2nd qbank pass Flashcards
1
Q
Contraindication to low molecular weight heparins (rivaroxiban and enoxaparinn)
A
ESRD
2
Q
Pt with hypotensionn, vomiting, abdominal pain, and fever post-op in s/o of using steroids for chronic condition
A
acute adrenal insufficiency
3
Q
CT scan findings in ischemic colitis
A
thickened bowel wall, if anything
Especially at splenic flexure or rectosigmoid junction
4
Q
Abdominal wounds requiring exploratory lapartomy
A
any penetrating wound below the 4th intercostal space (nipples)
5
Q
Patellar tendinitis vs patellofemoral pain syndrome
A
tendinitis: episodic pain and tenderness, usually seen in athletes in jumping sports
pain syndrome: chronic knee pain worsened by activity or prolonged sitting, common in women
6
Q
Gross hematuria and urinary retention in setting of MVA
A
pelvic fracture and extraperitoneal bladder injusry
7
Q
Required imaging to confirm presence of a psoas abscess
A
CT
8
Q
Required management of someone with clavicular fx
A
angiogram to r/o injury to brachial plexus/subclavian artery
9
Q
Post-op complication that can be prevented with fluid hydration and oral hygeine
A
acute bacterial parotitis (around POD8 with other wound-type complications)
10
Q
Patient with painless acute vision loss unilaterally with dilated veins and widespread retinal hemorrhages intermixed with patches white exudate
A
central retinal vein occlusion
Associated with HTN
11
Q
cardiogenic shock after coronary artery bypass grafting may be concerning for ___
A
aortic dissection
12
Q
When to transfuse platelets
A
when under 5k for anyone for preventing spontaneous bleeds
50k prior to surgery
13
Q
Lymphoma:presentation
A
child with pan-adenopathy
hepatomegaly
pancytopenia
14
Q
Major cause of male infertility
A
varicocele
15
Q
mupirocin
A
antibiotic topical cream used for impetigo
16
Q
older female presenting with peeling, scaling, and cracking of right nipple with otherwise normal breast exam
A
paget disease of the breast
17
Q
spinal dysraphism =
A
neural tube defect
18
Q
Hypocalcemia and hyperphosphatemia in s/o normal kidney function =
A
hypoparathyroidism (PTH deficiency)
Causes include post-surgical (parathyroidectomy or thyroidectomy, autoimmune destruction, non-autoimmune destruction from hemochromatosis/wilson disease/neck irradiation)
19
Q
Early anterior spinal cord infarction
A
spinal shock post-op
abrupt onset BL flaccid paralysis and loss pain/temp sensation below level of infarct
NOTE: UMN signs (spasticity and hyperreflexia) develop over days to weeks
20
Q
TX of acalculous cholecystitis
A
antibiotics and percutenous cholecystostomy followed by cholecystectomy when condition stabilizes
21
Q
Early satiety, nausea, nonbilious vomiting, and wt loss in patient with a previous acid ingestion =
A
gastric outlet obstruction 2/2 pyloric stricture
22
Q
Features and TX of a peritonsillar abscess
A
fever sore throat/difficulty swallowing trismus hot potatoe voice uvula deviation away from enlarged tonsil pooling of saliva
TX with needle aspiration (or I&D) plus antibx
23
Q
Former smoker with early satiety, weight loss, fatigue, and back/abdominal pain worse at night
A
pancreatotic adenocarcinoma
24
Q
Kid with vague left-sided chest discomfort weeks after MVA
A
diaphragmatic rupture
25
Post-prandial abdominal pain and bilious vomiting in kid with trauma to abdomen 2 days ago
duodenal hematoma
26
ipsilateral oculomotor nerve palsy
uncal herniation
27
Complications of supracondylar fx of humerus
NOTE: most common fxs in peds, mostly from falling on outstretched hand
Most common--entrapment of the brachial artery or median nerve
compartment syndrome rare but can lead to volkmann contracture (of the hand)
28
Sphincter of Oddi dysfunction
functional biliary d/o d/t dyskinesia or stenosis of the SOD
recurrent episodic pain in RUQ and/or epigastric region with worsening of pain with opioid analgesics.
