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Question 1

The only 2 diseases associated with MH?

Answer 1

Central core disease
King-Denborough syndrome (congenital myopathy).

Duchennes and other dystrophies are controversial

Question 2

The bone cement causes …. rxn

Answer 2

Exothermic rxn

Question 3

Maximum dose of daily Tylenol in adults … and children ….

The toxic dose after single acute ingestion is …

Answer 3

4 g/day in adults

90 mg/kg in children

Toxic dose is 150 mg/ kg ~ 7g in adults

Question 4

MoA of Sildenafil ? What medication class or it’s MoA to avoid in patient taking Sildenafil?

Answer 4

Sildenafil is a phosphodiesterase inhibitor effective in the treatment of erectile dysfunction the mechanism of action of which is related to an increase in intracellular cyclic guanosine monophosphate (GMP). Nitrates increase cyclic GMP via the activation of guanylyl cyclase. When the two drugs interact, there can be a dramatic fall in blood pressure related to extreme vasodilation. The other selections can reduce blood pressure; however, since their mechanisms of action are not associated with the intracellular concentration of cyclic GMP, there is no synergistic interaction with silde- nafil.

Question 5

To evaluate mixed ACID base problem, it’s evaluated by ..

Answer 5

Change in anion gab (AG) in relation to the change of HCO3

Delta AG/ delta HCO3

(Normal AG is 12 - AG in patient) / (normal HCO3 - HCO3 of patient)

If result is > 1.2 or < 0.8 suggest mixed disorder

Question 6

The rate of HBV to susceptible HCW ranges from … after a single needle stick of HBV-positive patient.

And for HIV is …

Answer 6

6-30%

0.3%

Question 7

Why you should avoid thiazides in patient taking Quinidine

Answer 7

Quinidine can prolong the Q-T interval resulting in the development of polymorphic ventricular tachycardia (torsade de pointes). Hypokalemia, a side effect of thiazide diuretics, increases the risk of torsade de pointes, which can then degenerate into fatal ventricular fib- rillation.

Question 8

Can bicarbonate treat hyperkalemia

Answer 8

Alkalosis may cause hypokalemia and symptoms of hypocalcemia due to cellular shift—and acido- sis may cause hyperkalemia by the same mechanism. Thus bicarbonate helps to treat severe hyperkalemia

Question 9

3 conditions cause MG-like clinical picture

Answer 9

Eaton-Lambert; eyes are spared and repetitive improves it

Organophosphate poisoning; sx of PSNS and worsening with endophonium test (ttx atropine and pralidoxime).

Aminoglycosides; prolonging muscular blockade after anesthesia

Question 10

Supplements use and side effects

Answer 10

Ginkgo biloba -> Memory enhancement (Increased bleeding risk)

Ginseng -> Improved mental performance
(Increased bleeding risk)

Saw palmetto -> Benign prostatic hyperplasia
(Mild stomach discomfort, Increased bleeding risk)

Black cohosh -> Postmenopausal symptoms (Hepatic injury)

St John’s wort -> Depression, Insomnia
(Drug interactions: Antidepressants (serotonin syndrome), OCs, anticoagulants (↓ INR), digoxin) and also causes Hypertensive crisis

Kava -> Anxiety, Insomnia
(Severe liver damage)

Licorice -> Stomach ulcers, Bronchitis/viral infections
(Hypertension, Hypokalemia)

Echinacea -> Treatment & prevention of cold & flu
(Anaphylaxis (more likely in asthmatics))

Ephedra-> Treatment of cold & flu
Weight loss & improved athletic performance
(Hypertension, Arrhythmia/MI/sudden death, Stroke, Seizure).