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COMAT Exams > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

What is the type of TB infection where the Xray findings shows 1- to 2-mm granulomas?
What is a possible side effect?

A

Miliary TB - hematogenously disseminated tuberculosis
–adrenal involvement in common
=can cause ADRENAL INSUFFICIENCY

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2
Q

HIV pt w/ back pain/night sweats/Fever. Dx?

A

TB

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3
Q

Dx Waldenstrom

A

S-Pep +
>10% Plasma Cells
Hyperviscosity
Tx: Rituxumab +Plasma Phoresis

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4
Q

What is the most common cause of death in dialysis patients?

A

Cardiovascular disease

*also the most common cause of death in renal transplant patients

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5
Q

What is the most likely diagnosis:
28 year old woman from Nigerial w 6 month history of persistent lower lumbar back pain, a/w low-grade fever, and night sweats. point tenderness over spinous processes of L4-L5

A

Tuberculous osteomyelitis (Pott disease)

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6
Q

A pt w chronic renal failure remains in the icu after a surgical procedure. The patient has diffuse microvascular bleeding from several puncture sites. Labs show normal PT/INR, aPTT, platelets.

what is the cause?

A

Coagulopathy from uremia.

—uremia causes platelet dysfunction - poor platelet adhesion

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7
Q

What is the most appropriate initial Abx choice:
85 year old nursing home resident w hx of CHF, dementia. Presents w 3 day hx of fever, productive cough, CXR shows right middle lobe consolidation

A

IV cefepime:
—nursing home = pneumonia is nosocomial not CAP
=high incidence of gram negative
—age, med hx = high risk = hosptialization and IV cephalosporin

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8
Q

complaining of RUQ abdominal pain. BP 75/46, HR 165/min, RR 18/min, O2 sat 97%, Temp 103.5 F. Phys exam shows scleral icterus and tenting of the skin. Elevated WBC’s

A

Ascending Cholangitis

Charcot’s triad (RUQ pain, fever, jaundice) starting to progress to Reynold’s Pentad (hypotension, altered mental status)

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9
Q

Pansystolic murmur post MI…

A

Septal rupture

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10
Q

Sign of DNA synthesis impairment

A

Hyper seg PMN

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11
Q

Giant Cell Sx…

A

Vasculitis,Fever, Anemia, ESR, Temporal HA

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12
Q

What vitamin deficiency commonly accompanies Carcinoid syndrome?

A 
Vitamin B3 (Niacin) deficiency
---Both serotonin and B3 are synthesized from tryptophan
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13
Q

What is the definition of Oligomenorrhea?

A

Menses occurring at infrequent intervals or more than 40 days or fewer than nine menses per year

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14
Q

When should valve replacement be considered in a patient with aortic stenosis?

A

aortic valve with an area less than 1 cm2

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15
Q

What is the diagnostic criteria for Amenorrhea

  1. primary
  2. secondary
A
  1. Absence of menarche by the age of 16

2. Absence of menstruation for 3 or more months in women w normal past menses

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16
Q

What therapy provides the greatest benefit to a patient with chronic stable emphysema and a resting oxygen sat of 86%

A

Supplemental oxygen used continuously
smoking cessation
–only medical therapies shown to decrease mortality among COPD pts

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17
Q

How is a latent TB infection treated?

A

Isoniazide for 9 months

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18
Q

Dx for AIHA

A

Coombs +
IgM - Cold
IgG - Warm

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19
Q

Dx for PNH

A

Flow Cytology, CD55- Cells

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20
Q

Walking on toes test nerve root ___

A

S1

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21
Q

What supplementation is often used along side Isoniazid?

A

Pyridoxine - prevent peripheral neuropathy

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22
Q

What is the definition of neutropenia? what are chemotherapy patients at risk for?

A

absolute neutrophil count less than 500 cells/mm3

Neutropenic fever

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23
Q

Dx for Hereditary Spherocytosis

A

Blood Smear + Osmo Fragility Test

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24
Q

Med for uncomplicated Pyleonephritis

A

Cipro

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25
Q

What is the treatment of hyperkalemia?

A

C BIG K

-Calcium, Bicarb/B-agonis, Insulin, Glucose, Kayexalate

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26
Q

What is the highest risk factor for cervical cancer?

A

Multiple sex partners - contracting HPV 16, 18, 45, 33, 58

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27
Q

What cardiac condition is related to a pattern of alternating amplitude of QRS complexes

A

Electrical Alternans - Cardiac tamponade

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28
Q

How is the BUN/serum CR ratio interpreted?

A

BUN/Cr >20:1 = pre-renal disease (ie volume depletion, renal A stenosis)

BUN/CR = normal or 10 to 15: 1 = ATN, AIN

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29
Q

Identify cause:
72 year old man w severe pain and swelling in knees post surgery. Intracellular and extracellular weakly positive birefringent crystals in synovial crystals

A

Pseudogout

gout - NEGATIVELY birefringent crystals

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30
Q

What are the tuberculin reaction sizes and the related circumstance required for diagnosis of latent M tuberculosis infection

A
  1. > 5mm - HIV, close contact w TB pt, Fibrotic lesions on CXR
  2. > 10mm - Recently infected (<2y), high risk medical conditions
  3. > 15mm - low risk persons
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31
Q

What is contraindicated in chemotherapy patients that are neutropenic?

A

Live vaccines (Varicella, Mumps)

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32
Q

What is the CHADS2VASc score? what is it used for/how do you interpret it?

A

prevention of cardioembolic stroke

  1. Congestive heart failure - 1
  2. HTN - 1
  3. Age >75 - 2
  4. Diabetes Mellitus - 1
  5. Stroke or TIA - 2
  6. Vascular dz - 1
  7. Age 65-74 - 1
  8. Sc (Sex category) female = 1
0 = aspirin or no antithrombotis
1 = aspirin or anticoagulant (warfarin)
2+ = heparin bridged to warfarin to INR of 2-3
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33
Q

Acute back pain w/o other Sx, TX?

A

Cont daily activity w/o restriction

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34
Q

The feeding of a patient (alcoholic, anorexic, malnourished) causing generalized tremors of entire body with confusion.

what is the cause?

A

Refeeding Syndrome - insulin causes uptake of phosphate by cells
–compensatory respiratory alkalosis = further intracellular shift of phosphate

HYPOPHOSPHATEMIA = myopathy, rhabdomyolysis, respiratory failure and severe CNS system dysfxn.

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35
Q

What are the ECG two criteria for Left Ventricular hypertrophy

A

Sokolow-Lyon:
S (V1) + R (V5,V6) > 35

Cornell:
R (aVL) + S (V3) > 28(men) > 20(women)

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36
Q

What does a more than 20:1 BUN:Cr ratio indicate about the type of kidney injury?

A

Prerenal failure

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37
Q

What is the best initial treatment of alcoholic ketoacidois?

A

infusion of 5% dextrose w 0.9% saline

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38
Q

Which atypical organism is most likely responsible?
65 year old smoker w hx of HTN, mild CHF, presents with worsening cough, fever, muscle aches, abdominal pain, diarrhea, non productive cough developing later that week and rapidly becoming worse.

A

Legionella pneumophila - typically presents w:

  1. myalgias
  2. abdominal pain
  3. diarhea
  4. severe pneumonia
    * consider because of history of smoking
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39
Q

Where is B12 absorbed?

A

Terminal Ileum

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40
Q

What would synovial fluid show in a patient with Gonococcal arthritis?

A

elevated (>72,000) WBC’s

>75% Polymorphonuclear leukocytes

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41
Q

CAP, TX?

A

Oral Doxy or Macrolide

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42
Q

What vaccine should a patient recently diagnosed with DM Type II receive if not previously vaccinated?

A

Hepatitis B Vaccine

–DM confers a 60% higher infection rate versus nondiabetics

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43
Q

Glanzmann Path

A

GPIIb-IIIa dysfxn

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44
Q

What are the urinalysis findings of:

  1. prerenal failure
  2. postrenal failure (what microscopic findings for which types of obstruction)
A
  1. high specific gravity and normal microscopic findings
  2. urine osmolality is equal to the serum osmolality,
    microscopic findings:
    —Hematuria = crystals or stones
    —leukocytes = prostatic hypertrophy
    —normal = extrinsic ureteral compression
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45
Q

Identify type of vitamin deficiency:
54 year old presents with sensory and motor impairments, mostly of distal extremities

what is the most common cause?
what are two presenting forms?

