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OBGYN, PSYCH, PEDS > IM 1 > Flashcards

IM 1 Flashcards

1
Q

most sensistive in detetcing vit b 12 deficiency

A

MMA

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2
Q

middle-aged woman with fatigue, pruritus, hepatomegaly, elevated alk phosp, serum anti-mitochondiral Ab

A

primary biliary cholangitis - give ursodeoxy

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3
Q

elevated in paget disease

A

alk phos, PINP and urnine hydroxyproline (ca and ph normal)

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4
Q

labs of primary hyperparathyroidism

A

+ ca,, low phosp, + alk phos

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5
Q

deep linear ulcers and esophagitis in HIV

A

CMV

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6
Q

lymphadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, multiple infections, lymphocytosis, smudge cells, B symptoms

A

CLL, dx with flow cytometry

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7
Q

anemia, bone pain, rouleaux formation, leukopnia

A

MM

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8
Q

pellagra

A

niacin deficiency: 3 ds: dermatitis, diarrhea, dementia

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9
Q

HIV vaccinations

A

Hep B, PCV, variclla (CD4 must be > 200), meningococcal

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10
Q

fatigue, painless oral ulcers, arthritis, renal abnormalities, LAD, splenomegaly, thrombocytopenia and anemia

A

SLE

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11
Q

tx of preg or lactating mom with lyme’s

A

amoxicillin, avoid teratogenicity of doxy

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12
Q

bilateral diffuse interstitial infiltratess

A

PJP

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13
Q

abx coverage of aspiration penumonia with anaerobics

A

clindamycin, metronidaolze + amoxicilline, amoxicillin-clavulanate, carbapenem

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14
Q

you find hypercalcemia on labs, what is your next step of evaluation?

A

PTH (if suppressed, think malignancy if NOT suppressed, think primary hyperparathyroidism)

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15
Q

causes of ATN

A

aminoglycosides, contrast, hypotension - AKI immediately following

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16
Q

two common causes of nephrotic syndrome

A

FSGS and membranous nephropathy

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17
Q

nephropathy + AA, HIV, heroin use, obesity

A

FSGS

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18
Q

leukocytosis, basophlia, shift towards early neutrophil precursor cells, low lukocytes alk phosphatase score (marker of neutrophil activity), BCR-ABL

A

CML

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19
Q

pancytopenia, myeloblasts on smear, auer rods

A

ALL

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20
Q

multiple ring enhancing lesions, low CD4 count in HIV

A

toxo, sulfadiazine and pyrimethamine

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21
Q

type 4 renal tubular acidosis

A

non-AG metabolic acidosis, persistent hyperK, mild-mod renal insufficiency; common in poorly controlled DM

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22
Q

acid status in vomiting

A

hypochloremic metabolic alkalosis

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23
Q

electrolyte disturbance of primary hyperaldosteronism

A

saves sodium and pushes potassium out (and H+ follows K) = hypernatremia, hypokalemia metabolic alkalosis

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24
Q

red flag symptoms for cavernous sinus thrombosis:

A

severe HA, bilateral periorbital edema, cranial nerve III, IV, V, and VI deficits

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25
Q

elevated liver transaminases and a + antinuclear antibody titer

A

autoimmune hepatitis, tx with glucocorticoids

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26
Q

causes of gout

A

increased urate production (myelproliferative disorders, tumor lysis, primary gout, enzyme deficiency)
decreased urate clearance (CKD, diuretics)

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27
Q

mgmt of non bleeding esophageal varieces in cirrhotic paient

A

nonselective bb (propranolol, nadolol)

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28
Q

tx of active variceal bleed

A

octreotide, endoscopic sclerotherapy and banding

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29
Q

statistical analysis to compare the means of two groups of subjects

A

two-sample t test

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30
Q

this statistical test is appropriate for categorical data and proporitons

A

chi-square

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31
Q

the two sample t-test is used to compare TWO means, what is used to compare MORE THAN two means?

A

ANOVA

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32
Q

causes of exudative effusions

A

infection (pneumonia, empyema, tb), malignancy, rheumatologic disease, PE

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33
Q

Can RA causes an exudative effusion?

