Adult medicine Flashcards
Meds that can cause hypokAlemia?
Insulin, albuterol, bronchodilators, tocolytics and pseudo ephedrine
Preferred first test to evaluate Reno-vascular HTN
Duplex Doppler USG kidneys
60% of all kidney stones are made up of what?
Calcium oxalate
Alkinization of urine helps reduce formation of which kidney stones?
Uric acid and cystine stones
Acidifying urine reduces which kidney stones
Calcium phosphate and pyruvate
What does betaine do?
Acidified urine
Symptoms assoc with amyloidosis.
Peripheral neuropathy, tongue enlargement. Cardiomegaly, CTS, ortho static hypotension
How do you treat erythrasma?
Erythromycin
Which antihypertensive slows the demineralization of bone?
Thiazide diuretic
True or False: the absolute risk reduction for breast cancer mortality is lower with screening mammography in women 40 to 49 years of age compared to women age 50 and older
True
What are the five A’s for quitting smoking counseling
Ask about tobacco use Advise to quit Assess willingness to quit Assist by offering man's counseling and help setting up a quit date Arrange follow-up
PPIs are associated with what vitamin issue
Reduced B12 absorption
What does sevelemar (renagel) do to lower calcium in renal insufficiency patients?
Blocking intestinal absorption of phosphate which reduces the secretion of PTH
What are common causes secondary HTN in <39 year old
Coarct, fibromuscular dysplasia, thyroid Dx, renal Dx
Causes Middle Aged HTN
Primary aldosteronism, sleep apnea, pheo (aldosterone-renin ratio–for aldosteronism), cushings
What pain med should be avoided in cirrhotics?
NSAIDS–they precipitate hepato-renal syndrome.
Lyme Dz affects primarily what JTs?
Large ones, esp the knee
What is DOC for pneumocystis in pt with Sulfa allergy?
Atovaquone
Can you tx in pneumocystis with clindamycin?
Yes but not as mono tx–add primaquine
What is the definition of apraxia?
Transmission disturbance on the output side (The patient can understand the request but has difficulty performing it)
Definition of agnosia?
Difficulty recognizing previously known sensory input. For example ability to recognize objects
What’s the definition of tertiary prevention?
Prevention of the disease complications in a patient with the disease
What is pes anserine bursitis?
Pain in the medial knee distal to the joint space at the insertion of the Sartorius, gracilis and semitendinosis
What is the significance of Virchow’s node (left supraclavicular node)?
It receives flow from the thorax and abdomen and may signal malignancy of the testes ovaries kidneys pancreas prostate stomach or gallbladder
What type of fiber does not work in irritable bowel syndrome?
Psyllium (soluble)
What is a “up and go” test and what are the normals.?
A gait test.
Less than 10 seconds is normal, greater than 14 seconds suggest risk for falls, greater than 20 seconds is a severe risk
Aromatase inhibitors like Femara are more likely than Tamoxiphen to cause what side effect?
Myalgia sand non-inflammatory arthralgias
What are causes of disequilibrium dizziness?
Medications, peripheral neuropathy and Parkinson’s
Management of a thrombosed hemorrhoid <72 hrs old
Elliptical incision and removal of hemorrhoid and overlying skin
What reduces the pain with pericarditis? What makes worse?
Sitting up and leaning forward.
Lying supine
What does the Valsalva maneuver due to the heart.?
Decreases venous return to the heart
What is lifetime risk of colon cancer in United States?
6%
What are the appropriate hormonal tests for a male with suspected hypogonadism.?
FSH, morning testosterone
How do you screen for primary aldosteronism?
Morning aldosterone/renin ratio
What is deQuervain’s tenosynovitis?
And inflammation of the extensor policus brevis and abductor policis longus pain worse with ulnar deviation of wrist with fingers wrapped around the thumb
What is the Lehrmitte test of the cervical spine
Flexion of neck causing shock down the spine
What is CSM?
Cervical spondylotic myelopathy (most common cause of spinal cord dysfunction in the elderly
How do you differentiate CSM from ALS?
Typically see fasciculations in the lower extremity with ALS.
What is Antizol (FomEpizoe)l?
Early treatment for ethylene glycol poisoning (antifreeze).
Who to use cCRPs in?
Men >50 women >60 with LDL <130
How do you treat calcium oxalate stones?
Take potassium citrate, eat alow-sodium, restricted protein, increased fluid intake dietand eat a low oxalate diet which is low in chocolate, tea, nuts and spinach.
What is Lofgren syndrome?
