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Internal Med > FireCracker 12/9 + Qbank > Flashcards

FireCracker 12/9 + Qbank Flashcards

1
Q

parietal periotneum pain

A

constant

severe

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2
Q

antibiotics in pancreatitis if

A

pseudocyst or abscess

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3
Q

acute abdomen etiology

A

periotnitis

obstruction

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4
Q

peritonitis PE findings

A

rigidity

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5
Q

Trousseau’s syndrome

A

migratory superficial thrombophlebitis

associated with pancreatic/visceral cancer

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6
Q

PPSV23 alone

A

adults <65 with chronic health conditions

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7
Q

viral conjunctivitis treatment

A

warm/cold compresses

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8
Q

bacterial conjunctivitis treatment

A

eryhtomycin/antibacterial drops

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9
Q

bacterial conjunctivitis treatment in contact lens users

A

fluroquinolone

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10
Q

Glucagonoma

A

necrolytic migratory erythema
DM
GI symptoms
glucagon >500

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11
Q

thiazide diuretic mechanism

A

inhibit NaCl co transport in DCT

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12
Q

thiazide - decreased levels of

A

K, Na, H

hypokalemia, hyponatremia, metabolic alkalosis

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13
Q

thiazide - increased levels of

A

Glucose, Lipids, Uric Acid, Calcium

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14
Q

loop diuretics mechanism

A

block Na/K/2CL symporter in thick ascendling limb of loop of Henle

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15
Q

loop diuretic toxicities

A

ototoxicity, hypokalemia, hypocalcemia, hypomagenseimia, dehydration, allergy-sulfa, nephritis (AIN), gout

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16
Q

potassium sparing diuretics mechanism

A

act on collecting tubule

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17
Q

spironolactone and eplerenone

A

competitive inhibitors of aldosterone receptors

only work in presence of aldosterone

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18
Q

spironolactone AE

A

hyperkalemia
gynecomastia
amenorrhea
anti-androgen effects

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19
Q

carbonic anyhdrase inhibitors

A

acetazolamide
PCT
inhibit production/reabsorption of filerted bicarb

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20
Q

carbonic anhydrase inhibitors use

A

treatment of ICHTN

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21
Q

acetazolamide toxicities

A 
hyperchloremic metabolic acidosis
hypokalemia
NH toxicity
neuropathy
sulfa allergy
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22
Q

mannitol

A

osmotic diuretic, increases tubular fluid osmolarity –> increase urine flow

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23
Q

mannitol toxicity

A

pulmonary edema

intravascular dehydration

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24
Q

stable angina treatment

A

BB, CCB, nitrate

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25
Q

localized complex empyema treatment

A

surgery

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26
Q

pneumonia in HIV - most commona

A

pneumococcal or streptococcal

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27
Q

ectoptic ACTH

A

small cell lung cancer

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28
Q

massive PE symptoms

A

hypotension and right heart strain

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29
Q

symptoms of right heart strain

A

jugular venous distension

RBBB on ECG

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30
Q

atb for human bite

A

amoxicillin-clauvanate

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31
Q

untreated hiatal hernia can lead to

A

esophageal adenocarcinoma

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32
Q

aspirin toxicity

A

resp alkalosis followed by increased AG metabolic acidosis

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33
Q

ventricular aneurysm following MI

A

5d-3months

decomponsenated heart failure

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34
Q

ventricular aneurysm ECG

A

peristent ST elevation and deep Q waves

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35
Q

when is CT approriate in pyelonephritis

A

no clinical improvement for 72 hrs

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36
Q

gallbladder biliary carcinoma blood tests

A

increased CEA and CA 19-9 but not sensitive/specific

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37
Q

gold stage 1

A

sa bet agnoist

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38
Q

gold stage II

A

la bronchodilator: anticholergic or laba

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39
Q

gold stage III

A

inhaled corticosteroids

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40
Q

gold stage IV

A

o2

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41
Q

hypertrophic cardiomyopathy

A
  • ventricular hypertrophy

- impaired ventricular relaxation

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42
Q

familial hypertrophic cardiomyopathy

A

pts 20-40
AD mutation in myosin
Freidreich’s ataxia

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43
Q

HCM murmur

A

sysytolic

diamond shaped, LSB

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44
Q

HCM treatment

A

asymptomatic - no treatment
surgery, alcohol ablation reduce outflow obstruction
beta blockers, ndh CCB

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45
Q

non-dhydropyridine CCB

A

diltiazem

verpamil

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46
Q

HCM pts should avoid

A

strenous exercise

drugs that increase LVOT (diuretics, nitrates, vasodilators)

