HAC: ACP (IM Ess.) Flashcards
1
Q
Listeria monocytogenes: gram stain
A
gram + rods
2
Q
L. monocytogenes meningitis tx
A
ampicillin
3
Q
Common groups infected w/L. monocytogenes meningitis
A
- elderly
- neonates
- immunocompromised
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.
5
Q
S. pneumo: gram stain
A
gram + diplococci
6
Q
S. pneumo meningitis empiric therapy
A
-vanc + 3rd gen. ceph (e.g. ceftriaxone)
7
Q
Imaging in suspicion of stroke
A
- Non-contrast CT Head ==> r/o hemorrhagic stroke
2. MRI if CT negative
8
Q
Important medication in resolving acute ischemic stroke
A
-aspirin vs. clopidogrel
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
10
Q
Dx testing suspected subarachnoid hemorrhage
A
- CT w/out contrast
- if neg. ==> lumbar puncture
- RBCs or xanthochromia indicate signs of SAH
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
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.
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
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)
15
Q
Small cell lung cancer treatment
A
- surgery = early stage
- chemo + radiation = “limited stage” (limited to chest)
- chemo only = extensive stage
16
Q
Evaluation of breast mass
A
“Triple assessment”:
- palpation
- mammography +/- US
- FNA/biopsy
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.
18
Q
Exceptions to typical colon cancer screening
A
-early colonoscopy for any individual w/first deg. family member w/colon cancer
19
Q
Stage III colon cancer tx
A
- resection
2. adjuvant chemo
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
21
Q
Histology in rapidly-progressing glomerulonephritis
A
-most commonly crescentic glomerulonephritis
22
Q
glomerulonephritis characteristics
A
-nephritic syndrome
- ==> hematuria, oliguria, HTN, acute kidney failure
- ==> pyuria, hematuria, cellular/granular casts
+/- proteinuria
23
Q
Examples of nephrotic syndromes
A
-MCD
-FSGS
-membranous glomerulonephropathy
==> edema, hypoalbuminemia, proteinuria, bland sediement (no casts, RBCs, leuks)
24
Q
MCD disease type
A
nephrotic syndrome
25
FSGS disease type
nephrotic syndrome
26
Membranous disease type
nephrotic syndrome
27
Dysmorphic erythrocytes or acanthocytes on urine micro ==>
- glomerular hematuria
| - indication of glomerulonephritis
28
Evaluation/work-up with glomerular hematuria
1. urine protein-cr ratio/serum cr measurement
2. serum complement
3. hepatitis panel
4. blood cx
5. ANA, ANCA, anti-GBM, antistreptolysin
29
Evaluations of hematuria
repeat UA
| >40yo ==> lower/upper urinary tract workup
30
Evaluation of sustained, isolated proteinuria
1. split urine collection ==> r/o orthostatic proteinuria
| 2. imaging vs. kidney biopsy
31
Tx of rhabdomyolysis
rapid NS
32
Lab findings in rhabdo
- serum CK > 5000
- blood on urine dip w/out sig. hematuria (myoglobin from m. breakdown)
- ==> hypocalcemia, hyperphosphatemia, hyperkalemia, hyperuricemia, metablic acidosis
- AK
33
Serum osmolality concentration
serum osm = 2[Na] + [BUN]/2.8 + [glucose]/18
34
Types/categories of hypo-osmolol hyponatremia
- hypovolemic
- euvolemic
- hypervolemic
35
Causes of hyperosmolal hyponatremia
- extreme hyperglycemia
| - exogenously administered solutes: mannitol or sucrose
36
Cuases of isosmotic hyponatremia
- glycine
- sorbitol
- pseudohyponatremia (lab artifact w/hyperglobulinemia or severe hyperlipidemia)
37
Tx of symptomatic hyponatremia 2/2 SIADH
- 3% (hypertonic) saline
| - NS ==> excretion of most of infused sodium and retention of water ==> positive water balance
38
Causes of SIADH
- antidepressants
| - xx
39
Tx of significant hypernatremia
correct water deficit w/5% dextrose
40
Potential causes of nephrogenic diabetes insipidus
- medications (for example, lithium)
- hypokalemia
- hypercalcemia
- sickle cell disease and trait
- amyloidosis
41
Tx of nephrogenic DI
- adequate water intake
- salt restriction
- thiazide diuretic
42
Sodium polystyrene use/characteristics
- 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
43
Characteristics of refeeding sydnrome
-occurs during reintro of nutrition after period of (relative) starvation
==> hypophosphatemia, hypokalemia, and hypomagnesemia
44
Tx of hypoparathyroidism
calcium
45
Tx of acute hypercalcemia
normalization of intravascular volume with saline will improve delivery of calcium to the renal tubule and aid in excretion of calcium.