A triad of erythema nodosum, Hilar adenopathy and polyarthralgias which is pathognomonic for sarcoidosis
At what percentage does an increasing creatinine with an ace inhibitor necessitate discontinuation of the ace inhibitor
More than 30% increase in creatinine
What is first treatment for grade 2 ascites
Spironoplactone
What is the “flick test” for carpal tunnel syndrome and how useful is it.
It’s a description by the patient of waking up and flicking the wrist to make numbness go away. It is both very sensitive and very specific
What has been shown to improve outcome in the ICU with ards?
Lower title volumes (6 mL per kilogram) instead of traditional volumes (10 to 15 mL per kilogram). Patients often need higher peep.
What is the difference between occupational asthma and hypersensitivity pneumonitis
Hypersensitivity pneumonitis begins with malaise fever in my house at 4 to 6 hours after exposure to an integer. Occupational and occurs with wheezing and chest tightness in a work environment. Diagnosis by a 10% decrease in FEV1 measured before and after work shift
What is BYssinosis
Pneumonitis secondary to exposure to the dust of hemp, flax or cotton
At what neutrophil count is peritonitis identified?
> 250ml
What does an abnormal nitroblue tetrazolium suggest?
A phagocytic disorder
What does lymphopenia suggest?
A disorder of cellular immunity such as severe combined immunodeficiency
What does thrombocytopenia suggest?
The Wiskott Aldrich syndrome - an infant disorder including eczema and thrombocytopenia and G.I. problems.
What is the treatment of choice for tinea capitis?
Oral griseofulvin (Topical antifungal’s are ineffective)
What are the criteria for chronic fatigue syndrome?
Six months of fatigue and a minimum of four of the following physical symptoms: impaired memory, postexertional malaise, muscle pain, polyarthralgia, tender lymph nodes, sore throat, new headaches, and unrefreshing sleep.
How long do you have to measure the blood pressure before and orthostatic test is complete.?
Three minutes
What is cardiac resynchronization therapy (CRT)?
Use of a pacemaker like device to get both ventricles contract in simultaneously, overcoming delay contraction of left ventricle caused by left bundle branch block. This is for New York heart Association functional class III or IV On maximal medical therapy
Drug of choice following carotid massage and adenosine in a patient with narrow complex tachycardia and no P waves.
Verapamil followed by Propafenone or Flecainide. Cardioversion if those measures fail to terminate it.
When do you use a C-reactive protein test?
Men over 50 and women over 60 who’s LDL cholesterol levels are less than 130. Also in younger patients with intermediate CV risk (10 to 20%)
How is enoxaparin metabolized?
Almost exclusively by the kidneys
How do you diagnose and am I on a EKG?
ST elevation >or= 1 mm in 2 or more limb leads and > or = 2 mm in two or more contiguous precordial leads
What is the best drug for isolated systolic hypertension in the elderly?
Diuretics preferred, then beta blockers, or long-acting dihydropyridine calcium channel blocker’s
What do you thiazide diuretics do for osteoporosis
It may improve it.
What is Budd-Chiari syndrome?
Thrombosis in the intrahepatic, super hepatic or hepatic veins
How does Lithium elevate Ca levels?
Elevates PTH secretion
What are symptoms of bronchiectasis?
Obstructive and infectious, luminal dilation, hemoptysis, wheezing, decreased FEV1
What can cause falsely low HbA1c?
Hemoglobinopathies and hemolysis.
Another name for Osler-Weber-Rendu syndrome.
Hereditary hemorrhagic telangiectasia (HTT)
Common pulmonary probs with HTT (hereditary hemorrhagic telangiectasia or Oslet-Weber-Rendu)
Pulmonary A-V malformations. 15-30%
What are adult causes of hypercalcinemia?
Lithium, thiazides diuretics,familial hypercalcemia, tertiary hyperparathyroidism, and end stage renal dysfunction
What test is useful with secondary hypothyroidism?
TRH stimulation test
What are the Thiazolidinediones and what is the mechanism of action?
ACTOS etc. activating PPARs (peroxisome proliferator-activated receptors which decreases insulin resistance.
How does acarbose or Precose work?
Acarbose is an α-glucosidase inhibitor that delays glucose absorption.
Diagnosis of impaired fasting glucose metabolism on a two hour glucose tolerance test
2-hour glucose level of 140-199 mg/dL on an oral glucose tolerance test. (75 g load)
What are red flags concerning thyroid cancer?
male gender; age 65 years; rapid growth of the nodule; symptoms of local invasion such as dysphagia, neck pain, and hoarseness; a history of head or neck radiation; a family history of thyroid cancer; a hard, fixed nodule >4 cm; and cervical lymphadenopathy
How does serum iron to respond to inflammation?
