IM 1 Flashcards
most sensistive in detetcing vit b 12 deficiency
MMA
middle-aged woman with fatigue, pruritus, hepatomegaly, elevated alk phosp, serum anti-mitochondiral Ab
primary biliary cholangitis - give ursodeoxy
elevated in paget disease
alk phos, PINP and urnine hydroxyproline (ca and ph normal)
labs of primary hyperparathyroidism
+ ca,, low phosp, + alk phos
deep linear ulcers and esophagitis in HIV
CMV
lymphadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, multiple infections, lymphocytosis, smudge cells, B symptoms
CLL, dx with flow cytometry
anemia, bone pain, rouleaux formation, leukopnia
MM
pellagra
niacin deficiency: 3 ds: dermatitis, diarrhea, dementia
HIV vaccinations
Hep B, PCV, variclla (CD4 must be > 200), meningococcal
fatigue, painless oral ulcers, arthritis, renal abnormalities, LAD, splenomegaly, thrombocytopenia and anemia
SLE
tx of preg or lactating mom with lyme’s
amoxicillin, avoid teratogenicity of doxy
bilateral diffuse interstitial infiltratess
PJP
abx coverage of aspiration penumonia with anaerobics
clindamycin, metronidaolze + amoxicilline, amoxicillin-clavulanate, carbapenem
you find hypercalcemia on labs, what is your next step of evaluation?
PTH (if suppressed, think malignancy if NOT suppressed, think primary hyperparathyroidism)
causes of ATN
aminoglycosides, contrast, hypotension - AKI immediately following
two common causes of nephrotic syndrome
FSGS and membranous nephropathy
nephropathy + AA, HIV, heroin use, obesity
FSGS
leukocytosis, basophlia, shift towards early neutrophil precursor cells, low lukocytes alk phosphatase score (marker of neutrophil activity), BCR-ABL
CML
pancytopenia, myeloblasts on smear, auer rods
ALL
multiple ring enhancing lesions, low CD4 count in HIV
toxo, sulfadiazine and pyrimethamine
type 4 renal tubular acidosis
non-AG metabolic acidosis, persistent hyperK, mild-mod renal insufficiency; common in poorly controlled DM
acid status in vomiting
hypochloremic metabolic alkalosis
electrolyte disturbance of primary hyperaldosteronism
saves sodium and pushes potassium out (and H+ follows K) = hypernatremia, hypokalemia metabolic alkalosis
red flag symptoms for cavernous sinus thrombosis:
severe HA, bilateral periorbital edema, cranial nerve III, IV, V, and VI deficits
elevated liver transaminases and a + antinuclear antibody titer
autoimmune hepatitis, tx with glucocorticoids
causes of gout
increased urate production (myelproliferative disorders, tumor lysis, primary gout, enzyme deficiency)
decreased urate clearance (CKD, diuretics)
mgmt of non bleeding esophageal varieces in cirrhotic paient
nonselective bb (propranolol, nadolol)
tx of active variceal bleed
octreotide, endoscopic sclerotherapy and banding
statistical analysis to compare the means of two groups of subjects
two-sample t test
this statistical test is appropriate for categorical data and proporitons
chi-square
the two sample t-test is used to compare TWO means, what is used to compare MORE THAN two means?
ANOVA
causes of exudative effusions
infection (pneumonia, empyema, tb), malignancy, rheumatologic disease, PE
Can RA causes an exudative effusion?
yes
causes of transudative effusions?
HF, cirrhosis, nephrotic syndrome
lipohyalinosis, microatheroma, HTN, DM, hyperlipidemia, smoking, internal capsule, pure motor hemiparesis
lacunar stroke
what must you be quick to suspect in cirrhotic patient
SBP and esophageal varices
decreased haptoglobin, increased LDH and bili
hemolytic anemia
CAP
s pneumo
+ hydrogen breath test, positive stool test for reducing substances, low stool ph and increased stool osmotic gap
lactose intolerance
clonal B cell neoplasm, BRAF mutation, pancytogepani, spelnomegaly, dx with BM biops yand flow cytometry
hairy cell leukochemia
hyperkalemia EKG findings
peaked T waves, shortened QT interval
PR prolongation, QRS widening
Disappearance of P waves
Conduction blocks, ectopy, sine wave pattern
steps of DKA care
NS and regular insulin infusion, serial assessment of electrolytes (esp K) and tx of underlying precipitating factors
elevated liver enzymes, DM, skin hyperpigmentation
hereditary hemochromatosis
can cholesterol emboli cause livedo reticularis, AKI, pancreatitis and mesenteric ischemia?
yes
tx of symptomatic bradycardia
IV atropine
two rxs that can be used in BP tx of hyperaldosteronism
eplerenone and spironolactone (want to antagonize effects of aldosterone)
it is recommended that pts < 65 with chronic medication cond’n (heart, lung diabetes, smoking, chronic liver disease) revice PPSV23 one dose
yes
when to start screening colonoscopy for UC
8 years after dx and every year then after
proximal muscle weakness, muscle atrophy + anxiety, tachycardia, weigth loss
acute thyrotoxic myopathy
middle-aged women, symmetric proximal muscle weakness and tenderness
polymyositis
what is mixed venous oxygen saturation during shock
high as tissues are not able to adequately extract oxygen
what is the difference between strawberry and cherry hemangiomas
strawberry = infantile, wherease cherry hemaniomase are common in again adults
painful, flaccid bullae, mucosal erosions, separation of epidermis from dermis by light friction, antibodies directed against desmogleins 1 and 3, row of tombstones, IgG and C3 deposits
pemphigus vulgaris
why ibuprofen + colchicine for pericarditis tx?
anti-inflammatory and colchicine lowers rate of recurrence
inflammatory arthritis + splenomegaly + neutropenai
felty syndrome, associated with RA
rx for CMV ppx
ganciclovir or valganciclovir