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Internal Medicine Shelf Flashcards

1
Q

What is commonly seen in patients with a Pulmonary Embolism?

A

elevated alveolar-arterial oxygen gradient

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2
Q

What causes wheezing in Pulmonary Embolism?

A

cytokine-induced bronchoconstriction in response to hypoxia and infarction

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3
Q

Risk factors for females for DVT

A

Obesity
Endometrial Cancer
Oral Contraception Use

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4
Q

Most Common Causes of Secondary Finger Clubbing?

A

Lung Malignancies, Cystic Fibrosis, Right-to-Left Cardiac Shunts

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5
Q

Does COPD cause Finger Clubbing?

A

NO

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6
Q

Dx: Asthma (intermittent wheezing, chest tightness), Chronic Rhinosinusitis (Nasal Congestion, Frontal Headaches with Nasal Polyps), Worsening of pulmonary symptoms with NSAIDs

A

Dx: Aspirin- Exacerbated Respiratory Disease (AERD)
increased production of leukotrienes

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7
Q

What does Paradoxical movement of the abdomen during inspiration indicate?

A

weak diaphragm, use of accessory inspiratory muscles
draws the flaccid diaphragm upward, and abdominal wall inward during inspiration (opposite to normal movement)

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8
Q

Dx: post cardiac surgery, dyspnea on exertion, orthopnea, paradoxical breathing movement

A

diaphragmatic weakness– phrenic nerve injury

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9
Q

CVP
PCWP
SVR
SvO2

A

CVP = central venous pressure
PCWP = pulmonary capillary wedge pressure
SvO2 = mixed venous oxygen saturation
SVR = systemic vascular resistance

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10
Q

Characteristics of Hypovolemic Shock

A

CVP: Low
PCWP: Low
Cardiac Output: Low
SVR: high
SvO2: low

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11
Q

Characteristics of Cardiogenic Shock

A

CVP: elevated
PCWP: elevated
LV Output: low
SVR: elevated
SvO2: low

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12
Q

Characteristics of Obstructive Shock

A

CVP: elevated
PCWP: low
LV Output: low
SVR: elevated
SvO2: Low

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13
Q

Characteristics of Distributive Shock

A

CVP: Low
PCWP: Low
LV Output: elevated
SVR: low
SvO2: elevated

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14
Q

Urinary Stones > 10mm First Line Therapy

A

Ureterorenoscopy (URS)

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15
Q

Urinary Stones < 10mm First Line Treatment

A

Observation for Spontaneous Stone Passage

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16
Q

Dx + DGx + Tx: flank pain + wt loss, fatigue, fever + palpable flank mass in a patient recently treated for pyelonephritis

A

Dx: Perinephric abscess
DGx: Abdominal CT scan with contrast- hypodensity in perinephric space w/ gas inclusions
Tx: Percutaneous Drainage + Abx treatment

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17
Q

asymptomatic microhematuria+ > 35 y.o

A

Cytoscopy + CT urography- evaluate entire urinary tract

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18
Q

Dx + DGx + Tx: bilateral colicky flank pain + increase in BUN and Cr + BUN:Cr <10: 1 in context of herpes zoster

A

Dx: Intrinsic Renal Damage
DGx: hematuria, pyuria, crystalluria
Tx: discontinue offending agent + IV fluids

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19
Q

Glycosylation of glomerular basement membrane

A

Diabetic nephropathy + Intrinsic Renal Injury

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20
Q

Anti- GBM antibody formation + deposition

A

Goodpasture Disease- Intrinsic Renal failure
Nephritic Syndrome
HTN + edema + hemoptysis, cough, dyspnea

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21
Q

Dx: UTI + hematuria with CHOP therapy for non-Hodgkin Lymphoma

A

Hemorrhagic Cystitis

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22
Q

CHOP therapy

A

Cyclophosphamide
Doxorubicin
Vincristine
Prednisolone

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23
Q

Metabolism of cyclophosphamide can lead to

A

Hemorrhagic cystitis- destroying bladder urothelium
Tx: with urinary excretion of cysteine, adequate hydration + frequent voiding

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24
Q

Long term Treatment of hyperkalemia in patients with cystic kidney disease

A

Hemodialysis

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25
Q

Dx, DGx, Tx: hypotension, hyponatremia, hyperkalemia, weight loss, anorexia, nausea, vomiting, loss of libido.

A

Dx: Addison Disease (primary adrenal insufficiency) - hypoaldosteronism, hypocortisolism, hypoandrogenism

DGx: Cosyntropin Stimulation Test- cortisol will not rise

Tx: Depends on etiology

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26
Q

Etiology of Grave’s Disease

A

Thyrotropin receptor autoantibodies (TRAbs)—> induce hyperthyroidism

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27
Q

Workup for differentiating Diabetes insipidus vs. Primary polydipsia

A

Plasma Na and Osm Urine Osms
- hyponatremia, pOSMs low, Urine osms <250 = primary polydipsia
- hypernatremia, pOsms high, Urine osms <500 = diabetes insipidus
Water deprivation Test
- pOsm- normal (270-290), urine Osm >600 - primary polydipsia
- POsm- high > 290, urine Osm <500- diabetes insipidus
Desmopressin admin—> urine Osm up - Central diabetes insipidus, Urine osm low- nephrogenic diabetes insipidus

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28
Q

Most Common thyroid cancer

A

Papillary Thyroid Carcinoma

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29
Q

Dx: painless cervical lymphadenopathy, hyperechogenic punctate regions (microcalcifications)

A

Most common type of thyroid cancer: Papillary Thyroid Cancer

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30
Q

Dx, DGx, Tx: woman, prior exposure to radiation, thyroid nodule, psammoma bodies, cells with clear, ground glass empty nuclei

A

Dx: papillary microcarcinoma
DGx: Fine needle aspiration biopsy
Tx: total thyroidectomy

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31
Q

Dx and Tx: Altered mental Status, hypothermia, bradypnea, bradycardia, hypotension, respiratory acidosis, periorbital and lower extremity edema- severe hypothyroidism

A

Myxedema Coma

Tx: liothyronine/levothyroxine, glucocorticoids,

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32
Q

Dx: dysphagia, hoarseness, elevated calcitonin, neck US- irregular margins, microcalcifications

A

Medullary thyroid Carcinoma

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33
Q

Dx: throbbing headaches, diaphoresis, heart palpitations

A

Pheochromocytoma

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34
Q

Dx: constipation, recurrent kidney stones, elevated Ca and ALP, decreased phosphorus

A

Primary hyperparathyroidism

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35
Q

Dx: medullary thyroid carcinoma, pheochromocytoma, primary hyperparathyroidism

A

Dx: MEN 2A- Altered RET proto-oncogene expression

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36
Q

Dx and Tx: elevated BMI, constipation, non-pitting edema, carpal tunnel syndrome, bradycardia

A

Dx: hypothyroidism
Tx: levothyroxine- improvement in several weeks

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37
Q

Dx & Tx: oliguria/anuria, dehydration, nausea, vomiting, altered mental status

A

Dx: hypercalcemia of malignancy common to metastatic thyroid cancer
Tx: normal saline + calcitonin/bisphosphonates/denosumab

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38
Q

Dx: chest pain, racing pulse, dizziness, difficulty breathing, loss of consciousness,
ECG: narrow QRS 100ms, regular R-R, and absent p waves

A

PSVT or paroxysmal supraventricular tachycardia, AVNRT- atrioventricular nodal reentrant tachycardia (AVNRT)
- alternative electrical conduction pathways - nonextinguishable circulating electrical impulse

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39
Q

Dx: dizziness, syncope, sinus bradycardia, elderly patient

A

Sick Sinus Syndrome- fibrosis of sinoatrial node + surrouding myocardium

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40
Q

Dx and Tx: Angina with ST elevation but negative troponin, later no abnormalities on ECG

A

Vasospastic angina (Prinzmetal Angina)
Diltiazem (CCBs) + Lifestyle Modifications
Acute: Nitroglycerin

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41
Q

Diastolic sound over the left sternal border =

A

Pericardial knock

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42
Q

Dx and Tx: JVP increase with inspiration, early diastolic sound over left sternal border, hepatic dysfunction, anasarca, low amplitude QRS complexes, CXR- calcifications over the left cardiac sihouette, Cardiac Catheterization- elevated right ventricular diastolic pressure with dip-and-plateau waveform.

A

Dx: Constrictive Pericarditis
Tx: Pericardiectomy

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43
Q

Muffled heart sounds, hypotension, JVD =

A

Beck Triad

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44
Q

Beck Triad following penetrating trauma, drop in systolic blood pressure > 10mmHg during inspiration.

A

Dx: Cardiac Taponade
Key Sign: Pulsus Paradoxus

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45
Q

Pathophysiology of AAA (Abdominal Aortic Aneurysm)

A

Accumulation of Foam Cells in the Tunica Intima

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46
Q

Strongest Predisposing factor for ischemic and hemorrhagic stroke (T2DM, HTN, ETOH, FHx, Obesity, HLD, or Tobacco?)

