High Yield Flashcards
Triad of paroxysmal nocturnal hemoglobinuria
DX and TX
- Hemolytic anemia- dark cola colored urine in AM
- Venous thrombosis of large vessels
- Pancytopenia–> hypercoagulable
DX: flow cytometry, ACQUIRED SC mutation
Tx Eculizumab
What is Plummer-Vinson syndrome
dysphagia + esophageal webs + atrophic glossitis + Fe def.
What is SIADH and what electrolyte abnormalities are a result
excess ADH–> free water retention–> impaired water excretion
- hyponatremia (isovolemic hypotonic hyponatremia)= no signs of edema
- increased urine osmo. ( concentraed urine despite decrease serum osmo)
Treatment of:
- Diptheria
- Botulism
- Tetanus
- Gas gangrene (myonecrosis)
- Listeriosis
- Antrax
- Syphilius
- Lyme disease
- RMSF
- Toxoplasmosis
- Pin worms (enterobiasis)
- MAC
- Rabies
- Hookwork
- diptheria antitoxin + PCN or Erythromycin x 2 weeks
- boatulism antitoxin + resp. support (add PCN G if wound botulism only)
- Tetanus Ig + Metronidazole (or PCN)
- IV PCN + IV clindamycin, debridement
- IV ampicillin (+ Gentamicin if meningitits)
- Ciprofloxacin
- PCN G
- Doxy, Amoxicillin in <8 and preg, (add IV ceftriaxone if severe)
- Doxy
- sulfadiazene (or clindamycin) + pyrimethamine (w/ folinic acid/leucovorin)
- Albendazole
- Clarithromycin + Ethambutol
- Rabies vaccine (day 0,3,7,14 +/- 28 if immunocomp.) + rabies Ig
- Albendazole
CXR: honeycombing, diffuse reticular opacities, ground glsas
idiopathic pulmonary fibrosis
-restrictive pattern
Describe findings of Obstructive shock
- CO: decreased, SVR: increased, PCWP: increased*
- cool, clammy skin
- Respiratory distress*
Describe hypertrophic cardiomyopathy murmur changes with different positions
- Decrease w/ increased venous return: squatting, laying down, handgrip
- increase w/ decreased venous return: valsalva, standing, exertion, amyl nitrate
What is Wegners
small vessel vasculitis w/ granulomatous inflammation and necrosis of nose, lungs and kidneys
- Upper resp./nose sx- refractory sinusitis or saddel nose deformity
- Lower resp. tract sx- cough, hemopytsis
- Glomerulonephritis- crescent shape RPGN
+C-ANCA
TX: corticosteroids + cyclophosphamide
Clinical manifestations of DI
- polyuria + polydipsia
- hypernatremia (increased serum osm)
- dehydration, hypotension
SE of phenytoin
- rash (erythema multiform/SJS)
- gingival hyperplasia
- hirsutism
- hypothension
- arrhythmias (esp. w/ rapid administration)
- nystagmus
SE of Lithium
- hypothyroidism
- hypoNa+
- increased urination and thirst
- DI
- hyperparathyroidism
- seizures
- arrhythmias
Tamoxifen vs Raloxifene
Tamoxifen (E. antagonist of breast and uterus)
- increased risk of endometrial CA and hyperplasia
- reduce breast CA*
- slows progression of osteoporosis
Raloxifene (E. antagonist of breast)
- reduce breast CA
- slows progression of osteoporosis
CXR: pleural plaques/thickening, intersitital fibrosis, MC in lower lobes
asbestosis
Describe findings of Septic shock
(type of distributive shock)
- CO: increased, SVR: decreased, PCWP: increased or decreased
- warm extremities, flushed
- brisk cap refill with wide pulse pressures and bounding pulses
Tx of Rheumatic fever
- ASA +/- corticosteroids in severe cases
2. PCN G
CXR: peribronchial fibrosis, bronchial wall thickening, “tram track” bronchials,
bronchiectasis
*foul smelling sputum, hemoptysis
MC- H. influenza, if CF= pseudomonas
- transmitted by raw pork, boar, or bear
- myositis, eosinophilia*, periorbital edema
- larvae in striated muscles
Trichinosis
TX: self limiting–> albendazole if severe
Sx of anterior cerbral artery stroke
- contraleral sensory/motor LE>UE–> abnormal gait
- face spared
- impaired judgement, confusion, personality change (flat affect)
- urinary incontinence
SE of 2nd generation antipyschotics agents
dopamine antagonist and serotonin antagonist
- EPS sx (less w/ Clozapin and Quetiapine) overall less than 1st geneartion
