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Emma Holliday Medicine Flashcards

1
Q

Typical physical exam findings of Prinzmetal angina

A

CP worse at night or upon waking in middle aged F, also w/ migraines
-transient ST elevations during episodes

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2
Q

How to differentiate TTP from DIC

A

PT and PTT are normal in HUS/TTP (microangiopathic hemolytic anemias)

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3
Q

MC cause of death from endocarditis

A

CHF

-valve destruction => heart failure

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4
Q

Name some causes of DIC in addition to sepsis

A
  • rhabdo
  • heatstroke
  • pancreatitis
  • snake bites
  • adnocarcinoma
  • OB stuff (amniotic fluid embolism)
  • Tx of AML (Auer rods!!)
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5
Q

Main side effects of CMV tx

(a) Ganciclovir
(b) Foscarnet

A

(a) Ganciclovir- neutropenia

(b) Foscarnet- renal tox

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6
Q

Hilar lymphadenopathy w/ elevated ACE

(a) Dx
(b) Skin finding
(c) Why hypercalcemic
(d) Important referral
(e) Dx
(f) Tx

A

(a) Sarcoidosis
(b) Erythema nodosum
(c) Macrophages in granulomas produce vitD like substance
(d) Optho- 25% chance of uveitis
(e) Dx by biopsy
(f) Tx = steroids

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7
Q

Type I RTA

(a) Problem
(b) Etiology
(c) K status
(d) Tx

A

Type I RTA = distal

(a) Kidneys cannot excrete H+
(b) Etiology = Lithium, amphotericin
(c) Hypokelamic serum
(d) Tx by repleting K+ and oral bicarb

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8
Q

2 branched microorganisms

a) Gram stain
(b) O2 use?
(c) Key clinical features
(d

A

Nocardia = branched, (a) gram positive, partially acid fast staining bacteria

(b) Aerobic => residse in lungs
(c) Cavitary lung disease (purulent sputum) in immunosuppressed pt w/ wt loss and fever
(d) Tx = Trim-Sulfa

Actinomyces = branched (a) G+ (b) Anaerobic

(c) Neck or face infection w/ draining yellow material
(d) High dose penicillin

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9
Q

Cardiac pt s/p ticlopidine (ADP receptor inhibitor) w/ renal failure, thrombocytopenia, fever and AMS

(a) Dx
(b) Tx

A

(a) TTP

b) Plasmapheresis- don’t give plts (they’ll just get consumed by whatever process is underlying

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10
Q

Who needs endocarditis ppx?

A

Ppx for endocarditis: prosthetic valve, history of endocarditis, any congenital lesion

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11
Q

Enveloped shaped crystals

A

Ethylene glycol intoxication (causes anion gap metabolic acidosis)

Tx w/ dialysis or NaHCO3 if PH under 7.2

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12
Q

Light’s criteria

A

If all 3 met then pulmonary effusion is transudative

  1. LDH under 200
  2. LDH effusion/serum under .6
  3. protein effusion/serum under .5
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13
Q

25 yo w/ acute onset sxs CHF

A

Consider myocarditis (coxsackie B?)

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14
Q

3 key causes of sickle cell crisis

A

Hypoxia, dehydration, acidosis

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15
Q

Tx for

(a) Hyponatremia
(b) Hypernatremia

A

(a) Fluid restriction, only 3% saline if Na under 120 or seizures
(b) Replace w/ water w/ D5W or other hypotonic fluid

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16
Q

Feurea cutoff for prerenal

A

FEurea under 35% = prerenal acute renal failure

-use instead of FENa for pts on diuretics

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17
Q

ECG findings of

(a) Hyperkalemia
(b) Hypokalemia

A

(a) Obv peaked T waves, but also
- prolonged PR
- short QT
- widened QRS

(b) Hypokalemia: ST depression and U waves

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18
Q

First line med for WPW

A

Procainamide

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19
Q

50 yo “meat-a-tarian” s/p 2 weeks of clinda p/w hemarthroses and oozing from venipuncture sites