A

Hypertension

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47
Q

Dx: Dull abdominal pain radiating to lower back, CT- retroperitoneal mass + hazy margins

A

Retroperitoneal hemorrhage

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48
Q

Tx: Acetominophin + Warfarin interactions—> retroperitoneal hematoma/hemorrhage

A

Phytonadione (Vitamin K supplement) + Prothrombin complex concentrate (replenish Vitamin K dependent factors II, VII, IX, X

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49
Q

B symptoms (fever, night sweats, weight loss) are classically associated with

A

Lymphomas

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50
Q

Dx: weight loss, fever, night sweats, lymphadenopathy
Biopsy = CD15/CD30 antigens and large cells with bilobed nucleus
Cx:

A

Dx: Hodgkin Lymphoma
Reed Sternberg Cells
Hypercalcemia- 1alpha- hydroxylase activity

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51
Q

Dx: painless nontender cervical and axillary lymphadenopathy, splenomegaly, leukocytosis in >65 yo

A

CLL Chronic Lymphocytic Leukemia

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52
Q

Characteristic of Peripheral Blood Smear for CLL

A

Smudge Cells

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53
Q

Tx of CLL

A

Ibrutinib, rituximab

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54
Q

Dx: left sided abdominal discomfort, spleenomegaly, anemia, leukocytosis, no lymphadenopathy

A

CML

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55
Q

Dx: erythema in linear, longitudinal band appearance, painful, edema, high fevers, common with Group A strep (strep pyogenes) or Sporothrix Schenckii

A

Lymphangitis

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56
Q

Dx: dermatonecrosis, sometimes with fever, rashes, myalgias, or rarely with DIC/end organ damage

A

Brown Recluse Spider Bites

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57
Q

Dx: pustular skin lesions, migratory poly arthralgia, tenosynovitis

A

Disseminated gonococcal infection

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58
Q

Dx: well refined region of raised induration and erythema, infection of the upper dermis, superficial lymphatics, most commonly Strep Pyogenes

A

Erysipelas

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59
Q

Dx: infection with mixed flora, acute onset of pain—-> anesthesia, gas formation (crepitus, bullae, severe pain out of proportion to physical exam

A

Necrotizing Fascitis

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60
Q

Joint fluid- needle shaped negatively birefringent crystals in first metatarsophalangeal join-

A

Gout

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61
Q

Microcytic anemia + HbA2 elevated >4%

A

Beta- Thalassemia Trait

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62
Q

Dx and Tx: episodic memory loss, dizziness, double vision, burning pain in toe, itching (pruritic), painless bluish- red discoloration of toe - elevated HgB, HCt, Leukocytes, Platelets

A

Polycythemia Vera- JAK-2 Mutation
Increased cell production/hematocrit- hyper-viscosity syndrome (blurred vision, CNS symptoms)
Erythromelalgia- burning red-blue discoloration in extremity vessels
Tx: Phelbotomy

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63
Q

Dx and Tx: transfusion of PRBC, fever and chills tachycardia,

A

Dx: acute febrile transfusion reactions
Tx: acetominophen + IV fluids

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64
Q

Dx: transfusion reactions plus coombs test= positive and hemoglobin in serum

A

Hemolytic transfusion reaction

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65
Q

Dx and Tx: risky sexual behavior, diaphoretic (sweating), no lymphadenopathy, painless lesion over glans penis, Serum rapid plasma reagin negative

A

Dx: syphillis, treponema pallidum, false negative primary stage, dark field microscopy is more sensitive
Tx: penicillin G IM injection

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66
Q

Match Dx with Treatment
Syphillis
HSV
Chlamydia

A

Syphillis: Penicillin
HSV: Acyclovir
Chlamydia: Doxycycline + Azithromycin

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67
Q

Match Neuro Tract

  1. ALS (anterolateral spinothalamic tract)
  2. CST (corticospinal tract)
  3. DC-ML (dorsal columns-medial lemniscus tract)
A

ALS—> fine touch (pinprick) + temperature
CST- motor function
DC-ML- vibration + proprioception

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68
Q

Match- Tract with Lesion

  1. Brain Stem Lesion
  2. Cerebral Hemisphere Lesion
  3. Peripheral Nerve Lesion
  4. Spinal Cord Lesion
A
  1. Brain Stem—> Ipsi lateral cranial nerve function + contralateral spinal cord function
  2. Cerebral Hemisphere—> contra lateral focal neurologic deficit
  3. Peripheral nerve lesion- lower motoneuron weakness, paresthesias, numbness in specific dermatone/ nerve distribution)
  4. Spinal Cord—> assymetric physical exa ispilateral + contralateral
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69
Q

Most important risk factor in decreasing stroke?

A

Hypertension Management > 140/90 is increased risk of stroke

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70
Q

Most important risk factor in preventing atherosclerosis?

A

Smoking cessation

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71
Q

Dx and Tx: diabetic/immunocompromised, pain with pulling ear, discharge, fluid/red external ear canal + granulation tissue, severe

A

Necrotizing otitis externa- pseudomonas

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72
Q

Dx: children, ear pain, fever, red tympanic membrane, retrotympanic pus, middle ear effusion

A

Otitis Media

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73
Q

Match Treatment:
1. Topical Erythromycin
2. Topical Hydrocortisone
3. Oral Docloxacillin

A
  1. Acne vulgaris
  2. Eczema
  3. MSSA
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74
Q

Side Effects of Atenolol

A

Bradycardia + AV block

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75
Q

Dx: vertebral pain + fever

A

Dx: Discitis- Osteomyelitis, Staph Aureus or Pseudomonas, normally throug hematogenous dissemination of infection (IV drug users/ children)

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76
Q

Dx: serum creatinine= 3, blood alcohol 200 mg/dL, unresponsive to painful stimuli, UA- pigmented casts

A

Rhabdomyolysis- necrosis of large muscle groups, myoglobin in blood— pigmented casts in urine, AKI from ATN,

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77
Q

Chronic ILD—-> Pulmonary HTN —> decreased lung expansion, neck vein distention, parasternal heave, diffuse inspiratory crackles, Shortness of Breath can lead to?

A

Cor pulmonale—> Right Heart Failure because of Pulmonary HTN

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78
Q

Most Common Cause of HF?

A

Systemic HTN

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79
Q

High urea in blood = nausea, asterixis, encephalopathy, platelet dysfunction, pericarditis

A

Uremia

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80
Q

Complication of ACEi with renal artery stenosis

A

Hypoperfusion of kidneys- dx with CT/MR angiography of renal arteries

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81
Q

Target for Lipid Levels for diabetic patients

A

LDL < 100mg/dL + HDL> 40mg/dL + TG <150

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82
Q

Dx: worst headache of my life, history of hypertension,

A

Dx: subarachnoid hemorrhage (ruptured aneurysm)
Berry aneurysm in Circle of Willis + thunderclap headache, neck stiffness, photophobia
Lumbar Puncture- RBCs,

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83
Q

Epidural + subdural hematoma occur

A

In trauma

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84
Q

Idiopathic intracranial hypertension occurs in

A

Young, overweight females taking Vitamin A, oral contraceptives,or danazole—> holocephalic headache + blurry vision + bilateral papilloedema + elevated opening pressure on LP

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85
Q

Apical pulmonary opacity with fibrocaseous cavitary lesion + prolonged fever, night sweats, weight loss, skeletal muscle wasting, hemoptysis

A

Dx: Tuberculosis
Tx: rifampin, isoniazid, pyrazinamide, ethambutol, respiratory isolation

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86
Q

Dx: elderly, stroke, dementia— cough,fever, consolidation in right middle/lower lobes

A

Dx: aspiration pneumonia

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87
Q

Dx: non-caseating granulomatous in hilar lymph nodes and lungs, coarse reticular pulmonary opacities, restrictive lung disease

A

Sarcoidosis

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88
Q

Dx: endocarditis of tricuspid valve + fever, dyspnea

A

Septic pulmonary emboli

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89
Q

Dx: multifocal cavitary pulmonary nodules in setting of URTI (perforarated nasal septum, chronic sinusitis and glomerulonephritis (hematuria)

A

Wegener granulomatosis

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90
Q

Tx: mild persistent asthma —> > 2days a week or > 2 nights per mont

A

Albuterol + ICS (fluticasone)

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91
Q

Dx Tx & Cx: acute SOB + nonproductive cough, consistent history, no chest pain, smoking habits, new pool/hot tub use, mild respiratory distress, fine crackles at lung bases, no wheezing, mild fever

A

Hypersenstivity Pneumonitis: Mixed Type III/IV reaction, bird droppings or hot tubs
Tx: avoid antigen
Cx: alveolar thickening, noncaseating granuloma formation, upper lobe predominant pulmonary fibrosis

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92
Q

Dx: semi- acute history of SOB, non productive cough, intermittent wheezing, history of intubation, high-pitched end-expiratory wheezes/stridor in anterior aspects of lung.

A

Tracheomalacia- softening/deteriorationof tracheal cartilage- excessive end expiratory collapse

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93
Q

Dx & Tx: impact to chest, severe chest pain on inspiration, hypoxia, clear lungs on auscultation, CXR-> bilateral interstitial infiltrates

A

Dx: Pulmonary Contusions- penetrating trauma to chest—> leakage of intra/extravascular fluid into pulmonary interstitium/alveolar airspaces
Tx: supportive—> pain control, pulmonary toilet, lung expansion, maintain V/Q perfusion

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94
Q

Esophageal ulcers in HIV vs. esophageal white plaques

A

HSV/ CMV vs. Candida

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95
Q

Dx: semi-acute history of constant increasing abdominal pain, not related to eating, generalized pruritis, mild epigastric tenderness, alk phose elevated AST/ ALT normal, amylase normal. Ab U/S—> common bile duct/ pancreatic duct

A

Pancreatic Adenocarcinoma

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96
Q

Dx: Acute RUQ + epigastric pain + N/V following a fatty meal. Pt has gallstones

A

Dx: Choledocholithiasis

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97
Q

Dx, DGx, Tx: middle aged females, jaundice, pruritus, fatigue, hypercholesterolemia, fat-soluble vitamin deficiencies, anorexia, elevated ALK phos

A

Primary Billiary Cirrhosis- destruction of intrahepatic bile ducts
DGx: positive serum antimitochondrial antibody + biopsy
Tx: Ursodeoxycholic Acid —> Liver Transplant

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98
Q

Dx: history of ulcerative colitis, anorexia, nausea, vomiting, malabsorption

A

Sclerosing Cholangitis- inflammation and chronic fibrosis of biliary trees— beaded appearance of biliary tree

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99
Q

Dx: transient pain with dilated biliary and pancreatic ducts

A

Sphincter of Oddi Dysfunction

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100
Q

Types of Inguinal Hernias

A

Reducible- reduce with gentle pressure, or valsalva
Incarcerated- do not return, obstruction can result
Strangulated- herniated content lose blood supply- necrosis/perforation

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101
Q

Dx: pink-tinged urine (hematuria), hx of URTI, UA- RBCs, complement within normal range

A

IgA nephropathy- episodic gross hematuria after an infection- large amounts of RBCs, normal Complement, negative anti-streptolysin O, anti-DNase titers

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102
Q

Dx: hematuria following infection low serum C3 complement

A

PIGN- post infectious glomerulonephritis

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103
Q

Dx and Tx: urinary retention, frequent loss of small amounts of urine at night (nighttime overflow incontinence), tender suprapubic mass, poor urinary stream, U/A- WBC elevated, 1+ bacteria

A

Dx: BPH —> relieve with catheterization of the bladder —> prevents complications

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104
Q

Prevent contrast induced nephropathy

A

IV .9% Saline infusion

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105
Q

Etiology of Hypocalcemia in CKD patient

A

Diminished native vitamin D synthesis (1,25 dihyrdoxycholecalciferol concentration)- decrease absorption of Ca, elevations of PTH, secondary hyperparathyroidism

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106
Q

Urticaria + Perioral Swelling + Rash + Hypotension + Respiratory Compromise + GI symptoms < 1hr

