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Step 2 CK Medicine > Internal medicine > Flashcards

Internal medicine Flashcards

1
Q

Antinuclear antibodies

A

SLE

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2
Q

Antimitochondrial

A

Primary Biliary Cirrhosis

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3
Q

Anti SSA anti SSB (Anti-Ro, Anti-La)

A

Sjogren Syndrome

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4
Q

c-ANCA

A

Wegener granulamotosis with polyangiitis

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5
Q

pANCA

A

Churg Strauss, microscopic polyangiitis, pAnca is positive in Ulcerative Colitis

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6
Q

antimicrosomal Ab

A

Hashimoto

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7
Q

anti-centromere

A

limited scleroderma CREST

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8
Q

anti cardiolipin, lupus anticoagulant

A

SLE, antiphospholipid syndrome

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9
Q

Rheumatoid factor

A

Rheumatoid arthritis

(IgM ab against Fc IgG)

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10
Q

Adult onset Still disease

A

a systemic inflammatory disorder characterized by quotidian (daily) fever, evanescent (salmon bumpy) rash, arthritis, and multisystem involvement. Dx of exclusion (infection, lymphoma, leukemia). Labs abnormalities in patients with AOSD include leukocytosis, anemia, thrombocytosis, elevated erythrocyte sedimentation rate, elevated serum ferritin level (≥1000 ng/mL [1000 µg/L]), and abnormal liver chemistry tests; antinuclear antibody titer and rheumatoid factor typically are negative.

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11
Q

A fib treatment

A

3 basic principles: rate control, restoration/maintenance of sinus rhythm, and stroke prevention. Hemodynamically unstable–>cardioversion, otherwise

  • Rate control: oral non-dihydropyridine calcium channel blocker (dialtiazem) or β-blocker (metoprolol) as first step in therapy with ventricular rate goal of 1 year) recurrence rate of symptomatic atrial fibrillation is 20% to 50%.
  • Ablation: around the ostia of the pulmonary veins -CHADS2 risk score to predict stroke in patients with nonvalvular atrial fibrillation. Use Warfarin target [INR] of 2.0-3.0 or Rivaroxaban and Apixaban (factor Xa inhibitor), Dabigatran (a direct thrombin inhibitor)
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12
Q

Toxic megacolon

A

is the most severe complication associated with ulcerative colitis. Pt usually have at least 1 week of bloody diarrhea that is unresponsive to medical therapy. Xray: transverse colon most affected, w/ dilatation exceeding 6 cm. About 50% of patients with toxic megacolon may improve with medical therapy (bowel rest, intravenous glucocorticoids, antibiotics, and fluids); however, progressive abdominal distention and tenderness with hemodynamic instability are indications for immediate surgery.

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13
Q

Diagnostic eval of CKD

A
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14
Q

Nephritic syndrome is characterized by

A

hematuria, variable proteinuria, and hypertension

postinfectious glomerulonephritis, IgA nephropathy, Wegener, microscopic and membranoproliferative glomerulonephritis (this last can also be nephrotic).

SLE commonly affects the kidneys and may cause nephritic or nephrotic syndrome. A kidney biopsy often is needed to make a specific diagnosis and to guide therapy.

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15
Q

Nephrotic syndrome is characterized by

A

high-grade proteinuria ( >3.5 g/24 h), hypoalbuminemia, and edema. Common causes include minimal change disease, focal glomerulosclerosis, membranous nephropathy, and amyloidosis. SLE commonly affects the kidneys and may cause nephritic or nephrotic syndrome. A kidney biopsy often is needed to make a specific diagnosis and to guide therapy.

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16
Q

T score of osteoporosis and osteopenia & dif of osteomalacia

A

Dual-energy x-ray absorptiometry (DEXA) scanning determines T score.

Osteoporosis: dx by T score <-2.5 or any presence of fragility fracture (ractures with normal life activity:). Typical sites of fractures: vertebra, neck of the femur, Colles fracture of the wrist).

Osteopenia: T score -1.0 to -2.5,

Osteomalacia: “softening of the bones” Generalized disorder of bone resulting in decreased mineralization of newly formed osteoid at sites of bone turnover. Asx or diffuse bone and joint pain, muscle weakness, and difficulty walking. MOST COMMONLY due to low levels of vitamin D or low Ca, but also hypophosphatemia and, increased serum parathyroid hormone and alkaline phosphatase levels.

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17
Q

Paget disease (bone)

A

Increase rate of bone turnover leading to mosaic lamellar bone patttern on xray. Usually asx, but aching bone or joint pain , HA, bony deformities, fractures, nerve entrapment (loss of hearing in 30-40% of cases involving skull)

Dx: ELEVATED alkaline phosphatase but nrml Ca and PO4.

Tx: Asx in most pt and no cure therefore no tx. Bisphosphonates, calcitonin can be used to slow bone resorption, NSAID for pain.

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18
Q

Celiac disease screening/dx

A
  • tissue transglutaminase (tTG) IgA antibody assay, if positive-> small bowel biopsy,
  • Histologic findings: increased intraepithelial lymphocytes and mucosal atrophy with loss of villi.
  • sx: diarrhea, bloating, and weight loss.
  • Associated disease: Iron deficiency anemia, autoimmune diseases: Hashimoto thyroiditis & type 1 diabetes mellitus.
  • tx: gluten free diet
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19
Q

Absolute risk

A

the risk of a specific disease based on its actual occurrence, or its event rate (ER), in a group of patients being studied, and is expressed as:

AR = Patients with event or disease in group/Total patients in group

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20
Q

How many patients need to be treated (number needed to treat [NNT]) with drug A compared with drug B to prevent one extra case of DVT?

Drug A 25 (DVT)/2500 (total pt)

Drug B 50(DVT)/2500 (total pt)

A

NNT=100

Drug A: Absolute risk AR= 25/2500=1%

Drug B: AR=50/2500=2%

Absolute benefit index (ABI) or Absolute risk reduction (ARR)= 2%-1%=1%

NNT= 1/ABI = 1/0.01 = 100

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21
Q

COPD dx Spirometry

A

FEV1/FVC < 70%

Level 1 (mild) COPD = FEV1 of 80% or greater of predicted.

Level 2 (moderate) = FEV1 of 50% -79% of predicted.

Level 3 (severe) = FEV1 of 30% - 49% of predicted. Level 4 (very severe)= FEV1 < 30% of predicted.

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22
Q

Viral vs bacterial meningitis

A

CSF findings that predict bacterial etiology with ≥99% certainty include:

Protein concentration >220 mg/dL (2200 mg/L)
Glucose concentration <34 mg/dL (1.9 mmol/L)
CSF-blood glucose ratio <0.23
Leukocyte count >2000/µL (2 x 10^9/L)
Neutrophil count >1180/µL (1.18 x 10^9/L)

In patients with suspected viral meningitis, CSF polymerase chain reaction (PCR) testing should be considered for non-poliovirus enteroviruses (echoviruses and coxsackieviruses) and HSV, as well as enzyme-linked immunosorbent assay (ELISA) testing for arboviruses (West Nile virus, St. Louis encephalitis virus, California encephalitis virus, and eastern equine encephalitis virus).

