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Medicine > card review II > Flashcards

card review II Flashcards

1
Q

what antibody is associated with primary sclerosing colangitis

A

P-ANCA

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2
Q

Are exudative plural effusions acidic, basic or normal

A

acidic

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3
Q

what are the features of Zollinger-Ellison syndrome

A

multiple, refractory peptic ulcers, with ulcers that are distal to the duodenum, chronic diarrhea.
there is elevated serum gastrin, (>1000) in the presence of normal gastric pH (<4)

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4
Q

what is the work up for ZE syndrome

A

endoscopy, CT/MRI and somatostatin receptor scintigraphy for tumor localization

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5
Q

what genetic condition is associated with ZE

A

MEN1

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6
Q

what is the definition of acute liver failure e

A

NO underlying disease, severe liver injury (AST/ALT > 1000), with hepatic encephalopathy and impaired synthetic function (INR > 1.5)

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7
Q

what are the features of Crohn’s disease

A

skip lesions, extending from mouth to the anus, rectum spared, perianal abscesses, non caveating granuloma, transmural inflammation, linear mucosal ulcerations, cobblestoning, creeping fat, diarrhea, fistulas, strictures

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8
Q

what are the features of ulcerative colitis

A

rectum (always) and colon, continuous lessons, no granuloma, mucosal and submucosal inflammation, pseudo polyps, bloody diarrhea, toxic megacolon

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9
Q

what are the features of primary sclerosing colangitis

A

fatigue and pruritis, 90% have underlying inflmmatory bowel disease, cholestatic liver function panels (aminotransferase <300) multifocal stricturing dilation of the intrahepatic and or extra hepatic bile ducts, fibrous obliteration of the bile ducts with concentric replacement by connective tissue in an onion skin pattern.

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10
Q

what is used to stabilize cardiac membrane in hyperkalemia

A

calcium infusion. Calcium glutinate.

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11
Q

what drug is infamous for turning your urine red

A

rifampin

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12
Q

what is hepatic hydrothroax

A

possible complication of cirrhosis that causes transudative plural effusions due to defects in the diaphragm, especially on the right.

so in patients with liver failure, listen to their lungs because of hepatic hydrothorax, especially on the right.

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13
Q

what does a mitral valve regurgitation sound like

A

holosystolic, blowing murmur, loudest at the apex of the heart and radiates to the axilla, enhanced by maneuvers that increase the total peripheral resistance, such as squatting

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14
Q

what are the causes of mitral valve regurgitation

A

ischemic heart disease, LV dilation, MVP

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15
Q

what is a tricuspid valve regurgitation

A

holosystolic, blowing murmur, loudest at thetricuspid area and radiates to the right sternal border. enhanced by inspiration or things that increase venous return. commonly caused by right ventricular dilation. rheumatic fever and infective endocarditis can cause either MR TR

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16
Q

what is an aortic stenosis murmur

A

crescendo-decrescendo, systolic ejection murmur, LV»aortic pressure during stole
loudest at the base and radiates to the carotids, Pulsus Parus et tardus –pulses are weak with a delayed peak. Can lead to syncope angina, and dyspnea on exertion,

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17
Q

what is often the cause of aortic stenosis

A

age related calcifications. or a bicuspid valve.

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18
Q

what drug delays the progression of primary billiary cholangitis

A

ursodeoxycholic acid

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19
Q

what is primary billiary colangitis

A

autoimmune destruction of the intrahepatic bile ducts. typically affects middle aged women, with an insidious onset of fatigue and pruritis, progressive jaundice, hepatomegaly, cirrhosis, cutaneous xanthomas.

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20
Q

what antibody is associated with primary biliary colangitis

A

antimitochondrial

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21
Q

what are the labs for primary biliary cholangitis

A

> > alkaline phos, increased transferases.

severe hypercholesteremia

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22
Q

what are the complications of primary biliary cholangitis

A

malabsorption, fat-solulable vit deficiency hepatocellular carcinoma, metabolic bone disease.

