We'll describe several clinical toxicology syndromes, that are certainly
favored by the boards...they are the core questions on almost every
exam.
Q: Which acid-base disturbance is most likely in SALICYLATE overdose?
A: A MIXED DISORDER of respiratory alkalosis (due to tachypnea) and
metabolic acidosis (due to uncoupling of oxidative phosphorylation).
Q: What type of acid-base disorder does ingestion of ETHYLENE GLYCOL cause?
A: Severe ANION GAP (AG) METABOLIC ACIDOSIS.
Q: Which medication is used as an antidote for BETA BLOCKER poisoning?
A: GLUCAGON....as this drug will increase HEART RATE, stroke volume and thus
cardiac output. (It is especially useful in a HYPOTENSIVE B-Blocker O.D. patient).
Q What is the metabolic cause of ORGANOPHOSPHATE poisoning?
A: This pesticide used by farms/orchards causes inhibition of the
CHOLINESTERASE ENZYME. (Diarrhea/vomiting/excessive lacrimation/
salivation and brochospasm are typically seen).
Q: What is the treatment of NARCOTIC overdose.
A: NALOXONE (Narcan). 0.4-2.0 mg for adults. Pediatric dose is 0.01 mg/kg.
(There is NO toxic dose for this drug, as it is safe to administer in larger
amounts).
Q: What rate is ALCOHOL metabolized in an acutely ETOH intoxicated patient?
A: Rate of breakdown metabolism is 20mg/dl per HOUR.
Q: What is the treatment of choice of moderate to severe LITHIUM TOXICITY?
A: HEMODIALYSIS. Especially in serum level greater 4.0 mEq/l. (Lithium
is very toxic and the therapeutic-toxic "window" is quite narrow. Level
greater the 2.0 mEq/l is already considered mild toxicity).
Q: In which medication overdose is the RUMACK-MATTHEW
NOMOGRAM used?
A: ACETAMINOPHEN (Tylenol) oversode. Serum acetaminophen (apap)
is measured at exactly 4 HOURS POST INGESTION. If the level is greater
then 150 mg/ml....treatment is initiated. (with N-Acetylcysteine IV or PO).
It is most effective, if given in first 8 hours post ingestion.
Thanks for your time, again. We'll be back soon with more and more challenging topics.
Sunday, November 29, 2009
Saturday, November 21, 2009
PHYSICAL SIGNS OF INTERNAL DISEASE...
Many times we'll observe a patient with a particular or peculiar physical finding
that can give us important insight...into an underlying pathology.
Needless to say....the boards also like you to know some of these clicinal clues.
I will highlight the MAIN association of a particular illness...the one the boards want you
to answer....as there may be multiple associations.
Q: What illness is associated with CAFE AU LAIT spots?
A: NEUROFIBROMATOSIS (Von Recklinghausen's Disease).
Q: What common disorder causes ALOPECIA AREATA?
A: HYPOTHYROIDISM/hyperthyroidism/pernicious anemia.
Q: What process causes BLUE TOE SYNDROME?
A: CHOLESTEROL/AtheroEMBOLI. (As in recent trauma patient or post angiography).
Q: What malignacy is associated with ACANTHOSIS NIGRICANS?
A: GASTRIC ADENOCARCINOMA.
Q: Which common cardiac medication causes GRAY-BLUEISH discoloration
of the sun exposed areas of the skin. (Light charcoal looking face).
A: AMIODARONE
Q: What condition causes KAYSER-FLEISCHER RINGS of the eyes?
A: WILSON'S DISEASE, especially in patients that have the neurologic complications
of the disease. E.g. personality changes/psychosis.
Q: Which genetic condition causes highly elastic skin(connective tissues)?
A: EHLERS-DANLOS SYNDROME. Patients have lax joints/fragile skin
and are prone to GI bleeding, due to lax vascular tissues.
Q: Which condition causes SADDLE NOSE DEFORMITY?
A: WEGENER'S GRANULOMATOSIS. The nasal bridge collapses due to destruction
of bony cartilage by the granuloma.
Q: Which tick borne illness causes ERYTHEMA MIGRANS rash?
A: LYME'S DISEASE...this finding can be absent in 25% of patients!
Thank you for you time...we'll be back soon.
that can give us important insight...into an underlying pathology.
Needless to say....the boards also like you to know some of these clicinal clues.
I will highlight the MAIN association of a particular illness...the one the boards want you
to answer....as there may be multiple associations.
Q: What illness is associated with CAFE AU LAIT spots?
A: NEUROFIBROMATOSIS (Von Recklinghausen's Disease).
Q: What common disorder causes ALOPECIA AREATA?
A: HYPOTHYROIDISM/hyperthyroidism/pernicious anemia.
Q: What process causes BLUE TOE SYNDROME?
A: CHOLESTEROL/AtheroEMBOLI. (As in recent trauma patient or post angiography).
Q: What malignacy is associated with ACANTHOSIS NIGRICANS?
A: GASTRIC ADENOCARCINOMA.
Q: Which common cardiac medication causes GRAY-BLUEISH discoloration
of the sun exposed areas of the skin. (Light charcoal looking face).
A: AMIODARONE
Q: What condition causes KAYSER-FLEISCHER RINGS of the eyes?
A: WILSON'S DISEASE, especially in patients that have the neurologic complications
of the disease. E.g. personality changes/psychosis.
Q: Which genetic condition causes highly elastic skin(connective tissues)?
A: EHLERS-DANLOS SYNDROME. Patients have lax joints/fragile skin
and are prone to GI bleeding, due to lax vascular tissues.
Q: Which condition causes SADDLE NOSE DEFORMITY?
A: WEGENER'S GRANULOMATOSIS. The nasal bridge collapses due to destruction
of bony cartilage by the granuloma.
