1
AQUIFER IM EXAM QUESTIONS
WITH SOLUTIONS
What is in initial diagnostic eval of delirium? - correct-answer - CBC, chemistry
panel
In a generally stable patient, what saline should be used to correct hyponatremia?
- correct-answer - 0.9% saline (use 3% saline if patient has seizures or coma)
What is the initial evaluation for patient with AMS? (10) - correct-answer - broad
workup: electrolytes, urine tox, serum ethanol level, serum drug screen, CXR,
urinalysis, CT of head, arterial blood gas, serum osmolality, EKG
Differential for patient with AMS and anion gap metabolic acidosis? (3) - correct-
answer - drug intoxication, ketoacidosis, lactic acidosis
Best treatment for hypernatremia? - correct-answer - IV 0.9% saline (to correct
volume depletion) followed by IV dextrose in water (hypotonic solution to lower
serum sodium)
What are symptoms of hypercalcemia? - correct-answer - abdominal pain, AMS,
constipation, fatigue, polyuria, shorterned QT interval
, 2
What are treatments of symptomatic hypercalcemia? - correct-answer - Normal
saline 4-6 Ls IV in first 24 hours (aggressive volume expansion); calcitonin (impairs
osteoclast function)
What test is the most important in eval of hypercalcemia? - correct-answer - PTH
What medication is best for tx of hypercalcemia due to lung malignancy? -
correct-answer - IV zoledronic acid
Diagnose: chest pain or pressure, radiating to neck or arm, associated with
diaphoresis and nausea - correct-answer - acute coronary syndrome (unstable
angina or acute MI)
Diagnose: sudden onset of pleuritic chest pain, lightheadedness or syncope, and
low grade fever - correct-answer - Pulmonary embolism
Orthopnea, PND, edema in lower legs - correct-answer - Heart failure
Cough, smoking history, wheezing, but breathing improves after bronchodilator
inhalers - correct-answer - COPD
Fever, cough productive of purulent sputum - correct-answer - Pneumonia
Sudden onset chest pain that is pleuritic, symptoms not improved with oxygen -
correct-answer - Pneumothorax
Initial work-up of suspected COPD (7) - correct-answer - arterial blood gas, BNP,
troponin, CBC, CXR, CMP, EKG
, 3
Management of COPD exacerbation (7) - correct-answer - Ambulation as
tolerated, antibiotics, bronchodilators (ipratropium bromide, albulterol), DVT
prophylaxis, glucocorticoids, BIPAP, oxygen therapy with goal sat of 90-94%
Long term non-pharmacologic management of COPD (4) - correct-answer -
continuous supplemental oxygen, quit smoking, immunizations against flu and
pneumonia, pulmonary rehab/PT program
Top 3 differential for fever, chills, hemoptyssi - correct-answer - TB, lung
malignancy, lymphoma
Which pulmonary physical exam findings are consistent with pleural effusion? (3)
- correct-answer - decreased vocal and tactile fremitus, dullness to percussion,
decreased breath sounds
Top 2 differential of fever, chills, hemoptysis, and unilateral pulmonary effusion -
correct-answer - TB, lung malignancy
Post thoracentesis, patient develops dyspnea, what is most likely diagnosis? -
correct-answer - Pneumothorax
What are some indications for chest tube placement in patient with
pneumothorax? - correct-answer - patient on mechanical ventilation, tension
pneumonthorax after needle decompression, pneumothorax secondary to chest
trauma, hemopneumothorax, esphoageal rupture with gastric leak into pleural
space
AQUIFER IM EXAM QUESTIONS
WITH SOLUTIONS
What is in initial diagnostic eval of delirium? - correct-answer - CBC, chemistry
panel
In a generally stable patient, what saline should be used to correct hyponatremia?
- correct-answer - 0.9% saline (use 3% saline if patient has seizures or coma)
What is the initial evaluation for patient with AMS? (10) - correct-answer - broad
workup: electrolytes, urine tox, serum ethanol level, serum drug screen, CXR,
urinalysis, CT of head, arterial blood gas, serum osmolality, EKG
Differential for patient with AMS and anion gap metabolic acidosis? (3) - correct-
answer - drug intoxication, ketoacidosis, lactic acidosis
Best treatment for hypernatremia? - correct-answer - IV 0.9% saline (to correct
volume depletion) followed by IV dextrose in water (hypotonic solution to lower
serum sodium)
What are symptoms of hypercalcemia? - correct-answer - abdominal pain, AMS,
constipation, fatigue, polyuria, shorterned QT interval
, 2
What are treatments of symptomatic hypercalcemia? - correct-answer - Normal
saline 4-6 Ls IV in first 24 hours (aggressive volume expansion); calcitonin (impairs
osteoclast function)
What test is the most important in eval of hypercalcemia? - correct-answer - PTH
What medication is best for tx of hypercalcemia due to lung malignancy? -
correct-answer - IV zoledronic acid
Diagnose: chest pain or pressure, radiating to neck or arm, associated with
diaphoresis and nausea - correct-answer - acute coronary syndrome (unstable
angina or acute MI)
Diagnose: sudden onset of pleuritic chest pain, lightheadedness or syncope, and
low grade fever - correct-answer - Pulmonary embolism
Orthopnea, PND, edema in lower legs - correct-answer - Heart failure
Cough, smoking history, wheezing, but breathing improves after bronchodilator
inhalers - correct-answer - COPD
Fever, cough productive of purulent sputum - correct-answer - Pneumonia
Sudden onset chest pain that is pleuritic, symptoms not improved with oxygen -
correct-answer - Pneumothorax
Initial work-up of suspected COPD (7) - correct-answer - arterial blood gas, BNP,
troponin, CBC, CXR, CMP, EKG
, 3
Management of COPD exacerbation (7) - correct-answer - Ambulation as
tolerated, antibiotics, bronchodilators (ipratropium bromide, albulterol), DVT
prophylaxis, glucocorticoids, BIPAP, oxygen therapy with goal sat of 90-94%
Long term non-pharmacologic management of COPD (4) - correct-answer -
continuous supplemental oxygen, quit smoking, immunizations against flu and
pneumonia, pulmonary rehab/PT program
Top 3 differential for fever, chills, hemoptyssi - correct-answer - TB, lung
malignancy, lymphoma
Which pulmonary physical exam findings are consistent with pleural effusion? (3)
- correct-answer - decreased vocal and tactile fremitus, dullness to percussion,
decreased breath sounds
Top 2 differential of fever, chills, hemoptysis, and unilateral pulmonary effusion -
correct-answer - TB, lung malignancy
Post thoracentesis, patient develops dyspnea, what is most likely diagnosis? -
correct-answer - Pneumothorax
What are some indications for chest tube placement in patient with
pneumothorax? - correct-answer - patient on mechanical ventilation, tension
pneumonthorax after needle decompression, pneumothorax secondary to chest
trauma, hemopneumothorax, esphoageal rupture with gastric leak into pleural
space
