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Internal Medicine HYHO > Amboss > Flashcards

Amboss Flashcards

1
Q

Eosinophiliuria

A

in patients with allergic intersitial nephritis this is caused by a hpersensitivity reaction to drugs like PPIs, NSAIDS, antibiotics and diuretics.

tx: discontinue PPI and give fluids

symptoms: microscopic hematuria, maculopapular rash, flank pain, increased creatinine and eosinophilia

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2
Q

osteoarthritis

A

pain and stiffness that worsenes with activity, it can affect the knee, hands, and hips the most

of the hands the PIP and DIP joints are most affected

herberden and bouchards nodes

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3
Q

nephritic syndrome

A

inflammatory damage to the glomerular capillary wall

leads to GBM disruption and decreased glomerular filtration rate with retention of water and salt

symptoms: peripheral edema, JVD, pulmonary edema, mild proteinuria, RBC casts

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4
Q

constrictive pericarditis

A

reduced ventricular filling and reduced cardiac output most of the times caused by tuberculosis but other causes like cardiac surgery, radiation therapy, viral infections can cause it

rigid pericardial sac (calcified sac)

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5
Q

signs of pericarditis

A

pericardial known ( high pitched, early diastolic sound that sounds like a premature S3)

fatigur, dyspnea, JVD,positive hepatojugular refluc , kussmaul sign, hepatomegaly

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6
Q

risk factors for esophageal adenocarcinoma

A

obesity, smoking, achalasia, high animal protein diets

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7
Q

eosphageal adenocarcinoma is located where

A

distal 1/3 of the esophagus

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8
Q

smoking and achlasia also increase the risk of what cancer

A

esophageal squamous cell cariconoma

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9
Q

what are the risk factors for cyrptococcous neoformans?

A

immunosppressed- HIV

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10
Q

symptoms that point towards cryptococcous neoformans

A

fever, fatigue, headaches, increased intracranial pressure, indica ink stain with prominent capsules

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11
Q

the onset of cyrptococcal neoformans in HIV patients is CD4 counts of what

A

less than 100 cells

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12
Q

in patients with blunt trauma to the head and neck what should be assumed?

A

cervical spine injury

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13
Q

in a patient that does not respond to questions but is conscious raises suspicion for what

A

that is airway is compromised and a cervical collar should be utilized to immobilize the cerival spine

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14
Q

in managing trauma patients what should you do

A

ABCDE

Airway
breathing
circulation
Disability (glascow scale)
Exposure (looking for occult injury

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15
Q

what are the two most common causes of urethritis?

A

gonorrhea and chlamydia

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16
Q

what are the signs of a chlamydia urethral infection?

A

usually asymptomatic but can cause clear urethral discharge

it is hard to stain because it is intracellular so only neutrophils indicating bacteria would be present

screen with DNA amplification

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17
Q

symptoms of gonorrhea urethritis

A

purulent discharge with gram negative or intracellular diplococci

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18
Q

common adverse affect of tetracyclines

A

photosensitivity ( tetracycline)

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19
Q

how do tetracyclines cause photosensitivity?

A

the drug metabolites will interact with UV light leading to a photochemical reaction with the formation of free oxygen radicals and damage to areas exposed to the sun

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20
Q

what are other adverse effects of tetracyclines?

A

discoloration of teeth, growth inhibition, hepatotoxicity, and damage to mucus membranes (esophagitis)

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21
Q

what tests confirm the presence of chlamydia trachomatis?

A

nucleic acid ampliification testing or first void urine

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22
Q

treatment of chlamydial infections

A

azithromycin (single dose) and one week of doxycycline

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23
Q

treatment of cryptococcous neoformans

A

amphotericin B and flucytosine for 2 weeks

oral flucanazole 8 weeks after then a lower dose flucanazole for 12 months to finish it off

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24
Q

peptic ulcer symptoms

A

epigastic pain that improves with food intake

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25
Q

endoscopic findings of duodenal ulcer?

A

mucosal breach in the anterior duodenum

hypertrophic brunner glands

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26
Q

anterior duodenum ulcers most common complication?

