What is an extrapulmonary manifestation of community-acquired pneumonia?
Click to see answer
Myalgia.
Click to see question
What is an extrapulmonary manifestation of community-acquired pneumonia?
Myalgia.
What is the glomerular filtration rate range for stage G4 chronic kidney disease?
15-29 ml/min/1.73 m².
What complications may occur as a result of antiretroviral therapy?
Lipodystrophy and metabolic syndrome.
What is a primary mechanism of anemia in chronic kidney disease?
Erythropoietin deficiency.
Who is at risk of developing multiple organ failure?
Patients with co-morbidities, especially limited functional cardiorespiratory reserve.
What percentage of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cases are caused by certain medications?
80%.
Which disease is defining for AIDS?
Kaposi's sarcoma.
What are some undesirable effects of loop diuretics?
Urate retention causing gout, hyperkalemia, hypercalciuria, hypermagnesemia, and decreased glucose tolerance.
Which clinical element is NOT associated with increased vertical HIV transmission?
Use of an effective antiretroviral regimen.
Which drugs are considered first-line anti-TB drugs?
Isoniazid and rifampicin.
What is the host cell receptor for HIV?
The gp120 surface glycoprotein.
What predisposes HIV-infected individuals to encapsulated bacterial infections?
Cell-mediated immune deficiency.
What are some causes of extracellular volume depletion (hypovolemia)?
Hemorrhage, burns, gastrointestinal losses, prolonged bed rest, and use of diuretics.
Which groups are at high risk of developing sepsis?
Elderly (> 65 years), very young patients (newborns), patients with a history of sepsis, patients with permanent medical devices, and pregnant women.
What is a metabolic response to trauma, major surgery, and severe infections?
Increased gluconeogenesis.
What is the main mechanism of anemia in chronic kidney disease?
Erythropoietin deficiency.
What is one criterion for clinical evaluation of respiratory disorders?
Bradypnea.
What is one of the main functions of dialysis?
Disposal of toxins.
What factors contribute to vascular calcifications in chronic kidney disease?
Increased product Calcium x Phosphorus, Hyperparathyroidism, Inflammation, Uremia.
What adverse effect is associated with Pyrazinamide?
May cause pruritus.
What is a potential potassium-related issue from massive transfusion?
Hypokalemia.
What must be adapted to the patient response in burn patients?
Intravenous fluid quantity.
What is healthcare-associated sepsis?
Sepsis occurring in patients discharged in the last 30 days or those in chronic care units and closed communities.
What are the causes of shock?
Hypovolemic, distributive (anaphylaxis and burns), and cardiogenic (obstruction and restriction of cardiac flow).
What is a characteristic of burns in which healing lasts longer than 3 weeks?
They will form hypertrophic scars.
What is a key symptom in the diagnosis of COPD?
History of dyspnea and productive cough in a chronic smoker.
Which syndromes are associated with distal convoluted tubules?
Gitelman Syndrome, Liddle syndrome, nephrogenic diabetes insipidus, Gordon Syndrome, and SIADH.
What are Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?
Rare life-threatening exfoliative skin disorders.
What electrolyte imbalance can occur due to massive transfusion?
Hypercalcemia.
What can cause increased renal bicarbonate losses?
Treatment with acetazolamide, accentuated catabolism of lysine and arginine, proximal renal tubular acidosis, hyperparathyroidism, and tubular lesions.
What is a key treatment step for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?
Immediate discontinuation of the triggering medication.
What are key parameters to check in sepsis?
Fever, bradypnea, bradycardia, hypertension, and hyperoxia.
What is a cause of metabolic alkalosis related to calcium levels?
Hypocalcemia from malignant diseases.
What is a common characteristic of necrotizing soft tissue infections?
They evolve rapidly, produce severe toxicity, and cause necrosis of the affected tissues.
What is the most common skin substitute used in burn grafting?
Bovine allograft.
What diseases are associated with acute respiratory distress syndrome due to indirect lung damage?
Cardiopulmonary bypass, drug overdose (heroin, barbiturates), lung reperfusion injury after lung transplantation or pulmonary embolectomy, altitude sickness, drowning.