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23
Q

what is seen in post-streptococcal glomerulonephritis

A

usually 10-21 after URI, more common in children, (6-10), gross hematuria, low complement C3 levels, elevated streptolysin O and anti-DNAse B, RBC casts, mild proteinuria

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24
Q

what is the pharmaceutical therapy to reduce overall CVD mortality in peripheral artery disease

A

anti platelet (aspirin) and a statin

statins stabilize atherosclerotic plaques

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25
Q

who gets focal segmental glomerulonephritis

A

fat, black, heroin, HIV

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26
Q

what are the labs for acute tubular necrosis

A

elevated BUN and creatinine (<20:1 ratio) urine sodium >20 and FeNA >2% kidneys are not working and cannot reabsorb.

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27
Q

What effect does alcohol have on the CVS

A

causes hypertension

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28
Q

is aspirin an anti platelet

A

yes

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29
Q

what is tamsulosin

A

alpha 1 blocker

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30
Q

what is the definition of nephrotic syndrome

A

edema, hypoalbuminemia, and proteinuria >3.5g/24 hours

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31
Q

what are the causes of WBC casts

A

acute interstitial nephritis, pyenephritis

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32
Q

what does elevated PCWP indicate

A

cardiogenic origin; typically cardiogenic shock

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33
Q

what is the CHADSVAS scoring

A 
Congestive heart failure
Hypertension
Age2 ≥75
Diabetes mellitus 
Stroke2/TIA/thromboembolus
Vascular disease
Age 65-74
Sex category (female)

If there is a 2, then its worth two points. maximum score of 9.

0 score, low risk, no treatment.
1 intermediate, aspirin or oral coagulant
2 or higher, High, oral anticoagulants

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34
Q

what antihypertensive is associated with peripheral edema

A

dihydropyridine calcium channel blockers

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35
Q

what is a cause of dilated cardiomyopathy and how does it present

A

coxsackie virus B.

recent URI then CHF, dilated ventricles, with diffuse hypokinesia, and low ejection fraction.

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36
Q

what is the initial management of a patient with pulmonary HTN that presents with JVD, low ejection fraction, bibasilar crackles,

A

loop diuretics and ACEi

the loop will help with the fluid overload and the ACE will stop further cardiac remodeling

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37
Q

If you have a patient in renal failure what should you think

A

uremia

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38
Q

If you have renal failure patient with pericarditis, what should you think

A

uremic pericarditis

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39
Q

what is the treatment for uremic pericarditis

A

hemodialysis NSAIDs

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40
Q

what is the first test for acute pancreatitis

A

amylase and lipase

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41
Q

what is the treatment for a hemodynamically stable patient with beta blocker over dosse

A

atropine and IV fluids

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42
Q

what is the treatment for a refractory beta blocker overdose patient

A

glucagon

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43
Q

why are beta blockers and CCB used for chronic stable angina

A

they are first line therapies because they reduce cardiac contractility and heart rate.

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44
Q

what is the work up for a patient with chest pain but a low risk for CAD

A

No further work up

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45
Q

what is the most common cause of sudden cardiac arrest in the immediate post infarction period

A

reentrant ventricular arrhythmia

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46
Q

what two antibodies are associated with celiac

A

IgA antiendomysial and antitissue transglutaminase

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47
Q

what is the most effective non pharmacological way to reduce BP in an otherwise healthy smoker with alcohol history

A

DASH dietary approaches to stopping hypertension

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48
Q

what is the presentation of acute bronchitis

A

preceding respiratory illness, cough for 5 days to 3 weeks, can be productive, absent systemic findings, wheezing or rhonchi, chest wall tenderness.

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49
Q

how does ventricular aneurysm pressent

A

2 months post MI CHF with persistent elevations/deep Q waves on ECG

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50
Q

what do you always give with IV acyclovir

A

IV fluids because it reduces the strain on the kidneys

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51
Q

when you see atherosclerosis what should you think

A

hypertension

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52
Q

what acid-base disturbance is associated with addisons and why

A

normal anion-gap metabolic acidosis

decreased aldoteromne means less Na in less acid and potassium out

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53
Q

what is the S4 and what is it associated with

A

atrial gallop. myocardial infarction

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54
Q

when is the S4 sound normal

A

in OLDER adults

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55
Q

when is the S4 abnormal

A

in younger adults and children. indicates ventricular hypertrophy and acute MI

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56
Q

what is the cause of a unilateral varicocele that fails to empty when the patient is laying down

A

renal cell carcinoma

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57
Q

what are the associated findings indicative of renal cell carcinoma

A

fever, anemia/erythrocytosis, thrombocytosis hypercalcemia, cachexia

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58
Q

what is SIADH

A

syndrome of inappropriate antidiuretic hormone causes the body to retain too much water.

