.A picture of Basal Cell Carcinoma was shown, asked for dx?

2.A patient had acute endocarditis (splinter hemorrhages). Asked what is the most
common bug? Staph Aureus #4398,8879

3.Central Diabetes Insipidus?

4.Behavioral: The patient is sick, the family wanted them to take advance
directives but the patient indicated �no heroic measures� (No DNR/DNI)�what do you
do? Autonomy/respect the patient�s wishes (i.e. follow the advance directions
already in order)

5.Picture of a penis � �painful/painless� ulcers and a rash that came and go.

6.Patient presented with typical GERD�tried life style modifications (i.e. lose
weight) but no help. What is the next best step? Start PPI

7.A 52-year old female comes in, what is the next best thing to do for her?
Mammography

8.Patient was in the 40s, normal health, no signs of �sexual activity��described

septic arthritis and asked what is the most common etiology? Septic Arthritis

9.Patient came in with chest pain and an EKG was already done (ST depression was
seen)�what is the next best step to do/check? Check troponin (diff b/w USA and
NSTEMI)

10.Patient came in with symptoms associated with the liver and asked what marker
would be associated? Options included CEA (colon, rectal), CA-19 (pancreatic), and
Alpha Fetoprotein (liver, testicles, ovaries)

11.What is the treatment of BPH? Alpha-blocker (-zosin) or Tamusolsin

12.A patient with �loose, foul smelling diarrhea� sick and can�t get out of bed and
Hepatitis B (essentially came off as immunosuppressed) and asked what is this due
to? AIDS

13.Hypothyroidism Q: Patient came in with weight gain, constipation. How do you

treat? Levothyroxine

14.Hypothyroidism Q: Patient came in with similar symptoms and asked the mechanism
of it? Autoimmune

15.Describes �CRAB� in a patient with Multiple Myeloma and asked what else would
you see? Osteolytic bone lesions

16.A patient came in with pain �worse on palpation�. What is this? Dx?
Costochondritis

17.Patient had DM and HTN and asked what is the best treatment? Hydrochlorothiazide
(#1 tx for HTN is Thiazides �based off race (Whites: ACEI and Blacks:
Hydroclothorothiazide)

18.Patient came in with presentation of osteoarthritis and was overweight, asked

what is the next best step? Weight reduction

19.Patient was �exercising� and found �blood in the urine�. Dx? Rhabdomyolysis

20.Patient had blood in the urine as well�Dx? Rhabdomyolysis

21.DVT/Heparin/Anticoagulation/ LMWH

22.Patient was a �truck driver� (i.e. immobile). What is he susceptible to? DVT

23.37-year-old woman, comes in and was a clerk in an office, no known exposure to

TB, asymptomatic, PPD was 8mm (>10 cut off for health care workers). What do you
do? Chest X-ray, Reassure and get annual PPD, re-do PPD in two weeks.

24.Patient comes in with upper and lower respiratory problems�typical

presentation�dx? Wegner�s Granulomatosis

25.Patient came in with eosinophilia and asthma�typical presentation�dx? Churg-

Struss

26.Patient came in with a female with pruritus, xanthomas, drank 2-3 glasses of
wine a week? AST: 30, AST: 25. Dx? Primary Biliary Cirrhosis (PBC)

27.Patient presented with typical signs of sepsis and asked dx? What is it? Sepsis

28.Patient came in with CHF and an Ejection Fraction <22% and asked what is this?
Systolic Heart Failure

29.Patient came in with Achalasia�know the presentation, dx, and tx � Young

patient, progressive dysphagia, difficulty swallowing solids and liquids, dx with
barium swallow and tx with dilatation and myometry

30.Which of the following should be done to lower the mortality the most? Lower the
LDL

31.Which of the following should be done in a patient with the lab value of LDL
195? Start statin therapy

32..A 32-year old man came in and no family hx of colon cancer and asked what is
the next screening he should get? Colonoscopy at 50 every 10 years

33.A patient came in with urethral discharge that was �clear� (assume that it is
Chlamydia)�what is this patient in risk of developing? Orchitis

34.After surgery- patient is now tachypnea and hypotensive�and the D-Dimer levels
shows LOW, what is the dx? Sepsis

35.4 EKG questions � One was a patient with lupus�experienced pain lying down, what
is it? Pericarditis

36.Guy has a history of hyper-trigylcercemia and CHF, pain that radiates to the
back�CT was revealed a mass at the head of the pancreatitis. Dx? Chronic
pancreatitis

