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ABIM Boards > ABIM October 2021 > Flashcards

ABIM October 2021 Flashcards

1
Q

ALS signs

A

40s-60s, bilateral extremities, hyperreflexia (upper motor neurons), fasciculations (lower motor neurons). Cramping

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2
Q

West Nile transverse myelitis

A

anterior horn cells, polio like. Reflexes decreased not increased.

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3
Q

CIDP (chronic inflammatory demyelinating polyneuropathy)

A

lower motor neuron weakness, areflexia, GBS

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4
Q

ALL

A

> 45y, blasts stain for TdT, CD19, CD20.

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5
Q

AML

A

CD13, CD33, CD34

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6
Q

DM diagnosis

A
  1. sxs + glucose >200
  2. FBG >=126 (two occasions) or post OGTT >200
  3. HbA1c >=6.5%
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7
Q

Thrombosis and prolonged aPTT

A

APLA. performed 1:1 mixing study. With APLA, doesnt correct with addition of normal plasma. Mixing study clots blood if due to clotting factors (need only half), not if due to inhibitors.

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8
Q

DVT ppx high risk surgeries

A

TKR then THR then pelvic/cancer

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9
Q

CAH

A

CYP21A2 (17-hydroxyprogesterone not converted). high cortisol and DHEAS. Increase ACTH -> hyperpigmentation, advanced bone age, precocious puberty.

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10
Q

Yersinia pestis

A

necrotizing pna, contagious - can cause epidemic

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11
Q

OSA-HS

A

neck circumference >16 inches (women), >17 inches (men)

AHI 5-14: mild, 15-30 moderate, >30 severe

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12
Q

Associated with latex allergy

A

spina bifida

Nasal polyps: ASA allergy
Eos gastroenteritis: food allergies

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13
Q

signs of OA

A

DIP (heberden nodes)
knee (genu varus)
bunion (lallux valgus of great toe)

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14
Q

neutropenic fever

A

Vanc and Cefepime. Day 4-7 if still febrile, add fungal coverage.

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15
Q

subacute thyroiditis

A 
After vial illness AKA de Quervain, granulomatous.
Hyperthyroid sxs (cell destruction) then euthyroid then hypothyroid then back to euthyroid when resolved.
Causes tender thyroid. uptake low as thyroid released via destructive process rather than increased uptake.
Hashimotos : chronic autoimmune, nontender
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16
Q

Increased RAI uptake

A

more synthesis of thyroid hormone

Graces, Toxic multinodular goiter

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17
Q

Tropical sprue

A

macrocytosis, glossitis, decreased folate. Causes malbsorption with partial villous atrophy. Carribean, SA, Venezuela, India. Rx: tetracycline and folate replacement.

Other diarrhea:
C. Diff: fidoxamin

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18
Q

H. Pylori

A

14d OCLAM: omemprazole, clarithromycine, amox
fu: urea breath test or stool antigen.
confirm cure 4-6w after. Cannot be on PPI for breath test, off abx for 4 wks.

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19
Q

Anti seizure during pregnancy

A 
AVOID valproate (high risk of neural tube defects)
Phenytoin and topiramate also associated with brith defects.
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20
Q

delayed hypersensitivity (type 4)

A

days later.
Examples: TB, contact dermatitis.

Type 1: immediate, mast cells (peanut allergy)
Type 2: drug induced cytopenias, antibody ITP and hemolytic anemia)
Type 3: serum sickness, Ag-AB complexes (vasculitis, drug fever, arthus reactions)

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21
Q

High iodine causes…

A

decreased thyroid RAIU bc gland saturated and cannot take up more.

Thyroiditis - destroy cells and causes low RAIU

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22
Q

Pleural tests and lights criteria

A

Cholesterol>45 high sensitivity and specificity for exudative effusions.
LDH: elevated in setting of chronic diuretic use.

Lights criteria:
pleural fluid to protein >0.5
pleural LDH to serum LDH >0.6
pleural fluid LDH >2.3ULN of serum LDH

HF: transudative
parapenumonic: exudative (low glucose, high neurtrophils)

Exudative:
pleural chol>45
pleural LDH> 0.45 ULN

chylous if TG>110. THINK NON-HODGKINS IF CA

Adenosine deaminase = TB!

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23
Q

acoustic neuroma

A

HA, vertigo, tinnitus, cerebellopontine signs

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24
Q

weber test

A

lateralized hearing loss, tuning fork on head

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25
Q

blastomycosis

A

lung and draining skin/bone lesions.
Central, southeast and mid-atlantic states.
Inhalation of spores via soil.

Histoplasmosis: Mississipi and Ohio River (erythema nodosium or erythema multiforme). Similar to Coccidoidiomycosis (seen in SW US).

Aspergillosis: immunocompromised

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26
Q

Strep

A

Strep Pneumoniae - skin and soft tissue infections

Strep pyogenes - skin infections, impetigo, erysipelas.

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27
Q

HCC

A

paraneoplastic syndrome
elevated AFP
hyperca, hypoglycemia, erythrocytosis, FUO, watery diarrhea.

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28
Q

screen for liver cancer in cirrhosis

A

AFP and US

Caused by cirrhosis and hepC, not hepB

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29
Q

Testicular

A 
15-35y,
germ cell tumors, curable with 5-year survival 90-95%.
solid painless mass.
>50y -> lymhoma
No biopsy (can seed)
Do us and if solid do orchiectomy
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30
Q

hemochormatosis

A

iron stored intracellularly.
liver, heart, pancreas, pituatary
rx: phlebotomy

(wilson’s rx: penicillamine)

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31
Q

Factor 7 deficiency

A

prolonged PT
normal aPTT
increased risk of bleeding.

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32
Q

C. diff relapse

A

if flagyl, use po vanc
if vanc, use fidaxoxcicin or pulsed vanc

IV flagyl and po vanc if fulminant disease - ileus, megacolon, hypotension.

Stool transplant after 2nd relapse.

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33
Q

Critically ill patients with low TSH

A
  1. Rule out adrenal insuff (random cortisol)
  2. Replace thyroid.

Avoid IV T3 in those wth cardiac disease. T4 is safer.

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34
Q

Pregnant vaccines

A

Tetanus with Tdap ok (after 20 w)
Inactivated flu ok.

NO: MMR, Varicella (live), nasal flu, zoster, polio, typhoid, yellow fever.

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35
Q

PMR

A

giant cell arteritis
20% develop GCA (visual changes, jaw pain, HA)
PMR - limb girdle pain

Rx PMR: low dose prednisone.

Rx GCA: high dose prednisone.

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36
Q

MV surgery

A

sxs or LVEF <60% of LVESD >= 40 mm

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37
Q

Tb testing

A

No controls.
Never choose 250 TU
2 step for those who work in prisons

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38
Q

Impingement syndrome

A

impingement of surpspinatus tendons
passive abduction to 90 degrees causes pain in deltoid region.

subacromial bursitis - pain at rest and with motion
rotatory cuff tear: pain during active than passive abdiction, positive drop arm test.

TOS: pain from base of neck to top of shoulder, down the arm

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39
Q

Sensitivity

A

TP/(TP+FN)
those who have disease, how many will test positive.
Test sensitivity not affected by disease prevalence

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40
Q

Asthma PFTs

A

response to bronchodilator.

mild increase in DLCO

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41
Q

HF PFTs

A

decrease DLCO

no repsonse to bronchodilators

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42
Q

Emphysema PFTs

A

decreased DLCO
increased TLC (hyperinflation)
no repsonse to bronchodilators

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43
Q

ILD PFTs

A

reduced DLCO
lower TLC
no response to bronchodilators

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44
Q

Sarcoidosis PFTs

A

reduced DLCO

no response to bronchodilators

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45
Q

treatment of rashes

A

erythema multiforme - targetoid lesions on palm: HSV - valcyclovir
erythema migrans - doxycycline (lyme)
latent syphilis - PCN

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46
Q

testicular seminoma

A

AFP not elevated (elevated in nonseminoma germ cell tumor)
Testicular ca: check AFP, beta subunit of HCG and LDH
AFP - not elevated, b-HCG infrequently elevated. LDH usually elevated.
AFP half life 5-7 days. b-HCT 1.5-3 d

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47
Q

klinefelters

A

high FSH and LH and small testes

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48
Q

prolactinoma

A

low FSH and LH

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49
Q

testicular tumor

A

elevated b-HCG and estradiol

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50
Q

sarcoidosis

A

AA
lung involvement
arthritis (symmetric and LEs)
anterior uveitis

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51
Q

pseudocyst

A

recurrence of pain after pancreatitis
never do ERCP
Rx: bowel rest and IVF, drain or surgery only after 3-6 mo

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52
Q

RA

A

doesn’t affect lumbar spine

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53
Q

Hairy cell leukemia

A 
dry tap
splenomegaly
pancytopenia
CD11c+, CD20+, CD103+
BRAF mutation (~100%)
Rx: cladrabine, pentostatin.
---
Philadelphia t (9;22):CML
t(14;18) DLBCL, follicular lymphoma
JAK2-  PCV, ET, myelofibrosis
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54
Q

alzheimers Rx

A

cholinestarese inhibitor (donepezil).

