Internal Medicine Flashcards
1
Q
Symptoms of Polymyalgia Rheumatica
A
> Age >50
bilateral pain and morning stiffness > 1 month
involvement of 2 of the following: neck or torso, shoulders or proximal arms, proximal thigh/hip, constitutional symptoms
2
Q
Labs for polymyalgia rheumatica
A
- ESR > 40
- Elevated CRP
- Normocytic anemia possible
- ~20% can have normal labs
3
Q
Treatment for Polymyalgia rheumatica
A
low-dose glucocorticoids (NSAIDs for mild breakthrough pain while tapering steroids)
4
Q
Clinical findings of HIV-associated nephropathy
A
> heavy proteinuria
rapidly progressive renal failure
renal biopsy showing collapsing focal segmental glomerulosclerosis
edema
5
Q
What is being measured when performing an inspiratory hold on a pt on a vent?
A
Pulmonary compliance
6
Q
What pathologies are associated with increased peak pressure and normal plateau pressure?
A
> bronchospasm
mucus plug
biting endotracheal tube
(These are causing increased airway resistance)
7
Q
What pathologies associated with increased peak and plateau pressure?
A
>pneumothorax >pulmonary edema >pneumonia >atelectasis >right mainstem intubation (These reduce lung compliance)
8
Q
How to measure auto-PEEP in a pt with obstructive lung disease?
A
end-expiration hold maneuver
9
Q
Management of frostbite
A
> rapid rewarming in water bath
analgesia and wound care
angio or tech-99m scan to assess for thrombosis if rewarming unsuccessful
thrombolysis in severe, limb-threatening cases
10
Q
Clinical symptoms of Chikungunya virus infection
A
> Pt visits Caribbean, central/south America, Africa, Asia
3-7 day incubation
high fever and severe polyarthralgia (almost always present)
headaches myalgia, conjunctivitis, maculopapular rash
Lymphopenia, thrombocytopenia, transaminitis
11
Q
What screening should pts receive who are about to start Trastuzumab?
A
Baseline assessment of cardiac function by echocardiography
12
Q
How does hepatorenal syndrome lead to renal dysfunction?
A
It causes splanchnic arterial dilation leading to renal vasoconstriction with decreased perfusion and GFR
13
Q
Clinical findings of hepatorenal syndrome?
A
> significant decrease in GFR in the absence of another cause of renal dysfunction
minimal hematuria (<50)
lack of improvement with volume resuscitation
14
Q
Treatment for hepatorenal syndrome
A
> address precipitating factors
splanchnic vasoconstrictors (midodrine, octreotide, NE)
liver transplant
15
Q
Imaging test of choice for Hodgkin lymphoma
A
PET scan with 18-fluorodeoxyglucose (FDG)
will pool in healthy organs with high glucose needs like the brain, kidney, and liver. Cleared in urine so will pool in GU system so don’t get confused by that
16
Q
Medications used for gastroparesis
A
> metoclopramide (extrapyramidal symptoms and tardive)
erythromycin (tachyphylaxis)
domperidone (cardiac arrythmias, QT prolongation, hyperprolactinemia)
17
Q
First line therapy for renal artery stenosis (RAS)
A
ACE/ARBs are first line due to their ability to reduce angiotensin II levels, which improves systemic blood pressure and dilated the efferent arterioles (increases GFR)
18
Q
Clinical findings of multifocal atrial tachycardia (3)
A
> typically, asymptomatic
rapid, irregular pulse
EKG: >3 P-wave forms, atrial rate >100/min, and irregular RR intervals
19
Q
Treatment of multifocal atrial tachycardia
A
> correct the underlying disturbance
>AV nodal blockade (verapamil (CCB)) if persistent
20
Q
What antibody is seen in PBC
A
anti-mitochondrial
21
Q
What characterizes acute liver failure? (3)
A
> LFTs >1000
hepatic encephalopathy
synthetic liver dysfunction (prolonged PT and INR>1.5)
22
Q
When is liver transplant required in pt with ALF?
A
> grade 3 or 4 hepatic encephalopathy
PT >100 seconds
serum creatinine >3.4
23
Q
Clinical findings in pt with Meniere disease (3)
A
> recurrent episodes last 20 minutes to several hours
sensorineural hearing loss
tinnitus and/or feeling of fullness in ear
24
Q
Clinical findings in pt with vestibular neuritis (3)
A
> acute, single episode that can last days
often follows viral syndrome
abnormal head thrust test
25
What is the cause of aplastic anemia?
bone marrow failure caused by damage to multipotent hematopoietic stem cells
26
How does vWF contribute to hemostasis? (2)
>aids in platelet-endothelial binding and platelet aggregation
>carrier protein for factor VIII
27
Clinical features of paroxysmal nocturnal hemoglobinuria (3)
>hemolysis leadings to fatigue
>cytopenia
>venous thrombosis (intrabdominal, cerebral veins)
28
Treatment for paroxysmal nocturnal hemoglobinuria
>iron and folate supplements
| >eculizumab (inhibits complement activation)
29
What test is used to confirm diagnosis of paroxysmal nocturnal hemoglobinuria?
