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Question 1

Idiopathic thrombocytopenic purpura mechanism

Answer 1

IgG antibodies are formed against the patient’s platelets, and the platlet-antibody complex is destroyed by the spleen.
bone marrow production of platelets is increased–> increased megakaryocytes within the marrow

Question 2

DIC mechanism

Answer 2

deposition of fibrin in small blood vessels leads to thrombosis and end-organ damage, as well as depletion of clotting factors and platelets leading to bleeding

Question 3

Thrombotic thrombocytopenic purpura mechanism

Answer 3

deficiency of ADAMTS-13 ( vWF-cleaving enzyme) –> abnormally large vWF multimers that create platelet microthrombi
RBCs are fragmented my contact with the microthrombi

Question 4

MC valvular disease

Answer 4

mitral valve prolapse

Question 5

medial management in patients with HIT

Answer 5

stop heparin

give agatroban

Question 6

signs of intravascular hemolysis

Answer 6

High LDH, bilirubin and reticulocytes count with a normal MCV, low haptoglobin and hemoglobinuria

Question 7

Heinz body

Answer 7

formed by damage to the hemoglobin (usually from oxidative stress) when spleen macrophages try to take this part out they form bite cells

Question 8

Benign familial hypocalciuric hypercalcemia labs

Answer 8

high serum calcium, high serum PTH, and low urinary calcium

Question 9

Tx for peripheral arterial disease

Answer 9

ASA, cilostazol ( vasodilator that heps with vascualr claudication ) and thromboxane inhibitors

Question 10

onychomycosis tx

Answer 10

fungal infection of the nail, hard to treat with topical agents, give oral terbinafine or itraconazole

Question 11

pain relived with meals

Answer 11

duodenal ulcer

Question 12

cryptococcal meningitis tx

Answer 12

Amphotericin B plus flucytosine

Question 13

Adjusting calcium for albumin

Answer 13

The only important Ca is the free(unbound to albumin calcium). The calcium reported is the total calcium.

For every 1 gram/L less of albumin (normal is 4 g/L) the read out of total calcium will decrease by 0.8 mg/dl

Question 14

MC cause of otitis externa and TX

Answer 14

Pseudomonas aeruginosa

Tx: aminoglycoside ( gentamicin, tobramycin, streptomycin) and a topical antibiotic

Question 15

glucogonoma symptoms

Answer 15

glucose intollerance, necrolytic migratory erythema,

Question 16

Dobutamine

Answer 16

acts as a positive inotrope
deceases preload, and shifts fluid from the lungs to the vascular

give to patients experiencing pulmonary edema secondary to Left ventricular dysfunction
(dobutamine is used instead of dopamine because it decreases afterload, dopamine actually has a presser effect and increases afterload)

If patient experiences severe hypotension after dobutamine then dopamine can be used

If pt does not respond to dobutamine, but has okay blood pressure, then used hydralazine (also reduces afterload)

Question 17

Drugs of choice for SVT

Answer 17

Adenosine and verapamil

Question 18

TX for a COPD exacerbation

Answer 18

1) oxygen
2) antibiotics to cover H. influenzae, and Strep pneumonia
3) SYSTEMIC steroids
4) Albuterol (unless patient is already tachycardic) and ipratropium

Question 19

theophylline

Answer 19

bronchodilates via inhibition of PDE

Question 20

Polyarteritis nodosa Sxs

Answer 20

arthralgia, rash, abdominal pain, CNS symptoms, and mononeuritis multiplex. Renal disease results from vascular nephropathy.

(associated with Hep B in 50% of cases)

Question 21

Polymyalgia rheumatica sxs

Answer 21

morning stiffness, bilateral shoulder-girdle aching, and elevated ESR

Question 22

Wegner granulomatosis

Answer 22

upper and lower respiratory tract symptoms and urinary casts caused by a necrotizing granuloma of the sins=uses, lungs and kidneys. c-ANCA is highly specific

Question 23

small-cell lung cancer tx

Answer 23

small cell lung cancer is rapidly growing and so is treated with chemo.

non small cell is usually treated with surgial resection and then either radiotherapy or chemotherapy