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Year 3 > COMBANK IM COMAT > Flashcards

COMBANK IM COMAT Flashcards

1
Q

H Pylori treatment

A

triple therapy: PPI (omeprazole), clarithromycin, and amoxicillin
— twice daily dosing

O-CLAM

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2
Q

What is H Pylori quadruple therapy? When to use?

A

Quadruple therapy is less preferred and is currently used if there is recurrence.
It consists of omeprazole 20 mg twice daily, bismuth subsalicylate 2 tabs four times daily, tetracycline 500 mg four times daily, and metronidazole 500 mg three times daily

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3
Q

H pylori chronic gastritis predisposes to what?

A

MALT Lymphoma (MALTomas)

Pathophys:

  • accumulation of CD4+ lymphocytes and mature B cells in the gastric lamina propria in H pylori-induced gastritis.
  • antigens produced from H. pylori activate T and B cell proliferation, and lymphoid follicle formation
  • If this is persistent if can become a monoclonal lymphoma (B cells)
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4
Q

deficiency in vitamin B3

A

(niacin)

Pellagra
4 D’s: dermatitis, diarrhea, dementia, and death
— (photosensitive pigmented dermatitis in sun exposed areas)

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5
Q

deficiency in vitamin B1

A

(thiamine)

Wernicke-Korsakoff syndrome

  • – Wernicke’s encephalopathy is manifested by necrosis of the mammillary bodies in the periventricular region of the brain. Symptoms include progressive dementia, confusion, ataxia, and paralysis of the extraocular muscles. This causes ophthalmoplegia of the bilateral lateral rectus muscles, which results in a sixth nerve palsy.
  • – Korsakoff psychosis is a thought disorder that results in retrograde memory failure and confabulation. The most common causes of thiamine deficiency include poor diet and chronic alcoholism.
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6
Q

deficiency in vitamin B12

A

(cobalamin)

subacute combined degeneration
— of the dorsal and lateral spinal columns due to a defect in myelin formation. Peripheral neuropathy can result, which is SYMMETRICAL in nature and affects the LEGS more than the arms. It manifests with paresthesias, ataxia, and loss of vibration and position sense.

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7
Q

who gets vit B12 deficiency

A

Get Cobalamin (vit b12) from animal products so think of this in vegans or due to inadequate absorption associated with pernicious anemia or Crohn’s disease

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8
Q

deficiency of vitamin B2

A

(riboflavin)

cheilosis or angular stomatitis (scaling lips with fissures), and glossitis.
— cracked and red lips, inflammation of the tongue, mouth ulcers, cracks at the corners of the mouth, and a sore throat.

may also cause dry and scaling skin, fluid accumulation in the mucous membranes of the mouth, and an iron-deficiency anemia. The eyes may also become sensitive to bright light. Additionally, patients may develop seborrheic dermatitis on the face or genitalia

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9
Q

who gets vit B2 deficiency

A

patients with anorexia nervosa or with malabsorptive syndromes such as celiac sprue.

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10
Q

deficiency in vitamin B6

A

(pyridoxine)

stomatitis, glossitis, cheilosis, irritability, confusion, and depression
— inflammation and fissuring of the lips, cheilosis occurring at the corners of the mouth, atrophy of the mucosa of the tongue, and seborrheic dermatitis.

can also lead to polyneuropathy in adults. Also microcytic, hypochromic sideroblastic anemia with the presence of basophilic stippling seen on a peripheral blood smear.

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11
Q

who gets vit B6 deficiency

A

pregnancy or therapy with certain medications, such as the anti-tuberculosis drug isoniazid.
Another common cause of vitamin B6 deficiency is chronic alcoholism.