flow cytometry to assess for the absence of the CD55 and CD59 proteins on the surface of the RBCs
30
Lab finds in pt with Beta cell tumor
>Increased insulin levels with low blood glucose
>elevated C-peptide levels
>proinsulin levels greater than 5pmol/L
31
What is the best index to monitor the response of treatment in a pt with DKA?
serum anion gap
32
Adverse effects of calcineurin inhibitors (tacrolimus, cyclosporine)
>vasoconstrictive properties
>hepatically cleared so P450 altering drugs can lead to adverse effects
>presents with HTN and prerenal acute kidney injury
33
How is subclavian steal syndrome diagnosed?
Doppler US or MR angio
34
What diseases are associated with erythema nodosum?
```
>strep infection
>sarcoidosis
>TB
>endemic fungal disease (eg, histo)
>IBD
>Bechet disease
```
35
What is a confounder?
extraneous factor that has properties linking it with both the exposure and the outcome of interest
36
What is the most common valvular abnormality detected in pts with IE?
mitral valve prolapse/regurgitation
37
Characteristic findings of pseudogout
>onset at age >65
>monoarticular arthritis
>chondrocalcinosis
38
Clinical signs of erysipelas
>acute onset of systemic symptoms
>regional lymphadenitis
>warm, tender, erythematous rash with raised, sharply demarcated borders
***involvement of the ear is suggestive of erysipelas since this skin lacks a lower dermis level
39
Most common organism involved in erysipelas
Group A strep
40
Treatment of erysipelas
>IV abx (ceftriaxone, cefazolin) if systemic symptoms
| >Oral abx (amoxicillin) if no systemic symptoms
41
Clinical features of herpetic keratitis
>branched dendritic ulcerations
>decreased corneal sensation
>watery discharge
>recurrent episodes
42
Clinical features of bacterial keratitis
>central, round ulcer
>stromal abscess
>mucopurulent discharge
>acute presentation
43
Clinical features of fungal keratitis
>ulcerations with feathery margins and satellite lesions
>mucopurulent discharge
>indolent course
44
What is the most important factor for survival in a pt with sudden cardiac arrest?
Time to rhythm analysis and defibrillation if indicated
45
Hyperkalemic RTA is commonly seen in what pts?
elderly patients who have poorly controlled diabetes with damage to the juxtaglomerular apparatus, which causes a state of hyporeninemic hypoaldosteronism
46
Renal vein thrombosis is most commonly seen with what kidney disease?
membranous glomerulopathy (causes loss of antithrombin III)
47
Microcytic anemias. How does ferritin level relate to pathology?
> low = iron deficiency
> normal = thalassemia
> high = anemia of chronic disease or lead poisoning
48
Children and adults. What type of hemangioma do they get?
> adults get cherry (cherry in a drink)
| > kids strawberry (strawberry patch kid)
49
Alarm features of IBS (9)
```
>older age (>50)
>GI bleed
>nocturnal diarrhea
>worsening pain
>weight loss
>iron deficiency
>elevated CRP
> (+) fecal lactoferrin or calprotectin
>family history of early colon cancer or IBD
```
50
Clinical symptoms of transverse myelitis
>motor weakness that progresses from flaccid to spastic
>autonomic dysfunction including bowel/bladder incontinence
>sensory dysfunction including pain, paresthesia, or numbness with a distinct sensory level
51
How to distinguish hypertrophic cardiomyopathy from athlete's heart
```
>HCOM has weird EKG findings
>HCOM has enlarged left atrium
>HCOM LV wall will be >15mm
>HCOM focal septal hypertrophy
>HCOM LV diastolic function impaired
```
52
Treatment for Guillain-Barre syndrome
>monitor of autonomic and respiratory function
| >IVIG or plasmapheresis
53
What is the way they describe livedo reticularis in questions and what is it associated with?
painless, purple mottling of the skin (usually b/l LE or lower back)
cholesterol emboli
54
Pts taking isoniazid require supplementation with what?
pyridoxine (vit B6)
55
What will you see on echo and biopsy in a pt with viral myocarditis?
Echo: 4-chamber dilation with diffuse hypokinesis
Biopsy: lymphocytic infiltration, viral DNA or RNA
56
Electrical issues in what part of the heart lead to Atrial Flutter?
tricuspid annulus (don't mix up with A fib which is from the pulmonary veins)
57
Treatment for uric acid stones
alkalinization of urine (potassium citrate)
58
Major risk factors for uric acid stones (4)
>gout
>DM/metabolic syndrome
>increased production of uric acid (hemolysis, MP disorders)
>chronic diarrhea (due to loss of bicarb)
59
Pts with untreated hyperthyroidism can go on to develop what?