Can ARDS be diagnosed solely based on X-rays?
No, it cannot be diagnosed solely based on X-rays.
What is a characteristic of myocardial function in septic shock?
Myocardial dysfunction - low ejection fraction.
What is the standard dose of Amikacin for treating sepsis?
20 mg/kg x 1 i.v.
At what stage of chronic kidney disease is a patient with a glomerular filtration rate of 37 ml/min/1.73 m²?
G3b.
In what situation can renal damage be reversible in chronic kidney disease?
Removal of an obstruction of the urinary tract.
What are the global targets for the eradication of the HIV/AIDS epidemic by 2030 under the United Nations HIV/AIDS Program?
90% of all people living with HIV should be diagnosed, 90% of diagnosed should receive ARV therapy, and 90% of those receiving ARV should have viral suppression.
Which of the following is NOT an undesirable effect of loop diuretics?
Increased glucose tolerance.
What causes decreased blood pressure when switching from decubitus to orthostatism?
Interference of medication with peripheral vasoconstriction, decreased circulating volume, medication interference with autonomic function, and drugs that block ß-adrenoceptors.
What complication can arise from microembolism during massive transfusion?
Microembolism.
What is the correct sequence of events in the SELDINGER technique?
Vascular puncture with a needle, advance of the guide, removal of the needle, dilation of the vessel, catheter advancement on guide, removal of the guide, catheter in situ.
What is a specific complication of hemodialysis related to blood pressure?
Intradialytic hypotension.
What is the goal of fluid therapy in sepsis?
To normalize lactate levels in patients with high lactate levels.
What are the disease control medications for asthma?
Inhaled long-acting β2 agonists, leukotriene modifiers, inhaled corticosteroids, inhaled short-acting β2 agonists, theophylline preparations.
What should be done with any infection in patients at risk for endocarditis?
It should be promptly investigated and treated correctly.
What is a criterion for transfer to a burn center?
Inhalation injury.
What is the most common cause of death in patients with large burns?
Sepsis originated from the burned skin.
What is the recommended dosage of rifampicin for adults in meningitis chemoprophylaxis?
600 mg daily for 4 days.
Which drug is a positive vasopressor/inotropic agent?
Norepinephrine.
Which of the following is NOT an abnormality of bone morphology in Chronic Kidney Disease?
Osteophyte.
What are risk factors for cardiovascular disease in chronic kidney disease patients?
High blood pressure, Diabetes mellitus, Dyslipidemia.
What is the clinical-immunological classification of an HIV-infected patient with cerebral toxoplasmosis and a CD4 count of 157 mm3?
C3.
How is the volume status evaluated?
By measuring central venous pressure, postural changes in blood pressure, and urinary flow at regular intervals.
Which of the following is NOT a late complication of tracheostomy?
Stomach infections.
Which condition is NOT a cause of hyponatremia with decreased extracellular volume?
Psychogenic polydipsia.
What causes metabolic acidosis with a normal anionic gap?
Increased losses of bicarbonate in the gastrointestinal tract.
In which type of burn patients does Acute Respiratory Distress Syndrome (ARDS) often appear?
In patients with minor and moderate inhalation burns.
What must be done to stop the combustion process?
The burning flame must be completely extinguished with water or by smothering.
Is annual flu vaccination recommended for HIV infected patients?
Yes, it is recommended.
Which of the following is NOT a carbapenem?
Amoxicillin.
What is required for intra-articular infections in sepsis?
An arthroscopic lavage and possibly debridement for joint prostheses.
What do Grade 1 burns involve?
The epidermis.
In which stage are most cases of chronic kidney disease found?
G3.
What is a common treatment for acute exacerbations of COPD?
Oral corticosteroid therapy.
Which medications may cause sodium retention?
Estrogens, mineralocorticoids, and licorice, but not loop diuretics.
What adverse effect can Rifampicin cause?
May increase liver enzymes.
What are potassium-saving diuretics?
Eplerenone, Amiloride, Triamterene, and Spironolactone.
What is a cause of hyponatremia with increasing extracellular volume?
Heart failure.
What type of care is often required for necrotizing soft tissue infections?
Aggressive fluid resuscitation, meticulous care, and surgical treatment.