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23
Q

HSV encephalitis

A

Herpes simplex virus is one of the most common causes of identified sporadic encephalitis worldwide, accounting for 5% to 10% of cases.

Sx: fever, hemicranial headache, language and behavioral abnormalities, memory impairment, cranial nerve deficits, and seizures.

dx: PCR assay

Imaging: CT or MRI: Bilateral temporal lobe involvement is nearly always pathognomonic for herpes simplex encephalitis but is a late development.

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24
Q

FeUrea <35% is suggestive of

A

Pre renal, (euvolemic pt have Feurea > or = to 35%)

FeNa <1% also pre-renal but cant use it if pt take s diuretics

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25
Q

+ Rheumatoid factor

+ Anti–cyclic citrullinated peptide (anti-CCP) antibodies

A

Rheumatoid arthritis

tx: NSAIDS, steroids, methotrexate,

Sulfasalazine (an aspirin-like agent often used in combination with methotrexate or another nonbiologic DMARD when there is an inadequate response to therapy), Infliximab (TNF factor α inhibitor that is often used when patients do not respond to methotrexate or if they have advanced disease and a poor prognosis, such as early erosive disease)

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26
Q

Graves Disease tx

A

Methimazole (preferred over propylthiouracil) and atenolol for tachycardic. (Atenolol preferred bc β-1 selectivity and long half-life allowing once a day dosing)

Sx of Grave: tachycardia; elevated systolic blood pressure with a widened pulse pressure; palpable goiter, which is classically smooth; thyrotoxic stare due to lid retraction; proptosis; and, infrequently, an infiltrative dermopathy

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27
Q

Primary Parathyroidism

A

Effects of excess parathyroid hormone include increased 1,25-dihydroxy vitamin D levels, increased osteoclast-mediated bone resorption, enhanced distal tubular reabsorption of calcium, decreased proximal tubular reabsorption of phosphorus, hypercalcemia, hypophosphatemia, and increased urine phosphate and calcium levels.

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28
Q

Stepwise approach of asthma treatment

A
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29
Q

Biguanides

A

Metformin: mechanism unknown, Increases insulin sensitivity.

First line in T2DM

SE: lactic acidosis. CI in RENAL FAILURE

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30
Q

Sulfonylureas

A

Glyburide, Glipizide

mecha: close K+ channel in beta c membrane, so cell depolarizes by triggering of insulin release via

increase in Ca2+ influx. Stimulates release of endogenous insulin

SE: Hypoglycemia, glipizide has fewer hypoglycemically active metabolites and has a shorter half-life than glyburide, it also frequently causes hypoglycemia, particularly in older patients

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31
Q

Glitazones: Rosiglitazone, Pioglitazone

A

Increase insulin sensi in peripheral tissue. Binds to PPAR-σ nuclear transcription regulator

SE: weight gain, edema, hepatotoxicity, HF

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32
Q

alpha-glucosidase inhibitors: Acarbose, miglitol

A

Inhibit brush border alpha glucosidase. Delays glucose absorption

Se: GI disturbances

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33
Q

Acral lentiginous melanoma

A

as a longitudinal dark pigmented streak on a fingernail or toenail, dark pigmentation of a proximal nail fold, and dark pigmented patches on the palms or soles. This variant of melanoma is the most common type among Asian and dark-skinned people. Acral lentiginous melanomas account for only 5% of melanoma cases.

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34
Q

Lentigo maligna melanoma presents i

A

nitially as a freckle-like, tan-brown patch. When confined to the epidermis, the lesion is called lentigo maligna type. The lesion may be present for many years before it expands and becomes more variegated in color. When it invades the dermis, it becomes melanoma. It most often arises in sun-damaged areas (face, upper trunk) in older people. Lentigo maligna melanoma accounts for approximately 10% of melanoma cases.

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35
Q

Nodular melanoma

A

presents as a dark blue or black “berry-like” lesion that expands vertically (penetrating skin-most agressive melanoma). It most commonly arises from normal skin and is most often found in people age 60 years or older. Nodular melanoma accounts for approximately 15% of melanoma cases.

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36
Q

Superficial spreading melanoma

A

presents as a variably pigmented plaque with an irregular border and expanding diameter ranging from a few millimeters to several centimeters. It can occur at any age and anywhere on the body, although it is most commonly seen on the back in men and on the legs in women. Most superficial spreading melanomas appear to arise de novo. Superficial spreading melanoma accounts for approximately 70% of melanoma cases.

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37
Q

Tumor lysis syndrome

A

Life-threatening complication in patients with malignancies associated with rapid cell turnover (leukemia, Burkitt lymphoma) or with bulky disease and high leukocyte counts associated with rapid and significant sensitivity to chemotherapeutic agents (large cell lymphoma, chronic lymphocytic leukemia).

Signs/Sx: hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, acute kidney injury, and DIC

tx: Aggressive hydration with diuresis + allopurinol and rasburicase or hemodialysis

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38
Q

TTP thrombotic thrombocytopenic purpura

(consumptive thrombocytopenia and microangiopathic hemolysis from platelet thrombi that form throughout the microvasculature)

A

Pathologic process w/ abnormal activation of platelets and endothelial cells, deposition of fibrin in the microvasculature, and peripheral destruction of erythrocytes and platelets.

TTP should be suspected in patients who have:

(1) microangiopathic hemolytic anemia, characterized by schistocytes on the peripheral blood smear, decreased haptoglobin and increased serum lactate dehydrogenase (LDH)

and

(2) thrombocytopenia

Possible Sx: fever; Hematuria, Elevated serum creatinine levels, and proteinuria; and fluctuating neurologic manifestations, such as headache, confusion, sleepiness, coma, seizures, and stroke, but the absence of these symptoms does not exclude the diagnosis.

tx: Plasma exchange should be instituted emergently at diagnosis because 10% of patients die of this disease despite therapy, glucocorticoids

Most patients with TTP have an autoantibody that inhibits a metalloproteinase (ADAMTS13) that normally cleaves unusually large von Willebrand factor multimers into smaller fragments

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39
Q

erythema multiforme (EM)

A

an acute, often recurrent mucocutaneous eruption that usually follows an acute infection, most frequently recurrent herpes simplex virus (HSV) infection. Drugs (ABx), cancer, autoimmune disease can also cause it.

pt 20-40yo

rash: erythematous plaques with concentric rings of color, on the extensor surfaces of the extremities, particularly the hands and feet. Mucosal lesions are present in up to 70% of patients and involve the cutaneous and mucosal lips, gingival sulcus, and the sides of the tongue. Mucosal lesions consist of painful erosions or, less commonly, intact bullae.