37.Patient came in and an image was shown of a male who practiced �cupping� and he
was taking the following medications: aspirin, atorvastin, Lisinopril. What are you
going to tell him to do next? �discontinue the cupping

38.Lady woke up a papular lesion on back and spread to neck, how would you treat?
Antifungal, Steroids

39.A guy was HIV + has a +PPD, - chest x-ray. What would you do? Repeat PPD 6 mths,
give PPD 12 mths, treat with isoniazid 6-9 months
40.A 37-year-old lady has weight loss, thrush (HIV), what would you recommend for
the patient? Give pneumococcal with Hep B

41.Patient has breaks leg, had a hip repair, described a gram positive organism was
present, what is it? Staph Aureus

42.An African-American male came in with target cells 3 months ago still had it?
What would you do next? Flow cytometry, Gel Electrophoresis (thalassemia)

43.A 37-year-old male came in, no hx of colon cancer. What do you do? At 50 do a
colonoscopy, every 10 years

44.Guy has a bleeding vessel with the endoscopy, given packed RBC cell, hgb 4 to 6�
4 hours later still has melena? What do you do next? Colonoscopy, tag red blood
cell, give more PRB, or observation

45.Patient came in with a hx of hypothyroidism and asked what would you see? (Had
to know that hypothyroidism can cause pseudogout) Calcium pyrophosphate

46.Patient came in, lab values showed that CK is normal and ESR is elevated, what
is it? Polyrheumatic Rheumatica

47.Man is being described with pain in the jaw, going blind (Giant Cell Temporal
Arthritis), what to do? Give high dose steroids

48.Patient has �modeled lacy appearance��livedo reticularis�give Heparin

49.A lady is going in for a hysterectomy and she is taking metformin, aspirin,
simvastatin�what would you tell her to do? Stop Aspirin and metoprolol

50.Patient lying down on the buttock�describing sciatic pain? What regions? L5-S1

51.A guy has initial has pain when he eats, but now without eating, he has red
swallow right side of face? Sialadenitis (choices, TMJ, Sjorgren, etc)

52.Old man has slight dementia, peeing on himself, after the insertion of the Foley
of the catheter, drains 300ml of urine? What is this? Overflow incontinence

53.Sodium is LOW, multi-lung nodules, where is it? SIADH

54.Guy falls through the ice, EMS comes and he starts having the seizure? What
specific electrolyte caused the seizure? Hypercalcemia, Hyperkalemia,
Hypernatremia, Hyponatremia

55.Person has CHF (needed to know that it was transexudative) what would confirm
this? LDH <200 (Remember Light�s Criteria: LDH <200, LDH eff/serum <0.6 and
Protein/serum <0.5)

56.Person has gastric and duodenal ulcer, what does he have? Growth/mass in the
pituitary gland (MEN II)

57.ZES�know that to dx it�Gastrin levels

58.A person who is a chronic nursing home patient, what would you give?
Fluoroquinolone - Know the meds for HAP vs. CAP

59.A �gardener� was gardening and becomes hypotensive�breaths 110 breaths per
minute, what is this? Anaphalysis
60.Blood in the urine, protein in the urine, elevated AST and ALT, what would you
do? Liver biopsy, kidney biopsy, renal ultrasound

61.Women falls and breaks her leg, lab values show hypercalcemia (Ca2+= 14)? What
is the cause/ Myeloma

62.Patient has Neuropathy, what does he need? Pyridoxine (Vitamin B6)

63.A women had a lip lag and experience fatigue towards the end of the day
(Myasthenia Gravis)-where is it issue located? NMJ

64.A 24 AA lady, 10-year smoking hx, develops wheezing at night? Dx? Asthma

65.A child keeps losing weight, but had a normal diet and fatty stools as well as
dermatomycosis herpamtis? What is the dx? Gluten insensitivity (Celiac Disease)

66.Picture showed a penis, explained there was �painful� vesicular rash? HSV

67.Patient presented with COPD�what would you see? ? FEV1 and you will also see: ?
FVC / FEV1/FVC ratio. DLCO decreased in emphysema (<.8), FRC increased

68.A patient had a berry/strawberry hemangioma- what would you do? Reassurance

69.Patient came in having a disease, what do you do/tell the patient? Don�t report,
on insult the patient, basically �console the patient with empathy�

70.Person had surgery, creatinine is normal, but the creatinine jumps 2.6 after 2
days, what is the reason? ATN (renal issue), hypotension, etc.

