Cardio answers:

Case 1:
1. HTN
2. Diabetes
3. Positional, pleuritic, painful
4. D - Atypical pain + EKG normal --> do stress
test
5. when can't read EKG (LBBB, LVH, pacemaker)
6. when can't exercise
7. angiogram
Case 1 continued:
1. B - asthma
2. yes
Case 2:
1. A - aspirin - treat first!
2. B - statin for all (abnormal stress test - RF's
don't matter = CAD, give statins for any LDL!)
3. PAD, DM, aortic stenosis
4. most common AE of statins is liver disease
Case 2 continued:
1. B - <100
2. D - Fibric acid derivatives
Case 3:
1. C - aspirin LOWERS mortality!
2. ASA, tPA, BB/ACE/statin, cath
3. can't use BB, prinzmetal's, cocaine use
4. have arrhythmia now
5. C - myoglobin
6. C - accelerated idioventricular rhythm
7. C - 3 vessels and >70%
Case 3 continued:
1. D - statins
Case 4:
1. A - prasugrel
Case 4 continued:
1. B - transfer for angioplasty
Case 5:
1. A - thrombolytics
2. A retreat with thrombolytics
Case 5 continued:
1. A - propranolol
2. A - diltiazem
3. A - hypertensive
Case 6:
1. C - Low molecular weight heparin
2. C - angiography
Case 7:

1. please see table

2. atropine
Case 7 continued:
1. A - right ventricular leads
2. C - ventricular septal rupture
3. C - tricuspid regurgitation
Case 8:
1. D - exercise tolerance test
2. If ischemia is found, the patient should be
offered angiography
3. C RCA 90% or LAD 90% in diabetic
4. A - tobacco cessation
5. Wait for 2-6 weeks or if stress is negative
Case 8 continued:
1. A - ASA, clopi, ACE-I, statins
2. A - hepatopulmonary syndrome
3. D - cholestyramine
4. C - decrease digoxin and warfarin doses
Case 9:
1. D - steroids and antihistamines
2. C - neurocognitive dysfunction
Congestive Heart Failure:
Case 1:
1. Oxygen, diuretics. nitrogen, morphine
2. C - dobutamine
3. MUGA scan
4. do the same thing - a creatinine as low as 2.3
in particular is not a contraindication to any of
these medications
5. When the ACE inhibitors cannot be tolerated
because of adverse effects, such as cough
6. D - EKG
7. A - ACE-I, BB, spironolactone, diuretic
Case 1 continued:
1. C - RBBB
2. A - LBBB
Case 2:
1. CHF
2. C - spironolactone, lisinopril, carvedilol,
furosemide
3. C - EF worsens --> heart transplant
Case 2 continued:
1. D
2. C - septic shock
3. E all of the above
Valvular heart disease:
Case 1:

1. mitral stenosis
2. echo 1st, cardiac cath best
3. diuretics
4. C - opening snap earlier
5. C - mitral balloon valvotomy now
6. B - increased thoracic pressure decreases
return
Case 1 continued:
1. A - ASD
2. B - mitral stenosis (really bad also peripartum CM, Eisenmenger's)
3. C wide splitting of S2
Case 2:
1. Mitral valve prolapse
2. Echo
3. increase murmur
4. B - verapamil
5. C - nothing
Case 2 continued:
1. D - aortic regurg
2. D - aortic regurg (phenylephrine is same as
hand grip)
Case 3:
1. LVH
2. echo first, cath best
3. valsalva decreases, hand grip decreases, leg
raise increases
4. D - CHF
5. replace valve in aortic stenosis, balloon in
mitral stenosis
6. repeat echo in 6-12 months
7. A - ACE-I
8. no ballooning for aortic stenosis unless refuse
or cannot tolerate surgery
Case 3 continued:
1. B - no viagra with nitrates, no viagra in aortic
stenosis
2. E - LBBB
3. D - angiography
4. E nothing
5. B fix heart
Case 4:
1. HOCM
2. A - dyspnea
3. BB, AICD
4. nothing
Case 4 continued:
1. A - MR

2. A - AICD
3. C - HOCM
Case 5:
1. atrial myxoma
2. echo
3. echo, then surgery to replace/remove
Congenital cardiac anomalies:
Case 1:
1. B can lead to aortic regurgitation
2. A coarctation
Case 1 continued:
1. E - refer for valve replacement
2. A - valve replacement
3. E - previous peripartum cardiomyopathy
4. B - okay to become pregnant
5. C - Selenium
Pericardial disease:
Case 1:
1. Pericarditis
2. Any infection (viral most common), trauma or
cancer near heart, connective tissue disease
(SLE most common)
3. C - PR depression
4. NSAID's
Case 1 continued:
1. D - Kussmaul's sign
2. C - pericardiocentesis
3. A constrictive pericarditis
Case 2:
1. Pericardial tamponade
2. D - decrease of 10 mmHg when inhale
3. C - electrical alternans
4. C -pericardiocentesis
Case 2 continued:
1. E - equalization of diastolic pressures
Rhythm disturbances:
Case 1:
1. Electrical defibrillation
2. Never
3. Never
4. Epinephrine or vasopressin prior to next
attempt at defibrillation
5. E - Beta blockers
Case 1 continued:
1. C - unsynchronized defibrillation
Case 2:
1. AICD

2. Electrophysiological testing to find inducible

VT/VF
3. Recurrence of the dysrhythmia while on
medications
4. C - Decreased ejection fraction under 35%
5. ACID
Ventricular tachycardia:
Case 1:
1. CP, dyspnea, hypotension
2. C - amiodarone
3. Torsades de pointes or hypomagnesemia
Case 2:
1. C - AICD (because dilated CM)
Case 2 continued:
1. D - implantable defibrillator
2. Brugada's syndrome
Atrial arrhythmias:
Case 1:
1. A - carotid sinus massage
2. vagal, adenosine, BB/CCB/digoxin
3. BB/CCB/digoxin
4. Ablation
5. Same for all atrial tachyrcardias
Case 2:
1. WPW
2. Loud S1, early depolarization
3. Procainamide
4. Ablation
5. CCB and digoxin
Case 3:
1. Control the rate with beta blockers
2. Anticoagulation with dabigatran, warfarin, or
rivaroxaban
3. Dofetilide and ibutilide
Case 4:
1. C - aspirin
Bradycardia:
Case 1:
1. C - Pacer
Case 2:
1. 1st degree AV block
2. Nothing
Case 3:
1.3rd degree AV block
2. Paced rhythm
Endocarditis:
Case 1:

1. blood cultures (if positive --> vanco

+gentamcin, then echo)
2. staph
3. D - vanco + gent
4. A - CHF
Case 2:
1. Penicillin or Ampicillin
2. Penicillin or Ampicillin + Gentamicin for 1st 2
weeks
3. Amp + Gent for 6 weeks
4. Same as above
5. Add rifampin
6. A - HACEK
7. A - Switch to vancomycin
Case 3:
1. E - continue present therapy
Case 4:
1. Stop warfarin (only for a fib)
Case 6:
1. None
2. None
3. None
4. None
5. None
6. None
Peripheral artery disease:
Case 1:
1. Ankle/brachial ratio
2. Angiography
3. Aspirin, stop smoking, statins, cilostazol, and
exercise
4. Cilostazol
5. Combination of aspirin and clopidogrel
6. B - metoprolol
Case 1 continued:
1. B - Diabetes
2. C - Angiography
Aortic disease:
Case 1:
1. TEE = CTA = MRA
2. Angiogram
3. Chest x-ray, CTA or TEE or MRA, propranolol,
nitroprusside
4. Surgical repair of the defect, if necessary (if >
5 cm)
5. Repeat ultrasonography annually, surgical
repair if gets bigger than 5 cm
Pre-op:

Case 1:
1. E - no further eval
Case 2:
1. C - Atenolol
Case 3:
1. E - no further eval
Case 4:
1. E - no further eval
Case 5:
1.
Peri-op:
1. C - S3 gallop
GI Answers:
Esophageal disease:
1) B
2) B - 10%
3) E
4) E - PPI
5) C - 24 hr pH
6) B - DES/nifedipine
7) A - peptic/Schatzski ring
8) D - manometry/motility
9) B - manometry
10) B - Barrett's esophagus
11) C - fluconoazole
12) C - 24 hr amb pH
13) C - 24 hr pH
14) D - anticholinergics
15) B - endoscopy
16) A - squamous cell
17)
18)
19)
20)
21)
22)
23)
24)
Stomach diseases:
1) B - endoscopy
2) D - both A and C true
3) B - gastrin levels
4) C - lanso, amox, clarith
5) A - secretin stim
6) A - EUS/octreoscan
7) B - duodenal ulcers

8) E - h pylori
9) C - resp failure
10) D - nuclear med scint
Diarrhea:
1) B - norovirus
2) A - norovirus
3) D - c. jejuni
4) E - staph toxin
5) B - vibrio
6) C - e coli
7) C - e. coli
8) A - b. cereus
9) E - yersinia
10) A - celiac
11) E - all
12) B - ischemic colitis
13) D - reassurance
14) D - c. diff
15) D - clear liquids/observation
16) if sxs recur once re-treat with
metronidazole, if sxs occur twice use
vancomycin, if toxic megacolon remove colon
17) prevent c. diff with probiotics
18) D strongyloides (treat with ivermectin or
abendazole)
19) A cryptosporidium (treat with
nitazoxanide)
20) C - e histolytica (treat with metronidazole)
21) strongyloides
22) irritable bowel syndrome, diarrhea use
loperamide, constipation use linaclotide or
lubiprostone
23) laxative use, stop laxatives
24) yersinia, treat with quinolones if needed
(fever + hypotension + tachycardia)
25) bacterial overgrowth syndrome from small
bowel diverticuli, treat with cipro +
metronidazole
26) celiac disease, small bowel biopsy, anti
endomysial ab, anti-tissue transglutaminase
27) bowel wall lymphoma, biopsy,
noncompliance
28) strongyloides, stool for worms
29) whipples disease, PCR, treat with doxy
Colon cancer screening
1) B - colonoscopy every 10 years
2) E - all acceptable
3) E - nothing like colonoscopy

4) C - 3-5 years
5) A - every 5 yrs, start at 40
6) A - colonoscopy every 1-2 yrs
7) C - every 1-2 yrs, starting now
8) B - flex sig at age 12
Inflammatory Bowel Disease:
1) D
2) A
3) B - pyoderma gangrenosum
4) B - mesalamine
5) C - prednisone
6) B - 6-MP
7) B - sclerosing cholangitis
8) A - sclerosing cholangitis
9) E - all of the above
10) A - infliximab
11) B - frequency similar
12) B - iron def anemia
13) C - corticosteroids
14) C - NSAID's
15) A - surveill colonoscopy
Bleeding and Liver:
Case 1:
1) B
2) E - B and D correct
3) A - low risk of rebleeding
4) D - prednisone
5) E - all of the above
6) D discharge
Pancreas
Case 1:
1) C - lab testing
2) B
3) B
4) C
5) A
6) C
7) B
8) B
9) D
10) B
11) B
12) B
14) if painful and > 4 cm drain
Case 2:
1) D
2) A
3) B

Hepatitis:
Case 1: Chronic Hepatitis
2) C
3) C
4) D
5) B
6) A
7) E
8) A
9) B
10) E
11) A
12) A
13) A
14) B
15) B
Case 2: Acute Hepatitis
1) A
2) B
3) A
4) E
Case 2 continued:
1) D
2) A
3) D
4) B
5) E
6) C
7) B
8) B
9) C
10) E
11) E
12) D
13) alcoholic hepatitis, folate/thiamine/vit K,
>32 points on DF start steroids
14) primary biliary cirrhosis, ursodeoxycholic
acid
15) autoimmune hepatitis, steroids +
azathioprine
16) primary sclerosing cholangitis, liver
transplant is only proven treatment
Neuro answers
Case 1:
1) stroke (L MCA)
2) CT (contrast neg)
3) A - Echo, Holter, carotid Doppler

4) tPA - 1st 3 hrs

5) D
Case 2:
1) TIA
2) A - ASA
3) add dipyr or switch to clopi
4) no indication
5) A - Anterior cerebral artery
6) A - MRI
7) C - clopidogrel
Case 2 continued:
1) A neurocardiogenic syncope
2) A - statin
3) C carotid doppler
Case 3:
1) MS - symptoms indicate
2) carbamazepine, oxcarbazepine
3) MRI
4) MRI
5) C - steroids
6) A - slow progression of MS - glatiramer, IFN,
mitoxantrone, natalizumab, fingolimod (MCC Q
about MS - know this!)
7) walking (dalfampridine), fatigue
(amantadine), urge incontinence (oxybutynin),
spasticity (baclofen, tizanidine)
8) D (internuclear opthalmoplegia)
9) E - CSF to look for oligoclonal bands
Case 3 continued:
1) PML
2) C - natalizumab
Case 4:
1) Guillain-Barre Syndrome
2) E - FVC (check if need to intubate)
3) A - IVIG OR plasmapheresis (but NO combos)
4) A - IVIG alone OR plasmapheresis ALONE
5) C - nerve conduction velocity
6) NEVER
7) C - IVIG
8) C - campylobacter
Case 5:
1) D - myasthenia gravis
2) C - ACh receptor antibodies
3) single fiber EMG
4) C - chest CT (look for thymoma)
5) pyridostigmine/neostigmine (for symptoms),
prednisone/plasmapheresis (acutely),

thymectomy (if pyr/neo not working & <60 yo),

IVIG for acute myasthenic crisis
6) gentamicin (can block NMJ)
7) B - small cell lung cancer (Eaton-Lambert)
Case 6:
1) peripheral vertigo likely labyrinthitis
2) central if focal symptoms, no hearing loss or
tinnitus
3) steroids, meclizine
4) focal signs to look at posterior fossa
5) Meniere's - chronic
BPV - positional
Labyrinthitis - acute
VB TIA Perilymphatic fistula barotrauma
6) C
Case 7:
1) subarachnoid hemorrhage (sudden onset
severe headache, stiff neck, photophobia)
2) C - lumbar puncture
3) to get location of SAH so know where to
embolize/clip
4) Cerebral vein thrombosis (DVT in the head!)
5) Mag resonance venography
6) A
7) B angiogram to figure out where it is so you
can fix it
8) C catheter embolization
9) A nimodipine (CCB decrease risk of stroke)
Case 8:
1) D
2) listed below question
3) D - xray of spine
4) C - MRI
5) C B12 deficiency
6) C - syringomyelia
7) A Brown-Sequard syndrome
Case 9:
1) C - restless leg syndrome
2) B - pramipexole or ropinirole
3) C iron
4) benzos, opiate, dopamine agonists
Case 10:
1) D - essential tremor
2) D - all of the above
3) A propranolol
4) when medical therapy does not work
Case 11:

1) C - nalaxone, thiamine, dextrose

2) bilateral pinpoint pupils
3) unilateral dilation
4) bilateral dilation
5) will see skin lesions
6) A thiamine, then glucose
Case 12:
1) A - vitamin B12 deficiency
2) F - MMA levels
Case 13:
1) C - ALS
2) E - Riluzole
3) D - CPAP
Case 14:
1) Parkinson's disease
2) mild, >60-70 yo, if can't use anticholinergics
3) severe disease
4) added to levo/carbi to extend duration of
therapy
5) alternative to levi/carbidopa, but less efficacy
and less side effects
6) when max out meds
7) never
8) C - quetiapine
9) progressive supranuclear palsy,
antidepressants may help (no real treatment
though)
Case 15:
1) benzodiazepine
2) fosphenytoin
3) phenobarbital
4) midazolam, then anaesthesia
5) 2 years with no seizures
6) B observation
7) C - temporal lobe
8) A - serology for cysticercosis
Case 16:
1) see chart on p. 147
2) donepezil
3) D - memory
4) B - NPH
5) C - memantine
6) E - stop lorazepam
7) CJD
8) EEG, but brain biopsy most definitive test
9) supportive
Case 17:
1) migraine