Decreases
Reason for surgical tx hyperparathyroidism
kidney stones, age less than 50, a serum calcium level greater than 1 mg/dL above the upper limit of normal, and reduced bone density.
Initial tx SVT
Adenosine
What is activated protein C resistance?
Leiden factor V
What is the insulin lispro?
Humulin
What is dermatitis herpetiformis
An immune mediated vesicular disease–extremely puritic on scalp, extensor services, of elbows, knees and buttocks. Assoc w/gluten sensitivity
What is erythema multiforma?
Acute blistering eruption found in all ages.
What is porphyria cutaneous tarda?
Erosions and bullae on sun exposed skin.
Where do SLE pts develop arthritis?
Knees, wrists, small jts of the hand
Went to the oral lesions of lupus look like??
Irregular, erosive and necrotic
What organism causes and foot and mouth disease?
Coxsackie a 16
What causes like in simplex chronicus?
Habitual scratching, usually hyperpigmented edematous lesions with scaly thickening in the center
What helps reduce pain from infiltrating local anesthetic?
Adding sodium bicarb to the solution (except for bupovoCain), warming the solution, and performing the infiltration slowly.
What is acne neonatorum?
Occurs in up to 20% of newborns, comedones on head nose and cheeks due to stimulation of sebaceous glands by maternal and infant androgens.
What is the treatment of chronic paronychia
High-dose steroid topical twice daily for 3 to 4 weeks
What is most devastating event that can occur with pseudo tumor cerebri (benign intracranial hypertension)
Loss of vision
What is most typical presentation for pseudotumor cerebra or benign intracranial hypertension?
Young obese woman with a headache, probable tinnitus and nausea and vomiting
What are effective treatment for chronic orthostatic hypotension
Fludrocortisone, midodrine and Physostigmine
What is sensitivity?
Percentage of patients with a disease who have a positive test for the disease
What is specificity?
Percentage of patients without the disease have a negative test
What is the positive predictive value
Percentage of patients with a positive or abnormal test who have the disease in question
What is negative predictive value?
Percentage of patients with a negative or normal test who do not have the disease question.
First test for Dx of primary biliary cirrhosis?
Anti-mitochondrial antibody’s
What is pamindronate used for?
Hypercalcemia of malignancy after proper hydration
What 2 murmurs get louder with reduction in cardiac output
Hypertrophic obstructive cardiomyopathy me and mitral valve prolapse
Drugs that cause pleuritis
Hydralazine, quinidine, amiodorone, procainimide, minoxidil, bromocryptine,,. Methotrexate
What is the recommended INR for mechanical valve
2.5–3.5
What surgical procedures have the highest incidence of venous thromboembolic events?
Neurosurgical procedures, especially brain or meninges and orthopedic surgeries especially the hip.
At what aortic valve gradient and aortic valve area should a patient undergo symptomatic aortic valve stenosis replacement?
Aortic valve gradient greater than 50 mm and aortic valve area smaller than 1 cm²
In women what is the most common cause of death from cancer?
Lung cancer followed by colon cancer and breast cancer. Ovarian cancer is fifth most common
For surgery what are the recommendations for obtaining an EKG?
Males over 45, females over 55, patients with diabetes, symptoms of chest pain or previous history of cardiac disease.
What needs to be done before patients are begun on TNF inhibitors (tunor necrosis factors).
Because they are associated with an increased risk of infection patient should be screened for TB and hep B and C
What does the gait look like in a patient with cerebellar degeneration?
Ataxic gate that is why based in staggering
Name antiphospholipid antibody tests?
Abnormal immunoglobulin G or M anti- cardiolipin antibodys, positive lupus anticoagulant test, false positive VDRL
What is the etiology of damage to the kidneys by an ACE inhibitor?
Ace inhibitors can impair the kidneys angiotensin II related vasoconstriction
In using acetazolamide for altitude sickness, what allergy can you not use it with
Sulfa
What are the most common drug related causes of acute interstitial nephritis?
Antibiotics, especially penicillin, cephalosporin and sulfonamide
What is horse chestnut seed extract useful for?
Treatment of chronic venous insufficiency including varicose vein’s
What will pulmonary function test show with pneumonitis?
A restrictive pattern
Went to patients with long QT syndrome have when they get an arrhythmia?
VTAch or torsades de pointes
What is the normal ankle brachial indices
0.91–1.30
What is the blood pressure specified for severe preeclampsia
160/110 on two occasions six hours apart
What is the most common cause of erythema multiforme and what kind of reaction is it?
Herpes simplex and a hypersensitivity reaction
What is scombroid poisoning?
A pseudoallergic condition from consumption of improperly stored scombroid fish such as tuna wahoo etc. this is due to high levels of histamine and saurine.