A

perforation into the peritoneal cavity

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27
Q

posterior dudodenal ulcers most common complication

A

massive bleeding (hematemesis) due to it being adjacent to the gastrododenal artery

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28
Q

Arteriovenous fistulas cause a decrease in?

A

peripheral vascular resistance

-shunt from high pressure to low pressure venous system

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29
Q

decreases in vascular resistance result in what symptoms?

A

elevated heart rate, decreases effective circulating volume and activation of the RAAS system

RAAS system causes retention of water and socium and increased cardiac filling pressures with elevated cardiac output- high output cardiac failure

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30
Q

treatmement of an AV fistula causing high output cardiac failure

A

immediate surgical division of the fistula to reverse current symptoms

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31
Q

what are common causes of high output cardiac failure

A

pregnancy, anemia, AV fistulas, hyperthroidism, wet beriberi

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32
Q

symptoms of bronchiectasis

A

chronic cough, copious amounts of sputum, dyspnea, hemoptysis (blood tinged sputum), coarse crackles on auscultation

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33
Q

symptoms of bronchiectasis exacerbate with?

A

acute respiratory tract infections

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34
Q

CXR signs of bronchiectasis

A

bronchial wall fibrosis (tram-track opacities)

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35
Q

the diagnosis of bronchiestasis is confirmed with?

A

CT scan that shows honeycombing, bronchi dilation and signet ring sign

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36
Q

treatment of bronchiectasis

A

exacerbation: sputum culture and empiric antibiotics

long term: smoking cessation, vaccinations

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37
Q

cholecystitis is usually caused by?

A

passage of gallstones into the cystic duct

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38
Q

symptoms of cholecystitis ?

A

cystic duct obstruction can lead to inflammation of the gallbladder causing RUQ pain, nausea, fever

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39
Q

HIDA scan of cholecystitis

A

delayed or absent radioactive tracer in the gallbladder

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40
Q

what is a HIDA scan primarily used for?

A

diagnose cystic duct obstruction

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41
Q

what labs are cholestatic (hepatic and common bile duct related)

A

ALP, GGT, Billirubin

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42
Q

antimicrobial prophylaxis for the prevention of infective endocarditis is recommended for high risk patients like who

A

people with prosthetic heart valves, history of infective endocarditis, congenital heart defect

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43
Q

what is the antiobiotic regimen for antimicrobial prophylaxis

A

oral amoxicillin administered 30-60 minutes prior to the procedure

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44
Q

what is the treatment of choice in acute severe pain from postoperative, malignancy, acute pancreatitis, burn injuries?

A

patient controlled anaglesia (hydromorphone, fentanyl)

*pumps include a lockout period where no further anaglesic can be given and respiratory depression does not occur

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45
Q

is there a link between opiods and aggravation of pancreatitis/worsen clinical outcomes

A

no

opiods can cause sphincter of oddi dysfunction but it will not aggravate pancreatitis

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46
Q

what medication is indicated for the immediate control of symptoms in patients with hyperthroidism?

A

beta blockers (propranolol)

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47
Q

what is streptococcous sanguinis

A

viridans streptococci that can cause subacute IE on damaged heart valves

***mutans too

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48
Q

what is the treatment of choice for infective endocartditis caused by HACEK organisms

A

3rd generation cephalosporins like ceftriaxone

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49
Q

intermittent catherterization is indicated in what kind of incontinence

A

overflow

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50
Q

what is overflow incontinence

A

urinary retention that is caused by a dysfunction of the bladder wall (underactive detrusor or spinchter)

people with diabetes can have neuropathy of the bladder and cannot sense bladder fullness

increased post residual void volume

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51
Q

what are the treatment options for overflow incontinence

A

behavioral changes, intermittent catheritization, triggered voiding, bethancol (muscarinic agonist)

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52
Q

oxybutynin is used for which incontinence

A

urge incontinence

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53
Q

what is oxybutynin

A

a M3 receptor antagonist that relaxes the detrusor muscle

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54
Q

what is urge incontinence

A

the sudden urge to urinate and leakage

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55
Q

cough, fever, decreased appetite, night sweat, hilar lymphadenopathy in the immunocompromised

