14 JAN 2017 1634 IM

Question 1

what is the treatment for bacillay angiomatosis caused by bartonella infection?

Answer 1

doxycycline or erythrocmycin

Question 2

history of a recent URT infection followed by sudden onset of cardiac failure in an otherwise healthy patient is suggestive of _______________ most likely secondary to __________________

Answer 2

• dilated cardiomyopathy

- acute viral myocarditis

Question 3

viral myocarditis is most commonly seen following infection by what type of virus?

Answer 3

coxsackie B (also parvo B19, HHV 6, adenovirus, enterovirus)

Question 4

what symptoms distinguish atypical pneumonia (e.g. Legionella) from CAP?

Answer 4

FIGAR
fever - high grade fever over 102.2
intersitial infiltrates - CXR shows interstitial infiltrates
GI - symptoms
ataxia - neuro symptoms (confusion, ataxia)
rales

Question 5

what antibiotics are used to treat Legionella?

Answer 5

(ie need to cover gram negative)

• macrolides or fluoroquinolones
• fluoroquinolones are favored when illness is severe enough to warrant admission

Question 6

what is the preferred first line drug for fibromyalgia? what are alternate options?

Answer 6

• amitriptyline (TCAs)

- SS/NRIs (duloxetine, milnacipran), pregabalin

Question 7

what antibiotic is used for fight bites (hand laceration from teeth)?

Answer 7

(eikenella = gram negative)

augmentin (amoxicillin/clavulanate) (covers majority of virulent oral bacteria - gram pos and gram neg)

Question 8

what are the side effects of hydralazine?

Answer 8

• salt and fluid retention
• peripheral edema
• palpitations
• orthostatic hypotension
• drug induced lupus

Question 9

what is a hazard ratio?

Answer 9

ratio of an event rate occurring in the treatment group compared to an event rate occurring in the non-treatment group

Question 10

what does a hazard ratio less than 1 mean? higher than 1?

Answer 10

• treatment group had a significantly lower event rate

- treatment group had a much higher event rate

Question 11

what is oscillopsia?

Answer 11

sensation of objects moving around in the visual field when looking in any direction

Question 12

what is the cause of Meniere disease? what is the classic triad of symptoms?

Answer 12

• excess endolymphatic pressure in the inner ear

- episodic dizziness, low frequency hearing loss, tinnitus

Question 13

pulsus parvus et tardus is seen with what murmur?

Answer 13

aortic stenosis

Question 14

aortic stenosis is associated with what type of pulse abnormality?

Answer 14

pulsus parvus et tardus

Question 15

what is the equation for anion gap?

Answer 15

AG = Na - (HCO3 + Cl)

Question 16

what are the indications for treating emergent hyperkalemia? what is the treatment and why?

Answer 16

• rapidly rising serum potassium
• potassium level 6.5mEq/L or higher
• ECG changes (tall peaked T waves)
• treatment: IV calcium (gluconate) to stabilize cardiac myocyte membranes and make them resistant to the effect of hyperkalemia

Question 17

what is the best initial test for SCC detected in a cervical lymph node?

Answer 17

panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)

Question 18

what therapy is used for SVT in patients who are hemodynamically stable? why?

Answer 18

• adenosine or vagal maneuvers
• temporarily slow conduction via the AV node and can aid in diagnosis by unmasking ‘hidden P’ waves in patients with atrial flutter or atrial tachycardia
• can cause transient AV nodal block and terminate AV node-dependent arrhythmias

Question 19

when is amiodarone or lidocaine used?

Answer 19

• hemodynamically stable patiends with wide QRS complex tachycardia
• amiodarone is also used to treat atrial fib

Question 20

what therapy should be initiated in a patient following coronary artery stenting in order to prevent future events as well as stent thrombosis?

Answer 20

• dual antiplatelet therapy (DAPT): aspirin and p2y12 receptor blockers (clopidogrel, prasugrel, ticagrelor)
• beta blockers
• ACEIs or ARBs
• HMG-CoA reductase inhibitors
• aldosterone antagonists (if LV EF under 0.40)

Question 21

when are factor Xa (apixaban) used?

Answer 21

• anticoagulatino in nonvalvular atrial fib

- management of DVT and PE

Question 22

what do beta AGONISTS do to potassium? why?

Answer 22

• potassium shift into intracellular space by stimulating NaK ATPase and NaK2Cl cotransporter
• adrenergic agents also stimulate release of insulin, which further promotes intracellular potassium shift, causing HYPOKALEMIA

Question 23

where is the stroke?

• unilateral motor impairment
• no sensory or cortical deficits
• no visual field abnormalities

Answer 23

posterior limb on internal capsule (lacunar)

Question 24

where is the stroke?

• contralateral somatosensory and motor deficit (face, arm, leg)
• conjugate eye deviation toward side of infarct
• homonymous hemianopsia
• aphasia (dominant hemisphere)
• hemineglect (nondominant hemisphere)

Answer 24

middle cerebral artery

Question 25

where is the stroke?

• contralateral somatosensory and motor deficit, predominantly in lower extremity
• abulia (lack of will or initiative)
• dyspraxia (emotional disturbances, urinary incontinence)

Answer 25

anterior cerebral artery occlusion

Question 26

where is the stroke?

• alternate syndromes with contralateral hemiplegia and ipsilateral cranial nerve involvement
• possible ataxia

Answer 26

vertebrobasilar system lesion (supplying the brain)

Question 27

a water hammer pulse is seen with what type of murmur?

Answer 27

AR

Question 28

• asian woman under 40
• fever, arthralgias, weight loss (early)
• claudication, distal ulcers (arterio-occlusive manifestations) in upper extremities
• BP discrepencies
• pulse deficits
• bruits
• elevated ESR, CRP
• possible mediastinal widening

Answer 28

takayasu arteritis