- increased prolactin (less)
- weight gain w/ Olanzapine
HIV drug SE
- ____= vivid dreams, depression, neuro disturbances
- __ = renal stones
- ___= bone marrow suppression
- ___= pancreatitis and periphearl neuropathy
- Efavirenz
- Indinavir
- Zidovudine
- NRTIs (truvada)
What vaccines are contraindicated with:
- Bakers yeast
- eggs
- gelatin
- thimerosal
- Neomycin and streptomycin allergy
- Hep B
- Influenza,
- influenza, varicella
- multi-dose vx
- MMR and inactivated polio
MOA and SE of thiazolidinediones (pioglitazone, rosiglitazone)
MOA: increased insulin sensitivity at peripheral receptor site
- fluid retention and edema/CHF
- cardiovascular toxicity w/ rosiglitazone- MI
Uses of carbamazepine
seizures, bipolar, trigeminal neuralgia, Central DI
TX of central DI
- desmopressin/DDAVP
2. carbamazepine
Describe findings of Cardiogenic shock
- CO: decreased, SVR: increased, PCWP: increased*
- cool, clammy skin
- Respiratory distress*
*only shock where you give small amounts of isontonic fluids for tx
- tight, shiny thickened skin
- calcinosis cutis, raynauds, esophageal motility disorder, claw hand (sclerodactyly) telangiectasia
Scleroderma
DX: + anti-centromere Ab, + anti-SCL Ab
TX: dMARDs, corticosteroids
Crohns or US?
- stovepipe sign vs string sign
- cobblestone vs pseudopolyps
- P-ANCA vs ASCA
- mucosa + submucosa
- LLQ, colicky pain vs RRL, crampy pain
- toxic megacolon vs. granulomas
- Wt loss vs tenemus, urgency
- stove= UC, string= C
- cobble= C, pseudo= UC
- ANCA= UC, ASCA= C
- Mucosa + sub= UC, transmural= C
- LLQ= UC, RLQ= C
- toxic megacolon= UC, granuolmas= C
- wt. loss= C, tenesmus, urgency= UC
How do you treat active TB?
- Isoniazide + rifampin + ethambutol (or streptomycin) + pyrazinamide for 6 months total (PZA can be stopped after 2 months)
- respiratory isolation for 1st 2 weeks of tx
What type of breathing pattern?
- periods of deep breathing alternating w/ periods of apnea, smooth increases in rate of breathing w/ smooth gradual decrease w/ periods of apnea
- irregular respirations w/ quick shallow breaths of equal depth with irregular periods of apnea
- rapid continuous respiration
- Cheyne-Stokes (HF, Resp. depression, uremia, brain damage)
- Biot’s (opioid-induced resp. depression, CNS depression)
- Kussmaul’s (metabolic acidosis, DKA, renal failure)
pemphigus vulgaris vs bullous pemphigoid
PV: autoimmune d/o secodary to desmosome distruption
+anti-desmosome/anti-epthelial Ab (HSN type 2)
+ Nikolsky and rupture easily
TX: HD corticostoroids–> methotrexate
BP: autoimmune subepidermal blistering in elderlies (HSN type 2)
tense bullae that dont rupture easily
- Nikolsky
TX: corticosteroids
- anti-dsDNA
- anti- centromere Ab
- anti-Mi2 Ab
- anti-smooth muscle Ab
- anti- endomysial Ab
- anti-mitochondrial Ab
- perinuclear anti-neutrophil cytoplasmic Ab
- anti- signal recognition protein (SRP)
- anti- cyclic citrulinatal peptide (CCP)
- SLE
- scleroderma
- dermatomyositis–> aloso Gottrons papules
- autoimmune hepatitis
- celiac
- PBC
- PSC
- polymyositis
- RA
What can cause nephrogenic DI
lithium, amp B, hypercalcemia and hypokalemia, ATN, hyperparathyroidism
Sx of Lacunar infarct
- pure motor MC
- ataxic hemiparesis and clumsiness Leg>arm
- dysarthria
- Hx of HTN
Tx of heparin induced thrombocytopenia
- stop heparin
2. Direct thrombin inhibitors (argatroban or bivalirudiin)
What meds are:
- direct thrombin inhibitors
- direct Factor Xa inhibitors
- antiplatelet
- Indirect thrombin inhibitors
- Inhibitors of Vit. K dependent clotting factors (10, 9, 7, 2)
- Dabigatran (pradaxa), argatroban, bivalirudin
- rivaroxaban (xarelto), apixaban (eliquis)
- clopidogrel, ticagrelor (brillinta)
- heparin
- warfarin
SE of rifampin
- thrombocyotpenia
- orange colored secretions
- GI upset, flu-like sx
- hepatitis
SE of phenobarbital
- depression
- osteoporosis
- irritability
Where is the herniation?
