Test 1 - Created June 24

Question 1

results of B12 deficiency

Answer 1

dementia, subacute combined degeneration; intramedullary hemolysis, ineffective erythropoiesis

Question 2

standardized mortality ration equation

Answer 2

observed number of deaths/expected number of deaths; used in occupational studies

Question 3

risk for long-term survivors of Hodgkin lymphoma

Answer 3

cardiovascular issues; radiation leads to fibrosis -> MI, restrictive CMP with diastolic dysfn, contstrictive pericarditis, valve issues, conduction defects

Question 4

eye exam with central retinal artery occlusion

Answer 4

pale fundus with “cherry red spot”

Question 5

eye exam with central retinal vein occlusion

Answer 5

fundus with retinal hemorrhages and optic disc edema

Question 6

eye exam with retinal detachment; see floaters

Answer 6

vitreous hemorrhage and marked elevation of retina

Question 7

eye exam with vitreous hemorrhage

Answer 7

decreased red reflex; visible hemorrhage

Question 8

eye exam with optic neuritis

Answer 8

optic disc edema

Question 9

eye exam with DM eye changes

Answer 9

neovascularization; possible hemorrhage

Question 10

triad in Meniere’s disease

Answer 10

periodic vertigo, unilateral hearing loss, tinnitus

Question 11

steps in root cause analysis

Answer 11

1. collect data 2. causal flow chart 3. root causes 4. recommendations and changes 5. measure results

Question 12

equation for (+) likelihood ratio

Answer 12

sensitivity / (1 - specificity) OR TP/FP

Question 13

equation for (-) likelihood ratio

Answer 13

(1 - sensitivity) / specificity OR FN/TN

Question 14

tx for lactational mastitis

Answer 14

dicloxacillin or cephalexin; IV vanc if MRSA risk factors; continue to breastfeed

Question 15

subclinical hypothyroidism: when to treat

Answer 15

TSH > 10; TSH 4.5-10 with elevated TPO Ab’s or sxs/goiter

Question 16

Lyme tx in pregnant woman

Answer 16

14-21 days of amoxicillin or cefuroxime

Question 17

tx of NSTEMI

Answer 17

NA-BASH (nitrates, ASA, BBs, anti-plt with -grel), statin, heparin); likely get “NA” en route; give “AH”; hold off on BS until later

Question 18

tx of STEMI

Answer 18

meds the same but need cardiac cath and revascularization within 90 minutes STAT

Question 19

adjustment disorder with depressed mood

Answer 19

onset w/in 3 mo. of stressor; marked distress and/or functional impairment

Question 20

illness anxiety disorder

Answer 20

excessive concern about having or developing a serious, undiagnosed general medical disease; concerns persist > 6 mo.; patients tend to have multiple (-) workup’s

Question 21

normal stress response

Answer 21

not excessive or out of proportion to severity of stressor; no significant functional impairment

Question 22

somatic symptom disorder

Answer 22

worry about symptoms; physical symptoms persist over time

Question 23

presentation of chronic prostatitis and workup

Answer 23

> 3 mo. of dysuria, pelvic pain, and/or pain during ejaculation; workup = U/A and UCx to r/o UTI; U/A will show >20 leukocytes

Question 24

treatment for chronic prostatitis

Answer 24

alpha blockers, Abx, anti-infl., and/or psychotherapy; give 6 wks of FQN or TMP-SMX if bacterial

Question 25

presentation of acute prostatitis

Answer 25

similar to chronic with dysuria and pelvic pain BUT has high fever and dirty urine; prostate is warm, edematous, tender; UCx shows E.coli or Proteus

Question 26

presentation of lithium toxicity; level for toxicity; common drugs that cause it; treatment

Answer 26

N/V/D, slurred speech, confused, tremors, ataxia; > 1.5; thiazides, ACE-i, NSAIDs; lithium levels, IVF, hemodialysis if bad

Question 27

presentation of neuroleptic malignant syndrome; drugs that cause it

Answer 27

fever, extreme rigidity, autonomic instability, AMS; antipsychotic meds

Question 28

presentation of serotonin syndrome; drugs that cause it

Answer 28

myoclonus, hyperreflexia, hyperthermia, tachycardia, confusion, tremors; multiple serotonin drugs

Question 29

treatment for Paget's disease

Answer 29

give if sxs, involves wt-bearing bones, or neuro involvement; bisphosphonates (activity against osteoclasts, the problem in Paget's)

Question 30

reasons why subchorionic hematoma can occur; complications down the road

Answer 30

reasons: infertility tx, anticoag., uterine anomalies, recurrent pregnancy loss; complications: spont. abortion, abruptio placentae, pPROM, PTD, PreE, IUGR, IUFD

Question 31

when placenta accreta more likely to occur

Answer 31

prior Csections (implants over scar)

Question 32

when placenta previa more likely to occur

Answer 32

h/o of prior Csection, multiparity, multiple babies (twins), prior placenta previa

Question 33

when to do basal-bolus insulin in hospital

Answer 33

T1DM, T2 if they did it prior, T2 poor controlled by SS, new DM pt

Question 34

when to do sliding scale insulin in hospital

Answer 34

T2 well controlled with diet and/or oral meds before admission; may need to add basal

Question 35

when to do insulin infusion insulin in hospital

Answer 35

T1 who aren't eating and whose bG is poorly controlled with subcut; T1 perioperatively or during labor; hyperglycemic emergencies

Question 36

stress incontinence and tx

Answer 36

leakage w/ cough, sneeze, laugh, lifting; urethral hypermobility, intrinsic sphincter def., or (+) urine stress test on PE; LS modification, pelvic floor exercises, pessary, urethral sling surgery

Question 37

urge incontinence and tx

Answer 37

sudden, overwhelming, or frequent need to urinate; LS modification, bladder training, antimusc. meds (oxybutynin, tolterodine)

Question 38

overflow incontinence and tx

Answer 38

constant dribbling of urine, incomplete bladder emptying, decr. perineal sensation on PE; intermittent cath, correct etiology if possible; may be from DM, spinal injury, MS or may be taking antihistamines and making it worse