1
Q
Onset of mild alcohol withdrawal?
A
6-24 hrs
2
Q
Onset of Seizures from alcohol withdrawal?
A
12-48hrs
3
Q
Alcoholic hallucinosis onset?
A
12-24 hrs, resolves w/in 48hrs
4
Q
Delirium tremens onset?
A
48-96hrs
5
Q
alcoholic hospitalized for operation, now 24 hrs later having visual hallucinations, stable VS and orientation. Dx?
A
alcoholic hallucinosis
6
Q
Normal saline is a crystalloid or colloid?
A
Crystalloid
7
Q
When are colloid solutions used?
A
In burns or conditions w/ hypOproteinemia
8
Q
mainstay of dehydration treatment?
A
rehydration w/ IV sodium containing crystalloid solutions
9
Q
acute onset unilateral weakness + positive Babinski sign = think?
A
acute ischemic stroke
10
Q
tPA should be given to stroke pt w/o hemorrhage w/in?
A
3-4.5 hrs of symptom onset
11
Q
what should be held and for how long should a stroke pt receive fibrinolytic therapy?
A
aspirin for 24hrs
12
Q
fears of negative evaluation and embarrassment in social and performance situations = Dx?
A
Social anxiety disorder
13
Q
poor eye contact + anxiety attacks when doing presentations = think?
A
social anxiety disorder
14
Q
performance anxiety is included in what type of anxiety disorder?
A
social anxiety disorder
15
Q
acute onset polyarticular and symmetric arthritis that resolves w/in 2mo, Dx?
A
Viral arthritis
16
Q
monoarticular arthritis (4)?
A
- Osteoarthritis
- Septic arthritis
- Crystalline arthritis (gout)
- Seronegative spondyloarthropathies (+ back pain)
17
Q
Symmetrical arthritis (2)?
A
- Rheumatoid arthritis
- Lupus
18
Q
Effective treatment of cancer-related anorexia/cachexia syndrome? (2)
A
- Progesterone analogues (megestrol acetate)
- Corticosteroids (more side fx)
19
Q
Effective treatment of advanced HIV cachexia?
A
synthetic cannabinoids
20
Q
delayed treatment of appendix (>5days) may dev into?
A
Appendiceal rupture –> appendiceal abscess
21
Q
What maneuvers are best for appendiceal abscess dx?
A
- Psoas sign (extension)
- Obturator sign (internal rotation)
- Rectal tenderness (esp on R rectal wall)
ant palpation may be less useful bc is deep tissue
22
Q
Rx of appendiceal abscess if pt is stable?
A
- IV abx, bowel rest, and possibly percutaneous drainage of abscess
- return in 6-8 wks for appendectomy
immediate surgery has high complication rate so wait for it to calm down
23
Q
arthralgias + psychosis + hematuria + proteinuria - concerning for?
A
Lupus
24
Q
acute onset of psychosis in a child or adolescent –> psych rare, what else is on diff dx? (7)
A
- CNS injury, infx, dysfunction (epilepsy)
- Metabolic disturbances (urea cycle disorder, acute intermittent porphyria, wilson disease, renal/liver fail)
- Autoimmine (Lupus, Thyroiditis)
- Electrolyte disrturbances (glucose, Na, Ca, Mg)
- Illicit substances or withdrawal from them
- Medication intoxication (serotonin syndrome, steroids, abx, anticholinergics, etc)
- Medication withdrawal (baclofen, benzo’s)
25
Prior gyn surgery esp a LEEP or cone biopsy puts pt at risk of?
cervical insufficiency/incompetence
26
gold standard for evaluating cervix for cervical incompetence/insufficiency?
transvaginal ultrasound
-abdominal u/s not accurate
27
Complications of diethylstilbestrol? (5)
- Clear cell adenocarcinoma of the vagina and cervix
- Structural anomalies of rep tract (hooded cervix, T shaped uterus, etc)
- Pregnancy problems (ectopic, preterm, etc)
- Infertility
- Males: Cryptorchidism, microphallus, hypospadias, & testicular hypoplasia
28
Clear cell adenocarcinoma of vagina and cervix --- maj risk factor?