Q: Which tick borne illness causes ERYTHEMA MIGRANS rash?
A: LYME'S DISEASE...this finding can be absent in 25% of patients!
Thank you for you time...we'll be back soon.
Thursday, November 19, 2009
RANDOM BOARD QUESTIONS...
We'll continue with topics that are frequently asked by the boards
assorted from random disciplines.
Q: What is LUPUS PERNIO?
A: It is a violaceous rash on the tip of the nose in patient with SARCOIDOSIS.
(It has no relation to SLE).
Q: What are common physical findings in Reiter's Syndrome (reactive arthritis)?
A: ONYCHOLYSIS
Painless MOUTH ULCERS
Painless PENILE LESIONS (Balanitis Circinata)
Painless SKIN LESIONS (Keratoderma Blenorrhagicum)
UVEITIS
HEEL PAIN
Q: What is ACOUSTIC NEUROMA?
A: A BENIGN TUMOR causing progressive UNILATERAL hearing loss, with
tinnitus but no vertigo!
Q: What is the BEST test to diagnose MUCOPURULENT CERVICITIS?
(Chlamydia Trachomatis)
A: Ligase Chain Reaction (LCR) Assay
Q: What is the MAIN risk factor for MELANOMA?
A: Excessive exposure to sunlight in CHILDHOOD years.
Be back soon....study hard!
assorted from random disciplines.
Q: What is LUPUS PERNIO?
A: It is a violaceous rash on the tip of the nose in patient with SARCOIDOSIS.
(It has no relation to SLE).
Q: What are common physical findings in Reiter's Syndrome (reactive arthritis)?
A: ONYCHOLYSIS
Painless MOUTH ULCERS
Painless PENILE LESIONS (Balanitis Circinata)
Painless SKIN LESIONS (Keratoderma Blenorrhagicum)
UVEITIS
HEEL PAIN
Q: What is ACOUSTIC NEUROMA?
A: A BENIGN TUMOR causing progressive UNILATERAL hearing loss, with
tinnitus but no vertigo!
Q: What is the BEST test to diagnose MUCOPURULENT CERVICITIS?
(Chlamydia Trachomatis)
A: Ligase Chain Reaction (LCR) Assay
Q: What is the MAIN risk factor for MELANOMA?
A: Excessive exposure to sunlight in CHILDHOOD years.
Be back soon....study hard!
Saturday, November 14, 2009
DEMENTIA SYNDROMES...Clues to differentiate
Thank you all for your patience in awaiting this next blog.
The boards love DEMENTIA related topics and questions, so let's cover the
most important ones. Subtle "clues" will have you select the correct
answer....and that is my aim. Remember, the CAPITALIZED words are
the KEY....but you should already know that from the previous blogs!?
Q: What is the MOST prominent feature of ALZHEIMER'S DEMENTIA?
A: Memory impairment of RECENT events.
The MMSE(Mini Mental Status Exam) score is usually 12-24 the first
5 years, then significantly worsens.
Q: What is DEMENTIA with LEWY BODIES?
A: Most prominent clinical feature is VISUAL HALLUCINATIONS.
Other features are disturbed REM sleep with VIVID DREAMS.
The MMSE score is usually 15-28 the first 5 years.
Q: What is FRONTOTEMPORAL DEMENTIA?
A Key clinical feature is APATHY, with a remarkably NORMAL MMSE score of 30!!!
Q: What is VASCULAR DEMENTIA?
A; As the name implies, the problem is vascular with MRI of BRAIN documenting
at least one INFARCT. The more infarcts...the more evident the diagnosis.
Q: What is NORMAL PRESSURE HYDROCEPHALUS (NPH)?
A: It is a TRIAD of SYMPTOMS in elderly patients:
1. DEMENTIA
2. GAIT IMPAIRMENT ("MAGNETIC GAIT"). Think Frankenstein!!!
3. URINARY INCONTINENCE
The CT/MRI in these patients will show enlarged ventricles and normal
CSF pressure, if measured.
Thanks again for your patience....the next blog will be coming soon.
Look forward to some quite interesting topics and cases.
The boards love DEMENTIA related topics and questions, so let's cover the
most important ones. Subtle "clues" will have you select the correct
answer....and that is my aim. Remember, the CAPITALIZED words are
the KEY....but you should already know that from the previous blogs!?
Q: What is the MOST prominent feature of ALZHEIMER'S DEMENTIA?
A: Memory impairment of RECENT events.
The MMSE(Mini Mental Status Exam) score is usually 12-24 the first
5 years, then significantly worsens.
Q: What is DEMENTIA with LEWY BODIES?
A: Most prominent clinical feature is VISUAL HALLUCINATIONS.
Other features are disturbed REM sleep with VIVID DREAMS.
The MMSE score is usually 15-28 the first 5 years.
Q: What is FRONTOTEMPORAL DEMENTIA?
A Key clinical feature is APATHY, with a remarkably NORMAL MMSE score of 30!!!
Q: What is VASCULAR DEMENTIA?
A; As the name implies, the problem is vascular with MRI of BRAIN documenting
at least one INFARCT. The more infarcts...the more evident the diagnosis.
Q: What is NORMAL PRESSURE HYDROCEPHALUS (NPH)?
A: It is a TRIAD of SYMPTOMS in elderly patients:
1. DEMENTIA
2. GAIT IMPAIRMENT ("MAGNETIC GAIT"). Think Frankenstein!!!
3. URINARY INCONTINENCE
The CT/MRI in these patients will show enlarged ventricles and normal
CSF pressure, if measured.
Thanks again for your patience....the next blog will be coming soon.
Look forward to some quite interesting topics and cases.
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