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HAC: ACP (IM Ess.) Flashcards

1
Q

Listeria monocytogenes: gram stain

A

gram + rods

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2
Q

L. monocytogenes meningitis tx

A

ampicillin

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3
Q

Common groups infected w/L. monocytogenes meningitis

A
  • elderly
  • neonates
  • immunocompromised
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4
Q

Most sensitive/specific test for HSV encephalitis

A

Cerebrospinal fluid polymerase chain reaction assay is the most sensitive and specific test for the diagnosis of herpes simplex encephalitis.

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5
Q

S. pneumo: gram stain

A

gram + diplococci

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6
Q

S. pneumo meningitis empiric therapy

A

-vanc + 3rd gen. ceph (e.g. ceftriaxone)

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7
Q

Imaging in suspicion of stroke

A
  1. Non-contrast CT Head ==> r/o hemorrhagic stroke

2. MRI if CT negative

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8
Q

Important medication in resolving acute ischemic stroke

A

-aspirin vs. clopidogrel

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9
Q

Guidelines for thrombolysis in ischemic stroke

A
  • rTPA treatment be initiated within 1 hour of arrival at the emergency department and within 3 hours of symptom onset
  • benefit of rtPA up to 4.5 hours after stroke onset w/ exclusion criteria = age greater than 80 years, severe stroke, diabetes mellitus with a previous infarct, and any anticoagulant use
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10
Q

Dx testing suspected subarachnoid hemorrhage

A
  1. CT w/out contrast
  2. if neg. ==> lumbar puncture
    - RBCs or xanthochromia indicate signs of SAH
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11
Q

Criteria for hospitalization after TIA

A 
-ABCD2 score:
Age of 60 years or greater (+1)
Blood pressure of >140/90 (+1)
Clinical sx: hemiparesis (+2)
Duration of >60 min. (+2)
Diabetes mellitus (+1)
-Score 3 or higher ==> indication for hospitalization
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12
Q

Treatment of blood pressure in ischemic stroke

A

Patients with ischemic stroke who are ineligible to receive recombinant tissue plasminogen activator and have no evidence of end-organ damage should not be treated for elevated blood pressure of up to 220/120 mm Hg.

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13
Q

Incidental lung nodules f/u

A
  • never smoked: 8mm ==> biopsy vs. 3,9,24 mo. CT f/u
  • never smoked: no f/u
  • current/former smokers: CT @ 12mo.
  • solid nodule stable on CT x 2 yrs = benign ==> no further f/u
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14
Q

Lung cancer tx

A
  • early-stage (stages I and II) disease ==> surgery
  • IB (>3cm tumor) ==> + adj. chemo
  • Chemotherapy plus radiation is indicated for locally advanced tumors (i.e., stage III disease characterized by mediastinal lymph node involvement)
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15
Q

Small cell lung cancer treatment

A
  • surgery = early stage
  • chemo + radiation = “limited stage” (limited to chest)
  • chemo only = extensive stage
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16
Q

Evaluation of breast mass

A

“Triple assessment”:

  1. palpation
  2. mammography +/- US
  3. FNA/biopsy
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17
Q

F/U for breast mass

A
  • simple cyst ==> f/u exam 4-6 wks after aspiration for recurrence/residual lump
  • solid mass ==> FNAB or excisional biopsy; if neg. ==> close clinical f.u.
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18
Q

Exceptions to typical colon cancer screening

A

-early colonoscopy for any individual w/first deg. family member w/colon cancer

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19
Q

Stage III colon cancer tx

A
  1. resection

2. adjuvant chemo

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20
Q

Method of estimating GFR

A
  • equation-based calculation of GFR
  • CKD-EPI (CKD epidemiology collaboration)
  • Cr clearance overestimates GFR (because some is excreted), but approximates true GFR in patients w/out kidney disease
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21
Q

Histology in rapidly-progressing glomerulonephritis

A

-most commonly crescentic glomerulonephritis

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22
Q

glomerulonephritis characteristics

A

-nephritic syndrome
- ==> hematuria, oliguria, HTN, acute kidney failure
- ==> pyuria, hematuria, cellular/granular casts
+/- proteinuria

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23
Q

Examples of nephrotic syndromes

A

-MCD
-FSGS
-membranous glomerulonephropathy
==> edema, hypoalbuminemia, proteinuria, bland sediement (no casts, RBCs, leuks)

