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hammer23 Flashcards

1
Q

Which heart disease are IV drug users at increased risk of? How does it sound?

A

RIGHT sided (tricuspid) endocarditis. Faint murmur that increases with inspiration and is heard in the lower sternal border.

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2
Q

What is the management of LV dysfunction leading to acute pulmonary edema?

A

Dobutamine which is a positive inotrope and reduced preload relieving the lungs.

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3
Q

What drug should be added to TMP/SMX in a patient with toxoplasmosis? What is the next step after cure?

A

Folinic acid. Lower dose for chronic suppression therapy.

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4
Q

What is the treatment for afib patietns who are hemodynamically stable?

A

Control the rate with digoxin, betablocker, CCB etc

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5
Q

What is the presentation of spontaneous bacterial peritonitis? What is the next step in management?

A

Ascites, mild diffuse abdominal pain, altered mental status and low grade fever. Take ascitic fluid, blood and urine culture before starting therapy.

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6
Q

What is the post op complication between days 8-15? on day 7?

A

Drug fever or deep abscess. Do a CT scan

Wound infection so do a PE exam.

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7
Q

What does intracranial hypertension present with? What type of herniation can occur?

A

Cushings triad (HTN, bradycardia, depressed respiration). Transtentorial herniation (uncal hernation) which compresses oculomotor nerve, posterior cerebral artery (occipital lobe), brainstem.

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8
Q

When is CVS sampling done?

A

at 10 - 13 weeks in advanced maternal age

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9
Q

What are EKG findings and symptoms in hyperkalemia?

A

Peaked T waves, widened QRS, short QT, prolonged PR. Muscle weakness and pain

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10
Q

What is myelophthisic anemia?

A

Abnormal hematopoetic or non hematopoetic cells in bone marrow leading to fragmented and nucleated cells. Suspect in cancer.

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11
Q

What is the tone of the bladder in overflow incontinence?

A

Hypotonicicty

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12
Q

When is target cells seen and what is the next step?

A

In thalassemia, iron deficiency, hemoglobin mutations, chronic liver disease. Do hemoglobin studies if microcytic and target cells

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13
Q

What is the CT findings of chronic subdural hematoma?

A

Hyperdense crescentric mass

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14
Q

What is the most common cause of brain abscess formation in meningitis? What other lab values are observed?

A

Citrobacter koseri. Elevated whites, elevated protein, low glucose

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15
Q

What is PTHrp associated with? What is the next step in the workup?

A

SCC of the lung. Chest radiograph followed by biopisy

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16
Q

What causes angioedema? What medication causes itr? WHat medications dont work? What is the best initial test?

A

C1 esterase inhibitor. ACE inhibitor. GLucocorticoids. C2 and C4 complements are decreased. C1 esterase also decreased.

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17
Q

What are the three types of hereditary angioedema?

A

Type 1 - decreased levels of C1INH, Type II - normal levels but decreased function of C1INH, Type III - no detectable abnormality in C1INH

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18
Q

What is the treatment for acute angioedema?

A

FFP and Ecallantide

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19
Q

What is the long term treatment for angioedema? What compound accumulates during angioedema?

A

Androgens (Danazole and Stanazole). Bradykinin

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20
Q

What is the treatment for urticaria?

A

Antihistamines (Hydroxyzine, diohenhydramine, fexofenadine, loratidine, cetirizine or ranitidine) and second line are leukotreine receptor antagonists (Montelukast and zafirlukast)

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21
Q

What is the presentation of CVID? Which cell types are deficient? What is patient at increased risk for?

A

Bronchitis, PNA, sinusitis, Otitis media. Can also have Giardiasis and Sprue like intestinal malabsorption. Reduced B cell output (Igs but normal number of B cells) and normal T cells. Normal amount of lymphoid tissue. Increased risk of lymphoma

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22
Q

What tests are used to test for CVID? Treatment?

A

Immunoglobulin level decreased and antigen levels. Use antibiotics for each infection, Regular IVIG

23
Q

What is the presentation of Brutons?

A

Low B cells in number and in number of lymphoid tissue unlike CVID. Normal T cells. Antibiotics and long term IVIG administration.

24
Q

What is the long term treatment for SCID?

A

Bone marrow transplant that can be curative

25
Q

What is the presentation of IgA deficiency?

A

Recurrent sinopulmonary infection, atopic disease, anaphylaxis to blood transfusion when blood donor has normal levels of IgA, sprue like condition, increased risk of vitiligo, thyroiditis

26
Q

What is the treatment of IgA deficiency?