What is recommended for the prevention of endocarditis in patients undergoing dental procedures?
Antibiotic prophylaxis and chlorhexidine gargle.
What is a cause of hyperkalemia related to tissue damage?
Rhabdomyolysis/tissue damage.
What is the aim of antibiotic chemoprophylaxis in splenectomy or splenic dysfunction?
To prevent severe meningococcal sepsis.
Which statement about antibiotic allergies is false?
The color of the antibiotic(s) to which patients are allergic.
What are the characteristic elements of hypovolemic shock?
Cold, clammy skin; low sympathetic tone; lactic acidosis; confusion and irritability.
What is true about Group M of HIV-1?
a) has a high degree of genetic diversity, b) has subtypes (clades), e) was transmitted from chimpanzee to gorilla and then to human.
What is the cardiac output status in septic shock?
Cardiac output is usually increased.
Which antibiotics belong to the quinoline class?
Levofloxacin, ciprofloxacin, and moxifloxacin.
What is true about the evaluation of HIV viral load?
a) has prognostic value, e) is the standard marker for evaluating the effectiveness of antiviral treatment.
Which statement regarding HIV epidemiology is true?
Sub-Saharan Africa is the most affected region.
How can phosphorus reduction be achieved in chronic kidney disease?
Through dietary restriction.
What clinical picture may be observed in elderly patients with community-acquired pneumonia?
State of confusion.
How does dialysis maintain electrolyte balance?
By maintaining the concentration of electrolytes within normal limits.
What regimens are recommended when initiating antiretroviral therapy?
Combination of two nucleoside/nucleotide reverse transcriptase inhibitors with either a non-nucleoside reverse transcriptase inhibitor, a boosted protease inhibitor, or an integrase inhibitor.
What is a potential adverse effect of Ethambutol?
May cause retrobulbar optic neuritis.
What is a true statement regarding the metabolism of patients with extensive burns?
The metabolism increases as a consequence of the hormonal response to trauma caused by the burns.
What is a treatment option for necrotizing soft tissue infections?
Surgical treatment is often required.
What characterizes delayed reactions to antibiotics?
They often occur after a dose of treatment and can lead to severe conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis.
What should patients at risk for endocarditis be instructed to recognize?
Signs of infectious endocarditis.
What is a long-term complication of dialysis that involves protein deposits?
Dialysis-associated amyloidosis.
What occurs during the clinical latency period of HIV infection?
b) the virus continues to replicate, c) the person is contagious, e) the interval of progression to symptomatic disease is about 10 years (without effective antiretroviral treatment).
What does the patient's palm represent in terms of burned area calculation?
Approximately 1% of the total body surface area (TBSA).
Which statement about electrical burns is true?
The superficial muscles may appear intact, and the deep ones may be injured.
What is the recommended dose of Amikacin for Acinetobacter spp.?
Only the maximum dose.
How long does treatment for drug-sensitive TB typically last?
6 months.
What therapy can reverse renal damage in glomerulonephritis?
Administration of immunosuppressive therapy.
When should antiretroviral therapy be started in HIV patients?
Immediately in a patient with primary HIV infection.
What causes defective osteoid mineralization (osteomalacia)?
Deficiency of 1,25-(OH)2D3.
What effect does massive transfusion have on oxygen affinity?
It increases the affinity of oxygen.
Which drugs are used to control parathyroid hormone levels in chronic kidney disease?
Calcitriol, Analogs of vitamin D, Calcimimetic agents.
What is the false statement regarding daily protein intake necessary in patients with extensive burns?
0.5-1.0 g of protein/kg daily.
What is a potential risk of tangential excision?
It can produce high blood loss.
What does the imaging appearance of Pneumocystis jirovecii pneumonia resemble?
'Matte glass' appearance.
Which infectious complication can occur in patients with extensive burns?
Pneumonia.
What conditions are associated with acute respiratory distress syndrome due to direct lung damage?
Sepsis, aspiration of gastric contents, severe trauma with shock and multiple transfusions, transfusion-associated lung injury (TRALI), fatty embolism.
What is a key characteristic of Clindamycin?
