Mix8

Question 1

In ascites, how do you determine if the fluid is due to portal hypertension or not?

Answer 1

Use the serum-to-ascites albumin gradient (SAAG). Ratio > 1.1 g/dL indicates portal HTN (cardiac ascites, cirrhosis) and ratio <1.1 suggests non-portal HTN (malignancy, pancreatitis, nephrotic syndrome, TB)

Question 2

What are meds that have been shown to improve long term survival in Pt w/LV systolic dysfunction?

Answer 2

ACEi, ARB, BB, mineralocorticoid R antagonists (spironolactone/eplerenone).

** Hydralazine and nitrates have also shown improvement with AA Pts.

Question 3

Marker for medullary thyroid cancer:

Answer 3

Calcitonin. Medullary thyroid cancer arises from parafollicular C cells of the thyroid. (Papillary and follicular cancers arise from thyroid epithelial cells)

Question 4

MOA of eplerenone:

Answer 4

Aldosterone R antag. It is a selective mineralocorticoid antagonist, meaning it has low affinity for progesterone or androgen R.

Question 5

Pregnant woman w/Lyme Dz:

Answer 5

Gets amoxicillin instead of doxy. PO amoxicillin is rx of choice for pregnant and lactating women, and kids <8yo

Question 6

Rx for polymyositis:

Answer 6

Reduce the flare up with glucocorticoids (prednisone) and follow up with long term treatment (MTX, azathioprine).

** Since polymyositis is assoc with paraneoplastic syndrome, should also do age appropriate cancer screening

Question 7

Pt with fever, renal insufficiency, microangiopathic hemolytic anemia, AMS, and thrombocytopenia:

Answer 7

TTP - thrombotic thrombocytopenic purpura

Due to acquired autoantibody of ADAMTS13 (plasma protease that cleaves vWF off endothelial surface)

Rx = emergent plasma exchange

Question 8

Early decrescendo diastolic murmur heard at LSB that increases with expiration:

Answer 8

Aortic regurg

Question 9

ECG with broad flat T wave, U wave, ST depression, and premature ventricular beats:

Answer 9

Hypo K. Can also show up with Afib, torsades, and V-fib.