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Internal Med > dec 13 firecracker cases etc > Flashcards

dec 13 firecracker cases etc Flashcards

1
Q

cardiac tamponade, compressed right atrium

A

JVD

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2
Q

cardiac tamponade, compressed left atrium

A

pulmonary edema

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3
Q

cardiac tamponade preload/etc

A

decrease preload
decrease systolic stroke volume
diminished CO

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4
Q

cardiac tamponade etiologies

A

post viral
uremia
neoplastic

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5
Q

acute hemopericardium

A

blunt/penetrating chest trauma
reputure of free wall of LV following MI
complication of retrograde aortic dissection

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6
Q

Beck’s triad + one more

A

JVD, muffled heart sounds, systemic hypotension

pulsus paradoxus

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7
Q

Kussmaul sign

A

JVD with inspiration

constrictive pericarditis

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8
Q

pulsus paradoxus

A

drop of 10 or more systolic with inspiration

exaggeration of normal physiology

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9
Q

cardiac tamponade - ec ho

A

severe compression of RA and RV

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10
Q

cardiac tamponade definitive diagnosis

A

cardiac catheterization

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11
Q

cardiac tamponade treatment

A

pericardiocentesis

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12
Q

what to avoid in cardiac tamponade

A

positive pressure ventilation

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13
Q

untreated cardiac tamponade

A

extra-cardiac obstructive shock

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14
Q

abd aorta screening

A

65-75
less than 4cm, yearly
4 cm, 6months
5 cm - surgery

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15
Q

achalasia LES

A

elevated LES pressure

inability to relax LES during swallowing

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16
Q

Waldenstrome macroglobinuria

A

igm spike

hyperviscosity

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17
Q

organism involved in RHD vegetations

A

streptoccus mutans

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18
Q

NMS

A

fever, rigidity, increased CK

treat with dantrolene, bromocriptine

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19
Q

Renal Cell Carcinoma

A

hematuria
left sided variocele
paraneoplastic symptoms: anemia/eryhtocytosis, leukocytosis

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20
Q

Hep C and pregnancy

A

low chance of transmission

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21
Q

Proteus UTI

A

ph >7

struvite stones

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22
Q

cutaneous ulcer + hemoptysis

A

wegners

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23
Q

chronic pancreatitis

A

inflamm process

  • fibrosis
  • calcification
  • irreversible damage
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24
Q

number one cause of chronic pancreatitis

A

alcohol

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25
Q

chronic pancreatiitis risk factors

A

male, recurrent acute attacks
gallstones, triglycerides
CF, PBC, PSC

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26
Q

difference between acute and chronic pancreatitis

A

irreversibly of damage

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27
Q

pathogenesis of chronic pancreatitis

A

repeated bouts of acute pancreatitis

  • loss of parencyhma
  • duct distortion
  • fibrosis
  • impaired secretion
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28
Q

duct flow becomes obstructed as a result of

A

fibrosis

pancreatic concretions

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29
Q

pancreatic concretions

A

due to increased protein concentration in pancreatic fluid

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30
Q

chronic pancreatitis - s/sx

A

epigastric pain
steatorrhea
wt loss, nausea
mild fever

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31
Q

gold standard diagnosis for chronic pancreatitis

A

72 hr quantitative fecal fat determination

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32
Q

chronic pancreatitis complications

A

fat/fat soluble vit/b12 malabsoprtion
pseudocyst, abscess formation
glucose intolerance
bile duct obstruction

