card review II Flashcards
what antibody is associated with primary sclerosing colangitis
P-ANCA
Are exudative plural effusions acidic, basic or normal
acidic
what are the features of Zollinger-Ellison syndrome
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)
what is the work up for ZE syndrome
endoscopy, CT/MRI and somatostatin receptor scintigraphy for tumor localization
what genetic condition is associated with ZE
MEN1
what is the definition of acute liver failure e
NO underlying disease, severe liver injury (AST/ALT > 1000), with hepatic encephalopathy and impaired synthetic function (INR > 1.5)
what are the features of Crohn’s disease
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
what are the features of ulcerative colitis
rectum (always) and colon, continuous lessons, no granuloma, mucosal and submucosal inflammation, pseudo polyps, bloody diarrhea, toxic megacolon
what are the features of primary sclerosing colangitis
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.
what is used to stabilize cardiac membrane in hyperkalemia
calcium infusion. Calcium glutinate.
what drug is infamous for turning your urine red
rifampin
what is hepatic hydrothroax
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.
what does a mitral valve regurgitation sound like
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
what are the causes of mitral valve regurgitation
ischemic heart disease, LV dilation, MVP
what is a tricuspid valve regurgitation
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
what is an aortic stenosis murmur
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,
what is often the cause of aortic stenosis
age related calcifications. or a bicuspid valve.
what drug delays the progression of primary billiary cholangitis
ursodeoxycholic acid
what is primary billiary colangitis
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.
what antibody is associated with primary biliary colangitis
antimitochondrial
what are the labs for primary biliary cholangitis
> > alkaline phos, increased transferases.
severe hypercholesteremia
what are the complications of primary biliary cholangitis
malabsorption, fat-solulable vit deficiency hepatocellular carcinoma, metabolic bone disease.
what is seen in post-streptococcal glomerulonephritis
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
what is the pharmaceutical therapy to reduce overall CVD mortality in peripheral artery disease
anti platelet (aspirin) and a statin
statins stabilize atherosclerotic plaques
who gets focal segmental glomerulonephritis
fat, black, heroin, HIV
what are the labs for acute tubular necrosis
elevated BUN and creatinine (<20:1 ratio) urine sodium >20 and FeNA >2% kidneys are not working and cannot reabsorb.
What effect does alcohol have on the CVS
causes hypertension
is aspirin an anti platelet
yes
what is tamsulosin
alpha 1 blocker
what is the definition of nephrotic syndrome
edema, hypoalbuminemia, and proteinuria >3.5g/24 hours
what are the causes of WBC casts
acute interstitial nephritis, pyenephritis
what does elevated PCWP indicate
cardiogenic origin; typically cardiogenic shock
what is the CHADSVAS scoring
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
what antihypertensive is associated with peripheral edema
dihydropyridine calcium channel blockers
what is a cause of dilated cardiomyopathy and how does it present
coxsackie virus B.
recent URI then CHF, dilated ventricles, with diffuse hypokinesia, and low ejection fraction.
what is the initial management of a patient with pulmonary HTN that presents with JVD, low ejection fraction, bibasilar crackles,
loop diuretics and ACEi
the loop will help with the fluid overload and the ACE will stop further cardiac remodeling
If you have a patient in renal failure what should you think
uremia
If you have renal failure patient with pericarditis, what should you think
uremic pericarditis
what is the treatment for uremic pericarditis
hemodialysis NSAIDs
what is the first test for acute pancreatitis
amylase and lipase
what is the treatment for a hemodynamically stable patient with beta blocker over dosse
atropine and IV fluids
what is the treatment for a refractory beta blocker overdose patient
glucagon
why are beta blockers and CCB used for chronic stable angina
they are first line therapies because they reduce cardiac contractility and heart rate.
