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RITE > FEB 2020 YEAR III > Flashcards

FEB 2020 YEAR III Flashcards

1
Q
  1. A 38/M, presents with chest heaviness during exertion for 2 days. ECG shows sinus tachycardia, LVH, T wave inversion in V2 and V3. CK-MB is slightly elevated. What is the most likely diagnosis?

A. Stable angina

B. Unstable angina

C. NSTEMI

D. STEMI

A

C. NSTEMI

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2
Q
  1. A 55/F, had total gastrectomy for gastric adenocarcinoma, presents with fever for 7 days with ANC of 100/mm3. Experiences diarrhea after starting on antibiotic. Which antibiotic produces diarrhea?

A. Ceftazidime

B. Piperacillin/Tazobactam

C. Imipenem/Cilastatin

D. Levofloxacin

A

C. Imipenem/Cilastatin

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3
Q
  1. What is the recommended tidal volume for patients with ARDS?

A. 4ml / kg

B. 6 ml / kg

C. 10ml / kg

D. 12 ml / kg

A

B. 6 ml / kg

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4
Q
  1. A 75/F presents with difficulty of breathing and fever. BP 70/50 mmHg; CR 115/min; RR 24/min; T 38.3 0C; O2 sat 97%. PE: crackles mid to lower left lung field. What is the initial fluid management?

A. IV crystalloid

B. Dobutamine

C. Dopamine

D. Vasopressin

A

A. IV crystalloid

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5
Q
  1. What type of shock occurs in severe sepsis?

A. Distributive shock

B. Cardiogenic shock

C. Obstructive shock

D. Hypovolemic shock

A

A. Distributive shock

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6
Q
  1. What is the recommended daily minimum protein intake of a normal adult?

A. 0.65 g/kg body weight

B. 0.70 g/kg body weight

C. 0.75 g/kg body weight

D. 0.80 g/kg body weight

A

D. 0.80 g/kg body weight

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7
Q
  1. Which physiological process occurs with prolonged semi-starvation?

A. Increase in total energy expenditure

B. Increase in thermic effect of food

C. Decrease in resting energy expenditure

D. Decrease in activity energy expenditure

A

C. Decrease in resting energy expenditure

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8
Q
  1. A 60/M, HPN, complains of palpitation 3 days ago and chest discomfort 15 min PTC. BP 130/70; HR 140 bpm, clear breath sounds. ECG: AF with rapid ventricular response. (-) Troponin I. Which management principles should be prioritized?

A. Anticoagulation

B. Cardioversion

C. Rate control

D. Rhythm control

A

C. Rate control

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9
Q
  1. A 55/F, chronic AF on warfarin, presents with a bleeding 3-inch incised wound on right palm. Despite suturing and parenteral Vitamin K, the bleeding persists. BP: 120/80mmHg, HR: 88/min. Hemoglobin 10.0 mg/dL; PT 36 vs control of 30, INR 6. Which blood product does this patient require?

A. Cryoprecipitate

B. Fresh frozen plasma

C. Packed red blood cells

D. Whole blood

A

B. Fresh frozen plasma

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10
Q
  1. Which patient is at risk to develop obstructive sleep apnea / hypopnea syndrome?

A. 35/M, hypertensive, BMI 27

B. 45/M, (+) Family history of OSAHS, BMI 25

C. 55/F, diabetic, BMI 30

D. 65/M, hyperthyroid, BMI 24

A

C. 55/F, diabetic, BMI 30

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11
Q
  1. A 26/M, medical student, reports lack of concentration in class. His sibling says no observed snoring or gasping during sleep. Polysomnogram studies shows: 70 apnea episodes and 50 hypopnea episodes on an 8-hour sleep. What is the severity of the patient’s obstructive sleep apnea / hypopnea syndrome (OSAHS)?

A. Mild

B. Moderate

C. Severe

D. Test inconclusive

A

B. Moderate

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12
Q
  1. A 65/M, post-stroke, on aspirin, presents with respiratory failure secondary to aspiration pneumonia. Develops tachypnea and sudden desaturation on the 4th HD. BP 80/50, HR 110 bpm, RR 30 cpm, afebrile. Chest CT scan shows a peripheral wedge-shaped density in the left lower lung. What will you do next?

A. Add Clopidogrel to Aspirin

B. Initiate Heparin then bridge with Warfarin

C. Start Rivaroxaban

D. Do Thrombolysis with rTPA, then start Heparin

A

D. Do Thrombolysis with rTPA, then start Heparin

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13
Q
  1. A 65/F, DM, HPN, is suffering from sepsis secondary to CAP, low risk. On the 3rd hospital, develops ARDS, intubated and hooked to mechanical ventilator. Which treatment strategy will result to fewer days on ventilation?

