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facts Flashcards

1
Q

What treatment should be added for patients with aspirin-exacerbated respiratory disease?

A

Leukotriene inhibitor, i.e monteleukast

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2
Q

3 tests for Cushings dz

A

low dose dexamethasone suppression test, late-night salivary cortisol, and 24-hour free urinary cortisol

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3
Q

patient with non-healing anal fissures should be screened for what?

A

chrons, colonoscopy

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4
Q

all patients with congenital long qt should be on what medication?

A

beta-blocker

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5
Q

Early Latent syphilis

A

postive labs w/ negative test w/i past year, only need one dose of penecillin

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6
Q

If lyme suspected by initial test is equivical?

A

Perform western blot

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7
Q

if you suspect CNS involvement in lyme?

A

do an LP

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8
Q

most common malaria found in travellers returning to the US?

A

plasmodium falciparum

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9
Q

tx for pyelonephritis?

A

fluorquinolone x7d

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10
Q

indications for IE abx ppx?

A

prosthetic valve, previous IE, structural abnormality, certain CHD

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11
Q

Fever + desquamating rash + multiorgan failure?

A

Toxic shock syndrome, tx w/ vanc and clinda

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12
Q

Indications to treat hep B?

A

> 4 weeks of symptoms + t. bili >3 OR acute liver failure

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13
Q

hypersensitivity pneumonitis or “hot tub lung” is caused by what?

A

MAC

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14
Q

dissemintated blasto

A

skin, GU, bone, lung involvement, ocular, look for CAP that doesn’t resolve + above symptoms

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15
Q

MAC dx?

A

two separate sputum cultures, tx w/ clarithromycin, ethambutol and rifampin

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16
Q

Actinomyces treatment?

A

penicillin

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17
Q

Pyrimethamine requires

A

leucovorin to decrease the risk of hematologic suppression

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18
Q

HIV patient with oral thrush and odynophagia should be treated for

A

candida esophagitis, no upper endoscopy is necessary

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19
Q

Patients with prior rheumatic fever c/b valvular heart disease should receive

A

continuous abx ppx w/ long acting penicillin g injections

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20
Q

Secondary Syphyillus:

A

maculopapular rash, systemic symptoms, cervical lymphadenopathy, patchy hair loss and mild hepatitis

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21
Q

High fever and cytopenias in a patient with suspected Lyme indicate co-infections with

A

anaplasma (causes human granulocytic anaplasmosis), has influenza-like symptoms with cytopenias, fever, and elevated transaminases

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22
Q

Immunocompetent vented patients with Candida on sputum cultures management

A

NOT be treated or re-cultured

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23
Q

LDH >450 is predictive of ___ rather than another pulmonary process

A

PJP

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24
Q

Thiazide diruretics increase risk of what?

A

T2D

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25
Q

Systemic Exertional Intolerance Disease:

A

fatigue >6mo, substantial reduction in pre-illness activities, post-exertional malaise, unrefreshing sleep, orthostatic intolerance or cognitive impairment

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26
Q

____ is an AGMA that can occur in patients receiving therapeutic doses of tylenol on a chronic basis in the setting of critical illness, poor nutrition, liver disease, CKD, vegan diet

A

Pyroglutamic acidosis

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27
Q

salicylate tox presents w/

A

respiratory alkalosis or with resp alk + AGMA

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28
Q

Scurvy is associated with

A

gingival hypertrophy, bleeding gums and petichiae

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29
Q

Obese patients have (higher/lower) pro-BNP levels than non-obese patients

A

lower

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30
Q

celiac patients need what vaccination?