A

pulmonary tuberculosis

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56
Q

tuberculosis pleurisy

A

pleuritis chest pain, lymphocyte predominant exudative pleural effusion, high adenosine deaminase

(inflammation of the plerua that occurs with tuberculosis )

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57
Q

symptoms and signs of emphysema

A

dspnea, productive cough, expiratory wheezing, low FVC/FEV1 ratio

DECREASED DLco (diffusion capacity of carbon monoxide)- loss of gas exhange and diffusion area

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58
Q

an FEV1: FVC ratio of less than 70% and reduced FEV1<80 percent is indicative of

A

obstructive lung disease

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59
Q

nonsmokers and individuals less than 50 who present with COPD and emphysema should be tested for?

A

alpha- 1 antitrypsin deficiency

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60
Q

clinical signs of infective endocarditis

A

fever, janewway lesions (macules/papules on the palms and soles) petechiae, a new heart murmur, hematuria (>3rbc on urinalysis ), roth spots (retinal hemorrhages with white centers)

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61
Q

neurological complications of infective endocarditis

A

ischemic stroke, intracerebral hemorrhage, cerebral microabcesses (septic emboli)

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62
Q

treatment of infective endocarditis

A

empiric antibiotic treatment with 3 sets of blood cultures

CT non-contrast

**thrombolytic therapy is not recommended due to risk of cerebral hemorrhage)

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63
Q

all patients with new-onset symptomatic afib should be evaluated for?

A

potential causes of arrythmia (TSH levels)

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64
Q

Dry cough that is worse when lying down, fine inspiratory crackles at the lung bases, and an S3 gallop on auscultation in a patient with multiple risk factors (e.g., hypertension, smoking, coronary artery disease) suggests?

A

congestive heart failure

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65
Q

Pulmonary edema usually indicates?

A

severe or decompensated heart failure

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66
Q

bronchial asthma is what

A

airway hyperresponsiveness and bronchial obstruction

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67
Q

symptoms of bronchial asthma

A

dry cough, nocturnal and exercise induced exacerbation, end expiratory wheezing

obstructive lung disease pattern

DLco is normal

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68
Q

does bronchial asthma get worse or better with methacholine challenge

A

worse!!!

improves with inhalation of a bronchodilator like albuterol

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69
Q

what is a subphrenic abcess

A

a collection of pus that collects between the spleen, diaphragm, and liver….this is seen 10 days after surgery

abdominal pain, fever, N/V

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70
Q

postoperative pneumonia

A

a post operative complication that happens 3-5 days after surgery

inspiratory crackles, fever, pleuritic chest pain (worse on inspitation), productive cough

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71
Q

what can maintain and improve lung function after surgery by keeping alveoli open?

A

Incentive spirometry and deep breathing exercises

early mobilization, and postoperative pain control

  • decrease the risk of atelectasis and pneumonia (postoperative pulmonary complications)
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72
Q

what are the preoperative measures to reduce pulmonary complications?

A

smoking cessation, oral care, treatment of optimization for chronic lung disease

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73
Q

what is the first line treatment for patients with CAP with P. Aerginosa

A

cefepime and levofoxacin

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74
Q

microbiology for psuedomonas

A

gram-negative rod

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75
Q

seminomas contain?

A

syncytiotrophoblasts

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76
Q

seminomas secrete

A

B-hCG

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77
Q

treatment of seminoma

A

radical inguinal orchiectomy

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78
Q

yolk sac tumors produce?

A

a-fetoprotein

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79
Q

seminoma pathology

A

clear cytoplasm and central nuclei

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80
Q

what treatment is indicated for any testicular mass that has features that suggest an underlying malignancy?

A

radical inguinal orchiectomy

RIO is the first step in management as it is necessary to confirm the diagnosis

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81
Q

the testicular lymphatic channels travel in the spermatic cord and drain into the ?