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24
Q

MCD disease type

A

nephrotic syndrome

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25
Q

FSGS disease type

A

nephrotic syndrome

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26
Q

Membranous disease type

A

nephrotic syndrome

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27
Q

Dysmorphic erythrocytes or acanthocytes on urine micro ==>

A
  • glomerular hematuria

- indication of glomerulonephritis

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28
Q

Evaluation/work-up with glomerular hematuria

A
  1. urine protein-cr ratio/serum cr measurement
  2. serum complement
  3. hepatitis panel
  4. blood cx
  5. ANA, ANCA, anti-GBM, antistreptolysin
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29
Q

Evaluations of hematuria

A

repeat UA

>40yo ==> lower/upper urinary tract workup

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30
Q

Evaluation of sustained, isolated proteinuria

A
  1. split urine collection ==> r/o orthostatic proteinuria

2. imaging vs. kidney biopsy

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31
Q

Tx of rhabdomyolysis

A

rapid NS

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32
Q

Lab findings in rhabdo

A
  • serum CK > 5000
  • blood on urine dip w/out sig. hematuria (myoglobin from m. breakdown)
  • ==> hypocalcemia, hyperphosphatemia, hyperkalemia, hyperuricemia, metablic acidosis
  • AK
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33
Q

Serum osmolality concentration

A

serum osm = 2[Na] + [BUN]/2.8 + [glucose]/18

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34
Q

Types/categories of hypo-osmolol hyponatremia

A
  • hypovolemic
  • euvolemic
  • hypervolemic
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35
Q

Causes of hyperosmolal hyponatremia

A
  • extreme hyperglycemia

- exogenously administered solutes: mannitol or sucrose

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36
Q

Cuases of isosmotic hyponatremia

A
  • glycine
  • sorbitol
  • pseudohyponatremia (lab artifact w/hyperglobulinemia or severe hyperlipidemia)
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37
Q

Tx of symptomatic hyponatremia 2/2 SIADH

A
  • 3% (hypertonic) saline

- NS ==> excretion of most of infused sodium and retention of water ==> positive water balance

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38
Q

Causes of SIADH

A
  • antidepressants

- xx

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39
Q

Tx of significant hypernatremia

A

correct water deficit w/5% dextrose

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40
Q

Potential causes of nephrogenic diabetes insipidus

A
  • medications (for example, lithium)
  • hypokalemia
  • hypercalcemia
  • sickle cell disease and trait
  • amyloidosis
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41
Q

Tx of nephrogenic DI

A
  • adequate water intake
  • salt restriction
  • thiazide diuretic
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42
Q

Sodium polystyrene use/characteristics

A
  • cation exchange resin
  • removes K from body ==> use in long-term control of hyperkalemia
  • slow onset; not useful in acute setting
  • contraindicated in pt.s w/recent bowel surgery
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43
Q

Characteristics of refeeding sydnrome

A

-occurs during reintro of nutrition after period of (relative) starvation
==> hypophosphatemia, hypokalemia, and hypomagnesemia

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44
Q

Tx of hypoparathyroidism

A

calcium

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45
Q

Tx of acute hypercalcemia

A

normalization of intravascular volume with saline will improve delivery of calcium to the renal tubule and aid in excretion of calcium.

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46
Q

Urine anion gap (UAG)

A

Urine anion gap (UAG) = ([urine sodium] + [urine potassium]) – [urine chloride]
Normal = 30-50

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47
Q

Type 2 RTA characteristics

A

-Type 2 (proximal) RTA = defect in regenerating bicarbonate in the proximal tubule
-normal anion gap metabolic acidosis
-hypokalemia
glycosuria (w/normal plasma glucose)
-low-molecular-weight proteinuria
-kidney phosphate wasting
-urine pH is less than 5.5
-no nephrocalcinosis/nephroliths

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48
Q

Type 1 RTA characteristics

A
  • Hypokalemic distal (type 1) renal tubular acidosis
  • normal anion gap metabolic acidosis
  • hypokalemia
  • urine pH > 6.0
  • nephrocalcinosis
  • *no ability to excrete H+ ions
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49
Q

Possible causes of type 1 RTA

A
  • autoimmune: Sjögren syndrome, systemic lupus erythematosus, or rheumatoid arthritis
  • drugs: lithium or amphotericin B
  • hypercalciuria
  • hyperglobulinemia
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50
Q

Expected compensation in respiratory alkalosis

A

PCO2 decrease by 10 ==> HCO3 decrease by 2

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51
Q

Expected compensation in respiratory acidosis

A
  • *predicted increase in the serum bicarbonate level is calculated as 1 mEq/L (1 mmol/L) for each 10 mm Hg (1.3 kPa) increase in Pco2 (acute)
  • *4 mEq/L (4 mmol/L) for each 10 mm Hg (1.3 kPa) increase in Pco2 (chronic).
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52
Q