A

pneumococcal due to hyposplenism

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31
Q

+LR

-LR

A

1-sens/spec

sens/1-spec

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32
Q

urge incontinence tx

A

first behavioral, then can try anticholinergic drugs i.e mirabegron, oxybutinin, solifenacin, tolterodine, trospium

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33
Q

Topiramate (carbonic anhydrase inhibitor) causes ____ in urinary citrate excretion and the formation of ____ urine that favors the creation of ____ crystals

A

Decrease, alkaline, ca Phos

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34
Q

BPH in patients with ED

A

For BPH and ED first line tx is PDE5i (tadalafil, sildenafil)

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35
Q

In patients with hypercalciuria and multiple kidney stones

A

can treat with Na restricted diet, which leads to decreased ca secretion by the kidneys

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36
Q

Early-stage laryngeal cancer should be treated with

A

radiation alone

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37
Q

Prolonged PTT that does not fully correct suggests

A

presence of an inhibitor

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38
Q

Acquired hemophilia A -

A

treat with activated factor VII (tx w/ factor VIII will not be successful due to inhibitor)

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39
Q

MDS patients requiring frequent transfusions should be started on

A

lenalidomide

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40
Q

Hook-like osteophytes are seen in

A

hereditary hemochromatosis

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41
Q

Asymptomatic INR elevation between 4.5- 10, manage w/

A

withholding warfarin

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42
Q

Polyclonal spikes can be caused by

A

inflammatory disorders, infections, and reactive processes and do not require further evaluation

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43
Q

Warm Agglutinin:

A

strongly positive IgG, negative compliment or weakly positive, anemia, jaundice, splenomegaly, spherocytes,

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44
Q

Cold agglutinin:

A

negative for IgG, positive for compliment

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45
Q

In symptomatic metastatic prostate cancer, first, treat with

A

anti-androgen (bicalutamide) rather than GNRH antagonist (leuprolide) bc GNRHa will cause worsening of symptoms initially

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46
Q

Sickle cell disease patients who have had a stroke can benefit from

A

monthly simple transfusions

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47
Q

In patients with metastatic prostate cancer assessment of _____ is required at the time of initiating androgen deprivation therapy

A

bone density

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48
Q

peripheral t cell lymphoma should be treated with

A

combination chemotherapy

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49
Q

If MM is suspected and SPEP is negative you should do

A

a UPEP and FLC analysis

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50
Q

Platelet dysfunction in chronic kidney disease should be treated first with

A

desmopressin

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51
Q

Hypoparathyroidism is associated with an ____ in the tubular reabsorption of phos

A

increase

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52
Q

____ defect can increase tubular reabsorption of phos, resulting in hyper Phos

A

FGF-23

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53
Q

Biotin can mimic _______

A

hypothyroidism by interfering with the assays that measure TSH and free T4

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54
Q

Most common cause of primary adrenal insufficiency is

A

autoimmune adrenalitis (antibodies to 21-hydroxylase in 90%)

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55
Q

Hypoparathyroidism: must monitor

A

urine ca bc hypercalciuria can limit therapy

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56
Q

hyperprolactinemia (mild) can be caused by

A

medications (metoclopramide, risperidone, phenothiazines)

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57
Q

amiodarone-induced hyperthyroid:

A

type 1 (hx of graves or multinodular goiter), type 2 no hx of thyroid disease

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58
Q

adynamic bone disease:

A

caused by over-treatment of secondary hyperparathyroidism in CKD. it is characterized by low bone turnover and low PTH

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59
Q

subacute (dequervian) thyroiditis should be treated with

A

steroids. patients present with anterior neck pain, diffusely tender thyroid and features of thyrotoxicosis

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60
Q

Acromegaly is associated with an increased risk of

A

cancer (skin, colon, esophageal)

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61
Q

Graves: tx w/

A

methimazole, PTU only for first trimester of pregnancy

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62
Q

Radioactive Iodine can ____ ophthalmopathy in patients with graves,

A

worsen, so avoid its use in these patients

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63
Q

Euthyroid sick syndrome: will need to check ____level

A

t3 level to confirm dx as they would be high in thyrotoxicosis

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64
Q

Suppression of TSH in patients with high-risk papillary thyroid cancer can lead to an increased risk for (3)

A

osteoporosis, afib and hypertension

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65
Q

if the patient does not respond to bisphosphonates after 1 year should

A

switch to teriparatide

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66
Q

best screening for cushings:

A

AM cortisol has low sensitivity and is not recommended for screening for cushings, better to use low dose dexamethasone suppression test, late-night salivary cortisol, and 24-hour free urinary cortisol

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67
Q

dexamethasone suppression test does not work if

A

you are on OCPs

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68
Q

X-ray shows thickening of the femoral neck with diffuse sclerosis of bone that is prominent in the left hemi pelvis.

