04 JAN 2017 1922 IM

Question 1

what type of drug is roflumilast? what is it used for?

Answer 1

• phosphodiesterase inhibitor with anti-inflammatory properties that helps decrease mucociliary malfunction and pulmonary remodeling
• maintenance therapy to reduce future exacerbations in patients with severe COPD and history of exacerbations (not indicated for acute exacerbations)

Question 2

what is the treatment for central retinal artery occlusion?

Answer 2

ocular massage and 100% oxygen

Question 3

what is the primary treatment for papillary thyroid cancer?

Answer 3

surgical resection with adjuvant radioiodine ablation and suppressive doses of thyroid hormone (TSH can stimulate occult residual or metastatic disease)

Question 4

what does the ABG show in salicylate toxicity and why?

Answer 4

• low PaCO2: primary respiratory alkalosis and respiratory compensation for metabolic acidosis
• low HCO3-: primary metabolic acidosis and metabolic compensation for respiratory alkalosis
• arterial pH usually in the normal range: the two primary acid-base disturbances shift the pH in opposite directions

Question 5

what is the triad of presenting symptoms in salicylate toxicity?

Answer 5

• fever
• tinnitus
• tachypnea

Question 6

what should be considered in a patient with

• palpable purpura
• proteinuria
• hematuria
• arthralgias (nonspecific)
• hepatosplenomegaly (nonspecific)
• hypocomplementemia (nonspecific)

Answer 6

mixed cryoglobulinemia

Question 7

what is confirmatory for diagnosing mixed cryoglobulinemia?

Answer 7

circulating cryoglobulins

Question 8

the majority of patients with mixed cryoglobulinemia have what underlying condition?

Answer 8

HCV

Question 9

what nonpharmacologic intervention is most likely to have the greatest impact on hypertension?

Answer 9

• weight loss to BMI under 25

- DASH diet if BMI is already under 25

Question 10

what ventilator setting improves mortality in ARDS?

Answer 10

low tidal volume ventilation (LTVV)

Question 11

patients with ARDS require mechanical ventilation with which two primary goals?

Answer 11

• low tidal volume ventilation to prevent over-distension

- adequate oxygenation (with PEEP)

Question 12

what is the most common ocular manifestation of temporal arteritis?

Answer 12

anterior ischemic optic neuropathy

Question 13

what are the Light criteria for exudative pleural effusion?

Answer 13

at least one of:

• pleural fluid / serum protein ratio over 0.5
• pleural fluid LDH / serum LDH ratio over 0.6
• pleural fluid LDH greater than 2/3 upper limit of normal for serum LDH

Question 14

what is the acute treatment for cocaine toxicity?

Answer 14

benzodiazepines to alleviate psychomotor agitation and sympathomimetic effects (tachycardia, hypertension)

Question 15

how is cocaine-induced acute coronary syndrome managed?

Answer 15

• antiplatelet therapy
• nitrates
• percutaneous intervention if indicated

Question 16

what is the diagnostic test for esophageal rupture?

Answer 16

water-soluble contrast esophagogram

Question 17

what is the management of myasthenic crisis?

Answer 17

1. intubation (if respirations deteriorate)
2. hold off on acetylcholinesterase inhibitors (pyridostigmine) to reduce excess airway secretions and risk of aspiration
3. IVIG or plasmapheresis (preferred) in addition to corticosteroids once stabilized

Question 18

antiviral therapy (oseltamivir) can be done in patients with influenza and without risk factors if they come to the office within what time frame?

Answer 18

within 48 hours

Question 19

what is Beck’s triad of cardiac tamponade?

Answer 19

• hypotension
• elevated JVP
• muffled heart sounds

Question 20

broad and notched P waves = ?

Answer 20

mitral stenosis

“P mitrale”