A

retroperitoneal LNs (para-aortic LNs)

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82
Q

Sporothrix schenckii

A

dimorphic fungus

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83
Q

in patients with upper airway obstruction or will need long term mechanical ventiliation what is the best procedure to do?

A

tracheostomy

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84
Q

what is a severe complication of thrombolytic therapy

A

intracerebral hemorrhage (hemorrhagic stroke and increased ICP)

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85
Q

if intracerebral hemorrhage is suspected what shoud you do

A

discontinue thrombolytic therapy

emergent CT scan

consult neruosurgery

thrombolysis reversal agents could be considered

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86
Q

what are thrombolysis reversal agents

A

antifibrinolytics, FFP, cyroprecipitate

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87
Q

what is the best initial step in the treatment of patients with biopsy confirmed acute renal allograft rejection

A

pulse steroid therapy (methyloprednisolone)

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88
Q

what type of graft rejection can be reversed

A

acute transplant rejection

89
Q

what is the first line imaging modality in someone with symptomatic carotid artery stenosis

A

duplex ultrasonography of the neck

90
Q

in patients with carotid artery stenosis what will the ultrasound show?

A

focally increased velocity of blood flow

*can quantify the degree of stenosis

91
Q

treatment of carotid artery stenosis

A

antiplatelet therapy, statin therapy, blood pressure control, lifestyle changes (smoking cessation, weight control, regular exercise)

92
Q

in carotid artery stenosis when is carotid revascularization with carotid endarterectomy indicated?

A

in patients with symptomatic disease and severe stenosis (>70%)

93
Q

with is heparin induced thrombocytopenia (HIT)

A

an autoantibody mediated platelet activation disorder

there are antibodies against the platelet factor 4 and heparin complex that causes platelet activation and increases the risk of clots

mesenteric vein thromobsis

94
Q

how does thrombocytopenia occur in HIT

A

immune complexes remove platelets by macrophages and platelet consumption

95
Q

in patients with HIT , heparin should be replaced with?

A

direct thrombin inhibitor (argatroban)

96
Q

which has a higher risk of unfractionated heparin or low molecular weight heparin

A

unfractionated heparin

97
Q

a patient that presents with splenomegaly, mild anemia, thrombocytosis, and leukocytosis should raise awareness for what

A

CML

98
Q

in CML what is the leukocytosis

A

> 100,000 with basophilia

99
Q

how can you differentiate CML from other forms of leukemia and leukemoid reaction

A

low leukocyte alkaline phosphatase

100
Q

Papillary thyroid carcinoma

A

peak incidence 30-50 years old
most common type of thyroid cancer
spread via lymphatics
painless cervical lymphadennopathy
no family history
microcalcifications (hyperechogenic punctate regions)

101
Q

anaplastic thyroid carcinoma

A

aggressive , rare

spreads via lymphatics

older patients (60)

102
Q

medullary thyroid carcinoma

A

rare
family history (MENII)
50-60 years old

103
Q

porecelain (calcified) gallbladder is associated with?

A

cholelithiasis and chronic gall bladder inflammation

104
Q

what is the risk of a porcelain gallbladder

A

gallbladder adenocarcinoma

105
Q

what is the treatment of a porcelain gallbladder

A

cholecystectomy

106
Q

oliguria + increased BUN and creatinine

A

AKI

107
Q

AKI that presents with hypovolemia, and a bun creatinine ration >20:1 is what kind

A

prerenal

108
Q

sodium concentration in prerenal AKI

A

less than 20mmol/L

109
Q

explain how prerenal AKI causes decreased urine sodium concentration

A

prerenal AKI is caused by hypoperfusion

this causes the kidneys to respond by reabsorbing lots of sodium and that sodium is then followed by water causing the urine to have low sodium and be concentration

110
Q

intrinsic AKI urine sodium levels

A

reduced reabsorption of sodium due to damage to the tubular system

urine sodium >40

111
Q

what is a good indicator of organ perfusion after burn incidents?

