USMLE UPDATED ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS
●● Gout crystals
Answer: negatively birefringent needles
●● Pseudogout crystals
Answer: positively birefringent needles
●● Vasculitis associated with chronic Hep B
Answer: polyarteritis nodosa
●● Vasculitis associated with chronic Hep C
Answer: cryoglobulinemia
●● Best blood test for polyarteritis nodosa
Answer: There is none. Get abdominal angiography first, then biopsy of
muscle, skin, or sural nerve.
●● Churg-Strauss
Answer: vasculitis + eosinophilia + asthma
,●● Takayasu's arteritis
Answer: young asian female with diminished pulses (usually preceeded
by fatigue, weight loss, arthralgia, anemia, elevated ESR)
●● Best test for Takayasu's
Answer: aortic angiography or MRA
●● Bite cells on blood smear
Answer: G6PD
●● Burr/Spur cells on blood smear
Answer: liver disease
●● Acanthocytes on blood smear (looks like spur cell but with more
rounded spurs)
Answer: liver disease, hypothyroidism, alcoholism
●● Basophilic stippling on blood smear
Answer: lead poisoning
●● Schistocytes on blood smear
Answer: TTP-HUS, DIC, prosthetic heart valve, malignant htn, sepsis
,●● Target cells on blood smear
Answer: thalassemia, other hemoglobinopathies, liver disease
●● 5 causes of microcytic anemia
Answer: iron deficiency, lead poisoning, anemia of chronic disease (but
usually normocytic), thalassemia, sideroblastic anemia (can also have
high MCV)
●● Antibody test for celiac disease
Answer: anti-endomysial, tissue transglutaminase (small bowel bx is
best though)
●● Antibiotics for MRSA
Answer: IV: vanc, linezolid, daptomycin, tigecycline;
if minor infection, can use oral: TMP/SMX, doxy, minocycline, or
maybe clindamycin (there is inducible resistance to clinda though)
●● Antibiotics for MSSA
Answer: Oxacillin/nafcillin, dicloxacillin (IV and oral), cefazolin (IV),
cephalexin (oral)
●● Can you use cephalosporins in pt allergic to PCN?
Answer: yes, if the rxn is rash only; no if pt has true anaphylaxis
, ●● Antibiotics to use for Staph with PCN allergy
Answer: cephalosporins if rash only; macrolides, clindamycin,
vancomycin, linezolid, daptomycin, TMP/SMX
●● Antibiotics for strep
Answer: PCN, ampicillin, amoxicillin
●● Antibiotics for GNRs
Answer: Cephalosporins: cefepime, ceftazidime
PCNs: piperacillin, ticaricillin
Monobactam: Aztreonam
Quinolones: cipro, levo, gati, moxi
Aminoglycs: gentamicin, tobramycin, amikacin
Carbapenems: imipenem, mero, erta
●● Limitation of ertapenem
Answer: does NOT cover pseudomonas
●● Piperacillin and ticarcillin
Answer: GNRs
strep
QUESTIONS AND CORRECT ANSWERS
●● Gout crystals
Answer: negatively birefringent needles
●● Pseudogout crystals
Answer: positively birefringent needles
●● Vasculitis associated with chronic Hep B
Answer: polyarteritis nodosa
●● Vasculitis associated with chronic Hep C
Answer: cryoglobulinemia
●● Best blood test for polyarteritis nodosa
Answer: There is none. Get abdominal angiography first, then biopsy of
muscle, skin, or sural nerve.
●● Churg-Strauss
Answer: vasculitis + eosinophilia + asthma
,●● Takayasu's arteritis
Answer: young asian female with diminished pulses (usually preceeded
by fatigue, weight loss, arthralgia, anemia, elevated ESR)
●● Best test for Takayasu's
Answer: aortic angiography or MRA
●● Bite cells on blood smear
Answer: G6PD
●● Burr/Spur cells on blood smear
Answer: liver disease
●● Acanthocytes on blood smear (looks like spur cell but with more
rounded spurs)
Answer: liver disease, hypothyroidism, alcoholism
●● Basophilic stippling on blood smear
Answer: lead poisoning
●● Schistocytes on blood smear
Answer: TTP-HUS, DIC, prosthetic heart valve, malignant htn, sepsis
,●● Target cells on blood smear
Answer: thalassemia, other hemoglobinopathies, liver disease
●● 5 causes of microcytic anemia
Answer: iron deficiency, lead poisoning, anemia of chronic disease (but
usually normocytic), thalassemia, sideroblastic anemia (can also have
high MCV)
●● Antibody test for celiac disease
Answer: anti-endomysial, tissue transglutaminase (small bowel bx is
best though)
●● Antibiotics for MRSA
Answer: IV: vanc, linezolid, daptomycin, tigecycline;
if minor infection, can use oral: TMP/SMX, doxy, minocycline, or
maybe clindamycin (there is inducible resistance to clinda though)
●● Antibiotics for MSSA
Answer: Oxacillin/nafcillin, dicloxacillin (IV and oral), cefazolin (IV),
cephalexin (oral)
●● Can you use cephalosporins in pt allergic to PCN?
Answer: yes, if the rxn is rash only; no if pt has true anaphylaxis
, ●● Antibiotics to use for Staph with PCN allergy
Answer: cephalosporins if rash only; macrolides, clindamycin,
vancomycin, linezolid, daptomycin, TMP/SMX
●● Antibiotics for strep
Answer: PCN, ampicillin, amoxicillin
●● Antibiotics for GNRs
Answer: Cephalosporins: cefepime, ceftazidime
PCNs: piperacillin, ticaricillin
Monobactam: Aztreonam
Quinolones: cipro, levo, gati, moxi
Aminoglycs: gentamicin, tobramycin, amikacin
Carbapenems: imipenem, mero, erta
●● Limitation of ertapenem
Answer: does NOT cover pseudomonas
●● Piperacillin and ticarcillin
Answer: GNRs
strep
