ICM Shelf Review: (look last few pages)

The normal breath sounds:

Know pictures of cross sections of spinal
cord or medulla or pons know the lesions
marked with an X.

Know the pupils- asymetry, where is the
lesion?
Neurotransmitters that are involved in
certain eye movements.
Vertigo
Nystagmus after resp infection
Altered mental status
Fever and seizure= meningitis
Headaches- young person: subarachnoid
hemorrhage
Medullary lesions
Lower limb numbness after surgerySural
nerve
Affect of head traumas
Cancer miosisptosis= Horners
Vit def due to alcohol
Papillary edema
Brain tumors: obsese with visual disturbances and papillary edema: show pic and
answer is psuedotumor cerebri

Know bates tables on Headaches and pupillary
summary.

Tertiary symphils- aortic insufficency murmor
Asthma child- charcot laiden crystals eosinpholics
Hepatocellular carcinoma exposure to aflotoxins
Know anemias!
B12- takes years and has neurological symptoms
Folate-takes months to weeks



Know ulcers due to vascular dz- medial malleus
Venous ulcers
KNOW PERIPHERAL VASCULAR DISORDERS=CHAP 14 IN BATES






FADI:
- Young males with sudden severe headache onset during sex: subarachnoid
hemorrhage?
- Hip trauma, some1 cancer myosi, ptosisi= horners
- Pt comes in with decrease breath sounds, decrease tactile fremitis, dullness
to percussion in the left lower lobe? Plueral effusion
- Pt recent mood changes, depression, muscle weakness. CSF: lympocytosis.
Rght upper lobe shows calcification? Tuberculosis
- Young child with painfill mass in distal femur- radiolucent mass with reactive
bone growth/ lesion- pleomorphic spindle cells with osteoid deposition?
Osteosarcoma
- Jews come to fertility couple. Wifes menstrual cycle is 24 days and
menstration last 7 days. Sex only allowed 7 days after menses. What should
you tell them? Also be accepting and understanding. Never be argumentative
or judgemental. Chose the answer that will validate their feelings
- Ask about exceptions that can be made?
- MC site of ectopic pregnancy- Ampulla
- 75 year old with untreated syphilis- bounding pulse- Aortic Regurgiation
- 10 month old baby baby wants to feed every 2 hours but has gas? Normal
- She has HIV, dont tell husband who is also your pts. What do you do?
Report and have a duty to protect husband
- 40 year old female- osteoarthritis and nerve pain. Makes family do all chores.
She is on pain meds. What do you tell your pt? Dr. Fulmer
- Deputryns contraction? Palmar fascia
- Pt in CHF what extra heart sound would you hear? S3
- Pt comes in with chest dysfunction, taking herbal medication? MaWan causes
this- has ephedrine in it
- Some one comes in and tells you he is going to comit suicide. What do you
do?
- In testicle- testosterone is higher
- Breat mass- afraid because mother and aunt died of cancer. Biopsy show
adenocarcinoma. What do you tell the pt? OPTIONS
- Needle shaped crystals= GOUT
- Pic of condyloma acumulta= male gentials- HPV 6 and 11
- Know shock
o Vital signs
o CO
o Wedge pressure
- Cavernous sinus thrombosis
- CN palsys
- Timing of heart mumurs- LOOK AT TABLE
- Claudication: peripheral vascular dz- blockage of arteries. Loose hair on the
legs in stocking distribution, pain with walking, kind of angina of mucles in
calves, feet and thigh
- Post MI infarction complications- arrthymias is the first thing you die from-
VFIB
- Which vit toxicosis causes papillary edema, cerebral edema? Vit D
- Affect of medication of renal eff and aff arterioles as they relate to a pt with
azotemia. Graphs
- Grade a heart murmur
- Pt with COPD which heart sound is most likely to be abnormal P2
- Post menopausal bleeding
- Echymosis of cervical tisse ITP/TTP/HUS?
- Post op PE
- Tall thin pneuomothorax
- SMA embolic occlusion- ischemic colitis. Hx of Afib
- Ddx diarrhea= watch out for c.diff- psuedomembranous
- Hemturia and increase hematacrit? Cancer of renal cell carcinoma- EPO
- Vit toxicit- papillary edema. Vegan headache?
- Leomyoma
- Tuners- coarctation of aortia, and increase carrying angle of the arm
- Acure renal failure. BUN 60. Cret 6.8= ARF due to ATN- post cardiac arrest
o BUN 60, Cre 6.8= 10:1= infarction
- Limb Girdle muscular dystrophy
- Reflex test on newborn: startle reflex
- Over use syndrome- Carpel Tunnel
- Tineal sign
- Impingement sign in shoulder
- Golfers (medial epicondyle) Vs Tennis
- 83 year old lady develops SOB, few years back she had treatment of breast
cancer? Cardiomyopathy due to -Rubicin drugs
- After upper resp infection, 5 year old male gets neck mass?
- 14 year old on a farm and never has been vacination. Develops exudative
pharyngitis Diptheria
- Perianal pain? Fistula
- Pulmonary function tests? Restricive FEV1/FVC. If decreased- COPD if high-
Restrictve
- Asthma is reversible














