Travel and Bloody Diarrhea Quiz
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Questions and Answers

What is the primary acid-base disturbance observed during the first 20 minutes of aspirin toxicity?

  • Mixed metabolic acidosis-respiratory alkalosis
  • Respiratory alkalosis (correct)
  • Metabolic alkalosis
  • Respiratory acidosis

    • What is the treatment for hypercalcemia when the calcium level is between 10.2 to 12 mEq/L?

  • Normal saline (0.9% NaCl) regardless of symptoms (correct)
  • Normal saline (0.9% NaCl) only if symptomatic
  • Calcium supplementation
  • Bisphosphonate immediately

    • What type of incontinence is characterized by a need to rush to the bathroom triggered by the sound of a key in a door?

  • Functional incontinence
  • Stress incontinence
  • Urge incontinence (correct)
  • Overflow incontinence

    • Which of the following symptoms is indicative of Wernicke encephalopathy?

    <p>Ataxia and confusion</p> Signup and view all the answers

    What is the expected calcium and PTH status in a patient with hypercalcemia due to sarcoidosis?

    <p>High calcium and low PTH</p> Signup and view all the answers

    What is the pharmacological treatment for urge incontinence?

    <p>Oxybutynin</p> Signup and view all the answers

    In cases of chronic respiratory acidosis accompanied by confusion, which electrolyte disturbance may be suspected?

    <p>Hypercalcemia</p> Signup and view all the answers

    What is the treatment approach for TCA toxicity?

    <p>Sodium bicarbonate</p> Signup and view all the answers

    What is the most common cause of otitis media?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    What is the appropriate treatment for recurrent otitis media?

    <p>Amoxicillin/clavulanate</p> Signup and view all the answers

    In which situation should tympanostomy tubes be considered?

    <p>Three or more episodes of otitis media in 6 months</p> Signup and view all the answers

    What indicates iron deficiency anemia based on hematocrit and serum markers?

    <p>Low hematocrit + low MCV + high transferrin</p> Signup and view all the answers

    Which condition is characterized by microcytic anemia that does not improve with iron supplementation?

    <p>Thalassemia</p> Signup and view all the answers

    What is the recommended treatment for anemia of chronic disease if renal failure is the cause?

    <p>Erythropoietin (EPO)</p> Signup and view all the answers

    In a patient with normotensive stroke, what diagnostic test should be performed first?

    <p>Electrocardiogram (ECG)</p> Signup and view all the answers

    What is a common cause of anovulation accompanied by hirsutism in females?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    What is the effect of abnormal GnRH pulsation in terms of LH/FSH ratio in anovulation?

    <p>It leads to a high LH/FSH ratio.</p> Signup and view all the answers

    What primary role does FSH play in the female reproductive system?

    <p>Stimulates granulosa cells to produce aromatase.</p> Signup and view all the answers

    Which treatment approach is recommended first for a patient with PCOS and a high BMI?

    <p>Weight loss.</p> Signup and view all the answers

    How does PCOS increase the risk of endometrial cancer?

    <p>Due to high levels of unopposed estrogen.</p> Signup and view all the answers

    Which treatment is appropriate for acute gout if indomethacin is not effective?

    <p>Colchicine.</p> Signup and view all the answers

    What type of crystals is diagnosed in pseudogout?

    <p>Calcium pyrophosphate crystals.</p> Signup and view all the answers

    What is the genetic basis of Lesch-Nyhan syndrome?

    <p>X-linked HGPRT deficiency.</p> Signup and view all the answers

    What is the primary role of leuprolide in the treatment of prostate cancer?

    <p>Inhibits testosterone production.</p> Signup and view all the answers

    What is the most specific antibody for systemic lupus erythematosus (SLE)?

    <p>Anti-Sm (anti-Smith)</p> Signup and view all the answers

    Which is the next best step in diagnosing viral-induced aplastic anemia?

    <p>Bone marrow aspiration</p> Signup and view all the answers

    What is the mechanism behind immune thrombocytopenic purpura (ITP)?

    <p>Antibodies against GpIIb/IIIa on platelets</p> Signup and view all the answers

    What treatment is considered the most effective way to decrease recurrence of ITP episodes?

    <p>Splenectomy</p> Signup and view all the answers

    Which laboratory finding is characteristic of hemophilia?

    <p>Normal PT and increased aPTT</p> Signup and view all the answers

    What is the main role of von Willebrand Factor (vWF)?

    <p>Promoting platelet adhesion</p> Signup and view all the answers

    Which of these statements about the heme findings in immune thrombocytopenic purpura (ITP) is accurate?