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47
Q

risk factors for Budd-Chiari

A

myeloproliferative disease, oral contraceptives, pregnancy, malignancy, hypercoaguable dz

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48
Q

Budd Chiari presentation

A

HSM
ascites
abdominal pain
renal impairement

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49
Q

budd chiari gold standard for diagnosis

A

venography

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50
Q

long term complications of budd chiari

A

liver failure
renal failure
SBP
portal htn

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51
Q

treatment of budd chiari

A 
anticoag with heparin + warfarin
venous stenting
diuretics
TIPS
liver transplant
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52
Q

hypOkalemia EKG changes

A

flattened/inverted T waves
U waves
ST depression
PVC/PAC, arrhythmias

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53
Q

rhonchi

A

larger airways

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54
Q

crackles/rales

A

inhalation/airway opening

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55
Q

first line bacterial sinusitis

A

amoxicillin clauvanate

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56
Q

centor criteria

A

fever, tonsillar exudates, tender anterior cervical LAD, absence of cough
RADT with 2

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57
Q

strep throat antibiotic

A

penicillin

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58
Q

microcytic anemia differential

A 
iron def
heavy metal toxicity
anemia of chronic dz
thalesemmia minor 
sideroblastic anemia
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59
Q

TCA toxicity - mechanism

A

fast Na channels slowed

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60
Q

TCA toxicity EKG

A

QRS>100

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61
Q

splenectomy

A

impaired antibody mediated opsonization in phagocytosis

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62
Q

MGUS diagnosis

A

<10% plasma cells

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63
Q

MGUS next step

A

metastatic skeletal bone survery

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64
Q

HF and alcohol abuse in pt

A

think alcholic dilated cardiomyopathy

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65
Q

heparin binds

A

ANTI-THROMBIN III

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66
Q

heparin inactivates

A

THROMBIN
Factors IXa, Xa, XIIa
Fibrin

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67
Q

Fondaparinux

A

binds antithrombin III but mainly inactivates factor Xa

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68
Q

monitoring of heparin

A

aPTT

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69
Q

Heparin/LWMH reversal

A

protamine

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70
Q

Warfarin mechanism

A

blocks vit-k dependent clotting factors (II, VII, IX, X, Protein C & S)

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71
Q

monitoring of warfarin

A

INR/PT

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72
Q

warfarin antidote

A

hold warfarin, let normalize
Vit K
FFP

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73
Q

days to achieve target INR

A

2-5

bridge with heparin

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74
Q

plasminogen activators

A

urokinase
streptokinase
alteplase
t-PA

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75
Q

desmopressin

A

treats hemophilia A & vWD by releasing vWF from storage sites

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76
Q

aspirin mechanism

A

inhibits both COX 1&2

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77
Q

clopidogrel

A

adp-receptor blocker

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78
Q

abciximab

A

gpIIb/IIIa inhibitor

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79
Q

dipyridamole

A

PDE III inhibitor

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80
Q

cilostazole

A

PDE III inhibitor

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81
Q

blocking PDE

A

increases cAMP
reduced platelet aggregation
vasodilation

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82
Q

ADP-receptor blockers, GP iib/iiia inhib/PDE inhibitors used…

A

after ACS

PCI

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83
Q

what to do when you suspect meningitis

A

cultures
empiric antibiotics + corticosteroids
lumbar puncture

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84
Q

corticosteroids are effective for what cause of meningitis

A

streptococcus

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85
Q

airborne isolation

A

tb, measles, varicella

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86
Q

ampicillin added to empiric menigitis treatment if

A

> 50 yr old
alcohol abuse
immunocomprimised

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87
Q

headache red flags

A

over age 50/new onst
hx of malignancy
acute in onset

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88
Q

prophrylaxis in transplant pts

A

tmp-smx for pcp

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89
Q

digoxin toxicity

A

nausea, vomiting

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90
Q

non-inflammatory chronic prostatitis

A

a febrile, normal leukocyte count

irritable voiding symptoms

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91
Q

primary hyperaldosteronism

A

HTN, metabolic alkalosis
hypokalemia
mild hypernatremia
aldosterone-plasma renin greater than 20

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92
Q

hypersensitivity pneumonitis treatment

A

avoid exposure

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93
Q

bacillary angiomatosis

A

HIV pts, Bartonella

treat w/ eryhtomycin

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94
Q

pigment gallstones

A

calcium bilrubinate

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95
Q

actinic keratosis

A

sandpaper-like

“cutaneous horns”

