21 JAN 2017 1500 IM

Question 1

what are the 3 drug classes used for prevention of stable angina symptoms?

Answer 1

• BBs
• CCBs
• long acting nitrates

Question 2

in painless thyroiditis radioiodine uptake is ______________ (decreased / normal / increased) because _________________

Answer 2

• decreased

- release of preformed thyroid hormone

Question 3

what are the only diuretics shown to have a survival benefit in CHF?

Answer 3

aldosterone antagonists like spironolactone and eplerenone

all diuretics improve symptoms, but only spironolactone and eplerenone confer mortality benefit

Question 4

purple papules / plaques that are pruritic, planar, or polygonal

Answer 4

lichen planus

Question 5

what is dacrocystitis? how does it usually present?

Answer 5

• infection of the lacrimal sac

- sudden onset pain and redness in the medial canthus region

Question 6

orbital cellulitis refers to an infection ______________ (anterior / posterior) to the orbital septum

Answer 6

posterior

Question 7

patients with macroprolactinomas or symptomatic pituitary tumors of any size should be treated with ___________________

Answer 7

dopaminergic agonists (cabergoline, bromocriptine)

Question 8

CML can be differentiated from leukemoid reaction by the ________________ levels

Answer 8

leukocyte alkaline phosphatase (in CML the neutrophils are cytochemically and functionally abnormal, so LAP score is usually LOW)

Question 9

leukocyte alkaline phosphatase score is a marker of _________________ activity

Answer 9

neutrophil

Question 10

what blood test is an indirect indicator for the presence of lupus anticoagulant and highly suggestive in the correct clinical setting?

Answer 10

PTT (increased)

Question 11

what is the reason for oxygen-induced CO2 retention in advanced COPD?

Answer 11

• loss of compensatory vasoconstriction in areas of ineffective gas exchange worsens V/Q mismatch
• increase in oxyHb reduces uptake of CO2 from the tissues by the Haldane effect
• decreased respiratory drive and slowing of respiratory rate causes reduced minute ventilation

Question 12

how does hypercapnia cause decreased consciousness and seizures?

Answer 12

• decreased consciousness: acidosis from high CO2 increases brain GABA and glutamine and decreases brain glutamate and aspartate
• seizures: high CO2 causing cerebral vasodilation

Question 13

an acute attack of a cluster headache can be aborted with what two therapies?

Answer 13

• 100% oxygen

- subQ sumatriptan

Question 14

equation: corrected serum sodium

Answer 14

sodium in mEq/L + 2 mEq/L sodium for each 100 mg/dL that glucose is above 100 mg/dL

Question 15

QRS interval > 100 msec in TCA overdose is an indication for __________________ therapy

Answer 15

sodium bicarbonate

Question 16

QRS interval over ___________ msec in TCA overdose is an indication for sodium bicarbonate therapy

Answer 16

100 msec

Question 17

why are seizures due to TCA overdose treated with benzodiazepenes?

Answer 17

benzodiazepenes are GABA agonists, and seizures caused by TCA overdose are due to inhibition of GABA receptors

Question 18

equation: effective plasma osmolality

Answer 18

(2 x plasma sodium [mEq/L] + (plasma glucose [mg/dL] / 18)

Question 19

what is the most important initial step in the management of hyperosmolar hyperglycemic state?

Answer 19

fluid replacements (normal saline)