- lateral hip/thigh/groin pain, sensory loss on bottom on foot btwn 1st and 2nd toe, weak big toe dorsiflexion, , heel walking harder than toes
- posterior calf pain, plantar foot surface, plantar flexion, toe walking harder than heel, loss of ankle jerk
- anterior thigh pain, sensory loss to medial ankle, weak ankle dorsiflexion, loss of knee jerk and weak knee extension
- L5 (L4-L5)
- S1 (L5-S1)
- L4 (L3-L4)
SE of 1st generation antispychotic agents
dopamine antagonist
- EPS sx (dyskinesia (torticollis–> give diphenhydramine IV), tardive dyskinesia, parkinsonism),
- Neuroleptic malignant syndrome (hyperthermia)–> give bromocriptine
- Prolong QT, arrhythmias
- increased prolactin**
- weight gain
Describe the findings of Hypoadrenal shock
(type of distributive shock)
- CO: decreased, SVR: decreased, PCWP: decreased or decreased
- hypotension refractory to fluids or pressors
- low serum glucose
DX:
1. lobar capillary hemangiomas, MC in pregnancy and kids and high incidence of gingival involvement - friable red nodules
- ulcerative skin lesion 2/2 immune dysregulation, a/w IBD, RA, spondyloarthropathies- painful necrotic ulcerw/ irregular purple undermined borders and purulent base
- Pyogenic granuloma— TX: excision, curettage
2. Pyoderma gangrenosum– Tx: TD topical steroids
What organism?
- “S”, comma, seagull shaped organism, Gram neg.
- dusky, necrotic tissue (nose), septate hyphae w/ regular branchig at wide angels
- safety-pin appearance, Gram neg. rod
- parasites w/in RBC in tetrads (Maltese cross)
- Morulae in WBCs, mulberry-shaped aggregates
- Owls eye appearance biopsy
- campylobacter jejuni
- Aspergillosis
- Plaque (Yersinia pestis)
- Babesiosis
- Ehrlichiosis (same tick as Lyme- Ixodes)
- CMV (HHV5)
What is considered a positive PPD test?
