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Inservice 2017 > Inservice 2016 > Flashcards

Inservice 2016 Flashcards

1
Q

J Osborn Waves =

A

Hypothermia

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2
Q

Causes of Torsades de Pointes:

A
  • NOT hyperkalemia|o
  • HYPOmagnesemia|
  • Prolonged QT syndrome
  • Hypokalemia
  • Hypothyroidism
  • Amiodarone, lithium, methadone, erythromycin, sotalol, procainimide, quinidine, celexa, haldol, prozac (all prolong QT interval)
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3
Q

Formula for LDL =

A

Total Cholesterol - HDL - (TG/5)

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4
Q

Pt with HR 188s, but hemodynamically stable, you give adenosine > rapid deterioration of the pt and Vfib…whats was patient’s initial rhythm?

A

WPW

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5
Q

Pt with hx of atrial fibrillation is on amiodarone for rhythm control but he also has structural heart disease. Which med should he be on for rhythm control?

A

Sotalol (Betapace)

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6
Q

Treatment of Beta-Blocker toxicity:

A

Glucagon

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7
Q

CHF with AS =

A

Poor prognostic sign

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8
Q

Criteria for metabolic syndrome:

A
  • Elevated waist circumference:
    • Men — Equal to or greater than 40 inches (102 cm)
    • Women — Equal to or greater than 35 inches (88 cm)
  • Elevated triglycerides: Equal to or greater than 150 mg/dL
  • Reduced HDL cholesterol:
    • Men — Less than 40 mg/dL
    • Women — Less than 50 mg/dL
  • Elevated blood pressure: Equal to or greater than 130/85 mm Hg|o
  • Elevated fasting glucose: Equal to or greater than 100 mg/dL|
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9
Q

Side effects of amiodarone? (related to dose and duration of tx)

A
  • CNS
    • Demyelinating polyneuropathy
    • Pseudotumor cerebri
  • Eyes
    • Corneal deposits > irreversible blindness
  • Thyroid
    • Hyper (Thyrotoxicosis) and hypothyroidism (Iodine is component of Amiodarone)
  • Pulmonary
    • Pulmonary fibrosis/infiltrates (pulm toxicity)
    • Pneumonitis, hypersensitivity
    • Pulmonary hemorrhage
    • ARDS
  • Cardiac
    • Complete AV block
    • Prolonged QT interval
    • Ventricular arrhythmias are worsened
  • Hepatic
    • Fatal hepatotoxicity
  • Renal
    • Rhabdomyolysis
  • Skin
    • Photosensitivity
    • Brown, blue-gray discoloration
    • Yellow-brown granules macrophages on biopsy (Amiodarone sequestered in M0)|
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10
Q

Cholesterol emboli syndrome:

A
  • Precipitated by invasive arterial procedures in pts with atherosclerosis.
  • ATN after a cardiac catherization
  • Features include: fever, livedo reticularis, eosinophilia, renal failure
  • Blue Toe Syndrome
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11
Q

Know the timing of dye toxicity vs. cholesterol emboli associated with cath/renal stenting.

A

What I found is dye toxicity happens within 48 hours and cholesterol emboli can happen weeks to months later

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12
Q

Blue toe syndrome

A

Find answer (cholesterol embolism?)

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13
Q

Pt had cardiac cath, 48h later develops AKI (sounded like ATN), lace-like rash, fever and eosinophilia. What is the likely cause?

A

Cholesterol embolism

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14
Q

ST elevation in II, III, aVF with hypotension. Diagnosis? Tx?

A
  • Right sided infarct
  • Tx: fluid resuscitation
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15
Q

Pt with HTN on ACEI, walks 3 miles a day, needs to get cataract surgery. What to do next?

A

Proceed with surgery because it is low risk surgery, minimally invasive

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16
Q

Atrial fibrilliation can’t take amiodarone due to wheezing, but needs rhythm control what to use?

A

Propafenone vs. Sotalol- cant use in structural heart disease

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17
Q

ASA and Plavix for 1 yr drug eluding stent, this pt now needs a tooth extraction, what to do?

A

ACC: Maintain ASA if possible, stop Plavix 5 days before surgery and restart 24 hrs Post-op

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18
Q

Mitral regurgitation murmur characteristics? S/Sx?

A
  • Holosystolic murmur radiating to axilla
  • S/Sx: dyspnea, pulm HTN, L axillary hypertrophy, afib
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19
Q

Mitral valve replacement pt, needs anticoagulation before procedure. Whats the choice of anticoagulation?

A

Lovenox 1mg/kg q12hrs x 5 days

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20
Q

CHD equivalents:

A

DM II, PVD

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21
Q

Antidepressant that leads to HTN:

A

Venlafaxine

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22
Q

Post-MI syndrome & Tx:

A
  • Myocarditis/Pericarditis (Dressler’s syndrome)
    • Fever, pericardial rub, effusion, pleuritic CP all 4-6 weeks after MI
    • Tx: colchicine, corticosteroids
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23
Q

Atrial fibrillation that is postural?

A

Atrial myxoma: most common is R atrium

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24
Q

Duke’s criteria:

A
  • 2 major criteria
  • 1 major + 3 minor criteria OR
  • 5 minor criteria|o
  • Major criteria includes:
    • Positive blood cultures (coxiella burnetti, staph A, HACEK)| + ECHO (endocardial involvement)|
  • Minor criteria includes:
    • Fever
    • IVDU/predisposition
    • Vascular phenomenon: embolism (janeway lesions)
    • Immunologic phenomenon: glomerulonephritis, +RF, osler nodes, roth spots
    • Blood cultures + not meeting major criteria
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25
Q

After heart valve replacement read Post-Pericardiotomy syndrome (Sx & Etio):

A
  • Fever, pericardial effusion, pleural effusion
  • 1st Question = Diagnosis (i.e. Dresser Syndrome when after MI)
  • 2nd Question = Etiology (i.e. Autoimmune)
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26
Q

16yr old with heart murmur:

A

Hypertrophic Cardiomyopathy

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27
Q

Dilated Cardiomyopathy causes:

A
  • Alcoholics, Thiamine Deficiency
  • Hemochromatosis, Amyloidosis
  • Postpartum, Thyroid & Parathyroid disease
  • Infection (Chagas, Coxsackie, HIV), Lyme Disease
  • Doxorubicin, Cocaine|CAD
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28
Q

C1 esterase deficiency:

A

Acquired angioedema usually happening after 4th decade of life

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29
Q

Multiple asthma attacks with central bronchiectasis what to do next?

A
  • Check skin test for aspergillosis (ABPA)
  • Tx with itraconazole (antifungals)
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30
Q

BOOP = COP

A
  • Bronchiolitis Obliterans Organizing Pneumonia = Cryptogenic organizing pneumonia (COP) is often confused with bronchiolitis obliterans
  • Nonresponsive to antibiotics, but presents like a pneumonia (fever, chills, dyspnea, cough), patchy uni or bilateral infiltrate on CXR
  • See more often in rheumatoid disease
  • Treat with steroids, Prednisone x24 wks
  • Bronchiolitis Obliterans not as predictably responsive to steroids
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31
Q

Noncaseating granulomas, erythema nodosum, increased T cells on lavage

A

Sarcoidosis

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32
Q

If you suspect OSA:

A
  • Obtain a sleep study (polysymnography test)
  • There were 3 questions:
    • All patients were obese
    • One was fatigued with daytime somnolence and headaches.
    • Another was refractory hypertension.
    • Another was atrial fibrillation.
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33
Q

If a pt has a normal A-a gradient then you think:

A
  • Central suppression, Hypoventilation
  • Normal A-a = Age/4 + 4
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34
Q

Hypoxia that can’t be corrected with O2 therapy with nasal cannula:

A

Shunt physiology should be suspected

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35
Q

Chronic RML infiltrate with bronchiectasis:

A

BOOP = COP

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36
Q

65 yr old mechanic that has malignant thoracentesis:

A

Mesothelioma; asbestos is the primary cause

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37
Q

Occupation = engraver:

A
  • Silicosis
  • Can occur in any occupation that disturbs the earths crust & causes mixed obstruction/restrictive lung disease
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38
Q

Occupation = dry cleaner:

A
  • Pulmonary Fibrosis
  • “Think a dry cleaner cleaning velcro & velcro crackles on exam”
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39
Q

Lower ext laceration with cellulitis on a pt walking in fresh water, failed antibiotic treatment. Bug =

A

Aeromonas hydrophila

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40
Q

HIV pt who is placed on statin develops proximal muscle weakness:

A

Immune-mediated necrotizing myopathy

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41
Q

Black necrotic looking nasal lesion =

A
  • Mucormycosis
  • Sx: fever, headache, sinus pain
  • Found in leaves and rotting wood
  • Causative agent is Rhizopus
  • Risk factors:
    • DM- uncontrolled
    • Neutropenia
    • Renal failure
    • Deferoxamine therapy
    • Others: CA, organ transplant, skin trauma|
  • With pulmonary and GI involvement they die w/in 2 weeks
  • Confirmed with biopsy
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42
Q

Gram negative rod that is lactose negative and oxidase positive?

A

Pseudomonas & Aeromonas

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43
Q

Tx for severe legionellosis?

A
  • Polymorphonuclear leukocytes usually present
  • Macrolides and fluroquinolones
  • Other options: ampicillin, tetracycline, (as per previous review sheet) – erythromycin and rifampin
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44
Q

35 y/o male has bumps on his arm, dies two days later. Dx and poss bugs?

A
  • Group A strep (S. pyogenes) causing necrotizing fasciitis. Other causes?
  • Staph a, clostridium perfringes, bacteroides, aeromonas
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45
Q

Heart Block with tick bite:

A

Lyme Disease

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46
Q

HIV ELISA is positive, indeterminate western blot, what to do next?

A

Repeat western blot w/in 6-12 weeks or check PCR

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47
Q

Young guy with severe cough, who then takes his girlfriend’s cipro notices his cough worsening…whats the cause of his cough?

A

Pertussis

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48
Q

Hantavirus (Camper in Southwest Colorado w/ Pulmonary Edema):

A
  • Hantavirus: associated with sinobrae virus
  • Pulmonary edema, hemorrhagic fever, cough, myalgia, lethargy, but NO rash
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49
Q

Rocky Mountain Spotted Fever:

A
  • Diffuse maculopapular rash typically present (but not always), high fevers
  • Dermacentor (Doxy) Tick (Tetracycline) vector for Rickettsia
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50
Q

Staph Saprophyticus is most common in…

A

Young Women

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51
Q

Sulfur granules think:

A

Actinomyces

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52
Q

19 yr old female presents with fever, hypotension and macular rash:

A
  • DIC from Toxic Shock Syndrome
  • Fever >102, SBP< 90, macular rash, usually 3 organ systems involved
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53
Q

Whipple’s Disease:

A
  • Involves CNS, heart, kidneys, and small bowel, joints “Whips around your body!”
  • White males
  • Gram negative bacillus: Trophyerma whippelii
  • Diarrhea from malabsorption, wt. loss, LAD, arthritis (organism in synovial fluid), neurologic sequelae
  • Steatorrhea on 72 hr stool sample
  • Diagnosed with small bowel biopsy showing PAS (periodic acid schiff) positive granules in macrophages
  • Tx: tetracycline or PCN for 1 year
  • Trophyerma/Tetracycline/Twelve months. Whippeli/Whipples/White poop (steatorrhea)
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54
Q

Jones criteria for diagnosis of Rheumatic fever requires:|

A
  • 2 Major OR
  • 1 Major, 2 Minor + Evidence of prior strep infection (ASO Ab, + rapid strep, recent scarlet fever)
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55
Q

Major Jones Criteria for Rheumatic Fever:

A
  • Major criteria:
    • Carditis
    • Polyarthritis
    • Chorea-CNS
    • Erythema marginatum
    • Subcutaneous nodules
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56
Q

Minor Jones Criteria for Rheumatic Fever:

A
  • Minor criteria:
    • Fevers
    • Arthralgias
    • Previous rheumatic heart disease or Previous rheumatic fever
    • Acute phase reactants (increased ESR/CRP/leukocytes)
    • Prolonged PR
    • “FAAPR!”
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57
Q

Tx for Neutropenic Fever:

A
  • Mult. right answers - pick Pseudomonal coverage
  • Imipenem vs Cefepime
  • High-Risk (Cefepime or Imipenem + Vanco if central line/unstable)
    • Inpatient
    • Clinically unstable or sig. medical comorbidity
    • Anticipated ANC ≤100 (UTD <500) & ≥7 days
    • Hepatic/Renal Insufficiency
    • CA, uncontrolled
    • PNA or complex infection
    • Mucositis grade 3-4
    • MASCC risk index <21
    • Alemtuzumab
  • Low Risk: <7 days neutropenia, no comorbidities, can take PO and have access to ED = Cipro + Augmentin
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58
Q

Tx of Meningitis (2-50 y/o):

A
  • MCC strep pneumo or N. meningitides
  • Vanco + 3rd gen cephalosporin
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59
Q

Tx of Meningitis (>50 y/o):

A
  • MCC: strep, neisseria, listeria, G- bacilli|​-vanco + amp + 3rd gen cephalosporin
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60
Q

Tx of Meningitis (immunocompromised):

A

vanco + amp + cefepime/meropenem

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61
Q

LP findings for Bacterial Meningitis:

A
  • Opening p >250
  • Leukocytes >1000
  • Glucose <40
  • Protein 100-500
  • G stain + 60-90%
  • Culture +
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62
Q

Early finding in Lyme Disease:

A

Erythema Migrans (Bull’s Eye Rash)

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63
Q

Early findings in disseminated Lyme Disease:

A
  • Weeks-Months after infection
  • Cardiac (e.g. heart block) and Neurologic (e.g. Bell’s palsy)|
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64
Q

What are late findings in Lyme Disease?

A

migratory arthritis, encephalopathy (decreased cognition and short term memory loss)

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65
Q

What is the Tx for Lyme Disease?

A

oral with doxycycline BID, cefuroxime BID, or Amoxicillin TID

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66
Q

Erlichiosis….go!

A
  • Rickettsial, more in southern states, rash similar to RMSF
  • Fever, HA, myalgias, fatigue, skin lesion in 30%, decreased WBC and platelets, increased LFT
  • Tx = Doxycycline
  • “Lick the spots off….down south.”
  • “Lick the leuk’s.”
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67
Q

MCC of Pneumonia:

A
  • S. pneumoniae [G+, alpha-hemolytic, lancet-shaped diplococci]
  • M. catarrhalis [G-, diplococci]
  • H. influenzae [G- rods, oxidase+, catalase +
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68
Q

MRSA Pneumonia (resident at a NH):

A
  • Tx with vancomycin
  • Influenza can lead to MRSA pneumonia
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69
Q

Endocarditis and prosthetic heart valve a/w…?

A
  • Staph epidermidis/Staph aureus
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70
Q

Streptococcus bovis infection a/w:

A

Colon CA & Endocarditis

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71
Q

Cat bite (Bug & Tx):

A
  • Pasteurella Multocida, S. aureus
  • Tx: Augmentin or Ceftin, Doxy, PCN
  • 80% of cat bites get infected; P. multocida infxn develop in 24 hrs
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72
Q

Cat Scratch FEVER a/w & Tx:

A
  • Bartonella henselae
  • Tx: Azithromycin
  • “Throw the cat….a là Monty Python”
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73
Q

Bad breath, EtOH & Dental Caries = Bug & Tx?

