Cardiology
A. Amiodarone
B. Epinephrine
C. Hypothermia
D. Time to initial defibrillation < 10 min
E. Vasopressin
Hypothermia has been confirmed as a benefit following out of hospital arrest in 2 studies. These trials showed that rapidly cooling to 32-34⁰C and maintaining these temperatures for 12-24 hours decreased in-hospital mortality and patients were 40-85% more likely to have good neurologic outcomes upon hospital discharge. None of these medications have ever demonstrated any effects on neurologic outcomes and only defibrillation within 5 minutes has the greatest likelihood for good neurologic outcomes.
A. Atrial septal defect
B. Pulmonary stenosis
C. Bicuspid aortic valve
D. Ventricular septal defect
E. Hypertrophic obstructive cardiomyopathy
This patient presents with a systolic murmur that varies with respiration. This makes it likely that the etiology is right sided, and given the location, pulmonary stenosis is more likely than tricuspid regurgitation. These right sided murmurs vary with respiration because filling of the right heart is influenced by changes in thoracic pressure.
A. Phenytoin intravenously
B. Carbamazepine orally
C. Pentobarbital intravenously
D. Ethosuximide orally
E. Diazepam rectally
Administration if IV lorazepam should be followed by the administration of phenytoin (or fosphenytoin) to control status epilepticus because the duration of action of lorazepam is limited. Carbamazepine is an effective anticonvulsant, but it cannot be given IV or IM. IV pentobarbital can be used but because the patient is not currently convulsing, induction of barbiturate coma is not indicated. Ethosuximide is indicated for the treatment of absence but not generalized tonic-clonic seizures. Rectal diazepam is used to abort seizures temporarily, especially in children.
A. Guillain-Barre syndrome
B. Chronic inflammatory demyelinating polyneuropathy
C. Vitamin B12 deficiency
D. Polymyositis
E. Cervical myelopathy
Chronic inflammatory demyelinating polyneuropathy is a cause of progressive predominantly motor neuropathy leading to distal weakness with associated loss of reflexes and possible sensory loss. Typically, bowel and bladder control is retained, and there is a paucity of pain. Vitamin B12 deficiency causes loss of lower extremity position and vibration perception. There can be mild leg weakness with evidence of an upper motor neuron lesion such as an extensor plantar response combined with hyporeflexia associated with a concurrent peripheral neuropathy. Cervical mylopathy causes lower extremity weakness with hyperreflexia. Sensory loss and bowel and bladder disordered function can be present. There is often neck discomfort. Upper extremity symptoms and signs can be present. Polymoysitis causes predominantly proximal weakness with sensory changes. Myalgias can be present. By definition, the weakness associated with Guillain-Barre syndrome does not progress beyond approximately 4 weeks. Therefore, the chronicity of this patient’s progressive symptoms excludes this diagnosis.
A. Lithium
B. Citalopram
C. Nortriptyline
D. Tranylcypromine
E. Trazodone
Tranylcypromine is a nonselective MAOI and may lead to serotonin syndrome if take with SSRIs due to an overall increase in serotonin. Serotonin syndrome is characterized by mental status changes, autonomic changes (fever, diaphoresis, tachycardia), and neuromuscular changes (tremor or rigidity).
Incorrect answers include:
Lithium – associated with tremor, hypothyroidism and nephrogenic diabetes insipidus.
Citalopram – SSRI associated with anxiety, insomnia, tremor, and nausea.
Nortriptyline – a tricyclic antidepressant associated with the 3 C’s: convulsions, coma, and cardiotoxicity.
Trazodone – a heterocyclic associated with sedation, nausea, priapism, and postural hypotension.
CME Webinar #8 – Gout Update
A. 4.0 mg/dL
B. 6.0 mg/dL
C. 8.0 mg/dL
D. 10.0 mg/dL
E. 12.0 mg/dL
New treatment guidelines for gout recommend decreasing uric acid levels to less than 6.0 mg/dL .
A. Thiazide diuretics
B. Niacin
C. Dairy products
D. A&B
E. All the above
Risk factors for gout include (A&B) thiazide diurectics, niacin and seafood. Protective factors for gout include: coffee, dairy products and low BMI.
