hammer23 Flashcards
Which heart disease are IV drug users at increased risk of? How does it sound?
RIGHT sided (tricuspid) endocarditis. Faint murmur that increases with inspiration and is heard in the lower sternal border.
What is the management of LV dysfunction leading to acute pulmonary edema?
Dobutamine which is a positive inotrope and reduced preload relieving the lungs.
What drug should be added to TMP/SMX in a patient with toxoplasmosis? What is the next step after cure?
Folinic acid. Lower dose for chronic suppression therapy.
What is the treatment for afib patietns who are hemodynamically stable?
Control the rate with digoxin, betablocker, CCB etc
What is the presentation of spontaneous bacterial peritonitis? What is the next step in management?
Ascites, mild diffuse abdominal pain, altered mental status and low grade fever. Take ascitic fluid, blood and urine culture before starting therapy.
What is the post op complication between days 8-15? on day 7?
Drug fever or deep abscess. Do a CT scan
Wound infection so do a PE exam.
What does intracranial hypertension present with? What type of herniation can occur?
Cushings triad (HTN, bradycardia, depressed respiration). Transtentorial herniation (uncal hernation) which compresses oculomotor nerve, posterior cerebral artery (occipital lobe), brainstem.
When is CVS sampling done?
at 10 - 13 weeks in advanced maternal age
What are EKG findings and symptoms in hyperkalemia?
Peaked T waves, widened QRS, short QT, prolonged PR. Muscle weakness and pain
What is myelophthisic anemia?
Abnormal hematopoetic or non hematopoetic cells in bone marrow leading to fragmented and nucleated cells. Suspect in cancer.
What is the tone of the bladder in overflow incontinence?
Hypotonicicty
When is target cells seen and what is the next step?
In thalassemia, iron deficiency, hemoglobin mutations, chronic liver disease. Do hemoglobin studies if microcytic and target cells
What is the CT findings of chronic subdural hematoma?
Hyperdense crescentric mass
What is the most common cause of brain abscess formation in meningitis? What other lab values are observed?
Citrobacter koseri. Elevated whites, elevated protein, low glucose
What is PTHrp associated with? What is the next step in the workup?
SCC of the lung. Chest radiograph followed by biopisy
What causes angioedema? What medication causes itr? WHat medications dont work? What is the best initial test?
C1 esterase inhibitor. ACE inhibitor. GLucocorticoids. C2 and C4 complements are decreased. C1 esterase also decreased.
What are the three types of hereditary angioedema?
Type 1 - decreased levels of C1INH, Type II - normal levels but decreased function of C1INH, Type III - no detectable abnormality in C1INH
What is the treatment for acute angioedema?
FFP and Ecallantide
What is the long term treatment for angioedema? What compound accumulates during angioedema?
Androgens (Danazole and Stanazole). Bradykinin
What is the treatment for urticaria?
Antihistamines (Hydroxyzine, diohenhydramine, fexofenadine, loratidine, cetirizine or ranitidine) and second line are leukotreine receptor antagonists (Montelukast and zafirlukast)
What is the presentation of CVID? Which cell types are deficient? What is patient at increased risk for?
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
What tests are used to test for CVID? Treatment?
Immunoglobulin level decreased and antigen levels. Use antibiotics for each infection, Regular IVIG
What is the presentation of Brutons?
Low B cells in number and in number of lymphoid tissue unlike CVID. Normal T cells. Antibiotics and long term IVIG administration.
What is the long term treatment for SCID?
Bone marrow transplant that can be curative
What is the presentation of IgA deficiency?
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
What is the treatment of IgA deficiency?
Treat infections, wash blookds. IVIG will not work.
What are the T and B levels in Wiskott-Aldrich Syndrome? Treatment?
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
What is the hallmark of CGD?
Lymph nodes leaking purulent material, apthous ulcers. Look for infections with odd combination of Staph, Burkholderia, Nocardia, Aspergillus. NADPH oxidase
When can you not use dipyridamole in a stress test in patients who can’t exercise?
It provokes bronchospasm so avoid in asthmatics.
What meds should be used for TB meningitis?
RIPE + Corticosteroids (for mortality benefit)
What are the risk factors for SCC of the head and neck?
Alcohol, tobacco, HPV (16, 18, 30)
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?
Circumstantiality. Tangentiality.
What is the presentation and treatment of ethyl glycol poisoning?
CNS depression, nephrotoxicity, metabolic acidosis. Fomepizole, Ethanol, or dialysis.
What is the most serious complication of acute pancreatitis? What is the next step?
Necrosis of pancreas. Pancratic aspiration to rule out super infection followed by surgical debridement is that is the case.
Which lung cancer is the most sensitive to chemotherapy?
Small cell lung cancer
Which primitive reflexes are the first to develop and disappear? Approximate dates/months?
Palmar grasp (28 weeks to 3 months) and rooting reflex (32 weeks to 1st month)
What is the presentation of CMV retinitis?
Retinal spots, flame hemorrhages and retinal detachment. Do a dilated fundoscopic exam and treat with IV foscarnet or gancyclovir,
What is absolutely required for rheumatic fever diagnosis?
Evidence of Group A Strep infection (antiDNASE B, antistreptolysin O, antihyalrunodinase)
What are Wiskott-Aldrich patients at increased risk of?
Lymphoma and ALL
What meds do you use for the treatment of HF?
ACEi/ARB and aldosterone antagonists (regress hypertrophy
What are skin findings in UC?
Erythema nodosum (panniculitis that is symmetric, tender, erythematous, subQ nodules) and pyoderma gangrenosum
What are the findings of dermatomyositis? Which markers are elevated?
Heliotrope rash, gottron papules, proximal muscle weakness, shawl sign, ANA and Anti jo antibodies
What is the pathophysiology behind analphylactoid reactions?
Direct mast cell degranulation, e.g exposure to IV contrast. No sensitization involved.
What are the metabolic derangements in rhabdomyolysis?
HyPOphospatemia and hyperkalemia
What are the symptoms and treatment for legionella PNA?
PNA with mental confusion and diarrhea. Treat with ceftriaxone plus macrolide or a fluoroquinolone while waiting for results.
Which cancer is the most common cause of mortality in both men and women?
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
What do you have to do before giving acetozolamide for pseudotumor cerebri?
Diagnose first with MRI
What are the symptoms of spinal epidural abscess? Which organism is implicated?
Focal back pain, motor weakness, sensory changes, incontinence, and paralysis. Staph aureus.
What type of stones should you suspect in a patietn with high urine pH? What are the stones made of?
Struvite. Ammonium, Magnesium, Phosphate plus Calcium carbonate apatite
What medication is safe for post stroke patient with insomnia ?
Trazadone
Which antibodies are present in mixed connective tissue disease?
Anti U1 ribonucleoprotein (U1-RNP)
What is the steps in evaluating bloody pleural effusion?
Cytology followed by CT to determine location of tumor
What is the treatment of Herpes Zoster with post herpetic neuralgia?
Acyclovir + Tricyclic antidepressant (Desipramine preferably)
What features are unique to Crohns and not UC?
Perianal disease, strictures, fistulas, ileal lesions, skip lesion, transmural involvement