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12
Q

vit B2 vs vit B6 deficiency

A

both can have cheilosis or stomatitis

  • B6 has irritability/confusion and polyneuropathy
  • anemias are different:
  • – B2 is IDA
  • – B6 is microcytic hypochromic sideroblastic anemia
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13
Q

long term management of Afib

A

rate control + anti-coagulation tx

  • – rate: Ca channel blocker or B-blocker
  • – anti-coag based on CHADS2VASC
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14
Q

When to do electrical cardioversion for Afib

A

Afib with RVR in hemodynamically unstable pts or for new-onset Afib of <48hrs

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15
Q

acid-base status in DKA

A

high anion gap metabolic acidosis (with respiratory compensation)

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16
Q

what to watch out for in pt on aldosterone antagonist and ACEi or ARB

A

hyperkalemia

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17
Q

HCTZ common side effects

A 
hypercalcemia
hyperuricemia
hyperglycemia
hypokalemia
hyponatremia
hypomagnesemia
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18
Q

Carvedilol common side effects

A 
bradycardia
heart block
hyperglycemia
weight gain
impotence
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19
Q

Enalapril common side effects

A

hyperkalemia
renal insufficiency
cough
angioedema

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20
Q

Spironolactone common side effects

A

hyperkalemia
gynecomastia
renal insufficiency

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21
Q

Aspirin common side effects

A

tinnitus
bleeding
interstitial nephritis

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22
Q

manifestations, causes, and corrections of every electrolyte disturbance

A

**look up****

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23
Q

Electrocardiogram shows a wandering baseline and irregular complexes with a faint pulse

A

V fib

  • characterized by irregular, random waveform with no discernible p waves or QRS complexes
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24
Q

atrial fibrillation rate

A

> 400/min

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25
Q

atrial flutter rate

A

typically ~300bpm

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26
Q

electrocardiogram remarkable for varying R-R intervals and a wavy baseline

A

A fib

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27
Q

best way to differentiate A fib from A flutter

A

A flutter has clear presence of p waves in a regular rhythm

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28
Q

main causes of atrial flutter

A

rheumatic heart disease (mitral valve involvement), chronic obstructive pulmonary disease, pericarditis and atrial septal defect

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29
Q

F waves on EKG

A

correspond to the sawtooth pattern of atrial flutter and are best appreciated in leads II, III, and aVF

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30
Q

Wolff-Parkinson-White (WPW) EKG

A
  • narrow complex tachycardia with a short PR interval and a delta wave.
  • delta wave is pathognomonic
  • – early depolarization of the ventricle
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31
Q

Clinical manifestations of WPW syndrome

A

sudden onset of tachycardia, rapid pulse and fatigue

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32
Q

Selenium deficiency dz & sx

A

Keshan disease
presents as congestive cardiomyopathy with an enlarged heart in children and young female living in endemic areas with low soil concentration of selenium

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33
Q

where do you see Selenium deficiency

A

some parts of China, New Zealand and Finland

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34
Q

foods rich in selenium

A

fish, shellfish and eggs.

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35
Q

Dry beriberi

A

symmetrical peripheral neuropathy with both motor and sensory impairment

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36
Q

Wet beriberi

A

(in addition to neuropathy) signs consistent with CHF including cardiomegaly, lower extremity swelling, and tachycardia.

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37
Q

Acute calcium deficiency sx

A

various manifestations of neuromuscular dysfunction including peri-oral numbness, paresthesias, muscle spasms, muscle cramps and seizures

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38
Q

foods rich in Zinc

A

oysters, beef, crabs and cereal.

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39
Q

where are zinc deficiencies seen

A

middle eastern countries

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40
Q

mild zinc deficiency

A

decrease taste sensation (hypogeusia), night blindness, and decreased spermatogenesis.

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41
Q

severe zinc deficiency

A

diarrhea, alopecia, pustular dermatitis, and decreased immunity with frequent infections

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42
Q

chronic zinc deficiency

A

stunted growth in children with hypopigmented hair

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43
Q

presentation of pulmonary embolism on ECG

A
  • most commonly sinus tachycardia
  • right-axis deviation
  • a S1Q3T3 (S wave in lead I, lead III with a Q wave and inverted T wave) pattern can also be noted as well
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44
Q

pulmonary popcorn-like calcification

A

pulmonary hamartoma

– typically benign

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45
Q

first step in tx acute COPD exacerbation

A

causes respiratory acidosis so correct the hypercapnia first. This will resolve the other common sx (hypoxia, tachycardia, dyspnea).