A

Vitamin B1 - Thiamine
–most common cause of deficiency = alcoholism

Wernicke-Korsakoff syndrome - horizontal nystagmus, ophthalmoplegia, cerebellar ataxia, mental impairment, confabulation psychosis

Beriberi

  • Dry = symmetrical peripheral neuropathy (motor + sensory)
  • Wet = neuropathy + CHF (cardiomegaly, lower extremity swelling, tachycardia)
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46
Q

Chemo Med that causes interactions/ allopurinol and gout, myelosuppression, hepatotoxic…

A

6-metacaptopurine

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47
Q

What is the next diagnostic step that should be taken when Alzheimer dementia is suspected?

what is the best treatment?

A

Assess for depression and reversible causes of dementia

Tx: Acetylcholinesterase inhibitor (donepezil, rivastigmine, galantamine) +

NMDA receptor Antagonist (Memantine)

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48
Q

What is the therapy of choice for acute Otitis Media? when is observation appropriate?

A

High dose oral Amoxicillin

-Pts > 2 yrs w recent onset of non-severe illness are observed to prevent the misuse of antibiotics when OM is caused by viral pathogen

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49
Q

Exacerbation of MS, Rx?

A

Methylprednisone

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50
Q

In the case of inflammatory arthritis what does Chondrocalcinosis or linear calcium deposition in joint cartilage suggest?

A

Pseudogout

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51
Q

Normocytic anemia includes

A 
Sickle Cell
G6PDD
Hereditary Spherocytosis
Autoimmune Hemolytic Anemia
Paroxysmal Nocturnal Hemolysis
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52
Q

Labs that indicate Normocytic Anemia

A

Inc LDH
Dec Hgb
Inc Bilirubin

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53
Q

45 year old admitted for acute pancreatis. after 3 months he still has epigastric but is able to eat solid food. amylase level is elevated at 260 IU/L

what is dx?

A

Pancreatic pseudocyst - presents as:

  1. abdominal pain/mass
  2. persistent hyperamylasemia
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54
Q

how do you differentiate arthritis from soft tissue disorders (ie cellulitis, or bursitis)?

A

True arthritis = swelling, redness, painful limitation of motion in all planes during ACTIVE AND PASSIVE motion.

soft tissue disorder - joint movement is not limited by passive motion

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55
Q

UA positive for blood, but no RNC on micro + Elevated creatine kinase…

A

Rhabdomyolysis

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56
Q

Dx HITT

A

Platelet Ab
Hosp pt on Heparin, 7-14 days post admin
Dx;: clinical, Plts dec
Tx: D/C heparin, start Argotoban + Warfarin Bridge

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57
Q

Complications of renal failure

A 
Hyperkalemia
Hypocalcemia
Anemia
Hyperphosphotemia
Hyperparathyroid
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58
Q

What therapy should be given to treat acute hypercalcemia in the following pt:
62 yr old woman, asymptomatic. hx of multiple myeloma, hypercalcemia. no bone lesions or end organ damage

A

Bisphosphonates - inhibits osteoclastic bone reabsorption

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59
Q

identify type of vitamin deficiency:
67 year old male w two day history of paresthesias and witnessed SEIZURES

what are additional symptoms?

A

Calcium deficiency

-paresthesias, peri-oral numbness, seizures, muscle cramps/spasms

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60
Q

What is the next best step in management:

45 year old man w saddle anesthesia and decreased ankle reflexes bilaterally?

A

Cauda equina syndrome - immediate referral for advandced imaging and surgical evaluation for decompression to avoid long-term denervation

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61
Q

What microorganism should be considered in a pregnant woman with meningitis?

A

Listeria monocytogenes

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62
Q

Med for SSD

A

Hydroxyurea

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63
Q

Dx test for Kidney Stones

A

Helical CT w/o contrast

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64
Q

First line Tx for hemochromatosis

A

Phlebotomy

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65
Q

What is precocious anemia

A

Intrinsic factor production malfunction

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66
Q

What is the underlying cause of a DVT formation in a patient with nephropathy?

A

loss of antithrombin III in the urine

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67
Q

Polydipsia, polyuria, MSC… Dx?`

A

HHS&raquo_space; Send to ER, inform ICU

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68
Q

What are urinalysis findings of Ischemic and Nephrotoxic ATN?

A
  1. Isothenuric (urine osmolality is equal to serum osmolality)
  2. proteinuria - containing muddy brown granular casts
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69
Q

How do you treat pregnant women with syphillis who are allergic to penicillin?

A

give penicillin after the women are desensitized

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70
Q

What is the best initial imaging test for acute abdominal pain?

A

CT abdomen

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71
Q

What artery is associated with transient monocular blindness (Amaurosis fugax)

A

Internal Carotid pathology

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72
Q

What is the usual diagnostic criteria for COPD?

A

FEV1/FVC <70%

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73
Q

MI complication post 14 days…

A

Free wall rupture

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74
Q

Med for N. Meningitidis

A

Cefotaxime

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75
Q

What is the therapy for an acute Hepatitis B infection?

A

Antiviral therapy:

  1. Tenofovir
  2. Disoproxil
  3. Fumarate

–can also be used for an HIV infection too.

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76
Q

Ig elevated in MM

A

IgG

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77
Q

What type of lung cancer is most likely to appear as a CAVITARY LESION on CXR? what are the associated paraneoplastic syndromes?

where in the lung is it usually located?

A

Squamous Cell Cancer

  • -produced PTH-like hormone
  • ——causes hypercalcemia

typically CENTRAL/HILAR

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78
Q

What cell produces IF

A

Parietal cells

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79
Q

What is the most likely organism in a chronic smoker with pneumonia. productive cough w greenish sputum.. Febrile w normal CXR. gram stain reveals gram-negative cocci

A

Moraxella catarrhalis

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80
Q

A patient with DKA dies secondary to a cardiac arrest. correction of what electrolyte abnormality could have prevented this patients death?

A

Potassium - DKA causes massive potassium loss

  • -correction of DK Acidosis with insulin causes potassium export from cells into intracellular space
  • –correction of acidosis causes renal loss of potassium = cardiac arrhythmias, arrest
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81
Q

Chemo Med that causes estrogen receptor antagonist…

A

Tamoxifen

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82
Q

Macro anemia that is Methylmalonic acid Positive

A

B12

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83
Q

What is the next diagnostic step when Acute Kidney Injury is suspected from a high BUN:Cr level?

A

Urinalysis and urine chemistries to determine whether the process is prerenal or renal or postrenal (less likely)

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84
Q

Post MI 2- 7days, New blowing murmur, pulmonary edema… Dx?

A

Papillary muscle rupture

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85
Q

What is the pharm therapy for a immune suppressed patient with a colonoscopy revealing large atypical cells with intranuclear inclusion bodies?

A

CMV colitis - use ganciclovir

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86
Q

What is the most probably diagnosis:
82 yr old female with sudden onset right knee pain. PMH of DM type 1, alcohol abuse, total right knee arthroplasty 6 months ago. Phys exam shows hot, red, swollen knee, with limited range of motion.

A

Septic Arthritis -
sexually active young adult - N. gonorrhea
everyone else - S. aureus

sudden onset joint pain, warm, erythematous, tender joint, limited range of motion.

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87
Q

Dx MM

A 
CRAB Sx >> Hypercalcemia/RF/Anemia/Bone Pain
Bence Jones Proteins
S-Pep +
U-Pep +
>10% Plasma Cells
Skeletal Survey +
Tx: >70 yo -- Chemo (Mel/Thai/Bort +steroid)
     <70 yo/Donor -- Stem Cells/Nothing
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88
Q

What is the typical outpatient therapy of community acquired pneumonia?