A. One tablet at onset and daily x 3 days
B. One tablet bid x 3 days
C. Two tablets bid x 3 days
D. Two tablets at onset and one tablet one hour later
E. Two tablets at onset and daily x 3 days
FDA indications for colchicine include taking two tablets at onset and one tablet one hour later. The maximum dose in one hour is 1.8mg.
A. Negatively birefringent on polarized microscopy
B. Composed of calcium pyrophoshate
C. Shaped liked needles
D. All the above
E. None of the above
Migraine and Cluster Headaches (A&B) are indications for sumitriptan. Basilar and Hemiplegic headaches are contraindications.
CME Webinar #7 – Migraine Headache
A. Migraine Headache
B. Cluster Headache
C. Basilar & Hemiplegic Migraine
D. A&B
E. All the above
Migraine and Cluster Headaches (A&B) are indications for sumitriptan. Basilar and Hemiplegic headaches are contraindications.
CME Webinar #7 – Migraine Headache
A. Migraine Headache
B. Cluster Headache
C. Basilar & Hemiplegic Migraine
D. A&B
E. All the above
Migraine and Cluster Headaches (A&B) are indications for sumitriptan. Basilar and Hemiplegic headaches are contraindications.
A. Meningioma
B. Glioma
C. Pituitary adenoma
D. Malignant melanoma
E. Small cell carcinoma
The number one type of diagnosed primary brain tumor is Glioma making up 54-60% of tumors. Gliomas can be either benign or malignant and include: ependymomas, astrocytomas including glioblastoma multiforme, oligodendrogliomas and mixed gliomas .
A. 100mg / 20mg / 6mg
B. 100mg / 40mg / 12mg
C. 200mg / 20mg / 6mg
D. 200mg / 40mg / 12mg
E. 400mg / 80mg / 18mg
The recommended maximum daily dose for oral sumitriptan is 200mg.
The recommended maximum daily dose for nasal sumitriptan is 40mg.
The recommended maximum daily dose for subQ sumitriptan is 12mg.
A. Alcoholism
B. Upper Motor Lesions
C. Diabetes Mellitus
D. Vitamin Deficiencies
E. Lead poisioning
Of the choices, only Upper Motor Lesions can increase Deep Tendon Reflexes. Deep Tendon Reflexes are decreases with: peripheral neuropathy (most common cause), diabetes mellitus, alcoholism, amyloidoisis, uremia, vitamin deficiencies (pellagra, beriberi), pernicious anemia, and toxins (lead, arsenic, isoniazid).
A. Alcohol
B. Nitroglycerine
C. Ergotamine
D. A&B
E. All the above
Vasodilating triggers of migraines include Alcohol and Nitroglycerine (A&B). Ergotamine is a known vasoconstrictor.
A. > 20 mm H2O
B. > 50 mm H2O
C. > 100 mm H2O
D. > 250 mm H2O
E. > 400 mm H2O
In adults and children over 8, normal opening CSF pressure is < 200. Obese patients may have pressures up to 250 mm H20. Intracranial hypertension is diagnostic when the CSF opening pressure is > 250 mm H2O.
A. Ischemic heart disease
B. TIA
C. Uncontrolled hypertension
D. A&B
E. All the above
Contraindications for sumitriptan include Ischemic heart disease, Cerebrovascular syndromes (strokes, TIA), and Uncontrolled hypertension (All the above). Other contraindications include: peripheral vascular disease, severe hepatic impairment, use within 24 hours of ergotamine derivaties, management of hemiplegic or basilar migraine, and concurrent administration or within 2 weeks of discontinuing an MAO type A inhibitor.
A. Benign
B. Asymptomatic
C. Schwanomas
D. A&B
E. All the above
Most meningiomas are Benign (92%) and Asymptomatic (A&B). Schwanomas are a type of nerve sheath tumor and NOT a type of meningioma.
A. Ergot derivatives
B. MAO Inhibitors
C. Metoclopromide
D. A&B
E. All the above
Drug interactions with sumitriptan that give a Risk X and should be AVOIDED indclude Ergot derivaties and MAO Inhibitors(A&B). Drug interactions with sumitriptan that give a Risk C and therapy should be monitored include: antipsychotics, metoclopramide, and serotonin modulators.
