One Step Further

Question 1

What is the name of the known syndrome that is associated with ovarian tumor, ascites, and pleural effusion?

Answer 1

Meigs Syndrome

Question 2

In severe croup, what will be the finding on chest radiography?

Answer 2

Subglottic narrowing called steeple sign on PA view

Question 3

What transfusion complication can present with a similar picture to acute respiratory distress syndrome?

Answer 3

TRALI - Transfusion related lung injury

Question 4

What pathology can present with dysphagia, vomiting, and a pleural effusion?

Answer 4

Esophageal Rupture

Question 5

Individuals infected with what virus have approximately a fourfold increased incidence of lung cancer compared with noninfected individuals?

Answer 5

HIV

Question 6

What percent oxygen saturation is used as a criterion indicating severe disease that warrants hospital admission in patients with bronchiolitis?

Answer 6

<95% RA

Question 7

What is the dosage of magnesium sulfate in the treatment of severe asthma exacerbations?

Answer 7

2 mg IV over 20 minutes

Question 8

What medication can cause cyanide toxicity?

Answer 8

Sodium nitroprusside

Question 9

What findings on the hands can be seen in bacterial endocarditis?

Answer 9

Janeway lesions and Osler nodes

Question 10

What term describes a pneumothorax occuring in the setting of menses due to thoracic endometriosis?

Answer 10

Catamenial PTX

Question 11

What is the best initial step in management of an esophageal meat bolus in a stable patient?

Answer 11

Glucagon

Question 12

What defines AIDS?

Answer 12

CD4<200 cells/mL or AIDS defining illness

Question 13

Which patients with COPD should be treated with prophylactic antibiotics?

Answer 13

People with frequent exacerbations, defined as greater than 2 per year despite optimal therapy

Question 14

What region of the esophagus is most likely to rupture in Boerhaave syndrome?

Answer 14

Left posterolateral aspect of thoracic esophagus

Question 15

Which antiviral medication may be beneficial in treating immunocompromised patients with severe RSV infections?

Answer 15

Ribavarin

Question 16

What unique enzyme can be found in the pleural effusion secondary to esophageal rupture?

Answer 16

Amylase

Question 17

Optic neuritis is a noted adverse effect of what antituberculosis medication?

Answer 17

Ethambutol. Neuropathy may manifest as a loss of visual acuity, or red-green colorblindness.

Question 18

What antibiotic is commonly used to cover atypical causes on pneumonia?

Answer 18

Azithromycin

Question 19

What electrolyte abnormality is common in pancreatitis?

Answer 19

Hypocalcemia

Question 20

Which types of viral hepatitis lead to hepatocellular carcinoma?

Answer 20

B and C

Question 21

In addition to lactulose, what is another treatment for hepatic encephalopathy?

Answer 21

Neomycin, Rifaximin

Question 22

What is Cullen’s sign?

Answer 22

Discoloration around the umbilicus indicative of hemorrhagic pancreatitis

Question 23

What medication can be prescribed to help with the pruritus frequently associated with primary sclerosing cholangitis?

Answer 23

Cholestyramine, a bile acid sequestrant

Question 24

What are the components of Ranson’s Criteria on admission?

Answer 24

Age, LDH, glucose, WBC, AST

Question 25

What common bile duct diameter is considered dilated in a patient who still has a gallbladder?

Answer 25

8mm

Question 26

What condition causes stenosis of the common bile duct via mechanical pressure and inflammatory changes due to gallstones in the gallbladder neck and cystic duct?

Answer 26

Mirizzi Syndrome

Question 27

What are the Ranson’s criteria for pancreatitis-associated mortality at admission?

