Cooties
Onco-logical Thinking
Intern-al Affairs
Urine Luck
Mixed Meds Bag
100

Which of the following transmission-based precautions should be initiated for shingles?

Airborne and contact precautions

100

TTP presents with (FATRN) fever, anemia, thrombocytopenia, renal dysfunction and neurologic abnormalities. It is due to decreased ADAMTS13 activity and positive ADAMST13 inhibitor. Initiating prompt treatment with ____ can be lifesaving.

  • plasma exchange (removes inhibitor and replaces deficient ADAMST13)
  • Do not order platelet transfusion in TTP-HUS because it can exacerbate the microvascular occlusion.
  • PT, aPTT, D-dimer, and fibrinogen levels are normal in TTP-HUS and abnormal in DIC.
  • Plasma exchange is superior to simple plasma infusion for TTP.
100

What is Beck’s triad, and what is it suggestive of?

  • hypotension, jugular venous distention, and muffled heart sounds
  • Cardiac tamponade
100

Name two causes of normal anion gap acidosis

  • GI HCO3– loss (diarrhea)
  • kidney HCO3– loss (type 2 proximal RTA)
  • reduced kidney H+ secretion (type 1 hypokalemic distal RTA, type 4 hyperkalemic distal RTA)
  • Fanconi syndrome (phosphaturia, glucosuria, uricosuria, aminoaciduria)
  • carbonic anhydrase inhibitor use (acetazolamide and topiramate)
100

What is the diagnosis? A 45-year-old man with a 15-year history of ulcerative colitis develops fatigue and pruritus. Serum alkaline phosphatase level is 750 U/L, AST is 48 U/L, ALT is 60 U/L, and total bilirubin is 2.0 mg/dL.

  • Primary sclerosing cholangitis
  • 85% of PSC patients have IBD
  • “string of beads” appearance
200

True or false: Patients with a positive EIA result but negative RPR or VDRL test result should have a second specific treponemal antibody test to confirm the result.

  • True!
  • Treponemal tests, also called confirmatory tests (FTA, TP-PA, EIA), detect antibodies specific to syphilis
  • Even with successfully treated syphilis the specific test may remain positive indefinitely
  • Nonspecific tests are (rapid plasma reagin [RPR] or Venereal Disease Research Lab [VDRL] test)
  • Patients with untreated syphilis can also have a negative nonspecific test (RPR or VDRL), so anyone with two positive specific tests for syphilis, regardless of the nonspecific test result, and no history of treatment should be offered therapy for syphilis of unknown duration (benzathine penicillin once weekly for three doses).
200

A 33-year-old man is evaluated for continued bleeding following a tooth extraction. His mother has easy bruising, and his sister required a transfusion following the birth of her first child. The hemoglobin concentration is 13 g/dL, and the platelet count is 210,000/μL. What is the most likely diagnosis?

  • Von Willebrand Disease
  • The most common inherited bleeding disorder is vWD, an autosomal codominant disorder.
  • vWF adheres platelets to injured vessels and acts as a carrier for factor VIII.
  • Clinically, patients have mild-to-moderate bleeding evidenced by nosebleeds, heavy menstrual flow, gingival bleeding, easy bruising, and bleeding associated with surgery or trauma.
200

Use this medication to treat hypertension in a patient with aortic dissection (name one)

Esmolol, labetalol

200

When patients are chronically malnourished or endure prolonged starvation, the body shifts from metabolizing carbohydrates to metabolizing protein and fat as the main source of ATP. In the process, intracellular depletion of key electrolytes such as potassium, phosphorous, and magnesium begins to occur. When carbohydrates or other simple sugars are reintroduced to the diet or given intravenously, production of insulin causes rapid intracellular uptake and a rapid drop in extracellular concentrations of electrolytes. These shifts have potentially life-threatening consequences, including diaphragmatic weakness and respiratory impairment, tissue hypoxia, fatal arrhythmias, and cardiomyopathies. Guidelines suggest that enteral intake should be increased slowly over a period of 3 to 7 days. What does this guideline help prevent?

