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hammer13 Flashcards

1
Q

When is screening for colon cancer in a family history of colon cancer with a single family member? When is colonoscopy repeated?

A

10 years earlier than the age at which the cancer developed or age 40. Repeat every 5 years if colon cancer person is under 60

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2
Q

When is screening for colon cancer in a family history of colon cancer with three family members, 2 generations, 1 premature before 50?

A

This is HNPCC. Start screening at age 25 with colonoscopy every 1 to 2 years.

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3
Q

When is screening for colon cancer in a familial adenomatous Polyposis? Previous adenomatous polyp? Previous history of colon cancer?

A

Start screening at age 12 every year with sigmoidoscopy. Colonoscopy every 3 to 5 years. Colonoscopy at 1 year after resection, then 3 years, then every 5 years

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4
Q

What is Peutz jeghers syndrome? Which cancers are increased?

A

Multiple hamartomatous polyps associated with melanotic spots on the lips and skin, increased frequency of breast cancer, increased gonadal and pancreatic cancer

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5
Q

What are lab findings in acute pancreatitis? What is the treatment for necrotic pancreatitis?

A

Leukocytosis, drop in hematocrit, elevated LDH and AST, hypoxia, Hypocalcemia, elevated urine trypsinogen activation peptide. Diagnose with biopsy and treat with imipenem of meropenem

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6
Q

What is the cause of elevated SAAG > 1.1? Lower SAAG?

A

Portal hypertension, CHF, hepatic vein thrombosis, constrictive pericarditis. For lower, I infection, cancer, nephrotic syndrome.

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7
Q

What is the treatment for ascites and edema?

A

Spirnolactone and other diuretics.

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8
Q

What is the presentation, diagnosis and treatment for primary biliary cirrhosis?

A

Tired, itchy 40-50 year old woman with elevated alkaline phosphatase and normal bilirubin. Xantherlasma and xanthoma plus osteoporosis. Anti mitochondrial antibody. Treat with ursodeoxycholic acid.

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9
Q

What is the presentation, diagnosis and treatment of primary sclerosing cholangitis?

A

Associated with IBD. Pruritis, elevated alkaline phosphatase, GGTP, bilirubin. MRCP that shows beading, narrowing or strictures in the biliary system. Treat with Cholestyramine or ursodeoxycholic acid.

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10
Q

Which organisms feed on iron for hemochromatosis?

A

Vibrio vulnificus, yersinia and listeria.

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11
Q

What is the treatment for chronic hepatitis B?

A

Only one of the following. Adefovir (renal dysfunction), lamivudine, telbivudine, entecavir, tenofovir, interferon (arthralgia ,thrombocytopenia, depression, leukopenia)

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12
Q

What is the treatment for chronic hepatitis C?

A

Lepisavir and sofosbuvir if genotype 1 sofosbuvir and ribavarin for type 2. Add interferon for other genotypes on top of ribavarin and sofosbuvir.

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13
Q

What is the most accurate diagnostic tests for Wilson disease and how does it present? Treatment?

A

Abnormally increase copper excretion in urine after penicillamine. Neurologic symptoms, Coombs negative hemolytic anemia, renal tubular acidosis or nephrolithiasis. Treatment is with penicillamine, zinc to interfere with absorption, trientine which is a chelator

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14
Q

What is the most accurate test for asthma? How is asthma exacerbation quantified?

A

More than 20% decrease in FEV1 with use of methacholine. Decreased peak expiratory flow (based on height and age), ABG with an increased AA gradient.

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15
Q

What is the order of Meds for asthma exarcebation?

A

SABA, SABA PLUS LOW DOSE INHALED CORTICOSTEROID OR LONG TERM CONTROL AGENTS (Cromolyn to inhibit mast cell mediator release and eosinophil recruitment, theophylline, leukotriene modifiers like montelukast), add LABA,Increase ICS dose, Omalizumab, oral corticosteroids when everything else fails.

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16
Q

What is an adverse side effect of Zafirlukast?

A

Hepatoxic and associated with Churg-Strauss syndrome

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17
Q

What is the best treatment for asthma exacerbation?

A

Oxygen, albuterol, steroids

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18
Q

What does PFT in asthma show vs. COPD.?

A

Increased diffusion capacity of THE lung for carbon monoxide in asthma but decreased in COPD.

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19
Q

What are EKG and echoradiography findings in COPD?

A

Right atrial hypertrophy and right ventricular hypertrophy. Atrial fibrillation or multifocal atrial tachycardia. Echo shows right atrial and ventricular hypertrophy and pulmonary HTN.

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20
Q

Which treatments can improve mortality and delay progression of disease of COPD?

A

Smoking cessation, oxygen for po2 less than 55 or O2 star less than 88%, influenza and pneumococcal vaccines.

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21
Q

What microorganism are present in chronic bronchitis and which antibiotics should be used to treat?

A

H influenza, strep pneumo, Moraxella catarrhalis. Macrolides, cephalosporin, amoxicillin clavulanic acid, quinolones

22
Q

What is the most common cause of bronchiectasis? Presentation? Treatment?

A

Cystic fibrosis. High volume purulent sputum production, hemoptysis, dyspnea and wheezing. Chest physiotherapy, antibiotics, surgical resection is necessary

23
Q

What are diagnostic tests and treatment findings for allergic bronchopulmonary aspergillosis?

