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card review Flashcards

1
Q

what is the definition and treatment of intermittent asthma

A

this is the lowest form of asthma. this is SABA use <2 days a week, <2 times a month of nighttime awakenings.

this is step 1 of indicated therapy

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2
Q

what is the definition and treatment of mild persistent asthma

A

this is the second lowest form of asthma. this is SABA use >2 days a week but not daily, 3-4 times a month of nighttime awakenings.

this is step 2 of indicated therapy

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3
Q

what is the definition and treatment of moderate persistent asthma

A

this is the a moderate asthma. this is SABA use daily, > 1 time a week nighttime awakenings.

this is step 3 treatment

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4
Q

what is the definition and treatment of severe persistent asthma

A

this is severe asthma. this is SABA use throughout the day. 4-7 times weekly. This is step 4-5 indicated therapy

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5
Q

what is step 1 asthma treatment

A

short acting beta-agonist therapy PRN

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6
Q

what is step 2 asthma therapy.

A

low dose inhaled corticosteroid

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7
Q

what is step 3 asthma therapy

A

low dose inhaled corticosteroids and long acting beta agonists or medium dose inhaled corticosteroids

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8
Q

what is step 4 of asthma therapy

A

medium dose inhaled corticosteroids and long acting beta agonists.

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9
Q

what is step 5 of asthma therapy

A

high dose inhaled corticosteroids and long acting beta agonists nd omalizumab for patients with allergies

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10
Q

what is step 6 in asthma therapy

A

high dose inhaled corticosteroids and long acting beta agonists and oral corticosteroids and omalizumab for patients with allergies

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11
Q

what does MEN1 syndrome consist of for tumors

A

pancreatic, pituitary and parathyroid adenomas

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12
Q

what is thromboangiitis obliterates

A

an occlusive vascular disease characterized by segmental inflammatory, nonathrosclerotic lesions of small and medium-sized blood vessels. history of tobacco is common. there are usually segmental occlusions in the arteries and veins and corkscrew collateral vessels.

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13
Q

what is thromboangiitis obliterates assocaited

A

strongly associated with smoking and cessation is the only management shown to be effective

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14
Q

what nutrient deficiencies are important in Roux enY bypasses

A

B12 deficiency is common in about 30% of patients

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15
Q

what is lichen sclerosis

A

usually widespread on the labia majora and involves both sides of the vulva. the skin will appear white and thin, usually described as parchment paper or cigarette paper thinness.

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16
Q

what is the treatment for lichen sclerosis

A

behavioral change such as hygiene nd minimizing scratching of the affected area. can be treated with topical steroids.

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17
Q

how does lichen planus present

A

white bands next to red, ulcerative lesions. they appear in the vulva and frequently occurs in the vagina./

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18
Q

what is pemphigus foliaceus

A

autoimmune disease characterized why thin walled blisters and it is caused by auotantibody demoglein-1.

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19
Q

what is epidermolysis bulls simplex

A

inherited disease affecting the adhesion of skin cells. the most common disorder resulting in blistering lesions that painful. this often shows up during childhood.

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20
Q

what is pemphigus vulgaris

A

severe form of pemphigus that affects both the cutaneous and mucosal surfaces. caused by autoantibody desmoglein-3

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21
Q

what is loeys-dietz syndrome

A

associated with bifid uvula, hypertelorism, and increased arterial tortuosity. it is highly associated with aortic aneurysms and dissections. regular screening with echocardiograms is indicated

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22
Q

what is the most likely origin of a bone mets in an elderly male

A

prostate cancer

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23
Q

what are the SE of cisplatin

A

nephrotoxicity, ototoxicity, nausea and vomiting, neurotoxicity.

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24
Q

what kind of drug is cisplatin

A

alkylating agent that cross links DNA thereby interfering with mitosis

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25
Q

what are the risk factors for endometrial hyperplasia

A

more likely to develop secondary to conditions that elevate estrogen, such as hormone replacement, granulosa cell tumors, obesity, anovulatory cycles, PCOS and null parity.