29
farmer presenting with chronic diarrhea, wt loss, migratory arthralgia, LDN, and low-grade fever
whipple disease
risk factors for contraction unclear
30
Positive prussian blue stain in urine sample =
hemosiderin in urine 2/2 hemolysis (think G6PD in s/o antibiotic use)
31
Malignancies and auto-antibodies associated with dermatomyositis
malignancies: ovarian, lung, pancreatic, stomach, colorectal, non-hodgkin lymphoma
auto-antibodies: anti-Jo1 (against synthetase) and anti-Mi-2 (against helicase)
32
Tdap vaccine guidelines: adults
q10yr x 3 doses
if get a wound and greater than 3 doses received-- clean wound if less than 10yrs away from last Tdap or give Td if >10yr since
if get a wound and less than 3 lifetime doses--Td if <5yr since tdap and td + IVIGif >5yrs
td is booster
NOTE: DTap ONLY for peds population (larger dose than Tdap)(
33
Pneumococcal vaccine guidelies: adults
once <60yo (13)
once >65yo (23)
NOTE: never give 13 and 23 at the same time
34
confounding vs effect modification
confounding: a third factor negates the relationship btw the exposure and outome (eg season negates relationship btw ice cream consumption and drowning)
effect modification: a third factor ENHANCES the relationship btw the exposure and outcome (eg smoking enhances relationship btw OCPs and thrombosis)
35
relative risk =
people who develop disease out of those exposed/ people who develop disease in those not exposed
NOTE: this is for cohort studies
36
Odds ratio =
odds of exposure in people who have the disease / the odds of exposure in people who do not have the disease
NOTE: this is for case-control studies
37
when to do aortic valve surgery in pt with infective endocarditis
if infection is persistent/difficult to treat medically
if there is significant valvular dysfxn resulting in heart failure
if septic embolization is recurrent
38
Inflammatory acne: TX
topical retinoids + nezoyl peroxide + topical antibiotivs
39
Nodular (cystic) acne: TX
oral isotretinoin
40
well-defined, erythematous plaques with satellite vesicles or pustules in intertriginous and occluded skin areas
intertrigo
d/t infection with Candida species
41
Widely distributed papules that are pruritic, skin-colored, and have areas of central umbilication in a person with HIV
molluscum contagiosum (poxvirus)
NOTE: can occur in children and adults w/out HIV through skin-to-skin contact or by fomites, but is less disseminated and shorter in duration
HIV testing should be considered if lesions widespread or involve face
42
2 conditions seborrheic dermatitis is associated with
HIV
| Parkinsons
43
Acanthosis nigricans associated with ____ in younger pts and ____in older pts
DM, malignancy (usually GI or GU)
44
US to screen for AAA in ____
any male btw 65-75yo who has a smoking h/o
45
Pt with recent URI treated with amoxicillin presenting with picture of hemolysis and splenomegaly
think warm (IgG mediated) agglutinin auto-iummune hemolytic anemia
46
Specific aminoglycoside that causes both ototoxicity and vestibulopathy
gentamicin
Note: this is a bilateral vestibulopathy, which negates any vertigo, albeit oscillopsia can still occur
47
Hepatitis, gastroenteritis, and pneumonitis in patient on immunosuppression for organ transplant
tissue-invasive CMV
48
Symptoms of PCP
occur in organ transplant pts without prophylaxis
Pulmonary sxs (respiratory failure, cough, dyspnea) only (no GI symptoms)
49
Sudden loss of vision + pale retina and dark "cherry red" macula
retinal artery occlusion
TX with 100% O2, ocular massage, acetazolamide, or anterior chamber paracentesis
50
Sudden vision loss with venous dilation and cotton wool spots
Retinal vein occlusion
TX with ranibizumab
51
VEGF-is
ranibizumab, bevacizumab, aflibercept
used to treat neovascular changes in diabetic retinopathy and or macular degeneration
52
blurred vision, floaters, photopsia (sensation of flashing lights) =
CMV retinitis
53
Acute angle glaucoma: TX
mannitol, acetazolamide, pilocarpine, or timolol
AVOID anti-cholinergic agents like atropine
54
Simple vs pre-proliferative vs proliferative/malignant diabetic retinopathy: the fundoscopic exam
Simple: microaneurysms, hemorrhages, exudates, and retinal edema
pre-proliferative: cotton wool spots
proliferative: newly-formed vessels
55
_____ is a complication of 5% of sternotomies
acute mediastinitis
NOTE": tx with drainage, surgical debridement, and prolonged antibiotic therapy
56
AC that reduces risk of systemic thromboembolism in pts with afib
warfarin or apixaban/dabigatran/rivaroxaban
57
peripartum cardiomyopathy: features
rapid-onset systolic heart failure (fatigue, dyspnea, cough, pedal edema) at >36weeks gestation or early puerperium.
