Internal Medicine Shelf Flashcards
1
Q
What is commonly seen in patients with a Pulmonary Embolism?
A
elevated alveolar-arterial oxygen gradient
2
Q
What causes wheezing in Pulmonary Embolism?
A
cytokine-induced bronchoconstriction in response to hypoxia and infarction
3
Q
Risk factors for females for DVT
A
Obesity
Endometrial Cancer
Oral Contraception Use
4
Q
Most Common Causes of Secondary Finger Clubbing?
A
Lung Malignancies, Cystic Fibrosis, Right-to-Left Cardiac Shunts
5
Q
Does COPD cause Finger Clubbing?
A
NO
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
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)
8
Q
Dx: post cardiac surgery, dyspnea on exertion, orthopnea, paradoxical breathing movement
A
diaphragmatic weakness– phrenic nerve injury
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
10
Q
Characteristics of Hypovolemic Shock
A
CVP: Low
PCWP: Low
Cardiac Output: Low
SVR: high
SvO2: low
11
Q
Characteristics of Cardiogenic Shock
A
CVP: elevated
PCWP: elevated
LV Output: low
SVR: elevated
SvO2: low
12
Q
Characteristics of Obstructive Shock
A
CVP: elevated
PCWP: low
LV Output: low
SVR: elevated
SvO2: Low
13
Q
Characteristics of Distributive Shock
A
CVP: Low
PCWP: Low
LV Output: elevated
SVR: low
SvO2: elevated
14
Q
Urinary Stones > 10mm First Line Therapy
A
Ureterorenoscopy (URS)
15
Q
Urinary Stones < 10mm First Line Treatment
A
Observation for Spontaneous Stone Passage
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
17
Q
asymptomatic microhematuria+ > 35 y.o
A
Cytoscopy + CT urography- evaluate entire urinary tract
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
19
Q
Glycosylation of glomerular basement membrane
A
Diabetic nephropathy + Intrinsic Renal Injury
20
Q
Anti- GBM antibody formation + deposition
A
Goodpasture Disease- Intrinsic Renal failure
Nephritic Syndrome
HTN + edema + hemoptysis, cough, dyspnea
21
Q
Dx: UTI + hematuria with CHOP therapy for non-Hodgkin Lymphoma
A
Hemorrhagic Cystitis
22
Q
CHOP therapy
A
Cyclophosphamide
Doxorubicin
Vincristine
Prednisolone
23
Q
Metabolism of cyclophosphamide can lead to
A
Hemorrhagic cystitis- destroying bladder urothelium
Tx: with urinary excretion of cysteine, adequate hydration + frequent voiding
24
Q
Long term Treatment of hyperkalemia in patients with cystic kidney disease
A
Hemodialysis
25
Dx, DGx, Tx: hypotension, hyponatremia, hyperkalemia, weight loss, anorexia, nausea, vomiting, loss of libido.
Dx: Addison Disease (primary adrenal insufficiency) - hypoaldosteronism, hypocortisolism, hypoandrogenism
DGx: Cosyntropin Stimulation Test- cortisol will not rise
Tx: Depends on etiology
26
Etiology of Grave’s Disease
Thyrotropin receptor autoantibodies (TRAbs)—> induce hyperthyroidism
27
Workup for differentiating Diabetes insipidus vs. Primary polydipsia
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
28
Most Common thyroid cancer
Papillary Thyroid Carcinoma
29
Dx: painless cervical lymphadenopathy, hyperechogenic punctate regions (microcalcifications)
Most common type of thyroid cancer: Papillary Thyroid Cancer
30
Dx, DGx, Tx: woman, prior exposure to radiation, thyroid nodule, psammoma bodies, cells with clear, ground glass empty nuclei
Dx: papillary microcarcinoma
DGx: Fine needle aspiration biopsy
Tx: total thyroidectomy
31
Dx and Tx: Altered mental Status, hypothermia, bradypnea, bradycardia, hypotension, respiratory acidosis, periorbital and lower extremity edema- severe hypothyroidism
Myxedema Coma
Tx: liothyronine/levothyroxine, glucocorticoids,
32
Dx: dysphagia, hoarseness, elevated calcitonin, neck US- irregular margins, microcalcifications
Medullary thyroid Carcinoma
33
Dx: throbbing headaches, diaphoresis, heart palpitations
Pheochromocytoma
34
Dx: constipation, recurrent kidney stones, elevated Ca and ALP, decreased phosphorus
Primary hyperparathyroidism
35
Dx: medullary thyroid carcinoma, pheochromocytoma, primary hyperparathyroidism
Dx: MEN 2A- Altered RET proto-oncogene expression
36
Dx and Tx: elevated BMI, constipation, non-pitting edema, carpal tunnel syndrome, bradycardia
Dx: hypothyroidism
Tx: levothyroxine- improvement in several weeks
37
Dx & Tx: oliguria/anuria, dehydration, nausea, vomiting, altered mental status
Dx: hypercalcemia of malignancy common to metastatic thyroid cancer
Tx: normal saline + calcitonin/bisphosphonates/denosumab
38
Dx: chest pain, racing pulse, dizziness, difficulty breathing, loss of consciousness,
ECG: narrow QRS 100ms, regular R-R, and absent p waves
PSVT or paroxysmal supraventricular tachycardia, AVNRT- atrioventricular nodal reentrant tachycardia (AVNRT)
- alternative electrical conduction pathways - nonextinguishable circulating electrical impulse
39
Dx: dizziness, syncope, sinus bradycardia, elderly patient
Sick Sinus Syndrome- fibrosis of sinoatrial node + surrouding myocardium
40
Dx and Tx: Angina with ST elevation but negative troponin, later no abnormalities on ECG
Vasospastic angina (Prinzmetal Angina)
Diltiazem (CCBs) + Lifestyle Modifications
Acute: Nitroglycerin
41
Diastolic sound over the left sternal border =
Pericardial knock
42
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.
Dx: Constrictive Pericarditis
Tx: Pericardiectomy
43
Muffled heart sounds, hypotension, JVD =
Beck Triad
44
Beck Triad following penetrating trauma, drop in systolic blood pressure > 10mmHg during inspiration.
Dx: Cardiac Taponade
Key Sign: Pulsus Paradoxus
45
Pathophysiology of AAA (Abdominal Aortic Aneurysm)
Accumulation of Foam Cells in the Tunica Intima
46
Strongest Predisposing factor for ischemic and hemorrhagic stroke (T2DM, HTN, ETOH, FHx, Obesity, HLD, or Tobacco?)
Hypertension
47
Dx: Dull abdominal pain radiating to lower back, CT- retroperitoneal mass + hazy margins
Retroperitoneal hemorrhage
48
Tx: Acetominophin + Warfarin interactions—> retroperitoneal hematoma/hemorrhage
Phytonadione (Vitamin K supplement) + Prothrombin complex concentrate (replenish Vitamin K dependent factors II, VII, IX, X
49
B symptoms (fever, night sweats, weight loss) are classically associated with
Lymphomas
50
Dx: weight loss, fever, night sweats, lymphadenopathy
Biopsy = CD15/CD30 antigens and large cells with bilobed nucleus
Cx:
Dx: Hodgkin Lymphoma
Reed Sternberg Cells
Hypercalcemia- 1alpha- hydroxylase activity
51
Dx: painless nontender cervical and axillary lymphadenopathy, splenomegaly, leukocytosis in >65 yo
CLL Chronic Lymphocytic Leukemia
52
Characteristic of Peripheral Blood Smear for CLL
Smudge Cells
53
Tx of CLL
Ibrutinib, rituximab
54
Dx: left sided abdominal discomfort, spleenomegaly, anemia, leukocytosis, no lymphadenopathy
CML
55
Dx: erythema in linear, longitudinal band appearance, painful, edema, high fevers, common with Group A strep (strep pyogenes) or Sporothrix Schenckii
Lymphangitis
56
Dx: dermatonecrosis, sometimes with fever, rashes, myalgias, or rarely with DIC/end organ damage
Brown Recluse Spider Bites
57
Dx: pustular skin lesions, migratory poly arthralgia, tenosynovitis
Disseminated gonococcal infection
58
Dx: well refined region of raised induration and erythema, infection of the upper dermis, superficial lymphatics, most commonly Strep Pyogenes
Erysipelas
59
Dx: infection with mixed flora, acute onset of pain—-> anesthesia, gas formation (crepitus, bullae, severe pain out of proportion to physical exam
Necrotizing Fascitis
60
Joint fluid- needle shaped negatively birefringent crystals in first metatarsophalangeal join-
Gout
61
Microcytic anemia + HbA2 elevated >4%
Beta- Thalassemia Trait
62
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
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
63
Dx and Tx: transfusion of PRBC, fever and chills tachycardia,
Dx: acute febrile transfusion reactions
Tx: acetominophen + IV fluids
64
Dx: transfusion reactions plus coombs test= positive and hemoglobin in serum
Hemolytic transfusion reaction
65
Dx and Tx: risky sexual behavior, diaphoretic (sweating), no lymphadenopathy, painless lesion over glans penis, Serum rapid plasma reagin negative
Dx: syphillis, treponema pallidum, false negative primary stage, dark field microscopy is more sensitive
Tx: penicillin G IM injection
66
Match Dx with Treatment
Syphillis
HSV
Chlamydia
Syphillis: Penicillin
HSV: Acyclovir
Chlamydia: Doxycycline + Azithromycin
67
Match Neuro Tract
1. ALS (anterolateral spinothalamic tract)
2. CST (corticospinal tract)
3. DC-ML (dorsal columns-medial lemniscus tract)
ALS—> fine touch (pinprick) + temperature
CST- motor function
DC-ML- vibration + proprioception
68
Match- Tract with Lesion
1. Brain Stem Lesion
2. Cerebral Hemisphere Lesion
3. Peripheral Nerve Lesion
4. Spinal Cord Lesion
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
69
Most important risk factor in decreasing stroke?
