Test 51 - Created Aug 14

Question 1

anion gap equation

Answer 1

Na - (Cl + HCO3)

normal: 10-14

Question 2

what can recall bias lead to

Answer 2

misclassification of an exposure

Question 3

presentation of acute mitral valve regurg

Answer 3

acute heart failure, sweaty, cool limbs, pulmonary edema, sudden-onset htn, hyperdynamic precordium, decrescendo holosystolic murmur at apex

Question 4

causes of acute mitral regurg

Answer 4

ruptured mitral chordae tendineae from MVP (CT dz like Marfan, Ehlers-Danlos), infective endocarditis, rheumatic heart dz, trauma

papillary muscle rupture due to MI or trauma

Question 5

presentation and tx of vulvodynia

Answer 5

raw, burning vulvar pain 3/+ months, dyspareunia, constant irritation, (+) Q-tip test, pain w/ labial separation

tx = behavior modification, pelvic floor physical therapy, CBT

Question 6

next step when evaluating normo/normo anemia that has no clear cause

Answer 6

retic count

if elevated -> hemolysis
if low -> dz w/ decreased RBC production

Question 7

next step if pt is suspected to have hyperaldosteronism (Conn’s) (hypoK, HTN, polyuria, polydipsia)

Answer 7

get plasma aldosterone to plasma renin activity

Question 8

depression and cardiovascular disease fact

Answer 8

untreated depression is associated with increased morbidity and mortality from cardiovascular disease

Question 9

risk factors for abruptio placentae

Answer 9

HTN, PreE, abd. trauma, prior abruptio placentae, cocaine, tobacco

Question 10

presentation of abruptio placentae

Answer 10

sudden-onset vaginal bleed, abdominal or back pain, high freq/low intensity contractions, rigid/tender uterus

Question 11

special considerations for infantile hemangiomas based on: 5/+, facial/segmental, cervicofacial, lumbosacral

Answer 11

5/+ - do liver u/s
facial/segmental - echo and MRI head
cervicofacial (beard) - do laryngoscopy
lumbosacral - do spinal u/s

Question 12

presentation of vasovagal and situational syncope

Answer 12

warmth, pale, nausea, sweaty, rapid recovery of consciousness (<1-2 min)

Question 13

tx of vasovagal and situational syncope

Answer 13

reassurance, avoidance of triggers, physical counterpressure techniques

Question 14

serum sickness like syndrome presentation

Answer 14

fever, polyarthritis, rash (urticaria, maculopapular, petechial), fatigue, malaise

Question 15

extrahepatic manifestations of hepatitis B that are explained by circulating immune ocmplexes

Answer 15

polyarteritis nodosa, GN, serum sickness-like syndrome

Question 16

subclinical hyperthyroidism

Answer 16

suppressed TSH with normal thyroid hormone levels; sxs may not be present

Question 17

indications for tx of subclinical hyperthyroidism and what tx is

Answer 17

TSH persistently below 0.1

TSH 0.1-0.5 plus age >65, heart dz, osteoporosis, nodular thyroid disease

tx = antithyroid medication or radioactive iodine

Question 18

graves disease

Answer 18

increased uptake on RAIU scan, thyrotropin receptor Ab’s, low TSH, may have normal TH’s if subclinical, may not have sxs if subclinical

Question 19

McCune Albright syndrome

Answer 19

triad of irregular cafe-au-lait spots (Coast of Maine), fibrous dysplasia of bone, peripheral precocious puberty; suppressed LH and FSH

Question 20

when to investigate veteran for PTSD

Answer 20

new-onset insomnia, substance use, interpersonal conflicts

Question 21

what to do next if acute cholecystitis is suspected but ultrasound only shows gallstones but no GB wall thickening or sonographic Murphy sign

Answer 21

HIDA scan to confirm dx