NOTE: afib is uncommon in this condition
58
Nitrates: MOA
Primarily smooth muscle relaxer, resulting in systemic vasodilation/venodilation and decrease in cardiac preload (decreased LV wall stress)
59
Management of rheumatic heart disease
treat prophylactically against recurrent group A strep pharyngitis with IM penicillin
60
Complete AV septal defect: auscultation findings
Most common congential heart defect in pts with Down syndrome
Findings: Loud S2 d/t pHTN
SEM at left heart base from increased flow
holosystolic murmur of VSD may be soft or absent if the defect is large
61
2 hour old infant becomes cyanotic and has a single lod 2nd heart sound on exam
transposition
62
Most common cause of constrictive pericarditis
TB
63
Physical exam findings in constrictive pericarditis
Right heart failure --> elevated JVP with abdominal compression (hepatojugular reflex)
Right heart failure --> Kussmauls sign (lack of decrease or even an increase in JVP on inspiration)
Pericardial knock (after S2)
Pericardial calcifications on CXR
64
TX of afib in stable pts with WPW
procainimide or ibutilide
NOTE: AV nodal blocking agents such as adenosine, beta blockers, and CCBs (verapamil) should never be used as they may promote conduction across the accessory pathway and lead to degeneration into VF
65
Monomorphic ventricular tacycardia
wide uniform QRS complex tacycardia with fusion beats showing p waves
treat stable sustained MVT with amiodarone
66
TX of stable afib/aflutter
beta-blocker or CCB (verapamil or dilt) if not in CHFexacerbation
if in CHFexacerbation, give digoxin or amiodarone
67
2 imaging modalities used to confirm renovascular fibromuscular dysplasia
CTa
| US doppler
68
4 meds that can potentiate AC effects of warfarin
acetaminophen
NSAIDs
amiodarone
antibx
69
Viruses implicated in dilated cardiomyopathy
```
coxsackievirus B
parvovirus B19
HHSV 6
adenovirus
enterovirus
```
70
Heart sound heard in MI
S4 d/t noncompliance of left ventricle
S4 specifically is the sound of atrial systole as blood is ejected from the atrium into a stiff ventricle
71
Which has a higher mortality rtate, inferior wall MI or anterior wall MI
Anterior wall MIs confer a 30-40% mortality rate vs < 5% for inferior wall MIs
NOTE: Posterior wall MIs (evidenced by ST elevation in leads V1 and V2) have a very low 1 year mortality rate
72
Meds that confer a mortality benefit following an MI
aspirin (if given immediately)
beta-blocker, statin (if LDL >100), ACE-i (espeically if LVEF <40% and anterior wall infarction; should be given during hospital stay)
73
Absolute contraindications to thrombolytics in someone with STEMI who cant get timely PCI
Major bleeding into bowel (melena) or brain
Recent surgery (w/in 2 weeks)
Severe HTN (>180/110)
Recent nonhemorrhagic stroke (w/in last 6 months)
74
Drug to give immediately (other than aspirin) in NSTEMI
heparin
75
Canon a waves =
3rd degree AV block
76
Causes of systolic CHF (9)
```
alcohol
thiamine
postviral (idiopathic)
Chagas disease
radiation
adriamycin (doxorubicin) use
hemochromatosis
thyroid disease
peripartum cardiomyopthy
```
77
Malignant HTN
severe HTN w/ retinal hemorrhages, exudates, or papilledema
78
Time frame for fat embolism
12-24hrs following injury
79
MOA of flushing with niacin use
prostaglandin-induced peripheral vasodilation
80
Defibrilation indicated in ____
symptomatic Vfib, Vtach
81
Hypotonic serum
serum osmolality < 275mOsm/kg
82
SIADH: etiologies and lab findings
CNS disturbance (stroke, hemorrhage, trauma)
Meds (carbamazepine, SSRIs, NSAIDs)
Lung disease (pna)
