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Step 2 CK UW > 7/26/16 > Flashcards

7/26/16 Flashcards

1
Q

tx for trigeminal neuralgia

A

carbamazepine

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2
Q

what dx should be suspected in a pt with long-term use of 1 or multiple analgesics (e.g., aspirin, ibuprofen) for chronic pain who presents with painless hematria, sterile pyuria, WBC casts, and trace proteinuria?

A

tubulointerstitial nephritis (hematuria is due to papillary necrosis)

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3
Q

acute, severe retroorbital pain that wakes pt from sleep, accompanied by redness of ipsilateral eye, tearing, and ipsilateral horner syndrome

A

cluster headache

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4
Q

what class of abx is associated with tendinopathy and tendon rupture?

A

fluoroquinolones

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5
Q

where are broca’s and wernicke’s areas?

A

broca: dominant FRONTAL lobe
wernicke: dominant TEMPORAL lobe

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6
Q

recurrent sinusitis and otitis, bloody/purulent nasal discharge, arthralgias, oral or auditory canal ulcers, hematuria, proteinuria, renal insufficiency = what is the dx and initial test?

A

granulomatosis with polyangiitis (Wegener granulomatosis); check serum autoantibodies (antineutrophil cytoplasmic antibodies [ANCA])

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7
Q

what should a pt found to have chondrocalcinosis (pseudogout), diabetes, and hepatomegaly be checked for?

A

hereditary hemochromatosis

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8
Q

what are the important secondary causes of pseudogout that should be investigated in pts with chondrocalcinosis?

A

hyperparathyroidism, hypothyroidism, and hereditary hemochromatosis

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9
Q

pts with hereditary hemochromatosis are at risk for what infections?

A

Very Yucky Liver: Vibrio vulnificus, Yersinia enterocolitica, Listeria

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10
Q

pathogenesis of milk-alkali syndrome

A

caused by excessive intake of calcium and absorbable alkali; the resulting hypercalcemia causes RENAL VASOCONSTRICTION and decreased glomerular blood flow. in addition, inhibition of the Na-K-Cl cotransporter and impaired ADH activity lead to loss of sodium and free water, which leads to hypovolemia and increased reabsorption of bicarbonate. Findings include METABOLIC ALKALOSIS, ACUTE KIDNEY INJURY

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11
Q

what pathogen is associated with infective endocarditis related to colonic polyposis?

A

strep gallolyticus (strep bovis biotype I)

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12
Q

what pathogen is associated with infective endocarditis related to peridontal infection or dental procedures that involve manipulation of gingival or oral mucosa?

A

Eikenella corrodens

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13
Q

what predisposes pts to calcium oxalate kidney stones?

A

small bowel disease, surgical resection or chronic diarrhea that leads to malabsorption of fatty acids and bile salts (fat malabsorption leads to increased absorption of oxalic acid because the unabsorbed fatty acids chelate calcium, making oxalic acid free for absorption)

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14
Q

recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, and part of the ear

A

glossopharyngeal neuralgia (CN9)

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15
Q

what is the presentation, lab findings, and treatment of ehrlichiosis?

A

flu-like illness, confusion, THROMBOCYTOPENIA, LEUKOPENIA, ELEVATED LIVER ENZYMES a few weeks after tick bite; doxycycline

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16
Q

best abortive tx for cluster headaches

A

100% nasal oxygen

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17
Q

how can you distinguish between plantar fasciitis and tarsal tunnel syndrome?