A

urine output

fluids should be tirated to maintain a urine output of 0.5ml

112
Q

treatment of thrombotic thrombocytopenia purpura

A

plasma exchange therapy which will remove the autoantibodies against ADAMTS13 and replaces the ADAMTS13 protein that can then cleave vonwillebrand factor

113
Q

labs in familial hypocaliuric hypercalemia

A

PTH is on the high end of normal
Ca+ is elevated
Urine Calcium/Creatine ratio<0.01

**asymptomatic, decreased in CaSR

114
Q

labs in primary parahyperthyroidism

A

increased PTH
increased Calcium
Increased urinary calcium/creatinine ratio >0.02

115
Q

what are some potential side effects of familial hypocalciuria hypercalcemia

A

pancreatitis and chondrocalcinosis

116
Q

FHH is a mutation in?

A

calcium sensing receptor

117
Q

what is a myasthenic crisis

A

this is when a person with MG has severe respiratory muscle weakness leading to respiratory failure

increasing bulbar muscle weakness (inability to cough up sputum)

worsening vital capacity

hypoxia

shallow respirations

118
Q

what is a myesthenic crisis precipitated by

A

infection, medications etc.

119
Q

treatment of myasthenic crisis

A

intubation to protect the airway

Theraputic Plasma exchange to reduce the level of pathological autoantibodies + Corticosteroids

HOLD acetylcholinesterase inhibitors (pyridiostigmine)

120
Q

symptoms of motor parkinsonism

A

bradykinesia, rigidity, and tremor

121
Q

drug induced parkinsonism drugs

A

antipsychotics (decrease dopamine), antiemetics like metaclopramide and procholrperazine

122
Q

what do you do if a patient has parkinsonism like symptoms and is on a drug that can cause these symptoms?

A

discontinue the drug

the diagnosis of idiopathic parkinsonism cannot be made if you are on one of these drugs

after discontinuation symptoms should resolve in 3 months

123
Q

what is supraventricular tachycardia

A

any tachycardia that originated above the bundle of HIS

narrow QRS complex and missing P waves , they are hidden in the ORD complex can be retrograde

R-R is constant

124
Q

what are the types of supraventricular tachycardias (7)

A

sinus tachycardia
multifocal atrial tachycardia
atrial flutter
a fib
atrioventricular nodal reentrant tachycardia
AV reentrant tachycardia
junctional tachycardia

125
Q

what is paroxysmal supraventrical tachycardias

A

supraventricular tachycardias with abrupt onsent and offset (AVNRT, AVRT, atrial tachycardia and junctional tachycardia)

126
Q

treatment of supraventricular tachycardias

A

use vagal manuvers (carotid sinus massage, valsalve, eyeball pressure)

OR IV adenosine

127
Q

how do adenosine and vagal maneuvers help Supraventricular tachycardias?

A

they slow down conduction through the AV node and can aid in unmasking hidden P waves

128
Q

what is painless (silent) thyroiditis

A

a variant of chronic autoimmune thyroiditis that has a brief hyperthyroid phase

small nontender goiter, low radioiodine uptake and positive TPO

129
Q

what is chronic autoimmune thyroiditis

A

predominant hypothyroid
diffuse goiter with positive TPO
usually increased radiodine uptake

130
Q

a patient with nausea, trouble swallowing, chest pain and a retrocardiac air-fluid level has what

A

a paraesophageal hiatal hernia

131
Q

what is a sliding hernia?

A

when the gastroesophageal junction and cardia herniate into the chest

cause GERD like symptoms

132
Q

what is a paraesophageal hital hernia

A

when the gastric fundus herniates into the chest it causes severe symptoms like N/V, dysphasia, chest pain etc.

133
Q

diagnosis of hernias are confirmed with?

A

upper endoscopy or barium swallow

134
Q

treatment of hiatal hernias

A

sliding: treat reflux symptoms
paraesophageal: surgery

135
Q

ACS due to unstable angina or non-ST segment elevation MI is managed how?

A

antiplatelet (clopidegrel)
anticoagulant (heparin)
beta blockers
nitrates
and statins

NOT STRESS TESTING UNTIL ACS IS RESVOLVED

136
Q

first line treatment for any type of urinary incontinence is?