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55
Q

hyperparathyroidism

A

elevated PTH despite elevated Ca

vit D suppresses PTH

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56
Q

pseudohyperparathyroidism

A

shortened 4th and 5th metacarpals.

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57
Q

protein in urine

A

Albumin: Cr ratio:
<30 mg/g - normal
30-300 - microalbuminuria
>300 - macroalbuminuria

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58
Q

PFTs

A 
If FEV1/FVC <0.7 the COPD is classified as obstructive:
FEV1:
>=80% - mild obstruction
50-80% - moderate obstruction
30-50% - severe obstruction
<30% - very severe obstruction.

TLC> 120% c/w hyperinflation.

TLC <80% restrictive pattern

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59
Q

medullary thyroid cancer

A

sporadic or familial
RET protooncogene
Rx: screen family, thyroidectomy

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60
Q

Zollinger Ellison Syndrome

A

gastrin secreting
serum calcium level after gastrin test
MEN1

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61
Q

tularemia

A 
Arkansas, Missouri, Oklahoma
Franciesella Tularensis
goats, sheep, cows
can go in skin, eyes, LN
dx: serial serologies.
--
Brucella - FUO - goats
-- 
Ehrlichia - missouri and arkasnsa, fever, HA, thrombocytopenia, leukopenia, pancytopenia
rash is ~30%
Morulae in white cells
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62
Q

Photosensitivity

A

Flouroquinolones, tetracycylines, NSAIDs, HCTZ, furosemide, amiodarone, diltiazem, statins

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63
Q

dermatitis herpetiromis

A

gluten senstivity (celiac disease)
Rx: dapsone
–
zinc deficiency: acrodermatiis enteropathica (dry patches and plaques) on mouth and anus

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64
Q

depression meds - qt prolongation

A

TCA, CELEXA, LEXAPRO, VENLAFAXINE (SNRI), mirtazapine, bupropion

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65
Q

RMSF

A

Fever, arthralgia, maculopapular rash-> petechial rash on trunk. Rx: doxycycline Dx: biopsy and IF on petechiae.

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66
Q

sinusitis

A

augmentin. if PCN allergic, then doxy>levofloxacin

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67
Q

pseudogout

A

calcium phyrophosphate deposition
positive birefringent, rhomboid crystals
gout: monosodium urate crystals

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68
Q

aplastic anemia

A

parvovirus B19, high epo

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69
Q

acute pap muscle rupture

A

crescendo-decresendo at apex

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70
Q

vsd

A

holosystolic LSB thrill

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71
Q

neurosyphilis

A

pcn g iv - crosses bbb

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72
Q

acute dystonic reaction (i.e haldol)

A

Rx: benztropine or benadruyl

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73
Q

CRC screening

A

every 5 yrs if CRC in first degree relative or adenoma <60 years

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74
Q

occult GERD

A

24 h ph probe

esophageal contraction over normal peristalsis.

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75
Q

babesia mircoti infection

A 
Northeast USA
like malaria
hemolytic anemia in splenectomized people
RX: moderate - atovaquone and azithro
severe: clindmycin and quinine
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76
Q

ADHD

A

before 12 years of age
sleep, social interactions, outbursts
PD - after 12 years of age

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77
Q

retina detachment

A

floaters or flashing lights

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78
Q

thyroid cancer risk factors

A

FH, XRT to neck, pain in anterior neck, dysphagia, <20 or >70 y, hoarseness (vocal cord paralysis), fixed, growing, LAN, M>F.

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79
Q

Pregnancy

A

no floroquinolones, ok to use macrolides, vancomycin, cephalosporins

ok to use erythtromycin

avoid: ACe, statin, doxy, cipro

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80
Q

iron deficiency anemia >50 yrs

A

colorectal cancer

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81
Q

AIDS associated malignancy

A

EBV associated CNS lymphoma in immunocomprommised
HPV oral cancers
HHV-8 Kaposis sarcoma
Merkel cell polyoma virus - merkel cell carcinoma

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82
Q

gout

A

“marginal erosions” on XR, hyperuricemia
HCTZ increases UA
negatively birefringent crystals

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83
Q

Correction of prolonged aPTT with 1:1 mixing (provides 50% of normal factor)

A

Prolongation after normal correction = inhibitor (takes a while to kick in).
Prolongation sustained = Factor deficiency (assay each of them).
Warfarin - prolonged PT

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84
Q

Coagulation cascade

A

PT: Vitamin K dependent (2,7,9,10 or fibrinogen)
PTT: 8,9,11,12
Factor 12 def: normal PT, prolonged aPTT (AR, no bleeding issues)

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85
Q

RA

A

anti-CCP and RF antibodies portends poor prognosis and extra-articular manifestations (vasculitis, rheumatoid lung and skin nodules). Rx: dmard

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86
Q

Metabolic acidosis

A

expected PCO2 = (15 + bicarb). Does it equal the actual PCO2. (Tells you if respiratory acid base disorder)
Anion gap = (Na+K)-(HCO3+Cl). Normal 12.
High anion gap metabolic acidosis: renal failure, lactic acidosis, ketosis, ingestions, D-lactic acidosis (short gut).
Lab assays only measuere L-lactic acid.

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87
Q

ethylene glycol

A

antifreeze, calcium oxalate crystals in urine, elevated osmol gap

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88
Q

hereditary retinoblastoma

A

associated with osteosarcoma (metaphyseal region of long bones, lytic lesion).

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89
Q

Crohns stricture

A

if >5 cm, cant do balloon dilation with colo; need surgery

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90
Q

Measles

A

Kopliks spots and rash
cough, conjunctivitis and coryza
rash: back of neck and goes downwards
Needs two shots of MMR

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91
Q

Anemia

A

Decrease production or increased destruction.
IDA: if ferritin <40, microcytic, hypochromic
Decreased EPO: normocytic
B12 or folate: macrocytosis

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92
Q

lithium

A

reduced suicide in bipolar

hypothyroidism is a side effect (inhibits secretion of thyroid)

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93
Q

ZES

A

gastrinoma (gastrin secreting tumor) - diarrhea
stop PPi and check gastrin
If see multiple ulcers, think ZES

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94
Q

Lyme carditis

A

3rd degree AVB, Rx: CTX and temp pacer (permanent not required)

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95
Q

hyponatremia

A

normal BUN and glucose - hypoosmolar hyponatremia.
During hypoN, the urine OSM should be low to pee out free water. If urine inapprorpiate concentrated, then SIADH (high urine Na and urine OSM>200).

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96
Q

acid base

A

expected PCO2 = 1.5xHCO3 + 8 +/- 2 (to see if respiratory disorder)

To see if nonanion gap, see if the drop in HCO3 (normal 24) is the same as the increase in AG (normal 6).

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97
Q

sarcoidosis

A

noncaseating granulomas (also seen in beryllium exposure)
uveitis, arthritis, fever, erythema nodosum
vitamin d excess, PHTN, cardiac sarcoid
proteinuria, inflammatory arthritis.

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98
Q

cullen sign (bluish near umbilicus)

A

hemoperitoneum in pancreatitis

also flank discoloration

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99
Q

carcinoid

A

mostly occur in jejunum, duodenum, ileum, right colon

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100
Q

Endocarditis

A

MSSA (nafcillin or oxacillin) or strep viridans (beta lactam and aminoglyocisde)

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101
Q

false positive HIV test

A

SLE, HLA antibodies, pregnancy

Dx: (p24 antigen/antibody), viral load, antigen testing

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102
Q

PPD interpretation

A

> 5 - immunocompromised (HIV, prednisone >15 mg)

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103
Q

parapneumonic effusion

A

ph<7.2, pleural fluid glucose <60, LDH>3x ULN.

Organisms/pus -> chest tube

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104
Q

Vitamin A intoxication

A

causes hypercalcemia, increases resorption of bone, causes muscle pain.

