Deck 1 Flashcards
what labratory abnormality is seen in antiphospholipid syndrome
prolonged PTT
signs of antiphospholipid syndrome
recurrent fetal loss, recurrent thromboembolism
what si the mechanism of acetazolamide
this increases urinary excretion of bicarb by inhibiting carbonic anhydrase which combines H and HCO3, meaning more bicarb is excreted
effect of altitude on acid base status
you develop a respiratory alkalosis because you increase your respiratory drive which blows off CO2
HSV encephalitis signs
cognitive/personality changes, focal neurologic deficits, and/or seizures due to temporal lobe involvement (often seen on brain imaging).
typical manifestations of CMV in HIV patients
typically a retinitis
manifestations of JC virus in HIV patients
PML- focal neuro signs, and cognitive changes
manifestations of toxo in hiv patients
focal neuro deficits, seen on imaging
lab abnormalities in acute tubular necrosis
high urine sodium, normal BUN:Cr, often casts
what type of AKI is ATN
intrarenal
what will be seen on UA/BMP of a patient with multiple myeloma
bence-jones proteins, elevated urinary calcium, elevated Cr, elevated Ca
what the common cause of dilutional hyponatremia
primary polydipsia
clinical features of chronic mesenteric ischemia
postprandial pain, weightloss, nausea/diarrhea, food aversion
what is associated with MEN1
pituitary (adenomas), Parathyroid (adenomas or hyperplasia), pancreas (VIPoma, glucagonoma, somatostatinoma, insulinoma, gastrinoma)
signs of babesiosis
flu like sx to severe DIC, ARDS, CHF, splenic rupture
what transmits babesia and region
ixodes tick, northeast
what is associated with better outcomes in SCA outside a hospital
faster time to rhythm analysis and defibrillaiton
machism of pharmacologic stress test
typically its adenosine used and this increases blood flow to all the coronary vessels by causing dilation which then shows varying flow of the contrast because obstructed vessels dont dilate as much
manfestations of refeeding syndrome
muscle weakness, hyporeflexia, rhabdomyolysis, hemolysis, arrhythmias, and congestive heart failure
labratory findings of refeeding syndrome
hypophosphatemia
whats in the TTP pentad
low platelets, neuro changes, signs of hemolytic anemia, renal insufficiency, +/- fever
what deficiency can be seen in carcinoid syndrome
niacin
what are the clinical features of carcinoid syndrome
flushing, valvular heart disease, diarrhea, cramping, telangectasias, bronchospasm,
which antibiotic can cause phototoxicity
doxy
signs of CMV infection
fever, fatigue, malaise, lymphocytosis (atyptical lymphocytes), elevated LFTs
initial lab testing for non sustained SVT
bmp to check electrolytes
effects of a bicuspid aortic valve
these can cause aortic stenosis and aortic regurg
where do you hear aortic regurg
you hear it on the left sternal border
what type of murmur is aortic regurg
early diastolic decrescendo
what is cardiac index
cardiac index is the measure of cardiac output to BSA
what is the cardiac index and PCWP in obstructive shock
low cardiac index because heart cannot pump out, and low PCWP because the heart is not getting filled (nothing in LA)
what is the cardiac index and PCWP in cardiogenic shock
low cardiac index because heart is not pumping well but high PCWP because it is filling and filling just cant pump
what shape are calcium pyrophosphate crystals
rhomboid shaped
what causes CPP crystal deposition
this is pseudogout and can be bc of elevated Ca, due to hyperparathyroidism, hypothyroidism, or hemachromatosis
what is the hamman sign and what is it associated with
crunching sound on auscultation of chest and this is associated with esophageal perf or pneumothorax
where is adenoCA in the lung
peripherally located
does gonorrhea cause ulcers
NO
what two things cause painful penile lesions
H ducryi and HSV
common complication due to nephrotic syndrome
renal vein thrombosis due to loss of anti-clotting proteins (ATIII etc)
what drugs to people need to be on post MI
aspirin, clopidegrel (P2Y12 blocker), beta blocker, ACE, statin, mineralicorticoid antagonist
treatment of 1st degree AV block
observation
treatment of 2nd degree type 1 mobitz AV block
observation
treatment of 2nd degree AV block Mobitz Type II
PPM
treatment of 3rd degree AV block
PPM
what is 1st degree AV block
this is just prolonged PR, so you have about 1 block between the P and QRS
differentiate between type one and type two 2nd degree block
type 1 is constant lengthening of the PR and then dropped QRS and type 2 is when you drop the QRS randomly
size of LA in acute mitral regurgitation
normal because this is an acute process so no remodeling has occured yet
LV end diastolic pressure in acute MR
there is increased EDV because blood flows from the ventricle to the atrium causing increased atrial pressure, then when diastole occurs, the increased LA pressure causes rapid and increased filling of the LV causing increased end diastolic volume
signs of decompression sickness
mottling of the extremities, rapid onset confusion, respiratory distress, stroke, dysarthria, etc
etiology of decompression sickness
formation of nitrogen gas bubbles that can get trapped and causes weakness, strokes, etc.
