Exam 5 Questions

1. A 26-year-old female with no past medical history at 37 weeks gestation presents to the emergency department complaining of headache and nausea. Her blood pressure is 166/80 mmHg on arrival, and she is subsequently diagnosed with preeclampsia and admitted to the ICU for further management. A continuous magnesium infusion is initiated. Several hours later, you note the patient has absent deep tendon reflexes, mild tachypnea, and has had no urine output since admission. After discontinuing the infusion, which of the following should be administered next? A. Furosemide B. Potassium chloride C. Calcium gluconate D. Pyridostigmine E. Methylprednisolone 2. A 44-year-old male is in the ICU recovering from resection of a falcine meningioma. Postoperatively, his neurological status has not returned to preoperative baseline, and you are concerned that the patient may be suffering from supplementary motor area (SMA) syndrome. What set of clinical findings would be most consistent with this diagnosis? A. Incontinence, gait instability, confusion B. Hemiparesis, mutism C. Internuclear ophthalmoplegia looking one direction, conjugate gaze palsy looking the other direction D. Weakness in the bilateral upper extremities with preserved lower extremity strength E. Ataxia, nystagmus, confusion 3. According to current guidelines, all of the following are clinical prerequisites before pronouncing a patient brain dead except: A. Establishing a proximal and irreversible cause of coma B. Ruling out the presence of neuromuscular blocking agents C. Ruling out the presence of severe electrolyte abnormalities D. Ensuring that the patient has a core temperate >36.0 °C E. Ensuring that the patient has mean arterial pressure (MAP) >60 mmHg 4. A 55-year-old 65 kg female was admitted to the ICU 5 days ago for management of intracerebral hemorrhage. On day 2 of her hospital stay, the patient is initiated on unfractionated heparin, 5000 units every 8 h for deep vein thrombosis (DVT) prophylaxis. Her platelet count on admission was 320 × 103/μL, and today it is 180 × 103/μL. Her 4T score is 3. What is the next best step in this patient’s management? A. Continue unfractionated heparin, send screening heparin PF4 immunoassay B. Switch to low molecular weight heparin, send screening heparin PF4 immunoassay C. Switch to low molecular weight heparin, do not send screening heparin PF4 immunoassay D. Switch to an argatroban infusion, send screening heparin PF4 immunoassay E. Continue unfractionated heparin, do not send screening heparin PF4 immunoassay 5. A 21-year-old male with a history of sickle cell disease and a remote right basal ganglia hemorrhage presents to the ED with a 1 week history of worsening midsternal chest pain. He reports a cough productive of purulent sputum for the past several days, along with night sweats, palpitations, and exertional dyspnea. A portable chest x-ray demonstrates a new left lower lobe infiltrate, and a bedside EKG reveals trace new ST depression in the precordial leads. The patient has an oxygen saturation of 88% on room air and a serum hemoglobin of 10.1 g/dL. You are evaluating the patient for exchange transfusion. On which elements of the patients presentation is the presumptive diagnosis of acute chest syndrome based? A. New infiltrate on chest x-ray plus sputum production B. Sputum production plus hypoxia C. Hypoxia plus new EKG changes D. EKG changes plus worsening midsternal chest pain E. Worsening midsternal chest pain plus palpitations 6. Which of the following statements regarding MRI imaging of the pituitary gland is true? A. The anterior pituitary is usually isodense compared to the cortex on T1 and T2 sequences B. The normal pituitary gland enhances after gadolinium administration C. Macroadenomas generally enhance strongly but heterogeneously on T1 post-contrast imaging D. It is usually included on contrast-enhanced coronal images E. All of the above 7. Which of the following is the correct characterization of cerebral vasospasm versus delayed cerebral ischemia (DCI) in the setting of subarachnoid hemorrhage (SAH)? A. Vasospasm is a radiographic diagnosis, while DCI is a clinical diagnosis B. DCI is a radiographic diagnosis, while vasospasm is a clinical diagnosis C. Vasospasm is an early SAH complication, while DCI is a late complication D. DCI is an early SAH complication, while vasospasm is a late complication E. DCI and vasospasm are usually clinically insignificant 8. Compared to a continuous midazolam infusion, patients on a continuous dexmedetomidine infusion are least likely to develop which of the following? A. Bradycardia B. Hypotension C. Hypoventilation D. Hypothermia E. Delerium 9. A 74-year-old female with a history of paroxysmal atrial fibrillation on no anticoagulation presents to the emergency department after falling at home. She is evaluated by an emergency department physician, and a stroke alert is paged overhead. A CT scan of the head is obtained before you have an opportunity to evaluate the patient (see Image 1). Based on the CT findings, what deficits would you expect in this patient? A. Unilateral leg weakness and abulia B. Hemiparesis and dysarthria C. Quadriparesis with intact upward gaze D. Dysmetria and dysdiadochokinesia E. Weakness in the upper extremities greater than the lower extremities