A

Anaphylaxis- Type I hypersensitivity
Treat with Epinephrine

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107
Q

Use and SFx
Tacrolimus

A

Transplant Rejection Prophylaxis
Diarrhea, Hypertension, Hyperglycemia

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108
Q

Use and SFX
Daclizumab

A

Renal Transplant Rejection Prophylaxis
Diarrhea, Pancytopenia, Skin Rash, Lymphadenopathy, Elevated Liver Enzymes

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109
Q

Use + SFX
Methotrexate

A

Neoplasms + Rheumatic Diseases
Myelosuppression and Diarrhea

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110
Q

Use and SFx
Mycophenolate Mofetil

A

Transplant Rejection Prophylaxis
Myelosuppression, GI symptoms (NVD), Infections, lymphoid neoplasms, progressive multifocal leukoencephalopathy

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111
Q

Use + SFX
Cyclosporine

A

Transplant Rejection Prophylaxis
Diarrhea + Hypertension + Tremors + Nephrotoxicity + Gingival Hyperplasia + Hirsutism

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112
Q

Liver Transplant < 6months —> Acute Liver Transplant Rejection Symptoms

A

Vomiting, Jaundice, Rising Bilirubin, Pain in Graft Region
DGx: U/S

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113
Q

Churg- Strauss Syndrome (Eosinophilic Granulomatosis with Polyangitis)

A

Adult Onset Asthma, Sinusitis, Mononeuritis Multiplex (Foot Drop + Loss of Sensation in ulnar distribution), SubQ skin nodules, palpable purpura, fatigue, fever, eosinophilia + renal symptoms

Tx: glucocorticoid immunosuppression

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114
Q

Polyarteritis Nodosa

A

SubQ Nodules, Renal Impairment, Polyneuropathy, palpable purpura, abdominal pain, melena, myalgia

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115
Q

Henoch- Schonlein Purpura

A

Children, Palpable Purpura, Renal impairment, arthralgias, arthritis, , hematuria, nausea, vomiting, occult blood in stool
, IgA
resolves on its own

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116
Q

CD4 counts symptoms and diseases:
1. Kaposi Sarcoma
2. TB
3. Pneumocystitis Pneumonia (PCP)
4. Progressive Multifocal Leukoencephalopathy
5. Pulmonary Aspergillosis
6. Candida Esophagitis
7. Cryptococcus Neoformans
8. Toxoplasma Gondii
9. CMV Retinitis

A
  1. violaceous skin lesions <500
  2. cavitations on CXR <400
  3. Ground Glass opacities on chest CT <200
  4. Multifocal Brain Demylination on Brain MRI <200
  5. Cavitary Lesions on CXR <100
  6. White Plaques on EGD <100
  7. Encapsulated Yeast on India Ink <100
  8. Multiple Ring Enhancing Lesions on Brain MRI <100
  9. Cotton Wool Spots on Fundoscopy <50
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117
Q

Sign of Immunocompromised

A

Oral Thrush scraps –> causes bleeding

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118
Q

Elevated Beta-D-Glucan, Respiratory Distress, Dry Cough, Diffuse Interstitial Infilitrates,

A

Pnumocystitis Jiroveci Pneumonia
DGx: Bronchoalveolar Lavage- Visualization of PJ cysts (disc shaped with central spores) on silver staining (ideal induced sputum samples)
Tx: TMP-SMX

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119
Q

child, cough, dyspnea, failure to thrive, meconium ileus, diarrhea, steatorrhea, abdominal distension

A

Cystic Fibrosis

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120
Q

fever, arthritis, increased photosensitivity, painless oral ulcers

A

SLE

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121
Q

Symptoms and Marker for Dz:
Microscopic Polyangitis

A

fever, fatigue, myalgia, arthralgia, oral ulcers, purpura, hemoptysis
antibodies against myeloperoxidase (p-ANCA)

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122
Q

Sensitive Marker for many Immunodiseases

A

Antibodies to nucleus- ANA

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123
Q

Marker of Rheumatoid Arthritis

A

Rheumatoid Factor- Fc Region on IgG

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124
Q

SLE specific marker for diagnosis

A

Anti Smith Ab- antibodies for nuclear Sm proteins

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125
Q

HIV post-exposure prophylaxis

A

raltegravir, tenofovir, emtricitabine

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126
Q

Severe SFX of Methotrexate

A

Pulmonary Fibrosis, get a baseline CXR before starting MTX

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127
Q

Kit Mutation indicates

A

systemic mastocytosis - diarrhea, flushing, pruritis, leads to gastric ulceration
Tx: antihistamines, mast cell stabilizers (Cromolyn), corticosteroids

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128
Q

leukocytes with basophilic granules

A

mast cells

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129
Q

Dx and Tx: Purulent Conjunctivitis, Suppurative lymphadenitis, pneumonia, skinning/hunting wild animals + tick bite, single ulcerative lesion on cutaneous

A

Dx: Tularemia- gram - coccobacillus- Francisella Tularensis

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130
Q

Parinaud oculoglandular syndrome

A

Purulent conjunctivitis + suppurative preauricular lymphadenitis- Francisella Tularensis + Bartonella Henselae + HSV

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131
Q

Dx and Tx: acute influenza-like prodrome + rapid-onset of erythematous macules, vesicles, bullae, necrosis and sloughing of epidermis with new drug

A

SJS (Stevens-Johnson Syndrome) <10% of body
Toxic Epidermal Necrolysis > 30%

Tx: supportive + IVF + wound care

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132
Q

Match Skin infection to bug
1. Erythema Multiforme- targetoid lesions
2. Impetigo- red macules + papular lesions + honey crust
3. scalded skin syndrome- <6 yo
4. Toxic Shock Syndrome- diffuse erythema

A
  1. HSV
  2. Staph or Strep Skin infection
  3. Staph Aureus
  4. Staph Exotoxin
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133
Q

Dx: fatigue + > 1 Cytopenias can lead to DIC, fatigue, prolonged bleeding, pancytopenia, coagulopathy, elevated LDH, pallor, no lymphadenopathy, hepatosplenomegaly. Atypical promyelocytes

A

AML- APML

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134
Q

Dx: Syncope on progressive dyspnea on exertion, fatigue, exertion syncope

A

Severe AS: pulsu parvus/tardus—> delayed and weak carotid pulse (slow rising and weak), S2, mid to late peaking systolic murmur

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135
Q

Dx: focal enlargement of the bone, weakness, or bone fracture, bowing of legs, radiculopathy, spinal stenosis, frontal bossing, headaches, cranial nerve dysfunction and hearing loss

A

Paget’s Disease of the Bone

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136
Q

Dx: post MI of RCA + SOB + hypotension + diaphoretic + tachypnea + soft early systolic murmur at apex + pulm edema

A

Papillary Muscle Rupture- 3-5 days

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137
Q

Dx: Post MI of LAD or RCA—> Chest pain + new holocystolic murmur

A

Interventricular septum rupture- 3-5days, Left —> Right ventricular shunt

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138
Q

Dx: Post MI LAD—> Chest Pain + Distant Heart Sounds + Rapid progression to Cardiac Arrest

A

LV Free Wall Rupture <5 days or 2 Weeks—> Pericardial Effusion with Tamponade

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139
Q

Dx: Post MI —> HF, Angina, Ventricular Arrhythmias

A

Thin Dyskinetic Myocardial Wall- Left Ventricular Aneurysm

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140
Q

Dx + DGx + Tx: multiple sex partners + maculopapular rashes, meningeal headache/N/V, neck stiffness, dizziness or ischemic stroke like- sudden onset unilateral weakness

A

Dx: meningovascular syphilis
DGx: CSF —> positive VDRL
Tx: IV penicillin 10-14 days

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141
Q

Dx: meningitis + petechial rash

A

Blood + CSF culture: meningococcemia

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142
Q

Menigitis + HIV + plaque rash

A

CSF India Ink Stain + Cryptococcus Neoformans

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143
Q

Meningitis + subacute + no rash

A

TB meningitis + CSF acid fast bacilli

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144
Q

Dx + DGx + Tx: recurrent upper ab pain + diarrhea/steatorrhea + wt loss + Diabetes

A

Dx: Chronic Pancreatitis
DGx: CT with calcifications in pancreas + dilated ducts + enlarged pancreas
Tx: Pain management, Alc/Tobacco Cessation + Frequent Small Meals, Pancreatic Enzyme Supplements

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145
Q

SFx of hydroxyurea

A

Myelosuppression (neutropenia, anemia, thrombocytopenia)

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146
Q

Hashimoto Thyroiditis antibodies?

A

Anti thyroid peroxidase- Anti-TPO

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147
Q

Recurrent pregnancy loss antibodies

A

Anti-cardiolipin
Lupus Anticoagulant

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148
Q

Fatigue + pruritis + elevated alk phos + Anti mitochondrial antibodies

A

Primary Biliary Cholangitis

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149
Q

Graves disease antibodies

A

Thyroid stimulating immunoglobulins

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150
Q

Dx: proximal muscle weakness, dry mouth, ptosis, diminished or absent deep tendon reflexes

A

Tx: Lambert-Eaton Syndrome: pre-synaptic membrane voltage gated calcium problem

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151
Q

Primary hyperaldosteronism—-> Hypokalemia—DGx:

A

Early morning plasma aldosterone concentration vs. plasma renin activity > 20 ratio with plasma aldosterone > 15 = primary hyperaldosteronism

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152
Q

Hypertensive Emergency treated with

A

Nitroprusside

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153
Q

Nitroprusside Cx in renal insufficiency

A

Cyanide toxicity— metabolic acidosis—> confusion agitation seizures- tachycardia, tachypnea

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154
Q

Diabetic ophthalmoplegia

A

Down and out position, normal reactive pupil, ptosis- CNIII- oculomotor nerve injury
Ischemic neuropathy of diabetes

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155
Q

Dx: red ulcerated oropharynx, drooling, conscious + alert, severe pain, hoarseness, airway compromise,

A

Caustic ingestion poisoning

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156
Q

Dx: xerostomia- dry mouth, altered mental status, tachycardia, urinary retention

A

Anticholinergic OD

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157
Q

Xerostomia + Altered mental status, sedation/delirium, cardiac arrythmias, hypotension, tachycardia

A

Tricyclic antidepressant toxicity

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158
Q

Visual blurring, epigastric pain, profound metabolic acidosis after being drunk

A

Methanol ingestion (drunk—> dead)

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159
Q

Salivation, bradycardia, miosis, increased urination, diarrhea

A

Organophosphate

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160
Q

Dx: painful vesicles (small ulcers with erythematous base) + tender lympadenopathy

A

HSV- genital herpes
Acyclovir, Vancyclovir

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161
Q

Dx: Painful large deep ulcer with gray yellow exudate, well demarcated borders, soft friable (bleedable base), Severe lymphadenopathy that may suppurate

A

Haemophilus ducreyi (chancroid)
Azithromycin

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162
Q

Dx: Painless single ulcer + indurated borders, hard non-purulent base

A

Treponema Pallidum (Syphilis) Chancre- penicillin

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163
Q

Dx: Painless small shallow ulcers—> painful fluctuant buboes

A

Chlamydia trachomatis serovars L1-L3 (lymphogranuloma venerum
Doxycycline

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164
Q

Neurogenic back pain

A

Posture dependent, lumbar flexion relives pain, lower extremity numbness/tingling normal pulses, MRI of spine

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165
Q

Vascular back pain

A

Exertion dependent pain, relief with rest, lower leg cramping/tightness, no weakness, decreased pulses, cool extremities, decreased hair growth, pallor with leg elevation
Ankle- Brachial Index

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166
Q

Hyperpigmented, hypopigmentd, or salmon-colored macles on upper trunk in summer

A

Tinea versicolor —> KOH prep (thick walled budding yeast)—-> treat with selenium sulfide or ketoconazole

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167
Q

Infective Carditis Cx

A

Right sided valves, tricuspid regurgitation- systolic murmur increase on inspiration

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168
Q

Calculation of Cerebral Perfusion Pressure

A

MAP- ICP

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169
Q

How do you relieve elevated intracranial pressure in mechanically ventilated patients?

