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EORs > Internal Med > Flashcards

Internal Med Flashcards

1
Q

Signs and symptoms of CVA of anterior cerebral artery

A
  • paralysis of contralateral foot and leg
  • sensory loss toes, foot, leg
  • gait/stance impairment
  • flat affect, slow, distracted
  • cognitive impairment
  • urinary incontinence
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2
Q

Myasthenia Gravis

- treatment of choice

A
  • Pyridostigmine
  • immune modulators second line
  • plasmapheresis and IVIG in crisis
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3
Q

Concussion

- sx

A
  • confusion
  • amnesia
  • +/- LOC
  • HA
  • Dizzy
  • Nausea
  • difficulty concentrating
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4
Q

Concussion

- when can return to sports

A
  • when asx and no longer taking medications for sx
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5
Q

Alzheimer treatment that is neuroprotective

A

Memantine

  • NMDA receptor antagonist. Excessinv NMDA stimulation can cause ischemia.
  • Best when used with cholinesterase inhibitor
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6
Q

Alzheimer treatment

- cholinesterase inhibitors

A
  • Donepezil, rivastigmine, galantamine

- improve cholinergic function by inhibiting esterase enzyme

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7
Q

Alzheimer treatment

- cholinesterase inhibitors

A
  • Donepezil, rivastigmine, galantamine

- improve cholinergic function by inhibiting esterase enzyme

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8
Q

MS

- pathophys

A
  • immune mediated

- destruction of myelinated axons in CNS

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9
Q

MS

- clinical

A
  • optic neuritis
  • Heat sensitivity
  • paresthesias
  • muscle cramping / spasm
  • bowel/bladder dysfunction
  • ataxia
  • tremor
  • cognitive changes
  • facial weakness
  • facial muscle twitching
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10
Q

MS

- dx

A
  • clinical manifestations
  • CSF: pleocytosis and elevated gamma globulin
  • MRI: confirmation
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11
Q

MS

- treatment

A
  • Steroids for acute attacks
  • plasma exchange
  • Disease modifying therapy
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12
Q

Sarcoidosis

- most commonly affected parts of boyd

A
  • Lungs
  • Skin
  • lymph nodes
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13
Q

Sarcoidosis

- overview

A
  • noncaseating granulomas in organs and tissues
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14
Q

Sarcoidosis

- skin manifestations

A
  • papular, nodular, plaque-like rashes
  • scarring
  • change in color
  • erythema nodosum
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15
Q

Sarcoidosis

- lung

A
  • bilateral hilar adenopathy
  • diffuse reticular or ground glass opacities
  • Sx: sternal pain, SOB, fatigue, dry cough, wheezing
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16
Q

Sarcoidosis

- lung

A
  • bilateral hilar adenopathy
  • diffuse reticular or ground glass opacities
  • Sx: sternal pain, SOB, fatigue, dry cough, wheezing
  • elevated ACE
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17
Q

Sarcoidosis

- treatment

A

steroids

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18
Q

Sarcoidosis

- treatment

A
  • no cure

- steroids

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19
Q

Chronic pancreatitis

- treatment

A
  • cessation etoh and smoking
  • small, low-fat meals
  • pain: TCAs, narcotics, occasional hospitalizations for NPO
  • pancreatic enzymes
  • medium chain TG - easily absorbed and provide extra calories if weight loss
  • malabsorption vitamins may occur but usu not clinically sx
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20
Q

Secondary prophylaxis for rheumatic fever post acute rheumatic fever with valvular effects

A
  • IM PCN G q 21-28 days until age 40
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21
Q

Heart failure

- RF

A
  • myopathy
  • familial heart dz
  • rheumatic heart dz
  • hyperthyroid
  • pheochromocytoma
  • dyslipidemia
  • DM
  • HTN
  • sleep apnea
  • PAD
  • substance abuse
  • chemo/radiation to chest
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22
Q

ABI

  • ratio of what indicates PAD
  • falsely high reading means what
A
  • <0.90

- falsely high ABI can occur when pt has severely hardened peripheral arteries which are non-compressible

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23
Q

PAD

- treatment

A
  • address underlying dz process
  • antiplatelets
  • stent or sx if severe
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24
Q

Classic signs of acute adrenal insufficiency

A
  • profound weakness
  • severe abd pain
  • peripheral vascular collapse
  • electrolyte abnl
  • shock
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25
Q

Adrenal insufficiency

- labs

A
  • hyponatremia
  • hypoglycemia
  • hyperkalemia
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26
Q

Adrenal insufficiency

- labs

A
  • hyponatremia
  • hypoglycemia
  • hyperkalemia
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27
Q

Adrenal insufficiency

- treatment

A
  • glucocorticoids
  • regulate NA and K
  • fludrocortisone (mineralocorticoid)
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28
Q

How to treat systemic acidosis in status epilepticus

A
  • watchful wait for auto-correction once seizure activity is controlled
  • acidosis thought to have anticonvulsant properties
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29
Q

Status epilepticus

- treatment

A
  • benzo: midazolam, lorazepam, diazepam etc
  • anticonvulsant: phenytoin, fosphenytoin, valproic acid, etc.
  • next step: barbiturate or general anesthetic like propofol
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30
Q

Hypercalcemia

- 2 common causes

A
  • primary hyperparathyroidism

- malignancy

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31
Q

Hypercalcemia

- treatment

A
  • bisphosphonates: zoledronic acid, pamidronate

- refractory: denosumab

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32
Q

Infective endocarditis

- best diagnostic test to confirm

A
  • TEE
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33
Q

Infective endocarditis

- MCC organisms

A
  • IVDA: S. aureus, tricuspid valve

- Native valve: streptococci, mitral vavle

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34
Q

Nephrolithiasis

- stone size and likelihood to pass

A
  • <4-5 mm pass with little medical management

- >8-10 mm unlikely to pass spontaneously, may require stent, nephrostomy, lithotripsy, etc.

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35
Q

Nephrolithiasis

- when is urgent urology referral indicated

A

> 8 mm stone

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36
Q

Kidney findings that require emergent treatment

A
  • hydronephrosis with UTI

- ureteral obstruction in transplanted kidney

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37
Q

nephrolithiasis

- dx

A
  • helical CT
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38
Q

Nephrolithiasis

- mc type stone

A

Calcium oxalate

  • struvite from urease predicting bacteria
  • uric acid: gout
  • cystine: metabolic dz
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39
Q

What metabolic condition does persistent diarrhea cause

A
  • metabolic acidosis

* normal anion gap acidosis, due to loss of bicarbonate

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40
Q

Normal anion gap metabolic acidosis

A
  • diarrhea
  • renal tubular acidosis
  • early renal failure
  • carbonic anhydrase inhibitors
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41
Q

Increased anion gap metabolic acidosis

A

MUDPILES

  • methanol
  • uremia
  • DKA
  • proplyene glycol
  • isoniazid intoxication
  • lactic acidosis
  • ethanol, ethylene glycol
  • salicylates
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42
Q

CAP - how to determine if should be hospitalized?

A

CURB65

  • Confusion
  • Urea > 7
  • RR >=30
  • BP: <= 90 / 60
  • > 65 yo

0-1 point: home tx
2 point: prob admission vs. close outpatient
3+: admission, manage as severe

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43
Q

Hodgkin Lymphoma

- dx

A
  • excisions biopsy: Reed-Sternberg cells
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44
Q

Hodgkin Lymphoma

- clinical

A
  • lymphadenopathy - often cervical and painless
  • pruritis
  • fever
  • night sweat
  • unintentional weight loss
  • ## frequent infection
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45
Q

Hodgkin Lymphoma

- cure rate

A

70-80%

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46
Q

Hodgkin Lymphoma

- remission health maintenance

A
  • Q3 month follow up first 5 years
  • H&P, lab: CBC, lipid, ESR, glucose
  • periodic eval for long term complications: breast, lung cancer, CVD, hypothyroid
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47
Q

Screening for HCC

A
  • liver US q 6 months
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48
Q

HCC

  • MCC
  • sx
  • dx
A
  • HBV and HCV cirrhosis
  • rapidly increasing ascites
  • bloody ascitic fluid
  • increased AFP
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49
Q

Polyarteritis nodosa

- overview

A
  • necrotizing vasculitis
  • medium sized muscular arteries
  • associated with HBV, HCV
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50
Q

Polyarteritis nodosa

- sx

A
  • fatigue, weight loss, weakness, fever, arthralgia
  • skin: tender red nodules, purpura, jivedo reticulaire, ulcers, bullous/vesicular eruption
  • kidneys: HTN, renal failure
  • Neuro: wrist/foot drop
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51
Q

Polyarteritis nodosa

- treatment

A

steroids

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52
Q

Pneumocystitis pneumonia

- organisms

A
  • fungus: pnuemocystis jirovecii
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53
Q

Pneumocystitis pneumonia

- patient most likely to get it

A

HIV with CD4 <200

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54
Q

Pneumocystitis pneumonia

- clinical

A
  • DOE
  • dry cough
  • fever
  • elevated LDH
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55
Q