46
Urine anion gap (UAG)
Urine anion gap (UAG) = ([urine sodium] + [urine potassium]) – [urine chloride]
Normal = 30-50
47
Type 2 RTA characteristics
-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
48
Type 1 RTA characteristics
- Hypokalemic distal (type 1) renal tubular acidosis
- normal anion gap metabolic acidosis
- hypokalemia
- urine pH > 6.0
- nephrocalcinosis
* *no ability to excrete H+ ions
49
Possible causes of type 1 RTA
- autoimmune: Sjögren syndrome, systemic lupus erythematosus, or rheumatoid arthritis
- drugs: lithium or amphotericin B
- hypercalciuria
- hyperglobulinemia
50
Expected compensation in respiratory alkalosis
PCO2 decrease by 10 ==> HCO3 decrease by 2
51
Expected compensation in respiratory acidosis
* *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).
52
Evaluation of metabolic alkalosis
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.
53
Urine chloride use in evaluation of metabolic alkalosis
- 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)
54
Compensation in metabolic acidosis
Winter's formula:
| Expected Pco2 = (1.5 × [HCO3] + 8) ± 2 = 26 ± 2
55
Calculation of corrected bicarbonate in AG metabolic acidosis
- Corrected [HCO3] = measured [HCO3] + (measured anion gap – 12)
- if corrected serum bircarb deviates from expected then there is another metabolic process in play
56
Correction in metabolic alkalosis
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
57
FENa use
- distinguish source of AKI
- prerenal vs. infrarenal vs. postrenal
- xx
58
Evaluation of AKI
- 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
59
Tx for acute pericarditis
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)
60
Tx of pituitary apoplexy
1. glucocorticoids
| 2. neurosurgery/tumor removal
61
Thyroid d/o w/low RAIU
- subacute/lymphocytic thyroiditis ==>
1. hyperthyroid x weeks
2. hypothyroid x weeks
3. euthyroid
62
TSH goal in hypothyroidism
0.1 - 2.5
63
Hypothyroid in preg.
- levothyroxine dose need increases by 30-50%
| - test/increase dose in first semester followed by repeat testing in 2-4 weeks
64
Testing in incidental adenoma
Nearly 10% of adrenal incidentalomas are functional, and testing is usually necessary to identify functional tumors secreting catecholamines, cortisol, or aldosterone.
65
Screening in T1DM
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.
66
Dx of DM
-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.
67
Modifiable risk factors for osteoporosis
- adequate amounts of both calcium and vitamin D
- regular exercise
- cessation of cigarette smoking
- avoidance of alcohol abuse
68
Contraindication to oral bisphosphonates and alternative therapies
-GERD
| ==> IV bisphosphonates (zoledronic acid)
69
Who should receive osteoporosis therapy?
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
70
Outpatient vs. Inpatient management of diverticulitis
- 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.
71
Indications of upper endoscopy in dyspepsia
-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
72
Characteristics of gilbert syndrome
Gilbert syndrome is a common and frequently incidentally discovered cause of indirect (unconjugated) hyperbilirubinemia that usually does not require evaluation or treatment.
73
Acute viral hepatitis presentation
- elevations of liver aminotransferase levels
| - increased direct hyperbilirubinemia
74
Elevated alk phos ==>
cholestatic pattern of liver injury
75
Primary biliary cirrhosis presentation
- PBC = immune-mediated cause of chronic liver inflammation
| - elevated serum alkaline phosphatase and bilirubin levels disproportionately higher than the aminotransferase elevation
76
Hep C therapy
- peginterferon + ribavirin
| - addition of an NS3/4A protease inhibitor for patients with genotype 1 hepatitis C virus.
77
Management of chronic hep B
- as long as no elevation in LFTs ==> monitor
| - serial LFTs q3-6mo.
78
Immune-tolerant hep B
- 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
79
Dx of SBP
In patients with cirrhosis and ascites, an ascitic fluid neutrophil count of ≥250/µL (250 × 106/L) is diagnostic for spontaneous bacterial peritonitis.