Evaluation of metabolic alkalosis

A
  1. clinical assessment of volume status and blood pressure; hypovolemic = “saline-responsive”
  2. measurement of urine sodium and chloride levels can help distinguish the various causes.
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53
Q

Urine chloride use in evaluation of metabolic alkalosis

A
  • low urine chloride levels ( vomiting vs. decreased effective arterial blood (diuretics or low cardiac output)
  • high urine chloride levels (>15 mEq/L [15 mmol/L]) ==> diuretics vs. (rare) genetic tubular disorder (Bartter syndrome or Gitelman syndrome)
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54
Q

Compensation in metabolic acidosis

A

Winter’s formula:

Expected Pco2 = (1.5 × [HCO3] + 8) ± 2 = 26 ± 2

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55
Q

Calculation of corrected bicarbonate in AG metabolic acidosis

A
  • Corrected [HCO3] = measured [HCO3] + (measured anion gap – 12)
  • if corrected serum bircarb deviates from expected then there is another metabolic process in play
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56
Q

Correction in metabolic alkalosis

A

Pco2 would be expected to increase by 0.7 mm Hg (0.09 kPa) for each 1 mEq/L (1 mmol/L) increase in the serum bicarbonate level

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57
Q

FENa use

A
  • distinguish source of AKI
  • prerenal vs. infrarenal vs. postrenal
  • xx
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58
Q

Evaluation of AKI

A
  • Kidney imaging, typically US, considered in all patients w/ AKI esp. w/ risk factors for obstruction are present
  • FENa can be useful, but is variable in obstruction
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59
Q

Tx for acute pericarditis

A
  1. NSAIDs/antiinflamatory meds + observation/supportive ==> most cases resolve w/in 24 hours
  2. steroids only if other anti-inflam contraindicated or refractory cases (==> increase risk recurrence)
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60
Q

Tx of pituitary apoplexy

A
  1. glucocorticoids

2. neurosurgery/tumor removal

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61
Q

Thyroid d/o w/low RAIU

A
  • subacute/lymphocytic thyroiditis ==>
    1. hyperthyroid x weeks
    2. hypothyroid x weeks
    3. euthyroid
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62
Q

TSH goal in hypothyroidism

A

0.1 - 2.5

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63
Q

Hypothyroid in preg.

A
  • levothyroxine dose need increases by 30-50%

- test/increase dose in first semester followed by repeat testing in 2-4 weeks

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64
Q

Testing in incidental adenoma

A

Nearly 10% of adrenal incidentalomas are functional, and testing is usually necessary to identify functional tumors secreting catecholamines, cortisol, or aldosterone.

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65
Q

Screening in T1DM

A
  1. lipid panel @ puberty
  2. urine albumin-creatinine ratio @ 10yo+ AND dx of DM1 for 5 or more years
  3. dilated funduscopic examination @ 10 years of age or older AND dx with type 1 diabetes for 3 to 5 years.
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66
Q

Dx of DM

A

-A1c > 6.5
-Fasting Gluc > 120
If results of two different diagnostic tests for diabetes mellitus are discordant, the test that is diagnostic of diabetes should be repeated.

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67
Q

Modifiable risk factors for osteoporosis

A
  • adequate amounts of both calcium and vitamin D
  • regular exercise
  • cessation of cigarette smoking
  • avoidance of alcohol abuse
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68
Q

Contraindication to oral bisphosphonates and alternative therapies

A

-GERD

==> IV bisphosphonates (zoledronic acid)

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69
Q

Who should receive osteoporosis therapy?

A
  1. dx of osteo via DEXA/fragility fx OR
  2. (FRAX) risk of major osteoporotic fracture over the next 10 years is 20% OR
  3. risk of hip fracture over the next 10 years is 3% or greater
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70
Q

Outpatient vs. Inpatient management of diverticulitis

A
  • most ==> outpatient + oral abx (metro + cipro
  • hospitalization/IV abx are generally reserved for patients with evidence of peritonitis, those with significant comorbidities, or those who cannot tolerate oral intake.
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71
Q

Indications of upper endoscopy in dyspepsia

A

-symptom onset after age 50 years
-anemia
-dysphagia
-odynophagia
-vomiting
-weight loss
-fhx of upper gastrointestinal malignancy
personal history of peptic ulcer disease, gastric surgery, or gastrointestinal malignancy
-abdominal mass or lymphadenopathy on exam

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72
Q

Characteristics of gilbert syndrome

A

Gilbert syndrome is a common and frequently incidentally discovered cause of indirect (unconjugated) hyperbilirubinemia that usually does not require evaluation or treatment.