A

Macrolide Abx = Azithromycin, doxycycline, antipneumococcal quinolones (moxifloxacin, levofloxacin)

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89
Q

what is the statistical advantage of a D-dimer? what does this mean?

A

very high negative predictive value

  • can have false positives
  • if ddimer is negative no further testing for PE
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90
Q

What therapy should be administered in a patient with dry/cracked skin cellulitis? (what is the most likely pathogen)

A

most likely pathogen = Streptococci / Staphylococci

Nafcillin = first line therapy

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91
Q

what is the classic triad of acute cardiac tamponade

A

Beck’s Triad:

  1. Hypotension
  2. elevated Jugular Venous Pressure
  3. Small quiet heart

**Look for Pulsus Paradoxus (decrease of >10mmHg systolic w inspiration)

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92
Q

Achalasia

A

Overly tight EG sphincter

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93
Q

What is septic shock?

A

“Severe Sepsis” (sepsis in a patient with signs of organ dysfunction)
+
unresponsive to fluid resuscitation for atleast 1 hour

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94
Q

Bernard-Soliel Path

A

GPIb dysfxn

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95
Q

What is the next suggested step after taking lead blood levels in a child that has been ingesting lead pain chips

A

Plain film radiograph of the abdomen to detect retained lead objects that may require surgical intervention for removal.

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96
Q

what is the pharm therapy for chronic hep B infection

A

interferon and oral Lamivudine

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97
Q

What is most appropriate next step when suspecting pulmonary edema?

A

Chest CT with intravenous contrast or other imaging study as indicated.

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98
Q

What is the most appropriate diagnostic modality for a patient with a Syncopal event and normal physical exam?

A

24-hour Holter monitor

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99
Q

What is the dx:
35 year old female w vertigo, nausea, vomiting. Constant ringing in ear and hx of recent flu-like illness.
Mild hearing loss, positive Dix-Hallpike maneuver

What is the appropriate management?

A

Labyrinthitis - inflammation of labyrinth of inner ear. most often seen after viral upper respiratory tract infection.

*both labyrinthitis and BPPV have a positive Dix-Hallpike maneuver

Tx: Meclizine (antihistamine), Prochlorperazine (antiemetic)

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100
Q

What is the best treatment for a DVT in a patient that presents with significant vaginal bleeding from cervical cancer?

A

vaginal bleeding = contraindication for anticoagulation

use Vena Cava filter

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101
Q

acute onset knee pain, rhomboid shaped crystals, positively birefringent

A

Pseudogout - positively birefringent (blue in parallel light)

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102
Q

Pt relives gastric pain by eating. Dx?

A

Duodenal ulcer

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103
Q

When should carotid endarterectomy be performed?

A

carotid artery stenosis greater than 70%
—angioplasty is used for high surgical risk

**Patients > 70yrs olf fare better w carotid endarterectomy

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104
Q

Tx for IgG AIHA

A

Steroids
Rituxumab
Splenectomy

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105
Q

What is the pharmacologic management of acute symptomatic hypocalcemia?

A

IV 10% Calcium gluconate

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106
Q

What type of movements are still present in a patient that is brain dead?

A 
Spinal reflexes (outside the brainstem)
ex: facial nerve twitching, fasiculations of trunk/extremities
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107
Q

What is the immediate support care for a patient with cardiac tamponade awaiting pericardiocentesis?

A

Intravenous fluids - pts with cardiac tamponade are preload dependent, fluids help maintain intravascular volume and cardiac output

–diuretics, nitrates, morphine may cause pts to become hypotensive

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108
Q

What is the strategy of choice for cardiogenic shock

A

Emergency PCI

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109
Q

Hodgkin Lymphoma characteristics

A 
Better Px
B-sx
Reed-Steinberg Cells
EBV
Pell-Ebstein Fever
Alcoholic Nodes
Spreads through Tz
Tx: ABVD, BEA-Copp
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110
Q

PCP Tx

A

TMP-SMX + Prednisone

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111
Q

What is the preferred daily medication for a patient with a history of asthma where symptoms occur >2/week, < 1/day, >2/month nocturnal symptoms?

what is the classification?

A

Mild persistent asthma (>2/wk;<1/day symptoms, >2/month nocturnal awakening)

–Low-dose inhaled steroids = preferred therapy

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112
Q

Fever, Flank pain, Discolored urine after transfusion, DX/TX?

A

Dx: Hemolytic Transfusion Reaction
Tx: Fluids, d/c transfusion

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113
Q

A pt treated for hypocalcemia with IV Calcium gluconate still shows hypocalcemia. What other electrolyte infusion should have been administered first?

A

Magnesium

–hypomagnesemia can cause PTH resistance

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114
Q

right lower lobe nodule is found incidentally on CXR. follow up CT shows nodule to be 7mm with popcorn like calcification

what is dx?

A

Pulmonary Hamartoma - do not have malignant potential

-composed of tissue elements normally found at site.

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115
Q

What micro-organism is most commonly associated with Septic Arthritis in of patients? (not sexually active)

A

S. aureus

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116
Q

What is the most appropriate management of aspiration pneumonitis?

A

Supportive care = observation w follow up CXR

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117
Q

what thyroid malignancy is associated with iodine deficiency?

A

Follicular carcinoma of the thyroid

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118
Q

What fluid characteristics suggest the need for chest tube drainage? (6)

A
  1. Empyema (frank pus in the pleural space)
  2. Positive Gram stain or culture of fluid
  3. Presence of loculations
  4. pH less than 7.20 (normal pleural - 7.6)
  5. Glucose less than 60 mg/dL
  6. LDH more than 1000 U/L
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119
Q

T2DM has an acute illness and is skipping insulin, next step?

A

Send to ER, provide H&P to ICU

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120
Q

In a patient with neutropenic fever, what should be done if infection is suspected to be from Catheter infection, skin/soft tissue infection, or mucositis?

what if the infection has no obvious source?

what if the fever persists?

A

Infection is probably gram-positive = IV Vancomycin plus antipseudomonal therapy

No obvious source = enteric gram negative = Antipseudomonal monotherapy (Cefepime, ciproflocacin, imipenem, beta-lactam + aminoglycoside)

persistent fever = Antifungal therapy (fluconazole, amphotericin B)

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121
Q

Apical cavitary lesion w/ b/l patchy infiltrate

A

TB Reactivation

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122
Q

Dx MGUS

A

Asx
S-Pep +
< 10% Plasma Cells
Tx: Watchful Waiting

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123
Q

What is the criteria for Systemic inflammatory response syndrome (SIRS)?

A

2 or more of the following:

  1. Temperature >100.4 F (38C), < 96.8 F (36)C
  2. HR > 90 bpm
  3. RR >24 breaths/min
  4. leukocyte count > 12x10^3/mcL, <4x103/mcL or >10% bands
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124
Q

What microorganism is most commonly associated with septic bacterial arthritis in patients who are bit by another human?

A

Eikenella corrodens

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125
Q

What is the usual intial treatment for SIADH if the pt does not have severe neurological Sx?

what if the pt has severe neuro sx?

A

No Neuro Sx: Water restriction

Severe Neuro Sx: rapid partial correction of sodium (HYPERTONIC Saline)

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126
Q

Empiric Tx for HAP

A

Moxifloxacin, Ceftriaxone, Augmentum, Levofloxacin, Ertapenam

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127
Q

What is the etiology of Transverse Myelitis

A

Neuro Sx usually presenting during recovery from infection

  1. Localized low back pain
  2. sudden paresthesias in legs
  3. sensory loss, paraparesis
  4. urinary bladder and bowel dysfunction
  5. possible allodynia
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128
Q

What follow up actions should be taken to assess End organ damage from HTN?

A
  1. fundoscopic exam
  2. auscultation of major arteries for bruits
  3. Palpation of organs for enlargment
  4. check for lower extremity edema
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129
Q

Identify type of vitamin deficiency?
Immigrant from middle east with stunted growth and hypopigmented hair, frequent infections, decreased taste sensation

what are other presenting symptoms?