A. Glioma
B. Pituitary adenoma
C. Meningioma
D. Neurofibroma
E. All the above
Bitemporal hemianopia is a symptom the can occur with Pituitary adenmas, if they are large enough to push on the optic chiasm.
CME Webinar #4 – Immunizations
A. Varicella
B. Measles, Mumps, Rubella
C. Haemophilus influenzae
D. Influenza
E. Meningococcal
Influenza vaccination should NOT be given if patients have an egg allergy. Measles, Mumps, & Rubella (MMR), varicalla, and polio vaccines should be avoided if patient has a neomycin allergy.
A. DTaP
B. Haemophilus influenzae
C. Measles, Mumps, Rubella
D. Polio
E. All the above can be given at 2, 4, and 6 months
Measles, Mumps, & Rubella (MMR) vaccine should NOT be given at the 2, 4, and 6 months but rather at one year (12-15 months) and repeated at 4-6 years.
The following vaccines can be given at 2, 4, and 6 months:
A. 1 mg
B. 2.6 mg
C. 4 mg
D. 1 gram
E. 2.6 grams
Acetaminophen is more commonly known around the world at paracetamol. In adults, the maximum daily dose of acetaminophen/paracetamol is 4 grams, usually divided 325 or 650 mg PO/PR every 4-6 hours PRN. In infants and children, the maximum daily dose of acetaminophen/paracetamol is 2.6 grams, usually divided 10-15 mg/kg/dose every 4-6 hours PRN.
A. 10 μg/dL
B. 25 μg/dL
C. 45 μg/dL
D. 65 μg/dL
E. 100 μg/dL
In May of 2012, the CDC changed their definition of a “blood lead level of concern” in children from 10 μg/dL to 5 μg/dL. What did not change was their recommendation of chelation therapy that should be started when the child’s lead level is 45 μg/dL or higher.
A. Erythromycin
B. Azithromycin
C. Clarithromycin
D. Bactrim
E. Vancomycin
The only medication recommended to treat pertussis in children less than 1 month is Azithromycin at a dose of 10mg/kg/day. Clarithromycin and Erythromycin are appropriate treatments but are not recommended for children under one month. Bactrim is contraindicated for children less than 2 months. Vancomycin is not an appropriate treatment for pertussis.
Webinar #3 – Heparin Induced Thrombocytopenia
Webinar #2 – Infective Endocarditis
A. Ceftriaxone (Rocephin)
B. Vancomycin (Vancocin)
C. Ampicillin-sulbactam (Unasyn)
D. A&B
E. All the above
A.
B.
C.
D.
E.
A. Crystal Violet
B. Iodine
C. Alcohol
D. Safranin
E. Crimson
A. Hepatotoxicity
B. Nephrotoxicity
C. Neurotoxicity
D. Suprainfection
E. All the above are adverse reactions with Gentamicin
Possible adverse reactions with Gentamicin include: pain at the injection site and thromophlebitis (~1%). Less common adverse reactions include Nephrotoxicity, Neurotoxicity and Suprainfections of other bacteria or fungi with prolonged use. Hepatotoxicity is not an adverse reaction with Gentamicin.
A. Janeway lesions
B. Osler nodes
C. Splinter hemorrhages
D. Roth spots
E. None of the above
Webinar #1 – Acid/Base Disorders
A. Use of saw palmetto
B. Radioimmunotherapy with ibritumomab tiuxetan
C. Treatment with finasteride
D. Tamoxifen
E. Androgen blockade
Prostate cancer cells are responsive to testosterone withdrawal. Total androgen blockade can be accomplished by the administration of luteinizing hormone-releasing hormone antagonists and drugs that would block the biosynthetic pathway of testosterone production. Tamoxifen is an antiestrogen agent that does not have a role in the treatment of prostate cancer. Both saw palmetto and finasteride are used for BPH and do not have significant effects on prostate cancer cells.
A. 24 hr urine calcium excretion
B. Serum ionized calcium
C. Serum intact parathyroid hormone (PTH)
D. Computed tomography of the neck
E. Serum phosphate
An elevated level of serum intact PTH, in the absence of renal failure or other cause of secondary hyperparathyroidism, is strong evidence for primary hyperparathyroidism. A high normal PTH is also compatible with primary hyperparathyroidism because the PTH should be suppressed due to the hypercalcemia and is, there fore, inappropriately elevated. In hypercalcemia of other causes (e.g., with cancer, sarcoidosis, or excessive vitamin D intake), the PTH level is suppressed by the hypercalcemia nd is low (or normal).
