step 2 high yield Q s..!!!
1. DX of achalasia (lady with narrowing of oesophagus) 2. Hypovolemic shock (CO LOW, PCWP LOW)
3. Normal pressure hydrocephalus (triad given but they asked the mechanism - imparied csf/ overproduction of csf)
4. dx of alzeimer dementia
5. what is reduced in restrictive ds (FEV/FVC, TLC, ERV, IRV)
6. Q desribed by drjiggy same came in my exam on dementia pt whose husband is not willing to keep her in the nursing home and wife doing sexual advances Mx???? 7. treatment of human papilloma virus
8. girl of 5 yrs talking at home but is silent in class. 9. treatment of tourette syn
10. association of tourette syndrome (ADHD same q on uw surprised how well UW has mastered the exam prep )
11. wiskott aldrich (triad was given)
12. IgA deficiency mx (plz see the book remember it is not immunoglogin admistration) 13. Sheehans scenario - what is reduced= prolactin
14. tumour picture of spine and histolgy photo also given and asked which type of tumor -no idea )
15. dx of fetal alcohol syndrome
16. ethics: a 7 YEARS boy dx with ALL and chances of his survival with tt is 80% parents not ready to get him treated. what will you do.
17. incomplete abortion dx 18. complete abortion dx
19. pt with stab wound VITALS NORMAL what next== laparotomy 20. DX OF pericardial tamponade
21. open hemothorax
22. PID. Increase risk of ----I chose infertility.
23. 20w pregnant woman had a vaginal bleeding with some effacement and dilation. (preterm labor w/o problems) What's next?
24. 37 y.o. pregnant woman. decreased level of ALP (fetal size matches with the dates) What to explain to her?
25. Annual pap smear, first episode of atypical cell finding. Choose from among corn biopsy, point biopsy, surgery, recheck one year later, and recheck 6 months later. 26. Young lady needs advice for contraceptive. What's best? Choose from among condom
only, condom+OCP, and combination OCP (what's this?)
67 y.o. woman w/o problems on regular checkup. What to recommend? Pap, mammo, or nothing this time.
27. 4 y.o. boy who is already trained urination recently wet bed. No option about new-stress, UTI, and Diseases.(I simply chose reassurance.)
28. Bee allergy (Mira's note #6) 29. Cyclothymia (Mira's note #15)
30. Bipolaror (obvious)
31. Schizo or Major dep w/ psych,,, confusing, looks like symple schizo 32. Schizo (obvious)
33. Picture of EKG (which has delta-wave), mechanism?---chose re-entry (Mira's note #34?, it was not confusing in my case)
34. Picture of EKG with 3-degree block, answered 3rd block (Mira's note #33)
35. Type 1DM boy before entering basket ball club. What to advice? Choose from among limit activity in 30 mins, reduce insulin and other options.
36. Shipyard worker, looks like having mesothelioma. Choose asbesto.
Pt after MVA, who is found to have ruptured spleen. Vital stable. What's next? 37. Malignant melanoma.
38. 17y.o. boy with nausea/vomitting (bloody), living with mother who is taking Iron supplement and Acetoaminophen. I chose he took her Acetoaminophen a lot. Picture of badly displaced clavicle fx. Treatment? (Pinning, Open surgery, conservative, external fixation)
39. Feeling funny of hands. Pushing wrist excerbate. I chose carpal tunnel syndrome 40. Mid humeral bone fx. What nerve impaired?--radial nerve
41. scoliosis (Mira's note #3, I wrongly chose DEXA....) 42. PPV from chart, 5-second question (Mira's note #7) 43. Splenectomy(Mira's note #11)
44. Tyramine crisis (Mira's note #20)
45. HIV, CD150, prophylaxis (Mira's note #28)
46. Picture of painful hip-femoral of Sickle cell kid (Mira's note #28) 47. Splenectomy make patient
48. Picture of foot ulcer in DM patient. Debridement, amputation, or topical steroid? (Mira's note #27?)
49. Amniofluid thrombosis case
51. 30y.o. woman with injection of eyes and multiple arthralgias. 52. Boy of mildly mental-retardated with large ears----fragile X? 53. Pt under chemotherapy for cancer. Arthralgia---I chose uric acid
54. Substernal pain after meal, who was found to have hiatal hernia. Need your advice. I chose sleep with head up. other options are surgery, reassurance. (No PPI included.) 55. Substernal pain after meal and exercise. confusing..
56. Becoming forgetful 74y.o. Dx among alzheimer, aging, depression, stroke. (Looked like simple aging)
57. Pt with only hypertension. I chose thiazide (This topic was argued in this forum before)
58. Patient has cancer with metastasized. You told him and his family before that the expectancy will be 6 month. His is now found to have brain metastasis and become strange. What to explain? (correct the expectancy period, he will be fine, or
something..)
59. How to treat with TB patients? Should they be packed in single-room, or mix with non-TB patients? (No option to wash hands or wearing gown)
60. 6-months baby's well-being evaluation and choose the best set, which seems normal-normal-normal.
Well, I got exhausted. I can add more if I recall more. Allow me for the disorganization.
I only studied for 1 month and half, only finished UW questions. (I couldn't finished 2nd round of UW).
I didn't have Kaplan dvd or Kaplan note..(.Where are they available?) I think I failed this time, but good Luck to you all.
1) screen: lady 62y/o, normal pap & cholesterol, heart and lungs for years, what to scren for? (mamography)
2)lady menopause, no HRT, back pain, screen for osteoporosis with DEXA/CT/MRI 3)lady menopause, no HRT, kyphoscoliosis...do: DEXA/ pet scan/ bone scan 4) man, 32, fam history of CAD, what to screen for?-cholesterol
5) female, 32, fam hist of colon cancer, when to start screening: colonoscopy now/at 40/at 50or sygmoidoscopy at 50
6) history of allergy to bees stings: where long sleeved clothes, avoid bushes, carry epinephrine ( someone else posted this before, i had the same q)
7) positive pred value-calculate from 2x2 chart 8) cluster headache- prophylaxis
9) trigeminal neuralgia-tx with carbamazepine
10) elective splenectomy for TTP, what vaccine to give before surgery? (except pneumo)
11) splenectomy at 9y/o, now 23 y/o, had pneumo, what other vaccine is needed? (i only had hep A< hep B , meningoccocal (does it exist?) and influenza to chose from) 12) splenectomy 10 y ago, now pulm inf with gram pozitive, what is the pathophys 13) REM sleep disorder ( same as the q in UW)
14) reactive attachement dz,4y/o girl who had probl only with dad, teacher and doctor where ok
15)cyclothymia- man, depressed/maniac for 3 y 16) major depressive dz vs grief...2y after wife died
17) oppositional defiant dz- kid who argued with everybody, but had good grades 18) chronic schizo, get halloperidol and NMS after..what to treat with
19) media clip: murmur in kid of diabetic mom
20) thyramine crisis, lady at restaurant, takes MAO inhib
21) risk for fetus if mom gets in contact with people with parvovirus B19
22) only urethral pain on urination, no frequency/urgency/fever etc...what is it? (non gonoccocal urethritis?)
