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Classic Presentations 2 Flashcards

1
Q

Blood/gas partition coefficient

A

Measures solubility of anesthetic in blood . Drugs with high blood/gas partition coefficients are more soluble in blood and demonstrate slower onset of action and slow equilibration with brain

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1
Q

infant with microcephaly, mental retardation, white pupils (cataracts), deafness, heart (PDA, peripheral pulmonic stenosis) problems, hearing loss

A

CONGENITAL RUBELLA SYNDROME

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2
Q

Camping trip 3 weeks ago in New Mexico later has fever, agitation, disorientation, hallucination, pharyngospasm, excessive salivation, photophobia leading to coma and death

A

Rabies, single stranded RNA with bullet-shaped capsule

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3
Q

First symptom of alcohol withdrawl

A

TREMOR, or Tremulousness, the so-called “shakes” usually occur 5-10 hours after last drink

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4
Q

5 year old girl’s skin becomes red and scaling with minimal sun exposure. Nevi on hands enlarge rapidly with thin hyperpigmented skin

A

XERODERMA PIGMENTOSUM, AR condition due to defect in DNA EXCISIONAL REPAIR, high incidenc of all forms of cutaneous malignancy

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5
Q

Sensorineural hearing loss, tinnitus, paralysis of facial muscles, loss of corneal reflex

A

involvement of CN V, VII, VIII, ACOUSTIC NEUROMA, NF2

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6
Q

56 year old smoker, recurrent hemoptysis, headaches, swelling of face, neck and upper extremities

A

Intrathoracic spread of bronchogenic carcinoma compression of SVC causing imparied venous return

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7
Q

Patient transfused and within minutes develops chills, SOB, fever, hypotension, possible DIC, renal failure, hemoglobinuria.

A

ACUTE HEMOLYTIC TRANSFUSION REACTION (Type II hypersensitivity) Anti-ABO antibodies bind.

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8
Q

62 year old female with cough, dyspnea, expectorates copious pale tan-colored fluid. CSR show pulmonary infiltrate, columnar mucin-secreting cells fill alveolar spaces

A

BRONCHIOALVEOLAR CARCIONOMA - uncommon and arises in non-smokers, from alveolar epithelium in periphery of lung

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9
Q

Fever, rebound tenderness, purulent endocervical discharge, cervical motion and adnexal tenderness on bimanual examination. What else is risk?

A

PID results in ectopic pregnancy rate approaching 50%

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10
Q

Painless lower GI bleeding

A

Most common manifestation of colonic diverticula

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11
Q

Main manifestations of Von Gierke’s

A

hypoglycemia, lactic acidosis, HYPERLIPIDEMIA, HYPERURICEMIA. HEAPTIC STEATOSIS is a CARDINAL MANIFESTATION

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12
Q

Main manifestations of Cori disease

A

Hypoglycemia, HYPERTRIGLYCERIDEMIA, Ketoacidoosis, hepatomegaly

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13
Q

Persistent vomiting, refusal to feed, green-yellow vomit, absence of large segment of small bowel with istal ileum winding around a thin vascular stalk.

A

“Apple-peel” atresia caused by SMA obstruction. Blind-ending proximal jejunum, missing a large section of small bowel and dorsal mesentary. Terminal ileum distal to atresia assumes spiral configuration around an ileocolic vessel

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14
Q

Bilious vomiting after the first 24 hours of life

A

sign of intestinal obstruction below second part of duodenum. M/C Cause is intestinal stenosis and atresia

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15
Q

66 year old man with recently discovered lung mass develops dizziness, dysarthria, and limb ataxia worsening over the past 2 weeks.

A

Paraneoplastic cerebellar degeneration - autoimmune response with antibodies that cross react with neurons and cause degeneration of cerebellum (anti-P/Q and anti-Hu in serum are elevated)

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16
Q

38 year old male demonstrates periodic non-peristaltic contractions of a large amplitude and long duration.