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26
Q

what are the characteristic findings in whipples disease

A

diarrhea, wasting, abdominal pain, joint pain.

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27
Q

what is the pathological findings for whipples

A

PAS positive in the lamina propria on small intestinal biopsy

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28
Q

what people are more likely to have whipples

A

farmers and people that work with soil and animals.

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29
Q

what is the causal organism for whipples

A

T. whipplei

gram positive

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30
Q

what is the treatment for whipples disease

A

antibiotics are first line treatment. IV Ceftriaxone for two weeks in people with nervous system involvement.

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31
Q

what are the conditions that can cause mediastinal mass

A

thymoma, teratoma, thyroid masses, and thoracic aortic aneurysm as well as Hodgkin lymphoma

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32
Q

what is the first line therapy for hypertension in pregnancy

A

labetolol is the first line treatment.

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33
Q

what hypertensive meds should be avoided in pregnancy

A

ACE and ARBs should be avoided.

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34
Q

Can thiazide diuretics be used in pregnancy

A

yes, but they should be avoided because they counteract the volume expansion

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35
Q

what drug use is associated with hepatic adenomas

A

sex hormone exposure, such as anabolic steroids. OCPs are also associated!

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36
Q

what to look for in a patient with streptococcus Bovis bacteremia

A

colorectal cancer can cause this need colonoscopy

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37
Q

what imaging finding is pathognomonic for asbestosis

A

pleural plaques

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38
Q

what is the treatment of patients with community acquired pneumonia in an inpatient setting

A

fluoroquinolone or beta-lactam and macrolide IV

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39
Q

what is the treatment for beta blocker overdose

A

glucagon. it increases cAMP

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40
Q

what is the treatment for iron overdose

A

deferoxamine –iron chelator

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41
Q

what is the treatment for methanol or ethanol overdose

A

fomepizole. inhibits alcohol dehydrogenase

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42
Q

what is familial hypercholesterolemia

A

genetic disorder of high cholesterol caused by a mutation in the LDL receptor

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43
Q

what is the treatment for familial hypercholesterolemia

A

statins such as atorvastatin

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44
Q

what is the treatment for ventricular tachycardia

A

immediate defibrillation

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45
Q

How should chemical burns such as bleach be handled immediately

A

with copious irrigation with water.

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46
Q

what does ceftriaxone cover

A

broad spectrum, but as a third generation cephalosporin it also has gram negative coverage

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47
Q

what is cefazolin

A

this is a first generation ceph. it has good gram positive coverage

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48
Q

what is cefuroxime

A

second generation cephalopods. this has good abroad spec coverage of gram positive

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49
Q

Is doxycycline used in children

A

no. tooth discoloration

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50
Q

what is penicillin

A

beta lactam. used for narrow spectrum gram positive streptococcal infections

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51
Q

what is ceftriaxone

A

third generation cef. with good gram negative ad positive coverage

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52
Q

what is one of the most common presentations of Hodgkins lymphoma

A

mediastinal masses are found in upwards of 75% of patients with HL.

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53
Q

what is the presentation of Hodgkins lymphoma

A

B cell symptoms (weight loss and fever), lymphadenopathy and splenomegaly, 25-50% of cases are EBV positive, mediastinal masses are very common, superior vena cava syndrome, cough and stridor.

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54
Q

eosinophilic esophagitis is what

A

autoimmune inflammatory conidtion of the upper esophagus that results in chest pain and trouble swallowing it is often seen with other allergic conditions like asthma, atopic dermatitis, and food allergies. there must be greater than 20 eosinophils on endoscope guided biopsy

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55
Q

what is the presentation and prognosis for lichen planus?

A

classically appears with the 6 ps purple, planar, polygonal, pruritic papule and plaques with a predilection to the flexor surfaces

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56
Q

what are the histologic findings of lichen planus

A

irregular acanthosis, of the epidermis colloid/civette bodies –immunoglobulins and degenerated keratinocytes

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57
Q

what is foster-kennedy syndrome

A

tumor on the inferior surface of the frontal lobe such as ol factory groove tour. the symptoms are anosmia, ipsilateral scotomna, and contralateral papilledemta.