Answer 27

``` Age >55 Glucose > 200 LDH > 350 AST > 250 WBC > 16000 ```

Question 28

What therapeutic device can be used to temporize patients with life threatening variceal bleeding?

Answer 28

Sengstaken-Blakemore tube

Question 29

If a previously vaccinated hospital worker tests negative for HBsAb and is exposed to a HBsAg positive source, what is the recommended postexposure prophylaxis?

Answer 29

Hep B Ig and Hep B vaccine

Question 30

What are two common causes of viral pancreatitis?

Answer 30

Mumps and Coxackie B

Question 31

What are the most common organisms to cause cholangitis?

Answer 31

E. coli, Klebsiella, Enterococcus, Bacteroides

Question 32

What is the molecular adsorbent recirculating system (MARS)?

Answer 32

MARS uses albumin in a dialysis solution to bind and remove toxins from the blood stream. It is approved for use in hepatic encephalopathy where the cause of liver failure was drug overdose or poisoning.

Question 33

What are the three types of gallstones?

Answer 33

Cholesterol stones and pigmented stones made of black (calcium bilirubinate) and brown (associated with infection) stones.

Question 34

What is the name of the flank bruising due to severe hemorrhagic pancreatitis?

Answer 34

Grey-Turner sign

Question 35

In the setting of liver cirrhosis, why is glucagon unlikely to help with episodes of hypoglycemia?

Answer 35

Glucagon acts by breaking down glycogen to glucose, but patients with cirrhosis do not have adequate enough glycogen stores for glucagon to be effective

Question 36

What are the disease components of multiple endocrine neoplasia (MEN) 2A syndrome?

Answer 36

Medullary thyroid cancer Pheochromocytoma Parathyroid adenoma

Question 37

What is the most common endocrine complication in chronic pancreatitis?

Answer 37

Glucose intolerance

Question 38

What antibody is commonly elevated in cases of Hashimoto thyroiditis, or chronic autoimmune thyroiditis?

Answer 38

Thyroid peroxidase antibody

Question 39

What are some infusions that are incompatible with the calcium in Ringer’s lactate?

Answer 39

Citrated blood products and ceftriaxone (especially in infants).

Question 40

What patients with pyelonephritis warrant imaging as part of their evaluation?

Answer 40

Those who are severely ill or septic, have persistent symptoms despite 48 to 72 hours of appropriate antibiotic treatment, or signs or symptoms concerning for urinary tract obstruction.

Question 41

Of the clinical features of generalized tetanus, which usually appears first?

Answer 41

Trismus

Question 42

What location is most commonly involved in cerebral venous thrombosis?

Answer 42

Superior saggital sinus

Question 43

Why are SCUBA divers told to avoid air travel for 12–48 hours after diving?

Answer 43

Sudden drop in atmospheric pressure can worsen or precipitate decompression sickness

Question 44

What is the role of corticosteroids in CNS abscess?

Answer 44

Cerebral edema

Question 45

For what disease process is an upper GI series the best initial test?

Answer 45

Malrotation and midgut volvulus

Question 46

What are other causes of elevated D-dimer?

Answer 46

Advanced age, malignancy, infection, pregnancy, inflammation, bed rest, recent surgery or catheter placement, recent MI, recent CVA, DVT.

Question 47

Which vessels are most likely to be injured in an open cricothyrotomy?

Answer 47

Superior cricothyroid vessels

Question 48

What is an appropriate inspiratory:expiratory ratio for a pediatric patient with a percutaneous needle cricothyrotomy?

Answer 48

1:4 to 1:5

Question 49

Intermittent, colicky abdominal pain in a patient with HSP is suggestive of what intra-abdominal process?

Answer 49

Intussusception

Question 50

What happens with the CO2 waveform with return of spontaneous circulation?

Answer 50

It abruptly increases

Question 51

High-quality chest compressions are associated with CO2 values

Answer 51

>10 mm Hg

Question 52

What is the most common cause of intussusception in adults?

Answer 52

Tumors

Question 53

What thoracic pathologies should always be considered in patients with abdominal pain?

Answer 53

