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COMLEX 2 > IM COMAT > Flashcards

IM COMAT Flashcards

1
Q

Symptoms of acute angle glaucoma

A

rapid onset of severe eye pain
halos around lights
affected eye’s pupil will be dilated and poorly responsive to light
nausea and vomiting
headache
vision loss in 2-5 hours of symptom onset

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2
Q

Symptoms of optic neuritis and what it indicates

A 
acute vision loss
pain
afferent pupillary defect
Most common in women age <50 
initial presentation of multiple sclerosis
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3
Q

What medications are shown to improve long-term survival in patients with LV systolic dysfunction?

A

ACE inhibitors, ARBs, beta blockers, mineralocorticoid receptor antagonists (eplerenone, spironolactone) and hydralazine/nitrates only in African Americans

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4
Q

Symptoms of chronic pancreatitis

A

Chronic epigastric pain with pain-free intervals, malabsorption (steatorrhea, weight loss), diabetes mellitus

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5
Q

how do you diagnose chronic pancreatitis?

A

CT scan looking for calcifications

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6
Q

What should you think in a patient with pancytopenia, thrombosis, and hematuria in the mornings? What causes this? How do you diagnose it?

A

paroxysmal nocturnal hemoglobinuria
caused by deficiency of CD55 and CD59 on cell surface
Diagnose with flow cytometry

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7
Q

schistocytes and helmet cells indicate what?

A

microangiopathic hemolytic anemia

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8
Q

What are the three types of microangiopathic hemolytic anemia?

A

DIC, HUS, TTP

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9
Q

What are the two disorders you should think of with spherocytes and/or elliptocytes?

A

hereditary spherocytosis/autoimmune hemolytic anemia

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10
Q

What disorder should you think of with bite cells and Heinz bodies?

A

G6PD deficiency

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11
Q

What should you think of with a patient with an increased LDH, decreased haptoglobin, anemia, splenomegaly and/or jaundice?

A

hemolytic anemia

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12
Q

What test diagnoses autoimmune hemolytic anemia?

A

Coomb’s test

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13
Q

What blood test diagnoses hereditary spherocytosis? What makes the definitive diagnosis?

A

osmotic fragility test; the definitive diagnosis is made by the presence of Howell-Jolly bodies on smear

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14
Q

What is the most common cause of asymptomatic microcytic anemia in an Asian patient?

A

alpha thalassemia

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15
Q

What are classic B symptoms and what do they indicate?

A

fever, pruritus, fatigue, night sweats, weight loss

indicate Hodgkin’s lymphoma

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16
Q

How do you diagnose Wegener’s granulomatosis?

A

biopsy of lung nodule

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17
Q

What chemotherapy drug can cause hearing loss and chronic kidney disease?

A

carboplatin

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18
Q

What chemotherapy drug can cause an acute gout attack?

A

6-mercaptopurine

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19
Q

What chemotherapy drug can cause pancytopenia and abortions?

A

methotrexate

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20
Q

What chemotherapy drug used to treat breast cancer can cause hot flashes and increase risk of endometrial cancer?

A

tamoxifen

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21
Q

What chemotherapy drug can cause acute renal failure and thrombocytopenia?

A

mitomycin

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22
Q

What chemotherapy drug can cause glove and stocking paresthesias?

A

vincristine

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23
Q

p-ANCA, asthma, eosinophilia

A

Churg-Strauss

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24
Q

c-ANCA, sinus, kidney, lung involvement

A

Wegener’s

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25
Q

Child with hematuria after an infection with arthralgias, purpura, and abdominal pain

A

Henoch-Schonlein Purpur

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26
Q

p-ANCA, no lung involvement, and they might have HepB

A

PAN (polyarteritis nodosa)

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27
Q

What is the treatment of TTP? What are the levels of coagulation factors?

A

emergent plasmapheresis (do NOT give platelets), normal coagulation factors

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28
Q

best test to find kidney stones?

A

CT

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29
Q

kid with a family history of kidney stones will have what kind of stones?

A

cysteine

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30
Q

chronic indwelling Foley catheter with very alkaline pee will have what kind of stones?

A

struvite

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31
Q

child with leukemia being treated and develops kidney stones will be what type of stones?

