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ABIM Review Course questions well answered graded A+
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ABIM Review Course questions well answered graded A+
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ABIM Review CourseMalignant Hyperthermia px and tx - correct answer ✔✔p/w masseter muscle rigidity, increased pCO2
Tx: Dantrolene
Neuroleptic Malignant Syndrome px & tx - correct answer ✔✔Adverse reaction to antipsychotics with
severe "lead pipe" rigidity, FEVER, and mental status changes
NO clonus, hypOreflexia
Tx: Dantrolene, bromocriptine
Serotonin Syndrome - correct answer ✔✔With any drug that increases 5-HT (MAO inhibitors, SNRIs,
TCAs, linezolid) hyperthermia, confusion, CLONUS, hypERreflexia, cardiovascular instability, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist), Benzos
Benzodiazepine Antidote - correct answer ✔✔Flumazenil
Lidocaine Antidote - correct answer ✔✔Intralipid bolus
Cyanide antidote - correct answer ✔✔sodium thiosulfate + hydroxycobalamin
Methemoglobinemia antidote - correct answer ✔✔methylene blue + vitamin C
Iron antidote - correct answer ✔✔Deferoxamine
,Ethanol poisoning px / lab findings - correct answer ✔✔Nausea & vomiting
NO AG
NO Osmolal gap
Isopropyl Alcohol poisoning px/labs - correct answer ✔✔Rubbing alcohol
Ketosis
NO AG
+ Osmolal gap
Methanol poisoning px/labs - correct answer ✔✔VISION CHANGES, hypOtension
+ AG
+ Osmolal gap
Tx: fomepizole
Ethylene glycol poisoning px/labs - correct answer ✔✔AKI w/ oxalate crystals, hypOcalcemia
+ AG
+ Osmolal gap
Tx: fomepizole
HTN emergency tx goals - correct answer ✔✔Reduce MAP by 10-20% within FIRST HOUR (~<180/120)
then 5-15% over next 23 HRS (~<160/110)
HTN emergency tx in its w/ ACUTE ISCHEMIC STROKE in pts NOT candidate for IV tPA - correct answer
✔✔NO tx unless >220/120
HTN emergency tx in its w/ ACUTE ISCHEMIC STROKE in pts PRIOR to receiving IV tPA - correct answer
✔✔NO tx unless >185/110
,HTN emergency tx in pts w/ ACUTE ISCHEMIC STROKE in pts AFTER receiving IV tPA for next 24 hrs -
correct answer ✔✔NO tx unless >180/105
HTN emergency tx in pts w/ AORTIC DISSECTION - correct answer ✔✔HR<60 and SBP<120 within 20
MINUTES
Tx of SYMPTOMATIC hypONa - correct answer ✔✔-ABSENCE of severe sx (coma/seizures): increase
[plasma Na] by 4-6 mmol/L in first 24 HRS if chronic or duration unknown.
-SEVERE: raise [serum Na] by 4-6mE/L over the first 6 HRS w/ 3% saline (513 mEq of Na).
Na requirement= TBW (desired Na-serum Na)
-Active SEIZURES: increase [Na] by 4-6mEq in FIRST HR w/ 100-150cc bolus of 3%.
---Raise [Na] by 9-12mEq in 24 HRS /18 mEq in 48 HRS.
TURP Syndrome - correct answer ✔✔Cx by absorption of hypOtonic irrigation soln (~6-8L of
glycine/sorbitol/mannitol) used during TURP (also seen in its post-op hysterectomy) --> increased ADH
secretion in post op period-->Hyponatremia and water intoxication (sx resembling CVA in elderly)--
>hypOnatremia, volume overload, neuro sx.
HypERnatremia Dx - correct answer ✔✔U osm should be >700 when [serum Na]>147
Uosm<Plasma osmol --> renal free H20 loss (DIABETES INSIPIDUS)
Uosm 300-600: partial DI, osmotic diuresis, psychogenic polydipsia
Water deprivation test - correct answer ✔✔Used to dx partial CENTRAL or NEPHROGENIC DI cx
hypERnatremia
Water is restricted
-if Uosm normalizes-->DI r/o
, -if Posm approaches 300 or Uosm does NOT change w/ increasing Posm--> administer AVP
---if Uosm INCREASES>50%-->CENTRAL DI
---if Uosm w/ NO CHANGE-->NEPHROGENIC DI
HypERnatremia Tx - correct answer ✔✔-Correct half of the deficit w/n 24 HRS, max: 8-10mEq/day
-Estimate FREE WATER DEFICIT
---TBW x [Serum Na/140-1)
----TBW Males: 0.6 x Wt(kg)
----TBW Females: 0.5 x Wt (kg)
-Correct with hypotonic IVF or PO free water
Discriminant Function - correct answer ✔✔used in pts w/ ACUTE ALCOHOLIC HEPATITIS
=4.6(PT of pt - PT control) + T. Bili
>32-->use steroids
Whipple Disease - correct answer ✔✔a systemic tissue damage due to tropheryma whippelii in
macrophage lysosomes.
Classically involves the small bowel lamina propria cx fat malabsorption as chylomicrons can't get in the
lacteal, p/w recurrent abdominal pain, diarrhea, arthralgia, LAD, neurologic sx including abnormal facial
mvmts
Tx: Ceftriaxone or Merrem x 2 WKS
-->followed w/ Bactrim x 1 YEAR
Menetrier's Disease - correct answer ✔✔40-60yo with lg, tortuous mucosal folds and elongated/dilated
gastric glands
p/w epigastric pain, N/V, anorexia, wt loss, edema, PROTEIN LOSING ENTEROPATHY
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