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96
Q

WPW treatment

A

cardioversion

antiarrythmics like procainamide

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97
Q

vitiligo

A

hypopigmentation

association with autoimmune dzs like pernicious anemia

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98
Q

cool extremities

A

cardiogenic shock, hypovolemic shock

blood shunted away from extremities

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99
Q

warm extremities

A

distributive shock - anayphylaxis, sepsis, spinal shock

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100
Q

wide complex tachycardia

A

qrs >120

indicates dz below AV node –> ventricular tachycarida

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101
Q

rate control in a fib

A

digoxin, CCB, BB

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102
Q

pressures in mitral stensosis

A

increased LA pressure

increase LA-LV pressure gradient

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103
Q

fish mouth valve

A

scarring/narrowing of mitral valve with fusion of commissures in RHD/MS

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104
Q

MS ausculation

A

low pitched diastolic rumble
opening snap
loud S1

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105
Q

MS ausculation with increasing severity

A

gap between oepning snap and s2 decreases

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106
Q

MS CXr

A

dilated left atrium
straightening of left heart border
elevation of mainstem bronchus

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107
Q

MS echo

A

LAE

possible RV enlargement

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108
Q

other symptoms associated with mitral stenosis

A

PA HTN –> right sided heart failure
stroke
TE, A fib

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109
Q

mitral stenosis drugs

A

diuretics
sodium restriction
BB

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110
Q

SIADH

A

excess ADH
impaired water excretion
excessive water retention

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111
Q

causes of SIADH

A 
ectopic production of ADH
CNS disorder/trauma
pul dz
surgery
drugs
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112
Q

ectopic production of ADH

A

small cell carcinoma

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113
Q

CNS trauma disorder/SIADH

A

stroke
hemorrhage
infection
psychosis

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114
Q

pulm disease/SIADH

A

pneumonia

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115
Q

surgery/siadh

A

transphenoidal pituitary surgery

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116
Q

main lab concepts in SIADH

A

HYPOnatreium
serum HYPOosmolality
uirne osmolality >100 (dilute)

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117
Q

lab values in SIADH

A 
low sodium, low serum osm, submax dilute urine osm
normal urine na excretion
reduced AG
low BUN
low uric acid
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118
Q

SIADH treatment - first line, emergency

A

3% hypertonic saline

raise 0.5-1meq/hr

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119
Q

SIADH treatment - non emergent

A

fluid restriction (force kidneys to excrete free water)
vasopression receptor antagonists
loop diuretics
demeclocycline

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120
Q

V2 receptor antagonists

A

reduce aquaporin channels in renal collecting ducts

decrease permeability to water, reduces amount of wtaer resaborbed

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121
Q

aspirin intox s/sx

A

hyperventilation
tinnitius
N/V
AMS

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122
Q

arrythmia treatment in TCA overdose

A
  • na bicarb
  • lidocaine
  • shock
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123
Q

TCA toxicity =

A

anticholinergic + cardiac

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124
Q

aspirin + respiratory system

A

hyperventilation + resp alkalosis

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125
Q

aspirin toxicity managed thru

A

IV hydration, GI decontimation, glucose, alkalization of serum and urine, possible hemidialysis

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126
Q

ECG in opioid toxicity

A

methadone - OTc prolongation

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127
Q

TCA toxicity treatment approach

A

cardiac monitoring, treat seizures, arrhythmias, hypotension

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128
Q

TCA toxicity, treat hypotension w/

A

Nabicarb
crystalloid solutions
Epi/Norepi

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129
Q

TCA cardiotoxicity

A

Widened QRS, prolonged QT and PR intervals

ventricular tachycardia, AV block

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130
Q

aspirin + metabolism

A

interferes with kreb cycle, oxidative phosphorylation

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131
Q

organophosphate =

A

acetylcholinesterase inhibitor

cholinergic agent

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132
Q

organophosphoate - what receptors

A

nicotinic

muscarinic

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133
Q

organophosphate symptoms

A

Salivation, Lacrimation, Urinating, Diaphoresis, GI, Emesis

Bradycardia, Bronchospasm, bronchorrhea

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134
Q

signs of organophosphate poisoning related to nicotinic

A

paralysis, muscle weakness, fasiculations

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135
Q

treatment of organophosphate poisoning

A

atropine
pralidoxime (regenerate achesterase)
decontamination of skin and clothes

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136
Q

atropine

A

competitivre muscarinic receptor antagonist

prevent resp arrest

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137
Q

pralidoxime

A

acetylcholinesterase reactivaing agent

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138
Q

OPIDP

A

organophosphate induced delayed polyneuropathy
1-5 weeks after
painful stocking glove paresthesias
weakness in LE