- 5mm or greater: HIV+, immunocompromised, close contact with active TB, calcified granulomas on CR (healed or old TB)
- 10mm or greater: (high risk population) healthcare workers, homeless, immigrants, incarcerated
- 15mm or greater: everyone else with no RF
Tx of IBD
- Aminosalicylates (sulfasalazine + folic acid, mesalamine)
- corticosteroids (flares)
- immune modifying agents (methotrexate)
- Anti-TNF agents (infliximab, adalimumab)
- Farmer exposed to contaminated soil
- presents w/ wt. loss, steatorrhea, fever, LAD, rhythmic motion of eye muscles while chewing
Whipple’s disease
DX: duodenal biopsy–> + periodic acid- schiff (PAS)-positive macrophages and dilation of lacteals
TX: PCN or Tetracycline 1-2 years
SE of Ethosuximide
- drowsy/dizzy
- ataxia
- HA
- GI upset
aspiration PNA are most common found in __ lobe and are __ bacterias
RLL
anaerobes
MOA and SE of GLP-1 agonists (Exenatide, liraglutide)
MOA: mimic incretin–> increases insulin secretion, decreased glucagon secretion, and delays gastric emptying
- CI w/ gastroparesis
- hypoglycemia
- pancreatitis
MOA and SE of sulfonylureas (glipizide, glyburide, glimepiride)
MOA: stimulate pancreatic insulin release from Beta cells (insulin secretagogue)
- hypoglycemia (MC)
- GI upset
- disulfiram reaction (sulfa allergy)
- Wt. gain
- CP450 inducer
emphysema v chronic bronchitis
emphysema
- MC sx= dyspnea
- hyperinflation, yperresoance to percussion, decreased BS and fremitus, barrel chest, pursed lip breathing
- resp. alkalosis
- Matched V/Q defects, mild hypoxemia
Chronic bronchitis
- MC sx= productive cough
- rales, crackles, rhonchi, wheezing, cor pulmonale–> MA.Tachy , peripheral edema, cyanotic
- resp. acidosis, increased HCT/RBC*
- SEVERE V/Q mismatch (poor perfusion), severe hypoxemia and hypercapnia
CXR: cavitary lesions MC in RUL w/ bulging fissure
Klebsiella PNA
SE of streptomycin
- Ototoxicity (CN 8)
2. nephrotoxicity
MOA and SE of metformin
MOA: decreased haptic glucose production
- Lactic acidosis (not given if renal or hepatic impairment)
- GI sx
- Macrocytic anemia (decreased B12 absorption)
- Renal failure if given w/ iodinated contrast (stop 24 hrs prior and resume 48 hrs post)
Tx of SIADH
- restrict H20
- Demeclocycline in severe cases (inhibits ADH)
- Severe hyponatremia: IV hypertonic saline w/ furosemide
*rapid correction of hyponatremia= risk of central pontine myelinolysis
Describe LAE and RAE on EKG
LAE: m-shaped P wave in II (> 0.12 sec), biphasic P in V1 with larger terminal component
RAE: tall p wave in II, 3mm or greater and biphasic p wave in V1 with larger initial component
Management of sickle cell
- Pain control- IV hydration and O2 (AVOID Meperidine)
- Hydroxyurea- reduces pain (increased RBC wter, decreased sickling formation, increased HgbF)
- Folic acid- RBC production and DNA synthesis
- SHiN immunizations
- Osteomyelitis 2/2 salmonella- Cipro if >18y/o otherwise ceftriaxone
Kids proph: PCN (4months-6y/o) + folic acid
Common causes of SIADH
- Stroke (SAH), head trauma, meningitis, CNS tumors,
- post-op
- Small cell lung CA
- meds: narcotics, NSAIDs, anticonvulsants, carbamazepine, IV cyclophosphamide, antidepressants (TCA/SSRIs), HCTZ, ecstasy
- hypothyroidism, conn syndrome
Cardiac presentation of
- Dilated cardiomyopathy
- Restrictive cardiomyopathy
- Hypertrophic cardiomyopathy
