Test 49 - Created Aug 13

Question 1

presentation of ABPA

Answer 1

recurrent asthma exacerbations, fever, lethargy, cough with brown mucus plugs, occasional hemoptysis, fleeting infiltrates on lung imaging; elevated IgE and eosinophilia

Question 2

presentation of glucagonoma

Answer 2

rash (red, itchy, painful, scaly, clears up in center 1st), lethargy, wt loss, D, abd. cramps, facial flushing, maybe recent DM dx

Question 3

how to confirm positive result on 1st trimester combined test with NT, b-hCG, and PAPP-A

Answer 3

chorionic villus sampling at 10-13 wks GA or amniocentesis after 15 wks GA

Question 4

length-time vs. lead-time bias

Answer 4

length-time - survival benefits of a screening test are overstated due to detection of disproportionate number of slowly progressive, benign cases

lead-time - test diagnoses a disease earlier which makes time from diagnosis until death appear prolonged even though survival doesn’t change

Question 5

an insulinoma and use of a hypoglycemic med can both have elevated insulin, C-peptide, and proinsulin. how to distinguish btwn the 2?

Answer 5

oral hypoglycemic agent screen
(+): found the source
(-): do CT next to look for a tumor

Question 6

transition from insulin drip in patient with hyperglycemic hyperosmolar nonketotic state

Answer 6

insulin drip -> blood G near 200 -> subcut. insulin sliding scale -> basal/bolus

Question 7

mgt of Asx GBS bacteriuria in pregnant woman

Answer 7

immediate tx w/ amoxi or cephalexin, repeat urine Cx in 1 wk, and Abx again during labor

Question 8

mgt of adhesive capsulitis aka frozen shoulder

Answer 8

rest, gentle ROM exercises

big limit in fn or no improvement with exercises, do steroid injection

Question 9

mgt of pt with ischemic stroke and BP 220/120 (for example)

Answer 9

lower BP to <185/110 with nicardipine -> alteplase -> maintain BP under 185/105 for 24h

if pt can’t get alteplase, slowly lower extreme HTN (>220/120) by 15% in first 24h

Question 10

criteria for DM diagnosis

Answer 10

1. HgbA1c 6.5% or higher
2. Fasting bG 126/+
3. random G 200/+ with sxs
4. oral GTT 200/+

Question 11

confidence interval in an study is changed from 99% to 95%. What does that do to the width of the C.I.? a-value?

Answer 11

decrease width, makes C.I. narrower

p-value gets larger (0.01 -> 0.05)

Question 12

tx of metoclopramide-induced acute dystonia

Answer 12

diphenhydramine or benztropine

Question 13

lung cancer screening

Answer 13

low dose CT, annually, ages 50-80, 20/+ pack yr hx and current smoker or quit w/in past 15 yrs

Question 14

presentation of viral conjunctivitis

Answer 14

red eye/s, watery/mucoid d/c, may have viral prodrome; “sandy” or “burning” sensation in 1 or both eyes

Question 15

comparing allergic conj., bacterial conj., and corneal abrasion and keratitis (corneal inf.) to viral conj.

Answer 15

1. allergic - itchy; no burning
2. bacterial - no viral sxs; more profuse, purulent d/c
3. /4. corneal abrasion or keratitis - intense eye pain, photophobia, foreign body sensation

Question 16

next best step in pt with regular, narrow complex tachycardia and stable

Answer 16

vagal maneuvers (carotid sinus massage, for ex) and/or IV adenosine

Question 17

presentation points to Cushing’s. what imaging is needed based on high dose dexamethasone suppression test and ACTH levels to find etiology?

Answer 17

ACTH low and NOT suppressed: look at adrenals

ACTH high with later suppression: look at pituitary

ACTH high and NOT suppressed: look at chest and abd.