Intern 101

Question 1

Discharging patients

Answer 1

1. Med recs (must be printed out at nurses station and placed in physical chart, give patient’s 7 days of medications)
2. D/C instructions
3. D/C order
4. SW placement

Question 2

SSI adjustment rule

total amount of SSI used in one day

Answer 2

• Total SSI given for 1 day/2 = X
• X added to original long acting insulin (Lantus)
• X added to total short acting (humalog) / 3 for meals

Question 3

Fever > 105.2

Answer 3

• Uncover, undress patient
• Ice packs
• IVF bolusses with pressure bags
• Tylenol 650 mg PO, or 1 gm IV
• Ibuprofen 600 mg IV
• Cooling blankets (usually only in ICU)

Question 4

Best way to tell if someone is faking weakness on neurologic exam

Answer 4

pronator drift

Question 5

Ulcers occurring in the sac of hiatal hernia

Answer 5

Cameron ulcers/lesions

Question 6

Indications for aldosterone antagonists (aldactone) in CHF

Answer 6

• Consider if HF severe or post-MI
• 30% reduced mortality in NYHA class 2-4 and EF < 35%
• 15% reduced mortality in HF post-MI, EF < 40%

Question 7

BRCA associated cancers in men

Answer 7

• prostate

- male breast

Question 8

Lee’s Revised Cardiac Risk Index (RCRI)

Answer 8

• High risk surgical procedure (intaperiotoneal, intrathoracic, suprainguinal vascular)
• History of CAD
• History of CHF
• History of CVA
• DM or preop treatment with insulin
• Renal insufficiency (Cr. > 2)

Each risk factor is assigned 1 point

0 > Class I > 0.4% risk
1 > Class II > 0.9%
2 > Class III > 6.6%
3+ > Class IV > 11%

Question 9

First sign of hepatic encephalopathy

Answer 9

sleep reversal/disturbance

Question 10

indications for erythropoiten stimulating agents (ESA’s) in CKD

Answer 10

Hg < 10 (target Hg 10-11)
but other causes of anemia, including iron deficiency, hemoglobinopathies, vitamin B12 deficiency, and gastrointestinal blood loss, should be considered before beginning this therapy.

Question 11

hyponatremia correction guidelines with 3% saline in first 24 hours

Answer 11

4-6 meq/L

Question 12

interferon beta 1b side effects

Answer 12

• flulike symptoms after injections
• elevated serum aminotransferase levels
• lymphopenia, and worsening of underlying spasticity
• depression
• migraines

Question 13

Antimitochondrial antibodies

Answer 13

autoimmune hepatitis

Question 14

Antineutrophil cytoplasmic antibodies

Answer 14

vasculitis
-granulomatosis with polyangiitis (Wegener
granulomatosis)
-microscopic polyangiitis
-Churg-Strauss syndrome
anti–glomerular basement membrane disease
drug-induced vasculitis

Question 15

ANA

Answer 15

SLE

Question 16

painless jaundice + diffusely enlarged pancreas with a narrowed pancreatic duct + IgG4 positive

Answer 16

Autoimmune pancreatitis

Question 17

Autoimmune pancreatitis treatment

Answer 17

• trial of corticosteroids
• re-imaging to differentiate pancreatic cancer from AIP
• relapse when steroids withdrawn > immunomodulatory therapy (azathioprine)

Question 18

Dermatitis Herpetiformis treatment

Answer 18

Dapsone

Question 19

Chronic draining organisms/treatment pnemonic

Answer 19

SNAP
Sulfa (TMP/SMX)
Nocardia
Mycobacteria
Actinomyces

Question 20

Leukoplenia + PANCA

Answer 20

Levamizole

Question 21

Statin contraindicated in HIV

Answer 21

Simvastatin (Zocor)

Question 22

Crestor (rosuvastatin) reduction in LDL with starting dose (5 mg)

Answer 22

37-45%

Question 23

Aldactone indications in CHF

Answer 23

Class 2-4 CHF

Question 24

BRCA association in males

Answer 24

prostate cancer

male breast cancer

Question 25

Differentiating sign in smokers

Answer 25

elevated carboxyhemoglobin

Question 26

HgA1c - blood glucose equation

Answer 26

average blood glucose = (35.6*HgA1c)-77.3

Question 27

HgA1c - blood glucose correlations

Answer 27

``` HgA1c + 1 --> BG + 35 -------------------------------- 6 > 135 7 > 170 8 > 205 9 > 240 10 > 275 11 > 310 12 > 345 ```

Question 28

Prometheus panel

Answer 28

- IBD diagnostic test that combines serologic, genetic, and inflammation markers - differentiate IBD vs. non-IBD and CD vs. UC in one comprehensive blood test. -ASCA, OmpC, CBir1, Anti-A4-Fla2, Anti-FlaX

Question 29

Role of surrogate decision maker

Answer 29

make sure living will is carried out

Question 30

Heyde's syndrome

Answer 30

syndrome of aortic valve stenosis with gastrointestinal bleeding from colonic angiodysplasia

Question 31

differentiating COPD from alpha-1 AT

Answer 31

COPD > bullae in upper lobes | alpha-1 AT > bullae in lower lobes

Question 32

Asthma response to bronchodilators

Answer 32

-> 12% increased in FEV1 and -200 cc increase

Question 33

Paracentesis criteria for supplemental albumin

Answer 33

>5 L removed, then add albumin 25g

Question 34

Therapeutic Lovenox renal adjustment

Answer 34

-if Cr. clearance < 30 will decrease from q12 > q24

Question 35

Elective PCI without stent placement anticoagulation therapy

Answer 35

First month: ASA 81-325 + clopidogrel 75 After 1st month: single antiplatelet

Question 36

Bare metal stent anticoagulation therapy

Answer 36

First month: ASA 81-325 + clopidogrel 75 Months 2-11: low dose ASA 81 and clopidogrel 75 > 12 months: single anti platelet therapy *Cilostazol 100mg twice daily as a substitute in dual antiplatelet therapy only in patients with allergies or intolerances to ASA or clopidogrel

Question 37

Drug eluting stent (DES)

Answer 37

- First 3-6 months: ASA 81-325 + Clopidogrel 75 - After 3-6 months to 12 months: low dose ASA 81 and clopidogrel 75 > 12 months: single antiplatelet therapy *Cilostazol 100 mg twice daily as a substitute in dual antiplatelet therapy only in patients with allergies or intolerances to ASA or clopidogrel

Question 38

Lone AF antiarrythmic

Answer 38

class IC drugs (flecainide, propafenone) or sotalol

Question 39

CAD + AF antiarrythmic

Answer 39

class III drugs (amiodarone, dronedarone, sotalol, dofetilide)

Question 40

CHF + AF antiarrythmic

Answer 40

dofetilide or amiodarone