Random leftovers

Question 1

This is a common cause of false positive VDRL in women or pregnancy age

Answer 1

Antiphospholipid antibody syndrome

-so positive VDRL needs to be confirmed with FTA-ABS

Question 2

Describe the pathophysiology and Bleeding lab findings in Antiphospholipid antibody syndrome causing spontaneous abortions

Answer 2

• Can promote arterial and venous thrombosis and resultant tendancy toward spontaneous abortions
• Thrombocytopenia and prolonged PTT are also common findings

Question 3

Positive VDRL, Negative FTA-ABS, thrombocyopenia, and prolonged PTT in pregnant women . . what should be started

Answer 3

Low molecular weight heparin and aspirin

Question 4

Cyclosporine and tacrolimus have the same mechanism of action which is what?

Answer 4

-Calcineurin inhibitors

Question 5

Toxicity of Cyclosporine

Answer 5

• Nephrotoxicity
• Hyperkalemia
• HTN
• GUM HYPERTROPHY
• HIRSUTISM
• tremor

Question 6

Toxicity of Tacrolimus

Answer 6

• Same as Cyclosporine WITHOUT gum hypertrophy and hirutism
• nephrotoxicity
• Hyperkalemia
• HTN

Question 7

This is a purine analog that is enzymatically converted to 6-mercaptopurine. it acts primarily by inhibiting purine synthesis

Answer 7

Azathioprine

Question 8

Major toxicities of Azathioprine

Answer 8

• Dose related diarrhea
• Leukopenia
• Hepatotoxicity

Question 9

This is a reversible inhibitor of Inosine monophosphate dehydrogenase (IMPDH) which is the rate limiting enzyme in de novo purine synthesis

Answer 9

Mycophenolate

Question 10

What is the major toxicity of mycophenolate

Answer 10

Bone MARROW suppression

-Think Marrow Mycophenolate

Question 11

Risk factors for HIV-associated neurocognitive disorders

Answer 11

• Long-standing HIV disease
• Age 50 or older
• CD4 count < 200

Question 12

HIV-associated neurocognitive disorder is characterized by a chronic decline in multiple cognitive domains (eg, memory, attention, calculation, executive function). Mood and behavior disturbances are common. The diagnosis is based primarily on clinical features and neuropsychological testing, but MRI may also be helpfus and shows what?

Answer 12

diffuse increase in the intensity in the white matter

Question 13

Progressive Multifocal leukoencephalopathy is caused by reactivation of the JC virus and has an increased incidence in patients with chronic HIV disease. symptoms include AMS, motor deficits, ataxia, and vision abnormalties. MRI shows what?

Answer 13

Focal, asymmetric (rather than diffuse) lesions

Question 14

“bath salts” are synthetic cathinones, which consist of a large family of amphetamine analogues. As such, they may increase the release, or inhibit the reuptake, or norepinephrine, dopamine, and serotonin. Symptoms of intoxication include what?

Answer 14

• Severe agitation
• Combativeness
• psychosis
• Delirium
• myoclonus
• rarely, seizures
• Increased sympathetic outflow may lead to significantly increased BP and HR

Question 15

What is the most distinguishing features of synthetic cathinone intoxication (bath salts)

Answer 15

• Prolonged duration of effect
• Delirium and psychosis due to bath salts may last up to a week whereas the effects of intoxication with other amphetamines or hallucinogens are usually of much shorter duration

Question 16

Do normal drug screens test for bath salts?

Answer 16

no

Question 17

Do normal drug screens test for PCP

Answer 17

yes

Question 18

distinguishing characteristic of PCP intoxication

Answer 18

multidirectional nystagmus

Question 19

symptoms of Opioid withdrawal

Answer 19

• dilated pupils
• piloerection
• dysphoria
• myalgia
• abdominal pain

Question 20

CVID is one of the most common primary immunodeficiences in adults. Most cases of CVID are due to SPORADIC mutation, and family history of the disease is typically absent the majority of patients are diagnosed in adulthood ( age 20-45) due to a combination of variable presentation and diagnostic delay. How is diagnosis made

Answer 20

Quantitative measurement of immunoglobulin levels (significantly reduced serum IgG with low levels of IgA and/or IgM) as well as by markedly reduced or absent immune response to vaccination

Question 21

Trastuzumab is a monoblonal antibody often used in combination with adjuvant chemo in patients with HER2-positive breast cancer. What is a known adverse effect of this medication?

Answer 21

• Cardiotoxicity that usually manifests as an asymptomatic decline in left ventricular ejection fraction; however, overt heart failure can occur
• The risk and extent of cardiotoxicity are amplified when trastuzumab is used in combination with chemotherapy agents that are also cardiotoxic (eg, doxorubicin)

Question 22

Prior to initiating Trastuzumab, patients should undergo what testing?

Answer 22

-Baseline assessment of cardiac function by echocardiography

Question 23

Inability to lift the skin on the dorsum of the second toe (positive stemmer sign) is highly specific for what?

Answer 23

lymphedema . . disruption of the lymphatic system

Question 24

Acute dystonia, which is a type of extrapyramidal symptoms can occur with antiemetics that are dopamine antagonists such as what?

Answer 24

• Metoclopramide
• Prochlorperazine
• Promethazine

Question 25

common adverse effects of beta-blockers

Answer 25

• Bradycardia
• AV block
• Bronchoconstriction (clinically significant in patients with asthma and COPD)
• male sexual dysfunction

Question 26

Aspirin and NSAIDs can cause allergic angioedema. It typically happens Immediately after exposure and it is accompanied by what?

Answer 26

itching and skin rash (urticaria)

Question 27

When after starting and ACEI can angioedema occur?

Answer 27

ANYTIME . . . not just within weeks of starting the medication