Usmle Step 2 Secrets

Front 1

With which CA is ETOH intake associated?

Back 1

Oral cavity, larynx, pharynx, esophagus, liver, lung.
Can also be gastric, colon, pancreatic, and breast

Front 2

What is the most common cause of cirrhosis and esophageal varices?

Back 2

Alcohol

Front 3

Relationship between ETOH and accidental or intentional death?

Back 3

ETOH involved in ~50% of fatal car accidents, 67% of drownings, 67% of homicides, 35% of suicides, and 70-80% of deaths caused by fire

Front 4

What may happen if you give glucose to an alcoholic without giving thiamine first?

Back 4

May precipitate Wernicke's encephalopathy

Front 5

What's Wernicke syndrome?

Back 5

Acute encephalopathy char. by ophthalmoplegia, nystagmus, ataxia, and/or confusion. Can be fatal, but is reversible with thiamine

Front 6

What is Korsakoff syndrome?

Back 6

Chronic psychosis char. by anterograde amnesia and confabulation to cover up amnesia. Generally irreversible and is thought to be d/t damage to mamillary bodies and thalamic nuclei

Front 7

T/F, ETOH withdrawal can be fatal?

Back 7

True

Front 8

Tx for ETOH withdrawal?

Back 8

Benzos, tapered gradually

Front 9

First stage of ETOH withdrawal?

Back 9

Acute withdrawal (12-48 hrs after last drink; tremors, sweating, hyperreflexia, seizures) "rum fits"

Front 10

Second stage of ETOH withdrawal?

Back 10

Alcoholic hallucinosis (24-72 hrs after last drink) auditory and visual hallucinations, and illusions with autonomic signs

Front 11

What is the third stage of ETOH withdrawal?

Back 11

Delirium tremens (2-7 days after last drink, possibly longer); hallucinations and illusions, confusion, poor sleep, and autonomic lability. Fatality is usually associated with this stage

Front 12

What are the classic physical stigmata of liver dz in alcoholics?

Back 12

Caput medusae, esophageal varices, testicular atrophy, encephalopathy, Hemorrhoids (internal), Jaundice, Ascites, palmar erythema, spider angiomas, gynecomastia, asterixis, prolonged PT, hyperbilirubinemia, hypoalbuminemia, anemia (macrocytic)

Front 13

What dzs and conditions may be caused by chronic ETOH intake?

Back 13

Gastritis, Mallory-Weiss tears, Pancreatitis, Peripheral neuropathy, dilated cardiomyopathy, rhabdo, fatty change in liver, hepatitis, cirrhosis, wernicke or korsakoffs, cerebellar degeneration

Front 14

What's the classic derangement of AST (SGOT) and ALT (SGPT) in alcoholic hepatitis?

Back 14

The ratio of AST to ALT is at least 2:1, although both may be elevated. Other causes of hepatitis are usually associated with the opposite ratio or equal elevation of both

Front 15

What's the best Tx for alcoholism?

Back 15

AA or other peer-based support groups have had the best success.

Front 16

Describe the effects of ETOH on pregnancy?

Back 16

It's the most common cause of preventable mental retardation in the US. Classic presentation of FAS: mental retardation, microcephaly, microphthalmia, short palpebral fissures, midfacial hypoplasia, and cardiac defects.

Front 17

Epidemiology of ETOH abuse?

Back 17

~10-15% of population abuses ETOH. More common in men. Genetic component passed most easily from father to son

Front 18

What kind of pneumonia should you suspect in a "skid-row" alcoholic?

Back 18

Aspiration. Look for enteric organisms (anaerobes, E.coli, streptococci, staphylococci). Especially think Klebsiella if sputum resembles currant jelly, or thick, mucoid capsules are mentioned

Front 19

T/F, ETOH can precipitate hypoglycemia?

Back 19

True, but give thiamine first, then glucose in an alcoholic

Front 20

What are the classic electrolyte abnormalities in alcoholics?

Back 20

Low magnesium, low potassium, low sodium, elevated uric acid/gout

Front 21

What are the classic vitamin/mineral abnormalities in alcoholics?

Back 21

Folate and thiamine

Front 22

How are bleeding esophageal varices treated?

Back 22

First ABC's, IV and blood if necessary. Next endoscopy to determine cause of UGI bleed and then sclerotherapy. Mortality rate is high