It is a useful agent in severe streptococcal or staphylococcal cellulitis.
Name an inhaled corticosteroid used for asthma.
Fluticasone.
What is the correct dosage of oral isoniazid for adults in tuberculosis chemoprophylaxis?
300 mg daily for 6 months.
What is the purpose of determining viral genotype in HIV infection?
b) is used to guide antiretroviral therapy, c) identifies well-defined mutations.
What is the recommended dose of Amikacin for Pseudomonas spp.?
Only the maximum dose.
What are the cardinal symptoms of pulmonary tuberculosis?
Cough, headache, haemoptysis, chest pain, dyspnea.
What are the renal function replacement therapies?
Hemodialysis, Peritoneal dialysis, Kidney transplant.
What are the adverse effects of Isoniazid?
May cause polyneuropathy secondary to vitamin-B6 deficiency, rash, and arthralgia.
Which medication is classified as a loop diuretic?
Bumetanide.
What is true about HIV?
HIV is a retrovirus with reverse transcriptase, has two major types (HIV-1 and HIV-2), and most antiretroviral drugs are active on both types.
What condition does dialysis help prevent?
Acidosis.
What clinical manifestations may suggest HIV primary infection?
Fever, myalgias, arthralgias, lymphadenopathy, oral mucosa ulcerations, pinkish maculopapular rash, and HIV-associated cachexia.
What are immediate hypersensitivity reactions associated with?
Anaphylaxis shock, mediated by immunoglobulin E, and begin within one hour of the first dose.
What is autografting?
Using full thickness or partial thickness grafts from the patient.
How does the risk of mother-to-child transmission of HIV relate to viral load?
It increases directly in proportion to the viral load.
Which medication can cause type 1 distal renal tubular acidosis?
Amphotericin B.
What is the dosage of rifampicin for adults in meningitis chemoprophylaxis?
600 mg double dose daily for 2 days.
What is the aim of antibiotic chemoprophylaxis in tuberculosis?
To prevent infections in tuberculin-negative individuals, children with uninfected mothers, and immunocompromised patients.
Is Clindamycin effective against anaerobes?
No, it is inactive against anaerobes.
What are the major regulatory factors of transport in the proximal tubules?
Angiotensin II, ephedrine, adrenaline, epinephrine, and aldosterone.
What temperature-related problem can arise from massive transfusion?
Temperature changes.
Which fluids are involved in HIV transmission?
Blood, cerebrospinal fluid, sperm, and cervical secretions.
Which parameter is NOT monitored at the initial choice of antibiotic regimen in sepsis?
Toxicity is not a parameter to be monitored.
What is a late complication of tracheal intubation?
Tracheal stenosis and fibrosis.
What does burn excision involve?
Removal of the affected skin and soft tissue down to the fascia.
What is a clinical symptom of Pneumocystis jirovecii pneumonia?
Insidious onset with fever and dry cough.
What information is required when a patient complains of an antibiotic allergy?
Details about the antibiotic's smell, time of onset of symptoms, nature of symptoms, time until symptoms cease, and previous use of the antibiotic.
What are signs of hemodynamic changes in hypovolemic shock?
Signs of myocardial insufficiency.
What should patients at risk for endocarditis maintain?
Good oral hygiene.
What factors influence HIV transmission?
a) related to the level of viral load, c) can be reduced by effective antiretroviral therapy, d) increases when sexually transmitted diseases are associated.
What is the central venous pressure (PVC) in hypovolemic shock?
Low PVC and pulmonary arterial occlusion pressure (POAP).
How can acute respiratory distress syndrome (ARDS) be defined?
Respiratory distress, pulmonary stiffness, increased lung compliance resulting in low inflationary pressures, pulmonary artery occlusion pressure >18 mmHg, chest radiography showing new, non-uniform or homogeneous, bilateral, diffuse pulmonary infiltrates.
What should be avoided in fluid therapy for sepsis?
Hydroxyethyl starch solutions.
What overdose can cause metabolic acidosis?
Aspirin: overdose of salicylates.
What diagnostic ratio is indicative of COPD?
Low FEV1 / CVF ratio and low PEF.
What is the target hemoglobin level in the treatment of chronic kidney disease?