A

bladder training and pelvic floor exercises

137
Q
A
138
Q

urge incontience is detrusor _

A

overactivity

139
Q

the detrusor muscle is mediated by the _ nervous system

A

parasympathetic

140
Q

to help urge incontinence you should use

A

antimuscarinic medications (oxybutynin)

or B3 agonist: mirabegron

141
Q

what is diabetic nephropathy

A

irreversible injury to glomerular basement membrane and surrounding structures due to metabolic byproducts of chronically elevated blood glucose

perisitent proteinuria

142
Q

what are common findings in someone with lymphoproliferative disorders on chemotherapy

A

thrombocytopenia and anemia

143
Q

treatment of chemotherapy induced anusea and vomiting

A

serotonin 5HT (receptor antagonists)- odansetron

low side effect profile

144
Q

parapneumonic effusions

A

effusions due to pneumonia

145
Q

uncomplicated parapneumonic effusion

A

sterile exudate in the pleural space

pH is greater than 7.2

146
Q

complicated parapneumonic effusion

A

bacterial invasion in the pleural space

low ph <7.2
low glucose
high WBC

147
Q

what is the next best step for a patient with severe asthma exacerbation with an elevated PaCO2

A

endotracheal intubation

high Paco2 indicated impeding respiratory failure

148
Q

stess incontinence treatments

A

sling, pessary, pelvic floor exercises

149
Q

Euythroid state

A

elevated T4 with normal TSH

150
Q

what increases thyroid binding globulin

A

estrogens and acute hepatitis

151
Q

how does estrogens and acute hepatitis increasing TBG cause an increase in total T4

A

increased TBG will bing T4 but to maintain a euthyroid state there would be an increase in total T4

free level of T4 is normal

normal TSH, normal free T4, high total T4

152
Q

things that decrease TBG

A

androgenic hormones, high dose glucorticoids, chronic liver disease, hypoproteinemia

low TSH, high free T4

153
Q

infectious keratitis

A

corneal opacification and ulceration that is an opthalmologic emergency

154
Q

bacterial keratitis

A

mucopurlent drainage and ulceration of the corena most commonly caused by staph aureus and psuedomonas aeruginosa

155
Q

contact lens use causing bacterial keratitis is mostly caused by?

A

psuedomonas aeruginosa

156
Q

treatment of bacterial keratitis

A

topical antibiotic drops - empiric fluroquinolones

157
Q

a patient with cirrhosis, lethargy, confusion, and asterixis has?

A

hepatic encephalopathy

158
Q

heptaic encephalopathy is

A

impaired CNS function in people with cirrhosis from ammonia neurotoxicity

159
Q

patients with hepatic encephalopathy on diuretics can develop

A

low intravascular volume despite having total volume overload

160
Q

treatment of hepatic encephalopathy

A

volume resuscitation and repletion of hypokalemia along with serum ammonia lowering medications ( lactulose)

161
Q

a postoperative patient with bilateral asymmetric ptosis that improves with the application of an ice pack raises suspicion for?

A

myasthenia gravis (antibody blockade and degeneration of acetylcholine receptors at the NMJ)

162
Q

hallmark presentation of myasthenia gravis

A

fatigable weakness (eyes, bulbar muscles, extremities)

163
Q

weakness in MG can be precipitated by?

A

infections, pregnancy, surgery, medications, nondepolarizing neuromuscular blocking agents

164
Q

the diagnosis of MG can be supported with?

it is confirmed with?

