Mix11

Question 1

What are the criteria for diagnosing infective endocarditis?

Answer 1

IE is identified by Duke Criteria. Definite IE = 2 major or 1 major + 3 minor

Major - Blood cx pos for typical organisms (S aureus, S viridians, enterococcus). Echo showing valvular degeneration.

Minor - Temp > 100.4, prior IV drug use, predisposing cardiac lesion, pos(+) blood cx, embolic/immunologic phenomena (i.e. glomerulonephritis).

• Need to confirm Dx before treatment.

Question 2

Excess admin of diphenhydramine can cause antihistamine and anticholinergic properties. What are some signs of cholinergic toxicity?

Answer 2

Anticholinergic excess:

• Dry mouth/skin
• Blurry vision/mydriasis (dilated pupil/blurred vision)
• Hyperthermia from impaired heat dissipation
• Urinary retention
• Decreased bowel sounds

Dry as a bone, blind as a bat, hot as a hare, full as a flask.

Physostigmine (cholinesterase inhibitor), can counteract the anticholinergic effects above.

Question 3

What’s the mutation in CML?

Answer 3

Bcr-Abl fusion protein (chr 9-22)&raquo_space;> constitutively active tyrosine kinase.

Rx = imatinib (tyrosine kinase inhibitor)

Question 4

What markers are used to identify sjogren’s?

Answer 4

anti-Ro (SSA) and/or anti-La (SSB)

Question 5

What’s the initial treatment for dermatitis herpetiformis?

Answer 5

Dapsone (inhibits myeloperoxidase)

Question 6

Normally Pt get PCV 13 followed by PPSV23 at around 6-12 months later. When would you give PPSV23 alone?

Answer 6

Recommended as a one time vaccine for adults < 65 who are smokers or who have other medical conditions like heart, lung, diabetes, or chronic liver disease.

Question 7

What part of the lung has the highest V and Q when a person is standing uprigtht?

Answer 7

V and Q are highest in the lung bases because gravity creates hydrostatic pressure acting on air and blood.

Question 8

What tumor markers are used to track progress in treatment of pancreatic vs gastrointestinal cancers?

Answer 8

Pancreatic cancer = Ca 19-9

GI cancers = CEA (carcinoembryonic antigen)

Question 9

Is enthesitis more commonly found in rheumatoid arthritis or psoriatic arthritis?

Answer 9

Enthesitis = inflammation/pain at sites where tendons and ligaments attach to bone. Can be isolated disorder (plantar fasciitis) but is a characteristic finding of spondyloarthropathy (ankylosing spondylitis, psoriatic arthritis, and reactive arthritis). Assoc with HLA B27.

Psoriatic arthritis can be assoc with sausage digits.

Question 10

If a Pt comes in with bradycardia, AV block, hypotension, cold/clammy extremities, and diffuse wheezing, what is the most likely Dx and Rx option?

Answer 10

Dx = BB overdose. Bradycardia and hypotension leading to cardiogenic shock (cold/clammy extremities) are common findings.

Rx = Secure airway, isotonic fluid bolus with atropine for hypotension and bradycardia, then administer IV glucagon.

Glucagon allows for ^ intracellular levels of cAMP and is used to treat BB and CCB toxicity.

If that fails other therapies should be tried in this order: IV Calcium, vasopressors (Epi/NE), high dose insulin and glucose, IV lipid emulsion therapy

Question 11

Why should you never take theophylline (bronchodilator for COPD) and ciprofloxacin together?

Answer 11

Because you can develop theophylline toxicity (mostly excess CNS stimulation) [headache, insomnia, seizure] because both are metabolized by liver CYP enzymes.

Question 12

Would an 5-alpha reductase inhibitor or an a-adrenoreceptor blocker be the primary treatment in uncomplicated BPH?

Answer 12

Uncomplicated BPH should preferentially be treated with alpha 1 blockers (terazosin, tamsulosin) which provide rapid relief by relaxing bladder neck and prostatic smooth muscle.

5-alpha reductase inhibitors (i.e. finasteride) can be used in cases of persistent Sx or as an alternate therapy in people who don’t tolerate alpha 1 blockers. But these have slower onset of action.

Question 13

What is a potential complication of long term glucocorticoid use in a patient with SLE who presents with hip pain that increases with weight bearing?

Answer 13

Look out for osteonecrosis. MRI is more sensitive than X-ray. MRI may allow you to see the border between normal and ischemic bone as well as the zone of hypervascularity.

Question 14

If a patient presents with pleuritic chest pain, dyspnea, acute distress, and diaphoretic with ECG findings of S1Q3T3 what is the Dx?

S wave in Lead I, Q wave in Lead III, inverted T wave in Lead III

Answer 14

Pulmonary Embolism

ECG may also display A-fib which may present as irregular RR intervals, absent P waves, and narrow QRS

Question 15

Antismooth muscle antibody is associated with what disease?

Answer 15

Autoimmune hepatitis

Question 16

Anticitrullinated peptide antibodies are assoc with what disease?

Answer 16

Rheumatoid arthritis

Question 17

A patient with acute monoarticular arthritis with chondrocalcinosis would be diagnostic of what disease?

Answer 17

CPPD - calcium pyrophosphate dehydrate crystal deposition (Pseudogout).

** Pt with Pseudogout should be evaluated for secondary causes like hyperparathyroidism, hypothyroidism, and hemochromatosis.

Question 18

What would the initial iron studies in hereditary hemochromatosis demonstrate in terms of serum iron, ferritin, and transferrin saturation?

Answer 18

They would all be increased.

** Dx can be confirmed with genetic testing for hemochromatosis associated mutations (HFE)