Ectopic ADH secretion (small cell lunng caner)
Pain and/or nausea
Labs: hyponatremia, serum osm < 275, urine osm >100, urine Na >40
83
Acute episodes of cough, breathlessness, fever, and malaise that occur within 4-6 hours of antigenic exposure =
hypersensitivity pneumonitis
84
CMV mononucleosis: sxs
persistent fever, malaise, and fatigue with absolute lymphocytosis on complete blood count and atypical lymphocytes on PBS
85
Essential tremor: txs
clonazepam (2nd line)
primidone
propranolol (1st line)
86
Indications for long-term O2 in pts with COPD
resting pulse ox of <88
pulse ox of <89% in pts with cor pulmonale, right heart failure, or Hct >55%
87
Types of casts on UA and their associations
muddy brown granular cast--acute tubular necrosis
Broad and waxy casts--chronic renal disease
WBC casts--AIN or pyelo
RBC casts--glomerulonephritis
Fatty casts--nephrotic syndrome
88
UA in ATN
FeNa >2%
urine osmolality 300-305
urine Na > 20
(kidney unable to concentrate urine)
muddy brown granular casts
89
Respiratory distress, neurologic dysfunction, and petechial rash 24hrs followed MVA
triad of sxs representing fat embolism syndrome
90
Una =
aldosterone
91
Uosm =
ADH
92
Work-up of euvolemic hypotonic hyponatremia
Rta
Addisons
Thyroid
SIADH
93
Persistent WBC on a UA with negative culture
TB
94
hemorrhagic cystitis caused by ____
cyclophosphamide
95
Postrenal azotemia and bleomycin, methylsergide, or radiation exposure =
retroperitoneal fibrosis
96
Meds that cause ATN
contrast, aminoglycosides, cisplatin, amphotericin, cyclosporin, NSAIDS
97
MOA of contrast in contrast nephropathy
contrast causes ATN through spasm of the afferent arteriole that leads to percieved ischemia and pre-renal labs: UNa < 20
FeNa <1%
Uosm > 300
urine specific gravity high
98
Sudden onset flank pain, fever, and hematuria in a patient with sickle cell who has been taking NSAIDS =
renal papillary necrosis
99
Goodpasture vs wegners
both glomerulonephritities
goodpasture: lung and kidny, but NOT upper respiratory or vascular, involvement, TX with PLEX and steroids
wegners: nose, lung, and kidney involvement
100
Alport syndrome: features
defect of type IVcollagen causing glomerular disease, sensorineural hearing loss, and visual distrubance
101
Polyarteritis Nodosa: features
systemic vasculitis of small and medium sized vessels that causes glomerular disease
associated with hep B
systemic sxs: fever, malaise, arthralgia, weight loss
Specific sxs: GI (pain worse with eating due mesenteric involvement), neurologic (stroke in a young person), skin (ulcers), cardiac disease
102
bethanechol: MOA
cholinergic agent used to treat urinary retention or atonic bladder
103
oxybutynin: MOA
anti-cholinergic agent that inhibits cholinergic input during bladder filling, helping to increase bladder capacity
104
tamsulosin: MOA
alpha-1 receptor that acts on the distal ureter, lowering muscle tone and reducing reflex ureteral spasm 2/2 stone impaction
105
Urinary retention in older male with a cold --> suspect ___
diphenhydramine use (potent anti-cholinergic effects)
106
Drugs used to mitigate secondary hyperparathyoidism in CKD
Ca
sevelemer (phosphate-binding agent) -- only in ESRD
cinicalcet (Ca-sensing receptor agonist)
107
1st line pharmacotherapy for enuresis
desmopressin
108
salicylate intoxication: sxs and acid-base disturbance
sx triad of tinnitus, fever, and tachypnea
Disturbances:
1st--respiratory alkalosis (from acute salicylate toxicity)
2nd--anion gap metabolic acidosis
109
Most likely electrolyte and acid-base disturbance in AKI