71.Patient is on lithium and her sodium was LOW, what did she develop? Nephrogenic
diabetes insipidus (DI) � a patient with a history of lithium use presents with
copious amounts of dilute urine.

72.Woman has elevated BP but everything else normal, BMI was 23, what would have
decreased mortality the MOST? ACEI (Lisinopril therapy)�for the HTN

73.Known the difference between PSC and PBC�a female patient came in with pruritus?
Which one is it? PBC. PBC is females, A/W autoimmune diseases, pruritus, elevated
ALK-P, normal bilirubin, intrahepatic, Dx AMA + and endoscopy, Tx with
ursodexoycholic acid and transplant. PSC is males, A/W IBD (UC), pruritus, elevated
ALK-P and bilirubin, extra hepatic, Dx MRCP shows beading and ERCP shows onion skin

74.Guy came in with small testes, diabetes mellitus, hyperpigmention (typical

presentation of Hemochromatosis), what to do next? Check ferritin level

75.Patient had a Cushing�s disease�mass in the adrenals�how would you treat?

Enucleation of the mass or cryalabation of the mass

76.A person is taking methotrexate�must know that you can get folate deficiency as
side effect. What should you do? Give folate

77.A guy has an MI, FOUR days later, what did he develop? Papillary muscle rupture

78.What is the treatment if a patient has a warm, hot tender joint who is already
on vancomycin? Drain the joint

79.Patient came in with dorsal and radial aspects of the hand are compromised? What
is it? Tightening of the facia lata
80.Murmur�4 Qs � Split S2, left 4th intercostal space�what murmur?

81.Person has a high pPTH �association with what paraneoplastic syndrome? Squamous
Cell carcinoma

82.Kid has a non-tender mass in the anterior cervical lymph node�what is it?
Hodgkin Lymphoma

83.A kid came in with a viral infection a couple WEEKS ago and �tender� mass is
present. What is it? PSGN