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139
Q

anticholinergics MOA

A

block ach in CNS and PNS

often have anti-muscarinic properties

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140
Q

anticholinergic toxicity treatment

A

physostigmine

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141
Q

other components of anticholinergic toxicity treatment

A

sedatives-benzos
cooling mechanisms
bladder emptying

142
Q

elevated RDW

A

mixed population of cells

micro + macro

143
Q

reticulocyte production index

A

% retic x pts hct divided by normal hct x reticulocyte maturation time

144
Q

lyme dz treatment

A

doxycycline

145
Q

lyme dz treatment in pregnancy

A

amoxicillin

146
Q

Babesiosis

A

ixodes tick, NE US

hemolytic anemia/jaundice

147
Q

zenker diverticulum

A

dysphagia, halitosis

~ neck mass

148
Q

cortisol associated electroylte abnormality

A

hypokalemia

149
Q

endopthalmitis

A

post op
pain, decreased visual acutity
culture vitreous

150
Q

metabolic alkalosis is due to…

A

gain in HCO3- or loss of H+

151
Q

most common cause of alkalosis

A

Vomiting

loss of H+ in GI fluids

152
Q

metabolic alkalosis and effects on kidney

A 
usually impaired renal fxn
- decreased GFR
- chloride depletion
= volume contraction
- hypokalemia
153
Q

kidney ability to secrete HCO3- depends on

A

countertransport of Cl-

154
Q

metabolic alkalosis overview

A 
ph high
low H+
high HCO3-
high PCO2
compensate with hypoventilation
155
Q

s/sx of metabolic alkalosis

A

similar to hypocalemia

confusion/paresthesias, tetany, muscle cramping

156
Q

Urine Cl

A

less than 20: responsive

greater than 20: chloride unresponsive

157
Q

urine k in metabolic alkalosis

A

usually low

158
Q

treatment of chloride responsive metabolic alkalosis

A

saline (increases filtered cl- and hco3- secretion)

159
Q

treatment of chloride unresponsive metabolic alkalosis

A

correct hypokalemia + saline

acetazolamide

160
Q

ph > 7.7 with hypervolemia

A

Hcl through central line

161
Q

babieosis etiology

A

tick bite
transfusion
perinatally

162
Q

babiesosis symptoms

A

fevers/chills/myalgia

–> anemia, jaundice

163
Q

babesiosis blood smear

A

maltese cross

intra-rbc ring form

164
Q

babesiosis treatment

A

atovaquone + azithromycin
OR
clindamycin + quinine

165
Q

cut off for kidney stones

A

greater than 5 cm

166
Q

increased homocysteine

167
Q

BNP associated with

A

ventricular stretch

S3

168
Q

cyclophosphamide adverse effect

A

bladder carcinoma

169
Q

tricupsid insuff, on the differential

A

carcinoid syndrome

170
Q

smudge cells

171
Q

hypocalcemia

A

hyperactive DTR

blood transufions

172
Q

before intubation in COPD exacerbation

A

2 hr trial of NPPV

173
Q

amikacin, class of drugs

A

aminoglycoside

174
Q

acyclovir AE

A

nephrotoxicity

175
Q

sebhorrehic dermatitis

A

yellow greasly looking scales

176
Q

sebhorreic dermatitis association with

A

HIV, parkinson dz

177
Q

superior vena cava sydrome

A

swelling of head/neck/arms

usually associated with malignancy

178
Q

porphyria cutanea tarda

A

painless blisters on dorsum of hands
facial hypertrichosis
hyperpigmentation

179
Q

recurrent renal stone - diet changes

A

decrease na, protein

increase citrate

180
Q

recurrent kidney stone - medication

A

thiazides
potassium citrate
bicarbonate

181
Q

increased renin, increased aldosterone

A

2ndry hyperaldosteronism (renin secreting tumor)

182
Q

decreased renin, increased aldosterone

A

primary hyperaldosteronism

183
Q

primary hyperaldosteronism

A

sodium retention –> HTN
hypokalemia
metabolic alkalosis

184
Q

primary hyperaldosteronism causes

A

adrenal adenoma - conn’s syndrome
bilateral adrenal hyperplasia
adrenal carcinoma

185
Q

aldosterone-to-renin ratio in primary alderstonism

A

greater than 30

186
Q

MEN 1

A

parathyroid
pancreatic
pituitary

187
Q

MEN 2A

A

MTC
pheochromocytoma
parathyroid

188
Q

MEN 2B

A

MTC, pheochromocytoma
marfanoid
mucous and intestinal neuromas

189
Q

sickle cell trait manifestations

A

hematuria (renal papillary necrosis)
UTI, renal medullary carcinoma
splenic infarcations, VTE, priapism

190
Q

phemphigus vulgaris

A

flaccid bullae - painful, rupture
Nikolsky’s sign (epidermal separation/acantholysis)
autoantibodies against desmoglein

191
Q

tinea corporis

A

ring shaped, annular patches w/ central clearing
itchy
associated with immunosuppresion

192
Q

mixed cryoglobulinemia - triad

A

palpable purpura, proteinuria, hematuria.