A

DIFFUSE ESOPHAGEAL SPASM (DES) - uncoordinated contractions of esophagus, several segments contract at same tie preventing propogation of food, involuntary and painful - PAIN MIMICS UNSTABLE ANGINA

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17
Q

ECG shows HR of 120 bpm, narrow QRS complex, no P waves

A

Atrial fibrillation - rapid, irregular atrial contrations

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18
Q

Average ventricular rate in atrial fibrillation is usually:

A

90-170 beats per minute, (atrial rate is 300-500 beats per minute)

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19
Q

Patient given cefazoline and within several minutes complains of shortness of breath, difuse itching, dizziness, BP is 62/30 and HR 130/min. Urticaria +/- angioedema, laryngeal edema (dysnea), visceral edema, hypotension

A

ANAPHYLAXIS - systemic type 1 hypersensitivity reaction occuring within seconds to miutes due to widespread MAST CELL DEGRANULATION and resulting HISTMINE RELEASE

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20
Q

65 year old with pulmonary mass complains of shoulder pain, persistent hiccups, and dyspnea. Nerve lesion is at this level

A

irritation of PHRENIC nerve that arises from C3-5 segments of SC and causes hiccups and diaphragmatic paralysis with dyspnea

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21
Q

Brachial plexus involvement causes pain at these nerve roots

A

C8, T1, and T2

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22
Q

Left foot drop (peripheral neruopathy), Sinusitis (possibly asthma), palpable purpura, may involve GI, heart, kidneys

A

Chur-Strauss syndrome, p-ANCA

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23
Q

A 1 year old child with Fever, lymphadenitis, conjunctivitis, changes in lips/oral mucosa, hand-foot erythema, desquamation

