5/12 (UWSA) Flashcards
Most common complication w/ TPN
Catheter tip infection
Methanol vs Ethylene glycol ingestion characteristics
Methanol- Visual disturbances
Ethylene glycol -RTA damage and formation of calcium oxalate crystals
When is an NST complete
Two or more accelerations of 15 ppm above baseline for at least 15 seconds over 20 mins
What is Ecthyma grangrenosum
Pseudomonas bacteremia w/ rapidly progressive skin lesions that develop into non-tender ulcers w/ central necrosis
What is decreased first in tamponade
Right atrial filling, leading to an increase in systemic venous pressure
CSF findings of HSV encephalitis
- Lymphocytic pleocytosis
- Increased protein
- Elevated RBC
- Normal glucose
CSF of mycobacterial meningitis
Lymphocytic pleocytosis w/ decreased glucose, increased protein
MRI finding of spinal stenosis
narrowing of lumbar spine
Most common cause of paraneoplastic cushings
Small cell lung cancer
What makes ACTH
Cleavage of POMC (also yielding melanocyte stimulate hormone)
Most effective treatment to decrease risk of stroke in A-fib
Anticoagulation w/ warfarin
TB pleural effusion features
Exudative w/ protein > 4 and lymphocytic leukocytosis w/ no gross purulence
Why are SVC headaches worse w/ leaning forward
Decrease gravitational effects on the blood column
MCC of SVC syndrome? Presentation?
Malignancy (either lung or lymphoma)
Presents w/ headache, facial swelling, and jugular venous engorgment w/out peripheral edema
Dx of SBP w/
Ascitic fluid neutrophil count > 250 in the appropriate clinical setting
Two labs that are elevated in breakdown of muscle tissue
LDH and CPK
Why hypotension in a tension pneumothorax
High intrathoracic pressure decreases venous return
2 lower motor neuron signs of denervatio
Atrophy and fasciculation’s
What is serositis
CP w/ pleural effusion and pericardial effusion
Seen w/ SLE
Wide complex tachycardia considered what until proven otherwise? tx?
Ventricular in origin
Tx w/ loading dose of amioderone in stable patients
Esophageal rupture usually leads to what
Mediastinitis
Why CT scan in primary hyperaldosteronism
To identify if it is bilateral adrenal hyperplasia or aldosterone producing adenoma
Drug for pt’s ww/ bilateral adrenal hyperplasia
Aldosterone antagonists
Serum Ca levels in hypercalcemia of malignancy vs Primary hyper PTH
Generally much higher in HOM than primary hyper PTH
Drug to prevent gallstone formation in patients w/ gastric bypass surgery
Ursodeoxycholic acid (higher risk due to increase in bile concentration)
Secondary hyperparathyroidism features
Elevated phosphate and low Calcium in setting of CKD
What is tertiary hyperparathyroidism
Chronic PTH stimulation leads to development of autonomously functioning adenomas w/ very high PTH levels and hypercalcemia
Neurologic manifestations of SLE
Cognitive dysfunction and seizures
What kind of pain is the crampy pain in SBO
Viceral (mechanical stretching of small bowel viscera)
Somatic abdominal pain features
Well localized, and usually 2/2 peritoneal irritation
2 broad categories of hypoglycemic symptoms
Neurogenic (sympathetic)
Neuroglycopenic (dec supply of glucose to brain causing mental status changes)
2 first line treatments of neurogenic bladder
- Augmented voiding techniques
2. Cholinergic agonists
Two B-blockers used to reduce the risk of esophageal vatical hemorrhage
Propranolol and nadolol
What can myocarditis develop into
Dilated cardiomyopathy
What is elevated in cholestatic jaundice
T bili and alk phos
What should always be considered in evaluation of patients w/ a-fib
Hyperthyroidism (TSH and free t4)
Symptoms of meniscal tear
Joint line tenderness
Effusion
Locking or catching when the joint is extended while under load
Prognosis of astrocytomas most affected by?
