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step 2 ck - IM mix > IM mix UWQ - may31st 2021 > Flashcards

IM mix UWQ - may31st 2021 Flashcards

1
Q

anaphylactic reaction.

-> occurs seconds to minutes after initiation of transfusion due to massive histamine release

sym?
rx?

A 
respiratory distress (eg, dyspnea, hypoxia)
-> bronchospasm

angioedema

hypotension

rx: IM Epi

IgA def inc risk

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2
Q

Acute hemolytic transfusion reaction from ABO incompatibility

sym?

A
  • > hypotensive
  • > fever,
  • > flank pain
  • > hemoglobinuria.
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3
Q

Febrile nonhemolytic transfusion reaction

sym?

A

most common adverse reaction to transfusion

  • > within 1-6 hours of transfusion.
  • > leukocytes release cytokines
  • > transient fevers, chills, and malaise.

NOT resp distress, shock

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4
Q

hepatic encephalopathy triggered by: recent initiation diuretics
-> lead to low Intravascular voln

rx?

A

K repletion + lactulose, rifaximin

neomycin if unable to tolerate rifaximin

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5
Q

fibromyalgia (FM)

rx?

A 
1st rx: 
Tricyclic antidepressants (eg, amitriptyline)

2nd line:
-> Serotonin

  • > norepinephrine reuptake inhibitors (eg, duloxetine, milnacipran)
  • > pregabalin
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6
Q

MG

moa?

A
  • > autoantibodies (originating in the thymus) directed against nicotinic acetylcholine receptors at the NMJ
  • > decrease available receptor available
  • > impaired action potential propagation and muscle weakness.
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7
Q

Lambert-Eaton syndrome (LES)

moa?

A

decreased acetylcholine release from the presynaptic terminal of motor neurons

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8
Q

Achalasia

moa?

A

degeneration of neurons within the myenteric plexus

uncoordinated peristalsis and failed relaxation of the lower esophageal sphincter (LES)

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9
Q

Norovirus

etio: chronic diarrhea in immunocompromised patients (eg, HIV, solid-organ transplant)

sym?

A

symptoms are typically brief (eg, 1-2 days)

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10
Q

Neisseria gonorrhoeae

sym?

A
  • > pharyngitis
  • > pharyngeal edema, erythema –> versicupustular rash at distal ext (2-10 lesions)
  • > nontender cervical LAD
  • > pelvic inflammatory disease
    rx: 3rd gen cephalosporin IV
    dx: screen for chlamydia
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11
Q

EBV
CMV

sym?

A

tender cervcial LAD

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12
Q

min ventilation = ?

A

min vent= respiratory rate x tidal volume

-> inc ventilation

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13
Q

acute viral hepatitis

-> fever, jaundice, indirect hyperbilirubinemia

lab?

A

inc AST, ALT >1000 U/L

HAV:
-> etio: day care

    • Budd-chiari syndrome:
  • -> RUQ pain, ascites, HSM
    • rupture hepatic adenoma: OCP
  • > RUQ pain, hemorrhagic shock, fever, liver enz elevated, anemia, hypotension, tachycardia
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14
Q

MM
RCC

often spread to spine

XR?

A

pure Osteolytic lesions

ALP normal

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15
Q

acne mechanica

moa?
sym?

A

pressure or friction is applied

Recurrent mechanical pressure damages pilosebaceous follicles

-> obstruction, comedone formation, and acneiform lesion

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16
Q

Irritant contact dermatitis

sym?

A

erythema, edema, vesicles, bullae

  • > lichenification (in chronic cases),
  • > burning or stinging sensation

affects exposed skin (eg, hands);

-> axillary involvement is uncommon.

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17
Q

acute calcium pyrophosphate dihydrate (CPPD) crystal arthritis (pseudogout)

XR?

A
  • > onset at age >65
  • > monoarticular arthritis
  • > chondrocalcinosis (calcification of articular cartilage)
  • > inflammatory effusion (15,000-30,000 cells/mm3)
  • > rhomboid-shaped
  • > weakly positively birefringent CPPD crystals.
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18
Q

Plantar fasciitis

sym?

A

subacute to chronic pain on the plantar surface of the hindfoot.