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105
Q

aplastic anemia Rx

A

ATG –> serum sickness.
caused by drugs (sulfa, valproate, chloramphenicol) or virus (HIV, Parvovirus B19)
dx: hypocellular (<20% marrow), low retic, pancytopenia

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106
Q

CJD

A

dementia and myoclonus, precipitated by startle

14-3-3 protein in csf

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107
Q

Prolactinoma

A

macroadenoma prolactin usually >200
if <100, look for other effects like thyrotroph (hypertrophies thyrotroph cells in repsonse to high TRH).
Mild prolactin elevation - nipple stimulation, pregnancy

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108
Q

hep c

A

associated with porphyria cutaneous tarda

resolved with hepatits Rx

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109
Q

sickle cell

A

parvovirus b19, cva, avn

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110
Q

PMR

A

20% develop GCA
Rx: asa, steroids 60 mg/d
if visual sxs, solumedrol 1g/d X3d, then oral

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111
Q

menieres

A

vertigo, hearing loss, tinnitus

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112
Q

hyperthyroid before surgery

A

delay and give bb

if cannot delay, give bb, ptu, iodine and steroids

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113
Q

B12 deficiency

A

hypersegmented neutrophils, impaired DNA synthesis

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114
Q

MDS

A

hypercellular marrow, dysplastic maturation

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115
Q

Myelofibrosis

A

teardrop cells on smear, “dry” tap

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116
Q

ACD

A

inhibition of absorption of iron from GI tract (hepcidin) (normal or increased iron stores)

G6PD- reduced glutathione so oxidative stress
hereditary sphreocytosis - memrabe fragility

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117
Q

acute cholangitis

A

biliary colic, fever, jaundice

Rx: IV abx and ERCP

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118
Q

osmolalality

A

= 2xNa + glu/18 + BUN /2.8
osmolal gap = measured vs calculated
>10 is increased

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119
Q

HAGMA

A

toxic ingestion
“GOLDMARK”
glycols: propylene hlycol, ethylene glycol
oxoprolyine: acetaminophen
L-lactic acidosis - shock, tissue ischemia
D-lactic acidosis - short gut, malabsoroption.
Methanol (also increases osmolal gap)
Aspirin (salicylates)
renal failure (uremia)
ketoacidosis: DM, etoh, starvation

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120
Q

sle

A

ANA TITER >1:160

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121
Q

GIARDIA

A

watery frothy diarrhea,

dx: antigen in stool

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122
Q

tetanus rx

A

tetanus toxoid (vaccine), tetanus IVIG, flagyl

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123
Q

postpartum thyroiditis

A 
1 mo hyper then hypo
measure TSH (high), FT4 (low)
check anti-TPO ab
Rx: thyroxine
check tsh monthly as this may resolve
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124
Q

risk factors for osteoporosis

A

BMI<19, menopasue <40y, wt <127

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125
Q

chemo agents side effects

A 
trastuzamab - cardiotoxicity
vincristine - nerves
cisplatin - nephrotoxicity
capecitabine - diarrhea and volume loss
eGFR (cetuximab)- acneiform skin rash
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126
Q

Retin-A

A

pancreatitis and hyper Tg
Can give with fibrate
Contraindicated: doxycycline (pseudotumor cerebri)

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127
Q

alports disease

A

X linked, hematuria, sensorineural deafness, progresses to ESRD

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128
Q

tramadol

A

associated with seizures

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129
Q

cancers with hyperCa

A

Rx: IVF, then lasix

squamous cell, breast, MM, T cell lymphoma, renal cell

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130
Q

dermatomyositis

A

“shawl sign”, proximal muscle weakness, +myositis Ab, , photosensitive rash.
Newly dx polymyositis - dermatomyositis - possibly paraneoplastic (especially if ANA with anti-ANA p-155/p140). LOOK FOR CANCER -

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131
Q

Takayasus arteritis

A

fatigue, ha, weight loss, fever
large vessel vasculitis
womem

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132
Q

behcets

A

HLA-B51

UVEITIS, oral/genital ulcers

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133
Q

flushing ddx

A 
hereditary angioedema - C1-INH level
Urine metanephrine and VMA - pheo
5-HIAA - carcinoid
tryptase - systemic mastocytosis
elevated vasoctive intestinal polypeptide, VIPoma.
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134
Q

silicosis

A

upper lung lobes

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135
Q

thryroid nodule

A

TSH. if low, then scan. “HOT” nodule

If high or normal, then biopsy.

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136
Q

breast cancer

A

HR+ positive prognosis

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137
Q

erythromycin-clindamycin D test x

A

inducible resistance of MRSA isolate

+ test - susceptible to clinda in vitro, resistace in vivo

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138
Q

cushings dx

A

2 negative 24h urinary free cortisol or dst

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139
Q

SIADH

A

urine osm high

urine na >40

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140
Q

postpartum thyroiditis

A

tsh low
do RAIU to see if graves (high) or acute or subacute thyroiditis (low RAIU) - improves on its own.
Can’t do RAIU if nursing.

Sestamibi for PTH

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141
Q

pseudolymphoma

A

secondary to phenytoin use

fever, elevated ALT/AST and LAN.

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142
Q

peritonsillar abscess

A

Group A strep or anaerobes
fever, throat pain, “hot potato” voice (muffled), uvular deviation.
vs.
RP abscess - fever, drooling, dysphagia

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143
Q

nephrotic syndrome/membranous GN

A

hypercoag

renal vein thrombosis or PE

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144
Q

asa overdose

A

resp alkalosis
fever and hyperventilation.

chronic - tinnitus, vertigo and hearing loss

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145
Q

specificity

A

those who do not have the disease

TN/ (TN+FP)

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146
Q

sensitivity

A

those who do have the disease

TP/(TP+FN)

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147
Q

asa overdose

A

resp alkalosis
fever and hypervent

chronic - tinnitus and hearing loss.

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148
Q

grapefruit juice

A

CYP3A4

simvastatin, nifedipine and lovastatin

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149
Q

pcp rx

A

bactrim + steroids (if PaO2<70)

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150
Q

blastomycosis

A

ohio and mississipi valley
rx: itraconazole
always Rx as colonization does not occur.

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151
Q

Lithium

A

interacts with CCB - may increase or decrease lithium, need to monitor lithium levels.
Thiazide increase lithium, ace inhibitors increase lithum,, MRA decrease lithium, loop can increase or decrease lithium

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152
Q

AKI from NSAIDS

A

prerenal azotemia (benign ua with hyaline casts and low fena)
AIN (weeks to months) -> nephrotic syndrome, biopsy with minimal change disease (urine eos).
ATN - abnormal US (dirty brown or cellular casts) increased FeNa.
Acute papillary necrosis - flank pain like renal colic.

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153
Q

pityriasis rosea

A

self limited rash
Rx; UVB, steroid
solitary oval patch on trunk (herald patch) –> 7-10d small, oval pink papules on trunk, extremeties and neck. last 6-8 wks. Follow lines of skin cleavage (christmas tree pattern).

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154
Q

prolonged aPTT

A

factor 8,9,11,12 deficiency or inhibitor.
1:1 mixing. If corrects, factor def. If corrects then prolongs, then inhibitor.

vWD - prolonged aPTT but mucocutaneous bleeding.
(ristocetein-platelet aggregation).

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155
Q

howell-jolly bodies

A

after splenectomy (black pellets on smaer)

B12 - hypersegmented polys
schistocytes - heart lave
basophilic stippling (blue granules in cytoplasm) - thalassemia or etoh abuse.

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156
Q

hand-schuller-christian syndrome

A

langerhans histiocytosis.
Triad: lytic bone lesions, DI, exopthalmus.

Treacher-Collins - malar hypoplasia, cleft in zygoma.
Loefflers- pulmonary infiltrates and peripheral eos.

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157
Q

pituitary apoplexy, hemorrhage

A

Rx: steroids.

1st: Polyuric, DI, hyperenatremia
2nd: transient SIADH, hyponatremia (cells release ADH).
3rd: recurrence of DI

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158
Q

renal sediment

A 
no - edema - minimal change unlikely.
memranoproliferative GN (assoc with hep C) and IgA nephropathy - hematuria
MM - hypercalcemia, mismatch between proetinuria on dipstick (trace) and urine protein:cr ration (high).
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159
Q

endocarditis ppx

A

none for gi or gu procedures

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160
Q

positive exercise challenge test

A

FEV1 falls by >10%

(flow-volume loop - upper airway obstruction).

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161
Q

sulfasalazine

A

reversible cause of infertility with low sperm count

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162
Q

uncomplicated salmonella gastroenteritis

A

no abx unless very old, very young or immunocompromised.

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163
Q

skin testing vs allergen-specific IgE testing

A

better NPV with skin testing

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164
Q

hereditary angioedema

A 
A/D
C1-INH function decreased
nonpitting edema 1-3 days, face and lips
doesnt respind to epi
NEVER USE ACEI in these pts
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165
Q

antibiotics in pregnancy

A

macrobid (after 1st trimester), PCN, cephalosporin, aztreaonam, fosfomycin.

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166
Q

HIT

A

5-10d, plts<50% baseline, thrombosis
PF4
Rx: stop hepatin and start DTI

(DIC: measure fibrin degradation products)

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167
Q

sputum with salty taste

A

adenocardcinoma (BAC)

peripheral loctaion, growth along intact alveola septa (“lepidic” growth pattern).

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168
Q

lipoid pneumonia

A

“cholesterol pna”

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169
Q

RAIU interp

A

low - subacute thyroiditis
high diffuse - Graves (rx: methimazole for 18 mo then see if remission)
focal - hot nodule (rest low due to suppression). Rx: 131I

If laryngeal nerve changes, get thyroid us

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170
Q

auer rods

A

azurophilic needle-shaped crystals in the cytoplasm of immature cells = myeloblasts (AML).

(light blue granules in neutrophils = Dohle bodies, infection or inflammation).

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171
Q

AML

A

median age 65y, pancytopenia.
CD 117, CD33

(CD19 - lymphoblastic cell lineage).

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172
Q

eggshell calcifications

A

silicosis (shell-like calcifications in hilar nodes).

