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PGY-3 and 4 > Inpatient Medicine > Flashcards

Inpatient Medicine Flashcards

1
Q

HIT- 4T’s

A

thrombocytopenia
timing:
thrombosis (skin)
no other cause

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2
Q

Charcot’s Triad

A

RUQ pain, jaundice, fever

acute cholangitis

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3
Q

Reynold’s Pentad

A

ruq, jaundice, fever
hypotension + confusion
50% mortality

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4
Q

DIC physiology=

A

abnormal activation of coagulation sequence
microthrombi throughout microcirculation
bleeding+thrombosis occuring

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5
Q

DIC consumption of

A

platelets
fibrin
coag factors

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6
Q

DIC labs

A 
increased BT, PT, PTT
decreased platelets
increased fibrin, D-dimer
decreased fibrinogen
\+schistocytes
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7
Q

HIT type 1

A

onset 1-4 days
nadir 100,000
not Ab mediated and w/o thromboembolic
observe

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8
Q

HIT type II

A

Onset 5-10 days
nadir 20,000
antibody mediated, thromboembolic events and hemmorhagic

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9
Q

Acute Pulmonary Edema- BP Control

A

nitroglycerin or nitroprusside for afterload and preload reduction

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10
Q

Paget Disease

A
  • elevated alk phos
  • bone pain
  • treat with bisphosphonates
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11
Q

Maturity Onset Diabetes of the Young (MODY)

A

AD
age 10-45
Lean body type, family history
normal C peptide, do NOT require treatment with insulin

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12
Q

Octreotide- mechanism of action in esophageal varices/HTN

A

vacoconstricting dilated splanchic blood vessels

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13
Q

TIPS

A

shunting blood from portal to hepatic vein

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14
Q

Lactulose - Mechanism of Action

A

actulose is metabolized by bowel flora and make the lumen more acidic, traps NH4+ in colon and decreases ammomnia in the blood
also may decrease ammont of urease producing bacteria

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15
Q

Hep B: Vaccinated

A

anti-HBs NOT anti-HBc

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16
Q

Hep B: Exposure and Immune

A

anti-HBs

anti-HBc

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17
Q

Hepatitis B Surface Antigen / HBsAg

A

infection: recurrent or chronic

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18
Q

Hepatitis B Surface Antibody / HBsAb

A

immunity: vaccination or infection

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19
Q

Hepatitis B Core Antibody / antiHBc

A

IgM- Acute Infection

IgG- Chronic Infection

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20
Q

Hepatitis B e-antigen / HBeAg

A

infectivity

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21
Q

Hepatitis B e-antibody/ HBeAb or antiHBe

A

low infectivity, window period between HBsAg and anti-HBs

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22
Q

Primary TB

A

walled off in granulomas

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23
Q

Secondary TB

A

reactivated

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24
Q

AKI- Official Definition

A

1.5xCr
GFR decreased by 25%
UOP less than 0.5 ml/kg/hr x 6 hr

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25
Q

Location of RTAs

A

type 1 - distal
type 2 - proximal
type 4 - distal

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26
Q

Causes of RTAs

A

type 1 - decreased secretion of H+
type 2 - decreased reabsorption of Bicarb
type 4 - aldosterone def/resistance

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27
Q

BiPAP- how to exhale CO2

A

increase IPAP

increase rate

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28
Q

Lasix/Spirolactone Ratio

A

2:5

20 Lasix, 50 spirolactone

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29
Q

IDA Labs Summary

A

Elevated TIBC, transferrin
Decreased transferrin saturation
Decreased ferritin

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30
Q

Primary Hyperparathyroidism Differential

A
  • Malignancy
  • Familial Hypocalciuria Hypercalcemia
  • Drugs (lithium, thiazides)
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31
Q

Primary Hyperparathyroidism

A
  • Elevated Ca
  • Elevated or Normal (inappropriate) PTH
  • Decreased Phos
  • Increased Vitamin D
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32
Q