24) placenta previa-bleeding, no pain, fetus transverse lie
25) female depressive adolescent, 2 suicide attempts, but says she won't do it again, admit to psych unit or treat with fluoxetine?
26) HIV, 37y/o married with attorney, doesn't want mechanical ventilation for pneumonia, husband ask you to do it anyway
27) diabetic with foot ulcer, what causes it (derma picture) 28) HIV, CD count 150, what to give prophylaxis for
29) sickle cell female, pain on hip, normal X-Ray, what does she have? (X-ray shown) 30) female, pain on hip, very ugly x-ray (shown) with necrosis, on femoral neck and intertrochanterian, but not on fem head
31) single liver mass- measure alpha-FP levels
32) study surgery vs stent for carotid stenosis, gave 3 results from 3 studies, asks to interpret (confusing)
33) ekg: third degree block, pulse rate of 38/min
34) ekg: looked like WPW, but the history was like HOCM...confusing (athlete on basketball
35) kawasaki-tx
36) osgood-schlatter in teenager athlete 37) slipped cap fem epyphisis- chubby 14 y/o
38) female, very high thyroxine level, very low TSH, all the signs for hyper thyroidism, lived with sister who took levo thyroxine for hypothyroidism- exogen adm??
39) pigmented lesion, grew over 2 mo, and after other appeared around it, also pigmented (derma picture)-melanoma
40) 9y/o girl, developed breasts and pubic hair, dresses like her mom, pretends to be older, mom takes OCP- what is the cause: mom's OCP/estrogen
lotions/Puberty/pituitary adenoma
41) male, around 50 y/o, has developed gynecomastia and and small firm testes low TSH, LOW T3 T4, what is the cause
42) varicella after splenectomy, what is the cause (derma picture)
43) female, marathon runner, pain on knee, normal XRAY (shown) no tenderness over tibial tubercule, full range of motion, what is it?
--rosacea --acne
--seborrheic dermamatitis --seborrheic keratitis --porphyria cutanea tarda
--Corticosteroid induced mental changes --Dementia Vs normal age related changes --Calculate negative predictive value --Interpret Odd ratio
--Investigate primary amenorrhea --Investigate ambiguous genitalia --Erosive esophagitis - Mx
--Sjogren syndrome
--Scleroderma - which ANA is raised --Serum sickness --Mx of intermittent claudication --Mx of pressure sores --Mx of status epilepticus --Mx of Alzheimer --Diagnose Parkinson Malignant hyperthermia Malignant neuroleptic syn Heat stroke
Heat exhaustion - how each presents
--Pathophysiology of all neurological diseases eg GBS, syringomyelia, myasthenia --How to investigate hypertension
--Diffuse esophageal spasm - Tx --Lots of cardio
- MI, unstable angina, stable angina - ASD, VCD, TGA, Coart - arrhy and Mx --Schizophrenia, brief psychotic disorder, acute stress disorder, PTSD, Adjustment disorder, delusional disorder
--Substance abuse - cocaine, cannabis, opioid, marijuana --Trauma - aortic dissection
first of all exam is completely based on concepts exam is tougher than nbme 3
usmle world gives u orientation i didnt get any video clips there were 4 ecgs
dermatology dx of rosacea
dx of seborrheic keratitis
acne prevention - options were avoiding fatty foods oily based creams washing with soap water
psychiatry
many qs on dementia almost every type of dementia delirium
alcohol withdrawal treatment panic disorder rx
panic disorder with agoraphobia rx and dx dysthymia
mdd rx
generalised anxiety disorder rx
depression due to medical condition hypothyroidism immunology brutons digoeorge scid aids haematology ddx of lymphadenitis fe def folate def mgus
multiple meloma ttp
hus cardilogy
ekgs on acute pericarditis svt afib mi rx of svt dx res cardiomyopathy dx of ar rx of as resp asthma mx
excercise induced asthma rx volumes in asthma
ards
copd developing into corpulmonale
asbestos worker non smoker cancer bronchogenic or mesothelioma musculosketletal
myasthenia pathophysiology
polymyalgia rhematica with gaint cell arteritis developing blindness sjogren syndrome dx
tension headache cluter headache dx multiple sclerosis dx
gynecolgy qs were eassy very few paeds and surgery qs
i will post some more topics as i remember i dint do well in the exam waiting for results
1) Ascities tap finding : hemooragic/atypical cells/ ----?D ---OP Malignancy , TB 2) AScities findings: wbc> 750 ---?d ---sbp
3)32 y m h/o whip lash car accident injury 2 year age came with b/l wasting of small muscles of hands and senory changes ---?d---op: Amotrophic lat sc/syringomylia/ MS/cervical spondylosis/disc prolapse
4)HIV pt female cd4 <200 -and leukoplakia ---what next step of mangement ---OP: TMX SMX/TM SMX+Pap smear/ MMR/ DTP/ pap smear
5) mechanism of action of indomathacin in closing pda
6) 15 y old out for camping with mates ----every one got dry cough, his cxy showed b/l LL infiltrate ---?RX---amoxicilline/azithro/doxy/none
7) bmi 34, b/l knee pain , smoker , sedentary, ----what will reduce her risk for OA ----OP. smoking/wt red/ activity/ etc
8) smoker 50 pack year history , 2 weeks h/o jvd raised, liver enlarged, pitting edema ---?d---op: LVF/constricted pericarditis/RVF/ CM
9)strongest risk factor for adenocancinoma of lung ---op:radon (i have forgotten other options but definitely smoking and asbestos were not in the list!) 10) too many questions on personality disorders and dementia and delirium 11) 6 m old few weeks h/o recurrent abd pains with legs crawling, NV and PR showed blood with mucus ---?d---OP: meckle diverticulum/ intussussion / peptic ulcer
