Test 46 - Created Aug 11

Question 1

tx of papular urticaria

Answer 1

second gen H1 blockers and topical corticosteroids

Question 2

next step when unexplained new-onset heart failure occurs

Answer 2

do stress test or coronary angiography to evaluate for CAD

Question 3

standard composition for enteral feeds

Answer 3

30 kcal/kg/day and 1 g/kg/day of protein

Question 4

tx of Asx bacteriuria in pregnant pt (even if culture was done at prenatal visit and this is a later visit)

Answer 4

Abx now: cephalexin, amoxi-clav, or fosfomycin

Question 5

why might a patient still have cost-sharing expenses above their deductible?

Answer 5

They have not met their plan’s annual out-of-pocket maximum (includes deductible, copays, coinsurance)

Question 6

cause of marked increase in Cr after ACE-i is started in kidney transplant pt

Answer 6

renal artery stenosis (leads to stimulation of renin-angiotensin-aldosterone system)

Question 7

presentation of ant. uveitis (iritis)

Answer 7

pain, red, variable visual loss, constricted and irregular pupil; leukocytes in ant. segment

Question 8

presentation of infectious keratitis

Answer 8

severe photophobia and difficulty in keeping bad eye open; penlight shows corneal opacity or infiltrate

Question 9

what to do if pt had mono, gets better, but LAP persists on one side or exists somewhere besides posterior cervical nodes

Answer 9

send pt to get LN biopsy; might be lymphoma

Question 10

which patients with asymptomatic bacteriuria need treatment

Answer 10

pregnant, undergoing urologic procedures, or within 3 months of renal transplantation

Question 11

reversal of warfarin therapy

Answer 11

prothrombin complex concentrate 1st, then IV vit. K; fresh frozen plasma only if PCC unavailable

Question 12

acute mgt of hypertriglyceridemia induced pancreatitis (other than the normal stuff)

Answer 12

insulin or apheresis now

long-term: fibrates

Question 13

how much of a washout period is needed between SSRI’s and MAOI’s

Answer 13

most - 14 days

fluoxetine - 5 weeks

Question 14

presentation of serotonin syndrome

Answer 14

fever, sweaty, agitated, tachycardia, autonomic instability, HTN, D, hyperactive BS, hyperreflexia, clonus, tremor, mydriasis

Question 15

mgt of serotonin syndrome

Answer 15

discontinue all serotonergic meds; supportive care and sedate w/ benzo

Question 16

presentation of diffuse esophageal spasm

Answer 16

CP and dysphagia to solids and liquids

Question 17

what testing shows for diffuse esophageal spasm

Answer 17

disordered and premature simultaneous contractions of distal esophagus with normal distal esophageal sphincter relaxation

Question 18

tx of diffuse esophageal spasm

Answer 18

CCB

Question 19

TB presentation in patients with low CD4 counts

Answer 19

lobar, pleural, or disseminated siease

Question 20

fluid characteristics of a TB pleural effusion

Answer 20

lymphocytic and exudative with an elevated ADA level

Question 21

what is needed to confirm dx of TB pleural effusion

Answer 21

pleural biopsy (smear is often negative)

Question 22

mgt of DKA: IVF

Answer 22

NS; add dextrose when G <200

Question 23

mgt of DKA: insulin

Answer 23

start IV insulin (unless K low); switch to SQ when able to eat, G <200, AG <12, and serum bicarb >15; overlap SQ and IV by 1-2 hrs

Question 24

effect modification

Answer 24

when magnitude of effect of independent variable (intervention) on dependent variable (outcome) varies depending on level of a third variable (effect modifier); need to do stratified analyses for each level of the effect modifier

Question 25

confounding bias

Answer 25

when extraneous variable associated with both exposure and outcome obscures the associate between exposure and outcome; stratification does not change direction of effect

Question 26

tx of acute gout

Answer 26

NSAIDs or colchicine or steroids, depending on pt

Question 27

acute stress disorder versus PTSD

Answer 27

ASD: sxs 3d-1mo
PTSD: sxs 1 mo. +

Question 28

complications of bicuspid aortic valve

Answer 28

infective endocarditis, severe regurg or stenosis, aortic dialtion -> aneurysm or dissection

Question 29

amount of levothyroxine tx after tx of papillary and follicular thyroid cancer

Answer 29

small/low risk: TSH 0.1-0.5 for 6-12 mo., then low/N range
intermediate risk: TSH 0.1-0.5
large/aggressive: TSH <0.1

Question 30

way to help manage persistent negative symptoms in schizophrenia patients

Answer 30

social skills training