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

@Zee Man



Hey everyone! I will be uploading important stuff which general review books MISS in the form of 5
facts at a time about a specific topic which you MIGHT NOT know. It is quick and extremely high
yield. Let me know if its helpful!! I call it theZee5-F!! Here is the 1st one...


5 things u MIGHT NOT know! #Zee5-FTopic: Microcytic Hypochromic Anemia (Set 1)
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 and thrombopoietin.
A2) IDA
A3) Sideroblastic
A4) Thallasemia
A5) Anemia of Chronic Disease (ACD)!! No no no no no.....RA leads to ACD but Osteoarthritis does
NOT!! If they give you a case with 15 lines dedicated to OA and 1 line dedicated to NSAIDS and ask
you to pick the cause of Microcytic Hypochromic, its Iron Deficiency Anemia and NOT ACD!!



Topic: Microcytic Hypochromic Anemia (Set 2)1) Which is the ONLY microcytic with HIGH
reticulocyte count?
2) Which is the ONLY microcytic that DOES NOT RESPOND to IRON therapy?
3) Does NORMAL FERRITIN RULE OUT Iron Deficiency Anemia?
4) Does Omeprazole DECREASE Iron Absorption?
5) Does Famotidine DECREASE Iron absorption?


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 it
A5) Yes...because ACID increases it

Topic: Macrocytic Anemia (Set 3)
1) Does a NORMAL B12 level rule out B12 deficiency? Explain why or why not?
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 or false...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 the carrier 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 ITS ABSORPTION

Topic: Pharm (Set 4)
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
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 already at risk for FA
deficiency.



Topic: HbA1c: All the levels you need to know!(Set 5)
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) <7


Topic: TTP-HUS: (Set 6)
1)You diagnose a patient with HUS.....n then start antibiotics....what will happen?
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 will happen?
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 and deposit in kidney
tubules
A2) Shigella
A3) Ticlopidine, Quinidine and Clopidogrel...Don't choose Heparin if given in the option...that is the
BIGGEST distractor!!!!! Also, Cyclosporine, OCPs, and PenicillinA4) Platelets clump when we give
them and can precipitate in the kidney and brain....So, we do phasmapheresis...which replaces
ADAMSTS13 in the patient
A5) True. As explained above.


Topic: Types of Cancer therapy(Set 7)
Name the type of therapy1)A 65 year old man is diagnosed with prostate cancer.
Prostatectomy was done and then External beam radiotherapy was given.
2)A 65 year old man is diagnosed with prostate cancer. Prostatectomy was done. 2
months later, when he came back for follow up, External Beam Radiotherapy was given
as PSA was 11 and recurrence was suspected.
3) A 65 year old man is diagnosed with prostate cancer. He is given local external beam
radiotherapy and then prostatectomy was done.
4) a) Chemotherapy is given for acute myeloid leukemia. b) After that multi drug therapy is given.
Both have different names.
5) A 65 year old man was diagnosed with prostate cancer. He is being given daily 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.


Topic: Smoking (Set 8)
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 smoking cessation. True
or false.
4) After how many years after the smoker stop smoking does his risk of lung cancer become the
same as a person who never smoked?
5) Smoking cessation programs will decrease the rate of IUGR the most. True or false?


Answers
A1) After 1 week to allow Varenicline to build up.
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 RR of 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, pancreas and bladder drops to level of never
smoker after 10yrs...Non smokers who lives in families with smoker have 30 percent
higher risk of lung cancer
A5) True. By 10-30%



Topic: Luekemia (Set 9)
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?


Answers
A1) M2
A2) ALL
A3) CML
A4) M6. I call it RB6
A5) ALL


Topic: Hemochromatosis (Set 10)
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. True or False?


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


Topic: MEN (Set 11)
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 or False?
4) What is the most frequent pituitary manifestation of MEN-1?
5) Exenatide and Liraglutide are associated with MEN2a and MEN2b. True or false?


Answers:
A1) Multiple parathyroid adenomas causing hyperparathyroidism are the most common
manifestation of MEN1, displaying almost 100 percent penetrance by age 40 to 50 years. In most
cases, it is the initial manifestation of MEN1.
A2) True!!!! No no no no no......Now slap yourself on both cheeks 11 times each and repeat
Medullary thyroid carcinoma manifests 10 years before pheochromocytoma and isolated
pheochromocytoma is an extremely rare presentation 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 the heck?".....Yup Exenatide and
Liraglutide are associated with medullary thyroid carcinoma!!! So, they are associated with MEN2!!!