Hypertension Management > 140/90 is increased risk of stroke
70
Most important risk factor in preventing atherosclerosis?
Smoking cessation
71
Dx and Tx: diabetic/immunocompromised, pain with pulling ear, discharge, fluid/red external ear canal + granulation tissue, severe
Necrotizing otitis externa- pseudomonas
72
Dx: children, ear pain, fever, red tympanic membrane, retrotympanic pus, middle ear effusion
Otitis Media
73
Match Treatment:
1. Topical Erythromycin
2. Topical Hydrocortisone
3. Oral Docloxacillin
1. Acne vulgaris
2. Eczema
3. MSSA
74
Side Effects of Atenolol
Bradycardia + AV block
75
Dx: vertebral pain + fever
Dx: Discitis- Osteomyelitis, Staph Aureus or Pseudomonas, normally throug hematogenous dissemination of infection (IV drug users/ children)
76
Dx: serum creatinine= 3, blood alcohol 200 mg/dL, unresponsive to painful stimuli, UA- pigmented casts
Rhabdomyolysis- necrosis of large muscle groups, myoglobin in blood— pigmented casts in urine, AKI from ATN,
77
Chronic ILD—-> Pulmonary HTN —> decreased lung expansion, neck vein distention, parasternal heave, diffuse inspiratory crackles, Shortness of Breath can lead to?
Cor pulmonale—> Right Heart Failure because of Pulmonary HTN
78
Most Common Cause of HF?
Systemic HTN
79
High urea in blood = nausea, asterixis, encephalopathy, platelet dysfunction, pericarditis
Uremia
80
Complication of ACEi with renal artery stenosis
Hypoperfusion of kidneys- dx with CT/MR angiography of renal arteries
81
Target for Lipid Levels for diabetic patients
LDL < 100mg/dL + HDL> 40mg/dL + TG <150
82
Dx: worst headache of my life, history of hypertension,
Dx: subarachnoid hemorrhage (ruptured aneurysm)
Berry aneurysm in Circle of Willis + thunderclap headache, neck stiffness, photophobia
Lumbar Puncture- RBCs,
83
Epidural + subdural hematoma occur
In trauma
84
Idiopathic intracranial hypertension occurs in
Young, overweight females taking Vitamin A, oral contraceptives,or danazole—> holocephalic headache + blurry vision + bilateral papilloedema + elevated opening pressure on LP
85
Apical pulmonary opacity with fibrocaseous cavitary lesion + prolonged fever, night sweats, weight loss, skeletal muscle wasting, hemoptysis
Dx: Tuberculosis
Tx: rifampin, isoniazid, pyrazinamide, ethambutol, respiratory isolation
86
Dx: elderly, stroke, dementia— cough,fever, consolidation in right middle/lower lobes
Dx: aspiration pneumonia
87
Dx: non-caseating granulomatous in hilar lymph nodes and lungs, coarse reticular pulmonary opacities, restrictive lung disease
Sarcoidosis
88
Dx: endocarditis of tricuspid valve + fever, dyspnea
Septic pulmonary emboli
89
Dx: multifocal cavitary pulmonary nodules in setting of URTI (perforarated nasal septum, chronic sinusitis and glomerulonephritis (hematuria)
Wegener granulomatosis
90
Tx: mild persistent asthma —> > 2days a week or > 2 nights per mont
Albuterol + ICS (fluticasone)
91
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
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
92
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.
Tracheomalacia- softening/deteriorationof tracheal cartilage- excessive end expiratory collapse
93
Dx & Tx: impact to chest, severe chest pain on inspiration, hypoxia, clear lungs on auscultation, CXR-> bilateral interstitial infiltrates
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
94
Esophageal ulcers in HIV vs. esophageal white plaques
HSV/ CMV vs. Candida
95
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
Pancreatic Adenocarcinoma
96
Dx: Acute RUQ + epigastric pain + N/V following a fatty meal. Pt has gallstones
Dx: Choledocholithiasis
97
Dx, DGx, Tx: middle aged females, jaundice, pruritus, fatigue, hypercholesterolemia, fat-soluble vitamin deficiencies, anorexia, elevated ALK phos
Primary Billiary Cirrhosis- destruction of intrahepatic bile ducts
DGx: positive serum antimitochondrial antibody + biopsy
Tx: Ursodeoxycholic Acid —> Liver Transplant
98
Dx: history of ulcerative colitis, anorexia, nausea, vomiting, malabsorption
Sclerosing Cholangitis- inflammation and chronic fibrosis of biliary trees— beaded appearance of biliary tree
99
Dx: transient pain with dilated biliary and pancreatic ducts
Sphincter of Oddi Dysfunction
100
Types of Inguinal Hernias
Reducible- reduce with gentle pressure, or valsalva
Incarcerated- do not return, obstruction can result
Strangulated- herniated content lose blood supply- necrosis/perforation
101
Dx: pink-tinged urine (hematuria), hx of URTI, UA- RBCs, complement within normal range
IgA nephropathy- episodic gross hematuria after an infection- large amounts of RBCs, normal Complement, negative anti-streptolysin O, anti-DNase titers
102
Dx: hematuria following infection low serum C3 complement
PIGN- post infectious glomerulonephritis
103
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
Dx: BPH —> relieve with catheterization of the bladder —> prevents complications
104
Prevent contrast induced nephropathy
IV .9% Saline infusion
105
Etiology of Hypocalcemia in CKD patient
Diminished native vitamin D synthesis (1,25 dihyrdoxycholecalciferol concentration)- decrease absorption of Ca, elevations of PTH, secondary hyperparathyroidism
106
Urticaria + Perioral Swelling + Rash + Hypotension + Respiratory Compromise + GI symptoms < 1hr
Anaphylaxis- Type I hypersensitivity
Treat with Epinephrine
107
Use and SFx
Tacrolimus
Transplant Rejection Prophylaxis
Diarrhea, Hypertension, Hyperglycemia
108
Use and SFX
Daclizumab
Renal Transplant Rejection Prophylaxis
Diarrhea, Pancytopenia, Skin Rash, Lymphadenopathy, Elevated Liver Enzymes
109
Use + SFX
Methotrexate
Neoplasms + Rheumatic Diseases
Myelosuppression and Diarrhea
110
Use and SFx
Mycophenolate Mofetil
Transplant Rejection Prophylaxis
Myelosuppression, GI symptoms (NVD), Infections, lymphoid neoplasms, progressive multifocal leukoencephalopathy
111
Use + SFX
Cyclosporine
Transplant Rejection Prophylaxis
Diarrhea + Hypertension + Tremors + Nephrotoxicity + Gingival Hyperplasia + Hirsutism
112
Liver Transplant < 6months ---> Acute Liver Transplant Rejection Symptoms
Vomiting, Jaundice, Rising Bilirubin, Pain in Graft Region
DGx: U/S
113
Churg- Strauss Syndrome (Eosinophilic Granulomatosis with Polyangitis)
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
114
Polyarteritis Nodosa
SubQ Nodules, Renal Impairment, Polyneuropathy, palpable purpura, abdominal pain, melena, myalgia
115
Henoch- Schonlein Purpura
Children, Palpable Purpura, Renal impairment, arthralgias, arthritis, , hematuria, nausea, vomiting, occult blood in stool
, IgA
resolves on its own
116
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