Pneumocystitis pneumonia

- treatment

A
  • Bactrim first line

- steroids if PO2 <70

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56
Q

Sarcoidosis

- dx if suspicious CXR findings

A

endobronchial lung biopsy

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57
Q

Celiac dz

  • screening
  • confirmation testing
A
  • IgA: Antigliadin antibodies
  • IgA: tissue transglutaminase
  • IgA: endomysial antibodies
  • duodenal biopsy confirmation
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58
Q

Celiac dz

- associated dz

A
  • Dermatitis herpetiformis
  • T1DM
  • Other autoimmune
  • MC in Downs, Turner, Williams syndromes
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59
Q

Paget’s disease of bone

- pathophys

A
  • hyper vascular bone
  • causes osteolysis and then overactive osteoblastic activity = high bone turnover
  • new bone/collagen is disorganized with mosaic pattern “woven bone”
  • weaker, more porous, hyper vascular, prone to fracture
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60
Q

Paget’s disease of bone

- sx

A
  • warmth, tenderness pain at site
  • most are asx
  • MC locations: skull, spine, femur, pelvis**, sacrum
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61
Q

Paget’s disease of bone

- dx

A
  • XR: lytic lesions, bony enlargement, cortisol thickening, etc.
  • Skull has classic “cotton wool” appearance
  • elevated alk phos
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62
Q

Paget’s disease of bone

- tx

A
  • bisphosphonates first line
  • Calcitonin
  • Supplemental Ca and Vitamine D
  • NSAIDS/acetaminophen for pain
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63
Q

Side effect of sildenafil

A 
cyanopsia
- blue discoloration of vision
- more likely with higher doses
- usually temporary
Also: hypotension, flushing, HA
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64
Q

PDE-5 inhibitors

- MoA

A
  • inhibits PDE-5 corpus cavernosum smooth muscle relaxation = blood flow erection
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65
Q

If asthmatic needs to be intubated, what induction agent should be used

A

Ketamine: improves pulmonary function

- direct smooth muscle dilator and increases catecholamines which also dilate smooth muscles tc.

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66
Q

Cardiac biomarkers

  • Detectable time
  • Peak time
  • return to baseline
  • Troponin, Creatinine kinase, myoglobin
A
  • Troponin: 3-12 hr, 34-48 hrs, 5-14 days
  • CK: 3-12 hrs, 24 hrs, 48-72 hrs
  • myoglobin: 1-2 hrs, 8-10 hrs, 1-2 days
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67
Q

type of genetic transmission of hemophilia A and B

A

X-linked recessive

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68
Q

Acute angle closure glacuoma

- dx

A
  • gonioscopy: examine the angle formed between cornea’s posterior surface and iris’ anterior surface
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69
Q

SLE

- lab testing

A
  • ANA (best initial, 95% sensitive)
  • Anti-DNA antibodies
  • Anti-smith antibodies
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70
Q

SLE

- sx

A
  • fever
  • lymphadenopathy
  • weight loss
  • general malaise
  • arthritis
  • malar rash
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71
Q

SLE

- treatment

A
  • NSAIDs
  • steroids
  • immunosuppresants
  • hydroxychloroquine
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72
Q

SLE

- drugs that induce

A

HIPPS

  • hydralazine
  • INH
  • Procainamide
  • Phenytoin
  • Sulfonamides
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73
Q

Iron deficient anemia

- sx

A
  • koilonychia
  • atrophic glossitis
  • angular cheilosis
  • fatigue, weakness, HA
  • pallor
  • dry/rough skin
  • blue sclerae
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74
Q

Jarisch Herxheimer reaction

- explain

A

Classically occurs within first 24 hours after tx for spirochetal infection, syphilis

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75
Q

Jarisch Herxheimer

- clinical

A
  • fever
  • chills
  • malaise
  • HA
  • tender lymphadenopathy
  • worsening infectious lesions
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76
Q

Jarisch Herxheimer

- tx

A

symptomatic: acetaminophen/ibuprofen

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77
Q

Best way to diagnose pneumonconiosis

A

CXR

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78
Q

Carcinoid tumor

- overview

A
  • neuroendocrine tumor
  • usu in GI, then lungs, anywhere else
  • secrete hormones, often serotonin
  • if symptemic symptoms, then considered carcinoid syndrome
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79
Q

Carcinoid syndrome

- sx

A
  • facial/trunk flushing
  • sudden/severe diarrhea
  • telangiectasia
  • wheezing
  • palpitations
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80
Q

Theophylline and acute exacerbation COPD

A
  • contraindicated

- if used for chronic treatment, continue using it to maintain therapeutic serum level

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81
Q

Methotrexate

- Potential severe ADR

A
  • hepatotoxicity
  • Pulmonary toxicity
  • infection
  • myelosuppression
  • lymphoproliferative disorders
  • nephrotoxicity

** check CBC and CMP 6 weeks after changing dose

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82
Q

What vitamin should be started with methotrexate?

A

folic acid - it is a folate inhibitor

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83
Q

What med for rheumatoid arthritis is safe while trying to conceive?

A

hydroxychloroquine

- should stop all RA meds when pregnant but is best option if have to use something

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84
Q

What testing should be done for methotrexate ADR?

A

annual ophthalmic exam

- can cause corneal and macular toxicity

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85
Q

RA

- serologic tests

A
  • RF

- anti-cyclic citrullinated peptide ab

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86
Q

Sjogren’s

- best med for dry mouth

A

Sevimeline

- cholinergic agent

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87
Q

Sjogren’s

- overview

A
  • destruction of exocrine glands (salivary and lacrimal)

- dry mouth and eyes

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88
Q

Sjogren’s

- lab findings

A
  • Anti-Ro/SSA or anti-La/SSB
  • RA
  • hyperglobinemia
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89
Q

Sjogren’s

- dx

A

Schirmer test

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90
Q

Polymyositis

- what muscle is bx for confirmation

A
  • Quadriceps femoris
  • proximal muscle and big
  • can bx deltoid if want UE
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91
Q

what drug can be added to statin to further reduce cardiovascular risk?

A

Ezetimibe: the only non-statin lipid-lowering drug that has proven to have addictive effects on prevention of CV adverse effects

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92
Q

TSH goal for patient post thyroidectomy

A

0.1-2.0

normal 0.5 - 5.0

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93
Q

Most common type of thyroid cancer

A

papillary

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94
Q

Pheochromocytoma

- meds that should be dc on diagnosis

A

meds that stimulate pheo activity:

  • BB (without alpha blocking agents)
  • glucagon
  • metoclopramide
  • histamine
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95
Q

When to start lipid screening

  • male
  • female
  • with and without RF
A
  • Male >= 35
  • male 20-35 with RF
  • Female >= 45
  • Female 20-45 with RF
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96
Q

What HF patients need hospitalization?

A
  • dyspnea at rest
  • ACS
  • hemodynamically sig dysrhythmias
  • acute decompensation: low bp, AMS, worsening renal function
  • new onset HF with congestion
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97
Q

Outpatient med treatment of HF

A
  • diuretics
  • ACEi
  • positive inotropes
  • BB
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98
Q

Myocarditis

- causes

A
  • infection
  • autoimmune
  • cardiotoxic drugs
  • systemic inflammation
  • radiation
  • idiopathic
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99
Q

Myocarditis

- s/sx

A
  • asx
  • HF, sudden cardiac death
  • fatigue, exercise intolerance
  • chest pain, pericarditis
  • Nonspecific ST changes
  • ECHO: nl or wall motion defects
  • cardiac enzyme elevations
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100
Q

Myocarditis

- Dx

A
  • clinical presentation
  • Cardiac cath and cardiac MRI to differentiate from MI
  • endomyocardial bx for definitive dx but usually not done
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101
Q

Myocarditis

- tx

A
  • usually supportive bc MCC is viral
  • DC drug if cause
  • steroids
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102
Q

Cause of jaundice in thyroid storm

A

hepatic tissue hypoxia due to increased peripheral consumption of O2

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103
Q

PTU and Methimazole MoA

A
  • Both: block synthesis of thyroid hormone

- PTU: also inhibits conversion of thyroxine to triiodothyronine

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104
Q

Thyroid storm treatment

A
  1. BB
  2. PTU (or methimazole)
  3. Iodine
  4. Steroids
  5. Bile acid sequestrant
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105
Q

Polycystic kidney disease

- genetics

A
  • Autosomal dominant

- Cyst formation and kidney enlargement

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106
Q

Polycystic kidney disease

- Clinical

A
  • abdominal, flank, back pain
  • HTN (usu diastolic elevation)
  • palpable bilateral flank mass, nodular hepatomegaly, sx related to renal failure
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107
Q

Polycystic kidney disease

- Dx

A

US test of choice

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108
Q

Polycystic kidney disease

- management

A
  • blood pressure control: ACEi/ARB
  • electrolyte management
  • UTI prevention/tx
  • pain management
  • nephrectomy
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109
Q