A
  • Bacteroides Pneumoniae
  • Anaerobic, G- bacilli, common in mouth & GI tract
  • Tx: Clindamycin
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74
Q

MCC of HIV Encephalitis:

A

Herpes

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75
Q

If HIV is initially negative and person has risky behavior:

A
  • Check PCR, if not a choice, then wait for 6-12 wks and recheck the Western blot prior to starting tx with HAART
  • First check EIA when screening
    • If negative, check RNA PCR if suspect infection (can be falsely elevated if levels <100,000)
    • If positive, check with repeat test and western blot before you can actually diagnose them with it
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76
Q

PCP is positive with:

A

Methenamine Silver staining

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77
Q

An organism that causes reactive arthritis:

A
  • Yersinia NOT listeria or serratia
  • Other causes: shigella, salmonella, chlamydia, campylobacter
  • Answer on test will be Yersinia
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78
Q

E.coli H157

A
  • Schistocytes and infectious diarrhea
  • Causes HUS
  • Causes hemorrhagic diarrhea
  • Must perform specific lab test on stool, bacteria isolated on sorbital-macconkay agar
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79
Q

MCC for Bacillary angiomatosis a/w HIV:

A
  • Bartonella henselae
  • Occurs in immunocompromised
  • Can cause hemangiomas, nodules, friable masses, plaques, easily confused with Kaposi sarcoma
  • CD4 usually less than 50
  • Tx: Erythromycin or Tetracycline
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80
Q

Kaposi Sarcoma:

A
  • HHV-8
  • ​MSM HIV pt
  • Red, purple, brown macules/papules/plaque on skin
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81
Q

Toxoplasmosis in HIV patient:

A
  • Encephalitis with CD4 <100
  • Treat with Bactrim
  • ​MAC and CMV <50: prevent with azithromycin
  • PCP <200: prevent with bactrim
  • ​Cryptococcus <100
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82
Q

Midwest differential (4):

A
  • Lime Babies born in the Rockies and raised by Hanta.
  • Lyme disease: MW
  • Babesia: MW (Hunter in Wisconsin)
    • Intraerythrocyte replication: causes hemolytic anemia
    • think Babesia/Baby Jesus on a cross (maltese cross on histology)
    • Hepatosplenomegaly, jaundice, AKI, DIC, heart failure
    • Tx with atovaquone and azithromycin (“bAbies = Atovaquone & Azithromycin”)
  • Rocky Mountain Spotted Fever: continental
    • Petechial rash, fever, HA, myalgia, confusion, thrombocytopenia, increased liver enzymes
    • CSF: lymphocytic
    • Doxycycline is the treatment (“Doxy for the Roxy”)
  • Hantavirus: no rash, hemorrhagic fever, cough, pulm edema, myalgia, lethargy, hypotension > renal failure (“Hant had no rash”)
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83
Q

Pt had cholecystectomy 6 wks ago, he now presents with 2 wks of abdominal pain, mild alk phos elevation, positive bilirubin 4.0. What is the cause of the problem?

A

Biliary leak? OR choledocolithiasis or bile duct stricture?

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84
Q

Fatty liver disease is a/w:

A
  • Metabolic syndrome
  • EtOH
  • Abdominal obesity
  • Diabetes mellitus
  • Hyperlipidemia
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85
Q

Alcoholic hepatitis and cirrhosis a/w:

A

2:1 ratio of AST: ALT

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86
Q

Pt with carcinoid tumor on octreotide tx:

A
  • Leads to Niacin Deficiency
  • 4 D’s: diarrhea, dementia, dermatitis, death
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87
Q

How does Octreotide work in treating Carcinoid Syndrome?

A
  • Decreases serotonin levels by breaking down 5-HIAA (usually elevated 24 h urine level is diagnostic of carcinoid syndrome)|
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88
Q

DM with hemachromatosis:

A

Check ferritin level

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89
Q

Gene mutation for hemochromatosis:

A

HFe and C282Y and H63D

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90
Q

Celiac sprue

A
  • Blunting of the villi
  • Young girl with bloating, hypocalcemia, iron deficiency, abdominal exam is tympanic on percussion
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91
Q

LFTs greater than 1000s:

A
  • Acetaminophen toxicity
  • Ischemic hepatitis
  • Viral hepatitis
  • Autoimmune hepatitis
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92
Q

Achalasia (definition, Dx, Tx):

A
  • Loss of peristalsis in distal 2/3rd of esophagus and impaired relaxation of LES
  • Bird beak sign on barium swallow
  • Diagnosis confirmed by esophageal manometry
  • Tx is botox, surgical myomectomy or dilation, oral nitrates or CCB
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93
Q

Suspect gastroparesis from diabetes mellitus:

A
  • Check a gastric emptying studying
  • Must have negative EGD and negative imaging for obstruction
  • Dx of exclusion
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94
Q

H. pylori infection (a/w, Dx, Tx):

A
  • a/w MALT (mucosal associated lymphoid tissue), PUD, dyspepsia, early gastric cancer
  • Urease breathe test (less S&S) and fecal Ag test
  • Rapid urease test on endoscopy
  • Can be treated with antibiotics against H. pylori and retest with endoscopy 4-6 weeks later
  • Triple therapy: PPI, clarithromycin, amoxicillin (or flagyl) for 10-14 days
  • Second line: PPI, tetracycline, flagyl, bismuth for 10-14 days
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95
Q

Extraintestinal manifestations of IBD:

A
  • NOT a/w pemphigous vulgaris
  • IS a/w: pyoderma gangrenosum, PSC, ankylosing spondylitis, erythema nodosum (crohn’s), nephrolithiasis, thrombosis
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96
Q

Radiologic findings in UC:

A
  • lead pipe”- toxic megacolon
  • NOT fistulas
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97
Q

ESR >100:

A
  • Occult infection (osteomyelitis, abscess)
  • Connective tissue disorder
  • Malignancy
  • Temporal arteritis (Giant cell arteritis)
    • If suspected – immediate tx with steroids – if delayed can lead to irreversible blindness
    • Confirmatory dx: temporal artery biopsy
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98
Q

Triad & Stages of Churg-Strauss angitis:

A
  • Triad of asthma, eosinophilia, and positive p-ANCA suggests Churg-Strauss Syndrome
  • First stage: asthma and allergic rhinitis
  • Second stage: eosinophilia
  • Third stage: vasculitis
  • I think question stem was something like pt presents with recurrent asthma attacks, found to have eosinophilia in the blood, which of the following will the pt also have?
    • p-ANCA in biopsy of blood vessels
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99
Q

Henoch-Schonlein Purpura

A
  • Vasculitis
  • Increased IgA and platelets
  • Palpable purpura
  • Involves kidneys, GI (usually abd pain), joints (hemarthrosis) and lungs
  • ​There was a question that sounded like it but correlated better with another answer choice so be careful
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100
Q

Slightly negative birefringent crystals in synovial fluid

A
  • Pseudogout:: rhomboid or coffin shaped
  • Gout: negatively birefringent crystals in synovial fluid, needle shaped
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101
Q

Specific test for Rheumatoid Arthritis (RA):

A

Check Anti-CCP (anti-citrullinated protein Ab)

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102
Q

Limited Sclerosis most associated with:

A

Pulmonary Hypertension

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103
Q

Wegener’s granulomatosis: (now called granulomatosis with polyangiitis)

A
  • C-ANCA 90%
  • Optho involvement is common: Conjunctivitis, Sclerosis, Uveitis, Retinal Vasculitis, Retro-orbital pseudotumor (proptosis)
  • Saddle nose deformity: also with leprosy/ septal perforation, Replasing polychondritis, Congenital syphilis
  • Upper and Lower Respiratory: Cough, Hemoptysis, Pleurisy, Granulomatous infections in the respiratory tract > Multiple infiltrates with diffuse opacity; Usually some kind of sinus problem in clinical vignette
  • Associated with FSGS and hematuria
  • Mononeuritis multiplex
  • Skin: purpura/ulcers
  • Tx: corticosteroids and cyclophosphamide for 3-6 months “weCener’s: C+C 6-month factory”
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104
Q