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58
Q

what is the presentation of trichomoniasis

A

vaginal and vulvar erythema, burning and pruritic, foul, thin yellow-green discharge

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59
Q

what is the treatment for trichomoniasis

A

metronidazole or tinidazole –partner must take as well.

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60
Q

what is the presentation of chlamydia

A

Cervicitis from Chlamydia trachomatis infection is characterized by vaginal discharge, abnormal vaginal bleeding, and purulent endocervical discharge. Pain may manifest with an ascending infection causing pelvic inflammatory disease.

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61
Q

what is the presentation of gonococcal infection

A

Most Neisseria gonorrhoeae infections are asymptomatic in women. N. gonorrhoeae cervicitis can manifest with vaginal pruritus, mucopurulent cervical discharge, dysuria, or perilabial pain.

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62
Q

what is the presentation of von hippel Lindau

A

AD familial multisystem tumopr syndrom caused by mutations in the VHL tumor suppressor. hemangioblastomas of the cerebellum, renal cell carcinoma, pheochromocytoma and pancreatic islet tumors.

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63
Q

what is HIV associated lipodystrophy

A

this is the loss of subcutaneous fat in individuals infected with HIV. it results in changes similar to cushings.

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64
Q

what is one cause of HIV associated lipodystrophy

A

protease inhibitors that are used to treat HIV

such as indinavir

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65
Q

what is a halo nevi

A

a nevus with a surrounding area of depigmentation.

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66
Q

what is halo nevus associated with

A

associated with vitiligo, turner’s syndrome and malignant melanoma

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67
Q

what is a pleomorphic adenoma

A

the most common salivary gland tumor. they are almost always benign, but have the potential to become malignant. they are biphasic tumors and contain a mixture of epithelial components in a mucoid myxoid cartilaginous or hyaline stroma

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68
Q

How does typhoid fever present

A

fever, abdominal pain, rose spots and dysentery.

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69
Q

what does salmonella typhii look like

A

gram negative motile rod.

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70
Q

what is the treatment for salmonella

A

antibiotics that treat gram negative such as ciproflaxacin, third generation cefalosporins such as ceftriaxone

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71
Q

what is the treatment for hemochromatosis

A

serial phlebotomy

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72
Q

what is choriocarcinoma

A

cancer characterized by the growth of malignant placental cytotophoblasts and syncytioblasts that lack chorionic villi. these tumors spread hematogenously and can present as hemoptysis and shortness of breath.

73
Q

what is the presentation of leptospirosis

A

jaundice, heptosplenomegaly, renal failure, and pulmonary hemorrhage, bilateral conjunctival injection

74
Q

where is leptospirosis found

A

zoonotic diseases transmitted by urine in contaminated water or soil

75
Q

what are the two most common causative organisms of pelvic inflammatory disease

A

chlamydia and gonorrhea

76
Q

how does PID present

A

purulent cervical discharge pain and fever

77
Q

what drugs do we give in acute coronary syndrome

A

anti-coagulants, anti-platelet, beta blockers and venous dilators are all recommended

78
Q

what does Ibuprofen do to the kidneys

A

causes acute kidney injury.

79
Q

what causes Acute kidney injury by NSAID

A

decreased production of prostaglandins which leads to reversible renal ischemia and reduced GFR.

80
Q

what is found in acute kidney injury

A

elevated creatinine and hyaline casts

81
Q

what is typically found with glomerular lesions or damage

A

significant proteinuria

82
Q

what is acute tubular necrosis

A

This is one of the most common causes of AKI due to ischemia or nephrotoxic drugs. muddy brown casts of epithelial cells or granular casts

83
Q

what is found in acute interstitial nephritis

A

white blood cells.

also pyuria, hematuria

84
Q

what is acute interstitial nephritis

A

nterstitial nephritis is an inflammation of the interstitium of the kidneys surrounding the tubules. Commonly causes include infection, or reaction to medication such as an analgesic or antibiotics such as methicillin. This disease is also caused by other diseases and toxins that damage the kidney. Both acute and chronic tubulointerstitial nephritis can be caused by pyelonephritis, but the most common cause is by an adverse reaction to a drug.

