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1
Q

Onset of mild alcohol withdrawal?

A

6-24 hrs

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2
Q

Onset of Seizures from alcohol withdrawal?

A

12-48hrs

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3
Q

Alcoholic hallucinosis onset?

A

12-24 hrs, resolves w/in 48hrs

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4
Q

Delirium tremens onset?

A

48-96hrs

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5
Q

alcoholic hospitalized for operation, now 24 hrs later having visual hallucinations, stable VS and orientation. Dx?

A

alcoholic hallucinosis

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6
Q

Normal saline is a crystalloid or colloid?

A

Crystalloid

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7
Q

When are colloid solutions used?

A

In burns or conditions w/ hypOproteinemia

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8
Q

mainstay of dehydration treatment?

A

rehydration w/ IV sodium containing crystalloid solutions

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9
Q

acute onset unilateral weakness + positive Babinski sign = think?

A

acute ischemic stroke

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10
Q

tPA should be given to stroke pt w/o hemorrhage w/in?

A

3-4.5 hrs of symptom onset

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11
Q

what should be held and for how long should a stroke pt receive fibrinolytic therapy?

A

aspirin for 24hrs

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12
Q

fears of negative evaluation and embarrassment in social and performance situations = Dx?

A

Social anxiety disorder

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13
Q

poor eye contact + anxiety attacks when doing presentations = think?

A

social anxiety disorder

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14
Q

performance anxiety is included in what type of anxiety disorder?

A

social anxiety disorder

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15
Q

acute onset polyarticular and symmetric arthritis that resolves w/in 2mo, Dx?

A

Viral arthritis

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16
Q

monoarticular arthritis (4)?

A
  • Osteoarthritis
  • Septic arthritis
  • Crystalline arthritis (gout)
  • Seronegative spondyloarthropathies (+ back pain)
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17
Q

Symmetrical arthritis (2)?

A
  • Rheumatoid arthritis

- Lupus

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18
Q

Effective treatment of cancer-related anorexia/cachexia syndrome? (2)

A
  • Progesterone analogues (megestrol acetate)

- Corticosteroids (more side fx)

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19
Q

Effective treatment of advanced HIV cachexia?

A

synthetic cannabinoids

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20
Q

delayed treatment of appendix (>5days) may dev into?

A

Appendiceal rupture –> appendiceal abscess

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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

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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

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23
Q

arthralgias + psychosis + hematuria + proteinuria - concerning for?

A

Lupus

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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)
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25
Q

Prior gyn surgery esp a LEEP or cone biopsy puts pt at risk of?

A

cervical insufficiency/incompetence

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26
Q

gold standard for evaluating cervix for cervical incompetence/insufficiency?

A

transvaginal ultrasound

-abdominal u/s not accurate

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27
Q

Complications of diethylstilbestrol? (5)

A
  • 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
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28
Q

Clear cell adenocarcinoma of vagina and cervix — maj risk factor?

A

Diethylstilbestrol exposure in utero

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29
Q

Overriding aorta is? think?

A
  • when the aorta is over a VSD rather than LV

- Tetralogy of Fallot

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30
Q

What are quad in tetralogy of fallot?

A
  • Right ventricular outflow tract obstruction (ie pulm stenosis or atresia)
  • RVH
  • Overriding aorta
  • VSD
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31
Q

Harsh systolic ajection murmur over L upper sternal border + single s2?

A

Tetralogy of Fallot

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32
Q

Right to L shunts? (5)

A

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)

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33
Q

Eisenmenger syndrome?

A

Uncorrected L–> R shunt causing pulm HTN –> RVH –> shunt becomes R to L –> cyanosis, clubbing, polycythemia in KIDs (LateR)

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34
Q

cyanosis in a kid w/ clubbing and polycythemia - think?

A 
Eisenmenger syndrome
 (L--> R shunt that switches and causes cyanosis LateR)
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35
Q

Transposition of great vessels associated w/?

A

DM mom

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36
Q

Ebstein Anomaly associated w/?

A

Prenatal Li exposure

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37
Q

Ebstein anomaly is?

A

Atrialized RV

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38
Q

Supravalvular aortic stenosis associated w/?

A

Williams syndrome (deletion in elastin)

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39
Q

22q11 syndromes (ie DiGeorge) associated w/ what cardiac issues (2)?

A
  • Truncus arteriosus

- Tetralogy of Fallot

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40
Q

Alcohol exppsure in utero (fetal alcohol syndrome) –> what cardiac issues (4)?

A
  • VSD
  • ASD
  • PDA
  • Tetralogy of Fallot
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41
Q

Boot shaped heart on xray think?

A

Tetralogy of Fallot

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42
Q

Low birth weight + closed fists w/ overlapping fingers + micrognathia + rocker-bottom feet - think?

A

Edward’s syndrome (Trisomy 18)

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43
Q

Micrognathia?

A

Undersized jaw (mandibule hypoplasia)

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44
Q

Hypotonia + flat face + upward and slanted palpebral fissure + hypoplasia of middle phalanx of 5th finger + brushfield spots + high arched palate - think?

