2009.06.30 Quiz: Miliary TB

Which of the following is incorrect about miliary TB?
A. It is caused by erosion of the infection into a pulmonary vein, and then the bacteria reach the left side of the heart and enter the systemic circulation and seed many other organs such as the liver and spleen
B. The bacteria may also enter the lymph node, drain into a systemic vein and eventually reach the right side of the heart, from the right side of the heart, the bacteria may then seed the lungs, causing the "miliary" appearance, or futher re-seed other organs.
C. Sputum for AFB smear is typically positive
D. Sometimes it can be missed on CXR and picked up by HRCT thorax.

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2009.06.29 Quiz: Noninvasive Ventilation

Which of the following condition is the least responsive to noninvasive ventilation (NIV)?
A. COPD
B. ARDS
C. APO
D. Post-op hypoxemia due to atelectasis

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2009.06.28 Sun Humanities Quiz: Phenomenology of Edmund Husserl (1859 - 1938)


Edmund Husserl (胡塞爾 1859 - 1938) was considered the founder of the philosophy called phenomenology (現象學). Which of the following is incorrect about this approach?

A. Examination of phenomena as they appear in a subject's experience; the world is analytically accessible only as it is present in a subject's experience
B. To remove all causal explanations and all presuppositions, to suspend both belief and disbelief, except one's own certainty, as a subject, that one is indeed an experiencing subject, and then look at the world in a different, a fresh way.
C. The Diagnostic and Statistical Manual (DSM) of Mental Disorders is a good example of the phenomenological approach to medicine.
D. Determinative thinking, judging, inferring, generalizing, particularizing, which are accomplished in the actual sphere of experience, take the appearing things, characteristics, regularities as appearing things, characteristics, regularities as the true one; but this truth is a relative and "subjectively conditioned" truths.  

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2009.06.27 Quiz: Alchoholic Hepatitis

In a patient with ascites and a history of heavy alcohol use, combination of the following is indicative of alcholic hepatitis until proven otherwise, except:
A. aspartate aminotransferase (AST) level that is elevated (but <300 IU per milliliter), and a ratio of the aspartate aminotransferase level to the alanine aminotransferase (ALT) level that is more than 2
B. a total serum bilirubin level of more than 5 mg per deciliter (86 μmol per liter)
C. Elevated CPK
D. an elevated INR
E. neutrophilia 

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2009.06.26 Quiz: Which disease derived its name from this container?

Which of the following condition derived its name from this container?

A. Kawasaki disease
B. Moyamoya disease
C. Takotsubo cardiomyopathy
D. Minamata disease

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2009.06.25 Quiz: Polymyositis- and Dermatomyositis-associated Interstitial Lung Disease

Which of the following is not commonlay associated with polymyositis and dermatomyositis?
A. bronchiolitis obliterans with organizing pneumonia (BOOP; or cryptogenic organizing pneumonia)
B. diffuse panbronchiolitis
C. nonspecific interstitial pneumonia (NSIP)
D. usual interstitial pneumonia (UIP)
E. diffuse alveolar damage (DAD)

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2009.06.24 Quiz: G chart and Ventilator-associated Pneumonia (VAP)

Presented by Dr TAM Oi Yan Jackie at the Daily Journal Club of ICU, PYNEH, Hong Kong, on 24 June 2009
In the paper "Hawe CS, et al. Reduction of ventilator-associated pneumonia (VAP): active versus passive guideline implementation. Intensive Care Medicine 2009: 25: 1180 - 1186, somthing called "g chart" (figure 1) is used to present the VAP events. What is incorrect about this g chart?
A. It is good to track events that happen very commonly
B. The method used to track these events is to calculate the days between events. The G Chart plots the days between events, with a point on the chart for each event.
C. For the reduction of Ventilator Associated Pneumonia Events, we would like to reduce the occurrence of these events by increasing the number of days between the events.
D. This chart also displays the number of days since the last event.

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2009.06.23 Quiz: Asthma in Pregnancy

Which of the following is incorrect about treatment of asthma in pregnancy?
A. No increased perinatal risks (including pre-eclampsia, preterm birth, low birth weight, and congenital malformations) were found to be associated wtih the use of short-acting beta2-agonists and corticosteroids
B. Use of oral corticosteroids has been associated with increased risk of pre-eclampsia and prematurity among their offspring, but residual confounding by greater disease severity and poor asthma control cannot be ruled out
C. Cromolyn and theophylline are contraindicated
D. Data on leukotriene-receptor antagonists and long-acting beta2-agoists are scarce, but so far they seem safe in humans

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2009.06.22 Quiz: Treatment "regimen" or "regime" or "regiment"?

About treatment "regimen" or "regime" or "regiment", which of the following is incorrect?
A. Regime can mean "a mode or system of rule or government: e.g. a dictatorial regime"
B. Regmen can mean "a regulated course, as of diet, exercise, or manner of living, intended to preserve or restore health or to attain some result"
C. Regiment is the past participle of both the verb form of regime or regimen
D. The three words orginated since the 14th century or afterwards, and appeared to have been modified through Latin to French to English

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2009.06.21 Sun Humanities Quiz: Karl R. Popper

Which of the following is not Karl R. Popper's approach to the philosophy of science?