Lesions usually last 1 to 2 weeks before healing; however, hyperpigmentation may persist.

tx: Symptomatic: steroids, antiviral

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40
Q

Acute lymphocytic leukemia

A

Most common childhood malignancy

Most responsive to chemotherapy

Sx: Anemia, thrombocytopenia, hepatosplenomegaly, swollen and bleeding gums

t(12, 21) better prognosis

Poor prgnosis: <1yo or >10yo, WBC>50,000, CNS involvement

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41
Q

Acute myelogenous leukemia

A

AML type M3: Acute Promyelocytic Leukemia (APL) has Auer rods, t(15,17) treated with ATRA (All thrans retinoic acid therapy= Vitamin A. DIC common in this type.

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42
Q

CLL

A

Smudge cell on peripheral smear

Well differentiated B lymphocytes mostly

Older adults >60yo

Flow cytometry: CD5+, CD20+ and CD21+

tx mostly palliative but chemotherapy

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43
Q

CML

A

t(9,22) philadelphia chrm, BCR-ABL translocation

3 phases:

chronic: w/o tx last 3.5-5y, tx ith imatinib (selective inhibitor of bcr abl tyrosine kinase product of 9,22 translocation)

Accelerated: Transition towards blast crisis w/ increase in peripheral and bone marrow blood counts

Blast crisis: Resembles acute leukemia, survival 3-6mths, tx same as for acute leukemia dasatinib + transplantation

Leukocyte alakaline phosphatase low, LDH/uric acid/B12 elevated

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44
Q

Non hodgkins lymphoma

A

Most are B cell origin

5 times more common than hogdkin’s

pt >50 yo

dx: LN biopsy

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45
Q

Hodgkin’s

A

30 and 60 yo

Prsentation is above the diaphragm

systemic B sx

dx: fine needle aspiration: Reed Sternberg cells
tx: chemo, radiation, prognosis is good

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46
Q

Sick sinus syndrome

A

Tachycardia-bradycardia sydrome

Intermittent supraventricular tachy and bradyarrhythmias

May develop syncope, palpitations, dyspnea, chest pain, TIA, stroke

Get PACEMAKER

((sinus bradycardia correlated with dizziness

Caused by collection of pathologic findings that result in bradycardia: sinus arrest, sinus exit block, and sinus bradycardia))

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47
Q

Adrenal insufficiency

A

Primary: Autoimmue=Addison’s disease, infection (TB leading cause of AI worldwide, Neisseria meningitis-: Waterhouse, Friderichsen syndrome), congenital enzyme deficiency.

Secondary/Tertiary: decreased ACTH by pituitaryMOST OFTEN DUE TO CESSATION OF LONG TERM STEROIDS (even 1 week of steroids is long enough to cause this)

Clinical manisfestation:

No adolsterone, no cortisol, no andorgen-> hyponatremia and Hypovolemia, HyperKalemia, acidosis. ADH elevated bc of hypovolemia so Urine Osm greater than Serum Osm (concentrated urine), Skin and mucosa hyperpigmentation in Primary

Females: loss of axilla and pubic hair, loss of libido

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48
Q

Adrenal crisis

A

Tx: 4S

Salt: 0.9% NS

Steroids: IV hydrocortisone 100mg q8h

Support (correct hypoglycemia with 50% dextrose)

Search of underlying cause

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49
Q

Addison’s disease

A

Primary AI due to adrenal atrophy or destruction by disease (TB, autoimmune, metastasis).

Deficiency in aldosterone and cortisone causing HYPOtension (hyponatremic volume contraction), HYPERkalemia, acidosis, and skin and mucosal HYPERpigmentation (due to MSH, a by-product of increased ACTH production from proopiomelanocortin (POMC). C

Distinguish from 2° adrenal insufficiency (decreased pituitary ACTH production), which has no skin/mucosal hyperpigmentation and no hyperkalemia.

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50
Q

RAAS

A
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51
Q

Management of acute, uncomplicated cystitis (ABX)

A

Trimethoprim-sulfamethoxazole or nitrofurantoin

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52
Q

The 1 for 10 Rule for Acute Respiratory Acidosis

A

The [HCO3] will increase by 1 mmol/l for every 10 mmHg elevation in pCO2 above 40 mmHg.

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53
Q

Winter’s formula

A

pCO2 = 1.5 x [HCO3] + 8 (+/- 2) for metabolic acidosis compensation

Respi compensation is usually 1.2 mmHg fall in pCO2 for every 1mEq/L fall in [HCO3]

Quick but less accurate formula:

pH: 7.XX then pCO2 should be XX

(Ex: pH 7.30 than expect pCO2 to be 30)

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54
Q

The 4 for 10 Rule for Chronic Respiratory Acidosi

A

The [HCO3] will increase by 4 mmol/l for every 10 mmHg elevation in pCO2 above 40mmHg.

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55
Q

Polyarteritis nodosa

A

Medium-sized vessels vasculitis involving CNS and GI. Immune complex mediated. PMN invasion of all layers and fibrinoid necrosis + resulting intimal proligeration=reduced luminal area->ischemia, infarction, aneurysms.

Pt: Associated with Hepatitis B seropositivity, HIV, drug reactions

Sx: Constitutional + Adominal pain (bowel angina)

Dx: Biopsy, mesenteric anguigraphy, ESR elevated, p-ANCA

Treat with corticosteroids, cyclophosphamide. Poor prognosis.

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56
Q

Gout tx acute vs chornic

A

Chronic: allopurinol, (febuxostat)

Acute: NSAIDS, Colchicine, steroids

Be careful! At first, allopurinol transiently increases the risk for acute gout attacks for 3 to 6 months; SO also use colchicine.

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57
Q

Restrictive lung disease pattern on Spirometry

A

Reduced FEV1 (less than 80%)

Normal FEV1/FVC ratio, (greater than 70%)

Reduced total lung capacity and DLCO (Diffusing Capacity of the Lung for Carbon Monoxide).

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58
Q

Enteropathic arthritis

A

Arthritis associated with IBD: Chron’s and ulcerative colitis

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59
Q

Churg-Strauss syndrome

A

Medium vessel vasculitis involving many systems: Respi, Cardiac, GI, Skin, Renal, Neuro

Clinical features: fever, fatigue, weight loss, PROMINENT respi findings (ASTHMA (usuall antecedent, DYSPNEA).

Dx: Eosinophilia, + p-ANCA

Prognosis: 5 y survival at 25% (death due to cardio or pulm complications), W/ tx: steroids, 5 y survival to 50%.

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60
Q

Wegener’s Granulomatosis (Granulomatosis with polyangiitis)

A

Medium vessel vasculitis

Involves predominantly kidneys and upper & lower respiratory tract

MOST pt have sinus disease +pulm disease + Glomerulonephritis

Dx: CXR: nodules, infiltrates. Elevated ESR, anemia, + C-anca in 90% of pt

Prognosis: poor, pt die w/in 1 y of diagnosis

Tx: cyclophosphamide and corticosteroids can induce remissino but relapse possible

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61
Q

Temporal arteritis

A

“Giant cell arteritis”

pt>50yo Women>men

Temporal arteries mostly but also aorta or carotids therefore increase risk of aortic aneurysm and dissection

Sx: HA-severe, visual impairment (involemt of ophthalmic artery), optic neuritis-> blindness (amaurosis fugax), Jaw pain with chewing, tenderness over temporal artery (no pulse), malaise, fatigue, weight loss, low-grade fever

40% of pt have also polymylagia rheumatica

Dx: ESR elevated, Biopsy of temporal artery

Tx: Prednisone IMMEDIATELY ( do not wait for biopsy results) bc of blindness risk, if visual lost do IV steroids may be reversible.

