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ABIM - PreTest Wrong

Questions I got wrong on the Pre-Test Assessment

QuestionAnswer
Two medications for treatment of alcohol dependence. Give the contraindications for each of the medications. 1. Naltrexone (Naltrexone is contraindicated in patients receiving or withdrawing from any opioid and in those with liver failure or hepatitis), 2. Acamprosate (contraindicated in kidney disease)
Top three preventable causes of death 1. Smoking, 2. Obesity, 3. Alcohol abuse
Which patients should not get naltrexone ? Naltrexone is contraindicated in patients receiving or withdrawing from any opioid and in those with liver failure or hepatitis.
When should you treat a patient with spinal cord injury for a UTI? These patients will usually have indwelling urinary catheters. Treat when the patient shows symptoms of UTI, such as increased spasticity or autonomic dysreflexia, And a urine culture with 10 to the third colony forming units.
Three treatments for polycythemia vera 1. Aspirin, 2. Phlebotomy, 3. If age greater than 60 or had a prior thromboembolic event, can add hydroxyurea
Sandpaper rash with red tongue Scarlet fever, strep A
who should get an implantable cardioverter – defibrillator? NYHA class II and III, EF=<35% on max med therapy, a life expectancy >1 yr. NYHA IV with reduced life expectancy, so no ICD unless awaiting transplantation or placement of a mechanical circulatory device.
who should get cardiac resynchronization therapy? NYHA class II to IV heart failure, a left ventricular ejection fraction less than or equal to 35% on guideline-directed medical therapy, and a left bundle branch block with QRS duration greater than or equal to 150 msec.
who should get aldosterone antagonists (spironolactone, eplerenone)? NYHA functional class II to IV, because it reduces mortality and morbidity
Who should not get aldosterone antagonists such as spironolactone and eplerenone? Risk of kidney dysfunction and hyperK, these drugs should be used only in pts with a serum creatinine level below 2.5 mg/dL (221 µmol/L) in men or below 2.0 mg/dL (176.8 µmol/L) in women, and with a serum potassium level below 5.0 mEq/L (5.0 mmol/L).
What imaging should always be included in the workup of asymptomatic hematuria? CT urography except in patients with chronic kidney disease, pregnant patients, or patients allergic to contrast; cystoscopy should be performed in patients over 35 years of age or those with risk factors for urologic malignancy.
How to treat scleroderma renal crisis? Captopril
hemolytic anemia, pancytopenia, or unprovoked thrombosis. What is it and how to diagnose? Paroxysmal nocturnal hemoglobinuria (PNH). flow cytometry results, which can detect CD55 and CD59 deficiency.
What gene is associated with paroxysmal nocturnal hemoglobinuria? PIG-A gene
Ampicillin causes what type of rash? morbilliform
In patient on morphine with decreased respiratory rate – what did you give them? naloxone
concave upward ST-segment elevation and PR-segment abnormalities, with elevation in lead aVR and depression in all other leads pericarditis
Three possible first-line treatment for pericarditis aspirin, 650-1000 mg every 6 to 8 hours; ibuprofen, 400-800 mg every 8 hours; indomethacin, 50 mg every 8 hours
When should ibuprofen not be used in pericarditis In patients with pericarditis associated with myocardial infarction, NSAIDs other than aspirin should not be used. These agents can impair myocardial healing and increase the risk of mechanical complications in these patients.
second line treatment for pericarditis Colchicine (0.5 to 1.2 mg/d for 3 months), in addition to NSAIDs, is an effective adjunctive therapy for acute pericarditis.
Side effects of colchicine side effects include gastrointestinal distress and, less commonly, bone marrow suppression, myositis, and liver toxicity.
Treatment for refractory pericarditis or containdication to NSAIDs Glucocorticoids, also good in autoimmune disorders, uremic pericarditis). A 3-month course of prednisone (0.25 to 0.50 mg/kg daily starting dose) may be used in these circumstances, with a slow taper beginning at 2 to 4 weeks.
mixed respiratory and metabolic acidosis, muscle rigidity, hyperkalemia, and rhabdomyolysis after use of an anesthetic. What is it and how to treat? Malignant hypothermia. Treatment includes prompt discontinuation of the triggering agent, increase in minute ventilation, bicarbonate infusion, correction of hyperkalemia, and dantrolene.
encephalopathy, muscle rigidity, autonomic instability, and fever after use of a neuroleptic like Haldol or Seroquel. What is it and how to treat? Neuroleptic malignant syndrome. Use benzodiazepines to treat
muscle rigidity and neurologic signs, including tremor, hyperreflexia, and clonus. what is it and how to treat? Cyproheptadine is used to treat serotonin syndrome
Radiographic images show a round mass within a pulmonary cavity or cyst what could be and how to treat? Aspergilloma - asymptomatic and have stable radiographs- no therapy. Surgical resection is indicated for hemoptysis and is considered definitive therapy. Anti fungal therapy is indicated for those who are symptomatic but unable to undergo surgery
galactomannan antigen immunoassay signifies what? Invasive aspergillosis
Cough productive of thick tan sputum and CT scan showing cavitation in the lungs Aspergillus fumigatus
voriconazole is what type of medication? antifungal with mold activity
women younger than 35 years of age with anovulatory bleeding - what to do? no additional evaluation prior to treatment if no risk factors for endometrial CA (obesity, nulliparity, age 35 years or older, diabetes mellitus, family history of colon cancer, infertility, and treatment with tamoxifen)
any patient with anovulatory bleeding 35 years of age or older - What to do? endometrial biopsy should be performed to exclude significant endometrial pathology
Postmenopausal woman with vaginal bleeding - does anything need to be done after the transvaginal ultrasound? When transvaginal ultrasonography is performed as an initial study and an endometrial thickness of less than or equal to 4 mm is found, endometrial sampling is not required. Endometrial thickness >4 mm should be further evaluated by endometrial sampling.
how to treat primary biliary cirrhosis ursodeoxycholic acid , liver transplantation
how to treat Nonextensive superficial venous thrombophlebitis (less than 5 cm in length and not near the deep venous system) symptomatic therapy consisting of analgesics, anti-inflammatory medications, and warm or cold compresses for symptom relief
How to treat extensive superficial venous thrombophlebitis short course of anticoagulant therapy. 6 weeks of a prophylactic dose of fondaparinux compared with placebo is beneficial for preventing local thrombosis progression and development of DVT and PE
What is autonomic dysreflexia? paroxysmal HTN (the sudden onset of severe high blood pressure) associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, slow heart rate, anxiety, and sometimes by cognitive impairment.
Created by: christinapham