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33
Q

pancreatitic insuff can be due to

A

cystic fibrosis
cancer causing obstruction (pancratitc)
pancreatic failure

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34
Q

pancreatic insufficiency diagnosis

A

fecal elastase

<200

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35
Q

pancreatic insuff treatment

A

pancreatic enzyme supplementation (lipases, proteases, amylases)
low fat diet

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36
Q

treatmetn of chornic pancreatitis

A

alcohol/smoking cessation
pain control
b12/adek suppl
pancreatic enzyme suppl

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37
Q

chronic pancreatitis - strictures

A

ERCP to dilate and stent pancreatic ducts

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38
Q

spontaneous ptx

A

due to rupture of apical blebs

tall, thin, healthy males

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39
Q

secondary spontaneous ptx

A

underlying path: COPD, trauma, infections

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40
Q

tension ptx

A

one-way valve effect
air can enter pleural space but not not exit
pressure on mediastinum –> hemodynamic instability
- mediastinal shift, tracheal deviation AWAY

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41
Q

tracheal deviation in tension ptx

A

AWAY

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42
Q

pneumothorax presentation

A

Pleuritic Chest Pain, Tracheal Deviation, Hyperresonace, Occurs Suddenly, reduced breath sounds, absent fremitus, x ray shows collapse

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43
Q

ptx diagnosis

A

chest xray
hyperlucent lung fields due to air accumulation
visceral pleural line

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44
Q

spontaneous ptx - tracheal deviation

A

spontateous: deviates towards affected lung due to decreased pressure from atelectasis on that side

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45
Q

tension ptx - tracheal deviation

A

away from affected lung, due to increased pressure on that side

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46
Q

tension ptx symptoms

A

can also have shock, JVD due to compression of SVC

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47
Q

spontaneous ptx if untreated

A

progress to tension ptx

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48
Q

large tension ptx

A

hemodynamic instability due to pressure on great vessels

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49
Q

treatment of small spontaneous ptx

A

resolves spontenous

o2 can expedite recovery

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50
Q

large, simple pneumothorax treatment

A

chest tube

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51
Q

treatment of secondary spontaneous ptx

A

hospitalized and pneumo drained

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52
Q

tension ptx treatment

A

needle decompression (needle thoracostomy)

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53
Q

needly thoracostomy placement

A

bottom of 2nd intercostal space at midclavicular line

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54
Q

PCP type of pneumonia

A

atypical pneumonia with dry cough, diffuse interstitial

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55
Q

PCP histological

A

fluffy, foamy exudate in alveolar spaces

BAL - silver stain

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56
Q

PCP clinical presentation

A

HIV cd4 <200
dry cough, fatigue, fevers, chills
- pnemothorax

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57
Q

PCP CXR

A

diffuse bilateral ground glass infiltrates extending from perihilar region

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58
Q

PCP treatment

A

tmp-smx

po2 less than 70 give prednisone (21 days)

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59
Q

PCP prophylaxis if sulfa allergic

A

dapsone (test g6pd def first)

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60
Q

cytoisospora

A

cd4 <50
diarrhea, wt loss
treat with tmp-smx or cipro

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61
Q

Kaposi sarcoma clinical presentation

A

rash that is non responsive to treatments
associated with HHV-8
low cd4 count makes visceral involvement more likely

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62
Q

kaposi sarcoma treatment

A

HAART

chemotherapy for lesions

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63
Q

hemothorax

A

blood in pleural space

- trauma, pulmonary infarction, TB, malignacy

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64
Q

hemothorax cxr

A

blunting of costophrenic angles

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65
Q

hemothorax treatment

A

underlying cause
supplemental o2
chest tube

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66
Q

hemothorax untreated

A

formation of thrombi and fibrosis

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67
Q

hypomagnesmia

A

<1.3

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68
Q

impaired intestinal absorption of magnesium in

A

alcoholics, malabsorption, diarrhea, NG suction

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69
Q

increased renal excretion of magnesium in

A

increased renal tubular flow such as osmotic diuresis, diuretic use

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70
Q

meds associated with hypomagnesium

A

aminoglycosides, amph b

cisplatin, pentamidine, cyclosporine

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71
Q

s/sx hypomagnesemia

A

neuromusculuar and cardiac

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72
Q

neuromuscular symptoms of hypomagnesemia

A

tremor, ataxia, nystagmus, tetany, seizures

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73
Q

cardiac symptoms of low mag

A

atrial and ventricular arrhythmias

- especially in pts being treated with digoxin

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74
Q

low mag can also cause

A

low calcium and potassium

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75
Q

low mag EKG

A

pr, qt prolong
widened qrs
potential torsades de pointes

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76
Q

mag replacement

A

asymptomatic - oral

symptomatic - IV mag sulfate, check tendon reflexes

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77
Q

Familial Adenomatous Polyposis

A
  • AD, APC gene
  • hundreds of adenomas
  • treatment is proctocolectomy
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78
Q