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62
Q

Takayasu’s arteritis

A

Large vessel vasculitis of aortic arch and its major branches

Young Asian women (suspect if decreased/absent peripheral pulses, discrepancies of BP (arm/leg), arterial bruits)

Dx: Arteriogram

Tx: steroids may help, treat HTN, surgery to recannulate stenosed vessles, bypass grafting sometimes required

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63
Q

Behcet’s syndrome

A

Autoimmune, multisystem vascultis disease

Recurrent oral and genital ulcerations, arthritis, eye sx, CNS sx

Dx: biopsy

Tx: steroids

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64
Q

Buerger’s disease

A

young men who smoke cigarettes

Acute inflammation of small and medium vessel affecting arm and legs-> gangrene

Sx: Ischemic claudication, cold, cyanotic painfule extremeties

SMOKING CESSATION needed

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65
Q

ABX for Pseudomonas

A

beta-lactam and aminoglycoside mostly for patients with neutropenia, bacteremia, sepsis, severe upper respiratory infections (URIs), or abscess formation

Ex: Piperacillin-tazobactam (Zosyn) + Gentamicin/neomycin/amakicin/tobramycin/streptomycin

Just zosyn, Just aminoglycosides

Ceftazidime (3rd generation cephalosporin)

Cefepime (4th generation cephalosporin)

Fluroquinilone: Ciprofloxacin, levofloxacin

Carbenapems: Imipenem, Meropenem

No proven benefits of combo>mono therapy unless Abx resistance but some still prefer combo as initial until sensitivities come back

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66
Q

Status epilepticus tx

A

IV benzo (lorazepam) + loading dose of fosphenytoin

If seizures continue intubate and load with phenobarbital

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67
Q

Serum osmolality formula =

A

2[Na+] + [BUN]/2.8 + [glucose]/18

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68
Q

Metabolic syndrome diagnosis

A

3/5 of

  • Increased waist circumference,
  • Elevated systolic ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg,
  • Decreased HDL cholesterol level <40 mg/dL men and <50 mg/dL women,
  • Elevated triglyceride level≥150 mg/dL,
  • Elevated fasting plasma glucose level ≥110 mg/dL .
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69
Q

Cauda Equina syndrome

A

Bowel, bladder dysfxn, impotence and saddle area anesthesia

SURGICAL EMERGENCY

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70
Q

Anti-Jo 1

A

Polymyositis/dermatomyositis

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71
Q

Antihistone

A

drug induced SLE

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72
Q

Anti-smooth muscle

A

Autoimmune hepatitis, SLE

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73
Q

Antitopoisomerase I (Anti-Scl-70)

A

Scleroderma

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74
Q

Anti ds DNA

A

SLE

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75
Q

SLE

A

DOPAMINE RASH: must have at least 4

Discoid rash

Oral ulcers

Photosensitivity

Arthritis

Malar rash

Immunologic criteria: anti-ds DNA, anti sm-Ab

Neurologic sx: seizures, psychosis

Elevated ESR

Renal disease

ANA +

Serositis: pleural or pericardial effusion

Hematologic abnormalities: leukopenia, lymphopenia, thrombocytopenia

tx: NSAIDs, steroids, hydroxychloroquine !eye-retina!, cyclophosphamide

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76
Q

Hypertension

Hypernatremia

Hypokalemia

Metabolic alkalosis,

and low plasma renin or high plasma renin

A

Primary Hyperaldosteronism: low plasma renin.

Causes: Adrenal hyperplasia or an aldosterone-secreting adrenal adenoma (Conn syndrome).

Normal Na+ due to aldosterone escape = no edema due to aldosterone escape mechanism.

Tx: Surgery to remove the tumor and/or spironolactone, a K+ -sparing diuretic that acts as an aldosterone antagonist.

Secondary Hyperaldosteronism: high plasma renin

Renal perception of low intravascular volume results in an overactive renin-angiotensin system. Due to renal artery stenosis, CHF, cirrhosis, or nephrotic syndrom

Tx: Spironolactone

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77
Q

Stroke management

A

tPA if 1h of entering emergency room and with/in 3h of sx onset

  • Thrombolysis is contraindicated in patients with intracerebral hemorrhage, a systolic BP >185 mm Hg or diastolic BP >110 mm Hg, or mean arterial pressure >130 mm Hg
  • If pass 3h mark, start antiplatelet therapy: aspirin within 48 hours of stroke and TIA to reduce subsequent stroke risk.
  • Do NOT treat HTN unless BP exceeds 220/120 mm Hg, UNLESS pt has acute coronary syndrome, heart failure, aortic dissection, hypertensive encephalopathy, or acute kidney injury.
  • Hypoglycemia associate with poor outcome. Give insulin if glucose levels >140 mg/dL
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78
Q

Variant angina tx

cocaine induced chest pain

A

Variant: CCB

COcaine: CCB and benzo ok

DO NOT USE beta blockers!!

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79
Q

Fibromyalgia tx

A

SNRI duloxetine

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80
Q

Bisphosphonates

A

bind to the bone matrix and decrease osteoclast activity, thereby slowing bone resorption while new bone formation and mineralization continue

PO: Alendronate

IV: Zoledronic acid (if any esophageal disorders as esophagitis is a SE of po biphosphonates).

81
Q

COPD tx

A

Bronchodilators:

1st line tx: short acting beta2-agonist (albuterol), short acting anticholinergics (ipratroprium), or combo

Long acting neta agonist (Salmetorol) or anticholinergics (tiotropium)

(Theophylline is the least preferred long-acting bronchodilator option because its effects are modest and toxicity is a concern)

If pt had repeated exacerbations add a steroid

O2 if pt had chronic hypoxemia

82
Q

anisopoikilocytosis

A

rbc of different size and shape (variant red blood cell distribution width (RDW) measurement)

(Think nutrient deficiency: iron, folate, or vitamin B12)

83
Q

Normal Sodium

Normal Potassium

Normal Chloride

Normal Calcium

A

Sodium: 136-145 mEq/L

Potassium: 3.5-5

Chloride: ~100

Calcium: ~10

84
Q

delayed hemolytic transfusion

A

5 to 10 days after erythrocyte transfusion, alloantibodies agaisnt erythrocytes

anemia, jaundice, and fever and a worsening pain crisis in patients with sickle cell anemia.

85
Q

DIC

A

Prolonged PT & aPTT

Increase D-dimer titer, (ascites increased this either way just FYI)

Decreased serum fibrinogen level & platelet count,

Presence of microangiopathic hemolytic anemia.

Most common causes: infection (GN mostly), cancer, obstretrics complications

86
Q

Light’s criteria

A

Exudate if:

Total protein / serum total protein ratio >0.5

Pleural fluid LDH >2/3 of the upper limit of normal (or pleural fluid / serum lactate dehydrogenase ratio >0.6).

