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Final Questions Flashcards

1
Q

What is microcytic anemia?

A

MCV < 80 (small volume of RBC)
There is insufficient Hb production, chronic disease, or defective heme synthesis (Iron def. anemia, Pb poisioning)
Defective globin chains (thalassemia)

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2
Q

What is macrocytic anemia?

A

MCV >100 (large volume of RBC)
Due to:
- Megaloblastic (VB12 def, folate def) - there is impaired DNA synthesis
- Nonmegaloblastic (liver dx, alcohol)

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3
Q

FUO is defined as

A

Fever >= 38.3 on 2 separate occasions
Illness duration of >= 3 weeks
No known immunocompromised state
Uncertain dx

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4
Q

What is thrombotic thrombocytopenic purpura (TTP)? Etiology? SX?

A

A thrombotic microangiopathy
Microthrombi (made of platelets) occlude the arterioles/capillaries.
Due to acquired autoAb vs ADAMTS13 (cleaves vWF)
SX: fever, neurological abnormalities, thrombocytopenia, microangiopathic hemolytic anemia, impaired renal function)

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5
Q

Coombs test

A

Direct: a hemagglutination test that can detect hemolytic antibodies or complement proteins bound to RBC’s
Indirect: Test which finds autoAb’s/Proteins in the serum

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6
Q

When is d-dimer (a fibrin degradation product) increased?

A

Increased serum concentrations of D-dimer indicate recent intravascular coagulation and/or fibrinolysis (e.g., from deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation).

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7
Q

When is d-dimer (a fibrin degradation product) increased?

A

Increased serum concentrations of D-dimer indicate recent intravascular coagulation and/or fibrinolysis (e.g., from deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation).

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8
Q

What is Well’s criteria?

A

To identify VTE risk in DVT and PE. It considers: malignancy, hemoptysis, tachycardia, previous PE/DVT, clinical symptoms for DVT, immobilisation.
>7 is high probablitity of PE. Modified >4 is high PTP

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9
Q

What is giant cell arthritis?

A

Chronic granulomatous vasculitis of extracranial branches of carotids. Assoc. with polymyalgia rheumatics

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10
Q

Large vessel vasculidities:

A

Giant cell arteritis (Temporal headache-blindness)
Takayasu (pulseless dx)

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11
Q

Medium vessel vasculitis

A

polyarteritis nodosa (HX of HBV, BX, CyloPho)
Kawasaki (children, CRASH BURN, aspirin)

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12
Q

Variable vessel vasculitis

A

Bechets: oral genital ulcers (+ pathergy test)

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13
Q

WHO analgesic ladder

A

Mild: NSAIDS, acetaminophen, aspirin (adjuvant)
Mod: opiods (codeine, tramadol) + above
Severe: opioids (morphine, fentanyl) + above

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14
Q

Non selective NSAID complications

A

(ibruprofen, naproxen)
gastric ulcers, renal damage

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15
Q

Selective NSAID complications

A

(-coxibs for COX2i) they increase coagulation so risk of CAD

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16
Q

Side effects of acetaminophen (inhibits PGE synthesis)

A

HTN, liver damage/failure

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17
Q

Colchicine uses

A

Its an anti-inflammatory and prevents microtubule formation.
Used in gout, and recurrent pericarditis

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18
Q

What is fulminant myocarditis?

A

A rare and life-threatening type of myocarditis characterized by cardiogenic shock, hemodynamically significant arrhythmias (e.g., heart block, ventricular tachycardia), and multiorgan failure.

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19
Q

Most common location of aortic dissection

A

Right lateral wall of ascending aorta

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20
Q

Debakey and Stanford classification of aortic dissection

A

De Bakey: I (ascending + descending), 2 (ascending), 3 (descending a above renal, b below renal).
- Stanford A (De Bakey I and 2), Stanford B (De Bakey 3)

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21
Q

What labs to determine end organ damage?

A

troponin, basic metabolic panel, lactate

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22
Q

Hypotensive pts hemodynamic support includes

A

Target MAP: 70mmHg
IV fluids
Vasopressors (norepinephrine, phenylephrine)

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23
Q

Hypertensive pt management in aortic dissection

A

Target SBP 100-120 HR<60
IV BB: to avoid reflex tachycardia
Vasodilators: IV sodium nitroprusside
If BB contraindicated: non-DHT CCB

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24
Q

Most common site of malignancy in breast cancer?

