Board Vitals Question Review Content

Question 1

What is paroxysmal nocturnal hemoglobinuria (PNH)? -presentation, age, diagnostics, treatment

Answer 1

Presentation: thrombosis in unusual places- abdominal veins
Median age: mid-30s
Anemia
Coombs negative hemolytic anemia** is positive for PNH
Labs: high LDH, low haptoglobin, low hemoglobin, high reticulocyte count: hemolytic process & bone marrow compensation
Tx: Eculizumab: inhibits process, decreases RBC lyses- helps to stabilize hemoglobin without transfusions

Question 2

What is purpose of IRB?

Answer 2

protecting rights of human subjects at a research institution

Question 3

How does renal disease affect calcium levels?

Answer 3

renal disease–> reduced production of active vitamin D (requires conversion to activate)- due to decreased activity of enzyme 1-alpha hydroxylase and decreased gut absorption-
results in renal osteodystrophy: increased bone resorption and secondary hyperparathyroidism
decreased GFR, kidney impaired phosphate excretion- hyperphosphatemia.

Question 4

If PCWP is higher than pulmonary artery diastolic pressure….

Answer 4

suggests catheter malplacement- in non-zone III position of the lung.
PCWP should be lower than pulmonary artery diastolic pressure
Requires**Swan Ganz catheter = pulmonary artery catheter.

Catheter would need to be withdrawn, not moved forward- typically high PCWP means catheter is too far forward.

Question 5

What is a Swan Ganz catheter?

Answer 5

Pulmonary artery catheter- located in R side of heart and arteries leading to the lungs- monitor heart function, blood flow and pressures in and around the heart.

Question 6

What is most common bacteria for community acquired pneumonia?

Answer 6

Haemophilus influenza- gram negative bacteria- common in COPD patients. associated with lobal pneumonia.

Question 7

What bugs are associated with interstitial infiltrates on CXR?

Answer 7

legionella pneumonia, mycoplasma pneumoniae, pneumocystis jirovicii

Question 8

Describe Bell’s Palsy characteristics:

Answer 8

paralysis of upper and lower face. facial droop, cannot move eyebrows, flattened nasolabial fold, ** loss of taste sensation of ipsilateral anterior 2/3 of tongue.
lower motor lesion

Question 9

What is Ramsay Hunt syndrome?

Answer 9

lower 7th cranial nerve lesion-

herpes zoster of external auditory meatus and geniculate ganglion

Question 10

What is gold standard test for diverticulitis

Answer 10

CT abd with oral and IV contrast- sensitivity and specificity of 97%. most of inflammation is seen in extraluminal space- intraluminal studies of colonoscopy may not identify this.

Question 11

moderate persistent asthma treatment recommendations….

Answer 11

daily symptoms, nocturnal awakening, daily rescue inhaler
low-dose inhaled glucocorticoids, plus long acting inhaled beta agonist (LABA) or medium dose of inhaled glucocorticoids, or trial of low-dose corticosteroids

Question 12

What are the ranges of ABI by arterial disease severity?

Answer 12

0.71-0.9 = mild disease
0.41-0.7 moderate obstruction
<0.4 severe obstruction

Question 13

What are risk factors for arterial disease?

Answer 13

old age, smoking, diabetes, HLD, HTN, renal insufficiency

Question 14

What is torus palatinus?

Answer 14

painless bony protuberance on hard palate of mouth-
20-30% occurrence in population
this is normal finding, asymptomatic, may grow slightly with age
no treatment needed

Question 15

what is diabetic nephropathy? how to diagnosis?

Answer 15

HTN, proteinuria, microalbuminuria, elevated serum creatinine, diabetic retinopathy.
This is slow onset, doesn’t have acute onset.

Question 16

what is treatment for acute angle glaucoma?