193
Q

bronchiectesis, history will include

A

recurrent bacterial infections

194
Q

Secondary HyperParaThyroidism

A

decrease Ca
increased Phos
increased PTH

195
Q

rash involving palms and soles think

196
Q

toxic shock syndrome

A

fever, hypotension, diffuse macular erythroderma

197
Q

toxic shock syndrome - risk factors

A

nasal packing

198
Q

amiodarone - 5 main side effects

A 
pulm tox
hepatotox
thyroid
skin changes
corneal deposits
199
Q

basal cell carcinoma on face

A

moh’s surgery

200
Q

febrile neutropenia treatment

A

anti-pseudomonal agent

201
Q

no breath sounds after endotracheal intubation, consider…

A

ETT advanced too far

202
Q

increased alk phos, always consider

A

paget’s disease

203
Q

increase pH and calcium

A

increased affinity of albumin for calcium –> decrease calcium

204
Q

Enthesitis

A

tenderness over heels, tibial tuberosities, iliac crests

associated wtih AS/B27

205
Q

dissolve gallstones with

206
Q

warfarin induced skin necrosis think

A

protein c def

207
Q

low magnesium can cause

A

low calcium

208
Q

small cell vs squamous cell

A

small - acth

squamous - pth

209
Q

giant cell tumor of bone

A

eccentrically placed lytic area/soap bubbles

epiphyses

210
Q

neutropenia =

A

ANC less than 1500

less than 500 - very high risk of infection

211
Q

therapuetic approaches to hepatic encephalopathy

A

lactulose
rifaximin, neomycin
diet - protein and energy
branched chain AA, probiotic supplementation

212
Q

3 common causes of neutropenia

A

bone marrow failure - drugs/toxins
bone marrow invasion - malignancy/metastatic
isolated neutropenia - granulocytosis

213
Q

work up for neutropenic fever

A

CXR - pulmonary infection
pan culture (including LP)
CBC with diff
CMP

214
Q

pancreatic cancer - all risk factors

A

smoking

chronic panc, obesity, DM, post family hx

215
Q

most common location of pancreatic cancer

A

head of pancreas

216
Q

Toursseau’s sign

A

migratory thrombophlebitis (pancreatic cancer)

217
Q

pancreatic cancer diagnosis

A

ct abdomen

ca 19-9, cea may be elevated

218
Q

What is the classic presenting sign for a patient with underlying pancreatic cancer?

A

painless jaundice

219
Q

What surgical procedure is indicated in patients with early stage pancreatic cancer?

A

resection by whipple - pancreaticodudoenectomy

220
Q

groups at greatest risk for pancreatic cancer

A

african americans, men

221
Q

What palliative surgical procedures can be done for patients with pancreatic cancer?

A

biliary stenting to prevent jaundice and permanent ablation of the celiac nerves to decrease back pain.

222
Q

What causes the deficiency of uroporphyrinogen decarboxylase seen in porphyria cutanea tarda?

A

80% acquired

20% autosomal dominant

223
Q

What is porphyria cutanea tarda?

A

deficiency of hepatic uroporphyrinogen decarboxylase (UROD) that results in chronic blistering skin and liver manifestations.

224
Q

What cutaneous manifestations are associated with porphyria cutanea tarda?

A

Chronic blistering skin lesions on sun exposed areas of the body (face, ears, neck, forearms, back of the hands, etc…) because the porphyrins that accumulate are photosensitizing.
hyperpigment, hypertrichosis

225
Q

What notable pharmacology correlate is associated with acute exacerbations of porphyrias?

A

barbituates (p450 inducers)

226
Q

What are some hepatic manifestations associated with porphyria cutanea tarda?

A

Mild elevations in liver enzymes (ALT and AST)
Advanced liver disease in older patients with recurrent disease
Increased risk of cirrhosis and hepatocellular carcinoma

227
Q

What risk factors are associated with porphyria cutanea tarda?

A 
Alcoholism
Hepatitis C
Iron overload
Estrogen use
Smoking
Hepatic siderosis
228
Q

What biochemical evidence can be used to support the diagnosis of porphyria cutanea tarda?