A. Low tidal volume

B. Fluid conservative management strategy

C. Prone positioning

D. Neuromuscular blockade

A

B. Fluid conservative management strategy

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14
Q
  1. Which substance when released excessively causes vasomotor collapse and pathologic shunting of oxygenated blood from susceptible tissues in patient with sepsis?

A. Lactate

B. Inflammasomes

C. Nitric oxide

D. Histone

A

C. Nitric oxide

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15
Q
  1. Which cardiac condition is vaginal delivery less stressful than cesarean section?

A. Marfan’s syndrome

B. Pulmonary Hypertension

C. Ehlers-Danlos syndrome

D. Peripartum cardiomyopathy

A

B. Pulmonary Hypertension

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16
Q
  1. A 25/F, known RHD, presents with shortness of breath. Echocardiogram reveals mitral stenosis with mitral valve area <1.0 cm2. What is your advice regarding pregnancy?

A. Undergo valvular correction prior to conception

B. Avoid getting pregnant

C. Undergo invasive hemodynamic monitoring delivery

D. Prophylactic therapy with ß-blockers

A

A. Undergo valvular correction prior to conception

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17
Q
  1. How much of the total cardiac output can respiratory muscles normally consume?

A. <5%

B. <10%

C. <15%

D. <20%

A

A. <5%

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18
Q
  1. A 60/M, chronic smoker, presents with severe dyspnea and productive cough. The diagnosis is COPD in acute exacerbation. ABG shows respiratory acidosis. What is the management?

A. Chest physiotherapy

B. Noninvasive positive-pressure ventilation

C. Endotracheal intubation

D. Frequent changes in position

A

B. Noninvasive positive-pressure ventilation

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19
Q
  1. Which is a Class I indication for pacemaker insertion in SA node dysfunction?

A. Asymptomatic patients with HR < 40/minute

B. Mildly symptomatic patients with waking chronic HR <40/ minute

C. Symptomatic bradycardia or sinus pause

D. Syncope provoked by electrophysiologic testing

A

C. Symptomatic bradycardia or sinus pause

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20
Q
  1. A 60/F, presents with palpitations. She has stable vital signs and ECG tracing shows regular, narrow QRS tachycardia. Which management is warranted?

A. AV-nodal blocking agent

B. Cardioversion

C. Procainamide

D. Vagal maneuver

A

D. Vagal maneuver

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21
Q
  1. Which clinical scenario is consistent with febrile nonhemolytic transfusion reaction?

A. 24/F, (+) urticarial reactions, T 38 degC after BT

B. 30/M , (+) dyspnea and hypotension during BT with only one ml of blood

C. 55/F, (+) hypoxia and pulmonary edema within 6 hours of BT

D. 60/M , (+) chills and rigors, T 38 degC

A

D. 60/M , (+) chills and rigors, T 38 degC

22
Q
  1. A 45/M, HPN, obese, reports daytime sleepiness and easy fatigability. Sleep studies done recorded 30 apneas, 50 hypopneas in 5 hours of sleep time. What is the severity of this patient’s OSA?

A. Mild

B. Moderate

C. Severe

D. Very severe

A

B. Moderate

23
Q
  1. What is the most appropriate management for a somnolent patient with obstructive sleep apnea who has a BMI of 22, a Mallampati of 1, and an RDI of 16?

A. Bariatric surgery

B. CPAP

C. Mandibular appliance

D. Oral surgery

A

B. CPAP

24
Q
  1. A 32/F, known asthmatic, presents with difficulty of breathing. She is restless and diaphoretic. PE: BP 110/70 mmHg, HR 118/min, RR 28/min. (+) intercostal and subcostal retractions and decreased breath sounds bilaterally. ABG: pH 7.35, PCO2 45mmHg, PO2 65mmHg, HCO3 26mmol/L, O2 sat 85% at room air. What is your initial management?

A. Chest CT Scan

B. Oxygen support and standby intubation set

C. Antibiotic

D. Nebulization

A

B. Oxygen support and standby intubation set

25
Q
  1. What is the most common cause of distributive shock?

A. Burns

B. Myocardial infarction

C. Pulmonary embolism

D. Sepsis

A

D. Sepsis

26
Q
  1. What is the effect of the release of vasoactive mediators at the level of the nephron during the initial stress of decreased effective arterial blood volume?

A. Increased afferent arteriolar resistance

B. Increased efferent arteriolar resistance

C. Increased renal sodium loss

D. Increased tubular cell shedding

A

B. Increased efferent arteriolar resistance

27
Q
  1. A 78/F, presents with multi-lobar pneumonia. Initial O2 sat is 60% at room air and improves to 82% on a non-rebreather face mask. Due to persistent hypoxemia, she is intubated and hooked to a mechanical ventilator with the ff set-up: AC mode, TV 6ml/kg, RR 24/min, FiO2 100% and PEEP at 12 cmH2O. ABG post- intubation shows pH 7.20, pCO2 32 mmHg, and pO2 54 mmHg. What is the cause of hypoxemia?