12) Pt from mexico, cough and sputum, CT of chest picture ---OP:
TB/bronchiectasis/ cancer---scan showed RUL scarring with dilated bronchi and also dilated bronchi B/L LL ---so i thought he has old RUL TB and now its bronchiectasis
13) a 6 year old 2 weeks h/o SOB, WHEEZING more on R side than left ---CXR RML infiltrate---OP: asthma/congenital RML malformation/
14) infant fell from cot, found broken femur, also echymosis and purpura, low weight , parents say they have a cat which had scratched the infants causing purpura---? next step---op: cast the femur/ inform child protection a/do nothing
15)congental lobar empysema
16)swiming, young boy, ear pain, external ear normal, tympanic membrane red bulging, throat =n ---?d---bullous otitis/ OM/OE/
17) a 2X2 table with values and was asked to calculate NPV
18) injury in punch fight, and skin torn and blue and insensitive---? RX--- OP: graft/cast/ bandge/
18) young guy with sweating, delirium and ecg=st elevation and BP=165/110 ---?RX---OP: alpha blocker/beta b
19) pt had k=8.8, ecg show=broad QRS, loss of p (typical of High K) ---RX?---ca gluconate/ insulin and D/ HCO3/ etc
20) young guy with svere pneumonia, all Ig low and WBC low but T cell ok ---RX?---IVIG, etc (Antibiotcs were not given in as option)
21) a young boy with left neck swelling, cries when neck turned to left and keep head toards right ---next step ---opt: neck collar/biopsy./ phsio ---- 22) a 37 year old woman----legs restless at night can not sleep --all tests and examination normal---?d ---restless leg syndrom
desire to move all the time ---?d ---akathsia
24) a 50 person whose dad committed suicide at age of 40, comes with funny movements of body esp UL ---?d ---huntington chorea
25) many questions on Rh immunization -learn this by heart
26) a female with UMN OF UL , lesion urinary incont, LMN lesion LL and sensory loss b/l and blidness in one eye ----?d ---Somatization disorder (I thought as it did not fit to MND/MS etc )
27) a young boy from developing country has b/l legs LMN lesion ---?d---ant horn cells lesion etc
28) man with h/o alcohol, reccurent pancreatitis, CT picture shown= had
panceatic necrosis and possibly a stone in GB , he is admitted with pancreatitis , you treated pain now what is the next step---bowel rest/ERCP/ percutanous drainage/MRCP/
30) person underwent left hemicolectomy and now post op, had 3 transfusions, now fever, blood culture gram positive cocci, urine few bacteria and wbc=4-6/hpf, b/l crepts in lungs, ---?d---UTI/cathetr sepsis/pnemonia etc 32) 65 y chest pain ECG= V2-V4 ST elevation
---?RX---thrombolysis/aspirrin/
33) lady with menorrhgia, USG=intrauterine multiple nodules, which contraceptive is contraindicated ---condom/diagpharm/IUD/OCD 34) 40, menorrhagis, intrauterine mass bluish,
---?d---leiomyomia/endometriosis/ca
35) a woman had left leg dvt post op and was started on heparin then develop stroke of Right cerebral circulation confirmed on ct----?test---Doppler right leg/ venography right leg/TEE/cartoid doppler ---I thought TEE as pt may have PFO
37) baby with erythmatous lesions on eyebrow and side of nose which increase with stress and cold , also has dandruff---?d---seborric dematitis/ allergic derma/
38) jeweller with hands dermatitis ---what allergen ?---gold/silver/copper 40) a youg boy started taking swiming classes came with ring like lesion on inner thigh with central pallor, no other s/s, he has used over the counter anti fungal without success----? RX---do not remember the options
41) exophytic lesion on vuvlovagina, itchy, in PM female ----?d---lichen sclerosis/ca
42) young female multiple sex partner extereme tender vaginal wall on left with swelling ---?RX---incision and drainage/antibiotic/ biopsy/
43) baby with sob and has LL sternal holosytolic murmur and apical mid diastolic murmur ---?d ---TOF/Transposition/VSD/ASD/MS
44) post accident not distressed cxr right side white out ---?d---aortic ruptur/pneumomediastinum/hemothorax
45) young female has headach all the time every day ---?d---migrain/cluster/tension
46)young boy eating all the time and dysmorphic fascial features ---?mechanisms of disease---?chromosome deletion
48)young female with ulnar nerve palsy right hand due to a nodule and has nodules on back and frecking in axilla ---?histology of nodules---?schownonna /lipoma
49) a male with heroin dependence, many time had failed treatment including rehab--- what is next step---clonidine/buprenorphine/methadone/ rehab/ disulfram/ etc
50) child in school sudden stridor/ sob/wheezing/ bp=90/50---next step---nebulized b agonist/ipratropium/epinephrine/intubate/steroid/antihistamine
51)child with cerbral palsy with b/l lower limb spastic paralysis unable to walk ---next treatment---baclofen/rihzotomy/surgery to break contractures
52) pt had bicuspid aortic valve-what is the mechanism of get aortic stensis in these pt?---opt:calcification/degeneration/thrombus/
CVS:
1. Effect of isolated HTN..I picked A.fibrillation 2. Know the mechanism of diastolic dysfunction. Ejection fraction will be normal in this case? 3. HOCM: murmur decreases with squatting, 4. Elderly COPD with irregular heart beat..MAT
5. PSVT or VTach. HR was 240, QRS normal and doesn't have any effect on cold emersion, I picked cardioversion and BP was very low