2) triptans
3) if headaches more than 4 times per month
4) propranolol for > 3 months
5) A - foods
6) A pregnancy and cardiac disease
Case 17 continued:
1) oxygen, verapamil
2) C
3) C
4) C - migraine
5) A - migraine
6) C
Case 18:
1) pseudotumor cerebri
2) A - diplopia
3) CT scan (rule out a space-occupying lesion)
3) LP (shows high pressure)
4) weight loss, check for vit A toxicity, stop
OCP's
5) acetazolamide, VP shunt, cut optic nerve
6) when med therapy doesnt work
7) A visual field loss
Case 19:
1) delirium
2) check sodium, oxygen, glucose, calcium,
infections exclude all correctable causes
3) haloperidol NOT benzos
4) C optic neuritis
5) D prednisone and eye lubrication
6) B laser photocoagulation
Case 20
1) somatization
2) reassurance, freq doctor meetings
3) A education and relaxation techniques
4) D
5) C - citalopram
6) C - fluoxetine
7) E - haloperidol
8) A - discontinue clozapine
9) D - fluoxetine
10) A 2 months
11) A - supportive therapy
12) A somatoform disorder
13) B borderline personality disorder
14) A bipolar disorder
Case 21:
1) D
2) C

3) A
4) B - radial nerve palsy
5) F
6) D
7) C
8) E
9) C
10) D
11) D
12) B
13) C
14) A
Endocrine answers
Case 1:
1) B - HCG
2) E - panhypopituitarism
3) C - pituitary adenoma
4) B - Sheehan syndrome
5) D - sarcoidosis
6) acute hemorrhagic necrosis of pituitary
7) A - histiocytosis X
Case 2:
1) acromegaly
2) B - IGF1
3) 2 hr glucose tolerance test
4) TSH
5) after biochemical confirmation
6) osteoarthritis, HTN, DM, 2x mortality
7) surgical resection
8) B lanreotide (or octreotide)
9) Add on (adjuvant) to somatostatin analogue
10) 3rd line agent
Case 3:
1. Kallman's syndrome (hypogonadotropic
hypogonadism)
2) Testosterone. If fertility is a concern, replace
LH/FSH
Case 4:
1) Prolactinoma
2) Serum prolactin level
3) D - MRI
4) see table p. 222
5) Visual field deficit, osteoporosis,
reproductive concerns, and macroadenoma
6) B - Cabergoline
7) Rarely; in the case of resistance to meds
8) A - repeat prolactin with hemodilution

Case 5:
1) Serum GGT level
2) Paget's disease
3) Bone survey
4) A - Bone scan
5) Bisphosphonates
6) Almost never (used for bone pain only)
7) C - bone biopsy
Case 6:
1) osteoporosis
2) DEXA scan - most accurate test
3) C - vit D and TSH
4) steroids, thyroid, vit D def
5) bisphosphonates
6) Never alone for OA, can be used within 7 yrs
of menopause
7) bisphosphonates
8) SERM - 2nd line agent
9) A - calcitonin (best tx for pain)
10) D - calcium and vit D
11) C - HRT increases fibroid size
12) C - testosterone
13) A - alendronate
14) E - d/c alendronate and start PTH
15) D - Raloxifene
Case 7:
1) E - calcium gluconate
2) calcium, PTH, vitamin D
3) QT prolongation
4) activated vitamin D
5) loop diuretics
6) A - TSH
Case 8:
1) hyperparathyroid, malignancy
2) stones, moans, groans, psychic overtones
(renal stones, hypertension, polyuria, fatigue,
mental status changes, bone pain, osteoporosis,
and pathologic fractures.)
3) B - normal saline
4) hypercalcemia due to malignancy
5) hypercalcemia secondary to granulomatous
disease
6) parathyroid adenoma and hyperplasia, most
common complication of surgery is
hypoparathyroidism
7) C - calcitonin
8) D - check sister's calcium
Case 9:

1) Cushings syndrome
2) ACTH
3) ACTH - to distinguish central vs adrenal vs.
extra-adrenal
4) E - serum and urinary cortisol
5) if adenoma
6) adrenal cancer or resistant cushings
Case 10:
1) B - hyperaldosteronism
2) D - renin and aldo
3) C - aldo supp test
4) CT (if adenoma --> take it out, if bilateral -->
no surgery)
5) A - increased plasma renin activity
6) adrenal vein sampling
7) adenoma only, NOT hyperplasia
8) C spironolactone
9) measuring aldosterone in samples of adrenal
venous blood
Case 11:
1) pheochromocytoma
2) D - urina metanephrines
3) adrenal CT
4) always!
5) preop - to prepare for surgery
6) B - after phenoxybenzamine
7) A - thyroid sonogram
Case 12:
1) A - 24 hr urinary cortisol
2) skip - cut out if functional
3) A - ACTH level
Case 13:
1) primary adrenal insufficiency
2) B - AM cortisol
3) if low AM cortisol
4) when primary insufficiency (tell if it's atrophy
or hemorrhage)
5) secondary adrenal insufficiency
6) hydrocortisone. prednisone
7) E - anti-CYP21 antibodies
Case 14:
1) D - Grave's disease
2) post-viral, tender thyroid
3) beta blockers
4) thyroid storm
5) toxic nodule
6) D - propranolol
7) B - free T4

8) A - factitious hyperthyroidism
9) A - increased uptake
10) B wait three months
Case 15:
1) hyperthyroid --> not FNA and no biopsy
needed, euthyroid --> FNA
2) A - sonogram-guided FNA
Case 16:
1) hypothyroid
2) TSH
3) levothyroxine
4) C - IV glucocorticoids
5) Steroids plus IV T4/T3, sepsis
6) Thyroid lymphoma
7) KI
Case 17:
1) Sick euthyroid syndrome
Case 18:
1) fasting sugar > 126, random 2 hr > 200, A1C >
6.5, impaired glucose tolerance 5.7-6.4
2) HbA1c (only one value needed)
3) C 24-26 weeks gestation
4) always (except if Cr > 1.4)
5) 3rd line
6) add on
7) HbA1c > 9.5
8) D - insulin
9) A
10) A - metformin
11) B diet and exercise
12) A - glipizide (shorter half-life because renal
insufficiency)
Case 19:
1) B - lisinopril
2) cough, hyperkalemia
3) urine microalbumin/cr > 30:1 (yearly)
4) exercise, UTI, menstruation
5) BP control and lipids
6) yearly ophtho checkups
7) quarterly podiatry exams, microfilament
8) D - duloxetine (gabapentin, tricyclics okay
too)
9) DM gastropathy --> add erythromycin
10) erectile dysfuction
11) EKG - because diabetics at increased risk for
the development of coronary artery disease
Case 20:
1) diabetic ketoacidosis

2) IVF + IV insulin
3) C - glucose < 200
4) K+ < 5, monitor PO4- < 1.5
5) 24 hour rate x 0.7 = basal dose = glargine
dose
6) normal AG, very high glucose
7) eliminated (said was stupid question)
8) C - decrease pre-dinner aspartate (somogyi)
9) Increase glargine (not one of the answer
choices, typo here)
10) D - increase pre-breakfast aspartate
Case 21:
1) meds (insulin, sulfonylureas), liver failure,
cachexia, chronic kidney disease, insulinoma
Case 22:
1) high testosterone
2) B - CT scan of adrenal
4) D - metformin
Case 23:
1) Rule out pregnancy with beta-hCG
2) Prolactin and TSH levels
3) C - MRI
4) D - observation
5) B - pelvic US (endometriosis)
6) B - fluoxetine
Case 24:
1) D - testosterone
2) FSH/LH
3) no testosterone indicated
4)
5) SSRIs
6) total testosterone, LH, FSH
7) pump to assist in erection
8) sex without protection 2-3 times per week
9) and 10) sildenafil after 24 hours, tadalafil
after 48 hours
12) adrenal CT scan
Nephro answers:
Acute Renal Failure:
Case 1:
1) E - no clear diagnosis
2) chart
3) if prerenal, give octreotide
4) no test
5) no specific therapy
Case 2:
1) AIN - Allergic Interstitial nephritis

