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Family med > deck 34 > Flashcards

deck 34 Flashcards

1
Q

initial therapy for atrial fibrillation due to hyperthyroidism

A

beta-blockers

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2
Q

potassium in patients with hyperosmolar hyperglycemic state

A

1) pts have a total body potassium deficit (glucose induces osmotic diuresis which sucks potassium out) (same is true for DKA)
2) problem with this is that insulin can abruptly lower serum potassium levels and cause severe hypokalemia

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3
Q

common cause of hypocalcemia in alcoholics

A

hypomagnesemia (causes decreased release of PTH and PTH resistance).

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4
Q

other impt cause of hypercalcemia

A

prolonged immobilization (due to increased osteoclastic activity)

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5
Q

treatment of hypercalcemia 2/2 immobilization

A

bisphosphonates

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6
Q

problem with pulse ox for CO poisoning

A

may appear normal because it can’t differentiate carboxyhemoglobin from oxyhemoglobin

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7
Q

exam finding suggesting CO poisoning

A

bright cherry lips

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8
Q

thyroid tumor and elevated calcitonin?

A

medullary thyroid cancer

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9
Q

next step after medullary thyroid cancer is diagnosed

A

screen for pheochromocytoma prior to thyroidectomy with plasma fractionated metanephrine assay

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10
Q

diabetes and polyneuropathy pathophys

A
  • microvascular injury + demyelination + oxidative stress + deposition of glycosylation end products
  • this leads to a length-dependent axonopathy
  • clinical features depend on the type of nerve fibers involved
  • small fiber injury is characterized by positive symptoms (pain, paresthesias, allodynia)
  • large fiber involvement is characterized by predominance of negative symptoms (numbness, loss of proprioception and vibration sense, diminished ankle reflexes)
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11
Q

primary hyperaldosteronism lab profile

A

HTN + mild hypernatremia + metabolic alkalosis + suppressed plasma renin (this is because of feedback inhibition in response to aldosterone secreting tumor)

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12
Q

management of caustic ingestion with sodium or potassium hydroxide (lye)

A

endoscopy to assess severity of damage

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13
Q

arsenic sources

A

pressure-treated wood + pesticides

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14
Q

arsenic poisoning presentation

A

painful sensorimotor polyneuropathy + hypo and hyper pigmented skin lesions + pancytopenia + mild transaminase elevation

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15
Q

patient populations with atypical ACS symptoms

A

women + elderly + diabetics

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16
Q

common atypical ACS presentations

A

dyspnea + epigastric pain + N/V

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17
Q

type 1 MEN

A

primary hyperparathyroidism + pituitary tumors + GI/pancreatic endocrine tumors

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18
Q

thyroid storm presentation

A

tachycardia + HTN + arrhythmias + high fever +tremor + AMS + lid lag

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19
Q

hypothermia management

A

mild with passive rewarming, severe with active rewarming (heated blankets) + heated peritoneal irrigation (internal warming)

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20
Q

methanol intoxication

A

vision loss + coma

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21
Q

PE in methanol intoxication

A

optic disc hyperemia

22
Q

how to differentiate methanol vs. ethylene glycol poisoning

A

methanol damages the eyes, ethylene glycol damages the kidneys

23
Q

how to differentiate postpartum adrenal insufficiency

A
  • can be due to adrenal or pituitary disease

- hyper pigmentation + signs of mineralocorticoid deficiency suggests primary rather than secondary AI

24
Q

meningococcal vaccination

A
  • all adolescents at age 11-12
  • booster at 16
  • especially important in sub-saharan africa
25
Q

vaccination and TNF-alpha antagonists

A

can’t use live vaccines

26
Q

adult Tdap vaccination

A
  • every 10 years

- if never received or vaccine history unknown, Tdap should be given followed by Td every 10 years

27
Q

vitamin deficiency with carcinoid

A

Niacin. This is because increased production of serotonin from tryptophan (required for niacin synthesis) results in niacin deficiency

28
Q

features of vertebral osteomyelitis

A
  • most cases chronic and insidious with minimal symptoms
  • fever not often present
  • exquisitely tender to gentle percussion
  • often normal white count
  • high ESR
29
Q

source of B12

A

dairy products

30
Q

when to scan pyelo patients

A

persistent symptoms despite 48-72 hours of therapy OR complicated pyelo

31
Q

aldosterone antagonists

A

spironolactone, eplerenone

32
Q

thiazide mechanism

A

block sodium-chloride symporter

33
Q

OI prophylaxis for patients who’ve had solid organ transplantation

A
  • *bactrim for pneumocystis pneumonia

- Many patients also require CMV prophylaxis with ganciclovir or valganciclovir

34
Q

p jirovecii diagnosis

A

need bronchoalveolar lavage/respiratory secretions using microscopy with specialized stains (can try induced sputum but may need bronchoalveolar lavage)

35
Q

typical symptoms of hypercalcemia

A

abdominal pain + constipation + polydipsia

36
Q

bacteria involved in puncture wound through SOLE of a shoe

A

pseudomonas (likes warm, moist environment)

37
Q

strep throat vs. mono

A
  • mono causes generalized lymphadenopathy unlike sore throat

- mono persists for longer (2 weeks)

38
Q

presentation of hypothyroid myopathy

A

myalgias + proximal muscle weakness + elevated CK level + additional features of hypothyroidism (fatigue, delayed reflexes)

39
Q

management of post exposure HIV prophylaxis

A

3-drug antiretroviral therapy for 1 month. start therapy ASAP

40
Q

presentation of disseminated gonococcal infection

A

mono arthritis and/or tenosynovitis + dermatitis (erythematous papule and pustules) + asymmetric migratory polyarthralgias

41
Q

hep A vaccine recommended for

A

gay men + chronic liver disease + travelers to countries where hep A is prevalent

42
Q

DKA management

A

1) NS
2) regular insulin
3) serial BMPs
4) treat underlying factor

43
Q

best antibiotic to cover oral bacteria

A

amoxicillin-clavulanate

44
Q

esophageal perforation presentation

A

chest pain + subcutaneous emphysema + left-sided pleural effusion

45
Q

causes of esophageal perforation

A

endoscopy + severe retching + penetrating trauma

46
Q

esophageal perforation diagnosis

A

contrast esophagram

47
Q

how does vasodilator stress testing work

A

adenosine causes an increase in blood flow in normal coronary arteries and a relatively small increase in blood flow in stenotic coronary arteries. Difference in blood flow allows for diagnosis of obstructive CAD due to reduced uptake of isotope in ischemic myocardium

48
Q

effect of CKD on phosphate

A

hyperphosphatemia

49
Q

common cause of male pattern hair loss in women

A

PCOS

50
Q

actinic dermatitis

A

skin damage from sun

Family med (48 decks)

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