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46
Q

“serious six” of acute chest pain in ER

A 
acute coronary syndrome
pericarditis with acute tamponade
aortic dissection
pulmonary embolus
pneumothorax
esophageal rupture
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47
Q

gold standard for dx PE

A

pulmonary angiography
– really only used in hemodynamically unstable or high clinical pretest probability w/ equivocal noninvasive test findings (contrast CT)

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48
Q

when to do aortic valve replacement

A

patient presenting with symptoms consistent with aortic stenosis (chest pain, exertional dyspnea, and syncope) and having a valve area of less than 1 cm2

  • otherwise medical
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49
Q

HCM murmur characteristics

A

systolic murmur
heard best over the left sternal border
murmur improves with squatting

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50
Q

Characteristic urine finding for prerenal azotemia

A

hyponatremia:
Prerenal acute renal failure stimulates release of aldosterone which leads to resorption of sodium from the collecting ducts. This will cause a fall in urine sodium to < 20 mOsm/L and fractional excretion of sodium to 1% or less. The urine becomes more concentrated than plasma.

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51
Q

what does a urine creatinine: plasma creatinine ratio of < 20 indicate?

A

intrarenal cause

– >20 in prerenal, postrenal, and acute glomerulonephritis

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52
Q

most likely electrolyte abnormality in DKA

A

HYPONATREMIA
- via plasma dilution of [Na+]

Note: likely to also have hypokalemia due to urinary losses (note that insulin may cause severe hypokalemia)

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53
Q

best test for overt type II diabetes mellitus

A

fasting plasma glucose,

as hemoglobin A1C can have approximately a 20% false negative in the screening setting.

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54
Q

common causes of peptic ulcer disease

A

Helicobacter pylori, NSAIDs, elevated acid secreting states, and Crohn’s disease.

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55
Q

most common cause of splenic vein thrombosis

A

chronic pancreatitis

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56
Q

Chronic somatic dysfunction

A

thin, smooth, dry, ropy/stringy.

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57
Q

Acute somatic dysfunction i

A

boggy and rough with lasting erythema.

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58
Q

first step in management of acute pancreatitis

A

early and aggressive fluid administration

— prevents organ hypoperfusion secondary to third spacing of fluid from vascular damage

59
Q

Patients at high risk for refeeding syndrome

A

hronically malnourished and those at high risk for malnutrition, such as in the case of cancer, prolonged starvation, chronic alcoholism, elderly, and postoperative patients.

60
Q

hallmark electrolyte disturbance of refeeding syndrome

A

hypophosphatemia
– which leads to widespread dysfunction of cellular processes

Other electrolytes are also deranged, including sodium and potassium, as well as thiamine, protein, glucose, and fat metabolism

61
Q

equation for calculation of anion gap

A

[Na+] - ([Cl−] + [HCO − 3])

62
Q

when re-feeding pt, important to remember to also replace

A

thiamine

63
Q

how uremia predisposes toward bleeding

A

platelet dysfunction with an inability to aggregate and adhere to the endothelium

64
Q

Alpha-fetoprotein (AFP) elevated in

A

gonadal germ cell tumors or hepatocellular carcinomas.

65
Q

CA-125 elevated in

A

arious malignancies including ovarian, endometrial, breast, and some lymphomas

66
Q

CEA elevated in

A

adenocarcinomas of the colon, pancreas, lung, breast, and ovary

67
Q

LDH elevated in

A

various malignancies as cancerous cellular growth is escalated to a point that metabolism takes place anaerobically.
LDH may also be elevated in dysgerminomas, lymphoma, and Ewing’s sarcoma

68
Q

CA 19-9 elevated in

A

pancreatic cancer

—- level above 1000 is diagnostic of pancreatic cancer

69
Q

Churg-Strauss syndrome distinguishing features

A

asthma
eosinophilia
p-ANCA

  • can present as pulmonary-renal syndrome like Wegner’s
70
Q

Microscopic polyangiitis distinguishing features

A

p-ANCA
triggered by infection

  • can present with hemoptysis and hematuria like Wegners and similar to Churg
71
Q

Goodpasture’s syndrome distinguishing features

A

aka anti-GBM dz

c-ANCA
elevated creatinine, hematuria, RBC casts
hemoptysis

  • also presents pulmonary-renal syndrome
72
Q

Wegner’s granulomatosis

A

c-ANCA
saddle nose deformity (causes granulomas)

  • also pulmonary-renal syndrome (hemoptysis and hematuria)
  • can cause +RF
73
Q

what is anti-ccp for?