anion gap metabolic acidosis
| hyperkalemia
110
Glomerular disease seen in Hogkin lymphoma
minimal change disease
NOTE: membranous nephropathy is the most common form of nephrotic syndrome associated with carcinoma
111
severe hypercalcemia with pancytopenia in older person =
MM
112
Causes of nephrogenic DI (5)
lithium, demeclocycline, CKD, hypokalemia, or hypercalcemia
113
Demeclocycline MOA
Blocks action of ADHat the collecting duct of the kidney tubule
Used to treat chronic SIADH from metastatic cancer
114
Drugs other than spironolactone and ACE-is/ARBs that can cause hyperkalemia
beta-blockers
digoxin
heparin
115
Vitiligo: TX
topical or corticosteroids
116
Minimal change disease: TX
Highly responsive to steroids
NOTE: if high-suspicion (child <10 with all the sxs, treat without first doing biopsy)
117
Pt with pruiritis triggered by hot baths, hepatospleomegaly, and HA coming in with first gouty attack =
polycythemia vera
118
Dyspareunia, urinary frequency, and bladder pain relieved with voiding =
interstitial cystitis (painful bladder syndrome)
119
Tetrology of fallot: auscultation findings
harsh systolic crescendo-descrescendo murmur over left upper sternal border (pulmonic stenosis)
single S2 (inaudible pulmonary component)
120
Time frame for rash following amoxicillin use with mono
after 24hrs
121
Lab findings in pagets disease
elevated ALP
elevated gone turnover markers (PINP, urine hydroxyproline)
NL calcium and phosphorus
122
Indications for dialysis
A--metabolic acidosis (ph < 7.1 that is refractory to medical therapy)
E--electrolytes. unstable hyperkalemia or asymptomatic hyperk >6.5 that is refractory to medical therapy
I-ingestion. txoic alcohols, salicylates, lithium, sodium valproate, carbamasepine
O-overload
U-uremia (aka symptomatic azotemia, by it with encephalopathy, pericarditis, or bleeding)
123
Causes of polyarticular joint disease
```
VIRUSSSSSSS
hepC, CMV, EBV, HIV, Parvo
Sero negative
Sero postive (lupus and RA)
Syphillis
Sarcoid
Stills disease
Sepsis
```
124
Causes of oligoarticular disease
```
Infectious (gonorrhea or not)
Crystal (gout, pseudogout)
Sero negative (PAIR--psoariasis, ankylosing spondylitis, IBD-related, reactive)
```
125
Sxs lupus
```
Malar rash
Discoid rash (causing allopecia)
```
Serositis
Oral ulcers
Arthropathy (large joint predilection)
Photosensitivity
Blood (anemia, thrombocytopenia)
Renal failure (ds-DNAassociated with this)
ANA + (gateway antibody--very sensitive)
Immunologic (APLS, anti-histone, anti-smith, ds-DNA)
Neuro
NOTE: need at least 4 of these
126
Lupus nephritis:TX
cyclophosphamide, then mycofenylate mofetil
NOTE: always get biopsy first to characterize severity of disease
127
Meds that cause drug-induced lupus
hydralazine
procainimide
methyldopa
128
Limited cutaneous systemic sclerosis
```
CREST
Calcinosis (of vessels->HTN)
Raynauds (tx with CCB)
Esophageal dysmotility (and GERD)
Sclerodactyly (tx with penicillamina)
telangectasias
```
Associated with anti-centromere antibody
129
Diffuse cutaneous systemic scleroderma
limited scleroderma (CREST) plus ILD complicated by pulmonary artery HTN, constrictive pericarditis, scleroderma renal crisis (tx with ACE-is NOTsteroid)
Accociated with anti-scl70 (anti-toporimise)
130
DMARDs in seronegative arthritis
only help with skin findings and distal arthritis (as in psoariatic arthritis), not in axial-skeleton (as in ank spond)
use anti-TNFa for axial-skeleton involvement
131
jaw claudication, vision changes, and temporal tenderness =
giant cell arteritis
age >50