Mixed Cryoglobulinemia:

A
  • Decreased C3 and C4
  • a/w Hepatitis C – type II- monoclonal IgM or IgA
  • Immunoglobulins that reversibly precipitate in cold temperatures
  • Meltzer’s triad: palpable purpura, arthralgias, and myalgia
  • Mononeuritis multiplex and immune complex glomerulonephritis
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105
Q

Cryoglobulins a/w:

A
  • Infective endocarditis
  • Lymphoma- type I (monoclonal immunoglobulins)- vasculitis, nephritis
  • Myeloproliferative disorders
  • Connective tissue disorder
  • Autoimmune diseases- type III- SLE, sjogren’s syndrome
  • Hypocomplimentemia
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106
Q

Anti-histone Ab a/w:

A
  • Drug-induced lupus
    • procainamide and hydralazine, methyldopa are the most common|​
    • ANA, anti-single stranded DNA usually positive too
    • Rash, arthritis, pleuropericarditis, cytopenia, fever
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107
Q

Male with visual disturbances, mm weakness and dysuria:

A
  • Reiter’s syndrome/arthritis
  • Oligoarticular arthritis, urethritis, conjunctivitis
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108
Q

Patients with SLE usually die from:

A

Late = MI

Infections- early and late from immunosuppression

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109
Q

4 immunologic factors for SLE include:

A
  • anti- ds DNA
  • anti- Smith
  • false positive VDRL
  • ANA
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110
Q

Criteria for Diagnosis of SLE:

A
  • 4 out of 11 = 95% specificity & 75% sensitive
  • DOPAMINE RASH
    • D: Discoid rash
    • O: Oral Ulcers
    • P: Photosens
    • A: Arthritis
    • M: Malar
    • I: Immuno markers (anti sm, dsdna, ro, la, histone for drug induced etc)
    • N: Neuro changes (psychosis, personality changes, seizures)
    • E: Elevated ESR
    • R: Renal
    • A: +ANA
    • S: Serositis (Pleurisy, pericarditis)
    • H: Hematologic (Hemolytic anemia, thrombocytopenia, leukopenia)
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111
Q

Treatment of SLE:

A
  • NSAIDS for arthralgias,
  • hydroxychloroquine prevents flares and increases survival; decreases organ damage, thrombosis and bone loss
  • cyclophosphamide- restricted to lupus nephritis, severe disease
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112
Q

CREST Syndrome (Limited Sclerosis):

A

o Calcinosis|o Raynaud’s syndrome/phenomenon|o Esophageal dysmotility|o Sclerodactyly|o Telangiectasia|usually with postive anti-centromere Ab and anti- Th/To

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113
Q

Diffuse Sclerosis:

A

• ILD > PHTN, Kidney dz, Serositis|• Proximal skin involvement to distal forearms and knees|o At risk for PBC (primary biliary cholangitis)|o Anti-Scl 70 (anti-topoisomerase)| |

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114
Q

Primary Sclerosing Cholangitis:

A

Pruritis, abd pain, jaundice|Alk phos 3-10x ULN|AST/ALT 2-3x ULN|+ANA and smooth muscle Ab, p-ANCA (in 2/3)|cholangiocarcinoma high risk|A/w UC > Both = risk of Colon CA|dx with cholangiography (MRCP “string of beads”)|

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115
Q

Testicular tenderness, hematuria, fever and leg numbness:

A

Check throat cultures; PAN?

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116
Q

Diastolic heart murmurs, ears hurt, myalgias:

A

Polychondritis |-Affects ears, nose, resp. tract|-Ocular inflammation, Polyarteritis|-Vasculitis, aortic/mitral valve insufficiency

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117
Q

What is the Tx for Polychondritis?

A

-NSAIDs |-Dapsone |-Immunomodulators

118
Q

Behcet’s disease:

A

-Mouth and perianal aphthous ulcers|-a/w erythema nodosum|-Japanese and middle eastern descent|-uveitis > meningoencephalitis > arteritis > arthritis > phlebitis > VTE|-High risk for VTE- migratory, superficial|-Hemoptysis from pulmonary vascular involvement

119
Q

What are the symptoms of Primary Biliary Cirrhosis?

A

Fatigue, pruritus, loose stools, jaundice (rare), hepato/splenomegaly, dry eyes, dry mouth

120
Q

What are common lab findings with Primary Biliary Cirrhosis?

A

• Asx elevation of alk phos >1.5x ULN|• AST/ALT >5x ULN|• anti-mitochondrial Ab in 90%- liver biopsy is next step if detected

121
Q

What is Primary Biliary Cirrhosis associated with?

A

Hashimoto’s Thyroiditis & Sicca Syndrome

122
Q

What is the Tx for Primary Biliary Cirrhosis?

A

• liver transplant|• urso-deoxycholic acid offers survival benefit

123
Q

Tx of Acute vs Chronic Gout:

A

Acute = Colchicines|Prophylactic = Allopurinol||Remember…Gout = Needle-shaped, Negative-birefringence crystals

124
Q

Polyarteritis Nodosa (PAN):

A

Medium and small muscular arteries|​40-60 yo|​a/w Hep B infection|​Fever, arthralgias, myalgias, abd pain|​Peripheral nerve involvement, testicular pain, skin (livedo reticularis, pupura, ulcers)|​Labs = pancytopenia, increased ESR|1/3 of the time renal artery is involved|Dx: necrotizing vasculitis on biopsy of skin, muscle or sural nerve​|

125
Q

PiZZ gene a/w:

A

Developing alpha-1 anti-trypsin deficiency

126
Q

Anti-histone Ab =

A

Drug-induced Lupus

127
Q

Ankylosing Spondylitis:

A

o HLA-B27, elevated ESR|o Can be a/w Crohn’s disease, anterior uveitis, psoriasis |• Bamboo spine- proliferative changes (syndesmophytes and calcification of longitudinal ligament)|• Pain/stiffness of spine, low back, buttocks, posterior thighs, forward posture, fx, radiculopathy, myelopathy|o M > F in Teens & twenties|• Tx = NSAIDS, steroids, TNF-α inhibitors

128
Q

What are some causes of Membranous Glomerulonephritis?

A
  • Hepatitis B
  • Also, other chronic infections: Hepatitis C, ​syphilis, subacute bacterial endocarditis, OM, mastoiditis,
  • autoimmune
  • malignancy
129
Q

Urine osmolarity 350, given DDAVP > urine osmolarity 360…

A

o Central diabetic insipidus - <200 and increases >10% after vasopressin given|o Nephrogenic diabetic insipidus - <200 and does not increase after vasopressin, treat with thiazide (reduces intravascular volume and polyuria)|o Osmotic diuresis- usually urine osm >300

130
Q

Which of the following is most consistent with ATN?||o BUN >20 :1|o FeNa < 0.9|o RBC casts|o Urine Na > 40|

A

For ATN:| BUN/Cr <20:1| FeNa >2| Urine Na >40| Muddy brown granular or epithelial cell casts| Urine osmolality <350-450|

131
Q

IgA nephropathy in 16yr old with renal failure

A

Absent in 40% of patients with Rheumatoid Arthritis

132
Q

Pt on digoxin + hyperkalemia do not give:

A

Calcium Gluconate > worsens Digitalis Toxicity

133
Q

18 yr old on HD with hyperkalemia of 7.0 what is the quickest way to resolve hyperkalemia?