A

yes

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34
Q

causes of transudative effusions?

A

HF, cirrhosis, nephrotic syndrome

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35
Q

lipohyalinosis, microatheroma, HTN, DM, hyperlipidemia, smoking, internal capsule, pure motor hemiparesis

A

lacunar stroke

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36
Q

what must you be quick to suspect in cirrhotic patient

A

SBP and esophageal varices

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37
Q

decreased haptoglobin, increased LDH and bili

A

hemolytic anemia

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38
Q

CAP

A

s pneumo

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39
Q

+ hydrogen breath test, positive stool test for reducing substances, low stool ph and increased stool osmotic gap

A

lactose intolerance

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40
Q

clonal B cell neoplasm, BRAF mutation, pancytogepani, spelnomegaly, dx with BM biops yand flow cytometry

A

hairy cell leukochemia

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41
Q

hyperkalemia EKG findings

A

peaked T waves, shortened QT interval
PR prolongation, QRS widening
Disappearance of P waves
Conduction blocks, ectopy, sine wave pattern

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42
Q

steps of DKA care

A

NS and regular insulin infusion, serial assessment of electrolytes (esp K) and tx of underlying precipitating factors

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43
Q

elevated liver enzymes, DM, skin hyperpigmentation

A

hereditary hemochromatosis

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44
Q

can cholesterol emboli cause livedo reticularis, AKI, pancreatitis and mesenteric ischemia?

A

yes

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45
Q

tx of symptomatic bradycardia

A

IV atropine

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46
Q

two rxs that can be used in BP tx of hyperaldosteronism

A

eplerenone and spironolactone (want to antagonize effects of aldosterone)

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47
Q

it is recommended that pts < 65 with chronic medication cond’n (heart, lung diabetes, smoking, chronic liver disease) revice PPSV23 one dose

A

yes

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48
Q

when to start screening colonoscopy for UC

A

8 years after dx and every year then after

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49
Q

proximal muscle weakness, muscle atrophy + anxiety, tachycardia, weigth loss

A

acute thyrotoxic myopathy

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50
Q

middle-aged women, symmetric proximal muscle weakness and tenderness

A

polymyositis

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51
Q

what is mixed venous oxygen saturation during shock

A

high as tissues are not able to adequately extract oxygen

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52
Q

what is the difference between strawberry and cherry hemangiomas

A

strawberry = infantile, wherease cherry hemaniomase are common in again adults

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53
Q

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

A

pemphigus vulgaris

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54
Q

why ibuprofen + colchicine for pericarditis tx?

A

anti-inflammatory and colchicine lowers rate of recurrence

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55
Q

inflammatory arthritis + splenomegaly + neutropenai

A

felty syndrome, associated with RA

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56
Q

rx for CMV ppx

A

ganciclovir or valganciclovir

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57
Q

rx for PJP ppx

58
Q

diabetes, liver disease, chondrocalcinosis + pseudogout + chronic arthopathy

A

hereditary hemochromatosis

59
Q

anti-histone Ab

A

drug induced lupus

60
Q

Anti-Ro (SSA) or Anti-La (SSB)

A

Sjogren’s syndrome

61
Q

Anti-Scl-70, Anti-topoisomerase

A

systemic sclerosis

62
Q

kid with Acrodermatitis

enteropathica

A

zinc deficiency

63
Q

dx and tx of basal cell

A

Shave or punch bx then surgical removal (Mohs)

64
Q

dx and tx of squamous cell

A

– Excisional bx at edge of lesion, then wide local excision.

65
Q

dilute urin

A

urine osmol < 1/2 plasma osmol

66
Q

primary polydipsia vs DI

A

DI = serum Na > 145 + dilute urine (urine osmol < 1/2 serum)

67
Q

central vs nephrogenic DI

A

central = decreased ADH; nephrogenic = ADH resistance, commonly 2/2 rx

68
Q

how do vagal nerves slow SVT

A

slow conduction in AV node

69
Q

is medullary thyroid CA associated with MEN II syndrome (pheo, hypercalcemia)

70
Q

weakness, hypotension, hyperpigmentation, weight loss, hyperkalemia, hyponatremia