A

With therapeutic hyperventilation

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170
Q

Gait ataxia, truncal ataxia, dysarthria, nystagmus, dysmetria, dysdiadochkinesia, and pronator drift

A

Cerebellar tumors- manifest ipsilaterally - left cerebellar— left beating nystagmus, left leaning ataxia, left sided pronator dirft

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171
Q

Common tumors after amputations

A

Neuroma

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172
Q

Monoarthritis + rhomboid shaped + positively birefringent crystals

A

Pseudogout

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173
Q

Secondary pseudogout can result from

A

Hyperparathyroidism—> increased calcium/decreased phosphorus—> calcium purophosphate crystal

Others-chondrocalcinosis, hemochromatosis, gout

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174
Q

Headaches, nausea, vomiting, diploplia, swishing sound in ear (pulsatile tinnitus), esotropia cross eyed CNVI damage, bilateral optic disc swelling

A

Elevated intracranial pressure

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175
Q

Pain/ temperature deficits in ipsilateral face and contralateral body
Dysphagia and hoarsenss and ipsilateral horner syndrome (miosis, ptosis, anhydrosis)

A

Lateral medullary syndrome- occlusion of posterior inferior cerebellar artery

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176
Q

Occlusion of right penetrating arteries

A

Left side motor weakness

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177
Q

Left sided weakness, hemineglect (unilateral stimuli absence)

A

Right MCA occlusion

178
Q

Sustained painful muscle spasms, of head neck and tongue—> torticollis, facial grimacing, fixed and deviated stare after starting haloperidol

A

Acute dystonia

179
Q

Treatment of acute dystonia

A

Centrally acting anticholinergic drug
Benztropine, diphenhydramine

180
Q

Treatment of Toxoplasmosis Gondii in HIV patient

A

Pyrimethamine, sulfadiazine, leucovorin

181
Q

Unilateral jaw pain, ear discomfort, headache, limited jaw opening, facial muscle spasms

A

Temporomandibular Joint dysfunction- resolves spontaneously, pain relief, splints,

182
Q

Unilateral pain worsening with chewing, muscle spasms, electric shocks, no cracking sound

A

Trigeminal Nerve Compression

183
Q

SFX of corticosteroids

A

Muscle wasting, Weakness in shoulders and hips, proximal myopathy, (normal DTRs, ESR, CK)

184
Q

Prophylaxis for benzodiazepine withdrawal

A

Carbamazepine—> flumazenil

185
Q

Prevention of vasospasm post cerebral ischemia after Subarachnoidal hemorrhage

A

Calcium channel blockers- Oral nimodipine

186
Q

Fever, muscle rigidity, tachycardia, tachypnea, increased CO2 production post anesthesia

A

RYR channel mutations—> malignant hyperthermia
Tx: Dantrolene- RYR antagonist

187
Q

Belladonna, Atropine, antipsych, TCAs, antihistamine OD can lead to

A

Confusion, agitation, delirium + mydriasis (non reactive to light, blurry vision, dry mouth, tachycardia/arrhythmia, warm dry skin, urinary retention, diminished bowel sounds, constipation,

188
Q

Impaired adduction on ipsilateral eye and abduction nystagmus of contralateral eye (dissociated nystagmus)—-> internuclear opthalmoplegia

A

Demylination of medial longitudinal fasciculus— MS

189
Q

Arterial hypertension (morning headaches), frequent UTIs, FH of renal failure—>

A

ADPKD—> have increased risk of saccular aneurysms

190
Q

Worst headache of my life, fever, xanthochromia (yellow colored CSF, meningismus- neck stiffness and Kernig Sign

A

Subarachnoid hemorrhage from saccular aneurysms

191
Q

Dx: fever, urticarial rash, myalgia, polyarthritis and proteinuria after exposure to nonhuman protein antigens

A

Serum Sickness + type III hypersensitivity
Complement system activation and consumption

192
Q

Dx and Tx: elderly woman, dyspareunia, vulvar pruritis, white vulvar plaque

A

Lichen sclerosus- increased risk of vulvar squamous cell carcinoma
Give superpotent topical glucocorticoids- betamethasone or clobetasol

193
Q

HIV esophagitis ulcers- round well-circumscribed superficial CD4 count <100

A

HSV infection- treat with acyclovir
DGx: PCR

194
Q

HIV esophagitis, linear/longitudinal ulcers CD4< 50

A

CMV infection

195
Q

Dx + Tx: Tender, red, subcutaneous nodules —> bruise like plaques, no ulceration, malaise, arthralgia

A

erythema nodosum - delayed type hypersensitivity- generally CXR—> strep pharyngitis, sarcoidosis, TB elevation of CBC + ASO

196
Q

Treatment of chlamydia in pregnant women

A

Oral Azithromycin

197
Q

IRIS

A

Recurrent or worsening symptoms of pre-existing opportunistic infection (TB, cryptococcosis) within 2 months of cART initiation

198
Q

MCC of cervicitis: cervical motion tenderness, friable cervix

A

Chlamydia + Gonorrhea
Purulent, bloody vaginal discharge, dyspareunia, postcoital bleeding
Without fever

199
Q

Dx: skin tightness and thickening non purulent ulcers on fingers (sclerodactyly), pulmonary fibrosis (fine inspiratory crackles), chest pain + weight loss (GERD)- esophageal hypomotility

A

Diffuses systemic sclerosis = Antitopisomerase I antibodies

200
Q

Dx: chronic rhinosinusitis, scleritis, episcleritis, uveitis, granulomas, vasculitic purpura

A

Granulomatosis with polyangitis - c-ANCA

201
Q

Dx: fatigue, generalized itching and elevated alk phos, GGT, total and direct bilirubin

A

PBC (Primary Biliary Cholangitis)- Antimitochondrial Antibodies

202
Q

Flu like symptoms + rash + isoniazid, hydralazine, procainamide)

A

Drug- induced lupus erythematosus - ANA, anti-histone antibodies

203
Q

Reflux esophagitis, respiratory complication, xerophthalmia, xerostomia (dryness of eyes and mouth

A

Sjogren syndrome- Anti-Ro/SSA and anti-La/SSB

204
Q

Flaccid paralysis and respiratory failure in logger/camper from washington

A

Tick paralysis- 2-7 days- tick removal and supportive measures.

205
Q

Polyneuropathy, intestinal colic, anemia, radial nerve palsy, blackish-blue line along margins of gums

A

Lead Poisoning

206
Q

Distal sensorimotor polyneuropathy, white bands across nails (Mees lines) + hyperkeratosis + battery factor worker + garlic like odor

A

Arsenic Poisoning
DGX: elevated arsenic levels
Tx: chelating agents- dimercaprol + succimer (children)

207
Q

Anosmia, yellowing of teeth, tubulointerstitial nephritis, emphysema

A

Cadmium Toxicity

208
Q

Polyneuropathy, intention tremor, emotional instability, bluish-violet discoloration of gums

A

Mercury Toxicity

209
Q

Recent onset abdominal pain with hypertension in a pregnant woman

A

HELLP syndrome
Form of pre-eclampsia- hemolysis, elevated liver enzymes, low platelets, rapid clinic deterioration
Check the serum transaminase levels + platelet count
Microvascular damage—> overactivation of coagulation cascade

210
Q

Hypotension + bradycardia after bupivacaine injection

A

Neurogenic shock—> distributive shock- vasodilation- unopposed parasympathetic tone

211
Q

When is chlorhexidine mouthwash recommended for patients?

A

When undergoing cardiac surgery

212
Q

What can prevent post-operative pneumonia?

A

Incentive spirometry/deep breathing exercises—> keeps alveoli open, decreases risk of atelectasis and pneumonia

213
Q

Obstructive Lung Diseases

A

Asthma, COPD, Bronchiectasis, Chronic bronchitis, Pulmonary Emphysema,

214
Q

Restrictive Lung Diseases

A

Interstitial Lung Disease, Obesity, Diaphragm Dysfunction, Radiation induced Pulmonary Fibrosis

215
Q

Dx: blisters, history of autoimmune disease, captopril, multiple flaccid blisters, ulcers in buccal, gingival, and vulvar mucosa, separation when skin is lightly stroked

A

Pemphigus Vulgaris- autoantibodies against- desmosomal adhesion proteins (desmoglein 3 and 1)
Tx: high does systemic corticosteroids, + immunosuppressive medications

216
Q

Drugs which can cause pemphigus vulgaris

A

Thiol drugs- captopril, penicillamine
Phenol drugs- cephalosporins, rifampicin, phenobarbital, aspirin

217
Q

Positive nikolsky sign

A

Formation of cutaneous blister upon stroking skin
Found on pemphigus vulgaris, staph scalded skin syndrome, SJS/TEN

218
Q

Dx: cutaneous blisters, captopril, tense symetrical, negative nikolsky sign, starts with pruritus and papules not found in mucous membranes

A

Bullous Pemphigoid

219
Q

Dx: painful blisters, child <6, erythema, fever, malaise, preceded by impetigo, or diarrhea

A

Staphylococcal scalded skin syndrome

220
Q

Dx: papulopustular lesions, painful oral/genital ulcers, 20-40 y/o, eye redness, decreased vision