6. Hypertensive Cardiomyopathy, ob echo everything is normal, wall motion and not valve defect?
7. Audiovisual Q: One on TR and another I am not sure, may be VSD?
8. P. Tamponade I don't remember the q. But HS was muffled and raised JVD, X ray shows cardiac silhouette
9/. Congestive Heart Failure
10. claudication/ arterial insufficiency 11. AVC common sites
choanal atresia
congenital heart vessels defect
effect of propanolol and verapamil I Mmii varies treatment of A fib
tracing for WPW syndrome –dx
torsades was asked in ecg but referred to as polymorhic ventricular syndrome wpw was asked and read ‗slurred‘ in stem
RESP
1. Please know the composition of pleural fluid like for different diseases the glucose content, protein content everything. Mine was for congestive Heart failure
2. Asthma pt with high PCO2 and silent chest--what is the next step- Intubate 3. Bronchiectasis and kartageners syndrome (Immotile cila) ism
4. Know Cystic fibrosis very well
5. ARDS with PEEP suddenly develops hypotension and breath sound diminished what is the next step--puncture with needle as developed pneumothorax
6. Sarcodoisis
7.One pt with lung consolidation and pleural thickening with exposure to asbestos, what is the Dx..I picked carcinoma but there was also asbestosis. 8. One q on pulmonary fibrosis,
9.Cor pulmonale
10.Asthma Tx. If the pt doesnt improve with B agonist what do you add..I picked corticosteroid inhaler
11.peep regulation – mechanical ventilation 12.pneumonia treatment
13.tension pneumothorax and hemothorax – clues will be only percussion 14.treatmet PCP pneumonia
16.college student with pneumonia, negative gram stain – mycoplasma 17. copd and influenza vaccine
18. copd and pathophysiology of PFT
farmer with copd and joint pain – kaplan sydrome
GIT: 1. Q on GERD know th Tx 2. Achalsia, 3. SSC 4. Celiac Disaese, 4. IBD, 5. VIPoma
4. Primary Billiary Sclerosis 5. Primary Sclerosing cholangitis, Also q on Hep A & B,
6. Acute Pancreatitis, after primary resucutation what to do next...CT of Abdomen
7. One q on Hemochromatosis
8.PUD with bleeding what to do next afetr giving blood, I picked gastroesophagoscopy,
9. Gastrinoma know the diagnostic steps, Rheumatology:
1. Know the back pain very well, 2. Raynauds phenomenn Px and Tx
3. Polymyositis (features) and dermatomyositis..know the diff 4. One q on Polymyalgia Rheumatica
5. Acute attack gout what do you give first I picked Ibuprofen..there was also naproxen
6. Septic Arthritis
7. Another Gout q with crystal finding negatively birefringent, prednisione mode of actions
Endo:
1. Two matching q on Ca, one was CRF and another was chronic alcoholism, 2. A Lot on adrenals,
3. Kallman's syndrome: A boy with short stature and underdeveloped testes..what other abnormalities you would see..smell
4. One q with graves disease,
5. What is the cause on Cong hypothy...thyroid dysgenesis, 6. Prolactinoma,
7.Pgy and postpartum bleeding...sheehan's syndrome
8. Lots of q on DM, I don't remember the q ..one was on insulinoma, DKA and DM nephropathy what drug to give ACEI
9. thyroid!
DM type 1 with auto immune phenomenon aldosterone and hypertension
ID:
1. Tx of Chanchroid, Gonorrhoea, Pseudomonas and PCP,
2. q was on Traveller's diarrhoea, Tx I picked cipro, person was travelling to MExico
3. Salmonella transmitted through egg, 4. Tx of cystitis
5hiv/hepc
6septic arthritis – what improves progosis – arthrocetesis x corticosteroids 7EBV – time to return to sports
8Sore ulcers – first sign 9Pyelonephritis treatment 10Chlamydia infection rx
11. INH with pyridozine deficiency
12. tricuris trichuria ass with rectal prolapse pathophysiology of shock
RENAL:
1. Tx of hyperkalemia
2. Know the antihypertensive drgs, 3. Kidney stones,
RTA! CNS:
1. Dementia, Dementia and Dementia, - all
2. I had a q on tertiary syphilis with Argyll robertson pulil ad Dementia 3. Alz
4. MS – MRI pics ad descriptio - dx 5. Transverse Myelitis
6.Meinier's Disease, 7. Stroke Tx,
8. ALS and GBS
9. Tx of Mysthenia crisis
10. BS of brain and lesion to differnt parts with loss of BS 11. Migraine Headache,
12.back pain
13.7th nerve palsy – taste sensation 14.atipsycotic induced akathasia
15.episodic headache ad high bpp (pheochromocytoma)
16.an 85 year old with little confusion, cannot sleep, nomral mmse – normal aging
17.CT of budd chiari
18.Multiple myeloma – dx. Presents with back pain, significant hypercalcemia man was reading newspaper on the street and suddely piece of paper hurt his eye – corneal abrasion
19. Brocas aphasia with asst hemiparesis 20. alcohol withdrawl and delirium
21. image of tuberoud sclerosis and ass with seizure. Treatment of cluster headache
OBYN
1. Amenorrhoea
2. Female incontinence and its pathophysiology 3. Preeclampsia – management
Placenta previa – transverse lie Post date pregnancy 41 weeks – NST Mullerian insesitivity sydrome
3.Hypertonic urge incontinence
4. Burning during mucturition with icthing in Vulva 5. Stages of labor
6. CST and NST interpretation
7. Abrupto placenta and ruptures uterus 8. GBBS tx
9. Breast ca and galactocele – all breast masses 10. Diff between breast engorgement and galactocele 11. Early genetic testing
12, Marfan's ..is it genetic disease, AD or AR disease
13. Pregnant woman at 12 weeks gestation schiz. Previously well on halidol. Started having positive symptoms. Do you start haldol?