bypass biopsy and treat with steroids immediately
132
wegners =
granulomatosis with polyangitis
133
Causes of avascular necrosis (8)
```
Steroid use
Alcohol abuse
SLE
APLS
hemoglobinoathies
infections (osteomyelitis, HIV)
renal transplantation
decompression sickness
```
134
Complications of ciprofloxacin
Note: this is a fluroquinolone
tendinopathy and tendon rupture (achilles most common)
tendon pain can occur w/in 24hrs, with median of 8 days after starting drug
135
AA female with recent fatigue and malaise presenting with stroke-sxs, found to have anemia, thrombocytopenia, psotive ANA, and postive RPR =
antiphospholipid syndrome
| anti-cardiolipin and anti-beta-2-glycoprotein-1 antibodies are the specific antiphopholipid antibodies
136
Juvenile Rheumatoid Arthritis
High-spiking fever in a young person with no clear etiology
Splenomegaly
pericardial effusion
mild joint symptoms
Labs: anemia, hypoalbuminemia, and leukocytosis
ANA normal
ferritin elevated
137
Lab findings in an acute lupus flare
complement levels drop
| anti-DS DNA levels rise
138
Asian/Middle Eastern perso with painful oral and genital ulcers also with erythema nodosum
Behcet syndrome
NOTE: Also associated with ocular lesions--> uveitis and blindness
arthritis
CNS lesions mimicking MS
139
Procedures of choice for foreign body aspiration vs ingestion
aspiration: rigid bronchoscopy
ingestion: flexible endoscopy
140
Hyperemesis gravidarum and a uterine size-date discrepancy =
molar pregnancy
141
Pt coming in with labor like pains and negative pregnancy test, found to have irregularly-shaped, enlarged uterus and firm smooth round mass at cervical os =
prolapsing submucosal myoma (fibroid) or leiomyoma uteri
142
Tardive dysinesia: management
stop antipsychotic or switch to clozapine
143
Best prognostic factors in breast cancer
TMN staging
NOTE: ER and PR postive tumors good prognostic factors, overexpression ofg Her-2/neu oncogene related to worse prognosis
144
Risk factors for carpal tunnel syndrome
DM
obesity
hypothyroidism
pregnancy
145
Antibx options in chorioamnionitis
ampicillin
gentamicin
clindamycin
146
Crystal-induced acute kidney injury: clinical features
common etiologies: IV acyclovir, sulfonamides, methotrexate, ethylene glycol, protease inhibitors
lclinical presentationn: usually asymptomatic elevation of creatinine within 1-7 days of starting drug (NOTE this is in contrast with AIN which takes 7-10days to occur and is symptomatic)
UA: hematuria, pyuria, and crystals
147
Acute dystonia: TX
benztropine (anti-cholinergic)
| diphenhydramine (antihistamine and anticholinergic)
148
3 pathognommonic facial dysmorphisms of fetal alcohol syndrome
(1) small palpebral fissures
(2) smooth philtrum (vertical groove above upper lip)
(3) thin vermillion border
149
Niemmann-Pick disease: path and features
path: sphingomyelinase deficiency
features: loss of motor milestones (btw 2-6 monthsw old), hypotonia, feeding dificulties, cherry red mecula, hepatosplenomegaly, areflexia
150
Tay-sachs disease: path and features
Path: beta-hexosaminidase A deficiency
Features: Loss of motor milestones (2-6 months old), hypotonia, feeding difficulties, cherry red macula, hyperreflexia
151
Thyrotoxicosis in a woman over the age of 40 with a pelvic mass, ascites, and abdominal pain =
struma ovarii
Note: thyroid gland is NOT enlarged with this
152
Association with mammary Paget disease
underlying breat adenocarcinoma
153
painful, itchy, eczematous and/or ulcerating rash on nipple that spreads to areola =
mammary Paget disease
154
Ototoxic agents (2)