A

Behcet Disease

221
Q

Dx: fever, tachycardia, hypotension, blisters on skin, mucous membranes, positive nikolsky sign <30% >30% after drug initiation <8 weeks

A

SJS vs.TEN

222
Q

Pathognomonic for PCP, Treatment

A

Elevated lactate dehydrogenase and beta-D-glucan
TX: TMP-SMX + adjunctive glucocorticoids for respiratory distress (PaO2 <70)

223
Q

Amphotericin B is effective against

A

Aspergillus, candida, cryptococcus

224
Q

Chest pain, fever, hemoptysis in HIV patient

A

Aspergillus
Tx: Amphotericin

225
Q

Dx and Tx: immunocompromised, acute SOB, dry cough, pruritic rash, fever, tachpnea, multiple vesicles on face trunk, extremities, nodular interstitial infiltrates can have hepatitis and encephalitis

A

Dx: Disseminated VZV
Tx: IV Acyclovir

226
Q

Dx: dyspnea, chronic dry cough, digital clubbing, fatigue

A

ILD- excess collagen deposition in extracellular matrix of the lung

227
Q

Dx: chronic productive cough, fever, respiratory insufficient, fatigue, long history of smoking

A

COPD- chronic airway inflammation

228
Q

Standard treatment for TB

A

RIPE regiment for 2 month intensive phase- Rifampin, Isoniazid, Pyrazinamide, Ethambutol
Isoniazid + Rifampin for 4 months
Monitor for hepatotoxicity, optic neuritis
Sputum samples for monthly until 2 consecutive cultures are negative

229
Q

Sentinel lymph node biopsy recommended in malignant melenoma?

A

If tumor thickness > 1mm

230
Q

Dx DGx and Tx: asthma, chronic rhinosinusitis, nasal polyps, hypersensitivity to aspirin or COX-1 inhibitors

A

AERD- asthma exarcebated respiratory disease—> Nasal Endoscopy
Intranasal corticosteroids + aspirin desensitization

231
Q

Standard treatment for Basal Cell Carcinoma not located on trunk/extremities

A

Mohs micrographic surgery

232
Q

Biggest Risk Factor Associated with Adolescent Idiopathic Scoliosis

A

Premenarchal Status

Female Sex, Age <12, Premenarchal Status, Skeletal Immaturity, Initial Severe Curvature

233
Q

Vaccines for HIV adults

A

All normal vaccines,
Hep A, Hep B, VZV -50 yrs old
Meningococcus and Strep Pneumo- 8 weeks, 5 years, 65age

234
Q

Prophylaxis for PCP (Pneumocystitis Pneumonia)

A

TMP+SMX
(Also give CMV- ganciclovir/valganciclovir)

235
Q

Specific sign for CHF

A

Elevated BNP + audible S3 heart sound

236
Q

Dx and Tx: recurrent pregnancy losses, arterial or venous thrombosis, mild thrombocytopenia, positive VDRL and prolonged activated PTT

A

Antiphospholipid-antibody syndrome
Prothrombotic autoimmune disorder
Tx: enoxaparin (LMW heparin)

237
Q

Macro/microprolactinoma treatment

A

Dopaminergic agonist—> cabergoline, bromocriptine
2nd-> transsphenoidal resection

238
Q

Known complication of abdominal aortic aneurysm repair

A

Bowel Ischemia- abdominal pain, bloody diarrhea, fever, leukocytosis,
Prevent- by checking sigmoid colon perfusion post graft placement

239
Q

Dx: bloody and purulent diarrhea, tenesmus

A

E.Coli or Shigella

240
Q

Voluminous watery diarrhea, abdominal pain, fever, pseudomembranous colitis, 4-5 days after antibiotic use

241
Q

Chronic erythematous rash on convex areas of face, flushing, vasomotor dysfunction with hot or spicy foods, alcohol, sun exposure, high ambient temperatures

A

Rosacea
Tx: Topical Metronidazole, azelaic acid, ivermectin

242
Q

Colon Cancer bacteria association

A

Clostridium septicum, Group D streptococci (strep Bovis)

243
Q

Alcohol Binging leads to

A

Lower extremities, pain, weakness, swelling,- rhabdomyolysis

244
Q

Cx of rhabdomyolysis

A

AKI- prerenal and interstitial

245
Q

Etiology of Acute Pancreatitis

A

Chronic Alcohol Use
Gallstones
Hypertrigylceridemia > 1000
Infections
Post-ECRP
Drugs- Azathioprine, Valproic Acid, Thiazides

246
Q

Previous history of hodgkins lymphoma high risk of?

A

Secondary malignancy

247
Q

Dx: hemoptysis, cough, dyspnea, fever, cavitary mass with air in periphery

A

Aspergillus

248
Q

Rabies vaccine recommendation?

A

Inactivated in HIV if traveling in high risk areas (Africa and Southeast Asia- not required always

249
Q

What predisposes elderly patients to heat stroke?

A

Impaired thermoregulatory capacity- impaired thirst, blood vessel dilation, reduced ability to sweat

250
Q

Heat stroke vs. Heat Exhaustion

A

Presence of neurologic symptoms in heat stroke

251
Q

Deficiency in what predisposes people to Neisseria Infections

A

Deficiency in terminal complement factors— No MAC

252
Q

Asymptomatic elderly person with splenomegaly, thrombocytosis, and peripheral leukocytosis

A

CML- increase in all myeloproliferative lines

253
Q

Tx of CML

A

Tyrosine kinase inhibitors- imatinib or dasatinib

254
Q

IDA

A

Iron: low
TIBC: increased
Ferritin: low
% Sat: low

255
Q

Anemia of Chronic Disease (ACD)

A

Iron: low
TIBC: low
Ferritin: increased
% Sat: normal

256
Q

1-2 weeks after RBC transfusion, hemolysis

A

Delayed hemolytic transfusion reactions
Positive coombs test, indirect hyperbilirubinemia, anemia
Tx: supportive

257
Q

Dx: head trauma- acute. Headache, N/V focal deficits, seizures

A

Subdural hematoma- tearing of bridging veins in subdural space

258
Q

Dx: headache, seizures, vomiting, contralateral superior quadrantanopia

A

Temporal lobe glioma

259
Q

Numerous seborrheic keratosis lesions suddenly

A

Leser Trelat Sign- GI malignancy

260
Q

Actinic keratosis can progress to

A

Squamous Cell Carcinoma

261
Q

Pain with active shoulder abduction—> relieved with passive motion

A

Rotator cuff tendinitis
Tx: RICE Therapy

262
Q

Dx: shoulder pain with range of motion, limited, catching locking sensation, instability, acute trauma

A

Dx: torn glenoid labrum: PE and MRI

263
Q

Acute treatment of gout vs. Chronic prevention of Gout

A

Colchicine vs. Allopurinol

264
Q

Antibiotic prophylaxis in dental procedures

A

30-60 minutes cover for oral flora- oral amoxicillin- covverage of gram - and aerobic

265
Q

Claudication of lower buttocks/ Lower extremities, parasthesias, paraplegia, or erectile dysfunction, shiny hairless skin,

A

Dx: CT/MRI + ABI
Tx: balloon/stent angioplasty, aortic endarterectomy, vascular bypass surgery, thrombolysis

266
Q

Pericardial effusion Beck’s Triad

A

Hypotension, JVD, distant heart sounds

267
Q

Tearing chest or abdominal pain radiating to back with different blood pressures between extremities, asymmetric pulses

A

Aortic Dissection

268
Q

Atrial fibrillation management

A

DOAC- warfarin or AC- apixiban—> prevent formation of atrial thrombus

269
Q

HAP pneumonia treatment vs. CAP pneumonia treatment

A

Vancomycin + Ceftazidime vs. Ceftriaxone and Azithromycin

270
Q

Pleurisy, mesothelioma, empyema

A

Pleural effusion and inflammation

271
Q

CXR of asbestosis

A

Inferior portions of lung + pleural thickening and nodularity

272
Q

Pathophysiology of steatorrhea with Crohn’s Disease

A

Bile salt resorption impairment- inflammation of terminal ilieum

273
Q

Salivary gland swelling, bilateral, fever, headache, malaise, myalgia

274
Q

Salivary gladn inflammation, acute onset of pain afebrile,

A

Sialadentitis (sialothithiasis)
Tx: supportive- analgesics, heat massage, hydration

275
Q

Dependent edema in buttocks, lower back, or legs, foamy/dark colored urine, hypoalbuminemia, hyperlipidemia, proteinuria.

A

Nephrotic syndrome- minimal change disease

276
Q

Cx of minimal change disease

A

Hypercoaguability- DVT
Infection: loss of 𝛄 globulins

277
Q

Fever, hypotension, diffuse erythematous rash, desquamation, end organ damage: AMS, myalgia, thrombocytopenia, azotemia, transminitis,

A

Toxic Shock Syndrome Toxin- Staph Aureus
- IVF + antibiotics

278
Q

cardiogenic shock complication

A

Metabolic Acidosis-Lactate—> end organ damage

279
Q

Most Common Infection from Central/ Peripheral Lines

A

Staph epidermidis
IV antibiotics + Line removal

280
Q

Hyperventilation + hypoxemia leads to

A

Respiratory alkalosis

281
Q

Dx: sharp chest pain + SOB + VQ mismatch + hypoxemia + respiratory alkalosis

A

PE 2/2 DVT

282
Q

Raloxifene SFx

A

Increased risk of DVT + PE

283
Q

No Urinary output 5 hours after surgery + AKI

A

SERIOUS
Perform bedside bladder scan- determine prerenal, intrarenal, post-renal
Urinary catheter if urinary retention present- volume > 400 mL

284
Q

PPD test > 10mm + high risk (<5 years from TB endemic areas)

A

TB-positive
Get CXR- to verify latent- no therapy or active TB- RIPE therapy
Symptoms—> isolation

285
Q

PPD > 5 + HIV or immunocompromised, exposure, organ transplants + previous + CXRs

A

Positive TB

286
Q

PPD >15mm + no risk factors

A

Positive TB

287
Q

Treatment of SCLC

A

Cisplatin + etoposide + radiation

288
Q

Dx: low grade fever, nonproductive cough, clear lungs, streaky and reticular infiltrates with confluent opacities in upper lobes

A

Atypical pneumonia

289
Q

Typical pneumonias

A

Klebsiella, Strep Pneumo, Haemophilus influenzae,

290
Q

Atypical Pneumonias

A

Mycoplasma, Legionella

291
Q

Dx: Hospital visit, diabetes, COPD, alcohol use disorder, high fever, shaking chills, cough, productive sputum thick and bloody (currant jelly), consolidation in upper lobe