    <p>Increased bleeding time, normal PT, normal aPTT</p> Signup and view all the answers

    Which of the following drugs is associated with drug-induced lupus?

    <p>Penicillamine</p> Signup and view all the answers

    Which treatment is considered a last resort for asthma management?

    <p>Oral steroids</p> Signup and view all the answers

    What is the confirmatory diagnostic method for Goodpasture syndrome?

    <p>Renal biopsy showing linear immunofluorescence</p> Signup and view all the answers

    Which condition is indicated by hematuria combined with eosinophilia?

    <p>Churg-Strauss syndrome</p> Signup and view all the answers

    A patient with chronic mucocutaneous candidiasis has impaired cell-mediated immunity due to which dysfunction?

    <p>T cell dysfunction</p> Signup and view all the answers

    In the case of acute pancreatitis, which diagnostic marker is most indicative of choledocholithiasis?

    <p>High ALP with high direct bilirubin and normal amylase</p> Signup and view all the answers

    Which imaging technique is best suited for viewing gallbladder disease?

    <p>Ultrasound</p> Signup and view all the answers

    What is the most effective way to decrease the recurrence of asthma symptoms in a pediatric patient already using a SABA?

    <p>Initiating ICS therapy</p> Signup and view all the answers

    What is the typical test to diagnose primary biliary cirrhosis (PBC)?

    <p>Anti-mitochondrial antibodies test</p> Signup and view all the answers

    Which fungal infection is characterized by a history of a rose thorn injury?

    <p>Sporotrichosis</p> Signup and view all the answers

    In a patient presenting with fever and abdominal pain post-cholecystectomy, which condition should be suspected?

    <p>Post-operative bile leak</p> Signup and view all the answers

    In patients with SCID, what is the most common infectious presentation?

    <p>Bacterial, fungal, protozoal, and viral infections</p> Signup and view all the answers

    Which test is next best after identifying antibodies in Goodpasture syndrome?

    <p>Renal biopsy</p> Signup and view all the answers

    What is the hallmark histological feature of Wegener's granulomatosis?

    <p>C-ANCA positivity</p> Signup and view all the answers

    With high ALP, high direct bilirubin, and normal amylase or lipase after a remote cholecystectomy, what is the likely diagnosis?

    <p>Pancreatic cancer</p> Signup and view all the answers

    What is the primary role of von Willebrand factor (vWF) in platelet function?

    <p>To bridge platelet GpIb to collagen</p> Signup and view all the answers

    Which of the following is an expected clinical manifestation of von Willebrand disease (vWD)?

    <p>Menorrhagia</p> Signup and view all the answers

    What underlying condition often causes vitamin K deficiency in adults?

    <p>Chronic antibiotic use</p> Signup and view all the answers

    What mutation is responsible for sickle cell disease?

    <p>Glutamic acid to valine</p> Signup and view all the answers

    Which drug is commonly used to increase the release of von Willebrand factor?

    <p>Desmopressin</p> Signup and view all the answers

    What is the strongest indication for anticoagulation therapy?

    <p>Prosthetic valve in the heart</p> Signup and view all the answers

    Which class of antibiotics is often used for the treatment of febrile neutropenia?

    <p>Broad-spectrum IV antibiotics</p> Signup and view all the answers

    How is ganciclovir primarily used in medical treatment?

    <p>Treatment of cytomegalovirus infections</p> Signup and view all the answers

    At what age should the first dose of the MMR vaccine be administered?

    <p>12-15 months</p> Signup and view all the answers

    What is the correct follow-up vaccine for individuals aged 65 or older who received the Pneumo PCV13?

    <p>PPSV23</p> Signup and view all the answers

    In individuals with centri-acinar emphysema, what is the most likely contributing factor?

    <p>Cigarette smoking</p> Signup and view all the answers

    What characteristic of emphysema is typically observed in a young adult non-smoker with a family history of hepatic cirrhosis?

    <p>Pan-acinar emphysema</p> Signup and view all the answers

    In cases of restrictive lung disease, how is the FEV1/FVC ratio typically affected?

    <p>Normal or increased</p> Signup and view all the answers

    What is the primary result of the acid-base disturbance in aspirin toxicity after the first 20 minutes?

    <p>Mixed metabolic acidosis-respiratory alkalosis</p> Signup and view all the answers

    Which treatment is recommended for symptomatic hypercalcemia with levels above 14 mEq/L?

    <p>Normal saline with additional therapies</p> Signup and view all the answers

    What is the underlying cause of low calcium or potassium levels that do not respond to supplementation?

