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Presentation is most commonly Rhino- mucormycosis
orbital-cerebral. With Acute Sinusitis all
sinuses with rapid expansion, periorbital
edema, proptosis, blindness; in a diabetic
host or immunocompromised host;
diagnosis and treatment
biopsy and tissue exam that show hyphae with irregular branching without
How do you diagnose mucormycosis? septations. (Unless its Aspergillus, which has regular branching - still needs
surgery, and amphotericin B)
scaly pruritic patch or plaque that is erythematous, circular, or oval with
Clinical features of tinea corporis? centrifugal spread. Subsequent central clearing with an actively advancing border
that appears annular (ring like)
Can you use nystatin against tinea No (ineffective against ringworm due to inactivity against dermatophytes)
corporis?
Topical tacrolimus is approved for atopic dermatitis/discoid lupus
treating inflammatory skin conditions such
as what?
Is there sufficient evidence to suggest No
that routine catheter exchange in patients
with long-term indwelling catheters will
reduce the risk of bacteriuria?
Immunocompromised patient presents Listeria monocytogenes
with acute, febrile gastroenteritis and
bacteremia with Gram-positive rods,
raising suspicion for what bacteria? Found
in soil/decaying vegetation/low-level
contaminated food
Exposure to bird feces is associated with Chalmydia psittaci
psittacosis due to what bacteria?
,Humans acquire these organisms Mycobacterium avium complex
primarily through aerosolized municipal
water, but transmission can occur through
contaminated soil, food, and birds.
Hypersensitivity pneumonitis with hot tub MAC
lung manifest as an acute flu-like illness
with dyspnea, cough, malaise, fever. Most
cases are self limited. Due to what
bacteria?
Would pseudomonas present as a lobar
interstitial infiltrate on CXR or lobar
infiltrate?
Current guidelines recommend what Carbapenems
antibiotic category for treating ESBL-
producing organisms?
gram-positive, atypical, and some gram-negative bacteria (Legionella) but not
What does Azithromycin cover?
MRSA
What risk is a pacemaker/ICD placement? low risk (no need to adjust warfarin)
What risk is cataract surgery? low risk (no need to adjust warfarin)
Should you ever adjust the target INR for No
a surgery for a patient on Warfarin?
Recommendation for AAA less than 4 cm U/S every 2-3 years
Recommendation for AAA between 4.0- Ultrasound every 6-12 months
4.9 cm
Recommendation for AAA between 5.0- Surgery for >5.5 cm
5.9
When is surgical repair indicated for > or equal to 5.5 cm in diameter or > or equal to 0.5 cm increase in 6 month period
AAA? in all symptomatic patients
Who gets screened for AAA Men ages 65-75 with a smoking history
Lady comes in after starting amlodipine ACEI
with feet swelling, and question asks,
which medication class if added with
amlodipine would've prevented this?
Patient needs his right sided knee Delay the surgery (Needs to be at least 6-12 months)
replacement but was recently started on
DAPT after DES 4 months prior, what
should you do with medicines?
Patient had a stent placed and is at low 30 months
bleeding risk, what is the perfect scenario
for DAPT
Which cardiac condition is seen in Coarctation of the aorta
approximately 3-10% of patients with
Turner syndrome?
What are the indications for primary Prior MI with EF < or equal to 30%, NYHA Class 2 or 3 symptoms, must be 40 days
prevention with AICD placement? post-MI and 3 months post-vascularization
Secondary prevention guidelines for Prior VF or unstable VT without a reversible cause; Prior sustained VT with
AICD underlying cardiomyopathy.
A patient comes in with hypertension, Diabetes (may influence you to pick an ACEI as well)
new; family history of thyroid cancer at a
young age, What test should be ordered
next? Thyroid ultrasound? CT chest?
,When do you screen for lung cancer in Ages 50-80 who have a 20 or more pack year history or who currently smoke or
the outpatient setting? quit within the last 15 years.
When would you screen someone MEN Type 2, Childhood Neck Irridiation
outpatient for a thyroid ultrasound for
thyroid malignancy?
Patients who present with carpal tunnel acromegaly; insulin-like growth factor 1 (Growth hormone was wrong because
syndrome but also have malodorous those levels can actually fluctuate)
sweat, enlarging hands, sleep apnea, oily
skin, and skin tags should be evaluated
for what with what test?
Patients with an elevated IGF-1 test should pituitary mass (found in 70% of patients)
undergo confirmatory testing with oral
glucose suppression testing. Patients with
acromegaly Usually will have GH >2 and
need MRI to look for
Is Carpal tunnel syndrome associated Yes
with Rheumatoid Arthritis and
hypothyroidism?