what is the work up for a patient with chest pain but a low risk for CAD
No further work up
what is the most common cause of sudden cardiac arrest in the immediate post infarction period
reentrant ventricular arrhythmia
what two antibodies are associated with celiac
IgA antiendomysial and antitissue transglutaminase
what is the most effective non pharmacological way to reduce BP in an otherwise healthy smoker with alcohol history
DASH dietary approaches to stopping hypertension
what is the presentation of acute bronchitis
preceding respiratory illness, cough for 5 days to 3 weeks, can be productive, absent systemic findings, wheezing or rhonchi, chest wall tenderness.
how does ventricular aneurysm pressent
2 months post MI CHF with persistent elevations/deep Q waves on ECG
what do you always give with IV acyclovir
IV fluids because it reduces the strain on the kidneys
when you see atherosclerosis what should you think
hypertension
what acid-base disturbance is associated with addisons and why
normal anion-gap metabolic acidosis
decreased aldoteromne means less Na in less acid and potassium out
what is the S4 and what is it associated with
atrial gallop. myocardial infarction
when is the S4 sound normal
in OLDER adults
when is the S4 abnormal
in younger adults and children. indicates ventricular hypertrophy and acute MI
what is the cause of a unilateral varicocele that fails to empty when the patient is laying down
renal cell carcinoma
what are the associated findings indicative of renal cell carcinoma
fever, anemia/erythrocytosis, thrombocytosis hypercalcemia, cachexia
what is SIADH
syndrome of inappropriate antidiuretic hormone causes the body to retain too much water.
what is nephrogenic diabetes insipidus
This is when the kidney cannot concentrate urine, thus the body excretes excessive dilute urine. It is not responsive to Desmopressin or water deprivation.
what imaging test is preferred for acalculus cholecystitis
ultrasound
what happens when people have multiple blood transfusions
they become hypocalcemia because of the citrate.
what is trousseau sign for hypocalcemia
you place a cuff around the persons arm and inflate it higher than the systolic bp and then the hand flexes
what is the first line therapy for central diabetes insidious
desmopressin
what is the treatment for hypocalcemia
calcium gluconate
what does aldosterone do
when secreted in the body it’s job is to retain fluid, the RAAS system. this system retains sodium and excretes potassium
why do some people become hypokalemic when placed on thiazide diuretics
because of primary hyperaldosteronism. when their fluids are reduced from the diuretic, the system overcompensates and potassium is lost
what are the wells criteria for PE
is a PE likely clinical signs of a DVT hemoptysis previous PE or DVT malignancy immobilization heart rate greater than 100
what is MEN 1
primary hyperparathyroidism, pituitary tumors, pancreatic tumors.
MEN1 –ALL P’S
what is MEN2A
medullary thyroid cancer (calcitonin), pheochromocytoma, parathyroid hyperplasia
what is MEN2B
medullary thyroid cancer, pheochromocytoma, mucosal neuroma and marfanoid habitus
what syndrome can look very similar to PCOS
cushings
what are the differences between cushings and PCOS
cushings causes muscle weakness and easy bruisability
what is Addison’s disease
autoimmune destruction of the adrenal glands. this is primary adrenal insufficiency
what is the treatment for menstrual cycles in PCOS
weight loss (peripheral conversion of estrogens) and OCP
what are the two most common ocular presentations of hyperthyroidism
exophthalmos and lid lag
what are some pro kinetic agents used in diabetic gastroparesis
metaclopromide, erythromycin and cisapride
what labs are expected in osteomalacia
decreased or normal calcium, decreased phosphorus and increased alkaline phosphatase.
what are the causes of high anion gap metabolic acidosis
MUDPILES methanol uremia diabetic ketoacidosis propylene glycol isoniazid/iron lactic acidosis ethylene glycol salicylates
why are mineralcoritcoids normal in secondary adrenal insufficiency
because the mineralocorticoids are regulated by RAAS, not the same systme
what is diabetes insipidus
when you cannot concentrate urine.
