Form 1 Block 3 - Created July 20

Question 1

who should get an implantable cardioverter-defibrillator to improve survival

Answer 1

1. prior MI and LVEF < 30%
2. HF w/ sxs and LVEF < 35%
3. prior episodes of V. tach

Question 2

indications for cardiac resync therapy

Answer 2

LVEF < 35% w/ long QRS or LVEF <30% w/ long QRS and LBBB

Question 3

MCC of inherited thrombophilia

Answer 3

Factor V Leiden -> protein C resistance -> thrombosis

Question 4

ways people can get enterohemorrhagic E.coli (EHEC)

Answer 4

farms, petting zoos, undercooked beef

Question 5

ways people can get Shigella

Answer 5

contaminated food or water

Question 6

which subtype of E.coli makes Shiga toxins

Answer 6

O157:H7

Question 7

presentation and ESR/CK levels in glucocorticoid-induced myopathy

Answer 7

progressive proximal m. weakness and atrophy; no pain; legs more involved; normal levels

Question 8

presentation and ESR/CK levels in polymyalgia rheumatica

Answer 8

muscle pain & stiffness in shoulder/pelvic girdle; tender w/ decr. RON at shoulder, neck, hip; responds to steroids; elevated ESR

Question 9

presentation and ESR/CK levels in inflammatory myopathies

Answer 9

muscle pain, tenderness, and proximal muscle weakness; skin rash and infl. arthritis may be present; ESR and CK elevated

Question 10

presentation and ESR/CK levels in statin-induced myopathy

Answer 10

prominent muscle pain/tenderness; rare rhabdo; elevated CK

Question 11

presentation and ESR/CK levels in hypothyroid myopathy

Answer 11

muscle pain, cramps, and weakness in proximal mm; delayed tendon reflexes and myoedema; occ. rhabdo; features of hypothyroid; elevated CK

Question 12

hypothyroidism features that are not classic features

Answer 12

carpal tunnel, mild normocytic anemia, mild hypoNa, hyperLipid, borderline elevation in Cr, muscle pain made worse with exercise

Question 13

preventive meds for migraines

Answer 13

BBs, TCAs, valproate

Question 14

abortive meds for migraines

Answer 14

ergotamines or triptans

Question 15

strategy to decrease incidence of vent associated lung injury

Answer 15

low tidal volume ventilation (6-8 mL/kg of predicted body wt)

Question 16

what 2 things to adjust on ventilator to maintain oxygenation within acceptable range

Answer 16

FiO2 and PEEP; do not keep FiO2 above 60% for long; high PEEP may be needed to prevent alveolar collapse

Question 17

minute ventilation equation

Answer 17

RR x TV

If decreasing TV to decr. chance of alveolar overdistention, be sure to increase RR accordingly.

Question 18

what can mechanical ventilation cause (quick and fixable complication)

Answer 18

hypotension

Question 19

possible complication of severe nephrotic syndrome

Answer 19

thromboses (mostly renal vv and deep vv of legs) and infections (with typical bugs)

Question 20

when to consider hemochromatosis as a diagnosis instead of depression

Answer 20

50 yo Male who is weak/tired, poor concentration, low libido, mildly elevated LFTs, high ferritin

Question 21

skin manifestation in hereditary hemochromatosis

Answer 21

hyperpigmentation

Question 22

MSK manifestations in hereditary hemochromatosis

Answer 22

arthralgia, arthropathy, chondrocalcinosis

Question 23

GI manifestations in hereditary hemochromatosis

Answer 23

hepatomegaly (early), cirrhosis (later), HCC (much later)

Question 24

endocrine manifestations in hereditary hemochromatosis

Answer 24

DM, hypogonadism, hypothyroidism

Question 25

cardiac manifestations in hereditary hemochromatosis

Answer 25

restrictive or dilated CMP; possible MI or stroke from thick blood

Question 26

infectious manifestations in hereditary hemochromatosis

Answer 26

Listeria, Vibrio vulnificus, Yersinia enterocolitica

Question 27

1st line tx for bulimia nervosa

Answer 27

CBT; fluoxetine may be added on; hospitalize if SI, uncontrolled purging, or medical complications

Question 28

which med is contraindicated in bulimia nervosa?

Answer 28

bupropion

Question 29

associated risk in pregnant patients who take oral fluconazole

Answer 29

spontaneous abortion, cleft palate, femoral bowing, congenital heart dz

Question 30

how urine chloride level can help differentiate btwn major causes of metabolic alkalosis with hypokalemia

Answer 30

1. low - ext. loss of gastric acid (V, NG suction)

2. high - diuretics or Gitelman/Bartter

Question 31

way elderly depression can look

Answer 31

increased restlessness, anxiety, behavioral agitation

Question 32

when to suspect gallbladder pathology based on labs

Answer 32

elevated bilirubin (>1.0) and elevated alk phos