5 things u MIGHT NOT know! #Zee5-FTopic: PSEUDO-Hypoparathyroidism (Set 12)
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 and PSEUDO-PSEUDO
Hypoparathyroidism?
4) Next step in pt presenting with Albright's phenotype?
5) Next step in the management of symptomatic hypocalcemia?
Answers:A1) PSEUDO-hypoparathyroidism is similar to PRIMARY HYPOPARATHYROIDISM with a
INCREASED PTH....So, Inc PTH + Dec Ca2+ and Inc phosphate
A2) 1a=Albright's phenotype + HORMONAL RESISTANCE TO TSH, PTH, ACTH.........
1b= Most mild version= NO Albright's phenotype + HORMONAL RESISTANCE TO ONLY PTH
I know what you are thinking: Bro, what the heck is Albright's phenotype?...Albright's phenotype is a
constellation of features you learned in step 1 for pseudohypoparathyroidism: short 4th metatarsal,
Mental retardation, short stature, brachydactyly, osteoma cutis, obesity, rounded facies; and in some
cases developmental anomalies.
A3) PSEUDO-PSEUDO is Albright's phenotype + all NORMAL HORMONES i.e. Normal Calcium,
Normal phosphate and Normal PTH. It is a G protein defect.
A4) We test for TSH and ACTH
A5) PTH!!!!!!!!!!!!!!! No no no no no............Please slap yourself 11 times on each cheek and repeat
after each slap.......For symptomatic hypocalcemia-> We first give IV Calcium Gluconate and then do
PTH!!


I am planning to start another series of cards..These cards will be about 5 most likely questions
about a disease....I call it #Zee5-K (Keep It Simple).....It will be short and extremely high
yield....Please try to answer them before seeing the answers..Let me know if it helps....Here is the
1st one:
Topic: Acromegaly (Card 1)
1) Best initial test?
2) Most accurate test?
3) Most common cause of death?
4) Treatment?
5) 3 interesting facts about the disease


Answers:
A1) IGF-1
A2) Oral Glucose supression test
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


Topic: Prolactinoma (Card 2)
1) Best initial test?
2) Most accurate test?
3) Most common cause of death?
4) Treatment?
5) 3 interesting facts about the disease


Answers
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) Most common presentation in a
male is DECREASED LIBIDO and ERECTILE DYSFUNCTION (Gynecomastia takes time to
develop)C) Surgery complications: c1) DECREASED ADH l/t INCREASED URINE OUTPUT and
INCREASED SERUM SODIUMc2) DECREASED ACTH can l/t Hyperkalemia, hypoglycemia and
shock



Topic: Paget (Card 3)
1) Best initial test?
2) Most accurate test?
3) Increased risk of?
4) Treatment?
5) 3 interesting facts about the disease


Answers
A1) Radiologic bone survey (After getting isolated Inc ALP)
A2) Nuclear bone scan
A3) 100 time increased risk of Osteosarcoma + Increased risk of High output cardiac failure
A4) Asymptomatic-Don't treatSymptomatic-Bisphosphonates
A5) a) Urinary Hydroxyproline is high along with ALPb) Calcitonin is used for the acute Mx of bone
painc) Alternate descriptions c1) Disordered modelling c2)) Defective osteoid formation c3)
Replacement of lamellar bone with ABNORMAL WOVEN bone c4) Thick bony cortex and trabeculae


Painful bladder syndrome
TRIAD = Urgency, Frequency, Chronic pelvic pain in the absence of another disease causing similar
symptoms e.g. UTI, PID, Cystocele.
- A chronic bladder condition.
- AGGRAVATION : Sexual intercourse, Exercise, Bladder filling (e.g. increased fluid intake, such
patients benefit by moderate restriction of fluid intake), spicy foods and certain beverages.
- RELIEF : Voiding !!
- P/E : Palpation of anterior vaginal wall elicits extreme pain (But NO FEVER/ CERVICAL MOTION
TENDERNESS)
- Often coexistent with chronic pain conditions (Fibromyalgia, IBS etc)
- DIAGNOSIS: Clinical ( the TRIAD symptoms above for >6wks duration)
- TREATMENT: 1ST line= Self care practices and behavioural modification (local heat/cold
application in bladder/perineum, avoid aggravating factors, maintaining fluid and voiding diary,
bladder training with urge suppression)

Children >2 years: Nasal spray (live) influenza vaccine preferred to intramuscular (inactivated)
vaccine because nasal spray provides better protection.
If nasal spray NOT AVAILABLE: give intramuscular.

'C'ymmetric IUGR= 3 'C's >> Congenital anomalies, Congenital infections (TORCH), Chromosomal
abnormalities.................All others: Asymmetric

The most effective emergency contraceptive method is Copper IUD (99% effective up to 120 hours
after unprotected sexual intercourse) followed by:
Ulipristal pill
Levonorgestrel
Combined OCPs.