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173
Q

CVT

A

thrombophilic state (SLE), APLAS
OCP, pregnancy, infection, caner
Sxs: HA, focal neurological signs, papilledema.

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174
Q

Wernickes aphasia

A

word salad

lesion in posterio temporal gyrus of dominant hemisphere

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175
Q

toxic shock syndrome

A

diffuse rash, multiorgan injury
S. aureus (purulent skin lesions) or S. pyogenes (hours to days incubation).

Pasteurella - colonizes dogs but causes local reaction
Bartonella - cat scatch disease - cellulitis and LAN,
lesions initially vesicular then papular.

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176
Q

hypoPTH

A

can be due to hypo MG

pseudoPTH - low Ca, high Phos and high PTH (abnormal PTH receptor)

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177
Q

AVN

A

long term steriod use

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178
Q

Anthrax

A

Bacillus anthracis
incubation 1 to 6 days
influenza like illness followed by respiratory distress and septic shock.
SIRS
Enlarged mediastinal nodes (wide mediastinum)

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179
Q

yersinia pestis (plaque)

A

airbone precautions.

via rodents from flea bite or infected animal.

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180
Q

Tularemia

A

francisella tularensis
hemorrahci PNA no hilan LAN
Rabbit carcasses.
no isolation needed

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181
Q

eyrthema nodosum

A

sarcoidosis, IBD, TB, drug alelrgy, strep infection.

Arrthralgias/arthritis + LNA = lofgen syndrome

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182
Q

cluster headache

A 
15-180 min
unilateral, stabbing
autonomic sxs on that side - tearing, rhinorrhea, horners, (miosis or ptosis),
Male>female
Rx: O2, triptans.
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183
Q

scleroderma

A

> 80% have esophageal involevement
reduced LES pressure (achalasia - high)
decreased contraction amplitude and peristalis.s
Raynaud’s, dry MM

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184
Q

esophageal high grade dysplasia

A

dont do esophagectomy 1st line - do RF ablation or photodynamic therapy along with endoscopic mucosal resection (if nodule present)

185
Q

hereditary sphreocytosis

A 
A/D 
chronic hemolysis
jaundice, splenomegaly, anemia.
Cholelithiasis due to bilirubin stones
Dx: osmotic fragility test or EMA binding test.
186
Q

g6pD deficiency

A

hemolytic anemia
ppt by oxudative stressors, infections, meds (dapsone, sulfa drugs,antimalarial), fava beans, DKA.
Dx; Heinz bodies or bite cells

187
Q

TDAP booster

A

dirty wounds and Tetanus >5y

188
Q

cyclosporine

A

can increase UA and cause gout

189
Q

Hodgkins lymphoma

A

chemo and xrt

ABVD

190
Q

CELLULITIS

A

purulent - s aureus
nonpurulent - s pyogenes
Moderate purulent - bactrim
severe - vanco, linezolid

191
Q

murmurs

A

R sided - louder with inspiration

HOCM- increase with valsalva. decrease with leg raise or squatting.
AS - increase with squatting

192
Q

mucormycosis

A

rhizopus, mucor and rhizomucor
DM
necrosis in nasal cavity, palate

193
Q

spororhyrix schenckii

A

gardner pricking finger on thorn

194
Q

serotonin syndrome

A

SSRI (fluoxetine) + MAOi (selegiline)

confusion, agitation, hallucination, diaphorsis, HTN, hyperthermia, dilated pupils, hyperreflexia, myoclonus

195
Q

GCA

A

dx: temporal artery biopsy
ESR high
50% have PMR, (20% PMR develop GCA)

196
Q

histoplasmosis

A

bird/barn cleaning
self limited
no Rx unless HIV or chemo or disseminated
Rx: itraconazole.

197
Q

diarrhea

A

E coli O157:H7 and shigella - blood

Enteroxigenic E.Coli (travelers nonbloody, veggies or ice)

198
Q

food poisoning

A 
B Cereus (rice) or S.aureus (eggs, produce, meat)
toxin mediated, within 2 hours

Salmonella -1-3 day incubation, nonbloody diarrhea

199
Q

hyponatremia in lung cancer

A

Small cell

200
Q

lung cancer

A

small cell - central, SIADH, dermatomyositis
Large cell - peripheral
AdenoCa- less association with smoking
squamous cell - central, cavitary, hyperCa

201
Q

photosensitive rash with drugs

A 
tetracycline = doxycycline
fluroquinolones
amiodarone
thiazide
furosemide
202
Q

CO poisoning

A

normal pO2 and high pulse Ox.
HA and nausea
Check carboxyhemoglobin.

203
Q

acid-base

A 
Write down teh variables:
ph, AG, HCO3, pCO2
(expected PCO2 - winters: Expected pCO2 = 1.5 x [HCO3] + 8 (range: +/- 2) 
1. acidosis or alkalosis?
2. expected PCO2 vs actual?
3. HCO3< 22 --> met acidosis
4. Calculate AG: Na - (Cl + HCO3)
5. Has HCO2 FALLEN BY AMT THAT AG HAS INCREASED?
204
Q

DM screning

A

Annually:
urine spot albumin:cr
eye screen (DM 1 after 5y, DM 2 immediately, regardless of HbA1c)

205
Q

sick euthyroid

A

TSH low or low-normal
low T4, low T3, low or low normal FT4
high rT3

206
Q

gilberts

A

elevated TB due to indirect (unconjugated)

207
Q

diffuse proliferative lupus nephritis

A

induction rx:
solumedrol 250-1000 mg IV daily x3d then..
prednisone 1mg/kg/d then..
cyclophasphamide or cellcept

(azathioprine and cyclosporine for maintenance but not induction rx)

208
Q

PITUATARY INCIDENTALOMA

A
  1. is it inhibiting pituatary hormones
    2.is it secreting something.
    <1 cm –> hypersecretion
    >1 cm –> hyper-, hypo-, visual field.

dx: igf-1m prl, dst

209
Q

NPH

A

magnetic gait, urine incontinence, dementia

210
Q

emphysema

A

high TLC, low DLCO

211
Q

large breast tumors, HR+

A

mrm, adjuvant chemo (if >1mm, +LN), hormone rx

  1. local control: lumpectomy, xrt
  2. systemic control: chemo, hormonal therapy
212
Q

PTLD

post transplant lymphoproliferative disease

A

5% after solid organ
usu in 1st year
EBV in setting of chronic Tcell immunosuppression.
LDH high, fever, LAN, night sweats

(H. pylori - MALT)

213
Q

GBS

A

Campylobacter infections

214
Q

Reactive arthitis

A

shigella, salmonella, campylobacter

215
Q

painless thyroiditis

A 
silent thyroiditis
TPO antibodies positive
Variant if chronic hashimotos.
sometimes s/p pregnancy
hyperthyroid -with low 123I uptake, then hypothydoi then euthyroid
216
Q

vaccinations

A 
Tdap >7y
HPV 9-26y
Hep A >1y
Hep B at birth
MMR
Meningococcal if in college.
Pneumococcal >65y or if <65y and smoke, CHF, COPD, alcoholic
217
Q

Wiscott Aldrich syndrome

A

X-linked recessive
thrombocytopenia, atopic dermatitis, recurrent infections
EBV associated malignancy (B-cell lyphoma and leukemia)
Cure with BMT

218
Q

Parvovirus B19

A

slapped cheek rash
expsoure to children
adults can have small joint arthritis and lacy reticular rash
dx: Parvoirus B19 IgM Ab

219
Q

isoelectric axis

A

I or aVF show positive=negative deflection

220
Q

SVC SYNDROME

A

small cell lung, lymphoma, mediastinal germ cell

221
Q

wasp sting anaphlaxis

A

do immunotherapy

222
Q

erythema migrans rash

A

start doxy

dont check Lyme IgM

223
Q

eosinophilic granulomatosis with polyangiitis (EPGA)

A

medium-small vessel vasculitis with necrotizing granulomas with eos.
adult onset asthma
eos>10%
fever, malaise, weight loss
arthrotos, skin rashes, peripheral neuropathy, sinusitis.
p_ANCA, elevated EST

224
Q

PAN

A

abdominal pain, rash, peripheral neuropathy, acute renal failure
not ANCA positive
small to medium vessels
spares the lungs

225
Q

ANCA associated

A

small vessel
p-ANCA/anti-MPO:
1.Microscopic polyangiitis - necrotising, crescentic GN
2.Eosinophilic granulomatosis with polyangiitis (EGPA)

c-ANCA/anti-pR3
Granulomaosis with polyangiiti
upper respiratory (sinuses)

226
Q

renal papillary necrosis

A

ischemia of distal renal papillae

Risk fxs: Pyelo, DM, sickle cell, chronic analgesic use (acetaminophen, salicylates, NSAIDs).

227
Q

when to admit PID

A 
tubo-ovarian abscess
pregnant
no response to Rx after 72h
unable to tolerate op therapy
fever, n/v
228
Q

AV infections

A

MRSA

2ND common: staph epideriditis

229
Q

Prolactin microadenoma

A

<2% chance of growth during pregnancy

Prolactin levels increase during pregnancy

230
Q

neck pain

A

retropharyngeal abscess - hurts on flexion of neck
epiglotitis - hurts on extension of neck
Ludwig angina - infection of submandibular space beneath the tongue.