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
117
Sign of Immunocompromised
Oral Thrush scraps --> causes bleeding
118
Elevated Beta-D-Glucan, Respiratory Distress, Dry Cough, Diffuse Interstitial Infilitrates,
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
119
child, cough, dyspnea, failure to thrive, meconium ileus, diarrhea, steatorrhea, abdominal distension
Cystic Fibrosis
120
fever, arthritis, increased photosensitivity, painless oral ulcers
SLE
121
Symptoms and Marker for Dz:
Microscopic Polyangitis
fever, fatigue, myalgia, arthralgia, oral ulcers, purpura, hemoptysis
antibodies against myeloperoxidase (p-ANCA)
122
Sensitive Marker for many Immunodiseases
Antibodies to nucleus- ANA
123
Marker of Rheumatoid Arthritis
Rheumatoid Factor- Fc Region on IgG
124
SLE specific marker for diagnosis
Anti Smith Ab- antibodies for nuclear Sm proteins
125
HIV post-exposure prophylaxis
raltegravir, tenofovir, emtricitabine
126
Severe SFX of Methotrexate
Pulmonary Fibrosis, get a baseline CXR before starting MTX
127
Kit Mutation indicates
systemic mastocytosis - diarrhea, flushing, pruritis, leads to gastric ulceration
Tx: antihistamines, mast cell stabilizers (Cromolyn), corticosteroids
128
leukocytes with basophilic granules
mast cells
129
Dx and Tx: Purulent Conjunctivitis, Suppurative lymphadenitis, pneumonia, skinning/hunting wild animals + tick bite, single ulcerative lesion on cutaneous
Dx: Tularemia- gram - coccobacillus- Francisella Tularensis
130
Parinaud oculoglandular syndrome
Purulent conjunctivitis + suppurative preauricular lymphadenitis- Francisella Tularensis + Bartonella Henselae + HSV
131
Dx and Tx: acute influenza-like prodrome + rapid-onset of erythematous macules, vesicles, bullae, necrosis and sloughing of epidermis with new drug
SJS (Stevens-Johnson Syndrome) <10% of body
Toxic Epidermal Necrolysis > 30%
Tx: supportive + IVF + wound care
132
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
1. HSV
2. Staph or Strep Skin infection
3. Staph Aureus
4. Staph Exotoxin
133
Dx: fatigue + > 1 Cytopenias can lead to DIC, fatigue, prolonged bleeding, pancytopenia, coagulopathy, elevated LDH, pallor, no lymphadenopathy, hepatosplenomegaly. Atypical promyelocytes
AML- APML
134
Dx: Syncope on progressive dyspnea on exertion, fatigue, exertion syncope
Severe AS: pulsu parvus/tardus—> delayed and weak carotid pulse (slow rising and weak), S2, mid to late peaking systolic murmur
135
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
Paget’s Disease of the Bone
136
Dx: post MI of RCA + SOB + hypotension + diaphoretic + tachypnea + soft early systolic murmur at apex + pulm edema
Papillary Muscle Rupture- 3-5 days
137
Dx: Post MI of LAD or RCA—> Chest pain + new holocystolic murmur
Interventricular septum rupture- 3-5days, Left —> Right ventricular shunt
138
Dx: Post MI LAD—> Chest Pain + Distant Heart Sounds + Rapid progression to Cardiac Arrest
LV Free Wall Rupture <5 days or 2 Weeks—> Pericardial Effusion with Tamponade
139
Dx: Post MI —> HF, Angina, Ventricular Arrhythmias
Thin Dyskinetic Myocardial Wall- Left Ventricular Aneurysm
140
Dx + DGx + Tx: multiple sex partners + maculopapular rashes, meningeal headache/N/V, neck stiffness, dizziness or ischemic stroke like- sudden onset unilateral weakness
Dx: meningovascular syphilis
DGx: CSF —> positive VDRL
Tx: IV penicillin 10-14 days
141
Dx: meningitis + petechial rash
Blood + CSF culture: meningococcemia
142
Menigitis + HIV + plaque rash
CSF India Ink Stain + Cryptococcus Neoformans
143
Meningitis + subacute + no rash
TB meningitis + CSF acid fast bacilli
144
Dx + DGx + Tx: recurrent upper ab pain + diarrhea/steatorrhea + wt loss + Diabetes
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
145
SFx of hydroxyurea
Myelosuppression (neutropenia, anemia, thrombocytopenia)
146
Hashimoto Thyroiditis antibodies?
Anti thyroid peroxidase- Anti-TPO
147
Recurrent pregnancy loss antibodies
Anti-cardiolipin
Lupus Anticoagulant
148
Fatigue + pruritis + elevated alk phos + Anti mitochondrial antibodies
Primary Biliary Cholangitis
149
Graves disease antibodies
Thyroid stimulating immunoglobulins
150
Dx: proximal muscle weakness, dry mouth, ptosis, diminished or absent deep tendon reflexes
Tx: Lambert-Eaton Syndrome: pre-synaptic membrane voltage gated calcium problem
151
Primary hyperaldosteronism—-> Hypokalemia—DGx:
Early morning plasma aldosterone concentration vs. plasma renin activity > 20 ratio with plasma aldosterone > 15 = primary hyperaldosteronism
152
Hypertensive Emergency treated with
Nitroprusside
153
Nitroprusside Cx in renal insufficiency
Cyanide toxicity— metabolic acidosis—> confusion agitation seizures- tachycardia, tachypnea
154
Diabetic ophthalmoplegia
Down and out position, normal reactive pupil, ptosis- CNIII- oculomotor nerve injury
Ischemic neuropathy of diabetes
155
Dx: red ulcerated oropharynx, drooling, conscious + alert, severe pain, hoarseness, airway compromise,
Caustic ingestion poisoning
156
Dx: xerostomia- dry mouth, altered mental status, tachycardia, urinary retention
Anticholinergic OD
157
Xerostomia + Altered mental status, sedation/delirium, cardiac arrythmias, hypotension, tachycardia
Tricyclic antidepressant toxicity
158
Visual blurring, epigastric pain, profound metabolic acidosis after being drunk
Methanol ingestion (drunk—> dead)
159
Salivation, bradycardia, miosis, increased urination, diarrhea
Organophosphate
160
Dx: painful vesicles (small ulcers with erythematous base) + tender lympadenopathy
HSV- genital herpes
Acyclovir, Vancyclovir
161
Dx: Painful large deep ulcer with gray yellow exudate, well demarcated borders, soft friable (bleedable base), Severe lymphadenopathy that may suppurate
Haemophilus ducreyi (chancroid)
Azithromycin
162
Dx: Painless single ulcer + indurated borders, hard non-purulent base
Treponema Pallidum (Syphilis) Chancre- penicillin
163
Dx: Painless small shallow ulcers—> painful fluctuant buboes
Chlamydia trachomatis serovars L1-L3 (lymphogranuloma venerum
Doxycycline
164
Neurogenic back pain
Posture dependent, lumbar flexion relives pain, lower extremity numbness/tingling normal pulses, MRI of spine
165
Vascular back pain
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
166
Hyperpigmented, hypopigmentd, or salmon-colored macles on upper trunk in summer
Tinea versicolor —> KOH prep (thick walled budding yeast)—-> treat with selenium sulfide or ketoconazole
167
Infective Carditis Cx
Right sided valves, tricuspid regurgitation- systolic murmur increase on inspiration
168
Calculation of Cerebral Perfusion Pressure
MAP- ICP
169
How do you relieve elevated intracranial pressure in mechanically ventilated patients?
