16

Question 1

ABG atelectasis

Answer 1

patients are hypoxemic (V/Q mismatch) so compensate by hyperventilating:
alkalosis, decreased PaCO2
PE may present similarly

Question 2

dead space ventilation

Answer 2

lungs in certain area are VENTILATED but NOT perfused, i.e. PE opposite of pneumonia: intrapulmonary shunting

Question 3

how to dx lactose intolerance

Answer 3

+ hydrogen breath test (indicates bac. carb metabolism), HIGH Osm gap due to unmetab. lactose and acids, ACIDIC stool pH
in contrast: + urine for reducing substances is seen in glycosuria, etc

Question 4

multiple hamatomatous polyps, melanotic spots on lips/skin, ^frequency breast, gonadal, pancreatic cancer, think?

Answer 4

Peutz-Jeghers Syndrome

Question 5

colon cancer + osteomas, desmoid tumors, other ST tumors

Answer 5

Gardner Syndrome

Question 6

Working up precocious puberty if advanced bone age

Answer 6

If LH is high, implies gonadotropin – dependent (central) precocious puberty
With LH is low, do GnRH stim test
If high LH in response, GnRH dependent – central
If LH remains low, gonadotropin independent – peripheral precocious puberty
Leydig cell tumor: will have unilateraltesticular enlargement or mass
Late onset CAH: coarse axillary/pubic care, severe cystic acne, Signs of androgen excess but no testicular tumor, will have normal electrolytes

Question 7

PPD greater than 5 mm is positive if?

Answer 7

HIV-positive, recent contacts of known TB, nodular/fibrotic changes on CXR consistent with previously healed TB, organ transplant recipients/other immunosuppressive patients
However, greater than 10 mm is positive if injection drug user, higher risk for TB reactivation: DM, prolonged steroid therapy, leukemia, ESRD, chronic mail absorption syndromes, Recent immigrant, live/work in high-risk setting: prison, nursing home, hospital, homeless shelter, lab for MTB, Kids less than 4

Question 8

Asymptomatic elevation of alkaline phosphatase an elderly patient, think?

Answer 8

Paget disease

Question 9

Postpartum blues versus depression

Answer 9

Postpartum blues self-limited, typically resolves within two weeks, if persists beyond two weeks evaluate for postpartum depression

Question 10

What type of bias is created when subjects or lost to follow up?

Answer 10

Attrition bias, a subtype of selection bias: the lost subjects may differ in a meaningful way from the subjects who remain in the study, which may overestimate or under estimate the association between exposure and disease in the study

Question 11

Subtle features that may qualify for PTSD

Answer 11

Amnesia, nightmares, sleep disturbance, irritability, emotional numbing, detachment, intrusive flashbacks, hypervigilance, increased startle response, occurring for more than one monthand patient with exposure to traumatic event i.e. combat veterans

Question 12

The arthritis in acute rheumatic fever versus juvenile idiopathic arthritis

Answer 12

Acute rheumatic fever will have migratory polyarthritis with erythema marginatum
Juvenile idiopathic arthritis is not migratory and his present for more than six weeks and may have a rash

Question 13

Sounds in pulmonary HTN

Answer 13

Wide splitting of S2 with loud P2 or tricuspid and pulmonary valve insufficiency

Question 14

Pulmonary hypertension on CXR/CT

Most accurate test?

Answer 14

Best initial tests, shows dilation and proximal arteries with narrowing of the store vessels
Most accurate test is right heart or Swan-Ganz catheter to measure pressure’s
EKG and echo will show RA/RV hypertrophy

Question 15

Treatment for pulmonary hypertensions

Answer 15

Prostacyclin analogues: epiprisyebol, treprostinil, iloprost, beraprost
Endothelin antagonists: bosentan, ambrisentan
Phosphodiesterase inhibitor’s: sildenafil
These are all better than CCP’s, hydralazine, nitroglycerin
O2 slows progression

Question 16

ARD ass looks like CHF on CXR except?

Answer 16

Has normal cardiac hemodynamic measurements– PCWP is normal, but not necessary to measure
CXR shows bilateral infiltrates that become confluent – white out

Question 17

Causes of ARDS

Answer 17

Sepsis, expiration, long contusion/drama, near drowning, burns, pancreatitis

Question 18

ARDS ratio

Answer 18

PO2 / FiO2 less than 300, if less than 200 moderately severe, less than 100 severe

Question 19

ARDS management

Answer 19

Low total volume ventilation: 6 mL/kg of tidal volume, PEEP to decrease the FI O2 as levels above 50% or toxic, maintain plateau pressure of less than 30
Steroids are not beneficial, but may help in late stage disease when fibrosis develops

Question 20

Altered patient with low hemoglobin, low platelets, low leukocytes,mild scleral actress, elevated Billy Rubin, elevated alkaline phosphatase

Answer 20

TTP

Question 21

Patients with a PE may develop?

Answer 21

Small pleural effusion’s due to hemorrhage or information, tend to be exudative and grossly bloody and can’t be associated with pain to the plural irritation