Polycystic kidney disease

- complications

A

ESRF by age 60 = dialysis or kidney transplant

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110
Q

Renal cell carcinoma

- incidence

A

MC type kidney cancer adults

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111
Q

Renal cell carcinoma

- RF

A

cigarette smoking**

  • obesity
  • chemical exposure
  • HTN
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112
Q

Renal cell carcinoma

  • classic sx triad
  • other sx
A
  • flank pain
  • hematuria
  • flank mass
    • few actually present this way
  • weight loss
  • fever
  • HTN
  • hypercalcemia
  • night sweats
  • malaise
  • L varicocele in men
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113
Q

Renal cell carcinoma

- dx

A
  • UA: abnl cells
  • CBC: anemia/infection
  • Electrolytes: eval kidney function
  • CT, PET, US, MRI
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114
Q

Renal cell carcinoma

- managemetn

A

surgical resection

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115
Q

Antiphospholipid syndrome

- overview

A
  • hypercoagulable state

- recurrent venous/arterial thrombosis at early age

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116
Q

Antiphospholipid syndrome

- who should be tested

A
  • thrombosis with no RF
  • miscarriage - esp late trimester or recurrent
  • heart murmur or valvular vegetation
  • heme abnl
  • pulm htn
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117
Q

Antiphospholipid syndrome

- testing

A
  • lupus anticoagulant
  • anticardiolipin
  • anti-beta 2 glycoprotein I ab
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118
Q

Antiphospholipid syndrome

- management

A
  • Low dose ASA for primary prevention of thrombotic events

- Warfarin for recurrent thrombotic events

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119
Q

Pulmonary Fibrosis

- overview

A
  • fibrosing interstitial pneumonia
  • MC in M > 50
  • linked to cigarette smoking
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120
Q

Pulmonary Fibrosis

- pathophys

A
  • epithelial cell damage
  • impropre repair
  • chronic/progressing sx
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121
Q

Pulmonary Fibrosis

  • Sx
  • PE
A
  • chronic nonproductive cough
  • gradual DOE
  • bibasilar crackles, digital clubbing
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122
Q

Pulmonary Fibrosis

- Dx

A

CT: structural change t lung parenchyma, honeycombing

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123
Q

Hyponatremia

- three types

A
  • isotonic / pseudohyponatremia
  • hypertonic
  • hypotonic / True hyponatremia (MC)
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124
Q

Hyponatremia

- MCC

A

disordered renal excretion of water

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125
Q

Hyponatremia

- hypertonic

A
  • increased conc serum solutes
  • increased tonicity draws water into serum = dilution of serum concentration
  • ex. hyperglycemia, IVIG, mannitol administration
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126
Q

Hyponatremia

  • hypotonic
  • associated diseases, etc.
A
  • renal failure
  • CHF
  • liver failure
  • SIADH
  • hypothyroid
  • GI fluid losses
  • Drugs: thiazide, ecstacy
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127
Q

Hyponatremia

  • correction rate
  • to avoid what
A
  • <8 mEq/L in 24 hours

- avoid osmotic demyelination syndrome

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128
Q

Diabetes insipidus

- two types

A
  • Central: MC, deficient secretion of ADH by posterior pituitary
  • Nephrogenic: kidney’s resistant to ADH
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129
Q

Diabetes insipidus

- Central causes

A
  • idiopathic
  • head trauma
  • pituitary sx
  • encephalopathy
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130
Q

Diabetes insipidus

- presentation

A
  • polyuria
  • polydipsia
  • hypernatremia if impaired thirst drive
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131
Q

Diabetes insipidus

- lab

A
  • low specific gravity urine
  • low urine osmolality
  • high plasma osmolality
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132
Q

Diabetes insipidus

- dx

A

Water restriction test

- positive if continue to produce dilute urine with low osmolality and spec gravity

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133
Q

Diabetes insipidus

- test to differentiate between central and nephrogenic

A

Desmopressin stimulation test

  • Central: urine osmolality will increase dt response to ADH
  • nephrogenic: dilute urine continues, no response to ADH
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134
Q

Diabetes insipidus

- management

A

desmopressin acetate

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135
Q

Histoplasmosis

  • location
  • associated with what
A
  • Ohio and Mississippi River valleys

- spelunking, caves, bats, bird droppings

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136
Q

Histoplasmosis

- sx

A
  • asx
  • mild influenza-like illness
  • 103 days
  • cough, chest pain
  • often dx as atypical PNA
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137
Q

Histoplasmosis

- sx of progressive disseminated

A
  • HIV

- fever, weight loss, cough, dyspnea, oropharyngeal ulcers, etc.

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138
Q

Histoplasmosis

- management

A
  • itraconazole

- amphotericin B for severe

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139
Q

Scleroderma

- overview

A
  • autoimmune dz
  • vascular damage and excess production and deposition of collagen
  • Almost 100% skin involvement
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140
Q

Scleroderma

- common early sx

A
  • skin tightening around fingers

- pitting of fingertips

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141
Q

Scleroderma

- two main kinds

A
  • localized

- systemic

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142
Q

PAD

- core treatment

A
  • ASA
  • statin
  • smoking cessation
  • structured exercise
  • Cilostazol
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143
Q

WPW

- EKG findings

A
  • slurred upstroke QRS (delta wave)
  • Wide QRS (>120 msec)
  • short PR (<120 msec)
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144
Q

WPW

- treatment

A
  • ablation

- procainamide/quinidine

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145
Q

PNA

  • treatment outpt
  • treatment inpt
A
  • macrolide or doxy

- FQ or ceftriaxone/cefotaxime + macrolide X 5D or until afebrile 48-72 hrs

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146
Q

Acute exacerbation chronic bronchitis

- tx

A
  • 2nd gen ceph

- macrolide or bactrim

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147
Q

Medical management of COPD

A
  • anticholinergics - ipatropium and tiotroprium
  • SABA for acute exacerbation dyspnea
  • Oral abx for infections
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148
Q

PE

- dx

A
  • spiral CT
  • ABG: resp alkalosis secondary to hyperventilation
  • EKG: S1Q3T3
  • VQ
  • D-dimer: can rule out if negative and had low pre-test probability
  • Angiography is definitive test of choice
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149
Q

PE

- Management

A
  • anticoagulation: heparin for acute, LMWH or warfarin after acute phase
  • Factor Xa inhibitors and direct thrombin inhibitors alt options
  • min 3 months
  • vena cava filter: helpful if high risk recurrance
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150
Q

Pulmonary Hypertension

- s/sx

A
  • dyspnea
  • angina-like retrosternal pain
  • waekness
  • fatigue
  • edema
  • ascites
  • cyanosis
  • effort syncope
  • narrow splitting/accentuation of second heart sound and systolic ejection click
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151
Q

Pulmonary Hypertension

- Dx

A
  • CXR: enlarged pulm arteries
  • EKG: RVH, atrial hypertrophy, RV strain
  • Echo: estimate pulm arterial pressure
  • Right heart cath: precise hemodynamic monitoring. >= 25 mmHg is dx
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152
Q

Pulmonary Hypertension

- management

A
  • oral anticoagulant
  • CCB: lower systemic arterial pressure
  • treat underlying disorder
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153
Q

Idiopathic pulm fibrosis

  • overview
  • RF
A
  • C dx among pt with interstitial lung dz
  • Men 50-75
  • RF: smoking, wood/metal dust, virus, DM, GERD
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154
Q

Idiopathic pulm fibrosis

- S/Sx

A
  • insidious dry cough, exertional dyspnea, constitutional sx

- clubbing of fingers, inspiratory crackles

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155
Q

Idiopathic pulm fibrosis

- dx

A
  • CXR: progressive fibrosis over several years
  • CT: diffuse, patchy fibrosis with honeycombing
  • PFT: restrictive (dec lung volume, normal/increased PEV1/FVC)
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156
Q

Pneumoconioses

- overview

A
  • chronic fibrotic lung dz

- inhalation dusts, lots of kinds

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157
Q

Pneumoconioses

- Asbestosis: occupation, dx, complications

A
  • insulation, demolition, construction
  • CXR: linear opacities at bases, pleural plaques
  • Bx: asbestos bodies
  • complications: lung cancer, mesothelioma (esp if smoke)
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158
Q

Pneumoconioses

- Coal workers: occupation, dx, complications

A
  • coal mining
  • CXR: nodular opacities upper lung fields
  • progressive massive fibrosis
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159
Q

Pneumoconioses

- Silicosis: occupation, dx, complications

A
  • mining, sand, stone, quarry
  • CXR: nodular opacities upper lung fields
  • Inc risk TB, progressive massive fibrosis
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160
Q

Pneumoconioses

- Berylliosis: occupation, dx, complications

A
  • high tech: aerospace, nuclear power, ceramics, etc.
  • CXR: diffuse infiltrates and hilar adenopathy
  • requires chronic steroids
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161
Q