With therapeutic hyperventilation
170
Gait ataxia, truncal ataxia, dysarthria, nystagmus, dysmetria, dysdiadochkinesia, and pronator drift
Cerebellar tumors- manifest ipsilaterally - left cerebellar— left beating nystagmus, left leaning ataxia, left sided pronator dirft
171
Common tumors after amputations
Neuroma
172
Monoarthritis + rhomboid shaped + positively birefringent crystals
Pseudogout
173
Secondary pseudogout can result from
Hyperparathyroidism—> increased calcium/decreased phosphorus—> calcium purophosphate crystal
Others-chondrocalcinosis, hemochromatosis, gout
174
Headaches, nausea, vomiting, diploplia, swishing sound in ear (pulsatile tinnitus), esotropia cross eyed CNVI damage, bilateral optic disc swelling
Elevated intracranial pressure
175
Pain/ temperature deficits in ipsilateral face and contralateral body
Dysphagia and hoarsenss and ipsilateral horner syndrome (miosis, ptosis, anhydrosis)
Lateral medullary syndrome- occlusion of posterior inferior cerebellar artery
176
Occlusion of right penetrating arteries
Left side motor weakness
177
Left sided weakness, hemineglect (unilateral stimuli absence)
Right MCA occlusion
178
Sustained painful muscle spasms, of head neck and tongue—> torticollis, facial grimacing, fixed and deviated stare after starting haloperidol
Acute dystonia
179
Treatment of acute dystonia
Centrally acting anticholinergic drug
Benztropine, diphenhydramine
180
Treatment of Toxoplasmosis Gondii in HIV patient
Pyrimethamine, sulfadiazine, leucovorin
181
Unilateral jaw pain, ear discomfort, headache, limited jaw opening, facial muscle spasms
Temporomandibular Joint dysfunction- resolves spontaneously, pain relief, splints,
182
Unilateral pain worsening with chewing, muscle spasms, electric shocks, no cracking sound
Trigeminal Nerve Compression
183
SFX of corticosteroids
Muscle wasting, Weakness in shoulders and hips, proximal myopathy, (normal DTRs, ESR, CK)
184
Prophylaxis for benzodiazepine withdrawal
Carbamazepine—> flumazenil
185
Prevention of vasospasm post cerebral ischemia after Subarachnoidal hemorrhage
Calcium channel blockers- Oral nimodipine
186
Fever, muscle rigidity, tachycardia, tachypnea, increased CO2 production post anesthesia
RYR channel mutations—> malignant hyperthermia
Tx: Dantrolene- RYR antagonist
187
Belladonna, Atropine, antipsych, TCAs, antihistamine OD can lead to
Confusion, agitation, delirium + mydriasis (non reactive to light, blurry vision, dry mouth, tachycardia/arrhythmia, warm dry skin, urinary retention, diminished bowel sounds, constipation,
188
Impaired adduction on ipsilateral eye and abduction nystagmus of contralateral eye (dissociated nystagmus)—-> internuclear opthalmoplegia
Demylination of medial longitudinal fasciculus— MS
189
Arterial hypertension (morning headaches), frequent UTIs, FH of renal failure—>
ADPKD—> have increased risk of saccular aneurysms
190
Worst headache of my life, fever, xanthochromia (yellow colored CSF, meningismus- neck stiffness and Kernig Sign
Subarachnoid hemorrhage from saccular aneurysms
191
Dx: fever, urticarial rash, myalgia, polyarthritis and proteinuria after exposure to nonhuman protein antigens
Serum Sickness + type III hypersensitivity
Complement system activation and consumption
192
Dx and Tx: elderly woman, dyspareunia, vulvar pruritis, white vulvar plaque
Lichen sclerosus- increased risk of vulvar squamous cell carcinoma
Give superpotent topical glucocorticoids- betamethasone or clobetasol
193
HIV esophagitis ulcers- round well-circumscribed superficial CD4 count <100
HSV infection- treat with acyclovir
DGx: PCR
194
HIV esophagitis, linear/longitudinal ulcers CD4< 50
CMV infection
195
Dx + Tx: Tender, red, subcutaneous nodules —> bruise like plaques, no ulceration, malaise, arthralgia
erythema nodosum - delayed type hypersensitivity- generally CXR—> strep pharyngitis, sarcoidosis, TB elevation of CBC + ASO
196
Treatment of chlamydia in pregnant women
Oral Azithromycin
197
IRIS
Recurrent or worsening symptoms of pre-existing opportunistic infection (TB, cryptococcosis) within 2 months of cART initiation
198
MCC of cervicitis: cervical motion tenderness, friable cervix
Chlamydia + Gonorrhea
Purulent, bloody vaginal discharge, dyspareunia, postcoital bleeding
Without fever
199
Dx: skin tightness and thickening non purulent ulcers on fingers (sclerodactyly), pulmonary fibrosis (fine inspiratory crackles), chest pain + weight loss (GERD)- esophageal hypomotility
Diffuses systemic sclerosis = Antitopisomerase I antibodies
200
Dx: chronic rhinosinusitis, scleritis, episcleritis, uveitis, granulomas, vasculitic purpura
Granulomatosis with polyangitis - c-ANCA
201
Dx: fatigue, generalized itching and elevated alk phos, GGT, total and direct bilirubin
PBC (Primary Biliary Cholangitis)- Antimitochondrial Antibodies
202
Flu like symptoms + rash + isoniazid, hydralazine, procainamide)
Drug- induced lupus erythematosus - ANA, anti-histone antibodies
203
Reflux esophagitis, respiratory complication, xerophthalmia, xerostomia (dryness of eyes and mouth
Sjogren syndrome- Anti-Ro/SSA and anti-La/SSB
204
Flaccid paralysis and respiratory failure in logger/camper from washington
Tick paralysis- 2-7 days- tick removal and supportive measures.
205
Polyneuropathy, intestinal colic, anemia, radial nerve palsy, blackish-blue line along margins of gums
Lead Poisoning
206
Distal sensorimotor polyneuropathy, white bands across nails (Mees lines) + hyperkeratosis + battery factor worker + garlic like odor
Arsenic Poisoning
DGX: elevated arsenic levels
Tx: chelating agents- dimercaprol + succimer (children)
207
Anosmia, yellowing of teeth, tubulointerstitial nephritis, emphysema
Cadmium Toxicity
208
Polyneuropathy, intention tremor, emotional instability, bluish-violet discoloration of gums
Mercury Toxicity
209
Recent onset abdominal pain with hypertension in a pregnant woman
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
Hypotension + bradycardia after bupivacaine injection
Neurogenic shock—> distributive shock- vasodilation- unopposed parasympathetic tone
211
When is chlorhexidine mouthwash recommended for patients?
When undergoing cardiac surgery
212
What can prevent post-operative pneumonia?
Incentive spirometry/deep breathing exercises—> keeps alveoli open, decreases risk of atelectasis and pneumonia
213
Obstructive Lung Diseases
Asthma, COPD, Bronchiectasis, Chronic bronchitis, Pulmonary Emphysema,
214
Restrictive Lung Diseases
Interstitial Lung Disease, Obesity, Diaphragm Dysfunction, Radiation induced Pulmonary Fibrosis
215
Dx: blisters, history of autoimmune disease, captopril, multiple flaccid blisters, ulcers in buccal, gingival, and vulvar mucosa, separation when skin is lightly stroked
Pemphigus Vulgaris- autoantibodies against- desmosomal adhesion proteins (desmoglein 3 and 1)
Tx: high does systemic corticosteroids, + immunosuppressive medications
216
Drugs which can cause pemphigus vulgaris
Thiol drugs- captopril, penicillamine
Phenol drugs- cephalosporins, rifampicin, phenobarbital, aspirin
217
Positive nikolsky sign
Formation of cutaneous blister upon stroking skin
Found on pemphigus vulgaris, staph scalded skin syndrome, SJS/TEN
218
Dx: cutaneous blisters, captopril, tense symetrical, negative nikolsky sign, starts with pruritus and papules not found in mucous membranes
Bullous Pemphigoid
219
Dx: painful blisters, child <6, erythema, fever, malaise, preceded by impetigo, or diarrhea
Staphylococcal scalded skin syndrome
220
Dx: papulopustular lesions, painful oral/genital ulcers, 20-40 y/o, eye redness, decreased vision
Behcet Disease
221
Dx: fever, tachycardia, hypotension, blisters on skin, mucous membranes, positive nikolsky sign <30% >30% after drug initiation <8 weeks
SJS vs.TEN
222
Pathognomonic for PCP, Treatment
Elevated lactate dehydrogenase and beta-D-glucan
TX: TMP-SMX + adjunctive glucocorticoids for respiratory distress (PaO2 <70)
223
Amphotericin B is effective against
Aspergillus, candida, cryptococcus
224
Chest pain, fever, hemoptysis in HIV patient
Aspergillus
Tx: Amphotericin
225
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
Dx: Disseminated VZV
Tx: IV Acyclovir
226
Dx: dyspnea, chronic dry cough, digital clubbing, fatigue
ILD- excess collagen deposition in extracellular matrix of the lung
227
Dx: chronic productive cough, fever, respiratory insufficient, fatigue, long history of smoking
COPD- chronic airway inflammation
228
Standard treatment for TB
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
Sentinel lymph node biopsy recommended in malignant melenoma?
