COMQUEST Flashcards
What is the most likely dx in a pt taking laxatives for weight loss who develops weakness and muscle cramps; what is seen on ekg?
- HYPOkalemia
- U waves on the ekg (small waves just after the T wave)
How does the DLCO differ btw chronic bronchitis and emphysema?
- Normal in chronic bronchitis
- Decreased in emphysema due to alveolar destruction
Pt’s with HIV and a CD4 count <50/mm3 should receive prophylaxis with what antibiotic(s) against MAC?
Clarithromycin or Azithromycin
Using the mnemonic N’ TIME2 what are the the features of Wiskott-Aldrich syndrome?
- Neutropenia
- Thrombocytopenia
- frequent Infections
- ↓ levels IgM
- Eczema
- ↑ levels IgE
What is the gold standard for dx of Dermatomyositis?
Muscle biospy
What is the most common cause of fever in a pt returning from a developing country; what is the initial test of choice?
- Malaria
- Initial test = thick and thin blood smear
Which anti-malarial agent can kill parasites lying dormant in the liver?
Primaquine
Which SNRI can be used in pt’s with stress urinary incontinence + concomitant depression?
Duloxetine
What is the next best step in the management of suspected Sheehan’s syndrome?
IV Dexamethasone (“stress dose” steroids) —> MRI of head
What is the initial step in managemnt of an otherwise healthy pt presenting with sx’s suggesting community-acquired pneumonia?
Empiric tx with a macrolide or doxycycline
What are the 3 major risk factors for pancreatic cancer and how does it classically present?
- Smoking (#1), chronic pancreatitis, and diabetes
- Presents w/ painless jaundice
What is the definitive tx for pheochromocytoma and how should the BP and HR be managed?
- Surgery
- 10-14 days prior give an alpha blocker i.e., phenoxybenzamine
- 3-4 days prior give a beta blocker i.e., propranolol
In acute MI what is the earliest marker of ischemia?
- Myoglobin, rises within first hour and peaks at 6
- CK-MB and troponins take several hours to rise
What are the first line agents for management of pyelonephritis?
- IV fluoroquinolones (ciprofloxacin, levofloxacin)
- IV ceftriaxone
- IV ampicillin/sulbactam
How can the aldosterone-renin ratio help distinguish primary from secondary hyperaldosteronism?
- >20 in primary
- <10 in secondary w/ high renin i.e., renin-secreting tumor, fibromuscular dysplasia, renal artery stenosis
An induration of 5mm or greater on PPD skin testing is considered positive for tuberculosis in which pt populations?
- HIV pt’s
- Immunocompromising conditions i.e., hx of chemo, post-organ transplant
- Household contact of TB pt
How is a diagnosis of sarcoidosis confirmed?
Biopsy of affected organ w/ evidence of non-caseating granulomas and no evidence of infection
Drusen (subretinal deposits - yellow/white deposits) are a characteristic finding of what eye pathology; how does it present?
- Age-related macular degeneration
- Gradual onset of bilateral central vision loss w/ preservation of peripheral vision
The diagnosis of orthostatic hypotension is confirmed with a drop of how much systolic or diastolic upon standing from a supine position?
>20 mmHg systolic or >10 mmHg diastolic
What is the tx of choice for acute bacterial meningitis w/ N. gonorrhea and S. pneumonia?
- N. gonorrhea = Cefotaxime or Ceftriaxone
- S. pneumo = Vanco + ceftriaxone
What is the test of choice for dx BPH?
Pelvic ultrasound w/ post-void residual
What are the 1st line tx’s for metastatic prostate cancer?
- GnRH agonists: leuprolide or goserelin
- GnRH antagonists: degarelix
What is the most effective first-line tx for hemochromatosis?
Periodic phlebotomy
In a pt with suspected diverticulitis what type of imaging is used to confirm the diagnosis?
Abdominal CT scan
What is the initial imaging study that should be ordered in a pt with diverticular disease who presents with signs of diverticular perforation?
Upright abdominal x-ray
What is the most likely dx in a pt with pathologic fractures, bone pain, anemia, and recurrent infections?
- Multiple myeloma
- IgG or IgA spike on serum electro. + Plasmacytosis on BM biopsy
Which type of lung cancer is associated with paraneoplastic secretion of PTHrP?
Squamous cell carcinoma
What is the first line tx for small cell lung carcinoma?
Chemotherapy; surgery is NOT indicated