A

Next step? bone scan. likely padgets disease of the bone

69
Q

indications for parathyroidectomy in primary hyperpara:

A

age <50, symptomatic hypercalcemia, complications (osteoporosis, nephrolithiasis, CKD), elevated risk of complications (24hr urine ca >400, ca > 1 above upper limit of normal)

70
Q

Toxic ademona w/ overt hyperthyroidism tx is

A

radioactive Iodide ablation therapy

71
Q

Risk factors for cancer in thyroid nodules:

A

hx of ionizing radiation, elevated TSH, age <30 or >60, iodine deficiency

72
Q

PCOS symptoms of hair growth need to be present for ___ months of OCP tx before consideration of MRA

A

PCOS symptoms of hair growth need to be present for SIX months of OCP tx before consideration of MRA

73
Q

Gout lifestyle mods:

A

increased dairy, decrease seafood, decrease etoh, limited high-fructose foods and drinks

74
Q

______ are indicated for the tx of Behcets related oral and genital ulcers,_____ can help prevent them

A

Topical glucocorticoids , colchicine

75
Q

systemic sclerosis (scleroderma) 3 antibodies:

A

anti-topoismoerase I (anti Scl 70), anti-centromere, ana

76
Q

Adult Onset Stills Disease

A

fevers, arthritis, leukocytosis (neutrophilic), rash, positive RF and elevated ferratin

77
Q

Felty Syndrome:

A

Patients w/ RA, splenomegaly and neutropenia

78
Q

Hypertrophic osteoarthropathy can be an early sign of ______ in a patient with a history of smoking and finger clubbing

A

lung cancer

79
Q

Pseudogout: young patients with pseudogout should be tested for

A

hemachromotosis

80
Q

Sweet syndrome:

A

acute febrile neutrophilic dermatosis, characterized by fever, painful erythematous lesions, neutrophilic infiltrate on biopsy w/o vasculitis, WILL have dramatic response to steroid

81
Q

In SSc (scleoderma) patients watery diarrhea can be caused by

A

SIBO (small intestine bacterial overgrowth)

82
Q

Antisynthetase syndrome:

A

interstitial lung disease, myositis, Raynaud phenomenon, nonerosive inflammatory arthritis, constitutional findings such as low-grade fever, and mechanic’s hands; anti-aminoacyl-tRNA synthetases antibodies, such as anti–Jo-1, are highly suggestive of the diagnosis

83
Q

GPA relapse is treated with

A

rituximab

84
Q

______ presents as intensely pruritic, pink to purple, flat topped papules or plaques, wickham striae can be seen on the surface

A

Lichen planus

85
Q

Brachoradial pruritis “itch without a rash” is

A

a neuropathic itch characterized by deep, crawling, or tingling sensation on forearms, shoulders and upper back

86
Q

_____ most effective topical tx for extensive AK

A

5FU cream is

87
Q

_____ is a category of cutaneous sclerosis that involves only the skin in absence of other systemic manifestations

A

Morphea

88
Q

Porphyria Cutanea Tarda characterized by

A

blisters, bullae, scarring, hypo/hyper pigmentation on sun-exposed skin, commonly associated with HepC, HIV, etoh, estrogen, smoking

89
Q

senile solar purpura:

A

intermittent ecchymotic lesions primarily on hands and forearms

90
Q

Multiple skin tags are associated with (3)

A

insulin resistance, pregnancy and chrons dz

91
Q

UC flare: patients workup>

A

should undergo stool studies for routine pathogens, ova, and parasites as well as c diff

92
Q

Primary Sclerosis Cholangigtis: must start screening for

A

colon cancer upon diagnosis and annually

93
Q

Auto-immune hepatits:_____ antibody

A

anti-smooth muscle

94
Q

Eosinophilic Esophagitis:

A

15 eos/ hpf, exclusion of other causes of esophageal eosinophilia

95
Q

If h pylori testing obtained in the acute setting of UGIB is negative then

A

testing should be repeated

96
Q

After diagnosis of celiac disease must perform

A

DEXA scan due to vit d def

97
Q

Ileal resection leads to

A

bilesalt malbsorption and b12 deficiency

98
Q

Microscopic colitis can be triggered by

A

medications including NSAIDS, PPIs and SSRI

99
Q

Persistently elevated lipase and mild abdominal tenderness following acute pancreatitis is characteristic of

A

pancreatic pseudocyst

100
Q

Cysteine stones show

A

hexagonal crystals

101
Q

dyspepsia and age >60 =

A

endoscopy

102
Q

gastroparesis requires

A

delayed gastric empty in absence of outlet obstruction; must get upper endoscopy prior to emptying study

103
Q

anal fissures that do not heal,_____ screening is indicated

A

chrons

104
Q

treatment of locally advanced rectal cancer:

A

preoperative chemoradiation, surgery, post-op chemo

105
Q

______ deficiency can present in gastric bypass patients very similar to a b12 def (anemia, leukopenia, myeloneuropathy), exacerbated by zinc!!

A

Copper

106
Q

Zoledronic acid toxicity classically causes

A

ATN

107
Q

Voriconazole use is a risk factor for

A

development of skin cancer

108
Q

If starting OCPs need to ____ the dose of lamotrigene

A

increase

109
Q

Acyclovir IV should be given

A

with at least 2L NS per day to reduce the risk of kidney injury

110
Q

Amiodarone induced hypothyroidism:

A

can cont amio and add levothyroxine

111
Q

Phenytoin toxicity:

A

rash, horizontal nystagmus, ataxia. slurred speech, lethargy, coma

112
Q

Valproic acid tox

A

hyperammonemic encephalopathy can happen after an increase in dosage, check and ammonia level

113
Q

Calcimimetics in CKD (cinacalcet) can (list the benefit of taking this medication)

A

decrease the levels of PTH and lead to a decrease in parathyroidectomy

114
Q

Weight neutral antipsychotic

A

aripiprazole, a second generation anti-psychotic is weight neutral

115
Q

mtx tox

A

Folate deficiency and stomatitis can be caused by mtx, answer is to supplement folic acid

116
Q

Combine ____ and ___ BP meds will reduce peripheral edema and improve CV outcomes

A

Combine ca channel blockers and ACEi or ARB will reduce peripheral edema and improve CV outcomes

117
Q

Natalizumab: need to check _____ prior to starting

A

JC virus titiers

118
Q

_____is characteristic of cholchicine induced myopathy

A

Cytosolic vasculozation

119
Q

_____ presents with insidious onset fever, cough, DOE, wheezing, night sweats and weight loss, chest imaging shoes bilateral pleural based opacities

A

Chronic eosinophilic pneumonia

120
Q

Aspirin induced respiratory disease will benefit from

A

leukotriene antagonist like monteleukast

121
Q

Imaging modality for CTEPH:

A

VQ scan, mor senesitive than CTA

122
Q

_____is the most common cause of ICH (intracerebral hemorrohage)

A

cerebral amyloid angiopathy

123
Q

Neuroleptic Malignant Syndrome:

A

fever, confusion, muscle rigidity, autonomic instability (abnormal vitals, sweating)

124
Q

Neuroleptic Malignant Syndrome (fever, confusion, muscle rigidity, autonomic instability) can occur when

A

withdrawling from parkinsons meds

125
Q

Optic Neuritis:

A

acute monocular vision loss w/ washed out color vision and afferent pupillary defect, must get MRI to r/o MS

126
Q

_______ should be suspected in a patient with morning syncope or pre-syncope (ie. putting on a tight collared shirt in the AM)\

A

Carotid sinus hypersensitivity

127
Q

PAF associated with MV disease always requires ___ AC due to increased risk of stroke

A

warfarin

128
Q

In hepatorenal syndrome intrapulmonary shunt can be confirmed with ______, symptoms consist of dyspnea that is worse when sitting up and improved supine]

A

contrast echo

129
Q

Think _____ in pregnant patient with hypertension, chest pain and horners syndrome, first test is echo

A

Aortic dissection

130
Q

_______should be avoided in myopericarditis as they have a higher rate of recurrence

A

glucocorticoids including prednisone

131
Q

congenital long qt should be on

A

betablocker

132
Q

nephrocalcinosis is

A

AKI caused by tumor lysis syndrome

133
Q

_______ should be given for hypercalcemia, along with fluids. must avoid loop diuretics

A

Bisphosphonates

134
Q

bacterial keratitis should be treated with

A

anti-pseudomonals

135
Q

____ with high-dose glucocorticoids is an appropriate treatment for primary angiitis of the central nervous system.

A

Cyclophosphamide

136
Q

Lupus flare can be seen in what antibody titer?