85
Q

what is chvostek’s sign and what does it show

A

this is tapping on the side fo the face and looking for muscle twitching. this is a sign of neuronal hyperexcitability. this is a sign of hypocalcemia

86
Q

what is mackonkey media

A

this is for bacteria that ferment lactose

87
Q

what is pseudomonas aeruginosa

A

gram negative rod that does not ferment lactose

88
Q

enterobacter aerogenes

A

this is a gram negative rod that does ferment lactose. it is a frequent nosocomial infection that causes UTI

89
Q

what is jarisch-herxheimer reaction

A

treatment of syphilis with penicillin G and characterized by headache, myelgias, hypotension, and tachycardia

90
Q

what happens to lipids in nephrotic syndrome

A

they increase –hyperlipidemia

the mechanism is hypoproteinuria from increased liver production of both protein and lipids

91
Q

what drugs cause interstitial nephritis

A

diuretics, NSAIDs, penicillins/cephalosporins/TMP-SMX, PPIs, rifampin

92
Q

what is CURB65 criteria and what is it used for

A

treatment guide and location for patients with community acquired pneumonia
confusion
uremia >20mg/dl
respirations >30
blood pressure <90 systolic; 60 diastolic
65 age.
one point for each criteria and the higher the score the increased risk for mortality

93
Q

what serum ascites albumin gradient indicates portal hypertension

A

> 1.1

94
Q

what is the earliest sign of kidney injury in diabetic nephropathy

A

increased GFR or hyperfiltration

95
Q

what does diabetes do the kidneys

A

thickens the GBM, mesangial expansion and glomerular sclerosis

96
Q

what are the treatments for outpatient treatment of community acquired pneumonia for a healthy person

A

macrolide or doxycycline

97
Q

what are the treatments for outpatient treatment of community acquired pneumonia for a person with comorbidities

A

fluoroquinolone or beta lactam + macrolide

98
Q

what are the treatments for inpatient community acquired pneumonia Non-ICU

A

fluoroquinolone (IV) or

beta-lactam + macrolide (IV)

99
Q

what are the treatments for inpatient community acquired pneumonia ICU

A

beta-lactam + macrolide (IV)

beta-lactam + fluoroquinolone

100
Q

what is the most common cause of hematuria in adults and what is the presentation

A

IgA nephropathy

gross hematuria 5 days after URI

101
Q

what does rhabdomyolysis do to the kidneys

A

causes acute tubular necrosis, hyperkalemia and elevated creatine kinase

102
Q

what are the copper chelators

A

D-peniillimine and trientine

103
Q

what is focal segmental glomerulosclerosis associated with

A

African American and hispanics, obesity, HIV and heroin use

104
Q

what is membranous nephropathy associated with

A

adenocarcinoma (breast and lung), NSAIDs, HepB, systemic Lupus, renal vein thrombosis

105
Q

what is membranoproliferative glomerulonephritis associated with

A

Hep B and C and lipodystrophy

106
Q

what is minimal change disease associated with

A

NSAIDs and lymphoma

107
Q

what is IgA nephropathy associated with

A

URI

108
Q

what can happen after a tonic clonic

A

post ictal lactic acidosis

109
Q

what nephrotic syndrome is associated with rheumatoid arthritis

A

amyloidosis

110
Q

what is the description of amyloidosis

A

apple green birefringence, Congo red

111
Q

what is Hep C infection associated with

A

cryoglobinuria

112
Q

what is osmotic diarrhea

A

high stool osmotic gap >125mOsm/kg. due to non absorbed osmotically active agents, such as lactose.

113
Q

what is a major side effect of amiodarone

A

drug induced interstitial nephritis

114
Q

what is the characteristic of biliary stasis

A

elevated alkaline phosphatase.