A

Chronic deficiency

  • -middle eastern countries
  • -foods rich in zinc = oysters, beef, crabs, cereal
  • -night blindness, decreased spermatogenesis
  • -severe deficiency = diarrhea, alopecia, pustular dermatitis, decreased immunity
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130
Q

Non-Hodgkin Lymphoma characteristics

A 
Worse DX
Starry Sky
Extranodal Sx
Recurr in 7-10 yr
Spread through blood
Tx: Rituxumab/R-Chop
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131
Q

What is the most common electrolyte abnormality in diabetic ketoacidosis?

A

hyperosmolar HYPONATREMIA

–from the plasma dilutional effect of hyperglycemia

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132
Q

what is the responsible organism:

HIV patient, noncompliant with meds, abdominal pain, bloody diarrhea, imaging shows free air under diaphragm

A

CMV colitis - mucosal perforation

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133
Q

The monitoring of which electrolyte is important in congestive heart failure?

A

Sodium - reduce sodium intake to control fluid retention

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134
Q

What is the treatment of Anaphylaxis??

A
  1. First assess ABC’s (Airway, Breathing, Circulation)

2. Epinephrine (intramuscular in thigh)

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135
Q

what are the drugs of choice for congestive heart failure

A

ACE inhibitors

B-blockers

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136
Q

What is the first line therapy for treating Osteoarthritis?

A

NSAIDs - NOT Acetominophen

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137
Q

A patient that was maced presents w post syncopal episode, itchy burning eyes/mouth/throat w facial rash., red, raised perioral rash

what was the offending agent?
what is another possible compound? (what symptoms)

A

Phenacyl chloride

pepper spray = Oleoresin Capsicum (capsaicin) = releases substance P
=inflammtion = lacrimation, rhinorrhea, coughing

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138
Q

What is the management of an adrenal crisis?

A
  1. repletion of circulating glucocorticoids

2. correction of water deficit + electrolyte imbalances (hypertonic saline)

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139
Q

What is the first line treatment of hyperkalemia with ECG changes?

A

Calcium gluconate

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140
Q

When should tPA or surgical embolectomy be used as primary therapy for a PE?

A

When the pt is at high risk if the embolism stays
it pt has:
1. Right heart failure
2. Hypotension (systolic >90mmHg)

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141
Q

Dx VW Dz

A

Dec Factor VIII and VWF
Normal platelets
Dx: VWF Assay
Tx: DDAVP

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142
Q

Four common causes of B12 anemia

A

Precocious
Crohn Dz
Gastric Bypass
Uneducated Strict Vegan

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143
Q

Macrocytic Anemias

A

B12

Folate

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144
Q

What disease is characterized by
asymptomatic or dysuria, hematuria, urinary frequency
+ the finding of leukocytes in the urine but negative bacterial cultures?

A

“Sterile pyuria” = Genitourinary TB

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145
Q

How would you confirm the diagnosis of Graves disease?

what is the treatment?

A

Low serum TSH
High free T4

Tx: antithyroid drugs, radioactive iodine ablation, surgical removal of thyroid

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146
Q

What is the lab test to check for the following causes of hepatitis:

  1. Wilson disease
  2. Hemochromatosis
A
  1. Low serum ceruloplasmin

2. High transferrin saturation (>45%), high ferritin

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147
Q

petechiae, vesicles, bullae, desquamation of the skin

  1. desquamation less than 10% of skin
  2. desquamation more than 30% of skin
A
  1. Steven Johnson syndrome

2. Toxic epidermal necrolysis

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148
Q

What kind of kidney stones are formed in a patient with a hx of ileal resection for Crohn’s disease?

A

Oxalate stones

–malabsorption of bile acids = bile unavailable to bind oxalates

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149
Q

What is the dx:
4 year old African American child w fever, pallor, fatigue, back pain. Pallor of conjunctiva, rales at right lung base, petechiae diffusely over the body. Labs show high white blood cell count and anemia

A

Acute lymphoblastic leukemia

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150
Q

Granulomatosis w/ Polyangitis sx…

A

Vasculitis, Upper + Lower Resp sx, C-anca, Renal dysfunctions, Skin Sx, Eye Sx

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151
Q

What preventative medication should be used in a patient with gouty arthritis and renal disease?

A

Febuxostat (Allopurinol needs to be given in lower doses in patients with renal insufficiency)

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152
Q

What is the intial management of an acute arterial occlusion?

A

Anticoagulation w heparin to prevent propagation of the thrombus

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153
Q

A pt who recently had a new medication added to treat his cholesterol presents with acute gout. What was this medication?

A

Niacin

–Side fx: glucose intolerance, pruritis, elevated uric acid

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154
Q

Dx of Sideroblastic Anemia …

A

Inc Fe
Ringed
Ferritin/TIBC normal

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155
Q

Churg-Strauss sx include…

A

Vasculitis, P-anca, Eosinophilia, Asthma Sx

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156
Q

How do you interpret hematocrit levels of pleural fluid?

A

Hemothorax (trauma, malignancy) = pleural fluid HCT is >50% of Hct of peripheral blood

Cancer, PE, Tuberculosis (pleural Hct <50% Hct of peripheral blood)

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157
Q

What criteria index used to risk-stratify pneumonia patients?

A

CURB-65

  1. Confusion
  2. Urea >20 mg/dL
  3. Respiratory rate > 30bpm
  4. Blood pressure, systolic <90mmHg
  5. Age > 65

score >2, pt should admitted to Hospital

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158
Q

what drug combo is helpful in the treatment of myeloma?

A

Dexamethasone + Thalidomide

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159
Q 
What is the:
MCV
Ferritin
TIBC
RDW
in a 34 year old man of mediterranean descent with a fam hx of anemia
A

MCV - Decreased
Ferritin - Increased
TIBC - Normal
RDW - Normal

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160
Q

What is the criteria for the diagnosis of at UTI in the elderly?

  1. clean catch
  2. specimen from catheterization
A
  1. 10^5 colony-forming units

2. 10^2 colony-forming units

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161
Q

Chemo Med that causes skin rashes and birth defects

A

Tretinoin (PML-RARA)

162
Q

What are patients with refractory H. pylori infections at risk for?

A

MALT lymphoma

163
Q

How do you interpret the T-score of a DEXA scan?

A 
Normal = Tscore > -1 Standard Deviation
Osteopenia = T-score of -1 to -2.5 SD
Osteoporosis = T-score less than -2.5 Standard dev
164
Q

What do most patients presenting with hemoptysis require?

A

bronchoscopy

—massive hemoptysis may result in death from asphyxiation

165
Q

Incidental ASx thrombocytopenia, TX?

A

> 30,000 PLT: Observe

<30,000 PLT: Glucocorticoid

166
Q

What prophylaxis should be given to an AIDS patient with a CD4 count of 180 cell/mm3

A

TMP-SMX to prevent pneumocytic pneumonia

167
Q

what micro-organism is responsible in an HIV patient with pneumonia, nonproductive cough, elevated LDH?

What is the definitive diagnostic method?

A

Pneumocystis Jirovecii

Giemsa or silver stain

168
Q

Pt can’t write, do math, confuses R/L, Does not recognize fingers, can’t mimic movement. Dx?

A

Mid cerebral infarct in the inf parietal lobe

169
Q

Elevated PT and PTT, Decreased put and bleeding from central lines, DX/TX?

A

DX: DIC
TX: Optimize ABx coverage

170
Q

MDD signs

A

Sigecaps

Suicide
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Sleep
171
Q

What are ECG findings in a Left bundle branch block?

A

QRS duration > 120 msec
no R wave in V1,
Wide + tall R waves in I, V5, V6

172
Q

What is the initial step in the management of acute pancreatitis?

A

(Early and aggressive fluid management) 0.9% Saline

173
Q

What are the leukocyte levels in synovial fluid for:

  1. Inflammatory
  2. Septic?
A
  1. leukocytes: 2000-75000

2. leukocytes: >100,000

174
Q

Chemo Med that causes cardiotoxicity, alopecia, myelosuppression…

A

Doxorubicin

175
Q

AML Chracteritics

A 
~67 yo
>20% Blasts
Auer Rods (M3 Variant)
Exposure to Benzene/Radiation
Myeloperoxidase +
Dx: Smear >> BM Bx
Tx: M3 Trans Vit A, all other get Chemo
176
Q

Chemo Med that causes Renal Failure, Hemolysis, Thrombocytopenia

A

Mitomycin

177
Q

Middle age pt, u/l claudication, unequal BP….