Pneumoconioses

- management

A
  • supportive: O2, vaccinations, rehab

- smoking cessation

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162
Q

ARDS

- clinical setting

A
  • Sepsis
  • severe multiple trauma
  • aspiration of gastric contents
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163
Q

ARDS

- pathophys

A
  • increased permeability of alveolar capillary membranes = protein rich pulmonary edema
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164
Q

ARDS

- clinical

A
  • rapid onset profound dyspnea 12-24 hours after precipitating event
  • PE: tachypnea, frothy pink/red sputum, diffuse crackles
  • cyanosis, severe hypoxemia refractory to O2
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165
Q

ARDS

- mgmt

A
  • Tx underlying condition
  • supportive: O2 via intubation with Positive pressure ventilation and PEEP

** high rate of mortality!!

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166
Q

Pneumonia

- MC org in children >5

A
  • mycoplasma pneumonia

- strep pneumonia

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167
Q

Pneumonia

- treatment for atypical CAP

A

macrolide - azithromycin

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168
Q

What is used to determine if pleural effusion is exudative or transudative

A

Light Criteria

  • pleural:serum protein
  • pleural:serum LDH
  • pleural fluid LDH
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169
Q 
Light criteria (pleural fluid)
- Transudate
A
  • pleural:serum protein <0.5
  • pleural:serum LDH <0.6
  • pleural fluid LDH <2/3 upper limit nl
  • HF, cirrhosis, nephrotic syndrome, PE
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170
Q 
Light criteria (pleural fluid)
- Exudate
A
  • pleural:serum protein >=0.5
  • pleural:serum LDH >=0.6
  • pleural fluid LDH >2/3 upper limit nl
  • malignancy, pneumonia, TB, PE, pancreatitis, etc
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171
Q

who should be screened for lung cancer

A
  • adults 55-80

- 30 year smoking history and currently smoke or quit within the last 15 years

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172
Q

Carcinoid syndrome

- treatment

A

octreotide

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173
Q

Solitary pulmonary nodule

- risk by size and follow up

A
  • <6 mm - low risk - no follow up necessary
  • 6-8 mm: follow via CT
  • > 8 mm: serial CT if low to intermediate risk
  • if high prob of malignancy, bx and excision should be considered
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174
Q

Lofgren syndrome

A
  • acute presentation of sarcoidosis
  • hilar adenopathy, erythema nodosum, polyarthralgia
  • MC in women
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175
Q

Carcinoid syndrome

- dx

A

24-hour excretion of 5-hydroxyindoleacetic acid (5-HIAA), the end product of serotonin metabolism

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176
Q

Pneumonia

- MC bacteria infection sp influenza

A
  • staph aureus
  • necrotizing pneumina
  • gram positive cocci in clusters
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177
Q

Causes of acute cor pulmonale

A
  • PE
  • ARDS

**usually chronic (COPD)

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178
Q

common side effect of SABA

A
  • tremor
  • tachycardia
  • hypokalemia (inc activity Na-K-ATPase pump)
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179
Q

Sarcoidosis

- MC lab abnormality

A

hypercalcemia

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180
Q

What meds are used to rate control a fib.

A
  • CCB: diltiazem or verapamil

- BB: metoprolol

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181
Q

Congenital long QT syndrome

- treatment

A

propranolol

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182
Q

Medication of choice to treat a. fib with RVR in patient who also has compensated systolic HF

A

carvedilol

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183
Q

Supraventricular tachycardia

- treatment

A
  • vagal maneuver: cold face, blow through straw, gag reflex

- Meds: adenosine, procainamide, amiodarone, BB

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184
Q

When is verapamil CI

A
  • <1 years old
  • children with HF
  • suspected WPW syndrome
  • wide QRS complex
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185
Q

what med can be used in patients with chronic stable angina who remain symptomatic?

A

ranolazine

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186
Q

EKG findings in hyperkalemia

A
  • peaked T wave
  • prolonged PR
  • wide QRS
  • eventually sine wave
187
Q

What tachydysrythmythia is MC with sick sinus syndrome

A

atrial fibrillation

188
Q

Stable pt with ventricular fibrillation - medication of choice

A

procainamide

189
Q

Min recommended anticoagulation after cardioversion for a fib

A

30 days

190
Q

MCC tricuspid valve stenosis

A

rheumatic heart dz

191
Q

Polyarteritis Nodosa

- overview

A
  • autoimmune dz

- necrotizing vasculitis of small and medium muscular arteries and renal and visceral arteries

192
Q

Polyarteritis Nodosa

- presentation

A
  • cutaneous manifestations
  • constitutional: fever, asthma, myalgias
  • nodules: painful violacious plaques surrounded by lived reticularis “starburst”. Classically on lower legs
193
Q

Polyarteritis Nodosa

- Untreated =

A
  • CV involvement
  • bowel infarction and perforation
  • renal failure
    • high morbidity and mortality
194
Q

Polyarteritis Nodosa

- Dx

A

deep wedge biopsy of suspicious nodules

195
Q

Polyarteritis Nodosa

- Treatment

A

steroids

196
Q

What cholesterol medication can exacerbate gout and elevate blood sugar?

A

Niacin

197
Q

DMARDS ADR

A
  • Common: nausea, vomiting, diarrhea, rash

- bone marrow suppression

198
Q

Methotrexate

- common ADR

A

hepatitis and hepatic toxicity

199
Q

Polymyositis

- overview

A

idiopathic inflammatory myopathy

- common F >50

200
Q

Polymyositis

- presentation

A
  • proximal myalgia/weakness
  • pharyngolaryngeal weakness: dyspnea, pysphagia, pysphonia
  • Classic findings: heliotrope rash (eyelids), cloak-like/cape rash on neck shoulders and chest, Gottron’s papules (scaly purple thick knuckle skin)
201
Q

Polymyositis

- Treatment

A
  • steroids
202
Q

What common medication can cause gout

A
  • diuretics: loop or thiazide

- decrease rate excretion

203
Q

Rheumatoid Arthritis

- overview

A
  • chronic, inflammatory
  • autoimmune
  • symmetric destructive polyarthropathy
  • incidence inc 25-55 years
  • F>M
204
Q

Rheumatoid Arthritis

- clinical

A
  • Pain worse in am, better with activity
  • insidious onset
  • swelling
  • usu peripheral joints
  • polyartricuar
  • ulnar deviation
  • flexor tenosynovitis
  • boutonniere deformity and swan-neck deformity
205
Q

Scleroderma

- MC lab finding

A

ANA +

206
Q

What medication helps with drymouth

A

Pilocarpine

Sjogrens

207
Q

Raynaud’s

- medical treatment

A
  • ASA
  • Prostaglandins
  • vasodilators
  • CCB
208
Q

Infections that MC cause reactive arthritis

A
  • enteric: c. jejune and shigella dysenteriae

- GI: chlamydia

209
Q

Cholchicine toxicity

A

severe GI distress first 24 hours

210
Q

Polymyalgia Rheumatica

- clinical

A
  • symmetrical aching and stiffness
  • shoulders, hip, neck, torso
  • worse in AM
  • > 50
211
Q

Polymyalgia Rheumatica

- tx

A

steroids

212
Q

Major ADR of long term use of hydroxychloroquine

A

retinal toxicity

- ophthalmologic exam q 6-12 months

213
Q

What med can be used for gout if colchicine and NSAIDs are CI

A

corticosteroids

214
Q

Esophageal cancer

- types

A
  1. Squamous cell

2. adenocarcinoma

215
Q

Esophageal cancer

- squamous cell RF

A

Tobacco

Etoh

216
Q

Esophageal cancer

- adenocarcinoma

A
  • Barrett’s metaplasia (chronic untreated GERD)

-

217
Q

Esophageal cancer

- presentation

A
  • progressive dysphagia

- weight loss common

218
Q

Esophageal cancer

  • dx
  • location of each type
A
  • EGD w/ bx
  • SCC: middle thoracic esophagus
  • Adeno: distal esophagus and GE junction
219
Q

Schatzki Ring

A
  • MC esophageal structural abnl
  • fibrous esophageal ring leads to esophageal stenosis
  • dysphagia
220
Q

Achalasia

- overview

A
  • MC dysmotility disorder
  • dysphagia
  • often pt <50
221
Q

Achalasia

- pathophys

A
  • loss of Auerbach’s plexus in esophagus
  • narrowing of lower esophageal sphincter (LES)
  • “bird beak” appearance
222
Q

Achalasia

- clinical

A
  • dysphagia to solids and liquids. Liquids often most problematic
  • difficulty belching
  • chest pain
  • regurg undigested food
  • dyspepsia
  • aspiration
223
Q

Achalasia

- Dx

A
  • barium esophagram = birds beak

- confirm with esophageal manometry

224
Q

Achalasia

- mgmg

A
  • balloon dilation of LES

- myotomy with fundoplication

225
Q

Mallory-Weiss Syndrome

- pathophys

A
  • laceration to gastric cardia due to forceful vomiting
  • often also have hiatal hernia
  • longitudinal mucosal lacerations
226
Q