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59
Q

what is nephrogenic diabetes insipidus

A

This is when the kidney cannot concentrate urine, thus the body excretes excessive dilute urine. It is not responsive to Desmopressin or water deprivation.

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60
Q

what imaging test is preferred for acalculus cholecystitis

A

ultrasound

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61
Q

what happens when people have multiple blood transfusions

A

they become hypocalcemia because of the citrate.

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62
Q

what is trousseau sign for hypocalcemia

A

you place a cuff around the persons arm and inflate it higher than the systolic bp and then the hand flexes

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63
Q

what is the first line therapy for central diabetes insidious

A

desmopressin

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64
Q

what is the treatment for hypocalcemia

A

calcium gluconate

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65
Q

what does aldosterone do

A

when secreted in the body it’s job is to retain fluid, the RAAS system. this system retains sodium and excretes potassium

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66
Q

why do some people become hypokalemic when placed on thiazide diuretics

A

because of primary hyperaldosteronism. when their fluids are reduced from the diuretic, the system overcompensates and potassium is lost

67
Q

what are the wells criteria for PE

A 
is a PE likely 
clinical signs of a DVT
hemoptysis 
previous PE or DVT
malignancy 
immobilization 
heart rate greater than 100
68
Q

what is MEN 1

A

primary hyperparathyroidism, pituitary tumors, pancreatic tumors.

MEN1 –ALL P’S

69
Q

what is MEN2A

A

medullary thyroid cancer (calcitonin), pheochromocytoma, parathyroid hyperplasia

70
Q

what is MEN2B

A

medullary thyroid cancer, pheochromocytoma, mucosal neuroma and marfanoid habitus

71
Q

what syndrome can look very similar to PCOS

A

cushings

72
Q

what are the differences between cushings and PCOS

A

cushings causes muscle weakness and easy bruisability

73
Q

what is Addison’s disease

A

autoimmune destruction of the adrenal glands. this is primary adrenal insufficiency

74
Q

what is the treatment for menstrual cycles in PCOS

A

weight loss (peripheral conversion of estrogens) and OCP

75
Q

what are the two most common ocular presentations of hyperthyroidism

A

exophthalmos and lid lag

76
Q

what are some pro kinetic agents used in diabetic gastroparesis

A

metaclopromide, erythromycin and cisapride

77
Q

what labs are expected in osteomalacia

A

decreased or normal calcium, decreased phosphorus and increased alkaline phosphatase.

78
Q

what are the causes of high anion gap metabolic acidosis

A 
MUDPILES
methanol 
uremia
diabetic ketoacidosis
propylene glycol 
isoniazid/iron
lactic acidosis 
ethylene glycol 
salicylates
79
Q

why are mineralcoritcoids normal in secondary adrenal insufficiency

A

because the mineralocorticoids are regulated by RAAS, not the same systme

80
Q

what is diabetes insipidus

A

when you cannot concentrate urine.

81
Q

what is the difference between central and nephrogenic diabetes insipidus

A

central there is high serum sodium due to decreased release of ADH from the pituitary. in nephrogenic the serum sodium is typically normal

82
Q

how does alkalosis affect ionized calcium and why

A

decreased because albumin has a higher binding affinity in alkalosis

83
Q

how does acidosis affect ionized calcium and why

A

increased because albumin has a lower binding efficiency in acidosis

84
Q

what does hypotension with low JVP indicate

A

inadequate preload

85
Q

how does a VIPoma present

A

flushing, watery diarrhea, hypokalemia, achlorhydria, VIP level greater than 75. there will be decreased gastric acid secretion

86
Q

what happens to potassium in HHS and DKA (there are two ways to think about this, one is total potassium and the other serum labs.

