2006 ITE

Question 1

What is the underlying pathophysiology of malignant hyperthermia?

Answer 1

inherited myopathy –> abnl skeletal muscle sarcoplasmic reticulum causes inc in intracellular Ca++ –> sustained contraction and hypermetabolic state

Question 2

What triggers most cases of malignant hyperthermia?

Answer 2

inhalational anesthetics or succinylcholine

Question 3

What are the signs/symptoms of malignant hyperthermia?

Answer 3

sudden rise in temp, tachycardia, inc muscle tone –> muscle rigidity

Question 4

What are the signs/symptoms of unrecognized/untreated malignant hyperthermia?

Answer 4

downward spiral = rhabdomyolysis, acidosis, renal failure, cardiovascular instability, and death

Question 5

What treatments reduce morbidity/mortality of patients with malignant hyperthermia?

Answer 5

Dantrolene + cooling the patient

Question 6

What cardiac meds should be used with caution when patient is taking a B-blocker? Why?

Answer 6

Verapamil and Diltiazem b/c they slow the HR and can affect AV conduction

Question 7

What is the difference between regular insulin and insulin asparte/insulin lispro?

Answer 7

Reg: onset 30-60 min and peaks in 2-3 hours

Asparte/Lispro: onset 15 min and peaks in 1 hour

Question 8

Vasopressin or epinephrine?

1. V-fib
2. PEA
3. asystole

Answer 8

1. V-fib: similar efficacy
   2: PEA: similar efficacy
2. Asystole: Vasopressin is better than epinephrine in these cases

Question 9

What is Direct Observational Therapy (DOT)?

Answer 9

The preferred care management strategy for all pts with TB - watch pt swallow meds. Works better with incentives or enablers (contracts, reminders for missed appts, etc)

Question 10

Which routinely-prescribed BP med can lead to fetal deformity, renal failure, and possible death?

Answer 10

ACE-I

Question 11

Describe the typical patient profile associated with Transient (toxic) synovitis

Answer 11

6yoM, otherwise healthy, no hx of trauma, acute pain and activity limitation, +/- low grade fever, ESR nl, PE: limited pain and spasm

Question 12

Describe the typical patient profile associated with Septic arthritis

Answer 12

Febrile pt with ESR >20, PE: severe TTP

Question 13

What medication has been shown to offer some benefit in tx of shingles and postherpetic neuralgia?

Answer 13

Oral acyclovir at high doses (800mg PO 5x/day)

- must be started in 1st 48hours

Question 14

What are some evidence-based indications for use of Gingko Biloba

Answer 14

• improved cognition/memory
• tinnitis
• claudication

Question 15

What is the standard treatment for seborrheic dermatitis? What is the treatment for HIV patients with this condition?

Answer 15

• hygiene, shampoos, mild topical corticosteroids

- ketoconazole in cream or shampoo form

Question 16

What chronic disease are patients on antipsychotics at increased risk for?

Answer 16

DM2

Question 17

Under what circumstances is treatment for Group B strep not required intrapartum?

Answer 17

If negative screening cultures within 5 weeks of delivery (even if 18h, or febrile)

Question 18

What medication should be used to treat Group B Strep intrapartum?

Answer 18

Penicillin>Cefazolin>Clinda (if sensitivities allow)>Vanc

Question 19

What are the causes of prolonged QT?

Answer 19

Electrolyte abnormalities:
Hypo- K+, Mg++, Ca++
Class IA antiarrythmics: Procainamide, Quinidine

Question 20

95% of all cases of Chronic paronychia is caused by what microorganism?

Answer 20

Candida