A

Takayasu

178
Q

What artery is associated with dizziness and vertigo in a 67 year old woman w extensive atherosclerotic cerebrovascular disease?

A

Vertebrobasilar insufficiency

179
Q

Thin Visceral pleural line displaced from chest wall on cxr

A

Spont Pneumothorax

180
Q

Tx for urticaria Transfusion Reaction…

A

Benadryl

181
Q

25 year old male with 20% total body surface burns to legs and chest. Rapid sequence intubation in successfully performed for airway protection. He later dies of from cardiac arrest. What happened?

A

Hyperkalemia - from Succinylcholine administration in burn patient

182
Q

What is contraindicated in an unconscious patient that drank drain-O?

A

NPO - do not intubate - may exacerbate the damaged mucosa from the drain-O = can cause esophageal rupture

183
Q

What test would reveal the underlying etiology:

Pt with recurrent pneumonia infections, severe sinusitis, bloody diarrhea

A

Quantitative measurement of serum immunoglobulin levels

(pt may has Common variable immunodeficiency

184
Q

What is the most ideal site for a creation of an AV fistula for dialysis?

A

Radial artery

Cephalic vein

185
Q

What is the preferred daily medication for a patient with a history of asthma and nocturnal awakenings secondary to cough and occasional wheezing that occurs 3-4 times per week?

what is the classification?

A 
Moderate persistent (daily symptoms, nocturnal awakenings >1/week)
--long acting B2-agonist = preferred therapy
186
Q

CML Chracteritics

A 
~47 yo
Mature EOS/BASO/PMN
Philidelphia 9:22 BRC-ABL
Dx: Diff CBC >> BM Bx
Tx: Imatianib
Can become AML >> "Blast Crisis"
187
Q

anti-proteinase 3 Ab, no deposits, glomerulonephritis, hemoptysis, systemic inflammation… Dx?

A

Granulmatosis w/ Polyangitis (Wegner)

188
Q

Chemo Med that causes pulmonary fibrosis…

A

Bleomycin

189
Q

Identify the syndrome and cause of thrombocytopenia:
Pt treated for Rheumatoid arthritis with chronic steroids. Fullness of upper left abdomen. Low platelets, neutropenia, anemia.

A

Felty Syndrome:

  1. rheumatoid arthritis
  2. neutropenia
  3. splenomegaly
  4. lymphadenopathy
  5. thrombocytopenia

Splenomegaly causes sequestration of platelets = thrombocytopenia

190
Q

what is the type of arrhythmia?
68 yr old female w hx of diabetes and HTN presents to the ED w weakness in the R leg. ECG shows a supraventricular tachyarrhythmia w an atrial rate of 425/min

A

Atrial fibrillation

–atrial rate is > 400/min

191
Q

What diagnostic test should be used to dx a gonococcal cause of arthritis?

A

gonococcal infection findings in urethra, cervix, pharynx

  • -synovial fluid cultures are usually sterile in gonococcal arthritis
  • -blood cultures are positive less than 50% of the time.
192
Q

What is the sequence of diagnostic tests used for diagnosing PE?

A
  1. Chest CT
  2. Lung Scan (V/Q)
  3. Venous ultrasound to look for DVT
  4. Transesophageal Echo
193
Q

If HIV is suspected…

A

Get an HIV Viral RNA Load

194
Q

What are the glycemic goals of Diabetic pts?

A

A1c <7%
preprandial glucose: 70-130 mg/dL
peak postprandial glucose < 180 mg/dL

195
Q

What is the most useful nonimaging diagnostic test for a PE?

A

D-dimer ELISA

196
Q

A pt on chronic corticosteroid therapy for SLE. I admitted to the hospital for a surgical procedure.
What is the most important intervention?

A

Hydrocortisone IV before surgery and every 6 hours for 24 hours
—prevent adrenal insufficiency before surgery

197
Q

Pt dx w/ AF,TX?

A

Heparin/Warfarin first five days then d/c the Heparin.

198
Q

Fever, malaise, Chills following a transfusion…

A

non-hemolytic Transfusion Reaction

199
Q

Identify type of vitamin deficiency?
13 year old male recently emigrated from china after being diagnosed with congestive cardiomyopathy

name of dz?
what other areas have this problem?
what are foods rich in this vitamin?

A

Selenium deficiency = KESHAN dz

  • -congestive cardiomyopathy, enlarged heart
  • -China, New Zealand, Finland
  • -selenium rich foods = fish, shellfish, eggs
200
Q

What two microorganisms are comon causes of meningitis in patients following neurologic procedures (ie ventriculoperitoneal shunt)

A

S. aureus

S. epidermidis

201
Q

CLL Chracteritics

A 
~87 yo
Mature Leukocytes
Typically Asx
Dx: Diff >> BM Bx
Tx: >65/Asx -- nothing
      >65/Sx -- Chemo
      <65/Donor -- Stem Cells
202
Q

Monoarthritis with sudden onset pain and swelling. Intra-articular fluid aspiration shows 10,000 leukocytes and negatively birefringent (yellow in parallel light) needle shaped crystals

what is dx and risk factors?

A

Gout

–male gender, diuretic use, alcohol abuse

203
Q

Tx of non-hemolytic Transfusion Reaction…

A

COX inhibitor

204
Q

What is the management of a solitary pulmonary nodule in relation to size?

A

nodules <8mm = follow radiographically

nodules >8mm = biopsy, consider surgical resection

205
Q

What is the criteria to determine the difference between transudative and exudative fluid?

A

Light Criteria

  • -EXUDATES meet at least one of the following criteria:
    1. Pleural fluid protein/serum protein ratio >0.5
    2. Pleural fluid LDH/serum LDH ratio >0.6
    3. Pleural fluid LDH >2/3 the upper limit of normal for serum LDH
206
Q

What kind of kidney stone can be prevented with the acidification of urine (ie drinking cranberry juice)

A

Calcium Phosphate stones (form in alkaline urine)

207
Q

What is the type of arrhythmia?
57 year old male is brought to the ED unconscious after a witnessed episode of syncope. ECG shows wandering baseline and irregular complexes w faint pulse

A

Ventricular fibrillation

Afib has a irregular palpable pulse

208
Q

Woman, Pulmonary remodel, Dyspnea, Fatigue, Right Heave, Loud S2, Mitral Regurgitation. DX/TX?

A

Dx: Pulmonary HTN
TX: Vasodilator (Epoprostenol/Sildenafil/Treprostinil)
Endothelin inhibitor (Bosntan)

209
Q

What is the Glasgow Coma Scale?

A 
Eye Opening
1-None
2-Response to Pain
3-Response to verbal command
4.Spontaneous

Verbal Response

  1. None
  2. Incomprehensible
  3. Inappropriate words
  4. Confused
  5. Oriented

Motor Response

  1. None
  2. Extension to pain
  3. Flexion to pain
  4. Withdrawal from pain
  5. Localizing to pain
  6. Obeys command
210
Q

What is the cause of 3.7g/day 24 hour protein in a patient with an acute hepatits B infection?

A

Membranous nephropathy

211
Q

Chemo Med that causes peripheral numbness…

A

Vincristine

212
Q

Med For UTI

A

Nitro

213
Q

What is the CD4 level diagnostic of AIDS?

A

CD4<200

214
Q

what is the use of aztreonam?

A

used with patients with penicillin allergy for gram negative rod infections (ie pseudomonas)

215
Q

Chemo Med that causes hemorrhagic cystitis…

A

Cyclophosphamide

216
Q

What ECG finding is associated with hypocalcemia?