A

tarsal tunnel syndrome pain WORSENS WITH USE whereas pain of plantar fasciitis is WORST IN THE MORNING and IMPROVES WITH WALKING A FEW STEPS

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18
Q

episodic anterior knee pain in an athlete who jumps a lot, tenderness at inferior patella

A

patellar tendonitis

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19
Q

young female athlete with subacute to chronic pain increased with using stairs, running, prolonged sitting

A

patellofemoral syndrome

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20
Q

young obese pt with headaches, vision disturbances (diplopia, transient vision loss), tinnitus, papilledema, CN 6 palsy (lateral rectus palsy) = dx, test, and tx

A

pseudotumor cerebri; LP (after MRI has ruled out intracranial mass); weight loss and acetazolamide

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21
Q

tx for urge incontinence refractory to bladder training and pelvic floor muscle exercises

A

oxybutynin (antimuscarinic agent)

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22
Q

unilateral neck pain and numbness over posterior surface of ipsilateral arm, limited neck rotation and lateral bending = dx and radiographic findings

A

cervical spondylosis (sensory deficit is due to osteophyte-induced radiculopathy); radiographic findings include BONY SPURS and sclerotic facet joints, narrowing of disk spaces and hypertrophic vertebral bodies

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23
Q

what are the sx of drug-induced interstitial nephritis? what drugs commonly cause this?

A

fever, MACULOPAPULAR RASH, renal failure, UA with WBC casts (may have eosinophiluria), RBCs, mild proteinuria; PENICILLINS, TMP-SMX, CEPHALOSPORINS, NSAIDS

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24
Q

tx for penicillin-sensitive Strep endocarditis

A

IV ceftriaxone or penicillin G (NO ORAL ABX)

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25
Q

diabetic pt with severe ear pain that radiates to temporomandibular joint, ear discharge, granulation tissue in ear canal, UNRESPONSIVE TO TOPICAL ABX = likely pathogen?

A

malignant otitis externa caused by PSEUDOMONAS AERUGINOSA

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26
Q

RA-like sx of bilateral, polyarticular arthritis involving hands, knees, ankles, morning joint stiffness, along with fever, diarrhea, mild skin itching and patchy redness

A

parvovirus B19

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27
Q

most common cause of bloody diarrhea without fever

A

E. coli (EHEC)

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28
Q

what are the important PFT findings in asthma?

A

decreased FEV1 and FVC (with a greater decrease in FEV1), decreased ratio of FEV1:FVC, increase in FEV1 of more than 12% and 200 mL with albuterol, decrease in FEV1 of more than 20% with methacholine or histamine, INCREASED diffusion capacity of lung for carbon monoxide

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29
Q

tx for acute asthma exacerbation

A

oxygen, albuterol, steroids

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30
Q

role of magnesium in acute asthma exacerbation

A

helps relieve bronchospasm, only used in acute, severe asthma exacerbation not responsive to SEVERAL rounds of albuterol while waiting for steroids to take effect (takes 4-6 hours)

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31
Q

what type of agent helps control sx in COPD but not in asthma?

A

anticholinergic agents (tiotropium, ipratropium)

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32
Q

recurrent episodes of VERY HIGH VOLUME PURULENT SPUTUM production with hemoptysis, dyspnea and wheezing = what is the most likely finding on CXR? what is the tx?

A

bronchiectasis; DILATED, THICKENED BRONCHI, sometimes with “TRAM-TRACKS”; CHEST PHYSIOTHERAPY and ABX

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33
Q

asthmatic pt with recurrent episodes of brown-flecked sputum and transient infiltrates on CXR = dx and tx

A

allergic bronchopulmonary aspergillosis (ABPA); ORAL STEROIDS (inhaled steroids are NOT EFFECTIVE), ITRACONAZOLE for recurrent episodes

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34
Q

what is a pilocarpine test?

A

test used to diagnose cystic fibrosis; pilocarpine increases acetylcholine levels which increases sweat production. increased chloride levels in sweat is diagnostic for CF

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35
Q

what pathogen causes community-acquired PNA associated with COPD?

A

haemophilus influenzae

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36
Q

what pathogen causes community-acquired PNA associated with alcoholism and diabetes?

A

klebsiella pneumoniae

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37
Q

what pathogen causes community-acquired PNA associated with animals at time of giving birth, veterinarians, farmers?

A

coxiella burnetii

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38
Q

what pathogen causes community-acquired PNA associated bullous myringitis (multiple reddened, inflamed blebs on tympanic membrane)?