loop diuretics
| aminoglycosides
155
CXR showing pleural plaques and interstitial abnormalities in the lower lung fields
asbestosis
156
CURB-65
To determine hospitalization with pna:
```
Confusion
Urea >20
RR >30
BP low (sys <90 or diastolic <60)
Age >65
```
0-->outpatient tx
1-2-->inpatient
3-4--> inpatient urgently, possibly ICU
157
Eosinophilic granulomatosis with polyangitis =
Churg-Strauss syndrome
chronic rhinosinusitis, including nasal polyps, asthma, and prominent eosinophilia
158
Side effects of high dose beta-agonists
hypokalemia (muscle weakness, arrythmias, and EKG abnormalities)
tremor
palpitations
HA
159
Aspirin-exacerbated respiratory disease: MOA
non-IgE mediated rxn that results from aspirin-induced prostaglandin/leukotriene misbalance
NOTE: most often seen in patient with a history of asthma or chronic rhinosinusitis with nasal poluposis
160
Headache, insonia, N/V, and palpitations in someone on theophylline who just started taking ciprofloxacin
theophylline toxicity
CNSstimulation
GI disturbances
cardiac toxicity
161
Complications of positive pressure ventilation
alveolar damage
pneumothorax
hypotension
162
Amniotic fluid embolism: risk factors
```
advanced maternal age
gravida > 5
Ceasarian or instrumental delivery
placenta previa or abruption
preeclampsia
```
163
Amniotic fluid embolism: clinical presentation
cardiogenic shock
hypoxemic respiratory failure
DIC
coma or seizures
164
Amniotic fluid embolism: TX
respirtory and hemodynamic support
consider transfusion
165
Lung abscess: TX
clindamycin or penicillin
166
Tests to confirm PCP infection
Most accurate: BAL
| NOTE: sputum stain is specific and if positive, BAL does not need to be done
167
High LDH and CXR showing bilateral interstitial infiltrates =
PCP
168
PCP: TX
TMP/SMX (for tx and ppx)
Add steroids if severe
If toxicity to TMP/SMX, use clindamycin + primaquine, or use pentamidine
169
Side effects of TMP/SMX
Rash
SJS/TEN
AIN
bone marrow suppresion
170
TB: Positive PPD with induration >5mm in which populations?
```
HIV-positive patiets
glucocorticoid users
close contacts of those with active TB
abnormal calcifications on CXR
organ transplant recipients
```
These people have a low threshold for a positive PPD
171
Pyrazinamide: side effects
hyperuricemia
172
ethambutol: side effects
optic neuritis/color vision change
Decrease dose in renal failure
173
Tx of active vs latent TB
ACTIVE (+CXR)
1st 2 months: Rifampin + pyridoxine, isoniazid, pyrazinamide + ethambutol if sensitivty of TB unknown
next 4 months: RI
NOTE: tx extended to >6months if TBcomplicated by meningitis or patient is pregnant
LATENT (-CXR)
9 months of isoniazid
174
ILD: clinical presentation
dyspnea, worsening on exertion
fine rales or crackles on auscultation
Loud P2 (2/2 pulm HTN)
clubbing of the fingers
175
TX of ILD if biopsy shows white cell or inflammatory infiltrate
prenisone
176
Sarcoid: best initial vs most accurate test
best initial: CXR (shows hilar adenopathy +/- interstitial infiltrates)
most accurate: lymph node biopsy (showing noncaseating granulomas)
177
Sarcoid: presentation
```
restrictive lung disease
parotid gland enlargement
facial palsy
heart block and restrictive cardiomyopathy
CNS involvement
iritis and uveitis
```
178
Sarcoid: TX
prednisone
NOTE: asymptomatic hilar adenopathy does not need to be treated
179
Best initial tests in suspected PE and their findings
CXR: usual nl. most common abnormality is atelectasis
EKG: sinus tachycardia, maybe with non-specific ST-T wave changes. Only 5% wll show right axis deviation or RVH and S1q3T3 NOT most common