A

rheumatoid arthritis

- more specific than RF

74
Q

what is raloxifene for

A

JUST vertebral fx prevention (not non-vertebral)

75
Q

DRESS syndrome presentation

A

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome

extensive rash, fever above 38°C, lymphadenopathy, hematologic abnormalities, hepatitis, and involvement of at least one internal organ. The onset of symptoms occurs 2–6 weeks after drug initiation

76
Q

what causes DRESS syndrome

A

multiple medications, including allopurinol, anticonvulsants, sulfa derivatives, antidepressants, nonsteroidal anti-inflammatory drugs, and antimicrobials.

77
Q

Brown-Sequard syndrome symptoms

A 
ipsilateral weakness (corticospinal tract), 
ipsilateral loss of vibration and proprioception (dorsal column tract) along with 
contralateral loss of pain and temperature sensation (spinothalamic tract).
78
Q

Nikolsky sign

A

epidermis easily separates upon gentle pressure due to skin necrosis

  • seen in TEN and pemphigus vulgaris
79
Q

TEN vs pemphigus vulgaris

A

TEN is acute onset dz with clear inciting acute event like drug rxn

80
Q

what is Behcet’s syndrome

A

immune-mediated, small-vessel multisystem disease that presents with recurrent oral and genital ulcers and possible skin and/or ocular lesions.
- see in young adults (25-30)

81
Q

initial step in the work-up of suspected lead poisoning

A

obtain a whole blood lead level (BLL).

A plain film radiograph of the abdomen is recommended in children to detect retained lead objects that may require surgical intervention for removal.

82
Q

herald patch that is described as a single oval lesion with a salmon colored center with a red border

A

pityriasis rosea

83
Q

multiple erythematous patches usually in the face, not one lesion and then multiple after weeks. These erythematous patches evolve into hypopigmented areas that eventually resolve after time.

A

Pityriasis alba

84
Q

multiple lesions and not just one. It may be over the trunk, buttocks, or extremities. These lesions are described as papules that become vesicles and may even develop into hemorrhagic crusts.

A

Pityriasis lichenoides

85
Q

descending rash that is described as redness and scaliness. This is found on the face and descends to where they may even have thickening of the skin on the soles of their hands and feet.

A

Pityriasis rubra pilaris

86
Q

hypopigmented lesions on darker skinned patients and hyperpigmented lesions on lighter skinned patients on chest and back

A

tinea versicolor

87
Q

Findings consistent with brain death

A

non-reactive pupils,
lack of corneal reflex,
lack of oculocephalic (doll’s eyes) reflex,
loss of respiratory drive even with elevated partial pressure of carbon dioxide.

Note: movements originating from the spinal cord or peripheral nerves may persist

88
Q

Exanthematous drug eruption

A

Rash appears 5-14 days after initiation of the medication.
Rash starts distally and spreads centrally.
Rash is self-limiting and resolves 1-2 days after discontinuing the medication.

89
Q

red rash that looks like a sunburn with a rough texture like sandpaper, most often starting on the chest and stomach then spreading to the rest of the body

A

Scarlet fever

rash may last between 2-7 days and is associated with red, swollen lips with a strawberry-like tongue. Skin may peel on hands and feet after the rash fades.