A

Kawasaki - Fever, Lymphadenitis, conjunctivis, changes in lipsoral mucosa

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24
"Portable heater"
Carbon monoxide toxicity
25
Irritability, forgetfullness, headache, dizzy, portable heater
Carbon monoxide toxicity
26
Recurrent infections (pneumonia), Chronic diarrhea, Failure to thrive
SCID - defect in early stem cell - caused by 7 different gene defects
27
Rash starts on palms and soles -\> body versus Body to palms and soles
Rickettsia on the wRists, Typhus on the Trunk. Two Rickettsial rashes.
28
Headache + Fever + Rash
Rickettsial triad
29
Applying corticosteroid cream to flexor areas of skin for many years presenting with telangiectasias, ecchymoses from mild trauma, atrophic striae
Chronic topical corticosteroid administration include ATROPHY/THINNING of DERMIS associated with LOSS OF DERMAL COLLAGEN, drying, cracking, tightening of skin, telangiectasias, and ecchymoses
30
Erythema nodosum, arthralgias, hilar lymphadenopathy, elevaed serum ACE
SARCOIDOSIS - evidence of liver involvement on histological exam in 75% of cases. Biopsy demonstrates scattered noncaseating granulomas
31
Insidious onset of personality changes in a 30-40 year old with jerky movements of husband's arms. Diagnosis and cause of movements?
Huntington disease, AD neurodegenerative disease, dementia + choreiform movements characterized by loss of GABA-containing neurons in the striatum (caudate and putamen) due to increased number of trinucleotide repeats in the HD gene on chromosome 4.
32
Meconium discharge from the umbilicus seen soon after birth
VITELLINE FISTULA present - failure of vitelline duct to close during the 7th week of embryonic development, small connection between intestinal lumen and outside body!
33
Aphthous ulcers and pancytopenia
SE Methotrexate - causes death of all rapidly-dividing cells (GI tract and bone marrow) inhibits DIHYDROFOLATE RDUCTASE - needed to make THF for PURINE SYNTHESIS
34
NEUROMUSCULAR EXCITATION (hyperreflexia, CLONUS, myoclonus, rigidity, tremor) + AUTONOMIC STIMULATION (hyperthermia, tachycardia, diaphoresis, n/v) + ALTERED MENTAL STATUS (agitation and confusion)
SEROTONIN SYNDROME - most commonly when SSRIs given in conjunction with other serotonergic agents (MAOIs or triptans
35
62 year old male hx HTN and DM, horrible headache earlier that day, bumping into objects, can only read half the newspaper
on PE you look for CONTRALATERAL HEMIANOPIA (with macular sparing) + Contralateral face and limb sensory loss due to PCA INFARCT. CT will demonstrate ischemic infarction + hemorrhagic change; PCA provides major blood supply to MIDBRAIN, thalamus, lateral
36
Do you want to eat raw or steamed shellfish?
Only if you want to contract HAV with a 30 day incubation, recovery is 3-6 weeks. There is a vaccine
37
Do you want to feed your infant honey?
12% of honey samples contain low numbers of C. botulinum spores
38
5 year old girl with colickly abdominal pain, loose stools, altered metnal status, oliguria, red urine.
HEMOLYTIC UREMIC SYNDROME (Nasty Fever Torched Her Kidneys) Fever, and triade of Renal failure, microangiopathic hemolytic anemia, thrombocytopenia
39
2 weeks after a cutaneous infection, patient presents with oliguria, hematuria, edema (periorbital), and hyertension
PSGN - (Anemia NOT seen like in HUS) caused by nephritogenic (lysogenized) strain of group A beta hemolytic streptococcus.
40
Infant with constipation for a few days/weeks, then mild weakness, lethargy, poor feeding
Infant botulism - may progress to loss of head control and infant appears "floppy"
41
Pallor, red urine
Hemolysis
42
High fever, conjunctivitis, cervical lymphadenopathy, periungual desquamation, mucucutaneous changes
Kawasaki disease
43
A 32 year old African American male is diagnosed with acute prostatis, treated with TMP-SMX and develops dark urine, anemia with a high reticulocyte count
G6PD deficiency, X-linked disorder (mostly males) more common in African, Asian, Mediterranean
44
