Mix6

Question 1

Rx for IE with S viridians (S mutans)

Answer 1

For Pt with penicillin susceptible strains, should give IV Pen G (4x per day) or IV ceftriaxone (once daily) for 4 weeks.

Question 2

Diagnostic pathway/procedure for complicated back pain:

Answer 2

Xray > ESR/CRP > MRI (if ESR or Xrays abnormal) or radionuclide bone scan in Pt who can’t get xray > CT guided needle aspiration/biopsy if necessary

Question 3

Formula for corrected calcium:

Answer 3

corrected calcium = measure Ca + 0.8 [4 - albumin]

Question 4

Pt with medication overdose has tonic clonic seizure, dilated pupils, widened QRS, and hypotension. What’s the best next step?

Answer 4

Sodium Bicarb. This is TCA overdose. TCA can decrease myocardial conduction velocity&raquo_space; QRS prolongation and risk of ventricular arrhythmia. TCA also causes hypotension. Bicarb should reverse all this.

Question 5

Pharmacologic intervention for Alzheimer’s:

Answer 5

AChEi (donepezil, tacrine) and NMDA antag (memantine)

Question 6

Initial eval tests for suspected primary adrenal insufficiency:

Answer 6

Early AM cortisol&raquo_space; plasma ACTH/cosyntropin test (ACTH stim test).

Normally, infusion of cosyntropin will cause a rapid increase in serum cortisol but pt with PAI won’t have this rise.

Question 7

MOA and adverse effects of methotrexate:

Answer 7

Purine antimetabolite. Hepatotoxicity, stomatitis, cytopenia.

** Pt should be on folic acid supplement w/MTX

Question 8

MOA and adverse effect of leflunomide:

Answer 8

pyrimidine synthesis inhibitor. Hepatotoxicity, cytopenia

Question 9

What is Felty syndrome?

Answer 9

Clinical disorder in Pt w/severe long standing (>10yr) RA that is characterized by neutropenia and splenomegaly

Question 10

Best test for suspected diabetic nephropathy:

Answer 10

random microalbumin/creatinine ratio

Question 11

Does osmotic demyelination syndrome happen when correcting low Na or high Na?

Answer 11

Central pontine myelinolysis happens when going from low to high too fast.

If going from high to low then you run the risk of cerebral edema.

Question 12

Patient presents with history of diabetes, recent weight loss, diarrhea, anemia, and erythematous plaques with central clearing on the mouth and extremities.

Answer 12

Glucagonoma. The rash is necrolytic migratory erythema. Dx is made with serum glucagon levels.

Question 13

Explosive onset of multiple itchy, seborrheic keratoses is assoc with:

Answer 13

GI malignancy

Question 14

What is first line for pt with HTN and RAS?

Answer 14

ACEi or ARB

Question 15

“eggshell calcification” of a hepatic cyst on CT is suggestive of:

Answer 15

hydatid cyst due to Echinococcus