A

primary adrenal insufficiency/addison’s disease

71
Q

kidney stones, constipation, new psych sx

A

hypercalcemia 2/2 hyperparathyroidism (high PTH, vitamin D, and Ca, LOW PO4)

72
Q

MEN 1

A

pituitary adenoma, parathyroid hyperplasia,

pancreatic islet cell tumor

73
Q

MEN 2

A

parathryoid hyperplasia, medullary thyroid cancer,

pheochromocytoma

74
Q

MEN 3

A

medullary thyroid cancer, pheochromocytoma,

Marfanoid

75
Q

EEG with 3 Hz spike-andwave

A

absence seizures, tx with ethosuxamide

76
Q

EEG with diffuse background slowing

A

Delirium. Contrast w/ psychosis that has no

EEG changes

77
Q

EEG with hypsarrhythmia

A

Infantile spasms. Tx w/ ACTH. Most are

associated w/ mental retardation.

78
Q

CSF shows albumino-cytologic dissociation, recent GI illness, ascending paralysis + Campylobacter, HHV, CMV, EBV

A

Guillan Barre, tx with IVIG or plasmapharesis

79
Q

nasal voice, ptosis, dysphagia, respiratory acidosis

A

MG - check nicotinic receptor anitbodies and if +, get chest CT to evaluate for thymoma; tx with pyridostigmine

80
Q

best test for achalasia

81
Q

best test for GERD

A

24 pH monitoring

82
Q

HIV with CD4 < 100 and dysphagia

A

CMV, HSV, candida

83
Q

mid epigastric pain with multiple ulcers that do not respond to tx

A

consider zollinger ellison syndrome (gastrin secreting tumor); look for pituitary and parathyroid issues as part of MEN 1

84
Q

chronic mid epigastric pain, steattorhea, DM

A

chronic pancreatitis

85
Q

bloody diarrhea ddx

A

EHEC, shigella, vibrio parahaemolyticus, salmonella, entamoeba histolytica

86
Q

pt presents with flushing, tachycardia, hypotension and is dx with carcinoid syndrome. pt is also found to have a skin rash, diarrhea, and memory changes.

A

pellagra due to niacin consumption in carcinoid syndrome

87
Q

auer rods, myeloperoxidase, esterase

88
Q

9:22 translocation, imatinib, B symptoms, low LAP, basophilia

89
Q

asymptomatic leukocytosis with lymphocyte predominance

90
Q

enlarged, painless, rubbery LAD

A

think lymphoma

91
Q

IgM monoclonal spike, hypercalcemia, punched out bone lesions,

92
Q

Blowing diastolic murmur with widened pulse pressure

93
Q

transudative pleural effusion with low glucose

94
Q

transudative pleural effusion with lymphocytes

95
Q

DLCO is reduced in this restrictive lung disease

96
Q

DLCO is reduced in this obstructive lung disease

97
Q

ptosis improved with looking up, antibody to presynaptic calcium channel, small cell lung cancer

A

lambert eaton

98
Q

4 syndromes associated with small cell lung cacners

A

Lambert Eaton (ptosis improved after looking upwards), ACTH (Cushing), SIADH (hyponatremia, HTN), Super sulcus syndrome (pain, ptosis, constricted puil, fascial edema)

99
Q

4 steps of COPD tx

A

SABA (albuterol), LAMA (ipratropium), LABA (salmeterol), ICS (prednisone)

100
Q

5 types of SSRIs

A

paroxetine, sertraline, fluoxetine, citalopram, esxitalopram

101
Q

COPD FEV1 for severe

102
Q

medial knee pain

A

pes anserine bursitis

103
Q

posterior knee pain with locking and catching

104
Q

pain on tibial tuberosity

A

osgood schlatter

105
Q

lateral hip pain

A

greater trochanter bursitis

106
Q

groin, buttock, lateral hip pain worse with exercise

107
Q

40-50 y/o F, proximal muscle weakness, unable to climb stairs, weak when lifting hands above head, difficulty chewing and swallowing, labs with + CK, aldolase, AST, ESR, ANA + anti-Jo Ab

A

for dx, get biopsy (necrotic and referating fibers) . likely POLYMYOSITIS, tx = steroids