Middle aged woman with severe pruritis (especially at night) and fatigue. PE Hepatosplenomegaly and xanthomatous lesions in eyelids, skin, tendons. She later develops jaundice, steatorrhea, portal hypertension, and possible ostepenia.
PRIMARY BILIARY CIRRHOSIS (PBC) - check labs for antimitochondrial antibodies, elevatd alkaline phosphatase (autoimmune destruction of intrahepatic bile ducts and cholestasis) elevated IgM. Associated with SS, Raynaud, scleroderma, hypothyroid, celiac, au
45
Painful skin lesions on mouth, PE shows erosions of buccal and gingival mucosa, flaccid bullae with erosions scattered over trunk. Blisters spread laterally with pressure and traction on univolved skin produces bullae.
PEMPHIGUS VULGARIS (PV) autoimmue bullous disease oral mucosa most commonly affected. Antibodies directed against DESOMSOMES (desmogleins 3 and 1) Asboe Hansen - bullae spread laterally with pressure, Nikolsky - bullae forms with gentle traction
46
Sudden onset severe headache with neck stiffness or developing within 24 hours. No focal neurologic findings but papilledema and pupillary dilation may be noted.
Suspect SAH (neck stiffess from blood in subarachnoid space irritating meninges). CT Scan is 90% sensitive, if negative, LP needed to evaluate CSF for presence of xanthochromia (Blood in CSF) most sensitive test for diagnosing SAH
47
Vaginal bleeding + Crampy abdominal pain
Partial mole (69XXX or XXY)
48
Weakness and arrhythmias
Hypokalemia (T-wave flattening), ST segment depression, prominent U waves, PAC, PVCs
49
"The FDA will approve your drug if it decreases the recurrence rate of breast cancer by 40% compared to standard therapy alone" What does the 40% represent?
RELATIVE RISK REDUCTION (RRR) - the percent reduction in absolute risk between treatment and control groups: RRR = [AR(con)-AR(new treatment)]/AR(con)
50
Abdominal pain, n/v, diarrhea, pupillary dilation, diaphoresis and fever
OPIATE WITHDRAWAL - described as "flu-like" Cancer patients may also develop. Also piloerection (but that would give it away)
51
Hypersomnolence, fatigue, depression, suicidality, strong craving for the drug
COCAINE WITHDRAWAL
52
Autonomic system hyperactivity (tremors, agitation, tachycardia, HTN) beginning 8-12 hours, peaking 48-96 hours. Risk of seizure peaks at 48 hours.
ALCOHOL WITHDRAWAL - potentially fatal
53
5 year old male with several day history of fever, irritability, refusal to eat. PE painful gingival ulcers, swollen gums, cervical lymphadenopathy
PRIMARY INFECTION with HSV-1. Tzanck prep shows multinucleated giant cells with intranuclear inclusions
54
Vertical diplopia
Trochlear nerve palsy (most noticeable when eyes look towards nose (read or walk down stairs)
55
Infant with opisthotonos, high-pitched cry, lethargy, poor suckling, absent moro reflex, loss of upward gaze. Followed by deafness, cerebral palsy, sensorineural deficits, mental retardation
Kernicterus - yellow staining and degenerative lesions in basal ganglia associated with high levels of unconjugated bilirubin in infants.
56
Very tender, small (few mm in diameter) Red-blue lesion under nail bed
BENIGN GLOMUS TUMOR (Glomangioma) - tumor originates from modified smooth muscle cells that control THERMOREGULATORY FUNCTIONS of dermal glomus bodies
57
Digital clubbing
Acquired bilateral most common due to PULMONARY or CV Dz: Bronchiectasis, emphysema, pneumonia, CHF
58
Stroke + intestinal or foot ischemia + renal infarct
Embolic phenomena - left atrial clots, LV clots, valvular vegitations, aortic atherosclerotic plaques. DVTs would cause PE
59
Diplopida, dysphagia, dysphonia, nausea, dry mouth
Botulism ate from damaged can 18-36 hours ago. INHIBITS CHOLINERGIC NERVES - prevents binding and fusion of acetylcholine-containing exocytotic vesicles blocking AcH release. AFFECT NICOTINIC receptor
60
Cutaneous vasodilitation, andhidrosis, hyperthermia, mydriasis, delirum
ANTICHOLINERGIC poisoning (Atropine or scopolamine) acting on MUSCARINIC ACETYLCHOLINE receptors with NO EFFECT on NICOTINIC (voluntary musculature) thus you will not asphyxiate
61
Muscarinic signs + muscular fasciculations -\> weakness and paralysis, CNS effects (respiratory depression, lethargy, seizures)
