11/4/21 Early Bird

Question 1

Acute Decompensated Heart Failure Treatment

Answer 1

• • BPAP: ↑ oxygenation, ↓ work of breathing, ↓ preload, afterload
• • Nitroglycerin: ↓ preload, afterload
• • Furosemide: diuresis
• • Hypotension w/o shock: dobutamine (may worsen hypotension)
• • Severe hypotension w/ shock: norepinephrine (↑ systemic vascular resistance, ↑ HR, ↑ BP, ↑ myocardial O2 demand)

Question 2

Name 2 sulfonylureas

Answer 2

Glipizide

Glyburide

Question 3

_______ work to improve target-cell response to insulin and similarly to sulfonylureas stimulate the pancreas to secrete insulin, but they DO NOT have the similar risks of hypoglycemic events.

Answer 3

Glitazones

such as pioglitazone or glinides

DO NOT have the similar risks of hypoglycemic events.

Question 4

What rare complication can develop in patients on metformin who receive iodinated contrast?

Answer 4

Severe lactic acidosis.

Question 5

The only screening test that has shown some utility in changing management of patients with asymptomatic elevated blood pressure is ______________

Answer 5

a serum creatinine for renal dysfunction

Question 6

What encapsulated organisms become opportunistic in splenectomy patients?

Answer 6

Hemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis.

Question 7

What scoring system may help risk stratify patients with TIA?

Answer 7

ABCD2

Question 8

10% of TIA patients will have a stroke within what time frame?

Answer 8

90 days

Question 9

What lab marker helps to distinguish primary from secondary adrenal insufficiency?

Answer 9

An elevated ACTH level in a patient with adrenal insufficiency is consistent with primary adrenal insufficiency.

Question 10

What tidal volume should be used for patients intubated secondary to pneumonia?

Answer 10

6 mL/kg of ideal body weight

Question 11

Treatment for hypotension in patients with pulmonary hypertension should focus on the early initiation of what?

Answer 11

Vasopressor therapy

norepinephrine recommended

Question 12

The treatment for most cases subacute thyroiditis is ______________

Answer 12

nonsteroidal anti-inflammatory drugs (NSAIDs)

Question 13

How is the qSOFA score calculated?

Answer 13

Parameters include:

• altered mental status (GCS <15)
• respiratory rate ≥ 22/min
• SBP ≤ 100 mm Hg.
• score ≥ 2 indicates organ dysfunction and mortality risk approx. 10%

Question 14

Systemic inflammatory response syndrome (SIRS) criteria

Answer 14

needs 2 or more of the following:

1) temperature > 100.4°F or < 96.8°F
2) HR > 90 bpm
3) RR > 20/min or PaCO2 < 32 mm Hg
4) WBC > 12,000/μL, < 4,000/μL, or > 105 bands.

Question 15

Sepsis Definition

Answer 15

Suspected or proven infection with signs of systemic inflammation and an increase in Sequential Organ Failure Assessment (SOFA) score of 2 or more from baseline

Question 16

Septic shock criteria

Answer 16

presence of sepsis, vasopressors to maintain MAP > 65 mm Hg, and a lactic acid level > 2 mmol/L despite adequate IVF

Question 17

What concurrent electrolyte abnormalities are often seen with hypomagnesemia?

Answer 17

Hypocalcemia (from interference with parathyroid hormone) and hypokalemia.

Question 18

_____________ cysts are located laterally, anterior to the border of the sternocleidomastoid near the angle of the mandible

Answer 18

branchial cleft cyst

Treatment is surgical excision. Infected cysts should be treated with antibiotics prior to surgery.

Question 19

INR of ______ is a contraindication to TPA, but anticoagulation therapy alone is not in itself a contraindication

Answer 19

INR of > 1.7

Question 20

What is the youngest age someone may receive tPA for acute stroke?

Answer 20

18 years.

Question 21

Ischemic Stroke

Anterior cerebral artery sx

Answer 21

Anterior cerebral artery: frontal lobe dysfunction, apraxia, contralateral paralysis (lower > upper)

Question 22

Ischemic Stroke

Middle Cerebral

Answer 22

Middle cerebral artery: contralateral paralysis (upper > lower), aphasia