231
Q

acid base

A
  1. write down the ph, pco2 and the HCo3-
  2. Look at HcO3 - what is the disorder?
  3. Winters formula if metabolic acidosis.
    If respiratory alkalosis - look at formula.
232
Q

metabolic change for respiratory alkalosis

A

ACUTE: decrease in HCO3 is 2 per 10 in PCO2
CHRONIC: decrease in HCO3 is 5 per 10 in PCO2.

233
Q

paresthesias

A

tingling, carpopeal spasm

234
Q

Toxic shock syndrome

A

Toxic shock: fever, rash and 3 organ dysfunction.
staph aureus or group A beta hemolytic strep.
strawberry tongue (also in Kawasaki and scarlet fever)
Rx; Clinda and nafcillin or vanc

235
Q

S. viridans

A

endocarditis.

236
Q

lithium toxicity

A

N/V/D and ataxia on exam, fasciultaions, cogwheel rigidity, hyperreflexia.
Ace inhibitors inhibit renal excretion of lithium.

237
Q

Carbamazepine toxicity

A

dose dependent.
>20 mg/kg, mild to moderate CNS and anticholinergic effects
>50 mg/kg - delta MS, intermittent agitation

238
Q

lithium drug interactions

A

ace inhibitors inhibit renal excretion

239
Q

neuroleptic malignant syndrome

A

blockade of central dopamine receptors
hyperthermia, autonomic dysfunction, muscular rigidity
Resembles serotonin syndrome (nausea, vomiting, shivering, hyperreflexia)

NMS: elevated CK, LDH, AST and WBC; myoglobinuria from rhabdo (normal in serortonin syndrome).

seen in patients with rapidly escalating doses of neuroleptics, like haldol.

RX; bromocriptine, amantadine, dantrole, stop haldol

240
Q

CLL (small lymphocytic lymphoma) in elderly

A

indolent non-hodgkins lymphoma
incurable.
treat only symptomatic patients (painful LAN, fever, cytopenias)
Diagnose with peripheral flow cytometry; dont need BM biopsy.
Is not PET avid as it is indolent (vs. Hogkins or DLBCL).

241
Q

acute rheumatic fever

A 
strep infection untreated (ASO titer) 1 major + 2 minor:
MAJOR:
arthritis, polyarthritis (migratory)
carditis and valvulitis
CNS (syndehams chorea)
subcutaeneous nodules
erythema marginatum
MINOR:
previous RF
arthralgia
fever
ESR or WBC eleveated
prolonged PR on ecg.

Rx: IM PCN or oral PCN for 10 days

242
Q

PMR

A

shoulder and hip girdle weakness
ACD
elevated ESR
Rx: prednisone 15-20 mg/day (use 60 mg if GCA present)

243
Q

fibromyalgia rx

A

TCAs

244
Q

homosexual men

A

give Hep A and B vax

245
Q

pneumococcal vaccine

A

chronic liver, lung, heart dx, DM, asplenia, immunocompromised.

246
Q

gram positive rods

A

listeria, clostridia (skin infection), erysipelothorix, bacillus, corynebacterium (acne or line sepsis), nocardia, actinomyces (rods in branching chains)

listeria monocytogenes - bacteria diarrhea, bactermia, meningitis, decreased cell mediated immunity.

RX; PCN or AMP. If allergic, Bactrim. Dont use after 32 weeks due to increased risk of fetal hyperbili and kernicterus

247
Q

pseudoa-achalsia

A

cancer that looks like achalasia (birds beak).
usually GE jxn
also see weight loss, older, smoking.

248
Q

viral meningitis

A

In viral meningitis, the opening pressure is 90-200 mm H2 O, and the WBC count is 10-300/µL. Although the glucose concentration is typically normal, it can be below normal in meningitis from lymphocytic choriomeningitis virus (LCM), herpes simplex virus (HSV), mumps virus, and poliovirus. The protein concentration tends to be slightly elevated, but it can be within the reference range.

249
Q

HSV encephalitis

A

HSV Type 1
CSF with lymphocytic predominance and increased RBcs
dx: HSV PCR in >90%
rapid onset delta ms and focal EEG or exam (frontotemporqal area)
MRI abnormal

250
Q

pseudohyperkalemia

A

small increase in K with normal platelets

more pronounced in thrombocytosis.

251
Q

pseudohyponatremia

A

thiazide diuretics (falsely low Na measurements)

252
Q

irregular menstrual bleeding

A

<18d interval = luteal abnormality
Rx: OCPs

prolonged bleeding with normal intervals = fibroids

253
Q

SCD (sick cell disease)

A 
hemoglobin SC (heterozygous)  - less pain crisis, can have splenic sequestration; hemolysis when RBCs trapped in spleen
Presents with painful splenomegaly, drop in Hb of >2 g/dL, low platelets and reticulosytosis. 
Rx: fluids, blood transfusion. consider splenectomy when resolved.
Hemoglobin SS (homozygous)

RX in emergences (aplastic critis, acute chest) = exchange transfusion.

254
Q

sjogrens and associated malignancy

A

40X higher risk of B cell lymphoma.

255
Q

associations of diease

A

IBD = Akylosing spondylitis
Scleroderma = esopageal involvement
Aortic aneurysm = GCA

256
Q

5mm PPD positive

A

after close contact with known case
organ transplant, HIV or when fibrotic changes on CXR present (i.e prior TB).

> 10 mm: healthcare workers, IVDU, prisoners, homeless.

257
Q

OA

A

PIP and DIP
No chondrocalcinosis

RA spared the DIPs.
Psoriatic can present with “pencil in cup” deformities.
Gout: marginal erosions with “rat bite” erosions or no radiographic changes

258
Q

transfusion reactions

A

febrile, nonhemolytic - fever, chills, subjective dyspnea, no hemolysis on labs
Rx: tylenol

hemolytic transfusion reactions- hyptension, ARF

Dx: DAT and measurement of free plasma Hb

Others:
delayed hemolytic, analphylactic, urticarial, TRALI.

259
Q

severe poison ivy reaction

A

give 2-3 weeks steroids.

260
Q

addisons disease

A

hypotension, weight loss, chronic abd pain, hyponatremia

primary adrenal insuff.

261
Q

asymptomatic bactiuria (>100,000 CFU) in pregnancy

A

treat bc of risk of pyelo, low birth weight etc.
PCN, cephalosporin or fosfomycin.
Macobid ok after 1st trimester
Screen all women at least once in early pregnancy

262
Q

MV repair

A

severe MR with sxs or asx with LV dysfunction (LVESD >= 40 mm)

263
Q

alcoholic ketoacidosis

A

hypoglycemia, hx of alcohol binge, HAGMA

Refeeding syndrome can occur - severe hypophasphatemia which can lead to rhabdomyolysis (3+ blood on urine dipstick)

264
Q

Ethylene glycol intoxication

A

calcium oxalate crystals in urine

like methanol and isopropyl alcohol with increased osmolal gap (>10 mOsm/L)

calculated osmolal gap: 2XNA + glucose/18 + BUN/2.8

265
Q

HRS

A

with cirrhosis
low urine Na (<10)
no response to volume resuscitation

266
Q

microscopic colitis

A

Dx: colo with biopsy (grossly normal mucosa).

older, stool output 500g/day

267
Q

hypokalemia ecg changes

A

STD, decreased T wave amplitude, prolonged QTc, U wave (vs. digoxin where all the same but with short QT)
Normal U is smaller than T and usually seen in v2 and v3.

268
Q

U wave

A

Normal U is smaller than T and usually seen in v2 and v3.
negative U wave is ischemic or systemic HTN
Increase amplitude with hypokalemia, dig effect, ICH and Class I and III antiarrhythmics and bradycardia.

269
Q

hypocalcemia ecg

A

prolonged QT (due to st prolongation)

270
Q

nonsmall cell lung cancer adjuvant chemo

A

> 3 cm

LN+ (stage IB or II)

271
Q

antidote for TCA poisoning

A

sodium bicarb

272
Q

empiric abx for animal bites

A 
use if high risk for infection (face, tissue destruction, edema or near joint or on hand).
Empiric Augmentin (covers cats/dogs and pasteurella)

Tetanus toxoid if >5yrs since immunization or toxoid + IG if not had at least three prior tetanus shots.