80
Anemia of inflammation lab values
- 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
Iron deficiency anemia lab values
- decreased transferrin saturation
- increased calculated serum TIBC levels
- decreased serum ferritin levels
82
Most sensitive/specific test for dx of B12 deficiency
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
Indications of IV iron
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
Management of acute chest syndrome
1. empiric broad-spectrum antibiotics
2. supplemental oxygen
3. pain medication
4. avoidance of overhydration
5. bronchodilators as needed
5. **erythrocyte transfusion for persistent hypoxia despite supplemental oxygen
85
Criteria for acute chest syndrome
- 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
Presentation of thrombotic thrombocytopenic purpura
- (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
Dx of immune thrombocytopenic purpura
- isolated thrombocytopenia or thrombocytopenia and anemia from bleeding
- otherwise normal peripheral blood smear
- absence of additional organ dysfunction
88
microangiopathic hemolytic anemia ==> elevated ___?
LDH
89
Elevated LDH ==> ?
hemolysis
90
Peripheral smear in warm autoimmune hemolytic anemia
spherocytes
91
Coagulation lab values in TTP vs. DIC
- DIC ==> abnormal coagulation
| - TTP ==> normal coags
92
Platelet clumping on peripheral smear ==> ?
- pseudothrombocytopenia = lab artifact
| - ==> repeat CBC
93
Tx of ITP
- asx + platelets > 30-40,000 ==> repeat/f/u CBCs
| - sx OR platelets steriods
94
Tx of PCV
Phlebotomy and aspirin are the initial treatments for patients with polycythemia vera.
95
Indications of hydroxyurea in PCV
- increased risk for thrombosis:
- age older than 60 years OR
- history of a previous thrombotic event
96
Dx of AML
peripheral blood smear showing myeloblasts that contain Auer rods
97
MGUS presentation
-asx
-serum monoclonal (M) protein level of less than 3 g/dL (30 g/L)
-
98
AL amyloidosis characteristics
- 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
Asymptomatic multiple myeloma
- 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
Tests for determination of monoclonal protein production
1. serum protein electrophoresis
| 2. urine protein electrophoresis combined with immunofixation
101
decreased anion gap + anemia + proteinuria, + hypercalcemia + kidney failure ==> dx?
multiple myeloma
102
Milk-alkali syndrome labs
- hypercalcemia
| - metabolic alkalosis
103
Timing of screening/testing for inherited thrombophilia
- 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
Pes anserine bursitis presentation
- overuse/running
- antero-medial pain
- worse w/stair climbing & @ night
105
IT band pain location
lateral knee
106
PF pain syndrome presentation
-women
107
Medical therapy for kidney stones
-stones
108
Most common cause of obscure small intenstinal bleeding in older pt.s & dx
- angiectasia
| - dx w/tech-99 scan
109
cough + SOB + glomerulonephritis ==> dx?
- Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
- systemic necrotizing vasculitis
- ==> upper and lower respiratory tract sx and pauci-immune glomerulonephritis
110
Tx of Bell's Palsy
prednisone
111
Typical joints of OA
* *DIP
* PIP
* 1st MCP joint
112
Presentation of pseudogout
- Ca-pyrophosphate dihydrate deposition disease
- osteoarthritis-like arthritis in atypical joints (e.g. metacarpophalangeal joints)
- AND chondrocalcinosis (calcification of cartilage)
113
Solar lentigo vs. Lentigo meligna
- 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
acute pancreatitis course/management
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
Factors that affect BNP value
- increased by: kidney failure, older age, and female sex
| - decreased by: obesity
116
Lambert-Eaton myasthenic syndrome (LEMS) characteristics
- 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
Normal response of HIV counts to HAART
-effective therapy x 24 wks ==> resistance/genotyping + consult ID specialist
118
TMP-SMX prophylaxis in HIV
-@ CD4
119
Hypersensitivty pneumonitis presentation
- 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
Mitral stenosis murmur
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
daily fever + salmon-colored rash + arthritis +multisystem involvement ==> dx?