A

mycoplasma pneumoniae

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39
Q

what pathogen causes community-acquired PNA associated with GI sx (diarrhea, abdominal pain) and CNS sx (headaches, confusion)?

A

legionella

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40
Q

what are the 5 agents that cause atypical PNA?

A

mycoplasma, coxiella, pneumocytis, chlamydia, viruses

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41
Q

what are the criteria for an exudate? what are the causes of exudate?

A

LDH greater than 60% of serum or protein greater than 50% of serum suggest an exudate. exudates are caused by infection and cancer.

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42
Q

what pathogens are more commonly seen in HAP compared to CAP? what is the preferred abx therapy?

A

gram negative bacilli such as E. coli and Pseudomonas. NO MACROLIDES! Antipseudomonal cephalosporins (cefepime or ceftazidime) OR antipseudomonal penicillin (piperacillin and tazobactam) OR carbapenems (imipenem, meropenem, or doripenem)

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43
Q

tx for ventilator-associated PNA

A

antipseudomonal beta-lactam PLUS a second antipseudomonal agent (aminoglycoside or fluoroquinolone) PLUS a MRSA agent (vancomycin or linezolid)

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44
Q

aspiration pneumonia occurs in the _____ lobe when lying flat

A

upper

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45
Q

what are the alternative tx for PCP pneumonia if TMP/SMX causes toxicity?

A

clindamycin and primaquine OR pentamidine (pentamidine is esp indicated if pt has G6PD deficiency)

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46
Q

side effects of TMP/SMX

A

RASH, BONE MARROW SUPPRESSION (HEMOLYTIC ANEMIA in pts with G6PD DEFICIENCY!), type 4 RTA (hyperkalemia), megaloblastic anemia (antifolate drug), teratogen, photosensitivity, drug-induced lupus

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47
Q

explain effect of TMP/SMX on levels of other drugs

A

displaces drugs from albumin, causing increased toxicity. for example, warfarin can be displaced from albumin, increasing risk for bleeding. it can also displace bilirubin from albumin causing kernicterus in neonates who were exposed in utero during last month of pregnancy. it also inhibits cytochrome P450 system so it can increase toxicity of many drugs.

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48
Q

alternate abx for PCP prophylaxis in those with TMP/SMX toxicity

A

ATOVAQUONE or DAPSONE

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49
Q

RIPE therapy for TB: list the side effects and management

A

Rifampin: red color to body secretions
Isoniazid: peripheral neuropathy; prevent with pyridoxine (vit B6)
Pyrazinamide: hyperuricemia (tx if symptomatic)
Ethambutol: optic neuritis/color vision (decrease dose in renal failure)

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50
Q

when should steroids be used in TB?

A

pts with pericardial involvement or meningitis (decrease risk of constrictive pericarditis and decrease neurologic complications, respectively)

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51
Q

what is considered a positive test on PPD?

A

5 mm: HIV pts, glucocorticoid users, close contacts of those with ACTIVE TB, abnormal calcifications on CXR, organ transplant recipients
10 mm: recent immigrants (past 5 years), prisoners, healthcare workers, close contacts of those with TB, hematologic malignancy, alcoholics, diabetics
15 mm: those with no risk factors

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52
Q

what should you do if a pt who has never had a PPD skin test before and their test comes back negative?

A

get a second test within 1-2 weeks

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53
Q

what should you do if PPD test was positive and CXR ruled out active disease?

A

isoniazid therapy for 9 months

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54
Q

medication management for TB

A

RIPE for 2 months, then rifampin and isoniazid only for 4 more months (6 total months of tx)

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55
Q

6 drugs that cause pulmonary fibrosis

A

ABC BMN (ABC Big Man Now): Amiodarone, Bleomycin, Cyclophosphamide, Busulfan, Methylsergide, Nitrofurantoin

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56
Q

pneumoconiosis associated with shipyard workers, pipe fitting, insulators

A

asbestosis

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57
Q

pneumoconiosis associated with cotton

A

byssinosis

58
Q

pneumoconiosis associated with electronic manufacture

A

berylliosis

59
Q

pneumoconiosis associated with moldy sugar cane

A

bagassosis

60
Q

what are the important PFT findings in pulmonary fibrosis?