14.Girl with primary amenorrhea without uterus, next step you do? 15. infertility
16. POC
17. diagram of deceleration and explanation 18. Mastitis dx
19. Congenital Adrenal Hyperplasia in a 20 year old OCP use as a cause of HT
OCP Breast Changes PID definition and dx Surgery
2. Diff between prepatellar bursitis and prepatellar sepsis 3. Osteosarcoma
4. Trauma
5. Pilonidal sinus treatment 6.Post surgical complications 7. fat embolism after post fracture 8. post operative analgesia
central retinal artery thrombosis diagram Psych
1.Adjustment disorder 2. GAD
3. Anorexia Nervosa – remember! Amenorrhea is required for diagosis of this. 4. Phenelzine antidote
5. Bipolar 6. ADHD
8. Know the neurotransmitter of all the disease A 12 year old boy who cannot focus – ADHD? A child with Mild Mental Retardation – values for MR Peds:
A baby with cepaholhematoma, breastfed and and jaundiced bili of 20 – next step
Skin
Herpetic whitlow
Child with wart on finger – etiology Kawasakis
dermatomyositis psoriasis picture
picture of malignant melanoma and treatment treatment of seborratic dermatitis
Random: Pagets disease
Fragile syndrome – CAG repeat, MR, macroorchidism, big ears Abnormal pap smear
Mild acne treatment – aboid oil based ointments Child abuse
Vitamin A toxicity – pseudo turmor cerebri
Hemophilia a – BT reaction (hypothermia, rapid transfusion without warmer) Galactose 1 phosphatase uridyl transferase dif.
Mcardles disease (cramps after strenous exercise DVT
CT/renal contrast complications and allergies Xray of fragmented rbsd
Scfe xray
q's on stress fracture of 1st metatarsal Rx,
A pt hd a puncture wound to his lt little finger 3 days ago, came with swollen finger upto 1st metacarpophalangeal jt and flexion causing pain-cause-osteomylitis,septicarthritis,tenosnovitis,midpalma rinfection, 2 q's on tesnion pneumothorax, confusion in elderly-alzeimers,psedodementia, stress,urge,incontinance etiology, midpelvic contraction mx, herpis encephalitis,
23 yr old female with resistant htn with impaired renal function and briut-pathology in renal arteries,
man had a RTA-blood at urethral meatus,high riding prostate,stable obs-next step in mx,
lady with elevated periosteum,stable obs- etiology,
asymptomatic oldman with elveted IgG 2000..whts the dx- i put as MGUS, man with loss of vision + loss afferent optic reflex -site of lesion,
man with loss of taste,hearing loss and loss of stepedial reflex,-etio q's on benign postural vertigo, and meneiers disease,
2 ecg's-one is a man with high K+ who is in VF,stbilised, next step- rx with ca gluconate,
next one is 27 yr old loss of consiousness,bradycardic ecg in 2 hb- mx- pacing, Q's on HOCM,
man with extensive mets in liver and 1 in pancreas came with itching , bili is >15, whts the
next step in mx- i put as stent??
Aymptomatic lady came to request to get investigate , as she has a strog family hx of thyroid ca in family, which Ix u do- ??
Pregnant lady with hyperthyriodism mx? q's on epidural hematoma,
2 q's on temporal arteritis, q's on histoplasmosis,
ulnar neuropathy, compartment synd,
adenocarcinnoma of lung- predisposing factor, esophageal ca,
diverticuosis-abscess- mx,
man wt severe abdo pain,septic,-ct scan of abdo- pancreas distended with grey matter,etio- i put pancreas necrosis,
femoral hernia,
man sht in thigh, a femoral anurysm developed, loss of puses distally and pale limb next step in mx,
man stabbed with butcher knife in left flank, 3cm deep, slight bleeding next step in mx,
q's on PNH, Vonwillibrands, Heamophila a, herpetic whitlow,
child with a wart on finger-etiology, Chlamydia infection rx,
atpical pnemonia rx,
heamochromatosis type of cardiomyopathy, pilonidal sinus rx,
Loads of inheritance and On female incontinance, MS-MRI pics and description-dx,
PNH,9;22 translocation ? CML,
post ercp rise of temps? cause- cholangitis, tension pneumothorax,
post splenctomy wht mx??sickle cl aneamia kid..which vaccine-an same for both, M.avium intracelluare.prophylactic drug,
boy came with a bee sting and treated with adrenaline..wht wud u do to prevent future such episodes..i didnt ahd a cue for this as the options were-dont let him play outside,carry adrenaline, prophylactic antihistamines,and use of insect repellants, confine to indoors..i choose insect repellants....i dono..,
pt on frusemide and digoxin-wht are the serum K+ and Hco3- levels in body, which anti hptn ive causes peripheral oedema,
erythema toxicum, praderwilli synd,
whts the defect in klinefelters, patau synd,
women with 1 amenorrhea and weak femoral pulses wht do u do next, PDA u use indomethacin-mode of action,
abdo perforation,
CRAO,
2 q's on temporal arteritis, 3 q's on SIADH,
dermato myositis,polymyalgia,compartment synd,conduct disorder,cocaine abuse,amphetamine abuse,DT,addisons disease,
lady with hypercalcemia and lytic lesions in humerus dx?, how do u prevent transmission from m other to baby( mother already on anti- HIVDRUGS), intususseption, pyloric atenosis,
rectal prolapse in an nicaraguan child?? cause, pap smear- high grade sq dysplasia wht u do next??, cerebral palsy 2 q's,
stain for pnemocystis,
50 yr old man with severe back ache-stable obs- pic of xray-which i thought showed a calcified abdo aorta..so put it as AAA.
q on hemothorax and pneumothorax (clues are percussion)
- question on an old lady in a nursing with so many findings and PE... only to know at the end that it is a q about delirium (UA with so many WBC and positive for leucocyte esterase).
- a 12 yo who cannot focus ... ADHD is the closest answer? - child with mild mental retardation
- A baby with cephalhematoma, breastfed and jaundiced... total bil 20... next step.... phototherapy or exchange Transfusion? baby is doing well and born at fullterm.
- an 85 year with a little bit of confusion, cannot sleep, normal mini-mental... looks like normal aging to me.
-pregnant woman at 12 weeks gestation schiz previously well on haloperidol... started having positive symptoms... choices... to start re start haldol?
- CT of Budd Chiari
- question on Multiple Myeloma... dx... presents with back pain, significant hypercalcemia in the lab...
- College girl with fever, cough.... looks like pneumonia... negative gram stain.... only possible answer is Mycoplasma...
