Form 2 Block 4 - Created Aug 7

Question 1

ARDS goal is to keep partial pressure of arterial oxygen at 55-80 mm Hg (or oxygen sat. at 88-95%). How is this maintained?

Answer 1

1. low TV’s at 6-8 mL/kg predicted wt
2. RR < 35/min
3. plateau pressure < 3 cm H2O
4. FiO2 < 60%

Question 2

ARDS pt is at goal with minimal level of PEEP. (5 cm H2O). What is next step?

Answer 2

Decrease FiO2 to < 40% to prepare for spontaneous breathing trial in the near future

Question 3

pt has exercise-induced hypothalamic amenorrhea. What should be done next?

Answer 3

Check DEXA to assess risk for stress fracture.

Question 4

with elderly pt who has TSH above normal on exam, what to do with it?

Answer 4

If it’s < 7 and no overt/bad signs of hypothyroidism, it’s subclinical. Leave them alone.

Question 5

when should grief counseling be suggested

Answer 5

when the person who lost a loved one has poor family and/or social support

Question 6

Pt had success with SSRI before with depression, but pt has bipolar disorder and hates Lithium. Next step?

Answer 6

Educate pt about the risks of mania with antidepressant therapy and give other options to stabilize mood. (lamotrigine, valproate, quetiapine, lurasidone)

Question 7

HIT type 1 vs. 2 presentation

Answer 7

1. plt’s at 100k w/in 2 days of starting heparin
2. plt’s go down 30-50%, occurs 5-10d after heparin or <1d if they’ve had heparin recently, see new thrombosis or skin necrosis

Question 8

HIT type 1 vs. 2 treatment

Answer 8

1. requires NO change in therapy

2. check plt factor 4 Ab, stop heparin, and start argatroban

Question 9

people at risk to get rhino-orbital-cerebral mucormycosis

Answer 9

diabetes, blood cancer, solid organ or stem cell transplant

Question 10

tx of rhino-orbital-cerebral mucormycosis

Answer 10

surgical debridement, Amp.B, and eliminate risk factors if possible

Question 11

presentation of splenic sequestration in SCD child

Answer 11

L sided abd. pain, palpable splenomegaly, severe anema

Question 12

tx of splenic sequestration in SCD child

Answer 12

IVF -> RBC transfusion -> possibly splenectomy

Question 13

tx of Lyme disease

Answer 13

doxy if skin/mild dz

ceftriaxone (hosp) if neuro or cardiac dz

Question 14

presentation of acalculous cholecystitis

Answer 14

critically ill pt, unexplained fever, jaundice, leukocytosis, GB wall thickening w/o choleliths

Question 15

tx of of acalculous cholecystitis

Answer 15

percutaneous cholecystostomy and Abx

cholecystectomy if perf or necrosis

Question 16

on nonstress test, if mom has a uterine contraction and baby has no acceleration in HR, next step?

Answer 16

do biophysical profile to assess fetus (NST, AFI, breathing, movements, tone)

Question 17

what is associated with a more aggressive course in RA?

Answer 17

anti-cyclic citrullinated peptide Ab’s

Question 18

what labs to monitor with neonatal polycythemia (Hct >65% or Hgb >22% in term babies)

Answer 18

glucose and bilirubin

Question 19

treatment of neonatal polycythemia

Answer 19

IVF, G, partial exchange transfusion

Question 20

presentation of postop ileus

Answer 20

no return of bowel function >72h after intraabdominal surgery -> V, lack of gas, can’t eat p.o.

Question 21

xray findings of SBO vs ileus

Answer 21

SBO - air fluid levels, dilated proximal bowel but collapsed distal bowel, no air in colon/rectum

ileus - dilated loops of bowel, air in colon and rectum

Question 22

mgt of postop ileus

Answer 22

IVF, antiemetics, bowel rest w/ ng tube placement, avoiding opiates

Question 23

part of the presentation of hydatidiform mole that’s not ob/gyn related per se

Answer 23

hyperthyroidism

Question 24

presentation of pt with heavy alcohol use and severe hypophosphatemia

Answer 24

sxs start 12-36h after admission to hospital; generalized weakness, diminished reflexes, paresthesias, ileus, and/or metabolic encephalopathy; do IV phosphate if having sxs; do p.o. if Asx

Question 25

risk with retaining a dead fetus

Answer 25

DIC

Question 26

possible causes of otitis externa

Answer 26

water, cotton swabs, headphones, hearing aids, derm conditions

Question 27

presentation of otitis externa

Answer 27

ear pain, discharge, pruritis, pain with auricle manipulation; red, edematous ext. auditory canal

Question 28

bugs that cause otitis externa

Answer 28

pseudomonas and staph aureus

Question 29

tx of otitis externa

Answer 29

topical FQN +/- topical glucocorticoid

Question 30

what can happen in pt with COPD who is started on NPPV

Answer 30

pulmonary barotrauma (Ptx, pneumoperitoneum, pneumomediastinum, subcut. emphysema)

Question 31

presentation of subcutaneous emphysema

Answer 31

rapid-onset, painless swelling of upper chest, neck, and/or face as well as crepitus; get a CXR to look