A

decreased FEV1, FVC, TLC, residual volume, NORMAL ratio of FEV1:FVC (greater than 70%), DECREASED diffusion capacity of lung for carbon monoxide

61
Q

which pneumoconiosis shows granulomas on biopsy?

A

berylliosis

62
Q

likely and possible sx of sarcoidosis

A

likely: young African American female with dyspnea on exertion, erythema nodosum, and lymphadenopathy
possible: parotid gland enlargement, facial palsy, heart block, restrictive cardiomyopathy, CNS involvement, iritis and uveitis

63
Q

biopsy of sarcoidosis

A

noncaseating granulomas

64
Q

lab findings, PFT findings, and tx of sarcoidosis

A

elevated ACE level, hypercalciuria, hypercalcemia (granulomas in sarcoidosis make vitamin D!), PFT shows restrictive pattern; tx with PREDNISONE

65
Q

what are the options for pts with PE/DVT who experience HIT?

A

fondaparinux, argatroban, lepirudin

66
Q

which drugs can be used instead of warfarin that do not require INR monitoring after DVT/PE?

A

rivaroxaban and dabigatran

67
Q

what is obesity/hypoventilation syndrome?

A

sleep apnea with increased bicarbonate

68
Q

how much tidal volume should be given for mechanical ventilation for ARDS?

A

6 mL per kg

69
Q

what should you suspect in a pt whose pneumonia has not cleared up after 4-6 weeks on follow-up CXR?

A

bronchoalveolar carcinoma (type of adenoma)

70
Q

tx of acute gout attack in a pt with renal insufficiency

A

steroid injection or oral steroids (triamcinolone)

71
Q

what medications should be stopped in a pt found to have gout?

A

THIAZIDE DIURETICS, ASPIRIN, and NIACIN

72
Q

gout medications: ______ is effective at preventing second gout attack. _____ decreases production of uric acid.

A

colchicine is effective at preventing second gout attack. allopurinol decreases production of uric acid

73
Q

what antihypertensive is best in gout pts?

A

losartan (lowers uric acid)

74
Q

positive straight leg raise test

A

herniated disk

75
Q

knee jerk reflex lost = what nerve root impinged?

A

L4

76
Q

ankle jerk reflex lost = what nerve root impinged?

A

S1

77
Q

tx for sciatica

A

NSAIDs with continuation of ordinary activities (NO BED REST!)

78
Q

tx for fibromyalgia

A

AMPed up for fibromyalgia!!: Amitriptyline, Milnacipran, or Pregabalin (NOT STEROIDS!)

79
Q

what is dupuytren’s contracture and what conditions is it associated with?

A

hyperplasia of palmar fascia leading to nodule formation and contracture of the 4th and 5th digits; alcoholism and cirrhosis

80
Q

anti-cyclic citrullinated peptide = what dx

A

rheumatoid arthritis

81
Q

rheumatoid arthritis, splenomegaly, neutropenia

A

felty syndrome

82
Q

rheumatoid arthritis, pneumoconiosis, lung nodules

A

caplan syndrome

83
Q

what is the most important thing to do with pts with RA before surgery

A

cerivical spine x-ray (RA is associated with C1/C2 subluxation)

84
Q

what DMARD for RA causes retinal toxicity?

A

hydroxychloroquine

85
Q

what DMARDs are safe in pregnancy?

A

hydroxychloroquine and sulfasalazine

86
Q

presentation of juvenile RA

A

high, spiking fever in a young person associated with a salmon-colored rash on chest and abdomen that occur only with fever spikes. splenomegaly, pericardial effusion, joint sx, anemia, and leukocytosis may also be present

87
Q

is complement decreased or increased in SLE?

A

decreased

88
Q

what are the laboratory findings that can specify acute lupus flare vs an infectious cause?

A

DECREASED complement and INCREASED anti-dsDNA

89
Q

what drug can control progression of SLE?