A

prolonged QT interval

217
Q

Tx for Iron overload

A

Defexoimine

218
Q

What is the etiology of the pt sx:

62 year old male w abdominal pain and blood clots in stool. CT scan shows gastric varices + thrombus in splenic vein

A

Chronic pancreatitis - most common cause of Splenic vein thrombosis

Tx for gastric variceal bleeding secondary to splenic V thrombosis = splenectomy

219
Q

Dx DIC

A

Fibrin Clot
Pt very sick – Septic Shock then bleeding
Dx: Schistocytes, Pt/Ptt Increased, Plts Dec, D-Dimer Inc, Fibrinogen Dec
Tx: Support, Transfuse PRN

220
Q

What is the therapeutic drug of choice for delirium tremens from alcohol withdrawal?

A

Benzodiazepines

221
Q

What are the stages of Chronic Kidney failure?

A

Assess by GFR

Stage 1: >90
Stage 2: 60-89
Stage 3: 30-59
Stage 4: 15-29
Stage 5: <15
222
Q

Dx of Chronic Dz Anemia …

A

Inflammation
Inc Ferritin
Dec TIBC
Dec Fe

223
Q

What are the characteristics of Coma?

A

Complete failure of arousal system
Reflexes, postural responses are intact
EEG shows auditory brainstem response

224
Q

Non-tender, enlarged lymph node. DX..

A

lymphoma – Total Excisional Biopsy

225
Q

How is urine Sodium interpreted in regards to kidney injury?

A

Urine sodium < 20 mmol/L = pre-renal azotemia

Urine sodium > 40 mmol/L = ATN, AIN

226
Q

How does essential tremor usually present?

A

bilateral hand tremor (frequency 4 to 6 Hz) that exacerbates with actions

improvement: beta blockers, anticonvulsants, small amounts of alcohol

227
Q

Chemo pt becomes febrile during a chemo session…Tx?

A

Broad spectrum ABx

228
Q

Cells that show G6PDD

A

Bite and Heinz

229
Q

Which infectious agent is most likely associated with an infected central venous catheter in a neutropenic agent?

A

Staphylococcus epidermidis (coagulase negative)

230
Q

Swollen. tender MCP/Hepatomegaly. At risk for___

A

CHF

231
Q

ALL Chracteritics

A 
Peds ~7 yo
Leukocytes
>20% Blasts
CALLA +
TdT +
Dx: Smear >> BM Bx
Tx: Chemo + ARA-C
232
Q

What was the most common cause of constrictive pericarditis in the US in the past?

what is the most common cause presently?

A

Tuberculosis

present: Radiation therapy, surgery, viral infection, uremia, malignancy

233
Q

How does distributive shock differ from cardiogenic and hypovolemic shock?

A

distributive - often caused by sepsis

  • –increase in cardiac output
  • –inability to maintain systemic vascular resistance (inappropriate vasodilation)
  • –***EXTREMITIES ARE WARM AND WELL PERFUSED = “Warm phase”

can progress to “Cold phase” - intense vasoconstriction in an apptempt to maintain blood pressure - bad prognosis b/c sepsis should be caught during “Warm phase”

234
Q

What are MRI findings in

  1. HSV meningitis
  2. TB meningitis?
A
  1. enhancement of temporal lobes

2. enhancement of basal region

235
Q

Which test is the most important to follow for a patient receiving isoniazid and rifampin for TB treatment?

A

Liver function tests

236
Q

What use is Zoledronic acid reserved for?

A

zoledronic acid = IV bisphosphonate

–used for prevention of skeletal fractures in patients with Multiple Myeloma and Prostate Cancer

237
Q

what is dx?

acute chest pain with free air under diaphragm on CXR

A

Perforated peptic ulcer

238
Q

What is the treatment of choice for Graves disease in nonpregnant patients?

A 
non-pregnant = radioactive iodine
pregnant = PTU
239
Q

Chemo Med that causes abortions/birth defects and myelosuppression…

A

Methotrexate

240
Q

what is the treatment of an addisonian crisis?

A
  1. IV 5% glucose w normal saline to correct volume depletion and hypoglycemia
  2. corticosteroid therapy

(given salt, sugar, steroids)

241
Q

Dx of Iron Deficient Anemia …

A

Slow Bleed
Inc TIBC
Dec Ferritin
Dec Fe

242
Q

What is dx:
51 year old w diffusely erythematous skin rash w associated fever. pt takea tenolol and allopurinol for HTN and gout. Rash is tender and over over 90% of body. Lymphadenopathy noted in the neck and inguinal region. elevated eosinophils, AST, ALT

what are some causes

A 
DRESS syndrome (Drug reaction w eosinophilia and systemic symptoms)
-extensive rash, fever, lymphadenopathy, hematologic abnormalities, hepatitis, involvement of atleast one internal organ

meds that cause DRESS:
allopurinol
anticonvulsants, sulfa derivatives, antidepressants, NSAIDs, antimicrobials

243
Q

What lab test can confirm an acute transfusion reaction?

A

elevated LDH levels

244
Q

What are some criteria that suggest a dx of SIADH?

A

SIADH is a dx of exclusion

  1. Euvolemic
  2. Urine is not maximally dilute (150-200mmol/L)
  3. Urine sodium > 20mmol/L
  4. normal adrenal and thyroid function
245
Q

What are the two most common precipitating factors for an adrenal crisis in a patient with Addison’s Disease?

A
  1. GI upset

2. Fever

246
Q

Describe the 5 parts of Thrombotic Thrombocytopenic Purpura syndrome

What is the cause of TTP?

A
  1. microangiopathic hemolytic anemia
  2. thrombocytopenia
  3. neurologic abnormalities
  4. fever
  5. renal dysfunction

Cause = ADAMTS13 deficiency = excess vWF = microvascular thrombi

247
Q

What is the most specific test for diabetes?
most sensitive?
most acceptable?

A

most specific: Fasting glucose: > 126 mg/dL
most sensitive: 2hr oral glucose tolerance test
Most acceptable dx test: HbA1c >6.5%

248
Q

What is the underlying cause of a pt with ESRD and a easily fractured hip?

A

Hypovitaminosis D (impairment of absorption of Calcium in the GI tract

249
Q

What is Ranson’s criteria?

A

Assess severity and predict mortality rate of acute pancreatitis

Admission:
glucose >200
Age > 55
LDH >350
AST > 250
WBC > 16000
Initial 48 hr exam:
calcium < 8
Decrease in HCT > 10%
PaO2 <60
Base deficit > 4mg
BUN increase  > 8mg/dL
Fluid sequestration >6L
250
Q

What location in the lung does:
1. primary pulmonary TB
2. reactivation TB
affect?

A
  1. often in children - Middle and lower lobes

2. Apical and posterior segments of upper lobes

251
Q

identify type of vitamin deficiency:
45 year old male from Africa with hyperpigmented scaling rash on the sun exposed area of his neck.

what is the name of this?

A

Niacin (B3) deficiency

  • -Casal’s necklace
  • -3D’s (diarrhea, dermatitis, dementia)
252
Q

What are abnormal Orthostatic vital signs?

A

Drop of:
20mmHg Systolic
10mmHg Diastolic

upon standing

253
Q

What is the appropriate next step after suspecting pleural effusion from history and chest xray?

A

Diagnostic thoracocentesis - diagnose cause of the pleural effusion and determine the necessity for fluid drainage

254
Q

What its the initial therapy for Immune thrombocytopenic purpura?

what should to performed if pts do not respond to medication chronically?

A

Oral Corticosteroids

–Splenectomy if pt doesnt respond to medication chronically

255
Q

What are most likely CXR findings in a patient with JVD, hepatojugular reflex, no crackles on lung auscultation, long hx of smoking?

A

Cor pulmonale = depressed diaphragm w prominent pulmonary artery

256
Q

Cardiac markers, when present?

A

Myoglobin – >2hours
Troponin – 3-12 hours
CK-MB – 3-8 Hours

257
Q

What the next best diagnostic step when COPD is suspected? what is the best initial treatment?

A

dx: ABG to assess oxygenation and acid-base status
tx: oxygen by nasal cannula,, bronchodilators and steroids for airway inflammation

258
Q

What distinguished hyperthyroidism from thyroid storm?

A

Fever and delirium (+bpm >140, fever (104-106))

259
Q

Walking on heels tests nerve root ___

A

L5

260
Q

What is a side effect of biologic DMARDs TNF antagonists (etanercept, infliximab, adalimumab)

what should you do before prescribing?