which endocarditis etiology is associated with colon CA
strep bovis/gallacticus
hallmark labs of ischemic liver disease
rapid elevation in liver enzymes can exceed >10,000
first line therapy for renal artery stenosis
ace inhibitor because RAS creates excess RAAS activation so you need to turn it down by
pathophysiology of raynauds phenomenon
cold- or stress-induced hyperreactivity of the digital arterial smooth muscle, leading to episodic vasospasm
what is dx of PAD
ABI <.9
what area of the lungs get destroyed in alpha-1-antitrypsin deficiency
the lower lobes
vision changes associated with idiopathic intracranial hypertension
vision loss, diplopia due to abducens nerve palsy
signs pointing to multiple myeloma
constitutional symptoms, hypercalcemia, constipation, renal insufficiency, bone pain, fractures
what is the carotid pulse like in severe aortic stenosis
weak and slow rising
signs of theophylline toxicity
tremors, nausea, vomiting, tachyarrythmia, hypotension
what does theophylline do
this is a nonspecific phosphodiesterase inhibitor
what is lemierre syndrome
oropharnygeal infection that turns to a severe infection and causes internal jugular venous thrombosis, pulmonary nodules, and worsening respiratory distress
what is the bug that causes lemierre syndrome
fusibacterium necrophorum
what organs is it normal for FDG to pool in in patients underoing a PET scan
brain, kidneys, ureters, bladder etc.
what increases risk of MALT gastric cancer
h pylori
treatment of DVT
initiate anti Xa (1st choice) or warfarin, dont necessarily need to give heparin, only for hemodynamically unstable patients.
what value is high in hereditary spherocytosis
MCHC is increased
acute onset onset of palpitations, HTN and fever agitation following CT w/contras
thyroid storm from the excess iodine that causes increased release of the thyroid homrone
treatment of hyperkalemia with T waves on ECG
calcium gluconate and insulin/glucose
rare side effect of nitrofurantoin (lungs)
acute lung injury- dyspnea fever, bilateral opacities 6-9 days after initiating therpay
clinical signs of rhabdomyolysis
muscle weakness, dark urine, decreased urine output, elevated creatinine, and
Urinalysis of rhabdo
blood on urinalysis without a significant number of red blood cells (RBCs) on urine microscopy
common variable immunodeficiency signs
recurrent respiratory infections, recurrent GI infections, chronic diseases, onset 20-40yo
causes of recurrent pneumonia in the same anotomic location
foreign body, malignancy, dysphagia
treatment of delierium in an agitated elderly patient
haloperidol
what is the phlebitis assiciated with pancreatic cancer
migratory thrombophlebitis
dx of polymyositis
EMG
and elevated CK, muscle bx
extrarenal manifestations of PCKD in adults
liver cysts, cerebral berry aneurysms, hypertension
what is the difference between painless thyroiditis and subacute thyroiditis
both will cause decreased iodine uptake but with painless thyroiditis you have no pain on palpation and in subacute you do have pain
what changes do you see on EKG with hyper/hypokalemia
hypo- you see flat T waves, hyper - you see peaked T waves
skin manifestations of blasto
wart-like lesions, violaceous nodules, skin ulcers
where is blasto vs. histo
blasto extends up in to the midwest more than histo
what is the pathophysiology of hepatorenal syndrome
this is where you have splanchnic dilation which causes decreased renal perfusion which then causes activation of RAAS which then causes massive renal vasoconstriction which causes AKI
features of pemphigus vulgaris
painful flaccid bullae that erupt on skin and mucosa
mucosal involvement in pemphigus vulgaris vs. bullous pemphigoid
PV has mucosa BP no mucosa
age of onset for pemphigus vulgaris vs. bullous pemphigoid
PV 40-60yo, BP 60+
who has negative CXR but will still likely have pneumonia given the right clinical picture
pts on immunosuppressants (steroids rejection meds etc) because they cant mount an immune response to create an infiltration to be seen on CXR
treatment for acute bronchitis
supportive unless they have wheezing then you can do a bronchodilator
what systems are involved in granulomatosis with polyangiitis
respiratory, renal, skin
dx of vertigo after viral illness
vestibular neuritis- abnormal head thrust test and vertigo
treatment of TTP
plasma exchange, steroids, then immunosuppressant
initial workup of syncope
ambulatory ECG
where do you hear aortic regurg
left sternal border
what is a common complication of people with aortic valve endocardiits if it gets bad
perivalvular abcess
what is shown on radionucleotide myocardial imaging
these are the coronary arteries that you can see
what does it mean if there is less flow after exercise in a radionuleotide myocardial scan
this means there is an obstruction in the coronary arteries which needs to be treated with statin and antiplatelet therapy
what age group gets hemangiomas
mostly infants
who gets kaposi sarcoma
people on immunosuppresants, HIV, organ transplant,
what is the main source of thrombus for PEs
the femoral or popliteal veins
where do most foci for atrial fibrillation occur
in the pulmonary vein ostia
first step after dx of cirrhosis due to alcohol
upper GI endoscopy
prophylaxis of non bleeding esophageal varices
non selective beta blocker like nadolol
lab abnormalities in tumor lysis syndrome
hyperphosphatemia, hyperuricemia, hypocalcemia (due to Ca-P preciptation), hyperkalemia
when do you administer hypertonic saline for hyponatremia
<120meq
treatment of SIADH
fluid restriction and salt tablets
what valves are typically effected for rheumatic heart disease
aortic or mitral regurg or stenosis
what is hypertrophic osteoarthopathy
this is bilateral enlaragment of wrists and ankles with digital clubbing and is typically associated with pulmonary etiology like adenoCA or CF etc.