2) Rifampin (Penicillin, Allopurinol, Quinidine,

Lamotrigine)
3) UA
4) Eosinophils in urine (Hansel stain)
5) Stop medication and wait, if progress --> use
steroids
6) Ethambutol caused visual disturbances
7) Not based on BUN/Creatinine
8) Refractory hyperkalemia, metabolic acidosis,
pericarditis, fluid overload, encephalopathy
Case 3:
1) K+ levels/EKG
2) B - urinanalysis
3) Mannitol, IV fluids, if K is up --> Bicarbonate
Case 4:
1) Hydration with normal saline
2) Cholesterol emboli
3) Biopsy skin (Cholesterol Crystals)
4) Nothing
5) A - contrast
Case 5:
1) Papillary necrosis
2) B - CT scan
3) No specific therapy
4) E - aminoglycosides
End-stage renal disease:
1) C - coronary disease
2) C cultures, vanco
Glomerular Disease:
Case 1:
1) All
2) All
3) B
4) Alports syndrome
Case 1 continued:
1) D - amyloidosis
2) B - cryoglobulinemia
Case 2:
1) B repeat sample in 2-3 weeks
2) A no further eval needed
3) D - split urine
4) B
Case 2 continued:
1) B - Goodpasture's syndrome
2) D - Bartter syndrome
Case 3:
1) Nephrotic syndrome
2) Lymphoma with Membranous

3) Protein:Creatinine Ratio
4) B kidney biopsy
5) Prednisone
Case 3 continued:
1) A -Focal segmental glomerulosclerosis
2) B Berger disease
3) B - Goodpasture's disease
4) C loss of urine carrier protein
Case 4:
1) E - antiretroviral therapy
Case 4 continued:
1) D - light chains
2) D - immediate hemodialysis
3) A - calcium acetate with meals
4) C - decrease efferent arteriolar pressure
5) B - continue
Sodium Disorders:
Case 1:
1) DI (Lithium) or Psychogenic Polydipsia
2) Both
3) Both
4) E - Nocturia
5) Urine Na and Urine osmolarity
6) ADH administration
7) Central - ADH replacement, nephrogenic thiazides, NSAID's
Case 1 continued:
1) C psychogenic polydipsia
Case 2:
1) non-ketotic hyperosmolar syndrome
2) normal saline and insulin
3) 357
Case 3:
1) SIADH
2) Mets, Tumor
3) TB, pneumonia
4) Una and Uosm - both high
5) Hypertonic saline or Saline+Diuretic
6) C - Tolvaptan (V2 receptor antagonist)
7) central pontine myelinosis
Case 4:
1) Nephrogenic DI
2) 8.57
3) High Ca and Low K
4) Thiazides, NSAID's
NSAIDs:
1) D constricts afferent arteriole
2) E - hypokalemia

Potassium disorders:
Case 1:
1) Diarrhea--> vomiting --> inhaled beta
agonists drove potassium into cells
2) Very low: <20 mEq/L
3) EKG - U wave
4) no maximum
5) < 20 mEq/hr
6) B - D5W
7) 5 mg/kg per point increase in potassium
8) Mg
Case 2:
1) Tumor lysis syndrome
2) EKG
3) Calcium chloride or gluconate if peaked T
waves
Phosphate disorders:
1) E Fanconi syndrome
2) E renal failure
Metabolic acidosis:
Case 1:
1) Ethylene glycol causes renal problems,
Methanol causes eye problems
2) All three will
3) All three will
4) UA for ethanol, eye exam for methanol
5) Fomepazole (stops toxic metabolite from
forming)
6) Normal anion gap
Renal tubular acidosis:
Case 1:
1) A - Proximal RTA
2) Bicarb
3) Diuretics
Case 2:
1) B - Distal
2) Give acid
3) Bicarb
Case 3:
1) Type IV
2) Na restriction
3) Fludrocortisone
Continued questions:
1) B low anion gap
2) E chronic renal failure
Metabolic Alkalosis:
Case 1:
1) Licorice

2) In Conn - high Urine K

3) In Bartters low or normal BP
4) Urine chloride
5) "U" waves
6) Stop licorice
Tubular disorders:
1) A Barrters (like taking furosemide all the
time)
2) B
3) C
4) C
5) D - all
6) D - all
Acid-base disorders
1) B licorice ingestion (like eating aldosterone)
2) B - diuretics
3) A gapped metabolic acidosis
4) B metabolic acidosis and alkalosis
Nephrolithiasis:
Case 1:
1) B - analgesics
2) Spiral CT
3) Calcium oxalate
4) If > 20 mm --> surgery, if 5-20 mm --> shock
wave, if < 5 mm --> wait/hydrate
Case 2:
1) Ca oversecretion in urine
2) Thiazides
3) C - Uric acid stones, citrate to alkalinize
Case 2 continued:
1) B - increased oxalate absorption
2) C - tamsulosin
Polycystic kidney disease:
Case 1:
1) Liver, ovary, pancreas, diverticuli
2) Mitral valve prolapse, diverticular disease,
and circle of Willis aneurysms
3) End stage renal disease
4) Not routine
Urinary Incontinence:
Case 1:
1) Urge incontinence
2) Urodynamic studies (manometry)
3) Oxybutynin, tolterodine, trospium,
darifenacin - dry mouth
4) B observation
5) A neurogenic bladder
Case 2:

1) Kegel exercises
2) Surgery
Hypertension:
Case 1:
1) Lifestyle modifications
2) Weight loss
3) Relaxation
4) Diuretics - thiazides
5) Add beta blocker, calcium blocker, ACE
inhibitor, or ARB
6) Never minoxidil, methyldopa in pregnancy,
clonidine if opiate/alcohol use
7) Reserpine, then clonidine, then beta blockers
Case 2:
1) Beta blocker
Case 3:
1) Beta blocker
2) <130/80
Case 4:
1) Beta blocker
2) Beta blocker
Case 5:
1) Labetalol, nitroprusside, nicardipine
2) see table
Case 6:
1) Young (<30), told (>60), hard to control HTN
Case 6 continued:
1) B - primary hyperaldo
Case 7:
1) Ultrasound
2) Angiogram
3) Balloon and stent
Case 8:
1) Phenoxybenzamine
2) Alpha blocker
Pulmonary answers:
Case 1:
1) FiO2 x 4-5 = pO2
2) are alveoli healthy & allowing gas exchange
3) B - Guillain-Barre syndrome
4) respiratory acidosis (pH/pCO2/pO2/HCO3)
Case 2:
1) metabolic acidosis
2) additional resp acidosis - Winter's formula
(expected CO2)
3) ignore
4) AG MA - MUDPILES, Non-AG MA - RTA 1 & 2

Case 2 continued:
1) D - dialysis
2) B - measure serum osmolarity
Case 3:
1) metabolic alkalosis
2) no additional resp disorder
3) urine chloride
4) B - Gitelman syndrome
Case 4:
1) metabolic acidosis
2) EtOH
3) 2Na + BUN/2.8 + glucose/18
4) met acidosis of unknown etiology
Case 5:
1) C- normal saline
2) septic shock
3) norepinephrine, dopamine
4)
5) 2D echo
Case 6:
1) ARDS (bilateral infiltrate, Fi02/PO2 < 200,
normal LV normal EF, wedge < 18)
2) D - 2D echo
3) maintain FiO2 < 40%, low TV
4) plateau - pulm tissue and airways, peak large airways
5) A- COPD
6) drops
7) C - bronchodilators
8) reducing tidal volume and thus allowing the
levels of carbon dioxide to rise. By reducing
tidal volume, the amount of barotrauma is
reduced
9) B decrease in BP
10) D - mucus plug
Case 6 continued.....
1) D - lobar atelectasis
2) C - occluded ET tube
3) D - pulmonary embolism
4) D semi-recumbent position
Pulm function testing:
1) FEV1 low, FVC high, ratio < 80%
2) FEV1 low
Flow Volume Loops:
1) A5, B6, C3, D2, E1, F4
2) A - DLCO
3) D - phrenic nerve paralysis
4) D - pulmonary edema

