UW 13

Question 1

How does acute massive PE present?

Answer 1

Syncope

Shock

Question 2

Cath values in acute massive PE

Answer 2

High RA and PA pressure

Normal PCWP

Question 3

Hypovolemic shock Cath values

Answer 3

Low intravascular volume
Low RA, RV, PA, PCWP
High SVR

Question 4

Cardiogenic shock cath values

Answer 4

High PCWP, SVR

Low CO

Question 5

Septic shock cath values

Answer 5

Peripheral VD
High CO
Low SVR
Low RA, PA, PCWP

Question 6

HIV testing

Answer 6

1. ELISA

2. Western Blot = confirm

Question 7

Pulmonary Cavitation in HIV

Answer 7

M.TB
Atypical Mycobacteria
Nocardia
Gram - Rods
Anaerobes

Question 8

Nocardia

Answer 8

Gram +
Weakly acid fast
Filamentous branching Rod
Immunocompromised hosts

Question 9

Tx for Nocardia

Answer 9

TMP-SMX

Question 10

Lack of response to progestin withdrawl =

Answer 10

Low estrogen

Question 11

Staph Scalded Skin Syndrome
Pathophys
Presentation

Answer 11

Toxin targets desmoglein 1 = keratinocyte adhesion in superficial epidermis
Prodrome of fever, irritability and skin tenderness
Erythema starts on face -> genearlizes 24-48 hours
Superficial flaccid blisters develop
Nikolsky sign +

Question 12

Impetigo pressentation

Answer 12

Flaccid blisters
Honey colored crusted lesion
Nikolsky -

Question 13

TX for Hairy cell leukemia

Answer 13

Cladribine - Purine analog

Question 14

AE’s of Cladribine

Answer 14

Neuro

Renal

Question 15

Opioid Presentation

Answer 15

Miosis
Depressed mental status
Depressed RR, bowel sounds
HypoTN, Bradycardia

Question 16

Best predictor of intoxication in opioid toxicity

Answer 16

Respiratory Rate

Question 17

Conditions that cause V/Q Mismatch

Answer 17

Pulmonary embolism
Atelectasis
Pleural Effusion
Pulmonary Edema

Question 18

A-a gradient and acid base in

V/Q mismatch

Answer 18

A-a increas

Question 19

Acid base seen in Alveolar hypoventilation

Answer 19

Respiratory Acidosis
High PaCO2
Low PaO2 - may just be this alone, 50-80

Question 20

Causes of Alveolar Hypoventilation and Respiratory Acidosis

Answer 20

Pulmonary/thoracic dz: COPD, OSA, Obesity hypoventilation, scoliosis
NM Dz: MG, Lambert-Eaton, GBS
Drugs: Anesthetics, narcotics, sedaties
Primary CNS dysfnc: Brainstem lesion, infxn, stroke

Question 21

What does A-a gradient measure

Answer 21

PAO2 - PzO2

Measures oxygen transfer from alveoli to blood

Question 22

What is a normal A-a gradient

Answer 22

< 15

Question 23

Causes of hypoxemia

Answer 23

Reduced inspired oxygen tension
Hypoventilation
Diffusion limitation 
Shunt
V/Q mismatch

Question 24

What is the most common presentation of Primary Hyperparathyroidism (PH)

Answer 24

Asymptomatic 80%

Question 25

How to differentiate PH from familial hypocalciuric hypercalcemia

Answer 25

24-hour urinary calcium > 250 = PH < 100 = Familial

Question 26

TX for Asymptomatic PH

Answer 26

Surgery (parathyroidectomy) if 1+ 1. Serum Calcium >1mg/dL above upper limit 2. Young < 50yoa 3. BMD < -2.5 any site 4. Reduced Renal Fnc (GFR < 50mL/min)

Question 27

When is bisphosphonates the TX in PH

Answer 27

1. Refuse surgery | 2. Hx of oxteopenia/osteoporosis

Question 28

Presentation of hypercalcemia in malignancy (labs)

Answer 28

Low PTH | mod-severe Hypercalcemia = > 13

Question 29

Presentation and pathophys of hypercalcemia due to immobilization

Answer 29

Immobilized pt Pre-existing high bone turnover Median onset - 4 wks High bone turnover = increased osteoclastic activation

Question 30

TX for hypercalcemia due to immobilization

Answer 30

1. Hydration | 2. Bisphosphonates

Question 31

Presentation of Ehrlichiosis

Answer 31

``` Tick bite - white tail deer SE and SC US (Arkansas) Flu-like illness - febrile, malaise Neuro sx's No rash ```

Question 32

Labs in Ehrlichiosis

Answer 32

Leukopenia Thrombocytopenia High LFTs High LDH

Question 33

DX for Ehrlichiosis

Answer 33

Intracytoplasmic morulae in WBCs | PCR

Question 34

TX for Ehrlichiosis

Answer 34

Doxycycline | 2nd line = Chloramphenicol

Question 35

Presentation for RMSF

Answer 35

Maculopapular rash involving palms and soles after fever

Question 36

Do we vaccinate pts w influenza that are symptomatic (moderate to severe)

Answer 36

No. CDC recommends agasint it

Question 37

TX for influenza

Answer 37

``` Oseltamivir, Zanamivir (NA inhibitor) - If pt presents w/in 48 hrs of onset OR - sx's not improving or high risk IC'd, pregnant, > 65, Native American ```

Question 38

TX for Bartonella henselae

Answer 38

Azithromycin

Question 39

Eschar presentation

Answer 39

moderate full thickness burn w pain and swelling = eschar constriction

Question 40

Management for Eschar

Answer 40

1. IVF 2. Analgesics 3. Topical Abx and wound dressing 4. Monitor for signs of healing 5. Doppler US for peripheral pulses and compartment pressure - 25-40 = threshold for escharotomy

Question 41

ABO incompatibility seen in?

Answer 41

Group O Mother Group A or B Baby A and B Ags are antigenic - mother forms IgG abs to A or B = cross placenta

Question 42

EEG w sharp, triphasic and synchronous discharges

Answer 42

Creutzfeldt-Jakob Disease

Question 43

Creutzfeldt Jakob Presentation

Answer 43

Rapidly progressive dementia Myoclonus Sharp, triphasic synchronous discharges on EEG

Question 44

Acne TX

Answer 44

1. Topical retinoids, salicylic 2. + benzoyl peroxide 3. + Topical Abx = erythromycin, clindamycin 4. + Oral Abx 5. Oral isotretinoin = only for unresponsive severe

Question 45

TX for acne that is severe or nodular OR moderate acne unresponsive to topical Abx

Answer 45

Oral Abx

Question 46

MOA of spirnolactone

Answer 46

Blocks effects of testosterone at receptor

Question 47

MC symptoms of MR

Answer 47

Exertional dyspnea Fatigue - Decreased CO and increased LA Pressure

Question 48

Pt with MR + dry cough

Answer 48

Pulmonary congestion/edema Severe dz LV dysfnc

Question 49

What does PCWP measure

Answer 49

LA Pressure | LVEDV

Question 50

Hypovolemic shock findings

Answer 50

``` HypoTN Tachycardia Low CO High SVR Low CVP, PCWP ```

Question 51

Bacteria in IE w nosocomial UTI, cytoscopy

Answer 51

Enterococcus

Question 52

Differentiate b/t IM and Primary HIV infxn

Answer 52

Rash and diarrhea = less common in IM | Tonsillar exudates = uncommon in primary HIV