A

Upper outer quadrant (close to axilla)

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25
Age differential for breast nodules
20: fibroadenoma, benign nodules 50: cysts 60: cancer
26
Which imaging study if liver cirrhosis is present?
MRI CT: enhancement in late arterial phase and hypoattentuation in portal venous phase
27
What is zollinger ellison syndrome?
Multiple peptic ulcers due to gastrinoma
28
What is whipples triad
used to identify hypoglycemia Presents with Hypoglycemia SX, relief with glycemia normalises, low plasma glucose
29
Transudative pleural effusion is due to which conditions?
Increased hydrostatic pressure HF, cirrhosis, hypoalbuminemia (CKD)
30
Exudative pleural effusion occurs in which situations?
Increased capillary permeability Pneumonia, cancer, PE, TB
31
What spatial organisation does typical/atypical pneumonia have?
Typical: lobar Atypical/interstitial
32
Scores for pneumonia are CURB65 and PSI which include
CURB65 (confusion, urea >7, RR>30, SBP<90, age 65)
33
The treatment of PE should last how long
6 months If stable: initial dose of LMWH/fondaparinaux, with 6mo of DOAC/warfarin If unstable: thrombolytis or embolectomy IVC filter if acute VTE
34
Congestive HF is due to?
due to CAD, DM, HTN. These conditions cause ventricular dysfunction with low CO.
35
Acute Heart failure can be
A de novo episode (due to post-MI, pulmonary embolism, pericardial effusion.) or decompensation of pre-existing HF (common in hospitalised old pt)
36
Pulmonary edema is , and is caused by?
Is fluid right outside the alveoli. Can be cardiogenic (LVHF), or non cardiogenic (sepsis, severe infection)
37
Pulmonary effusion is, and is caused by?
Is fluid in the pleural space. Can be transudative or exudative. Due to infections, malignancy, HF
38
Hemoptysis is? It is most commonly due to
Bleeding from the lower respiratory tract. Due to pulmonary infection (TB) then lung cancer
39
Indications for endotracheal tube
Airway obstruction: (anaphylaxis) Airway protection (if you have lost reflexes during general anesthesia, coma, severe altered mental status, or if deterioration is anticipated (smoke inhalation injury, overdose)
40
What are purpura?
subtype of hematoma which does NOT blanch with pressure (meaning it is due to RBC extravasation and not vasodilation)
41
What are non palpable purpura?
Which are either petechia or ecchymosis (bigger)
42
Where do disks herniate?
posteriorly as posterior longitudinal ligament is thinner than anterior longitudinal ligament
43
Which scale is used for AMS
AVPU (alert, verbal, pain, unresponsive), GCS, four score is useful in intubated patients bc doesn't rely on verbal responses (eye, motor, brainstem reflexes, respiration. Max 16)
44
What are cheyne stokes respirations
progressively deeper and faster, until there is apnea, this is repeated -damage to brainstem respiratory centres or cardiac failure
45
Three types of hyponatremia and the movement of water in them
Hypertonic: water moves into capillaries - volume overload - diabetic hyperglycemia Hypotonic: water moves out of capillaries and into cells - cerebral edema and AMS Pseudohyponatremia: Correct chronic hyponatremia slowly to avoid acute demyelinating syndrome
46
Hypoglycemia levels in diabetics and non diabetics
Diabetics <70 Non diabetics <50
47
Types of syncope and what they are caused by
Cardiac: Arrythmias (decreased EF -> cerebral hypoperfusion), Structural heart disease -> myocardial dysfunction, decreased EF (aortic stenosis, pulmonary embolism, hypertrophic cardiomyopathy, cardiac tamponade etc) Non-Cardiac: - Reflex: can be vasovagal - Orthostatic -Swallow syncope
48
Normal functioning of the carotid/aortic baroreceptors?
sense the fall in BP and block the inhibitory activity of the vagal/glossopharyngeal nerves
49
Explain the valsalva maneuvre
1) px blows into syringe, BP increases, HR decreases 2) decreased BP due to reduced CV return due to increased intrathoracic pressure (blowing) + increased HR 3) px stops blowing, starts to breathe normally -> decreased BP with increased HR 4) increased BP and reflex decrease in HR
50
Define cardiac syncope
Arrythmogenic, myocardial, and vascular causes of syncope that are often life threatening
51
Pathophysiology of cardiac syncope?