Case 7:
1) B
2) C
3) yes, cover atypicals (quinolones, azithro)
4) C
5) B - LV failure
6) B - home oxygen
7) E - smoking cessation
8) E - recommend lung resection surgery
Case 8:
1) GERD, post-nasal drip, cough-variant asthma
2) nasal steroids
3) A - methacholine challenge test
4) not necessarily
5) B - fluticasone
6) B - peak flow (FEV1)
7) albuterol, steroids
8) add on to albuterol
9) steroids
10) D - stat MICU consult and intubation
11) find and get rid of trigger
12) add omalizumab
Case 8 continued.....
1) B - chest xray
2) D - inhaled steroid and salmeterol
3) D - skin test for aspergillus
4) C - corticosteroids
5) E - CT scan
6) D - stop aspirin
7) E - short-acting beta agonist
Case 9:
1) B - bronchiectasis
2) chest x-ray
3) CT chest - shows dilated airways
4) obstructive pattern
5) D - alpha-1-antitrypsin
Case 10:
1) sarcoidosis
2) A - lymph node biopsy to look for
noncaseating granulomas of unknown origin
3) serious organ involvement
4) restrictive pattern
Case 11:
1) cough, SOB associated with work
2) fever, increased WBC
3) high neutrophil count in CAP
4) B - pleural biopsy
5) oral steroids

Case 12:
1) chest x-ray (idiopathic pulmonary fibrosis)
2) CT chest
3) biopsy
4) restrictive
5) D - refer for heart-lung transplant
Case 12 additional cases:
1) bronchiolitis obliterans organizing
pneumonia (BOOP)
2) alveolar proteinosis
3) pulmonary lymphangioleiomyomatosis
Case 13:
1) narcolepsy
2) sleep studies (polymsomnography) - see
increased REM sleep
3) stimulants - methylphenidate
Case 14:
1) obstructive sleep apnea
2) nighttime pulse oximetry
3) sleep studies with at least 30 apneic episodes
4) D - CPAP
5) obesity hypoventilation
6) acetazolamide (CA inhibitor)
Case 15:
1) pleural effusion
2) lateral decubitis film
3) if fluid layers > 10 mm thick, order serum to
fluid ratio of LDH > 60%, protein > 50%
4) exudate
5) E - cirrhosis
6) infections, rheumatic, cancers, pancreatitis
7) B - rheumatoid arthritis
8) pleurodesis
9) palliative measures
10) empyema (pH < 7.19, gross pus, or lg WBC),
must insert chest tube
Case 15 continued.....
1) A - open pleural biopsy
2) C - pleurodesis
3) A- antibiotic therapy
4) C - decortication
Case 16:
1) history &radiographic appearance of nodule
2) compare current x-ray with previous ones
3) A
4) popcorn calcifications
5) onion-skin or bulls-eye calcification
6) A

7) D
Case 17:
1) chest x-ray
2) C - mediastinoscopy
3) staging
4) no surgery - chemo and radiation
5) stages 1-3A
6) PFT's
Case 18:
1) pulmonary hypertension
2) A - 2D echo
3) right heart cath with nitrate challenge
4) class I symptoms
5) class IV symptoms
6) if vasculature responds to adenosine,
prostacyclin or nitrous oxide
7) right heart failure on prostacyclin or cannot
tolerate medical therapy
Case 19:
1) pulmonary embolism
2) hemodynamically unstable PE without
contraindications to thrombolytics
3) E - VQ scan (high resolution CT lungs ideal)
4) D - dalteparin (heparin)
5) 6 months (3 months - 1 year)
6) immobility, malignancy, nephrotic syndrome,
oral contraceptives, pregnancy, obesity,
hormone replacement therapy, heart failure
7) B - CT
Case 19 continued.....
1) A
2) C
3) D
4) B
Case 20:
1) A - alveolar hemorrhage
2) B - bronchoalveolar lavage
3) A - anti-GBM antibodies
4) A - crack cocaine
Case 21:
1) A - acetazolamide
2) B - descent to lower altitudes

Heme/Onc:
Microcytic anemia:
Case 1:
1) C - reticulocytes

2) B vitamin C
3) C - PPI
Case 1 continued:
1) D
2) C iron deficiency anemia
3) C - hypothyroidism
4) D - colonoscopy
5) A sideroblastic anemia
Case 2:
1) B
2) C peripheral smear
3) D MMA level
4) B12 or folate replacement
5) C - hypokalemia
6) F MMA level
7) E
8) C - both
9) metformin
Hemolysis:
Case 1:
1) D peripheral smear
2) A - hemoglobin electrophoresis
3) A - oxygen, fluids, and analgesics
4) high WBC or fever
5) ceftriaxone, levofloxacin, moxifloxacin
6) C exchange transfusion
7) parvovirus B19
8) B reticulocyte count
9) E PCR for DNA
10) IVIG
11) hydroxyurea
12) D aseptic necrosis
Case 2:
1) normal
2) C - renal involvement
3) more than SS trait, less than SS disease (SC in
middle)
4) A - visual disturbance
2) D cold agglutinin disease
3) B autoimmune, cold IgM antibodies
4) C - parvovirus
Leukemias:
Case 1:
1) myelodysplastic syndrome
2) Pelger-Huet cell, bi-lobed, pancytopenia
3) D - % of blasts
4) A - bleeding and infection

5) transfuse GCSF, infection, 5q deletion azacytadine

Case 2:
1) AML
2) smear with blasts
3) cytogenetic abnormalities
4) M3
5) relapsed disease
Case 3:
1) differential WBC, 91% neutrophils
2) CML
3) increased basophils
4) B - BCR/ABL
5) C - imitanib
6) leukopheresis
7) hyroxyurea
8) lung fibrosis
Case 4:
1) CLL
2) A - no treatment necessary
Case 5:
1) B - fludarabine
Case 6:
1) hairy cell leukemia
2) immunophenotyping/cell sorter
3) cladribine
CLL Review questions:
1) A - observation
2) C - hypogammaglobulinemia
3) D - prednisone
Myeloproliferative disorders:
Case 1:
1) polycythemia
2) C - splenomegaly (hypoxia can raise HCT)
3) ABG's, renal US
4) B - JAK-2
5) D - none
6) phlebotomy
7) hydroxyurea to drop cell count
8) thrombosis
Case 2:
1) B - myelofibrosis
2) C - lenalidomide
Case 3:
1) essential thrombocythemia
2) C both bleeding and thrombosis
3) ASA, hydroxyurea, anagrelide
4) C - CML

5) C - observation
Case 3 continued:
1) B leukemoid reaction
Plasma cell disorders:
Case 1:
1) Myeloma
2) C - bone marrow biopsy
3) B-J protein, hyperuricemia, increased
ESR, low anion gap, rouleau formation,
suppression of other Ig lines
4) D (auto stem cell can be used up to 70 years
old) (B would have been the most effective
*medication*, but that wasn't the question!)
Case 2:
1) MGUS
2) A - no treatment
Case 3:
1) Waldenstroms Macro IgM
2) B - plasmapheresis
Aplastic Anemia:
Case 1:
1) HIV, EBV, CMV, hepatitis B and C serology,
ANA, B12, folate levels
2) none - diagnosis of exclusion
3) B - allogenic bone marrow transplant
4) C - cyclosporine and antithymocyte globulin
5) D - oral polio
6) A - B12
7) A - cobalamin deficiency
Lymphoma:
Case 1:
1) excisional biopsy
2) chest x-ray, chest/abdomen/pelvic CT scans,
bone marrow biopsy and LDH level
3) A - lymphocyte predominant
4) B - lymphocyte depleted
5) A - radiation therapy
6) B - ABVD chemotherapy
7) B - ABVD chemotherapy
8) D - bone marrow transplant
9) filter out antigens - don't alloimmunize
Case 1 continued.....
1) B - lung cancer
2) C - acute leukemia
Case 2:
1) start treatment; more tests wont change
therapy
2) radiation local, chemo widespread, CHOP