Diethylstilbestrol exposure in utero
29
Overriding aorta is? think?
- when the aorta is over a VSD rather than LV
| - Tetralogy of Fallot
30
What are quad in tetralogy of fallot?
- Right ventricular outflow tract obstruction (ie pulm stenosis or atresia)
- RVH
- Overriding aorta
- VSD
31
Harsh systolic ajection murmur over L upper sternal border + single s2?
Tetralogy of Fallot
32
Right to L shunts? (5)
5 T's
1. Truncus arteriousis (1 vessel)
2. Transposition (2 switched vessels)
3. Tricuspid atresia (3 - tri)
4. Tetralogy of Fallot (4 - tetra, most common)
5. Total Anomalous Pulmonary Venous Return (5 words, TAPVR)
Early cyanosis (eaR-->Ly)
33
Eisenmenger syndrome?
Uncorrected L--> R shunt causing pulm HTN --> RVH --> shunt becomes R to L --> cyanosis, clubbing, polycythemia in KIDs (LateR)
34
cyanosis in a kid w/ clubbing and polycythemia - think?
```
Eisenmenger syndrome
(L--> R shunt that switches and causes cyanosis LateR)
```
35
Transposition of great vessels associated w/?
DM mom
36
Ebstein Anomaly associated w/?
Prenatal Li exposure
37
Ebstein anomaly is?
Atrialized RV
38
Supravalvular aortic stenosis associated w/?
Williams syndrome (deletion in elastin)
39
22q11 syndromes (ie DiGeorge) associated w/ what cardiac issues (2)?
- Truncus arteriosus
| - Tetralogy of Fallot
40
Alcohol exppsure in utero (fetal alcohol syndrome) --> what cardiac issues (4)?
- VSD
- ASD
- PDA
- Tetralogy of Fallot
41
Boot shaped heart on xray think?
Tetralogy of Fallot
42
Low birth weight + closed fists w/ overlapping fingers + micrognathia + rocker-bottom feet - think?
Edward's syndrome (Trisomy 18)
43
Micrognathia?
Undersized jaw (mandibule hypoplasia)
44
Hypotonia + flat face + upward and slanted palpebral fissure + hypoplasia of middle phalanx of 5th finger + brushfield spots + high arched palate - think?
Down syndrome
45
cleft lip + flexed fingers w/ polydactyly + low set ears + large distance b/t eyes (ocular hypotelorism) + hypoplastic ribs - think?
Patau's syndrome (Trisomy 13)
46
microcephaly w/ protruding metopic suture - think?
Cri-du-chat syndrome
47
Obstructive lung disease FEV/FVC
DECREASED ---> FEV/FVC
48
Restrictive lung disease FEV/FVC?
Normalish --> FEV/FVC >70%
49
Mom w/ Graves disease + euthyroid during pregnancy --> neonatal tachy w/ low birth weight and irritable - think?
Neonatal thyrotoxicosis (hyperthyroid)
50
Neonatal thyrotoxicosis caused by?
Transplacental passage of maternal anti-TSH receptor Ab (Abs bind to infant's TSH receptors --> excessive thyroid hormone release --> hyperthyroid)
51
Dx neonatal thyrotoxicosis cause?
Test for ant-TSH receptor Ab
52
Rx of neonatal thyrotoxicosis?
- short term rx w/ methimazole + beta blocker
| - self resolves over weeks - months
53
Does levothyroxine cross placenta?
NO
54
Trihexyphenidyl can cause what maj side fx?
```
Anticholinergic excess (blind as a bat...etc)
- headache, dizziness, tachy, acute glaucoma
```
55
Selegiline is? maj complication?
MAO-B inhibitor
| Serotonin syndrome
56
GI perforation + pt on warfarin for afib --> best initial step (after fluids, abx, NG tube compression)?