100-120 g/L.
What parameters should be evaluated at the initial choice of antibiotic strategy in sepsis?
Route of administration, frequency of administration, and duration of treatment.
Which condition can cause hypernatremia due to hormonal imbalance?
Pituitary diabetes insipidus.
When should burn lesions be covered?
Begins 21 days after the burn is produced.
What decision must be made at 72 hours when most cultures become available?
One of the following: stopping antibiotic treatment, deescalation to oral treatment, change of treatment, continuation of intravenous treatment, or discharge with oral antibiotics.
What nervous system abnormality is associated with chronic kidney disease?
Cognitive impairment.
What defines 'septic shock'?
Patients who require vasopressor support to maintain a mean blood pressure of at least 65 mmHg and have a high serum lactate concentration (> 2 mmol/L) despite adequate volume resuscitation.
What should patients at risk for endocarditis receive after gastrointestinal or genitourinary tract procedures?
Appropriate antibacterial therapy covering organisms that cause endocarditis.
What is the recommended initial fluid resuscitation volume for sepsis?
30 ml/kg in the first 3 hours.
What is the recommended dosage of Phenoxymethylpenicillin for antibiotic chemoprophylaxis in splenic dysfunction?
500 mg double dose daily.
What depletion can lead to metabolic alkalosis?
Chlorine depletion.
What ingestion can cause metabolic alkalosis in kidney disease?
Massive or reduced bicarbonate ingestion.
What is a cause of metabolic acidosis with an enlarged anion gap related to diabetes?
Ketoacidosis: diabetic or alcohol.
Which statement about antibiotic chemoprophylaxis in tuberculosis is false?
It aims to prevent infections in children with infected mothers.
What is the maximum dose of Amikacin?
30 mg/kg x 1 i.v.
What parameters are measured in gasometry analysis of arterial or venous blood?
Partial pressures of carbon dioxide (PCO2) and oxygen (PO2), calculated base excess (BE), bicarbonate (HCO3), and blood pH.
What is the function of the distal convoluted tubule?
Secretion of drugs and drug metabolites, reabsorption of solvents, and involvement in sodium and chlorine transport.
What is a cause of hypernatremia related to water intake?
Deficiency of water intake: feeling thirsty or affected state of consciousness.
What is a complication of tracheal intubation?
Upper airway trauma.
What is a common characteristic of Pneumocystis jirovecii pneumonia in HIV patients?
Occurs often in patients with CD4 lymphocyte level < 200 cells/mmc.
What is the first step in the treatment for sepsis?
Administer oxygen to maintain SpO2 > 96%.
What is used to achieve optimal blood flow during Hemodialysis?
Arteriovenous fistula.
What is a complication associated with hemodialysis?
Dialysis disequilibrium syndrome.
Do patients with inhalation burns typically require large quantities of intravenous fluids?
No, they rarely need large quantities.
What happens to systemic vascular resistance in hypovolemic shock?
It increases.
When should post-exposure HIV prevention be administered?
Within the first 72 hours after exposure.
What are the signs and symptoms of sepsis?
Vasoconstriction with cold periphery, nausea, vomiting, slow capillary refilling.
What electrolyte imbalance can occur due to hemodialysis?
Hyperphosphatemia.
What cells are part of the chronic inflammatory infiltrate in COPD?
Neutrophils, eosinophils, lymphocytes, macrophages.
What renal condition can lead to metabolic acidosis?
Renal failure: accumulation of organic acids.
What is a recommended home antibiotic treatment for community-acquired pneumonia (CRB-65=0)?
Amoxicillin orally 500 mg three times a day.
What are early complications of tracheostomy?
Hypoxia, stomach infections, pneumonia, cardiac arrhythmias, hypotension.
What stimulates the entry of potassium into the cell?
Insulin.
Which condition related to diarrhea can cause metabolic alkalosis?
Villous adenoma or congenital chloride.
What causes hyponatremia with normal extracellular volume (euvolemia)?
Increased sensitivity to ADH, abnormal release of ADH, mental illness, tubulointerstitial renal disease, and acute tubular necrosis recovery phase.
What is a treatment approach for SJS and TEN regarding affected tissue?
