CSAM Test Bank UPDATED ACTUAL Questions and CORRECT
Answers
1. Primary & Secondary syphilis cas- B
es in the U.S. have surged reaching BOTH a nontreponemal test AND a treponemal test are
a 20-year record high & cases of required. The treponemal test will be positive in patients
congenital syphilis have more than with current or past infection. The nontreponemal test
doubled in the past 4 years. All the may be positive for conditions other than syphilis; when
following are true about syphilis in ICU for rapidly progressive re-
EXCEPT:
A. Neonatal symptoms of con-
genital syphilis include de-
formed bones, severe anemia,
hepatosplenomegaly, neurologi-
cal problems, meningitis, & skin
rashes.
B. Screening for syphilis requires
use of a nontreponemal test (e.g.
VDRL or RPR) or a treponemal
test (e.g. EIA, FTA-ABS, TPPA, or
MHA-TP), but not both.
C. Up to 40% of pregnancies with
untreated syphilis will result in
miscarriage, stillbirth, or early in-
fant death.
D. Known risk factors for syphilis
include: multiple sex partners,
substance use disorders, poverty,
exchanging sex for drugs, money,
or housing, & a history of incarcer-
ation.
Next
2. A 57-year-old woman is evaluated
,syphilis is present, this test will differentiate current in-
fection needing treatment from prior, treated infection.
Patients with SUDs are in a high-risk group for syphilis.
Screening for syphilis is a required part of admission to
opioid treatment programs.
Repeated testing is recommended for pregnant woman
at increased risk. Up to 40% of pregnancies with untreat-
ed syphilis result in miscarriage, stillbirth, or early infant
death. Potential symptoms of congenital syphilis include
deformed bones, severe anemia, hepatosplenomegaly,
jaundice, neurological problems, meningitis, & skin rash-
es. Usually, symptoms emerge within the first few weeks
of life, but baby may be asymptomatic only to have symp-
toms occur years later, causing serious problems (such
as those listed above), developmental delay, seizures, or
death. The global pooled syphilis prevalence amongst
men having sex with men has risen to unacceptable levels
and was estimated at 7.5% (95% CI 7·0-8·0, 345 data
points; n=606, 232) between 2000 and 2020
B
Patient has hepatorenal syndrome. The diagnosis is
,nal failure that may require dial- made in the absence of other causes of renal disease
ysis. Patient had been hospital- in the setting of advanced liver disease. Key point: The
ized for advanced liver disease hepatorenal syndrome resolves with liver transplantation
including mental status changes but can be prevented proactively by careful monitoring of
secondary to encephalopathy. She renal function and avoidance of renal toxic medications
has ascites. Liver disease is the when signs of worsening renal insuflcency are detected.
result of chronic hepatitis C virus Other causes of renal failure should be excluded by per-
infection. Patient has no history forming a careful history and physical examination, ob-
of renal insufficiency and has not taining basic laboratory tests, and ruling out an infectious
received antibiotics, intravenous process (especially spontaneous bacterial peritonitis).
contrast agents, or other nephro- Failure to improve following withdrawal of diuretics and
toxic agents. Medications include administration of 1-1.5 L of normal saline is indicative of
lactulose, nadolol, midodrine, oc- the hepatorenal syndrome. Dialysis is indicated for pa-
treotide, and albumin. She does tients with clinically significant volume overload or severe
not drink alcohol. VITAL SIGNS: electrolyte abnormalities. Two types: Type 1, occurs over
Temperature 36.6 C. (97.8 F.), a short period of 1-2 weeks and leads to dialysis. Type 2
blood pressure 110/70 mmHg, more commonly occurs in the outpatient setting in pa-
pulse 97, respirations 12. BMI is tients who also have diuretic-resistant ascites. The hepa-
22. LABORATORY Creatinine 5.4 torenal syndrome is purely a reflection of advanced liver
mg/dL (412.0 μmol/L), Urea ni- disease caused by severe renal vascular vasoconstriction
trogen 120 mg/dL (42.8 mmol/L), in the setting of profound splanchnic vasodilation. The
Urine sodium less than 5 mEq/L (5 syndrome is not usually due to intrinsic renal disease and
mmol/L), Urinalysis Negative. UL- reverses with liver transplantation. Therefore, this patient
TRASOUND: Normal-size kidneys should proceed with liver transplant alone, and the kid-
and no obstruction. Which of the ney function will return after liver function is restored.