Figure. Karl R. Popper (1902 - 1994)
A. It is wrong to begin by accumulating observations to seek confirmation of a theory, i.e. the so-called induction method.
B. Repeated observations and experiences should function in science as tests of our conjectures or hypotheses, i.e. attempted falsifications.
C. We should advance bold conjectures derived from intuition, or creative genius, or anyway we like, and attempt to refute them.
D. Development of empiricism was greatly enhanced by Karl Popper's philosophy.

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2009.06.20 Quiz: Pharmacology - Efficacy, Potency, Competitive and Non-competitive Antagonist

 
About the pharmacology of drug effect in the above figure, which of the following is incorrect?
A. B has higher potency than C
B. B has lower efficacy than C
C. When a competitive antagonist is added to drug A, its effect becomes like C.
D. When a non-competitive antagonist is added to drug A, its effect becomes like D.

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2009.06.19 Quiz: Pneumocystis Pneumonia


Figure. Pneumocystis carinii (jirovecii), Source: Wikepedia (subject to the GNU Free Documentation License)
Regarding Pneumocystis pneumonia, which of the following is correct?

A. Sputum induction gives a diagnostic yield of <50%
B. Steroid is indicated if PaO2 <70mmHg or A-a gradient > 35 mmHg
C. Pneumocystis carinii (jirovecii) can be grown by special culture medium outside the infected host.
D. Severe pneumocystis pneumonia is characterized by lymphocytic lung inflammation that may result in diffuse alveolar damage.

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2009.06.18 Quiz: Stewart's Approach to Acid Base (2)

In Stewart's approach to body fluids as physico-chemical systems of interacting chemical species, three conditions have to be maintained, based on which Stewart found out six simultaneous equations which he solved with a 4th order polynomial equation, and hence three independent variables (pCO2, Atot and SID) determing the pH of a solution were obtained. Which of the following is not one of the three conditions?
A. Electrical neutrality must be present in the solution
B. Conservation of mass must occur
C. All dissociation equilibria must be satisfied simultaneously
D. All reactions must take place at body temperature

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2009.06.17 Quz: Stewart's Approach to Acid-Base (1)

Regarding Stewart's approach to acid-base, which of the following is incorrect?
A. In the control of pH, there are 3 independent variables (pCO2, SID and [ATot]) and 6 dependent variables ( [HA], [A-], [HCO3-], [CO2-3], [OH-], [H+] )
B. Low SID is associated with acidosis
C. Hypoalbuminemia is associated with alkalosis
D. Infusion of lactated Ringer's solution produces more acidosis than normal saline solution because of the presence of lactate.

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2009.06.16 Quiz: Diastolic dysfunction

What of the following is incorrect about Grade II diastolic dysfunction (pseudonormal pattern)?
A. E/A 1 - 2
B. Deceleration time (DT) 150 - 200 ms
C. S/D <1
D. Atrial retrograde velocity (AR) < 0.35 m/sec

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2009.06.15 Quiz: Dexmedetomidine

About dexmedetomidine, which of the following is incorrect?
A. It is not necessary to discontinue before extubation. In healthy volunteers, no respiratory depression was found.
B. Serious adverse reactions reported include hypotension, bradycardia and sinus arrest, as well as transient hypertension.
C. US FDA approved continuous infusion for up to 24 hours. If it is to be administered for >24 hours and abruptly stopped, withdrawal symptoms are possible.
D. It is a novel opioid group of sedative.

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2009 06.14 Humanities Quiz: Ethics


About ethics, the branch of philosophy concerned with morality and how we should act, which of the following is incorrect?

A. In consequentialism, actions are judged right or wrong by virtue of their consequences. In deontological ethics, actions are considered inherently good or evil, regardless of the consequences of the action.
B. Utilitarianism and pragmatism are examples of consequentialism. The Divine Command Theory and Categorial Imperative are examples of deontological ethics. 
C. Under the condition of constraints, for example, dealing with the situation in which we can save five persons by not saving one person, the answer of consequentialists is that we must save the one instead of the five, and deontologists say we will not save the one for the five.
D. John Stuart Mill, in his book Utilitarianism, argued that Kant's Categorical Imperative in fact used consequential logic. 

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2009.06.13 Quiz: Hepatopulmonary Syndrome

About hepatopulmonary syndrome, which of the following is correct?
A. It consists of the triad of liver disease, pulmonary vascular dilatation, and a defect in oxygenation
B. Orthopnoea is a symptom but spider nevi are characteristically absent.
C. Contract echocardiography shows that the bubbles of agitated saline appears in the left cardiac chambers between the first few beats.
D. Hypoxemia almost always responds to 100% oxygen 

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2009.06.12 Quiz: Fulminant Hepatic Failure

Which is the following is incorrect about fulminant hepatic failure?
A. High peripheral vascular resistance and low cardiac output
B. Can be caused by herpes simplex virus (HSV) transmitted by herpes labialis
C. low serum Na and low K
D. cerebral edema

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2009.06.11 Quiz: Sensitivity, Specificity, PPV, NPV, LR, Odds

Which of the following is incorrect?
A. Sens = TP/(TP+FN); Spec = TN/(TN+FP)
B. PPV = TP/(TP+FP); NPV = TN/(TN+FN)
C. Positive likelihood ratio (LR+) = sens/(1 - spec)
D. Post-test probability = pre-test probability x likelihood ratio 


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