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1
Q

Tea + toast diet = what vit deficiency?

A

Folate
(macrocytic anemia)
Also folate is broken down by heat, so heated foods don’t have it either.

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2
Q

potential complication of brochiectasis

A

hemoptysis

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3
Q

what does bronchiectasis look like on ct scan?

A

dilated bronchi with thickened walls

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4
Q

what kind of mutations have the most severe disease? (missense, etc)?

A

nonsense (stop)

and frameshift.

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5
Q

NF2

A 
cafe au lait
acoustic neuromas (schwanomas)/deafness
subcutan neurofibromas (nodules)
fam hx
auto-dom mutation in TSG on chr 22
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6
Q

drug of choice for diabetic neuropathy

A

TCAs (amitriptyline)

gabipentin instead if the TCAs worsen urinary sx or if they cause orthostatic hypotension

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7
Q

Waldenstrom’s macroglobulinemia

A

hyperviscous blood d/t excess IgM production (see IgM spike on electrophoresis)

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8
Q

Primary Hyperaldosteronism (Conn’s)

A 
HTN
mild hyper Na+
hypo K+
metabolic alkalosis (so high bicarb)
low renin
high aldosterone
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9
Q

Rx for uric acid stones

A

alkalinize urine to >6.5 with oral potassium bicarb or potassium citrate

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10
Q

Drug of choice for stable angina w HTN

A

beta blocker

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11
Q

Px’ing sx of PKD

A

HTN, hematuria

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12
Q

What is chemosis?

A

swelling/edema of the conjunctiva

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13
Q

What is asterixis?

A

tremor of hand when wrist is extended

hepatic encephalopathy or wilson’s

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14
Q

periorbital edema + myositis + eosinophilia

A

Trichinellosis (roundworm).

can also have splinter hemorrhages and conjunctival/retinal hemorrhages

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15
Q

Non-pitting edema is due to…

A 
either lymphedema (lymphatic obstruction)
or increased interstitial accumulation of and other proteins, with low-normal lymphatic flow (the myxedema seen in hypothyroidism)
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16
Q

What is myxedema?

A

Cutaneous and dermal edema d/t increased CT deposition, seen in hypothyroidism and also graves

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17
Q

Drug of choice for torsade de pointes

A

Mg sulfate
(including when TdP is caused by digoxin toxicity)
It decreases Ca2+ influx.

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18
Q

Cancer in pancreatic head vs pancreatic body

A

Head- steatorrhea, obstructive jaundice, weight loss

Body/Tail- abd pain rads to back + wt loss

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19
Q

Phys Ex findings in pancreatic ca

A

palpable, non-tender, enlarged GB
virchow’s node- L supraclavicular lymphadenopathy
trousseau’s sign- migratory thrombophelbitis

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20
Q

In what cells is medullary thyroid cancer (MTC)? and what is the serum marker for MTC

A

MTC is in the parafollicular C cells of the thyroid.

Marker is calcitonin. Carcinoembryponic Ag can also be used as a marker.

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21
Q

MEN 2A

A

Pheo
Parathyroid hyperplasia
MTC

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22
Q

Pt w DM and HTN- what is drug of choice?

A

ACE inhib

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23
Q

Finding of osteoblastic metastases in a man means the ca came from where?

A

Prostate

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24
Q

central pontine myelinosis- what is the px?

A

quadriplegia and pseudobulbar palsy

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25
Q

what causes central pontine myelinosis?

A

correcting sodium too quickly

this can also cause cerebral edema

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26
Q

Px of sarcoidosis

A

young afr amer
bilateral hilar adenopathy
pulm infiltrates
skin, eye lesions

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27
Q

Sarcoidosis is a/w palsy of which nerve?

A

CN VII facial- bell’s palsy

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28
Q

How to treat the HTN in pheo?

A

alpha blocker (-zosin)

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29
Q

Pts w mult myeloma are at risk for what vascular problem?

A

hypercoag and DVT

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30
Q

What is the initial treatment for DVT?

A

IV heparin

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31
Q

fever, abd pain, and ascitic fluid polymorphonuclear cell count >250

A

spontaneous bacterial peritonitis

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32
Q

What is most common organism causing SBP (peritonitis)?