A

Albuterol Tx peak effect = 90 min |o 50% dextrose/regular insulin- onset in 10 min, sustained for 4-6h|o Bicarb- only use if acidotic|

134
Q

Thiazides lead to…

A

• Hypercalcemia|• There was a question that asked what is the cause of hypercalcemia and the pt was on a thiazide but I think it was a different answer, probably malignancy

135
Q

Workup for painless hematuria (>3 ery/HPF):|

A

Repeat UA if pt is <40 yo||If erythrocytes are normal in size and shape > Cystocopy|If amorphic erythrocytes > need glomerular workup > Imaging & Bx

136
Q

Low anion gap acidosis causes:

A

Increased K, Ca, Mg, lithium intoxication|o Think of gammaglobulinemia|• Hyperparaproteinemic states (e.g. MM)||AG= 2.5 x change in albumin + calculated AG|

137
Q

HAGMA causes:

A

GOLD MARRK||Glycols|*Ethylene|*Propylene|**Metabolized into D-Lactate & L-Lactate|**Used as a solvent for Lorazepam, Phenobarbital and other infusions|Oxoproline (5-oxoproline; aka pyroglutamic acid)|*Chronic Paracetamol use (i.e. Acetaminophen), esp. in malnourished women|L-Lactate|*Iron, Isoniazid|D-Lactate|*Short Bowel Syndrome|Methanol|Aspirin|*Especially if pH is very low (e.g. 6.8)|Renal Failure|*Buildup of sulfates & phosphates|Rhabdomyolysis |Ketoacidosis|*Diabetic|*Alcoholic|*Starvation|*Isoniazid ||Isopropyl Alcohol does NOT cause HAGMA but is metabolized into acetone (only other things that cause serum acetone are recovering DKA or starvation ketosis)|

138
Q

Delta Gap =

A

Delta Gap = change in AG/change in HCO3||<1 NAGMA + HAGMA |>2 metabolic alkalosis + HAGMA |

139
Q

In working up NAGMA, you should check:

A

Check Urine anion gap= (Na+K) – Cl||​If negative= increased Cl and likely increased NH4 à kidney responding appropriately to loss of bicarb and cause is something other than kidney (e.g. diarrhea)|

140
Q

Differentiate between Types I-IV RTA:

A

Step one: Determine it is RTA (hyperchloremic acidosis with a normal anion gap and near normal GFR in the absence of diarrhea = RTA) |Step two: Look at the potassium level, if it is higher than the normal range (3.5-4.5) then it is automatically RTA-IV. If it is lower, rule out RTA-IV and go to step 3. |Step three: Look at urine pH. If it is lower than 5.5 it is automatically RTA-II. If it is higher than 5.5 go to step 4. |Step four: Look at the bicarb level. If the bicarb level is near normal it is RTA-I. If the bicarb level is markedly decreased it is RTA-II. |Step five: confirm diagnosis as follows: -RTA-I: administer ammonium chloride (an acid). If urine pH does not drop below 5.5 as serum pH decreases, you have your diagnosis. -RTA-II: administer bicarb. If the urine pH continually rises as bicarb is given, you have your diagnosis. -RTA-IV: salt restrictive diet. If urine sodium is persistently high, while serum sodium begins to decrease, you have your diagnosis. ||Type I- urine pH >6.0, decreased serum K, increased kidney stones from potassium wasting|Type II- proximal, urine pH<5.5, rare by itself, K normal|Type IV- increased serum K|​pH <5.5- decreased aldosterone level or activity|​pH > 6.0 tubulointerstitial injury (obstruction or interstitial dz)

141
Q

Increased osmolar gap causes:

A

o Ethylene glycol toxicity (oxalate crystals in the urine)|o Ethanol|o Isopropyl alcohol|o Methanol|o Methanol and ethylene glycol also causes AG metabolic acidosis

142
Q

ATN causes:

A

-ischemia |-tubular toxicity from meds|​ -aminoglycosides, amphotericin B, foscarnet, tenovovir, IV dye, NSAIDS, chemo, heavy metals|

143
Q

Alport Syndrome:

A
  • disrupted glomerular basement membrane with type IV collagen|
  • usually family history of deafness and kidney disease
  • Sensorineural hearing loss (musician in stem?)
  • Hematuria|o Progressive renal disease
  • ESRD in teen years or 4th decade of life
  • Ocular lesions: early-onset cataracts
144
Q

Polycystic Kidney Disease is a/w:

A

Berry aneurysm|Diverticulitis|Hernias|Cysts: pancreas, spleen, thyroid, seminal vesicles, liver

145
Q

What is an example of drug dosing that doesn’t change with CKD?

A

Penicillin G

146
Q

What are 3 medications that cause Hyperkalemia by inhibiting potassium excretion in the kidney?

A

Gentamicin |Bactrim |Cisplatin

147
Q

Necrolytic migratory erythema from zinc deficiency:

A

Red, blistering rash on lower abd, buttocks, perineum and groin |A/w liver disease |Elevated Glucagon, malabsorption > dec amino & fatty acids |

148
Q

What is the most common cause of Vitiligo?

A

Thyroid disease

149
Q

Pt has a reaction to poison ivy. This is an indication of which part of immune system is intact?

A

Cell mediated immunity is intact (T cell mediated)

150
Q

Pt has blisters on the dorsum of the hand then think porphyria cutanea tarda:

A

Photosensitivity > Facial reddening > Hyperpigmentation |A/w EtOH, Hepatitis C, Fe, Estrogen |NO GI or Neuro manifestations

151
Q

Ash-leaf spots on skin =

A

Tuberous Sclerosis

152
Q

Seborrheic Keratosis is a/w:

A

GI malignancy!!

153
Q

Tx of long-term Urticaria:

A

H1RA > H2RA > Steroids > TCA > Immunomodulators

154
Q

What are the most common underlying causes of long-term Urticaria?

A

Infection |Allergies |Meds: | PCN, Beta-Lactams, Vanco | ASA, NSAIDs

155
Q

DDx for hand blisters:

A

Vitamin C or B12 Deficiency |Hypothyroidism |Hepatitis C |Porphyria

156
Q

Rapidly fatal dementia =

A

Creutzfeldt-Jakob Disease

157
Q

What is the Tx for Trigeminal Neuralgia?

A

Carbamazepine (Tegretol)

158
Q

Triptans are used for…

A

Migraine Abortive Tx||Prophylaxis = SSRI

159
Q

Causes of Bell’s Palsy:

A

Pregnancy |Lyme Disease |Viruses: CMV, EBV, HSV, VZV

160
Q

What is the most common cause of dementia?

A

Alzheimer disease - biggest risk factor is AGE

161
Q

When to treat BP in patients with stroke:

A

o BP >185/110 mm Hg in pt being treated WITH tPA|o BP >220/120 in pt being treated WITHOUT tPA

162
Q

25yr old with supracellar mass with calcification and lack of peripheral vision:

A

o pituitary adenoma OR|o craniopharyngioma-calcified on Ct|o tumor grows too large for blood supply > pituitary apoplexy|o sudden HA, visual changes, AMS, hormone dysfunction (affects multiple endocrine systems)

163
Q

Differentiating central lesion vs Bell’s Palsy:

A

Differentiated with frontalis muscle- cannot wrinkle forehead with peripheral Bell’s Palsy

164
Q

Monoplex Neuritis (mononeuritis multiplex) definition & causes:|

A

Damage to peripheral nerves (asymmetric)||RA, SLE|MS, DM|Amyloid|Vasculitis, PAN|Lymphoma/Leukemia, Paraneoplastic|

165
Q

Normal Pressure Hydrocephalus (NPH):

A

• Wide-based gait with urinary incontinence and dementia|• “wacky, wet and wobbly”|• Tx: shunt|

166
Q

Pseudotumor Cerebri:

A

• Benign intracranial hypertension – increased ICP in absence of tumor or other cause|• HA, visual changes (visual loss), tinnitus|• Treat with Diamox|

167
Q

Miller Fisher variant of Gullian Barre:

A

Often confused with botulism |Descending rather than ascending paralysis

168
Q

Multiple Sclerosis is a/w:

A

Scanning speech |Optic Neuritis |Monoplex Neuritis |Increased IgG |Oligoclonal bands in CSF

169
Q

Worst HA of my life =

A

AV malformation with ICH or SAH

170
Q

Schmidt’s syndrome (autoimmune polyendocrine syndrome type 2):

A

Addison’s disease|Hashimoto’s thyroiditis|DM||APS type I = gonadal failure, hypoparathyroid, hypothyroid, vitiligo

171
Q

Familial Hypercalcemic Hypocalciuria:

A

o lack of calcium sensing receptor in the parathyroid gland|autosomal dominant|o hypocalciuria ( <50mg/24hrs); urine Ca/urine Cr <0.01|o variable hypermagnesemia|o minimally elevated or normal levels of PTH|o good prognosis, usually asymptomatic and do NOT need treatment

172
Q

Which oral hypoglycemic causes acute pancreatitis: Pioglitizone vs. Sitagliptin?