Fresh frozen plasma prior to surgery
| - (to rapidly normalize PT by restoring vit K dependent clotting factors - don't want to bleed in surg)
57
Acute bleeding in pt w/ liver failure, best treatment?
Fresh Frozen Plasma
| - to rapidly replace clotting factors that liver normally makes
58
Obstructive lung diseases? (4)
- COPD (Emphysema &Chronic Bronchitis
- Asthma
- Bronchiectasis
- CF
59
Pink puffers?
EmPhysema
60
Blue bloaters?
chronic Bronchitis
61
Obstructive lung disease causes inc in what and dec in what PFTs?
Inc: RV --> inc TLC, FRC
Dec: VC, FEV, FEV/FVC (
62
Restrictive lung disease causes inc in what and dec in what PFTs?
Inc:
Dec: FVC (a lot) --> FEV/FVC (>70%) + TLC, FEV
63
non caseating granulomas + cough + hyperCalcemia + uveitis + issues w/ saliva and lacrimal glands - think?
Sarcoidosis
| (can mimic sjogren's syndrome, but has sarcoid has non-caseating granulomas which sjogren's doesn't)
64
Restrictive lung diseases? (2)
- interstitial lung diseases (fibrosis, pneumoconioses, sarcoid, hypersensitivity pneumonitis)
- wall abnormalities (ie obesity, ankylosing spondylitis)
65
Silicosis is found where and inc risk of what?
- Nodules upper lobe
| - Inc risk of TB
66
noncaseating granulomas have what type of metabolic derangement?
hyperCalcemia
67
Lung disease + Aerospace industry or mining (specific type) - think?
Berylliosis
68
Lung disease + sand blaster work - think?
Silicosis
69
Lung disease + coal miners - think?
Coal worker pneumoconiosis or black lung
70
Lung disease + construction worker or plumber or shipyard worker - think?
asbestosis
71
Asbestos inc risk of what? (2)
- lung CA (most common)
| - Mesothelioma
72
anthracosis think?
coal dust exposure
73
long golden brown fibers w/ associated iron think?
asbestos bodies
74
"reticular" or "reticulonodular" or "ground glass" or "honeycombing" -- think?
Interstitial lung disease (restrictive)
75
elevated serum findings in sarcoidosis? (2)
- ACE
| - Ca
76
Main lung findings on xray in sarcoidosis?
Bilateral hilar adenopathy
77
Sarcoidosis treatment?
- usually spontaneously self resolves
- Symptomatic --> corticosteroids
- Refractory --> methotrexate
78
hemoptysis + dyspnea + kidney issues - think?
goodpasture's
79
Goodpasture what type of hypersensitivity?
type 2 (Ab mediated)
80
Type 3 hypersensitivity is caused by and ex (3)?
Immune complexes
| - SLE, RA, HSP
81
treatment of goodpasture syndrome (3)?
- plasmapheresis
- cyclophosphamide
- coricosteroids
82
Antiglomerular basement membrane Ab?
Goodpasture syndrome
83
Ground glass appearance w/ bilateral alveolar infiltrates that resemble a bat shape?
Pulmonary alveolar proteinosis (restrictive lung disease)
84
Pulmonary alveolar proteinosis is?
accumulation of surfactant-like protein and phopholipids in alveoli --> restrictive lung disease
85
Pulmonary alveolar proteinosis looks like on CXR?
Ground glass appearance w/ bilateral alveolar infiltrates that resemble a bat shape
86
Pulmonary alveolar proteinosis treat?
lung lavage and Granulocyte colony-stimulating factor
| - NO steroids
87
mesothelioma --> what in pleura?
pleural effusion
88
Light's criteria
Exudative effusions have at least one of the following:
- Pleural protein/Serum protein >0.5
- Pleural LDH/Serum LDH >0.6
- LDH > 2/3 upper limit of normal serum LDH ()
89
Budd chiari syndrome is?
thrombosis of hepatic vein --> infarction of liver
90
cyanosis w/ chocolate colored blood?
methemoglobinemia
91
methemoglobinemia treatment?
