Rapid review

Question 1

Abdominal pain, ascites, hepatomegaly

Answer 1

Budd-Chiari syndrome (posthepatic venous thrombosis)

Question 2

Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing

Answer 2

Aortic regurgitation

Question 3

Chest pain, pericardial effusion/friction rub, persistent fever following MI

Answer 3

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)

Question 4

Golden brown rings around peripheral cornea

Answer 4

Wilson disease (Kayser-Fleischer rings due to copper accumulation)

Question 5

Lucid interval after traumatic brain injury

Answer 5

Epidural hematoma (middle meningeal artery rupture)

Question 6

Periorbital and/or peripheral edema, proteinuria (> 3.5g/ day), hypoalbuminemia, hypercholesterolemia

Answer 6

Nephrotic syndrome

Question 7

Rapidly progressive limb weakness that ascends following GI/upper respiratory infection

Answer 7

GBS

Question 8

Rash on palms and soles

Answer 8

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

Question 9

Swollen gums, mucosal bleeding, poor wound healing, petechiae

Answer 9

scurvy (vit C deficiency)

Question 10

Systolic ejection murmur (crescendo-decrescendo)

Answer 10

Aortic stenosis

Question 11

Anti–glomerular basement membrane antibodies

Answer 11

Goodpasture syndrome (glomerulonephritis and hemoptysis)

Question 12

Antimitochondrial antibodies (AMAs)

Answer 12

1° biliary cirrhosis (female, cholestasis, portal hypertension)

Question 13

Basophilic nuclear remnants in RBCs

Answer 13

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

Question 14

Basophilic stippling of RBCs

Answer 14

Lead poisoning or sideroblastic anemia

Question 15

“Delta wave” on EKG, short PR interval, supraventricular tachycardia

Answer 15

Wolff-Parkinson-White syndrome (Bundle of Kent bypasses AV node)

Question 16

“Honeycomb lung” on x-ray or CT

Answer 16

Interstitial pulmonary fibrosis

Question 17

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Answer 17

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ c-ANCA) and Goodpasture syndrome (anti–basement
membrane antibodies)

Question 18

Ring-enhancing brain lesion on CT/MRI in AIDS

Answer 18

Toxoplasma gondii, CNS lymphoma

Question 19

Carcinoid syndrome

Answer 19

Octreotide

Question 20

Acute gastric ulcer associated with CNS injury

Answer 20

Cushing ulcer ( intracranial pressure stimulates vagal gastric H+ secretion)

Question 21

Acute gastric ulcer associated with severe burns

Answer 21

Curling ulcer (greatly reduced plasma volume results in sloughing of gastric mucosa)

Question 22

Holosystolic murmur

Answer 22

VSD, tricuspid regurgitation, mitral regurgitation

Question 23

Winters formula

Answer 23

PCO2 = 1.5 [ HCO3] + 8 … +/-2

Question 24

Answer 24

PW is diagnosed by the presence of a short PR interval and a delta wave in sinus rhythm, it is important to be able to make the diagnosis of WPW with atrial fibrillation when presented with an ECG such as this one.

In WPW with atrial fibrillation, drugs that slow AV nodal conduction increase the number of impulses that go down through the bypass tract and actually increase ventricular rate in this setting. Only drugs that slow conduction down the bypass tract are indicated.

Procainamide slows conduction down bypass tracts in WPW

Question 25

Answer 25

These three criteria
Wide complex tachyarrhythmia
Irregularly irregular rhythm
Varying widths of the QRS complexes-> should prompt consideration of preexcited atrial fibrillation or atrial fibrillation in a patient with an accessory conduction pathway.

Tx: ibutilide or procainamide

Question 26

_____ is a Class III antiarrhythmic drug that prolongs refractoriness of both the AV node and accessory pathway and acutely terminates atrial fibrillation or flutter.

Answer 26

Ibutilide

Question 27

_____ is a Class Ia antiarrhythmic that increases refractoriness of atrial and ventricular myocardium without any AV nodal-blocking effect. It can also be effective for acute termination of preexcited atrial fibrillation, and even when it fails to terminate the atrial fibrillation, it usually slows the ventricular rate due to decreased conduction and increased refractoriness in the accessory pathway.

Answer 27

Procainamide

Question 28

Although ____ may slow conduction through the accessory pathway with chronic administration, it does not slow accessory pathway conduction with acute IV administration, and its β-blocking properties make it a primarily AV nodal-blocking agent in the acute setting, making it a nonpreferred agent in preexcited atrial fibrillation.

Answer 28

amiodarone

Question 29

Answer 29

Auto-PEEP ventilator waveform. Expiratory flow fails to return to a baseline of zero flow (red line), and pressure gradually increases (blue line).

Question 30