The Big Heart Disease Lie

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DIRECTIONS: Each question below contains five suggested responses. Choose the one best response to each question.

250. Which one of the following drugs is LEAST likely to result in thrombocytopenia?

(A) Heparin

(B) Quinine

(C) Quinidine

(D) Estrogen

(E) Heroin

251. All of the following statements regarding platelet abnormalities are TRUE EXCEPT

(A) bleeding complications may arise if platelets are < 50,000/^L

(B) patients are at risk for spontaneous bleeding if platelet counts are < 10,000/^L

(C) when platelets drop below 10,000/^L, the patient should receive a platelet transfusion

(D) patients with ITP respond well to platelet transfusion

(E) each unit of platelets transfused should raise the platelet count by about 10,000/^L

252. A suicidal 28-year-old male ingested a handful of rodenticide pellets containing brodifacoum 30 min before ED presentation. Paramedics administered 1 mg/kg of activated charcoal en route to the hospital. The patient is awake and alert, with normal vital signs. There is no evidence of mucosal bleeding, skin bruising, or abdominal pain. A test for occult fecal blood is negative. Laboratory examinations for prothrombin time (PT), partial thromboplastin time (PTT), complete blood count (CBC), and platelets are all normal. What is the MOST appropriate action?

(A) Give additional charcoal, observe for 2 h, and discharge to psychiatry if stable

(B) Admit and request urgent psychiatric consultation

(C) Administer vitamin K 1 mg intravenously, observe for 2 h, and discharge to psychiatry if stable

(D) Administer vitamin K 5 mg subcutaneously, observe for 4 h, and discharge to psychiatry if stable

(E) Admit, mobilize pharmacy resources to assess vitamin K inventory, and obtain psychiatric consultation

253. All of the following antibiotics are associated with drug-induced deficiencies of vitamin K-dependent factors EXCEPT

(A) cefotaxime

(B) trimethoprim

(C) cefoperazone

(D) moxalactam

(E) cefamandole

254. All of the following proteins require vitamin K to function properly EXCEPT

(A) factor II (prothrombin)

(B) factor VII

(E) antithrombin III

255. All of the following statements regarding fresh frozen plasma (FFP) are TRUE EXCEPT

(A) it contains all factors

(B) intravenous administration can lead to volume overload

(C) viral transmission is possible with transfusion

(D) it is a first-line treatment for uremic patients with bleeding

(E) it is a first-line treatment for bleeding patients with a coagulopathy

256. A 50-year-old male presents with a crush injury to the left lower extremity. He underwent a 45-min extrication after an accident at a construction site. Peripheral pulses are intact, but sensorimotor function is diminished. He is hemodynamically stable after standard resuscitation, but the wound site continues to bleed despite a pressure dressing. Available laboratory results include hemoglobin of 12, hematocrit of 32, platelet count of 45,000/^L, PT of 18, and fibrinogen of 80 mg/dL. The surgical team has been called to treat the wound. While awaiting their arrival, all of the following are appropriate interventions EXCEPT

(B) type and screen 2 units of packed red blood cells

(C) give cryoprecipitate, 10 bags

(D) give platelets, 6 packs

(E) give low-molecular-weight heparin

257. All of the following statements concerning heparin therapy are TRUE EXCEPT

(A) it facilitates antithrombin III binding to activated factors II, IX, XI, and XII

(B) the most common complication is bleeding

(C) one milligram of protamine sulfate neutralizes 1000 units of heparin

(D) thrombocytopenia is a common complication

(E) co-use of cimetidine or NSAIDs increases bleeding risk

258. All of the following statements regarding thrombo-cytopenia in the setting of heparin use are TRUE EXCEPT

(A) the incidence is lower with low-molecular-weight heparin

(B) the most common form is transient and seldom lowers the platelet count below 100,000/^L

(C) the type with platelet antibody formation can be life threatening and may lower the platelet count below 50,000/^L

(D) arterial thromboses can occur in the more severe form

(E) patients must have a previous exposure to heparin to develop anti-platelet antibodies

259. All of the following statements regarding thrombo-lytic drugs are TRUE EXCEPT

(A) they are contraindicated if the patient has a history of hemorrhagic stroke

(B) they cannot be used if the patient has active bleeding

(C) they must be avoided if aortic dissection is suspected

(D) they decrease pulmonary artery pressures, improve reperfusion, and increase survival after massive pulmonary embolus

(E) they are indicated for treatment of acute myocardial infarction

260. Which one of the following is the LEAST common hematologic complication of HIV?

(A) Thrombocytopenia

(B) Anemia

(D) Thrombotic thrombocytopenic purpura (TTP)

(E) Acquired circulating antibodies

261. All of the following statements regarding factor VIII inhibitors are TRUE EXCEPT

(A) PTT is normal, but the PT is prolonged

(B) these inhibitors may develop in patients with previously normal hemostasis

(C) if present, mortality rate approaches 50 percent

(D) these inhibitors may develop in patients with underlying conditions such as pregnancy and autoimmune or lymphoproliferative disorders