A

total potassium decreases (osmotic diuresis)

labs show increased or normal potassium due to low insulin potassium will come out of cells

87
Q

what diseases cause low DLCO with obstructive pattern

A

emphysema

88
Q

what diseases cause low DLCO with restrictive pattern

A

interstitial lung disease, sarcoidosis, asbestosis, heart failure

89
Q

what diseases cause low DLCO with normal spirometry

A

anemia, PE, pulmonary HTN

90
Q

what diseases cause normal DLCO but a obstructive pattern

A

chronic bronchitis, asthma

91
Q

what diseases cause normal DLCO but a restrictive pattern

A

neuromuscular disease, musculoskeletal deformity

92
Q

what diseases cause normal DLCO but a normal spirometry

A

none

93
Q

what diseases cause increased DLCO but a obstructive pattern

A

asthma

94
Q

what diseases cause increased DLCO but a restrictive pattern

A

morbid obesity

95
Q

what diseases cause increased DLCO but a normal spirometry

A

pulmonary hemorrhage opr polycythemia

96
Q

what happens to ADH in primary adrenal insufficiency

A

increased; there will be excess corticotropin releasing hormone, since the adrenals are not responding and thus excessive stimulation of ADH release due to dilution hyponatremia

97
Q

what are the characteristics of ovarian tumors that secrete androgens

A

elevated testosterone, normal DHEAS. causes hirsutism,

98
Q

what is the ratio of AST/ALT in alcoholic fatty liver

A

> 2

99
Q

what is the ratio of AST/ALT in nonalcoholic fatty liver

A

<1

100
Q

what diabetes drug causes weight loss

A

GLP-1 agonists

101
Q

what are the characteristics of primary hyperaldosteronism

A

hypertension, metabolic alkalosis, hypokalemia, low plasma renin,

102
Q

what is the medical treatment for primary hyperaldosteronism

A

spironolactone

103
Q

what do you usually find in renovascular hypertension

A

continuous abdominal bruit

104
Q

what labs confirm primary adrenal insufficiency

A

low cortisol with high ACTH

105
Q

how do labs change in vitamin d deficiency

calcium, phosphate, PTH

A

Calcium decreased, phosphate decreased, and PTH increased

106
Q

what is the distinguishing factor for MEN2B

A

mucosal neuromas marfanoid habitus

107
Q

What is the diagnosis for a patient with infective endocarditis that develops AV heart block

A

perivalvular abscess

108
Q

what is an example of a copper chelator

A

D-penicillamine

109
Q

how do we treat severe hyponatremia caused by SIADH

A

hypertonic saline

110
Q

what symptoms does b12 anemia cause

A

shiny tongue, palor of the palmer creases and hemolysis (due to ineffective erythropoiesis

111
Q

what is tumor lysis syndrome

A

release of uric acid and potassium causing hyperkalemia and hyperuricemia leading to hypocalcemia. this causes premature ventricular beats and AKI

112
Q

what is pathophysiology of thrombotic thrombocytopenic purpura

A

decreased ADAMTS13 uncleaved vWF multimers platelet trapping and activation. can be acquired or hereditary.

113
Q

what are the features of TTP

A

hemolytic anemia (increased LDH, decreased haptoglobin) with schistocytes. thrombocytopenia, sometimes with fever, neurologic manifestations, renal failure.

114
Q

what is the management for TTP

A

plasma exchange

115
Q

what is a serious SE of PTU or methimazole

A

agranulocytosis

116
Q

what is salvage therapy

A

when therapy is given after standard treatments dont work

117
Q

what is adjuvant therapy

A

when the standard treatment and adjuvant therapy such as radiation is given

118
Q

what is neoadjuvant therapy

A

when adjuvant therapy is given before standard treatment

119
Q

what are the EKG findings for left ventricular hypertrophy

A

ST-segment depression/T-wave inversion in leads V5-6

120
Q

what disease is associated with gallbladder carcinoma

A

primary sclerosing cholangitis

121
Q

what is waldenstroms macroglobinemia

A

plasma cell dyscrasia similar to multiple myeloma except that the excess serum protein is IgM rather IgA or IgA.

122
Q

how does waldenstroms macroglobinemia present

A

as a hyperviscosity syndrome characterized by headaches or blurred vision

123
Q

what is monoclonal gammopathy of unknown significance

A

monoclonal expansion of plasma cells and the most common type of plasma cell dyscrasia has the potential to turn into multiple myeloma or waldenstroms macroglobinemia

124
Q

what is the presentation of hepatitis b acute infection

A

serum sickness-like syndrome with fever, arthalgias, and palpable purpura due to circulating cryoglobulins (uncommon cause –more associated with C)
remember AST/ALT in the 1,000s

125
Q

what tests should be performed for adrenal insufficiency

A

morning cortisol, plasma ACTH and cosyntropin stimulation test

126
Q

what is the confirmatory test for heparin induced thrombocytopenia

A

serotonin release assay

127
Q

what is the hallmark of hereditary spherocytosis

A

increased MCHC

128
Q

what is rheumatoid factor

A

it is an autoantibody to the Fc portion of IgG

129
Q

what is cobalamin deficiency

A

macrocytic anemia and neurological dysfunction.