-> Inflammatory features

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19
Q

acute exacerbation of COPD (AECOPD)

lab?
rx?

A

Noninvasive Positive pressure ventilation:

  • > decreases work of breathing
  • > improves alveolar ventilation
  • > decrease in RR and (PaCO2),
  • > with an increase in tidal volume, minute ventilation, and arterial oxygen tension (PaO2).
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20
Q

Invasive mechanical ventilation

indicated in?

A

more severe condition

hypercapnic patients

  • > poor mental status (eg, somnolence, lack of cooperation, inability to clear secretions)
  • > hemodynamic instability
  • > profound acidemia (pH <7.1).
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21
Q

colon ca screening earlier

etio?
dx?
rx?

A

hx abdominal radiation -> 4 times the risk of colon ca

  • > Lynch syn: germline DNA mismatch repair gene –> colorectal ca, endometrial ca, ovarian ca
  • > FAP

dx: colonscopy
rx: ASA/ NSAIDS, high fiber diet

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22
Q

Age-related macular degeneration (AMD)

vision?

A
  • > progressive and bilateral loss of central vision.
  • > Peripheral fields maintained

exam:
- > drusen deposits
- > degeneration and atrophy of the central retina (macula)
- >retinal pigment epithelium
- >Bruch’s membrane
- > choriocapillaries.

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23
Q

Tumor lysis syndrome

induce:
- > AKI
- > electro imbalance
- > cardiac arrhythmia

lab?
etio?
rx?

A

cytotoxic chemotherapy or immunotherapy

lab:
inc PO4, K, UA
dec Ca

rx: IV fluid
- > allopurinol, rasburicase, febuxostat

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24
Q

Leucovorin

moa?
rx?

A

rx:

methotrexate or other folic acid antagonists

-> prevent adverse events from damage to rapidly dividing cells in the gastrointestinal system and liver.

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25
Q

N-acetylcysteine

rx?

A

moa:
antioxidant precursor to glutathione

rx:
acetaminophen poisoning and acute liver failure.

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26
Q

Raynaud phenomenon

common related to?
african american

sign?
lab?
rx?

A

CREST syndrome
-> vasospastic angina

Pulmonary arterial hypertension (PAH)
–> hyperplasia intimal smooth muscle layer

Asso with: interstitial lung disease

sign:
-> Left parasternal lift, right ventricular heave
-> Loud P2
-> right-sided S3
-> Pansystolic murmur of tricuspid regurgitation
JVD, ascites, peripheral edema, hepatomegaly

lab:
- > anti-Scl 70 topoisomerase 1 ab (diffuse)
- > anti-RNA polymerase III ab (diffuse)
- > anticentromere ab ) limited)

rx: CCB

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27
Q

resting tremor

dx?
rx?

A

PD

  • > improves with action
  • > 5-7 Hz freq
  • > inv one hands first than bilateral hands

rx:
Trihexphenidyl (antiAch)
Younger age <65 yo

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28
Q

action tremor

dx?
rx?

A

essential tremor with action

rx:
beta blockers + primidone ( anticonvulsants)

clonazepam (lims)

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29
Q

lymphoma

sym?

A

mao: BM infiltration dx
- > generalized lymphadenopathy
- > splenomegaly,
- > constitutional symptoms

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30
Q

first-line treatment for chemotherapy-induced nausea?

A

Serotonin (5HT) receptor antagonists (eg, ondansetron)

-> target 5HT3 receptor

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31
Q

Rx?

help reduce motion sickness

A

primary anticholinergic

-> treat vomiting: scopolamine

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32
Q

refractory vomiting

rx?

A

Dopamine antagonists such as metoclopramide and prochlorperazine

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33
Q

promote gastrointestinal motility

rx?

A

Erythromycin

  • > antibiotic, motilin receptor agonist
  • > help treat nausea secondary to gastroparesis.
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34
Q

organophosphate poisoning

sym?
antidopt?