Answer 16

ocular emergency- increased intraocular pressure, decreased visual acuity
IV acetazolamide, topical beta blocker, topical steroid
500 mg IV acetazolamide, and 500 mg PO
decrease production of aqueous humor

Question 17

what is the MOST COMMON bug for CLABSI?

Answer 17

coagulase negative staphylococcus- S. epidermidis. introduced by contamination of insertion
S. aureus is associated with CLABSI, but not most common

Question 18

What cardiac drug is risky in diabetic patients?

Answer 18

metoprolol or beta blockers- can mask early signs of hypoglycemia and lead to severe hypoglycemia symptoms before patients realizes

Question 19

which thiazolidinedione has better cardiac risk profile? rosiglitazone vs pioglitazone

Answer 19

Pioglitazone- better lipid profile. All thiazolidinediones are contraindicated in heart failure patients.

Question 20

What is a helical CT?

Answer 20

allows direct visualization of pulmonary arteries. diagnostic for PE

Question 21

What is gonococcal arthritis?

Answer 21

migratory arthralgias; knees, wrists, ankles, elbows
rash also common.
tx: broad spectrum cephalosporin- ceftriaxone

Question 22

What is preferred treatment for DVT outpatient?

Answer 22

enoxaparin q12 subQ

not warfarin- high side effect profile

Question 23

when is it indicated to prescribe warfarin for DVT treatment?

Answer 23

if there is renal insufficiency; enoxaparin contraindicated in this case

Question 24

what is wernicke’s encephaloapthy?

Answer 24

thiamine deficiency- chronic alcohol use disorder
triad: ophthalmoplegia, ataxia, confusion
tx: thiamine supplementation
Korsakoff psychosis is also common presentation

Question 25

what are risk factors for osteoporosis?

Answer 25

smoking, excessive alcohol use, chronic steroid use, insufficient calcium or vitamin D intake, sedentary lifestyle, post-menopause, early menopause.
Caucasian and asian females - greater risk

Question 26

metabolic acidosis: MUDPILERS

Answer 26

Methanol
Uremia
Ddiabetic ketoacidosis
Pparaldehyde toxicity
Isooniasiz toxicity
Lactic acidosis
Etoh, ethylene glycol
Renal failure, or rhabdo
Salicylate toxicity

Question 27

what is anion gap calculation? what is normal range

Answer 27

(Na+ + K+) – (Cl- + HCO3-) = Anion Gap

normal range 4-12

Question 28

what is gold standard for diagnostic of renal calculus?

Answer 28

non-con CT scan

KUB will only show radiopaque urinary stones, and bowel gas and bony structures can obscure stones

Question 29

how often should thyroid levels be checked in pregnancy if history of thyroid disease?

Answer 29

every 4 weeks during first half of pregnancy.
at least 1x between 26-32 weeks
check thyroid antibody- if positive, these women need monitoring during pregnancy

Question 30

what is ankylosing spondylitis: incidence, diagnosis, management

Answer 30

males age 15-40. inflammatory back pain, insidious onset, dull quality. causes spine bones to fuse overtime, similar to kyphosis posture
back pain worse in morning, improves with activity, worse at night
inflammation of Achilles tendon and plantar fascia is common
symptoms: fatigue, anorexia, mild fever, eye pain, red eye, blurry vision,
diagnostics: HLA-B27 gene.
sclerosis/ erosive changes of sacroiliac joints- bamboo spine- vertebrae closer together
TX: NSAIDS- inflammation reduction

Question 31

asbestosis: affect on FVC and TLC

Answer 31

decreased FVC and TLC

Question 32

what is allodynia?

Answer 32

allodynia- centrally stimulated pain sensitization- occurs after repetitive stimulation, causing pain response that is exaggerated, from stimuli that would not normally provoke pain. Common symptom in patients with neuropathic pain.
Ex. pain on wrists from wearing long sleeves.

Question 33

what are symtpoms of uremic pericarditis

Answer 33

fever, pleuritic chest pain, increased in recumbent position. no ST segment T wave elevations