A

• Sitagliptin—|• Serious reaction:|o Stevens Johnson syndrome|o Angioedema|o Pancreatitis|o Pancreatitis, acute hemorrhagic|o Pancreatitis, necrotizing||• Pioglitizone—|• Serious reaction:|o CHF|o Hepatotoxicity|o Fractures in female patients|o Diabetic macular edema|o Bladder cancer “Pee-oh-glitazone!”||

173
Q

18-hydroxysteroid and postural changes in serum levels:

A

Aldosterone increases normally with standing

174
Q

Pt with hypotension and septic shock. Her sepsis resolved but she is still hypotensive what is the reason?

A

Adrenal Insufficiency

175
Q

MIBG (iodine meta-iodobenzylguanidine) scan:

A

Confirm the presence of pheochromocytoma and neuroblastoma

176
Q

Hyperosmolar state, glucose 1200. Whats the initial treatment?

A

NS 1000 ml/h WITH insulin 0.1 U/kg bolus and 0.1 u/kg/h infusion after

177
Q

Know hyperparathyroidism well!

A

-Primary: increased PTH (adenoma MCC), increased Ca, decreased phos, increased vitamin d|​-Secondary: increased PTH from decreased vitamin d or renal osteodystrophy- increased phosphate, decreased or increased ca|​-Tertiary: increased PTH from ESRD and loss of feedback, increased Ca, vitamin d level varies|

178
Q

With respect to thyroid function: Decreased total T4, normal T3

A

• think of hypothyroidism in pregnancy|• T3 levels fluctuate, free T4 in normal pt is only relevant, total T4 in pregnancy is only relevant

179
Q

1.5 cm Thyroid Nodule….what do you do, Jack?!?

A

Check an ultrasound and biopsy if TSH increased|Risk factors that support biopsy: strong family history, history of neck radiation|• check RAIU if TSH decreased|

180
Q

Where is Acanthosis Nigricans usually found and what are some things it is a/w?

A

Found in intertriginous areas ||A/w: insulin resistance, PCOS, Obesity, DM, Cushings, Prednisone, Thyroid disease, Adenocarcinoma of GI tract, Acromegaly||If found in thin pt >40 yrs THINK MALIGNANCY!

181
Q

How is PCOS diagnosed and treated?

A

• Diagnosis of exclusion, confirmed with US|• Rotterdam criteria- oligoovulation, excess androgen (hair), polycystic ovaries|Tx = Metformin |

182
Q

What’s a lab that can differentiate b/w Primary & Secondary Adrenal Insufficiency?

A

ACTH

183
Q

Findings a/w renal osteodystrophy:

A

Inc PO4, Dec Vit D & Ca |Secondary Hyperparathyroidism |Bone pain, Fx

184
Q

DeQuervain thyroiditis:

A
  • Preceded by viral URI
  • Initially causes hyperthyroidism but may develop into hypothyroidism after thyroid burn out
  • Decreased uptake on thyroid scan
  • Tx- BB and NSAIDS|
185
Q

What lab findings hint that pt is using exogenous thyroid hormone to lose weight:

A

Iodine uptake scan shows 0% activity|Dec TSH and thyroglobulin|

186
Q

Jod-Basedow phenomenon:

A

• Iodine-induced hyperthyroidism|• Usually there’s pre-existing iodine deficiency goiter, followed by increased iodine uptake

187
Q

Wolf checkov phenomenon:

A

• Decreased hormone levels from increased iodine uptake|• Drug-induced hypothyroidism: usually from Tx in Graves disease

188
Q

RN with hypoglycemia:

A

Check C-peptide

189
Q

Which type of DM is more hereditary?

A

NIDDM

190
Q

Small Cell Lung cancer (SCC) is a/w what paraneoplastic syndrome?

A

SIADH

191
Q

Increased Calcitonin think…

A

Medullary Thyroid Carcinoma

192
Q

What is a Krukenberg tumor?

A

Metastatic CA involving the Ovaries usually mets from the GI tract

193
Q

What is Bowen’s disease?

A

Squamous Intraepidermal Carcinoma, often involving the penis

194
Q

What is Mycoses fungoides and Sezary Syndrome?

A

Aggressive skin cancer with mets to lymph nodes and blood a/w cutaneous T-cell lymphoma|

195
Q

What is associated with Sipple syndrome?

A

MEN IIa (autosomal dominant)||4 C’s:|o medullary Carcinoma of the thyroid|o pheochromocytoma (inc Catecholamines)|o hyperparathyroidism (inc Ca)|o occasionally Cutaneous lichen amyloidosis

196
Q

Tartrate Resistant Acid Phosphatase is diagnostic of:

A

Hairy Cell Leukemia ||”IT’S A TRAP!!”

197
Q

Tx of Hemolytic Anemia:

A

Autoimmune = Corticosteroids |Drug-induced = discontinue offending agent

198
Q

Pt with hx of sickle cell disease is shown to have aplastic anemia on bone biopsy what is the cause of this?

A

Parvovirus B19

199
Q

Tx for Prostate CA:

A

Lupron (Leuprolide)

200
Q

Before starting Infliximab (Remicade) you must:

A

Must do a PPD (Mantoux) test > Immunosuppression can make TB worse|

201
Q

Myelofibrosis:

A

Fatigue (anemia), night sweats|Wt loss, abd pain, early satiety (Hepatosplenomegaly d/t extramedullary hematopoiesis)|​Anemia, increased or decreased WBC and platelets|​Usually accompanied by previous Jak 2 mutation|

202
Q

Nose/gum bleeding, thrombocytopenia, fragmented red cells:

A

TTP/HUS (+schistocytes)|-Check von Willebrand factor|-Usually check ADAMTS 13

203
Q

What is AML Type 3 a/w?

A

Promyelocytic anemia |Auer rods can cause DIC

204
Q

If a pt has multiple 3rd trimester miscarriages, you should workup:

A

Antiphospholipid Ab Syndrome||Check for anticardiolipin Ab|Need 2+ blood tests, 3 months apart|A/w rheumatologic disorders|Can also cause: Thrombocytopenia, sterile endocarditis, and recurrent thromboembolic disease

205
Q

TRALI =

A

Donor against recipient

206
Q

What vitamins can cause Coumadin toxicity?

A

Vitamin E (large doses) & of course Vitamin K

207
Q

What are 2 common hypercoagulable states:

A

1) Factor V Leiden |2) Prothrombin G20210A mutation

208
Q

What are two potent congenital hypercoagulable states?

A

Protein C & S Deficiencies and Antithrombin III Deficiency

209
Q

Inc PT, nml PTT =

A

Liver disease |Vitamin K deficiency |Dec Factor VII |Coumadin

210
Q

Tell me about Factor XII:

A

Hagerman factor |Prolonged aPTT, but no bleeding |If elevated though, can cause thrombus!!

211
Q

Multiple Myeloma (MM):

A

o check congo red staining because of high association with secondary amyloidosis|• no need to check complement levels|• three criteria|o monoclonal protein in urine/serum (“M” spike) ≥3 g/dL|o 10% or more clonal plasma cells on BM biopsy|o evidence of end-organ damage|• • Lytic lesions on Xray with a negative bone scan:|o o Multiple myeloma NOT prostate cancer|• Smoldering/Asymptomatic- Abscense of EOD|• MGUS- <3 g/dL, <10%, no end organ damage

212
Q

Paclitaxel side effects:

A

o Myelosuppression- pancytopenia|o Peripheral neuropathy|o Hypersensitivity rxn|o Cardiac conduction disturbances- bradycardia|o Steven’ Johnson syndrome, extravasation, alopecia|• Neuroencephalopathy- Grand mal seizures|• Renal impairment|o Arthralgia/myalgias

213
Q

What is the goal INR for Antiphospholipid Ab Syndrome?

