Test Yourself!

The last 2 weeks have been extremely hectic - moving always is. My time at the VA is almost over (only 4 more work days), which also means I'll be leaving Tucson soon. I thought Tucson was the perfect college town to experience the last 5 years in :). Switching gears, just because I haven't updated in a couple of weeks doesn't mean the learning suddenly stopped! I've been taking careful notes qday, which I will summarize over the next few days. Until then, I put together a pre/post self assessment for future rotation students. Personally, I would have liked a stress-free "test" to assess how much knowledge I gained from this rotation. Here it is!

Acute Care

1.     What are the 5 stages of Chronic Kidney Disease?

a.     Stage 1:

b.     Stage 2:

c.      Stage 3:

d.     Stage 4:

e.      Stage 5:

2.     What lab change(s) define acute kidney injury? Circle all that apply.

a.     30% increase in serum creatinine from baseline

b.     50% increase in serum creatinine from baseline

c.      0.5 mg/dl increase in serum creatinine from baseline

d.     0.3 mg/dl increase in serum creatinine from baseline

3.     What does the Blood Urea Nitrogen (BUN): Creatinine ratio tell us regarding kidney dysfunction in AKI (acute kidney injury)?

a.     BUN:Cr > 20:1 –

b.     BUN:Cr >10:1 and <20:1 –

c.      BUN:Cr <10:1 – 

4.     What two classes of drugs most commonly cause prerenal kidney damage?

a.     Steroids and Beta Blockers

b.     ACE inhibitors and Calcium Channel Blockers

c.      ACE inhibitors and NSAIDs

d.     NSAIDs and Steroids

5.     Which drugs can cause pancreatitis? Circle all that apply.

a.     Steroids

b.     Sulfonamides

c.      NSAIDs

d.     Diuretics

e.      Azathioprine

f.       Antipsychotics 

6.     Which penicillins can be used for Staphylococcus infections? Circle all that apply.

a.     Ampicillin

b.     Nafcillin

c.      Oxacillin

d.     Penicillin

e.      Dicloxacillin

7.     What is drug of choice for enterococcus infections?

a.     Cephalosporins

b.     Aminopenicillins

c.      Aminoglycosides

d.     Fluoroquinolones

8.     Which class of antibiotics will NOT cover enterococcus?

a.     Cephalosporins

b.     Aminopenicillins

c.      Aminoglycosides

d.     Fluoroquinolones

9.     Which cephalosporin does not need to be renally adjusted?

a.     Cefuroxime

b.     Ceftazadime

c.      Cephalexin

d.     Ceftriaxone

10.                        When do you measure a trough for vancomycin and what is the therapeutic range for complicated skin infections, bone infections, bacterial meningitis, bacteremia, and hospital-acquired pneumonia?

a.     Before the 3^rd dose, 10-20mg/L

b.     Before the 4^th dose, 15-20mg/L

c.      Before the 3^rd dose, 15-20mg/L

d.     Before the 4^th dose, 10-20mg/L

11.                        Atypical pneumonia organisms include: (circle all that apply).

a.     Kleibsiella

b.     Legionella pneumonia

c.      Mycloplasma pneumonia

d.     Streptococcus pneumonia

e.      Chlamydia 

12.                        Which oral antibiotics can you use for MRSA? Circle all that apply.

a.     Bactrim

b.     Augmentin

c.      Clindamycin

d.     Doxycycline

e.      Ceftobiprole

13.                        Drug of choice for community acquired pneumonia is:

a.     Vancomycin and Zosyn

b.     Azithromycin and Zosyn

c.      Azithromycin and Ceftriaxone

d.     Vancomycin and Ceftriaxone

14.                        Drug of choice for hospital acquired pneumonia is:

a.     Vancomycin and Zosyn

b.     Azithromycin and Zosyn

c.      Azithromycin and Ceftriaxone

d.     Vancomycin and Ceftriaxone

15.                        The CHADS2 score is associated with the risk of stroke in a patient with atrial fibrillation. What does CHADS stand for?

a.     C:

b.     H:

c.      A:

d.     D:

e.      S:

16.                        If a patient presents with chest pain in the emergency department, certain medications are given with the acronym MONA-BS. What does this stand for?

a.     M:

b.     O:

c.      N:

d.     A:

e.      B:

f.       S:

17.                          Which medications have been shown to improve survival in congestive heart failure patients? Circle all that apply.

a.     Furosemide

b.     Beta blockers

c.      Calcium channel blockers

d.     Spironolactone

e.      ACEI/ARBs

f.       Hydralazine/isosorbide dinitrate 

18.                        Shown in literature, which three beta blockers have shown benefit in congestive heart failure?

a.     Metoprolol

b.     Metoprolol XL

c.      Atenolol

d.     Carvedilol

e.      Bisoprolol 

19.                        What is the reversal agent for benzodiazepines

a.     Narcan

b.     Flumazenil

c.      Vitamin K
d.     Tricyclic antidepressants

   
      20.          Match the following situations with the appropriate doses.    

a.     DVT prophylaxis dose of Enoxaparin (2 options):

b.     DVT prophylaxis dose of Enoxaparin renally adjusted:

c.      DVT treatment dose of Enoxaparin (2 options):

d.     DVT treatment dose of Enoxaparin renally adjusted:

Answer Choices: 30mg BID, 30mg Qday, 40mg BID, 40mg Qday, 1.5mg/kg Qday, 1.0mg/kg BID, 1.0mg/kg Qday, 1.5mg/kg BID

21.                       What is the CrCl cutoff for the need to renally adjust enoxaparin?

a.     <40ml/min

b.     <20ml/min

c.      <35ml/min

d.     <30ml/min

22.                        What is the goal INR range for a patient with atrial fibrillation and a CHADS2 score of 4 (who is currently taking warfarin)?

a.     2.5-3.5

b.     3.5-4.5

c.      2.0-3.0

d.     3.0-3.5

23.                        What is the goal INR range for a patient with a mechanical mitral heart valve (who is currently taking warfarin)?

a.     2.5-3.5

b.     3.5-4.5

c.      2.0-3.0

d.     3.0-3.5

24.                        Regarding the causes of metabolic acidosis, what does MUDPILES stand for?

a.     M:

b.     U:

c.      D:

d.     P:

e.      I:

f.       L:

g.     E:

h.     S:

Good luck!