Dirty Medicine Q's

Question 1

Patient is admitted to hospital
24-72 hours later they undergo an acute change in mental status.
What is the diagnosis?

Answer 1

Alcohol Withdrawal

Question 2

What are the symptoms of alcohol withdrawal?

Answer 2

Diaphoresis
Low grade fever
Hypertensive
Tachycardic
Fine tremulusness
Visual hallucinations
Seizures (delirium tremens)

Question 3

What is the treatment for alcohol withdrawal?

Answer 3

Benzodiazepenes

Question 4

What are the CYP450 inducers?

Answer 4

BS CRAP GPS induces my rage

Barbituates
St. Johns Wart

Carbemazepine
Rifampin
Alcohol
Phenytoin

Griseofulvin
Phenobarbitol
Sulfonylureas

Question 5

What is metabolized by CYP 1A2?

Answer 5

AcetAminophen

1 word, 2 A’s

Question 6

What is metabolized by CYP 2E1?

Answer 6

Ethanol (alcohol)

21 to drink ethanol

Question 7

What is metabolized by CYP 2C9?

Answer 7

Warfarin/Coumadin

Warfarin acts on Factors 2, 7, 9, 10, Protein C, Protein S

Question 8

What is metabolized by CYP 2D6?

Answer 8

Cardiovascular drugs

2D echo is used to look at heart

Question 9

What are the CYP 450 subtypes?

Answer 9

CYP-1A2
CYP-2E1
CYP-2C9
CYP-2D6
CYP-34A

Question 10

What are the CYP450 inhibitors?

Answer 10

Valproate
Ketoconazole
Isoniazid
Sulfonamides
Chloramphenicol
Amiodarone
Erthromycin
Clarithromycin
Quinidine
Grapefruit Juice

Question 11

What drug is used to treat NMS?

Answer 11

Neuroleptic Malignant Syndrome is treated with Dantrolene

Question 12

What drug is used to treat serotonin syndrome?

Answer 12

Cyproheptadine

Question 13

What drug is used to treat extrapyramidal symptoms?

Answer 13

Benztropine

Question 14

What is bromocriptine and what is it used for?

Answer 14

Bromocriptine is a dopamine agonist used to treat Parkinsons

Question 15

What is an important side effect of metformin?

Answer 15

Metformin can cause Lactic Acidosis with kidney damage.

Ex: Ct contrast can cause damage to kidneys. Coupled with metformin, lactic acidosis can occur

Question 16

What is anticardiolipin?

Answer 16

Anti-phospholipid antibody seen with SLE

Anticardiolipin targets cardiolipin, a lipid protein in the inner mitochondrial membrane that binds to Beta-glycoprotein 1

Anticardiolipins are also present in Syphilis (causing false positive RPR)

Anticardiolipins can bind to platelet membranes, causing clot formation, WHICH CAN RESULT IN ABORTIONS

Question 17

What finding can occur within 24 hours of an MI?

Answer 17

Ventricular Arrhythmia

D/t calcium mediated hypercontraction

Question 18

What finding can occur 1-3 days after an MI?

Answer 18

Fibrinous Pericarditis

D/t neutrophil mediated coagulative necrosis

Question 19

What finding can occur 3-14 days after an MI?

Answer 19

Free Wall Rupture, Interventricular septal rupture, LV Pseudoaneurysm

D/t granulation tissue and macrophages

Question 20

What finding can occur 2+ weeks after an MI?

Answer 20

Dressler Syndrome or Mural thrombus

D/t scar formation

Question 21

What is the diagnostic criteria for Major Depressive Disorder?

Answer 21

5 SIGECAPS symtpoms for 2 weeks

Sleep
Interest
Guilt
Energy
Cognition/Concentration
Appetitie
Psychomotor
Suicide

Question 22

What is the diagnostic criteria for Adjutment DO

Answer 22

Anxiety symptoms lasting < 6 months

Ex: fired from job, develop anxiety 2 months later, goes away

Question 23

What is the diagnostic criteria for Generlized anxiety DO?

Answer 23

Anxiety symptoms for > 6 months

Question 24

What are the diagnositc criteria for pathologic grief?

Answer 24

Findings of guilt lasting over 12 months and functional impairment

• Sadness
• Anxiety
• Apathy
• Wanting to die (not just to be with deceased person)
• Hallucinations (also seen in normal guilt)

Question 25

What does EBV bind to?

Answer 25

CD21

Question 26

Waht does HIV bind to?

Answer 26

CXCR4

Question 27

What does Rhinovirus bind to?

Answer 27

ICAM-1

Question 28

Waht does Rabies bind to?

Answer 28

Nichotinic acetylcholine receptors

Question 29

What reflex is absent in testicular torsion?

Answer 29

Cremaster reflex

Question 30

What shape are uric acid crystals?

Answer 30

Rhomboid

Question 31

What shape are calcium oxalate crystals?

Answer 31

Envelopes

Question 32

What shape are calcium phosphate crystals?

Answer 32

Wedge-shaped pyramids

Question 33

What shape are ammonium, Mg, phosphate crystals?

Answer 33

coffin lid

Question 34

What shape are cysteine crystals?

Answer 34

hexagonal

Question 35

What causes calcium oxalate stones?

Answer 35

Vit C excess Ethylene glycol Crohns

Question 36

What causes Ammonium, Mg, Phosphate stones?

Answer 36

Urease + bugs (proteus, stag horn calculi)

Question 37

What causes cyteine stones?

Answer 37

Cystinuria, fm hx

Question 38

What can be seen on UA with Hypertensive Urgency?

Answer 38

RBC Casts | also seen in nephritic

Question 39

What cann be seen on UA in ESRD?

Answer 39

Waxy casts

Question 40

When would you see WBC casts in urine?

Answer 40

Pyelonephritis Interstitial Nephritis (drug induced; rash, itching, eosinophilia) Transplant rejection

Question 41

When would you see fatty casts in urine?

Answer 41

Nephrotic syndrome | fatty casts under polarized light shows a maltese cross

Question 42

What would you find on UA in a patient with Acute tubular nechrosis?

Answer 42

Granular (muddy brown) casts

Question 43

What is the most likely casue of meningitis?

Answer 43

Strep pneumo | not N meningitites

Question 44

What is the most likely cause of UTI in a young sexually active female?

Answer 44

E coli

Question 45

What conditions is S pneumo the #1 most common cause of?

Answer 45

MOPS Meningitis Otitis Media Pneumonia Sinusitis

Question 46

What are the 2 causes of scid?

Answer 46

Adenosine Deaminase Deficiency - Autosomal recessive Gamma IL-2R Light Chain defect - X-linked recessive