Internal Medicine Uworld Flashcards
Paget’s Disease (H/N/L): Serum Ca, phosphorous, alk phos, and urine hydroxyprolin
Normal Ca and Phosphorous
High alk phos and urine hydroxyproline (derived from breakdown of collagen)
What are the preferred modalities for diagnosing a ureteral stone?
ultrasound or NONcontrast spiral CT
Name 6 categories of drugs associated with acute pancreatitis
1) anti-seizure (valproate); 2) diuretics (furosemide, thiazides); 3) drugs for IBD (sulfasalazine, 5-ASA); 4) immunosuppressive (azathioprine); 5) HIV (didanosine, pentamidine); 6) abx (metronidazole, teteracycline)
Jugular venous pulse tracing shows prominent x and y descents, dx?
constrictive pericarditis
__ and __ are the two most common causes of cor pulmonale, which develops due to __.
COPD and PE
pulmonary hypertension
Name two hallmarks of secretory diarrhea and what you expect to see on the SOG (stool osmotic gap)
1) large daily stool volumes (gt 1L/day); 2) diarrhea that occurs even during fasting or sleeping; SOG is low usually lt 50 mOsm/kg
What is the equation for SOG (stool osmotic gap)
SOG = plasma osmolality - 2 x (stool Na + stool K)
(plasma osmolality is considered equivalent to measured stool osmolarity and the 2nd half of equation is calculated stool osmolality)
Diagnosis of COPD requires an FEV1/FVC ratio of less than ___.
0.7
Name 3 main symptoms of primary hyperparathyroidism
1) hypercalcemia (polyuria, polydipsia); 2) kidney stones; 3) neuropsychiatric presentations (confusion, depression, psychosis)
bones, stones, abdominal groans, psychiatric overtones (also can cause HTN)
Name 8 causes of high anion gap metabolic acidosis
MUDPILES - methanol, uremia, DKA, paracetamol/acetaminophen, iron/isoniazid, ethylene glycol, salicylates/aspirin
How do you tx diffuse esophageal spasm (main and 2 alternates)? How does it present (2)?
CCBs (diltiazem); alternates: nitrates or tricyclics; intermittent chest pain and dysphagia for solids and liquids
(uncoordinated, simultaneous contractions of esophageal body)
Name 4 of 8 etiologies of avascular necrosis
1) steroid use; 2) alcohol use; 3) SLE; 4) antiphospholipid syndrome; 5) hemoglobinopathies (e.g. sickle cell); 6) infxns (osteomyelitis, HIV); 7) renal transplantation; 8) decompression sickness
Name 4 common lab findings in multiple myeloma
1) normocytic anemia; 2) renal insufficiency; 3) hypercalcemia; 4) monoclonal paraproteinemia
pH decreases by about __ for every __ mm Hg of acute increase in PaCO2
0.08; 10
Name two symptoms almost always present in Chikungunya infxn
high fever and severe polyarthralgias (also often see lymphopenia and thrombocytopenia)
Suspected cauda equina, imaging?
MRI lumbar spine
anti__ and anti__ antibodies are present in over 90% of Hashimoto’s thyroiditis
TPO (thyroid peroxidase) and thyroglobulin
Afib is most commonly caused by ectopic foci within the __. Atrial flutter commonly involves reentrant circuit around the __.
pulmonary veins; tricuspid annulus
What is the major toxicity of azathioprine (3)? Mycophenolate (1)? Btwn tacrolimus, cyclosporine, azathioprine, and mycophenolate, which can cause gingival hypertrophy and hirsutism?
dose related diarrhea, leukopenia, and hepatotox; bone marrow suppression; cyclosporine
Name 6 causes of normal anion gap metabolic acidosis
1) diarrhea; 2) fistulas (pancreatic, ileocutaneous); 3) carbonic anhydrase inhibitors; 4) renal tubular acidosis; 5) ureteral diversion (ileal loop); 6) iatrogenic
In a woman, elevated testosterone levels with normal DHEAS suggest a __ source. Elevated DHEAS levels suggest a __ source.
ovarian (more common); adrenal (less common)
___ is the imaging modality of choice for the diagnosis of cavernous sinus thrombosis
MRI with MR venography
Howell-Jolly bodies are __. They are seen in pts with a hx of __ or __.
remnants of the RBC nucleus; splenectomy or functional asplenia
Macular degeneration affects __ vision. Atrophic (dry) causes unilateral/bi fast/slow vision loss, and exudative/neovascular (wet) causes unilateral/bi fast/slow vision loss. Which one shows drusen and patchy depigmentation in the macular region?
central;
Dry - bilateral progressive (slow)
Wet - unilateral, aggressive (fast)
dry MD
Osmolal gap = ?
measured serum osmolality - calculated serum osmolality
calculated = 2xNa + glucose/18 + BUN/2.8
Name 3 things that cause HAGMA and an osmolal gap
1) ethanol (most common); 2) ethylene glycol (urinary calcium oxalate crystals); 3) methanol (blindness)
This tick borne illness presents with flu-like symptoms and leukopenia and thrombocytopenia. How do you tx?