A

Vit K deficiency

-clinda wiped out gut flora => no vit K produced

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20
Q

Complication of silicosis

(a) Tx

A
  • increased risk to Tb => need annual Tb test

(a) Tx = INH for 9 mo

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21
Q

Define neutropenic fever

(a) MC cause
(b) First step
(c) Key contraindication

A

Neutropenic fever = single temp over 101.3 or sustained over 100.4 for 1 hour in pt w/ ANC under 500

(a) Mucositis causing bacteremia, usually from gut translocation
(b) Get BCx then start Cefipime or ceftazidime
(c) DONT do DRE- can translocate gut flora and induce bacteremia

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22
Q

Kidney stone in child w/ leukemia on chemo

A

Uric acid

-tumor lysis releases tons of urate

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23
Q

Pt w/ seizure w/ deja vu aura and meningitis sxs

A

Deja vu aura means the seizure started in the temporal lobe, so if +meningitis (w/ RBC in LP) = HSV encephalitis

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24
Q

Crohns vs. UC

(a) Terminal ileum
(b) Continuous involving rectum
(c) Associated w/ some biliary duct d/o
(d) Fistulae likely
(e) Granulomas on biopsy
(f) Higher risk of

A

(a) Terminal ileum = Crohn’s (can mimic appendicitis)
(b) Continuous involving rectum = UC
(c) UC associated w/ PSC (=> increased risk of cholangiocarcinoam)
(d) Fistula likely in Crohns (whenever have fistula, tx w/ metronidazole)
(e) Granulomas on biopsy Crohns

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25
Q

Antimitochondrial Ab vs. antismooth muscle Ab

(a) Tx difference

A

Antimitochondrial anitbody = PBC
(a) Won’t be helped by steroids

Antismooth muscle Ab = autoimmune hepatitis
(a) Tx w/ steroids

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26
Q

Crohns vs. UC

(a) Transmural inflammation
(b) Cured w/ colectomy
(c) Lower risk in smokers
(d) Higher risk of colon cancer
(e) Associated w/ p-ANCA

A

(a) Transmural inflammation in Crohns
(b) UC cured w/ colectomy
(c) Smoking decreases risk of UC, smokers have higher risk for Crohns
(d) Higher risk of colon CA in UC (another reason for colectomy, to prevent the cancer)
(e) UC associated w/ p-ANCA

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27
Q

Post-exposure ppx for HIV

A

Stuck w/ HIV needle: triple drug (not one or two…three drugs) therapy for 4 weeks

ex: AZT, lamivudine, nelfinavir

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28
Q

Lung cancer causing the following paraneoplastic syndromes

(a) Kidney stones
(b) Ptosis that improves w/ 1min of upward gaze
(c) Euvolemic hyponatremia

A

(a) Squamous cell carcinoma produces PTHrP
(b) Small cell carcinoma => Ab to pre-synaptic Ca (Lambert-Eaton)
(c) SIADH from small cell

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29
Q

2 clotting factors not depleted in severe cirrhosis

A

factor VIII and vWF b/c made by endothelial cells

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30
Q

MC cause of meningitis in HIV pt

A

Still Strep pneumo

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31
Q

HIV pt on HAART p/w macrocytic anemia

A

Zidovudine (AZT) causes leukopenia and macrocytic anemia

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32
Q

Pneumonia

(a) Old smokers w/ COPD
(b) Alcoholic w/ current jelly sputum
(c) Old M w/ HA, altered mental status, diarrhea
(d) Just had the flu
(e) Farmer w/ vom/diarrhea
(f) Just skinned a rabbit

A

(a) H. influenza, tx w/ 2-3rd gen ceph
(b) Current jelly sputum = Klebsiella
(c) Legionella
(d) After the flu- c/f staph
(e) Coxiella burnetti (Q fever)
(f) Tulleremia

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33
Q

2 dx: CXR w/ thickened peritracheal stripe and splayed carina bifurcation

A
  • LA enlargement (2/2 bad mitral stenosis)

