zee5-f and zee5-k

8/10/2019 Zee5-F and Zee5-K

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12 sets of Zee5-F and 3 sets of Zee5-K

Dr. Zeeshan (Zee Man)

#Zee5-F ( 5 things you MIGHT NOT know)Important stuff which general review books MISS in the form of 5 facts abouta specific topic which you MIGHT NOT know. It is quick and extremely high

yield

SET 1

Topic: Microcytic Hypochromic Anemia

1) Which is the ONLY microcytic with INCREASED platelet count? Why?

2) Which is the ONLY microcytic with INCREASED RDW?

3) Which is the ONLY microcytic with INCREASED CIRCULATING IRON?

4) Which is the ONLY microcytic with NORMAL SERUM IRON?

5) Which is the ONLY microcytic associated with Osteoarthritis?

A1) IDA. Because of chemical overlap between erythropoietin andthrombopoietin.

A2) IDA

A3) Sideroblastic

A4) Thallasemia

A5) Anemia of Chronic Disease (ACD)!! No no no no no.....RA leads to ACDbut Osteoarthritis does NOT!! If they give you a case with 15 lines dedicated toOA and 1 line dedicated to NSAIDS and ask you to pick the cause ofMicrocytic Hypochromic, its Iron Deficiency Anemia and NOT ACD!!

SET 2

Topic: Microcytic Hypochromic Anemia

1) Which is the ONLY microcytic with HIGH reticulocyte count?

2) Which is the ONLY microcytic that DOES NOT RESPOND to IRONtherapy?

3) Does NORMAL FERRITIN RULE OUT Iron Deficiency Anemia?

4) Does Omeprazole DECREASE Iron Absorption?5) Does Famotidine DECREASE Iron absorption?


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A1) HbH Alpha Thallasemia 3 genes deleted

A2) Thallasemia because Iron is NORMAL

A3) No no no....33% have NORMAL FERRITIN

A4) Yes...because ACID increases itA5) Yes...because ACID increases it

SET 3:

Topic: Macrocytic Anemia

1) Does a NORMAL B12 level rule out B12 deficiency? Explain why or whynot?

2) Is Hashimoto's associated with B12 deficiency?

3) B12 treatment cause Hyperkalemia...True/False..Explain

4) Reticulocyte count is INCREASED in B12 deficiency...True orfalse...Explain

5) Metformin causes B12 deficiency. True/False...Explain...

A1)1 No a third of pts with vit B 12 deficiency may have normal B12 as thecarrier protein transcobalamin is an acute phase reactant

A2) Yes, pernicious anemia autoimmune associated with other autoimmune

A3) False,it will cause hypokalemia

A4) False.Count is decreased because of ineffective erythropoesis..

A5) True metformin can cause B12 deficiency by DECREASING ITSABSORPTION

SET4

Topic: Pharma

1) GLP-1 analogs are associated with MEN 2a and MEN2b..True/False

2) GLP-1 analogs are associated with Pancreatitis..True/False

3) Dorzolamide causes acidosis..True/False...Explain

4) HCTZ can cause IMPOTENCE...True/false

5) Triamterene can cause FA deficiency...True/False

A1) True!

A2) True


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A3) False...It has the ability IF GIVEN ORALLY..BUT it is given topically!!!

A4) True

A5) True.Triamterene can cause folic acid deficiency anemia in people alreadyat risk for FA deficiency.

SET 5

Topic: HbA1c (All the levels you need to know!)

1)What is the level of HbA1c at which you add a second hypoglycemic?

2)What is the level of HbA1c at which you add Insulin?

3)What is the level of HbA1c which DIAGNOSES Diabetes?

4) What is the level of HbA1c which DIAGNOSES Impaired Glucose

tolerance?5)What is the target goal of HbA1c in a diabetic?

A1) >7

A2) >8.5

A3) >6.5

A4) 5.7-6.4

A5)

SET 6

Topic: TTP-HUS

1)You diagnose a patient with HUS.....n then start antibiotics....what willhappen?

2) Which is the the 2nd most common cause of HUS?

3) Which drugs can cause TTP-HUS?4) You diagnose a patient with TTP.....n then start platelets....what willhappen?