Ehrlichiosis; doxy
True positive rate describes the __ of the test.
sensitivity
true negative rate is specificity
Moraxella catarrhalis primarily causes __ in children and __ in adults
otitis media; COPD exacerbation
Albuminocytologic dissociation (elevated CSF __ with a normal __ on LP) is characteristic of __
protein; cell count; Guillain-Barre syndrome
The presence of 14-3-3 protein in CSF indicates a __.
Neurodegenerative prion disease (e.g. CJD)
Name 5 medications that can cause hyperkalemia
1) b-blockers; 2) ACEi/ARBs; 3) K+ sparing diuretics; 4) cardiac glycosides (digoxin); 5) NSAIDs
(also trimethoprim, heparing, cyclosporine, and succinylcholine)
Uncontrolled hyperglycemia due to insulin deficiency can shift potassium in/out of cells to cause hyper/hypokalemia
out of cells; hyperkalemia - can give insulin (and glucose!) to tx
Pericardial tamponade can cause dyspnea and classically presents with this triad
1) hypotension; 2) muffled heart sounds; 3) JVD
Alveolar oxygen is calculated with this formula: PAO2 =
simplified version for room air at seal level
PAO2 = 150 - (PaCO2/0.8)
once you calculate PAO2, you can calculate the A-a gradient by PAO2 - PaO2 (from ABG results)
Pts with acute hyperkalemia may develop __ or __ changes.
ascending muscle weakness with flaccid paralysis; EKG changes
What EKG changes do you expect with hyperkalemia (4)?
peaked T waves, followed by short QT interval, QRS widening, and sine wave with ventricular fibrillation
In young pts (and often old), a sub auricular systolic bruit is highly suggestive of __.
Fibromuscular dysplasia
Encephalopathy, ocular dysfunction, and gait ataxia are the classic triad for ___.
Wernicke encephalopathy
CT WITH contrast is useful in identifying structural abnormality or mass lesions (primary or metastatic cancer, abscess, infarct) but is not helpful for identifying ___
intracranial hemorrhage
do CT w/OUT contrast in emergency setting to look for bleed and MRI in non-emergent settings
Septic shock is a form of distributive shock characterized by these 3 things.
1) decreased SVR due to peripheral vasodilation; 2) decreased (or low normal) PCWP due to capillary leakage, which causes decreased preload; 3) elevated mixed venous oxygen (MvO2) saturation due to hyperdynamic circulation (as CO is inc in response to reduced SVR to maintain peripheral tissue perfusion) with an inability of tissues to adequately extract oxygen (may develop lactic acidosis from hypoperfusion)
The most feared side effect of PTU and methimazole is __.
agranulocytosis
Undiagnosed pleural effusion is best evaluated by __, except in pts with clear cut evidence of __
thoracentesis; CHF (use diuretics)
MEN 1 disease (3 things and how they present)
primary hyperparathyroidism (hypercalcemia); pituitary tumors (prolactin, visual defects); pancreatic tumors (especially gastrinomas)
MEN2A and 2B
Both: medullary thyroid cancer (calcitonin) and pheochromocytoma
A: parathyroid hyperplasia
B: mucosal neuromas/marfanoid habitus
Name the nephrotic syndrome based on clinical association - African American and Hispanic ethnicity
Focal segmental glomerulosclerosis
Name the nephrotic syndrome based on clinical association - HIV and heroin use
Focal segmental glomerulosclerosis
Name the nephrotic syndrome based on clinical association - hep B and C
membranoproliferative glomerulonephritis (hep B can also be membranous nephropathy)
Name the nephrotic syndrome based on clinical association - adenocarcinoma (breast, lung), SLE, NSAIDs
membranous nephropathy (also hep B)
The most common site of colon cancer metastasis is ___
liver
Hepatorenal syndrome is likely due to increased __ generation in the __ secondary to portal hypertension, which is thought to cause systemic __, leading to renal hypo perfusion.
nitric oxide; splanchnic; vasodilation
How does nephrotic syndrome lead to hyper coagulation?
increased urinary loss of antithrombin 3 (also altered levels of protein C and S, increased plt aggregation, hyperfribrinogenemia due to increased hepatic synthesis, and impaired fibrinolysis)
Clinical presentation of __ includes classic triad of fever, leukocytosis, and LUQ abdominal pain. Left sided pleuritic chest pain with left pleural effusion is also commonly seen
splenic abscess
___ is the drug of choice in primary biliary cholangitis. In this disease, pts have positive __ antibodies.
ursodeoxycholic acid (UDCA); anti-mitochondrial
___ reactions are the most common adverse reaction to blood transfusions. They present with __ and __ within 1-6 hours of transfusion.
