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1
Q

ABG atelectasis

A

patients are hypoxemic (V/Q mismatch) so compensate by hyperventilating:
alkalosis, decreased PaCO2
PE may present similarly

2
Q

dead space ventilation

A

lungs in certain area are VENTILATED but NOT perfused, i.e. PE opposite of pneumonia: intrapulmonary shunting

3
Q

how to dx lactose intolerance

A

+ hydrogen breath test (indicates bac. carb metabolism), HIGH Osm gap due to unmetab. lactose and acids, ACIDIC stool pH
in contrast: + urine for reducing substances is seen in glycosuria, etc

4
Q

multiple hamatomatous polyps, melanotic spots on lips/skin, ^frequency breast, gonadal, pancreatic cancer, think?

A

Peutz-Jeghers Syndrome

5
Q

colon cancer + osteomas, desmoid tumors, other ST tumors

A

Gardner Syndrome

6
Q

Working up precocious puberty if advanced bone age

A

If LH is high, implies gonadotropin – dependent (central) precocious puberty
With LH is low, do GnRH stim test
If high LH in response, GnRH dependent – central
If LH remains low, gonadotropin independent – peripheral precocious puberty
Leydig cell tumor: will have unilateraltesticular enlargement or mass
Late onset CAH: coarse axillary/pubic care, severe cystic acne, Signs of androgen excess but no testicular tumor, will have normal electrolytes

7
Q

PPD greater than 5 mm is positive if?

A

HIV-positive, recent contacts of known TB, nodular/fibrotic changes on CXR consistent with previously healed TB, organ transplant recipients/other immunosuppressive patients
However, greater than 10 mm is positive if injection drug user, higher risk for TB reactivation: DM, prolonged steroid therapy, leukemia, ESRD, chronic mail absorption syndromes, Recent immigrant, live/work in high-risk setting: prison, nursing home, hospital, homeless shelter, lab for MTB, Kids less than 4

8
Q

Asymptomatic elevation of alkaline phosphatase an elderly patient, think?

A

Paget disease

9
Q

Postpartum blues versus depression

A

Postpartum blues self-limited, typically resolves within two weeks, if persists beyond two weeks evaluate for postpartum depression

10
Q

What type of bias is created when subjects or lost to follow up?

A

Attrition bias, a subtype of selection bias: the lost subjects may differ in a meaningful way from the subjects who remain in the study, which may overestimate or under estimate the association between exposure and disease in the study

11
Q

Subtle features that may qualify for PTSD

A

Amnesia, nightmares, sleep disturbance, irritability, emotional numbing, detachment, intrusive flashbacks, hypervigilance, increased startle response, occurring for more than one monthand patient with exposure to traumatic event i.e. combat veterans

12
Q

The arthritis in acute rheumatic fever versus juvenile idiopathic arthritis

A

Acute rheumatic fever will have migratory polyarthritis with erythema marginatum
Juvenile idiopathic arthritis is not migratory and his present for more than six weeks and may have a rash

13
Q

Sounds in pulmonary HTN

A

Wide splitting of S2 with loud P2 or tricuspid and pulmonary valve insufficiency

14
Q

Pulmonary hypertension on CXR/CT

Most accurate test?

A

Best initial tests, shows dilation and proximal arteries with narrowing of the store vessels
Most accurate test is right heart or Swan-Ganz catheter to measure pressure’s
EKG and echo will show RA/RV hypertrophy

15
Q

Treatment for pulmonary hypertensions

A

Prostacyclin analogues: epiprisyebol, treprostinil, iloprost, beraprost
Endothelin antagonists: bosentan, ambrisentan
Phosphodiesterase inhibitor’s: sildenafil
These are all better than CCP’s, hydralazine, nitroglycerin
O2 slows progression

16
Q

ARD ass looks like CHF on CXR except?

A

Has normal cardiac hemodynamic measurements– PCWP is normal, but not necessary to measure
CXR shows bilateral infiltrates that become confluent – white out

17
Q

Causes of ARDS

A

Sepsis, expiration, long contusion/drama, near drowning, burns, pancreatitis

18
Q

ARDS ratio

A

PO2 / FiO2 less than 300, if less than 200 moderately severe, less than 100 severe

19
Q

ARDS management

A

Low total volume ventilation: 6 mL/kg of tidal volume, PEEP to decrease the FI O2 as levels above 50% or toxic, maintain plateau pressure of less than 30
Steroids are not beneficial, but may help in late stage disease when fibrosis develops

20
Q

Altered patient with low hemoglobin, low platelets, low leukocytes,mild scleral actress, elevated Billy Rubin, elevated alkaline phosphatase

A

TTP

21
Q

Patients with a PE may develop?

A

Small pleural effusion’s due to hemorrhage or information, tend to be exudative and grossly bloody and can’t be associated with pain to the plural irritation