115
Q

what is the characteristic of extra-hepatic cholestasis

A

biliary dilation with elevated alkphos

116
Q

what is the characteristic of intrahepatic cholestasis

A

NO biliary dilation with elevated alkphos

117
Q

what are the causes of hyperbilirubinemia with normal LFTs and alkphos

A

dubin-johnson syndrome and rotors syndrome

118
Q

what is hepatopulmonary syndrome

A

due to intrapulmonary vascular dilations in the setting of chronic liver disease. leads to platypnea and orthodeoxia

119
Q

what is the test of choice for patient that has an intermediate risk for CAD

A

stress test

120
Q

what is the test of choice for a patient with a high risk for CAD

A

coronary angiogram

121
Q

what can beta-2 agonists cause

A

hypokalemia and thus muscle weakness

122
Q

what is the most common cause of aortic dissection

A

hypertension

123
Q

what physical exam maneuver can distinguish between hepatic and cardiac causes of edema

A

hepatojugular reflex. tilting the head to one side and pressing on the abdomen allows to test for JVD changes.
a positive test is suggestive of cardiac causes

124
Q

what is the treatment for acute TB

A

RIPE therapy rifampin, isoniazid,pyrazinamide, and either ethambutol or streptomycin

125
Q

what is the difference between primary hyperparathyroidism and familial hypocalciuric hypercalcemia

A

there is increased renal clearance of calcium in primary hyperparathyroidism

126
Q

what are hexagonic crystals on urinalysis indicative of

A

cystinuria

127
Q

How does renal failure cause coagulopathy

A

renal decreases urea clearance and this causes platelet dysfunction.

128
Q

how is platelet dysfunction by uremia managed

A

Desmopressin or hemodialysis

129
Q

what are the causes of reactive arthritis and how does it present

A

cant see, cant pee and cant climb a tree. conjunctival, urethral and polyarthalgia (achilles tendonitis), can also present with mouth ulcers
caused by various infections such as chlamydia, salmonella, etc.

130
Q

first line treatment for reactive arthritis

A

NSAIDs

131
Q

what is the laser tralet sign

A

multiple seborrheic keratoses begin associated with internal malignancy

132
Q

what are the long and short term treatments for dermatitis herpetiformis

A

acute dapsone and long term is gluten free diet

133
Q

what is the abortive and preventive therapies for prinzmetal angina

A

abortive is sublingual nitroglycerine and preventive is CCB.

134
Q

what hormonal changes are present in small cell lung cancer

A

SIADH and entropic ACTH or cushings

135
Q

how do we treat symptomatic bradycardia

A

acutely with atropine and one term itch pacemaker

136
Q

what is beck’s triad and what does it indicate

A

JVD, muffled heart sounds, hypotension indicates cardiac tamponade

137
Q

what is the EKG finding for cardiac tamponade

A

electrical alternans alternating low voltage QRS

138
Q

what should you think when a person has wheezing, hypotension, respiratory distress after a transfusion

A

IgA deficiency causing anapohylacis

139
Q

what is the presentation of Jarisch-herxheimer reaction

A

fever, headache, myalgia, diffuse macular rash on the palms and soles

140
Q

what is the presentation of CMV in an immunocompromised person

A

lung, liver, gut.

dyspnea, LFTs and diarrhea.

141
Q

what is the presentation of ehrlichiosis

A

flu-like illness after bite from lone star tick. licks the liver. elevated LFTs, leukopenia, thrombocytopenia

142
Q

what is the recommended treatment for infective endocarditis with pen sensitive strep

A

IV ceftriaxone or IV penicillin G for 4 weeks.

143
Q

what is the treatment for toxoplasmosis

A

sulfadiazine and pyrimethamine.

144
Q

what are the dermatological presentations of dermatomyositis

A

gottrons nodules and periorbital heliotrope rash

145
Q

what antibodies are associated with dermatomyocitis

A

anti-RNP, Jo-1, Mi-2

146
Q

what is the characteristic sign of diversticulosis bleeds

A

usually painless, large volume and self-limiting.

147
Q

what type of esophageal cancer is associated with smoking and alcohol consumption

A

squamous cell carcinoma.