Febrile non-hemolytic transfusion; fever and chills
Patient rapidly develops fever, flank pain, hemolysis, oliguric renal failure, and DIC within an hour of a transfusion, dx?
acute hemolytic transfusion rxn due to mismatched blood (ABO mismatch)
A delayed hemolytic response to transfusion typically present 2-10 days after transfusion with mild fever and hemolytic anemia and is caused by ___.
anamnestic antibody response (against a minor red blood cell antigen)
Anaphylaxis following a blood transfusion is seen in pts with ___. Will see rapid onset of shock, angioedema/urticaria, and respiratory distress within a few minutes of transfusion
anti-IgA antibodies
Transfusion related acute lung injury is caused by donor ___. Pt experiences respiratory distress and signs of noncardiogenic pulmonary edema within 6 hrs of transfusion.
anti-leukocyte antibodies
Severe side effect of hydroxychloroquine? Methotrexate (3)?
retinopathy; hepatotox, stomatitis, cytopenias
IV glucagon increases the intracellular levels of cAMP and has been effective in treating __ and __ toxicity
beta blocker and/or calcium channel blocker
In pts with symptomatic bradyarrhythmias, try and identify and tx reversible causes, next step is administration of __. In pts with inadequate reopens further tx options include these 3.
IV atropine; 1) IV epinephrine; 2) IV dopamine; 3) transcutaneous pacing
Malignant otitis externa (MOE) is a serious infxn of the ear seen in elderly pts with poorly controlled diabetes and most commonly caused by ___. Presentation consists of ear pain and ear __, and __ may be seen within the ear canal on exam. Progression can lead to __ of the skull base and destruction of the __.
pseudomonas; drainage; granulation tissue; osteomyelitis; facial nerve (facial palsy)
Name 3 common medications that cause pill esophagitis
potassium supplements, tetracyclines, bisphosphonates
Pts with an acute, severe illness may have abnormal thyroid function tests. The most common pattern is a fall in __ with normal __ and __. This condition is referred to as __.
total and free T3 levels; T4 and TSH; euthyroid sick syndrome (or low T3 syndrome) - thought to be due to decreased peripheral 5’-deiodination of T4
Name the two major criteria (Duke criteria) for infective endocarditis
1) blood culture positive for typical microorganism (strep viridians, staph aureus, enterococcus); 2) echocardiogram showing valvular vegetation
Digital clubbing is often associated with hypertrophic osteoarthropathy (painful joint enlargement, periostosis of long bones, and synovial effusions). Name the 3 most common causes of secondary clubbing
1) lung malignancies; 2) cystic fibrosis; 3) right to left cardiac shunts
Pathophysiology of digital clubbing (hypertrophic osteoarthropathy) involves __ becoming entrapped in the distal fingertips due to their large side and releasing __ and __ that increase connective tissue hypertrophy
megakaryocytes; PDGF and VEGF
Initial management for gastric outlet obstruction (GOO) includes __ and __, and doing __ for definitive diagnosis. A physical exam maneuver for GOO is called __, which involves placing stethoscope over upper abdomen and rocking pt back and forth at hips
nasogastric suctioning (to decompress the stomach); intravenous hydration; endoscopy; abdominal succussion splash (retained gastric material gt 3 hours after a meal will generate a splash sound)
Bullous pemphigoid is caused by __ autoantibodies against the __. First line tx is __.
IgG; hemidesmosome (at the dermal epidermal junction); high potency topical glucocorticoid (use topical even for extensive disease)
What test do you order to diagnose acute diverticulitis? How do you tx?
Abdominal CT with contrast; bowel rest and antibiotics (cipro + metronidazole)
__ is the most sensitive and specific imaging study to detect gallstones
abdominal ultrasound
__ and __ are the most common causes of acute pancreatitis. Name 4 others
gallstones and chronic alcohol abuse; 1) hypertriglyceridemia; 2) drugs (azathioprine, valproate, thiazides); 3) infxns (CMV, aspergillus, legionella); 4) iatrogenic (post ERCP)
Diagnosis of acute pancreatitis requires 2 of the 3 following.
