Big Pimpin'

Question 1

DDx for ring-enhancing lesions in HIV?

Answer 1

1 = toxo; also: lymphoma, PML (rarely enhances), cryptococcal cerebritis and tuberculoma, and stroke

Question 2

Initial serologies to order for dx of Hep B?

Answer 2

HBSAg, HBSAb, HBcAb

Question 3

PBC: epidemiology, presentation, diagnosis, treatment and prognosis

Answer 3

women in 50s (b for bitches); p/w pruritus, fatigue and destroyed INTRAhepatic bile ducts; dx w/ elev Alk Phos and anti-mitochondrial Ab (present 95% cases); tx w/ ursodiol; nl life expectancy (Stage I/II),

Question 4

Define orthostatic vital signs

Answer 4

Fall in SBP of >20 mm Hg w/ standing
Increase in HR of >30 beats/min
Unable to remain standing d/t dizziness

Question 5

Mnemonic for screening for dementia?

Answer 5

A-I-D-A: Acute onset, Inattention, Disorganized thinking, Altered LOC (a.k.a. the CAM-ICU Tool)

Question 6

DDx for hypercoaguable states

Answer 6

By decreasing order of frequency: Factor VIII elev (6-8%), Factor V Leiden (5%), Hyperhomocysteinemia (5%), Prothrombin 20210 gene mutation (2-3%), Anti-thrombin, Prot C or Prot S deficiencies (each 0.3%)

Question 7

Auto-antibodies seen in auto-immune hepatitis? Cut-off titer?

Answer 7

ANA, anti-smooth musce, and anti-LKM antibodies; titers 1:80 support a diagnosis of autoimmune hepatitis.

Question 8

sterile pyuria

Answer 8

think diverticulitis

Question 9

smoking and IBD

Answer 9

increases risk for Crohn’s, decreases symptoms in UC

Question 10

IBD: skip lesions and rectal sparing means?

Answer 10

Crohn’s; UC would be continuous and involve the rectum (usually)

Question 11

Normal serum osmolality?

Answer 11

285-295 mOsm/kg

Question 12

How to r/o pseudo-hyponatremia?

Answer 12

Measured serum osmolality will not be affected by the increased lipids or proteins, but calculated osmolality (2 serum [Na+] + glucose/18 + BUN /2.8) will be abnormal

Question 13

Beginning w/u for hypoNa+

Answer 13

1. Assess acute vs. chronic? Severity of neuro sx? Risks for neuro comps (EtOH? malnourished? cirrhosis? ♀ on thiazides? hypoxia? hypoK+?)
   - Most hypotonic
   - If isotonic think hyper-lipidemia/-proteinemia
   - If hypertonic think hyperGLY or mannitol
2. Check BMP, SOsm, UOsm, UNa and UCr
3. Assess volume status
   3a. HYPERvolemic
   - Hypervolemic w/ UNa 20 = advanced CKD
   3b. EUvolemic
   - UOsm 100 = SIADH, hypoTHY, glucocort def.
   - UOsm var = reset omsostat
   3c. HYPOvolemic
   - UNa > 20 - renal losses, MR def
   - UNa

Question 14

Indications for abx in acute bronchitis

Answer 14

ONLY indicated for: COPD hx (i.e. pt having a COPD exacerbation) OR pt w/ Pertussis (then give macrolide)