Reduced cerebral perfusion post insufficient CO due to cardiac/circulatory failure. Due to: PSVT (self limiting), LVOT, MI, PE, hemorrhage before physiological response of sympathetic activation occurs.
52
What causes pulmonary HTN?
Left sided HF
53
Define non cardiogenic syncope and its most common causes
Benign causes of syncope that are neurological, hormonal, metabolic. E.g: reflex syncope, vasovagal, situational, carotid sinus syndrome, orthostatic HAS PRODROME It is triggered by physiological/environment triggers. Do tilt table test. PNS hyperactivity, SNS hypoactivity
54
Midodrine is an
Alpha one agonist Used: vasovagal syncope
55
What is meckels diverticulum and what does it cause?
A congential abnormality (incomplete obliteration of omphalomesenteric duct). Painless LGIB (hematochezia) in <2yrs. If it gets perforated ten intussesception/volvulus, diverticulitis, peritonitis. DX with scintigraphy, CTA, laprascopy. TX: resection
56
What is initial harmacological management of Upper GIB?
PPI and ocreotide (inhibits HCl acid and pepsin secretion)
57
GLASGOW BLATCHFORD SCORE is for?
is a screening tool to assess the likelihood that a person with an acute UGIB will need medical intervention such as a blood transfusion or endoscopic intervention: BUN, Hb, SBP, HR, melena, syncope, liver dx, heart disease
58
Oakland score is used for
LGIB: age, gender, previous LGIB, DRE positive, HR, SBP, Hb
59
What should your INR be on anti-coagulants
if px is taking anticoagulants: INR SHOULD BE AROUND 1. IF: -INR > 2.5: reverse anticoagulants (Vit K/protamine sulfate) before endoscopy -INR < 2.5: straight to endoscopic hemostasis
60
If a pt is taking anti platelets and you need to perfrom urgent surgery what do you do?
Give platelets
61
Whats the forest classification for?
Bleeding peptic ulcers. Stage 1: active hemorrhage) Stage 2: evidence of a recent hemorrhage Stage 3: clean based ulcer
62
what is the hinckey classification used for
perforation due to diverticulistis 1A: pericolonic phlegmon with inflammation 1B: pericolonic abscess 2: abscess >4cm or fistula 3: peritonitis 4: fecal peritonitis
63
What score for sepsis
SOFA (confusion, RR>30, hypotension)
64
Sepsis tx
O2 take blood and urine vulture IV broad spectrum abx (pip/tazobactam, ceftriaxone, merepenem) IV fluids check hourly fluid output check lactate level
65
DDX for pelvic pain in women according to age
Menarche to 21: menstrual pain, first intercourse, imperforate hymen 21-35: ovarian cyst, endometriosis 35 to menopause: uterine fibroids, cancer
66
What is a klatskin tumor
Cancer that forms in the common hepatic duct. Klatskin tumor is a type of extrahepatic bile duct cancer.
67
Probably pathogen in acute diarrhea according to time of symptom onset
sx < 6h after eating = S.aureus -sx 8-16h after eating = C.Perfringens -sx >16h after eating = viral or E.Coli
68
What are the causes of A fib
Pulmonary embolism Ischemia Respiratory disease Atrial enlargement or myxoma Thyroid disease Ethanol Sepsis/sleep apnea
69
What are the indications for bariatric surgery
BMI>40 without comorbidities, or BMI>35 with comorbidities
70
What are the MOA of the following drugs used in nausea and vomiting: Prochlorperazine metclopramide domperidone erythromycin/bethanchol
Prochlorperazine: antiemetic (yes in pregnancy) metclopramide (D2R antagonist, antiemetic, prokinetic properties) domperidone same as above but doesnt penetrate BBB (less dystonia/anxiety) erythromycin/bethanchol (prokinetics, improves gastric emptying without improving nausea)
71
When to use NJ tube instead of NG?
NJ or N-duodenum if pt has gastroparesis, reduced risk of aspiration (GERD, hiatal hernias)
72
When do you use peripheral parenteral nutrition
peripheral venous access for 1-2w only in px with low risk of malnutrition and those who just need hydration
73
When to use total/central parenteral nutrition
needs CVC (jugular, subclavian, femoral) or PICC -can cause pneumothorax, arrythmias, brachial plexus injury, sepsis, CVC occlusion/thrombosis -can cause overhydration/dehydration, hypoglycemia, hyperglycemia =electrolyte abnormalities
74
Most probable causes of bilateral pitting edema, generalised pitting edema, non pitting edema
bilateral pitting edema in lower limbs is usually due to congestive heart failure (+ CCB) -generalised pitting edema with swelling of the eyelids is due to hypoalbuminemia eg nephrotic syndrome -non pitting edema is seen in px with lympatic and thyroid conditions (lymphedema/myxedema)