following is the most appropriate Angiotensin-converting enzyme (ACE) inhibitors such as
management? lisinopril have been used in the treatment of hepatorenal
A. Kidney transplantation syndrome without success. Prevention with careful mon-
B. Liver transplantation itoring of subtle changes in renal function, avoid renal
C. Add lisinopril toxins and management of fluids including paracentesis
D. Increase the paracentesis vol- for ascites to not over diurese patients with advanced
liver disease e is the best approach. (Source: Arroyo V,
, umes to drain all detectable as- Fernandez J, Ginès P. Pathogenesis and treatment of
cites hepatorenal syndrome. Lenz K. Treatment and manage-
ment of ascites and hepatorenal syndrome: an update.
Therap Adv Gastroenterol. 2015 Mar; 8(2): 83-100.)
3. The patient returns approximate- B
ly two years later for a rou- At an individual level, low assertiveness, poor self esteem
tine physical examination, and his and poor behavioral self control are all risk factors that
mother notes that in addition to may contribute to the risk of escalation among ado-
use of e-cigarettes, she found a lescents. Additionally, feeling disconnected from family,
glass pipe with a strongly smelling reduced participation in school and lack of knowledge
residue consistent with cannabis. about the risks of substance use all predict further esca-
You speak with the patient and his lation. Principles of Addiction Medicine 5th Edition 2014.
family to learn more about the pa- Richard K Ries.
tient. His mother notes that she is
very surprised that her son is us-
ing marijuana, noting "I just feel
like I don't know my son anymore."
She describes him as being friend-
ly and outgoing and is a natur-
al leader because he is assertive
and able to speak his mind easily.
She mentions that the school has
called her with complaints about
his not being in class when he
should be and noting that he faces
suspension if he does not improve
his grades. When you speak with
the patient, he tells you that he re-
cently quit sports in order to hang
out at the beach after school. "I
hate school, and I just don't want
Answers
1. Primary & Secondary syphilis cas- B
es in the U.S. have surged reaching BOTH a nontreponemal test AND a treponemal test are
a 20-year record high & cases of required. The treponemal test will be positive in patients
congenital syphilis have more than with current or past infection. The nontreponemal test
doubled in the past 4 years. All the may be positive for conditions other than syphilis; when
following are true about syphilis in ICU for rapidly progressive re-
EXCEPT:
A. Neonatal symptoms of con-
genital syphilis include de-
formed bones, severe anemia,
hepatosplenomegaly, neurologi-
cal problems, meningitis, & skin
rashes.
B. Screening for syphilis requires
use of a nontreponemal test (e.g.
VDRL or RPR) or a treponemal
test (e.g. EIA, FTA-ABS, TPPA, or
MHA-TP), but not both.
C. Up to 40% of pregnancies with
untreated syphilis will result in
miscarriage, stillbirth, or early in-
fant death.
D. Known risk factors for syphilis
include: multiple sex partners,
substance use disorders, poverty,
exchanging sex for drugs, money,
or housing, & a history of incarcer-
ation.
Next
2. A 57-year-old woman is evaluated
,syphilis is present, this test will differentiate current in-
fection needing treatment from prior, treated infection.
Patients with SUDs are in a high-risk group for syphilis.
Screening for syphilis is a required part of admission to
opioid treatment programs.
Repeated testing is recommended for pregnant woman
at increased risk. Up to 40% of pregnancies with untreat-
ed syphilis result in miscarriage, stillbirth, or early infant
death. Potential symptoms of congenital syphilis include
deformed bones, severe anemia, hepatosplenomegaly,
jaundice, neurological problems, meningitis, & skin rash-
es. Usually, symptoms emerge within the first few weeks
of life, but baby may be asymptomatic only to have symp-
toms occur years later, causing serious problems (such
as those listed above), developmental delay, seizures, or
death. The global pooled syphilis prevalence amongst
men having sex with men has risen to unacceptable levels
and was estimated at 7.5% (95% CI 7·0-8·0, 345 data
points; n=606, 232) between 2000 and 2020
B
Patient has hepatorenal syndrome. The diagnosis is
,nal failure that may require dial- made in the absence of other causes of renal disease
ysis. Patient had been hospital- in the setting of advanced liver disease. Key point: The
ized for advanced liver disease hepatorenal syndrome resolves with liver transplantation
including mental status changes but can be prevented proactively by careful monitoring of
secondary to encephalopathy. She renal function and avoidance of renal toxic medications
has ascites. Liver disease is the when signs of worsening renal insuflcency are detected.