87
Q

Tricuspid regurgitation

A

systolic murmur at the lower left sternal border that may increase in intensity with inspiration.

88
Q

Multiple sclerosis dx test

A

Clinical young adult with relapsing and remitting neuro signs and sx that are difficult to explain due ton involvment of different areas of CNS matter.

MRI- test of choice, demyelinating lesions

Lumbar puncture! NEXT test of choice : oligoclonoal bands of IgG (in 90% of MS pt)

89
Q

Radioactive iodine uptake in Grave’s disease

A

Diffuse iodine uptake

Grave’s: autoimmune HYPER thyroidism, autoAb stimulate the increase of T3 and T4 production by stimulating the TSH receptor

tx:Propanolol, methimazole

90
Q

Thyroid cancer Papillary

A

Popular: most common

Papable LN

“pupil” nuclei: “Orphan Annie” nuclei

Psommomma bodies

91
Q

MEN 1

A

Diamond

Parathyroid tumors

Pituitary tumors (prolactin or GH)

Pancreatic endocrine tumors (Zollinger- Ellison syndrome, insulinomas, VIPomas, glucagonomas (rare))

Commonly presents with kidney stones and stomach ulcers

Auto Dominant

  • primary hyperparathyroidism (>90%)
  • Enteropancreatic tumors (60-70%)
  • Pituitary tumors (10-20%)
92
Q

MEN2A

A

Square

Medullary thyroid carcinoma (secretes calcitonin) (>90%)

Pheochromocytoma (40-50%)

Parathyroid hyperplasia (10-20%)

RET gene mutation, auto dominant

93
Q

MEN2B

A

Triangle:

Medullary thyroid carcinoma (secretes calcitonin)

Pheochromocytoma

Oral/intestinal ganglioneuromatosis (mucosal neuromas).

Associated with marfanoid habitus

RET gene mutation, auto dominant

94
Q

Hypercalcemia

A

“Stones, Bones, Moans, Groans and psychiatric overtones”

tx: IV fluids and loop diuretics

95
Q

familial hypocalciuric hypercalcemia

A

Inherited disorder due to mutation in calcium sensing receptor present on parathyroid and kidney, presents with elevated calcium levels BUT unlike primary hyperparathyroidism, pt are asx and have LOW urinary calcium levels.

96
Q

C. diff treatment and if relapse treatment

A

Tx: metrodinazole, add oral vancomycin if relapse (not IV)

97
Q

porphyria cutanea tarda

A

Most common porphyria. Skin manifestations are varied and include blisters, erosions, hyperpigmentation, and hypertrichosis.

very strong association with chronic hepatitis C infection

a deficiency in uroporphyrinogen decarboxylase, an enzyme in the heme biosynthesis pathway.

Sunlight activates the large amounts of uroporphyrinogen that are deposited in the skin, leading to photosensitization and tissue damage

98
Q

Lichen planus

A

polygonal, pruritic, papular, planar, purple, and with plaques (the six Ps).

association with hepatitis C,

99
Q

CURB-65

A

Confusion,

Uremia: BUN >19.6 mg/dL,

Respiration rate ≥30/min,

Systolic Blood pressure <90 mm Hg or diastolic <60 mm Hg, and

age ≥65 years

100
Q

bilateral hilar adenopathy

A

Sarcoidosis

101
Q

Target cells

A

Thalessemia, liver disease

Asplenia, HbC disease

102
Q

Primary Hyperaldosteronism

A

Hypertension, mild hypernatremia, suppressed renin activity, metabolic alkalosis,

HypoKalemia not always present (but will be if pt on diuretics. CLinical significant hypernatremia and edema not present due to aldosterone escape mechanism.

Cause: Bilateral nodular hyperplasia, hyperfunctioning adrenal adenoma

Leads to: Aldosterone elevated, therefore K+ excreted, H+ excreted, Na+ reabsorbed->Hypokalemia, Metaboli alkalosis, Hypertension -> decrease renin and aldosterone levels

BUT: Increased renal Blood flow, increased GFR, increased atrial natriuretic peptide avoids edema and hypernatremia by leading to Na+ excretion (ALdosterone escape).

103
Q

chlorthalidone

A

diuretic that works like thiazide but doesnt have the same molecular structure

104
Q

Renal Tubular Acidosis type 1, 2, 4

A

Type 1:

  • Cant secrete H+ in distal tubule -> non anion gap metabolic acidosis
  • Urine pH>5.5 increased
  • Hypokalemia
  • Calcium Phosphate Kidney Stones
  • Causes of type 1: amphotericin B toxicity, multiple myeloma…

Type 2:

  • Defect at proximal tubule in HCO3- reabsorption leading to increased excretion -> non anion gap met acidosis
  • Hypokalemia
  • Causes: Fanconi syndrome, chemical toxic (lead, aminoglycosides) and carbornic anhydrase inhibitors

Type 4:

  • Hyperkalemia -> decreased buffering capacity and decreased H+ secretion, ph urine<5.5
  • Hypoaldosteronism, aldosterone resistance, or K sparing diuretics
105
Q

Treatment for idiopathic intracranial hypertension or pseudotumor cerebri

A

Acetazolamide: inhibits the choroid plexus carbonic anhydrase: to decrease CSF production

Clinical findings: Increased CSF opening pressure but CSF is normal

106
Q

ECG findings for hyperkalemia

A

Reduced P waves, Increased ‘peaked’ T waves, widden QRS complex, ECG can evolve in sinuisodal shape.

Tx: Give Calcium chloride or gluconate to protect and revert Potassium effects

107
Q

Tzanck cells (multinucleated cells)

A

Found in:

  • Herpes simplex
  • Varicella, herpes zoster
  • Pemphigus Vulgaris
  • CMV
108
Q

Hepatitis B tx

A

Interferon: younger patient with compensated liver disease, short term tx

Lamivudine: (Increased resistance)

Entecavir: Decompensated cirrhosis, less resistance

Tenofovir: Most potent with limited drug resistance, preferred

109
Q

Dementia , gait apraxia, urinary incontinence

A

Normal Pressure Hydrocephalus NPH

110
Q

Cat scratch disease

A

Bartonella henselae

Localized cutaneous reaciton: Vesicular, erythematous, pustular or nodula

+ draining LN: localized, regional, tender, may be supporative

Tx: 5 days of azithromycin

111
Q

Aortic dissection type B tx

A

B betablockers and only then (after bet blockers) vasodilators, otherwise you have tachycardia that creates more stress

112
Q

Acute cocaine toxicity

A

O2 and IV benzos

Benzo reduce sympathetis outflow, improve BP and HR (if pt is having MI related to cocaine tox)

DO NOT use Beta-blockers as it will leave alpha adrenergic stimulaiton unopposed and lead to more coronary artery vasoconstriction.

Cocaine potentiates sympathomimetic actions by causing inhibition of NE reuptake -> alpha and beta adrenergic receptors stimulation and therefore coronary vosconstriciton, increase myocardial demand and increased HR.