>Bone loss leading to osteoporosis and increased risk of fracture
>also increased risk of cardiac tachyarrhythmias
60
Why do pts with sepsis develop hypoglycemia?
Increased use of glucose in the tissues, which is promoted by inflammatory cytokines
*Can also suppress gluconeogenesis
61
What can be observed in a pt with brain death?
DTRs because they originate in the spinal cord
62
Anterior uveitis can be associated with what diseases?
>certain infections
>sarcoidosis
>spondyloarthritis
>IBD
63
How is anterior uveitis characterized?
painful, red eye associated with photophobia, tearing, and diminished visual acuity
64
Brown granular casts are associated with what renal issue?
Acute tubular necrosis
65
WBC casts are associated with what kidney issue?
Acute interstial nephritis
66
What is the classic triad of hereditary spherocytosis?
hemolytic anemia, jaundice, and splenomegaly
67
What is wrong in a pt with hereditary spherocytosis?
RBC scaffolding proteins (spectrin, ankyrin) are deficient
68
What three things may a pt with hereditary spherocytosis require?
>cholecystectomy
>folate supplementation
>splenectomy (give vaccines as well if this happens)
69
What is the classic pentad of TTP?
```
>thrombocytopenia
>MAHA
>renal insufficiency
>neurologic changes
>fever
```
70
What is the best recommendation to prevent calcium stones?
Reduced sodium diet
71
Symptoms of Takayasu arteritis (3)
>constitutional
>arterioocclusive in upper extremities
>arthralgia/myalgias
**Distinguish this from coarctation with the systemic symptoms
72
What lab finding can be seen in a pt with obesity hypoventilation syndrome?
Decreased chloride due to bicarb retention
**Excreting chloride in the urine to reabsorb bicarb. Bicarb used to create metabolic alkalosis to compensate for respiratory acidosis
73
What imaging is used to diagnose fibromuscular dysplasia (FMD)?
CT angio of the abdomen
**If inconclusive then catheter based digital subtraction arteriography can be used
74
Adrenal vein sampling is used to distinguish between what two things?
>adrenal hyperplasia and adenoma
**Aldosterone/renin ratio will be >20
75
What is the cause of infertility in a pt with Klinefelter syndrome?
testicular fibrosis with seminiferous tubule dysgenesis
76
Clinical symptoms of idiopathic hypogonadotropic hypogonadism (Kallmann syndrome)
>anosmia (loss of smell)
| >congenital abnormalities (cleft palate, skeletal abnormalities)
77
What is a common cause of constrictive pericarditis in developing or endemic area?
TB (Africa, India, China)
**USA MCC are idiopathic or viral (40%), radiation therapy (30%), cardiac surgery (20%), and connective tissue disorders
78
What medications are given to a pt with ACS due to unstable angina
```
>antiplatelets
>anticoagulants
>beta blockers
>high-intensity statins
>nitrates as needed
```
79
What is one of the earliest findings in macular degeneration?
Distortion of straight lines such that they appear wavy (perform grid test to rule this out)
**Drusen deposits in the macula are also common lesions seen
80
Infectious mono typically appears with what findings? (5)
```
>prolonged fever
>malaise
>exudative pharyngitis
>splenomegaly
>generalized lymphadenopathy
```
81
Metoclopramide and prochlorperazine are what class of drug?
dopamine antagonists
**Can lead to EPS
82
MSK risk in pts with RA
osteopenia/osteoporosis
83
What is the time frame onset in pts experience delayed hemolytic transfusion reaction?
>24 hours and up to a month after transfusion
**B cell antibody response to minor antigens in transfused blood
84
Warfarin affects what clotting and anticoagulant factors?
factors 2, 7, 9, 10
| Protein C and S (these go first though)
85
Classic triad of dialysis-related amyloidosis
>scapulohumeral periarthritis
>carpal tunnel syndrome
>bone cysts
86
What will the calcium level be in pts with humoral hypercalcemia of malignancy (HHM)?
>14mg/dL
*** Look for pt with smoking history, likely has squamous cell producing PTHrP
87
What will the calcium levels be in a pt with HCTZ induced hypercalcemia?
<12mg/dL
**use this to distinguish between this and hypercalcemia of malignancy (>14)
88
What is the most common side effect of hydroxyurea?
>myelosuppression
**neutropenia, anemia, thrombocytopenia
89
Lab findings in a pt with adrenal insufficiency
>renal sodium wasting and potassium retention leading to hypotension/orthostasis
>reduced cortisol production causing constitutional symptoms and hypoglycemia
>eosinophilia due to reduced migration into tissues secondary to reduced cortisol
90
What test should be performed to check for adrenal insufficiency?
cosyntropin stimulation test (synthetic form of ACTH)
91
What should be avoided in pts with premature atrial complexes?