A. Quinidine
B. Lidocaine
C. Procainamide
D. Phenytoin
E. Propranolol
Propranolol is a beta blocker and beta blockers form the antiarrhythmic group II.
A. Amyl nitrate
B. Esmolol
C. Nitroglycerin (sublingual)
D. Nitroglycerin (transdermal)
E. Hydralazine
Transdermal nitroglycerin can sustain blood levels for as long as 24 hours but because tolerance can occur, it is recommended that the patch be removed after 10 to 12 hours to allow recovery of sensitivity. Esmolol (IV), amyl nitrite, and sublingual nitroglycerin all have short durations of actions. Hydralazine may actually precipitate an anginal attack.
A. Procainamide
B. Lidocaine
C. Metoprolol
D. Verapamil
E. Quinidine
Numerous studies show that Beta blockers such as Metoprolol help prevent cardiac arrhythmias that occur related to myocardial infarctions. None of the other medications listed have been proven to be more effective.
A. Clonidine
B. Enalapril
C. Diltiazem
D. Losartan
E. Hydrochlorothiazide
Increased sympathetic nervous system activity occurs if clonidine is abruptly stopped after prolonged administration causing uncontrolled elevation in blood pressure. Patients should be slowly weaned from clonidine while other antihypertensive medications are initiated.
A. Digoxin
B. Enalapril
C. Dopamine
D. Metoprolol
E. Dobutamine
Heart failure usually causes a decrease in cardiac output and the body will naturally try to compensate by sympathetic stimulation. Beta blockers such as metoprolol prevent this increased heart rate and renin release. Enalapril is an ACE-inhibitor that will actually increase renin release. Digoxin slows the heart rate because of its vagomimetic effects, but does not affect renin release. Dopamine and Dobutamine are positive inotropic medications and neither decreases heart rate or affects renin release.
A. Fenofibrate
B. Niacin
C. Cholestyramine
D. Gemfibrozil
E. Atorvastatin
The primary producer of circulating free fatty acids is lipolysis in adipose tissue. The liver normally utilized these free fatty acids as a major precursor for triacylglycerol synthesis. Niacin strongly inhibits adipose lipolysis and hence decreases the free fatty acids needed in liver triacylglycerol synthesis and VLDL production.
A. Anticholinergic
B. Thiazide diuretic
C. Loop diuretic
D. Carbonic anhydrase inhibitor
E. Beta blocker
Acetazolamine is a carbonic anhydrase inhibitor that is used prophylactically for severaly days before an ascent above 10,000 feet. This treatment helps prevent nausea and cerbral and pulmonary complications associated with acute mountain sickness.
A. Nedocromil
B. Triamcinolone
C. Cromolyn
D. Albuterol/ipratropium
E. Proair HFA
Because older inhalers contain an ozone-depleating chlorofluorocarbon propellant they are being discontinued by the FDA. Proair HFA is the is the NEW formulary of albuterol sulfate that contains the environmentally friendly hydrofluoroalkanes.
A. Salmeterol
B. Formoterol
C. Omalizumab
D. A&B
E. All the above
A&B, both Salmeterol and Formoterol are long long-acting B2-agonists. Omalizumab is a recombinant DNA-derived monoclonal antibody that selectively binds to human immunoglobulin E (IgE), and may be used to treat moderate to severe allergic asthma in patiients who are poorly controlled with conventional therapy.
A. Hypoglycemia
B. Somulence
C. Nausea
D. Lactic acidosis
E. All the above
Lactic Acidosis is the most dangerous adverse effect of metformin administration with death resulting in approximately 50 percent of individuals who develop lactic acidosis while on this drug. Metformin does not induce insulin production; thus, administration does not result in hypoglycemic events. Some nausea, vomiting, and diarrhea may develop but is usually not severe AND N/V/D is not specific to metformin. Metformin does not induce sleepiness.
A. Thromboembolic complications
B. Stroke
C. Early or mid-cycle bleeding
D. A&B
E. All the above
Serious adverse effects of oral contraceptives include A&B, thromboembolic complications (DVT), stroke, and myocardial infarction. These risks are increased in women who smoke. Early or mid-cycle bleeding are effects of estrogen deficiency.