A

e. coli

also klebsiella pneumonia

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33
Q

Rx for SBP

A

3rd gen ceph (ceftoxamine)

and repeat percentesis in 48 hrs to confirm it’s working

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34
Q

osler-weber-rendau syndrome

A

hereditary hemorrhagic telangectasia.
vascular lesions- telangectasias, aneurysms, AV malformations- found thru-out body
esp lungs, brain, GI tract

35
Q

Erlichiosis

A 
from ixodes tick
fever, chills
headache
myalgia, malaise
naus/vom
mental stat chg
leukopenia, thrombocytopenia, mild transam elevation.
rx doxy
36
Q

what is CHOP chemo?

A

cyclophosphamide
doxyrubicin
oncovin (vincristine)
prednisone

get it for hodgkin’s lymphoma

37
Q

how to dx mallory-weiss tear

A

hematemesis after excessive vomiting

do an endoscopy to dx

38
Q

primary hyperaldosteronism- electrolytes?

A

hypokalemia!!
metabolic alkalosis (bicarb hi)
HTN
aldo incrs’s Na+ reabs (so hypernatremia) and incrs’s secretion of K+ and H+.

39
Q

treatment for primary hyperaldosteronism

A

spironolactone (bc it’s K+ sparing, and also increases secretion of K+, so want to reverse that). spiro antagonizes aldo receptor in distal conv tubule

40
Q

Large lymphoblasts w prominent nuclei and light blue cytoplasm

A

ALL

acute lymphoid leukemia

41
Q

What drug type can cause bilateral cataracts after prolonged use?

A

high-dose steroids

42
Q

anti-mitochonidrial Ab

A

primary billiary cirrhosis (will also have elevated alk phos)

43
Q

how to tell alcoholic hepatitis apart from viral hep or cholestasis

A

look at the AST to ALT ratio- it is 2:1 in alch, esp if AST is <400

44
Q

rx for alch hep

A

corticosteroids and treat delerium tremens

45
Q

phys exam for differentiating RUQ pain

A

murphy’s sign- pos (painful) in cholecystitis. neg if stones, pyeloneph, or ascending cholangitis

46
Q

Budd-Chiari

A

Caused by hepatic vein thrombosis
usu secondary to hyper-coag states: cancer, prego, OCP use, hematologic dz
Rx thrombolysis, then anti-coag

47
Q

Rx for benzo OD

A

flumazenil

48
Q

PSC primary sclerosing cholangitis

A

inflam and fibrosis of extrahepatic and intrahepatic biliary tree.
pts w UC have increased risk
leads to cirrhosis and hepatic failure
need a transplant

49
Q

Most common benign tumor of lung

A

Hamartoma

hamartomas are common cause of solitary lung nodule (nodule = <3cm)

50
Q

Causes of Conn’s syndrome

A

Conn’s = primary hyperaldo

Caused by adrenal adenoma or adrenocortical hyperplasia

51
Q

Where to insert needle for pericardiocentesis

A

B/t xyphoid process and left costal margin, aim for left shoulder

52
Q

Acute tumor lysis syndrome

A 
Rapid destruction of WBCs by chemo --> rls of intercellular stuff into blood.
Get hyperuricemia (incrsd BUN), which preciptates in renal tubules and causes renal failure, anuria
also causes high K+ levels, which can cause arrhythmia
53
Q

How to prevent acute tumor lysis syndrome?

A

Allopurinol (to prevent uric acid), lots of fluids, close electrolyte monitoring

54
Q

Pts who are most at risk for tumor lysis syndrome

A

ALL pts w high WBC counts at dx

Burkit’s lymphoma pts

55
Q

most sensitive dx’tic test for pheo

A

plasma free metanephrines

urine metanephrines 2nd best

56
Q

10% rule for pheo

A 
10% extra-adrenal
10% familial
10% in kids
10% malignant
10% bilateral
57
Q

Osteitis fibrosia cystica

A

Von Recklinghausen syndrome. HyperPTH –> hi bone turnover, fragile bones. See bone resorption in distal phalanges and subperiosteal regions

58
Q

Lab results in hyperPTH

A 
PTH hi
Ca2+ hi
Phosphate low
Alk phos hi (bc increased bone turnover)
PTH stims osteoclast activitiy
59
Q

Most common cause of bacterial meningitis in adults (<60)

A

Pnemococcus and Meningiocccus

60
Q

Rx for bacterial meningitis in adults s the drugs cover)

A

Vanco & ceftriaxone
Ceft covers S. pneumo, GBS, H. influenza, N. meningitidis
Vanco added for resistant strands of S. pneumo (gram pos orgs)