Loop diuretic mechanism

A

thick ascending limb of Henle

Bind Na/2Cl/K receptor, block NaCl reasborption

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33
Q

Direct Thrombin Inhibitors

A

argatroban

bivalirudin

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34
Q

Factor Xa inhibitor

A

fondaparinux

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35
Q

Chronic pancreatitis- classic triad

A

pancreatic calcifications
steatorrhea
DM

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36
Q

Revised Cardiac Risk Index

A

H/o ischemic heart disease, CHF, CVA

Pre-op factors: Cr>2, insulin use,

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37
Q

ADH - mechanism/function

A

increase water reabsorption by kidney’s collecting ducts

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38
Q

SIADH diagnosis

A

hyponatremia
inappropriate concentrated urine >100
plasma osm < 270

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39
Q

SIADH treatment

A

H20 restriction
NS or salt tabs+loop
Lithium or Demeclocyline

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40
Q

ST changes

A

has to be in 2 continguous leads
greater than 1mm for limb leads
greater than 2mm for chest leads

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41
Q

SIRS

A

Hr 90
RR 20
T 101, 96
WBC 12, 4

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42
Q

Light’s Criteria

A

exudative if one of the following
ratio of pleural to serum protein 0.5
ratio of pleural LDH to serum LDH 0.6
PLeural LDH 0.6 or 2/3 ULN

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43
Q

amaurosis fugax

A

ischemic event involving retinal artery

often carotid bruit on neck

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44
Q

Heberden’s Nodules

A

DIP

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45
Q

Bouchard’s Nodules

A

PIP

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46
Q

Uncomplicated UTI Adults Outpatient Medications

A

Bactrim, Macrobid, Fosfomycin

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47
Q

Iron Absorbed In

A

duodenum

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48
Q

When to Start ESA in CKD

A

when hemoglobin is less than 10

target 10-11.5

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49
Q

Warm Autoimmune Hemolytic Anemia

A

IgG

SLE, CLL (lymphoproliferative disorder)

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50
Q

Cold Autoimmune Hemolytic Anemia

A

IgM

EBV, Mycoplasma

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51
Q

Target Cells

A

Thalassemia

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52
Q

anti-NMDA receptor encephalitis

A

classically a young woman with teratoma + psychosis

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53
Q

Chvostek Sign

A

tapping facial nerve elicits contraction of facial muscles in HYPOcalcemia

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54
Q

Bronchiectasis Physiology =

A

permanent abnormal DILATION and DESTRUCTION of bronchial walls

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55
Q

ACS IV Septum Rupture

A

w/in 10 d

new onset systolic murmur

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56
Q

Centrilobular Emphysema

A
  • smoking

- upper lung zones

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57
Q

Panlobular Emphysema

A
  • alpha-1 antitrypsin

- lung bases

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58
Q

Hoarseness in Adults, remember

A

recurrent laryngeal nerve palsy 2/2 mass

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59
Q

Categories for Thrombocytopenia Differential

A
  • Decreased Production
  • Increased Destruction
  • Increased Consumption
  • Sequestration
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60
Q

Thrombocytopenia- Decreased Production

A

bone marrow dysfunction - myelofibrosis, aplastic anemias, granulomatosis disease etc
Nutrient Deficiencies- b12 or folate

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61
Q

Thrombocytopenia- Increased Destruction

A

Splenomegaly/Sequestration
ITP, HIT
MAHA- HUS, TTP

62
Q

Thrombocytopenia- Increased Consumption

A

DIC

Bleeding

63
Q

Herpes Zoster- what should you test for

A

HIV!! (looking for reason for being immunocompromised)

64
Q

Postherpatic Neuralgia

A

Pain >1 month after infection

65
Q

Ramsey Hunt Syndrome

A

vesicular rash in external ear

associated with ipsilateral peripheral facial palsy and altered taste

66
Q

Zoster treatment

A

if w/in 72 hours of presentation

67
Q

How to Recheck a platelet count

A

drawn in citrate or heparin (not EDTA)

68
Q

TTP testing

A

ADAMTS13 level less than 10%

69
Q

Treatment of acute ITP

A

symptomatic or platelets less than 30,000

70
Q

HIT diagnosis

A

screening test: platelet factor 4 (sensitive but not specific)
confirmatory test: serotonin release assay or heparin-induced platelet aggregation assay

71
Q

Polyarthritis

A

more than 5 joints

72
Q

Oligoarthritis

A

2-4 joints involved

73
Q

Viral causes of acute polyarthritis

A

parvovirus
rubella
HIV, Hepatitis B

74
Q

enthesis

A

structure on the site of ligament or tendon inserting into bone
suggestive of spondyloarthritis