If tumor thickness > 1mm
230
Dx DGx and Tx: asthma, chronic rhinosinusitis, nasal polyps, hypersensitivity to aspirin or COX-1 inhibitors
AERD- asthma exarcebated respiratory disease—> Nasal Endoscopy
Intranasal corticosteroids + aspirin desensitization
231
Standard treatment for Basal Cell Carcinoma not located on trunk/extremities
Mohs micrographic surgery
232
Biggest Risk Factor Associated with Adolescent Idiopathic Scoliosis
Premenarchal Status
Female Sex, Age <12, Premenarchal Status, Skeletal Immaturity, Initial Severe Curvature
233
Vaccines for HIV adults
All normal vaccines,
Hep A, Hep B, VZV -50 yrs old
Meningococcus and Strep Pneumo- 8 weeks, 5 years, 65age
234
Prophylaxis for PCP (Pneumocystitis Pneumonia)
TMP+SMX
(Also give CMV- ganciclovir/valganciclovir)
235
Specific sign for CHF
Elevated BNP + audible S3 heart sound
236
Dx and Tx: recurrent pregnancy losses, arterial or venous thrombosis, mild thrombocytopenia, positive VDRL and prolonged activated PTT
Antiphospholipid-antibody syndrome
Prothrombotic autoimmune disorder
Tx: enoxaparin (LMW heparin)
237
Macro/microprolactinoma treatment
Dopaminergic agonist—> cabergoline, bromocriptine
2nd-> transsphenoidal resection
238
Known complication of abdominal aortic aneurysm repair
Bowel Ischemia- abdominal pain, bloody diarrhea, fever, leukocytosis,
Prevent- by checking sigmoid colon perfusion post graft placement
239
Dx: bloody and purulent diarrhea, tenesmus
E.Coli or Shigella
240
Voluminous watery diarrhea, abdominal pain, fever, pseudomembranous colitis, 4-5 days after antibiotic use
C. Diff
241
Chronic erythematous rash on convex areas of face, flushing, vasomotor dysfunction with hot or spicy foods, alcohol, sun exposure, high ambient temperatures
Rosacea
Tx: Topical Metronidazole, azelaic acid, ivermectin
242
Colon Cancer bacteria association
Clostridium septicum, Group D streptococci (strep Bovis)
243
Alcohol Binging leads to
Lower extremities, pain, weakness, swelling,- rhabdomyolysis
244
Cx of rhabdomyolysis
AKI- prerenal and interstitial
245
Etiology of Acute Pancreatitis
Chronic Alcohol Use
Gallstones
Hypertrigylceridemia > 1000
Infections
Post-ECRP
Drugs- Azathioprine, Valproic Acid, Thiazides
246
Previous history of hodgkins lymphoma high risk of?
Secondary malignancy
247
Dx: hemoptysis, cough, dyspnea, fever, cavitary mass with air in periphery
Aspergillus
248
Rabies vaccine recommendation?
Inactivated in HIV if traveling in high risk areas (Africa and Southeast Asia- not required always
249
What predisposes elderly patients to heat stroke?
Impaired thermoregulatory capacity- impaired thirst, blood vessel dilation, reduced ability to sweat
250
Heat stroke vs. Heat Exhaustion
Presence of neurologic symptoms in heat stroke
251
Deficiency in what predisposes people to Neisseria Infections
Deficiency in terminal complement factors— No MAC
252
Asymptomatic elderly person with splenomegaly, thrombocytosis, and peripheral leukocytosis
CML- increase in all myeloproliferative lines
253
Tx of CML
Tyrosine kinase inhibitors- imatinib or dasatinib
254
IDA
Iron: low
TIBC: increased
Ferritin: low
% Sat: low
255
Anemia of Chronic Disease (ACD)
Iron: low
TIBC: low
Ferritin: increased
% Sat: normal
256
1-2 weeks after RBC transfusion, hemolysis
Delayed hemolytic transfusion reactions
Positive coombs test, indirect hyperbilirubinemia, anemia
Tx: supportive
257
Dx: head trauma- acute. Headache, N/V focal deficits, seizures
Subdural hematoma- tearing of bridging veins in subdural space
258
Dx: headache, seizures, vomiting, contralateral superior quadrantanopia
Temporal lobe glioma
259
Numerous seborrheic keratosis lesions suddenly
Leser Trelat Sign- GI malignancy
260
Actinic keratosis can progress to
Squamous Cell Carcinoma
261
Pain with active shoulder abduction—> relieved with passive motion
Rotator cuff tendinitis
Tx: RICE Therapy
262
Dx: shoulder pain with range of motion, limited, catching locking sensation, instability, acute trauma
Dx: torn glenoid labrum: PE and MRI
263
Acute treatment of gout vs. Chronic prevention of Gout
Colchicine vs. Allopurinol
264
Antibiotic prophylaxis in dental procedures
30-60 minutes cover for oral flora- oral amoxicillin- covverage of gram - and aerobic
265
Claudication of lower buttocks/ Lower extremities, parasthesias, paraplegia, or erectile dysfunction, shiny hairless skin,
Dx: CT/MRI + ABI
Tx: balloon/stent angioplasty, aortic endarterectomy, vascular bypass surgery, thrombolysis
266
Pericardial effusion Beck’s Triad
Hypotension, JVD, distant heart sounds
267
Tearing chest or abdominal pain radiating to back with different blood pressures between extremities, asymmetric pulses
Aortic Dissection
268
Atrial fibrillation management
DOAC- warfarin or AC- apixiban—> prevent formation of atrial thrombus
269
HAP pneumonia treatment vs. CAP pneumonia treatment
Vancomycin + Ceftazidime vs. Ceftriaxone and Azithromycin
270
Pleurisy, mesothelioma, empyema
Pleural effusion and inflammation
271
CXR of asbestosis
Inferior portions of lung + pleural thickening and nodularity
272
Pathophysiology of steatorrhea with Crohn’s Disease
Bile salt resorption impairment- inflammation of terminal ilieum
273
Salivary gland swelling, bilateral, fever, headache, malaise, myalgia
Mumps
274
Salivary gladn inflammation, acute onset of pain afebrile,
Sialadentitis (sialothithiasis)
Tx: supportive- analgesics, heat massage, hydration
275
Dependent edema in buttocks, lower back, or legs, foamy/dark colored urine, hypoalbuminemia, hyperlipidemia, proteinuria.