adult-onset Still disease
122
Labs in Still disease
- markedly elevated serum ferritin
- leukocytosis
- thrombocytosis
- elevated erythrocyte sedimentation rate
- anemia
- abnormal liver chemistry tests
123
Memantine: MOA, use
- N-methyl-D-aspartate receptor antagonist
| - first-line treatment of moderate to advanced Alzheimer disease
124
Presentation/cause of delayed hemolytic transfusion rxn
- @ 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
Risk factors for pseudomonal PNA
- smoking and chronic lung disease
- broad-spectrum antibiotic use in the previous month
- recent hospitalization
- malnutrition
- neutropenia
- glucocorticoid use
126
Tx/coverage for suspected pseudomonal PNA
- dual therapy: β-lactam and an aminoglycoside
| - e.g. pip-tazo + amikacin
127
Blood products used with risk of anaphylaxis
"washed" erythrocytes/platelets
128
γ-Irradiation of erythrocytes purpose
- minimize the incidence of graft-versus-host disease
| - eradicates any lymphocytes present in the transfusion when given to an immunocompromised recipien
129
leukoreduction of erythrocytes purpose
decreases the incidence of febrile nonhemolytic transfusion reactions, CMV transmission, and alloimmunization
130
Stage IA vs. IB NSCLC
1A 3cm tumor
131
Tx of metastatic prostate cancer
- androgen deprivation
| - chemical (GnRH agonist) vs. surgical castration
132
Tx of asx hyperuricemia
no tx needed
133
Management of lesions suspicion for melanoma
excisional biopsy
134
Indications for further workup of acute diarrhea
- bloody stools
- diarrhea in pregnant, elderly, or immunocompromised patients
- hospitalization
- employment as a food handler
- recent antibiotic use
- volume depletion
- significant abdominal pain
135
Lung Cancer Screening
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
Tx for resolving sx of ischemic stroke
aspirin
137
Aortic regurgitation murmur
grade 2/6 high-pitched blowing diastolic decrescendo murmur is heard to the left of the sternum at the third intercostal space
138
Features and tx of severe C. diff
- fever
- leukocytosis
- oral vancomyocin +/- IV metronidazole
139
Indications for noninvasive positive pressure ventilation in COPD exacerbation
-moderate to severe dyspnea, -moderate to severe acidosis (pH 25/min
140
Exclusion criteria for NNPV in COPD exacerbation
- 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
Indication for intubation in COPD exacerbation
-Severe acidosis (pH 35/min
142
Anticoagulants to avoid in advanced kidney disease
-LMWH
143
Optimal medical therapy in severe systolic heart failure
- ACE
- B-blocker
- spiro
144
Predictors of poor prognosis in acute pancreatitis
- APACHE II score
- markers of hemoconcentration: elevated blood urea nitrogen, serum creatinine, or hematocrit levels
- multiple medical comorbid, age > 70yrs, BMI > 30
145
Polymyalgia rheumatica presentation
- hip and shoulder girdle stiffness and pain
- elevated inflammatory markers
- closely associated w/GCA ==> if any sx ==> temporal a. biopsy
146
Prophylactic tx of tumor lysis syndrome
- aggressive hydration + diuresis -allopurinol and rasburicase
- if necessary, hemodialysis before initiation of antineoplastic therapy.
147
CURB-65 criteria
```
Confusion
Urea > 20
RR > 30
BP ward
3 criteria ==> consider ICU
```
148
Indications for endocarditis prophylaxis
- 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
Tx of Raynauds
dihydropyridine ca-channel blocker (amlodipine)q
150
Characteristic findings in hodgkin lymphoma
- 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
Tx of fibromuscular dysplasia
revascularization with kidney angioplasty
152
Tx of early-stage large B-cell lymphoma
1. abbreviated course of chemotherapy
2. immunotherapy: rituximab
2. involved-field radiation therapy
153
Lymphangioleiomyomatosis classic presentation
young woman w/emphysema or chylothorax or tuberous sclerosis
154
Respiratory bronchiolitis-associated interstitial lung disease characteristics
micronodular disease that causes mild symptoms and typically presents in active smokers with subacute progressive cough and dyspnea.
155
Churg-Strauss syndrome presentation
- vasculitis that typically occurs in patients with a history of asthma
- peripheral eosinophilia
- perinuclear antineutrophil cytoplasmic antibody (pANCA).
156
Microscopic polyangiitis presentation
- involves small arterioles and may be associated with glomerulonephritis and purpuric skin lesions
- no immune deposits in the skin
- positive p-ANCA titer.