A. Ventilation-perfusion mismatch

B. Alveolar hypoventilation

C. Shunt

D. Impaired diffusion

A

C. Shunt

28
Q
  1. Which condition will put a severely obese individual at risk for hypercapneic respiratory failure?

A. Increase dead space ventilation

B. Increase CO2 production

C. Decrease neuromuscular transmission

D. Decrease mobility of the chest wall

A

D. Decrease mobility of the chest wall

29
Q
  1. A 55/M, smoker, presents with intermittent pain on both legs on walking. BP 160/90, HR 98/ min. Both feet are cold to touch with some discoloration. The Ankle-Brachial Index is 0.5. What is the single most important thing that can be done to reduce complications?

A. Quit smoking

B. Regular exercise

C. Reduce weight

D. Lower blood pressure

A

A. Quit smoking

30
Q
  1. Which information is LEAST helpful in the diagnosis of acute gouty attack?

A. Joint involved

B. Precipitating factors like ethanol intake

C. Serum uric acid level

D. Recent initiation of hypouricemic therapy

A

C. Serum uric acid level

31
Q
  1. Aside from the presence of pleuritic chest pain, what is the prominent distinguishing feature of chest pain of acute pericarditis vs. acute myocardial infarction?

A. Waxing and waning in character

B. Intensified by lying supine and relieved by leaning forward

C. Duration of the pain

D. Radiation of the pain to the interscapular area

A

B. Intensified by lying supine and relieved by leaning forward

32
Q
  1. Aside from the prominent x descent of the jugular veins, which manifestation is more common in cardiac tamponade than in constrictive pericarditis?

A. Kussmaul’s sign

B. Third heart sound

C. Pulsus paradoxus

D. Pericardial knock

A

C. Pulsus paradoxus

33
Q
  1. Which arrhythmia is described as continuous irregular activation with no discrete QRS complexes?

A. Idioventricular rhythm

B. Ventricular fibrillation

C. Ventricular tachycardia

D. Premature ventricular contractions

A

B. Ventricular fibrillation

34
Q
  1. A 75/M underwent an overnight polysomnogram study which shows an apnea-hypopnea index of 5-14 events/hour. What is your recommended treatment?

A. Oral appliances

B. Upper airway surgery

C. Continuous Positive Airway Pressure

D. Upper airway neuro-stimulation

A

C. Continuous Positive Airway Pressure

35
Q
  1. A 40/M, is being treated for bowel obstruction. BP 110/70 mmHg; CR 100/min; RR 19/min. PE: direct tenderness over epigastric area, absent bowel sounds. What is the recommended feeding for this patient?

A. Enteric elemental formula

B. Enteric Immune enhancing formula

C. Peripheral Parenteral Nutrition

D. Central Parenteral Nutrition

A

C. Peripheral Parenteral Nutrition

36
Q
  1. A 30/M, on his 3rd HD for multiple fractures from a vehicular accident presents with sudden onset of dyspnea. BP 100/80 mmHg; HR 120/min; RR 36/min; T 36.8C O2sat 80%. PE: crackles on both lung fields. CXR reveals pulmonary edema. What is the initial step in the management of the patient?

A. Diuresis

B. Oxygenation

C. Minimize acidosis

D. Ventilation

A

D. Ventilation

37
Q
  1. A 67/M, diabetic, presents with septic shock secondary to a non-healing wound on the right foot. On the 2nd HD, he was referred due to shallow breathing with SaO2 of 78% at room air. His BP is persistently palpatory despite norepinephrine and dopamine. What will you do now?

A. Dobutamine drip

B. Nebulization

C. Hook to oxygen via facemask at 10 / min

D. Intubate and connect to mechanical ventilator

A

D. Intubate and connect to mechanical ventilator

38
Q
  1. A 45/M, obese, presents with snoring and daytime sleepiness. There is difficulty maintaining alertness, morning headache and mood disturbances. PE: Enlarged tongue and a low-lying soft palate. What is the standard therapy for this condition?

A. Supplemental oxygen

B. Oral appliance

C. Continuous positive airway pressure

D. Upper airway surgery

A

C. Continuous positive airway pressure

39
Q
  1. A 70/M, post stroke, bedridden, is evaluated for pulmonary embolism. His Wells Point Score is 5. Which diagnostic test is recommended?

A. Chest xray

B. Chest CT with IV contrast

C. Lung scanning

D. Pulmonary angiography

A

B. Chest CT with IV contrast

40
Q
  1. A 60/F, complains of cramping of the right calf area. She is being evaluated for deep venous thrombosis with a Wells Point Score of 1. Which diagnostic test will you recommend?

