04 APR 2017 1258 MIX

Question 1

what is the pathophysiology of ARDS? what are the implications for lung physiology?

Answer 1

• fluid / cytokine leakage into alveoli

- impaired gas exchange, decreased lung compliance, PHTN

Question 2

bilateral lung opacities (pulmonary edema) NOT due to CHF / fluid overload?

Answer 2

ARDS

Question 3

in ARDS there is hypoxemia with a PaO2/FiO2 ratio equal to or less than ______ mm Hg - why?

Answer 3

• 300 mm Hg

- decreasing PaO2 leads to higher FiO2 requirement

Question 4

what should you consider in hypoxemia with a PaO2/FiO2 ratio equal to or less than 300 mm Hg?

Answer 4

ARDS

Question 5

why is lung compliance decreased in ARDS?

Answer 5

• loss of surfactant

- increased elastic recoil of edematous lungs

Question 6

ARDS causes shunting with an ______________ (decreased / increased) A-a gradient

Answer 6

increased

Question 7

_________________ (sympathetic / parasympathetic) fibers are located on the periphery of the oculomotor nerve, which means that compression would cause __________________

Answer 7

• parasympathetic

- mydriasis

Question 8

when do you do a workup for neonatal hydration / dehydration?

Answer 8

if infant has lost more than 7% of body weight

Question 9

when can formula supplementation be recommended for infants?

Answer 9

infants who have lost over 7% of birth weight despite optimization of breastfeeding

Question 10

why should water never be given to infants under 6 months?

Answer 10

due to the immature kidneys of infants, it can dilute the blood, resulting in hyponatremia and seizures

Question 11

what are the first and second line medications for bipolar disorder?

Answer 11

• first line: lithium, valproate

- second line: quetiapine, lamotrigine

Question 12

how does digoxin toxicity present?

Answer 12

• nausea
• vomiting
• decreased appetite
• confusion
• weakness
• scotoma
• blurry vision / color changes

Question 13

elevation of peak and plateau pressures indicates a process causing ____________ (decreased / increased) pulmonary compliance, such as pulmonary edema, atelectasis, pneumonia, or right mainstem bronchus

Answer 13

decreased

Question 14

what type of drug is raloxifene? what is the MOA? what is the indication?

Answer 14

• SERM
• estrogen agonist activity on BONE
• decrease post-menopausal osteoporosis in patients who cannot tolerate bisphosphonates or are at high risk for invasive breast cancer

Question 15

SERMs have estrogen _____________ (agonist / antagonist) activity in the breast, estrogen ______________ (agonist / antagonist) activity in the bone, and estrogen _________________ in the uterus

Answer 15

• breast: antagonist
• bone: agonist
• uterus: antagonist

Question 16

what is the treatment for acute bronchitis?

Answer 16

SYMPTOMATIC TREATMENT

Question 17

in a suspected ectopic pregnancy in a hemodynamically stable patient, what is the course of action after an equivocal transvaginal US?

Answer 17

• serum BhCG
• if over 1500 repeat BhCG level and transvaginal US in 2 days
• if under 1500 repeat BhCG level in 2 days

BhCG should increase every 2 days in viable pregnancies but rise at a slower rate in ectopic and nonviable pregnancies

Question 18

in a woman over 35, infertility is considered when there is lack of conception after ____ months due to _____________

Answer 18

• 6

- diminished ovarian reserve

Question 19

wide complex tachycardia with 2 fusion beats is diagnostic for:

Answer 19

sustained monomorphic ventricular tachycardia

Question 20

enterococci are a common etiology of bacterial endocarditis following what type of infection?

Answer 20

nosocomial infections (e.g. UTI)

Question 21

what are the 3 first line abx for asymptomatic bacteriuria?

Answer 21

• cephalexin
• amoxicillin-clavulanate
• nitrofurantoin

Question 22

TMP-SMX is safe to use during which trimester? why cant it be used during the other trimesters?

Answer 22

• 2nd trimester
• 1st trimester: interferes with folate metabolism
• 3rd trimester: neonatal kernicterus

Question 23

what is the explanation for the large oxygen saturation gap seen in methemoglobinemia?

Answer 23

• metHb absorbs light at distinct wavelengths, so pulse oximetry is commonly around 85% regardless of the true oxygen saturation
• in parallel, blood gas analysis frequently returns a falsely elevated result for oxygen saturation as it provides an estimate based on only the PaO2 and not on effective Hb-oxygen binding