Form 2 Block 3 - Created Aug 7

Question 1

why hepatic encephalopathy occurs

Answer 1

infection, hypovolemia, GI bleed, metabolic abnormalities, sedative use (like opioids or benzos)

Question 2

tx of hepatic encephalopathy

Answer 2

eliminate offending cause and give lactulose or lactitol; rifaximin is 2nd line

Question 3

antidepressant discontinuation syndrome presentation

Answer 3

fatigue, HA, dizzy, chills, N, muscle aches/pains; psych sxs such as dysphoria, irritable, anxiety; tremor, paresthesias, “electric shock” sensations; setting of missed doses

Question 4

tx of antidepressant discontinuation syndrome

Answer 4

restart med; taper over 2-4 wks if pt wants to stop med

Question 5

tx of hypercalcemia of malignancy from bone mets

Answer 5

short-term: IVF and calcitonin

long-term: bisphosphonates

Question 6

medical tx of primary hyperparathyroidism

Answer 6

cinacalcet

Question 7

clinical features of PCP

Answer 7

violent, dissociation, hallucinations, amnesia, nystagmus, ataxia

Question 8

clinical features of LSD

Answer 8

visual hallucinations, euphoria, dysphoria/panic, tachycardia/HTN

Question 9

clinical features of cocaine

Answer 9

euphoria, agitation/psychosis, chest pain, seizures, tachycarida/HTN, mydriasis

Question 10

clinical features of methamphetamine

Answer 10

violent, psychosis, diaphoresis, tachycardia/HTN, choreiform movements, tooth decay

Question 11

clinical features of marijuana

Answer 11

increase appetite, euphoria, dysphoria/panic, slow reflexes, impaired time perception, dry mouth, conjunctival injection

Question 12

clinical features of heroin

Answer 12

euphoria, depressed mental status, miosis, resp. depression, constipation

Question 13

Light criteria for exudative pleural effusion

Answer 13

any of the following:
A. (pleural protein/serum protein) >0.5
B. (pleural LDH/serum LDH) >0.6
C. pleural LDH 2/3 upper limit of normal of serum LDH

Question 14

common conditions causing exudate versus transudate

Answer 14

exudate - TB, pna, cancer, CT dz, PE, pancreatitis, post-CABG

transudate - cirrhosis, nephrotic syndrome, heart failure, constrictive pericarditis

Question 15

presentation suggestive of COPD

Answer 15

progressive SOB and chronic cough, significant smoking hx, obstructive scooped out pattern on spirometry, (FEV1/FVC) ratio <0.7

Question 16

pattern on spirometry of interstitial lung disease

Answer 16

restrictive or witch hat look

Question 17

MCC of sick sinus syndrome

Answer 17

degeneration of cardiac conduction system

Question 18

2 groups at greatest risk of getting Pneumocystic jirovecii

Answer 18

1) advanced HIV and 2) those on chronic glucocorticoids + immunosuppressant (both immunocompromised overall)

HIV - sxs develop over wks

steroids - fulminant respiratory failure, dry cough, and fever

Question 19

what meds can cause HTN

Answer 19

NSAIDs, glucocorticoids, stimulants, decongestants, OCPs, TCAs, SNRIs

Question 20

how to prevent vertical transmission of HSV

Answer 20

start acyclovir at 36 wks GA and continue until delivery; if at delivery pt has prodromal sxs or active genital lesion, then do Csxn also

Question 21

when is hypospadias surgically corrected

Answer 21

age 6 months

Question 22

tx of ITP

Answer 22

1. obs if plt’s >30k
2. steroids if plt’s <30k
3. bleed - IVIG and plt’s

Question 23

presentation of open-angle glaucoma

Answer 23

loss of peripheral vision and enlargement of optic cup (increased cup to disc ratio); IOP may not be elevated; common in elderly and Afr.Am.

Question 24

presentation of macular degeneration

Answer 24

painless, progressive loss of central vision; drusen present

Question 25

presentation of HTN retinopathy

Answer 25

blurry vision; AV nicking, copper or silver wiring, exudates, retinal hemorrhages

Question 26

presentation of angle-closer glaucoma

Answer 26

acute ocular pain, HA, V, loss of visual acuity; red eye with corneal opacification and a nonreactive, dilated pupil

Question 27

what to do if pregnant woman has possible exposure to parvovirus B19 or has symptoms suggestive of it

Answer 27

check B19 antibodies
IgG(+) - Mom immune
IgM(+) - active infection -> close watch of fetus

Question 28

pt has a calcium type kidney stone - ways he can help prevent recurrence

Answer 28

increase fluids and calcium; limit oxalate, sodium, and animal protein in diet

Question 29

preventive care for patient with sickle cell disease

Answer 29

1. med - PCN (Px against encapsulated bugs)
2. vaccines - routine, PPSV23, flu, early meningococcus
3. imaging - transcranial doppler u/s to assess risk of stroke

Question 30

presentation of generalized anxiety disorder

Answer 30

excessive worry >6 mo.; restless, feeling on edge, fatigue, difficulty concentrating, irritable, muscle tension, sleep disturbance; stomachaches, HA’s, perfectionism

Question 31

risks associated with the different types of twins

Answer 31

di-di: risks with all twins
mono-di: twin-twin transfusion
mono-mono: cord entanglement and conjoined twins

Question 32

cardiovascular complications seen in obstructive sleep apnea

Answer 32

resistant HTN, coronary artery disease, arrhythmias, and heart failure; if pt has any of these in combo with snoring and daytime sleepiness, do a sleep study!