Test 25,26,27 - Created July 23

Question 1

problem with hypertransfusion regimen

Answer 1

iron overload and organ damage; happens commonly in kids with bad anemia

Question 2

tx of urge incontinence

Answer 2

tolterodine, oxybutynin, solifenacin

Question 3

staff gets a needlestick injury, what to do if pt refuses HIV testing

Answer 3

start staff member on HIV prophylaxis

Question 4

signs of aspirin toxicity

Answer 4

tachycardia, tachypnea, hyperthermia, dizzy, N/V; also shows respiratory alkalosis and AG metabolic acidosis

Question 5

tx of aspirin toxicity

Answer 5

Na bicarb, glucose, activated charcoal (w/in 2h); dialysis if really bad

Question 6

what increases risks for pyloric stenosis

Answer 6

macrolides in first 2 wks of life, first born boy, formula feeding

Question 7

celiac disease presentation

Answer 7

large volume, foul smelling, excess gas, wt loss, microcytic anemia; increases osmotic gap

Question 8

celiac disease pathology

Answer 8

villous atrophy with increased extraepithelial lymphocytes; crypt hyperplasia

Question 9

tx of celiac disease

Answer 9

gluten free diet; replace nutritional deficiencies; DEXA scans; pneumococcal vaccine; dapsone for dermatitis herpetiformis

Question 10

risk associated with central venous access for TPN

Answer 10

Candida endophthlamitis, esp. if in ICU or has neutropenia

Question 11

Candida endophthlamitis presentation

Answer 11

fever, eye pain, decreased vision; fundoscopy shows focal, white, glistening, mound-like lesions that leads to vitreous haze

Question 12

tx of Candida endophthlamitis

Answer 12

vitrectomy and systemic Amp B (plus antifungal injected into eye)

Question 13

teen presents with hunchback. when is tx necessary?

Answer 13

back brace with chronic pain. surgery of angle of convexity is >60*

Question 14

when U/A and urine culture is needed to evaluate UTI in adult female

Answer 14

if possible pregnancy, pyelonephritis, or vaginal infection

Question 15

empiric tx of uncomplicated UTI in female

Answer 15

TMP-SMX x3 days or nitrofurantoin x5 days

Question 16

when to do colonoscopy in pt who is high risk for colon cancer

Answer 16

at age 40 or 10 yrs before age of dx in 1st degree relative (whichever comes first); repeat q3-5 yrs

Question 17

mgt of UTI in pregnant pt

Answer 17

cephalexin, amoxi-clav, fosfomycin, nitrofurantoin

Question 18

tx of pyelonephritis in pregnant pt

Answer 18

IVF and Abx until afebrile 48h; oral Abx 10-14d; daily suppressive Abx until 6w postpartum

Question 19

tx of bipolar patients with severe mania

Answer 19

lithium (or valproate) plus antipsychotic

Question 20

smoking cessation at an older age: benefits

Answer 20

mortality risk will drop below that of current smokers within next 5 years. decreased risk of cardiac events, osteoporosis (w/in 10 yrs), and decline in lung function.

Question 21

what to do with pt who has bilateral nipple d/c and negative PE, labs, and imaging

Answer 21

reassure and observe

Question 22

moa for organophosphate toxicity

Answer 22

inhibition of acetylcholinesterase

Question 23

tx of organophosphate toxicity

Answer 23

IVF, decontaminate, atropine (inhibit ACh) plus pralidoxime (reactivate enzyme)

Question 24

overall risk with antipsychotic use in dementia patients

Answer 24

increased mortality risk; short-term benefits may outweigh long-term risks; use as last resort and low dose

Question 25

organ systems that may get damaged by diphtheria

Answer 25

heart, kidneys, neuro

Question 26

tx of PCP intoxication

Answer 26

mild - low stim environment

bad - lorazepam

Question 27

presentation of PCP intoxication

Answer 27

tachycardia, HTN, ataxia, bizarre behavior, nystagmus, possible hallucinations

Question 28

presentation of coarctation of aorta (later in child’s life)

Answer 28

claudication, arm HTN, leg htn, weak/delayed distal pulses; possibly continuous murmur

Question 29

management of pressure (decubitus) ulcers

Answer 29

1. full-thickness wounds (III, IV) -> debride devitalized or necrotic tissues
2. shallow ulcers (I, II) -> use dressings to maintain moist, wound environment

Question 30

presentation of Vitamin D deficiency in pt with h/o gastric bypass surgery

Answer 30

LBP, low P, high alk phos, osteomalacia, 2* hyperPTH; need 2000-3000 IU/day

Question 31

presentation of appendicitis in pregnant woman

Answer 31

can look similar to pyelonephritis: fever and R sided abd. and flank pain; do abdominal U/S

Question 32

possible complication of untreated appendicitis

Answer 32

pylephlebitis (infected portal vein thrombosis)