75
Q

RA and morning stiffness

A

usually >60 minutes

76
Q

ESR =

A
  • fall of erythrocytes through through anticoagulated plasma
  • erythrocytes are negative charged
  • fibrinogen and APR neutralize the charges and cause slower rate (higher ESR)
77
Q

Anti-U1-RNP

A

MCTD

78
Q

Anticentromere

A

Crest Syndrome

79
Q

Anti–Scl-70 (antitopoisomerase-1)

A

Systemic Scleroderma

80
Q

Anti–Jo-1

A

Polymyositis

81
Q

Antihistone

A

drug induced lupus

82
Q

Cryoglobulins

A

Vasculitis; hepatitis C; myeloma; SLE; RA

83
Q

Secondary Sjogren Syndrome

A

response to another rhem disease, most commonly RA and SLE

84
Q

Sjogren patients at risk for…

A

non-Hodgkin lymphoma

due to chronic lymphocyte activation

85
Q

Reasons for CT prior to LP in Adults

A 
Immunocompromised state
History of CNS disease
Seizure within 1 week of presentation
Papilledema
Abnormal level of consciousness
Focal neurologic deficits
86
Q

Felty Syndrome

A

Form of RA w/
splenomegaly
chronic neutropenia

87
Q

Nephrotic Syndrome (4)

A

Proteinuira
HLD
Edema
Hypoalbuminemia

88
Q

Nephritis Syndrome (4)

A

Hematuria
Mild Proteinuria
HTN
Azotemia/AKI

89
Q

Central DI

A

Central: low ADH from posterior pituitary

90
Q

Nephrogenic DI

A

Nephrogenic: ADH secretion normal but tubules cannot respond

91
Q

DI Diagnosis

A
  • urine low SG and low osmolality
  • water deprivation test
  • Urine osm will ot increase with DI
  • W/ desmopressin, urine osm will will NOT correct with nephrogenic version
92
Q

TCA overdose therapy

A

sodium bicarbonate

93
Q

Dermatomyositis

A

gottron’s papules, heliotropic rash
association with any malignancy
anti-jo

94
Q

High Reticulocyte Count

A

hemolysis or blood loss

95
Q

Transudative Pathophysiology

A

elevated capillary pressure

or decreased plasma oncotic pressure

96
Q

Monitoring frequent transfusions

A

hypocalcemia from citrate binding
hyperkalemia or hypokalemia
metabolic alkalosis (from citrate metabolism).

97
Q

SLE mainstay of treatment

A

hydroxychlorquine

98
Q

Causes of lymphocytosis in pleural effusions

A
  • Malignancy
  • TB, histo, blasto, etc
  • RA
  • Chylous effusion
99
Q

Diuretic Conversion

A

1 bumex
20 toresmide
40 furosemide

100
Q

Plasma Osmolality

A

275-295

101
Q

Osmolal Gap

A

Difference between calculated and measured should be less than 10
Greater than this suggests LWM alcohol

102
Q

Diuresis with Kidney Injury

A

Urea Diuresis (kind of osmotic diuresis)

103
Q

Methacholine Challenge Test

A

FEV1 reduction by 20%

high NPV, but many things can make this positive

104
Q

DLCO

A

gas transfer than alveolar/capillary unit

proportional to surface area of functional lung

105
Q

Bronchodilator Response

A

12% increase in FEV1 or FVC or both

at least 200 ml

106
Q

Things that cause false decrease in pulse saturations

A
  • CO
  • methemoglobinemia
  • topical anesthetics
  • methylene blue
107
Q

Medications that Reduce Frequency of COPD Exacerbations

A

Azithromycin

Roflumilast

108
Q

Muddy brown casts

A

ATN

109
Q

RBC casts

A

glomerular disease

110
Q

WBC casts

A

pyelo or AIN

111
Q

Pancolitis DDx

A

IBD
Infectious - E coli
Ischemia - hypotension or drugs

112
Q

Asthmatic triad

A

wheezing, nasal polyps, ASA sensitivity

113
Q

Single use of LABA in asthma?

A

increased risk of asthma related death

114
Q

When should you get alpha anti-trypsin

A

less than age 45 with a strong family history and/or w/o strong risk factors

115
Q

How to diagnosis bronchiectasis when looking at CT

A

airway larger than accompanying vessel

116
Q

MDS can transform to….