(E) these inhibitors can be seen in patients with congenital factor VIII deficiency (hemophilia A)

262. All of the following statements regarding lupus anticoagulant are TRUE EXCEPT

(A) it is an antiphospholipid antibody that interferes with coagulation

(B) most patients with lupus anticoagulant do not have lupus (SLE) or a clinical bleeding disorder

(C) affected patients are at risk for arterial and venous thrombosis

(D) affected women may have recurrent fetal loss

(E) it is associated with a normal PTT

263. A 15-year-old male with hemophilia A presents with hoarseness, stridor, and anterior neck swelling after an assault in which he sustained a "karate chop" to the throat. What is MOST appropriate sequence of actions?

(A) endotracheal intubation, factor VIII replacement, neck CT

(B) factor VIII replacement, lateral soft-tissue film of the neck

(C) factor VIII replacement, neck CT, close observation for need to intubate

(D) check PTT and factor VIII assay, neck CT, close observation for need to intubate

(E) surgical airway, check factor VIII levels

264. All of the following statements regarding desmo-pressin (DDAVP) are TRUE EXCEPT

(A) it is a beneficial treatment for mild to moderate hemophilia A

(B) it can raise factor VIII activity up to threefold

(C) the usual dose is 0.3 ^g/kg of body weight intravenous or subcutaneous every 12 h

(D) a rise in factor VIII levels occurs between 4 and 6 h after administration

(E) common side effects include headache and mild hyponatremia

265. A 22-year-old female with sickle cell anemia (Hb SS) presents with a 2-day history of pleuritic chest pain and mild dyspnea. Vital signs are: temperature 38°C, pulse 90, blood pressure of 126/80 mm Hg, respiration rate of 24 breaths per minute, and room air pulse oximetry of 92 percent. Chest x-ray and electrocardiography are unremarkable. Which one of the following is the LEAST appropriate action?

(A) Give empiric antibiotics, such as cefuroxime and erythromycin

(B) Hydrate the patient with normal saline at 200 cc/h

(C) Treat pain with morphine sulfate boluses of 4 to 6 mg intravenously

(D) Obtain a ba. se. line arterial blood gas and arrange a V/Q scan or spiral CT

(E) Give supplemental oxygen

266. A 62-year-old African-American male who received TMP-SMX and pyridium for a urinary tract infection 2 days previously at an outside clinic presents to the ED complaining of dark urine. He denies fever or low back pain. Urinalysis shows a dark yellow urine, positive for blood, leukocytes, nitrites, bilirubin, and urobilinogen and negative for ketones, glucose, and protein. Microscopy shows red blood cells, white blood cells, and bacteria. What is the MOST likely diagnosis?

(A) rhabdomyolysis

(B) side effect of pyridium

(C) gallbladder obstruction

(D) G6PD deficiency

(E) hepatitis

267. A 60-year-old female presents to the ED with a fever of 37.8°C, mild confusion, and headache for the past 2 days. The patient is awake with no nuchal rigidity or lateralizing neurologic signs. CT is negative for mass effect or intracranial bleed. Laboratory findings show a platelet count of 20,000/^L, reticulocytosis, mild leukocytosis with a left shift, schistocytes on peripheral smear, and mild azotemia. Urinalysis shows proteinuria and hematuria. All of the following are appropriate actions EXCEPT

(A) administering FFP

(B) plasma exchange transfusion

(C) prednisone or methylprednisolone intravenously

(D) platelet transfusion

(E) ICU admission

268. A 50-year-old male with known malignancy complains of bilateral lower extremity weakness and acute urinary retention. Ambulation has become increasingly difficult over the past 2 days. Examination is remarkable for percussion tenderness at the thoracolumbar junction. Rectal sphincter tone is preserved. All of the following actions are appropriate EXCEPT

(A) giving decadron 10 mg intravenously

(B) giving solumedrol 30 mg/kg

(C) ordering CT of the thoracolumbar region

(D) calling for emergent neurosurgical consult

(E) placing a Foley catheter with a leg bag and discharging with close urology follow-up

269. A 55-year-old female with previously documented metastatic breast cancer presents to the ED with an altered sensorium. She is afebrile, and there are no focal neurologic signs. Serum calcium is 15 mg/dL. Which of the following is the LEAST appropriate action?

(A) Oncology consultation followed by glucocorti-coid administration

(B) Intravenous saline infusion

(C) Intravenous furosemide administration

(D) Oral phosphate administration

(E) Intravenous inorganic phosphate bolus administration

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Headache Happiness

Headache Happiness

Headache Happiness! Stop Your Headache BEFORE IT STARTS. How To Get Rid Of Your Headache BEFORE It Starts! The pain can be AGONIZING Headaches can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows. And just think of how unwelcome headaches are while you're trying to work.

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