderly person fractures a rib while coughing. What do you suspect?

pathologic fracture

Patients with Gilbert Syndrome become symptomatic in what circumstances?

stressors like FASTING, physical exercise, fat diet