273
Q

muscle pain vs weakness

A

pain: think PMR if ESR up (vs. fibromyalgia) and try prednisone 12.5-15 mg and check SPEP (if weight loss present)
weakness: test for Ach R antibodies (for myasthenia, which worsens with use and imrpves with rest), CK (myositis)

274
Q

flu antiviral

A

oseltamivir, zanamavir

275
Q

PE ECG

A

ST

S1Q3T3

276
Q

HTN crisis in scleroderma

renal crisis

A

use IV ace inhibitors (also treat renal crisis) even in setting of ARF
renal crisis usually in AA

277
Q

exercise induced hyponatremia

A

low serum Na
high urine Osm
Due to excess fluid with high ADH from prolonged exercise

278
Q

WPW with orthodromic tachycardia or AVRT

A

RP >100 msec.
vs.
AVNRT (RP usually <70 msec)

(WPW with antidromic = WCT)

279
Q

Bactrim interaction with…

A

MTX
increase in marrow suppression
(use doxyclycline instead for S. Aureus coverage)

280
Q

Dicloxacillin

A

doesnt cover MRSA

like doxy or bactrim

281
Q

prognosis for DLBCL

A

Poor: age >60y, LDH, > nodal involvement site (both sides of diaphragm or DM involement) and functional status.

282
Q

ostium secundumum defect

A

diastolic murmur rarely heard
flow murmur in PA heard because of high flow.
fixed splitting of S2.

283
Q

primary adrenal insuff

A

thin, decreased body hair, hyperK with met acidosis. low glucose
dx; cosyntropic/ACTH stimulation test (nromal >20; if low, then confirms)
rx; start dexamethasone
Tan skin: from excess ACTH to overcome adrenal insuff.

Loses aldo activity too so use hydrocort instead of dexa (as hydrocort has mineralocorticoid activity).

284
Q

CML

A 
t(9;22) - Philadelphia chromosome
low leukocyte alkaline phosphatase (LAP) score
BCR-ABL
neutrophilia
HSM
uncontrolled mature neutrophils
285
Q

HUS

A

diaeehar E. Coli
increased immune complement
ADAMTS13 activity (low in TTP but normal is aHUS)
RX; plasmaphresis but less responsive to plasmaphresis than TTP

vs. DIC - coagulopathy in setting of hemolytic anemia and thrombocytopenia.

286
Q

tularemia

A

pna unresponsive to CTX - consider “strange” organism.
Dx: serologically or through indirect fluorescence AB; not on blood cxs.
Rx: streptomycin

287
Q

Yersinia pestis

A

bubonic plague - GNR (coccobacillaus - safety pin)
W and SW USA.
rats/fleas, rodents
raidly progressive and fatal
CXR with bilateral infiltrated and effusions
Rx: IV gent or IV doxy

288
Q

mycobacterium marinum

A

saltwater and freshwater pathogen
infect skin, joints, bone after traumatic inoculation
chronic bone and join infections
Nodular skin lesions and noncaseating granulomas
Rx: clarithromycin, Bactrim or doxycycline

289
Q

nocardia brasiliensis

A

soil contamination.
noncaseating granulomas
purulent cellulitis
gram positive branching chains

290
Q

blastomyces dermatidis

A

soil exposure and verrucous skin lesions.

gram stain/fungal stain

291
Q

MALT

A

linked to H. pylori

292
Q

Burkitts lymphoma

A

linked to EBV

293
Q

Whipple disease

A

diarrahe and dementia

Tropheryma whipplei

294
Q

Hepatocellular carcinoma

A

HBV

295
Q

Castleman disease

A

HHV

diffuse systemic LAN

296
Q

ZES

A

gastrinoma, multiple ulcers in upper jejunal region, diarrhea.
Dx: fasting gastrin level or secretin stimulation test
PPI can cause vitamin B12 deficiency, so check B12 annually
Rx: B12 supplementation

297
Q

sideroblastic anemia

A

usually microcytosis

Hb usually <7 g/dL

298
Q

renal infarct

A

acute flank pain and elevated LDH

look for AF

299
Q

renal papillary necrosis

A

rare severe form of ATN

with analgesic abuse, sickle cell, pyelo or postpartum hemorrhage

300
Q

reactive arthritis

A

seronegative spondyloarthropathy
ReA triad: urethritis, conjunctivity, arthritis (esp with achilles tended) - cant see, cant pee and cant climb a tree.
Infections: Chlamydia, salmonella, shigella, yersinia, campylobacter, C. Diff.

301
Q

target cell microcytic anemia

A

iron def (reduced serum ferritin, low iron sat)
or
hemoglobinopathy.
Dx: get iron studies.

(dx for thalassemia - Hb electrophoresis, normal iron and normal or elevated ferritin should get this)

ACD: low iron, low to normal TIBC, elevated ferritin

302
Q

internuclear opthalmoplegia

A

small stroke on ipsilateral medial longitudinal fasciculus
ipsilateral eye cannot adduct. convergence is preserved.

old patient: stroke
young: MS

303
Q

tylenol overdose

A

NAC within 8-16h of ingestion

charcoal if within 4 hours

304
Q

burr cell

A

echinocyte -
uremia, pyruvate kinase deficience, lymphosarcoma, GN and ulcers.
acid- base disorder.

305
Q

HTN urgency

A

lower BP by no more than 25% in first hour, then to 160/100 in 2-6 hours then to normal over 24-48h.

306
Q

RCC

A

secondary erhythrocytosis in 1-5%

clots (Budd-Chiari, PE, migrating IVC vlot)

307
Q

sudden painless loss of vision with cherry spot

A

retinal artery occlusion.

common with carotid athero

308
Q

RMSF

A

Rickettsia rickettsii
Myalgias, HA, petechial rash with centrifugal distribution (due to vasculitis)
May to October - eastern coast, southeasterm, far western
Labs: Hyponatremia, thrombocytopenia, elevated ALT/ASK, leukopenia and anemia
Rx: doxycycline.

(Legionella also with HypoNa)

309
Q

metformin risks in inpatient

A

AKI, Lactic acidosis, contrast

310
Q

Sulfonylureas

A

cause hypoglycemia if fasting.

311
Q

thiazide diuretics and kidney stones

A

reduce urinary calcium and prevent recurrent stones.
To reduce stones: DRINK H2O!

(increased risk with: sodium, protein and oxalate)

312
Q

opioids in renal dysfunction

A

fentanl and methadone safest
dilaudid and oxycodone ok
dont use morphine.

313
Q

headache

A

migraine: abortive - triptan
ppx: propanolol, valproate, amitryptiline

Cluster rx: verapamil

314
Q

SIBO

A

due to poor peristalsis
assoc with scleroderma
bacteria impair carbohydrate metabolism -> distention
Vitamin Def common

Scleroderma and gi tract: decreased esoph peristalsis, decrease LES tone, reflux, barretts, stricture, decreased peristalsis.

Rx: rifaximin, augmentin, flagyl, bactrim, cipro, doxy/tetracycline

315
Q

Ataxia-telangiectasia

A

A/R
neurodegeneration, immunodeficiency, sensitive to radiation, predisposition to cancer.
Cerebellar atxia and telangecctasias
Chronomose 11 - ATM gene
defects in celluar and humoral immunity and chronic lung disease (bronchiectasis) and sinopulmonary infections.

316
Q

SCID

A

T and B cel immunity
p/w severe bacterial, viral, fungal infection, ILD, diarrhea, FTT, Ear infections, PJP PNA, oral thrush.
fatal unless treated with BMT.

317
Q

Freidrichs ataxia

A

A/R

progressive limb and gait ataxia, sensity loss, weakness and dysarthria.

318
Q

CF

A

CFTR gene
abnormal sodium and chloride transport
lung, live, pancreas and intestinal disease.

319
Q

von Willebrands disease

A

normal PT, elevated (or normal if mild) pTT
normal CBC
reduced ristocetin induced platelet aggregation
prolonged bleeding time.

320
Q

normal aPTT, prolonged PT

A

Vit K def

Factor 7 def.

321
Q

Bernand-Soulier

A

giant platelet syndrome

have abnormal RIPA but giant platelets.

322
Q

A-a gradient

A

Different between alveolar concentration (A) of oxygen and arterial concentration (a)

calculated PAO2= 150 - (pCO2X1.25)

A-a gradient: calculated - measured (normal 5-20, elevated 25).

Elevated A-a: suggests a defect in V/Q perfusion, diffusion, R to L shunt or intrapulmonary shunt.

323
Q

ovarian tumor

A

germ cell tumors most common in young women (10-30y).

Ovarian Ca: 4th leading cause of cancer death; >50% of cases in pts >65y, epithelial or germ cell.
Only 5% of ovarian cancers are germ cell; 85% epithelial

324
Q

breast cancer

A

risk is 3X higher with first degree relative
BRCA 1 and 2 -> 30-50% of inherited cancers.
only 5-10% due to genetic abnormality.

325
Q

pyoderma gangrenosum

A

neutrophilic dermatoses
associated with MM, RA, IBD
Rx: steroids, dapsone, TNF inhibitors, immunosuppressive.
Worse with trauma

326
Q

Hepatitis tests interpretation

A

Anti-HAV IgM - looks for acute Hep A
HbsAg - acute infection and carrier states
Anti-HBc IgM - acute infection in “window”
Anti-HBc IgG - hepB infection in past. Doesn’t tell you if still infectious (required HBsAg).
Hepatitis C Ab - tells if infected (not chronic or resolved)

327
Q

animal bites

A

staph, strep, gram negatives, anaerobes, Pasteurella
Rx: amp-sulbactam (IV), augentin (PO)
Tetanus >5y

328
Q

chlamydia pna

A

fever, malaise, hoarseness, nonproductive cough
uri sxs 1-2 wks before pna onset.
Rx: macrolides, cipro.