- Mediastinal lymphadenopathy (2/2 cancer)

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34
Q

ECG finding associated w/ bad pulmonary disease

A

MAT (multifocal atrial tachycardia)

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35
Q

Gram positive bacteria that is partially acid fast staining

A

Nocardia

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36
Q

Meningitis

(a) 3 most common
(b) Old and young, add what to tx
(c) In ppl w/ brain surger

A

(a) H. flu, N. meningitides, strep pneumo

(b) add ampicillin for listeria coverage in old and young
(c) Worry about staph aureus in those w/ recent instrumentation- tx w/ Vanc

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37
Q

Causes of metabolic acidosis

A

Anion gap = MUDPILES

Nonanion gap = diarrhea, diuretics, RTA (I, II, IV)

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38
Q

Contrast induced nephropathy timeline

A

48-72 hrs

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39
Q

Tx for RV infarct

A

NO NITROOOO- will drop preload and can put pt into cardiogenic shock

Instead need aggressive fluid resuscitation

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40
Q

First test if suspecting rhabdo

(a) Tx for rhabdo

A

EKG and serum K+

(a) Tx for rhabdo: bicarb to alkalinize urine to prevent precipitation

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41
Q

Obstructive vs Restrictive lung disease

(a) Asthma
(b) Obesity
(c) emphysema
(d) sarcoidosis

A

(a,c) Asthma, emphysema, COPD = obstructive

(b,d) Obesity, sarcoid/asbestosis/silicosis, scoliosis = restrictive

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42
Q

Most concerning cause of meningitis in HIV+ pt

(a) Stain for diagnosis
(b) Tx

A

Cryptococcus neoformans (fungi)

(a) India ink stain- black background, organisms light up, stains the gelatinous capsule
(b) Amphotericin IV for 2 weeks, then fluconazole maintenance

43
Q

Side effects of Tb drugs

(a) Rifampin
(b) INH

A

(a) Rifampin: orange/red body fluids, cyt p450 inducer

(b) Hepatitis, neuropathy (so give B6 w/ it) and sideroblastic anemia

44
Q

Proteinuria

(a) MC cause in adults
(b) Heroin use and HIV
(c) Chronic hepatitis and low complement

A

Proteinuria

(a) Membranous (thick capillary walls w/ subepithelial spikes)
(b) Mesangial IgM deposits = focal-segmental glomerulonephritis
(c) Membranoproliferative (tram-track basement membrane w/ subendothelial deposits)

45
Q

Concern if nephrotic pt suddenly develops flank pain

A

Suspect renal vein thrombosis

-peeing out ATIII (antithrombotic protein), protein C and S => do CT or U/S stat

46
Q

What size kidney stones get lithotropsy

A

5mm - 2cm
under 5mm just gotta pass it, just hydrate them
stones over 2cm get endoscopic surgical removal

47
Q

Kid eats a hamburger then has diarrhea w/ renal failure, microangiopathic hemolytic anemia, and petechiae

(a) Tx

A

Dx = HUS = hemolytic uremic syndrome
-E. coli or shigella

(a) Tx w/ just support- NO ABX will just release more toxin

48
Q

Cold agglutinin

(a) Ab
(b) Location of destruction
(c) Association

A

Cold agglutinin

a) IgM
(b) Destruction in the liver
(c) Mycoplasma (walking PNA

49
Q

Elevated alk phos, normal GGT, normal Ca

A

Paget’s disease

-associated hearing loss (b/c of ossicle damage)

50
Q

Pulm disease

(a) Eggshell calcification nodule in upper lobe
(b) Patchy lower lobe infiltrate, Culture thermophilic actinomyces

A

(a) Silicosis

(b) Hypersensitivity pneumonitis = farmer’s lung

51
Q

3 diagnostic criteria of ARDS

A

ARDS (sepsis 2/2 LPS, pancreatitis, trauma)

  1. Radiologic evidence: b/l alveolar infiltrates on CXR
  2. PaO2/FiO2 under 200 (if under 300 = acute lung injury)
  3. PCWP under 18 (aka r/o cardiac cause of pulmonary edema)
52
Q