130
Q

how do we screen for pheocromocytoma

A

plasma fractionated metanephrine assay

131
Q

why does niacin cause flushing and pruritis and what can be done about it

A

prostaglandin induced peripheral vasodilation.

treat with low dose aspirin

132
Q

what characterizes anemia of chronic disease

A

high ferritin, low iron, low total iron binding capacity

133
Q

what happens to bicarb levels in chronic respiratory acidosis

A

They increase proportionately with pCO2. this is compensation

134
Q

what is a common cause of erythema multiorme

A

viral infections such as herpes simplex.

herpes is one of the most common causes of EM; mycoplasma pneumoniae is another common cause.

135
Q

what is the presentation of herpes simplex

A

prodromal symptoms such as fever, malaise and itching and burning at this site of eruption

136
Q

how does biliary colic differ from cholecystitis

A

cystitis usually has fever, abdominal tenderness on palpation and leukocytosis

137
Q

what two things improve survival in COPD

A

smoking cessation and long term O2 therapy

138
Q

what antibiotics are used for refractory acne vulgaris

A

erythromycin and clindamycin

139
Q

when is an AIDS patient susceptible to pneumocystis and what is the prophylaxis

A

CD4 < 200

TMP-SMX

140
Q

when is an AIDS patient susceptible to toxoplasmosis

A

CD4<100

TMP-SMX

141
Q

what are the EKG findings for left ventricular hypertrophy

A

ST-segment depression/T-wave inversion in leads V5-6

142
Q

what vitamin is responsible for calcium and phosphate absorption

A

vitamin D

143
Q

what ions are increased in tumor lysis syndrome

A

phosphate, potassium and uric acid due to cellular lysis

144
Q

what ion is reduced in tumor lysis syndrome and why

A

calcium is reduced because phosphate binds it

145
Q

what parasite do we contract from ingesting dog feces

A

echinococcus granulosus

146
Q

what is the treatment for echinococcus granulosus

A

albendazole

147
Q

what is the confirmatory test for heparin induced thrombocytopenia

A

serotonin release assay

148
Q

what is the hallmark of hereditary spherocytosis

A

increased MCHC

149
Q

what is rheumatoid factor

A

it is an autoantibody to the Fc portion of IgG

150
Q

which antibiotics provide anaerobic coverage

A

amoxicillin-clavulanate, clindamycin, metronidazole + amoxicillin

151
Q

how do we screen for pheocromocytoma

A

plasma fractionated metanephrine assay

152
Q

why does niacin cause flushing and pruritis and what can be done about it

A

prostaglandin induced peripheral vasodilation.

treat with low dose aspirin

153
Q

what characterizes anemia of chronic disease

A

high ferritin, low iron, low total iron binding capacity

154
Q

what is the cause of leprosy

A

mycobacterium leprae

155
Q

How is leprosy transmitted and what is the vector

A

droplets, armadillo

156
Q

what is the treatment for leprosy

A

dapsone and rifampin

add clofazimine if severe.

157
Q

how does biliary colic differ from cholecystitis

A

cystitis usually has fever, abdominal tenderness on palpation and leukocytosis

158
Q

what is the classic presentation of rosacea

A

flushing, telangiectasia that can preceipated by hot drinks or alcohol

159
Q

when is an AIDS patient susceptible to pneumocystis

A

CD4 < 200

160
Q

when is an AIDS patient susceptible to toxoplasmosis

A

CD4<100

161
Q

what is the prophylaxis for MAC

A

azithromycin

162
Q

how does infective endocarditis present

A

splinter hemorrhages, fever, malaise, aortic regurgitation following dental procedure

163
Q

what is associated with seborrheic dermatitis

A

HIV and parkinsons

164
Q

what is the treatment for seborrheic dermatitis

A

topical antifungals. usually associated with malassezia infections

Medicine (14 decks)

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