ABIM Review Course UPDATED ACTUAL
Exam Questions and CORRECT Answers
Malignant 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.
Exam Questions and CORRECT Answers
Malignant 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.
