Mixed Categories
AKI with Hypercalcemia and anemia
Diagnostic test?
SPEP and UPEP and Immunoglobulins
In Ascites evaluation:
SAAG >1.1 with < 2.5 g/dl Ascitic fluid protein is seen in:
A. CirrhosisB. Right sided Heart Failure
C.Nephrotic SyndromeD.Malignancy/TB
Cirrhosis
45 year old man with known alcoholic liver cirrhosis now with CAP restless and agitated 48 hours after admission
Most appropriate treatment of patient's agitation?
Chlordiazepoxide? Clonidine? Propranolol? or Lorazepam?
Lorazepam
Longer acting chordiazepoxide poses more sedation in patients with chronic liver disease and elderly
65 yr old man with Pneumonia at the MICU on IV antibiotics EKG sinus rhythm Troponin 1.3ng/ml. Next step?
Echocardiogram
25 year old woman hospitalized with a 4 day history of fever and cough productive of brown sputum. She is 14 wks AOG. PMHx Asthma. PE T 38.2 PR 122 RR 24 O2 Sat 94% RA Crackles Left base; CXR LLL infiltrate.Most likely cause of pneumonia?
The microbiology of CAP in pregnancy is the same to that seen in gen population In hospitalized patients: Strep pneumoniae, Haemophilus influenzae and atypical organisms including legionella species, Chlamydia pneumoniae and Mycoplasma pneumoniae
65 year old develops eosinophilia, AKI and a net like rash on his lower extremities following a cardiac catheterization
Dx?
Atheroembolic disease with cholesterol emboli to the skin and kidney
Antimicrobial prophylaxis should be administered during variceal bleeding even if ascites is absent. True or False
True, choices will be Norfloxacin, IV Cipro or Ceftriaxone
Very severe withdrawal syndrome characterized by profound autonomic hyperactivity, extreme confusion, agitation, vivid delusions and hallucinations usually begins on the 3rd to 5th day post last drink
Delirium Tremens
Elevated troponins are poor prognostic factors and can be seen in other cases other than ACS like:
CHF
Critical illness
LVH
HOCM
Peripheral arterial disease
Two sets of Criteria that identify patient who will benefit from hospital care
CURB 65
Pneumonia Severity Index
67 year old woman hospitalized for ulcer on the bottom of her right foot. Px with Type 2 DM, CKD, HTN peripheral neuropathy. A deep 3 x 4 cm ulcer is located in the distal medial compartment of the plantar surface of the right foot, ulcer base is necrotic, no signs of skin or soft tissue infection or sepsis, probe to bone test is negative, Both feet warm and palpable pulses ESR and CRP are elevated and CBC normal Xray soft tissue swelling and Ulceration MRI consistent with Osteomyelitis of the distal head of the first metatarsal
Most appropriate mgt:
A. Bone biopsy and culture
B. Forefoot amputation
C.Swabbing and culture of wound base
D. Start Vanco and Pip tazobactam
A Bone biopsy and culture
Osteomyelitis in a px with diabetic foot infection with no evidence of skin and soft tissue infection or sepsis requires a bone biopsy before antibiotics are administered
Blood transfusion goal for bleeding esophageal varices
Hgb :7g/dl
Alcohol related syndrome characterized by ataxia, ophthalmoplegia and confusion often assoc with nystagmus, peripheral neuropathy cerebellar signs, impaired short term memory, inattention and emotional lability
Wernicke's Encepalopathy
Drug therapy given to Patients with NYHA Class III to IV and EF <40% to reduce moratality if they cannot tolerate ACE or ARB
Hydralazine plus nitrates
Empiric antibiotic treatment of CAP In patient NON ICU
Moxifloxacin 400 mg po or IV OR
Levofloxacin 750 mg po or IV
OR
Beta lactam Ceftriaxone, Ampicillin, Cefotaxime, Ertapenem plus macrolide
Best test to differentiate restrictive versus obstructive lung disease
Total Lung capacity
Ascitic Fluid Granulocyte count >______ confirms SBP
250
Patient just had Cardiac cath Creat the following day inc to 2 from 1.5; Muddy brown casts on UA
Expect FeNa to be?
>2%
27 year old woman hospitalized for exertional dyspnea and edema.no chest pain; PE HR 112 BP 118/66 RR18 O2 94RA (+) JVD (+) Crackles bibasal,(+)peripheral edema
CBC, CMP, Lipid panels normal EKG sinus tach Echo LVEF 25%
Which of the following is the appropriate next step?
A. cardiac cath
B. Thyroid function tests
C. Viral titers
Thyroid function tests
Include BNP as part of initial evaluation of patients with new onset heart failure
82 year old man admitted to the ICU with a 7 day history of fever and cough productive of green sputum. Med history is remarkable for Bronchiectasis and Polymyalgia rheumatica. his only medication is prednisone 10 mg/d. Temp 38.8 PR 115 RR25 O2 87% RA
Which of the following is the most appropriate treatment?
A. Ampicillin Sulbactam and Levofloxacin
B.Cefepime and Ciprofloxacin
C. Ceftriaxone and Azithromycin
Combination of Cipro and cefepime achieves the requirement of of dual antipseudomonal coverage for patients admitted with pseudomonas risk: Structural Lung damage such as Bronchiectasis, repeated COPD exac with prior antibiotics and long term steroids
Tight inpatient glycemic control (80-110mg/dl) is not consistently associated with improved outcomes and may increase mortality
True or False
True. Insulin is preferred for inpatient mgt of hyperglycemia 180 mg/dl and adjusted to maintain a glucose level between 140 to 180 for most patients. Glucose levels less than 140 may be reasonable in select non critically ill patients if hypoglycemia is avoided
62 year old woman on ffup after HCV treatment. She has Childs A cirrhosis. Her HCV RNA is undetectable. She had endoscopy done last year. MELD score of 8. Most appropriate next mgt for this patient?
A. Liver Transplantation
B. Ultrasonography of the liver every 6 months
C. Upper Endoscopy
68 year old with BUN 60 Creat 2 Urine Osm 700 Urine Sodium 10 Fena <1% Urinalysis with SG >1.020 and Hyaline casts
Etiol: A. Radiocontrast B. Dehydration
Dehydration
Hypervolemic Hyponatremia with urine sodium less than 20 is seen in?
Cardiac failure
Liver Cirrhosis
Nephrotic syndrome
74 year old homeless woman is evaluated for hospital discharge. Admitted 6 days ago for CAP given empiric Ceftriaxone and Azithromycin, fever resolved within 48 hrs of admission, Discharge delayed due to difficulty in placement. Sputum grew Strp pneumoniae Sen to PCN, Ceftriaxone, Levofloxacin, Vancomycin and R to erythromycin. Most appropriate mgt at discharge:
A. Cont only Azithromycin
B.Cont only ceftriaxone
C. Stop all antibiotics
D. Switch to oral Amoxicillin
E. Switch to oral levofloxacin
C. In patients with uncomplicated CAP not requiring ICU admission a short course of antibiotic therapy 5 to 7 days is sufficient.