A

Treat infections, wash blookds. IVIG will not work.

27
Q

What are the T and B levels in Wiskott-Aldrich Syndrome? Treatment?

A

Normal T cells and normal B cells but decline with age. T lymphocytes markedly deficienct in blood and lymph nodes. BM transplantation is only definitive treatment

28
Q

What is the hallmark of CGD?

A

Lymph nodes leaking purulent material, apthous ulcers. Look for infections with odd combination of Staph, Burkholderia, Nocardia, Aspergillus. NADPH oxidase

29
Q

When can you not use dipyridamole in a stress test in patients who can’t exercise?

A

It provokes bronchospasm so avoid in asthmatics.

30
Q

What meds should be used for TB meningitis?

A

RIPE + Corticosteroids (for mortality benefit)

31
Q

What are the risk factors for SCC of the head and neck?

A

Alcohol, tobacco, HPV (16, 18, 30)

32
Q

WHat is the type of speech that is delayed at getting to the final point but will eventually do so? same but doesn’t get to the final point?

A

Circumstantiality. Tangentiality.

33
Q

What is the presentation and treatment of ethyl glycol poisoning?

A

CNS depression, nephrotoxicity, metabolic acidosis. Fomepizole, Ethanol, or dialysis.

34
Q

What is the most serious complication of acute pancreatitis? What is the next step?

A

Necrosis of pancreas. Pancratic aspiration to rule out super infection followed by surgical debridement is that is the case.

35
Q

Which lung cancer is the most sensitive to chemotherapy?

A

Small cell lung cancer

36
Q

Which primitive reflexes are the first to develop and disappear? Approximate dates/months?

A

Palmar grasp (28 weeks to 3 months) and rooting reflex (32 weeks to 1st month)

37
Q

What is the presentation of CMV retinitis?

A

Retinal spots, flame hemorrhages and retinal detachment. Do a dilated fundoscopic exam and treat with IV foscarnet or gancyclovir,

38
Q

What is absolutely required for rheumatic fever diagnosis?

A

Evidence of Group A Strep infection (antiDNASE B, antistreptolysin O, antihyalrunodinase)

39
Q

What are Wiskott-Aldrich patients at increased risk of?

A

Lymphoma and ALL

40
Q

What meds do you use for the treatment of HF?

A

ACEi/ARB and aldosterone antagonists (regress hypertrophy

41
Q

What are skin findings in UC?

A

Erythema nodosum (panniculitis that is symmetric, tender, erythematous, subQ nodules) and pyoderma gangrenosum

42
Q

What are the findings of dermatomyositis? Which markers are elevated?

A

Heliotrope rash, gottron papules, proximal muscle weakness, shawl sign, ANA and Anti jo antibodies

43
Q

What is the pathophysiology behind analphylactoid reactions?

A

Direct mast cell degranulation, e.g exposure to IV contrast. No sensitization involved.

44
Q

What are the metabolic derangements in rhabdomyolysis?

A

HyPOphospatemia and hyperkalemia

45
Q

What are the symptoms and treatment for legionella PNA?

A

PNA with mental confusion and diarrhea. Treat with ceftriaxone plus macrolide or a fluoroquinolone while waiting for results.

46
Q

Which cancer is the most common cause of mortality in both men and women?

A

Lung cancer followed by PC and BC in men and women respectively. Common by incidence in men is Prostate Lung Colorectal and women is Breast Lung Colorectal

47
Q

What do you have to do before giving acetozolamide for pseudotumor cerebri?

A

Diagnose first with MRI

48
Q

What are the symptoms of spinal epidural abscess? Which organism is implicated?

A

Focal back pain, motor weakness, sensory changes, incontinence, and paralysis. Staph aureus.

49
Q

What type of stones should you suspect in a patietn with high urine pH? What are the stones made of?

A

Struvite. Ammonium, Magnesium, Phosphate plus Calcium carbonate apatite

50
Q

What medication is safe for post stroke patient with insomnia ?

A

Trazadone

51
Q

Which antibodies are present in mixed connective tissue disease?

A

Anti U1 ribonucleoprotein (U1-RNP)

52
Q

What is the steps in evaluating bloody pleural effusion?

A

Cytology followed by CT to determine location of tumor

53
Q

What is the treatment of Herpes Zoster with post herpetic neuralgia?

A

Acyclovir + Tricyclic antidepressant (Desipramine preferably)

54
Q

What features are unique to Crohns and not UC?

A

Perianal disease, strictures, fistulas, ileal lesions, skip lesion, transmural involvement

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