A

Klebsiella Pneumoniae

292
Q

DX: high fever, shaking chills, productive cough, decreased breath sounds, crackles, lobar consolidation

A

MC: strep pneumoniae

293
Q

Dx: child, high fever, shaking chills, productive cough, decreased breath sounds, crackles, lobar consolidation

A

Haemophilus Influenzae

294
Q

Dx: post-viral pneumonia + interstital patchy infiltrates on CXR, immunodeficient

A

Staph Aureus

295
Q

Dx: young patients, crowded environments, interstitial space, lungs clear on auscultation, small skin lesions with blue livid center, pale intermediate zone, dark red peripheral rim (erythema multiforme)

A

Mycoplasma pneumoniae
- macrolides, tetracyclines, floroquinolones
- azithromycin, doxycycline, levofloxacin

296
Q

Dx: smokers, COPD, contaminated water, high fever and chills, diarrhea, confusion, hyponatremia, patchy unilateral/lobar infiltrates

A

Legionella Pneumophila

297
Q

CT: hyperdense in thoracic cavity, gravity dependent + pleuritic chest pain, cough, decreased breath sounds, dullness on percussion

A

Pleural Effusion- needle thoracocentesis

298
Q

Tx: Pleural effusion + respiratory failure (hypoxemia

A

Chest tube insertion (thoracostomy)

299
Q

Dx + DGx + Tx: nephrolithiasis, flank pain, bilateral flank masses, hypertension, hematuria, proteinuria, enlarged kidneys with multiple anechoic masses

A

ADPKD (Autosomal Dominant Polycystic Kidney Disease)
DGX: US of abdomen
Tx: Captopril - manage hypertension + control proteinuria, increase fluid intake- prevent kidney stone formation, avoid nephrotoxic substances
ESRD progression—> hemodialysis + kidney transplant

300
Q

Cx of ADPKD

A

ESRD, UTI, mitral valve prolapse, saccular aneurysms

301
Q

Dx + DGx + Tx: unilaterally decreased breath sounds, chest pain, dyspnea, after high speed injury—> tachypnea, hemodynamic instability, JVD

A

Dx: Tension Pneumothorax
DGx: Clinical
Tx: needle thoracostomy

302
Q

Dx: hematuria, no RBC casts, hypertension, polycythemia (headache, facial plethora, blurry vision), obesity, smoking, occupational exposure to gasoline

A

Renal Cell Carcinoma + Complications- Polycythemia (EPO production) + Hypertension (renin release)

303
Q

Simultaneous contractions of detrusor muscle and internal urethral sphincter following spinal cord injury- acute urinary retention

A

Spastic neurogenic bladder - give alpha blockers- prazosin

304
Q

Dx: shortness of breath + hypoxia worsening after giving fluids + blunt injury to chest wall

A

Damage to capillaries—> pulm edema—> pulm contusion—-> patchy infiltrate on CXR

305
Q

Dx and Tx: : massive hemoptysis + pulmonary nodule on X-ray _ smoking history

A

Correct positioning, airway protection, cardiovascular support, bronchoscopy—> identify source of bleeding, stop bleeding with balloon tamponade
Bronchogenic carcinoma

306
Q

Dx: Crohn’s Disease + microtrauma—> rapidly progressing skin lesion with necrotic base + purplish borders, extensor side of limbs

A

Pyoderma gangrenosum

307
Q

Dx: wart like lesion + irregular borders + ulcerations/bleeding + Midwest

A

Blastomycosis

308
Q

Prophylaxis for patients with Hep B exposure + negative Hbsag, Hbsab, and HCab

A

Hepatitis B immunoglobulin + 3 dose vaccination

309
Q

Average lifespan for onset for severe dementia

A

<18 months

310
Q

Dx + DGx + Tx: syncope, orthostatic hypotension, conjunctival pallor, ploppin sound on auscultation of heart, low-pitched, rumbling mid-diastolic murmur at apex

A

Dx: Cardiac Myxoma- obstruction of AV valve- embolization, mitral stenosis mimic
DGx: Echo
Tx: surgical resection

311
Q

Dx + Tx: fatigue, conjunctival pallor, low hemoglobin + scleral icterus + elevate reticulocyte, increase total bili, normal direct bili, increased LDH + normal haptoglobin, splenomegaly, triggered with infection

A

Dx: extravascular hemolysis- hereditary spherocytosis
DGx: negative coombs test, elevated MCHC and osmotic fragility of RBCs
Tx: Splenectomy

312
Q

Treatment of gonorrhea + chlamydia in pregnant patients vs. non pregnant patients

A

IM ceftriaxone + azithromycin vs. IM ceftriaxone + doxycycline

313
Q

Tx: pneumonia + failed antibiotic treatments, COPD, immunosuppressed, greenish sputum, gram - rods

A

Dx: high suspicion of Pseudomonas + CAP
Cefepime + levofloxacin

314
Q

CHF—> reduced CO —> compensatory response

A

Organ hypoperfusion—> activation of RAAS system—> vasoconstriction of efferent renal arterioles—-> maintains CO

315
Q

Dx + Tx: T2DM + dysphagia + fever + drainage of pus + submandibular and anterior neck tenderness + swelling

A

Dx: ludwig angina- infection spread to submandibular/sublingual space
Tx: IV antibiotics (Zosyn) + airway control + surgical drainage
EMERGENCY

316
Q

Dx: tonsillar ulceration + nontender cervical lymphadenopathy, sore throat, halitosis, dysphagia

A

Dx: HPV—> SCC of oropharynx
DGx: biopsy
Tx: surgery + radiation + chemotherapy

317
Q

Dx + Tx: recurrent nose bleeds, anemia, weight loss, splenomegaly, tartrate resistant acid phosphatase activity on PBS, abnormal large WBCx w/ centrally placed nuclei and multiple hair-like cytoplasmic projections

A

Dx: hairy-cell leukemia
Tx: chemotherapy with Cladribine or pentostatin

318
Q

Dx: sub-acute history of fatigue, diarrhea and cramping abdominal pain in RLQ, microcytic anemia, leukocytosis, noncaseating granulomas + neutrophilic inflammation of crypts, chronic watery, nonbloody diarrhea

A

Dx: Crohn’s Disease 15-35 but also 60

319
Q

Dx: child, fever, chest pain, respiratory distress, pulm infiltrates in girl of east mediterrian descent, deep bone pain, hemolytic anemia (jaundice, increased LDH, increased total bilirubin, normal direct bilirubin, decreased haptoglobin

A

Dx: Acute Chest syndrome with SCD
Tx: respiratory support, pain management, IV fluids, bronchodilators, abx (ceftriaxone + azithromycin), blood transfusion if necessary

320
Q

Dx: JVD, right parasternal heave, hepatomegaly, ascites, pedal edema, bibasilar crackels

A

Dx: chronic pulmonary hypertension—> pulmonary edema—> cor pulmonale—-> isolated right ventricular failure

321
Q

Dx: watery diarrhea, muscle weakness/cramps, hypokalemia, decreased gastric secretion (achlorhydria)

A

Dx: VIPoma tumor affecting pancreatic cells
DGx: CT pancreatic tail tumor + VIP level > 75

322
Q

Dx + DGx + Tx: fluctuating diploplia + ptosis, dysphagia or dysarthria after ABx, cardiac medications or physiologic stress (pregnancy, surgery, infection)

A

Dx: Myasthenia Gravis
DGx: Ice Pack Test (bedside), AChR-Ab (specific) + CT scan of chest
Tx: AChE inhibitors -pyridostigmine + corticosteroids + thymectomy

323
Q

4 aspects of Decision Making Capacity

A

Communicates a choice
Understands Information Provided
Appreciates Consequences
Rationale for Decision

324
Q

Dx: facial weakness of upper and lower face unilaterally, eye lacrimation, decreased sensation of taste in anterior 2/3s, acute, last for 2-3 weeks with improvement in 3-6 months

A

Dx: Bell’s Palsy likely secondary to neutrophic virus (HSV)
Tx: glucocorticoids + Valacyclovir

325
Q

Dx: facial weakness of lower face

326
Q

Dx: young adult, substernal chest pain, racing heart, no SOB,cough, fever, recurring symptoms, agitation, diaphoresis, hypertension, tachycardia, dilated pupils, acute ST elevations

A

STEMI secondary to cocaine intoxication
Tx: benzodiazempines, nitrates + antiplatelet therapy

327
Q

Dx: rapid onset SOB, faint fruity odor, pupils pinpoint, diffuse rhonchi/wheezing

A

Dx: organophosphate poisoning
DgX: DUMBELS- diarrhea, urination, miosis, bronchospasms, bradycardia, emesis, lacrimation, salivation, sweating
RBC acetylcholinesterase activity test
Tx: remove clothes, irrigate skin, atropine + pralidoxime

328
Q

Dx + DGx + Tx + Cx: shiny thickened skiny, multiple telangiectasis, fatigue, weakness, digital ulcers, myalgias, arthralgias, contractures, esophageal dysmotility, dysphagia, raynaud phenomenon

A

Dx: Systemic Sclerosis
DGx: ANA, Anti-topoisomerase I, Anti-centromere antibody
Cx: interstitial lung disease, pulmonary arterial HTN, Kidney HTN, myocardial fibrosis, pericarditis, pericardial effusion Renal Crisis

329
Q

How do nitrates work

A

Vasodilators- dilate veins, arterioles, and coronary arteries
Lowers preload + LVEDV reducing wall stress

330
Q

Dx + DGx + Tx: fever, fatigue, myalgias, ARDS, CHF, DIC, splenic rupture, anemia, thrombocytopenia, increased bili, LDH, LFTS, north east US

A

Dx: Babesia microti + Ixodes Scapularis tick bite
DGx: PBS + Maltese cross
Tx: Atovaquone + Azithromycin or Quinine + Clindamycin if severe

331
Q

Dx: scleral icterus + direct hyperbilirubinemia, normal liver function, dark granular pigment in hepatocytes

A

Dubin Johnson Syndrome- Nothing to Worry About

332
Q

Dx + Tx: firm domed papule with central umbilication

A

Molluscum Contagiosum
Tx: Cryotherapy or cantharidin

333
Q

grid lines appear curved

A

Macular degeneration

334
Q

Dx: ESDR, muscle weakness, bradycardia, hypotension, QRS complex widening no p waves, peaked t waves

A

Hyperkalemia > 5.5
Tx: IV calcium (chloride or gluconate)—-> stabilize cardiac myocyte,
Renal etiology- IVF + diuretics
GI etiology- cation exchangers
Dialysis

