Mix11

Question 1

Varicella post exposure prophylaxis in nonimmunized kid:

Answer 1

Vaccine only (if immunocompetent). Give within 5 days of exposure. Varicella Ig if immunocompromised.

Question 2

Why are ACEi effective in treating microalbuminuria in DM patients with otherwise good glycemic control?

Answer 2

ACEi reduces urinary albumin excretion and the decline in creatinine clearance. Effect is due to reduction in BP as well as direct effect on decreasing intraglomerular pressure. Slows progression of renal damage.

VERY HIGH YIELD.

Question 3

What do you do if patient on new antipsychotic develops akathisia?

Answer 3

Antipsych dose reduction and start propanolol, anticholinergic (benztropine), or benzo.

Akathisia = subjective sense of inner restlessness

Question 4

Atrophy of the caudate is assoc with ____ Dz

Answer 4

Huntingtons

Question 5

What brain structural changes would you find on imaging for schizophrenic patient?

Answer 5

Enlargement of lateral cerebral ventricles. May also see decreased volume of the hippocampus and amygdala

Question 6

Patient recently had dose of risperidone increased and subsequently developed automatisms of foot tapping, tongue protrusion, and lip smacking. What’s the next best step?

Answer 6

Switch from risperidone to clozapine/quetiapine. Clozapine is antipsych med least likely to cause EPS.

This is tardive dyskinesia due to prolonged dopamine receptor blocking drugs.

Question 7

Tardive dyskinesia vs tardive dystonia:

Answer 7

Tardive dyskinesia = involuntary hyperkinetic movement, should switch from antipsych to clozapine. Can also use valbenazine (reversible inhibitor of VMAT2.

Tardive dystonia = occurs shortly after admin of antipsych. Muscle spasm/stiffness, torticollis, opisthotonus, and oculogyric crisis. Anticholinergic meds (benztropine and diphenhydramine [has antichol prop] can help)

Question 8

What is Acamprosate used for?

Answer 8

First line med for alcohol use disorder.

Question 9

MOA of cabergoline?

Answer 9

Dopamine agonist (like bromocriptine)

Question 10

Rx for septic arthritis in a child:

Answer 10

If kid < 3 mo: MCC is Staph, GBS, and G (-) bacilli. Treat with antistaph agent (nafcillin or vanc) + Gent + CTX

If kid > 3mo: MCC is Staph, Group A strep, and S pneumo. Treat with nafcillin + clinda + cefazolin OR vanc

Question 11

Inheritance pattern of myotonic dystrophy:

Answer 11

AD, CTG repeat expansion, Chr 19

Question 12

Rx for babesiosis:

Answer 12

atovaquone + azithro

quinine + clinda (if severe)

Question 13

Rx for RMSF

Answer 13

Doxy or chloramphenicol (for pregnant women)

Question 14

Arrhythmia assoc with digitalis:

Answer 14

atrial tachy with AV block. ** Digitalis can create ectopy in the atria or ventricles&raquo_space; atrial tachy

Question 15

Neuroblastomas are common cancers in kids. They can occur anywhere in the sympathetic nervous system but they are commonly involving the ___

Answer 15

Adrenal glands. Presents as abdominal mass that crosses the midline with systemic symptoms.

Question 16

Best diagnostic test for suspected spinal epidural abscess:

Answer 16

MRI of the spine. Would also see ^ ESR, and should get blood & aspirate cultures.

Question 17

MOA behind obstructive sleep apnea:

Answer 17

Intermittent airway collapse due to relaxation of pharyngeal muscles&raquo_space; airway closure. Can present with loud snoring and periods of apnea.&raquo_space; systemic HTN, pulmonary HTN, and RHF