Features of large cell lung cancer

(a) Location
(b) CXR finding
(c) Prognosis

A

Large cell

a) Peripheral
(b) Peripheral cavitation (likely to cavitate
(c) CT w/ distant mets- poor prognosis

53
Q

Sxs of ventricular wall aneurysm after MI

A

Persistent ST elevations for a month w/ systolic MR murmur

54
Q

Differentiate murmur heard w/ HOCM and MVP

A

Both HOCM and MVP give systolic murmur and are louder w/ valsalva (decreases preload)

  • while AS gets softer w/ valsalva
  • HOCM: softer w/ squatting and handgrip
  • MVP louder w/ handgrip (increased afterload), softer w/ squatting (increased preload), also MVP w/ late systolic click
55
Q

Microcytic anemia: differentiate labs for anemia of chronic disease vs. sideroblastic

A

Anemia of chronic disease: low Fe and TIBC, low retic, normal ferritin (normal stores)

Sideroblastic: high iron, high ferritin, low TIBC

So diff is the iron level- sideroblastic you’re not making protoporphyrin so iron builds up in blood

56
Q

HIV pt w/ hemisensory loss, visual impairment, pos Babinski

(a) Dx

A

Presents like MS- but in HIV pt = PML = JC polyomavirus = demyelinating at gray-white junction

(a) Dx gold standard = brain biopsy

57
Q

Polyarteritis nodosa

(a) MC organs involved
(b) Lab abnormality
(c) Tx

A

Polyarteritis nodosa

(a) everywhere EXCEPT lung
(b) Associated w/ hep B
(c) Cyclophosphamide

58
Q

Hereditary spherocytosis

(a) mutation
(b) Tx
(c) Clinicaly presentation

A

(a) Autosomal dom mutation in spectrin
(b) Treat w/ splenectomy
(c) Splenomegaly, family hx, bilirubin gallstones, elevated MCHC
- high LDH/indirect bili and low haptoglobin b/c hemolytic

59
Q

When to use hypertonic saline in the tx of hyponatremia

A

Only if Na is under 120 or pt has seizures

60
Q

Type II RTA

(a) Problem
(b) Etiology
(c) K status
(d) Tx

A

Type II RTA = proximal

(a) PCT cant reabsorb bicarb
(b) Etiology = Fanconi anemia
(c) Hypokalemic
(d) Replete K+
- oral bicarb doesn’t help here

61
Q

Best prognostic indicator for COPD

(a) Only 2 ways to improve survival
(b) Goal O2 sats

A

FEV1 = best prognostic indicator for COPD pts

(a) Stop smoking, constant (over 18 hrs/day) of O2 therapy
(b) Goal O2 sat 92-94% b/c these chronic CO2 retainers need hypoxia to maintain respiratory drive

62
Q

Side effects of zidovudine (AZT)

A

AZT = NRTI (nucleoside reverse transcriptase inhibitor):

  • GI
  • leukopenia
  • macrocytic anemia**
63
Q

Cause of megaloblastic anemia that is not folate/B12 deficiency

(a) Finding on peripheral smear

A

Severe liver disease (ex: cirrhosis)

a) Acanthocytes (spikey RBCs

64
Q

Tick bite w/o rash

(a) Other symptoms
(b) Tx

A

Tick bite w/o rash- think Ehrlichiosis

(a) Tick bite w/ no rash, +myalgia, fever, headache (flu like symptoms). Also hematologic (low plts and WBC) and elevated ALT
(b) Doxy
- tick bite? tx w/ doxy

65
Q

Cuttoff values for positive PPD

A
  • normal: 15mm
  • prison, healthcare, nursing home, DM, EtOH, chronically ill: 10mm
  • AIDS or immunosuppressed: 5mm
66
Q