Mallory-Weiss Syndrome

- RF

A
  • forceful vomiting or other causes of intra-abdominal pressure increase: cough, strain, etc.
  • Etoh
  • ASA
  • bulimia
227
Q

Mallory-Weiss Syndrome

- Dx

A
  • upper GI bleed with hx of vomiting or retching

- Upper endoscopy to confirm

228
Q

Mallory-Weiss Syndrome

- mgmg

A
  • supportive
  • endoscopic treatment if active bleeding
  • Acid suppression if no active bleeding
229
Q

Esophageal varices

- cause

A
  • cirrhosis > portal hypertension > varices
230
Q

Esophageal varices

- acute mgmg

A
  • hemodynamic resuscitation
  • octreotide
  • banding/sclerotherapy
  • prophylactic abx
231
Q

Esophageal varices

- chronic mgmt

A
  • BB

- endoscopic variceal ligation

232
Q

Esophageal varices

- Dx

A
  • upper endoscopy: dilated submucosal gastric veins
233
Q

Gastric cancer

- Overview

A
  • MC adenocarcinoma
  • mean age dx 70
  • M>F
234
Q

Gastric cancer

- RF

A
  • nitrates
  • h. pylori
  • tobacco use
235
Q

Gastric cancer

- clinical

A
  • upper abd pain: vague or severe
  • postprandial fullness
  • early satiety
  • nausea
  • weight loss
  • recurrent vomiting
236
Q

Gastric cancer

- PE

A
  • palpable enlarged stomach

- enlarged liver

237
Q

Gastric cancer

- mgmt

A
  • chemo
  • resection
  • radiation
238
Q

Gastric cancer

- dx

A

EGD

239
Q

Benign esophageal stricture

- Causes

A
  • Chronic reflux esophagitis
  • medications
  • Radiation
  • Eosinophilic esophagitis
240
Q

Benign esophageal stricture

- Sx

A
  • MC: progressive solid food dysphagia
  • liquid dypshagia
  • heartburn
  • odynophagia
  • weight loss
  • chest pain
  • et.
241
Q

Benign esophageal stricture

- Dx

A
  • Barium esophagram
  • endoscopy
  • esophageal manometry
  • 24 hour ph monitoring
242
Q

Benign esophageal stricture

- MC initial treatment

A
  • balloon dilation

- PPI

243
Q

Trousseau’s syndrome

  • associated with what
  • describe
A
  • pancreatic cancer

- migratory thrombophlebitis

244
Q

Courvousier’s sign

  • associated with what
  • describe
A
  • pancreatic cancer

- palpable, contender gallbladder

245
Q

Primary adrenal insufficiency

- overview

A
  • MCC autoimmune adrenalitis

- loss of glucocorticoids, mineralocorticoids, adrenal androgens

246
Q

Primary adrenal insufficiency

- clinical

A
  • hyperpigmentation
  • fatigue
  • anorexia
  • orthostasis
  • n/v/d
  • abdominal pain
  • muscle and joint pain
  • salt craving
247
Q

Primary adrenal insufficiency

- dx

A
  • serum morning cortisol level first
  • confirm with ACTH stimulation test
  • ACTH to differentiate between causes
248
Q

Primary adrenal insufficiency

- mgmt

A
  • hydrocortisone

- supportive

249
Q

Primary adrenal insufficiency

- labs

A
  • reduce sodium and glucose

- increased potassium

250
Q

Thyroid storm

- RF

A
  • sx
  • trauma
  • infectin
  • acute iodide load
  • parturition
251
Q

Thyroid storm

- clinical

A
  • tachycardia >140
  • HF
  • Hypotension
  • Dysrhythmia (a. fib)
  • Hyperpyrexia
  • Agitation
  • Psychosis, stupor
  • Coma
252
Q

Thyroid Storm

- Labs

A
  • Low TSH

- High FT3,4

253
Q

Thyroid STorm

- Mgmg

A
  • BB: propranolol
  • Thionamides (PTU)
  • Iodine (after thionamide)
  • Steroids
  • Bile acid sequestrants
254
Q

Diabetes

- diagnostic criteria

A
  • Sx + random glucose >200
  • Fasting >126 on two occasions
  • Plasma glucose >200 2 hours after 75 glucose load OGTT
  • A1C > 6.5% (adults)
255
Q

Hashimotos’ thyroiditis

- ab

A
  • anti-thyroid peroxidase ab

- anti-thyroglobulin ab

256
Q

Diabetes insipidus

- overview

A
  • disorder of ADH fn
  • central: production
  • nephrogenic: action at the kidney
257
Q

Diabetes insipidus

- clinical

A
  • polyuria

- polydipsia

258
Q

Diabetes insipidus

- labs

A
  • UA without glucose or protein
  • UA with low specific gravity, low osmolality, dilute color
  • Increased serum osmolality
259
Q

Diabetes insipidus

- dx

A
  • UA

- desmopressin stimulation test to determine type

260
Q

Diabetes insipidus

- mgmt

A
  • central: DDAVP

- Nephrogenic: hctz, amiloride, indomethacin

261
Q

Acromegaly

- clinical

A
  • insidious onset
  • enlarged supraorbital ridges, mandible
  • widened nose
  • arthralgia, fatigue, hA
  • increased ring/shoe size, visual field defects
  • weight gain
  • bone growth
  • glucose intolerance
262
Q

Acromegaly

- pathophys

A
  • growth hormone secreting pituitary adenoma
263
Q

Acromegaly

- dx

A
  • Initial: serum IGF-1
  • GH blood test
  • MRI to confirm
264
Q

Acromegaly

- mgmt

A

transsphenoidal sx to remove adenoma

265
Q

Graves

- which medication best during pregnancy

A
  • PTU 1st and 2nd trimester

- Methimazole 3rd trimester

266
Q

What medication blocks the release of stored thyroid hormone

A

Iodine

267
Q

Major ADR of GLP-1 medication

A

pancreatitis

268
Q

TIA

- medication mgmt

A

ASA

also clopidogrel and combo therapy

269
Q

Guillain-Barre

- overview

A
  • acute immune-mediated polyneuropathy
270
Q

Guillain-Barre

- related to what infection

A

Campylobacter jejuni

271
Q

Guillain-Barre

- clinical

A
  • progressive, ascending, symmetric muscle weakness

- absent or depressed DTR

272
Q

Guillain-Barre

- Dx

A
  • clinical

- Lumbar puncture: albuminocytologic dissociation: elevated protein with normal/mild pleocytosis

273
Q

Guillain-Barre

- mgmt

A
  • supportive
  • measure vital capacity and negative inspiratory force
  • plasmapheresis
  • IVIG
274
Q

What anticonvulsant is highly teratogenic?

A

valproic acid

275
Q

Trigeminal neuralgia

- medication

A

Carbamazepine

276
Q

Migraine

- Acute exacerbation

A
  • Triptans
  • Ergots
  • NSAIDs
  • Acetaminophen
  • Antiemetics
277
Q

Migraine

- prophylaxis

A
  • Propranolol
  • verapamil
  • Amytriptyline
  • Valproic acid, topiramate
  • Botox
278
Q

Intracranial neoplasm

  • MCC
  • other common casues
A
  • metastases (lung, breast)
  • Meningioma MC primary
  • Glioma MC malignant
279
Q

HA from brain tumor are classically worse during what time of day

A

morning - intracranial pressure highest after night of recumbent posture

280
Q

Huntington’s Disease

- genetics

A
  • autosomal dominant

- CAG trinucleotide repeats

281
Q

Huntington’s Disease

- pathology

A
  • neuronal loss
  • astrogliosis
  • atrophy of caudate nucleus and pitman (basal ganglia) and cerebral cortex
282
Q

Huntington’s Disease

- 3 main sx

A
  • movement disorder: chorea, ballism, dystonia, parkinsonian features
  • cognitive: dementia
  • mood/behavior: depression, bipolar, psychosis, personality, sex/sleep disturbance
283
Q

Chorea

A
  • excessive, spontaneous and abrupt movements or irregular frequency and random distribution
  • Ex: restlessness, fidgeting, gesture and facial expression alterations and dancelike gait
284
Q

choreathetosis

A

slow distal writhing movements

- milder form chorea

285
Q

Ballism

A

gross, proximal, flinging movements of the extremities

286
Q

Athetosis

A

contorted, twisting movements

287
Q

Huntington’s Disease

- Mgmt

A
  • benzos
  • dopamine-depleting meds
  • dopamine-antagonist meds
288
Q

Subdural hemorrhage

- chronic vs. acute

A
  • acute within 3 days of presentation

- chronic: >3 weeks old

289
Q

Chronic Subdural hemorrhage

- who is at elevated risk

A
  • elderly

- alcoholic

290
Q

Chronic Subdural hemorrhage

- clinical presentation

A
  • insidious onset HA
  • cog impairment
  • somnolence
  • occasional seizures
291
Q

Chronic Subdural hemorrhage

- imaging

A
  • CT: hypodense (dark) crescent (isodense compared to cerebrospinal fluid)
292
Q