52.EBOLA?
53.Acromegaly vs Pagets
54.Breast Ca + OCP use
55.Ca + Vit D
56.Osteomyelitis = MRI?
57.Hip pain?
58.Septic Shock
59.Sinusitis?
60.Home FOBT + in 1/6 = do colo or repeat fobt?
61.Impotence in DM MOA
62.IBS diarrhea = Vit D def?
63.Pancreatic CA = CA 19-9
64.Takayasu ateritis = Diff BP in arms?
65.Acne = Mechanical Follicule Infiltration
66.Call Family Meeting
67.Intention-to-treat analysis = 20/20
68.Guy s/p total thyroidectomy has + chovstek sign - tx = calcium gluconate?
69.ERCP?
70.CT Abdomen
71.Brick worker w/ calcium deposit in shoulder = Arthritis
72.Menierees
73.Hearing loss w/ family hx = Congenital Nerve Lesion
74.Dyspagia + Halitosis = Zenkers Diverticulum (Esophageal diverticulum)
75.MUGA?
76.EGD?
77.Pain radiating to inguinal area
78.Pre-renal azotemia
79.Folate Def?
80.Large tongue + DM = HFE vs Amyloidosis
81.Hemochoromatosis
82.Increased Iron
83.Nitrofurantoin for UTI in young female
84.Glucose 420, Sodium 122 = 3% Saline?
85.Thrombocytopenia = Give steroids?
86.Chest pain after fatty meal, ? w/ inspiration, ECG show ST-E in II, III. avF =
Pericarditis vs MI
87.RAP + PCWP + PAP???
88.Effusions w/ pH 6.9 = Empyema
89.Dyspnea 3d after surgery = Pulm Embolism
90.Emphysema PFTs = ? FEV1/ ? FVC / FEV1/FVC ratio
91.Chronic Asthma = ABPA
92.AST/ALT/ALP/GGT QQQQ
93.PPx if mom has N. meningitidies = Rifampin
94.MCV high, should have supplemented = B6 or B12???
95.Give allopurinol before chemo
96.Staph Epidermis
97.Cefepime?
98.Guy drowns/ coma = Hyponatremia/ Hypernatremia???
99.ALL hypers/hypos
100.Laxitive abuse
101.Muddy brown casts = ATN!!!!****
102.Eos = AIN***
103.Cr goes up during hosptial visit!!! *** = Contrast Nephropathy
104.Uremia + Pericarditis?
105.CKD and EPO
106.CKD and Uremia
107.Shishtiocytes?
108.Asthma?
109.Kidney Stones = Next step CT!!
110.Syncope = Neurocardiac if prodrome
111.Urine protein 4+
112.Sickle cell Aplastic crisis =
113.CLL cold agglutinins = IgM
114.DIC
115.Oral ulcers = SLE
116.Rash on eyebrows/ behind ears = Subherric dermatitis?
117.Penile ulcers bleeding painful = H. Ducaryi
118.Peeing dilute urine (DI) = head injury/surgery?
119.Thyorid nodule = Excisional biopsy?
120.Loss of sensation in anal area confirmed on radio = next step?
121.Varicies = Banding?
122.MEG pain worse w/ eating (Gastric ulcer) vs better w/ eating (Duodenal ulcers)
123.RUQ pain + fever + jaundice = ERCP
124.Acute pancreatitis
125.Chronic pancreatitis
126.Fatigue, Night sweats, weight loss = CML
127.P. Vera
128.Contact dermatitis
129.Old man with PNA hospitalized becomes unconscious - judge says he's incompetent
& assigns lawyer as his guardian - he has a wife and competent daughter - he needs
to be moved to nursing home, who has to give consent, wife daughter or guardian?
130.Guy weighs 78 kg - which has more reliability and less validity - gives sets of
5 numbers - i put the ones closest to 78 going either way
131.Pericarditis ekg - tx = ibuprofen
132.Lady gardening yest and develops itchy oozing rash on hand - what is mechanism?
IgE or macro release cytokines or complement
133.Teen has a bunch of acne all over body - mom says its bc of his bad diet - eats
fast food every day - mechanism for acne = mechanical follicle infiltration or
increased triglycerides?
134.Redness and pealing skin btwn toes that w improved by changing sneakers and
shoes = dermatophytosis?
135.Guy with normal kidney function about to get contrast = give him IVF before
136.Guy s/p total thyroidectomy has + chovstek sign - tx = calcium gluconate?
137.Woman with hirsuitism, cushinoid face - adrenal tumor - dexa suppression test
shows no suppression with high or low - what do u do? Adrenalectomy? Pituitary
irradiation?
138.Guy with h/o cholelithiasis but no cholecystectomy p/w pain, nausea, vomiting,
total bili 10 - next best test = hida? Ercp?
139.80 y/o af am woman on tea and toast diet has anemia with high mcv = B12 def?
Acd, ida, folate def, sideroblastic, thalassemia, sickle cell?
140.Old guy with 3 episodes of vertigo, tinnitus and nystagmus - bppv or meniere?
141.Glucagonoma, vipoma, etc.
142.Dysphagia + white plaques in hiv + = esophageal candidasis
143.Dysphagia + gerd = schitz Ring? scleroderma (but no pulm or any other
involvement)?
144.27 y/o girl undergoing chemo/rad for scc of cervix is having hot flashes give
her estrogen? Medroxyprogesterone?
145.Cold leg = phlegasma cerulea dolens
146.Acute pancreatitis - next step = CT abdomen
147.70 y/o lady with progressive memory loss for past 4 years started a small fire
in kitchen the other day - give her donepezil
148.Guy was painting house and then had bad shoulder pain - could abd arm above 90
- showed XR but nothing looked broken to me so i put rotator cuff tendinitis?
149.Guy with copd or smoker or something has swelling of the face and b/l
extremities - svc syndrome?
150.Person can't get up from a chair - weakness in lower limbs - i thought they had
polymyositis - what is going to show on bx? Muscle infiltration with blah blah blah
151.Guy can't feel thumb or move it - what nerve? Radial? or median?
152.Lady comes in for pre-op & she's perfectly fine except she says she was told
she had a murmur when she was little - next best step? Ppx with atb or nothing?
