Jordan AbramsNBME Medicine Form 4 - Answers & Explanations
Updated: Aug 28, 2020
1) X-ray of the chest • Clubbing of fingers & toes = hypertrophic osteoarthropathy
2) Hypercarbia • O2 supplementation → ↓ respiratory drive → retained CO2 (hypercarbia)
3) Mycoplasma pneumoniae • young, non-productive cough, low grade fever with patchy or diffuse interstitial infiltrate = atypical mycoplasma pneumonia
• CXR looks worse than the patient feels
4) Legionella pneumophila • Pneumonia + diarrhea = legionnaires disease • Pulse temperature dissociation (fever with relative bradycardia)
5) Renal artery stenosis • Carotid bruit = atherosclerosis of carotid artery; atherosclerosis in one vessel indicates multi vessel disease → RAS secondary to atherosclerosis
6) Erythropoietin • Corrected reticulocyte count is ~1.2%, meaning there is not enough marrow stimulation • Chronic kidney disease → ↓ EPO production
7) Pamidronate • Short term treatment of hypercalcemia is normal saline and calcitonin
• Long term treatment of hypercalcemia is bisphosphonates
8) Drug induced neutropenia • PTU and methimazole → neutropenia
9) Villous atrophy in the small bowel • D-xylose depends only on viable mucosa (not enzymatic breakdown) for absorption in the proximal small bowel • Celias disease → villous blunting → ↓ D-xylose absorption
10) Three-drug antiretroviral therapy only
• Start antiretrovirals straight away regardless of CD4 count
• Need to use three because of increased resistance
• No need for P. jiroveci prophylaxis because CD4 count >200
11) Direct current countershock • Direct current countershock = DC cardioversion • Wide QRS complex = ventricular tachycardia → shock
12) Choledocholithiasis
• This patients high amylase indicates there is a blockage at the pancreatic duct, and the elevated direct bilirubin indicates a blockage of the common bile duct
13) Left medial longitudinal fasciculus • The right PPRF send a signal to the left medial rectus via the left MLF; weakness of left adduction upon right gaze indicates a problem at the left MLF
14) Calcification of a bicuspid aortic valve • Systolic ejection murmur at the young age of 19 indicates a congenital cause
• Aortic stenosis (due to calcified bicuspid aortic valve) → ↑ LV pressure → hypertrophy and stiffening of the LV → S4
15) Supraspinatus tendon • Pain over lateral deltoid, awaking at night (lying on affected shoulder) and pain elicited from abduction against resistance = rotator cuff pathology
16) Acute tubular necrosis
• 3+ blood with no RBC’s → rhabdo → myoglobinuria → ATN
17) Seborrheic dermatitis • Usually appears on hairy areas (eg, scalp behind ears, beard, etc.)
• Greasy looking yellowish scaly rash • Associated with HIV & Parkinson disease
18) Switch from heparin to direct thrombin inhibitor therapy • Heparin-induced thrombocytopenia → stop all heparin products and start a direct thrombin inhibitor or fondaparinux
19) Gout
• Chronic alcohol use with asymmetric arthritis
20) MRI of the lumbosacral spine
• Compression of sacral nerves by tumor → Cauda Equine syndrome (B/L paralysis and numbness of LE, urinary incontinence (overflow), saddle anesthesia, absent DTRs below the knee)
• MRI is the modality of choice to diagnose nerve root compression
21) α1-antitrypsin deficiency
• Increased lucency at lung bases in young patient → panacinar emphysema
22) Hodgkin disease
• Single enlarged LN, pruritis, and absence on pharyngeal erythema make Hodgkin disease more likely than mono
• Pathologic lymphocytes are confined to affected nodes (unless a leukemic transformation occurs) which is why leukocyte count is not elevated
23) Addition of lisinopril to the medication regimen • ACEi → ↓ glomerular hyper-filtration associated with DM
24) Lisinopril therapy
• Hemorrhagic stroke are commonly caused by HTN
• Although weight reduction of 10kg lowers BP by 5-20 mmHg, this patient has already suffered a complication of HTN and must be treated aggressively with BP medication (while he continues to make lifestyle changes)
25) Nonketotic hyperosmolar state
• Glucose > 600 = HHS