IV methylene blue
92
Room temp, room air, sea level A-a gradient formula?
(150 - 5/4PCO2) - PaO2
93
estimated nL A-a gradient by age?
Aa gradient
94
normal PaO2/FiO2 ratio?
>300
95
Acute Respiratory Distress Syndrome
- mild: 200- 300
- Mod: 100-200
- Severe:
96
PCWP
ARDS
97
PCWP >18 + pulm edema - think?
cardogenic pulm edema
98
Hypoxemia is?
PaO2
99
Main line of treatment in ARDS?
high PEEP w/ low tidal volumes
100
middle mediastinal mass? (6)
- bronchogenic cyst
- tracheal tumor
- pericardial cyst
- lymphoma
- lymph node enlargement
- aortic aneurysm of arch
101
anterior mediatstinal masses? (5)
- thymoma
- restrosternal thyroid
- teratoma
- lymphoma
- nonseminomatous germ cell tumor
102
Posterior mediastinal masses? (6)
- meningocele (all neurogenic tumors are posterior)
- enteric cysts
- lymphomas
- diaphragmatic hernias
- esophageal tumors (ie leiomyomas)
- aortic aneurysms
103
Priority of treatment for rib fracture?
- pain management and respiratory support in order to prevent hypoventilation --> atelectasis and PNA
104
Treatment options for rib fracture?
- NSAIDs
- Opiates
- Intercostal nerve block (if oral meds not sufficient)
105
Exudative effusion - main 2 types?
- Compicated parapneumonic effusion
| - Empyema
106
Findings in pleural fluid of exudative effusion?
- Low glucose (
107
Distinguish b/t complicated parapneumonic effusion from empyema how?
- Pleural fluid gram stain usually NEG in CPE and POS in empyema
- Pleural fluid cx usual NEG in CPE and POS in empyema
108
Continued fever post abx treatment + loculation in CXR - think? (2)
- complicated paranpeumonic effusion
| - empyema
109
Pulmonary contusion is?
parenchymal bruising of the lung
110
pulmonary contusion dev in what time frame?
minutes - 24hrs
111
ARDS manifest how soon post trauma?
24-48hrs
112
How to distinguish b/t ARDS and pulmonary contusion?
1) Timeframe: Pulm contusion sooner (
113
Recurrent pneumonias in the same anatomic region of the lung suggests?
Bronchial obstruction due to an underlying abnormality (ie CA, foreign body, bronchial stenosis)
114
bronchiolitis caused by what virus?
respiractory syncytial virus
115
prophylaxis for RSV and to what category pts?
- Palivizumab (monoclonal Ab)
| - kids
116
bronchiolitis has inc risk of what?
Otitis media
117
Lymphoma and nasopharyngeal CA associated w/ what virus?
EBV
118
EBV associated w/ what CAs? (2)
- lymphoma
| - nasopharyngeal CA
119
who do you give palivizumab to?
kids
120
elevated AFP and B-hCG - think? (2)
- Endodermal sinus tumor (ie nonseminomatous germ cell tumor)
- Teratoma
121
tell difference b/t seminoma and nonseminomaotus germ cell tumor?
NSGCT has elevated AFP, seminoma does not
- both elevated B-hCG
122
dysgerminomas are equivalent to what male tumor?
seminoma
123
panacinar emphysema caused by?
alpha-1 antitrypsin deficiency
124
panacinar emphysema located where usually?
lower lobes
125
AAT deficiency --> where emphysema useuall?
panacinar emphysema descruction in lower lobes
126
Pt w/ COPD at young age (
AAT deficiency
127
COPD w/ minimal or no smoking hx - consider?
AAT deficiency
128
Basilar-predominant COPD - consider?
AAT deficiency
129
PE can --> what lung abnl?
small Pleural effusion (due to hemorrhage or inflammation) --> pain
130
What type of effusion generally seen w/ PE?
exudative
| - potentially bloody
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