2UPMCMercy2023

Dermatology

200

What is the diagnosis?

Paronychia, also called whitlow. 

400

What is the cause AND treatment of this pruritic finding in a 62 yo F presenting with dyspareunia and dysuria?

Most commonly hypo-estrogenic state. Can also be driven by autoimmune pathologies.

Treat with ultrapotent topical steroid such as clobetasol, or mometasone in mild disease. 

600

This 38 yo F traveled from Iran to Yemen for work and then developed this facial lesion with histopathology demonstrating dermal infiltrate with macrophages, lymphocytes, eosinophils, and plasma cells. Amastigotes were noted in the macrophages. Her husband has similar lesions and traveled with her. 

Diagnose it. 

Cutaneous/mucocutaneous leishmaniasis.

Treat with oral allopurinol and IM meglumine antimonate. 

800

This 64 yo M with HTN, EtOH use disorder, emphysema, and psoriatic arthritis presents with an unknown duration of this systemic body rash. His labs are suggestive of mild AKI, EtOH of 149, and leukocytosis of 15.

Name this systemic finding.

Erythrodermic psoriasis.

Note: Treat with IVF, temperature management, emollients, wet dressings. You can use low-dose MTX or TNF-alpha inhibitors like etanercept or adalimumab. 

1000

This older gentleman presented with pruritic cutaneous plaques with scattered diffuse brownish nodules on his trunk, as well as lymphadenopathy, and new hepatomegaly. Histopathology demonstrated aggregates of atypical CD4+ cells within the epidermis suggestive of Pautrier microabscesses. For 1000 points, name this syndrome, its advanced leukemic disseminated form, and the first-line treatment for this condition. 

Mycosis fungoides

Sezary syndrome

Corticosteroids

Disposition Issues

200

When starting the Options process for a patient, your attending has to sign which form?

MA-51

400

What time does meds to bed close?

Mon-Thurs at 4 pm

Friday at 3:30 pm

600

What are the indications for continuous long-term oxygen therapy for your patients with chronic lung disease?

Arterial oxygen tension (PaO2) less than or equal to 55 mmHg (7.32 kPa), or a pulse oxygen saturation (SpO2) less than or equal to 88 percent

PaO2 less than or equal to 59 mmHg (7.85 kPa), or an SpO2 less than or equal to 89 percent, if there is evidence of cor pulmonale, right heart failure, or erythrocytosis (hematocrit >55 percent)  

For patients with normal awake oxygenation, oxygen may be prescribed during sleep if any of the following occur during sleep: the PaO2 is 55 mmHg or less, the SpO2 is 88 percent or less, the PaO2 decreases more than 10 mmHg (1.33 kPa), and/or the SpO2 decreases more than 5 percent with signs or symptoms of nocturnal hypoxemia (eg, impaired cognitive function, morning headaches, restlessness, or insomnia).

800

Who do you have to call to get a patient transferred to a different hospital? Who do you have to call after that?

Dr. Pinevich to approve the transfer.

Medcall to connect you with a hospitalist at the receiving facility.

1000

There is an observation and interview-based assessment to evaluate function in basic living skills by testing 17 skills in the 5 areas of self-care, safety and health, money management, community mobility and telephone, and employment and leisure participation. It is often used to make recommendations for living situations that promote safety, health, and independence. This assessment can be performed either inpatient or outpatient. What is it called and who can perform it?

Kohlman Evaluation of Living Skills (KELS) assessment

Occupational therapy

Demographics

200

A 47-year-male with invasive gastric carcinoma involving regional lymphadenopathy with dyspepsia, weight loss, and anorexia is likely to be of which ethnic descent?

Asian

400

This 32 yo M track-and-field athlete has sudden cardiac arrest during a regional competition and is unable to be revived. 

Which cause of SCD in young male athletes likely accounts for this? 

Arrhythmogenic right ventricular dysplasia 

600

Name the most common cancer in women AND in men.

Women:

1. Breast
2. Lung
3. Colorectal

Men:
1. Prostate
2. Lung
3. Colorectal

800

This 32 yo F Mongolian female with history of erythema nodosum presents with intermittent claudication, lower extremity rash, hair loss, diarrhea, and volume overload with echo suggestive of heart failure. She does have dyspnea on exertion. Incidentally, left ventricular mural thrombosis is noted. She has erythema nodosum and weak peripheral pulses. Physical exam shows positive Pemberton sign. Her labs show leukocytosis, elevated ESR and CRP, and she has a low-grade fever. Name this disease AND its treatment (okay to mention class).

Takayasu arteritis

Systemic glucocorticoids + glucocorticoid-sparing agent (DMARD such as methotrexate or azathioprine)

Okay to use mycophenoloate or leflunomide. Can use anti-TNFalpha alone, or additionally to above meds. Tocilizumab is okay too. 

