Scotts Flashcards
Food allergy is present in ⅓ of children with:
a. Asthma b. Allergic Rhinitis c. Atopic Dermatitis d. Chronic Urticaria
C. Atopic Dermatitis.
From Adverse Food Reaction trans/Immuno exam 2 dignity: There is a 35% prevalence of children with adverse food reaction who also have atopic dermatitis. Extra info: Atopic March, sometime called Allergic March, refers to the natural history or typical progression of allergic diseases that often begin early in life. These include food allergy, atopic dermatitis (eczema), asthma, and allergic rhinitis (hay fever).
A 50 year old female complained of itchy generalized raised, erythematous well-circumscribed blanching lesions of four weeks duration. She is most likely suffering from
a. intermittent angioedema b. acute urticaria c. chronic angioedema d. persistent urticaria
B
Acute: recurrent episodes
A 45/F was seen at the dentist office for a tooth extraction. 15 minutes after administration of Lidocaine to the affected tooth and gum, the patient complained of itching around the neck and feeling lightheaded. She develops an itchy rash, facial and lip swelling and is immediately rushed to the ER. She is able to give her history but notices her voice is different. What is the initial pharmacologic intervention of choice?
a. Epinephrine IM b. Epinephrine IV c. Diphenhydramine IM d. Hydrocotisone IV e. Cetirizine PO
: A. Epinephrine IM
Trans on Adrenergic Agents in Allergy: Best route is through IV when the patient already has IV attached. If none available, IM is the best route since blood supply to the muscles are still high, while for the skin it’s variable. Since initial intervention ang tanong, and no mention of IV inserted, I think the best answer is A
In a patient who developed wheezing after being given several medicines for acute coronary syndrome, the initial step in assessing this patient is
a. Do serum IgE for all meds given
b. Do a skin test to all meds given
c. Do a drug chart of all meds given
d. Do rechallenge to all meds given
C. Make a drug chart.
From Scotts/trans on Adverse Drug Reactions: Part of the algorithm of the approach to ADR is making a drug chart, listing down all the drugs the patient has and is taking.
Which of the following is an organ specific autoimmune disease?
a. Dermatomyositis
b. Myasthenia gravis
c. Rheumatoid arthritis
d. Scleroderma
B. Myasthenia gravis
A lady with multiple sexual partners tested positive for HIV-1. If she becomes pregnant, the probability that her infant is going to test positive for HIV-1 using the antibody-based assay is:
a. 0%
b. 8%
c. 25%
d. close to 100%
D. Close to 100%.
From Scotts: Remember that the presence of antigen (meaning infection) is different from presence of anti-HIV Ab (which is the one tested for HIV screening). In screening for the newborn, there is almost 100% positive result for HIV because of maternal IgG against HIV that were able to pass through the placenta, not because of an actual infection in the newborn. If the question was the probability of the infant actually being infected, then it would be another matter. In the absence of prophylactic antiretroviral therapy to the mother during pregnancy, labor, and delivery, and to the fetus following birth, the probability of transmission of HIV from mother to infant/fetus ranges from 15 to 25% (Harrison’s, 18th ed- paragraph on HIV Maternal-fetal transmission)
This type of virus infection predisposes to Dengue Hemorrhagic Fever (DHF) rather than just Dengue Fever (DF)?
a. Homologous b. Heterologous c. Persistent d. Subclinical
B. Heterologous Dengue viruses (DENV) circulate as four serotypes with significant immunologic cross-reactivity that does not provide protection from secondary infection with heterologous serotypes. The strong association of severe dengue illness, dengue hemorrhagic fever (DHF), with heterologous secondary infection and high cytokine levels has led to a prevailing view that DHF is immunologically mediated
Chronic ingestion of non-steroidal anti-inflammatory medication can cause iron deficiency anemia by
a. interfering with iron transport
b. reducing amount of total iron binding capacity
c. inducing occult GI bleeding
d. preventing iron incorporation in the red cells
C.
Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can irritate the stomach lining and cause bleeding that produces anemia
Choice of blood for exchange transfusion in ABO incompatibility:
a. Type O Rh positive Fresh Whole Blood
b. Type-specific Rh positive Fresh Whole Blood
c. Type O Rh positive packed RBC
d. Type-specific Rh positive packed RBC
A. Type O Rh+ FWB
Choice of blood for exchange blood transfusion
The following screening tests are done in blood donors, EXCEPT
a. Hgb determination
b. Hepatitis A
c. Hepatitis B
d. Hepatitis C
B. Hepatitis A.
Hepatitis A is transmitted via Oral-Fecal route.
a 60 yo male presenting with fever, dysuria, hematuria, pallor, gum bleeding, and multiple ecchymoses was admitted with impression of urosepsis and DIC. An expected laboratory finding is:
a. normal platelet count
b. presence of fragmented red cells in the peripheral blood smear
c. elevated fibrinogen
d. low fibrin degradation products
B. (+) fragmented RBC in peripheral blood smear
This is thrombotic thrombocytopenic purpura (TTP).
● CBC usually reveals a normal or slightly elevated total white blood cell count.
● Hemoglobin is moderately depressed at 8-9 g/dL.
● Platelet count generally ranges from 20,000-50,000 per microliter.
● Review of peripheral smears reveals moderate-to-severe schistocytosis (fragmented RBCs–helmet cells.)
The primary problem in thrombotic thrombocytopenic purpura is:
a. neurologic deficits
b. circulating large multimers of von Willebrand Factors
c. immunemediated
d. platelet dysfunction
B.