- atrial fibrillation... treatment - Tracing of WPW syndrome q is dx
- girl with primary amenorrhea without uterus, next thing to do.. - psoriasis
- of course the ever famous pulmonary embolism (cue VQ mismatch in lab) - fat embolism (easy.. post fx)
- pt with neuropathy on iNH.... ans.. b6 broca aphasia wit asst hemiparesis INH with pyridozine def
alcohol wihdrawal and delirium
optic neuritis wit d colour looked washd out..usmle world tricuris trichuria ass with rectal prolapse
diagram of deceleration and interpretation image of tuberous sclerosis and ass wit seizure pic of malignant melanoma and Rx
Diag and Rx malignant melanoma mastitis..diag
CAH in 20yrs old PCOS in 36yr
Endmetriosis and dyspaurenia Anovulation and infertility OCP use as a cause of HT OCP breast changes PID def Diag
Ectopic def Diag
ovarian Ca secreting oestrogen
Benign Ovarian mass ass wtt pregnancy HSV with enhephalitis bldy CSF
transviginal infection of HSV Candidiasis as primarily vagintis T.vaginalis Diag frouty discharge Rx seborrheic dermatitis
squamous cell Ca Rx
Central retinal A thrombosis Diagram Polymyositis features
DM type1 as with auto immune phenomenon aldosteronism and hypertension
A fib and warfarin
sress incontinence pathophysiology sigmiod colon and Rx
mild preeclampsia features CO poisoning features cluster headache acute Rx shock pathophysiology 3 quests sclerderma and raynaud Rx scleroderma and HT Rx Osteoathriti Rx
TOF and systolic mumur
aotic stenosis and systolic mumur crescendo-descrendo COPD and influenza vaccine
COPD pathopysiolgy of PFT CGD nitroblue tetrazolium
common variable immunodef in a 32yr old
intubation tube found in bronchiole wit poor lung perfusion wat do u do? otitis external in a swimer prevention
Di George synd patholgy rhematoid A Rx
Bronchiectasis X-rays findings
Hypocalcaemia in relaton to hypoalbuminaemia 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
- 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
- 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 condition, 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
- Arab guy has rash on the face that resolves, MCV is low? Thalassemia - 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? Gentamycin - CO was low, resistance was high, PCWP was low, what kind of shock? 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 (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? Normal, hypothalamic problem, adrogen insensitivity, turners, etc.
- 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
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? Spiral CT, d-dimer, CXR, ekg (angiography wasn‘t there)
- 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.
a number of questions about teenagers exhibiting normal teenage behavior vs adjustment vs depression
odd questions:
one about anaphylaxis, the answer was "nuts" alot of mythenia, MS, GB
alot of postrenal azotemia
not alot of pharm, not alot of ped's
a number of questions about teenagers exhibiting normal teenage behavior vs adjustment vs depression
odd questions:
one about anaphylaxis, the answer was "nuts" alot of mythenia, MS, GB
alot of postrenal azotemia
not alot of pharm, not alot of ped's Statistic:
1. The same case like in kaplan book pag. 130 excercise 34. They ask you how to calculate VVP and VPN giving you the prevalence or the incidence. So do the excercise no. 34
2. Know the diferent kind of bias. when a gropu receive one drug and the other group receive another droug, what is the bias in the study when it is followed for some period of time.
3. A question asking about interprete the result with RR> Remember that always you interprete in confidence interval
4. A question telling you which result is more trustful. They give you p value. like p = 0.89 , p=0.04, remember that p <0.05 make the study statistically
significative Cardiology:
1. video clip with a neonate that during the check you hear a murmur...a machinery one.
2. video clip: A boy that collapses during physical education, you hear a murmur similar to mitral regurgitation, but the answer is mitral valve prolapse because there is no the choice for mitral regurgitation.
3. EKG with ST elevation and T abnormalities randomly in a pt after a car crash. Myocardial contusion. The pt also has pneumothorax and can get distracted for it. 4. EKG of a lady with A-fib, asymptomatic. They do not give the diagnosis just go straight forward and ask you about treatment. ASA...but there is not ASA in the choices.
5. Make a chart knowing the radiation of the murmurs and how they change with valsalva. Like 2 qs. about it.
6. A pt with ostium secundum who is going to cystoscopy. Need or not prophylaxis.
7. the same pt with ostium secundum who is going to hemicolectomy for poliposis.
8. Statin induced injury...which one is the lower incidence in producing muscle damage
9. Two questions about CO and PCWP in shock Infectio and dermato
Like 3 questions asking the same in different ways.
1. pt with necrotic ulcer in foot, diabetic...they ask the next diagnosis test if suspect osteomyelitis
2. the same as before with osteomylitis confirmed ..they ask how the bone got contaminated
3. the same as before and they ask about which factor is the best to assure you that the pt is going to be healed:
a. time with antibiotic, b. no bearing or pressure, c. management of diabetes 4. pt with antibiotic who get sun exposure and come back with rash...with antibiotic: quinolones or tetracyclines
5. Some that make the differential diagnosis pemfigus vulgaris vs bullous pemfigoid based just in immunologic markers.
6. a history of a changing mole
7. A seborreic dermatitis with a picture
8. Kawasaki disease, they ask you for treatment, no ASA in the options. ENT and eye
1. glaucoma in a very young pt ? post vs anterior uveitis
2. an hypertensive and diabetic pt with decrease of vision. mechanism of decrease in her vision....alteration of vasculature in retine, exudades in retine,
hypertonic and hyperosmotic vitreo
3. a young pt with decreased visual acuity....looks like multiple sclerosis, but she has a bruit in carotid, they ask which test is next.
4. pt with a lot of drugs for pneumonia. which causes decreased audition acutely? Reumato
everything....
1 Pt with RPC antibodies
2 Pt wih a gout clinically but they show u x ray more than osteoarthritis.
Treatment as next step...they put lose weight and there is no NSAIDS in answer. 3 a lady with history of migraine but increase in ESR, when you see the choices in the answer you realize that is not migraine and it is giant cell arteritis
4.Inside out polymyalgia rheumatica vs polymyositis vs. fibromyalgia 5. Reiter‘s
6. Still‘s
7. Pt with recurrent tumor in meninges in lumbar area and they tell you that there is numbness of lateral aspect of thigh and they ask which one is compromised: L2 -L3 -L4.. and so on
8. Carpal tunel...mechanism of disease...
inflammation, infiltration with fibrotic tissue, and so on.
9. Easy one like treatment of lumbar disc and lumbar stenosis treatment. 10. Paget....mechanism of disease...osteoclastic dysfuntion, osteoblastic, vit D/PTH imbalance. Remodelation was not in the choices.