>tobacco
>alcohol
>caffeine
>stress
92
What should be given in an agitated pt with delirium?
low-dose haloperidol
**can also use quetiapine, risperidone
93
Clinical features of Wernicke Encephalopathy (3)
>encephalopathy
>oculomotor dysfunction (horizontal nystagmus and b/l abducens palsy)
>postural and gait ataxia
94
What is the timeframe of acute renal allograft rejection?
most commonly occurs within the first 6 months following transplant
**T cell mediated
95
What will biopsy show in acute renal allograft rejection?
lymphocytic infiltration of the intima with inflammatory tubular disruption
**T cell mediated
96
How will BK virus reactivation appear on renal biopsy?
intranuclear inclusion and a mixed lymphocytic and neutrophilic infiltrate
97
Medical management for ascites (3)
>spironolactone with furosemide
>alcohol abstinence, sodium restriction
>avoid ACE/ARBs and NSAIDs
98
Why does beta blocker overdose lead to hypoglycemia?
>beta blockers act as competitive antagonists to catecholamines --> prevents catecholamines from inducing hepatic glucose production and glycogen breakdown
99
First line treatment for beta blocker overdose
>IV fluids
>atropine
>glucagon
100
Symptoms of crypto in pts with AIDS (CD4 <180)
>SEVERE WATERY DIARRHEA
>low-grade fever
>weight loss
101
Symptoms of microsporidium/isosporidium in pts with AIDS (CD4 <100)
>watery diarrhea
>crampy abdominal pain
>weight loss
>FEVER IS RARE
102
Symptoms of MAC in pts with AIDS (CD4<50)
>watery diarrhea
>HIGH FEVER (>39 or 102.2)
>weight loss
103
Symptoms of CMV is pts with AIDS (CD4 <50)
```
>FREQUENT, SMALL-VOLUME DIARRHEA
>HEMATOCHEZIA
>ABDOMINAL PAIN
>low grade fever
>weight loss
```
104
Treatment ladder for BPH
1. alpha-blockers
| 2. 5-alpha-reductase inhibitors
105
What is a common side effect of calcium channel blockers?
peripheral edema (other major ones include HA, flushing, and dizziness)
**likely related to the preferential dilation of precapillary vessels which leads to increased capillary hydrostatic pressure
106
What medications can be added to avoid peripheral edema in pts on CCBs?
ACE/ARBS
***cause post-capillary venodilation and help normalize the capillary hydrostatic pressure
107
What is the most common complication of influenza?
secondary bacterial pneumonia
***MCO being strep pneumo or staph aureus
108
Light's Criteria
* Protein ratio >0.5
* LDH ratio >0.6
* Pleural fluid LDH >2/3 ULN serum LDH
***if any are positive then it is exudative
109
Actinic keratosis can progress to what cancer?
squamous cell carcinoma
110
First line treatment for pts with fibromyalgia
>patient education
>regular aerobic exercise
>good sleep hygiene
111
Second line treatment for fibromyalgia
TCAs or duloxetine
112
Clinical findings of lumbosacral strain (3)
>pain in lumbar area, may radiate to butt, hips, thighs (above knee)
>paraspinal tenderness
>no neurologic deficits; negative straight leg raising test (if + then likely radiculopathy)
113
Clinical features of glucagonoma (4)
>weight loss
>necrolytic migratory erythema
>DM/hyperglycemia
>GI symptoms
114
Most common cancer in pts with asbestosis exposure
bronchogenic carcinoma
115
Clinical findings in hypertrophic osteoarthropathy
digital clubbing is accompanied by sudden onset arthropathy, commonly affecting the wrist and hand joints
116
Most common organism in joint infections.
<3 months
3-12 months
>12 months
< 3 months: staph aureus, gram neg rods, anaerobes
3-12 months: coag neg staph, Propionibacterium species, enterococci
>12 months: staph aureus, gram neg rods, beta-hemolytic strep
117
What are common causes of nephrotic syndrome in adults?
>membranous nephropathy
>focal segmental glomerulosclerosis
>amyloidosis
118
What is the MCC of AA amyloidosis in the US?
rheumatoid arthritis
119
Clinical manifestation of Human Monocytic Ehrlichiosis (3)
>flu-like illness (high fever)
>neurologic symptoms (confusion)
>rash is uncommon
120
Treatment for Human Monocytic Ehrlichiosis
empiric doxycycline while awaiting confirmatory testing
121
Imaging used in pancreatic cancer based on presence of jaundice
>If jaundice tumor is likely in head, use US
| >If no jaundice, likely in body or tail, use CT
122
Treatment for bacterial infectious keratitis
antibiotics that have pseudomonal coverage (moxifloxacin)
123
What will special tests show in pts with alcoholic cerebellar degeneration?
