General medicine Flashcards by Oliver Fischer

Most likely vascular malformation responsible for SAH?

Arteriovenous malformation - AVM most likely to present with focal seizures, unilateral throbbing headache, and slowly progressive focal neurologic signs

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Most common pituitary tumor

lactotroph adenoma (prolactinoma) 25%

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47 yo F HA, weight gain in trunk, facial hair

corticotroph adenoma (Cushing syndrome)

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Somatotroph adenoma

produce growth hormone and cause acromegaly in adults and gigantism in prepubertal patients

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Hypertension with hypokalemia

hyperaldosteronism

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secondary cause of HTN with flank mass

polycystic kidney disease

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secondary cause of HTN with unilateral abdominal bruit in young aptient with marked HTN; new-onset HTN with severe end-organ disease

renovascular disease

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markedly labile BP with tachycardia and headache

pheochromocytoma

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persistent hypokalemia in absence of diuretic therapy or marked drop with low-dose diuretics

hyperaldosteronism

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delayed or absent femoral pulses in a young patient

coarctation of the aorta

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truncal obesity and abdominal striae

cushing syndrome

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Treatment for uncomplicated gonococcal infection of cervix, urtehra or rectum

ceftriaxone 250 mg IM in single dose plus azithromycin 1 g orally in single dose

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Study type to investigate a possible association between and exposure or potential risk factor and an outcome of interest

case-control study

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Treat acute life-threatening staphylococcal infections with this agent

vancomycin

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Subacute bacterial endocarditis (SBE) prophylaxis is recommended for what ophthalmic surgical procedure?

Dacryocystorhinostomy

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perioperative modification that may worsen postoperative delirium

soft mechanical restraints

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Subtype of systemic sclerosis (SSc) formerly known as scleroderma infrequently involves internal organs and has best prognosis?

limited SSc

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Important lab for 32 year old woman with CVO

anticardiolipin antibodies to r/o antiphospholipid antibody syndrome

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Medication used to treat mycobacterium tuberculosis causes pink-tinged tears and blepharoconjunctivitis

rifampin

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What percentage of normal population has an antinuclear antibody (ANA) titer of >1:40

30% (high false-positive rate) Must also check anti-dsDNA, anti-smith, antiphospholipid which are highly specific

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ANA titer in patient with true SLE

1:160 or higher

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Nearly all isolates of Haemophilus influenzae are now resistant to what antibiotic class?

macrolides

current treatment - amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, quinolone (ciprofloxacin) or third-generation cephalosporin (ceftriaxone or cefotaxime)

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Most radiosensitive structure in the eye

lens > cornea > retina > optic nerve

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Recommended screening for thyroid dysfunction?

TSH, free T4 (sensitivity of 99.5%)

TSH rise early in hypothyroidism and fall in hyperthyroidism even before free T4 are outside reference range

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JNC 8 guidelines for BP

60 years and older systolic blood pressure target less than 150 mm Hg and/or diastolic blood pressure less than 90 mm Hg

Stage of treponema pallidum infection characterized by fever, lymphadenopathy, patchy hair loss, and malaise?

Secondary resolve in 2 to 6 weeks with 25% relapse in first 2 to 4 years

Indication for prophylactic implantable cardioverter-defibrillators (ICDs)

survivors of hemodynamically unstable ventricular tachycardia previous cardiac arrest inducible ventricular arrhythmia

Adverse effect of anticytokine drugs sucha as etanercept and infliximab

optic neuropathy

Cyclosporine is associated with this ophthalmic finding

disc edema

Ocular associations of bisphosphonates (pamidronate and alendronate)

conjunctivitis, scleritis, episcleritis and anterior uveitis

Monoclonal antibody against interleukin-6 receptor (pro-inflammatory cytokine)

tocilizumab - FDA approved for treatment of moderate to severe rheumatoid arthritis and JIA

Class of infliximab

tumor necrosis factor alpha antagonist

Class of rituximab

B-cell depleting monoclonal antibody used primarily as chemotherapy in treating non-Hodgkin's lymphona and CLL, RA, graves ophthalmopathy, neuromyelitis optica, and IgG4-related diseases

MOA of cyclosporine

inhibits transcription of interleukin-2 -> decreases production of inflammatory cytokines by T-lymphocytes (transplant rejection)

Risk of myopathy while taking simvistatin

Gemfibrozil

arthritis, urethritis, and conjunctivitis

reactive arthritis 63%-95% positive for HLA-B27

M/c vector-borne illness in the US

Borrelia burgdorferi

Most frequent cause of death of patients suffering shock

respiratory failure

Workup for Sjogren syndrome

anti-SS-A antibody, Anti-SS-B antibody, and minor salivary gland biopsy

Criteria for metabolic syndrome

``` 3 of the following HDL <40 men <50 women, abdominal obesity >40 men elevated TGA >150 HTN >130/85 Elevated fasting glucose >100 mg/dL ```

Large vessel vasculitidies

GCA | Takayasu

Medium-sized vasculitis

Polyarteritis nodosa | Kawasaki

Small vessel vasculitis

Granulomatosis with polyangiitis

Size vasculitis of Behcet

All sizes!

What systemic condition increases the risk of latex allergy?

spina bifida or myelodysplasia

Treatment for chronic, active hepatitis C virus

peginterferon alpha-2b + ribavirin

M/c type of thrombosis that occurs in patients with antiphospholipid antibody syndrome (APS)

DVT (occurs in 1/3)

Last resort immunosuppressant medication in 15 yo with DM2 and bilateral vision threatening HLA B27 associated panuveitis

cyclophosphamide - causes sterility

Gene that confers immunity to HIV

CCR5

Gene a/w Leber congenital amaurosis and RP

RPE65

Only antiplatelet agent shown to be effective in early treatment of ischemic stroke

aspirin

Preferred treatment for Toxoplasma chorioretinitis

pyrimethamine, folic acid (leukovorin), sulfadiazine

Somatoform disorder

symptoms that includes a preoccupation with fear of having a serious disease

Study that showed intensive glycemic control in patients with DM2 reduced complicatoins

United Kingdom Prospective Diabetes Study (UKPDS)

MOA moxifloxacin

inhibits bacterial DNA replication

CEA recommended for what percentage of ipsilateral carotid artery stenosis?

70%-99%

Patients with TMVL (transient monocular vision loss), retinal infarcts (artery occlusions) or TIAS have an annual stroke rate of...

TMVL - 2% Retinal infarcts - 3% TIA - 8%

first-line treatment for ocular syphilis

intravenous penicillin G

acceptable colorectal cancer screening

3 fecal occult blood cards from home CT colonography q5 years Double-contrast barium enema or colonoscopy every 10 years

Recommendation after MI

ACE inhibitor such as captopril or lisinopril in combination with a second antiplatelet agent for at least 1 year after placement of a drug-eluting stent

Clinical feature that would suggest the diagnosis of relapsing polychondritis?

saddle-nose deformity from nasal chondritis

M/c inherited bleeding disorder

von Willebrand disease (VWD) found in 1% of population

Standard antiviral treatment for CMV retinitis

oral valganciclovir and intravitreal ganciclovir

Most commonly elevated auto-antibody found in patients with Graves hyperthyroidism (TED)

thyroid-stimulating hormone TSH receptor antibody (90%)

Found in more than 95% of Hashimoto thyroiditis and in 55% of Graves patients and 10% with no thyroid disease

Thyroid microsomal antibody

Most effective treatment for pseudomonal infections

ceftazidime