113
Q

Bugs causing atypical pneumonia

A

Mycoplasma pneumonia, Chlamydia pneumonia, Legionella

114
Q

Mycobacterium avium complex treatment

A

Clartithromycin,

2nd line: Ethambutol +/- rifabutin

Prophylaxis is arythromycin

Sx: Non spe systemic sx, splenomegaly in pt with CD4<50

115
Q

Toxoplasmosis treatment

A

Pyrimethamine + Sulfadiazine and leucovorin

116
Q

Partial/weak acid-fast, filamentous, branching

A

Nocardia, GP anaerobe, causes pulm infection in immunocompromised and cutaneous infection afer trauma in immunocompetent

tx: Bactrim

(Actinomyces, P anaerobe, does not stain on acid-fast but is also branching, oral/facial abcesses drains through sinus tracks, forms yellow sulfur granules)

117
Q

Post-viral pneumonia

A

S pneumo, Staph a., H. influ

118
Q

common causes of esophagitis in HIV

A
  • HSV: Herpetic vesicle, round/ovoid ulcers, concurrent peri-oral/oral HSV
  • Candida: white plaques, oral thrust
  • Idiopathic/Aphthous: aphthous ulcers in mouth
  • CMV: deep linear ulcers, distal esophagus
119
Q

Bloody diarrhea

A

Campylobacter

E.histolytica (amebic dysentery, liver abscess)

Enterohemorrhagic E.Coli (O157:H7, can cause HUS, Shiga-like toxins

Enteroinvasive E.Coli (invasdes colonic mucosa)

+/- Salmonella (lactose (-), flagellar motility, poultry& eggs)

Shigella (lactulose (-), Shiga toxin, bacillary desentery)

Y. enterocolitica (day care outbreaks, pseudoappendicitis)

120
Q

Watery diarrhea

A

C.diff

C.perfringes

Enterotoxigenic E.COli (travelers diarrheas, heat labile and heat stable toxins)

Protozoa: Giardia

Chlorea

Viruses: rotavirus, norovirus

121
Q

Treatment for HIstoplasmosis

A

Itraconazole and if severe amphotericin B

122
Q

CMV treatment

A

Ganciclovir

123
Q

Restless leg syndrome treatment

A

1st line: Dopamine agonist: pramipexole

2nd line: Apha 2 calcium channel ligand: gabapentin

124
Q

Porphyria cutunea tarda

A

Strong correlation with Hepatitis C

Fragile, photosensitive skin-> vesicle and erosion on dorsum of hands

Hep C also strongly associated with essential mixed cryoglobulinemia

125
Q

Whipple’s disease

A

Caused by Tropheryma whippelii

White men 40-60 yo

Weight loss, diarrhea, malabsorption with distension, flatulence, steatorrhea, myocardial or valvular involvement -> congestive HF or valvular regurgitation, also low grade fever, lymphadenopathy, pigmentation

Later: CNS involvement including dementia

Biopsy finding: PAS-positive materal in the lamina propria of the small intesting + FOAMY MACROPHAGES

Tx: Penicillin, Ampicillin, Tetracycline for 1-2 years or doxycyline + hydroxychloroquine for 12-18mths

126
Q

Conn’s syndrome

A

Primary Hyperaldosteronism:

Too much aldosterone (therefore low renin) -> to HTN

Causes: enlargement of adrenal glands, adrenal adenoma making aldosterone

Tx: aldosterone antagonist: Spironolactone

127
Q

young pt with progressive low back pain w/ morning stiffness lasting >30min w/ improvement w/ physical therapy. Reduced forward flexion, tenderness at sacro-iliac joint

A

Ankylosing spondilitis

Chronic inflammation disease of spine and sacroiliac joint (get XR of sacro-iliac joints, bamboo spine on back XR), uveitis, Aortic regurgitation.

HLA-B27 (test not spe for diagnosis)

Young male pt (>female). 20-30yo

Anterior uveitis (most commone side effect)

128
Q

Glomerulonephritis associated with HIV

Nephritic or Nephrotic?

A

Focal segmental GN

More common in blacks>whites

Nephrotic

129
Q

CMV retinitis

A

White-yellow patches of retinal opacification and retinal hemorrhages. Tx: ganciclovir or foscarnet. AIDS pt with CD4 ct less than 50cells/uL

130
Q

Charcot joint

A

Neurogenic arthropathy

Decreases prioprioception, pain & temperature perception can be caused 2/2 to DM, peripheral nerve damage, syrngomyelia, spinal nerve injury, B12 deficiency

Pt traumatize joint bc cant feel pain anymore

Xray: degenerative joint, loss of cartilage, osteophyte development, loose bodies

131
Q

Bisphosphonates rare but tested SE

A

Jaw necrosis

132
Q

Polymyalgia Rheumatica

A

Age>50, Bilateral pain and morning sitffness> 1mth

2 of the following involved:

Neck or torso, Shoudlers or proximal arms,proximal thigh or hip, Constitutional sx

PE: decreased active ROM in shoulders, neck and hips. NO MUSCLE WEAKNESS.

Labs: ESR>40 or >100, elevated CRP, normocytic anemia, (20% of time normal)

Tx: Glucocorticoids

133
Q

cor pulmonale

A

Right sided heart failure 2/2 to pulmonary HTN (COPD, sleep apnea, interstitial lung disease)

134
Q

Posterior limb of internal capsule stroke (lacunar infarct)

A

Unilateral motor impairment

No sensory or cortical deficits

No visual field abnormalities

135
Q

Anterior cerebral artery occlusion

A

Contralateral paresis (weakness therfore motor affected) and sensory loss in leg. Cognitive and personality changes.

Abulia (lack of will or initiative)

136
Q

Middle cerebral artery occlusion

A

Contralateral somatosensory and motor deficit (face, arm , leg)

Conjugate eye deviation toward side of infarct

Homonymous hemianopia

Aphasia

Hemineglect

137
Q

Vertebrobasilar system lesion (supplying the brain stem)

A

Alternate syndromes with contralateral hemiplegia and ipsilateral cranial nerve involvement

Possible ataxia

138
Q

Central vision loss

A

Macular degeneration:

Progressive and bilateral central vision loss in 50 yo and + due to degeneraiton and atrophy of outer retinar, retinal pigment epithelium…

Tx: None, Vit and antioxidant

139
Q

Lack of Pharyngitis and cervical lymphadenopathy, mono like sx, atipycal lymphocytes, negative monospot

A

CMV!!

Atypical lymphocytes: large basophilic cells with vacuolated appearance.

140
Q

Cutaneous larva migrans

A

Helminth worm, caused by Ancylostoma braziliense (dog, cat hookworm). Infection occurs after skin contact with dog or cat feces containing the larvae. Prevalent in the topical and subtropical regoins (including southeast US). People at risk: sandboxes, sandy beaches.