75
What is anasarca
severe, massive generalised edema
76
NOTE
adverse effects of diuretics in px with ascites: hepatic encephalopathy and kidney failure
77
What are stokes adams attacks
episodes of loss of consciousness associated with self limited rapid tachyarrythmias at the onset of heart block or transient asystole
78
What are the indications for liver transplant?
decompensated chronic liver dx Acute liver failure (injury w/ encephalopathy +INR>1.5) HCC
79
What does the MELD score do? What does it measure? If the pt has HCC do you use this for them? What does the child pugh score measure?
predicts 3 months mortality in px waiting for transplant (you must have >15 to be on the list) Includes: creatinine, INR, bilirubin, serum sodium If a pt has HCC use the milan criteria (1 nodule<5cm, 3 noduels <3cm no vascular invasion) Child pugh: prognosis of chronic liver dx. Albumin, ascited, bilirubin, encephalopathy, PT/INR)
80
What is small for size syndrom in liver transplant?
is a clinical syndrome that can be defined by the presence of prolonged cholestasis, coagulopathy, and ascites in the absence of ischemia within the first week of liver transplant caused by a partial liver graft that is inadequate to sustain metabolic demand in the recipient
81
What is the outflow (IVC) inflow (PV HA) problem?
vessel clamping during reconstruction causes diffuse hypotension/ischemia SO hyperkalemia and lactic acidosis which can spread after reperfusion. Portal clamping can cause splanchnic hypertension THEN small bowel congestion and post op renal failure
82
Donor cold ischemia time is
between the chilling of a tissue, organ, or body part after its blood supply has been reduced or cut off and the time it is warmed by having its blood supply restored reduce to about 6.25 +/- 2.3h
83
Donor warm ischemia time
time a tissue, organ, or body part remains at body temperature after its blood supply has been reduced or cut off but before it is cooled or reconnected to a blood supply
84
Post liver transplant lymphoproliferative dx
tumor only in post transplant patients caused by EBV reactivation due to immunosuppression == uncontrolled B cell proliferation. Treat with rituximab and slight reduction of immunosuppressive drugs
85
Hounsfield units on CT
-0 Hounsfield is water -minus 1000 Hounsfield is air -negative values are usually fat (hypoattenutation)
86
What is the bosniak classification?
For renal cysts 1 to 4: septa, calcifications and enhancement
87
Which pathogen is most often responsible for Potts disease?
Mycobacterium
88
TX for septic arthritis GP cocci GN bacilli GN cocci
GP cocci: vanco, if MSSA give cefazolin is MRSA give linezolid (S.aureus) -GN bacilli: piperacillin/tazobactam + aminoglycoside if septic, otherwise give cefepime (Pseudomonas) -GN cocci: ceftriaxone
89
Non metastatic causes of generalised muscle weakness
a thymoma is associated with myasthenia gravis in 10% of cases. Eaton lambert myasthenic syndrome is associated with small cell lung carcinoma
90
Diagnosis/Tx of myasthenia gravis
EMG, Blood test for ACh receptor antibodies tx: Corticosteroids
91
Test urine antigens for which pneumonia pathogens?
S pneumoniae Legionella
92
What is virchows triad
stasis, clotting factors, damaged vessel endothelium
93
CHAFVASC score and HASBLED score
CHADVASC looks at risk of thromboembolic events while HASBLED defines risk of bleeding CHAD VASC >2/3 == anticoagulant tx if HASBLED > CHADVASC do not start anticoagulation
94
TB therapy regimen
Isoniazide, rifampicin, pyrazinamide, ethambutol (8 weeks) Continutation phase of isoniazide and rifampicin for 4 months
95
HEPB therapy
nucleoside polymerase inhibitors (tenofovir, entecavir); oral daily antivirals Note that they cause: renal failure, myopathy, neuropathy
96
What does the FNCLCC include?
Tumor differentiation Mitotic count Tumor necrosis Histiological grade
97
Scores to assess pancreatitis severity
APACHE: (considers 12 variables) Marshall: (Pa02/fio2, SBP, serum creatinine, ATLANTA: (mild moderate severe) Ranson criteria for gallstone pancreatitis (age>70, WBC, glucose, LDH, AST)

Patient management (11 decks)

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