Good Pasture’s symptoms

A

renal + lung

dysmoprhic RBCs

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79
Q

Good Pastures’ antibody

A

alpha 3 chain of type IV collagen

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80
Q

pt has LDL >/= 190

A

high intensity statin

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81
Q

pt has ASCVD 10 year higher than 7.5%

A

moderate-high intensity statin

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82
Q

pt is 40-75 yr old with DM

A

high intensity if ASCVD greater tahn 7.5

moderate intensity if ASCVD less than 7.5

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83
Q

pt has clinical atherosclerotic disease

A

less than or equal to 75, high intensity

older than 75, moderate intensity

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84
Q

crystal induced nephropathy in HIV pts

A

indinaivr (protease inhibitor)

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85
Q

didanosine

A

reverse transcripatse inhibitor

pancreatitis

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86
Q

abacavir

A

NRTI

hypersensitivity syndrome

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87
Q

NRTIs

A

nucleoside reverse transcripatase inhibitor

lactic acidosis

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88
Q

NNRTIs

A

SJS

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89
Q

Nevirpine

A

liver failure, NNRTI

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90
Q

cyclosporine AE

A

nephrotoxitiy/neurotoxicity
glucose intolerance
gingivial hypertrophy

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91
Q

cafe au lait spots

A

neurofibromatosis

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92
Q

chagaz dz

A

megacolon/esophagus + cardiac disease

protozoan

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93
Q

hep c virus type

A

single stranded RNA flavivirus

94
Q

initial diagnostic test for hep C

A

anti-HCV antibody test

95
Q

test for confirmation of Hep C

A

qualitative PCR

96
Q

other tests for Hep C

A

quantitatie HCV testing

genotype testing

97
Q

HCV treatment standard of care

A

pegylated interferon and ribavirin

98
Q

2014 HCV recommendations

A

add polymerase inhibitor –> sofosbuvir

99
Q

time period for spontaneous clearance of HCV

100
Q

most common causes of digital clubbing

A

lung malignancy
cystic fibrosis
r to l shunt

101
Q

Pseudogout

A

calcium pyrophosphate deposition

rhomboid shaped crystals with positive bireferengence

102
Q

most common cause of liver malignancy

A

metastasis

103
Q

PAD treatment

A

exercise

antiplatelet

104
Q

pain relief related to malignacy

A

start with short acting morphine

105
Q

HACEK

A 
hameophilus
aggregitabcteier(actinobaccilus)
cardiobacterium hominis
e corrodens
kingella kingae
106
Q

d xylose test

A

absorption in proximal SI

celiac sprue

107
Q

widened mediastinum and gi symptoms

A

esophageal perforation

order water soluble contrast esophogram

108
Q

rifampin ae

109
Q

extramsucular findings of dermatomyositis

A

interstitial lung dz, dysphagia, myocarditis

association with malignancy

110
Q

wisconsin

A

blastomycosis

111
Q

blastomycosis

A

lung/tb like symptoms

skin lesions

112
Q

most common complication of PUD

A

hemorrhage

113
Q

cervical sponyldosis xray

A

bony spurs

sclerotic facet joints

114
Q

toxo infections in immunosuppressed

A

pneumonitis
myocarditis
necrotiizing encephalitis

115
Q

SIADH meds

A

antidepressants, antipsychotics
narcotics, nsaids
chlorpropamide

116
Q

antipseudomonal B lactam

A

cefotaxime, ceftriaxone, or ampicillin-sulbactam

117
Q

what are ranson’s criteria

A

WBC count of >16,000 on admission
Age >55, Glucose >200 mg/dL on admission
AST >250 on admission
LDH >350 on admission