A

uric acid stone

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32
Q

how do you treat small stones?

A

pass them

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33
Q

How do you treat large stones? how large is large?

A

> 2 cm = surgical removal

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34
Q

Most common cause of nephrotic syndrome in adults?

A

membranous

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35
Q

Most common cause of nephrotic syndrome in heroin user or patient with AIDS?

A

focal segmental glomerulonephritis

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36
Q

Most common cause of nephrotic syndrome associated with chronic hepatitis?

A

membranoproliferative

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37
Q

A nephrotic patient suddenly develops flank pain. What are you worried about? Why?

A

renal vein thrombosis, they are peeing out coagulation factors

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38
Q

What will the TIBC in anemia of chronic disease?

A

low TIBC

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39
Q

What will the TIBC in iron deficiency anemia? What about ferritin?

A

high TIBC, low ferritin

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40
Q

What are you thinking if your patient has high homocysteine but normal methylmalonic acid?

A

folate deficiency

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41
Q

What are you thinking if your patient has high homocysteine and high methylmalonic acid? What other symptoms might be present?

A

B12 deficiency, neurological symptoms

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42
Q

anemia with high MCV and acanthocytes?

A

liver disease

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43
Q

normal MCV, high LDH, high indirect bilirubin, low haptoglobin?

A

hemolytic anemia

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44
Q

sudden onset of hemolytic anemia after taking drugs (penicillins, cephalosporins, sulfas)? Caused by what kind of immunoglobulin?

A

warm agglutinins, IgG (cold is caused by IgM)

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45
Q

large spleen, positive fam hx, bilirubin gallstones, mean cell hemoglobin is high? Treatment?

A

hereditary spherocytosis, splenectomy

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46
Q

young woman, heavy periods, recurrent epistaxis, petechiae, low platelets? Treatment?

A

ITP; prednisone 1st line, splenectomy 2nd

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47
Q

young woman, heavy periods, petechiae, recurrent epistaxis, but bleeding time and PTT are high?

A

von Willebrand

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48
Q

male, recurrent bleeding, hemarthrosis, bruising, hematuria, elevated PTT, corrected with mixing studies?

A

hemophilia; mixing with normal blood corrects it, means something was missing from pt’s blood

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49
Q

50 year old carnivore, hemarthrosis, woozing at venipuncture sites, took clindamycin

A

vit K def

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50
Q

What are the two factors not depleted in liver failure?

A

factor 8 and vWF (made in endothelial cells)

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51
Q

Treatment of DIC?

A

correct underlying disorder

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52
Q

Low platelets but clotting still?

A

HIT (heparin-induced thrombocytopenia)

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53
Q

Skin necrosis following warfarin therapy indicates what?

A

protein C/S deficiency

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54
Q

CHADS-VAC score of >/= 2, treat with what?

A

warfarin/newer anticoagulants

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55
Q

CHADS-VAC score <2, treat with what?

A

aspirin

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56
Q

Strep CENTOR criteria >/= 4, treat with what?

A

penicillin empirically

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57
Q

Strep CENTOR criteria 2-3, do what?

A

rapid strep test

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58
Q

1st line Abx for inpatient pneumonia?

A

fluoroquinolone

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59
Q

1st line Abx for outpatient typical pneumonia?

A

amoxicillin

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60
Q

1st line Abx for outpatient atypical pneumonia?

A

azithromycin

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61
Q

SIRS criteria?

A

temp < 36 or > 38
WBC < 4,000 or > 12,000
HR > 90 bpm
Tachypnea > 20 or PaCO2 > 32mmHg

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62
Q

Definition of sepsis?

A

SIRS + source of infection

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63
Q

Definition of severe sepsis?

A

sepsis with end organ damage or hypotension

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64
Q

Definition of septic shock?

A

sepsis + hypotension and not responding to fluid

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65
Q

LIGHTS criteria

A

serum protein: pleural fluid protein > .5 = exudative
serum LDH: pleural fluid LDH > 0.6 = exudative
or pleural LDH > 2/3 normal

66
Q

causes of exudative pleural fluid?

A

malignancy, infection, autoimmune disease, pancreatitis, post-CABG, PE, esophageal rupture

67
Q

causes of transudative pleural fluid?

