hammer14 Flashcards
What is the most common cause of spontaneous lobar (eg parietal, occipital) hemorrhage? What causes it?
Cerebral amyloid angiopathy. Beta amyloid deposition in the walls of small to medium size cerebral arteries associated with Alz dementia.
How is premature ovarian failure treated?
Invitrofertilization with donor oocytes
Which structures cause symmetric and circumferential narrowing of the esophagus? Risk factors/
Peptic strictures. GERD, radiation, systemic sclerosis, caustic ingestions
What should you do before starting antibiotic therapy in patients with suspected endocarditis?
Take a blood culture from separate venipuncture sites
What monotherapy can you use for patients with migraine, nausea and vomiting?
Chlorpromazine, prochloperazine or metoclopramide which are IV antiemetics.
What is the presentation of endometritis? What are risk factors? Initial treatment?
Fever, i=uterine tenderness, foul smelling lochia. Prolonged ROM, prolonged labor, operative vaginal delivery and Csection. Clindamycin and gentamicin
When do left ventricular aneurysms occur? What are ECG findings? What can they lead to?
5 days to 3 months post MI. persistemnt ST elevation after MI and deep Q waves in the same leads. Large VAs can progress to HF, refractory angina, ventricular arrhythmia, functional MR or mural thrombus.
What is Cluster headache presentation?
Acute, severe retrororbital pain that wakens from sleep. Redness, tearing, stuffy nose, ipsilateral Horners.
What is D xylose test used for?
If impaired, it shows small intestinal mucosal disease like Celiacs.
What is the strongest predictory of stent thrombosis?
Premature discontinuation of antiplatelet therapy.
What is the presentation of MAC, CD4 count and treatment?
What is the standard diagnostic test for TB? Which meds and for how long? When would treat to be extended?
Pleural biopsy. RIPE for first 2 months. Stop Ethambutol (optic neuritis/color vision), pyrazinamide (hyperuricemia) , continue rifampin (red color to body secretions) and isoniazid (peripheral neuropathy) for next four months for total of six months. Osteomyelitis, miliary tb, meningitis, pregnancy
When is positive PPD greater than 5 mm positive? What is the next step?
HIV positive patients (chemo prophylaxis with Isonazid for 9 months), glucocorticoid users, close contact with TB active patients, abnormal calcifications on CXR, organ transplant recipients. Confirm with CXR.
When is positive PPD greater than 10mm positive?
Recent immigrants, prisoners, healthcare workers, close contact with someone with TB, hematologic malignancy, alcoholics, Adam
When is positive PPD greater than 15 mm positive?
Those with no risk factors
When do you test twice for a PPD skin test? What test has equal significance to PPD?
If first one is negative Ina first time patient. Interferon gamma release assay is a blood test equal in significance to PPD
What are features of malignant pulmonary nodules?
> 40, enlarging, smoker, spiculated spikes, large>2 cm, adenopathy, sparse eccentric calcification.
What pneumoconioses is associated with sandblasting, rock mining, tunneling? Shipyard worker, pipe fitting, insulator?cotton? Electronic manufacture? Moldy sugar cane?
Silicosis. Asbestosis. Byssinosis. Berylliosis (granulomas) Bagassosis.
Which PFT tests are normal in restrictive lung disease?
FEV1/FVC
What is the presentation of sarcoidosis?
Young AA woman with SOB on exertion and occasional fine rales on lung exam. Eythema nodosuma and LAD on exam especially on CXR. Also with parotid gland enlargement, facial palsy, heart block , restricivtive cardiomyoppathy, iritis and uveitis.
What do diagnostic tests show in sarcoidosis? Treatment?
Lymph node biopsy shows noncaseating granulomas that make Ca., elevated ACE levels, hypercalcemia, hypercalciuria, restrictive PFTs. Prednisone.
What are the three initial tests to do for PE? What are expected findings?
CXR - atelectasis, wedge shaped infarct, pleural based lesion and oligemia of one lobe. EKG showing sinus tachycardia and non specific ST T wave changes, 5% shows RAD, RV hypertrophy or RBBB. ABG shows hypoxia and respiratory alkalosis (high pH and low pCO2) with normal CXR.
When is an IVC filter the right answer?
Contraindication to anticoagulation, recurrent emboli, right ventricular dysfunction with an enlarged RV on echo
What is management if LE doppler is positive in PE?