118
Q

what kind of defect is osteoporosis

A

quantittive

119
Q

osteoprosis =

A

loss of osteoid (organic bone matrix)

120
Q

WHO osteoporosis defintion

A

L2-L4 2.5 sd below normal

121
Q

decreased bone mass manifests as`

A

decreased thickness of cortical and trabecular bone

fewer trabecular interconnections

122
Q

why is osteoporosis more common in women?

A
  • they have lower peak bone mass
  • live longer
  • rapid bone loss during menopause secondary to decreased estrogen production
123
Q

role of genetics in osteoporsis

A

greater than daily activity or calcium intake

124
Q

osteoporosis most common patient type

A

older caucasion postmenopausal woman

125
Q

decreased peak bone mass

A
  • due to malnutrition

- malabsorptive dz (celiac)

126
Q

increased resportion

A

old age (decreased osteoblasts)
sex steroid def
decreased load bearing
glucocorticoid use

127
Q

lifestyle factors associated with osteoporosis

A

alcohol

smoking

128
Q

most common fractures in osteoporosis

A

vertebral > hip > Colles

129
Q

hip fractures

A

femoral head

130
Q

colles fracture

A

radial fractue

131
Q

osteoporosis diagnosis

A

DEXA

also look for hypothyroidism, hypercortisoloism, hyperPTH, renal/hepatic dysfxn

132
Q

DEXA scan age

133
Q

treatment of osteoporis

A

vit d and calcium supplementation

bisphosphonates

134
Q

osteoporosis - lifestyle adjustments

A

wt bearing exercise, smoking cessation, limit alcohol, more calcium and vit d

135
Q

raloxifene

A

SERM, inhibits bone turnover
anatgnoist to estrogen on breast and endometrial tissue
decrease risk of breast and uterine cancer
increased risk of thromboembolic events

136
Q

PTH - osteoporosis

A

pts with one fracture, intolerance to bisphosphonates

osteoblastic activation in periodic doses

137
Q

DJD also called

A

osteoarthritis

138
Q

DJD =

A

chronic noninflammatory deterioration of articular cartilage

139
Q

DJD pathophysiological

A

cartilage deteriorates

lytic lesions with sclerotic edges

140
Q

DJD most common joints

A

knee, hand, hip

141
Q

DJD modificable risk factors

A

obestiy
trauma
labor-intensive occupations

142
Q

non-modifiable DJD risk factors

A

age
family hx
female gender

143
Q

DJD presentation

A

joint pain, stiffness

worse with activity, wt bearing

144
Q

DJD PE findings

A 
decreased ROM
effusion
malalignment
joint creptius
DIP, PIP joint osteophytes with MCP sparing
145
Q

DJD xray

A

joint space narrowing, osteophytes, subchondral sclerosing, subchondral cysts

146
Q

DJD first line

A

acetaminophen if no symptoms of inflamm

NSAIDs

147
Q

nonoperative DJD treatment

A

bracing
wt loss if bmi >25
pt
corticosteroid injection

148
Q

DJD operative treatment

A

arthrosocopy in degenerative meniscal tears

total joint replacement

149
Q

causes of pulseless electrical activity

A

6hs and 5ts

150
Q

6 h’s

A

hypovolemia, hypoxia, hydorgen ions (acidosis) hyper/hypokalemia, hypoglycemia, hypothermia