A

hypoalbuminemia (cirrhosis, nephrotic syndrome), CHF, constrictive pericarditis

68
Q

Wells criteria >/= 4, do what?

A

CT angiogram to look for PE

69
Q

Wells criteria < 4, do what?

A

D-dimer to look for PE

70
Q

What Glasgow coma scale score indicates intubation?

A

= 8

71
Q

Ascites analysis with 250+ neutrophils indicates what?

A

SBP (spontaneous bacterial peritonitis)

72
Q

Ascites analysis with SAAG > 1.1 indicates what?

A

portal hypertension

73
Q

1st line treatment for stable angina?

A

nitrates, aspirin, beta blocker

74
Q

1st diagnostic test to order with chest pain?

A

EKG

75
Q

1st line treatment for unstable angina?

A

MONA C BASH - morphine, oxygen, nitrates, aspirin, clopidogrel, beta blockers, ACE-inhibitors, statins, heparin

76
Q

Indications for CABG?

A

3 vessel disease or LAD with >/=70% blockage

77
Q

Tx prinzmental angina with?

A

calcium channel blockers or nitrates

78
Q

What helps with an inferior wall MI? What hurts? What leads will this show in?

A

fluids help, nitrates harm, leads II, III, avF

79
Q

What will CSF WBC, glucose, and protein levels be in bacterial meningitis?

A

WBC very high, glucose low, protein pretty high

80
Q

What will CSF WBC, glucose, and protein levels be in TB meningitis?

A

WBC fairly high, glucose low, protein high

81
Q

What will CSF WBC, glucose, and protein levels be in viral meningitis?

A

WBC high, glucose normal, protein slightly elevated or normal

82
Q

What will CSF WBC, glucose, and protein levels be in Guillain-Barre?

A

WBC normal, glucose normal, protein elevated

83
Q

What is the difference between primary hyperparathyroidism and familial hypocalciuric hypercalcemia?

A

both can have elevated or inappropriately normal PTH; patients with primary hyperparathyroidism will have increased urinary calcium excretion whereas patients with FHH will have decreased urinary calcium excretion (<100 mg/24 hours or UCCR of < 0.01)

84
Q

What infections should you test someone for when you suspect idiopathic thrombocytopenia?

A

hep C and HIV

85
Q

What is the treatment of choice for agitation in the elderly?

A

haloperidol

86
Q

What are the clinical features of cholesterol crystal embolism?

A 
derm (livedo reticularis, ulcers, gangrene, blue toe syndrome)
Renal (acute or subacute kidney injury)
CNS (stroke)
Ocular involvement (Hollenhorst plaques)
GI (intestinal ischemia, pancreatitis)
87
Q

What are the lab findings in cholesterol crystal embolism?

A

elevated serum creatinine, eosinophilia, hypocomplementemia

Urinalysis - begins with few cells or casts, may have eosinophilia

88
Q

How do you definitively diagnose cholesterol crystal embolism if clinical diagnosis isn’t enough?

A

skin or renal biopsy

89
Q

What ECG rhythm is typical of digitalis toxicity?

A

Atrial tachycardia with AV block

90
Q

How is exertional heat stroke defined?

A

body temp > 40 (104) with central nervous system dysfunction and other tissue/organ dysfunction

91
Q

What is the definitive way to diagnose CAD?

A

CT angiography

92
Q

What is first line for cariogenic shock?

A

dobutamine

93
Q

What is the treatment for cariogenic shock with bradycardia due to inferior wall MI?

A

atropine

94
Q

Drugs proven to decrease mortality in MI?

A

aspirin, beta blockers, ACE-inhibitors

95
Q

Drugs proven to decrease mortality in CHF?

A

beta blockers, ACE inhibitors, spironolactone

96
Q

Treatment of 1st degree and 2nd degree Mobitz type 1 heart block?

A

No treatment

97
Q

Complete AV block as well as Mobitz type 2 heart block treatment?

A

pacemaker

98
Q

Symptoms of Dressler syndrome?

A

2 weeks post MI, fever, leukocytosis, symptoms of pericarditis

99
Q

Treatment of Dressler syndrome?

A

aspirin

100
Q

Bilateral hilar LAD, dry cough, uveitis, and erythema nodosum, restrictive cardiomyopathy?