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73
Q

Acute viral hepatitis presentation

A
  • elevations of liver aminotransferase levels

- increased direct hyperbilirubinemia

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74
Q

Elevated alk phos ==>

A

cholestatic pattern of liver injury

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75
Q

Primary biliary cirrhosis presentation

A
  • PBC = immune-mediated cause of chronic liver inflammation

- elevated serum alkaline phosphatase and bilirubin levels disproportionately higher than the aminotransferase elevation

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76
Q

Hep C therapy

A
  • peginterferon + ribavirin

- addition of an NS3/4A protease inhibitor for patients with genotype 1 hepatitis C virus.

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77
Q

Management of chronic hep B

A
  • as long as no elevation in LFTs ==> monitor

- serial LFTs q3-6mo.

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78
Q

Immune-tolerant hep B

A
  • immune-tolerant, identified by the presence of a circulating viral level in the absence of markers of liver inflammation
  • typically occurs in patients born in hepatitis B–endemic areas such as Southeast Asia or Africa in whom HBV was likely acquired perinatally
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79
Q

Dx of SBP

A

In patients with cirrhosis and ascites, an ascitic fluid neutrophil count of ≥250/µL (250 × 106/L) is diagnostic for spontaneous bacterial peritonitis.

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80
Q

Anemia of inflammation lab values

A
  • Inflammatory cytokines ==> decrease transferrin saturation and calculated serum total iron-binding capacity (TIBC) levels
  • ferritin = acute phase reactant ==> serum ferritin levels tend to increase
  • Serum ferritin levels less than 100 to120 ng/mL (100-120 µg/L) may reflect co-existing iron deficiency in patients with inflammatory states.
81
Q

Iron deficiency anemia lab values

A
  • decreased transferrin saturation
  • increased calculated serum TIBC levels
  • decreased serum ferritin levels
82
Q

Most sensitive/specific test for dx of B12 deficiency

A

An elevated serum methylmalonic acid level is more sensitive and specific for diagnosing cobalamin (vitamin B12) deficiency than a low serum vitamin B12 level.

83
Q

Indications of IV iron

A

Parenteral iron, either intramuscular iron dextran or intravenous iron sucrose, is reserved for patients receiving dialysis or for patients who cannot absorb or tolerate oral iron replacement.

84
Q

Management of acute chest syndrome

A
  1. empiric broad-spectrum antibiotics
  2. supplemental oxygen
  3. pain medication
  4. avoidance of overhydration
  5. bronchodilators as needed
  6. **erythrocyte transfusion for persistent hypoxia despite supplemental oxygen
85
Q

Criteria for acute chest syndrome

A
  • sickle cell disease
  • new infiltrate on a CXR that involves at least one lung segment AND 1+:
  • chest pain
  • temperature less than 38.3°C (100.9°F)
  • tachypnea
  • wheezing/cough/labored breathing
  • hypoxia relative to baseline
86
Q

Presentation of thrombotic thrombocytopenic purpura

A
  • (TTP) = abnormal activation of platelets and endothelial cells, deposition of fibrin in the microvasculature, and peripheral destruction of erythrocytes and platelets
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • peripheral smear = schistocytes.
87
Q

Dx of immune thrombocytopenic purpura

A
  • isolated thrombocytopenia or thrombocytopenia and anemia from bleeding
  • otherwise normal peripheral blood smear
  • absence of additional organ dysfunction
88
Q

microangiopathic hemolytic anemia ==> elevated ___?

89
Q

Elevated LDH ==> ?

90
Q

Peripheral smear in warm autoimmune hemolytic anemia

A

spherocytes

91
Q

Coagulation lab values in TTP vs. DIC

A
  • DIC ==> abnormal coagulation

- TTP ==> normal coags

92
Q

Platelet clumping on peripheral smear ==> ?

A
  • pseudothrombocytopenia = lab artifact

- ==> repeat CBC

93
Q

Tx of ITP

A
  • asx + platelets > 30-40,000 ==> repeat/f/u CBCs

- sx OR platelets steriods

94
Q

Tx of PCV

A

Phlebotomy and aspirin are the initial treatments for patients with polycythemia vera.