A

ice pack test (improvement in ptosis)

confirmed with acetylcholine receptor antibody testing

165
Q

is qualitative HBsAb alone sufficient to determine immunological protection against HBV ( means patient was immunized but never contracted it)

A

no

patients can have positive HBsAb but insufficient HBsAB titers

166
Q

if HbsAb is positive what should you do next

A

check for titers

if titers are > 10 then you do not need any prophylaxisis

if titers are <10 you need hepatitis B immunoglobulin and repeat HBV vaccination

167
Q

why can niacin cause pruritus and flushing

A

it causes vasodilation and drug induced release of histamine and prostaglandins

take with low dose aspirin to combat these symptoms

168
Q

what is acute respiratory distress syndrome

A

direct or indirect pulmonary injury that leads to the release of proteins, inflammatory cytokines and neutrophils into the alveolar space. Protei, fluid and surfactant all leak out causing pulmonary edema

pulmonary edema causes decreased gas exchage and hypoxemia with a V/Q mismatch

lack of surfactant causes decreased lung compliance

hypoxemia causes pulmonary artery vasocostriction and intubation causes further ateriole compression causing pulmonary artery hypertension

169
Q

clinical findings of acute respiratory distress syndrome

A

respiratory distress, bilateral alveolar infiltrates, crackles, hypexemia

170
Q

PaO2 and FiO2 in ARDS

A

decreased PaO2 and increased FiO2 to maintain oxygenation

PaO2/FiO2 is decreased

171
Q

a patient with a Hx of chrons disease that had bowel resection that now has bone pain and muscle weakness, on X ray he has osteopenia and psuedofractures

diagnosis?

A

osteomalacia

172
Q

what is osteomalacia?

A

reduced mineralization of osteoid at bone forming sites

173
Q

osteomalacia is common in patients with?

A

malaborptive disorders. (chronic vitamin D def)

174
Q

symptoms of osteomalacia

A

asymptomatic or generalized bone pain and muscle weakness

175
Q

labs in osteomalacia

A

increased alkaline phosphatase (bone remodeling)

decreased vitamin D

decreased calcium

decreased phosphorus

increased PTH

176
Q

x ray findings in osteomalacia

A

psuedofractures- looser lines
cortical thinning
concave vertebral bodies

177
Q

pulmonary involvement in systemic sclerosis has what 2 manifestations

A

pulmonary arterial hypertension

intersitial lung disease

178
Q

signs of SS with pulmonary hypertension

A

normal lung sounds, dyspnea, exertional syncope

normal FEV1 and FEVc

decreased DLCO

limited SS

right sided heart failure ( right side deviation on EKG, JVD, loud P2)

*narrowing of the lumen of the pulmonary arteries

179
Q

intersitial lung disease findings in a patient with SS

A

diffuse SS (organ scarring)

alveolar basement membrane inflammation and fibrosis

restrictive lung patter

velcro like rales, cough, dyspnea

180
Q

symptoms of chronic pancreatitis

A

intermittent epigastric/abdominal pain that is intermittent and relieved when leaning forward

pancreatic inflammation that causes exocrine or endocrine functinonal damage- diarrhea, steatorrhea, weight loss

pancreative calcifications

181
Q

first line imaging for a patient with chronic pancreatitis

A

CT scan or X-ray showing pancreatic calcifications

182
Q

optic disc in glaucoma

A

enlarged cup/disc ration >0/6
increased cup size
loss of peripheral vision
thinning of disc rim

183
Q

what is open angle glaucoma

A

atrophy of the optic nerve head due to increased intraocular pressure

184
Q

patient with cough, fever, leukocytosis, mild hyponatermia and a right lower lobe infiltrate has?

A

community acquired pneumonia

185
Q

patients with community acquired pneumonia are risk stratified using?

A

CURB65

186
Q

inpatient treatment of community aquired pneumonia is treated how

A

sputum culutre and blood culture taken

empiric treatment with beta lactam plus macrolide (ceftriazone + azithromycin)

187
Q

outpatient treatment of CAP includes

A

healthy patients: amoxicillin or doxy

comorbid conditions: beta lactam + macrolide OR fluroquionolone

188
Q

intermittent claudication, diminished pulses and low ankle brachial index is concerning for

A

peripheral arterial disease (athersclerosis of large arteries)

smoking is sthe strongest risk facts

189
Q

PAD has an increased risk for

A

CAD/MI/Stroke

190
Q

leukemoid reaction has high

A

leukocyte alkaline phosphatase

191
Q

CML has low

A

leukocyte alkaline phosphatase

192
Q

what is the next best step when an X-ray finds a lung lesion

A

compare to previous lesions if there are any

if no history of lesion or growth get a CT

193
Q

aquagenic pruritis, facial plethora, and increased hematocrit raise suspicion for?