Epidural vs. subdural hematoma

A

Epidural

  • artery (middle meningeal): rapid expansion
  • skull fracture
  • dura pushed inward (convex)

Subdural

  • bridging veins: slow expansion
  • does not cross falx, tentorium bc dura attached to the skull
293
Q

Epidural vs. subdural hematoma

A

Epidural

  • artery (middle meningeal): rapid expansion
  • skull fracture
  • dura pushed inward (convex)

Subdural

  • bridging veins: slow expansion
  • does not cross falx, tentorium bc dura attached to the skull
294
Q

Caloric testing

A
  • tests oculovestibular reflex of eye
  • intact brain stem will = nystagmus
  • truly comatose = no response
    • COWS: cold opposite (fast portion will beat towards opposite ear) and warm same
295
Q

Increased intracranial pressure

- triad of sx

A

Cushing Triad:

  • bradycardia
  • HTN
  • irregular breathing
  • sign of impending brain herniation…
296
Q

Parkinson’s Disease

- MC medication

A

L-dopa: carbidopa/levodopa

  • Levodopa converted to dopamine in brain
  • carbidopa prevents conversion in peripheral circulation
  • Con: increased dose required over time, does not slow dz progress, causes tardive dyskinesia
297
Q

Parkinson’s Disease

- med for motor abnl

A

dopamine agonists

  • bromocriptine
  • pramipexole
  • ropinirole
  • less benefit but less side effects than L-dopa
298
Q

Parkinson’s Disease

- med for motor abnl

A

dopamine agonists

  • bromocriptine
  • pramipexole
  • ropinirole
  • less benefit but less side effects than L-dopa
299
Q

Parkinson’s Disease

- pathophys

A
  • lewy bodies (intracellular cytoplasmic inclusions)
  • dopaminergic neuron loss in substantia nigra
  • depigmentation
300
Q

Meningitis

  • MCC for all ages
  • 2nd MCC
A
  • Streptococcus pneumonia

- Neisseria meningitidis: older children/young adults (dorm, military)

301
Q

Which infectious org is most commonly associated with meningitis with petechiae?

A

N. meningitidis

302
Q

Meningitis

- empiric treatment

A
  • Ceftriaxone + vancomycin

- add ampicillin if >50 or etoh (listeria)

303
Q

Meningitis

- empiric treatment

A
  • Ceftriaxone + vancomycin

- add ampicillin if >50 or etoh (listeria)

304
Q

Classic triad of bacterial meningitis

A
  • fever
  • AMS
  • nuchal rigidity
305
Q

Meningitis

  • Brudzinski
  • Kernig
A
  • Neck flexion = hip/knee flexion

- Flex hip and knee to 90, pain if extend the knee

306
Q

Dystonic reaction

- medication to tx

A
  • benztropine
  • diphenhydramine
    (anticholinergics)
307
Q

Alzheimer Disease

- memory loss

A
  • remote memory preserved better than recent memory
308
Q

Alzheimer Disease

- progression

A
  • ST memory loss
  • Language difficulty, disorientation, mood swing, loss motivation, self care
  • withdrawal
  • loss bodily fn
  • death
309
Q

Glasgow Coma Scale

- Eye

A

4 spontaneous
3 opens to verbal
2 opens to pain
1 none

310
Q

Glasgow Coma Scale

- Verbal

A 
5 oriented
4 confused
3 inappropriate response, discernible words
2 incomprehensible
1 none
311
Q

Glasgow Coma Scale

- motor

A 
6 obeys commands
5 purposeful movement from pain
4 withdraws from pain
3 flexion/decorticate
2 extension/decerebrate
1 none
312
Q

Glasgow Coma Scale

- motor

A 
6 obeys commands
5 purposeful movement from pain
4 withdraws from pain
3 flexion/decorticate
2 extension/decerebrate
1 none
313
Q

Acute myasthenic crisis

  • cause
  • clinical
  • mgmt
A
  • infection, medication
  • respiratory failure
  • mechanical ventilation
  • plasma exchange, IVIG
314
Q

MCC acute onset altered consciousness in pediatric population

A

toxic ingestion

315
Q

SAH

- classic signs

A
  • Sudden onset worst HA of life
  • n/v
  • impaired consciousness > coma
316
Q

SAH

- RF

A
  • recent head trauma
  • HTN
  • tobacco
  • heavy Etoh
    • females of advanced age greatest risk
317
Q

SAH

- dx

A
  • CT w/o contrast
  • CTA
  • LP if suspect but negative CT
318
Q

SAH

- LP findins

A
  • red

- yellow (xanthochromia)

319
Q

SAH

- mgmt

A
  • admission
  • cerebral angiography
  • Sx clipping/endovascular tx
320
Q

Cryptococcus meningoencephalitis

A
  • opportunist infection, usually CD4 <100
  • progressive hA< nausea, malaise, fever (can be subtle)
  • CT > LP (elevated WBC with lymphcytosis, dec glucose, mild elevated protein)
  • IV amphotericin B
321
Q

Vascular dementia

- RF

A
  • hyperlipidemia
  • HTN
  • DM
322
Q

Vascular dementia

- clinical

A
  • patchy cog impairment
  • focal neuro s/sx
  • abrupt or stepwise onset
323
Q

Vascular dementia

- mgmt

A
  • prevent further strokes: antiplatelet drugs, control RF
324
Q

Herpes simplex encephalitis

- Clinical

A
  • rapid onset fever
  • HA
  • seizure
  • focal neuro sx
  • impaired consciousness
  • personality change
325
Q

Herpes simplex encephalitis

- LP

A
  • lymphocytic pleocytosis
  • inc RBC
  • inc protein
  • normal glucose
326
Q

Herpes simplex encephalitis

- Mgmt

A
  • IV acyclovir
327
Q

Common side effect topiramate

A

CNS:

  • paresthesias**
  • nervousness
  • fatigue
  • ataxia
  • drowsy
  • dizzy, confusion
328
Q

Common side effect topiramate

A

CNS:

  • paresthesias**
  • nervousness
  • fatigue
  • ataxia
  • drowsy
  • dizzy, confusion
329
Q

Brain herniation

  • Cause
  • MC type
  • presenation
A
  • ICP
  • uncle transtentorial
  • compression of parasympathetic fibers running with CN III = fixed and dilated pupil (unopposed sympathetic tone)
330
Q

Brain herniation

  • Cause
  • MC type
  • presenation
A
  • ICP
  • uncle transtentorial
  • compression of parasympathetic fibers running with CN III = fixed and dilated pupil (unopposed sympathetic tone)
331
Q

Putamen hemorrhage

- signs

A 
Rapid progression:
- hemiplegia
- n/v
- HA
Then:
- ipsilateral deviation of eyes, stupor, coma, mydriatic pupils
332
Q

Thalamic hemorrhage

- signs

A
  • complete hemisensory loss

- aphasia and hemiparesis also common

333
Q

Thalamic hemorrhage

- signs

A
  • complete hemisensory loss

- aphasia and hemiparesis also common

334
Q

What level does spinal cord terminate in adults

A

L1-L2

335
Q

Median nerve

  • test motor
  • test sensation
A
  • opposition of thumb and pinky

- tip of index finger

336
Q

Radial nerve

  • test motor
  • test sensation
A
  • wrist/finger extension

- sensation of first webspace dorsum

337
Q

Ulnar nerve

  • test motor
  • test sensation
A
  • 5th finger abduction

- 5th finger sensation

338
Q

Carotid artery dissection

- how common

A
  • common ischemic stroke in young patients

- may have underlying connective tissue disorder

339
Q

Carotid artery dissection

- clinical

A
  • abrupt severe neck, facial, retroorbital pain
  • Partial horner: mitosis and ptosis
  • carotid bruit
340
Q

What test should be done on a patient who presents with stroke sx such as acute onset focal weakness?

