UW 11

Question 1

Metabolic acidosis in sepsis

Answer 1

High metabolic demand causes a shift to anaerobic metabolism, increasing lactid acid

Question 2

CHF with hx of viral infection

Answer 2

Myocarditis

Can also present with chest pain or arrythmias

Some people recover cardiac function. Others develope dilated cardiomayopathy
Dilated myocarditis
Alcoholism
Beri beri
Chagas
Coxackie
Cocaine
Doxirubicin
hEmochromatosis

Question 3

Patient with irregular rithym tachy and weight loss

Answer 3

Afib due to hyperthyroidsm

Question 4

Acute iron poisoning

Answer 4

Abdominal pain, hematemesis, diarrhea, melena
Shock,
liver necrosis (1-2 days after ingestion)
Stools may be green/black due to iron

pill visualization on xray
Elevated iron levels

Management
Deferoxamine
Whole bowel irrigation

Question 5

Indication of prophylaxis in Infective endorcarditis and management

Answer 5

Indications:
Prosthetic valve
Hx of previous IE
Valve defect in transplanted heart
Uncorrected cyanotic congenital heart disease
Corrected cyanotic congenital heart disease with residual dysfuntion

Prophylaxis:
Dental: S. viridians. Amoxicillin
GU/GI: enterococcus: ampicilin (if active infection)
Infected skin or muscle: S. aureus. Vanco
Placement of prosthetic cardiac material: S. aureus. Vanco

Question 6

Rituximab (MOA and use) (NOT SURE WHAT IS THE CORRECT ANSWER)

Answer 6

CD20 inhibitor (expressed on lymphocytes)

First line treatment in CLL??
Usually fludarabine and chlorambucil

Question 7

CLL sings and symptoms

Answer 7

Lymphadenopathy + hepatosplenomegaly
Constitutional symptoms

Cytopenias (anemia and trhombocytopenia)
Leukocytosis with lymphocytosis

Question 8

Treatment for CML

Answer 8

Imatinib

BCR-ABL tyrosine kinase inhibitor (the product of t(9,22) translocation. Philadelphia chromosome

Question 9

Smudge cells

Answer 9

Clasic finding of CLL

Fragile malignant lymphocytes are disrupted during blood smear preparation)

Question 10

Etiology of infections in sickle cell
Pneumonia
Osteomyelitys/septic arthritis
Meningitis
Bacteriemia/Sepsis

Answer 10

Pneumonia: S. pnumonia

Osteomyelitys/septic arthritis: S. aureus, Salmonella

Meningitis: S. pneumonia

Bacteriemia/Sepsis: S. pneumonia. H. influenzae

Empiric antibiotics:
3rd gen cephalosporin +/- vanco if osteomyelitis or meningitis

Question 11

Digoxin toxicity

Answer 11

Anorexia, nausea, vomiting, diarrhea
Confusion, lethargy, blurry vision

Atrial tachy + avblock

Question 12

Prolactinemia due to pituitary adenoma treatment

Answer 12

Bromocriptine

Question 13

Mid shaft humerus fracture

Structure compromised?

Answer 13

Radial nerve

Wrist drop and decreased sensation of dorsum of the hand

Question 14

Atrial septal defect ausculatotry findings

Answer 14

Wide fixed split of S2: Due to delay clossure of pulmonic valve

Mid sistolic ejection murmur: Due to increased flow through the pulmonic valve. (The low flow through the defect does not produce a murmur)

Mid diastolic rumble: due to increased flow through the tricuspid valve

Question 15

Pathologic finding in lewi body dementia

Answer 15

Eosinophilic incluision in the susbsantia nigra

Question 16

Renal disease in Multiple Myeloma

Answer 16

Direct tubular damage do to light chain deposition that clog renal tubules
Hematuria and no proteinuria (light chain is not detected on urianalysis)

Glomerular demage: Amyloidosis and Monoclonal Inmunoglobolin deposition disease.
Nephrotic sd.

Question 17

Psoriasis:

Extensor or Flexor?

Answer 17

Extensor

Question 18

Atopic dermatitis

Extensor o flexor?

Answer 18

Flexor (in adults)

Extensor in infants

Question 19

Labs in Hemolysis

LDH
WBC

Answer 19

Elevated

May also present with elevated WBC

Question 20

Delirium managment

Answer 20

If patient is agressive and hallucinating, administer haloperidol

Benzos are contraidicated because they can worsen delirum. Indicated only in delirum due to alcochol/benxo withdrawal

Question 21

Acutely psychotic patient managment

Answer 21

Haloperidol
Benzo
or Combination of both