5) Plasmapheresis is given as a treatment in TTP...True/False

A1) Worsening of the case by the toxins of killed Ecoli that are releases anddeposit in kidney tubules

A2) Shigella

A3) Ticlopidine, Quinidine and Clopidogrel...Don't choose Heparin if given inthe option...that is the BIGGEST distractor!!!!! Also, Cyclosporine, OCPs, andPenicillinA4) Platelets clump when we give them and can precipitate in the


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kidney and brain....So, we do phasmapheresis...which replaces ADAMSTS13in the patient

A5) True. As explained above.

SET 7Topic: Types of Cancer therapy (Name the type of therapy)

1)A 65 year old man is diagnosed with prostate cancer. Prostatectomy wasdone and then External beam radiotherapy was given.

2)A 65 year old man is diagnosed with prostate cancer. Prostatectomy wasdone. 2 months later, when he came back for follow up, External BeamRadiotherapy was given as PSA was 11 and recurrence was suspected.

3) A 65 year old man is diagnosed with prostate cancer. He is given localexternal beam radiotherapy and then prostatectomy was done.

4) a) Chemotherapy is given for acute myeloid leukemia. b) After that multidrug therapy is given. Both have different names.

5) A 65 year old man was diagnosed with prostate cancer. He is being givendaily anti androgen therapy after initial therapy was given.

A1) Adujuvant

A2) Salvage (after failure of standard Rx)

A 3) Neoadjuvant

A4) a) Induction, b) Consolidation,

A5) Maintenance.

SET 8

Topic: Smoking

1) When do we stop smoking after starting Varenicline?2) Who has more efficacy, Bupropion or Varenicline?

3) Amitryptiline is moderately effective and FDA approved for smokingcessation. True or false.

4) After how many years after the smoker stop smoking does his risk of lungcancer become the same as a person who never smoked?

5) Smoking cessation programs will decrease the rate of IUGR the most. Trueor false?

A1) After 1 week to allow Varenicline to build up.


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A2) Varenicline

A3) False. Although its moderately effective, its NOT FDA approved.

A4) 15 years....Also remember that risk of Acute coronary events falls to a RRof 1.02 after > 3 years cessation and risk of stroke at 2-4 years after cessation.smoking cessation does not negate the need for AAA screening, AAA -> U/S

for 65 yrs male pt who have ever smoked. Risk of oral, esophagus, pancreasand bladder drops to level of never smoker after 10yrs...Non smokers wholives in families with smoker have 30 percent higher risk of lung cancer

A5) True. By 10-30%

SET 9

Topic: Leukemia

1) Most common subtype of AML?

2) Most likely leukemia to involve CNS and Scrotum?

3) Autosplenectomy more common in CML or CLL?

4)Which subtype of AML involves RBCs?

5)Most common leukemia that responds to therapy?

A1) M2A2) ALL

A3) CML

A4) M6. I call it RB6

A5) ALL

SET 10

Topic: Hemochromatosis

1) Most common cause of death?

2) Most accurate test?

3) What if the option you chose in 2 is NOT given in options?

4) S3 is more common than S4. True or False?

5) Diabetes insipidus and Diabetes Mellitus both are associated with it. Trueor False?

A1) Restrictive Cardiomyopathy!!! No no no no no....Its Cirrhosis (Slapyourself 11 times n repeat that after each slap!!!!!)


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A2) Liver Biopsy (Bet u knew that!)

A3) HFE gene + MRI

A4) False. S4 is more common due to Restrictive CMP

A5) True. But DM is way more common!

SET 11

Topic: MEN

1) What are the most common manifestations of MEN-1?

2) Pheochromocytoma always manifests 1st in MEN2. True or false?

3) Acanthosis Nigricans is associated with MEN2a and MEN2b. True orFalse?

4) What is the most frequent pituitary manifestation of MEN-1?

5) Exenatide and Liraglutide are associated with MEN2a and MEN2b. True orfalse?

A1) Multiple parathyroid adenomas causing hyperparathyroidism are themost common manifestation of MEN1, displaying almost 100 percentpenetrance by age 40 to 50 years. In most cases, it is the initial manifestationof MEN1.

A2) True!!!! No no no no no......Now slap yourself on both cheeks 11 timeseach and repeat Medullary thyroid carcinoma manifests 10 years beforepheochromocytoma and isolated pheochromocytoma is an extremely rarepresentation of MEN2!!!