1000

This parasitic infection is also known as bilharziasis, originates in certain freshwater snails, and comes in the form of seven speicies residing in Africa, South America, the Middle East, and Asia. Infection can cause bowel inflammation and ulceration, periportal fibrosis, portal hypertension, granulomatous infection of the bladder with pseudopolyps, and even neurologic manifestations from the migration of eggs. Patients sometimes experience a generalized prodromal illness but can occur over weeks. Name the disease and its treatment. 

Schistosomiasis

Treat with prednisolone and then praziquantel. 

Dated Treatments

200

This historical treatment for cavitary tuberculosis was discontinued in the 1950s and involved the intra- or extra-pleural injection of oil, usually paraffin oil, to control bronchopleural fistulas, to prevent persistent tuberculous empyema, or to prevent recurrent tuberculous pneumothorax.

Oleothorax

400

Mercury has been used for centuries in multiple capacities, including medicinal and widespread industrial use. It is a common chemical exposure and environmental pollutant and now is classified as an exceedingly rare toxidrome mostly presenting with accidental ingestion or occupational exposure. How do you treat it?

Remove exposure.
GI decontamination should be performed. Attempt charcoal and whole bowel irrigation.
Early chelation with dimercaprol. Oral succimer follows this.
Questionable whether peritoneal or hemodialysis helps. Exchange transfusions should be attempted. 

600

During 1906-1940, nearly 3 million cases and approximately 100,000 deaths occurred as the result of an illness characterized by photosensitive pigmented dermatitis, diarrhea, and dementia. It was treated via the enrichment of flour on a mass scale. Name the illness, the cause, and name one modern cause.

Pellegra

Niacin (B3)

Bariatric surgery, EtOH use disorder, anorexia nervosa.

800

This historic treatment has been used for severe decompression sickness, artieral gas embolism, as well as in carbon monoxide poisoning. Its original use was in the ventilation of patients afflicted with polio. Small data sets suggest it may be helpful in sensorineural hearing loss. 

Name this treatment modality. 

Hyperbaric oxygen therapy

1000

This treatment originated in China in the 1960s and has been used for non-invasive management for recurrent anginal episodes. Treatment is administered through three pairs of external inflatable cuffs that are applied around the lower legs, upper legs and buttocks. These cuffs continuously inflate and deflate between the resting period of the heartbeat and increase blood returned to the heart. There are numerous contraindications, including presence of pacemaker, afib, valvular disease, PAD, HTN, tachycardia, PHTN, and presence of VTE. Name the treatment.

Enhanced External Counter Pulsation (EECP)

Note: CMS will cover EECP for patients with anatomy not amenable to PCI or CABG and with class III/IV angina. 

Diseases

200

What does the diagnosis of migraine require?

≥ 5 episodes (4-72hrs when untreated)

2 of these:
unilateral location
throbbing nature
moderate to severe intensity
worsens with physical activity

must include:
nausea or combination of photophobia and phonophobia

400

In addition to Kayser-Fleischer rings noted on slit lamp exam, these two laboratory findings will confirm a diagnosis of Wilson's disease.

Decreased serum ceruloplasmin

Elevated urinary copper excretion

600

Name two of the four criteria that would indicate the presence of allergic bronchopulmonary aspergillosis.

- skin test positive for Aspergillus fumigatus

- Eosinophilia >500/μL

- IgE>417 IU/mL

- specific IgG and IgE for A fumigatus

800

A 75-year-old man presented to the emergency department with a 6-month history of epigastric pain, watery diarrhea, and weight loss. Physical examination was notable for epigastric tenderness. Esophagogastroduodenoscopy revealed severe esophagitis, antral erosions, and duodenal ulcers. The gastric pH was below 2, and the fasting serum gastrin level was above 1000 pg per milliliter (reference range, 13-115). These patients are also at risk for pituitary adenomas, parathyroid hyperplasias, and gastro-enter-pancreatic tract tumors. What is the initial diagnosis? And what is the larger syndrome it is part of?

Zollinger Ellison syndrome.
Multiple Endocrine Neoplasia type 1. 

Treatment with PPI initiated. Ultimately requires surgery. These patients should be pan-scanned. 

1000

A 21-year-old woman with a history of surgically corrected Hirschsprung’s disease presented with 6-week history of abdominal pain and constipation. Her blood pressure was 162/108 mm Hg. She had an elevated creatinine and CT showed large subcapsular urinomas and hydronephrosis caused by distal ureteral obstruction from a rectal mass. What is the likely mechanism of her hypertension?

 

Page kidney. 

Page kidney refers to the phenomenon whereby external compression of the renal parenchyma impedes renal blood flow, resulting in increased renin secretion and hypertension. The patient underwent percutaneous drainage of the urinomas with normalization of her blood pressure followed by ureteral stenting and biopsy of the rectal mass, which showed adenocarcinoma.