Rosh Review PANCE practice Questions And Answers With 100% Correct Answers

Central retinal vein occlusion - classic exam findings? - BLOOD AND THUNDER -> retinal hemorrhages**** aspirin overdose includes aggressive volume resuscitation with intravenous fluids (A), especially in those who are hypotensive due to fluid loss and inappropriate systemic vasodilation. Frequent laboratory testing is done to assess clinical status and response to treatment. Arterial blood gas analysis (B) is critical and should be drawn every 1-2 hours to monitor acid-base status in patients with a salicylate overdose. Salicylate removal can be improved with the use of hemodialysis (D). Indications for hemodialysis include altered mental status, renal insufficiency, cerebral or pulmonary edema, serum salicylate concentration > 100 mg/dL (in acute overdose) and > 50 mg/dL (in chronic overdose), and clinical deterioration despite aggressive resuscitation. A 72-year-old woman was hospitalized for atrial fibrillation with rapid ventricular rate. She is being discharged today on amiodarone for long term control of her dysrhythmia. Which of the following diagnostic studies should be followed as an outpatient? - chest x-ray 3 main types of polyps (colon) - 1. hyperplastic (no risk of malignant transformation) 2. adenomatous ("tubular adenomas") (most common; possible risk of malignant transformation) -> repeat colonoscopy in 5 to 10 years 3. malignant A 29-year-old pregnant patient presents with a three day history of diarrhea following a trip to Mexico. The patient describes having seven to eight loose, watery stools per day. She does not note any blood in the diarrhea and is otherwise asymptomatic. Vital signs are BP 116/72, HR 86, RR 15, T 38.7°C. Physical exam reveals mild dehydration, but is otherwise normal. After providing fluid replacement, what is the indicated treatment? - thinking diagnosis is travelers diarrhea - one of the cause is e. coli etc Fluid replacement is always the primary treatment of traveler's diarrhea. Most cases are self-limited and resolve on their own within three to five days of treatment with fluid replacement only. Antimicrobial therapy shortens the disease duration to about one day. Antibiotics are warranted to treat diarrhea in those who develop severe diarrhea, characterized by more than four unformed stools daily, fever, or blood, pus, or mucus in the stool. In addition, some travelers desire antibiotic treatment for milder disease if the illness is a large burden on a business trip or vacation. Azithromycin is the preferred antibiotic therapy in pregnant women and children.A 32-year-old woman presents to the clinic with acute vertigo that began 12 hours ago and has been constant. She complains of nausea, vomiting and difficulty ambulating but denies tinnitus or change in hearing. Past medical history is significant for a recent viral illness. Physical exam reveals horizontal nystagmus and a negative Dix-Hallpike maneuver. Which of the following is the most likely diagnosis? A Benign paroxysmal positional vertigo B Ménière's diseaseYour Answer C Vestibular migraine D Vestibular neuronitis - D A 58-year-old woman with a history of previous cerebrovascular accident presents to the emergency department by ambulance due to concern for possible overdose. According to her husband, at home she was vomiting and complaining of nausea and ringing in her ears. The patient is confused and unable to answer questions upon arrival. Her blood pressure is 90/57 mm Hg, heart rate is 112 beats/minute, respiratory rate is 28 breaths/minute, and temperature is 103.1°F. Which of the following interventions should be avoided if possible? A Administration of intravenous fluids B Arterial blood gas analysis C Endotracheal intubation D Hemodialysis - C Providers need to be aware that airway management can worsen the condition of patients with aspirin overdose. The brief moment of apnea that occurs in preparation for intubation can cause acute and significant worsening of the patient's respiratory alkalosis. Intubation of patients exhibiting tachypnea in aspirin overdose has resulted in death and should be reserved for patients with hypoventilation and severe respiratory distress. Amiodarone is a class III anti-dysrhythmic drug used to treat many common dysrhythmias. An annual chest radiograph is recommended when patients are on chronic amiodarone therapy. Pulmonary toxicity generally correlates more closely with the total cumulative dose than the serum levels. It usually occurs months to years after initiation. Several types of pulmonary toxicity may result from chronic amiodarone therapy; however, the most common is a chronic interstitial pneumonitis. A kidney transplant recipient who is considered high-risk for cytomegalovirus disease. What antiviral agent is recommended to prevent cytomegalovirus disease? - Valganciclovir is a prodrugmetabolized to ganciclovir that is indicated to prevent cytomegalovirus (CMV) in high-risk kidney, heart, and kidney-pancreas transplant recipients. A soccer player presents to the emergency department after being kicked in the shin by his opponent. Upon presentation he demonstrates pain out of proportion as well as extreme pain with passive range of motion. You have a high suspicion for acute compartment syndrome. What laboratory finding is most closely associated with this disorder? Aldolase Creatine kinase Creatine kinase MB Erythrocyte sedimentation rate - Creatine kinase ->>>> marker of muscle injury and is elevated in rhabdomyolysis and commonly associated with compartment syndrome. Skeletal muscle has the highest concentration of creatine kinase than any other tissue. Therefore, it is the most sensitive indicator of an injury as well as marker to follow during the course of a muscular injury Creatine kinase-MB (C) is an isoenzyme form of the creatine kinase enzyme. The majority of this enzyme is found in cardiac tissue and is found to be elevated in cases of myocardial infarction or any stress to the heart muscle. Boerhaave Syndrome - Patient will be complaining of severe chest pain PE will show Hamman crunch (mediastinal crackling with each heartbeat) Chest X-ray will show pneumomediastinum Diagnosis is made by esophogram with water-soluble oral contrast Most commonly caused by a full-thickness esophageal rupture due to iatrogenic > forceful vomiting Most common location is left posterolateral distal esophagus Treatment is emergent surgical consult and broad-spectrum antibiotic Carbidopa/Levodopa what is eachs MOA - carbidopa = converted by the brain into DA levodopa = prevents carbidopa from being converted into DA in the peripheral circulation pros: significantly improves mobilitycons: does not slow progression of the disease, no effect on cognitive function or depression; will need to increase the dose As the central retinal vein is occluded, there is increased resistance to venous flow in the retinal venous system. The impaired bloodflow can increase pressure causing retinal hemorrhages and the classic "blood and thunder" appearance on funduscopic examination. In addition to these findings, the retinal veins may appear dilated and tortuous with macular and optic disc edema (unilateral). child has a rash for 36 hours and looks like the typical target lesions of erythema multiforme - what is the most likely cause? - HSV clinical presentation for anterior vs posterior hip dislocations - posterior = leg will be shortened, adducted, INTERNALLY ROTATED anterior = markedly abducted, EXTERNALLY rotated *posterior much more common* Dermatitis herpetiformis associated with? - Dermatitis herpetiformis almost universally occurs in association with celiac disease. It is characterized by an intense, pruritic papulovesicular rash that occurs in a symmetrical distribution over the extensor surfaces of the arms and limbs. Treatment for celiac disease is aimed at adopting a gluten-free diet, however recurrent cases of dermatitis herpetiforms should be treated with dapsone, in conjunction with a gluten-free diet.