Multipe pruritic, erythematous papules at site of larva entry–> pruritic elevates serpiginous reddish brown skin lesions,

Tx: PO:Albendazole, ivermectin

TOPICAL or PO: thiabendazole

Benadryl for the itch

141
Q

Alcoholic hepatitis labs:

A

AST/ALT> or= 2

AST and ALT<300U/L

increased GGT and ferritin

142
Q

Haptoglobin

A

Protein that binds free hemoglobin. Made by liver. Will be decreased in hemolysis bc free hemoglobin overload binds all the free haptoglobulin

143
Q

gliobastoma multiforme

A

Common, hilghly malignant primary brain tumor with mean survival of 1 year. In cerebral hemisphere. “Butterfly glioma”. stain astrocytes for GFAP. “psudopalisading” pleomorphic tumor cells: border central areas of necrosis and hemorrhage.

144
Q

Hypokalemia, normotensive, alkalosis

A

Surreptitious vomiting

Diuretic abuse

Bartter’s syndrome (urine chloride=HIgh)

Gitelman’s syndrome (Urine chloride= HIgh)

145
Q

Contralateral hemianesthesia with transient hemiparesis, athetosis, ballistic mvt. Dyesthesia of the area affected by the sensory loss is characteristic of thalamic pain phenomenon

A

Dejerine Roussy Syndrome aka thalamic stroke

Hemi sensory loss with severe dyesthesia of affected area

146
Q

Mulitple system atrophy (Shy-Drager syndrome)

A
  1. Parkisonism
  2. Autonomic dysfxn (postural hypotension, abnorml sweating, disturbance of bowel or bladder ctrl, abnrml salivation/lacrimation, impotence, gastroparesis)
  3. Widespread neurological signs (cerebellar, pyramidal, lower motor neuron)
147
Q

Cross sectional study

A

Estimate prevalence: do people have the disease at this point in time.

Disadvantage: cant determine cause of disease, cant determine incidence or risks

148
Q

Prevalence vs incidence

A

Prevalence= #of cases in pop / total pop

Incidence: # new cases in pop over given time/total pop at risk during time*

*(new cases-total pop)

Prevalence= Incidence* average duration of disease

If mortality decreases, prevalence increases

Prevalence is more general than incidence

149
Q

Sensitivity vs Sensitivity

A

Sensitivity: Probability that pt with the disease will have a positive test. (remember table).A sensitive test rarely misses people with the disease and is really good at RULING OUT (SNOUT)

High sensi desired early in a diagnostic workup or screening test to reduce broad differential.

Specificity: The probability that pt wihtout the disease will have a negative test. A specific test will rarely determine that someone has the disease when infact they dont and is really good at RULING IN (SPIN)

High spe useful in confirming likely diagnosis

Think Lyme: elisa (sensi) if - (dont have it) if + –> western blot (spe) if - (dont have it) if + (have it)

150
Q

Cohort study

A

Group of people withOUT the disease but possibly with risks being followed over time for disease development. Classified as exposed and unexposed to risk factor.

Determines Incidence.

151
Q

Case control studies

A

The researched determines whether the participants have the disease or not and looks back retrospectively to whether they were exposed or unexposed.

HAVE DISEASE LOOK BACK FOR EXPOSURE/RISKS

(Backwards of cohort study: HAVE RISKS-> DO they get disease?)

152
Q

p-value<0.05

A

Statiscally signigicant

153
Q

Modified Wells criteria

A

+3 pt: DVT, no other better dx than PE

+1.5pt: Previous PE or DVT, HR>100, recent surgery and immobilization

+1pt: hemoptysis, cancer

Total >4=PE likely

154
Q

Rectangular, envelope shaped urine crystals

A

Calcium oxalate crystals seen with ethylene glycol poisoning

155
Q

Fulminant hepatic failure

A

Hepatic encephalopathy that develops within 8 weeks of acute liver failure. MC in heavier users of acetminophen, alcohol, methamphetamines or co-infected with hep B and D.

Mortality rate >80% high priority for liver transplant risk

156
Q

Febrile nonhemolytic transfusion reaction

A

MC reaction

Fever and chills

1-6h post transfusion

Due to cytokines accumulation during blood storage

157
Q

Acute hemolytic transfusion reaction

A

Fever, flankpain, hemoglobinuria, renal failure, DIC

Within 1 hour!!!!!

+ direct coombs test

Due to ABO incompatibility!!!!!!!!!!!!

158
Q

Anaphylctic transfusion reaction

A

Rapid onset of shock, angioedema/urticaria and respi distress

Few sec to min of transfution

DUE to recipient anti-IgA antibodies

159
Q

Transfusion related acute lung injury transfusion reaction

A

Respi distress and pulm edema (ARDS)

within 6h of transfusion

caused by donor anti leukocyte antibodies.

160
Q

Type 2 heparin induced thombocytopenia

A

Due to heparin exposure >5 days and

  • Plt count reduction >50% from baseline
  • Arterial and venous thrombosis
  • Necrotic skin lesions at heparin injectino
  • Acute systemic (anaphylactic) reactions to injection

Due: to Antibodies against heparin plt factor 4 complexes

Test: Serotonin release assay (gold standard)

Tx: STOP heparin, start direct thrombin inhibitor (argatroban) or fondaparinux

161
Q

Kidney stones less than …mm pass on their own

A

less than 5mm

162
Q

Steppage gait with foot drop due to ….

A

L5 radiculopathy or common peroneal nerve neuropathy

163
Q

Broad flat and inversion T waves, U waves, ST depression and

A

Hypokalemia

(peaked T waves in HYPERkalemia and small nondiscernible P wave)

164
Q

Holosystolic murmur that increases with inspiration

A

Tricuspid regurgitation

best heard at left lower sternal border

165
Q

Lung Cancer Screening

A

Age 55-80, have a > or = 30 pack-year smoking hx currently smoking or quit within the past 15 years

166
Q

Hematologic complication of Mononucleosis

A

Thrombocytopenia and Autoimmune hemolytic anemia

2-3 weeks post sx

due to crossreactivity of EBV induced Ab against rbc and plt (IgM cold Ab–> complement mediated destruction of rbc)

167
Q

Risk factors for esphageal adenocarcinoma

A

Barett’s esophagus, obesity, high dietary calorie and fat intake, smoking, meds that provoke GERD

168
Q

Risk factors for esophageal squamous cell carcinoma

A

SMOKING, alcohol, dietary deficency of beta carotene, vit B1, zinc, selenium, envmt viral infection, toxin producing fungi, hot food and beverages, pickled veggies and food rich in N nitroso compounds

169
Q

Wernicke encephalopathy

A

Thiamine deficiency: ataxia, ophtalmoplegia, nystagmus and confusion

If untreated can progress to Korsakoff syndrome: memory loss with confabulation (cant remember therefore make things up

170
Q

Huntington

A

Autosomal dominant, age 35-50, choreiform mvmt

Atrophy of caudate nuclei

171
Q

Sturge Weber syndrome

A

Somatic disorder. Dvlmpt anomaly of neural creast cells

Affects small blood vessels

Port wine stain of the face (birthmark)

Ipsilateral leptomeningeal angioma-> seizures /epilepsy

Intellect disability

Early onset glaucoma

Tram-track Calcium deposits

172
Q

Fetal alcohol syndrome 3 physical features:

A

Small palpebral fissures, smooth philtrum, thin vermillon border (upper lip is thin)

173
Q

Anterior spinal cord syndrome

A

Anterior spinal artery supply anterior 2/3rd of spinal card: motor tract and sensory tract for pain/temperature

Thoracic aortic surgery complication by impeding flow into radicular arteries–> anterior spinal infarction

Abrupt onset of bilateral flaccid paralysis (due to spinal shock), loss of pain/temp sensation below site of infarction

VIBRATION AND PROPRIOCEPTION are preserved. (dorsal column not affected).