Refeeding syndrome

200

What is the Berlin Criteria used for?

ARDS

300

Live vaccines are contraindicated in immunocompromised patients, but the MMR, varicella, and recombinant zoster vaccines can be given to patients with HIV with CD4 cell counts greater than ?

200/μL.

300

Tumor lysis syndrome is the result of the rapid breakdown of malignant cells, resulting in dangerous increases in serum urate, potassium, and phosphate concentrations. In addition to IV hydration, how is it treated?

  • Rasburicase
  • and furosemide, if needed, to enhance urine flow
300

What stage is a pressure ulcer described as follows: Shallow ulcer with a red-pink wound bed or serum-filled blister.

Stage 2

300

After a patient’s kidney stone was analyzed, his urologist recommended increasing his dietary calcium. What type of stone did he have (name one)?

Calcium oxalate or calcium phosphate

300

What is the diagnosis and treatment? A 48-year-old man is evaluated in the hospital for acute onset of hyperpyrexia and muscle rigidity. He was hospitalized 12 hours ago for upper gastrointestinal bleeding. Within the last hour he underwent upper endoscopy using rapid sequence intubation with succinylcholine and etomidate. Soon after completion of the procedure, he developed fever, tachypnea, and tachycardia.

  • Malignant hyperthermia 
  • Dantrolene
400

Patient presents with difficult-to-control asthma and recurrent pulmonary infiltrates. They have elevated IgE and positive skin testing. What is the diagnosis?

ABPA (allergic bronchopulmonary aspergillosis)

400

For warm autoimmune hemolytic anemia, initial therapy is glucocorticoids. For cold agglutinin disease, primary therapy is cold avoidance or __

  • rituximab for persistent symptoms
  • glucocorticoids or splenectomy are usually ineffective
400

How long before surgery should warfarin be held?

  • Stop warfarin 5 days before surgery.
  • Stop apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa) 1 to 2 days before surgery if eGFR >50 mL/min/1.73 m2. Stop earlier if eGFR is lower.
400

Which RTA causes hyperkalemia?

Type 4, distal

400

What condition is the Anti–Scl-70 antibody associated with?

  • DcSSc = diffuse cutaneous systemic sclerosis
  • more likely to develop pulmonary fibrosis if positive
500

Name an acceptable antibiotic regimen for PID (inpatient or outpatient)

Outpatient (14-day course)

  • single parenteral dose of ceftriaxone plus doxycycline plus metronidazole
  • OR cefoxitin and probenecid with doxycycline and metronidazole

Inpatient

  • ceftriaxone, doxycycline, plus metronidazole
  • OR cefotetan and doxycycline
  • OR cefoxitin and doxycycline
500

An Auer Rod is found on peripheral blood smear. What is the diagnosis?

  • This myeloblast has findings associated with AML: a large nucleus, displaced nuclear chromatin, azurophile cytoplasmic granules, and a rod-shaped inclusion (Auer rod).
  • The diagnosis is confirmed by bone marrow aspiration and biopsy showing >20% myeloblasts.
500

Name two types of neurally-mediated syncope

  • vasovagal syncope, situational syncope, and carotid sinus hypersensitivity
500

This antibody is associated with membranous nephropathy

anti-phospholipase A2 receptor (PLA2R) antibodies

500

This type of dementia is characterized by parkinsonian motor features (particularly gait problems and slowness of movements), visual hallucinations, rapid eye movement sleep behavior disorder, and frequent fluctuations in attention.

  • Lewy Body dementia
  • In patients with dementia with Lewy bodies, both rivastigmine and donepezil (acetylcholinesterase inhibitors) can improve cognition, global function, and activities of living.
  • Melatonin is preferred therapy for rapid eye movement sleep behavior disorder in patients with dementia with Lewy bodies.
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