A

BELIMUMAB

90
Q

PT and PTT findings in antiphospholipid syndrome

A

ELEVATED PTT and normal PT

91
Q

what are the two best tests (initial and most specific) for antiphospholipid syndrome?

A

initial: mixing study (PTT will remain elevated even when normal plasma is added because of the APL antibodies)
specific: Russel viper venom test (prolonged with APL antibodies and does not correct on mixing with normal plasma)

92
Q

when should a mother be investigated for anticardiolipin antibody as cause of spontaneous abortion?

A

two or more first-trimester events or a single second-trimester event

93
Q

what should be given to prevent recurrence of spontaneous abortion caused by anticardiolipin antibody?

A

HEPARIN and ASPIRIN (remember – warfarin is contraindicated in pregnancy!!)

94
Q

sx of limited scleroderma

A

CREST syndrome: Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasias

95
Q

what are the serious manifestations of scleroderma in lung and renal systems?

A

lung: restrictive lung disease and pulmonary hypertension
renal: sudden HYPERTENSIVE CRISIS (may lead to microangiopathic hemolytic anemia)

96
Q

what antibodies are extremely specific to scleroderma? what test is most specific?

A

specific: antiCENTROMERE antibodies

most specific: antiTOPOISOMERASE (SCL-70) antibodies

97
Q

tx for following parts of scleroderma: long-term, renal crisis, pulmonary fibrosis, pulmonary HTN

A

long-term: methotrexate
renal crisis: ACE inhibitors
pulmonary fibrosis: cyclophosphamide
pulmonary HTN (same with idiopathic pulmonary HTN): bosentan, sildenafil, prostacyclin analogs (iloprost, treprostenil, epoprostenol)

98
Q

what is the most dangerous complication of Sjogren syndrome?

A

lymphoma (evaluate in everyone)

99
Q

best initial test for Sjogrens

A

Schirmer test: filter paper is placed against eye

100
Q

peroneal neuropathy leading to foot drop in a young pt vs asthma plus foot drop in an adult

A

polyarteritis nodosa

101
Q

all pts with polyarteritis nodosa should be tested for what disease?

A

hepatitis B and C

102
Q

what is mononeuritis multiplex?

A

sx of polyarteritis nodosa where there is multiple peripheral neuropathies of nerves large enough to have a name

103
Q

pt over age 50 with pain and stiffness in shoulder and pelvic girld muscles, difficulty combing hair and rising from chair, elevated ESR

A

polymyalgia rheumatica; Churg-Strauss

104
Q

expected lab findings of polymyalgia rheumatica

A

elevated ESR, normochromic normocytic anemia, normal CPK and aldolase

105
Q

child recovering from recent URI with GI bleeding, painless palpable purpura, arthralgias, and hematuria

A

henoch schonlein purpura

106
Q

biopsy shows leukocytoclastic vasculitis

A

henoch schonlein purpura

107
Q

presentation of cryoglobulinemia

A

pt with hepatitis C who has joint pain, glomerulonephritis, non-blanching purpuric skin lesions, and neuropathy

108
Q

abnormal lab tests in cryoglobulinemia

A

positive RHEUMATOID FACTOR and COLD PRECIPITABLE IMMUNE COMPLEXES

109
Q

what diseases are cold agglutinins associated with?

A

EBV, mycoplasma, lymphoma, waldenstrom macroglobulinemia

110
Q

presentation of behcet syndrome

A

asian or middle eastern person with:

  1. painful oral and genital ulcers
  2. erythema-nodosum like lesions of skin
  3. ocular lesions leading to uveitis and blindness
111
Q

sterile skin pustules from minor trauma like a needle stick

A

pathergy = BEHCET syndrome

112
Q

tx for ankylosing spondylitis refractory to NSAIDs

A

anti-TNF drugs (infliximab, adalimumab, etanercept)

113
Q

presentation of psoriatic arthritis

A

psoriasis, SAUSAGE DIGITS, NAIL PITTING, “PENCIL IN A CUP” deformity on x-ray

114
Q

tx for psoriatic arthritis refractory to NSAIDS

A

methotrexate or anti-TNF drugs (NO STEROIDS)