1) acute epigastric pain radiating to back; 2) increased amylase or lipase gt 3x normal; 3) abnormalities on imaging consistent with pancreatitis
Pt with bradycardia, miosis, rhonchi, muscle fasciculations, salivation, lacrimation, urination, and defecation, dx? Tx?
organophosphate poisoning (acetylcholinesterase inhibitor = cholinergic excess!); tx with atropine and pralidoxime (and remove any vomitus on skin because it can continue to be absorbed that way)
In ___, pts experience shoulder stiffness out of proportion to pain, and exam shows reduction of both passive and active range of motion.
adhesive capsulitis (frozen shoulder syndrome) - rotator cuff tendinopathy presents similarly but more pain than stiffness
Ventricular aneurysm occurs as a complication of acute MI generally how long after? ECG often shows persistent __ along with __.
5 days - 3 months; ST segment elevation; deep Q waves
Epitrochlear lymphadenopathy is pathognomonic for ___.
syphilis
S1Q3T3 pattern on EKG, dx?
Pulmonary embolism (might also see new onset right bundle branch block)
Name 2/4 most common side effects of EPO.
1) worsening of HTN; 2) headaches; 3) flu-like syndrome; 4) red cell aplasia
Pt has suspected infective endocarditis, what is the next step?
Obtain blood cultures from separate venipuncture sites (then can start Abx and do cardiac imaging)
Polymyalgia rheumatica affects pts gt 50 and is characterized by pain and __ in the neck, shoulders, and pelvic girdle. Also associated with this lab finding. Tx of choice for uncomplicated PMR is __.
stiffness; elevated ESR; low-dose prednisone
PMR associated with giant cell temporal arteritis
___ should be suspected in pts who have a combo of hemolytic anemia, cytopenias, and hyper coagulable state. How can you confirm dx?
Paroxysmal nocturnal hemoglobinuria; flow cytometry to assess for CD55 and CD59 on surface red blood cells (absence = PNH)
___ infection typically presents with GI complaints and the characteristic triad of periorbital edema, myositis, and eosinophilia
Trichinellosis (other findings include fever, subungual splinter hemorrhages, and conjunctival or retinal hemorrhages)
The criteria for initiating long term home oxygen therapy (LTOT) in pts with COPD include PaO2 lt/= __ or SaO2 lt/= __ on room air.
55mmHg; 88%
(lt/= 59 mmhg and 89% in pts with R heart failure)
(titrate so SaO2 is greater than 90%)
___ is the most common cause of mitral regurgitation in developed countries.
mitral valve prolapse
When should nitrates not be given during a STEMI (3)?
1) hypotension; 2) right ventricular infarction (preload is impt in these pts); 3) severe aortic stenosis
Name 7 things in the management of STEMIs
1) oxygen (for arterial sat lt 90%); 2) nitrates; 3) antiplatelet therapy (aspirin + P2Y12 receptor blocker (clopidorgrel); 4) Anticoagulation (heparin); 5) beta blockers; 6) prompt reperfusion with PCI (within 90 mins); 7) statin therapy
Breath sounds, tactile fremitus, percussion: consolidation (lobar pneumonia)
increased breath sounds (crackles and egophany present), increased tactile fremitus, dullness to percussion
Breath sounds, tactile fremitus, percussion: Pleural effusion
decreased/absent breath sounds; decreased tactile fremitus; dullness to percussion
Breath sounds, tactile fremitus, percussion: pneumothorax
decreased/absent breath sounds; decreased tactile fremitus; hyperresonant
Breath sounds, tactile fremitus, percussion: Emphysema
decreased breath sounds; decreased tactile fremitus; hyper resonant
Fat malabsorption leads to the increased absorption of oxalic acid because the unabsorbed fatty acids chelate __, making oxalic acid free for absorption.
calcium
So small bowel disease, surgical resection, or chronic diarrhea can lead to malabsorption of fatty acids and bile salts predispsoing to formation of calcium oxalate renal stones
Gottron’s papules (violaceous, scaly papules over knuckles, elbows, and knees) are pathognomonic for ___. Lab tests show elevation in these 3 tests and positive __. Tx includes __.
Dermatomyositis; CPK, aldolase, LDH; anti-Jo-1 (and anti-Mi2 and anti-RNP); high dose glucocorticoids PLUS glucocorticoid sparing agent
(screen pts for malignancy)
The presence of nephrotic syndrome w/palpable kidneys, hepatomegaly, and ventricular hypertrophy (4th heart sound) in the setting of chronic inflammatory disease is suggestive of __ as a common unifying diagnosis.
secondary amyloidosis (chronic inflammation resulting in extracellular tissue deposition of fibrils into tissues and organs)
___ is a disease of bronchial thickening and dilation due to recurrent infection and inflammation. Cough with large volume mucopurulent sputum production, hemoptysis, and dyspnea are common. Diagnosis is made by __.