Organophosphate compounds, edrophonium, limit acetylcholine breakdown
62
Lifelong history of gingival bleeding, epistaxis, mucosal bleeding, and/or menorrhagia. Labs Hb 9.2 g/dL, MV 72 and low ferritin.
VON WILLEBRAND FACOTR DEFICIENCY, AD with variable incomplete penetrance. (low HB due to iron deficiency anemia so vwD causing anemia)
63
Subacute headache, fever, and neck stiffness with lymphocytic CSF pleocytosis, modeslty elevated CSF protein, and otherwise normal CSF parameters
ASEPTIC MENINGITIS - ENTEROVIRUSES - COXSACKIE and ECHOVIRUS are most common cause of aseptic meningitis
64
35 year old with hard mass under jaw developed 3 months ago after a tooth extraction. Drains yellow pus
Actinomyces isralii, gram (+) causing CERVICOFACIAL ACTINOMYCOSIS after dental manipulation or oral trauma. Rx: long term penicillin treatmentand surgical debridement
65
Dyspnea, bibasilar crackles + S3 sound in patient with recent mycocardial infarction
LEFT HEART FAILURE
66
Cessation of cerebral blood supply for 5-10 seconds leads to
Loss of consciousness (syncope\_
67
Cessation of cerebral blood supply for \> 1 minute
Cessation of neuronal activity
68
Permanent damage to brain tissue occurs after hypoxia lasting for
4-5 minutes
69
Yellowish eyelid papule or plaque containing lipid-laden macrophages
XANTHELASMA - assoicated with primary or secondary hyperlipidemia also BILIARY CIRRHOSIS producing cholestasis
70
Duodenal ulcer
PUD, and 80-95% of patients with duodenal ulcers harber H. pylori (remainding are associated with NSAID use)
71
Bruise changes to greenish color several days after injury
HEME OXYGENASE converts heme (released from lysed RBCs) to BILIVERDIN, a green pigment, then reduced to bilirubin and transported to liver
72
Exertional dyspnea (and possible exertional pre-syncope)
PULMONARY HYPERTESION - inability of right heart to adequately increase CO against increased pulmonary vascular resistance during exercise -\> leads to RV hypertrophy
73
Grayish pharyngeal exudate
C. diphtheriae
74
Ptosis, "down and out" gaze, a fixed, dilated pupil, and no accommodation reflex
NERVE COMPRESSION affecting both SOMATIC and PARASYMPATHETIC fibers
75
Ptosis, "down and out" gaze, pupils are equal and reactive to light
DIABETIC ISCHEMIC NEUROPATHY - somatic fibers lost that inervate (inferior, superior, medial rectus, inferior oblique, and LEVATOR PALPEBRAE (ptosis). Parasympathetic fibers of CNIII intact (different blood supply) sphincter of iris and ciliary intact, co
76
Fixed, dilated pupil, and no accomodation reflex
Loss of peripheral PARASYMPATHETIC fibers, affected FIRST by COMPRESSION (Berry aneurysm, uncal herniation
77
Can't see in lower left quadrant for both eyes
Left homonymous inferior quadrantoanopia ("pie on floor") RIGHT PARIETAL LOBE (dorsal optic radiation) due to lesion or stroke of parietal lobe
78
Can't see upper left quadrant of both eyes
Left homonymous superior quadrantanopia ("pie in sky") RIGHT TERMPORAL LOBE (Meyer's loop) resulting from lesion or stroke involving temporal lobe
79
Cants see left half of visual field only in right eye
Right nasal hemianopia caused by Right PERI-CHIASMAL lesion due to calcification or aneyrysm of the INTERNAL CAROTID artery impinging on uncrossed, lateral retinal fibers
80
Can't see in left visual field for both eyes
LEFT HOMONYMOUS HEMIANOPIA - due to RIGHT OPTIC TRACT (occlusion of ANTERIOR CHOROIDAL ARTERY)or OPTIC RADIATION (occlusion of MCA branch or lesion to POSTERIOR LIMB of IC)
81
Can't see left half of visual field but can still read print clearly
LEFT HOMONYMOUS HEMIANOPIA with MACULAR SPARING - RIGHT PRIMARY VISUAL CORTEX (occipital lobe) - Occlusion of PCA (Macula spared due to collateral blood from MCA)
82
Weight gain, edema, pulmonary vascular congestion; Hyperkalemia asymptomatic b/c 30, FeNa \>1
Acute Renal failure due to ATN - retain H+ and anions leading to high anion gap metabolic acidosis
83
Fever, rash (maculopapular), oliguria 1-3 weeks after initiation of treatment with a ampicillin (beta lactam antibiotic). Peripheral eosinophilia + eosinophiliuria
DRUG-INDUCED ACUTE INTERSTITIAL NEPHRITIS (AIN) NSAIDs, sulfonamides, rifampin, and diuretics.