- LV dilation, thin walls, decreased EF, regional or global LV hypokinesis (systolic dysfunction)- dilated and weak
- Dilation of both atria, diastolic dysfunction, Kussmaul sign
- Asymmetric wall thickness (esp septal), LVH, diastolic dysfunction, SAM
How do you DX DI
- Establish dx w/ fluid restriction (will continue to produce dilute urine)
- differentiate central DI from nephrogenic DI–> desmopressin stimulation test
- reduction in dilute urine= central
- no change, continual production of dilute urine= nephrogenic
Sx of posterior cerebral artery stroke
- visual hallucinations, contralateral homonymous hemianopsia
Tx of HHS
1st- IV fluids (NS)
2nd- regular insulin
3rd- potassium
SE of carbamazepine (tegretol)
- hyponatremia
- SIADH
- SJS
- blood dyscrasias (rare)
Use for: seizures, bipolar, trigeminal neuralgia, Central DI
How do you manage:
- Dawn phenomenon
- Somogyi effect
- Insulin waning
- bedtime injection of NPH, avoid late night snacking
- decrease nighttime NPH or give bedtime snack
- move insulin dose to bedtime or increased the evening dose
SE of Benzisoxazoles (risperidone, ziprasidone)
- EPS
2. increased prolactin
Diseases w/ eschars
- Tularemia (a/w rabbits)
- Anthrax (painless, black, found in livestock)
- Leishmaniasis (a/w female sandfly)
- Coccidiodomycosis
- Mucormycosis (rhino-orbital- cerebral infection ex. sinusitis)
How do you diagnose active TB
- Screen w/ PPD
- Confirm w/ acid fast smear and sputum culture x 3 days (AFB culture is gold standard)
- CXR: upper lober= reactivation (cavitary lesions), middle/lower lobe= active TB, millet seeds= miliary
SE of ethambutol
- Optic neuritis*–> scotoma, color perception problems, visual changes
- peripheral neuropathy
Describe the percussion, fremitus, and breath sound finding for:
- PNA
- pleural effusion
- Pneumothorax/ Obstructive lung dz
- PNA: percussion: dull, fremitus: INCREASED, BS: egophony, bronchial
- pleural effusion: percussion: dull, fremitus: decreased, BS: decreased
- Pneumothorax/ Obstructive lung dz: percussion: HYPERRESONANCE, fremitus: decreased, BS: decreased
causes of transexudative pleural effusion
PE= MC
pneumonia
Tx of OD of:
- anticholinergics
- tricyclic antidepressants
- organophosphate poisoning (cholinergics)
- Iron
- tumor lysis syndrome
- physiostigmine
- supportive- sodium bicarb
- atropine + pralidoxime
- deferoxamine
- allopurinol and fluids
SE of isoniazide
- Hepatitis*
- peripheral neuropathy*–> given pyridoxine (B6 to prevent)
- drug-induced lupus rash
- cytochrome P450 inhibition
SE of clozapine
agranulocytosis and myocarditis, prolonged QT, wt gain
How do you tx latent TB?
- Isoniazide + pyridoxine (B6) X 9 months
- if HIV + or granuloma on CXR: Isoniazide + pyridoxine (B6) X 12 months
*latent TB= no sx, + PPD, neg. CXR– not contagious
Biphasic fever, Biphasic rash (maculopapular), severe myalgias and joint pain, HA,
- hemorrhagic fever
- hepatitis
Dengue fever (Flavivirus)
TX: volume support, acetaminophen,
Describe the labs found in anemia of chronic dz
- low serum Fe
- high ferritin
- low TIBC
CXR: small upper lobe nodules and hyperinflation
Coal workers pneumoconiosis
-obstructive pattern
Tx of nephrogenic DI
- restrict Na+ and protein restriction and HCTZ + indomethacin
- if symptomatic: hypotonic fluid
MOA and SE of DDP-4 inhibitors (Sitagliptin, linagliptin)
increased GLP-1
- pancreatitis
- renal failure
Where are lesions typically found for the following lung CAs?