A

Muscarinic:

Diarrhea/diaphoresis
Urination
Miosis
Bronchospasms, bronchorrhea, bradycardia
Emesis
Lacrimation
Salivation

Nicotinic:
muscle weakness, paralysis, fasciculations

rx:
- > Atropine reverses muscarinic symptoms

-> Pralidoxime reverses nicotinic and muscarinic symptoms (administer after atropine)

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35
Q

anticholinergic toxicity

antidopt?

sym:
- > flushing, mydriasis, anhidrosis, fever, urinary retention

A

physiostigmine

-> AchEase inhibitor

36
Q

Primary biliary cholangitis

sym:
-> insidious onset of fatigue & pruritus

  • > Progressive jaundice, hepatomegaly, cirrhosis
  • > Cutaneous xanthomas & xanthelasmas

lab?
rx?
asso with?

A

lab: Antimitochondrial antibody
rx: Ursodeoxycholic acid (delays progression)

inc risk:
-> Malabsorption, fat-soluble vitamin deficiencies

  • > Metabolic bone disease (osteoporosis, osteomalacia)
  • > Hepatocellular carcinoma
37
Q

Ascending cholangitis is associated with primary sclerosing cholangitis (PSC)

asso with?

A

asso with:

IBD, UC, CRC

38
Q

controlling confounding

allow ?

A

randomization distribution of all potential confounders even

39
Q

Poor sleep hygiene

rx?

A

rx:
- >avoiding late afternoon naps

  • > nicotine, caffeine
  • > alcohol, and heavy meals in the evening.
40
Q

glucagonoma, a pancreatic neuroendocrine tumor

sym?

-> unregulated release of glucagon >500pg/ml

A

-> weight loss
-> Necrolytic migratory erythema: erythematous papules
large, indurated plaques with central clearing

-> Diabetes mellitus/hyperglycemia
Gastrointestinal symptoms

41
Q

humoral hypercalcemia of malignancy (HHM) due to?

A

parathyroid hormone-related protein (PTHrP) by malignant cells

squamous cell
renal + bladder, breast, ovarian ca

lab:
- > dec PTH
- > inc PO4 excretion
- >

42
Q

breast, MM

lab?

A

osteolysis inc

  • > dec PTH
  • > dec vit D
43
Q

sarcoidiosis
lymphoma

lab?

A

inc ca absorption
-> inc 1,25 OHD3

  • > dec PTH
  • > inc PO4

-> inc Vit D

44
Q

Milk-alkali syndrome

lab?

A

excessive Ca intake

  • > hypercalcemia
  • > met alkalosis
  • > AKI
  • > HCO3 inc
45
Q

AIN

lab?
sym?

A
  • > acute renal failure
  • > fever, disseminated maculopapular rash
  • > a recent history of para-aminobenzoic acid analogue antibiotic (sulfonamide)
  • > white blood cell (WBC) casts
  • > esinophiluria

sym:
arthralgias
sym appears after 5 days

46
Q

Renal vein thrombosis (RVT) + other thromboembolism

biopsy?
moa?
sym?

A

Bx:
membranous glomerulopathy

moa:
loss antithrombin III

inc urine
increase risk of venous / arterial thrombosis

47
Q

AR

dx?

A

dx: echocardiogram

** diastolic / continuous murmur are pathologic !!!

sound:
early and gradually decreasing (decrescendo) diastolic murmur @ left sternal border 3-4th ICS

-> begins immediately after A2 (aortic component of the second heart sound)

48
Q

how to increase PPV testing?

A

PPV = TP/TP + FP

dep on prevalence in the POPULATION

-> increase dx prevalence -> more TP, few TN

49
Q

transverse myelitis

etio?
sym?

A

HIV

sym:
- > sensory level loss
- > flaccid paralysis
- > NO fever
- > acute Urinary retention
- > motor wkness

50
Q

scleroderma renal crisis

hist?

A

diffuse :

schistocytes + thrombocytopenia

51
Q

Burr cell (echinocytes) / spur cell (acanthocytes)

indicate?

A

RBC

etio: liver disease / ESRD

52
Q

howell jolly bodies

indicate?

A

basophilic remnants nucleus -> splenectomy / functional asplenia

53
Q

target cell

ind?

A

RBC -> bull eye appearance

thalassemia / Chronic liver dx

54
Q

contact lens asso keratitis

dx?

A

pseudomonas/ serratia keratitis

rx: ER

sym:
corneal perforation, scarring, permenant vision loss

55
Q

episcleritis

etio?
sym?