A. Reye's syndrome
B. Cholinergic effects
C. Paradoxical CNS stimulation
D. Nausea
E. Diarrhea
Typically, first generation OTC antihistamines have a sedating effect because of passage into the CNS. However, in some individuals, especially infants and children, paradoxical CNS stimulation occurs and is manifested by excitement, euphoria, restlessness, and confusion. For this reason, use of first generation OTC antihistamines has declines, and second generation product usage has increased. Reye’s syndrome is a systemic response to a virus. First generation OTC antihistamines do not exhibit a cholinergic effects and do not commonly cause nausea or diarrhea.
A. Seizures
B. Hyperpyrexia
C. Metabolic acidosis
D. Cardiac arrhythmias
E. Pulmonary Fibrosis
Excessive ingestion of TCAs result in life-threatening cardiac arrhythmias with wide QRS complex tachycardia. TCA overdose can induce seiures, but they are typically not life-threatening. TCAs do not cause an elevation in body temperature, metabolic acidosis or pulmonary fibrosis.
A. It is not associated
B. It is irreversible
C. It is always symptomatic
D. All the above
E. None of the above
None of the above. Prolonged use of a proton pump inhibitor (PPI) can lead to hypomagnesemia as noted by the FDA. While most patients who take PPIs for a long time do not develop hypomagnesemia, about 30 cases of severe hypomagnesemia have been reported in long-term PPI users. When the PPI was stopped, serum magnesium levels returned to normal in less than 2 weeks. The exact mechanism is unknown. Patients also taking other drugs that cause hypomagnesemia, such as diuretics and digoxin, may be at increased risk.
A. Hypocalcemia
B. Hypokalemia
C. Weakness
D. All the above
E. None of the above
All the above. Hypomagnesemia is often accompanied by hypocalcemia and hypokalemia. Patients with hypomagnesemia often do not have symptoms but they may include muscle weakness, tremor, muscle cramps, carpopedal spasm, tetany, seizures, and cardiac conduction disturbances and arrhythmias.
A. Hepatoxicity because the dosage of acetaminophen is higher than recommended
B. Hepatoxicity because morphine increases serum concentrations of acetaminophen
C. Acetaminophen may mask a post-operative fever that could be a sign of infection
D. Acetaminophen could have an additive effect on respiratory depression due to morphine
E. None of the above
Acetaminophen may mask a post-operative fever that could be a sign of infection due to its antipyretic effects. IV acetaminophen does not affect respiratory depression and has not been associated with hepatotoxicity, but overdose can cause serious or fatal hepatic injury. IV analgesic adult dosage is 1000mg q6h or 650 mg q4hr (max: 4,000 mg/d). Given in conjunction with an opiod for moderate to severe pain, it has been shown to have an opiod-sparing effect.
A. Testicular torsion
B. Cyst of the epididymis
C. Epididymo-orchitis
D. Lipoma of the cord
E. Testicular cancer
Painless solid tumors in the testes are testicular caner until proven otherwise. Nonhematogenous testicular tumors are divided into 2 categories – germ cell tumors (seminoma, nonseminoma [embryonal, choriocarcinoma, teratoma, teratocarcinoma, yolk sac tumors]) and nongerm cell tumors (Leydig cell or Sertoli cell). There is no mass within the testis with torsion. Epididymitis presents with a painful tender testis.
A. Thymoma
B. Neurogenic tumor
C. Lymphoma
D. Teratodermoid tumor
E. Pheochromocytoma
The most common cause of primary mediastinal tumor is a neurogenic tumor (20-25%), and 10% are malignant (more likely in children). They usually arise form an intercostal nerve or sympathetic ganglion. Varieties of neurogenic turmors include schwannoma, neurofibroma, ganglioneuroma, and neuroblastoma. Next in frequency (of primary mediastinal tumors) are thymoma, congenital cysts, and lymphoma.
A. Incarcerated
B. Irreducible
C. Sliding
D. Interstitial
E. None of the above
A sliding hernia refers to the peritoneum that slides along with the hernia in its passage along the cord. The viscus forms part of the wall of the sac. The peritoneum should not be removed from the bowel wall, because devascularization may occur.
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