>impaired tandem walking/heel-knee-shin
| >preserved finger-nose testing
124
Clinical manifestations of necrotizing otitis externa
>severe, unremitting ear pain (worse at night and with chewing)
>deficits of lower cranial nerves (7,10,11)
>granulation tissue in the external auditory canal
>elevated ESR
125
Treatment for necrotizing otitis externa
>IV antipseudomonal abxs (ciprofloxacin)
| > possible surgical debridement
126
Lab findings in ethylene glycol poisoning (3)
>high osmolar gap
>increased anion gap metabolic acidosis
>calcium oxalate crystals in urine
127
Which antibodies are found in Sjogren syndrome?
anti-RO and anti-La
128
RA can involve what part of the spine leading to what?
atlantoaxial joint which can lead to subluxation
129
What is myoclonus status epilepticus?
The acute form of posthypoxic myoclonus that typically develops within 24 hours after the initial hypoxic insult while the pt is still unconscious
*Generalized myoclonus, if persistent is a marker of poor prognosis
130
What is Lance-Adams syndrome?
the chronic form of posthypoxic myoclonus; presents days to weeks after the initial insult once the pt has regained consciousness
*Focal in nature
131
What imaging should be performed in a pt with posthypoxic myoclonus?
EEG should be done to distinguish betwen other forms of seizure and PHM
132
Which antibodies are found in a pt with SLE?
>antinuclear antibodies
| >anti-dsDNA and anti-Smith
133
What CNS manifestations are seen in SLE? (4)
>vasculitis
>thrombotic or thromboembolic disease
>seizures
>transverse myelitis
134
How do you diagnose hairy cell leukemia?
Bone marrow biopsy with flow cytometry
135
Clinical findings and cause of Lemierre syndrome
>usually caused by gram-negative anaerobic bacillus Fusobacterium necrophorum
>begins with an oropharyngeal infection
>affects neuromuscular structures leading to internal jugular vein thrombosis
136
When should Lemierre syndrome be considered?
In any toxic appearing pt with respiratory difficulties and significant neck swelling or tenderness in the week following an oropharyngeal infection
137
What 3 things are required to diagnose acute renal failure?
>severe acute liver injury (LFTs >1000)
>signs of hepatic encephalopathy (confusion, asterixis)
>synthetic liver dysfunction (INR >1.5)
138
First line treatment in a stable pt with A fib
>rate control (beta blocker or non-hydropyridine CCB)
139
Clinical findings in leprosy
>macular, anesthetic skin lesions with raised borders
| >nodular, painful nearby nerves with loss of sensory/motor function
140
How do you diagnose leprosy?
>full thickness biopsy of skin lesion along the active edge
| >M leprae cannot be cultured
141
Treatment for leprosy
>dapsone + rifampin
| >add clofazimine if severe
142
What are precautions/contraindications to metformin?
>renal insufficiency (check serum creatinine)
>hepatic insufficiency
>decompensated heart failure
143
How to diagnose Babesiosis
>thin blood smear: intraerythrocytic rings ("Maltese cross")
144
Treatment for Babesiosis
>atovaquone + azithromycin
| >quinine + clindamycin (if severe)
145
>internuclear ophthalmoplegia involves damage to what part of the brain?
damage to the heavily myelinated fibers of the medial longitudinal fasciculus (MLF)
**mediates communication betweeen CN III and VI nuclei
```
**unilateral = lacunar stroke
bilateral = MS
```
146
A lesion in the medial lemniscus would result in what?
contralateral loss of vibration, proprioception, and light touch
147
What are high risk features of a pancreatic cyst? (4)
>large size (>3 cm)
>solid components or calcifications
>main pancreatic duct involvement (ductal dilation)
>thickened or irregular cyst wall
148
Treatment for post-cardiac injury syndrome
>NSAID (usually high-dose aspirin) +/- colchicine
| >corticosteroids in refractory disease
149
Clinical presentation of drug-induced acne (3)
>monomorphic papules or pustules
>lack of comedones, cysts, and nodules
>location and age of onset may be atypical for acne
150
Common triggers of drug induced acne (4)
>glucocorticoids, androgens
>immunomodulators
>anticonvulsants, antipsychotics
>anti TB drugs
151
What two lab values provide the best analysis for a pt's acid-base status?
pH and PaCO2
152
Treatment for acute aortic dissection (4)
>pain control (morphine)
>IV beta blockers
>+/- sodium nitroprusside (if SBP > 120mmHg and beta blockers didn't work)
>emergent surgical repair for ascending dissection
153
What drug to give for V tach and SVT
V tack: IV amiodarone
SVT: adenosine
Unstable: both received synchronized cardioversion
154
Primary polydipsia is more common in what pts?
psychiatric pts possibly due to a central defect in thirst regulation
155
Management of triglyceride-induced pancreatitis
>triglycerides >500 consider insulin infusion
| >triglycerides >1000 or severe pancreatitis consider apheresis (therapeutic plasma exchange)
156
What antibodies are seen in diffuse cutaneous scleroderma?