what is the difference between central and nephrogenic diabetes insipidus
central there is high serum sodium due to decreased release of ADH from the pituitary. in nephrogenic the serum sodium is typically normal
how does alkalosis affect ionized calcium and why
decreased because albumin has a higher binding affinity in alkalosis
how does acidosis affect ionized calcium and why
increased because albumin has a lower binding efficiency in acidosis
what does hypotension with low JVP indicate
inadequate preload
how does a VIPoma present
flushing, watery diarrhea, hypokalemia, achlorhydria, VIP level greater than 75. there will be decreased gastric acid secretion
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.
total potassium decreases (osmotic diuresis)
labs show increased or normal potassium due to low insulin potassium will come out of cells
what diseases cause low DLCO with obstructive pattern
emphysema
what diseases cause low DLCO with restrictive pattern
interstitial lung disease, sarcoidosis, asbestosis, heart failure
what diseases cause low DLCO with normal spirometry
anemia, PE, pulmonary HTN
what diseases cause normal DLCO but a obstructive pattern
chronic bronchitis, asthma
what diseases cause normal DLCO but a restrictive pattern
neuromuscular disease, musculoskeletal deformity
what diseases cause normal DLCO but a normal spirometry
none
what diseases cause increased DLCO but a obstructive pattern
asthma
what diseases cause increased DLCO but a restrictive pattern
morbid obesity
what diseases cause increased DLCO but a normal spirometry
pulmonary hemorrhage opr polycythemia
what happens to ADH in primary adrenal insufficiency
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
what are the characteristics of ovarian tumors that secrete androgens
elevated testosterone, normal DHEAS. causes hirsutism,
what is the ratio of AST/ALT in alcoholic fatty liver
> 2
what is the ratio of AST/ALT in nonalcoholic fatty liver
<1
what diabetes drug causes weight loss
GLP-1 agonists
what are the characteristics of primary hyperaldosteronism
hypertension, metabolic alkalosis, hypokalemia, low plasma renin,
what is the medical treatment for primary hyperaldosteronism
spironolactone
what do you usually find in renovascular hypertension
continuous abdominal bruit
what labs confirm primary adrenal insufficiency
low cortisol with high ACTH
how do labs change in vitamin d deficiency
calcium, phosphate, PTH
Calcium decreased, phosphate decreased, and PTH increased
what is the distinguishing factor for MEN2B
mucosal neuromas marfanoid habitus
What is the diagnosis for a patient with infective endocarditis that develops AV heart block
perivalvular abscess
what is an example of a copper chelator
D-penicillamine
how do we treat severe hyponatremia caused by SIADH
hypertonic saline
what symptoms does b12 anemia cause
shiny tongue, palor of the palmer creases and hemolysis (due to ineffective erythropoiesis
what is tumor lysis syndrome
release of uric acid and potassium causing hyperkalemia and hyperuricemia leading to hypocalcemia. this causes premature ventricular beats and AKI
what is pathophysiology of thrombotic thrombocytopenic purpura
decreased ADAMTS13 uncleaved vWF multimers platelet trapping and activation. can be acquired or hereditary.
what are the features of TTP
hemolytic anemia (increased LDH, decreased haptoglobin) with schistocytes. thrombocytopenia, sometimes with fever, neurologic manifestations, renal failure.
what is the management for TTP
plasma exchange
what is a serious SE of PTU or methimazole
agranulocytosis
what is salvage therapy
when therapy is given after standard treatments dont work
what is adjuvant therapy
when the standard treatment and adjuvant therapy such as radiation is given
what is neoadjuvant therapy
when adjuvant therapy is given before standard treatment
what are the EKG findings for left ventricular hypertrophy
ST-segment depression/T-wave inversion in leads V5-6
what disease is associated with gallbladder carcinoma
primary sclerosing cholangitis
what is waldenstroms macroglobinemia
plasma cell dyscrasia similar to multiple myeloma except that the excess serum protein is IgM rather IgA or IgA.