95
Q

Indications of hydroxyurea in PCV

A
  • increased risk for thrombosis:
  • age older than 60 years OR
  • history of a previous thrombotic event
96
Q

Dx of AML

A

peripheral blood smear showing myeloblasts that contain Auer rods

97
Q

MGUS presentation

A

-asx
-serum monoclonal (M) protein level of less than 3 g/dL (30 g/L)
-

98
Q

AL amyloidosis characteristics

A
  • AL amyloid = deposition of monoclonal light chains
    1. nephrotic-range proteinuria w/worsening kidney fxn
    2. restrictive cardiomyopathy
    3. hepatomegaly
    4. neuro = symmetric distal sensorimotor neuropathy, carpal tunnel syndrome, and autonomic neuropathy with orthostatic hypotension
    5. Periorbital purpura and macroglossia
99
Q

Asymptomatic multiple myeloma

A
  • Asymptomatic (smoldering) multiple myeloma = serum M protein level of 3 g/dL (30 g/L) or more OR
  • 10% or more of clonal plasma cells on bone marrow examination
  • absence of myeloma-related end-organ damage
100
Q

Tests for determination of monoclonal protein production

A
  1. serum protein electrophoresis

2. urine protein electrophoresis combined with immunofixation

101
Q

decreased anion gap + anemia + proteinuria, + hypercalcemia + kidney failure ==> dx?

A

multiple myeloma

102
Q

Milk-alkali syndrome labs

A
  • hypercalcemia

- metabolic alkalosis

103
Q

Timing of screening/testing for inherited thrombophilia

A
  • factor V Leiden and the prothrombin gene mutation (PTG2021A) can be done at any time
  • antithrombin, protein C, protein S, and dysfibrinogenemia testing may be altered during acute thrombotic events and their treatment ==> wait until AFTER completion of tx
104
Q

Pes anserine bursitis presentation

A
  • overuse/running
  • antero-medial pain
  • worse w/stair climbing & @ night
105
Q

IT band pain location

A

lateral knee

106
Q

PF pain syndrome presentation

107
Q

Medical therapy for kidney stones

108
Q

Most common cause of obscure small intenstinal bleeding in older pt.s & dx

A
  • angiectasia

- dx w/tech-99 scan

109
Q

cough + SOB + glomerulonephritis ==> dx?

A
  • Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
  • systemic necrotizing vasculitis
  • ==> upper and lower respiratory tract sx and pauci-immune glomerulonephritis
110
Q

Tx of Bell’s Palsy

A

prednisone

111
Q

Typical joints of OA

A
  • *DIP
  • PIP
  • 1st MCP joint
112
Q

Presentation of pseudogout

A
  • Ca-pyrophosphate dihydrate deposition disease
  • osteoarthritis-like arthritis in atypical joints (e.g. metacarpophalangeal joints)
  • AND chondrocalcinosis (calcification of cartilage)
113
Q

Solar lentigo vs. Lentigo meligna

A
  • lentigo meligna = slow-growing melanoma
  • Solar lentigines = brown macules/patches in elderly fair-skinned persons in sun-damaged areas
  • SL = benign, usually more homogeneous pigmentation and lighter color
  • in equivocal cases, a biopsy is indicated.
114
Q

acute pancreatitis course/management

A
  1. bowel rest, opioids, iv fluids
  2. mild/mod ==> sx improvement @ 72-96H ==> resume PO
  3. severe = no improvement ==> CT scan + can consider NJ feedings
115
Q

Factors that affect BNP value

A
  • increased by: kidney failure, older age, and female sex

- decreased by: obesity

116
Q

Lambert-Eaton myasthenic syndrome (LEMS) characteristics

A
  • autoimmune neuromuscular dz that is classically associated with small cell lung cancer
  • autoantibodies that target voltage-gated calcium channels @ NMJ
  • ==> proximal muscle weakness, autonomic symptoms, and loss of reflexes
117
Q

Normal response of HIV counts to HAART

A

-effective therapy x 24 wks ==> resistance/genotyping + consult ID specialist

118
Q

TMP-SMX prophylaxis in HIV

119
Q

Hypersensitivty pneumonitis presentation

A
  • inflammatory lung disease that is also called extrinsic allergic alveolitis
  • esults from exposure to airborne allergens that cause cell-mediated immunologic sensitization
  • Most patients who are exposed to an inhalational antigen have symptoms within 4 to 12 hours.
120
Q

Mitral stenosis murmur

A

opening snap followed by a diastolic murmur that is accentuated with atrial contraction. S1 is usually loud, and S2 may be variable in intensity.