A

dsDNA antibodies

137
Q

Anti-cytosolic 5′-nucleotidase 1A antibodies

A

have been identified in about half of patients with inclusion body myositis

138
Q

gouty cellulitis tx

A

w/ pred

139
Q

Screen for the ______ in a patient at high risk for allopurinol hypersensitivity.

A

HLA-B*5801 allele

140
Q

_____ is the most appropriate initial immunosuppressive therapy in the treatment of isolated class V lupus nephritis, especially without kidney dysfunction.

A

Mycophenolate mofetil

141
Q

Anti–Jo-1 antibodies

A

anti-synthetase syndrome

142
Q

Anti-U1-ribonucleoprotein

A

MCTD, SLE

143
Q

_______ is FDA approved as an addition to standard therapy in patients who have systemic lupus erythematosus with persistent mild to moderately active disease.

A

Belimumab

144
Q

_______ is a noninflammatory condition that involves ossification of spinal ligaments and entheses and usually presents as back pain and stiffness; characteristic radiographic changes include confluent ossification of at least four contiguous vertebral levels, usually on the right side of the spine.

A

Diffuse idiopathic skeletal hyperostosis

145
Q

________can present as annular with central clearing or papulosquamous with patchy erythematous plaques and papules, and both forms can be seen in the same patient;

A

Subacute cutaneous lupus erythematosus (SCLE)

146
Q

first-line therapy for minimal change disease

A

prednisone

147
Q

____ can lead to hypoaldosteronism and hyperkalemia

A

heparin

148
Q

in patients with hypercalciuria ____ can help decrease urine Ca and decrease stone formation

A

HCTZ

149
Q

Orthostatic hypotension associated with

A

increase in all-cause mortality

150
Q

among antidepressants, ___ is associated with less weight gain and fewer sexual side effects

A

Buproprion

151
Q

empiric tx of post-influenza pneumonia

A

cef+vanc+ azithro=

152
Q

definition of severe acute chest

A

multi-lobar infiltrates on xray, O2 sat < 85%

153
Q

bupropion is contraindicated

A

in seizure disorder

154
Q

anorexia tx

A

1st CBT, 2nd olanzapine

155
Q

after diagnosis of medullary thyroid cancer (3)

A

check RET, eval for metastatic dz, id co-existing tumors

156
Q

patients with presumptive ITP should be tested for

A

HIV, Hep C

157
Q

HIV patients with cryptococcus meningitis and increased ICP (opening pressure > 200) need antifungal plus ?

A

serial LP

158
Q

n. memningitis requires what time of precautions?

A

droplet, surgical mask

159
Q

AC in pregnancy

A

LMWH

160
Q

primary biliary cholangitis

A

anti-mitochondiral

161
Q

systemic sclerosis antibodies (scleroderma)

A

scl70, anti-centromere

162
Q

in patients with nephrotic syndrome, ____ is a common presentation of renal vein thrombosis

A

Pulmonary embolism

163
Q

anit- dna-histone antibodies

A

drug induced lupus

164
Q

MCTD antibodies

A

anti-RNP (or U1-RNP)

165
Q

limited scleroderma anti-body

A

anti-centromere

166
Q

polymyositis antibody

A

amino-acyl t-RNA synthetase

167
Q

microscopic polyangiitis anti-body

A

MPO (pANCA)

168
Q

GPA ( wegners)

A

cANCA (Proteinase 3)

169
Q

reduce the risk of recurrent nephrolithiasis in patients with ca oxylate kidney stones?

A

increase dietary calcium

ABIM (1 decks)

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