hammer25 Flashcards
What are the features of benign solitary pulmonary nodule and how is it managed?
Large, popcorn like calcification, young non smoker, serial CT scans every 3 months for 2 years
What is the treatment for patients who fail medical treatment of trigeminal neuralgia?
Surgical decompression
What is the management of empyema? What is the fluid characteristics?
Thoracocentesis followed by spiral CT scan with IV contrast to determine if it is uni or multiloculated. If uniloculated, chest tube and antibiotics. If multiloculated, thoracoscopic drainage. Low pH with low glucose
What is aortic coarctation associated with?
Bicuspic aortic valves (aortic stenosis), VSD, hypoplastic left ventricle
What is scleroderma characterized by? Which antibodies?
Sclerosis of skin and fibrosis of internal organs, pulmonary fibrosis, GERD from GI dysmotility, cardiac disease, Raynauds. anti anti Scl-70 (anti DNA topoisomerase) and positive ANA
When is Tdap preferred over Td?
Tdap is for previoslu unvaccinated or for children <7 between 11 - 64
What are the indications for chest radiograph?
Elevated pulse (>100), temperature (>38), respiratory rate (>24), SARS, rales, consolidation, epidemiologic signs
How does pancreatitis cause ARDS?
Release of phospholipase which damages the alveolar capillary membranes in the lungs
What are withdrawal symptoms and complications from cocaine use?
Hypotension, respiratory depression , seizures. Pulmonary edema, stroke, rhabdomyolysis, pneumomediasteinum, pneumothorax
What is the presentation of juvenile nasopharyngeal angiofibroma? What does it look like?
Severe epistaxis, rhinorrhea, hearing loss, diplopia, nasal obstruction. Grayish red mass in posterior nasopharynx.
What are the characteristics of hemolytic uremic syndrome?
Prodrome of diarrhea followed by thrombocytopenia, microangiopathic hemolytic anemia, acute renal failure (BUN/Cr <15:1)
What is eosinophilic fascitis?
Muscle fascia fibrosis leading to flexion contractures and orange peel appearance of skin on extremities
What is the most common cause of lateral epicondylitis (tennis elbow)?
Tear of extensor carpi radialis brevis
When do you not treat localized prostate cancer?
IN patients who have less than 10 years to live (or older than 70)
How is Lyme disease diagnosed? Treated if you are less than 8 yo?
ELISA followed by western blot. Amoxicillin if younger than 8 and doxycycline if older.
What is the presentation of gastrojejunocolic fistula?
weight loss, severe diarrhea, halatosis
What is the presentation and treatment of TTP?
Thrombocytopenia, hemolytic anemia, neurological signs, , renal fialure, Plasmapheresis.
What testing should be performed for sisters of fragile X males?
Cytogenetic testing since they might present with ADHD symptoms.
What is the first medication a patient diagnosed with hyperthyroidism should be placed?
Non selective beta blocker especially if they have afib.
What is the age group for screening for AAA? Annual spiral CT?
65 - 75. 55 - 80 with a 30 year smoking history who have stopped smoking for at least 15 years
What is the most accurate test for heart valve lesions like aortic stenosis? Best initial test?
Left heart cath and angiogram. TEE
What is the difference between central artery and central retina occlusion?
Central artery - painless loss of vision, pale retina with cherry red fovea
Central retina - painful loss of vision, retinal hemorrhages, tortuosity, disk swelling, venous dilation
What is the REM status of nightmares vs night terrors?
Nightmares are REM and night terrors are non REM
What is the initial test in persons with acute renal failure? What FeNa is indicative?
Ultrasound. FENa > 2%
What are common complications with hepatorenal syndrome?
Greater dyspnea and arterial desaturation with standingup
What is the first line treatment for angiodysplasia?
Endoscopic cauterization or anticoagulation. Accounts for 6% of lower GI bleeds
What is the presentation and treatment of right ventricle infarct?
Hypotension, ST elevation in inferior leads (II, III, aVF), clear lungs. Increase preload by giving fluids
What is the presentation and imaging findings of PML 2/2 JC virus?
Hemiparesis, visual defects, ataxia, aphasia 2/2 myelin destruction. Imaging shows patchy focal non enhancing lesions of white matter
What is the presentation of eczema herpeticum? what is its other name? WHich HSV? What do the lesions look like?
HSV1. Kaposi varicelliform eruption. Affects children with eczema, burns, pemphigus vulgaris, BP, ichthyosis vulgaris, Vesicles and punched out ulcers spread outwards
What is the biopsy findings in inclusion body miositis? What medication doesn’t it respond to? What are presenting symptoms?
basophil rimmed vacuoles in muscle sarcoplasm. Responds poorly to corticosteroids. Suspect in dysphagia and proximal muscle weakness
What is the presentation of complete heart block post MI? Treatment?
Hypotension, bradycardia. Treat wtih Atropine.
What should you suspect if you have a diastolic murmur with stroke like symptoms?
Intracardiac lesion (myxoma).
What is the treatment for CMV disseminated?
Ganciclovir +- Foscarnet
Infection with which organism is implicated in gall bladder carcinoma? Cholangiocarcinoma?
Salmonella typhi. Clonorchis sinensis
What is the treatment for ascending cholangitis?
IV hydration, Ceftriaxone plus metronidazole and elective sphincterectomy
What is the order of drugs in status epilepticus?
Lorazepam followed by fosphophenytion followed by phenobarbital if it doesn’t improve followed by anesthesia with midazolam or propofol
What is the most common cause of death from CHF?
Ischemia induced arrhythmia
What is the treatment for acute pulmonary edema?
Diuretics, oxygen, morphine, nitrates. If that doesn’t work positive ionotropes like dobutamine, milrinone, PDE (increase contractility, decrease afterload)
What medications decrease afterload in acute pulmonary edema?
ACEi/ARBs, nitroprusside plus hydralazine if can’t tolerate ACEi/ARB
Which medications have mortality benefit in CHF?
Betablockers (carvedilol, metorpolol bisoprolol), ACEi/ARBs
What is the treatment for minimal change disease?
Steroids oral prednisone
What are the symptoms of vertebrobasilar artery stroke?
Vertigo + diplopia, dysphagia, drowsiness, hemisensory loss, facial paresthesia, syncope
What genes are MENIIa associated with and what characteristics?
RET gene. MTC, Pheochromocytoma, hyperparathyroidism (AD)
What is the presentation and feared complication of JRA?
Symmetric joint arthritis of four or less weight bearing large joints. Uveitis/iridocyclitis. Do a slit lamp exam
When are ACEi indicated in HTN?
Diabetics, post MI, CKD, HF with systolic dysfucntion
What are absolute contraindications for thrombolytic use?
- Prior intracranial hemorrhage
- Known structural cerebral vascular lesion
- Known malignant intracranial neoplasm
- Ischemic stroke within 3 months
- Suspected aortic dissection
- Active bleeding
7 .Significant closed-head trauma or facial trauma
What is the presentation of Type 2 RTA?
Non anion gap metabolic acidosis and hypophosphatemia. Osteomalacia with defect in bone mineralization
What is the murmur of hypoplastic left heart syndrome
Precordial hyperactivity, loud second heart sound, weak pulse
What are radiographic findings of RA?
Unequal joint spaces and osteophytes
What are indications for intubation in COPD?
PaO2 < 50, altered mental status, acidosis, cardiac dysrrythmias