>anti-Scl-70 (topoisomerase-1)
| >anti-RNA polymerase III
157
What antibodies are seen in limited cutaneous scleroderma (CREAST syndrome)?
>anti-centromere
158
What causes the "pounding" sensation in pts with Carcinoid?
due to flushing and associated rise in pulse rate
159
First line treatment for chronic venous insufficiency
>leg elevation
>exercise
>compression stockings
**If pt does not response then duplex US should be done to identify venous reflux
160
What will be seen on peripheral blood smear in a pt with scleroderma renal crisis?
>schistocytes
**presents like MAHA or DIC along with thrombocytopenia
161
When would Burr cells be seen on blood smear?
liver disease or end stage renal disease
162
When would target cells be seen on blood smear?
Pts with hemoglobinopathies (eg thalassemia) or chronic liver disease (especially obstructive liver disease)
163
If a pt has a stepwise decline in function and mental status what should be suspected?
vascular dementia
**cortical infarcts affect behavior
subcortical infarcts affect motor and sensory
164
What heart sound is associated with acute coronary syndrome (ACS)?
S4
**decrease in ATP does not allow the muscle to relax producing a stiffened left ventricular wall which causes the murmur
165
Clinical findings for a pt with multiple myeloma? (7)
```
>constitutional symptoms
>bone pain
>hypercalcemia
>renal insufficiency
>normocytic anemia
>protein gap (>4)
>rouleaux formation on blood smear
```
166
Management of pt with symptoms and calcium >14?
>normal saline hydration plus calcitonin
>avoid loop diuretics unless volume overload
*do this as pt typically volume-deplete due to polyuria and decreased oral intake
167
Treatment for prolactinoma
>dopaminergic agonists (cabergoline, bromocriptine)
| >if these do not work or pt cannot tolerate then surgical resection
168
When should treatment be started for a prolactinoma?
>macro prolactinoma (>10mm)
>risk or presence of neurologic symptoms
>hypogonadism
>galactorrhea
169
Clinical features of normal pressure hydrocephalus (5)
>gait instability (wide based) with frequent falls
>cognitive dysfunction
>urinary urgency/incontinence
>depressed affect
>upper motor neuron signs in lower extremities
170
What life threatening coagulopathy is seen in pts with APML?
DIC
171
What antibodies are seen in Antiphospholipid syndrome?
Anti-cardiolipin
172
What antibodies are seen in pts with autoimmune hepatitis?
anti-smooth muscle
173
If person was vaccinated for Hep B what will serology show?
Hep B surface antibody (HBsAb)
**HBcAb will be present if the person contracted the virus and then cleared it
174
Which drugs can lead to SIADH?
>carbamazepine
>SSRIs
>NSAIDs
175
Antibodies in bullous pemphigoid attack what part of the skin?
hemidesmosomes
176
Treatment for bullous pemphigoid
topical: high potency steroids
systemic: steroids, doxycycline
177
What should you do with vent settings if PaO2 >90 or <60
>90: decrease FiO2
| <60: increase PEEP
178
What should you do with vent setting if
>increased PaCO2 and pH <7.25
>decreased PaCO2 and pH > 7.45
> increase RR or ventilation
| >decrease RR and ventilation
179
When is anemia with reticulocytosis seen?
>acute bleeding
| >hemolysis
180
CLL is associated with what type of anemia?
warm autoimmune hemolytic anemia
**IgG attacks RBCs
181
Phenytoin should be supplemented with what?
folic acid
182
Treatment for QRS prolongation
sodium bicarb
183
How can leukocyte alkaline phosphatase (LAP) be used to distinguish between leukemoid reaction and CML
```
leukemoid = High
CML = Low
```
184
Initial diagnostic evaluation in first-time seizure pat in adults is aimed at excluding what?
metabolic and toxic causes
**perform EKG as well to rule out arrhythmias
185
Management of chest pain in pt with cocaine intoxication
>benzo for blood pressure and anxiety
>aspirin
>nitroglycerin
>immediate cath if indicated
186
If pt has chronic kidney disease, excessive bruising, and normal coagulation studies what should you be thinking?