3) CD20 antiboduy
4) add rituximab
5) BM transplant
Transfusion reactions:
Case 1:
1) major blood group ABO incompatibility
2) Stop the transfusion. Recheck the blood type.
Hydrate the patient and consider forced
diuresis with mannitol. Possible use of
bicarbonate.
3) D - filter and irradiated
4) delayed development of jaundice
5) C - hypocalcemia
6) A IgA deficiency reaction (anaphylaxis)
Case 2:
1) C - leukoagglutination
Case 3:
1) D - urticarial reaction
Case 4:
1) B - anaphylaxis
Case 5:
1) A - febrile nonhemolytic reaction
2) E - febrile nonhemolytic reaction
Coagulation:
Case 1:
1) von willebrand's disease
2) superficial
3) A - bleeding time
4) A - desmopressin
5) B - factor VII replacement
6) B Bernard-Soulier syndrome
7) C Glanzmanns
9) post-transfusion purpura, tx with IVIG
Case 2:
1) ITP
2) none
3) steroids
4) splenectomy
Case 3:
1) IVIG
2) D - e. coli O157: H7
Case 4:
1) factor XIII deficiency
2) euglobulin clot lysis time
3) E - fresh frozen plasma
Case 5:
1) factor XI deficiency
2) E - mixing time

3) F specific factor level

4) B - fresh frozen plasma
Coagulation Review Questions:
1) A acquired VW factor antibody
2) A fibrin low, D dimers high, fibrin split
products high
3) B - DIC
4) C fresh frozen plasma
5) B - hypocalcemia
6) A - VIII, IX, XI, XII
7) A - nothing
8) A lower dose
9) C proceed with surgery
10) C - FFP
11) A nothing until echo done
12) C smear to look for clumping
Case 6:
1) heparin-induced thrombocytopenia
2) C venous thrombosis
3) stop heparin
4) argatroban, lepirudin (direct-acting thrombin
inhibitors)
5) platelet factor IV antibodies, serotonin
release assay
6) A increased aPTT (lupus anticoagulant)
Case 7:
1) D antiphospholipid syndrome
2) mixing study
3) Rusell viper venom test
4) E ASA and heparin
Case 8:
1) E factor V Leiden
2) lifelong warfarin
3) skin necrosis
4) heparin resistance
Thrombophilia questions:
1) C no treatment necessary
2) C advise not to use oral contraceptives
3) C antiphospholipid syndrome
Case 9:
1) uremia-induced platelet dysfunction
2) desmopression/DDAVP
Case 9 continued.....
1) C - acquired factor VIII inhibitor
Case 10:
1) Wiscott-Aldrich syndrome
Prostate Cancer:
Case 1:

1. A perform PSA
2. B - transrectal ultrasound with biopsy
Case 2:
1. local - Gleason scoring (low - do nothing, high
- surgery/radiation)
2. A - radiation or surgery (use flutamide first)
Case 3:
1. flutamide, GnRH agonist
Testicular cancer:
1. B - inguinal orchiectomy
2. A - regular follow up, no chemotherapy
unless it recurs
Breast Cancer:
Case 1:
1. mammogram, pap smear, colonoscopy
2. neg = no axillary dissection
3. positive nodes = chemotherapy
4. ER or PR + = tamoxifene, raloxifine,
5. B - HER2/Neu positive
6. alternative to tamoxifen
7. B - yearly mammogram
Case 1 continued....
1. A - lymph node involvement
2. E - lumpectomy with adjuvant chemotherapy
and local radiation
3. A - radiation followed by tamoxifen and
chemotherapy
Case 2:
1. D - tamoxifen
2. DVT
3. B
4. A
Cervical cancer:
1. D
2. D
3. E
Endometrial cancer:
1. A
2. C
Ovarian cancer:
1. C
General Internal Med answers:
Case 1:
1. gastric lavage
2. caustics
3. never dangerous
4. never

Case 2:
1. narcan, dextrose, thiamine
2. intubate and lavage (empty stomach)
3. never
4. seizures
Case 3:
1. salicylate overdose
2. bicarbonate
Case 3 continued.....
1. B ASA toxicity
Case 4:
1. D - EKG
2. if wide QRS --> give bicarbonate to protect
heart
Case 5:
1. give oxygen
2. myocyte ischemia - EKG
3. normal
hyperbaric oxygen indications - cardiac
problems, metabolic acidosis, pregnancy
Case 5 alternate:
1. C - call an ambulance
Case 6:
1. nerve gas
2. C - atropine
3. pralidoxime
Case 7:
1. gastrointestinal disturbance
2. B
3. vtach
4. EKG
5. low potassium
6. life-threatening dysrhythmias or hypotension
unresponsive to other measures
Case 8:
1. spider bite (black widow spider)
2. C - low calcium
3. calcium, anti-venom antitoxin
Case 9:
1. B - EKG
2. j waves on EKG (look like ST elevation)
Case 10:
1. scurvy
Case 11:
1. vitamin A toxicity
Case 12:
1. high altitude pulmonary edema - B
Case 13:

1. D - nicotinic acid deficiency (pellagra)

Case 14:
1. C - chromium
Case 15:
1. D - zinc
Case 16:
1. C
Case 17:
1. E - all of the above
Acetaminophen overdose:
Case 1:
1. nothing that can be done (too late for nacetylcysteine - only in 1st 24 hours)
Case 2:
1. n-acetylcysteine
Case 3:
1. n-acetylcysteine and charcoal
Adverse effects and toxicity:
Case 1:
1. C
Case 2:
1. B
Case 3:
1. C
Case 3 alternate:
1. B
Case 4:
1.metabolic acidosis with normal AG
Case 5:
1. B
Case 6:
1. E
Case 7:
1. C - serotonin syndrome
Case 8:
1. C - methadone (opiate withdrawal)
Case 9:
1. C
Case 10:
1. B - diphenhydramine
2. B - calcium carbonate
3. D - amiodarone
4. B - lactic acidosis
5. D methemoglobinemia
6. B malignant hyperthermia
7. C - glucagon
8. calcium
Epidemiology:

1. D - >85
2. B - CHF
3. A - urine
Immunology:
Case 1:
1. D desensitization (immunotherapy)
Case 1 continued.....
1. B - stop propranolol
Case 2:
1. enalapril
Case 3:
1. C - glucagon
Case 4:
1. E - encase everything
Complement deficiency:
Case 1:
1. A - C2 deficiency
Case 2:
1. B - C1 inhibitor deficiency
Case 3:
1. A - C2 and C4 levels
Case 4:
1. B - danazol
Case 5:
1. C - decreased C2 and C4 levels
Case 6:
1. A - nasal steroids
Case 7:
1. C pneumococcal sepsis
Selective IgA deficiency:
1. D common variable immunodeficiency
Hyper IgE syndrome:
1.C IVIG
Stats/Ethics:
Stats:
Case 3:
1) B - reassurances
Case 4:
1) A lead-time bias
Case 5:
1) B confounding variable
Case 6:
1) B type 2 error
Case 7:
1) all of the above
Case 8:
1) C 5