ABG: high pH and low pCo2
Spiral CT (CT angio): specificity and sensitivity excellent
180
Definition of ARDS
Acute respiratory distress syndrome
= pO2/FIO2 ratio < 300
(e.g.if pO2 is 105 on RA or 21% O2, then ratio is 105/0.21 or 500)
181
Pulmonary HTN: TX
prostacyclin analogues (PA vasodilators): epoprostenol, treprostinil, iloprost, beraprost
endothelin antagonists: bosentan, ambrisentan
phosphodiesterase inhibitors: sildenafil
NOTE: O2 slows progression, especially with COPD
182
platypnea (dyspnea worse with sitting upright) in s/o cirrohosis =
hepatopulmonary syndrome
183
Reversible causes of complete heart block
3rd degree heart block
Myocardial ischemia
increased vagal tone (during sleep or due to pain)
metabolic disturbances (hyperk)
AV nodal blocking agents (CCBs)
NOTE: In absence of reversible causes, permanent pace maker indicated. With reversible causes, temporary pace maker can be inserted aand further evaluation undertaken
184
Preferred method of respiraoty support in acute exacerbation of COPD
non-invasive positive-pressure ventilation
| ventilatory support delivered by facemask rather than ETtube
185
Location of pain: patellofemoral syndromevs patellar tendonitis vs osgood-schlatter disease
patellofemoral: chronic petalla (young women athletes, pain with using stairs or prolonged sitting)
patellar tendonitis: episodic inferior patella, ("jumpers knee")
Osgood-Schlatter disease: tenderness and swelling at tibial tubercle , pain with sports, relief with rest, pre/adolescent athletes
186
Pyelonephritis: Outpatient TX vs inpatient TX
Outpaitnet: fluoroquinolones (cipro, levo)
Inpatient: IV antibx (fluoro, aminoglycoside + ampicillin) and obtain urine culture beforehand
187
TX uncomplicated vs complicated cystitis
uncomplicated: nitrofurantoin, TMX/SM, fosfomycin
complicated: fluoroquinolones
188
Kidney injury with chronic analgesic use
tubulointerstitial nephritis (sterile pyuria and WBCcasts with elevated creatinine) +/- papillary necrosis (trace blood and RBCs)
189
Most common malignancy in smokers with asbestos exposure
bronchogenic carcinoma (NOT mesothelioma)
190
Work up of solitary pulmonary nodule
low risk: serial CTs
Intermediate: PET scan and biopsy
high: resection
191
Intermediate risk of a solitary pulmonary noudle being lung cancer
size: .8-2cm
Surface: scalloped
Smoking: current
Self: btw 40-60yo
192
Pulmonary HTN =
mean arterial pressure > 25
193
DLCO in bronchitis- vs emphysema- predominant COPD
bronchitis-normal
| emphysema-decreased
194
Malignant otitis externa: TX
IV cipro
| NO surgery
195
Glazed, brightly erythematous lesions on the vulva with erosive (ulcerated )areas
lichen planus (from chronic inflammatory skin dystrophy)
196
Normal internal genitalia, external virilization/amiguity (clitoromegaly) and undetectable serum estrogen levels (high FSH and LH)
aromatase deficiency
197
McCune-Albright syndrome: clinical features
Triad of cafe au laits spots, polyostotic fibrous dysplasia, and autonomous endocrine HYPERfunction (gonadotropin-independent precocious puberty)
198
Ambiguous external genitalia, normal uterus and ovaries, and electrolyte abnormalities
congential adrenal hyperplasia d/t 17-alpha hydroxylase deficiency
199
2 causes ofg symmetrical fetal growth restriction
chromosomal abnormalities
congenital infection
(first trimester insults)
200
Echinococcus/hytidid vs amebic cysts: clinical features and management
hytidid (asym): aspiration and albendazole
amebic cyst (RUQ pain and low grade fevers): metronidazole only