A

polycythemia vera

194
Q

what is polycythemia vera

A

chronic myeloproliferative disorder that causes an increased RBC mass

causes thombotic complications

195
Q

what thrombotic complication can be seen from polycythemia vera

A

budd chiari syndrome

196
Q

what is budd chiari syndrome

A

hepatic venous outflow obstruction due to thrombosis

197
Q

clinical signs of budd chiari

A

vague abdominal discomfort, ascites, hepatoslenomegaly, elevations in liver transaminases, billirubin and alkaline phosphatase

198
Q

how do we diagnose budd chiari syndrome

A

abdominal ultrasound

199
Q

dialysis related amyloidosis is?

A

decreased clearance of Beta 2 microglobulin that depostis and causes

shoulder pain/hypertrophy, carpal tunnel syndrome and bone cysts

200
Q

what is shock liver (ischemic hepatic injury)

A

rapid and significant increase in transaminases due to hypotension

hypotension can be caused by septic shock or heart failure

201
Q

can carbon monoxide poisoning cause a heart attack?

A

yes

202
Q

CO binds hemoglobin at greater affinity than oxygen which creates

A

carboxyhemoglobin

203
Q

symptoms of CO poisoning

A

drowsiness, elevated lactate, arrythmias, myocardial ischemia , pulmonary edema

204
Q

how to diagnose CO poisoning

A

co-oximetry of arterial blood gas showing elevaed carboxyhemoglobin

205
Q

treatment of CO poisoning

A

100% O2 in a nonrebreather facemask (hyperbaric oxygen)

206
Q

individuals with secondary polycythemia vera and no evidence of hypoxia should undergo?

A

CT scan (to evaluate for renal cell carcinoma)

(elevated EPO, only HCT increased)

207
Q

colon cancer screening for people with ulcerative colitis

A

start screening 8-10 years after disease diagnosis

colonoscopy every 1-3 years

208
Q

colon cancer screening for first degree relative with colorectal cancer or high risk adenomatous polyp

A

colonoscopy at age 40 or 10 years prior to the age of diagnosis in the first degree relative

repeat every 5 years

repeat every 10- if the first degree relative was diagnosed later than the age of 60

209
Q

colon cancer screening for average risk people

A

start at age 45

colonscopy every 10 years
gFOBT or FIT every year
FIT-DNA every 1-3 years
CT colonography every 5 years
flexible sigmoidoscopy every 5 years

210
Q

MOA of warfarin

A

inhibits the synthesis of vitamin K dependent factors which include: II, VII, IX, X, protein C and S

211
Q

necrotizing malignant otitis externa

A

severe ear pain with granulation tissue in the external auditory canal that is caused by psuedomonas aeruginosa

can cause cranial nerve neuropathies

RF: diabetes, elderly, aural irrigation

treatment: IV antipsueduomonal antibiotics and surgical debridement

212
Q

what causes otitis externa most commonly

A

psuedomonas

next common is staph aureus

213
Q

treatment of otitis externa

A

topical fluroquinolone and glucocorticoid

214
Q

vesicular ear rash and ipsilateral facial droop

A

herpes zoster oticus (varicella zoster virus reactivation)

can cause loss of taste, hearing, taste

215
Q

treatment of herpes zoster oticus aka ramsay hunt

A

antiviral medications like valacylovir

216
Q

chrons disease of the gi tract predisposes people to what

A

abscess, fistula, fissures

rectovaginal fistulas ( foul tan discharge coming from the vagina)- passage of flatus from the vagina

217
Q

treatment of a rectovaginal fistula

A

surgical correction

218
Q

patients diagnosed with an STD are at increased risk of coinfection with other sexually transmitted pathogens and should be tested for what other pathologies?

A

chlamydia trachomatis, HIV, and treponema pallidum (syphillis)

Internal Medicine HYHO (3 decks)

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