A

finger stick glucose to rule out hypoglycemia

341
Q

Myasthenia gravis

- overview

A
  • autoimmune: ab vs. acetylcholine receptors

- muscle weakness and fatigue, worse with use

342
Q

Myasthenia Gravis

- clinical

A
  • ptosis
  • diplopia
  • blurred vision
343
Q

Myasthenia gravis

- what improves the sx

A

cooling - “ice test” for ptosis

344
Q

Myasthenia Gravis

- clinical

A
  • ptosis
  • diplopia
  • blurred vision
  • normal DTR
345
Q

Fell asleep on chair after night of drinking is what nerve

A

Radial: wrist drop

“Sat night palsy”

346
Q

MCC spontaneous intracerebral hemorrhage

A
  • HTN vasculopathy
347
Q

Lidocaine OD

- sx

A
  • dizzy
  • HA
  • tingling
  • tinnitus
  • sedation
  • tremor
  • seizure
  • bradycardia
  • Heart block
  • dysrhythmias
348
Q

Lidocaine OD

- sx

A
  • dizzy
  • HA
  • tingling
  • tinnitus
  • sedation
  • tremor
  • seizure
  • bradycardia
  • Heart block
  • dysrhythmias
349
Q

Optic neuritis

A
  • acute monocular loss of vision
  • dt focal demyelination of optic nerve
  • usually normal fundoscpic exam
  • pain with movement, afferent pupillary defect, loss of color vision (red)
  • related to MS
350
Q

Optic neuritis

A
  • acute monocular loss of vision
  • dt focal demyelination of optic nerve
  • usually normal fundoscpic exam
  • pain with movement, afferent pupillary defect, loss of color vision (red)
  • related to MS
351
Q

Testicular cancer

  • dx tests
  • definitive diagnosis
A
  • scrotal US, CT scan

- Radical inguinal orchiectomy

352
Q

MC type testicular cancer

A

seminoma

95% germ cell

353
Q

Testicular cancer

- tumor marker

A

Serum alpha-fetoprotein

354
Q

Prostatitis

- clinical

A
  • fever, chills, perineal/back pain, dysuria, urinary retention
  • warm, exquisitely tender and boggy prostate
355
Q

Prostatitis

- Mgmt

A

< 35: ceftriaxone and doxy

> 35: cipro or bactrim

356
Q

Prostatitis

- Mgmt

A

< 35: ceftriaxone and doxy
> 35: cipro or bactrim

**4-6 weeks treatment

357
Q

Prostate cancer

- Dx

A
  • PSA
  • DRE
  • transrectal US guided bx
358
Q

Prostate cancer

- screening

A

> 50 with life expectancy >10 years:

  • DRE
  • serum PSA
359
Q

Prostate cancer

- screening

A

> 50 with life expectancy >10 years:

  • DRE
  • serum PSA
360
Q

Nephrolithiasis

- stone composition

A
  • calcium oxalate (MC)
  • uric acid
  • cystine
  • struvite
361
Q

Nephrolithiasis

- dx

A
  • poss leukocytosis
  • UA: hematuria, culture to r/o infection
  • CT without contrast
  • IV pyelogram: rare
362
Q

BPH

- clinical

A
  • hesitancy
  • Intermittence, incontinence
  • frequency, fullness
  • urgency
  • nocturia
363
Q

BPH

- mgmt obstruction

A
  • Foley cath

- suprapubic cath if foley placement fails

364
Q

MC type prostate cancer

A

adenocarcinoma

365
Q

Prostate cancer

- tx after prostatectomy

A

Leuprolide

366
Q

Bladder cancer

- most definitive test

A

cystoscopy

367
Q

Bladder cancer

- clinical

A
  • dysuria
  • frequency, hesitancy
  • hematuria
  • sx of obstruction
368
Q

Bladder cancer

- RF

A
  • cigs

- industrial dye

369
Q

Acute pyelonephritis

- Outpatient treatment

A
  • Cipro, levo

- Bactrim

370
Q

Acute pyelonephritis

- inpt treatment

A
  • ceftriaxone
  • cipro/levo
  • aztreonam
    Severe:
  • cefepime
  • pipercillin-tazobactam
  • meropenem
371
Q

Epididymitis

- clinical

A
  • dull, unilateral scrotal pain
  • red, painful, swollen scrotum
  • relief with elevation
372
Q

Epididymitis

- cause <35 and >35

A

<35 chlamydia and gonorrhea

>35 e. coli

373
Q

Epididymitis

- mgmg

A

< 35: ceftriaxone and doxy

> 35: bactrim, FQ

374
Q

Epididymitis

- dx

A
  • clinical signs

- increased flow on doppler US

375
Q

BPH

- medical mgmt

A
  • alpha blockers (prazosin and tamsulosin) to relax bladder neck and improve urination
  • 5-alpha reductase inhibitors: block conversion testosterone, decreases size of prostate
376
Q

Hodgkin Lymphoma

  • incidence
  • Assoc with what
A
  • Bimodal: 20s and >50s, MC males

- Epstein-Barre virus

377
Q

Hodgkin Lymphoma

- Clinical

A
  • Painless lymphadenopathy
  • alcohol may induce lymph node pain
  • Advanced: night sweats, weight loss, cyclical fever
378
Q

Hodgkin lymphoma

- Dx

A
  • Reed Sternberg cells (owl eyes) large cells with bilobed or multi lobar nucleus
  • mediastinal lymphadenopathy (PET/CT)
379
Q

Non-Hodgkin lymphoma

  • Overview
  • Risk factors
A
  • lymphocyte neoplasm
  • MC >50 yo
  • ** peripheral lymph nodes
  • RF: age, immunosuppression (HIV)
380
Q

Non-Hodgkin lymphoma

  • clinical manifestations
  • subtype name and sx
A
  • Local painless lymphadenopathy (Gi, skin, CNS MC)

- Burkitt lymphoma: abd pain, jaw involvement, starry sky histology

381
Q

Non-Hodgkin lymphoma

- managment

A
  • unpredictable course

- rituximab

382
Q

Multiple Myeloma

- pathophys

A
  • proliferation of a single clone of a plasma cell
  • monoclonal ab (IgG and IgA MC)
  • ab accumulate in bone marrow, interrupt nl cell production
383
Q

Multiple Myeloma

- Risk Factors

A
  • > 65 yo
  • AA
  • Men
384
Q

Multiple Myeloma

- Clinical manifestations

A

BREAK

  • Bone pain (MC spine and ribs): osteolytic, destructive lesions
  • Recurrent infection dt leukopenia
  • Elevated calcium
  • Anemia
  • Kidney failure
385
Q

Multiple Myeloma

- Dx

A
  • Serum protein electrophoresis: monoclonal protein spike**
  • Urine protein electrophoresis: Bence-Jones proteins**
  • CBC: Rouleaux formation, increased ESR
  • Skull xray: punched out lesions
  • Bone marrow bx: plasmacytosis
386
Q

Acute Lymphocytic Leukemia (ALL)

  • pathophys
  • distribution
  • RF
A
  • malignancy of lymphoid stem cells
  • MC childhood (3-7 yo)
  • RF down syndrome
387
Q

Acute Lymphocytic Leukemia (ALL)

- clinical

A
  • Pancytopenia –> Fever (MC)

- CNS: HA, stiff neck, vision

388
Q

Acute Lymphocytic Leukemia (ALL)

  • PE
  • DX
A
  • hepatosplenomegaly, lymphadenopathy

- Bone marrow: hyper cellular >20% blasts

389
Q

Acute Lymphocytic Leukemia (ALL)

- Tx

A

chemo

390
Q

Chronic Lymphocytic Leukemia (CLL)

  • pathophys
  • Clinical
A
  • B cell clonal malignancy

- Most asx, incidental finding on CBC, fatigue MC

391
Q

Chronic Lymphocytic Leukemia (CLL)

- Dx

A
  • well differentiated lymphocytes with “smudge cells”

- Pancytopenia

392
Q

Acute Myeloid leukemia (AML)

- common population

A

MC acute leukemia in adults (>50)

393
Q

Acute Myeloid leukemia (AML)

- Clinical

A
  • pancytopenia: anemia, splenomegaly, gingival hyperplasia

- Leukostasis: WBC>100,000

394
Q

Acute Myeloid leukemia (AML)

- Dx

A

Bone marrow bx:

  • Auer Rods
  • > 20% blasts
395
Q

Chronic Myelogenous Leukemia (CML)

  • pathophys
  • age
  • clinical
A
  • granulocyte proliferation
  • Usu >50 yo
  • most asx until blastic crisis, splenomegaly
396
Q

Chronic Myelogenous Leukemia (CML)

- Dx

A
  • Philadelphia chromosome (tx with imatinib)

- Very high WBC counts

397
Q

TTP

- classic pentad

A
  1. fever
  2. thrombocytopenia
  3. renal failure
  4. neuro findings
  5. anemia: microangiopathic, hemolytic
398
Q

Botulism

- types

A
  • infant MC: floppy baby
  • Food-borne
  • Wound
399
Q

Botulism

- clinical

A
  • descending, symmetric, flaccid paralysis
  • decreased DTR
  • normal sensation
  • CN deficits: diplopia, ptosis, pupillary dilation, etc.
  • parasympathetic blockade: dec salvation, GI ileus, urinary retention
400
Q

Botulism

- mgmt

A
  • Supportive
  • respiratory support
  • antitoxin if >1
  • IV botulism Ig if <1
  • abx for wounds
401
Q

TB

  • mc org
  • transmission
  • s/sx
  • CXR
A
  • mycobacterium tuberculosis (acid fast bacilli)
  • aerosolized droplets
  • fatigue, weight loss, fever, night sweats, productive cough
  • CXR: caseating granuloma formation, pulmonary opacities (MC apical)
402
Q

PPD results

A

Positive:

  • induration >15 mm and no risk factors
  • induration >10 mm and high risk (high prevalence area, homeless, immigrant in 5 years, prisoner, health care, nursing home, contact, etoh, DM)
  • induration >5 mm and very high risk (HIV, steroid, organ transplant, TB contact, CXR with cavitation)
403
Q