Test to differentiate CHF from pulm HTN

A

R. heart catch, CHF will have high PCWP while PCWP (surrogate for LA pressure) is normal in pulmonary HTN

67
Q

Asbestosis

(a) CXR finding
(b) MC cancer
(c) Increased risk for what cancer

A

Asbestosis

(a) Reticulonodular process in lower lobes w/ pleural plaques
(b) MC bronchogenic carcinoma
(b) Increased risk mesothelioma

68
Q

Hematuria + deafness

A

= Alports- X-linked recessive mutation in collagen IV

69
Q

MC cancer in non smokers

(a) Location
(b) Mets
(c) Characteristic effusion

A

MC nonsmokers: adenocarcinoma (can occur in scars of old PNA

(a) Peripheral
(b) Liver, bone, brain, adrenals
(c) Exudative w/ high hyalurinidase

70
Q

Kidney stone in pt s/p bowel resection for volvulus

A

Pure oxylate stone

-Ca is not reabsorbed by the gut

71
Q

Rash on wrists/ankles/palms/soles w/ fever and headache

(a) Tx
(b) Tx in kids

A

Rickettsia- rocky mtn spotted fever

(a) Doxy
(b) Doxy anyway! can’t use amox (like can in Lymes) so use doxy anyway

72
Q

Clinical signs of RV infarct

A

Hypotension, tachycardic, JVD w/ clear lungs (so not CHF), no pulsus paradoxus

73
Q

Clinical features suspicious for squamous cell carcinoma

A

Squamous cell carcinoma (central)

-kidney stones, constipation, malaise (bones, groans,…) and low PTH b/c of paraneoplastic from PTHrP release

74
Q

Side effects of Tb drugs

(a) Pyrazinamide
(b) Ethambutol

A

(a) Pyrazinamide = benign hyperuricemia

(b) Ethambutol = optic neuritis, other color vision abnormalities

75
Q

Which type of renal tubular acidosis:

(a) Hyperkalemia
(b) Improves w/ oral bicarb repletion

A

RTA

(a) Type IV = hyperkalemic (b/c hypo-aldo)
(b) Type I improves w/ oral bicarb b/c the problem is that kidneys can’t excrete H+

76
Q

Indications for CABG over PCI

A

CABG over stent if

  • L. main disease
  • 3 vessel disease, or 2 vessel disease in diabetic
  • over 70% stenosis despite optimal medical management
77
Q

Kidney stone in pt w/ chronic indwelling foley and alkaline pee

A

Struvite stone (Mg/Al/PO4) from urease positive organism = proteus, staph, pseudomonas, klebisella

78
Q

PCP pneumonia

(a) Serum abnormality
(b) 1st line tx
(c) 2nd line tx

A

(a) Elevated LDH
(b) Trim-sulfa
(c) Sulfa allergy? Trim-dapsone or primaquine-clinda, or pentamidine
- Add steroids if PaO2 under 70

79
Q

Type IV RTA

(a) Problem
(b) Etiology
(c) K status
(d) Tx

A

Type IV RTA

a) Hyperrenin hypoaldo
(b) Diabetes
(c) Hyperkalemia (b/c hypoaldo
(d) Replete mineralocorticoid

80
Q

Murmur worse w/ inspiration

A

Right sided murmurs are always worse w/ inspiration

81
Q

HIV+ pt w/ ring enhancing lesion(s) on CT head

A

Start pyramethamine sulfadiazine (+folic acid) for 6 weeks

  • if improves = Toxo
  • if doesn’t improve = think CNS lymphoma
82
Q

5-7 days post-MI, new systolic murmur

A

Regurg from papillary muscle rupture

83
Q

Pt w/ lung tumor and

(a) Ptosis, constricted pupil, facial edema
(b) Ptosis that improves after 1 min upward gaze

A

(a) Pancoast tumor = superior sulcus tumor, from small cell tumor
(b) Lambert Eaton syndrome (also from small cell)
- Ab to pre-synpatic calcium channel

84
Q

HIV pt w/ diarrhea- what tests? Top 3 dx?