A

AML

117
Q

Chronic Myeloid Leukemia and associated genetics

A

BCR-ABL fusion gene/Philadelphia chromosome

treat w/ tyrosine kinase inhibitors

118
Q

Polycythemia Vera

A

elevated Hgb
fatigue, HA, erythromyelgia, pruritic, HTN, thrombosis
JAK2 mutation

119
Q

Polycythemia Vera Treatment

A

ASA for thrombosis, sometimes hydroxyurea

Phlebotomy

120
Q

Most common secondary cause of polycythemia vera

A

testosterone

121
Q

Essential Thrombocytopenia

A

50% have JAK2 mutation

can have headaches, dysthesias of hands/feet, visual disturbances, TIAs

122
Q

Essential Thrombocytopenia Treatment

A

hydroxyurea

123
Q

Hyperkalemia- always consider…

A

pseudohyperkalemia

K is intracellular so will rise with Cell Death (first pumping, elevated WBC, platelets)

124
Q

Hyperkalemia in patients who make urine!

A

R/o obstruction, hyperglycemia
Loop diuretics + Normal Saline
Fludrocortisone

125
Q

How to think about ILD

A
  • smoking related
  • steroid responsive
  • CT related
  • exposure related
126
Q

Obesity Hypoventilation Syndrome triad

A
  • obesity
  • sleep disordered breathing
  • day time hypercapnia
127
Q

autoPEEP

A

intrathoracic pressure remains positive at end of exhalation

can decrease venous return

128
Q

C diff treatment (adults, kids)

A

adults PO vanc or fidaxomicin

kids PO vanc or flagyl

129
Q

DKA definition based on numbers

A

glucose >250
pH <7.3
+ketones

130
Q

When to discontinue beta blockers in cirrhotics

A

Systolics <90
AKI
Na 120

131
Q

High Risk Lung Nodules

A

6mm
spiculated
upper lobes

132
Q

Subtype of lung nodule with highest risk of malignancy

A

subsolid

133
Q

qSOFA

A

quick sequential organ failure assessment
RR>22
SBP <100
altered mental status

134
Q

Treatment of Invasive Candidiasis

A

capsofungin, micafungin

poor penetration in CNS and eye though- use azole or amph B

135
Q

Treatment of histoplasmosis

A

itraconazole

disseminated/severe disease- amph B

136
Q

Treatment duration for CLABSI

A

7-14 days (non S aureus)

S aureus - 4 weeks

137
Q

HAP

A

Pneumonia 48 hours after hospitalizations

138
Q

VAP

A

Pneumonia 48 hours after mechanical ventilation

139
Q

Treatment for ESBL organisms

A

meropenem!

140
Q

Physiology of Type II RTA (Proximal)

A

damage to proximal tubule (where bicarbonate is reabsorbed)
Lower TM of bicarb and will pee out Bicarbonate
aka loss of bicarb/HCO3-

141
Q

Causes of Type II RTA

A

Fanconi syndromes
drugs - acetazolamide, topiramate
Multiple Myeolma

142
Q

Physiology of Type I RTA (Distal)

A

failure to excrete Hydrogen

143
Q

Causes of Type I RTA

A

autoimmune (SLE, RA, sjogens)
Amph B
obstructive uropathy, sickle cell anemia

144
Q

Physiology of Type IV RTA

A

hyperkalemia interferes with ammonia, hence you can’t store H+ in ammonium

145
Q

Causes of Type IV RTA

A

chronic hyperkalemia AKA diabetes, ACE/ARB

obstructive uropathy, sickle cell anemia

146
Q

Antisynthetase Syndrome

A

ILD
Raynauld
Mechanics hands
Anti jo

147
Q

Cameron Lesions

A

Seen with hiatal hernias

148
Q

Predictor of DM membranous nephropathy

A

DM for at least 8 years

149
Q

Treatment of calcium oxalate stones

A

Potassium citrate

150
Q

First Line CAP in Adults

A

doxy or azithromycin

151
Q

First Line CAP In adults w/ recent antibiotic use or medical issues

A

Fluroquinolone

Beta lactam + macrolide

152
Q

Autoimmune adrenalitis testing

A

21 hydroxylase antibodies

PGY-3 and 4 (13 decks)

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