121
Q

daily fever + salmon-colored rash + arthritis +multisystem involvement ==> dx?

A

adult-onset Still disease

122
Q

Labs in Still disease

A
  • markedly elevated serum ferritin
  • leukocytosis
  • thrombocytosis
  • elevated erythrocyte sedimentation rate
  • anemia
  • abnormal liver chemistry tests
123
Q

Memantine: MOA, use

A
  • N-methyl-D-aspartate receptor antagonist

- first-line treatment of moderate to advanced Alzheimer disease

124
Q

Presentation/cause of delayed hemolytic transfusion rxn

A
  • @ 5 to 10 days after transfusion ==> anemia, jaundice, and fever
  • cause = new alloantibody formation against non-abo antigen
  • tend to occur more frequently in sickle cell pt.s who receive multiple transfusion
125
Q

Risk factors for pseudomonal PNA

A
  • smoking and chronic lung disease
  • broad-spectrum antibiotic use in the previous month
  • recent hospitalization
  • malnutrition
  • neutropenia
  • glucocorticoid use
126
Q

Tx/coverage for suspected pseudomonal PNA

A
  • dual therapy: β-lactam and an aminoglycoside

- e.g. pip-tazo + amikacin

127
Q

Blood products used with risk of anaphylaxis

A

“washed” erythrocytes/platelets

128
Q

γ-Irradiation of erythrocytes purpose

A
  • minimize the incidence of graft-versus-host disease

- eradicates any lymphocytes present in the transfusion when given to an immunocompromised recipien

129
Q

leukoreduction of erythrocytes purpose

A

decreases the incidence of febrile nonhemolytic transfusion reactions, CMV transmission, and alloimmunization

130
Q

Stage IA vs. IB NSCLC

A

1A 3cm tumor

131
Q

Tx of metastatic prostate cancer

A
  • androgen deprivation

- chemical (GnRH agonist) vs. surgical castration

132
Q

Tx of asx hyperuricemia

A

no tx needed

133
Q

Management of lesions suspicion for melanoma

A

excisional biopsy

134
Q

Indications for further workup of acute diarrhea

A
  • bloody stools
  • diarrhea in pregnant, elderly, or immunocompromised patients
  • hospitalization
  • employment as a food handler
  • recent antibiotic use
  • volume depletion
  • significant abdominal pain
135
Q

Lung Cancer Screening

A

individuals age 55 to 79 years who have a 30-pack-year or greater smoking history either as current smokers or as former smokers who have quit within the past 15 years.

136
Q

Tx for resolving sx of ischemic stroke

137
Q

Aortic regurgitation murmur

A

grade 2/6 high-pitched blowing diastolic decrescendo murmur is heard to the left of the sternum at the third intercostal space

138
Q

Features and tx of severe C. diff

A
  • fever
  • leukocytosis
  • oral vancomyocin +/- IV metronidazole
139
Q

Indications for noninvasive positive pressure ventilation in COPD exacerbation

A

-moderate to severe dyspnea, -moderate to severe acidosis (pH 25/min

140
Q

Exclusion criteria for NNPV in COPD exacerbation

A
  • respiratory arrest
  • cardiovascular instability (hypotension, arrhythmias, and myocardial infarction)
  • AMS
  • high aspiration risk/copious secretions
  • recent facial or gastroesophageal surgery
  • craniofacial trauma
  • fixed nasopharyngeal abnormalities
  • burns
  • extreme obesity
141
Q

Indication for intubation in COPD exacerbation

A

-Severe acidosis (pH 35/min

142
Q

Anticoagulants to avoid in advanced kidney disease

143
Q

Optimal medical therapy in severe systolic heart failure

A
  • ACE
  • B-blocker
  • spiro
144
Q

Predictors of poor prognosis in acute pancreatitis

A
  • APACHE II score
  • markers of hemoconcentration: elevated blood urea nitrogen, serum creatinine, or hematocrit levels
  • multiple medical comorbid, age > 70yrs, BMI > 30
145
Q

Polymyalgia rheumatica presentation

A
  • hip and shoulder girdle stiffness and pain
  • elevated inflammatory markers
  • closely associated w/GCA ==> if any sx ==> temporal a. biopsy
146
Q

Prophylactic tx of tumor lysis syndrome

A
  • aggressive hydration + diuresis -allopurinol and rasburicase
  • if necessary, hemodialysis before initiation of antineoplastic therapy.
147
Q