A

increase risk of infection (reactivation of latent TB)

–pts should be screened for TB

261
Q

What is the most common cause of secondary HTN?

A

Renal dz

in young pts - think fibromuscular dysplasia

262
Q

Elevated Ca and PTH, Dx?

A

Hyperparathyroidism

263
Q

A 65 asymptomatic male presents for a routine wellness examination. Hx of HTN, 30 pack year smoking hx. active lifestyle. Cardiac/lung exam are unremarkable

what is the most appropriate prevention recommendation at this time?

A

Abdominal ultrasound

–Abd US screening for Abdominal aortic aneurysm for all men aged 65-75 who have ever smoked in their lives

264
Q

What type of malignancy are pts with hashimotos thyroiditis at a higher risk for?

A

thyroid lymphoma

265
Q

Takayasu involves primarily the …

A

aorta

266
Q

what is the best intervention to slow the progression of Diabetic Nephropathy?

A

Angiotensin inhibition

  • -ACE-i
  • -ARB
267
Q

Tx for PNH

A

Support/Eculizumab

268
Q

What is the USPSTF suggestion for screening for lung malignancy? in what patients?

A

low-dose helical scan of the chest
Adults 55-80 w >30 pack-year hx
+ currently smoke or quit within last 15 years

269
Q

what is the type of arrhythmia?
40 year old female w phm of rheumatic heart disease presents w fatigue and dyspnea. ECG shows narrow complexes at 150/min in a regular rhythm w F waves in leads II, III, and aVF

A

Atrial flutter

F waves = sawtooth pattern, best seen in II, III, aVF

270
Q

Abnormality on CBC w/ a pt w/ polycythemia vera

A

Increased EPO

271
Q

What is the next step when a Transient ischemic attack is suspected?

what medication should be administered? in what time frame?

A

NONCONTRAST CT of the brain.

thrombolytics (IV recombinant tPA) - within 3-4.5 hours

272
Q

Tx for Thyroid Storm…

A

Beta-blocker, Hydrocortisone, PTU, Iodine

273
Q

What are the Microcytic anemias

A

Iron Deficient
Chronic Dz
Thalassemia
Siderblastic

274
Q

Pt has secondary HTN, Epigastric Bruit, confirm Dx w/…

A

Renal angiography&raquo_space; Beads on a String

275
Q

What are ECG findings that suggest a PE?

A

usually: Sinus Tachycardia
rarely:
S1Q3T3 (inverted T wave in lead III)

276
Q

Describe Hemolytic Uremic Syndrome

A

clinical complex consisting of

  1. progressive renal failure
  2. microangiopathic hemolytic anemia
  3. thrombocytopenia
277
Q

Young pregnant women w/ b/l hydronephrosis w/ or w/o ureteral or bladder dilation, clear UA DX?

A

Pregnant

278
Q

What is the cause and treatment for a HIV patient with new onset seizures. CT scan shows multiple ring-enhancing lesion of the brain.

A

Toxoplasmosis

Tx: Sulfadiazine with pyrimethamine

279
Q

What are extrapulmonary manifestations of Small Cell Lung Cancer?

A

SIADH
ectopic ACTH - Cushing
Eaton-Lambert
-peripheral neuropathy

280
Q

Dx ITP

A

Autoimmune
Ab against Plts
Dx: R/O others
Tx: Steroids/IVIG/Spleenectomy/Rituxumab

281
Q

What is the diagnosis?
46 year old HIV positive male w SOB and profuse epistaxis. Bloody diarrhea and left flank pain. Diffuse petechial rash, non-focal neuro exam, tissue texture changes from T9-T11 bilaterally.
Anemia, thrombocytopenia, acute renal failure, schistocytes in peripheral smear

what study can confirm dx?

A

Hemolytic uremic syndrome

stool culture fro E. coli O156:H7

282
Q

Large Dark WBC on Peripheral Blood Smear…DX?

A

EBV

283
Q

Dx TTP

A 
Hyline Clot
Adam 13
FAT RN -- Fever/Anemia/Thrombocytopenia/RF/Neuro Sx
Dx: Smear -- Schistocytes
Tx: Exchange Transfusion
284
Q

Dx of Iron Thalassemia Anemia …

A

Labs normal

285
Q

Chemo Med that causes: Ototoxicity, Nephrotoxicity and nausea…

A

Carboplatin

286
Q

what is the NYHA classifications of Congestive Heart Failure?

A

Class I (Mild) - No limitation of physical activity

Class II (Mild) - slight limitation of physical activity, comfortable at rest, prolonged/moderate activity causes symptoms

Class III (Moderate) - marked limitation of physical activity. walking across room, getting dressed causes symptoms

Class IV (Severe) - Unable to carry out physical activity without discomfort

287
Q

What is the managment of acute pericarditis?

A

NSAIDs,

Aspirin, Ibuprofen, Indomethacin

288
Q

How is FeNa calculated? how do you interpret results?

A

FeNa = 100x(Serum creatinine/Urine creatinine)/(Serum Sodium/Urine Sodium)

<1% = prerenal azotemia (ie volume depletion)
>2% = ATN, AIN
289
Q

Dx APLA/APS

A

Lupus Ab – causes clots in arterial and venous
Dx: Russell Viper Test
Tx: Warfarin lifelong

290
Q

Initial step in Giant cell arteritis…

A

High dose Steroids

291
Q

Tx for Opioid Overdose

A

Naloxone

292
Q

HTN and Hypokalemia, Dx…

A

Primary aldosteronism

293
Q

When to CT the nasal sinus in regards to sinusitis…

A

Chronic/Recurrent

294
Q

Dx Test for OSA

A

Polysomnography

295
Q

Dx test for Aortic Dissection (Hem Stable)

A

Contrast CT

296
Q

Lab to confirm Acromegaly

A

ILGF-1

297
Q

Trauma to the CNS, Hypernatremia, Polyuria, Intubated…Dx

A

Central DI

298
Q

Bronzing, DM, Fluid wave…Dx Test?q

A

Serum Iron panel
High Ferritin and Transferrin
Dx = Hereditary Hemochromatosis

299
Q

LMWH MOA

A

Activate AT-III

300
Q

Yellow deposits around macula, Progressive loss of central vision

A

Age related macular degeneration

301
Q

PMH that contributes to Cholelithiasis

A

Hereditary Spherocytosis.

302
Q

HIV, w/ CD4 <100, at risk for …

A

T. plasmodia

303
Q

DM w/ HTN, Tx w/ …

A

Ace-i

304
Q

Age to get a DEXA…

A

65

305
Q

Backpain, osteoblastic lesion, prostate node.. Dx/Tx

A

Dx: Met Prostate cancer
Tx: GnRH Agonist/Antagonist – androgen deprivation

306
Q

Tx for ETEC

A

ABX/Fluids/Anti-motility

307
Q

Ring lesion, N, V, Constant HA…Dx

A

Gliablastoma

308
Q

Muddy brown casts…

A

ATN

309
Q

Tx for Raynauds Phenom…

A

avoid triggers

310
Q

ANA Ab, Dx…

A

SLE

311
Q

Anti-CCP Ab, Dx…

A

RA

312
Q

Anti-centromere Ab, Dx…

A

CREST

313
Q

Anti-dsDNA Ab, Dx…

A

SLE

314
Q

Anti-Histone Ab, Dx…

A

Drug induced SLE

315
Q

Anti-Jo Ab, Dx…

A

Polymyositis/Dermatomyositis

316
Q

Anti-Mitocondrial Ab, Dx…

A

Primary Biliary Cirrhosis

317
Q

Anti-Topsomerase Ab (Scl-70), Dx…

A

Scleroderma

318
Q

Anti-Sm Ab, Dx…

A

SLE

319
Q

Anti-TSHR Ab, Dx…

A

Graves

320
Q

C-ANCA, Dx

A

Vasculitis (Wegner)

321
Q

P-ANCA, Dx

A

Vasculitis, Micro poly

322
Q

U1RNP Ab, Dx

A

Mixed CT Dz

323
Q

Anti-RNA Poly III Ab, Dx…

A

Sys Sclerosis

324
Q

Anti-la/ro

A

Sjogren

325
Q

Anti-hu, Sx and DX

A

Paraneoplastic Cerebellar Degeneration, Ataxia, d/t SCC of the lung

326
Q

Anti-yo Ab, Sx and Dx

A

Paraneoplastic Cerebellar Degeneration, Ataxia, d/t breast/gyn cancer

327
Q

Med that causes toxic inflammatory lung disease, Foam Cells

A

Amiodarone

328
Q

Colonoscopy starts at age…

A

50

329
Q

Dx Test for Pulmonary HTN

A

Right Heart Cath

330
Q

TST +, CXR -, Sputum - next step?