A

Peripheral eosinophilia, elevated serum IgE levels. Treat with oral steroids for severe cases, inhaled steroids are not as effective and itraconazole for recurrent episodes

24
Q

What is the inheritance mode of CF? How does it affect fertitility in men and women?

A

Autosomal recessive. Men have azoospermia with missing vas deferens and women have menstrual cycle irregularities because of chronic lung disease and thick cervical mucus.

25
Q

What do PFTs show in CF?

A

Mixed obstructive and restrictive patterns, decrease in FVC and TLC and decreased diffusing capacity for carbon monoxide.

26
Q

Which disease is H influenza associated with? Legionella?

A

COPD . Gastrointestinal symptoms (abdominal pain, diarrhea) or CNS symptoms such as headache and confusion.

27
Q

What is the best initial test for respiratory infections? What are. LDH and protein levels for empyema?

A

Chest X-rays. Above 60% for LDH and 50% for protein.pH

28
Q

What diagnostic tests are up for legionella, PCP?

A

Urine antigen cultured on charcoal yeast extract, broncheoalveolar lavage

29
Q

What is the decision branch point for outpatient treatment for pneumonia?

A

If previously healthy or no antibiotics in past 3 months and mile symptoms, macrolide or doxycycline. If patient has comorbidites or antibiotics in past 3 months, fluoroqunilones.

30
Q

What is CURB 65 and why?

A

Confusion, uremia, respiratory distress, low BP, older than 65 admit to hospital if more than or equal to 2 points.

31
Q

What is the treatment for hospital acquired PNA?

A

Macrolides are not acceptable. Antispeudomomal cephalosporins or penicillin (piptazo) or carbapenem are used instead.

32
Q

What treatments for ventilator associated pneumonia?

A

Antipseudomonal betalactam(cephalosporin or penicillin or carbapenem) plus aminoglycoside or fluoroqunilones plus MRSA agents.

33
Q

Which carbapenem causes seizures?

A

Imipenem because it is renally cleared.

34
Q

What value is elevated in PCP? What should treatment be switched to if TMP/SMX toxicity?

A

LDH is elevated. Clindamycin and primaquine(contraindicated in G6PD deficiency as is Dapsone) or pentamidine. If there is a rash from TMP/SMX use Atovaquone or Dapsone

35
Q

What is the presentation and cause of a retroperitoneal hematoma? How is it diagnosed and treated?

A

Presents with sudden hemodynamic instability and ipsilateral flank pain or back paain due to a local vascular complication of cardiac catherization. Non-contrast abdominal and pelvic CT or abdominal US. Supportive treatment.

36
Q

What is the presentation of Rotor syndrome? What is the interpretation of a positive urine bilirubin assay? A positive urobilinogen assay?

A

Normal AST, ALT, alkaline phosphatase with elevated conjugated bilirubin. If there is a buildup of conjugated bilirubin, positive bilirubin assay. Excess unconjgugaterd bilirubin excreted in feces leads to positive urobilinogen assay.

37
Q

What is the presentation of schizoaffective disorder?

A

MDD or manic episode plus lifetime of delusions or hallucinations for >2weeks in the absence of MDD or manic episode

38
Q

Which microorganisms are implicated in brain abscess?

A

Anerobic organisms e.g Viridians streptococci, S. aureus and gram negative organisms.

39
Q

What is the red cell distribution width and total RBC count in Thalessemia?

A

Normal

40
Q

What are clinical findings in Rickets? What is Alkphos level?

A

Ping pong skull, delayed fontanel closure, enlarged skull, costochondral joints, long bone joints, genu varum.Alk phos is elevated

41
Q

What are GI findings of systemic sclerosis?

A

Atrophy and fibrosis of smooth muscle in the lower esophagus. Decreased peristalsis and decreased tone in LES. Heartburn and dysphagia.

42
Q

What is the pathology of a Baker cyst?

A

Excess fluid production by an inflamed synovium

43
Q

What is the presentation of dacryocystitis? Which organisms are implicated?

A

Inflammatory change in the medial canthal region of the eye. Staph aureus and beta hemolytic Streptococcus.

44
Q

What is the presentation of Hordeolum?

A

Abscess, localized tender swelling, located over upper or lower eyelid. Staph aureus.

45
Q

What is the presentation of Chalazion?

A

Lid discomfort. Chronic granulomatous inflammation of the meibomian gland.

46
Q

How can you increase PaO2 in a ventilated patient?

A

PEEP and FiO2 (keep under 60%) increase.

47
Q

What is the complement level in SLE?

A

Low C3

48
Q

What is the management for uncomplicated low back pain?

A

Moderate activity and NSAIDs

49
Q

What are the thyroid hormonal changes during pregnancy?

A

Total T4 and free T4 are increased and TSH is decreased

50
Q

How are valve infective endocarditis prevented from being septic embollic? When do you do surgery for the vegetation?

A

IV abx. When there is significant valvular dysfunction, difficult to treat infection or recurrent embolism.

51
Q

What is the presentation of ethylene glycol ingestion?

A

Flank pain, hematuria, oliguria, CN palsy tetanu, calcium oxalate crystals in urine. Fomepizole which is a competitive inhibitor of alcohol dehydrogenase.

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