108
Q

> 50 y/o F, stiffness in shoulder, hip, neck, + ESR and CRP, associated with GIANT CELL arteritis

A

polymyalgia rheumatica, tx is glucocorticoids

109
Q

enthesitis, dactylitis, uveitis, aortic valve regurgitation, sacroilitis, restrictive PFTS

110
Q

bilateral hilar adenopathy, hypercalcemia, african amercian, co + dyspnea + skin findings

A

sacroidosis; tx with steroids

111
Q

pH for acidosis

112
Q

SAVES SODIUM, PUSHES POTASSIUM OUT

A

aldosterone, hyperaldosterone = hypernatremia, hypokalemia, metabolic alkalosis (H+ follows K+)

113
Q

this rx blocks the effect of aldosterone

A

spironolactone

114
Q

this nerve is compressed in carpal tunnel

115
Q

anti-centromere, anti-nuclear, anti-topo Ab

A

CREST syndrome; scleroderma (fibrosis + vascular dysfunction; esophageal fibrosis, arthralgias, raynaud, ILD, renal crisis, heart issues, hardneing of skin)

116
Q

MPC, PIP, wrist, cervical spine, axial skeleton, risk of subluxation with SC compression

117
Q

+ iron, ferriting, transferrin, HFE gene, tan, diabetes

A

hemachromatosis

118
Q

hip pain worse with weight-bearing, nl XR, no point tenderness

A

worry about avascular necrosis

119
Q

asymptomatic elevation of alk phosp

A

paget disease

120
Q

rx that decreases Ca stones but increases gout events

121
Q

anti-cardiolipin Ab

A

anti-phospholipid syndromes; recurrent SAB, hypercoagulabor state, falsely + VDLR

122
Q

mouth to anus, transmural inflammation, fistulae, skip lesions

A

Crhon’s disease

123
Q

tx of aspiration pneumonia

A

azithromycin + clindamycin

124
Q

low haptoglobin, high indirect bili, LDH and retic count

A

intravascular hemolytic anemia

125
Q

how is extravascular hemolytic anemia different from intravascular

A

extravascular = normal labs

126
Q

hemolytic anemia in 4th decade of life, cytopenia, hypercoagulable state, CD55 + CD 59

A

paroxysmal nocturnal hemo

127
Q

causes of microcytic anemia

A

iron deficiency, hemoglobinopathy, lead toxicity, chronic disease

128
Q

labs for iron deficiency anemia

A

low MCV, iron, and ferritin, HIGH TIBC

129
Q

factor V unable to respond to protein C, thrombosis, hypercoagulation, AD

A

Factor V Leiden

130
Q

myeloproliferative, JAK2, HCT > 50%, thrombosis, gout, pruritus, visual changes, HTN

A

polycythemia vera

131
Q

acronym for MM

A

CRAB (calcium, renal failure, anemia, bone fractures)

132
Q

B cell neoplasm, Reed Sternberg cells, mediastinal mass, LAD, cyclical fevers

A

Hodgkin Lymphoma

133
Q

causes of vitamin B12 deficiency (macrocytic anemia)

A

vegan, gastritis, gastrectomy, low IF, pernicious anemia

134
Q

white, northern european ancestery, atrophic glossitis, vitiligo, thyroid, neuro

A

pernicious anemaia

135
Q

If B12 or folate is low, what would you expect homocysteine levels to be?

A

HIGH, because unable to convert to methionine

136
Q

AD, NE European, defect in RBC membrane proteins so get rigid RBCs trapped in spleen, jaundice, pigment gallstones, acute cholecysitis

A

Hereditary Spherocytosis

137
Q

ANCA, lower and upper respiratory, golumerulonephritis, otitis, sinusitis, hemoptysis, fatigue, wt loss

A

granumolatosis polyangiiitis

138
Q

fatty casts

139
Q

RBC casts

140
Q

3 step workup for seizure

A

check electrolytes, check urine, get imaging

141
Q

this electrolyte disturbance can lead to - broad flat T waves, u waves, ST depression, afib, torsades

A

HYPOkalemia

OBGYN, PSYCH, PEDS (8 decks)

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