Mix6

Question 1

What hematologic side effect do you need to look out for when using isoniazid?

Answer 1

Isoniazid is a pyridoxine antagonist and can cause sideroblastic anemia.

** Acquired sideroblastic anemia typically manifests as microcytic hypochromic anemia and can be mistaken for iron deficiency anemia. Can distinguish between the two by ^ Fe and decreased TIBC, also sideroblastic anemia typically shows up as hypochromic and normochromic RBC population on microscopy.

Question 2

What test would you order if you suspected infectious mononucleosis?

Answer 2

IM is due to EBV infection and can present with constitutional sx, mild to moderate fever, exudative pharyngitis, malaise, lymphadenopathy, and splenomegaly.

Primary diagnostic test = heteophile Ab / Monospot test

Question 3

What type of abnormal heart sound can typically be appreciated during an acute MI?

Answer 3

4th heart sound (atrial gallop). Acute phase of MI&raquo_space; ischemia induced MI&raquo_space; LV stiffening and dysfunction

Question 4

Would bounding pulses be more characteristic of AS or AR?

Answer 4

Aortic Regurg. Mild AR&raquo_space; waterhammer/bounding pulse. AR&raquo_space; ^ stroke volume&raquo_space; abrupt rise in systolic BP&raquo_space; rapid distension of peripheral arteries.

Question 5

What’s the mechanism behind hypomagnesia causing hypocalcemia?

Answer 5

Hypomagnesia&raquo_space; hypocalcemia by inducing resistance to PTH and can cause decreased PTH secretion.

Question 6

Why are some Pt with Crohns’ disease predisposed to forming kidney stones?

Answer 6

Crohns’ can cause ^ hyperoxaluria. Normally, calcium binds oxalate in the gut and prevents its absorption. In Pt with fat malabsorption, Ca2+ is preferentially bound by fat leaving oxalate unbound and free to be absorbed in the bloodstream.

• In Crohns’ you also have decreased bile salt reabsorption due to fat malabsorption&raquo_space; excess bile salts in small intestine&raquo_space; damaged colonic mucosa&raquo_space; increased oxalate absorption.

Question 7

What was flumazenil used for?

Answer 7

Flumazenil is a benzo receptor antagonist that can be used in cases of benzo intoxication.

Question 8

What medication is indicated in Pt with persistent HF symptoms despite use of ACEi/ARB and BB?

Answer 8

Mineralocorticoid R blockers = spironolactone and eplerenone.

These block deleterious effects of aldosterone on the heart and improve survival and mortality in HF Pt with LV systolic dysfunction.

Question 9

How does treatment differ for acute vs chronic prostatitis?

Answer 9

Acute = TMP-SMX or fluoroquinolone 
Chronic = Fluoroquinolone only 

MCC agent = E coli
* Start empiric therapy before waiting for clean catch results to come back.

Question 10

What’s the most likely cause of epididymitis in older populations?

Answer 10

Epididymitis = swelling of the epididymis of the scrotum.
Presents as unilateral testicular pain, epididymal edema, dysuria, and increased frequency (if due to coliform infection).

Age < 35 MCC = Gonorrhea/chlamydia
Age > 35 MCC = Coliform bacteria (E coli)

Question 11

What drug would you use to counteract organophosphate toxicity?

Answer 11

Organophosphate toxicity = acetylcholinesterase is considered non-functional&raquo_space; cholinergic excess. Atropine should be given immediately. Competes with ACh at the muscarinic R.

Question 12

What’s the cause of Whipple Dz, and how do you diagnose it?

Answer 12

Whipple Dz is a multisystem D/o with a varied presentation caused by g(+) bacillus Tropheryma whippeli. Sx include chronic malabsorptive diarrhea, weight loss, migrating non deforming arthritis, lymphadenopathy and a low grade fever.

Dx is made by intestinal biopsy showing PAS Macs in the lamina propria containing non acid fast G(+) bacilli, and by PCR