A3) True!! Its also associated with PCOS.

A4) Prolactin secreting macroadenoma

A5) I know you answered no!!!!! But its yes!!! You are like, "What theheck?".....Yup Exenatide and Liraglutide are associated with medullarythyroid carcinoma!!! So, they are associated with MEN2!!!

SET 12

Topic: PSEUDO-Hypoparathyroidism

1) What's the Ca+2, Phosphate and PTH level in PSEUDO-Hypoprathyroidism?

2) What's the difference between PSEUDO-hypoparathyroidism 1a and

PSEUDO-hypoparathyroidism 1b?3) What's the difference between PSEUDO-hypoparathyroidism andPSEUDO-PSEUDO Hypoparathyroidism?


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4) Next step in pt presenting with Albright's phenotype?

5) Next step in the management of symptomatic hypocalcemia?

A1) PSEUDO-hypoparathyroidism is similar to PRIMARY

HYPOPARATHYROIDISM with a INCREASED PTH....So, Inc PTH + DecCa2+ and Inc phosphate

A2) 1a=Albright's phenotype + HORMONAL RESISTANCE TO TSH, PTH,ACTH.........

1b= Most mild version= NO Albright's phenotype + HORMONALRESISTANCE TO ONLY PTH

I know what you are thinking: Bro, what the heck is Albright'sphenotype?...Albright's phenotype is a constellation of features you learned instep 1 for pseudohypoparathyroidism: short 4th metatarsal, Mental

retardation, short stature, brachydactyly, osteoma cutis, obesity, roundedfacies; and in some cases developmental anomalies.

A3) PSEUDO-PSEUDO is Albright's phenotype + all NORMAL HORMONESi.e. Normal Calcium, Normal phosphate and Normal PTH. It is a G proteindefect.

A4) We test for TSH and ACTH

A5) PTH!!!!!!!!!!!!!!! No no no no no............Please slap yourself 11 times oneach cheek and repeat after each slap.......For symptomatic hypocalcemia->

We first give IV Calcium Gluconate and then do PTH!!

#Zee5-K (keep it simple)

5 most likely questions about a disease

CARD 1

Topic: Acromegaly

1) Best initial test?


3) Most common cause of death?

4) Treatment?

5) 3 interesting facts about the disease

A1) IGF-1A2) Oral Glucose supression test


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A3) Cardiomyopathy from coronary disease

A4) Surgical removal of macro adenoma + adjunctive Lanreotide/Octreotide/Somatostatin analogs

A5) a) We test for colon cancer bcoz IGF-1 leads to colonic polyp formationb)It causes carpal tunnel syndrome bcoz it causes protein growth abnormally.c)

You test for prolactin bcoz about 10% co-produce prolactin

CARD 2

Topic: Prolactinoma



3) Most common cause of death?4) Treatment?


1) Prolactin level ( I bet you knew that!)

2) MRI

3) Prolactinoma DOES NOT shorten life!

4) a)Cabergoline...b) Surgery 1) when medical therapy fails (rare) 2) Pituitary

apoplexy

5) a) Opiates, Verapamil and Hypothyroidism increase prolactin!b) Mostcommon presentation in a male is DECREASED LIBIDO and ERECTILEDYSFUNCTION (Gynecomastia takes time to develop)C) Surgerycomplications: c1) DECREASED ADH l/t INCREASED URINE OUTPUT andINCREASED SERUM SODIUMc2) DECREASED ACTH can l/tHyperkalemia, hypoglycemia and shock

CARD 3

Topic: Paget



3) Increased risk of?

4) Treatment?



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A1) Radiologic bone survey (After getting isolated Inc ALP)

A2) Nuclear bone scan

A3) 100 time increased risk of Osteosarcoma + Increased risk of High outputcardiac failure

A4) Asymptomatic-Don't treatSymptomatic-BisphosphonatesA5) a) Urinary Hydroxyproline is high along with ALPb) Calcitonin is used forthe acute Mx of bone painc) Alternate descriptions c1) Disordered modellingc2)) Defective osteoid formation c3) Replacement of lamellar bone with

ABNORMAL WOVEN bone c4) Thick bony cortex and trabeculae

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