148
Q

what is the classic hematuria for glomerular disease

A

microscopic

149
Q

what are the most common causes of glomerular disease

A

glomerulonephritis (post-strep, IgA) alport syndrome (basement membrane disease).

150
Q

what are the characteristic findings of rheumatoid arthritis

A

soft tissue swelling, osteopenia, erosions, and joint space narrowing. later changes are subluxation causing ulcer deviation, Z-thumb, boutonnueire and swan neck deformities. as well as ankylosis

151
Q

what is the most common feature of a mallory weis tear

A

hematemesis. distal esphageal rupture due to forceful retching.

152
Q

what is the smell of bitter almonds or breath of bitter almonds indicative of?

A

cyanide poisoning

153
Q

remember that chronic atopic dermatitis can cause what

A

lichen simplex chronicus

154
Q

what is porphyria cutanea tarda

A

caused by deficiency of uroporphyrinogen decarboxylase and leads to a build up of porphyrins in the blood. symptoms are photosensitivity and tea colored urine. may be precipitated by alcoholism

155
Q

what are the risk factors for porphyria cutanea tarda

A

alcoholism, hepatitis C, smoking, estrogen use,

156
Q

what happens to potassium in DKA

A

there is usually high blood potassium, but low total body potassium. Potassium needs to be administered during DKA

157
Q

what is the definition of euthyroid sick syndrome

A

when there is low t3 and or t4 with a normal functioning thyroid

158
Q

how long do troponins stay elevated in someone with an MI

A

apporx a week

159
Q

shortness of breath and hematuria with signs of nephrotic syndrome

A

goodpastures.

think lung and kidney.

160
Q

what is the histology of good pastures

A

crescent shape of the glomeruli. antibody attack ruptures the basement membrane

161
Q

what is a sign of intestinal transplant rejection

A

watery diarrhea.

Since the intestine is responsible for water reabsorption, lack of function is what you would see in rejection

162
Q

what antibodies are associated with hashimotos

A

anti-TPO and anti-thyroglobulin

163
Q

what is the most common cause of hypothyroid that is not iatrogenic

A

hashimotos

164
Q

what are the risk factors for DVT

A 
previous DVT
active cancer 
immobilization/bedridden > 3 days 
tenderness along venous tracts
unilateral leg selling
pitting edema 
if score is greater than or equal to 2 DVT likely
165
Q

give at least two examples of pro-kinetic agents for diabetic gastroparesis

A

metacloperamide and erythromycin

166
Q

ovarian mass and hyperthyroidism

A

think struma ovarii or teratoma

167
Q

which tumor causes torsion of the ovary

A

dermoid cyst

168
Q

what is the gene for severe combined immunodeficiency

A

adenosine deaminase

169
Q

what is the presentation and cause of MALT lymphoma

A

marginal zone B cell lymphoma is caused by H pylori infection. low grade type of non-hodgkin lymphoma.

170
Q

what is the treatment of thyroid disease in pregnancy

A

methimazole

171
Q

what is the treatment for community acquired cellulitis (even with nares positive MRSA)

A

TMP-SMX and cephalexin

vancomycin and clindamycin also cover staph.

172
Q

how can you tell that its papillary adenocarcinoma of the thyroid

A

there are psommoma bodies

173
Q

how does polymyositis present

A

PAIN and stiffness in the shoulders and weakness in the proximal muscles. there is elevated Ck, elevated aldolase and positive anti-jo-1 antibodies

174
Q

what is the presentation of polymyalgia rheumatica

A

proximal muscle PAIN and STIFFNESS with NO weakness. normal CK and aldolase
increased ESR.

175
Q

what cells are destroyed in MS

A

oligodendrocytes you asshol e

176
Q

what type of RX is SJS/TEN

A

type IV hypersensitivity

177
Q

what is the treatment for basal cell carcinoma or SCC in immunocompromised patients

A

MOHS

especially on cosmetically sensitive areas

178
Q

what is a common cardiovascular SE of OCPs

A

hypertension

Medicine (14 decks)

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