A

Down syndrome

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45
Q

cleft lip + flexed fingers w/ polydactyly + low set ears + large distance b/t eyes (ocular hypotelorism) + hypoplastic ribs - think?

A

Patau’s syndrome (Trisomy 13)

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46
Q

microcephaly w/ protruding metopic suture - think?

A

Cri-du-chat syndrome

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47
Q

Obstructive lung disease FEV/FVC

A

DECREASED —> FEV/FVC

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48
Q

Restrictive lung disease FEV/FVC?

A

Normalish –> FEV/FVC >70%

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49
Q

Mom w/ Graves disease + euthyroid during pregnancy –> neonatal tachy w/ low birth weight and irritable - think?

A

Neonatal thyrotoxicosis (hyperthyroid)

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50
Q

Neonatal thyrotoxicosis caused by?

A

Transplacental passage of maternal anti-TSH receptor Ab (Abs bind to infant’s TSH receptors –> excessive thyroid hormone release –> hyperthyroid)

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51
Q

Dx neonatal thyrotoxicosis cause?

A

Test for ant-TSH receptor Ab

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52
Q

Rx of neonatal thyrotoxicosis?

A
  • short term rx w/ methimazole + beta blocker

- self resolves over weeks - months

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53
Q

Does levothyroxine cross placenta?

54
Q

Trihexyphenidyl can cause what maj side fx?

A 
Anticholinergic excess (blind as a bat...etc)
  - headache, dizziness, tachy, acute glaucoma
55
Q

Selegiline is? maj complication?

A

MAO-B inhibitor

Serotonin syndrome

56
Q

GI perforation + pt on warfarin for afib –> best initial step (after fluids, abx, NG tube compression)?

A

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
Q

Acute bleeding in pt w/ liver failure, best treatment?

A

Fresh Frozen Plasma

- to rapidly replace clotting factors that liver normally makes

58
Q

Obstructive lung diseases? (4)

A
  • COPD (Emphysema &Chronic Bronchitis
  • Asthma
  • Bronchiectasis
  • CF
59
Q

Pink puffers?

60
Q

Blue bloaters?

A

chronic Bronchitis

61
Q

Obstructive lung disease causes inc in what and dec in what PFTs?

A

Inc: RV –> inc TLC, FRC
Dec: VC, FEV, FEV/FVC (

62
Q

Restrictive lung disease causes inc in what and dec in what PFTs?

A

Inc:
Dec: FVC (a lot) –> FEV/FVC (>70%) + TLC, FEV

63
Q

non caseating granulomas + cough + hyperCalcemia + uveitis + issues w/ saliva and lacrimal glands - think?

A

Sarcoidosis

(can mimic sjogren’s syndrome, but has sarcoid has non-caseating granulomas which sjogren’s doesn’t)

64
Q

Restrictive lung diseases? (2)

A
  • interstitial lung diseases (fibrosis, pneumoconioses, sarcoid, hypersensitivity pneumonitis)
  • wall abnormalities (ie obesity, ankylosing spondylitis)
65
Q

Silicosis is found where and inc risk of what?

A
  • Nodules upper lobe

- Inc risk of TB

66
Q

noncaseating granulomas have what type of metabolic derangement?

A

hyperCalcemia

67
Q

Lung disease + Aerospace industry or mining (specific type) - think?

A

Berylliosis

68
Q

Lung disease + sand blaster work - think?

69
Q

Lung disease + coal miners - think?

A

Coal worker pneumoconiosis or black lung

70
Q

Lung disease + construction worker or plumber or shipyard worker - think?

A

asbestosis

71
Q

Asbestos inc risk of what? (2)

A
  • lung CA (most common)

- Mesothelioma

72
Q

anthracosis think?

A

coal dust exposure

73
Q

long golden brown fibers w/ associated iron think?

A

asbestos bodies

74
Q

“reticular” or “reticulonodular” or “ground glass” or “honeycombing” – think?

A

Interstitial lung disease (restrictive)

75
Q

elevated serum findings in sarcoidosis? (2)

76
Q

Main lung findings on xray in sarcoidosis?

A

Bilateral hilar adenopathy

77
Q

Sarcoidosis treatment?

A
  • usually spontaneously self resolves
  • Symptomatic –> corticosteroids
  • Refractory –> methotrexate
78
Q

hemoptysis + dyspnea + kidney issues - think?

A

goodpasture’s

79
Q

Goodpasture what type of hypersensitivity?

A

type 2 (Ab mediated)

80
Q

Type 3 hypersensitivity is caused by and ex (3)?

A

Immune complexes

- SLE, RA, HSP

81
Q

treatment of goodpasture syndrome (3)?

A
  • plasmapheresis
  • cyclophosphamide
  • coricosteroids
82
Q

Antiglomerular basement membrane Ab?

A

Goodpasture syndrome

83
Q

Ground glass appearance w/ bilateral alveolar infiltrates that resemble a bat shape?

A

Pulmonary alveolar proteinosis (restrictive lung disease)

84
Q

Pulmonary alveolar proteinosis is?