A

HIV pt w/ diarrhea

(a) CMV colitis- can see on colonoscopy/biopsy
(b) Watery diarrhea w/ mucus, oocysts are acid fast positive = Cryptosporidium
(c) Night sweats, wasting, fevers, dx of exclusion = MAC

85
Q

Crohns vs. UC

(a) Painful lesions on shins
(b) String sign on barium study
(c) Pyoderma gangrenosum

A

(a) Erythema nodosum- UC and sarcoid
(b) String sign- Crohns
(c) Pyoderma gangrenosum- UC, inflammation tissue and WBCs (not infectious)

86
Q

ASD murmur

A

Wide fixed and split S2

87
Q

Physical exam finding of AV dissociation

A

3rd degree AV block => cannon A waves

-neck waves: atrial blood hitting closed tricuspid valve b/c atria and ventricles are totally out of sync

88
Q

Causes of metabolic alkalosis w/

(a) High urine chloride
(b) Low urine chloride

A

Metabolic alkalosis (high HCO3 and high pCO2)

(a) Urine [Cl] over 20 and hypertension = Hyperaldo (Conns). W/o HTN think Barter/Gittlemans (congenital inability to reabsorb Na)
(b) Low urine Cl = vomiting/overaggressive NG suction, antacids, diuretics

89
Q

Valve abnormality that widens pulse pressure

A

Aortic insufficiency

90
Q

After exposure to Tb who gets ppx?

A

Most don’t!!! Only kiddos under 4 who are exposed to Tb get ppx

Ppx = INH for 9 mo

91
Q

Indications to start supplemental O2 in COPD pt

A
  1. PaO2 under 55 (or under 59 if core pulmonale)

2. Sats under 88%

92
Q

New onset clubbing in COPD pt

A

Get CXR for cancer

93
Q

Rate of correcting sodium abnormalities

A

Don-t correct faster than 12-24 mEq/day (.5-1 mEq/hr) in either direction or else

  • central pontinue myelinolysis if correct hyponatremia too quickly
  • cerebral edema if correct hypernatremia too quickly
94
Q

When to start HAART

A

Start HAART when CD4 under 350 or viral load over 55,000

95
Q

CXR characteristics of benign pulmonary nodules

A
  • popcorn calcification = hamartoma
  • concentric calcification = old granuloma
  • well circumscribed

Concerning findings

  • eccentric calcification
  • over 3cm
96
Q

Pleural effusion buzzwords

(a) High LDH
(b) Low glucose w/ negative gram stain
(c) High lymphocytes
(d) Bloody

A

(a) High LDH (exudative) = bacterial pneumonia or malignancy
(b) Low glucose not infectious consider rheumatoid arthritis (high inflammatory cells use up tons of glucose)
(c) High lymphs = Tb
(d) Bloody = PE or cancer

97
Q

Mycoplasma pneumonia

(a) Associated hematologic d/o
(b) First line tx

A

(a) Cold agglutinin

b) Macrolide (azithromycin

98
Q

Define nephritic syndrome

A

Proteinuria but not nephrotic range (under 2g over 24 hrs)
Hematuria
Edema
Azotemia

99
Q

Change in meds if get stent

A

Already on ASA, if stented give clopidogrel for 9-12 mo

100
Q

Kidney stones

(a) Best test
(b) MC type

A

(a) CT

(b) Calcium oxalate

101
Q

Churg Strauss

(a) MC organs involved
(b) Lab abnormality
(c) Tx

A

Churg Strauss = p-ANCA vasculitis

a) Renal failure, asthma (upp resp tract
(b) eosinophilia
(c) Cyclophosphamide

102
Q

Warm agglutinin

(a) Ab
(b) Location of destruction
(c) Association

A

Warm agglutinin

(a) IgG
(b) Destruction in spleen
(c) Associated w/ drug rxn (PCN, ceph, sulfa, rifampin) or cancer

103
Q

Etiologies of Torsades

A
  • Electrolyte abnormalities: hypoK, hypomag

- Drugs: lithium, TCA

Step 2 (3 decks)

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