Myocardial infarction (or ischemia), pneumonia, pulmonary embolism, pericarditis and myocarditis.

Question 54

What is the appropriate therapy of sigmoid volvulus?

Answer 54

Sigmoidoscopy with rectal tube decompression

Question 55

What infectious colitis mimics appendicitis?

Answer 55

Yersenia entercolitica

Question 56

How is Hirschsprung's disease definitively diagnosed?

Answer 56

Rectal biopsy

Question 57

What is the upper limit of normal diameter for the different segments of bowel?

Answer 57

Small bowel (3 cm), colon (6 cm), cecum (9 cm)—the 3/6/9 rule.

Question 58

What is the appropriate treatment for cecal volvulus?

Answer 58

Surgical resection

Question 59

What lab test best correlates with the severity of hepatic encephalopathy?

Answer 59

CSF glutamine

Question 60

Which type of bowel obstruction is generally associated with elderly or psychiatric patients who are bedridden and taking chronic anticholinergic medications?

Answer 60

Sigmoid volvulus

Question 61

What is the correct laryngoscopy blade to use on a neonate?

Answer 61

A #0 or #1 Miller blade

Question 62

Hemodynamic effect of etomidate

Answer 62

Hemodynamically neutral

Question 63

Adverse effects of etomidate

Answer 63

Myoclonus | Adrenal suppression

Question 64

What is a typicalchest radiograph finding in acute mitral regurgitation?

Answer 64

Normal cardiac silhouette with severe pulmonary edema

Question 65

How should ventilator settings be adjusted to address air trapping (auto-PEEP) in intubated patients with COPD

Answer 65

Maximize the expiratory time by adjusting the I:E ratio to 1:3 or 1:4. Tidl volume should be reduced and the inspiratory flow rate increased (>100 L/min)

Question 66

What is the target temperature for postarrest therapeutic hypothermia?

Answer 66

32-36 C

Question 67

What treatment is indicated for low to moderate risk PE with contraindications to anticoagulation?

Answer 67

IVC filter

Question 68

Enoxaparin IV or heparin IV bolus and drip are appropriate treatments for what kinds of PEs?

Answer 68

Low or moderate risk pulmonary embolisms

Question 69

Definition of Hampton's hump?

Answer 69

Pleural-based wedge infarct

Question 70

Definition of Westermark's sign

Answer 70

sign that represents a focus of oligemia (hypovolemia) (leading to collapse of vessel) seen distal to a pulmonary embolism (PE) - seen in 2% of PE CXR

Question 71

Which type of lung cancer results in the majority of malignancy-related syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Answer 71

Small cell lung cancer

Question 72

What is the preferred agent for treating deep venous thrombosis in pregnancy?

Answer 72

LMWH alone

Question 73

What percentage of patients diagnosed with DVTs have concomitant PE when studied?

Answer 73

50%

Question 74

What are other causes of elevated D-dimer besides PE?

Answer 74

Advanced age, malignancy, infection, pregnancy, inflammation, bed rest, recent surgery or catheter placement, recent MI, recent CVA, DVT

Question 75

What condition occurs in up to half of patients with thymomas?

Answer 75

Myasthenia gravis

Question 76

What size endotracheal tube should be used for intubation in massive hemoptysis?

Answer 76

Size 8.0 to facilitate bronchoscopy.

Question 77

Define massive hemoptysis

Answer 77

≥ 100 mL/hour or ≥ 500 mL over 24-hours

Question 78

Besides the calf veins, what other areas of the venous system does proximal duplex ultrasonography have difficulty in visualizing when evaluating for DVT?

Answer 78

Iliac veins, or veins proximal to the common femoral vein, and the femoral vein within the adductor canal

Question 79

What is the treatment of choice for left ventricular aneurysms?

Answer 79

Afterload reduction, usually with an angiotensin converting enzyme inhibitor, and anticoagulation if there is evidence of significant left ventricular dysfunction or thrombus formation.

Question 80

What has been found to decrease the risk of developing fat embolism syndrome?

Answer 80

Early immobilization of fractures

Question 81

What is a major cause of hoarseness in patients with lung cancer?

Answer 81

Compression of the recurrent laryngeal nerve