61
Q

Rx for bacterial meningitis in elderly and infants

A

Ceftriaxone & Vanco (like for adults)

plus ampicillin- this covers for listeria

62
Q

Plummer Vinson syndrome

A

Dysphagia, esophageal webs, anemia (IDA)

63
Q

non-small cell lung cancer

A 
stg 0 - carcinoma in situ
stg 1 - limited local; no nodal/mets
stg 2 - limited local w local nodes
stg 3 - limited local w contralat nodes
stg 4 - distant mets.

for stg 1, surg resection is enough.
stg 2- surg + rads

64
Q

prophylaxis for esphgl varices

A

non-selective B-blockers

they reduce portal and collateral blood flow, reducing rate of bleeding varices

65
Q

hypokalemia on EKG

A

U waves and prolonged QT interval

66
Q

Pt w DKA- what happens to potassium?

A

normal/elevated on initial px d/t K+ mvmt out of cells from secondary acidosis
But, as soon as you give insulin, will drop (a LOT)- can cause hypokalemia.

67
Q

How does cardiac tamponade usu px?

A

Cardiogenic shock: beck’s triad of distant heart sounds, elevated JVP, hypotension

68
Q

restrictive cardiomyopathy

A

decreased ventricular compliance –> impaired ventricular filling
px’s w heart failure (right > left), incrsd JVP, hepatic congestion, ascites, periph edema

69
Q

Constrictive pericarditis vs Restrictive cardiomyopathy- differences in CT and echo

A

Px similarly, but:
Restrictive cardiomyopathy = increased wall thickness on echo, normal pericardium on CT
Constrictive pericarditis = normal wall thickness on echo, thickened and tethered pericardium on CT.
EKG for both shows low voltage.

70
Q

Carcinoid syndrome - triad of sx

A

flushing
diarrhea
hypotension

71
Q

Carcinoid syndrome- what will be elevated in blood? in urine?

A

Increased plasma serotonin

Increased 5-HIAA in urine (byproduct of serotonin metabolism)

72
Q

How do carcinoid tumors affect the heart?

A

Affect R heart d/t fibrinous deposits on R-sided valves, can cause R heart failure

73
Q

Rx for ITP

A

kids- nothing

adults- immunosuppressants or dialysis, or splenectomy

74
Q

APKD w pyleonephritis- Rx?

A

amplicillin and gentamicin

75
Q

How to treat minimal chg dz (nephrotic)?

A

Steroids- prednisone

76
Q

Rx for central DI (and another dz it’s also used for)

A

Desmopressin (DDVAP)

Also used to treat vWF deficiency, so it raises serum vWF

77
Q

Abrupt withdrawal of corticosteroids causes what?

A

(Secondary) adrenal insufficiency

AI sx = fatigue, naus/vom (but not hyperpigment bc ACTH is low)

78
Q

In secondary adrenal insufficiency, what does stim w cosyntropin cause?

A

cosyntropin = ACTH
stim w ACTH causes increased cortisol levels (as ACTH normally would). the problem in secondary! AI is that the HPA is suppressed, so there’s no ACTH. adrenal fn is fine if ACTH is around.

79
Q

Metyropone stimulation in secondary adrenal insufficency

A

Stim with metyropone does NOT cause an increase in ACTH. metyropone inhibits cortisol production at the adrenals. so no cortisol should mean that ACTH would increase, but in secondary! AI, the HPA fails to respond and make ACTH.

80
Q

T/F malignant thyroid nodules are usually painless

A

True.

Tender nodule is usu benign- eg subacute viral thyroiditis or hemorrhage into a benign cyst

81
Q

Sign that a malignant thyroid tumor has spread

A

Hoarseness

82
Q

Massive PE Rx

A

First: hemodynamically stable. give NE to constrict arteries and increase CO. then work on thrombolysis (i don’t quite believe you should give NE- ok for massive PE w hypotension

83
Q

Hypotension in ill pt that doesn’t correct w fluids and pressors

A

Acute adrenal crisis. Inadequate production of cortisol = hypotension, shock, reduced SVR

84
Q

Thrombotic thrombocytic purpura- classic pentad

A 
Thrombocytopenia
Microangiopathic hemolytic anemia (see schistocytes aka helmet cells)
less so:
mental status chgs
fever
renal failure

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