General IM/CTU

Question 1

What is the dose for epinephrine for anaphylaxis (IM)?

Answer 1

0.3-0.5 mg for a 1 mg/mL formulation. Repeat q5-15 min as needed

Question 2

What is the pattern of homocysteine and MMA in folate and B12 deficiency?

Answer 2

Homocysteine elevated in both

MMA only elevated in B12 deficiency

Question 3

What is the initial treatment and doses of a 60M who presents with meningitis of unknown etiology (microbiology wise)?

Answer 3

Dexamethasone 10 mg IV q6h (0.15 mg/kg per dose q6h) for 2-4 days (first or WITH first dose of antibiotics)

Ceftriaxone 2g IV q12 h (give first)
Vancomycin 750 mg in q6h (load and maintenance according to kg)
Ampicillin 2g Iv q4h
Acyclovir 10 mg/kg IV q8h

Question 4

What three beta blockers are used in chf?

Answer 4

Bisoprolol, carvedilol, long acting metoprolol

Question 5

What is a paradoxically split S2 and which conditions is it seen in?

Answer 5

S2 is split in expiration (P2 then A2 closes second) and no split in inspiration.

Seen in conditions that prolong LV emptying like severe aortic stenosis and LBBB and HOCM

Question 6

What time from last drink can someone experience alcohol withdrawal seizures?

Answer 6

6-48 hours

Question 7

What time from last drink can alcohol hallucinosis develop?

Answer 7

12-24 hours

Question 8

What time since the last drink can alcohol withdrawal delirium develop?

Answer 8

72-96 hours

Question 9

GABA is an excitatory or inhibitory neurotransmitter?

Answer 9

Inhibitory

Question 10

SPICE HAM organisms are which?

Answer 10

Serratia
Providencia
Indolent + proteus
Citrobacter
Enterobacter
Hafnia
Acinetobacter
Morganella

Question 11

What antibiotics should be used for SPICE HAM organisms?

Answer 11

Carbapenums
Septra
Fluroquinolones
Aminoglycosides (if sensitive)

Question 12

ESBL E.coli or Klebsiella should be treated with what antibiotics?

Answer 12

Carbapenums
Septra
Fluoroquinolones
Aminoglycosides (if sensitive)

Question 13

What antibiotics cover MRSA

Answer 13

Vancomycin
Doxycycline (tetracycline)
Septra
Clindamycin 
Linezolid
Daptomycin
Ceftobiprole (5th generation cephalosporin)

Question 14

What antibiotics cover pseudomonas?

Answer 14

Pip tazo
Ceftazidime (3rd gen cephalosporin)
Cefepime (4th gen cephalosporin)
Meropenum
Imipenum
Cipro flows in
Aminoglycosides 
Aztreonam
Colistin

Question 15

What covers enterococcus bacteria?

Answer 15

Vancomycin (except if it’s VRE)
Linezolid
Daptomycin

Question 16

In general (there are exceptions), which bugs ARE NOT covered by cephalosporins?

Answer 16

Listeria
Atypicals (mycoplasma/chlamydia)
MRSA
Enterococcus

Question 17

What are the 5 minor criteria for duke’s criteria of IE?

Answer 17

1. Predisposition such as heart condition or IVDU
2. Fever > 38
3. Vascular phenomena
4. Immunologic phenomena
5. Positive blood culture not meeting major criteria (excluded single positive cultures for cons or other organisms that don’t cause endocarditis)

Question 18

What are the 4 immunologic phenomena that count as part of duke phenomena (IE)

Answer 18

1. Glomerulonephritis
2. Osler node
3. Roth spots
4. Positive RF

Question 19

What are the major criteria from Duke Criteria (IE)?

Answer 19

1. Persistently positive blood cultures for organisms typical for IE from 2 separate blood cultures (>12 h apart)
2. Coxiella burnetii positive blood culture
3. Echo showing mass/vegetation, paravalvular abscess, new or worsening valvular regurgitation, valve dehiscence

Question 20

What cardiac conditions have a positive Kussmaul’s sign?

Answer 20

Constrictive pericarditis
Restrictive cardiomyopathy
Right ventricular myocardial infarction
Massive pulmonary embolism
Severe pulmonary hypertension
Right heart failure
Right-sides cardiac tumors 
Superior vena cava obstruction

Question 21

What is the first line treatment of hypertrophic cardiomyopathy?

Answer 21

Beta blockers

Avoid hyovolemia as well

Question 22

What CD4 count should you start prophylaxis for PJP in HIV infected individuals?
What do you use for prophylaxis?

Answer 22

1. <200
2. Septra 1 DS or SS Po fab daily

Alternatives:

• septra 1 DS M/W/F
• dapsone (not in G6PD of if SJS to septra. Okay if Sulfa allergy)
• Atovaquone
• aerosalized pentamidine monthly

Question 23

What level of CD4 should you start prophylaxis for toxoplasma and what do you use?

Answer 23

1. <100
2. Septra 1 DS Po daily or dapsone or atovaquone +/- pyrimethamine/leucovorin

Alternatives include septra 1 DS MWF or septra 1 SS daily

Question 24

What level of CD4 should you start prophylaxis for MAC and what do you use?

Answer 24

1. <50
2. Azithro my in 1200 mg Po weekly or clarithro my in 500 mg Po bid

Alternative is rifabutin

Question 25

What is the treatment for dystonic reactions secondary to medications (e.g. haldol)?

Answer 25

Benztropine/Cogentin 1-2 mg IV followed by 1-2 mg daily to BID po Benadryl/Diphenhydramine 25-50 mg IV x 1 followed by 25-50 mg q 4-8 hours

Question 26

Sarcoidosis has caseating or non-caseating granulomas?

Answer 26

Non-caseating (usually)