A. D-dimer alone

B. D-dimer + venous ultrasound

C. D-dimer + magnetic resonance venography

D. D-dimer + contrast phlebography

A

A. D-dimer alone

41
Q
  1. A 70/M, diabetic, 50-pack year smoker, presents with 3 weeks pain on both feet on walking, associated with digital blanching and cyanosis of the toes after cold exposure. PE: ulceration at the tip of the toes, normal brachial and popliteal pulses, absent tibial pulses. What is your impression?

A. Thromboangiitis obliterans

B. Peripheral Artery Disease

C. Sneddon’s syndrome

D. Paget-Schroetter syndrome

A

A. Thromboangiitis obliterans

42
Q
  1. A 33/F, presents with fever and chills after sustaining an insect bite at the left malar area. She developed bright red appearance of the involved skin with a peau d’ orange texture, followed after 2 days with superficial blebs. What is the most likely diagnosis?

A. Pyoderma

B. Erysipelas

C. Crepitus cellulitis

D. Erythrasma

A

B. Erysipelas

43
Q
  1. A 42/F, with untreated breast cancer presents with shortness of breath. BP 80/50 mmHg, HR 115/min, RR 24/min. Distended neck veins and muffled heart sounds. 2-D echo shows a large echo free space surrounding the heart with late diastolic RV collapse. What other PE finding do you expect?

A. Prominent y descent

B. Prominent x descent

C. Kussmaul’s sign

D. Pericardial knock

A

B. Prominent x descent

44
Q
  1. A 70/M, smoker, diabetic, hypertensive, with a history of myocardial infarction, presents with pain, cramps and numbness of both lower extremities upon walking 20 steps, relieved by rest. PE: smooth, shiny skin, reduced skin temperature, hair loss, thickened nails, decreased pulse and beginning ulcer formation in the distal toes. The pain is reproducible when the physician let the patient walk a few steps. What is the most likely diagnosis?

A. Acute arterial occlusion

B. Peripheral arterial disease

C. Thromboangiitis obliterans

D. Fibromuscular dysplasia

A

B. Peripheral arterial disease

45
Q
  1. A 28/M, presents with pain due to cutaneous lesions described as “dusky” macules with bullae formation and sloughing of skin and oral mucosa. Estimated cutaneous involvement is 40% of his body. He had intake of Cotrimoxazole 5 days prior to the noted cutaneous eruption. What is the diagnosis?

A. Bullous impetigo

B. Erythema multiforme

C. Steven-Johnson syndrome (SJS)

D. Toxic epidermal necrolysis (TEN)

A

D. Toxic epidermal necrolysis (TEN)

46
Q
  1. A 60/F, hypertensive, presents with severe dyspnea, cough and fever. PE: BP 160/100mmHg, T 39 degC, RR 30 bpm and O2 sat 70% room air. CXR: pulmonary edema. She is intubated and hooked to ventilator. Which modality is LEAST likely to be beneficial?

A. ECMO

B. High-PEEP or “open lung”

C. Prone position

D. Surfactant replacement

A

D. Surfactant replacement

47
Q
  1. A 62/F, HPN, DM, on oral hypoglycemic presents with fever and RUQ pain radiating to the back. PE: BP 180/100mmHg, HR 108 bpm, RR 22/min, T 38.5 0C, BMI 31. She is scheduled for an emergency laparoscopic cholecystectomy possible open cholecystectomy.

What is the risk for mortality in this patient?

A. Low risk

B. Intermediate risk

C. Moderately high risk

D. High risk

A

B. Intermediate risk

48
Q
  1. A 60/M, presents with loss of consciousness, gasping, with the ff. vital signs: BP 200/120mmHg, HR 55 bpm, O2 sat of 92%. CT scan shows a large intracerebral hemorrhage. What is the mode of ventilation for this patient?

A. Non-invasive ventilation

B. Pressure-support ventilation

C. Assist-control ventilation

D. Continuous positive airway pressure

A

C. Assist-control ventilation

49
Q
  1. A 52/F, presents with cough, fever, difficulty of breathing and hypotension. The initial impression is sepsis. Based on the “bundles of care” for sepsis, what must be done within the 1st 3 hours?

A. Vasopressor

B. Broad-spectrum antibiotic

C. Boluses of IV fluid

D. Central venous line

A

B. Broad-spectrum antibiotic

50
Q
  1. A 56/M had splenectomy for hereditary spherocytosis 6 months ago. He presents with 3-day generalized weakness and fever. BP 70/50 mmHg; CR 120/min; RR 25/min; T 40 0C. CXR and urinalysis are normal. CBC shows marked leukocytosis with neutrophilic predominance. What is the most appropriate empiric antibiotic?

A. Amikacin

B. Ampicillin-Sulbactam

C. Ceftriaxone

D. Ciprofloxacin

A

C. Ceftriaxone

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