Test 25 - IM

Question 1

What is the difference between pneumocystis pneumonia and pneumococcus pneumonia in an HIV patient?

Answer 1

Pneumocystis is a fungus and px with dry cough and dyspnea.

Pneumococcus is a bacteria and px with acute onset high grade fever and pleural effusion

Question 2

What type of bacteria are HIV patients more susceptible to?

Answer 2

Encapsulated because of their weakened humoral immunity

Question 3

What are the encapsulated bacteria?

Answer 3

"Even some pretty nasty killers have shiny bodies"
E. coli
Salmonella
Pseudomonas
Nisseria meningitidus
Klebsiella 
Haemophilus influenza
Streptococcus pneumoniae
Bacteriodes fragilis

Question 4

What are the symptoms of carcinoid syndrome?

Answer 4

1. EPISODIC FLUSHING (with pounding sensation)
2. Chronic diarrhea - secretory in nature
3. plaque like deposits on tricuspid cause TRICUSPID REGURG
4. Cutaneous telangectasia
5. bronchospasm

Question 5

What is carcinoid syndrome?

Answer 5

Neuroendocrine tumors usually in the distal SI or proximal colon or lung. They like to met to the liver.
They like to secrete anything and everything. (histamine, seratonin, VIP are most popular). When tumor is just in GI, hormones are metabolized in liver, but when liver mets are present, hormones are secreted directly into the systemic blood causing carcinoid SYNDROME.

Question 6

How do you diagnose carcinoid syndrome?

Answer 6

Elevated 24-h urineary 5-hydroxyindoleacetic acid

Question 7

Treatment of carcinoid syndrome?

Answer 7

Octreotide - symptomatic patients/ prior to surgery

Surgery for liver METS

Question 8

What is octreotide?

Answer 8

is an octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone.

Question 9

Why is FISH important in breast cancer?

Answer 9

Fluorescence In Situ Hybridization (FISH) is used to detect the level of expression of oncogenes, in this case HER2.

Question 10

What is HER2? Why is it important?

Answer 10

Breast cancer oncogene, present in about 20% of primary tumors. If HER2 overexpression is present you can treat with trastuzumab. HER2+ patients also have more favorable response to anthracyclines.

Question 11

What is trastuzumab?

Answer 11

Ab that targets cells expressing HER2

Question 12

What are the screening tests and diagnostic test for syphilis?

Answer 12

Screening: VDRL or FTA-ABS’
Diagnostic: Direct visualization via darkfield microscopy

Question 13

Difference between cancer and fungus ball on CXR?

Answer 13

Fungus ball: smaller with air cresent

Cancer: more well defined, often larger

Question 14

What do we watch for in patients with hx of Hodgkin’s Lymphoma in childhood?

Answer 14

Secondary cancers: 18X more likely than regular population to get cancer.

Question 15

Examples of methyxanthines? What are they used for?

Answer 15

1. aminophylline, theophylline

2. cause bronchodilation by blocking phophodiesterase and increasing cAMP.

Question 16

COPD patient comes into the ER with an acute exascerbaton (AECOPD). What is 1st line trt? 2nd line trt?

Answer 16

1. Inhaled short-acting b-agonists, abx, glucocorticoids
2. Non-Invasive Positive Pressure Ventilation (NPPV) - ventilator support by face mask
3. Intubation