• Information
• Answers

1. A 62 year old patient is admitted to the intensive care unit for treatment of a dissecting aortic aneurysm. In order to control hypertension, the patient is given sodium nitroprusside by vein to a total dose of 5.5 milligrams per kg. The patient develops acute metabolic acidosis and an increased mixed venous oxygen content. The most likely cause of this event is due to toxicity from [1]:

   A. Cyanide
   B. Methanol
   C. Formic acid
   D. Oxalic acid
   E. Ethylene glycol

2. The patient's blood pressure in question 1 is difficult to control. Which agent in the list below should be used next in maintaining blood pressure prior to surgery [2]:

   A. Diltiazem (intravenous)
   B. Nicardipine (intravenous)
   C. Labetolol (intravenous)
   D. Metoprolol (intravenous)
   E. Nitroglycerine (intravenous)

3. A patient with a history of aortic stenosis at age 80 has a hip fracture that requires repair. She has no symptoms of aortic stenosis. An echocardiogram shows a gradient of 80 mm Hg over the aortic valve, mild left ventricular hypertrophy, an ejection fraction of 65% and normal wall motion. She is otherwise healthy with no other medical problems. You should recommend [3]:

   A. The patient should proceed with surgery
   B. The patient should have her aortic valve replaced first, surgery should be postponed
   C. The patient should have surgery with Swan (Pulmonary Artery Catheter) placed for management
   D. Cancel surgery and treat with traction
   E. The patient should have aortic valvuloplasty

4. A patient with atrial fibrillation takes atenolol and digoxin and at age 70 he is asymptomatic without hypertension. He has mild benign prostatic hyperplasia but no other medical conditions. What should you add [4] ?

   A. Aspirin 325 milligrams per day.
   B. Coumadin, dose to keep the INR between 2 and 3
   C. No additional treatments
   D. Low dose Coumadin approximately one to 2 milligrams per day
   E. Low dose heparin subcutaneously

5. A patient with Wolff-Parkinson-White pre-excitation syndrome comes in to the emergency room with tachycardia, diapheresis, and mental status changes. Her blood pressure is 60mm over Palpable. The patient is pale and diaphoretic and it is unable to give a history. The EKG shows a wide complex tachycardia. You should treat with [5]:

   A. Lidocaine bolus
   B. Adenosine bolus
   C. Procainamide bolus
   D. Acute cardioversion
   E. Intravenous amiodarone

6. The patient with WPW now recovers. You recommend follow-up with,

   A. Cardiac catheterization
   B. Aspirin 325 milligrams per day
   C. Coumadin, dose to the keep the INR between two to than three
   D. Amiodarone, 400mg per day loading dose for one week, then 200mg/day
   E. An electro-physiological study and ablation of the bypass and tract

7. A young man with sickle cell anemia disease is admitted to the hospital with chest pain, hypoxia, and low hematocrit. Laboratory evaluations show anemia and a vigorous reticulocyte count. You recommended [7]:

   A. V/Q scanning
   B. Intravenous fluids and exchange transfusion
   C. Bone marrow biopsy
   D. Observation
   E. Pain medications

8. A 50 year old man complains of a red, scratchy eye discomfort of acute onset. On physical exam there are red conjuctiva, no photophobia, and decreased vision. You recommend [8]:

   A. Referred to eye clinic in two weeks
   B. Treat with erythromycin eye ointment
   C. Refer immediately to eye clinic
   D. Reassure and advise saline eye drops
   E. Treat with pilocarpine or dorzolamide eye drops

9. A patient with significant nail pitting and arthritis likely has which rash?

   A. A pruritic vesicular rash around her wrist
   B. Silvery scaling over red plaques on elbows and knees
   C. A red malar rash over the face
   D. Non-blanching purpura on the lower legs
   E. Target-like rash lesions diffusely over the body

10. For a patient with a rash consistent with Erythema chronica migrans, you should [10]:

    A. Send serologies.
    B. Treat with antibiotics
    C. Treat only if arthritis is noted on exam.
    D. Biopsy the lesion
    E. Treat with topical steroid ointments

Answers

1. A
2. C (Both alpha and beta-adrenergic blocking activity is important.)
3. C (Patient has intermediate risk of poor outcome but can be managed with modern care.)
4. B
5. D (Unstable patients must be cardioverted.)
6. E
7. B
8. C (Any decrease in vision should prompt emergent evaluation by a specialist.)
9. B
10. B (Serologies require 2-4 months to become positive.)