I didn't know that :/ Flashcards
Patient with type 2 DM who presents with a UTI, blurred vision and signs of dehydration should raise suspicion of a
hyperosmolar hyperglycemic state (HHS)
Patients with type 2 DM have a reduced insulin secretion capacity, leading to acute ___ in times of stress (infections, surgery, trauma)
hyperglycemia
due to increased insulin demand
Thyroid nodule felt on physical exam. What do next?
2-3
Get TSH levels→ RAIU → If HOT get fT4 levels → if COLD ≥ 1cm get FNA → Cytology
(Fine needle biopsy)
In a cirrhotic patient who underwent TIPS, increasing confusion, irritability, and an altered sleep-wake cycle, as well as a below-average performance in the number connection test, should raise suspicion of
hepatic encephalopathy (HE)
Can be 2/2 Constipation
What is the first-line treatment for acute hepatic encephalopathy
lactulose (1st line)
(Improves HE by decreasing absorption of AMMONIA in the bowel & is a laxative for constipation)
Rifaximin (add on med)
a poorly absorbed ABx that reduces ammonia production by eliminating ammonia-producing colonic bacteria.
H/o hematochezia, anal pruritus, painful defecation, and weight loss in a patient with an exophytic, friable, ulcerated mass above the anal verge/ BELOW dentate line is suggestive of
Anal Squamous cell carcinoma
Biopsy (if a female, get gynecologic screen)
Risk factors for Anal SCC
2
HIV
HPV
Chronic excessive alcohol intake causes what 2 electrolyte abnormalities?
hypocalcemia
hypomagnesemia
(Replace hypomagnesemia first otherwise Ca will not respond)
Hypothyroidism can cause what neurological finding especially in obese patients?
Carpal Tunnel
treat the hypothyroidism
1st line treatment for patients with essential tremor and asthma or COPD?
Primidone (barbituate)
not propanolol
Elevated BUN, elevated creatinine, and hyperkalemia, as well as signs of volume overload (pitting edema, jugular venous distention), in conjunction with a history of untreated SLE, are concerning for
renal failure
2/2 lupus nephritis
Asymptomatic microhematuria and risk factors for urothelial carcinoma such as nicotine abuse, age > 35, and reccurent UTIs.
Next step is to obtain what?
CT Urography
to r/o cancer
Edema, massive proteinuria, fatty casts, hypoalbuminemia, and hyperlipidemia are suggestive of
nephrotic syndrome
thickened loops/ spike & domes
Hypertrophic osteoarthropathy (HOA) presents with arthritis, digital clubbing, and periostal thickening of the distal diaphysis of long bones.
Associated with what malignancy?
adenocarcinoma of the lung
can be used to treat acute postoperative urinary retention, postpartum urinary retention, or urinary retention in patients with a neurogenic bladder
Bethanechol
M3 agonist
Decreased breath sounds, hyperresonant percussion, and decreased tactile fremitus are consistent with pulmonary hyperinflation, which can be 2/2
severe asthma exacerbation
wheezing not always present
___ may result in aortic regurgitation (due to involvement of the aortic valve), which causes an early diastolic murmur that is heard best at the right upper sternal border.
Aortic dissection
Conjunctival injection, accumulation of pus in the anterior chamber (hypopyon), and a round corneal infiltrate (ulcer) w/ a h/o contact lenses = infective Keratitis caused by what bacteria?
Pseudomonas
The presence of neutrophilia (segmented) without left shift (no increase in bands) is classic for ____ -induced leukocytosis.
glucocorticoid
Patient presents with systemic (fatigue, fever, weight loss) and musculoskeletal symptoms (symmetric pain in the shoulders and hips, morning stiffness w/o weakness on PE) as well as elevated ESR/CRP.
These features are consistent with
polymyalgia rheumatica (PMR)
tx: low dose steroids
Empiric antibiotic treatment for vertebral OSTEOMYELITIS should provide coverage against staph (including MRSA), strep, & gram (–)
What 2 Abxs would you use:
Vancomycin (staph/MRSA) \+ Cefepime (anti-pseudomonal, Gram+/–) or Ciprofloxacin/Levofloxacin (anti-pseudomonal FQ, Gram+/–)
__ is commonly used to treat arthritic gout and ankylosing spondylitis.
Indomethacin (NSAID)
In cases of massive PE with hemodynamic instability (e.g., SBP < 90 mm Hg), ___ is indicated.
Thrombolysis with alteplase or tissue plasminogen activators (tPA)
Anticoagulation with ___ is appropriate treatment for patients with hemodynamically stable PE.
heparin, rivaroxaban, warfarin, or apixaban
Cocaine can induce acute lung toxicity in the form of diffuse
alveolar hemorrhage (DAH)
crackles
New-onset asthma can present as an acute exacerbation
Treatment includes (2)
Albuterol (SABA)
Prednisone (glucocorticoid)
Supplemental oxygen in patients with advanced COPD can worsen hypercapnia due to a combination of (2)
- increased dead space perfusion causing v/q mismatch
- decreased affinity of oxyhemoglobin for CO2
- reduced alveolar ventilation (decr min ventilation)
___ in patients with acute COPD exacerbation helps to unload the work of breathing and decreases mortality and need for intubation.
Noninvasive positive pressure ventilation