    <p>Hypomagnesemia</p> Signup and view all the answers

    Which condition is primarily indicated by ataxia, confusion, and ophthalmoplegia?

    <p>Wernicke encephalopathy</p> Signup and view all the answers

    What is the main characteristic symptoms of urge incontinence in a patient with multiple sclerosis?

    <p>Sudden urge to urinate</p> Signup and view all the answers

    In a young African American woman presenting with a dry cough and normal chest X-ray findings, what is the most likely diagnosis?

    <p>Asthma</p> Signup and view all the answers

    Which treatment is commonly used for urge incontinence if pelvic floor exercises are insufficient?

    <p>Oxybutynin</p> Signup and view all the answers

    What is the reasoning behind hypercalcemia seen in sarcoidosis with low PTH levels?

    <p>Vitamin D related hypercalcemia</p> Signup and view all the answers

    What is the most common cause of otitis externa?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What is the typical treatment for earwax buildup?

    <p>Carbamide peroxide drops</p> Signup and view all the answers

    Which laboratory findings are indicative of iron deficiency anemia?

    <p>Low hematocrit, low MCV, low ferritin</p> Signup and view all the answers

    In a patient presenting with anemia and low hematocrit, what abnormality is expected in thalassemia?

    <p>Normal iron and normal ferritin</p> Signup and view all the answers

    Which treatment is appropriate for patients with anemia of chronic disease when renal failure is not the cause?

    <p>Treating the underlying condition</p> Signup and view all the answers

    What characterizes the hematological profile in iron deficiency anemia compared to thalassemia?

    <p>Increased RDW</p> Signup and view all the answers

    In patients with recurrent otitis media, when is a tympanostomy tube indicated?

    <p>Four or more episodes in a year</p> Signup and view all the answers

    What is the treatment for otitis media caused by Streptococcus pneumoniae?

    <p>Oral amoxicillin</p> Signup and view all the answers

    What causes hirsutism in women experiencing anovulation?

    <p>High LH/FSH ratio due to abnormal GnRH pulsation</p> Signup and view all the answers

    Why does a high LH/FSH ratio contribute to anovulation and PCOS?

    <p>It causes follicular maturation without ovulation</p> Signup and view all the answers

    What is the role of FSH in the female reproductive system?

    <p>Promotes the production of aromatase in granulosa cells</p> Signup and view all the answers

    What is the first-line treatment for a patient with PCOS and a high BMI?

    <p>Weight loss</p> Signup and view all the answers

    Which treatment should be avoided in patients with a history of uric acid stones?

    <p>Probenecid</p> Signup and view all the answers

    In patients with pseudogout, what is the main crystal type found?

    <p>Calcium pyrophosphate crystals</p> Signup and view all the answers

    What is the most effective drug for acute gout treatment in patients with renal insufficiency?

    <p>Steroids</p> Signup and view all the answers

    What is the genetic cause of Lesch-Nyhan syndrome?

    <p>HGPRT deficiency</p> Signup and view all the answers

    What symptom is typically associated with a platelet problem in von Willebrand disease (vWD)?

    <p>Petechiae</p> Signup and view all the answers

    What is the secondary function of von Willebrand factor (vWF) in the blood?

    <p>Stabilizes factor VIII in plasma</p> Signup and view all the answers

    Which of the following drugs is associated with causing agranulocytosis?

    <p>Clozapine</p> Signup and view all the answers

    What is a common clinical presentation of sickle cell disease related to the kidneys?

    <p>Renal papillary necrosis</p> Signup and view all the answers

    What is the recommended treatment for febrile neutropenia?

    <p>Immediate broad-spectrum IV antibiotics</p> Signup and view all the answers

    Which condition is indicated by a deficiency of vitamin K?

    <p>Increased PT and aPTT with normal bleeding time</p> Signup and view all the answers

    What inherent genetic inheritance pattern does sickle cell disease possess?

    <p>Autosomal recessive</p> Signup and view all the answers

    Which of the following best describes the role of desmopressin in the treatment of von Willebrand disease?

    <p>Increases release of von Willebrand factor</p> Signup and view all the answers

    What is the primary treatment for sarcoidosis?

    <p>Steroids</p> Signup and view all the answers

    Which of the following conditions is characterized by hematuria and hemoptysis?

    <p>Goodpasture syndrome</p> Signup and view all the answers

    In the diagnosis of primary biliary cirrhosis (PBC), which antibody is most indicative?

    <p>Anti-mitochondrial antibodies</p> Signup and view all the answers

    Which treatment is recommended as a last resort for managing asthma symptoms?