Nephrotic syndrome- minimal change disease
276
Cx of minimal change disease
Hypercoaguability- DVT
Infection: loss of 𝛄 globulins
277
Fever, hypotension, diffuse erythematous rash, desquamation, end organ damage: AMS, myalgia, thrombocytopenia, azotemia, transminitis,
Toxic Shock Syndrome Toxin- Staph Aureus
- IVF + antibiotics
278
cardiogenic shock complication
Metabolic Acidosis-Lactate—> end organ damage
279
Most Common Infection from Central/ Peripheral Lines
Staph epidermidis
IV antibiotics + Line removal
280
Hyperventilation + hypoxemia leads to
Respiratory alkalosis
281
Dx: sharp chest pain + SOB + VQ mismatch + hypoxemia + respiratory alkalosis
PE 2/2 DVT
282
Raloxifene SFx
Increased risk of DVT + PE
283
No Urinary output 5 hours after surgery + AKI
SERIOUS
Perform bedside bladder scan- determine prerenal, intrarenal, post-renal
Urinary catheter if urinary retention present- volume > 400 mL
284
PPD test > 10mm + high risk (<5 years from TB endemic areas)
TB-positive
Get CXR- to verify latent- no therapy or active TB- RIPE therapy
Symptoms—> isolation
285
PPD > 5 + HIV or immunocompromised, exposure, organ transplants + previous + CXRs
Positive TB
286
PPD >15mm + no risk factors
Positive TB
287
Treatment of SCLC
Cisplatin + etoposide + radiation
288
Dx: low grade fever, nonproductive cough, clear lungs, streaky and reticular infiltrates with confluent opacities in upper lobes
Atypical pneumonia
289
Typical pneumonias
Klebsiella, Strep Pneumo, Haemophilus influenzae,
290
Atypical Pneumonias
Mycoplasma, Legionella
291
Dx: Hospital visit, diabetes, COPD, alcohol use disorder, high fever, shaking chills, cough, productive sputum thick and bloody (currant jelly), consolidation in upper lobe
Klebsiella Pneumoniae
292
DX: high fever, shaking chills, productive cough, decreased breath sounds, crackles, lobar consolidation
MC: strep pneumoniae
293
Dx: child, high fever, shaking chills, productive cough, decreased breath sounds, crackles, lobar consolidation
Haemophilus Influenzae
294
Dx: post-viral pneumonia + interstital patchy infiltrates on CXR, immunodeficient
Staph Aureus
295
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)
Mycoplasma pneumoniae
- macrolides, tetracyclines, floroquinolones
- azithromycin, doxycycline, levofloxacin
296
Dx: smokers, COPD, contaminated water, high fever and chills, diarrhea, confusion, hyponatremia, patchy unilateral/lobar infiltrates
Legionella Pneumophila
297
CT: hyperdense in thoracic cavity, gravity dependent + pleuritic chest pain, cough, decreased breath sounds, dullness on percussion
Pleural Effusion- needle thoracocentesis
298
Tx: Pleural effusion + respiratory failure (hypoxemia
Chest tube insertion (thoracostomy)
299
Dx + DGx + Tx: nephrolithiasis, flank pain, bilateral flank masses, hypertension, hematuria, proteinuria, enlarged kidneys with multiple anechoic masses
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
Cx of ADPKD
ESRD, UTI, mitral valve prolapse, saccular aneurysms
301
Dx + DGx + Tx: unilaterally decreased breath sounds, chest pain, dyspnea, after high speed injury—> tachypnea, hemodynamic instability, JVD
Dx: Tension Pneumothorax
DGx: Clinical
Tx: needle thoracostomy
302
Dx: hematuria, no RBC casts, hypertension, polycythemia (headache, facial plethora, blurry vision), obesity, smoking, occupational exposure to gasoline
Renal Cell Carcinoma + Complications- Polycythemia (EPO production) + Hypertension (renin release)
303
Simultaneous contractions of detrusor muscle and internal urethral sphincter following spinal cord injury- acute urinary retention
Spastic neurogenic bladder - give alpha blockers- prazosin
304
Dx: shortness of breath + hypoxia worsening after giving fluids + blunt injury to chest wall
Damage to capillaries—> pulm edema—> pulm contusion—-> patchy infiltrate on CXR
305
Dx and Tx: : massive hemoptysis + pulmonary nodule on X-ray _ smoking history
Correct positioning, airway protection, cardiovascular support, bronchoscopy—> identify source of bleeding, stop bleeding with balloon tamponade
Bronchogenic carcinoma
306
Dx: Crohn’s Disease + microtrauma—> rapidly progressing skin lesion with necrotic base + purplish borders, extensor side of limbs
Pyoderma gangrenosum
307
Dx: wart like lesion + irregular borders + ulcerations/bleeding + Midwest
Blastomycosis
308
Prophylaxis for patients with Hep B exposure + negative Hbsag, Hbsab, and HCab
Hepatitis B immunoglobulin + 3 dose vaccination
309
Average lifespan for onset for severe dementia
<18 months
310
Dx + DGx + Tx: syncope, orthostatic hypotension, conjunctival pallor, ploppin sound on auscultation of heart, low-pitched, rumbling mid-diastolic murmur at apex
Dx: Cardiac Myxoma- obstruction of AV valve- embolization, mitral stenosis mimic
DGx: Echo
Tx: surgical resection
311
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
Dx: extravascular hemolysis- hereditary spherocytosis
DGx: negative coombs test, elevated MCHC and osmotic fragility of RBCs
Tx: Splenectomy
312
Treatment of gonorrhea + chlamydia in pregnant patients vs. non pregnant patients
IM ceftriaxone + azithromycin vs. IM ceftriaxone + doxycycline
313
Tx: pneumonia + failed antibiotic treatments, COPD, immunosuppressed, greenish sputum, gram - rods
Dx: high suspicion of Pseudomonas + CAP
Cefepime + levofloxacin
314
CHF—> reduced CO —> compensatory response
Organ hypoperfusion—> activation of RAAS system—> vasoconstriction of efferent renal arterioles—-> maintains CO
315
Dx + Tx: T2DM + dysphagia + fever + drainage of pus + submandibular and anterior neck tenderness + swelling
Dx: ludwig angina- infection spread to submandibular/sublingual space
Tx: IV antibiotics (Zosyn) + airway control + surgical drainage
EMERGENCY
316
Dx: tonsillar ulceration + nontender cervical lymphadenopathy, sore throat, halitosis, dysphagia
Dx: HPV—> SCC of oropharynx
DGx: biopsy
Tx: surgery + radiation + chemotherapy
317
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
Dx: hairy-cell leukemia
Tx: chemotherapy with Cladribine or pentostatin
318
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
Dx: Crohn’s Disease 15-35 but also 60
319
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
Dx: Acute Chest syndrome with SCD
Tx: respiratory support, pain management, IV fluids, bronchodilators, abx (ceftriaxone + azithromycin), blood transfusion if necessary
320
Dx: JVD, right parasternal heave, hepatomegaly, ascites, pedal edema, bibasilar crackels
Dx: chronic pulmonary hypertension—> pulmonary edema—> cor pulmonale—-> isolated right ventricular failure
321
Dx: watery diarrhea, muscle weakness/cramps, hypokalemia, decreased gastric secretion (achlorhydria)
Dx: VIPoma tumor affecting pancreatic cells
DGx: CT pancreatic tail tumor + VIP level > 75
322
Dx + DGx + Tx: fluctuating diploplia + ptosis, dysphagia or dysarthria after ABx, cardiac medications or physiologic stress (pregnancy, surgery, infection)
Dx: Myasthenia Gravis
DGx: Ice Pack Test (bedside), AChR-Ab (specific) + CT scan of chest
Tx: AChE inhibitors -pyridostigmine + corticosteroids + thymectomy
323
4 aspects of Decision Making Capacity
Communicates a choice
Understands Information Provided
Appreciates Consequences
Rationale for Decision
324
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
Dx: Bell’s Palsy likely secondary to neutrophic virus (HSV)
Tx: glucocorticoids + Valacyclovir
325
Dx: facial weakness of lower face
Stroke
326
Dx: young adult, substernal chest pain, racing heart, no SOB,cough, fever, recurring symptoms, agitation, diaphoresis, hypertension, tachycardia, dilated pupils, acute ST elevations
STEMI secondary to cocaine intoxication
Tx: benzodiazempines, nitrates + antiplatelet therapy
327
Dx: rapid onset SOB, faint fruity odor, pupils pinpoint, diffuse rhonchi/wheezing
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
Dx + DGx + Tx + Cx: shiny thickened skiny, multiple telangiectasis, fatigue, weakness, digital ulcers, myalgias, arthralgias, contractures, esophageal dysmotility, dysphagia, raynaud phenomenon
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
How do nitrates work
Vasodilators- dilate veins, arterioles, and coronary arteries
Lowers preload + LVEDV reducing wall stress
330
Dx + DGx + Tx: fever, fatigue, myalgias, ARDS, CHF, DIC, splenic rupture, anemia, thrombocytopenia, increased bili, LDH, LFTS, north east US
Dx: Babesia microti + Ixodes Scapularis tick bite
DGx: PBS + Maltese cross
Tx: Atovaquone + Azithromycin or Quinine + Clindamycin if severe
331
Dx: scleral icterus + direct hyperbilirubinemia, normal liver function, dark granular pigment in hepatocytes
Dubin Johnson Syndrome- Nothing to Worry About
332
Dx + Tx: firm domed papule with central umbilication
Molluscum Contagiosum
Tx: Cryotherapy or cantharidin
333
grid lines appear curved
Macular degeneration
334
Dx: ESDR, muscle weakness, bradycardia, hypotension, QRS complex widening no p waves, peaked t waves
Hyperkalemia > 5.5
Tx: IV calcium (chloride or gluconate)—-> stabilize cardiac myocyte,
Renal etiology- IVF + diuretics
GI etiology- cation exchangers
Dialysis
335
Dx + DGx + Tx: bone pain, headaches, hearing loss, spinal stenosis, radiculopathy, bowing bones, fracture, arthritis in adjacent joints, giant cell tumor or osteosarcoma
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
Dx + DGx + Tx: ESRD, painful nodules + ulcers, calcification in soft tissues, arteriolar calcification/occlusion, subintimal fibrosis, local tissue necrosis/ischemia
Dx: Calciphylaxis (calcific uremic arteriolopathy)
DGx: hypercalcemia + phosphatemia
Tx: Supportive + Optimization
337
First line treatment of delirium
Low dose haloperidol
338
Changing cutoff point to quantitative diagnostic test
Inversely affects sensitivity and specificity
Raising—> increase specificity, decrease sensitivity
Lowering—> decreases specificity, increases sensitivity
339
Dx + Tx: acute: garlic breath, vomit, watery diarrhea, QTc prolongation, chronic, hypo-/hyperpigentation, hyperkaratosis, stocking glove neuropathy
Dx: Arsenic poisoning (pesticides, contaminated water, pressure treated wood
Tx: Dimercaprol or DMSA (meso-2,3-dimercaptosuccinic acid, succimer)
340
Cx of Acromegaly
Myocardial left ventricular hypertrophy, dilation + global hypokinesis
341
Common SFX of glucocorticoids
Leukocytosis + hyperglycemia
342
Beta blockers SFX
Impaired glucose control + increased weight gain- don’t use in T2DM
343
ACEi + ARB SFx
Hyperkalemia- firstline drugs with T2DM
344
Tx of orthostatic hypotension
Binding, compression socks + prazosin/doxazosin
345
DCCB SFX (amlodipine, nifedipine
Peripheral edema
346
Crypt abscesses
Ulcerative colitis
347
Intestinal villous atrophy
Celiac disease
348
IBS GI findings
Normal colonic mucosa
349
Tx: Hyperferritinemia =
Hereditary Hemochromatosis
Tx: Therapeutic Phlebotomy
350
Opioid Intoxication Symptoms
AMS, respiratory depression, miosis
Tx: Naloxone
351
Where does tophaceous gout normally occur?