A

Increased total plasma porphyrin
Increased urine porphyrin
Decreased uroporphyrinogen decarboxylase
Elevated AST and ALT

229
Q

preferred treatment of Porphyria cutanea tardia?

A

repeated phlebotomy

230
Q

In addition to repeated phlebotomy, what other treatment options are available for patients with porphyria cutanea tarda?

A 
Low dose chloroquine or hydroxychloroquine (for patients who do not tolerate phlebotomies)
Sunscreen use (to mitigate photosensitivity)
Avoidance of triggers (alcohol, tobacco, estrogens, iron supplements)
231
Q

transcellular K shift causing hyperkalemia

A

insul def
acidosis
tumor lysis syndrome/cell destruction
beta blockers

232
Q

SLE - photosensitivity

A

rash

fever, fatigue, joint pain

233
Q

pseudohyperkalemia

A

hemolysis
leukocytosis
fist clenching

234
Q

SLE antibodies

A

anti-dsDNA
anti-Sm
decreased C3,C4

235
Q

SLE - renal disorders

A

Class IV - diffuse prolif GN (nephritic)

Class V - MGN (nephrotic)

236
Q

what causes the rise in systemic pressure in chronic constrictive pericarditis

A

reduced right ventricular EDV

237
Q

SLE treatment

A

NSAIDs - pain
hydroxychloroquine - skin, renal
corticosteroids
anticoag

238
Q

discoid rash

A

red raished patches

keratotic scaling

239
Q

SLE rare complications

A

LSE
abortions
anti-ro(SSA) ab crossing placenta
interstitial lung fibrosis

240
Q

electrolyte abn in hyperaldosteronism

A

hypokalemia, alkalosis

decreased free ca concentration

241
Q

primary hyperaldosteronism complications

A

metabolic aklalosis, hypernatremia
increased GFR w urinary albumin excretion
increased risk of CVD

242
Q

treatment post unilateral adenalectomy

A

monitor aldosteron, K
d/c HTN, spirolactone meds
sodium rich diet

243
Q

SOAP

A

serositis
oral ulcers
arthritis
photosensitivity

244
Q

BRAIN

A 
blood disorders
renal
ANA
immunological
neurological
245
Q

SLE - serositis

A

pleuritis
pericarditis
pneumonitis

246
Q

osteomyelitis presentation

A

bone pain

fever, chills, fatigue

247
Q

osteomyelitis - 3 lab findings

A

WBCs
ESR
CRP

248
Q

osteomyelitis - imaging

A

Xray - lytic lesion surrounded by sclerosis

MRI - soft tissue involvement

249
Q

osteomyelitis - organims specific to patient populations

A

sickle cell - salmonella

diabetics/IV drugs - pseudomonas

250
Q

most common cause of osteomyelitis

251
Q

osteomyelitis complications

A

amputation

pathologic fractures

252
Q

osteomyelitis - physical exam

A

tenderness over bone

erythema

253
Q

development of osteomyelitis

A

hematogenous spread
local extension
direct inoculation

254
Q

osteomyelitis risk factors

A

immunodef
iv drug use
poor vascular supply
recent trauma/surgery

255
Q

MVP

A

myxomatous degeneration of mitral valve leaflets

256
Q

flattening of diaphragm in COPD due to

A

increased work of breathing

257
Q

renal disorder requiring emergency plasmapheresis

A

good pastures

258
Q

mediastinal mass differential

A

thymoma
teratoma
thyroid neoplasm
terrible lymphoma

259
Q

seminoma

A

elevated bhcg only

260
Q

DI treatment

A

desmopressin

261
Q

positive prussian blue

A 
hemosidering
hemolytic episodes (G6PD def)
262
Q

G6PD def pathophys

A

underlying oxidative stress

263
Q

Bullous pemphigoid

A

blisters
often caused by meds
itching

264
Q

Bullous phemphigoid - biopsy

A

igg and c3 deposits

265
Q

med for decreased appetite in cancer pt

A

progesterone analog - megestrol acetate

266
Q

infiltrating ductal carcinoma prognosis

A

TNM staging

267
Q

palpable masses + HTN

268
Q

hypopigmented patches - summer, tropical location

A

tinea versicolor

269
Q

malassezia globosa

A

tinea versicolor

270
Q

pleural fluid glucose less than 60

A

rheumatoid, tb, lupus
parapneumonia
malignant

271
Q

amyloid deposits

A

apple-green birefringence

272
Q

amyloidosis renal failture

273
Q

epiglottis common organisms

A

h flu

streptococcus pyogenes

274
Q

solitary pulmonary nodule

A

rounded opacity
less than 3 cm
completely surrounded by pulmonary parenchyma
no associated LAD

275
Q

hypertrophic osteoarthropathy

A

digital clubbing
sudden onset arthropathy - usually wrist and hand joints
can be assocciated with lung dz

276
Q

lumbar spinal stenosis exacerbated by

A

extension - standing, walking downhill

277
Q

rx for dermatitis herpetiformis

278
Q

GVHD - cause

A

activation of donor T lymphocytes

279
Q

variocele

A

soft scrotal mass
decreases when supine/increases when standing
doesn’t illuminate

280
Q

What medications have been linked to bullous pemphigoid?