A

sarcoidosis

101
Q

Treatment for acute decompensation of CHF?

A

NO LIP - nitrates, O2, loop diuretics, inotropes, positioning (elevate bed)

102
Q

Supraventricular tachycardia treatment?

A

vagal maneuvers then stable - adenosine

unstable - cardioversion

103
Q

Causes of restrictive pericarditis?

A

sarcoidosis, amyloidosis, hemochromatosis

104
Q

Treatment of ventricular tachycardia?

A

stable - amiodarone

unstable - cardioversion

105
Q

V fib and pulseless V tach treatment?

A

defibrillation

106
Q

What will you find on CXR of constrictive pericarditis?

A

calcifications (can be caused by TB or lupus)

107
Q

Treatment of constrictive pericarditis?

A

pericardiectomy

108
Q

Treatment of viral pericarditis?

A

NSAIDs (usually caused by Coxsackie)

109
Q

What is Beck’s triad, and what does it indicate?

A

Indicates cardiac tamponade
Beck’s Triad - hypotension, JVD, muffled heart sounds
Also associated with pulses paradoxus (systolic pressure drops by >10 with inspiration), low voltage QRS, Kusmal sign (JVD increases with inhalation)

110
Q

What symptoms will you see with Carcinoid syndrome?

A

flushing, right heart murmurs, diarrhea, bronchospasm

111
Q

Three causes of holosystolic murmurs?

A

mitral regurgitation, tricuspid regurgitation, VSD

112
Q

Patient with fever, leukocytosis, and new onset murmur has what? What’s the empiric treatment?

A

Viral endocarditis - treat with vancomycin and an aminoglycoside

113
Q

What is the definition of hypertensive emergency? Treatment?

A

180/120; IV hydralazine, nitroprusside, or labetalol; to be considered an emergency, there must be evidence of end organ damage (if emergency, treat with IV meds. If urgency, treat with oral meds)

114
Q

What would you expect to find on lumbar puncture in subarachnoid hemorrhage? When would you get lumbar puncture?

A

xanthochromia (bilirubin in CSF); order this with negative non contrast head CT but still high suspicion of subarachnoid hemorrhage

115
Q

How do you diagnose an aortic dissection? Treatment?

A

Diagnose with CT angiogram or TEE; Type A (proximal to left subclavian, treat with surgery), Type B (distal to left subclavian ONLY), treat with beta blocker

116
Q

Number one risk factor for peripheral artery disease? How to diagnose?

A

smoking, ankle brachial index (<0.9 = disease)

117
Q

What is the first step for treatment of a PE? 2nd?

A

Give heparin, then get spiral CT

118
Q

In what condition will you see medial malleolus ulcer?

A

venous insufficiency

119
Q

How do you treat neurogenic shock?

A

IV fluids

120
Q

What are the two greatest risk factors for stroke?

A

age and hypertension

121
Q

What is amaurosis fugax? What condition does it indicate?

A

cholesterol plaque that embolisms through ophthalmic artery that causes transient curtain blindness; indicates TIA

122
Q

Most common area of the brain to have a stroke?

A

middle cerebral artery

123
Q

What artery could be affected with lower extremity signs of stroke?

A

ACA

124
Q

What artery could be affected with upper extremity signs of stroke?

A

MCA

125
Q

What part of the brain is Broca’s area in? What artery supplies it?

A

left inferior frontal lobe, MCA

126
Q

What part of the brain is Wernicke’s area in? What artery supplies it?

A

temporal lobe (opposite side of hand of dominance); MCA

127
Q

What disorder is associated with berry aneurysms?

A

autosomal dominant polycystic kidney disease

128
Q

What is included in a post-stroke work-up?

A
  1. carotid doppler
  2. Echo
  3. EKG
129
Q

What is the most common cause of a lacunar stroke?

A

hypertension

130
Q

What will a lacunar stroke affecting the thalamus (specifically VPL) present like?

A

pure sensory stroke

131
Q

What will a lacunar stroke affecting the internal capsule present like?

A

pure motor stroke

132
Q

What are the three ways to lower intracranial pressure?

A
  1. hyperventilation
  2. mannitol
  3. elevated head of bed
133
Q

Treatment of ischemic stroke?