platelet dysfunction
*** pts with CKD have high nitric oxide levels which decreases platelet adhesion, activation, and aggregation
187
Clinical presentation of tinea corporis (ringworm)
>scaly, erythematous, pruritic patch with centrifugal spread
| >subsequent central clearing with raised annular border
188
Associated neoplasms in Lynch syndrome (3)
>colorectal cancer
>endometrial cancer
>ovarian cancer
189
Associated neoplasms in FAP (3)
>colorectal cancer
>desmoids and osteomas
>brain tumors
190
Associated neoplasms in von Hippel-Lindau syndrome (3)
>hemangioblastomas
>clear cell renal carcinoma
>pheochromocytoma
191
MEN1 neoplasms (3)
>parathyroid
>pancreatic
>pituitary
192
MEN2A neoplasms (3)
>parathyroid
>medullary thyroid
>pheochromocytoma
193
Clinical features of idiopathic intracranial hypertension (4)
>HA/N/V
>visual changes (diplopia due to abducens nerve palsy)
>pulsatile tinnitus
>retrobulbar pain/neck pain/back pain
194
Diagnosis of idiopathic intracranial hypertension (4)
>papilledema and enlarged blind spots
>MRI to rule mass/hydrocephalus
>MR venography to rule out venous thrombosis
>lumbar puncture: shows elevated opening pressure
195
Long term medical management for idiopathic intracranial hypertension
acetazolamide
** may consider repeat LP of CSH shunt if vision becomes threatened
196
Treatment for uncomplicated acute pyelonephritis
>oral fluoroquinolone, trimethoprim-sulfamethoxazole
| >IV if vomiting, elderly, septic
197
Treatment for complicated acute pyelonephritis
>IV fluoroquinolone, aminoglycoside, extended spectrum beta-lactam/cephalosporin
198
What is considered salvage therapy?
Defined as a form of treatment for a disease when a standard treatment fails
199
What is consolidation therapy?
therapy typically given after induction therapy with multidrug regimens to further reduce tumor burden
** an example is multidrug therapy after induction therapy for acute leukemia
200
Hodgkin lymphoma is associated with what virus in immunosuppressed pts?
EBV
201
Methylmalonic acid levels to distinguish folate vs B12 deficiency
```
high = B12 deficiency
normal = folate deficiency
```
202
How is CLL diagnosed?
flow cytometry showing a clonality of mature B cells
203
What will be seen on peripheral blood smear in a pt with CLL?
smudge cells (CLL = crushed little lymphocyte)
204
What should you do before starting amiodarone?
check to see if they are taking digoxin
** if they are then decrease dose by 25-50%
205
What is a characteristic feature of euthyroid sick syndrome?
decreased peripheral conversion of T4 to T3 by 5'-monodeiodinase
206
When should you start rabies PEP?
If it is a high risk risk animal that is caught and tests positive, or if the animal is not able to be observed
207
What should all pts that come in with asthma exacerbation receive?
>inhaled SABA (albuterol)
> +/- ipratropium
>systemic glucocorticoid
208
Treatment of high altitude illness
Acetazolamide (carbonic anhydrase inhibitor, blocks reabsorption in the proximal tubule)
**accelerates HCO3 excretion in the urine
209
Management of opioid withdrawal
>opioid agonist: methadone or buprenorphine
| >nonopioid: clonidine or adjunctive medications (antiemetics, antidiarrheals, benzos)
210
Diagnosis of Echinococcus granulosus (2)
>large, smooth hydatid cyst often with internal septations on imaging
>IgG serology
211
What are typical symptoms of Paget disease of bone? (4)
>bone pain
>headaches
>unilateral hearing loss
>femoral bowing
** all this happens due to osteoclast dysfunction
212
Treatment of spontaneous bacterial peritonitis
>empiric abx: third gen cephalosporins
| >fluoroquinolones for SBP prophylaxis
213
Treatment for autoimmune hepatitis
glucocorticoids +/- azathioprine
214
Clinical manifestations of bacillary angiomatosis (3)
>vascular cutaneous lesions (papular, nodular, peduncular)
>systemic symptoms (fever, night sweats, fatigue)
>organ involvement rarely (liver, bone, CNS)
215
Initial treatment for hyperthyroidism
beta blockers to control heart rate and hyperadrenergic symptoms
216
What is first line treatment for Alzheimers?
Cholinesterase inhibitors (donepezil, galantamine, and rivastigmine for mild to moderate)
**memantine for moderate to severe (NMDA inhibitor)
217
What lab value is an independent predictor of mortality in pts with HFrEF?
hyponatremia
** <130 have an estimated 1 year survival as low as 15%
218
What is initial management in a pt with Meniere disease?
sodium, caffeine, nicotine, and alcohol restriction
219
What are the two most common symptoms in ALS?
>asymmetric limb weakness
| >bulbar symptoms (dysarthria, dysphagia)
220
Clinical manifestations of CVID (4)
>recurrent respiratory infections
>recurrent GI infections (salmonella, campy, GIARDIA)
>Chronic diseases
>Doesn't respond to vaccines
221
Clinical findings in osmotic diarrhea (3)
>high osmolar gap (>125)
>diarrhea occurs after ingestion of the causative substance
>does not occur during fasting
222
Clinical findings in secretory diarrhea (3)
>low osmolar gap (<50)
>diarrhea is typically large volume
>diarrhea persists while fasting and at night
223
Where do Pancoast tumors arise in the body?