Heparin and 6 months of Warfarin
What is the definition of ARDS? What is ten wedge pressure? What should the plateau pressure be kept on ventilator?
PO2/FiO2 below 300. Normal wedge pressure. Less than 30 cm of water.
What is the first step after seeing microalbuminuria Ina diabetic patient?
Start ACEi or ARB
Which tests detect eosinophils in the urine?
Wright and Hansel stains.
What do red cell casts indicate? White cell casts?
Glomerulonephritis. Pyelonephritis.
What do hyaline casts indicate?
Dehydration concetrates urine and normal Tamm-Horsfall protein precipitates or concentrates into a cast.
What do broad, waxy casts indicate?
Chronic renal disease.
What do granular muddy brown casts indicate?
Acute tubular necrosis, collection of dead tubular cells.
What are the three etioogies of AKI?
Pre renal azotemia (decreased perfusion, hypotension, hypovolemia), post renal azotemia (obstruction), intrinsic renal disease (ischemia and toxins).
What are the BUN to Creatinine ratio for both pre renal and post renal azotemia? Intrinsic?
Above 20:1. 10:1 for intrinsic.
What is a common manifestation in sickle cell trait?
Renal concentrating inability or isothenuria so make sure to hydrate
What is the difference in urine sodium and FeNa in pre renal vs ATN?
Pre renal holds the Na to pull in water so UNa less than 20 and FeNa less than 1 percent but high urine osmolality more than 500.
What is the urine findings in contrast induced nephrotoxicity?
Very low urine Na, low FeNa
What kidney disorder I causes Creatinine elevation in patients who receive chemo? What should be given to chemo patients then?
Tumor lysis syndrome leading to hyperuricemia. Cisplatin causes it in 5 to 10 days. Allopurinol, hydration and rasburicase
What is the treatment for rhabdomyolysis?
Saline hydration, mannitol, bicarbonate
What are findings in hepatomegaly syndrome and how is it treated?
Severe liver disease, very low urine sodium, elevated BUN to Creatinine greater than 20:1. Midodrine,octreotide, maybe albumin
What are some presentations of analgesic nephropathy?
ATN, AIN, membranous glomerulonephritis, vascular insufficiency 2/2 lack of construction of afferent arterioles, papillary necrosis(best diagnosed with CT).
What are characteristics of tubular disease?
Acute, toxin related, no nephrotic syndrome , no steroids
Which organs does good pasture syndrome involve? What is the best initial test? Treatment?
Lung and kidneys. Anti glomerular basement membrane antibodies in linear fashion. Anemia is often present. Plasmapheresis and steroids.
What is the most common cause of acute glomerulonephritis in the US? Diagnosis and treatment?
IgA nephropathy. Asian patient with recurrent episodes of gross hematuria 1-2 days after URI. Kidney biopsy. Severe proteinuria treated with ACEi and steroids.
What is the presentation, diagnosis and treatment of PSGN?
1 to 3 weeks after throat or skin infection. Dark colored urine, periorbital edema, HTN and oliguria. ASO for PSGN from GABS and antiDNAse antibody titers. Low complement levels. Do a biopsy, but not often. Antibiotics and diuretics.
Which organs does polyarteritis nodosa spare? How does it present and treatment?
Lungs. Associated with HepB. Glomerulonephritis , fever, malaise, weight loss, myalgia, stroke in young person, digital gangrene, live do reticularis. Prednisone and cyclophosphamide.
What is the treatment for amyloidosis when primary disease can’t be controlled?
Melphalan and prednisone
What is the official definition of nephrotic syndrome and how is it treated? What does UA show?
Hyperproteinuria (more than 3.5 grams per 24 hours), hyproteinemia, hyperlipidemia, edema. Glucocorticoids, if no response cyclophosphamide. ACEi or ARBS to control proteinuria.uA shows Maltese cross which are lipid deposits in sloughed off tubular cells.
What meds do you use for hyperphosphatemia 2/2 ESRD?
Oral phosphate binders lie, calcium acetate, calcium carbonate, sevelamer, lanthanum.
What common symptoms and lab values do HUS and TTP have? How is TTP treated?
Intra vascular hemolysis with schistocytes, helmet cells and fragmented red cells, renal insufficiency, thrombocytopenia. TTP also has neurological symptoms and fever. Plasmaphersis for TTP or FFP. No steroids or platelet transfusion.
What is the presentation and common cause of death in polycystic kidney disease?
Flank pain, hematuria, stones, infection, HTN. Renal failure