Case 9:
1) C - random selection across population
Ethics:
Case 1:
1) tell father
Case 2:
1) dont do it
Case 3:
1) no blood to mom, give blood to kid
Case 4:
1) C
2) A
3) A
4) A
5) B
6) B
7) C
8) A
Preventative medicine:
Case 1:
1) A
2) D ASA with PPI
3) E
4) E
5) B
6) E
7) C
8) A family history
9) C serum cholesterol only
10) D
11) D
12) E
13) E
14) B
15) E
16) B
17) B
18) A
19) E
20) A
21) B
22) C
23) C
24) B
25) C
Rheum answers:
Case 1:

1. E - rheumatoid arthritis
2. E - skin nodules
3. A anti-CCP
4. NSAID's and prednisone
5. A - methotrexate
6. A - liver and lung fibrosis
7. B - anti-TNF
8. E - high RF and most joints involved
9. A dry eye
Case 1 continued.....
1. E - spinal fusion
2. A - anti-CCP or RF
3. C hydroxychloroquine
4. B low glucose
5. D accelerated coronary disease
6. C - cricoarytenoid joint involvement
7.
8. E infective endocarditis
9. Bakers cyst, removal
10. Caplans sydrome
11. C palindromic rheumatism
12. A - better
Case 2:
1. D - parvovirus
2. C decreased reticulocyte count
3. B - duration
4. A - PCR for DNA
5. normal
6. A - anemia
7. NSAID's for joint pain, IVIG for anemia
Case 3:
1. E - Sjogren syndrome
2. B - Schirmer test
3. C - SSA and SSB
4. C - salivary gland biopsy
5. A - ANA
6. A - joint pain
7. C - lymphoma
8. artificial tears and saliva (no steroids),
civemeline, pilocarpine
Case 4:
1. C - CREST syndrome
2. ANA
3. verapamil, nifedipine
4. C - renal and cardiac involvement
5. E - no effective therapy
6. worse with exercise, treated with steroids
7. eosinophiliic myositis, steroids work

8. A - ACE inihibitor
9. A - pulmonary hypertension
10. D - right heart catheterization
Case 5:
1. SLE
2. A - ANA
3. B - dsDNA
4. 4 skin (malar, discoid, photosensitivity,
ulcers), joint, renal, CNS, chronic heme
5. A - hydroxychloroquine
6. acute exaacerbations
7. C - CNA and renal involvement
8. B - antiphospholipid antibodies
9. A - mixing study
10. A - anti-Ro (do EKG on baby for AV block)
11. C anti-Sm abs
Case 5 continued:
1. B - restrictive pulmonary disease
Case 6:
1. Still disease
2. A - ibuprofen
3. D - prednisone
4. C - CBC and ferritin levels
Case 1 p. 434:
1. B - relapsing polychondritis
Case 2 p. 435:
1. A - Behcet syndrome
Case 3- p. 435:
1. D - reflex sympathetic dystrophy
2. A - bone image (scintigraphy)
Case 7 - p. 437:
1. C bursitis
2. trauma
3. fever and increased WBC count
4. A NSAIDs and physical therapy
Case 7 continued.....
1.D - anserine bursitis
2.C prepatellar bursitis
3.A Jumpers knee (patellar tendonitis)
4.B - plantar fasciitis
Case 8:
1.A
2.B
3.C
4.E
5.aortic reg, uveitis
6.bent over test
7.A

8. B clinical symptoms
Case 8 continued:
1.C
2.E
3.A
Case 9:
1.psoriatic arthritis
2.pencil in cup deformity
3. asymmetric, inflammatory arthritis of distal
joints of fingers and axial skeleton
4.E
5.part of the sero negative, enthesitis
6.NSAIDs, Methotrexate
Case 10:
1.D
2.B
3.GI campylobacter, chlamydia .....give
antibiotics
4.NSAIDs, antibiotics if infection
Case 11:
1.C
2.ESR
3.temporal artery biopsy
4.high dose steroids immediately
5.shoulder and hip pain with no temporal artery
symptoms PMR with lower dose steroids
6.thoracic aneurysm
Case 12:
1.C
2.B
3.GI angiogram
4.D
5.D
6.steroids
Case 13:
1.C
2.B
3.Biopsy
4.A
5.E
Case 14:
1.B
2. Linear radiodense calcium deposits
3.A
4.D
5.patients who cannot take an NSAID
6.preventive
7.NSAIDs not working, multiple joints

8.stop eating organ meats, no beer

9.after acute attacks
10.allopurinal alternative
Case 14 continued.....
1. D
2. E
3. C
Case 15:
1.B
2.osteophytes
3.none
4.lose weight, exercise
5.A
Case 16:
1.A
2.x-ray
3.MRI
4.calcuim & Bisphosphonates
5.chronic steroid therapy can cause it
Tendon, Ligament, Cartilage, Bursa disorders:
1. relapsing polychondritis, steroids
2. bicipital tendonitis
3. rotator cuff injury, surgical repair
4. medial epicondylitis, NSAIDs and PT
5. Dupuytrens contracture, inject collagenase
and steroids
6. scaphoid fracture, nothing
7. ACL tear, surgically reattach
Case 17:
1. A - dermatomyositis
2. C CPK and aldolase
3. biopsy
4. must look for solid organ cancer
5. pulmonary HTN (if lung involvement)
6. A - prednisone
7. B - azathioprine
Case 18:
1. E - none
2. depression/chronic fatigue, sleep disorders
3. TCAs
Case 18 continued:
1. C (fibromyalgia)
Case 19:
1. carpel tunnel
2. C nerve conduction study
3. hand splinting
4. inject steroids

5. severe pain refractory to medical therapy or

significant thenar muscle atrophy
6. DM, acromegaly
Case 20:
1. B
2. D
3. A
4. C
5. familial mediterranean fever
6. Churg-Strauss
7. microscopic polyangiitis, steroids and
cyclophosphamide
8. eosinophilic fasciitis, steroids
Infectious diseases answers:
CNS infections
Case 1:
1. focal neurologic abnormalities, severe
confusion that makes the neurologic
examination inaccurate, papilledema, and/or a
recent seizure
2. culture
3. strep pneumoniae
4. ceftriaxone
5. bacteria on Gram stain, CSF WBC >1,000
6. in pneumococcal meningitis
Case 2:
1.viral meningitis
Case 3:
1. Listeria monocytogenes
2. ampicillin, add gentamicin when listeria
confirmed
3. TMP-SMX
Case 4:
1. Neisseria meningitis
2. Antibiotics and CT
3. LP
4. C - C5-C9 levels
Case 4 continued:
1. B - listeria
Case 5:
1. B - CD4
2. D - ampho, 5FC
3. cryptococcal antigen testing
4.CD4<500
Case 6:
1. herpes simplex encephalitis
2. C - CT without contrast

3. C - PCR for DNA

4. A acyclovir
Case 6 continued:
1. D - reduce the dose of acyclovir and increase
hydration and urine flow
2. mollaret meningitis
Otitis Media:
Case 1:
1. C - immobility of the tympanic membrane
2. tympanocentesis
3. amoxicillin
4. add clavulic acid or 2nd/3rd gen cephalosporin
Case 2:
1. treat
2. C - biopsy
3. amoxicillin
Influenza:
Case 3:
1. neuraminidase inhibitor
2. antigen detection on nasopharyngeal wash
3. everybody every year
Head and Neck infections:
Case 5:
1.C - airway obstruction
Case 6:
1.C - ceftriaxone and clindamycin (epiglottitis)
Case 7:
1.D - peritonsillar abscess (moved uvula)
Case 8:
1.D - otic solution of neomycin and topical
steroids (otitis externa)
Case 9:
1.D - septic thrombophlebitis of internal jugular
vein
Case 10:
1. B clinda and vanco
2. B skilled nursing facility wearing diapers
Case 11:
1. mucormycosis
Pneumonia:
Case 1:
1. pulse ox or blood gases, give oxygen
2. chest x-ray
3. sputum gram stain and culture
4. hypoxia, hypotension, tachycardia,tachypnea,
altered mental status, hyponatremia, elevated BUN
5. empirirc therapy of CAP