Nov 2012 (ICM shelf)


1. Patients right eye is small than the left eye during light. Where is the lesion?
Right sympathetic branch cause sympathetic dilates the pupil
2. Patients left eye pupil is larger than the right eye during the light. Left eye
dose not show any dirct or consensual light reflex. Where is the lesion? Left
parasympathetic branch.
3. There was one question I was not sure, but I have chosen benign position
vertigo. The question was: patient had viral infection few days ago. Past few
hours he has vomiting and vertigo; however, patient dose not has any
hearing loss or tinnitus. The options were: meineir disease/ acute
laryntities/ benign positional vertigo.
4. After recovery from a respiratory infection, patient shows a mass on the
midline on the top of the thyroid cartilage. The answer will be thyroglossal
duct cyst. These kinda cyst can be latent for a long time, and suddenly a
stimulus can appear the cyst.
5. Patient has headache after having sex/during the sex. I have put idiopathic
headache
6. One question was regarding the Medullary lesions. I forgot the exact
wording, but it was medial medullary syndrome. Like patient has ipsilateral
tongue deviation and contralateral hemiparesis.
7. Lower limb numbness after surgerysaphenous nerve (it will be a picture)
8. An old man fall in bath tub. His wife brought her to the emergency. MRI
showd nothing. After 3 days, he was dead/something happen. Whats you
diagnosis? Raptured of the bridging vein.
9. Patient has the symptoms of the horners syndrome. Where is the cancer
location? I have chosen lungs.
10. Patient is alcoholic. Basically the question is asking wernicki koraskoff
syndrome. Which vitamin is deficient? Vitamin B1
11. Patient has bilateral Papillary edema and something happened in the skin.
This is due to which vitamin toxicity? Vitamin A
12. One question something happened with the child, and he is ataxic and wide
gaitsomething. I have chosen cerebellar astrocytoma.
13. Headache after exposure to the bright light. Migrane headache.
14. Mesothelioma= asbestos.
15. One question had some kinda brisue and yellowish discoloration around the
area of the medial meleolus. There was couple of options. I have chosen
venos insufficiency. Lymph node blockage was also another option.
16. One question was something related to the medium sized blood vessel.
Among the options only poly artrites nodosa made sense to me. However,
please know the symptoms of the polyartrities nodosa.
17. Pt comes in with decrease breath sounds, decrease tactile fremitis, dullness
to percussion in the left lower lobe? Left lower lobe Plueral effusion
18. Pt recent mood changes, depression, muscle weakness. CSF: lympocytosis.
Also, the question seems to me saying that patient has meningities ( I may
forget). However, radiograph shows that patient has rght upper lobe
calcification? Tuberculos meningities.
19. Young child with painfill mass in distal femur- radiolucent mass with reactive
bone growth/ lesion- pleomorphic spindle cells with osteoid deposition?
Osteosarcoma
20. Jews come to fertility couple. Wifes menstrual cycle is 24 days and
menstration last 7 days. Sex only allowed 7 days after menses. What should
you tell them? Also be accepting and understanding. Never be argumentative
or judgemental. Chose the answer based on your opinion. I have chosen
Icant help you if you are restricted to your religion. Cause patient is not
having sex during the ovulating time, so producing baby would be a tough
job.
21. MC site of ectopic pregnancy- Ampulla
22. 75 year old with untreated syphilis- bounding pulse- Aortic Regurgiation
23. A mother brought a 10 month old baby, who wants to feed every 2 hours but
has gas? Normal
24. She has HIV, dont tell husband who is also your pts. What do you do? The
answer can vary, but I have chosen Your husband is one of my patient, so its
my duty to tell and protect him.
25. 40 year old female- osteoarthritis and nerve pain. She is on pain meds. She
dose not go to her work for 5 months and her husband and kids dose all job
at home What do you tell your pt? I forgot the answers.
26. Deputryns contraction? Palmar fascia
27. Pt in CHF what extra heart sound would you hear? S3
28. Pt comes in with chest dysfunction, taking herbal medication? MaWan causes
this- has ephedrine in it ( I actually forgot the exact question, but if the
question ask patient is taking a weight loss drug and those problem start,
then choose ginseng, but if the patient takes a cough drug and then those
problem starts, chose Ma Huang)
29. Some one comes in and tells you he is going to comit suicide. What do you
do? Tell the patient before leave the hospital must see the doctor.
30. In testicle- I forgot the exact question..testosterone is higher
Breat mass- afraid because mother and aunt died of cancer. Biopsy show
adenocarcinoma. What do you tell the pt? I know it is sorry for you but I
have to tell you that you have breast cancer.