CURB-65 criteria

A 
Confusion
Urea > 20
RR > 30
BP  ward
3 criteria ==> consider ICU
148
Q

Indications for endocarditis prophylaxis

A
  • prosthetic cardiac valve
  • history of infective endocarditis
  • unrepaired cyanotic congenital heart disease
  • congenital heart disease repair with prosthetic material or device within the last 6 months
  • palliative shunts and conduits
  • cardiac valvulopathy in cardiac transplant recipients
149
Q

Tx of Raynauds

A

dihydropyridine ca-channel blocker (amlodipine)q

150
Q

Characteristic findings in hodgkin lymphoma

A
  • B sx: fever, weight loss, night sweats
  • lymphadenopathy
  • Reed sternberg cell: abundant pale cytoplasm and two or more oval lobulated nuclei containing large nucleoli
151
Q

Tx of fibromuscular dysplasia

A

revascularization with kidney angioplasty

152
Q

Tx of early-stage large B-cell lymphoma

A
  1. abbreviated course of chemotherapy
  2. immunotherapy: rituximab
  3. involved-field radiation therapy
153
Q

Lymphangioleiomyomatosis classic presentation

A

young woman w/emphysema or chylothorax or tuberous sclerosis

154
Q

Respiratory bronchiolitis-associated interstitial lung disease characteristics

A

micronodular disease that causes mild symptoms and typically presents in active smokers with subacute progressive cough and dyspnea.

155
Q

Churg-Strauss syndrome presentation

A
  • vasculitis that typically occurs in patients with a history of asthma
  • peripheral eosinophilia
  • perinuclear antineutrophil cytoplasmic antibody (pANCA).
156
Q

Microscopic polyangiitis presentation

A
  • involves small arterioles and may be associated with glomerulonephritis and purpuric skin lesions
  • no immune deposits in the skin
  • positive p-ANCA titer.
157
Q

Polyarteritis nodosa

A
  • small- to medium-vessel vasculitis
  • may be associated with renal artery involvement and hypertension
  • Purpura with skin biopsy findings of immune deposits is not a characteristic cutaneous feature.
158
Q

Goal of pressors

A
  • maintain MAP > 65

- MAP = [(2xdbp) + sbp]/3

159
Q

Tx in high grade carotid stenosis

A

carotid endarterectomy

160
Q

de Quervain tenosynovitis presentation

A
  • inflammation of the abductor pollicis longus and extensor pollicis brevis tendons
  • associated with repetitive use of the thumb
  • also assoc. w/ pregnancy, RA, and calcium deposition disease. -pain on the radial aspect of the wrist that occurs when the thumb is used to pinch or grasp. -Examination: localized tenderness @ distal radial styloid process + pain with resisted thumb abduction and extension.
161
Q

Prevention of migraines

A
  • b-blcokers
  • TCAs
  • anticonvulsants
162
Q

SVC syndrome initial w/u

A

biopsy to guide tx

163
Q

Ventricular interdependence/”to-and-fro diastolic motion of the ventricular septum” ==> dx?

A

constrictive pericarditis

164
Q

Constrictive pericarditis presentation

A

Dyspnea, pedal edema, clear lung fields, and jugular vein engorgement with inspiration

165
Q

initial tx in uncomplicated cystitis

A
  • TMP-SMX

- nitrofurantoin

166
Q

abx to avoid in kidney disease

A

aminoglycoside

167
Q

burning distal extremity pain + sensory loss ==> dx?

A

-small-fiber peripheral neuropathy

==> glucose tolerance testing

168
Q

Tx of severe sx of PVCs

A

b-blockers

169
Q

Stage III colon cancer tx

A
  1. surgery/resection

2. adjuvant chemo: 5-fluorouracil and leucovorin x 6 mo.

170
Q

Tx of recurrent gout w/hyperuricemia

A

allopurinol + colchicine

171
Q

Indication for PPX tx in migraine

A

sx > 10 days/month (limit of use of triptan)

172
Q

Threshold for thoracentesis for pleural effusion

A
  • unexplained
  • > 1cm
  • ? loculated
173
Q

Late complication of gastric bypass

A
  • Small intestinal bacterial overgrowth

- ==> diarrhea, bloating, and features of malabsorption

174
Q

Characteristics of Acral lentiginous melanoma

A

unevenly darkly pigmented patch that most often arises on the palmar, plantar, or subungual surfaces

175
Q

Ca-channel blocker to add for HTN in heart failure

A

amlodipine

176
Q

Criteria for exudative pleural effusion

A
  1. pleural fluid total protein–serum total protein ratio greater than 0.5
  2. pleural fluid lactate dehydrogenase level greater than two thirds of the upper limit of normal (or a pleural fluid–serum lactate dehydrogenase ratio >0.6)
177
Q

Workup in suspected CLL?