84
72 year old patient evaluated for syncope and long standing dyspnea
Severe aortic stenosis, Afib occurs in 10% of patints with severe aortic stenosis
85
72 year old patient with severe aortic stenosis presents with acute pulmonary edema and blood pressure of 90/60, irregularly irregular. Why is he hypotensive? How did he develop the pulmonary edema?
Acute atrial fibrillation precipitated sudden onset of heart failure: Loss of contribution of atrial contraction causes REDUCED LV PRELOAD causing dangerous systemic HYPOTENSION. Acute AF may also increase steady state PVP to cause acute Pulmonary EDEMA
86
Fixed and dilated pupil -\> ipsilateral paralysis of oculomotor muscles, contralateral or ipsilaterl hemiparesis (possible contralateral homonymous hemianopsia with macular sparing may also occur)
Transtentorial (uncal) herniation is a complication of an ipsilateral mass lesion - medial temporal lobe (uncus) herniates through the gap between crus cerebri and tentorium cerebelli
87
Boys appear female, girls develop genitalia. Hypogonadism, hypertension, hypokalemia
17 alpha hydroxylase deficiency
88
Angular stomatitis, cheilitis, glossitis, seborrheic dermatitis, eye changes (keratitis, corneal neovascularization), anemia
Riboflavin deficinecy - affect heart, liver kidney, FMN and FAD required cofactors for flavoproteins needed for redox reactions. Components of ETC FMN is complex I, FAD complex II. FAD is cofactor in TCA for SUCCINATE DEHYDROGENASE (succinate into fumarat
89
Small outbreak of self-limited infection in summer camp. Several children develop low-grade fever, throat pain, cervical lymphadenopathy
ADENOVIRUS - common cause pharyngoconjunctival fever occuring in close quarters
90
Summer outbreaks of meningiits possibly connected to swimming pools
ECHOVIRUS (a pircornavirus), also coxackie, enterovirus
91
Proximal muscle weakness, can't climb stairs, rise from chair or comb hair. Flat-toped violaceous papules over joints with heliotrope rash
DERMATOMYOSITIS
93
Progressive solid food dysphagia accompanied by weight loss, chronic GI blood loss
Esophageal squamous cell carcinoma
94
29 year old with scrotal mass and sweating, palpitations, recent weight loss. Increased T4 and T3
hCG is structurally similar to TSH, can stimulate TSH receptors (non-seminomatous germ cell tumor like a teratoma)
95
Child with marked hyperlipidemia, pancreatitis (abdominal pain), lipemia retinalis, eruptive skin xanthomas (small yellowish papules surrounded by erythema that occur mainly on extensor surfaces of extremities) and hepatosplenomegaly.
LIPOPROTEIN LIPASE DEFICIENCY
96
54 year old with hemorrhagic pleural efusion. Worked in shipyard for past 25 years and smoked 30 years. CT shows diffuse nodular thickening of pleura. Pleural biopsy shows columnar cells joined by desmosomes with abundant tonofilaments studded with very l
MESOTHELIOMA
97
64 year old man being treated for stable angina receives a new medication and presents to ER 7 days later with severe dizziness, PE blood pressure is 100/70 mm Hg and HR is 38 beats per minute
Combined use of Beta-blocker (atenalol) + non-dihydropyridine calcium channel blocker can have additive negative chronotropic effect = severe bradycardia and hypotension
98
Normal blood sugar, severe cardiomegaly, cardiomegaly, macroglossia, hypotonia, mental retardation in its most severe form, glycogen accumulation in lysosomes, normal glycogen structure
Pompe's disease (II) (ALPHA 1,4 GLUCOSIDASE or ACID MALTASE) - only glycogen storage dz where glycogen accumulates in the LYSOSOMAL VACUOLES
99
18 year old male develops confusion and nausea four days after an uncomplicated laparotomy conducted under general anesthesia. Unsignificant PMH. Labs show elevated AST, ALT and bilirubin level.
MASSIVE HEPATIC NECROSIS - rare but severe complication of halothane exposure. Due to direct liver injury by halothane metabolites and formation of autoantibodies against liver proteins. 2 days to 4 weeks after exposure. Massive centrilobular hepatic necr

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