335
Q

Dx + DGx + Tx: bone pain, headaches, hearing loss, spinal stenosis, radiculopathy, bowing bones, fracture, arthritis in adjacent joints, giant cell tumor or osteosarcoma

A

Dx: Paget’s Disease of Bone
DGx: elevated alk phos, elevated PINP,urine hydroxyproline, Ca/P- normal, Xray- osteolytic/mixed lytic sclerotic lesions
Tx: Bisphosphonates

336
Q

Dx + DGx + Tx: ESRD, painful nodules + ulcers, calcification in soft tissues, arteriolar calcification/occlusion, subintimal fibrosis, local tissue necrosis/ischemia

A

Dx: Calciphylaxis (calcific uremic arteriolopathy)
DGx: hypercalcemia + phosphatemia
Tx: Supportive + Optimization

337
Q

First line treatment of delirium

A

Low dose haloperidol

338
Q

Changing cutoff point to quantitative diagnostic test

A

Inversely affects sensitivity and specificity
Raising—> increase specificity, decrease sensitivity
Lowering—> decreases specificity, increases sensitivity

339
Q

Dx + Tx: acute: garlic breath, vomit, watery diarrhea, QTc prolongation, chronic, hypo-/hyperpigentation, hyperkaratosis, stocking glove neuropathy

A

Dx: Arsenic poisoning (pesticides, contaminated water, pressure treated wood
Tx: Dimercaprol or DMSA (meso-2,3-dimercaptosuccinic acid, succimer)

340
Q

Cx of Acromegaly

A

Myocardial left ventricular hypertrophy, dilation + global hypokinesis

341
Q

Common SFX of glucocorticoids

A

Leukocytosis + hyperglycemia

342
Q

Beta blockers SFX

A

Impaired glucose control + increased weight gain- don’t use in T2DM

343
Q

ACEi + ARB SFx

A

Hyperkalemia- firstline drugs with T2DM

344
Q

Tx of orthostatic hypotension

A

Binding, compression socks + prazosin/doxazosin

345
Q

DCCB SFX (amlodipine, nifedipine

A

Peripheral edema

346
Q

Crypt abscesses

A

Ulcerative colitis

347
Q

Intestinal villous atrophy

A

Celiac disease

348
Q

IBS GI findings

A

Normal colonic mucosa

349
Q

Tx: Hyperferritinemia =

A

Hereditary Hemochromatosis
Tx: Therapeutic Phlebotomy

350
Q

Opioid Intoxication Symptoms

A

AMS, respiratory depression, miosis
Tx: Naloxone

351
Q

Where does tophaceous gout normally occur?

A

First metatarsophalengal MCP joints—-> Monosodium urate crystal deposition

352
Q

Tx of HHS

A

Begin wtih IVF with Normal Saline, Replete K, IV Insulin

353
Q

Dx + DGx + Tx: osteoarthritis, <40, in 2-3 MCP joints/wrists, chondrocalcinosis

A

Dx: Hereditary Hemochromatosis
DGx: X-ray- joint space narrowing + chondrocalcinosis + osteophyte formation
Tx: phelbotomy, acetominophen, NSAIDs

354
Q

Dx: vertigo, recurrent episodes 20mins-several hours, sensorineural hearing loss (sound more prominent on opposite side), tinnitus/fullness of ear

A

Meniere Disease- increased volume/pressure of endolymph

355
Q

Dx: vertigo, brief episodes triggered by head movements, nystagmus with Dix-Hallpike maneuver- <1min

A

BPPV- (Benign Paroxysal Positional Vertigo)— calcium debris in semicircular canals

356
Q

Dx: Vertigo, acute single episode lasts for days, after viral syndrome, abnormal head thrust test + nausea vomiting

A

Vestibular neuritis- inflammation of vestibular nerve
Labyrinthitis- + hearing loss to symptoms

357
Q

Difference between AIHA (autoimmune hemolytic anemia) + hereditary spherocytosis (HS)

A

AIHA- negative family history and +coombs test
HS- positive family history and -coombs test

358
Q

Intravascular Hemolysis

A

Reduced haptoglobin, elevated total bili, normal direct bili, elevated LDH
etiologies: DIC, transfusion rxns, infxns, paroxysmal nocturnal hemoglobinuria, Iv Rho(D) immunoglobulin infusion

359
Q

Extravascular Hemolysis

A

RBCs destroyed by phagocytes, slightly low haptoglobin, slightly elevated LDH, slightly elevated total bilirubin, normal direct
Etiologies: G6PD, Sickle Cell, Thalassemia, hereditary spherocytosis, hypersplenism, IV immunoglobulin infusion, autoimmune hemolytic anemia, infxn (bartonella, malaria)

360
Q

Dx: subacute fever, night sweats, weight loss, cough with foul-smelling sputum, coughing during eating, swallowing dysfunction

A

Oropharangeal aspiration abscess
DGx: cavitary infiltrates with air fluid levels
Tx: Ampicillin-sulbactam, impenem, meropenem, clindamycin

361
Q

Tx of hemophilia A/B

A

Factor replacement + desmopressin for hemophilia A
Hemophilia A: absent factor 8
Hemophilia B: absent factor 9

362
Q

Prerenal AKI in setting of CHF

A

Cardiorenal syndrome—> reduction of GFR, elevated venous pressure, reduced CO, exacerbation of HF
Tx: IV diuretics

363
Q

Dx: proximal muscle weakness etiologies

A

Glucocorticoid induced myopathy
Endocrine- hypothyroidism/hyperthyroidism, cushings disease
Neuro- Labert-Eaton, Myasthenia gravis

364
Q

Common organisms for traveller’s diarrhea- prolonged profuse watery diarrhea

A

Cryptosporidium Parvum, Cyclospora, Giardia

365
Q

Vomiting Diarrhea

A

Staph Aureus
Bacillus Cereus

366
Q

Noninflammatory diarrhea

A

Virus (norovirus, rotavirius)
Clostiridium perfringens
ETEC
Vibrio Cholerae
Listeria
Parasites (Giardia, Cryposporidium, Cyclospora)
Tapeworms

367
Q

Inflammatory Diarrhea

A

Shigella toxin EColi
Shigella
Campylobacter
Salmonella
Vibrio Parahaemolyticus
Yersinia

368
Q

Extraintestional Food borne Diseases

A

Clostridium Botulinum- descending paralysis (canned foods)
Listeria- meningitis (cheese)
Vibrio vulnificus- (cellulitis, sepsis)
Hepatitis A (jaundice)- shellfish, seafood

369
Q

Symptoms + Treatment of Stress Urinary Incontinence

A

Sx: leaking with valsalva, coughing, sneezing, laughing
Tx: lifestyle modification, kegel exercises, pessary, pelvic floor surgery

370
Q

Symptoms + Treatment of Urgency Urinary Incontinence

A

Sx: Sudden Overwhelming, frequent need to void
Tx: lifestyle modifications, bladder training, antimuscarinic drugs (oxybutynin)- decrease detrusor contractions/reduce sense of urgency

371
Q

Symptoms + Treatment of Mixed Urinary Incontinence

A

Stress + Urgency
Variable Treatment

372
Q

Symptoms + Treatment of Overflow Urinary Incontinence

A

Sx: Constant involuntary dribbling + incomplete emptying
Tx: cholinergic agonists, self-catherization

373
Q

Achalasia vs. pseudoachalasia

A

Achalasia- dysphagia to solids/liquids- loss of peristalsis, lack of lower esophageal sphincter relaxation, normal appearing esophageal mucosa
Pseudoachalasia-esophageal cancer- narrowing of distal esophagus- tobacco, weight loss, > 60, widened mediastinum

374
Q

Hyponatremia eval

A

Serum Osms > 290 —> hyperglycemia (check glucose), renal failure (check creatinine)
If Not, Check Urine Osms <100–> primary polydipsia, malnutrition (beer drinker’s potomania)
If not, check urine sodium <25 —> volume depletion (check JVD), CHF (check BNP), Cirrhosis (check LFTs)
If Not, SIADH, adrenal insufficiency (check cortisol) , hypothyroidism (check TSH)

375
Q

Dx + Tx: Hepatorenal syndrome

A

Reduced renal perfusion, advanced cirrhosis + portal hypertension + edema
FeNa <1% (urine Na <10 meq, no tubular injury (no RBC, protein, granular casts in urine), no improvement in renal function with fluids

Tx: address precipitating factors, hypovolemia, anemia, infection
Give splanchnic vasoconstrictors (midodrine, octreotide, norepinephrine, liver transplant

376
Q

Tx of Alcohol Use Disorder

A

1st line- Acamprosate (liver disease + opioid use)+ naltrexone
2nd Line- disulfiram- highly motivated

377
Q

Pentad of TTP

A

Thrombocytopenia
Microangiopathic hemolytic anemia (MAHA)
Renal insufficiency
Neurologic changes AMS
Fever

FAT RN (fever, Anemia, Thrombocytopenia, Renal Insufficiency, Neuro Changes)

378
Q

DGx + Tx of TTP

A

PBS- schistocytes, helmet cells, triangle cells
ADAMTS13
Tx: plasma exchange + glucocorticoids

379
Q

Test for EBV

A

Heterophile antibody (Monospot test) +

380
Q

Primary hyperaldosteronism (Conn Syndrome)

A

HTN, hypokalemia, metabolic alkalosis, adrenal mass
Dgx: plasma renin elevated serum aldosterone

381
Q

Fatigue, Hemolytic anemia (elevated LDH, low haptoglobin, elevated t bili), cytopenias, hypercoagulable, intra/extravascular hemolysis, hemoglobinuria (dark urine), abdominal pain

A

PNH- paroxysmal nocturnal hemoglobinuria
DGx: flow cytometery— CD55, CD59 absence
Tx: Eculizumab + Iron + Folate

382
Q

Young Woman, early pubic/axillary hair growth, severe acne, hirsutism, oligomenorrhea, high hydroxyprogesterone, hirsutism, amenorrhea

A

Partial 21-hydroxylase deficiency

383
Q

Internal Validity

A

Change in independent variable causes change in dependent variable
Threats: confounding, history, maturation, measurement, regression toward mean, repeated testing, selection

384
Q

External validity (generalizability)

A

How applicable is this research
Threats: artificial research environment, measurement effects, non-representative sample

385
Q

Rapid progressive, septicemia, cellulitis near marine environments

A

Vibrio vulnificus
- empiric- highly fatal- IV ceftriaxone, doxycycline

386
Q

Sudden onset SOB, pleuritic chest pain, tachypnea, tachycardia, hypoxemia, low grade fever, JVD, atrial fib