A

accumulation of surfactant-like protein and phopholipids in alveoli –> restrictive lung disease

85
Q

Pulmonary alveolar proteinosis looks like on CXR?

A

Ground glass appearance w/ bilateral alveolar infiltrates that resemble a bat shape

86
Q

Pulmonary alveolar proteinosis treat?

A

lung lavage and Granulocyte colony-stimulating factor

- NO steroids

87
Q

mesothelioma –> what in pleura?

A

pleural effusion

88
Q

Light’s criteria

A

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
Q

Budd chiari syndrome is?

A

thrombosis of hepatic vein –> infarction of liver

90
Q

cyanosis w/ chocolate colored blood?

A

methemoglobinemia

91
Q

methemoglobinemia treatment?

A

IV methylene blue

92
Q

Room temp, room air, sea level A-a gradient formula?

A

(150 - 5/4PCO2) - PaO2

93
Q

estimated nL A-a gradient by age?

A

Aa gradient

94
Q

normal PaO2/FiO2 ratio?

95
Q
A

Acute Respiratory Distress Syndrome

  • mild: 200- 300
  • Mod: 100-200
  • Severe:
96
Q

PCWP

97
Q

PCWP >18 + pulm edema - think?

A

cardogenic pulm edema

98
Q

Hypoxemia is?

99
Q

Main line of treatment in ARDS?

A

high PEEP w/ low tidal volumes

100
Q

middle mediastinal mass? (6)

A
  • bronchogenic cyst
  • tracheal tumor
  • pericardial cyst
  • lymphoma
  • lymph node enlargement
  • aortic aneurysm of arch
101
Q

anterior mediatstinal masses? (5)

A
  • thymoma
  • restrosternal thyroid
  • teratoma
  • lymphoma
  • nonseminomatous germ cell tumor
102
Q

Posterior mediastinal masses? (6)

A
  • meningocele (all neurogenic tumors are posterior)
  • enteric cysts
  • lymphomas
  • diaphragmatic hernias
  • esophageal tumors (ie leiomyomas)
  • aortic aneurysms
103
Q

Priority of treatment for rib fracture?

A
  • pain management and respiratory support in order to prevent hypoventilation –> atelectasis and PNA
104
Q

Treatment options for rib fracture?

A
  • NSAIDs
  • Opiates
  • Intercostal nerve block (if oral meds not sufficient)
105
Q

Exudative effusion - main 2 types?

A
  • Compicated parapneumonic effusion

- Empyema

106
Q

Findings in pleural fluid of exudative effusion?

A
  • Low glucose (
107
Q

Distinguish b/t complicated parapneumonic effusion from empyema how?

A
  • Pleural fluid gram stain usually NEG in CPE and POS in empyema
  • Pleural fluid cx usual NEG in CPE and POS in empyema
108
Q

Continued fever post abx treatment + loculation in CXR - think? (2)

A
  • complicated paranpeumonic effusion

- empyema

109
Q

Pulmonary contusion is?

A

parenchymal bruising of the lung

110
Q

pulmonary contusion dev in what time frame?

A

minutes - 24hrs

111
Q

ARDS manifest how soon post trauma?

112
Q

How to distinguish b/t ARDS and pulmonary contusion?

A

1) Timeframe: Pulm contusion sooner (

113
Q

Recurrent pneumonias in the same anatomic region of the lung suggests?

A

Bronchial obstruction due to an underlying abnormality (ie CA, foreign body, bronchial stenosis)

114
Q

bronchiolitis caused by what virus?

A

respiractory syncytial virus

115
Q

prophylaxis for RSV and to what category pts?

A
  • Palivizumab (monoclonal Ab)

- kids

116
Q

bronchiolitis has inc risk of what?

A

Otitis media

117
Q

Lymphoma and nasopharyngeal CA associated w/ what virus?

118
Q

EBV associated w/ what CAs? (2)

A
  • lymphoma

- nasopharyngeal CA

119
Q

who do you give palivizumab to?

120
Q

elevated AFP and B-hCG - think? (2)

A
  • Endodermal sinus tumor (ie nonseminomatous germ cell tumor)
  • Teratoma
121
Q

tell difference b/t seminoma and nonseminomaotus germ cell tumor?

A

NSGCT has elevated AFP, seminoma does not

  • both elevated B-hCG
122
Q

dysgerminomas are equivalent to what male tumor?

123
Q

panacinar emphysema caused by?

A

alpha-1 antitrypsin deficiency

124
Q

panacinar emphysema located where usually?

A

lower lobes

125
Q

AAT deficiency –> where emphysema useuall?

A

panacinar emphysema descruction in lower lobes

126
Q

Pt w/ COPD at young age (

A

AAT deficiency

127
Q

COPD w/ minimal or no smoking hx - consider?

A

AAT deficiency

128
Q

Basilar-predominant COPD - consider?

A

AAT deficiency

129
Q

PE can –> what lung abnl?

A

small Pleural effusion (due to hemorrhage or inflammation) –> pain

130
Q

What type of effusion generally seen w/ PE?

A

exudative

- potentially bloody

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