First metatarsophalengal MCP joints—-> Monosodium urate crystal deposition
352
Tx of HHS
Begin wtih IVF with Normal Saline, Replete K, IV Insulin
353
Dx + DGx + Tx: osteoarthritis, <40, in 2-3 MCP joints/wrists, chondrocalcinosis
Dx: Hereditary Hemochromatosis
DGx: X-ray- joint space narrowing + chondrocalcinosis + osteophyte formation
Tx: phelbotomy, acetominophen, NSAIDs
354
Dx: vertigo, recurrent episodes 20mins-several hours, sensorineural hearing loss (sound more prominent on opposite side), tinnitus/fullness of ear
Meniere Disease- increased volume/pressure of endolymph
355
Dx: vertigo, brief episodes triggered by head movements, nystagmus with Dix-Hallpike maneuver- <1min
BPPV- (Benign Paroxysal Positional Vertigo)— calcium debris in semicircular canals
356
Dx: Vertigo, acute single episode lasts for days, after viral syndrome, abnormal head thrust test + nausea vomiting
Vestibular neuritis- inflammation of vestibular nerve
Labyrinthitis- + hearing loss to symptoms
357
Difference between AIHA (autoimmune hemolytic anemia) + hereditary spherocytosis (HS)
AIHA- negative family history and +coombs test
HS- positive family history and -coombs test
358
Intravascular Hemolysis
Reduced haptoglobin, elevated total bili, normal direct bili, elevated LDH
etiologies: DIC, transfusion rxns, infxns, paroxysmal nocturnal hemoglobinuria, Iv Rho(D) immunoglobulin infusion
359
Extravascular Hemolysis
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
Dx: subacute fever, night sweats, weight loss, cough with foul-smelling sputum, coughing during eating, swallowing dysfunction
Oropharangeal aspiration abscess
DGx: cavitary infiltrates with air fluid levels
Tx: Ampicillin-sulbactam, impenem, meropenem, clindamycin
361
Tx of hemophilia A/B
Factor replacement + desmopressin for hemophilia A
Hemophilia A: absent factor 8
Hemophilia B: absent factor 9
362
Prerenal AKI in setting of CHF
Cardiorenal syndrome—> reduction of GFR, elevated venous pressure, reduced CO, exacerbation of HF
Tx: IV diuretics
363
Dx: proximal muscle weakness etiologies
Glucocorticoid induced myopathy
Endocrine- hypothyroidism/hyperthyroidism, cushings disease
Neuro- Labert-Eaton, Myasthenia gravis
364
Common organisms for traveller’s diarrhea- prolonged profuse watery diarrhea
Cryptosporidium Parvum, Cyclospora, Giardia
365
Vomiting Diarrhea
Staph Aureus
Bacillus Cereus
366
Noninflammatory diarrhea
Virus (norovirus, rotavirius)
Clostiridium perfringens
ETEC
Vibrio Cholerae
Listeria
Parasites (Giardia, Cryposporidium, Cyclospora)
Tapeworms
367
Inflammatory Diarrhea
Shigella toxin EColi
Shigella
Campylobacter
Salmonella
Vibrio Parahaemolyticus
Yersinia
368
Extraintestional Food borne Diseases
Clostridium Botulinum- descending paralysis (canned foods)
Listeria- meningitis (cheese)
Vibrio vulnificus- (cellulitis, sepsis)
Hepatitis A (jaundice)- shellfish, seafood
369
Symptoms + Treatment of Stress Urinary Incontinence
Sx: leaking with valsalva, coughing, sneezing, laughing
Tx: lifestyle modification, kegel exercises, pessary, pelvic floor surgery
370
Symptoms + Treatment of Urgency Urinary Incontinence
Sx: Sudden Overwhelming, frequent need to void
Tx: lifestyle modifications, bladder training, antimuscarinic drugs (oxybutynin)- decrease detrusor contractions/reduce sense of urgency
371
Symptoms + Treatment of Mixed Urinary Incontinence
Stress + Urgency
Variable Treatment
372
Symptoms + Treatment of Overflow Urinary Incontinence
Sx: Constant involuntary dribbling + incomplete emptying
Tx: cholinergic agonists, self-catherization
373
Achalasia vs. pseudoachalasia
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
Hyponatremia eval
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
Dx + Tx: Hepatorenal syndrome
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
Tx of Alcohol Use Disorder
1st line- Acamprosate (liver disease + opioid use)+ naltrexone
2nd Line- disulfiram- highly motivated
377
Pentad of TTP
Thrombocytopenia
Microangiopathic hemolytic anemia (MAHA)
Renal insufficiency
Neurologic changes AMS
Fever
FAT RN (fever, Anemia, Thrombocytopenia, Renal Insufficiency, Neuro Changes)
378
DGx + Tx of TTP
PBS- schistocytes, helmet cells, triangle cells
ADAMTS13
Tx: plasma exchange + glucocorticoids
379
Test for EBV
Heterophile antibody (Monospot test) +
380
Primary hyperaldosteronism (Conn Syndrome)
HTN, hypokalemia, metabolic alkalosis, adrenal mass
Dgx: plasma renin elevated serum aldosterone
381
Fatigue, Hemolytic anemia (elevated LDH, low haptoglobin, elevated t bili), cytopenias, hypercoagulable, intra/extravascular hemolysis, hemoglobinuria (dark urine), abdominal pain
PNH- paroxysmal nocturnal hemoglobinuria
DGx: flow cytometery— CD55, CD59 absence
Tx: Eculizumab + Iron + Folate
382
Young Woman, early pubic/axillary hair growth, severe acne, hirsutism, oligomenorrhea, high hydroxyprogesterone, hirsutism, amenorrhea
Partial 21-hydroxylase deficiency
383
Internal Validity
Change in independent variable causes change in dependent variable
Threats: confounding, history, maturation, measurement, regression toward mean, repeated testing, selection
384
External validity (generalizability)
How applicable is this research
Threats: artificial research environment, measurement effects, non-representative sample
385
Rapid progressive, septicemia, cellulitis near marine environments
Vibrio vulnificus
- empiric- highly fatal- IV ceftriaxone, doxycycline
386
Sudden onset SOB, pleuritic chest pain, tachypnea, tachycardia, hypoxemia, low grade fever, JVD, atrial fib
PE- CTA-
ECG- S1Q3T3
387
Treatment of Acute Pericarditis Post MI
NSAIDs: High Dose Aspirin +/- Colchicine
388
Dx: sudden focal neurologic deficits gradually worsening over mins to hours, HA, N/V, AMS
Intraparenchymal brain hemorrhage
389
Most common cause of spontaneous IPH
Hypertensive vasculopathy
390
Tx of Polymyositis
Glucocorticoids (prednisone) + glucocorticoid-sparing agent (methotrexate, azathioprine) + screen age appropriate cancers
391
Characteristic findings of Crohn Disease vs. Ulcerative Colitis
Crohn Disease -Cobblestone appearance, skip lesions, deep ulcerations, transmural inflammation, granulomas
Ulcerative Colitis- continuous, shallow ulcerations limited to mucosa/submucosa, pseudopolyps)
392
Reynold’s pentad (RUQ pain, fever, jaundice, hypotension, AMS) + hematochezia history