90
Q

rash following the fever is a raised, red, pinpoint rash that starts on the face and spreads downward. The rash can itch and last up to 3 days

A

German Measles
(rubella virus)

low grade prodromal fever with swollen, tender lymph nodes

91
Q

fever, usually greater than 39.5°C (103.1°F), with a rash developing as the fever is resolving. The rash is rosy pink, blanchable and develops first on the neck and chest before spreading to the rest of the body

A

Roseloa infantum or Sixth Disease,
(HHV-6)

children ages 6-36 months

92
Q

raised red rash that first appears on the child’s cheeks (“slapped cheek”). A lace-like rash starts on the torso and arms after 1-4 days then spread to the rest of the body

A

Fifth Disease (erythema infectiosum) is caused by human parvovirus B19

preschool to young school-aged children

Flu-like symptoms may be present 7 days prior to appearance of the rash

93
Q

Essential tremor

A

benign familial tremor
usually bilateral hands

most often confused with Parkinson’s disease

94
Q

Physiologic tremor

A

very low amplitude and high frequency (10 to 12 Hz) tremor that is usually invisible under normal daily circumstances but exaggerated in certain circumstances.

95
Q

Rubral tremor

A

result of a midbrain or cerebellar injury which produces a mixture of posture, intention and resting tremor with a low-frequency of 3 to 5 Hz only.

96
Q

EKG in STEMI vs acute pericarditis

A

STEMI EKG has 2-3 consecutive leads of ST elevation but not diffuse ST elevation that is seen in pericarditis
— ex pericarditis EKG: ST elevation in leads I, II, III, and V2-V6

97
Q

tx for acute pericarditis

A

NSAIDs

98
Q

clinical manifestations of adrenal crisis

A

nausea, vomiting, abd pain, CV collapse, and/or hypovolemic shock

can be triggered by physiological stress like trauma, infection, GI upset, surgery (ACTH can’t respond)

99
Q

Addison’s disease

A

destruction of adrenal glands. In US, most commonly caused by autoimmune diseases

100
Q

polyglandular autoimmune syndrome type II

A

Hashimoto thyroiditis
T1DM
Addison’s disease`

101
Q

management goals in tx of adrenal crisis

A

adequate replacement of fluids, electrolytes, and circulating glucocorticoids

102
Q

ideal AV fistula location

A

the most distal vessels in the non-dominant upper extremity

– ex/ radial artery and cephalic vein

103
Q

how are symptoms caused in carcinoid syndrome

A

serotonin-producing tumor converts niacin to tryptophan and serotonin
— can result in niacin deficiency

104
Q

elevated 5-HIAA sign of

A

carcinoid syndrome

105
Q

factor V leiden deficiency

A
  • most common hereditary hypercoaguable disorder

- is protein C resistance -> increase risk for thrombotic dz

106
Q

common cause of syncope in pt with normal phys exam

A

must r/o arrhythmias with a 24hr Holter monitor

107
Q

SIADH causes what electrolyte abn

A

isovolemic hypotonic hyponatremia

– most common cause of this

108
Q

what is pseudohyponatremia

A

isotonic hyponatremia. Normal amount of serum sodium just lower plasma sodium concentration due to increased plasma solids.

Seen in HLD, hyperproteinemia, and hyperglycemia
Asymptomatic

109
Q

Sarin: MOA & toxicity

A

potent inhibitor of acetylcholinesterase which results in toxic accumulation of acetylcholine at the post synaptic cleft,
causing miosis, rhinorrhea, bronchospasm, diaphoresis, nausea, vomiting and urinary incontinence
–> apnea, coma, convulsions or death

110
Q

Ricin sx

A

severe nausea, diarrhea, seizure, tachycardia and hypotension followed by cardiovascular shock and death within 3-5 days of exposure

111
Q

Phosgene sx

A

laryngospasm with inspiratory stridor and partial airway obstruction and irritation of the eyes, nose and throat.

– via free radicals

112
Q

Anthrax - inhalation exp sx

A

flu-like symptoms followed by pneumonia and severe respiratory collapse

113
Q

anthrax - dietary exp sx

A

(via infected meat with spores)

hematemesis, severe diarrhea and gastrointestinal inflammation

114
Q

Sulfur mustard sx

A

Within 24 hours of exposure, victims experience skin irritation followed by fluid filled blisters in the areas of contact or first and second degree burns. Eye exposure results in miosis and conjunctivitis which can result in temporary blindness. If inhaled in very high concentrations, damage to the mucous membranes causing bleeding, blistering and pulmonary edema.

