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 about
a 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 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!!

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 IRON
therapy?
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 it
A5) Yes...because ACID increases it

SET 3:
Topic: Macrocytic Anemia

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

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

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.

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 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.

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

1)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.

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 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?

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%

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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) M2
A2) 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. True
or False?

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!

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 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?

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!!!

SET 12
Topic: PSEUDO-Hypoparathyroidism

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

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?

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!!

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#Zee5-K (keep it simple)

5 most likely questions about a disease

CARD 1
Topic: Acromegaly

1) Best initial test?

2) Most accurate test?
3) Most common cause of death?
4) Treatment?
5) 3 interesting facts about the disease

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

CARD 2
Topic: Prolactinoma

1) Best initial test?

2) Most accurate test?
3) Most common cause of death?
4) Treatment?
5) 3 interesting facts about the disease

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

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CARD 3
Topic: Paget

1) Best initial test?

2) Most accurate test?
3) Increased risk of?
4) Treatment?
5) 3 interesting facts about the disease

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