- Adenocarcioma
- small cell
- squamous cell
- bronchial carcinoma
- PEIRPHERAL (MC in smokers and non-smokers)
- central
- central
- central
When do you use synchronized cardioversion vs unsynchronized
Synchronized- unstable tachycardia
Unsynchronized- VF and pulseless VT (aka defibrillate)
MOA and SE of meglitinides (Repaglinide, Nateglinide)
MOA: stimulate pancreatic insulin release from Beta cell (insulin secretagogue)
- hypoglycemia (less than SU)
- weight gain
SE of pyrazinamide
- hepatitis*
- hyperuricemia*
- photosensitive dermatologic rash*
- GI sx
**Caution w/ gout or liver dz
CXR: bilateral hilar lymphadenopathy, interstitial lung dz
Sarcoidosis
-restrictive pattern, T cell exaggeration, noncaseating granulomas, Lupus pernio
spread by bite of female sandfly
-small erytheamatou papules, ulcerations, dry indurated plaque w/ satellite pustules, hepatosplenomegaly, regional LAD
Leishmaniasis
How do screen and dx Cushings Syndrome
Screen:
- LD dex. suppression (no suppression= cushings syndrome)
- 24 hr urinary free cortisol: increased cort. =CS
- Salivary cortisol test at night: increased cort. = CS
DX and differentiating
- HD dex. suppression test: ( supressed= CD, no suppression= adrenal or ectopic ACTH tumor)
- ACTH levels: (decreased= adrenal tumor, increased/normal= CD or ectopic ACTH tumor)
CXR: egg shell calcifications of hilar and mediastinal nodes
silicosis
-a/w sandblasters
- ____ murmurs increase in intensity w/ squatting/ lying down
- __ murmurs decrease in intensity w/ valsalva/standing
- __ murmurs increase w/ expiration
4 .__ murmurs increase w/ inspiration - __ murmurs increase w/ handgrip
- __ murmurs decrease w/ amyl nitrate
- all but HCM (increased venous return)
- all but HCM (increased venous return)
- all LEFT sided murmurs
- all RIGHT sided murmurs
- regurgitation murmurs (increased backflow and afterload)
- regurg. murmurs (increase forward flow and decrease afterload)
What vitamin deficiencies:
- Hyperkeratosis, hemorrhages (perifollicular, gums or joints), hemoatolgic anemia
- diarrhea, dementia, dermatitis
- magenta tongue, chelitis, photophobia, scrotal dermatitis
- ataxia, global confusion, ophthalmoplegia (abn. EOM)
- nighttime blindness, white spots on conjunctiva (Bitots spots) squamous metaplasia
- looser bone lines, bone bowing, bone pain
- Vit. C def.
- Niacin (B3) def.
- Riboflavin (B2) def.
- Thiamine (B1) def.
- Vit. A def.
- Vit. D def.
MOA and SE of alpha-glucosidase inhibitors (acarbose, miglitol)
MOA: delays intestinal glucose absorption
- hepatitis
- GI sx
SE of valproic acid (depakene) and divalproex sodium (depakote)
- pancreatitis
- hepatotoxicity
- thrombocytopenia
Describe the findings of Neurogenic shock
(type of distributive shock)
- CO: decreased, SVR: decreased, PCWP: decreased or decreased
- hypotension WITHOUT tachycardia
Sx of middle cerebral artery stroke
- contralateral sensory/montor loss of Face, arm> LE
- gaze towards lesion
- L- aphasia, wernicke, agraphia
- R- spatial defects, anosgnosia
Describe findings of Hypovolemic shock
- CO: decreased, SVR: increased, PCWP: decreased*
- pale, cool, mottled skin w/ dry mucous membranes
- prolonged cap refill
Describe LBBB and RBBB on EKG
LBBB: deep S in V1, wide QRS w/ broad slurred R in V5 and V6
RBBB: Wide QRS w/ RsR’ in V1 and V2, wide S in V6
causes of transudative pleural effusion
CHF=MC
Cirrhosis
nephrotic syndrome
What is Jones Criteria
Dx rheumatic fever (2 major or 1 major + 1 minor) + evident of recent strep
Major: (JONES)
- Joint (migratory polyarthritis)
- Oh my heart- active carditits
- Nodules
- Erythema marginatum
- Sydenhams chorea
Minor:
- fever
- Joint pain
- increased acute phase reactants (CRP, ESR, leukocytosis)
- Prolonged PR interval
puncture wound from raw fish or meat–> non-pitting edema, purplish erythema w/ sharp irregular margis extending peripherally but clearing centrally
Erysipeloid (gram + bacillus)
TX: PCN G or V
Describe the labs found in iron def. anemia
- low serum Fe
- low ferritin
- high TIBC
Sx of vertebral artery stroke
- vertigo, nystagmus, NV
2. diplopia
MOA and SE of SGLT-2 inhibitor (canagliflozin, dapagliflozin)
MOA: increased urinary glucose excretion
- thirst
- nausea
- UTIs