174
Q

Craniopharyngiomas

A

Derived from epithelial cells remnants of Rathke’s pouch

May be confused with pituitary adenoma

Calcified lesion above sella with bitemporal hemianopsia with increase intracranial pressure

Benign childhood tumor

175
Q

Histaplasmosis tx

A

Itraconazole

176
Q

Lesch-Nyhan Syndrome

A

Genetic deficiency of enzyme hypoxanthine-guanine phosphoribosyl transferase. Overproduction of uric acid, behavioral problems (self injury), neuro disability. Dx in childhood

177
Q

MMSE less than…. suggest dementia

A

Less than 24/30

178
Q

Hypertrophic cardiomyopathy murmur

A

Harsh crescendo-decrescendo systolic murmur heard best at the apex and lower sternal border

Vasalva and abrupt standing decreases preload (decreased LV) and increases the mumur

179
Q

Decrescendo diastolic early murmur

A

AR (bicuspid aortic valve)

Best heard at Left sternal border 3rd and 4th intercostal spaces

Sometimes only heard if pt is sitting up, leaning forward and holding breath in full expiration.

180
Q

Cholinesterase inhibitors

A

Galantamine, rivastigmine, Donepezil,

181
Q

Serotonin syndrome

A

Fever, myoclonus, mental status change, cardiovas collapse

182
Q

Extrapyramidal sx

A

Hours: Acute dystonia tx: anticholinergics (benztropine, diphenhydramine)

Days: Dyskinesia (pseudoparkisonism) tx: anticholinergic, dopamine agonist

Weeks: Akathisia (sujective/objective restlessness that is perceived as distressing) tx: betablockers, benzos, anticholinergics

Months: tardative dyskinesia (oral-facial mvmt, stereotypic) 30% irreversible tx: change neuroleptic, anticholinergics (may worsen first before getting better)

183
Q

Venous thrombosis + hx of miscarriages

A

Antiphospholipid syndrome

Antibodies such as lupus anticoagulant (LA), anticardiolipin antibody, or beta 2 glycoprotein 1 antibody.

REMEMBER IN VITRO it prolongs PTT test bc it binds the phospholipids present in most assays. ARTIFACT

184
Q

Eggshell cyst on CT abdomen on liver

A

Hydatid cyst, echinococcus granulosus

Tx: resection with albendazole tx

Common in sheep breeders

185
Q

Diabetes + Skin rash and findings:

Erythematous papules/plaques on face, perineum, extermities with lesions that enlarge and coalesce -> central clearing and blistering, crusting and scaling border

A

Glucagonoma:

Necrolytic migratory erythema (findings noted before)

Diabetes mellitus (easily controlled with meds and diet)

GI sx: Diarrhea, anorexia, abdominal pain, +/- constipation

Other findings: weight loss, neuropsych (ataxia, dementia, proximal muscle weakness), venous thrombosis

Dx: Hyperglycemia with elevated glucagon> 500; Normocytic, normochromic anemia; Abdominal imaging (CT or MRI)

186
Q

cosyntropin=

A

ACTH

187
Q
  1. Decreased T3, Nrml T4 and TSH
  2. Increased TSH, Nrml T4 and T3
A
  1. Euthyroid sick syndrome
  2. Subclinical hypothyroidism
188
Q

Hyperthyroidism + decrease radioactive iodine uptake

A

Thyroiditis

  1. Subacute granulomatous thyroiditis (De Quervain’s)
  2. Levothyroxine overdose
  3. iodine-induce thyrotoxicosis
  4. Subacute painless thyoiditis
  5. Struma ovarii
189
Q

Pronator drift

A

UMN lesion!

190
Q

erythema nodosum

A

Subcutaneous, painful, pre-tibial nodules

Associated with Tuberculosis, sarcoidosis, histaplasmosis, recent strep and IBD (occurs at same time as IBD flair-up so watch for GI sx)

191
Q

Digitalis toxicity leads to ….arrhthymia

A

Atrial tachycardia with AV block

(Atrial tachy has a slower rate than atrial flutter 250-350 bpm)

Digitalis toxicity increases ectopy and vagal tone

192
Q

Central cord syndrome (neuro injury)

A

Occurs with hyperextension (car accident) in elderly patients with pre-existing degenerative changed (arthritis) in ther cervical spine. Selective dmage to central portion of anterior spinal cord: central portions of corticospinal tracts and decussating fibers of the lateral spinothalamic tract

193
Q

Testicular atrophy, decreased sexual drive, arthropathy, diabetes and hepatomegaly

A

Hereditary hemochromatosis

Auto recessive disorder of HFE gene causing increased intestinal iron absorption.

Skin: Hyperpig

MSK: Arthalgia, arthropathy, chondrocalcinosis

GI: Increased hepatic enzymes w/ hepatomegaly, can lead to cirrhosis, can lead to increased risk of hepatocellular carcinoma

Endocrine: DM, secondary hypogonadism and hypothyroidism

Cardiac: Restrictive or dilated cardiomyopathy and conductive abnormalities

Infection: at increased risk of LIsteria, V.Vulnificus, Yersinia Enterocolitica

194
Q

Primary hyper parathyroidism + Pheochromocytoma

A

MEN (multiple endocrine neoplasia) type 2A:

  • Medullary thyroid cancer ( almost all)
  • Pheochromocytoma (50% pt)
  • PHPT (20% pt)
195
Q

Ulcer with purulent base and voiletaceous borders associated with 50% of patient with systemic disease (such as inflammatory bowel diseases)

A

Pyoderma Gangrenosum

196
Q

Nrml PR interval

Nrml QRS

Nrml QT

A

PR= 120-200msec

QRS<120

QT<440

197
Q

Conditions with pulsus paradoxus

A

Pulsus paradoxus: when systolic pressure falls by > 10mmhg during inspiration

Conditions: severe asthma, COPD, cardiac tamponade

198
Q

The probability of being disease free if the test result is negative

A

Negative predictive value (varies with pretest probability of a disease)

199
Q

OBGYN: hydatiform mole

A

One form of gestational trophoblastic neoplasia-> products of contraception become a tumor. Clues:

  • Preeclampsia bf 3rd trimester
  • hCG levels off
  • expulsion of grapes like structure
  • snowstorm on US

Complete mole: karyotype 46 XX (all chrm from father and no fetal tissue). Incomplete mole: karyote 69 XXY with fetal tissue.

Step 2 CK Medicine (3 decks)

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