31. Needle shaped crystals= GOUT (It will be a picture)
32. Pic of condyloma acumulta= male gentials- HPV 6 and 11
33. What is the difference between cardiogenic shock and hyperthermic shock? I
forgot the options, but I have chosen cardiogenic shock has less pulse
pressure (I think I may got this wrong, so read the book for the answer)
34. Timing/grading of heart mumurs- look at the table have chose 4/6 grading
murmer.
35. Claudication: peripheral vascular dz- blockage of arteries. Loose hair on the
legs in stocking distribution, pain with walking, kind of angina of mucles in
calves, feet and thigh
36. Post MI infarction complications- arrthymias is the first thing you die from-
VFIB
37. One question will be patient is taking NSAIDs for long time for some pain or
something like gout. He has chance for acute papillary necrosis
38. Pt with COPD which heart sound is most likely to be abnormal P2
39. Post menopausal bleeding suddenly. I have chosen leimyoma.
40. Echymosis of cervical tisse ITP/TTP/HUS? (exactly forgot the question, but
the answer I have chose is the low platelet quality cause TTP can cause
ecchymosis)
41. Patient has cholecystectomy and after that he was hospitalized for 5 days,
then something happen like shortness of breath.I have chosen pulmonary
embolism.
42. SMA embolic occlusion- ischemic colitis. Hx of Afib
43. One question also asking something happen on the left middle to lower
descendin colon. I have chosen inferior mesenteric artery.
44. Ddx diarrhea= watch out for c.diff- psuedomembranous
45. Hemturia and increase hematacrit? Patien had weight loss in last 6 months.
Cancer of renal cell carcinoma
46. Tuners- coarctation of aortia, and increase carrying angle of the arm (I forgot
the exact question, but turner syndrome may not be the right one). Please
know that what makes increase the carrying angle of the arm
47. Acure renal failure. BUN 60. Cret 6.8= ARF due to ATN- post cardiac arrest
a. BUN 60, Cre 6.8= 10:1= infarction
48. Limb Girdle muscular dystrophy. Something happen with the boy, and he has
proximal muscle weakness and rest of the body/function is fine.
49. Reflex test on newborn: startle reflex
50. Over use syndrome. When patient extend his wrist, he gets pain, so- Carpel
Tunnel (basically, the question was asking did you understand the reverse
fallen test.)
51. Patient can not supine and heard to flex the forarm. Bicipital tendenities
52. 14 year old on a farm and never has been vacination. Develops exudative
pharyngitis Diptheria
53. Perianal pain during the bowel movementanal fissue
54. Pulmonary function tests? Restricive FEV1/FVC. If decreased- COPD if high-
Restrictve (there will be one/two, I forgot the exact one)
55. Patient visits to the numerous doctor in one week and has various problem.
Whats you diagnosis. Somatization disorder.
56. Patient is too shy to have a girlfriend. He used to have one, but then she left.
The patient wants to have girlfriend but he thinks that other people rejected
him socially, so avoidant disorder.
57. Patient has sever pain on right colic, especially on the left quadrent. It will
have diverticulitis.
58. Dry skin and weight gain is due to hypothyroidism.
59. One question was skin lesion. It was a slow growing nodule or plaque for last
2 years. Sometimes if the patient scratch, blood comes out from the lesion. I
have chosen basal cell carcinoma (it was a picture)
60. Patient had problem with difficulty of eating solid food, now he cannot even
drink too. Whats your diagnosis. I have chosen achalasia (according to the
FA organ system)
61. I question had the direct answer of sarcoidosis. I forgot the exact question.
62. Pain starts on the epigastric region, and after 8 hours, it is radiating into the
right subscapular region. Whats your diagnosis? Cholecystities.
63. One answer I have chosen benificance. I have forgot the questions or the
options.
64. Patients tongue is deviated in the right side. Where is the lesion? Right
hypoglossal nerve.
65. Which of the following cause the unilateral nerve deafnes? In the options,
there will be the entire track for the hearing. Like cochlear nuclei, lateral
lamniscus..etc. I have chosen cochlear nuclei.
66. Another question will give two persons bp and pulse rate. Bp of the two
patient is almost the same; however, person B has the high pulse rate. The
question was asking what u can see in the person B? I have chosen increase
preload cause CO= SV*HR, increasing heart rate means more CO, so more
venous return; therefore, high preload. Some people were saying the person
B was described as athlete. If it is, then choose the increase stroke volume (I
dont know the exact underlying mechanism)
67. There was one question was asking regarding prostate something. It was
prostate hyperplasia.
68. The was one question regarding sound. I mean what kinda sound you can
hear on the sternal notch. I was looking for tracheal sound, but I havent seen
any option, so I have chosen bronchial sound. I may get that question wrong.