6. >65; diabetes, cirrhosis, COPD, CHF, asplenic,

hematologic malignancies; steroid users, renal
failure, HIV, organ transplant recipients,
immunosuppressive medications
7. >65; diabetes, cirrhosis, COPD, CHF, asplenic,
hematologic malignancies; steroid users, renal
failure, HIV, organ transplant recipients,
immunosuppressive medications
8. nobody (only one revaccination needed!)
Case 2:
1. A gram negative rods
Case 3:
1. D imipenem toxicity
Case 4:
1. C coxiella burnetti
2. D - leptospirosis
Case 5:
1. coccidioidomycosis
2. serology with complement fixation titers
3. amphotericin
Case 5 continued:
1. D - staphylococcus
Tuberculosis:
Case 1:
1. sputum AFB stain/culture, respiratory
isolation, never PPD 1st in acutely symptomatic
patients
2. 6 months (2 months of RIPE then 4
months INH + rifampin)
3. no pyrazinamide or streptomycin
4. substitute rifabutin for rifampin and use
efavirenz
5. bone, brain, military TB, pregnancy
6. A pericardial and CNS
Case 1 continued..
1. A
Case 2:
1.A - pleural biopsy
Case 3:
1.A - new case of tuberculosis in workplace
Case 4:
1.D - all
PPD testing:
Case 1:
1. C - high risk groups
2. >5 (close contacts, HIV, steroids), >15 (no
tests)

3. people who've never been tested or not

recently - test twice to make sure 1st one
wasn't false
4. B INH
5. no cross-reaction with BCG
6. C - 10% in a lifetime
7. no effect
8. E - no one
Case 1 continued
1. nothing
2. INH for 9 months
3. nothing
4. INH for 9 months
5. INH for 9 months
6. nothing
7. INH
Tropical diseases/animal-borne stuff
Case 1:
1. B - strongyloides (assoc w/ eosinophilia)
Case 2:
1. D - trichinosis
Case 3:
1. tularemia (ulceroglandular syndrome)
2. serology
Case 3 continued.....
1. A - dengue
2. C - babesia
3. D - ehrlichia/anaplasma
4. A brucellosis
5. D - varicella
6. D capnocytophagia
7. pasteurella
8. bacillary angiomatosis, bartonella henselae
9. bartonella quintana
10. anthrax, A cipro or doxy
11. pseudomonas
Food poisoning and diarrhea
Case 1:
1. campylobacter (most common), shigella,
salmonella, yersinia
2. B fecal leukocytes
3. A stool culture
4. quinolones when severe (low BP, tachycardia,
fever, metabolic acidosis)
5. scombroid (histamine fish poisoning)
Case 1 continued
1. D

2. C vibrio vulnificus
Postexposure prophylaxis
Case 1:
1. D - Ig and vaccine
2. E - no treatment, A - 0.3%
3. B - immunoglobulin (VZIG)
4. D - Ig and vaccine
5. C - contact and resp isolation
6. Ig and booster vaccine
7. no
8. TIG only for never vaccinated, Tdap for at
least one booster
Case 1 continued.....
1. C Ig and vaccine
2. D - pneumococcus, meningococcus, etc.
Malaria:
1. prophylaxis - mefloquine,
atovoquone/proguanil
2. treat with atovoquone/proguanil, oral
quinine and doxyclycine, artemisinin
3. quinidine
Sexually transmitted diseases:
Case 1:
1. Urethritis
2. Urethral swab for PCR DNA genetic testing
3. One drug for chlamydia (azithromycin or
doxycycline) and one drug for gonorrhea
(ceftriaxone, cefixime)
4. single-dose therapy with azithromycin
5. check for deficiency of terminal complement
Case 1 continued.....
1. D - treat without parental consent
2. C - chlamydia
3. D - do nothing
4. D blood test
Case 2:
1. urinary wet mount and KOH preparation
Case 2 continued:
1. B - trichomoniasis
Case 3:
1. suppression with fluconazole
Case 4:
1. PID
2. E - laparoscopy
3. pregnancy test
4. high fever and WBC
5. 2 weeks of doxycycline
Case 4 continued.....

1. B ceftriaxone and azithro

Case 5:
1. D - partner not treated and he reinfected her
2. D - hemophilus ducreyi
Syphilis:
Case 6:
1. jarisch reaction
2. B - aspirin
Case 7:
1. D - do nothing and tell to get married
Case 7 continued.....
1. B - syphilis
2. C - haemophilis ducreyi
3. E - FTA
Warts:
Case 8:
1. no test
2. removal, freeze, burn, cut, laser, shave, and
melt with podofilox or trichloroacetic acid,
gradually remove with imiquimod
Case 9:
1. scabies/pediculosis
2. oil scrape
3. permethrin, lindane
Urinary infections:
Case 1:
1. D - TMP-SMX for 3 days
2. extend the length of therapy to 1014 days
with the same drugs
3. stones, strictures, tumors, obstruction,
diabetes
4. extend therapy to 2 weeks for acute prostatitis
5. C - pregnant patients
Case 1 continued:
1. C - amoxicillin
2. B
3. D
Case 2:
1. B - private room with contact isolation
Case 3:
1. D - proceed with surgery
Fournier gangrene:
Case 4:
1. A - Zosyn (pip/tazo)
2. B - hospitalize for IV abx and consult with
another surgeon
Case 4 continued.....
1. B - chlamydia

Case 5:
1. E - ceftriaxone
Case 6:
1. D renal transplant rejection
Bone and joint infections:
Case 1:
1. A - x-ray
2. A - biopsy
3. staph - ox, naf, MRSA - vanco, linezolid,
dapto, gram neg - cipro
4. to detemine duration of treatment
5. never
Case 2:
1. B - arthrocentesis
2. E - culture of synovial fluid
3. ceftriaxone and vanco
4. D - polyarticular involvement, rash,
tenosynovitis
Case 2 continued:
1. B - itraconazole
2. C - bartonelle henselae
3. F - amoxicillin/clavulinic acid
Lyme disease:
Case 1:
1. D - oral doxycycline
Case 2:
1. A - offer reassurance
2. grab head, NOT body
Case 3:
1. just treat
2. oral (joint, rash, facial)
3. oral (joint, rash, facial), IV ceftriaxone
(cardiac, CNS)
Case 4:
1. C stop the antibiotics
Fever and neutropenia:
Case 1:
1. A - ceftriaxone
2. add vanco, then caspofungin
3. C - add caspofungin
Case 2:
1. E - slow rate of vanco infusion (Red Man
syndrome)
2. A - continue abx and retain catheter
3. C hepatosplenic candidiasis
4. C - voriconazole
Case 3:

1. E - nitroblue tetrazolium disease (chronic

granulomatous disease - missing NADPH burst)
Case 4:
1. D treat with irtrapenem
Catheter infections, etc:
Case 1:
1. B
2. B
3. B
Case 2:
1. A
2. C
3. A
HIV disease:
1. A
2. D
3. D
4. TMP-SMX, meropenem, minocycline
Case 1:
1. CMV retinitis
2. A - dilated ophtho exam
3. IV ganciclovir or foscarnet
4. uveitis
5. no routine primary prophylaxis, oral valganciclovir
Case 2:
1. D - tuberculosis
2. elevated AP and GGTP with normal bilirubin
3. clarithromycin and ethambutol
4. azithromycin
Case 2 continued:
1.D - none (treatment is clarithro and
ethambutol)
Case 3:
1. CNS toxo
2. pyrimethamine/sulfa
3. brain biopsy
4. TMP-SMZ
Case 3 continued:
1. D - tuberculosis
Case 4:
1. CD4 < 500, viral load > 1000
2. 3 meds, 2 + PI or efavirenz
Additional cases:
1. 2 drugs + PI/efavirenz
2. 2 drugs + switch to efavirenz
3. start HAART now! (answer to "OR" question
is D - continue meds)
4. 2 drugs + PI

5. genotype for sensitivity

6. D - zidovudine, lamivudine, nelfinavir
Case 5:
1. D
2. E
3. B
4. B