A

sym: localizes / patchy

mild pain/ discharge

asso with:
RA

56
Q

RRR = (rate control - rate Rx) / rate control

A

rate control = #/total population of control

rate rx= #/ total pop intervention

57
Q

Sporotrichosis

sym?

rx?

A

Sporothrix schenckii is a fungus found in decaying vegetation and soil.

sym:
- > A papule forms at the site of entry and soon ulcerates, draining an odorless, nonpurulent fluid.

  • > Several proximal lesions may develop along lines of lymphatic drainage
    rx: itraconazole
58
Q

ARDS

PaO2 <60mmHg (hypoxia)

PaO2 > 90 (hyperoxia)

Adjusting Oxygenation!!!

rx?

A

etio:
sepsis, lung injury, trauma, pancreatitis

moa: intrapulmonary shunt effect
- > neutrophil lung inflammation

–> dec lung COMPLIANCE!! -> inc work breathing

–> severe V/Q mismatch: severe hypoxemia

–> inc hypoxic pul vasoconstriction: inc RV afterload + acute Pul HTN

–> dec SVR: reduced after load

PEEP improve O2 by propping alveoli OPEN

Increase PEEP >10cm H2O -> reduce shunting

risk: barotrauma

** FiO2 <60% to avoid potential o2 toxicity –> PaO2 > 90 mmHg

59
Q

ARDS

adjust ventilation!!!

PaCO2/ Ph –> inc/ dec

A

inc PaCO2 + Ph <7.25
–> resp acidosis

rx: inc: RR and TV

    • PaCO2 dec + Ph >7.45
  • -> resp alkalosis

rx: dec TV, dec RR

60
Q

multiple sclerosis

sym?
CSF?

A

-> neurologic deficits disseminated in space and time –> eg, trigeminal neuralgia, spastic lower limb paralysis, left upper limb sensory loss

CSF:
-> oligoclonal bands

61
Q

HIV prophylaxis?

A
  1. PCP: CD4< 200/mm3
    - > TMP-SMX
  2. toxoplasmosis:
    - > TMP-SMX
  3. Primary prophylaxis against MAC
    - > (azithromycin) is no longer required.

–> No other primary prophylaxis is routinely given

-> patients in Histoplasma-endemic areas with CD4 counts ≤150/mm3 given prophylactic itraconazole.

62
Q

Mixed cryoglobulinemia associated with hepatitis C

sym?

A
  • > immune complex deposition in small blood vessels, -> endothelial injury and end-organ damage.
  • > palpable purpura, arthralgias, and glomerulonephritis
63
Q

porphyria cutanea tarda

moa?
sym?

A

moa:
inhibit uroporphyrinogen decarboxylase

sym:
- > abdominal pain and neuropsychiatric manifestations (eg, psychosis, neuropathy)
- > photosensitivity with blisters

RF:
HCV, estrogen, Etho

rx:
phlebotomy
hydrochloroquine

64
Q

Laxative abuse

lab?

A

hypotension, hypovolemia

eg. bisacodyl, senna, glycerol
- > for constipation ( GI loss)

65
Q

Diuretic abuse

lab?

A

lab:
- > hyponatremia, and hypokalemia
- > Urinary sodium and potassium will be elevated ( cuz inc excretion)

66
Q

CMT diarrhea

rx

A

loperamide/ diphenoxylate -atropine

IV fluid and electrolyte repletion

67
Q

pancreatitis related steatorrhea

rx ?

A

pancrelipase

68
Q

warfarin-induced skin necrosis

moa?
sym?

A

moa:
-> Warfarin inhibits production of vitamin K–dependent clotting factors II, VII, IX, and X, pn C, pn S

sym:

  • > transient hypercoagulable state.
  • > increases the risk for venous thromboembolism and skin necrosis,
69
Q

Factor V Leiden mutation

sym?

A
  • > risk for venous thromboembolism (deep venous thrombosis or pulmonary embolism)
  • > increases the risk for cerebral, mesenteric, and portal vein thrombosis
70
Q

upper GI bleeding with AMS

rx?

A

prevent aspiration –> endotracheal intubation

rx: prophylactic ab + octreotide

71
Q

spontaneous bacterial peritonitis

dx?