115
Q

triad of reactive arthritis

A

JOINT pain, OCULAR findings (uveitis, conjunctivitis), GENITAL abnormalities (urethritis, inflammation of foreskin and head of penis)

116
Q

scary side effect of bisphosphonates

A

osteonecrosis of jaw

117
Q

empiric tx of septic arthritis

A

CEF and VANC

118
Q

tx for septic arthritis of prosthetic joint

A

remove the joint, give abx for 6-8 weeks, then replace joint

119
Q

recurrent gonorrhea infections = what should you test for?

A

C5-C9 (terminal complement) deficiency

120
Q

what are the unique sx of gonococcal arthritis compared to septic arthritis?

A

POLYARTICULAR involvement, TENOSYNOVITIS (inflammation of tendon sheaths, making finger movement painful), petechial RASH

121
Q

best initial test to order for osteomyelitis and best second test to order if the first one is negative

A

x-ray; if x-ray is normal, order MRI

122
Q

arthritis in an adult that resembles RA but is RF negative

A

psoriatic arthritis or parvovirus B19

123
Q

arthritis in a child that resembles RA but is RF negative

A

JRA (rheumatoid factor is often negative in a pauciarticular variant)

124
Q

anemia with high iron

A

sideroblastic anemia (inability of iron to be incorporated with heme; most commonly caused my alcohol’s suppressive effect on bone marrow)

125
Q

in iron deficiency anemia, is the platelet count high or low?

A

high

126
Q

how can you distinguish iron deficiency anemia from a thalassemia?

A

both are microcytic anemias, but thalassemia has normal RDW, normal iron and ferritin, RBC count is normal, and target and teardrop cells are seen on smear

127
Q

what deficiencies are seen in celiac disease?

A

B12, folate, and iron

128
Q

what can cause macrocytic anemia other than folate and B12 deficiency?

A

direct alcohol effect on bone marrow or liver disease (always get a peripheral smear before ordering folate or B12 labs!)

129
Q

only way to distinguish B12 deficiency from folate deficiency by labs

A

increased methylmalonic acid levels

130
Q

how does pancreatic function relate to B12 deficiency?

A

pancreatic enzymes are needed to absorb B12. they free it from carrier proteins so it can bind with intrinsic factor

131
Q

what electrolyte abnormality do you need to watch for when replacing folate or B12?

A

hypokalemia

132
Q

what are the manifestations of sickle cell trait?

A

defect in ability to concentrate urine (isothenuria), occasional hematuria

133
Q

best initial therapy for parvovirus B-19 infections in sickle cell pts

A

IVIG

134
Q

tx for cold agglutinins

A

rituximab, other immunosuppressive agents (cyclophosphamide, cyclosporine). STEROIDS AND SPLENECTOMY DO NOT WORK!

135
Q

distinguishing features of cryoglobulins from cold agglutinins

A

cryoglobulins are associated with hepatitis C, joint pain, and glomerulonephritis

136
Q

does renal cell cancer cause increased EPO or decreased? is Hct low or high?

A

increased EPO, so high hematocrit

137
Q

most accurate test for polycythemia vera

A

JAK2 mutation

138
Q

what is the tx for essential thrombocytosis and who should be treated?

A

hydroxyurea; if pt is over age 60 and there are thromboses OR platelet count is above 1.5 MILLION

139
Q

tx for myelofibrosis

A

TNF inhibitors THALIDOMIDE and LENALIDOMIDE

140
Q

sudden pain and redness in medial canthal region with purulent discharge

A

dacryocystitis

141
Q

hereditary hemochromatosis increases risk of what?

A

hepatocellular carcinoma

142
Q

tx for aplastic anemia in pts too old for BMT (over age 50) or there is no matched donor

A

antithymocyte globulin (ATG) and cyclosporine (goal is to suppress T cells!)

Step 2 CK UW (12 decks)

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