151
Q

5 t’s

A

toxins/drugs, tamponade, tension ptx, thrombosis (myocardial or PE), trauma

152
Q

diffuse esophageal spasm

A

chest pain and dysphagia

153
Q

osteomalacia - lab valuves

A

low ca, phosphate

increased pth, alk phos

154
Q

osteomalacia - xray

A

pseudofractures

155
Q

laryngeal edema

A

acute onset dyspnea

156
Q

splenic abscess triad

A

fever, leukocytosis, LUQ pain

157
Q

splecic abscess cause

A

staphylococcus, streoptocccus, salmonella

158
Q

splenic abscess treatment

A

bs antibiotics and splenectomy

159
Q

RA - part of spine invovled

160
Q

gastric adenocarcinoma diagnosis

A

endoscopy/biposy

CT abd/pelvis

161
Q

hereditary spherocytosis genetics

A

AD

defective proteins - spectrin, ankyrin

162
Q

hereditary spherocytosis - defect in RBC

A

spherical shape, causes them to get stuck in narrow passages of splenic cord –> destroyed = extravascular hemolysis

163
Q

hereditary spherocytosis presentation

A

hemolytic anemia
jaundice
splenomegaly, gallstone formation

164
Q

hereditary spherocytosis labs

A

anemia, reticulorcytosis
MCHC elevated
increased membrane fragility

165
Q

hereditary spherocytosis complications

A

hemolytic crises
leg ulcers
priapism
hypertrophic cardiomyopathy

166
Q

hereditary spherocytosis treatment

A

splenectoy

167
Q

herediatary sphereocytosis supportive care

A

folic acid
blood transfusions
EPO

168
Q

abnormal eosin 5-maleimide binding test

A

hereditary spherocytosis

169
Q

causes of epididymitis

A

young - chlyamydia, gonorrhea

old - GNR (e coli)

170
Q

antiphospholipid lab abnormality

A

elevated PTT due to phopholipids binding in vitro

171
Q

PTHrp associated with

A

squamous cell carcinomas

172
Q

s sanguininis

A

viridians group, endocarditis after dental procedures

173
Q

antithyroidperoxidase antibody

174
Q

pneumonia with GI symptoms

A

legionella!!!

175
Q

legionella treatment

A

azithromycin or fluoroquinolone

176
Q

acromegaly - first test to order

177
Q

erytheum nodosum differential

A

streptococcus, TB/histo, sarcoid, IBD

178
Q

infective endocarditis - what valve

A

tricuspid

holosytolic murmur that increases with inspiration

179
Q

paget’s disease treatment

A

bisphosphonates

180
Q

vipoma - symptoms

A

watery diarrhea, flushing
hypokalemia, hypercalecemia, hyperglycemia
pancreatic mass

181
Q

malt treatment if no metastases

A

treat for h pylori

omperazole + clarithomycin + amoxicillin

182
Q

periotonsillar bascess

A

muffled voice/hot potato voice
unilated LAD
deviated uvula

183
Q

prevention of uric acid stones

A

potassium citrate to alkalinize urine

184
Q

zinc def

A

alopeica
skin lesions
abnormal taste

185
Q

cutaneous larva migrans

A

creeping eruption

sand boxes/beaches

186
Q

lymph nodes <1 cm

187
Q

rubella in adults

A

arthralgia/arthritis

188
Q

rubella in children

A

conjunctivitis, coryza, cervical LAD
forschemier spots
cephalocaudal spread of blancing maculopapular rash

189
Q

ADPCK complications

A

intracranila aneurysms
valvular heart disease
hepatic cysts, colonic diverticula, abdomainal wall and inguinal hernia

190
Q

complications of anklyosing spondylitis if present for two decades

A

osteopenia/osteoporisi

191
Q

spinal ostemomyelitis physical exam

A

tender to percussion

192
Q

reactive arthritis

A

urethritis, oligoarthirit, conjunctiviti

achilles tendon pain

193
Q

AVF

A

high output cardiac failure

194
Q

conn syndrome

A

low renin, increased aldosterone

195
Q

lidocaine in ACS

A

don’t use

decreases VF but increases asystole

196
Q

hereditary spherocytosis symptoms

A

hemolytic anemia
splenomegaly
jaundice

197
Q

RPGN presentation

A

acute renal fialure, oliguria, nephritic

198
Q

How is echocardiography used in cardiac arrest?