A

diagnostic paracentesis

72
Q

polymyalgia rheumatica (PMR)

sym?
asso with?
lab?
rx?

A

-> Age >50
Subacute-to-chronic (>1 month) pain in the shoulder and hip girdles

  • > asso with: GCA
  • > Morning stiffness lasting >1 hour
  • > Constitutional symptoms (eg, malaise, weight loss)
  • > Elevated ESR >40 mm/h
  • > elevate CRP

rx:
low dose glucocoticoids

73
Q

delirium

rx?

inc risk for?

A

agitation
rx:
haloperidol

risk : cognitive decline

74
Q

NNT = ?

ARR= ?

A

1/ ARR

ARR = Rate control - Rate rx

eg. 0.1 = 0.16- x
x = 0.06 rate Rx
Rate rx = # inf/ n
0.06 = 12 / n 
n = 200
75
Q

bronchiolitis obliterans

moa?

A

proliferative narrowing med + small bronchioles

asso with:
Rheumatologic dx

76
Q

Hodgkin lymphoma CMT/ RT

inc risk?

A
  • > Secondary CA: radiation exposure -> hema Ca

- > CVD

77
Q

bact meningitis

ICP

etio?
rx?

A

MC:
-> step pn, Neisseria meningitis, listeria

  • > GN rods
    rx: VNC ( Ceph resistant) + AMP (listeria) + cefepime (4th gen cover most bact + pseudomonas)
78
Q

lights criteria?

A
  1. pleural fluid Pn/ serum pn ratio >0.5
  2. pleural LDH/ serum LDH > 0.6
  3. pleural fluid LDH > 2/3 upper limit

exudates:

  • > infection
  • > CA
  • > RA
79
Q

MS

heart sound?
echo?
risk?
rx?

A

dx:
-> Opening snap with middiastolic rumble at the apex

  • > Echocardiography: ↑ transmitral flow velocity
  • -> irregular irregular rhythm + absent P wave ( AFib)
  • > Lt atrial dilation –> acute decompensated HF

risk:
higher thrombogenic risk

rx: anticoagulants

80
Q

addison dx

lab?

A

primary: autoimmune adrenalitis (TB, histoplasmosis), inf, Ca

-> dec aldo, dec cortisol (hypoglycemia) + peripheral eosinophilia
-> Increase ACTH
XR: miliary TB

sym: inc all 3 layers (adrenal cortex)
- > hypovolemia, hyperkalemia, hypoNa (( dec aldo))
- > hyperpigmentation

secondary (central axis ): chronic glu rx, infiltrative dx (sarcoidosis)

  • > dec cortisol, dec ACTH
  • > normal ALDO
81
Q

Takayasu arteritis

moa?

A

chronic vasculitis affects aorta

-> cell -mediated inflammation

82
Q

seperation anxitey dx

asso with?

A

somatic sym + functional impairment

83
Q

Tardive dyskinesia

sym?
rx?

A

abnormal involuntary movements of the face, lips, tongue, trunk, or extremities result of prolonged exposure to antipsychotic medication.

rx: causative medication should be tapered and discontinued.

** akathisia: restlessness, inability to sit still –> rx: Beta blocker

84
Q

Small cell lung Ca

sym?

A

inc ACTH ectopic:

  • > hypercortisolism
  • > WG, hyperglycemia
85
Q

CKD -> IDA

rx?

A

microcytic anemia -> EPO + iron IV

-> IDA is the most common cause of inadequate response to ESAs in patients on dialysis.

86
Q

Sjögren syndrome

autoimmune dx : lymphocytic inflammatory infiltrate exocrine glands

sym?
dx?

A

exocrine:
-> Keratoconjunctivitis sicca
-> Dry mouth, salivary hypertrophy
Xerosis

extraglandular:
-> raynaud phenomenon

dx:
+ anti-Ro (SSA), + anti-La (SSB)
-> salivary gland bx with focal lym sialoadenitis

87
Q

age-related sicca syndrome (ARSS)

dx?

A

sym:

  • > older women with dry eyes and mouth
  • > exorcine output from lacrimal and salivary glands decline with age
  • > atrophy , fibrosis, ductal dilation of the glands
  • > impaired vision

step 2 ck - IM mix (5 decks)

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