    <p>Oral steroids</p> Signup and view all the answers

    What is the most effective way to decrease the recurrence of asthma in a child already using a SABA?

    <p>Inhaled corticosteroids</p> Signup and view all the answers

    What type of imaging is preferred for viewing gallbladder in suspected cholecystitis?

    <p>Ultrasound</p> Signup and view all the answers

    Which finding is typical in a patient with chronic mucocutaneous candidiasis?

    <p>T cell dysfunction</p> Signup and view all the answers

    What is the mechanism of action for Bruton’s agammaglobulinemia?

    <p>Tyrosine kinase mutation</p> Signup and view all the answers

    Which condition is associated with eosinophilia in an asthma patient?

    <p>Churg-Strauss syndrome</p> Signup and view all the answers

    In a patient who had a recent cholecystectomy with fever and abdominal pain, what condition should be suspected?

    <p>Post-op bile leak</p> Signup and view all the answers

    What is the confirmatory test for Goodpasture syndrome?

    <p>Renal biopsy</p> Signup and view all the answers

    What is the next best step for a patient diagnosed with choledocholithiasis?

    <p>ERCP</p> Signup and view all the answers

    In Churg-Strauss syndrome, which laboratory marker is typically observed?

    <p>p-ANCA</p> Signup and view all the answers

    Which condition is typically characterized by greasy, scaly scalp with itchy papules in adults?

    <p>Seborrheic dermatitis</p> Signup and view all the answers

    Study Notes

    Travel Diarrhea

    • Traveler diarrhea is often caused by ETEC, HL or HS toxins. Bloody diarrhea after poultry consumption is often Campylobacter jejuni or Salmonella.
    • Antibiotic use associated with diarrhea can cause C. difficile.
    • Fever of 104°F + abdominal distension with C.diff suggests toxic megacolon and warrants a laparotomy.
    • Treatment for C.diff is vancomycin, not metronidazole.
    • Bloody diarrhea and travel history could be Entamoeba histolytica.
    • Treatment is metronidazole + iodoquinol or paromomycin.
    • Close quarters, military, cruise ship or other similar environments + watery diarrhea could be Norwalk virus.
    • Children <5 years with watery diarrhea, Rotavirus is likely.

    Bloody Diarrhea

    • Few organisms causing bloody diarrhea are Shigella.
    • Bloody diarrhea +appendicitis-like pain in a child might be Yersinia enterocolitica.
    • Bloody diarrhea + reactive arthritis in a adult could be related to Y. enterocolitica, Campylobacter, Shigella or Salmonella.
    • Diarrhea and Guillain-Barré syndrome might indicate Campylobacter infection.

    Cardiac Ischemia

    • ECG stress test is first-line for evaluating suspected cardiac ischemia.
    • If baseline ECG shows abnormalities (e.g., BBB), an echo stress test may be necessary.
    • A dobutamine stress echo is indicated for those unable to exercise on an ECG stress test.

    Pericarditis

    • Diffuse ST-segment elevations on ECG suggest pericarditis.
    • Pericarditis is often associated with central chest pain that is worsened when lying supine and improved when leaning forward.
    • Pericarditis following viral infection can lead to increased creatine kinase.
    • Posterior MI is suggested by ST-segment depressions in anterior ECG leads.
    • Pericardial effusion or tamponade presents with pulsus paradoxus (systolic blood pressure drop >10 mmHg with inspiration).
    • Beck's triad (hypotension; muffled heart sounds; jugular venous distension) strongly suggests pericardial tamponade.

    Pneumonia

    • Pneumonia in CF patients <10 years is most commonly caused by S. aureus and >10yrs by Pseudomonas.
    • Pneumonia following influenza infection is commonly caused by S. aureus.
    • Pneumonia associated with rabbits is F. tularensis
    • Pneumonia associated with cattle is Coxiella (Q fever)
    • Pneumonia associated with birds is Chlamydia psittaci

    Pulmonary Embolism

    • Leg swelling, pain, shortness of breath signifies pulmonary embolism potentially caused by deep vein thrombosis.
    • In pregnant women, V/Q scan instead of CT is required for PE diagnosis and management.
    • Someone already on warfarin (blood thinner) needs a spiral CT to confirm and an IVC filter for treatment.

    Acid-base disturbances

    • Respiratory alkalosis (low CO2, high pH) is common in PE and asthma.
    • Aspirin toxicity also causes respiratory alkalosis during the initial 20 minutes.

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    Test your knowledge on the causes, symptoms, and treatments of travel and bloody diarrhea. This quiz covers key pathogens, diagnostic criteria, and appropriate management strategies. Ideal for students of medicine or healthcare professionals.

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