A

furosemide
NSAIDS
ACEI
antiobiotics

281
Q

What is bullous phemphigoid?

A

autoimmune supepidermal blistering disease

282
Q

How is bullous pemphigoid diagnosed?

A

skin biopsy with direct immunofluoresence

igg and C3

283
Q

bullous phemphigoid - oral lesions?

284
Q

What do the skin lesions look like on physical exam in bullous pemphigoid?

A

tense fluid filled blisters on flexor surfaces

negative nikolsky’s sign

285
Q

Describe the classic presentation in bullous pemphigoid.

A

prodrom - pruritis, plaque-like lesions for weeks

then fluid filled blistesrs

286
Q

Complications seen with bullous phemphigoid?

A

bacterial infection

287
Q

What is the first-line treatment of bullous pemphigoid?

A

corticosteroids

288
Q

What is the treatment of bullous pemphigoid in patients who are refractory to medical therapy?

289
Q

How does G6PD deficiency lead to hemolysis?

A

oxidative injury to RBC

290
Q

G6PD classic presentation

A

sudden anemia
dark urine
jaundice

291
Q

What are the 2 common findings on peripheral smear in a patient with G6PD deficiency?

A

heinz bodies

bite cells

292
Q

What are the two man precipitants of hemolytic episodes in patients with G6PD deficiency?

A

infections

medications

293
Q

What is the inheritance pattern of G6PD deficiency? In whom is it most commonly seen?

A

X linked recessive

men

294
Q

What drugs can precipitate a hemolytic episode in patients with G6PD deficiency (remember the mnemonic!)?

A

hemolysis IS D PAIN

inh, sulfonamides, dapsone, primarquine, aspirin, ibuprofen, nitrofurantoin

295
Q

What is the most appropriate initial test for patients with suspected hemolytic episode due G6PD deficiency?

A

perpiheral blood smear

296
Q

What test is diagnostic for G6PD deficiency? When should the test be performed?

A

quantification of g6pd with enzyme assay

297
Q

What psychiatric disorders have been associated with mitral valve prolapse?

A

anxiety/panic

298
Q

What is mitral valve prolapse and what is its cause?

A

prolapse of mitral valve intro atrium during systole

cause: excess leaflet tissue or myxomatous degen of valve or chodae tedinae

299
Q

What is the murmur of mitral valve prolapse?

A

midsystolic or late systolic click

mid-to-late systolic murmur

300
Q

MVP symptoms

A

asymptomatic

palpitations, chest pain

301
Q

myxomatous degeneration

A

increase in spongiosa (dermatan sulfate)
decrease in fibrosa
increased size

302
Q

What is the effect of standing and valsalva on the murmur of mitral valve prolapse?

A

decrease preload
decrease LVV
cordae tendinae slack
makes murmur louder

303
Q

What is the effect of squatting on the murmur of mitral valve prolapse?

A

increase preload
increase LVV
tighten mitral apparatus
delays click, quieter murmur

304
Q

conjugated, direct bilirubin

A

water soluble

non toxic

305
Q

unconjugated indirect bilirubin

A

not soluble in water

neurotoxic

306
Q

hepatocytes convert

A

indirect –> direct

307
Q

How is hyperbilirubinemia diagnosed in an infant?

A

nomogram (age in hrs)

308
Q

Elevated indirect bilirubin and absence of bilirubin in the urine indicates what 2 possible processes?

A

Excess bilirubin production (likely due to hemolysis) OR

Impaired uptake/conjugation by the liver (e.g. Gilbert’s, Crigler-Najjar, or physiologic in the newborn)

309
Q

What are the three patterns of hyperbilirubinemia?

A

obstructive
hepatocellular
hemolytic

310
Q

hepatocellular jaundice

A

mixed direct/indirect
increased urine bilil
increase urine urobili to nromal

311
Q

obstructive jaundice

A

increased direct
increased urine bili
decreased urobili

312
Q

urobili formed in

A

intestines

313
Q

What are possible treatments for a neonate with hyperbilirubinemia?

