Test 21 - Created July 17

Question 1

clinical presentation of constrictive pericarditis

Answer 1

fatigue, dyspnea on exertion, peripheral edema, ascites, incr. JVP, pericardial knock, pulsus paradoxus, Kussmaul’s sign; pericardial calcifications on CXR

Question 2

why constrictive pericarditis may occur

Answer 2

viral, CABG, radiation, TB

Question 3

attributable risk percent

Answer 3

(risk in exposed - risk in unexposed)/risk in exposed

Question 4

population attributable risk percent

Answer 4

(risk in total pop - risk in unexposed)/risk in total pop

Question 5

how you get Vibrio vulnificus

Answer 5

eating oysters or wound contamination during raw fish handling

Question 6

presentation of Vibrio vulnificus

Answer 6

1. progresses < 12h
2. sepsis - shock, bullous lesions
3. cellulitis - hemorrhagic bullae, nec fasc

Question 7

dx and tx of Vibrio vulnificus

Answer 7

dx: Cx, leukocytosis with left shift, renal insuff.
tx: IV ceftriaxone and doxycycline; TREAT NOW

Question 8

presentation of Mycobacterium marinum

Answer 8

papular and ulcerative lesions that develop over days after contact with salt/fresh water and wound infection

Question 9

what to do if under-anticoagulated and thrombotic disease worsens

Answer 9

give IV heparin or subQ LMWH; do CT if pt has PE-like sxs

Question 10

difference btwn TH resistance syndrome and TSH-secreting pituitary adenoma

Answer 10

both: elev TSH, T4, T3, goiter
res: normal levels of alpha subunit and sex HBG; suppressible by levothyroxine

Question 11

what to do if patient invites you to significant life event

Answer 11

use professional judgment and cultural sensitivity

Question 12

reversible causes of asystole/PEA: 5Hs

Answer 12

Hypovolemia, Hypoxia, Hydrogen iosn, Hypo/hyperkalemia, Hypothermia

Question 13

reversible causes of asystole/PEA: 5Ts

Answer 13

Tension Ptx, Tamponade, Toxins, Thrombosis, Trauma

Question 14

when to test for Lyme disease

Answer 14

when patients present with early disseminated and late Lyme disease; no need to test of early localized (rash, flu-like sxs)

Question 15

testing for Lyme disease

Answer 15

ELISA followed by Western blot

Question 16

tx for Lyme disease

Answer 16

oral doxy; IV ceftriaxone if severe

Question 17

things that increase risk of C.diff diarrhea

Answer 17

1. PPIs
2. recent ABx (FQN, clinda, PCNs, cephalosporins)
3. hospitalization
4. advanced age (more likely to have 1 of 3 above)

Question 18

why anemia occurs in patients with end-stage renal disease

Answer 18

decreased renal EPO but also can be from iron def., severe hyperPTH, folate def., systemic infl., and aluminum toxicity

Question 19

when to give end-stage renal disease patient an EPO-stimulating agent

Answer 19

Hgb < 10; give IV iron if transferrin sat < 30% and ferritin < 500

Question 20

2 labs to monitor active renal dx in patients with SLE

Answer 20

anti-dsDNA and complement

Question 21

mgt of Bell’s palsy

Answer 21

NO imaging; prescribe corticosteroids and artificial tears; workup for Lyme or sarcoidosis if bilateral

Question 22

tx of CAH

Answer 22

hydrocortisone, fludrocortisone, salt, surgery for girls, psychosocial support

Question 23

high-intensity statin

Answer 23

atorva 40-80

rosuva 20-40

Question 24

medicine to treat severe hypertriglyceridemia

Answer 24

fibrates (gemfibrozil)

Question 25

presentation of polymyositis

Answer 25

progressive, painless proximal muscle weakness (problems with stairs, exiting chair/car, lifting arms above head); labs show elevated CK, LFTs, CRP

Question 26

elevated antibodies in polymyositis

Answer 26

ANA and anti-Jo-1

Question 27

important thing to check in patient with polymyositis

Answer 27

PFT’s (or a CT) for interstitial lung disease development

Question 28

clinical features of mitral stenosis

Answer 28

SOB, orthopnea, PND, hemoptysis, Afib. thromboembolus, hoarse voice

Question 29

PE features of mitral stenosis

Answer 29

loud S1, opening snap, mid-diastolic rumble at cardiac apex

Question 30

MCC of mitral stenosis

Answer 30

rheumatic heart disease

Question 31

Noonan syndrome

Answer 31

short, facial dysmorphisms, heart issues (PS, ASD, HCMP)