329
Q

legionella

A

hyponatremia, gi tract vomiting, diarrhea

330
Q

what to check when a woman is pregnant

A

RPR
HIV
urine culture

331
Q

bleomycin

A

IPF in up to 10%

332
Q

doxorubicin

A

cardiac toxicity; CHF

333
Q

cyclophasamide

A

hemorrhagic cystitis

334
Q

vincristine

A

neuropathy

vomiting, myelosuppression

335
Q

psoriatic arthritis

A

nail pitting

sausage digits

336
Q

Wiskott Aldrich syndrome

A

X-linked
eczema, thrombocytopenia, recurrent infections
low IgM and high levels of IgA and IgE
Rx: BMT

337
Q

prostate cancer staging

A

do a bone scan

TNM

338
Q

vaccines in HIV

A

annual influenza
dual pneumococcal vaccination
Hep A
Tetaunus

339
Q

travelers bloody diarrhea

A

Entamoeba histolytica - protozoan

(vibrio, norovirus, B. cerus and S. aureus produce watery, not bloody).

340
Q

brain abscess

A

HA, fever, and focal neurological defects

341
Q

reactions to antipsychotics

A

acute dystonic reaction - abnormal posture, twisting
Tardive dyskinesia - chronic expsosure

(NMS: diffuse rigidity, delta MS and high temps)

342
Q

CMV retinitis

A

(usually a reactivation so CMV IgM may be negative)
pizza pie eye
HIV with CD4< 50 (AIDS-defining illness)
(fluffy exudates and scattered hemorrhages)
Rx: IV ganciclovir

343
Q

Meningitis

A

Empiric rx: Vanc and CTX bc 5-10% of S. pneumoniae is resistant to CTX.
S. pneumo > N. meningitis

344
Q

hematuria

A

Decide if upper or lower urinary tract

If see casts, it is GN and send for biopsy and check complement, lupus seroloy, ANCA, hep serology and anti-GMB testing

345
Q

conjunctivitis

A

adenovirus

346
Q

Parvovirus B19

A

Kids: slapped cheek
rash worse in sun

adults: arthritis

worry if: pregnant (risk of fetal loss), HIV (red cell aplasia) and those with chronic hemolysis (sickle cell, who can have aplastic crisis)

347
Q

Roseola

A

HHV 6

Pna and meningitis in immunocompromised adults

348
Q

crohns disease

A

early osteo from disease and steroid use

consider BMD.

349
Q

IgA deficiency

A

recurrent sinoupulmonary and GI illnesses

Rx: abx as needed, avoid blood and plasma products (as anti-IgA antibodies can cause anaphylactic reactions).

350
Q

chronic granulomatous disease

A

CGD disease, rare immunodeficiency

severe bacterial infections.

351
Q

DiGeorge syndrome

A

complete - in infancy with hypocalcemia due to hypoparathyroidism, thymic hypoplasia, congenital heart defects, facial features.

352
Q

normal anion gap

A

toluene ingestion, severe diarrhea, renal failure.

353
Q

necrotizing fasciitis

A

rapid onset cellulitis, systemic infection (fever, hypotension, tachycardia, tachypnea), risk factors (like DM)

354
Q

rheumatic MS

A 
opening snap (heard after S2) followed by low pitched diastolic rumble.
caused by Group A strep
355
Q

sensitivity

A

of those with the disease, how many test positive.

356
Q

specificity

A

of those without the disease, how many test negative

357
Q

PPV

A

Of those with + tests, how many are true positives

358
Q

NPV

A

of those with - tests, how many are true negatives

359
Q

prevalence

A 
# cases at a given time.
the higher the number, the higher the PPV
360
Q

grid

A

Test Result on Left

Disease state on Top

361
Q

morphine iv to po

A

1 mg IV = 3 mg PO (SR) = 2 mg oxycodone.

362
Q

dilaudid iv to po

A

1.5 mg IV = 7.5 po dilaudid

363
Q

fentanyl

A

0.1 mg IV fentanyl = 1.5 IV dilaudid = 10 mg morphine

364
Q

HCAHPS survey

hospital consumer assessment of healthcare providers and systems.

A

hospital inpatient experience survey tied to reimbursement and required by CMS.
Asks about: communication with doctors, cleanliness and nurse communication.
Pts surveyed after discharge.

365
Q

RA scoring system

A
  1. # and site of involved joints
  2. RF or anti-CCP Ab positive
  3. Elevated ESR or CRP
  4. symptom duration
366
Q

neurofibromatosis

A

10% will have sarcoma

367
Q

fabry disease

A

lysosomal storage disorder with stroke and neuropathy

368
Q

germ cell tumor of testes

A

pulmonary mets

increased estrogen production (gynecomastia)

369
Q

acute angle-closure glaucoma

A

painful red eye with reduced visual acuity
associated with symphatomimetics like pseudoephedrine.
Rx: urgent reduction of elevated IOP

370
Q

constipation

A

fiber and water

2nd line: polyethylene glycol.

371
Q

kidney stones with crohns, bypass, small bowel resection.

A

calcium oxalate stones

mechanism: increased oxalate excretion into urine

372
Q

bifid pulse

A

HCM

373
Q

water-hammer pulse

A

chronic AR

374
Q

thready pulse

A

acute AR

375
Q

Giant R sided a waves

A

tricuspid stenosis

376
Q

MEN1

A

multiple parathyroid adenomas
(serum calcium and PTH levels) p/w asx hypercalcemia or kidney stones, weakness, arthralgia.

PPP - parathydoi, pitutary, pancreas (gastrin producing)
multiple lipomas

377
Q

CREST

A

cutaneous systemic sclerosis
calcinosis, Raynauds, esoph dysmotility, sclerodactyly and telangectasias.
Dx: anticentromere AB specific for limited cutaneous systemic sclerosis

378
Q

noncaseating granulomas in lung

A

ddx: sarcoid, hypersensitivity pna, aspiration pna, infectious granulomatous disease, berrylium/aluminum expsire, rarely Wegeners (granulomatosis with polyangiitis)

379
Q

chronic eosinophilic PNA

A

fever, night sweats, eosinophilia.
More common in women
50% have asthma
CXR: “negative” of pulmonary edema.

380
Q

ABPA (allergic bronchopulmonary aspergillosis)

A

coughing brownish sputum and mucus plugging

segmental atelectasis on CXR

381
Q

Type 4 RTA

A

due to bladder outlet obstruction or prostate hypertrophy.
also possible due to diabetic nephropathy.
Defect in renal acidication.
hyperkalemia due to hyporeninemic hypoaldo

382
Q

Type 1 and 2 RTA

A

hypokalemia

383
Q

cancer of unknown primary

A

70% adeno

do PET-CT

384
Q

shock and “menses”

A

think TSS or disseminated gonococcal infection.

385
Q

RA effusions

A

pleural fluid <30 mg/dL

low glucose, normal protein, normal WBC

386
Q

statistics

A

disease prevalence increases –> # FP decreases and FN increases.
Prevalence increases –> PPV increases
Sensi and speci not affected by prevalence (qualities of test).
PPV and NPV affected by prevalence

387
Q

drug induced lupus

A 
procainamide
arthritis/arthralgias prsenr
anti-histone Ab in 95%
rash less common
renal involvement rare
388
Q

clues that it is ZES

A

unusual location of ulcer - past the duodenal bulb
FH of ulcers
having diarrhea
refractory to medical rx
ulcer recurrence after acid reducing rx
frank complications (bleeding, obstruction, perforation)

389
Q

thyroid drug interactions

A

levothyroxine poor absorption with iron and calcium.
also PPIs and sucralfate or cholestyramine

lower effects: SSRIs (sertraline) - monitor thyroid function.

levothyroxine can enhance warfarin effect.

390
Q

“red flag: sxs of low back pain

A

cancer hx, IVDU, immunocompromised, osteoporosis

MRI if severe or progressive neuro deficits

391
Q

CML

A

splenomegaly
theombosis
stage based on % blasts: chronic <10%, accelerated 10-19%, blast phase (>19%)
Rx: TKI (remission in 90%); imatinib, bosutinib, ponatinib
t9;22 - good prognosis

392
Q

SLE in pregnancy

A

Increased risk of preeclampsia, IUGR and premature delivery.
Anti Ro/SSA antibodies cross placenta and can cause neonatal lupus (congenital heart block). Rx: hydroxychloroquine.
pregnancy increases sle flares as does HTN, APLA Ab,

dsDNA Ab associated with higher risk of renal involvement but not neonatal lupus.

393
Q

PDE5 inhibitors

A

sildenafil, avanafil
hearing loss

2nd line rx for ED: alprostadil penile injections

394
Q

anorexia nervosa

A

low phos, K, Na, Cl

sick euthyroid

395
Q

hidradenitis suppurativa (HS)

A

sterile abscesses, scarring

Rx: topical and systemic antibiotics, intralesional steroids, anti-TNF agents or other biologics.

