Test 53 - Created Aug 14

Question 1

what to suspect in pt with h/o IVDU, fever, petechiae, holosystolic murmur at apex; what to suspect with all of that plus HA, lethargy, and neck stiffness

Answer 1

1. infective endocarditis

2. subarachnoid hemorrhage secondary to rupture of a mycotic aneurysm

Question 2

hypocalcemia presentation in pt undergoing major surgery and had multiple transfusions

Answer 2

hyperactive DTRs

Question 3

hypermagnesemia presentation

Answer 3

decreased DTRs, muscle paralysis

Question 4

tx of focal dystonia such as blepharospasm

Answer 4

botox injections

Question 5

something to keep in mind with metformin and upcoming iodine contrast exposure procedure

Answer 5

can increase risk for lactic acidosis; stop metformin day of procedure and restart 48 hrs after

Question 6

1st line tx of benign paroxysmal positional vertigo

Answer 6

canalith repositioning procedure

Question 7

what to do with patient who is very ill and spouse has advance directive with them

Answer 7

assess patient’s decision making capacity and then ask for their preferences. DNR/DNI forms usually discuss terminal conditions and are used in absence of family or decision-making capacity.

Question 8

presentation of HOCM

Answer 8

fatigue, exertional dyspnea, systolic murmur that increases with Valsalva, asymmetric septal hypertrophy, systolic anterior motion of mitral leaflets, and increased LV outflow tract gradient

Question 9

1st line med for HOCM

Answer 9

BBs

may add on verapamil or disopyramide with persistent sxs; if meds fail, do alcohol septal ablation

Question 10

mgt of flail chest

Answer 10

oxygen, pain control, PPV, and surgery

Question 11

single-item predictors that correlate with severity of acute pancreatitis

Answer 11

older age, obesity, CRP, Hct >44% on admission, BUN 20/+ on admission

Question 12

important things about terminating physician-patient relationships

Answer 12

physician must give reasonable notice about termination OR have alternate care arrangements already prearranged

Question 13

presentation of West Nile virus

Answer 13

summer and early fall

meningitis sxs - fever, HA, photophobia, nuchal rigidity

encephalitis sxs - confusion and hyperreflexia

Question 14

tx of HELLP syndrome

Answer 14

magnesium for seizure prophylaxis, BP med if over 160/110, deliver baby if mom still pregnant

(can occur postpartum)

Question 15

important thing to consider in teen ager with scoliosis

Answer 15

besides Cobb angle, consider how much growth potential the child has left; Tanner Stage 5 kids likely has reached skeletal maturity

Question 16

tx of postpartum preeclampsia

Answer 16

magnesium for seizure prophylaxis, BP med if over 160/110, fluid restriction, oxygen support, diuretics for pulmonary edema

Question 17

if pregnant mom needs the Tdap vaccine, when should you give it?

Answer 17

28/+ wks GA