result of chronic hepatitis C virus Other causes of renal failure should be excluded by per-
infection. Patient has no history forming a careful history and physical examination, ob-
of renal insufficiency and has not taining basic laboratory tests, and ruling out an infectious
received antibiotics, intravenous process (especially spontaneous bacterial peritonitis).
contrast agents, or other nephro- Failure to improve following withdrawal of diuretics and
toxic agents. Medications include administration of 1-1.5 L of normal saline is indicative of
lactulose, nadolol, midodrine, oc- the hepatorenal syndrome. Dialysis is indicated for pa-
treotide, and albumin. She does tients with clinically significant volume overload or severe
not drink alcohol. VITAL SIGNS: electrolyte abnormalities. Two types: Type 1, occurs over
Temperature 36.6 C. (97.8 F.), a short period of 1-2 weeks and leads to dialysis. Type 2
blood pressure 110/70 mmHg, more commonly occurs in the outpatient setting in pa-
pulse 97, respirations 12. BMI is tients who also have diuretic-resistant ascites. The hepa-
22. LABORATORY Creatinine 5.4 torenal syndrome is purely a reflection of advanced liver
mg/dL (412.0 μmol/L), Urea ni- disease caused by severe renal vascular vasoconstriction
trogen 120 mg/dL (42.8 mmol/L), in the setting of profound splanchnic vasodilation. The
Urine sodium less than 5 mEq/L (5 syndrome is not usually due to intrinsic renal disease and
mmol/L), Urinalysis Negative. UL- reverses with liver transplantation. Therefore, this patient
TRASOUND: Normal-size kidneys should proceed with liver transplant alone, and the kid-
and no obstruction. Which of the ney function will return after liver function is restored.
following is the most appropriate Angiotensin-converting enzyme (ACE) inhibitors such as
management? lisinopril have been used in the treatment of hepatorenal
A. Kidney transplantation syndrome without success. Prevention with careful mon-
B. Liver transplantation itoring of subtle changes in renal function, avoid renal
C. Add lisinopril toxins and management of fluids including paracentesis
D. Increase the paracentesis vol- for ascites to not over diurese patients with advanced
liver disease e is the best approach. (Source: Arroyo V,
, umes to drain all detectable as- Fernandez J, Ginès P. Pathogenesis and treatment of
cites hepatorenal syndrome. Lenz K. Treatment and manage-
ment of ascites and hepatorenal syndrome: an update.
Therap Adv Gastroenterol. 2015 Mar; 8(2): 83-100.)
3. The patient returns approximate- B
ly two years later for a rou- At an individual level, low assertiveness, poor self esteem
tine physical examination, and his and poor behavioral self control are all risk factors that
mother notes that in addition to may contribute to the risk of escalation among ado-
use of e-cigarettes, she found a lescents. Additionally, feeling disconnected from family,
glass pipe with a strongly smelling reduced participation in school and lack of knowledge
residue consistent with cannabis. about the risks of substance use all predict further esca-
You speak with the patient and his lation. Principles of Addiction Medicine 5th Edition 2014.
family to learn more about the pa- Richard K Ries.
tient. His mother notes that she is
very surprised that her son is us-
ing marijuana, noting "I just feel
like I don't know my son anymore."
She describes him as being friend-
ly and outgoing and is a natur-
al leader because he is assertive
and able to speak his mind easily.
She mentions that the school has
called her with complaints about
his not being in class when he
should be and noting that he faces
suspension if he does not improve
his grades. When you speak with
the patient, he tells you that he re-
cently quit sports in order to hang
out at the beach after school. "I
hate school, and I just don't want