A

id cause

nothing/phototherapy/blood transfusion

314
Q

hemolytic jaundice

A

increased indirect
no urine bili
increased urine bili

315
Q

jaundice =

A

yellow
dark colored urine
light colored stool
pruritis

316
Q

Elevated direct bilirubin and presence of bilirubin in the urine indicates what 2 possible processes?

A

intrahepatic

extrahepatic obstruction

317
Q

In a patient with ADPKD (autosomal dominant polycystic kidney disease), when does renal function start to decrease?

318
Q

What are the first-line agents in treating hypertension in ADPKD?

319
Q

What are the possible complications associated with autosomal-dominant polycystic kidney disease?

A

renal/liver failure
stroke/mi
ruptured intracrainial aneurysm
RCC

320
Q

Aside from imaging and genetic testing, what other tests may be performed to aid in the diagnosis of autosomal dominant polycystic kidney disease?

A

urinalysis/culture
gfr
cbc
serum calcium/phosphorus

321
Q

What 2 mutations are associated with autosomal-dominant kidney disease?

A

PKD1 polycystin-1

PKD2 polycystin 2

322
Q

In general, development of renal cysts leads to the development of what structural and physiological defects?

A

massive bilateral kidney enlargement
destruction of renal parenchyma
renal failure

323
Q

What are the common causes of renal failure in patients with autosomal dominant polycystic kidney disease (ADPKD)?

A

pyelonephritis

nephrolithiasis

324
Q

What is the most common presenting symptom in patients with autosomal dominant polycystic kidney disease and what other symptoms can accompany it?

A

hypertension
abd mass
polyuria/flank pain/polydipsia

325
Q

polycystin

A

transmembrane protein important for CT cohestion

326
Q

What are some common extra-renal findings in autosomal dominant polycystic kidney disease?

A

extrarenal cysts (liver, pancreas, spleen)
berry aneursyms
MVP
colonic diverticular

327
Q

isolated systolic hypertension

A

decreased elasticity of arterial wall

328
Q

malloy weiss tears

A

after repeated vomitting

329
Q

immobilization can cause

A

hypercalecemia due to increased osteoclastic activity

330
Q

lactose interolance testing

A

+ hydrogen breath test
+ stool for reducing substances
low stool pH
increased stool osmotic gap

331
Q

leukemoid reaction

A

increase in leukocytes due to severe infection/inflamm

increased leukocyte alkaline phosphatase score

332
Q

primary parahyperthyroidism sympstoms

A

hypercalcemia
kidney stones
neuropsych
HTN

333
Q

scleroderma esophageal dysmotility manometry

A

absence of peristaltic waves in lower 2/3

decrease in LES tone

334
Q

hyperthyroidism with reduce radioactive iodine uptake

A

subacute granulomatous thyroiditis (deq’s)
synthyroid overdose
iodine-induced thyrotoxicsosis

335
Q

estrogen and thyroid hormones

A

increase TBG concentration

need to increase synthroid dose

336
Q

after trauma with fluid resustication, what might be present on urinalysis

A

hypovolemia = atn

muddy brown casts

337
Q

causes hyponatremia with <100 serum Osm

A

primary polydisia

malnutrition (beer potmania)

338
Q

aspirin exacerbated resp disease

A

pseudoallergic rxn

asthma, chronic rhinosinusitis with nasal polyposis

339
Q

Esophageal strictures

A

circumferential narrowing

dysphagia to solids

340
Q

hematuria following pharyngitis

A

IgA nephropathy

341
Q

hemodilaysis indictations

A

refractory hyperkalemia/metabolic acidosis
volume overload/pulm edema
uremic pericarditis, encephalopathy, neuropathy
coagulopathy due to RF

342
Q

membranoproliferative gluomerolonephritis

A

dense deposits within GBM

increased C3 - activation of complement system

343
Q

methimazole AE

A

agranulocytosis

344
Q

differential with peluritic pain with IV druge use

A

infective endocarditis

345
Q

contact lens associated keratitis

A

pseudomonas, serratia

346
Q

post cholecystectomy pain

A

dysfunction of sphincter of oddi

347
Q

chondrocalcinosis

A

pseudogout

348
Q

high velcoity eye injury - next step

A

slit lamp (flurocein exam)

349
Q

otitis externa treatment

A

ciprofloxacin

350
Q

cupping of optic disc

A

open angle glaucoma

351
Q

erysipelas

A

sharply demarcated
raised borders
fevers and chills
GAS - pyogenes

Internal Med (23 decks)

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