Primary Sclerosing Cholangitis
393
PE Finding: Diastolic/ Continuous Mumur
Further work up with transthoracic echocardiogram
394
Treatment of opioid withdrawal: Nausea, Cramps, Diarrhea, Restlessness, Rhinorrhea, Lacrimation, Myalgia, Arthralgia, HTN, Tachycardia, mydriasis, piloerection, hyperactive bowel sounds
Buprenorphine or low dose methadone
395
Hyponatremia, euvolemia, serum osms <275 (hypotonic), urine osms > 100, urine NA > 40
Dx: SIADH (syndrome of inappropriate antidieuretic hormone
Tx: fluid restriction + salt tabs + hypertonic saline (3%)
396
DGx for Esophageal Perforation
Upright X-Ray of chest + abdomen
397
MC association of Renal Vein Thrombosis
Nephrotic Syndrome ( Membranous Glomerulopathy
398
Cirrhosis F/U
Upper GI endoscopy—> for varices
399
Treatment of CX of Cirrhosis
Variceal Hemorrhage
Ascites
Hepatic Encephalopathy
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
Dx: chronic epigastric pain, steatorrhea (mucous fatty poops), weight loss, DM, calcifications/dilated ducts in enlarged pancreas
Chronic Pancreatitis—> Pancreatic Fibrosis (severe pancreatic exocrine insufficiency
DGx: low fecal elastase
Tx: pancreatic enzyme replacement including lipase
401
Serious Cx and Tx of excess anticoagulation on warfarin
Intracerebral hemorrhage
INR only associated with Warfarin
Tx: give IV vitamin K and prothrombin complex concentrate
402
HHS and DKA and potassium
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
Dx, DGx, Tx: fever, sore throat, drooling, muffled voice, stridor, pooled oropharynx secretions (droolin), laryngotracheal tenderness)
Dx: Infectious epiglottitis - Strep Pneumoe or H. Flu
DGx: Clx + lateral neck x-ray
Tx: artificial airway + IV antibiotics (ceftriaxone + vancomycin)
404
Upper airway cough syndrome is DGx:
Post-nasal drip, asthma, GERD >8weeks
405
Hypocalcemia + low PTH
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
Low Calcium + High PTH
Metabolic: Vit D deficiency, CKD
Inflammatory: Pancreatitis, Sepsis
Oncology: Tumor Lysis Syndrome
PTH Resistance: Pseudohypoparathyroidism
407
Dx, DGx, Tx: Fatigue, Malaise, Weakness, Wt loss, Nausea, Ab pain, Diarrhea, loss of vascular tone, hypotension, dizziness, syncope, hyperpigmentation, hyponatremia, hyperkalemia
Dx: primary adrenal insufficiency
DGx: low morning cortisol, high ACTH, hyponatremia, hyperkalemia, eosinophilia,
Tx: Corticosteroids (hydrocortisone, prednisone) or Mineralocorticoids (fludrocortisone)
408
common bugs of Bacterial Meningitis
< 50?
> 50?
Immunocompromised?
Neuro/Penetrating?
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
Polyarteritis Nodosa
medium sized arterial vasculitis
most common renal hypertension/infarct or GI mesenteric ischemia/infarct
410
Thromboangitis Obliterans
microaneurisms in young smokers
distal extremeties (fingers, gangrene, ulcers)
inflammatory thrombi
411
Tx of Cryptococcal Meningitis
Amphotericin B + Flucytosine- 2 weeks
Fluconazole- 8 weeks
412
Carcinoid Syndrome
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
Myxamatous Valve Disease
weakening of valvular structures- mitral valve
414
hyponatremia in a marathon runner
ingestion of too much hypotonic solutions + SIADH
415
Refeeding Syndrome
reintroduction of carbs after chronic malnutrition
muscle weakness, hyporeflexia, arrythmias, CHF,
hypophosphatemia---> hyper insulin release
416
Tx of diabetic gastroparesis
Metoclopramide
417
Diabetic gastroparesis
nausea, emesis, early satiety, bloating, in the setting of poor glycemic control
418
N/V + postprandial fullness + dysphagia + epigastric/chest pain + retrocardiac air-fluid level
Dx: Paraesophageal Hiatal Hernia
Dgx: barium swallow or EGD
Tx: Surgical Repair
419
high fever, diffuse maculopapular rash, severe polyarthritis (long lasting), subtropical regions,
Chikugunya
supportive + methotrexate (long term)
420
Dx: periodic high fever, mild splenomegaly, jaundice, anemia, thrombocytopenia
Dx: Malaria
DgX; Blood smear + Giemsa Stain
421
Dgx and Tx of Leprosy
full thickness biopsy of skin lesion
Tx: Dapsone + Rifampin + Clofazimine (if needed)
422
prosthetic joint infections
<3 months = staph aureus, gram - rods, anaerobes
>6 months = staph epidermidis, propionibacterium, enterococci,
> 12 months = staph aureus, gram- rods, beta- hemolytic streptococci
423
Myasthenic Crisis
Generalized and Oropharyngeal Weakness
Respiratory Insufficiency
In context of Myasthenia Gravis
424
Tx of Myasthenic Crisis
Intubation + Plasmapheresis + IVIG + Corticosteroids
425
DGx of Ankylosing Spondylitis
X-Ray of Pelvis--> Sacroilitis
426
Post MI 4 months-> ST elevation with deep Q waves
Left Ventricular Aneurysm
thinned and dyskinetic myocardial wall
427
Normal STI screening
NAAT - Gonorrhea + Chlamydia
HIV- Ag + Ab test
Syphillis- Rapid plasma reagin (RPR)
428
Unprovoked first seizure Diagnostic Step
CT w/o contrast, rule out intracranial + subarachnoid bleed (emergency) or MRI (Nonemergency)
429
Diagnostic Criteria of Laxative Abuse
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
Colonoscopy of C. Diff
bowel wall edema, erythema, friability (pseudomembranous colitis)
healthcare + antibiotic use
431
Carcinoid Syndrome
flushing, venous telangiectasia, bronchospasms, cardiac valvular abnormalities + diarrhea
elevated urine 5-hydroxyindoleacetic acid levels
432
parapneumonic effusion
bacterial invasion into pleural space--> drainage + abx
433
resting tremor
basal ganglia dysfunction = parkinsons
434
great lakes, mississippi, ohio--> verrucous, crusted lesions, lytic lesions of bone, broad based budding yeast
Blastomycosis
435
fatigue, retrosternal heaviness, non productive cough, alcohol associated pain, elevated LDH and eosinophilia
Hodgkin's Lymphoma
436
retrosternal heaviness, cough, SOB, no eosinophilia, myasthenia gravis
thymoma
437
hemodynamically stable ventricular tachy cardia
Amiodarone
438
Tx of Hypertriglyceridemia
statins, exercise, wt loss, reduce alc intake
439
palpable purpura, glomerulonephritis, peripheral neuropathy, arthralgias, positive RF, hypocomplementemia
mixed cryoglobulinemia syndrome- chronic HCV
440
acute AA treatment
IV labetalol/esmolol
441
ITP
isolated thrombocytopenia, test for HIV, HepC,SLE
442
TTP
ab to ADAMTS13--> microangiopathic hemolytic anemia, thrombocytopenia
life threatening--> give Plasma Exchange
