Mix15

Question 1

MCC of sepsis in SCD:

Answer 1

S pneumo (NOT Staph)

Question 2

Rx for neonatal thyrotoxicosis from maternal anti-TSH R

Answer 2

Methimazole + BB. Generally self resolving after 3 mo

maternal anti-TSH R Ab (Graves) pass into placenta and bind baby’s TSH-R. Present as low birth weight infant w/tachy, warm/moist skin, and poor feeding/irritability.

Question 3

Most likely cause of hearing loss in an AIDS patient:

Answer 3

Serous otitis media. Presents with dull hypomobile tympanic membrane. Due to auditory tube dysfunction from HIV lymphadenopathy or obstructing lymphoma.

Question 4

Etiology of vulvar SCC:

Answer 4

Persistent HPV infection and chronic inflammation. Unifocal friable plaque or ulcer on labia majora that causes persistent vulvar irritation and/or pain.

Question 5

Mammo screening guidelines:

Answer 5

Biennial for women 50-74

Question 6

Why do you get ^ BUN in prerenal AKI?

Answer 6

Hypovolemia&raquo_space; decreased renal BF&raquo_space; activation of RAAS&raquo_space; ^ resorption of Na and H2O&raquo_space; passive reabsorption of urea

** kidneys don’t show actual injury (unless its prolonged and leading to ATN), so urine sediment in AKI is typically bland.

Question 7

How do you differentiate Parkinsons Disease Dementia from Lewy Body Dementia?

Answer 7

By time to onset. PDD is diagnosed when parkinsonism predates cognitive changes by 1 year. In LBD though, the cognitive changes happen at the same time as parkinsonism.

Question 8

Why do you use normal saline for initial correction of low BP in hypovolemic hypernatremia instead of free water or D51/2NS?

Answer 8

Don’t use hypotonic solutions because they quickly exit the intravascular system and lower serum sodium [ ] too rapidly

Question 9

acute diffuse noninflammatory hair loss w/hair shafts easily able to be pulled out:

Answer 9

telogen effluvium. generally triggered by stressful event, is self limiting but may take up to a year to resolve

Question 10

Which happens sooner after birth, gonorrhea or chlamydial conjunctivitis?

Answer 10

Gonorrhea (day 2-5) - purulent discharge. Rx = CTX IM

Chlamydia (day 5-14) - mucopurulent dc. Rx = Ertyhro PO

Question 11

Pathophys of HIV assoc dementia:

Answer 11

macrophage mediated signaling pathway&raquo_space; neuronal dysfunction. Subacute onset w/increasing apathy and impaired attention. May have subcortical dysfunction (basal ganglia, nigrostriatal) with slowed movement and problems with smooth limb movement.

Question 12

Hawthorne bias:

Answer 12

subject of study changes behavior because they are aware they are under observation.

Question 13

MOA of quetiapine:

Answer 13

2nd gen antipsych

Question 14

MOA of fluphenazine:

Answer 14

high potency 1st gen

Question 15

MOA of ziprasidone:

Answer 15

2nd gen antipsych

Question 16

1st line Rx options for asymptomatic bacteruria:

Answer 16

Cephalex, amoxicillin-clavulanate, nitrofurantoin, fosfomycin

Question 17

Azathioprine is a purine analog that is converted to 6-MP. Acts by inhibiting purine synth. The major toxicity of azathioprine is:

Answer 17

dose related diarrhea, hepatotoxicity, and leukopenia.

Question 18

Major toxicity of mycophenolate:

Answer 18

Bone Marrow suppression

Question 19

Cyclosporine and tacrolimus are both IL-2 transcription inhibitors. Cyclosporine is unique in that it causes ___ and ____ in addition to the following side effects shared with tacrolimus: Hyper K, glucose intolerance, nephrotoxicity, HTN, and tremor

Answer 19

hirsutism and gum hypertrophy.

Question 20

Felty syndrome

Answer 20

Advanced RA with neutropenia and splenomegaly

Question 21

Rx for neurocysticercosis:

Answer 21

albendazole (antiparasitic), corticosteroid (brain inflammation), and antiepileptic (phenytoin) for seizure

Question 22

Effects of pregnancy on thyroid hormone levels;

Answer 22

Estrogen increases serum TBG levels, requiring an increase in the amount of thyroid hormone to saturate the binding sites. hCG stimulates TSH R to ^ thyroxine production. Total thyroid hormone levels ^ with a minimal increase in free T4 levels

Question 23

13 mo old kid with erythematous, nonblanching rash on trunk and lower extremities. Developed fever, lethargy, and pos brudzinski sign. Dx and Rx?

Answer 23

Dx = meningococcal meningitis (Neisseria meningitis).

Rx = Penicillin and 3rd gen ceph

Question 24

Pain, watering, and redness in the eye with vesicles and dendritic ulcers in the cornea:

Answer 24

Herpes simplex keratitis

Question 25

Recommended dietary changes for Pt with Ca oxalate stones;

Answer 25

1. Increase fluid intake
2. Decrease sodium intake.
3. Normal dietary Ca2+ intake

** Increased sodium enhances Ca2+ excretion. Low sodium intake promotes Na+ and Ca2+ reabsorption through effects on the medullary concentration gradient. Reabsorption of Na+ and Ca2+ is coupled by CaSR in TAL.

Question 26

Respiratory distress and signs of noncardiogenic pulmonary edema within 6 hrs of receiving a blood transfusion:

Answer 26

TRALI (transfusion related acute lung infection) due to donor anti-leukocyte Ab.

Question 27

Fever, flank pain, hemoglobinuria, and renal failure in a patient 1 hr after receiving a blood transfusion:

Answer 27

Acute hemolytic transfusion rxn due to ABO mismatch.

Question 28

Bone conduction > air conduction on side of decreased hearing. Weber lateralizes to affected side:

Answer 28

Conductive hearing loss (stapes footplate becomes fixed to oval window)

Question 29

Air conduction > bone conduction in both ears. Weber lateralizes away from affected side:

Answer 29

Sensorineural hearing loss (i.e. acoustic neuroma, Meneire’s, ototoxic drugs)

Question 30

What is metoclopramide used for?

Answer 30

Prokinetic drug that can be used to treat diabetic gastroparesis. Presents with symptoms of anorexia, nausea, vomiting, early satiety, postprandial fullness.