396
Q

ARDS

A

low tidal volume ventilation
(<6 mL/kg) and Plateau <30
prone
paralyze

397
Q

Naive B cells

A

first produce IgM

398
Q

E. Coli O157

A

No abx (can make worse and cause HUS)

399
Q

ischemic colitis

A

IVF and if severe, abx (flagyl)
surgery if evidence of gangrene

painless hematochezia (diverticular)

400
Q

nasal foreign body

A

malodorous, sometimes bloody discharge.

401
Q

hot tub folliculitis

A

psuedomonas folliculitis
48h to 5d
papules and pustules around hair follicles
No Rx, self limied

402
Q

multinodular goiter and normal TSH/euthyroid

A

get thyroid us not RAI uptake to determine biopsy

403
Q

high risk features for pulm nodule

A

large
noncalcified
in a smoker

404
Q

nail in tennis shoe

A

pseudomonas (colonizes glue in shoe)

rx: cefepime if osteo present

405
Q

pseudomonas coverage

A

cefepime, ceftaz
cipro
others: zosyn (pip/tazo), aztreonam, carbapenem (except ertapenem), aminoglycosides
BACTRIM DOES NOT COVER

406
Q

addisons

A

adrenal insuff
rx: dexamethasone and ACTH stim test (also hydrocort ok but ALL STEROIDS EXCEPT DEXA cross react with ACTH stimulation test)

Clues:
hypotension
tanned male (excess ACTH) with sparse hair
hypoNa and hyperK (low aldo)
pre-renal
407
Q

steroid equiv

A

4 dexa = 50-100 hydrocort

stress doses

408
Q

treponema whipplei

A

whipple disease
present after a long time.
weight loss, diarrhea, arthopathies
skin hyperpigmentation in sun exposed areas
LAN
REMEBER: PAS STAIN with FOAMY MACROGHAPES
Rx: IV Ctx or PRN for 2 wks, then bactrim X 1yr

409
Q

Q fever

A

Coxiella burnetii
flu-like illness, hepatitis, PNA
Dx; serology

410
Q

Multiple Myeloma Clues

A 
CRAB
Calcium (elevated)
Renal dysufnction
Anemia
Bone pain or lesions (lytic not blastic)
411
Q

acute angle glaucoma

A

increased IOP due to obstruction of outflow from aqueous humor
visual loss
colorful halos
needs gonioscopy to diagnose with slit lamp

412
Q

HIV-related thrombocytopenia

A

treat the HIV.

413
Q

NPH peak effect

A

8 hours

414
Q

meth use

A

associated with HIV

415
Q

idiopathic intracranial hypotension

A

obese
visual changes
papilledema.

416
Q

HA

A

can be caused by OCPs

417
Q

urine sxs Rx

A

stress incotinence: kegel
overactive bladder: oxybutynin
BPH: doxazosin

418
Q

A-a gradient

A

alveolar-arterial gradient

distinguishes hypoventolation, poor gas exchange and circulation issues.

419
Q

acute rhinosinusitis indications for Rx

A

7-10 daus
high fever, purulent discahrge or facial pain
worsening after initial improvement.

420
Q

autosomal dominant polycystic kidney disease

A

increase in cerebral aneurysms.
screen patients
hematuria, proteinura, kidney stones. HTN, UTIs

421
Q

alport syndrome

A

sensorineural hearing loss

hematuria with renal cysts.

422
Q

Nonanion grap acidosis

A

RTA or GI losses (diarrhea or laxative misuse

UAG = (Na +K) - Cl.
If neGUTive, then NH4 present which makes RTA unlikely.

423
Q

leukemoid reaction

A

has expansion of the myeloid cell line

424
Q

think CLL

A

persistently elevate lymmphocytes (mature but dysfunctional, no blasts)

425
Q

HIV ppx

A

blood, semen, vaginal fluids
(possibly CSF, synovial, pleural, peritoneal, pericardial, amniotic)
NONINFECTOIUS: urine, sweat, stool, saliva, nasal secretions, tears, sputum and vomit.

If intact skin, no ppx needed
if nonintact or mucus membranes, need ppx

PPX: bictergravir + tenovifir + efavirenz

426
Q

when to do ECG for epigastric pain

A

Healthy/young and no “alarm” sxs: check H. Pylori

Do EGD if anorexia, dysphagia, GIB, >60y or mass, anemia, weight loss, vomiting.

427
Q

affects INR

A

bactrim, raises it!

antibiotics

428
Q

cystic fibrosis

A

recurrent sinusitis, bronchitis, P. aerugonisa.

Dx: sweat Cl- testing and genetic testing.

429
Q

hearing loss

A

Rinne test - checks for conductive hearing loss in affected ear (bone conduction louder than air conduction in affected ear).

Weber test - lateralized to ear with conductive hearing loss.

Conductive hearing loss = otosclerosis
AG toxicity/Menieres: sensory hearing loss.

430
Q

hypothyroid sxs

A

dry skin
elevated cholesterol
constipation
muscle pain

iron interacts with levothyroxine absorption.

431
Q

IgA deficiency

A

IgA 1st line of defense - lungs, GI tract, GU tract
1/300 (common)
frequent URIs, diarrhea, chronic bronchiectasis,
Asthma, alllergies, autoimmune

432
Q

indications for intubation in astham

A

“normal” ABG - pt tiring (should see resp alkalosis early)
accessory muscles
leabing forward.

433
Q

pregnant patient with AF and pulm edema

A

think MS or secundum ASD

434
Q

Sjogrens associated with which lymphoma

A

NHL (20-40X higher risk)
look for fever, malaise, weight loss, LAN and new anemia
Most MALT - amenable to treatment.

435
Q

perioral dermatitis

A

variant of rosacea
Rx:
Mild - metronidazole or calcienueuin inhibitors
Severe - doxycycline.

436
Q

ethambutol toxicity

A

problems with visual acuity, especially color perceptions.

437
Q

ethambutol toxicity

TB drug toxicity

A

problems with visual acuity, especially color perceptions.

INH, rifampin, pyrazinamide - hepatotoxic.

438
Q

prior to starting biologics for RA…

A

check for TB

skin or blood

439
Q

Liddle syndrome

A

hypokalemia and HTN

Autosomal dominant

440
Q

lactoferrin in stool

A

iron binding protein
present in PMNs in pts with bacterial and IBD diarrhea
Shigella, Salmonella, EHEC (O157), Campylobacter, Yersinia

441
Q

essential tremor

A 
resting and action
bilateral
seldom interferes with function
improved with alcohol
familial

(Parkinsons. pill rolling at rest, improved with action and unilateral)

442
Q

thyroid nodules

A

FNA if risk features: >1 cm in size and microcalfications.

443
Q

TPO Ab

A

Hashimotos (can have goited)

Increased risk of thyroid cancer with Hashimotos

444
Q

when to get a RAIU

A

if TSH is low

If just nodule, get US or do FNA

445
Q

dermatomyositis

A 
periorbital heliotrope rash
proximal muscle weakness
erythema and telangectasias of cuticle
palmar arythema
papules over joints (Gottron papules)
>50y - think canccer (GU, GI, lung)
446
Q

cluster headache Rx

A

young to middle aged males
unilateral, lacrimation, facial flushing, nasal discahrge
several times a day

Rx; O2 (15-20 min by face mask), short-acting triptans

Prevention: verapamil, valproic acid, lithium, topiramate

447
Q

IgA nephropathy

A

hematuria after viral illness.
Recur for months/years intermittently
Serum completment normal. Microscopic hematuria can persistent.

Post-strep GN: 1-3 weeks following pharyngitis
complement low, ASO titer high

448
Q

PNH

A

fatigue, jaundice, red urine

hemolysis and hemogliobinuria

449
Q

Rhabdo

A

false positive on dipstick for blood

actually myoglobinuria.

450
Q

symptomatic anemia in CKD

A

treat with EPO

Target Hb 10-11.5

451
Q

osteoporosis

A

goal: reduce fx in femoral neck

Rx if T score

452
Q

SSRIs and sex

A

delayed ejaculation, difficult orgasm

453
Q

endocarditis ppx

A

prosthetic valves
previoue IE
CHD - unrepaired, repaired w/in 6 mo or repaired with residual defects
Transplant with regurgitation

None for GU or GI unless biopsy

454
Q

cushings syndrome

A

dont do 1 mg DST if on OCP (can give FP due to change in cortisol binding globulin).
diagnostic cutoff of >1,8 mcg/dL

1st line tests: 24h urinary free cortisol, late-night salivary cortisol (not influenced by OCP)

455
Q

anklylosing spondylitis

A

lumbar Xrays

456
Q

Associated with HLA-27

A

reactive arthritis
ankylosing spondylitis
IBD
anterior uveitis

457
Q

Behcets

A

HLA-B51

458
Q

androgen secreting tumor of adrenals (secreting DHEAS)

A 
increased testosterone
higher estradiol (peripheral aromatization)

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