A

PE- CTA-
ECG- S1Q3T3

387
Q

Treatment of Acute Pericarditis Post MI

A

NSAIDs: High Dose Aspirin +/- Colchicine

388
Q

Dx: sudden focal neurologic deficits gradually worsening over mins to hours, HA, N/V, AMS

A

Intraparenchymal brain hemorrhage

389
Q

Most common cause of spontaneous IPH

A

Hypertensive vasculopathy

390
Q

Tx of Polymyositis

A

Glucocorticoids (prednisone) + glucocorticoid-sparing agent (methotrexate, azathioprine) + screen age appropriate cancers

391
Q

Characteristic findings of Crohn Disease vs. Ulcerative Colitis

A

Crohn Disease -Cobblestone appearance, skip lesions, deep ulcerations, transmural inflammation, granulomas
Ulcerative Colitis- continuous, shallow ulcerations limited to mucosa/submucosa, pseudopolyps)

392
Q

Reynold’s pentad (RUQ pain, fever, jaundice, hypotension, AMS) + hematochezia history

A

Primary Sclerosing Cholangitis

393
Q

PE Finding: Diastolic/ Continuous Mumur

A

Further work up with transthoracic echocardiogram

394
Q

Treatment of opioid withdrawal: Nausea, Cramps, Diarrhea, Restlessness, Rhinorrhea, Lacrimation, Myalgia, Arthralgia, HTN, Tachycardia, mydriasis, piloerection, hyperactive bowel sounds

A

Buprenorphine or low dose methadone

395
Q

Hyponatremia, euvolemia, serum osms <275 (hypotonic), urine osms > 100, urine NA > 40

A

Dx: SIADH (syndrome of inappropriate antidieuretic hormone
Tx: fluid restriction + salt tabs + hypertonic saline (3%)

396
Q

DGx for Esophageal Perforation

A

Upright X-Ray of chest + abdomen

397
Q

MC association of Renal Vein Thrombosis

A

Nephrotic Syndrome ( Membranous Glomerulopathy

398
Q

Cirrhosis F/U

A

Upper GI endoscopy—> for varices

399
Q

Treatment of CX of Cirrhosis
Variceal Hemorrhage
Ascites
Hepatic Encephalopathy

A

Variceal hemorrhage- start nonselective beta blocker (Propanolol, Nadolol), repeat EGD q year
Ascites- Na restriction, diuretics, paracentesis, no EtOH
Encephalopathy- lactulose therapy heck for infection/ GI bleeding

400
Q

Dx: chronic epigastric pain, steatorrhea (mucous fatty poops), weight loss, DM, calcifications/dilated ducts in enlarged pancreas

A

Chronic Pancreatitis—> Pancreatic Fibrosis (severe pancreatic exocrine insufficiency
DGx: low fecal elastase
Tx: pancreatic enzyme replacement including lipase

401
Q

Serious Cx and Tx of excess anticoagulation on warfarin

A

Intracerebral hemorrhage
INR only associated with Warfarin
Tx: give IV vitamin K and prothrombin complex concentrate

402
Q

HHS and DKA and potassium

A

Total Body Potassium Deficit masked by serum potassium normal—> shifted out of cells
Giving insulin can rapidly lower potassium levels —> replete K+ with insulin

403
Q

Dx, DGx, Tx: fever, sore throat, drooling, muffled voice, stridor, pooled oropharynx secretions (droolin), laryngotracheal tenderness)

A

Dx: Infectious epiglottitis - Strep Pneumoe or H. Flu
DGx: Clx + lateral neck x-ray
Tx: artificial airway + IV antibiotics (ceftriaxone + vancomycin)

404
Q

Upper airway cough syndrome is DGx:

A

Post-nasal drip, asthma, GERD >8weeks

405
Q

Hypocalcemia + low PTH

A

Surgical: parathyroidectomy, thyroidectomy, radical neck surgery
Autoimmune: polyglandular autoimmune syndrome
Infiltrative Disease: metastatic cancer, Wilson disease, hemochromatosis
Genetic: PTH gene or calcium sensing receptor gene mutations

406
Q

Low Calcium + High PTH

A

Metabolic: Vit D deficiency, CKD
Inflammatory: Pancreatitis, Sepsis
Oncology: Tumor Lysis Syndrome
PTH Resistance: Pseudohypoparathyroidism

407
Q

Dx, DGx, Tx: Fatigue, Malaise, Weakness, Wt loss, Nausea, Ab pain, Diarrhea, loss of vascular tone, hypotension, dizziness, syncope, hyperpigmentation, hyponatremia, hyperkalemia

A

Dx: primary adrenal insufficiency
DGx: low morning cortisol, high ACTH, hyponatremia, hyperkalemia, eosinophilia,
Tx: Corticosteroids (hydrocortisone, prednisone) or Mineralocorticoids (fludrocortisone)

408
Q

common bugs of Bacterial Meningitis
< 50?
> 50?
Immunocompromised?
Neuro/Penetrating?

A
  1. Strep Pneumo, N. Meningitidis - Vanc + Ceftriaxone
  2. Strep Pneumo, N. Meningitidis, Listeria- Vanc + Ceftriaxone + Ampicillin
  3. Strep Pneumo, N. Meningitidis, Listeria, Gram -, Vanc + Ampicillin + Cefepime
  4. Gram-, MRSA, staphylococci- Vanc + Cefepime
409
Q

Polyarteritis Nodosa

A

medium sized arterial vasculitis
most common renal hypertension/infarct or GI mesenteric ischemia/infarct

410
Q

Thromboangitis Obliterans

A

microaneurisms in young smokers
distal extremeties (fingers, gangrene, ulcers)
inflammatory thrombi

411
Q

Tx of Cryptococcal Meningitis

A

Amphotericin B + Flucytosine- 2 weeks
Fluconazole- 8 weeks

412
Q

Carcinoid Syndrome

A

Dx: episodic flushing, secretory diarrhea, wheezing, tricuspid regurg murmur, cutaneous telangeictasias, neuroendocrine tumor in GI tract
DGx: elevated 24-hr urinary 5-hydroxyindoleacetic acid
Tx:

413
Q

Myxamatous Valve Disease

A

weakening of valvular structures- mitral valve

414
Q

hyponatremia in a marathon runner

A

ingestion of too much hypotonic solutions + SIADH

415
Q

Refeeding Syndrome

A

reintroduction of carbs after chronic malnutrition
muscle weakness, hyporeflexia, arrythmias, CHF,
hypophosphatemia—> hyper insulin release

416
Q

Tx of diabetic gastroparesis

A

Metoclopramide

417
Q

Diabetic gastroparesis

A

nausea, emesis, early satiety, bloating, in the setting of poor glycemic control

418
Q

N/V + postprandial fullness + dysphagia + epigastric/chest pain + retrocardiac air-fluid level

A

Dx: Paraesophageal Hiatal Hernia
Dgx: barium swallow or EGD
Tx: Surgical Repair

419
Q

high fever, diffuse maculopapular rash, severe polyarthritis (long lasting), subtropical regions,

A

Chikugunya
supportive + methotrexate (long term)

420
Q

Dx: periodic high fever, mild splenomegaly, jaundice, anemia, thrombocytopenia

A

Dx: Malaria
DgX; Blood smear + Giemsa Stain

421
Q

Dgx and Tx of Leprosy

A

full thickness biopsy of skin lesion
Tx: Dapsone + Rifampin + Clofazimine (if needed)

422
Q

prosthetic joint infections

A

<3 months = staph aureus, gram - rods, anaerobes
>6 months = staph epidermidis, propionibacterium, enterococci,
> 12 months = staph aureus, gram- rods, beta- hemolytic streptococci

423
Q

Myasthenic Crisis

A

Generalized and Oropharyngeal Weakness
Respiratory Insufficiency
In context of Myasthenia Gravis

424
Q

Tx of Myasthenic Crisis

A

Intubation + Plasmapheresis + IVIG + Corticosteroids

425
Q

DGx of Ankylosing Spondylitis

A

X-Ray of Pelvis–> Sacroilitis

426
Q

Post MI 4 months-> ST elevation with deep Q waves

A

Left Ventricular Aneurysm
thinned and dyskinetic myocardial wall

427
Q

Normal STI screening

A

NAAT - Gonorrhea + Chlamydia
HIV- Ag + Ab test
Syphillis- Rapid plasma reagin (RPR)

428
Q

Unprovoked first seizure Diagnostic Step

A

CT w/o contrast, rule out intracranial + subarachnoid bleed (emergency) or MRI (Nonemergency)

429
Q

Diagnostic Criteria of Laxative Abuse

A

multiple hospitalizations
watery,frequent, voluminous, nocturnal,
metabolic alkalosis
hypokalemia
+ stool screen for disacodyl or PEG
melanosis coli- dark brown discoloration with pale patches of lymph follicles

430
Q

Colonoscopy of C. Diff

A

bowel wall edema, erythema, friability (pseudomembranous colitis)
healthcare + antibiotic use

431
Q

Carcinoid Syndrome

A

flushing, venous telangiectasia, bronchospasms, cardiac valvular abnormalities + diarrhea
elevated urine 5-hydroxyindoleacetic acid levels

432
Q

parapneumonic effusion

A

bacterial invasion into pleural space–> drainage + abx

433
Q

resting tremor

A

basal ganglia dysfunction = parkinsons

434
Q

great lakes, mississippi, ohio–> verrucous, crusted lesions, lytic lesions of bone, broad based budding yeast

A

Blastomycosis

435
Q

fatigue, retrosternal heaviness, non productive cough, alcohol associated pain, elevated LDH and eosinophilia

A

Hodgkin’s Lymphoma

436
Q

retrosternal heaviness, cough, SOB, no eosinophilia, myasthenia gravis

437
Q

hemodynamically stable ventricular tachy cardia

A

Amiodarone

438
Q

Tx of Hypertriglyceridemia

A

statins, exercise, wt loss, reduce alc intake

439
Q

palpable purpura, glomerulonephritis, peripheral neuropathy, arthralgias, positive RF, hypocomplementemia

A

mixed cryoglobulinemia syndrome- chronic HCV

440
Q

acute AA treatment

A

IV labetalol/esmolol

441
Q

ITP

A

isolated thrombocytopenia, test for HIV, HepC,SLE

442
Q

TTP

A

ab to ADAMTS13–> microangiopathic hemolytic anemia, thrombocytopenia
life threatening–> give Plasma Exchange

SHELF EXAMS (3 decks)

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