TB treatment

- latent

A

(negative CXR, sputum, or both)

9 months INH

404
Q

TB Treatment

- active

A
  • droplet precautions until sputum negative AFB
  • 2 months 4 drug RIFE tx then 4 months INH and rifampin
  • if isolate is INH and rifampin sensitive, can use 2 drug regimen
  • treat 3 months past negative culture
405
Q

Tetanus

- clinical

A
  • descending paralysis
  • Muscle rigidity starts in jaw and facial muscles and descends to limbs
  • opisthotonos (bridge back)
  • risus sardonicus (facial expression)
  • trismus
  • dysphagia
  • diaphoresis, HTN, tachycardia
406
Q

Tetanus

- mgmt

A
  • supportive: benzo, opioids
  • low stimulation
  • clean wound
  • metronidazole
  • tetanus IVIG
407
Q

SIRS criteria

A
  • HR >90
  • Resp >20
  • Temp >100.4 (38)
  • WBC >12k or <4k or >10% bands
408
Q

Sepsis criteria

A

SIRS + suspected or present infection

409
Q

Severe sepsis

A

Sepsis + lactic acidosis or low bp (<90 or drop >40)

410
Q

Rocky Mountain spotted fever

  • Org
  • clinical presentation
  • Tx
A
  • rickettsie rickettsii
  • Tick bite (dog or wood ticks)
  • abrupt onset sx
  • Fever, HA, myalgias, Rash (palms and soles to trunk)
    • Petechiae formation after blood pressure cuff inflation
  • Doxy
411
Q

Rheumatic fever

- Major jones criteria

A
  • carditis
  • erythema marginatum
  • subcutaneous nodules
  • chorea
  • polyarthritis

*JONES: joints, oh my carditis, nodules, erythema marginatum, sydenham chorea

412
Q

Rheumatic fever

- minor jones criteria

A
  • fever
  • polyarthralgias
  • reversible prolonged PR interval
  • rapid ESR
  • CRP
413
Q

Rheumatic fever

- management

A
  • bed rest
  • IM penicillin (erythromycin if PCN allergic)
  • antipyretics and steroids to reduce joint sx
414
Q

Shigellosis

  • sx
  • lab
  • mgmt
  • complications
A
  • fever, bloody/mucoid diarrhea, seizures
  • fecal RBC and WBC
  • azithromycin or cipro
  • HUS, reactive arthritis
415
Q

Abx vs. MRSA

A
  • Bactrim
  • Rifampin
  • Clindamycin (GI ADR)
  • Tetracyclines
  • LInezolid
416
Q

Cholera

- mgmt

A
  • fluid resuscitation
  • doxy, cipro
  • azithromycin for kids/preggo
417
Q

Malaria

- dx

A

thick and thin smear

418
Q

Malaria

- mgmt

A
  • chloroquine
  • atovaquone-proguanil
  • Quinine + doxy/tetra/clinda
  • others
419
Q

Syphilis tx if allergic to PCN

A

oral doxy

420
Q

What drug is used to treat Lyme disease in kid <8 yo

A

amoxicillin

421
Q

Mumps

- MC anatomical structure affected

A
  • parotid glands
422
Q

What is a common chronic medication for angina

A

beta blocker

423
Q

Hypertrophic cardiomyopathy

- meds to use with caution

A
  • Digoxin, nitrates, diuretics
  • dig: up contractility
  • nitrates/diuretics: reduce LV volume
424
Q

HF

- meds taht decrease mortality

A
  • ACE/ARB
  • BB
  • Nitrate/hydralazine
  • spironolactone
  • ICD if EF < 35%
425
Q

Loop diuretics

- ADR

A
  • volume depletion
  • hypo K, Na, Ca
  • Hyper lycemia and hyperuremia
426
Q

HF

- role of digoxin

A

use when HF and A.fib

- no mortality benefit

427
Q

CHF

- mgmt

A

LMNOP

  • lasix
  • morphine
  • nitrates
  • O2
  • position - upright
428
Q

Endocarditis

- valves

A
  • MC mitral valve

- exception: IVDU, then tricuspid valve

429
Q

Endocarditis

- blood culture

A

must get 3, 1 hour apart

430
Q

Endocarditis treatment

A
  • empiric
  • native valve: vanc +/- cefazolin
  • Ill with HF: gentamicin + cefepime + vanc
  • Valve replacement if refractory or abscess
431
Q

Endocarditis

  • criteria for dx name
  • criteria
A
  • Duke Criteria

- 2 major, 1 major and 1 minor, 5 minor

432
Q

Endocarditis

Major criteria

A
  • two + blood cultures with typical org

- echo with new valvular regurgitation

433
Q

Endocarditis

minor criteria

A
  • predisposing factor
  • Fever >100.4 (38)
  • vascular phenomena (embolic dz or pulmonary infarct)
  • Immunologic phenomena (glomerulonephritis, osler node, roth spot)
    • blood culture not meeting major criteria
434
Q

Pericarditis

- EKG

A
  • diffuse ST elevations

- PR depressions

435
Q

Pericarditis

- heart sounds

A
  • acute/restrictive: friction rub

- constrictive: pericardial knock

436
Q

HTN goals

A

< 60: 140/90

> 60: 150/90

437
Q

First line HTN med

  • non AA
  • AA
  • BPH
  • Gout
A
  • thiazide, ACE/ARB, CCB
  • thiazide, CCB
  • alpha-blocker
  • CCB, losartan
438
Q

Hypertensive urgency

- mgmt

A
  • reduce MAP 25% 24-48 hours
  • ORAL agents
  • Clonidine, captopril, furosemide, labetolol, nicardipine
439
Q

Hypertensive emergency

- mgmt

A
    • usu >180/120
  • reduce BP 25% first HOUR
  • reduce BP 5-15% next 23 hours
  • IV agents
440
Q

1st line med to tx:

  • LDL
  • triglycerides
  • HDL
A
  • statins
  • fibrates
  • niacin
441
Q

Niacin medication

  • main effect
  • ADR
A
  • vitamin B3
  • increase HDL
  • flushing, HA, warm sensation, itching
  • hyperuricemia (gout)
  • hyperglycemia
442
Q

Statins

  • aka
  • main effect
A
  • HMGcoA reductase inhibitors
  • inhibits rate-limiting step in hepatic cholesterol synthesis and increases LDL receptors so more LDL removed from blood
443
Q

Statin

  • ADR
  • when to give
A
  • myositis, myalgia, rhabdomyolysis
  • Hepatitis: LFTs first 3 mo
  • bedtime
444
Q

Fibrates

- ADR

A
  • myositis, myalgias
  • esp with concomitant statin us
  • gallstones
445
Q

Ezetimibe

A

zetia

  • inhibits cholesterol absorption in intestine
  • lowers LDL
  • increased LFTs, esp with statin use
446
Q

What is the only lipid lowering agent that is safe in pregnancy

A

bile acid sequestrants

447
Q

MCC bronchitis

A

adenovirus

448
Q

bronchitis

- mgmt

A
  • fluid
  • rest
  • bronchodilators
  • antitussive
  • *abx: elderly, COP, immunocompromised, cough >7-10 days
449
Q

Bronchiectasis

- PFTs

A
  • obstructive
450
Q

FEV1/FVC

  • obstructive
  • restrictive
A
  • obstructive: reduced ratio dt reduced FEV1

- restrictive: normal ratio with reduced FEV1 and FVC

451
Q

classic presentation of sarcoidosis

A

young patient with respiratory and constitutional sx, blurred vision, erythema nodosum

452
Q

pulmonary nodule

- size

A

<3 cm

453
Q

Non-small cell carcinoma

A

85% lung cancer

  • MC adenocarcinoma: peripheral
  • Squamous cell: central
  • large cell: very aggressive
454
Q

Non-small cell carcinoma

- Squamous cell

A

Cs

  • Centrally located
  • Cavitary lesion
  • hyperCalcemia
  • panCoast syndrome
455
Q

Small cell carcinoma

A
  • very aggressive
  • usually met early
  • centrally located
456
Q

Pancoast

A
  1. shoulder pain
  2. Horner’s syndrome
  3. hand/arm atrophy
457
Q

pulmonary HTN

- MCC secondary

A

COPD

458
Q

pulmonary HTN

- heart sounds

A
  • fixed, paradoxically split S2

- accentuated S2 (bc P2)

459
Q

Cor pulmonale

A

RV failure due to pulmonary HTN (MCC COPD)

460
Q

Dysphagia to both solid and liquid

A

achalasia

461
Q

Dysphagia to solids and then fluids

A

esophageal neoplasm

462
Q

Diffuse esophageal spasm

A
  • stabbing chest pain worse with hot/cold food/liquid
  • corkscrew esophogram
  • CCB or nitrates
463
Q

Nutcracker esophagus

A
  • excessive contractions during peristalsis
  • dysphagia and chest pain
  • CCB, nitrates, botox, sildenafil

EORs (9 decks)

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