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- Jul 12, 2007
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Took a timed test without answers/not sure which I got right or wrong and wanted follow-up. Sorry for the lack of answer choices but these were the ones I recall. Thanks!
1.) Meningitis with a strictly lymphocytes (this was the only part of CSF profile provided with faint AFP staining) in a child of a farmworker? My hunch is viral, but if the only options were bacterial (including Tb, listeria, strep pneumo)....would it be Tb since Tb/fungal have lymphocytes?
2.) Infant child comes in....doctor says initial DNR but parents refuse and so ventilation is started...few days later parents realize condition is not improving and decided to withdraw care...do you continue with the vent or follow parents wishes or consult ethics committee?
3.) Heavy menstrual bleeding in a child and her mom (both african american). What would you be most concerned about on labs? Choices came down to ultimately vwf def and Fe-def anemia...I chose vwF def because of the family history.
4.) Bilateral abdominal masses in an infant who pees a ton...question asked for a diagnosis. My initial hunch was ARPKD but this was not a choice. I think I picked nephrogenic diabetis insipidus...not sure.
5.) Stroke patient comes in...really not cooperating with hospital staff (doesn't appear to be delirium or dementia) and 4 days in says wants to be DNR. Family says patient never expressed such wishes in past and basically opposes DNR. Who do you listen to? This one was tricky because I went with the stroke patient indeed having decision making capacity (I didn't equate stroke with loss of decision making capacity) and listen to the patient. Ideally, I would've went with something along the lines of re-assess patient and his/her decision but this was not an option.
6.) Rando genetics question in a CFTR patient who had a genotype of I507/F508 and the phenotype of cystic fibrosis
In his family tree (which depicted genotypes), he got the I507 allele from his mom's side but there was NO F508 (either carrier or disease) in the paternal side. Answers had crazy choices: imprinting, uniparental disomy, heterozygous disomy, and reactivation of a silenced gene. I think I picked the reactivation of a silenced gene. I was looking for mutation or mosaicism but that was not there.
7.) Loose Diarrhea/diffuse abdominal pain in a foreigner who didn't drink water but did drink some frozen fruit juice. Choices were your classic enteric G(-) bacteria: Camplyobacter jejuni, E. coli, salmonella.
I think I went with E. coli- seemed the most common since the diarrhea was non-bloody.
8.) Someone with gastritis with numerous RF...which one contributes the most- smoking, stress, hot liquids, tynenol use?
9.) Child who becomes hypoglycemia/has baseline hypoglycemia immediately 30 minafter a meal but becomes normoglycemia immediately after eating sugars/taking glucagon. Choices were glycogen storage disorder, insulinoma, brush border enzyme deficiency. I think I went with insulinoma since insulin would spike after a meal and also remain elevated at baseline.
10.) Untrained athlete who starts feeling dizzy 5 miles into a 50 mile bike ride in hot 100 degree+ and high humid temps....if he had trained should he have done that would've been most beneficial? (I think the choices were like drink tons of fluid, change core-body temp)...I went with the try to affect core-body temp, I guess if you lower it, you sweat better (but in retrospect I think that's wrong since the conditions are very humid and sweating is ineffective)?
11.) What is your most important cooling mechanism of training in low humid, hot temperatures? Radiation, convection, evaporative cooling (I think I picked this one).
12.) Someone with a rash who goes out in the woods...sounds like contact dermatitis (>2d)...question asked biopsy features....I think I went with spongiosis since I saw this in UWorld
13.) In a Pneumothorax...what is increased? Alveolar dead space (went with this one) or pulmonary vascular resistance? The latter I felt would've been more common in a PE but I guess my mind was boggling with the concept of reactive vasoconstriction.
1.) Meningitis with a strictly lymphocytes (this was the only part of CSF profile provided with faint AFP staining) in a child of a farmworker? My hunch is viral, but if the only options were bacterial (including Tb, listeria, strep pneumo)....would it be Tb since Tb/fungal have lymphocytes?
2.) Infant child comes in....doctor says initial DNR but parents refuse and so ventilation is started...few days later parents realize condition is not improving and decided to withdraw care...do you continue with the vent or follow parents wishes or consult ethics committee?
3.) Heavy menstrual bleeding in a child and her mom (both african american). What would you be most concerned about on labs? Choices came down to ultimately vwf def and Fe-def anemia...I chose vwF def because of the family history.
4.) Bilateral abdominal masses in an infant who pees a ton...question asked for a diagnosis. My initial hunch was ARPKD but this was not a choice. I think I picked nephrogenic diabetis insipidus...not sure.
5.) Stroke patient comes in...really not cooperating with hospital staff (doesn't appear to be delirium or dementia) and 4 days in says wants to be DNR. Family says patient never expressed such wishes in past and basically opposes DNR. Who do you listen to? This one was tricky because I went with the stroke patient indeed having decision making capacity (I didn't equate stroke with loss of decision making capacity) and listen to the patient. Ideally, I would've went with something along the lines of re-assess patient and his/her decision but this was not an option.
6.) Rando genetics question in a CFTR patient who had a genotype of I507/F508 and the phenotype of cystic fibrosis
In his family tree (which depicted genotypes), he got the I507 allele from his mom's side but there was NO F508 (either carrier or disease) in the paternal side. Answers had crazy choices: imprinting, uniparental disomy, heterozygous disomy, and reactivation of a silenced gene. I think I picked the reactivation of a silenced gene. I was looking for mutation or mosaicism but that was not there.
7.) Loose Diarrhea/diffuse abdominal pain in a foreigner who didn't drink water but did drink some frozen fruit juice. Choices were your classic enteric G(-) bacteria: Camplyobacter jejuni, E. coli, salmonella.
I think I went with E. coli- seemed the most common since the diarrhea was non-bloody.
8.) Someone with gastritis with numerous RF...which one contributes the most- smoking, stress, hot liquids, tynenol use?
9.) Child who becomes hypoglycemia/has baseline hypoglycemia immediately 30 minafter a meal but becomes normoglycemia immediately after eating sugars/taking glucagon. Choices were glycogen storage disorder, insulinoma, brush border enzyme deficiency. I think I went with insulinoma since insulin would spike after a meal and also remain elevated at baseline.
10.) Untrained athlete who starts feeling dizzy 5 miles into a 50 mile bike ride in hot 100 degree+ and high humid temps....if he had trained should he have done that would've been most beneficial? (I think the choices were like drink tons of fluid, change core-body temp)...I went with the try to affect core-body temp, I guess if you lower it, you sweat better (but in retrospect I think that's wrong since the conditions are very humid and sweating is ineffective)?
11.) What is your most important cooling mechanism of training in low humid, hot temperatures? Radiation, convection, evaporative cooling (I think I picked this one).
12.) Someone with a rash who goes out in the woods...sounds like contact dermatitis (>2d)...question asked biopsy features....I think I went with spongiosis since I saw this in UWorld
13.) In a Pneumothorax...what is increased? Alveolar dead space (went with this one) or pulmonary vascular resistance? The latter I felt would've been more common in a PE but I guess my mind was boggling with the concept of reactive vasoconstriction.