A

within 3 hours -> tPA

after 3 hours -> aspirin

134
Q

Diagnosis of Tourette’s? Treatment?

A

Diagnosis requires a phonic and motor tick for 1 year

Treatment = clonidine

135
Q

Symptoms of essential tremor? Treatment?

A

tremor with movement, better at rest, goes away with alcohol

Treat with beta blocker

136
Q

Symptoms of Fredreich’s ataxia?

A

triad of scoliosis, hypertrophic obstructive cardiomyopathy, and dorsal column problems

137
Q

What is Charcot’s triad of multiple sclerosis?

A

scanning speech, internuclear ophthalmoplegia, intention tremor, nystagmus (SIIN)

138
Q

How do you diagnose MS? What will you see on lumbar puncture?

A

MRI, will see periventricular plaques

Lumbar puncture will show oligoclonal bands (IgG Ab)

139
Q

What is the treatment of MS?

A

Disease-modifying - interferon

Acute flares - steroids

140
Q

What is the treatment of myasthenia gravis?

A

Pyridostigmine (ACh esterase inhibitor)

141
Q

What is the ASHLEAF mnemonic for tuberous sclerosis?

A 
A - Ashleaf spots
S - Shagreen patches
H - heart rhabdomyosarcoma
L - lung hamartomas
E - epilepsy from cortical tubers
A - angiomyolipoma in kidney
F - facial angiofibroma
142
Q

What is Sturge Weber syndrome?

A

port-wine stains on face with retardation

143
Q

What is the triad of VHL?

A

renal cell carcinoma, pheochromocytoma, cavernous hemangiomas of the brain

144
Q

What are the symptoms of Brown Sequard syndrome?

A

ipsilateral paralysis, ipsilateral loss of pressure, proprioception, vibration, and touch, and loss of contralateral pain and temp

145
Q

What are the symptoms of a lower motor neuron injury?

A

fasciculations, flaccid paralysis

146
Q

What are the symptoms of upper motor neuron injury?

A

spastic paralysis, hyperreflexia

147
Q

What is the treatment for BPPV?

A

meclazine

148
Q

What is the triad of Meneiere’s disease?

A
  1. tinnitus
  2. vertigo
  3. hearing loss
149
Q

What is the treatment for trigeminal neuralgia?

A

carbamazepine (sodium channel blocker)

150
Q

What spinal tract is affected with tabes dorsalis? What is the treatment?

A

Dorsal columns - vibration, proprioception, pressure, touch

Penicillin (tertiary syphilis)

151
Q

Subacute combined degeneration is caused by what?

A

Vit B12 def/megaloblastic anemia

dorsal columns problems as well as corticospinal tract problems (UMN injuries)

152
Q

What malignancy is Hashimoto’s thyroiditis associated with?

A

thyroid lymphoma

153
Q

What disorder causes a painful thyroid following a URI? What is the treatment?

A

subacute/DeQuervain’s thyroiditis

Tx = NSAIDs/aspirin

154
Q

Which thyroid cancer arises from the parafollicular C cells? What’s the next best step?

A

medullary thyroid cancer

Check for other aspects of MEN 2A/2B (like urine metanephrines for pheochromocytoma)

155
Q

MEN 2A?

A

PPM = pheochromocytoma, hyperparathyroidism, medullary thyroid cancer

156
Q

MEN 2B?

A

MMP = medullary thyroid cancer, marfinoid habitus/mucosal neuromas, pheochromocytoma

157
Q

What is the first blood test to get with acromegaly?

A

IGF-1

158
Q

If HTN with hypernatremia and hypokalemia, what do you want to check? What will the results tell you?

A

Renal to aldosterone ratio
If aldosterone is high and renin is low -> adrenal problem (Conn syndrome)

If renin is high and aldosterone is high -> renal artery stenosis or fibromuscular dysplasia

159
Q

What are the three ways you can diagnose diabetes mellitus?

A
  1. fasting glucose of >126 twice
  2. random glucose reading of >200 with symptoms of polyphagia, polydipsia, polyuria, dehydration, weight loss
  3. HgA1C > 6.5%
160
Q

When is metformin contraindicated?

A

kidney failure and CHF

COMLEX 2 (11 decks)

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