A

INR 2-3, if recurrent disease = 3-4

214
Q

Some drugs that affect Coumadin levels:

A

• Major ones are antibiotics and antidepressants|• Amiodarone|o Statins|o Rifampin|o Ketoconazole|o Ranitidine|o Quinidine|o Propanolol

215
Q

Lung CA + Hypercalcemia =

A

Squamous Cell Carcinoma (SCC)

216
Q

Tumor Lysis Syndrome:

A

• usually caused by malignancy with rapid cell turnover- leukemia, burkitts lymphoma|• can be spontaneous or treatment induced|o usually elevated potassium, phosphate and uric acid, decreased Ca, pt goes into DIC and AKI|• Tx = Hydration and Allopurinol, can use risburicase if uric acid significantly increased for quicker action|• Hemodialysis if severe|

217
Q

Steroid side effects:

A

o Adrenal insufficiency, CV collapse, arrythmias|o Cushing’s syndrome > Acne, rash, DM|o Immunosuppression > Infection|o Neutrophilia, Lymphopenia|• Myocardial rupture after MI|• Thromboembolism|• Fluid and electrolyte imbalance > Edema, Elevated BUN with normal Cr|• Increase liver enzymes, Pancreatitis, Peptic ulcers|• Bone marrow suppression/stimulation > Osteopenia/ osteoporosis > Osteonecrosis of femoral head|• Muscle loss/weakness/myopathy |-Steroid psychosis|

218
Q

X-ray shows a calcified strip of spine with medial elbow & foot pain. Diagnosis =

A

DISH (Old DM bear hunter image) = Diffuse Idiopathic Skeletal Hyperostosis

219
Q

DiGeorge Syndrome:

A

CATCH-22, mentally retarded ||Cardiac = Tetralogy of Fallot, Truncus Arteriosus, VSD, ASD, Pulmonary Atresia, Interrupted Aortic Arch |Abnormal facies = micrognathia, microcephaly |Thymus hypoplasia |Cleft palate |Hypoparathyroidism = low PTH, low Ca |22 = chromosome 22q11 deletions ||

220
Q

Elevated serum Tryptase is due to what?

A

o Mastocytosis|o Tryptase is a marker of mast cell degranulation released in parallel with histamine. Total tryptase levels in plasma correlate with the density of mast cells in urticaria pigmentosa lesions in adults with systemic mastocytosis. Total tryptase values are recommended by the WHO as a minor criterion for use in|the diagnostic evaluation of systemic mastocytosis.

221
Q

Pt on Coumadin presents with skin necrosis:

A

Protein C Deficiency

222
Q

6 wks pregnant female with her Td updated last week comes to your clinic in October which other immunization is she qualified for?|

A

Influenza vaccination- inactivated (subq)||Can’t give live (nasal) or MMR, HPV, VZV

223
Q

Pt develops altitude sickness at the start of a ski/mountain vacation in utah or something, how to prevent this in the future?

A
  • Acetazolamide (Diamox) 2 days before leaving
  • “Dos days of Diamox”
224
Q

How can Delirium Tremens kill you?

A

Arrhythmias (V-tach)

225
Q

Causes of Hypophosphatemia:

A

Refeeding Syndrome |Hyperparathyroidism |Respiratory Alkalosis |EtOH > malabsorption |Vitamin D deficiency

226
Q

What findings are a/w Hypophosphatemia?

A

AMS |Weakness, Diplopia |Dysphagia

227
Q

Vitamin B12 Deficiency:

A

CNS demyelination: mania, psychosis, neuropathy > ataxia|Inc Homocysteine & MMA |Need gastric IF |Common in IBD

228
Q

Thiamine Deficiency (B1):

A

Beri-beri|Dry = Korsakoff (confabulation) & Wernicke encephalopathy (Nystagmus, EOM palsies, vomiting)||Wet = Cardiovascular collapse

229
Q

Niacin Deficiency:

A

Pellagra = 4D’s||Diarrhea > Dermatitis, Dementia, Death

230
Q

Folate Deficiency:

A

Weakness > Depression > Palpitations |Megaloblastic anemia

231
Q

Vitamin B6 Deficiency:

A

|”6 Signs of low B6” 1,2,3 + CCB: Bloody Nerves and Skin|Anemia |Peripheral neuropathy, CNS depression |Dermatitis, Seborrheic Keratosis, Conjunctivitis ||”More like amNOdipine”|CCB worsen deficiency > neuromuscular disease, peripheral edema, proteinuria

232
Q

Tx for Torticollis:

A

Botulinum toxin injection

233
Q

Alendronate is a/w:

A

Esophageal ulcers & dysphagia > do NOT give GERD|Osteonecrosis of the jaw |Atypical femur fracture

234
Q

Marfan Syndrome:

A

o Defect in fibrillin gene causing decreased elastin deposition|o MVP, MR, AR, aortic root aneurysm > Acute aortic dissection|o Tall stature, hypermobile joints, arched palate, scoliosis, arachnodactyly|o Subluxation of the lens (ectopia of lens) > myopia, retinal detachment

235
Q

Older man at church, shaking hands, turns his head to one side then becomes nauseous, diaphoretic and passes out. Diagnosis? Tx?

A

-Carotid Hypersensitivity|-Reassuranced

236
Q

Man c/o left leg pain after walking 2 blocks. ABI on left is 0.8 and right is 1.0. What do you do?|A) Peripheral angiography & Stenting|B) Conservative mgmt|C) Increase walking program

A

<0.9 = Risk Factor Mod (quit smoking, walking program, etc)|<0.8 = Vascular Surgery Referral

237
Q

EKG changes, “small” Q’s in II, III, aVF with T-wave inversions; Trop 1.0 & chest pain s/p knee arthroscopy. BP 196/120 with tachycardia, SpO2 95% on NRB. Diagnosis?||A) Pulmonary Embolism|B) Myocardial Infarction|C) Elevated Troponin 2/2 Tachycardia

A

PE with Right Heart Strain (recent surgery, pos Trop, etc)

238
Q

1st line treatment for A-fib w/RVR, HR 110? With LVH?

A

Diltiazem vs. Metoprolol (LVH I’m guessing implying structural heart disease - maybe Metoprolol?)

239
Q

-pulmonary wedge pressure questions x2 in hypotensive ICU pt, one with cardiogenic shock and ok BP. Both had cardiac output 3.0L (low) and cardiac index 1.8 (low) - Just flip and review

A
  • Dobutamine if high PCWP and low cardiac index, SBP 70-100 and no clinical signs of shock
  • Dopamine if signs/symptoms of shock
  • for the question with ok BP, probably Lasix drip
  • PCWP (Pulmonary Capillary Wedge Pressure) is used to estimate left atrial pressure in heart failure. Normal pulmonary artery pressure is 25/10. Normal PCWP is 6-12 or 2-15mmHg. >20 means acute pulmonary edema.
  • Cardiac output should be 4-8 liters, and cardiac index 2.5-4.0L/min/m^2
240
Q

Older male p/w A fib with RVR, elevated troponin (1.0), BP 80/50, what to do next?

A

Cardiovert (unstable A-fib)

Other options were Cardizem, Amiodarone, Digoxin

241
Q

Pt with CHF and NYHA class 2 or 3, (on ACE-I and BB) which additional medication would provide mortality benefit?

A

Spironolactone

242
Q

Pt has hypertension, no family history, Na 146, bicarb 28, potassium 3.0, urine potassium 60 (normal 25-125), what is the most likely diagnosis?