Gyneco
1. Mother who sniffs cocaine and has bleeding
2. Teenager with amenorrhea and ovarian mass but with green vaginal secretion...option...surgery...laparoscopic....ova rian ? ectopic?
3. Pt wih baby and mola at the same time
4. Squamous carcinoma in different stages in 2 or 3 questions...they ask about managment....vaginal hysterectomy, and so on.
5. Pt with 21 years with family with ovarian cancer and breast cancer, she never had sexual relations...what to screen for...PAP
6. Which is the cancer that u suspect in galactorrea with blood....choices are intraductal papilloma, inflamatory cancer...
7. Pt with 42 weeks....baby with tachypnea...mechonio aspiration
8. Pt that can not void she has ulcers in vulva, you palpate big bladder...no cateterization in the answer ...just drugs ( acyclovir, ceftriaxone. and others) 9.17 year old with vesicles in vulva. during labor .. what is the neonate at risk... pneumonia, encephalitis, sepsis....
10. baby born at home, family with blood diseases, now the baby is bleeding through his gums...what you do next. frozen plasma, factor VIII, cryoprecipate, vit K
Psych
1. Pt upset because the doctor is late....what kind of personality 2. Teenager that looks with ADHD...but there is defiant disorder... 3. Teenager some kind of autistic....but it is asperger disorder.
4. Neuroleptic maling sd.
5. pt who has nuuroleptic malig sd in the past, but now is going to elective surgery, they ask what is the risk....alt of blood presure,...sd.
Pediatrics.
I had several lisosomal storage disease...asking the mechanism of disease
Several asking Gammaglobulinemia the bruton or Wistock aldrich, no buzz words, ...know exactly which inmunoglobuline is affected in each one,...know which kind of infection ( bacterial or fungus or viral ) in each one...know the age that they appear...
Time of exposure that a pregnant woman is at risk after being in contact with a kid with Herpes 6 infection.
Pt camping...rash...allergic to penicilin
Pt with asthma who does not get better with albuterol, and has eczema....what is next...corticosteroids systemically, or inhaled or cromolin....
Floppy baby
Strawberry muffin rash
Methadone withdrawal in newborn Hemato
2 pt with anemia...show the slide of sickle cells they ask about mechanism of disease: valina substitution for glutamic acid position 6
pt with basofilic stipling....they tell you that is anemic and microcitic...they ask you the best treatment...is lead intoxication....so no Fe.
Several ones with B 12 deficiency like pt with gastric surgery in past HUS vs. ITP and Henoch Schonlein
THAT IS ALL THAT I HAVE GUYS. after doing my test...in went into my car and wrote them down before forgetting and making some time to avoid the new york rush hour at friday night.
1. Make charts.
2. Know what can make one disease different from the other ones that are very similar
3. Do not neglect the second drug of choice in treatment of disease...they do not ask the first choice....everybody knows them...think what if the pt is allergic and special circumstances like children and pregnancy.
4. Do not neglect the lab tests.
5....know the exudade vs. trasudate very well in ascites and pleural effusion. 6. Rashes...make a list of all the rashes in every single disease...how to differentiate them
1. Elderly woman about 67 y/o old experience difficulty driving lately and seen ―HALOS ―---your answer is?????
2. Elderly woman experience ―curtains are falling down honey ―—your answer is???
3. Young girl with a classical clinical picture of appendicitis -what is the mechanism =intestinal fecalith
4. Young woman with Raynolds (clinical picture) treatment =Nifedipine 5. Young man clinical picture with calcinosis, Raynolds =Scleroderma 6. Young man with low back pain-x-ray shows no abnormalities???? 7. Elderly pt with cardiac problem, abdominal pain=ischemic colitis 8. Pathogenesis of Type I/II DM
9. Pathogenesis of GB
10. Pathogenesis of CHF/RHF/LHF 11. Viral Myocarditis
12. Pericarditis EKG Picture 13. Inferior Wall MI
14. Rx of SLE
15. Acantosis Nigrans (velvety hyperpigmented lesion around the neck and axilla ) with increased Lipid Panel -what test to order – Serum Glucose 16. Dg of CDI
17. Treatment of SIADH –water restriction, saline, demecoclyne or what??? 18. Antifreeze poisoning which is glycol poisoning which cause increased anion gap –choose the correct labs….
19. Lead poisoning in a child 20. CSpherocytosis Rx 21. Dactylitis Rx
22. Hypothyroidism Dg
23. Atrovastatin Induce Myopathy 24. EPS Rx =Benztropine
25. To recognize Neuroleptic Malignant Syndrome and Rx =Dantrolene 26. DKA Rx
27. DKA Mechanism 28. Pagets Mechanism
29. Multiple MYeloma Mechanism 30. CO Poisoning
31. Benzodiazepines Overdose Rx =Flumazenil 32. To recognize Delirium
33. To recognize Delirium Tremens 34. Treatment of DT
35. ER forgot to give Thiamine for an alcoholic pt 36. Asking to give B6 in a pt taking INH
37. Bullas Formation Pemfigus –Mechanism 38. Abruption Placente due to Cocaine use
39. The Syllabus of Jovana is continuing =To recognize Placenta Previa 40. Rx of fetal distress –Lt Lateral position of the mother
41. Preventive medicine questions –Tetanus,DT,MMR, time frame-when you order colonoscopy, FOBT,Sigmoidoscopy
42. Vitamin D Deficiency
43. A-Fib due to Hyperthyroidism 44. Addison‘s
46. Toxoplasmosis 47. SCID 48. Lesch Nyhan 49. ODD 50. ADHD 51. OCD
52. Major Depressive Disorder 53. Schizoaffective Disorder 54. Schizophrenic Disorder 55. Conversion Disorder
56. Substance induced Mood Disorder 57. Bereavement
58. Acute Stress Disorder 59. Rx of Panic Disorder 60. Social Phobia
61. Bulimia Nervosa Metabolic Disturbances 62. Rx Colles Fracture