how does waldenstroms macroglobinemia present
as a hyperviscosity syndrome characterized by headaches or blurred vision
what is monoclonal gammopathy of unknown significance
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
what is the presentation of hepatitis b acute infection
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
what tests should be performed for adrenal insufficiency
morning cortisol, plasma ACTH and cosyntropin stimulation test
what is the confirmatory test for heparin induced thrombocytopenia
serotonin release assay
what is the hallmark of hereditary spherocytosis
increased MCHC
what is rheumatoid factor
it is an autoantibody to the Fc portion of IgG
what is cobalamin deficiency
macrocytic anemia and neurological dysfunction.
how do we screen for pheocromocytoma
plasma fractionated metanephrine assay
why does niacin cause flushing and pruritis and what can be done about it
prostaglandin induced peripheral vasodilation.
treat with low dose aspirin
what characterizes anemia of chronic disease
high ferritin, low iron, low total iron binding capacity
what happens to bicarb levels in chronic respiratory acidosis
They increase proportionately with pCO2. this is compensation
what is a common cause of erythema multiorme
viral infections such as herpes simplex.
herpes is one of the most common causes of EM; mycoplasma pneumoniae is another common cause.
what is the presentation of herpes simplex
prodromal symptoms such as fever, malaise and itching and burning at this site of eruption
how does biliary colic differ from cholecystitis
cystitis usually has fever, abdominal tenderness on palpation and leukocytosis
what two things improve survival in COPD
smoking cessation and long term O2 therapy
what antibiotics are used for refractory acne vulgaris
erythromycin and clindamycin
when is an AIDS patient susceptible to pneumocystis and what is the prophylaxis
CD4 < 200
TMP-SMX
when is an AIDS patient susceptible to toxoplasmosis
CD4<100
TMP-SMX
what are the EKG findings for left ventricular hypertrophy
ST-segment depression/T-wave inversion in leads V5-6
what vitamin is responsible for calcium and phosphate absorption
vitamin D
what ions are increased in tumor lysis syndrome
phosphate, potassium and uric acid due to cellular lysis
what ion is reduced in tumor lysis syndrome and why
calcium is reduced because phosphate binds it
what parasite do we contract from ingesting dog feces
echinococcus granulosus
what is the treatment for echinococcus granulosus
albendazole
what is the confirmatory test for heparin induced thrombocytopenia
serotonin release assay
what is the hallmark of hereditary spherocytosis
increased MCHC
what is rheumatoid factor
it is an autoantibody to the Fc portion of IgG
which antibiotics provide anaerobic coverage
amoxicillin-clavulanate, clindamycin, metronidazole + amoxicillin
how do we screen for pheocromocytoma
plasma fractionated metanephrine assay
why does niacin cause flushing and pruritis and what can be done about it
prostaglandin induced peripheral vasodilation.
treat with low dose aspirin
what characterizes anemia of chronic disease
high ferritin, low iron, low total iron binding capacity
what is the cause of leprosy
mycobacterium leprae
How is leprosy transmitted and what is the vector
droplets, armadillo
what is the treatment for leprosy
dapsone and rifampin
add clofazimine if severe.
how does biliary colic differ from cholecystitis
cystitis usually has fever, abdominal tenderness on palpation and leukocytosis
what is the classic presentation of rosacea
flushing, telangiectasia that can preceipated by hot drinks or alcohol
when is an AIDS patient susceptible to pneumocystis
CD4 < 200
when is an AIDS patient susceptible to toxoplasmosis
CD4<100
what is the prophylaxis for MAC
azithromycin
how does infective endocarditis present
splinter hemorrhages, fever, malaise, aortic regurgitation following dental procedure
what is associated with seborrheic dermatitis
HIV and parkinsons
what is the treatment for seborrheic dermatitis
topical antifungals. usually associated with malassezia infections