A

Primary Hyperaldosteronism

243
Q

Older woman with CAD and recurrent angina is on multiple meds: nitrates, aspirin, bblocker, etc and still has exertional angina but she doesn’t want any surgery, what do you recommend?

A

Ranolazine for symptomatic Tx

244
Q

Man with stable angina who was nearly maxed out of meds but was borderline hypotensive so another agent could not be added. What do you prescribe?

A

Ranolazine

245
Q

Likely lab finding on question with Sarcoidosis:

A

Hypercalciuria

246
Q

Plaques on lungs describing mesothelioma but states mild fibrosis. What is the patient’s likely occupation?

A

Plumber

247
Q

Patient with COPD, GOLD stage 3 on albuterol and ipratropium, what tx to add?

A

Inhaled steroids

248
Q

Patient with CREST type picture, normal FEV and FEV/FEV1 with DLCO 44% (<45% is severe respiratory impairment), dx?

A
  • Pulmonary HTN
  • Low DLCO and low lung volumes indicate interstitial lung disease, but the question had normal spirometry, so pulmonary hypertension seems to be the answer. Also seen with normal spirometry and low DLCO are rheumatoid arthritis and vasculitides, or anemia
249
Q

Pt has implied unilateral transudative effusion, what the cause?

A
  • Lytes criteria: pleural/serum LDH ratio ≥0.6 or protein ≥0.5, oir LDH > 2/3 upper limit of normal: If any then is exudative
  • In question, believe it was transudative by Lytes, so CHF
250
Q

Pulmonary condition a/w widened mediastinum on CXR?

A
  • Anthrax
  • G+bacillus, box-shaped
  • Occupations that handle wool
251
Q

Non-Hodkins Lymphoma (NHL) patient post chemotherapy, has meningeal symptoms, lumbar puncture shows organism seen on India ink stain(crytococcus). Initial tx with?

A

Liposomal Amphotericin B

252
Q

Pts with late compliment deficiencies are prone to _________ infections.

A

Gonococcal

253
Q

Which persons with valvular replacements need prophylaxis for endocarditis?

A

Bioprosthetic Valves

254
Q

Dog bite (Bug & Tx):

A
  • Pasteurella canis, S. aureus
    • Capnoctyophagia caniformis (asplenia > sepsis w/DIC)
    • Bacteroides sp. Fusobacterium sp.
  • Tx: Augmentin or Clinda + Fluoroquinolone
255
Q

Pt from a hotel with infiltrates on CXR, diarrhea, hyponatremia and positive Dieterle silver stain. Dx?

A

Legionella

256
Q

22y/o male solider returning from Afghanistan had a leg papule turn into a large ulcer. Causative agent?

A

Leishmaniasis from sandlfy

257
Q

HIV pt presents for vaccination with recent Tdap 8 years ago. Which vaccination is contraindicated at this time?

A

Don’t give live viruses in immunocompromised patients (VZV, MMR).

258
Q

Ashkenazi Jewish female, stem says MFEV (Mediterranean Familial Fever) gene? But has AA amyloidosis, what med to both prevent and treat it?

A

Colchicine

259
Q

What medication could cause hypercalcemia 13, hypophosphatemia, and hypomagnesemia

A

Lithium

260
Q

Diet to recommend in epiloeptic patient?

A

Ketogenic

261
Q

Diet to avoid in Parkinson’s pt?

A

High-Protein

262
Q

What pre=op test should you get in a Down Syndrome pt?

A

Cervical X-ray (rule out atlanto-axial instability)

263
Q

What are Down Syndrome with atlatno-axial instability at risk for?

A

C1-C2 myelopathy; ALL

264
Q

Kleinfelter syndrome, gynecomastia, hypogonadism, at increased risk for what?

A

Germ Cell Tumor

265
Q

Menstruating woman p/w severe mastalgia with menses (cyclic mastalgia), treatment?

A

Danazol (picture Tony Danza being like, “Boobs hurt? Alriiight….I got ya!”

266
Q

People with acromegaly are at increased risk for:

A

Colon CA

267
Q

Chlorthalidone is protective against ______.

A

Osteoporosis

268
Q

Pt has a hemorrhagic stroke, is now quadriplegic, mute, and can only move his eye vertically. What’s the location of the stroke?

A

Pons

269
Q

Multiple sclerosis is a/w:

A
  • Oligoclonal band in CSF
  • Scanning speech
  • Optic neuritis
  • Mononeuritis multiplex
  • Increased IgG
270
Q

Central lesion vs. peripheral Bell’s palsy

A

Cannot wrinkle forehead in Bell’s palsy

271
Q

25yr old with suprasellar mass with calcification and lack of peripheral vision:

A

Craniopharyngioma

272
Q

Pt has zoster infection of T5 dermatome, they are at increased risk for what?

A

CVA (or MI)

273
Q

1cm, nummular lesions, erythematous with red/violet centers, most associated with which drug?

A

Sulfa, Anticonvulsants

274
Q

Renal involvement with hemoptysis. Clear lung sounds on exam with benign CXR, with chest and epigastric pain?

A

Goodpasture’s (anti-GBM)

275
Q

Older guy comes in for gross hematuria, UA is done and shows like +1 protein and many RBCs. What is it?

A

We put (hemorrhagic) cystitis (CA); otherwise If dysmorphic > glomerular

276
Q

Recurrent pneumococcal pneumonia with hx of giardia infection?

A

CVID (Common Variable ImmunoDeficiency)

277
Q

Frequent URI with diarrhea?

A

IgA deficiency? CVID again? Not sure

278
Q

Gout, tx in a patient with chronic gout who is allergic to allopurinol?

A

Febuxostat

279
Q

Insidious onset of respiratory symptoms/vague and over 1 months , central sparing, what is it?

A

Chronic Eosinophilic Pneaumonia

280
Q

Pt has hand pain (bilaterally?) with hook like osteophytes on imaging, what is the diagnosis?

A

Hemochromatosis, CPPD if that’s not an option

281
Q

Pt described with Restless Leg Syndrome picture, asks for next step in the workup?

A

B12

282
Q

P/w high fever, joint pain, and salmon colored papular rash, lymphadenopathy, elevated ferritin, negative ANA and rheumatoid factor:

A

Adult onset Still Disease

283
Q

Older male, maybe 60 y/o p/w leg pain and swollen legs improved with elevation. CT shows distal tibial periosteal hypertrophy. Diagnosis?

A

Hypertrophic Osteoarthropathy (periostitis of long bones, digital clubbing, arthritis)

284
Q

Younger female patient with nonspecific fever, myalgia, weight loss, has arm pain with lifting overhead objects (arm claudication, ?subclavian steal). What’s the diagnosis?

A

Takayasu Arteritis

285
Q

Anti-Smith most specific for:

A

SLE

286
Q

Linear hyperdensities B/L knee joint space

A

CPPD

287
Q

Young male (teenage or 20s) with painless? rectal bleeding, negative scope, third presentation with negative past 2 rectal exams, now has objective blood within rectum, dx?

A

Meckel’s Diverticulum

288
Q

60yo female p/w fecal incontinence. She had 4 kids but the largest was only 7 pounds. What was her biggest risk factor for this?

A

Episiotomy

289
Q

Female in her 20s on birth control has a vascular lesion in the liver (likely hemangioma, the most common benign hepatoma), what to do next?

A
  • If lesion is <5cm and asymptomatic, no f/u imaging needed
    • >5cm, f/u imaging 6-12 months
  • If painful or it’s compressing structure, then surgery
290
Q

Guy who works in a warehouse c/o bloody stools for couple of months, non healing ulcer on his leg (pyoderma gangrenosum). What is is?

A

Ulcerative colitis

291
Q

45yo Male with 4cm salmon colored lesion in esophagus (Barrett’s esophagus) how should you treat it?

A

PPI (Don’t think esophagecetomy)

Inservice 2017 (1 decks)

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