what drugs need to be held in AKI
metformin, ace/arb etc.
clinical course of hyperthyroidism after radioactive iodine treatment
takes about 6 weeks for hyperthyroidism to resolve, and then >90% of patients develop hypothyroidism
what test do you need to do dx spontaneous bacterial peritonitis
cell count with diff of the peritonitic fluid
what is the sodium level like in diabetes insipidus
it is high because water is not being retained
what is sodium level like in primary polydipsia
it is low because the patient is just taking in a bunch of water
what would the EKG show of a patient with viral myocarditis
non specifc ST segment changes
alternate treatment of syphillis if pt cannot do penicililn
doxy
acute management of acute coronary syndrome
nitrates (if chest pain), beta blocker, antiplatelet therapy, anticoagulation, statin therapy, coronary reperfusion
extrahepatic manifestations of wilsons
parkinsonism, gait disturbances, depression, psychosis, etc.
management of HHS
aggressive rehydration with normal saline and then IV insulin
clinical signs of bronchietasis
chronic daily production of thick occosionally blood tinged mucus
what area of lymphadenopathy is indicative of secondary syph
epitrochlear (above elbow)
what infection can you get from cave exploring
histoplasma
what is light’s criteria for pleural effusion
pleural: serum protein ratio >0.5 OR pleural:serum lactate ratio >0.6 OR greater than 2/3 upper limit normal of serum lactate pleural lactate
what is becks triad for cardiac tampanode
distended neck veins, muffled heart sounds, hypotension
hypothyroidism effect on LH and FSH levels
this causes increased prolactin because there is increased TRH which increases both TSH and prolactin and prolactin suppresses LH and FSH
hallmarks of amyloidosis due to dialysis
carpal tunnel, bone cysts, shoulder pain and hypertrophy
what is broken heart syndrome
this is stress induced cardiomyopathy which is where you get a surge of catecholamines which causes chest pain like an MI
EKG changes in broken heart syndrome
can show ischemic changes like t wave inversions or ST changes
CT scan of acute aspergillosis
nodules with surrounding ground-glass opacities (“halo sign”
leukemoid vs. CML LAP score
LAP is decreased in CML vs. leukemoid reaction
metamyelocytes in CML vs. leukemoid
in CML there are more immature cells which are the metamyelocytes and in leukemoid there are more myelocytes which are mature
what type of nephritis do patients with RA get
amlyloid nephritis (nephrotic)
are deep or superficial infections for diabetic foot ulcers poly or monomicrobial
superficial are mono and deep are poly
management of vfib
defibrillation
what is the main cause of intrinsic AKI
ATN (85%)
muddy brown casts what do they MEANNNN
ATN
why do you get secondary mitral regurg in heart failure
as the ventricle dilates, it pulls the chordae tendinae due to papillary muscle displacement which causes continual opening of the valves resulting in regurgication
peripheral pulses in HCM vs. AS
in HCM they are brisk and rapid, in AS they are soft and delayed
what is the calcium like in hyperparathyroidism due to CKD
it is low or low normal because it is not high bc the kidney is not converting VitD to active form
is raynaouds painful
yes
what is a poor prognostic indicator for heart failure (labs)
hyponatremia
acute kidney injury pathogenesis IV acyclovir
the IV acyclovir precipitates and causes obstructive damage to the tubules
enlarged lymph nodes, night sweats, HIV patient
non hodgkins lymphoma due to EBV
management of chemotherapy induced diarrhea
loperamide