Patients with TTP have unusually large multimers of von Willebrand factor (vWF) in their plasma
Which of the following categories of disease affecting the nervous system is most likely to have a gradual onset and focal localization?
a. Infectious
b. Neoplastic
c. Metabolic
d. Vascular
e. Degenerative
B. Neoplastic.
The best way to conduct history taking with patients complaining of dizziness
a. ask if the dizziness is vertiginous in nature
b. ask if they feel unsteady
c. ask if they are feeling uneasy
d. ask them what they mean by dizzy
D.
From Approach to a Dizzy Patient trans: Ask the patient to describe what he means by “dizzy”. You must ask the right questions to determine what is the cause of the patient’s dizziness. Don’t ask leading questions and put any words in the patient’s mouth as this may lead to mismanagement, e.g., “Does the room spin?”, “Do you feel unsteady?”, or “Are you feeling lightheaded?”
A patient is rushed to the emergency room for loss of consciousness. A bottle of silver jewelry cleaning solution was found beside him. On the way to the hospital he had a seizure. He was intubated upon admission and he remained stuporous. The cause for decreased sensorium is most likely due to:
a. decreased oxygen carrying capacity of the blood
b. reduction in the delivery of oxygen to the blood
c. hypovolemia leading to decreased cerebral perfusion
d. impaired utilization of oxygen by the tissues
D
Silver jewelry cleaning solution contains cyanide among others (thiourea, isopropanol, sulfuric and nitric acids and ammonia). Cyanide can be rapidly absorbed in the human body and blocks utilization of oxygen in all organs. Cyanide affects virtually all body tissues, attaching itself to ubiquitous metalloenzymes and rendering them inactive. Its principal toxicity results from inactivation of cytochrome oxidase (at cytochrome a3), thus uncoupling mitochondrial oxidative phosphorylation and inhibiting cellular respiration, even in the presence of adequate oxygen stores. Cellular metabolism shifts from aerobic to anaerobic, with the consequent production of lactic acid. Consequently, the tissues with the highest oxygen requirements (brain and heart) are the most profoundly affected by acute cyanide poisoning.
A 9 month old child consulted at the ER for fever of 5 days duration. At the ER she had generalized tonic clonic movements of the extremities. Lumbar puncture was performed which showed the following findings: opening pressure of 25 cm H2O, clear colorless CSF, RBC 10(?), WBC 4 all lymphocytes, sugar 3.2 mmol, protein 0.70 gms%. What is the likely diagnosis?
a. viral meningitis
b. bacterial meningitis
c. tuberculous meningitis
d. febrile seizure
A NORMAL CSF findings: ● color should be clear as water ● normal glucose (CSF:blood ratio) is >= 0.6 or 2.5 mmol/L ● normal protein:
Suspect stroke mimickers in the ff. situations EXCEPT:
a. 55 yo female, diabetic with isolated hemifacial weakness
b. 40 yo female with vertigo with changes in head position
c. 60 yo male with sudden onset of monocular blindness and left hemiparesis
d. 29 yo male with progressive headache, fever, and R hemiparesis
e. All are correct (no exceptions)
C
A female neonate who was born to a consanguineous couple presented on the 3rd day of life with poor suck, lethargy, and spastic lower extremities. The mother had unremarkable history and investigations for sepsis were negative. What is the best thing to do to further evaluate this baby?
a. get a detailed family history
b. get a cranial CT scan
c. get an EEG and lumbar tap
d. get electrolytes and blood gas
A. Get a detailed family history.
Which of the following patients has/have epilepsy
a. A 13 y.o. girl who has episodes of loss of consciousness in school after standing up for prolonged periods of time
b. A 6 m.o. baby who developed cyanosis and some flickering of the fingers during vaccination
c. A 7 y.o. boy with clonic movements associated with fever
d. A 9 y.o. boy with left facial twitching during sleep
e. AOTA
D
The following are aims of a clinical genetic evaluation:
a. Make accurate diagnosis and provide prognosis and natural history information
b. Discuss management and provide recurrence risks
c. Provide anticipatory guidance and education
d. All of the above
D
Which is a red flag for developmental problems?
a. No 2-word phrases by age of 2 years
b. No pointing by 6 months
c. No sitting alone by 4 months
d. Cannot read by age of 4 years
e. Temper tantrums at age 2 years
A
A 2-year old should be able to form 2-3 word sentences. All other choices are normal for the age.
A 17-year old male is brought to the hospital because he is talking even when alone. Observation of him shows that he seems to be answering someone and at some point arguing to that person. This symptom is:
a. Hallucination b. Depersonalization c. Delusion d. Psychosis e. Neurosis
A. Hallucination
Hallucinations are perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space.
A score of 0 in Axis V means
a. poorest level of functioning
b. most psychotic
c. unable to work and socialize
d. uncommunicative
e. inadequate information
E. Inadequate information.
The different axis levels were not discussed in class. But just so you know,
Axis I - clinical psychiatric disorders (ex. depression, schizophrenia)
Axis II - Personality disorders (ex. bipolar, conduct disorder, borderline) and Mental retardation
Axis III - General medical conditions (ex. Diabetes, Hypertension, Stroke)
Axis IV - Psychosocial and environmental problems (ex. Death of loved one, Divorce, Job-loss, Bankruptcy)
Axis V - Global assessment function (ex. scale of 1-100) 1 is low level of function and 100 being superior function. The scale is compiled by a physician.
In 2008, the most common Axis I diagnosis made by the PGH C-L psychiatrist
a. Delirium
b. Adjustment disorder
c. Anxiety disorder
d. Schizophrenia
B. Adjustment disorder.