63. Carpal Tunnel Nerve Involvement 64. Deltoid Muscle Nerve Problem 65. Forceps Delivery – Facial Palsy
67. Croup Dg and Croup – name the causative agent 68. HEP A if you want to visit Mexico
69. Blood Smear for Plasmodium Vivax 70. Cranypharingeoma Dg
71. Bitemporal Hemianopia – Optic Chiasm Involvement 72. Your pt is on Glypizade, Metformin and is NOT compliant – Do you give him Acarbose, Insulin or Roglatizon or what?? 73. Sheehan Syndrome-Hypothalamic Amenorrhea
74. Turner Amenorrhea-Karyotype Analysis 75. Progesterone Challenge Test for Infertility
76. Cause of Syphilis,HSV ulcers, GC –more step 1 Questions 77. Axonal Injury
78. Rest Tremor Mechanism 79. Intention Tremor Mechanism 80. Benign Essential Tremor 81. Anovulation
82. Some Genetic Pedigree – AR
83. Myotonic Dystrophy Mode of Inheritance 84. Polymyositis
85. PMR
86. Giant Cell Arteritis Rx and most deadly complication 87. Papillary Renal Necrosis due to Analgesic Abuse 88. ATN
89. Side effect of Amynoglycosides – Ototoxicity 90. B12 Deficiency
91. Syringomyelia
92. Side Effect – Hypercalcemia
93. Ca Channel Blocker Induced Constipation 94. HIT
95. ITP
96. HUS – eating Hamburgers – O :157 97. Rash on the Forearm
99. Nephrotic Syndrome 100. Preclampsia /Eclampsia
101. MgSO4 Toxicity and Indication
102. KLarke –Betke Test Positive-Vasa Previa 103. ABO Incopatibility
104. Case of Cardiogenic Shock –Increased PCWP 105. Case of Hypovolemic Shock-Low CVP
106. Duodenal Atresia –Down Syndrome
107. Pyloric Stenosis Pathogenesis –Hypertrophy of smooth concentric muscle 108. Sclerosing Cholangitis in Pt with UC
109. Fistula in Chrohn Disease 110. Pannus Formation in RA 111. Knee Pain Pt Management 112. Low Back Pain Management 113. HTN Management
114. Woman Bleeding Management
115. Painless Jaundice ,Older Pt=Pancreatic Ca
116. Post Cholecystectomy Pancreatitis –Next do ERCP 117. Opthalmic Artery Occlusion
118. Aortic Stenosis Murmur –Audio
119. MVP with Mitral Regurgitation–dental procedure = Clindamycin +Gentamycin
120. VSD in a Child 121. PDA Mechanism
122. Down Syndrome Clinical Picture 123. Opoide Withdrawal Rx=Naloxone 124. PCP =Teen Agitated
125. Mycoplamsma Pneumonia Ear Complication –Bullous Myringitis 126. Abdominal Viscus Rupture Dg
127. SBO –Dilated Sentinel Loops
128. Cluster Headache Rx-100 % Oxygen 129. Wiskitt-Aldrich –MR TEXT Pnemeonic 130. Chedaki-Higashi
131. Chronic Granulomatous Disease 132. EBV Rash –Post Ampicillin Use
133. SMA Thrombosis _Portal Vein Thrombosis Rx =Tpa 134. Rx of DVT
135. Gold Standard of PE 136. Screening Test for PE
137. Clinical Picture of PE ,Fever, unilateral chest pain +Tachypnea ,New appearance of RBBB
138. Pleural Effusion –Cloudy Appearance, Exudates, Thoracocentesis Done – Next Step is???
139. Acute Attack of Gout Second Step in Management 140. Chronic Gout Rx
141. Felty Syndrome
142. Primary Hyperthyroidism 143. PTH and Ca Mechanism
144. Chronic Renal Failure –Increase Phosphorus, Increase PTH, Decrease Ca 145. Zolpidem Rx for Insomnia due to Sertraline (just a starter )
146. Court Order to proceed with a neurosurgery procedure in a kid 147. Osteoporosis Picture –DEXA Indication
149. Surperstious /superimpose use of Thyroxin 150. a canon wave seen in AF
151. CHF Pathophysiology –Afterload, Preload, Contractility –increased or decreased or what???
152. Heat Stroke
153. Tetracycline side effect –photosensitivity
154. Serosanguinous discharge from breast of 45 y/o old woman 155. Torsion of testis –woke the boy at night with excruciating pain 156. Woman as soon as she cough or sneeze she is embarrassed –stress incontinence
157. Overflow incontinence Pt 158. Uterine Proplapse in elderly pt 159. Asthma Pt in ER –Intubation needed 160. COPD –Oxygen to prolong her life
161. Flucortisone added Management in Astma beside the Albuterol 162. Albuterol – ( acting on B2 receptor )
163. Terbutaline use as tocolytic
Listen up!!, The best Flash cards are the ones made by yourself guys. If you are taking the U.W as well, just write in the card what you don't know and not what you already know, so try not to waste your time.
These are the "loved ones" by the Step 2 ck: Internal medicine:
Cardio: Afib, MI, Ejection fraction (there is a treatment post-MI and EF less than 40%, Know it!!) Angina.
Respiratory: Obstr vs restrict., Asthma Renal: Nephrotic vs Nephritic, Vasculitis.
M-E: Autoimmune diseases (LES, RA), vasculitis (know your antibodies +++) Orthopedics: All the pediatric ones including tumors.
Eye: Glaucoma.
Surgery: Know very well your trauma. Go to Schwartz and memorize the diagrams, mostly Neck and abdomen. Tamponade vs Pneumothorax +++ Liver: They love Biliary tract and ERCP.
U.T: Testicular evertything!! Incontinence, Prostate, STD's (all of them). OB-GYN: Bleedings everywhere!! Know your Diagnosis and treatment. Mole, they love the grapes. Eclampsia, Hypertension and don't forget what is normal and what is not.
Know your OB complications and specially how to treat, how to protect the fetus.
Oncology: Know very well what is the MCC. Know very well anti-CA drugs adverse effects.
Neuro: My dear friends, if you are not good at it, don't bother. Just do the CNS infections and autoimmnune and demyelinizating diseases. If you don't know how to localize the lesion, i will post the easiest way to do it.
ENT: Know your few (they are few) most common pathologies, mostly ear in the children and just Malignant otitis in the diabetic (pseudomonas)
Pediatric: Well, know what is normal and the congenital diseases from head to toes, but just the MCC.
Behavioral: If you studied for step one, you are ok then, however, go through the material if you are not sure. Remember that every question counts.