153.Guy was sirs + and had uti = sepsis
154.Lady gets rash when she goes outside and also has arthritis = answer was SLE or
the Ab's
155.Guy with copd is put on 4L oxygen at hospital and then goes into coma - why? Bc
of too much o2?
156.Know how to correct hypo and hypernatremia - I forgot which one it asked about
- either NS or D5W
157.Thrombocytopenia of 20 = give steroids
158.Glucose 1000, in & out of consciousness = HONKC
159.Old man with HTN had a stroke that affected left side of his face and right
side of his body, no sensory loss I was between capsular and pontine stroke, I
forgot which was motor stroke.
160.Patient had pain of his leg, recently had A. fib arterial occlusion, asked
what caused it I put atrial emboli, other option was arterial thrombus.
161.Lady has a rash 24 hours after she was cutting weeds earlier t-cell mediated
hypersensitivity.
162.Patient had alopecia and skin lesions, what to do next heavy metal test (zine
deficiency).
163.Old lady dying from cancer refusing Tx, she�s competent and aware of her
prognosis, family wants Tx, what do you do IV morphine.
164.Patient had recurrent resp infections bronchiectasis.
165.47-year-old man has asthma attacks, smoker of 25 years, dad was Dx with
emphysema and cirrhosis at age of 37, what do you do for him measure A1AT.
166.Old man with tender prostate and increased frequency urination, dysuria
prostatitis.
167.Patient with night sweats, weight loss, hemoptysis and fever, CXR shows upper
lobe cavitation TB.
168.Patient with hemoptysis and hematuria anti-GBM.
169.Patient with asthma, what�s MOA bronchial hyperresponvisve
170.Patient with sudden headache, has bitemporal hemianopsia and other pituitary
hormone deficiencies, shows MRI of God knows what pituitary hemorrhage is the only
option that made sense to me.
171.Patient with Sxs of SIADH and a mass on CXR small cell carcinoma.
172.2 questions same options, different scenarios asked what is causing the
hyponatremia
173.one I put CHF because they gave Sxs of HF
174.this one had nausea and vomiting so I put intravascular fluid depletion because
all his electrolytes were down
175.2 questions same options, different scenarios asked what is causing the pleural
effusion
176.one I put empyma because pH was <7.2 and glucose was <50
177.I don�t remember the other one
178.Patient had dental infection and taking Amoxicillin but is allergic what do you
switch it to I put Clindamycin because figured it�s anaerobes in oral cavity,
other options were Cefixime, and other �-cillin�.
179.Man with 5 painful penis ulcers and painful inguinal adenopathy, what caused it
I put H. Ducreyi, but I just looked it up and HSV is usually multiple and ducreyi
is usually one.
180.Patient with �mono-like� Sxs, fever, LAD, random shit but he�s got multiple
sexual partners, what does he have acute HIV infection.
181. I could be way off on this one but there was a female patient who wasn�t
lactating and no period for like 3 weeks after she had removal of a mass or
something, looked like choriocarinoma to me, asked what do you do next I put
dilatation and curettage.
182.47-year-old female no period for 3 months, sexually active with husband
pregnancy test.
183.Patient had all labs normal but cholesterol is 260, what to do next I put
thyroid function tests.
184.Patient had CHF what kind of pleural effusion, you need to know its
transudative and what would you see protein ratio of <0.5 (Know the Light�s
criteria).
185.Girl has acne that won�t go away, washes face 3 times a day and she thinks its
because she eats too much chocolate, what would you tell her eating less
chocolate, wash her face more, PHisoHex? I put that last one cause other options
didn�t make sense to me. I don�t even know what that is.
186.Screening for colonoscopy at 50 then 10QY
187.Patient from Arizona was in a cave with bats histoplasmosis.
188.Patient was vomiting what electrolytes you see, up/down arrows for Na, K, HCO3,
Cl I put increased Na, decreased everything else.
189.Patient with MI, BP drops what kind of acid-base metabolic acidosis I think
because of lactic acid.
190.Patient with hyperthyroid Sxs but didn�t give Grave features I put toxic
adenoma. Grave was an option.
191.Patient was walking in the cold snow, and shows a picture of his foot half
turned black and said there�s faint pulse above the ankle, and asked what to do I
put amputate half the foot.
192. Patient comes in with her mother who has OA and shows a picture of her hand
(wrinkly and old), daughter says how can she prevent it from happening to her hand
I had no idea. Options I was debating, exercise daily for an hour, counseling on
how to cope with it, or there�s medications for the pain and inflammation to treat
it.
193.EKG of ST-elevations all over, and says patient feels better when inspiring and
lean forward, ask what she has pericarditis.
194.EKG of MI.
195.EKG of SVT and asks what to give IV Adenosine.
196.Picture of Rocky mountain rash and know the bugs that cause them
197.Patient with PBC and asks the values of bilirubin, Alk-p, AST, and albumin, it
was up/down arrows.
198.Patient with diarrhea and multiple duodenal ulcers, what is increased gastrin.