A

distinguish pulseless electrical activity (PEA) that results in myocardial contraction from patients with no mechanical activity

199
Q

bone marrow biopsy of multiple myeloma patients?

A

myeloma cells are present on bone marrow biopsy, which are plasma cells in various stages of maturation. They will have acidophilic cytoplasmic inclusions of immunoglobulin called Russell bodies.

200
Q

What is the role of lidocaine in adult cardiac arrest?

A

v. fib/v. tach cardiac arrest if amiodarone fails.

201
Q

What antiplatelet medications are indicated for patients who have received coronary interventions for STEMI?

A

aspirin and a P2Y12 blocker (ticagrelor, prasugrel)

202
Q

CO =

203
Q

SV is and =

A

LVEDV - LVESV

blood ejected from ventricle during systolic

204
Q

SV and hypovolemic shock

A

decrease in SV –> increase in HR

205
Q

MAP =

A

average arterial pressure over cardiac cycle

(CO x SVR) + CVP

206
Q

MAP calculation

A

1/3 systolic + 2/3 diastolic

207
Q

main resistance vessels

A

arterioles

determine SVR

208
Q

septic shock and CO

A

decrease in SVR

increase CO

209
Q

causes of pulsus paradoxus

A

cardiac tamponade

copd, asthma

210
Q

arrhythmia in digitalis

A

atrial tachycardia with AV block

211
Q

drug that causes prolong QRS during exercise

A

flecainamide (IC)

212
Q

Acute infective endocarditis caused by

213
Q

subacute infective endocarditis caused by

A

viridans streptococci
s epidermis
enterococci
HACEK

214
Q

HACEK =

A

hameophilus, actinobacillus, cardiobacterium, eikenella, kingella

215
Q

culture negative cause of endocarditis

216
Q

nonbacterial thrombotic endocarditis

A

sterile vegetations of platelets and thrombi form on valves

highly susceptible to emoblization

217
Q

marantic endocarditis

A

NBTE in setting of advanced malignancy

218
Q

s bovis

A

infective endocarditis in colon cancer

219
Q

veridans group

A

occurs on native valves

sanguinis

220
Q

infective endocarditis - FROM JANE

A

fever, roth’s spots, osler’s nodes, murmur

janeway lesions, anemia, nailbed hemorrhage, emboli

221
Q

roth’s spots

A

retinal hemorrhages around white spots

222
Q

osler’s nodes

A

tender raised lesions on toes and fingers

223
Q

janeway lesions

A

nontender erythematous lesions on sole and palm

224
Q

empiric infective endocarditis therapy

A

vancomycin + aminoglycoside (gentamicin)

225
Q

therapy for Viridans, Strep bovis

A

(Penicillin or ceftriaxone) + gentamicin
or
vancomycin

226
Q

therapy for staph endocarditis

A

Oxacillin + gentamicin, or
Nafcillin + gentamicin, or
Cefazolin + gentamicin, or
Vancomycin for patients with penicillin allergy or MRSA endocarditis.

227
Q

if pt has prosethic valve and endocarditis

A

need gentamicin and rifampin

228
Q

antibiotic prophylaxis for infective endocarditis

A

Congenital cyanotic lesions (ventricular septal defect and atrial septal defects should NOT be treated)
Prior valve repair using prosthetic material (mitral valve prolapse should not be treated)
A prior history of endocarditis
A history of heart transplant

229
Q

untreated endocarditis

A

heart failure, abscess formation, emboliation causing end-organ damage

230
Q

reversible cause of HF

A

hemochromatosis

231
Q

cardiac myoxoma

A

left atrium
constitutional symptoms
diastolic heart sound
embolization

232
Q

acute limb ischemia after MI

A

arterial embolus from LV thrombus (order TEE)

Internal Med (23 decks)

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