115
Q

Hypophosphatemia sx

A

neuromuscular instability including seizures and coma

116
Q

lung cancer with hypercalcemia

A

squamous cell carcinoma

117
Q

normal range common bile duct dilation

A

avg 4.1mm

118
Q

signs of ascending cholangitis

A

charcot’s triad (RUQ p, f, jaundice)

reynold’s pentad (+ hypotension, AMS)

119
Q

otitis media tx of choice

A

amoxicillin 80-90 mg/kg/day for 10 days

120
Q

cyclophosphamide side effects

A

hemorrhagic cystitis

SIADH

121
Q

cisplatin side effects

A

nephrotoxicity
neurotoxicity
ototoxicity

122
Q

first line tx for cellulitis of dry skin

A

Nafcillin

covers Strep and Staph

123
Q

risk factors for MRSA

A

recent hospitalization, long hospital stay, resident of a long-term care facility, hemodialysis, recent antibiotic therapy, HIV, men who have sex with men, sharing sports equipment, diabetes, IV drug use, incarceration, military service, sharing needles, razors or other sharp objects

124
Q

condition that predisposes to warfarin skin necrosis

A

protein c deficiency

125
Q

chronic meningitis likely caused by

A

cryptococcus, esp in immunocompromised

126
Q

bowel perforation in HIV pt

A

CMV

127
Q

classic presentation of HUS

A

hemolytic uremic syndrome

anemia
thrombocytopenia
acute renal failure

and NO neuro findings
also can have prodromal bloody diarrhea

128
Q

how to tell HUS from TTP

A

TTP has focal neuro findings

129
Q

marker for TTP

A

ADAMTS-13 (deficient)

130
Q

ALL vs sickle cell

A

ALL has petechiae

both have anemia, fever, pain

131
Q

ALL presentation

A

2-5yo kid
fever
pallor
petechiae

(can have high WBC)

132
Q

cellulitis vs nec fasc

A

Cellulitis is not associated with skin coloration and necrosis, as seen in nec fasc.

Nec fasc has involvement of the deep fascial layers, which are not involved in cellulitis.

133
Q

when do you see Basophilic stippling ?

A

thalassemias, alcohol abuse, iron overload, and lead poisoning.

134
Q

Indications for urgent dialysis in patients with CKD

A

pericarditis or pleuritic,
severe metabolic acidosis,
severe hyperkalemia (refractory to conservative treatment),
progressive uremic encephalopathy,
intractable volume overload (despite diuretic therapy),
failure to thrive/ malnutrition,
peripheral neuropathy,
a bleeding tendency, and
intractable gastrointestinal symptoms (e.g., nausea, vomiting)

135
Q

kidney stones that form in alkaline urine

A

calcium phosphate > struvite stones

136
Q

Initial management of pulmonary embolism

A

supplemental oxygen,
acute anticoagulation with unfractionated or low-molecular-weight heparin, and
initiation of long-term anticoagulation therapy with oral warfarin

137
Q

when to consider thrombolytic therapy and embolectomy in PE

A

patients with massive PE who are hemodynamically unstable or have evidence of right heart failure

138
Q

tx for acute hepatitis B infection

A

tenofovir disoproxil fumarate

139
Q

hypocalcemia symptoms

A

paresthesias, muscle cramps, chvostek sign, troussea’s sign, decreased cardiac contractility, prolonged QT interval, T-wave inversion, heart block, and V fib

140
Q

hypocalcemia tx

A

first: magnesium
then: IV calcium gluconate

141
Q 
What distinguishes vertigo types from each other?:
labyrinthitis
Meniere's dz
Vestibular neuritis
BPPV
A

all have vertigo, tinnitus, hearing loss

labyrinthitis - after recent infection
Meniere’s dz - attacks last for several months
Vestibular neuritis - auditory function preserved
BPPV - only specific positions / changes

142
Q

Central pontine myelinosis: cause

A
  • cerebral edema due to rapid over correction of chronic hyponatremia
143
Q

Central pontine myelinosis: sx

A
  • altered mental status including lethargy, obtundation, dysphagia and even paraparesis or coma

Year 3 (15 decks)

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