Apical pleuropulmonary groove
224
Indications for aortic valve replacement (4)
>severe AS + one of the following:
* onset of symptoms (angina, syncope)
* left ventricular ejection fraction <50%
* undergoing other cardiac surgery (CABG)
225
What is the most common complication of acromegalic cardiomyopathy?
left ventricular aneurysm
226
When will cannon A waves be seen?
These waves can be seen with any arrhythmia involving atrioventricular dissociation, complete AV block, and frequent premature ventricular contractions (PVCs)
227
What causes cannon A waves?
Caused by the surge of jugular venous pressure that occurs due to right atrial contraction against a closed tricuspid valve
228
What gene is affected in pts with Follicular Lymphoma?
(t14;18) leading to overexpression of BCL-2
**oncogene that prevents apoptosis
229
Clinical findings of follicular lymphoma (3)
>older pt with months or years of waxing and waning lymphadenopathy
>B symptoms and lab abnormalities are rare
>mediastinal/hilar lymphadenopathy is sometimes seen
230
Clinical findings in Lewy body dementia (3)
>history of periodic confusion
>visual hallucinations
>parkinsonian motor symptoms
231
What would be seen on brain biopsy in a pt with Lewy body dementia?
Eosinophilic intracytoplasmic inclusions representing accumulation of alpha-synuclein protein, may be seen in neurons of the substantia nigra, locus coeruleus, dorsal raphe nucleus, and substantia innominata
232
What class of antihypertensive agents is associated with weight gain and worsening glucose tolerance?
>beta blockers
**alpha-1 receptors go unopposed, causing vasoconstriction, which reduces glucose uptake into skeletal muscles
**carvedilol, labetalol have vasodilatory alpha-1 receptor blocking properties and do not cause this issue
233
What are the mucin producing tumors and what can they cause?
>Pancreatic, gastric, ovarian, breast
| >they secrete tissue factor into the blood which can lead to DIC
234
What is D-xylose used to measure?
Used to measure proximal small intestine absorption
** if it is low then there is an issue with absorption (eg celiac)
** if it is high then that can point towards an enzyme deficiency (eg lactose intolerance)
235
Which lab value is tested for to diagnose rhabodo?
serum creatine phosphokinase
236
What are two big complications of giant cell arteritis?
>permanent vision loss
| >aortic aneurysm due to large-vessel involvement
237
What are useful tests for evaluating factitious diarrhea? (3)
>stool osmolality
>stool electrolyte
>stool osmotic gap
238
Treatment for Paget disease of bone
>bisphosphonates
239
What is the best way to prevent febrile nonhemolytic transfusion reaction from occurring?
>using leukoreduced blood products
240
Treatment progression for a pt with hyperthyroidism
1. beta blockers
2. methimazole or PTU
3. radioactive iodine therapy
241
What is the LAP score used to distinguish between?
```
high = leukemoid reaction
low = CML
```
242
What are the alternate treatments for syphilis?
>Doxycycline (14 or 28 days if late latent or tertiary)
| >ceftriaxone (14 days if neurosyphilis)
243
What is the "rare disease assumption"?
in a case control study, if the outcome is uncommon in the population, the odds ratio is a close approximation of the relative risk
244
What is the MCC of AA amyloidosis?
long-standing rheumatoid arthritis
245
What are the two MCC of a singular brain abscess?
>viridans streptococci
>Staph aureus
** these usually result from direct extension of an adjacent tissue infection (otitis media, sinusitis, dental infection)
246
Treatment for brain abscess
>aspiration/surgical drainage
| >prolonged antibiotic therapy (ceftriaxone, vanco, metro)
247
How long can heterophile test be negative in a pt with EBV mono?
25% false-negative rate during the 1st week of illness so this test cannot be used to rule out the diagnosis
248
What should be checked for in the serum of all pts suspected of having GPA?
antineutrophil cytoplasmic antibodies (ANCA)
* **c-ANCA is most commonly positive in GPA
* **p-ANCA more common in microscopic polyangiitis and EGPA
249
Treatment of Myasthenic crisis?
>intubation for deteriorating respiratory status
| >plasmapheresis or IVIG as well as corticosteroids
250
Empiric antibiotics for pts age 2-50 with bacterial meningitis
Vanco + 3rd gen cephalosporin
251
Empiric antibiotics for pts age >50 with bacterial meningitis?
Vanco + ampicillin + 3rd gen cephalosporin
252
Empiric antibiotics for immunocompromised pts with bacterial meningitis?
Vanco + ampicillin + cefepime
253
Lab findings in pts with polycythemia vera (4)
>elevated hemoglobin
>leukocytosis and thrombocytosis
>low EPO levels
>JAK2 mutation
254
When should steroids be given to pts with PCP pneumonia? (3)
>pulse ox <92%
>PaO2 <70
>alveolar-arterial gradient >35 on room air
***antiretroviral therapy should also be started within 2 weeks