The initial evaluation for primary Plasma Aldosterone Concentration (PAC) to plasma renin activity (PRA) ratio.
hyperaldosteronism should include what
test?
How to confirm a diagnosis of primary aldosterone suppression test (oral sodium load test or saline infusion test)
hyperaldosteronism?
If you suspect primary Adrenal venous sampling to differentiate between hyperplasia and adenoma
hyperalderosteronism and the CT doesn't
show anything, what's the next step?
Chronic opioid use leads to decreased hypogonadism (loss of libido, low testosterone, and inappropriately low FSH and
gonadotropin releasing hormone LH - they should be high to crank up his testosterone!)
secretion and is a common cause of...
Diabetic patient's blood sugars are SGLT2's can decrease BP by messing with the RAAS so adjusting HCTZ is most
uncontrolled (she's older with borderline appropriate.
softer blood pressures), on metformin,
HCTZ, Norvasc, and a statin. Considering
adding a SGLT2, what medication might
need adjusting?
What is the mechanism of action of Glucagon-like peptide agonists.
exenatide?
Do statins interact with SGLT'2's? No
Urine alkalization or allopurinol (This question's correct answer was potassium
How to treat kidney stones from gout? citrate, in addition to alkalization, citrate is a stone inhibitor and reduces
crystallization)
Would you add Lasix to someone with Increases urinary calcium excretion and resulting in increased the risk for calcium
gout? stone formation.
decreases calcium excretion and is used to minimize these stones! (The catch- the
HCTZ's role in hypercalciuric renal stones
lower the pH increasing the risk for gout stones)
When would would a patient with ABI of 0.5 or less who fail other therapies. Wh
claudication be a candidate for re-
vascularization?
In what situation would you not use Heart failure as it decreases mortality
Cilostazol?
decreases venous return in the early phase; and increases venous return in the
What does a valsalva maneuver do?
late (release) phase.
, Which murmurs get louder with valsalva HCM (decreased volume leads to a higher gradient) and MVP (decrease LV
and why? volume and increased leaflet prolapse)
Standing and valsalva decrease venous HCM and MVP
return so what two murmurs are
accentuated?
increases venous return; increases after load by kinking of the formal arteries, and
What does squatting do ?
increases reverse flow
Squatting makes which murmurs louder? Aortic Regurgitation, Mitral Regurgitation, and VSD
Handgrip and squatting increase after AR, MR, and VSD
load so accentuate what murmurs?
Patients with an ASD usually have what Wide, fixed splitting of the second heart sound
type of murmur?
Bicuspid aortic valve typically causes prominent ejection click followed by a mid-systolic murmur, heart best of there
what type of murmur? right second intercostal space.
Restore sinus rhythm or aggressive control of ventricular rate which often leads to
How to treat tachycardia-induced
significant or complete recovery of the LV function (Dude's EF in the question was
cardiomyopathy with AFRVR
25%...I picked mitral valve surgery. heart rate control was correct)
How does strict dietary salt restriction possibly enhancing the renin-angiotensin aldosterone system activity; 3 gram
worsen outcomes with patients with heart restriction is more appropriate.
failure?
hematoma that remains in continuity with the arterial lumen with blood flow into
What is a pseudoaneurysm? and out of the hematoma cavity. Usually detected by a pulsatile mass with a
systolic bruit
Are VSD's usually accompanied by a Yes
thrill?
What is the sound that a tricuspid holosystolic murmur best heard over the left second or third intercostal space or
regurgitation makes? at the subxiphoid area.
Patients with a history of peripartum Avoid future pregnancy (death with subsequent pregnancies)
cardiomyopathy and persistent LV
dysfunction have a high risk of further
decline in LV function and what if they
want to get pregnant again?
Early diastolic murmur at the second right Echocardiogram
intercostal space is associated with
Marfan's syndrome and the next step
would be
Aortic root dilation can be found in Aortic root diameter greater than or equal to 50 mm to reduce the risk of aortic
approximately 50% of children and 60- dissection or rupture
80% of adults with MFS. Aortic dissection
is the cause of death in 30-45% of
patients, followed by heart failure. When
is elective operation indicated?
When do you operate on a AAA? Greater than or equal to 5.5 cm
When do you screen for AAA? Men, Ages 65-75, who have ever smoked.
When is lung cancer screening Annual screening for patients 50-80 with a 20 pack year smoking history. May be
recommended? d/c when they haven't smoked for 15 years
What if the only EKG change is T wave Normal variant
inversions in the right precordial leads V1-
2
Moderate mitral stenosis frequently Atrial Fibrillation (Prescribe a heart monitor)
progresses to...