157
Polyarteritis nodosa
- 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
Goal of pressors
- maintain MAP > 65
| - MAP = [(2xdbp) + sbp]/3
159
Tx in high grade carotid stenosis
carotid endarterectomy
160
de Quervain tenosynovitis presentation
- 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
Prevention of migraines
- b-blcokers
- TCAs
- anticonvulsants
162
SVC syndrome initial w/u
biopsy to guide tx
163
Ventricular interdependence/"to-and-fro diastolic motion of the ventricular septum" ==> dx?
constrictive pericarditis
164
Constrictive pericarditis presentation
Dyspnea, pedal edema, clear lung fields, and jugular vein engorgement with inspiration
165
initial tx in uncomplicated cystitis
- TMP-SMX
| - nitrofurantoin
166
abx to avoid in kidney disease
aminoglycoside
167
burning distal extremity pain + sensory loss ==> dx?
-small-fiber peripheral neuropathy
| ==> glucose tolerance testing
168
Tx of severe sx of PVCs
b-blockers
169
Stage III colon cancer tx
1. surgery/resection
| 2. adjuvant chemo: 5-fluorouracil and leucovorin x 6 mo.
170
Tx of recurrent gout w/hyperuricemia
allopurinol + colchicine
171
Indication for PPX tx in migraine
sx > 10 days/month (limit of use of triptan)
172
Threshold for thoracentesis for pleural effusion
- unexplained
- > 1cm
- ? loculated
173
Late complication of gastric bypass
- Small intestinal bacterial overgrowth
| - ==> diarrhea, bloating, and features of malabsorption
174
Characteristics of Acral lentiginous melanoma
unevenly darkly pigmented patch that most often arises on the palmar, plantar, or subungual surfaces
175
Ca-channel blocker to add for HTN in heart failure
amlodipine
176
Criteria for exudative pleural effusion
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
Workup in suspected CLL?
flow cytometry
178
PFTs in respiratory m. weakness
- reduced total lung capacity
| - increased residual volume
179
Cholangitis presentation
- fever, jaundice, and altered mental status
| - abdominal pain is usually present
180
Management of cholangitis
1. broad-spectrum antibiotics directed against gram-negative bacteria, enterococci, and gut anaerobes
2. ductal decompression = urgent endoscopic retrograde cholangiopancreatography
181
Synovial fluid in inflammatory arthritis
synovial fluid leukocyte count greater than 5000/µL (5 × 109/L)
182
Churg-Strauss sx/presentation
- antecedent asthma, allergic rhinitis, or sinusitis
- eosinophilia, migratory pulmonary infiltrates
- purpuric skin rash
- mononeuritis multiplex
- fever, arthralgia, and myalgia
- kidney disease
- (+) pANCA
183
Tx of essential tremor
1. Lifestyle changes: getting enough sleep and reduction of caffeine
2. Meds: β-blockers (such as propranolol) or anticonvulsants (such as primidone)
184
Prostate cancer monitoring s/p remission
serial DRE + PSA q6-12 mo.
185
Tactile fremitus
increased ==> consolidation
| decreased ==> pleural effusion
186
Indications for surgical intervention for spinal osteo
1. abscess drainage
2. removal of an orthopedic implant
3. stabilization of the spine.
187
Signs/sx of CAP that persist after a course of abx ==> dx?
cryptogenic organizing pneumonia
188
Indications for valve replacement in endocarditis
endocarditis complicated by heart failure, abscess, severe regurgitation, or hemodynamic derangements ==> urgent surgery w/out waiting for response to abx
189
LeMierre syndrome presentation
- fever, leukocytosis, sore throat
- unilateral neck tenderness
- multiple densities on CXR (septic emboli)
190
Treatment of Lemierre syndrome
- 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
Positive skin TB test
- 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
Management of calcium oxalate stones
increased dietary calcium intake and avoidance of oxalate-rich foods such as rhubarb, peanuts, spinach, beets, and chocolate
193
Contraindication to B-blockers in management of MI
heart failure, systolic blood pressure of less than 90 mm Hg, bradycardia (
194
Mitral valve prolapse murmur
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
Management of acute afib
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
Adenosine: MOA, use
- 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
first-line treatment for a hemodynamically stable ventricular tachycardia
1. intravenous antiarrhythmic agent such as amiodarone, procainamide or sotalol
2. lidocaine can be used as a second-line agent.
198
Multifocal atrial tachycardia characteristics
Multifocal atrial tachycardia is characterized on electrocardiograms by three or more P wave morphologic patterns and variable P-R intervals.
199
Characteristics of Lyme carditis
Lyme carditis is manifested by acute-onset, high-grade atrioventricular conduction defects that occasionally may be associated with myocarditis.