Debridement of devitalized tissue and use of adequate temporary wound coverage.
Are delayed reactions immune mediated?
No, they are not immune mediated.
What is the Wallace rule of 9s used for?
To calculate the burned area.
What are the clinical features of acute severe asthma?
Inability to complete a sentence in one breath, bradycardia or hypotension, cyanosis, intense vesicular breath sounds, PaO2 < 60 mmHg.
What is the bone concentration characteristic of Clindamycin?
It provides low bone concentration and is not used in the treatment of osteomyelitis.
Which endocrine abnormality does NOT occur in chronic kidney disease?
Increased serum testosterone levels.
What is a clinical manifestation of a lung abscess?
Persistent chest pain.
What causes hyponatremia with decreased extracellular volume (hypovolemia)?
Hemorrhage, antidepressant treatment, severe potassium depletion, burns, and pancreatitis.
Which nephrotoxic drug should be avoided in chronic kidney disease?
Gentamicin.
What symptoms are associated with immediate hypersensitivity reactions?
Facial edema, rash, and mild dyspnea.
What are some causes of abnormal release of antidiuretic hormone (ADH)?
Hypothyroidism, severe potassium depletion, osmotic diuresis, pancreatitis, and diuretics.
What determines the degree of tissue damage in chemical burns?
The nature of the agent.
What is a non-pharmacological treatment used to alleviate pain associated with burn wounds?
Breathing exercises.
What dietary habit can lead to metabolic acidosis?
Overeating.
What is the aim of antibiotic chemoprophylaxis in meningitis due to Hemophilus influenzae type B?
To decrease nasopharyngeal colonization and prevent contact infection.
What bacterial condition can cause metabolic acidosis?
D-lactate: bacterial proliferation in the small intestine.
What is elevated in the serum of individuals with allergic asthma?
Serum IgE levels.
What are some complications of radial artery cannulation?
Distal ischemia, loss of venous pulsations, infection, accidental drug injection, and disconnection.
What should be done quickly in the treatment of sepsis?
Administer fluids quickly.
What are indications for the use of non-invasive ventilation?
Low level of consciousness, obstructive sleep apnea, severe pneumonia, cardiogenic pulmonary edema, chest wall deformities/neuromuscular disease.
What genetic condition is associated with metabolic alkalosis?
Cystic fibrosis.
What complication can arise from hemodialysis related to vascular access?
Malfunction, thrombosis of the vascular access.
What is 'source control' in the context of sepsis?
Addressing the underlying causes of sepsis, such as drainage of abscesses or obstruction.
What is a common cause of sepsis that may require intervention?
Obstruction of the bile and urinary tract.
Which conditions are directly related to HIV?
a) dementia associated with HIV infection, b) sensitive polyneuropathy, d) enteropathy by atrophy of the intestinal villi, e) tumors caused by oncogenic viruses.
What are common comorbidities associated with COPD?
Obesity, ischemic heart disease, hypertension, diabetes, cancer.
What is the main treatment for ARDS?
Excessive fluid resuscitation is NOT the main treatment.
What is a significant concern with Clindamycin?
It is widely used due to its association with Clostridium difficile infection.
What is involved in the initial assessment of burn patients?
Evaluation of the respiratory tract, respiration, and circulation.
How is beat volume maintained in septic shock?
By ventricular dilation.
What is the most common cause of community-acquired pneumonia?
a) Streptococcus pneumoniae.
Which of the following may NOT be shown in chest radiographs of pulmonary tuberculosis?
e) enlargement of the mediastinum.
What is a common history factor in allergic asthma?
Long history of cigarette smoking.
What test result is positive in allergic asthma?
Positive allergen skin tests.
Which of the following is NOT a trigger in the pathogenesis of asthma?
b) alpha-1-antitrypsin deficiency.
When does allergic asthma typically onset?
In childhood.
What is the most useful therapeutic measure for patients with chronic obstructive pulmonary disease (COPD)?
c) Smoking cessation.
Which site is NOT a frequent location for distant metastasis in bronchopulmonary cancer?
b) spleen.
What family history aspect is noted in allergic asthma?
Allergic disorders that run in families.