Tumor grade
First line therapy for CLL
Rituximab (CD20 mAb) and Fludarabine
IL-1 receptor antagonists useful in
Treatment of RA
How can extra-renal fluid losses lead to hypovolemic hyponatremia
Due to secretion of ADH and retention of free water
Ab for sepsis in SS kids
3rd gen cef (for presumed s pneumo)
Two MCC of malignant pleural effusion
Breast and Lung
Two drugs classes for rate control in A-fib
B blockers (metoprolol, esmolol) non-dihydropyridine CCBs (verapamil and diltiazem)
3 murmers of large ASD (w/ L to R shunt)
- Wide and fixed split S2
- Midsystolic murmur of LUSB
- Mid-diastolic rumble
Next step in septic shock if pt doesn’t respond to fluids
Vasopressors (dopamine or NE)
Check of anti-endomysial Ab in who
Patients suspect of having celiac spure
MCC of renal failure in multiple myeloma
Toxic effect of light chain casts on renal tubules
Fragile X features
Delayed milestones, autistic behavior, ID, elongated face, large testes
pH of urine in women w/ yeast infections
Normal (3.8-4.5)
Alpha thal minor symptoms
Asymptomatic but mild fatiguability
Hypo chromic anemia w/ severe microcytosis and target cells
Initial workup of new psych symptoms
- Head CT
- CBC
- TFTs
- Syphilis screen
- metabolic panel
- Urine tox
What should be suspected in any pt w/ fever and monoarticular joint symptoms
Septic arthritis (even when pt’s have pre-existing joint disease)
Bleeding in meckels from
Ectopic gastric tissue
Anemia most commonly seen w/ DIC
Microangiopathic hemolysis
Mitral stenosis murmur
Low pitched diastolic murmur best heard at the apex (earlier in beginning and can become holosytolic in severe dz)
Mammogram age
50-75
Good step to reduce pressure ulcers on LE
Pillows under the legs
What should be suspected in pt’s that develop rapid accumulation of pleural effusion, SOB, and hemodynamic instability after thoracentesis
Hemothorax
Who gets focal segmental glomerulosclerosis
AA and Hispanics
Obese folds
HIV and heroin use
Glomerular dz ass w/ Hep B and C
Mebranoproliferative glomerulonephritis
First day of pulmonary contustion
Airspace opacity on CXR and findings c/w alveolar fluid on physical exam
Presentation of juvenile myoclonic epilepsy
Progression from absence seizures to myoclonic to generalized
Typically occur upon awakening and worse w/ sleep deprivation
How do nitrates reduce pain in MI
Venous dilation (thus reducing preload leading to reduction in myocardial O2 demand)
Bacterial meningitis empiric tx
Ceftriaxone and vanc
Aortic regurg mumur
Decrescendo diastolic murmur
What is albuminocytologic dissociation
In CSF when protein is elevated and WBC is normal
seen in GB
MCC of spinal epidural abscess
S. aureus
No tx or further workup in kids w/ pharyngitis when
Cough, runny nose, and oral vesicles present (likely viral)
Smear of MDS
Ovalo-macrocytes and neutrophils w/ decreased segmentation
What is seen after peaked T waves in hyperkalemia
Loss of P waves
Then widened QRS w/ sine wave pattern
What part of adrenal gland makes catecholamines
Renal medulla (Epi and NE)
GAS impetigo can lead to
Glomerulonephritis
rheumatic fever follows strep throat
Most common complication of neutropenia
Infection (septic signs may be more subtle than in an immunocompetent patient)
Labs of tumor lysis syndrome
Hypocalcemia
Hyperphosphatemia
Hyperkalemia
Elevated Uric Acid levels
When is debridement alone in a diabetic ulcer ok
When there is no infection and the ulcer does not involve the bone
3 big things in hyperprolactinemia
- Irregular menstrual periods
- Infertility
- Galactorrhea
What is susceptibility bias
Selection bias where a pt’s treatment regimen is selected based on the severity of their condition
What causes DKA
Lack of insulin causing breakdown of fatty acids to ketones in the liver
(FFA from peripheral tissue due to HIGH level of catecholamines)
AIDs drug that causes bizarre CNS effects
Efavirenz
Pancreatitis w/ what AIDs drug
Didanosine
Abacavir AE
Lactic acidosis
Hepatitis
Hypersensitivity reaction
Half of HSP cases preceded by
URI (thought to trigger abnormal immune response)
Light microscopy of HSP
Leukoclastic vasculitis in the post capillary venules
Bartholin’s gland abscess presentation
Extremely painful unilateral labial sweeping, often making it very painful to sit and screw
Nail manifestations of Graves
Oncholysis
Aropachy (ail clubbing in setting of hyperthyroidism)
Why is mild hypercalcemia seen in Graves
Increased bone turnover
Triptan + Ergot can cause
Severe prolonged vasoconstriction resulting in elevated BP, MI, or stroke
“Glare” while driving at night classic manifestation of
Cataracts
painless loss of vision that is worse at night
Look for what in pt’s w/ splenectomy
Thrombocytosis b/c spleen removes old platelets from circulation
5 Drugs that dec. mortality in LV dysfunction ***
- ACEi
- ARBs
- B-blockers
- Aldosterone antagonists
- Hydrazine + nitrates
3 best B-blockers for CHF
Metoprolol succinate
Carvedilol
Bisoprolol
Avoid what B-blockers in CHF? Why?
PIndolol and acebutolol
These have intrinsic sympathomimetic activity
Carpal tunnel in pregnancy due to
Accumulation of fluid w/in the tunnel
What causes carpal tunnel in RA
Tenosynovial inflammation
How does Mag cause neuromuscular depression
Reducing act release at myoneural junction
First line tocolytics that can cause pulmonary edema? how?
Terbutaline and ritodrine (B-agonists) due to inc HR causing dec. diastolic filing time combined with excess plasma volume in pregnant patients
Why does SS not get infants
Protective effect of fetal hemoglobin
Hypertriglyceridemia tx
Fenofibrate (fabric acid derivative)
What is cholestyramine
Bile acid binding resin that can reduce LDL (but raise TG)
Ezetimibe MOA
Prevents dietary absorption of cholesterol from gut
*LDL double dec when used w/ statin
Drug to use w/ statin to reduce LDL a lot
Ezetimibe
Most effective tx in slowing progression of diabetic nephropathy
Maintaining BP less than 130/80
Sulfonylurea MOA
Acts on pancreas to increase endogenous insulin production
COCs dec risk of what cancers
Ovarian and endometrial
Confirmatory HIT test
ELISA Ab test
Typical volume status in severe hypercalcemia
Typically volume depleted due to increased natriuresis
Sudden onset of syncope w/out a prodrome most likely
Ventricular arrhythmia
4 big risk factors for torsades
- Antiarrhythmic drugs
- Structural heart disease
- Hypokalemia
- Hypomagnesemia