A

Latent TB Tx, no isolation

331
Q

Broca Aphasia, wheres the occlusion…

A

L MCA Sup Div

332
Q

Wernicke Aphasia, wheres the occlusion

A

L MCA Inf Div

333
Q

Sx: Ataxia, Incontinence, Dememtia

A

Normal Pressure Hydrocephalus

334
Q

Smokes, wt loss, jaundice, palpable gallbladder, Dx…

A

Pancreatic Cancer, Get a And CT

335
Q

Common AF of Statins

A

Muscle pain

336
Q

Fever, new UL HA, Neuro Deficit, Dx…

A

Dx: Brain Abscess

337
Q

imaging for Renal Stones

A

Non contrast CT

338
Q

Abd pain, Neuro sx, discolored urine

A

Acute Inter Prophyria

339
Q

Acute Stroke imaging

A

Non Contrast CT

340
Q

Imaging for ADPKD

A

U/S

341
Q

Lab finding for Exudative (inflammation) Pleural Effusion

A

All musty be met, Ratio is Fluid /Protein
Protein > 50%
LDH > 60%
LDH > 66% of nl Serum LDH (~300)

342
Q

Most common reasons for a Transudate Pleural Effusion

A

Cirrhosis

CHF

343
Q

Common Exudative Pleural Effusions

A

Cancer
TB
Pnuemo

344
Q

Pulmonary Fxn Test to differ Asthma and COPD

A

Diffusion Capacity

345
Q

Fever, Malaise, Rigors, Recent Travel…Dx

A

Malaria

346
Q

Test to Dx C.Diff

A

Stool ELISA for Toxins

347
Q

When to get a mammogram and how often

A

50-74yo, q 2yrs

348
Q

Ischemia of hands/feet, Different BP Right versus Left, Smoker…Dx

A

Thromboangiitis Obliterans

349
Q

AI, Proximal Muscle Weakness, Purple rash on knuckles and per-iorbital, Anti-Jo…Dx

A

Dermatomyositis

350
Q

Psychmotor slowing w/o aphasia

A

NPH

351
Q

Magnetic Gait

A

NPH

352
Q

Define Aphasia

A

Cant talk

353
Q

Define Agnosia

A

Cant interpret sensation

354
Q

Define Apraxia

A

Cant complete an intentional task

355
Q

Tx for AML

A

Imatinib

356
Q

Myeloid Leukemia, T15:17

A

AML-M3 (APL)

357
Q

How to prevent in-patient Delirium

A

Remind of Location
Sleep Aid
Eliminate Restraints

358
Q

Cres-Decres Mid-systolic mimer that radiates to the neck

A

Aortic Stenosis

359
Q

Tender Subs nodules, Fever, Abd Pain, Arthralgia, Weakness, Myalgia, Liver/Renal Dys Fxn… Dx

A

Polyarteritis Nodosa

360
Q

Polyarteritis Nodosa Tx

A

Steroids, unless Hep B/C pos, then Plasma Exchange.

361
Q

1 Risk Factor for Stroke

A

HTN

362
Q

Subdural bleed present as…

A

Crescent Shape/Concave away from skull/Passes sutures

363
Q

RA sx w/o signs of inflammation, labs will show…

A

Elevated ESR

364
Q

Sx of T. Saginata

A

Beef Tape worm

N/Fatigue/D/Adb Pain/Weight Loss

365
Q

Sx of T. Asiatica

A

Pork Tape worm found in ASIA

N/Fatigue/D/Adb Pain/Weight Loss

366
Q

Sx of T. Solium

A

Pork Tape worm found in Americas

Acute onset seizures/Neuro Deficits

367
Q

Do not mix Sildenafil w/…

A

Nitros

368
Q

NASH, Wt Loss, ABD Pain, Liver Mass…Dx

A

Hepatocellular Carcinoma

369
Q

ASx pt, incidental liver mass…Dx

A

Hemangioma

370
Q

Hemochromatosis can develop into…

A

Hepatocellular Carcinoma

371
Q

Female taking OCP, RUQ Pain, Liver Mass…Dx/Tx

A

Dx: Hepatic Adenoma
Tx: D/C OCP, Resect tumor

372
Q

Tx Osteoarthritis w/…

A

NSAIDs

373
Q

Common Risk factor of acute sinusitis…

A

Recent Infxn

374
Q

Anti epileptics (Valproic Acid, Carbamazapine, Phenytoin, Felbamate) may cause this bleeding disorder

A

aplastic anemia

375
Q

Hereditary pediatric Aplastic Anemia d/t DNA Repair Defect

A

Fanconi Anemia

376
Q

Dz cause of bone fibrosis

A

CML, Poly Vera

377
Q

Tx of hyperthyroid in 1st trimester

A

PTU

378
Q

Tx of hyperthyroid in 2nd trimester

A

Methimazole

379
Q

Tx for frontaltemporal dementia

A

Occupational Therapy

380
Q

HA, Hx of medullary thyroid ca, HTN…Next Step

A

Measure Urinary Metanephrines, possible Pheochromocytoma

381
Q

Ocular finding on an uncontrolled DM pt

A

Wool Spots, Blot Hemorrhage, Retinal Microaneurysms

382
Q

Cupping Disc…Dx

A

Glaucoma

383
Q

Non-productive cough, Hypoxemia, DOE, CP…Dx

A

PCP

384
Q

CKD, Hyperkalemia, Weakness…ECG will show

A

Wide QRS, Peaked T-waves

385
Q

HIV pt w/ CD4 < 200, prophylaxis w/…

A

TMP-SMX, PCP

386
Q

HIV pt w/ CD4 < 100, prophylaxis w/…

A

TMP-SMX, Toxo

387
Q

HIV pt w/ CD4 < 50, prophylaxis w/…

A

AZT, Micro Avium

388
Q

Smoker, Hyponatremia, SIADH…Dx

A

SSC of lung

389
Q

Smoker, Hyponatremia, Hypercalcemia, Hypophophatemia…Dx

A

SCC of the lung

390
Q

Central lung cancers

A

Squamous and Small Cell

391
Q

Sheehan’s is suspected, next step…

A

IV Dexamethasone

392
Q

Most important cell in osteoarthritis

A

Chondrocyte

393
Q

Stones w/ a decrease in urine pH

A

Uric Acid, Cystine, Calcium Oxalate

394
Q

Stones w/ increased Urine pH

A

Struvite, Calcium Phosphate

395
Q

Imaging for acute abd

A

X-ray

396
Q

Renal Bx shows double membrane with Sub-endothelial Deposits…Dx

A

MPGN

397
Q

Renal Bx shows Thick Membrane and Mesangial Expansion…Dx

A

DM Nephropathy

398
Q

Renal Bx shows Sclerosis and hyalinosis, Assoc w/ HIV …Dx

A

FSGN

399
Q

Renal Bx shows Sub-endothelial deposits and Mesangial Expansion…Dx

A

SLE Nephritis

400
Q

Renal Bx shows Thick Membrane and IgG, C3 Deposits, assoc w/ Virus/Ca/Med induction…Dx

A

Membranous Nephropathy

401
Q

Tx for post strep erythema nodosum

A

NSAIDs, Potassium Iodine, Oral Steroids

402
Q

Pt w/ asymmetric, hard prostate and a PSA >4…next step

A

Transrectal Bx

COMAT Exams (6 decks)

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