A

flow cytometry

178
Q

PFTs in respiratory m. weakness

A
  • reduced total lung capacity

- increased residual volume

179
Q

Cholangitis presentation

A
  • fever, jaundice, and altered mental status

- abdominal pain is usually present

180
Q

Management of cholangitis

A
  1. broad-spectrum antibiotics directed against gram-negative bacteria, enterococci, and gut anaerobes
  2. ductal decompression = urgent endoscopic retrograde cholangiopancreatography
181
Q

Synovial fluid in inflammatory arthritis

A

synovial fluid leukocyte count greater than 5000/µL (5 × 109/L)

182
Q

Churg-Strauss sx/presentation

A
  • antecedent asthma, allergic rhinitis, or sinusitis
  • eosinophilia, migratory pulmonary infiltrates
  • purpuric skin rash
  • mononeuritis multiplex
  • fever, arthralgia, and myalgia
  • kidney disease
  • (+) pANCA
183
Q

Tx of essential tremor

A
  1. Lifestyle changes: getting enough sleep and reduction of caffeine
  2. Meds: β-blockers (such as propranolol) or anticonvulsants (such as primidone)
184
Q

Prostate cancer monitoring s/p remission

A

serial DRE + PSA q6-12 mo.

185
Q

Tactile fremitus

A

increased ==> consolidation

decreased ==> pleural effusion

186
Q

Indications for surgical intervention for spinal osteo

A
  1. abscess drainage
  2. removal of an orthopedic implant
  3. stabilization of the spine.
187
Q

Signs/sx of CAP that persist after a course of abx ==> dx?

A

cryptogenic organizing pneumonia

188
Q

Indications for valve replacement in endocarditis

A

endocarditis complicated by heart failure, abscess, severe regurgitation, or hemodynamic derangements ==> urgent surgery w/out waiting for response to abx

189
Q

LeMierre syndrome presentation

A
  • fever, leukocytosis, sore throat
  • unilateral neck tenderness
  • multiple densities on CXR (septic emboli)
190
Q

Treatment of Lemierre syndrome

A
  • abx that cover streptococci, anaerobes, and β-lactamase-producing organisms.
  • Penicillin with a β-lactamase inhibitor (eg, ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin-clavulanate) OR
  • carbapenem
191
Q

Positive skin TB test

A
  • 5mm @ HIV+, recent contacts, CXR w/evidence of past TB, immunosuppresed
  • 10mm @ recent from high-risk country, IVDUs, high-risk settings
  • 15mm @ everyone else
192
Q

Management of calcium oxalate stones

A

increased dietary calcium intake and avoidance of oxalate-rich foods such as rhubarb, peanuts, spinach, beets, and chocolate

193
Q

Contraindication to B-blockers in management of MI

A

heart failure, systolic blood pressure of less than 90 mm Hg, bradycardia (

194
Q

Mitral valve prolapse murmur

A

The auscultatory feature of mitral valve prolapse is a midsystolic click followed by a late systolic murmur. Performing the Valsalva maneuver and standing from a squatting position move the click-murmur complex closer to S1.

195
Q

Management of acute afib

A

The acute management of atrial fibrillation in symptomatic but hemodynamically stable patients includes rate control with a β-blocking agent, such as metoprolol, or a calcium channel blocker, such as diltiazem.

196
Q

Adenosine: MOA, use

A
  • Adenosine = IV agent that transiently blocks atrioventricular nodal conduction
  • tx of supraventricular tachycardia (whne dependent on the av node)
  • may be used to break the reentrant rhythm in atrioventricular nodal reentrant tachycardia, or orthodromic atrioventricular reciprocating tachycardia.
197
Q

first-line treatment for a hemodynamically stable ventricular tachycardia

A
  1. intravenous antiarrhythmic agent such as amiodarone, procainamide or sotalol
  2. lidocaine can be used as a second-line agent.
198
Q

Multifocal atrial tachycardia characteristics

A

Multifocal atrial tachycardia is characterized on electrocardiograms by three or more P wave morphologic patterns and variable P-R intervals.

199
Q

Characteristics of Lyme carditis

A

Lyme carditis is manifested by acute-onset, high-grade atrioventricular conduction defects that occasionally may be associated with myocarditis.

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