Bronchiectasis; high resolution CT scan of the chest
Pts with cocaine-associated chest pain should be treated initially with ___. __ is contraindicated.
IV benzodiazepenes (reduce sympathetic outlfow and reduce anxiety, agitation, improve BP and HR); beta-blockers (due to unopposed alpha adrenergic activation and further vasoconstriction)
Name the 6P’s of acute arterial limb ischemia
pain, pallor, parasthesias, pulselessness, poikilothermia (cool extremity), and paralysis
__ is a multisystem inflammatory condition characterized by recurrent oral and genital ulcers. Skin and ocular involvement is common. __ is a major cause of morbidity.
Behcet syndrome; thrombosis
most common in pts of Turkish, Middle Eastern, and Asian descent
Chronic pancreatitis diagnosis is established by the presence of __ on __ or __.
pancreatic calcificaitons; CT scan or plain film; (characterized by recurrent bouts of upper abdominal pain, diarrhea/steatorrhea, and weight loss)
What is beck’s triad and what is it indicative of?
hypotension, distended neck veins, and muffled heart sounds; cardiac tamponade (these sxs are due to exagerrated shift of interventricular septum toward the left ventricular cavity, which reduces left ventricular preload, stroke volume, and CO)
D-xylose is a monosacchardie that is absorbed in the proximal small intestine without degradation by __ or __. Pts with small intestinal mucosal disesase will have normal/impaired absorption of D-xylose. Pts with malabsorption due to enzyme deficiencies will have normal/impaired absorption of D-xylose.
pancreatic or brush border enzymes; impaired; normal
The __ test is a statistical method that is commonly employed to compare the means of two groups. __ is used to compare three or more means.
Two sample t-test; ANOVA
The __ test is a statistical method that is appropriate for categorical data and proportions
chi-square test
___ should be suspected in pts with mild diabetes mellitus or hyperglycemia with necrotic migratory erythema, diarrhea, anemia, and weight loss. __ confirms the diagnosis.
Glucagonoma; glucagon greater than 500 pg/mL
What is the preventive treatement for vasospastic angina (prinzmetal)? What is the abortive tx?
CCBs; sublingual nitroglycerin
Greater than __ mL postvoid residual bladder volume is considered diagnostic for urinary retention
50
___ is the most common cause of abnormal hemostasis in pts with chronic renal failure and it is due to __. __ is the treatment of hoice.
Platelet dysfunction; uremic coagulopathy; DDAVP
(PT, PTT, and plt count are normal; BT is prolonged; plt transufsions are not indicated because transfused plts quickly become inactive)
Felty syndrome is a clinical disorder seen in patients with severe long standing __ (greater than 10 years). It is characterized by __ and __
rheumatoid arthritis; neutropenia and splenomegaly
3 adverse effects of methotrexate
hepatotoxicity, stomatitis (oral ulcers), cytopenias
Name the 3 exudative Lights criteria
1) pleural fluid protein/serum protein ratio gt 0.5
2) pleural fluid LDH/serum LDH ratio gt 0.6
3) pleural fluid LDH gt 2/3 of the ULN for serum LDH
In the setting of fat malaborption (eg Crohn’s disease), calcium is preferentially bound by fat, leaving __ unbound and free to be absorbed into the bloodstream leading to increased ___ formation.
oxalate; oxalate stone formation (symptomatic hyperoxaluria)
Muddy brown granular casts, dx? RBC casts dx?
ATN; glomeruloneprhitis
WBC casts, dx?
interstitial nephirtis or pyelonephritis
Fatty casts, dx? Broad and waxy casts, dx?
Nephrotic syndrome; chronic renal failure (broad due to dilated tubules of enlarged nephrons undergoing compensatory hypertrophy)
Renal vein thrombosis is an important complication of all nephrotic syndromes. It is due to loss of ___ in the urine increasing the risk of venous and arterial thrombosis. It is most commonly associated with this nephrotic syndrome.
antithrombin III; membranous glomerulopathy
___ is an inherited disease causing recurrent renal stone formation. The characteristic sstones are hard and radiopaque/radiolucent. Urinalysis shows typical __ crystals. Urinary __ test is positive and can confirm the diagnosis.
Cystinuria; radioopaque; hexagonal; cyanide nitroprusside test
High-output heart failure can occur in patients with these 5 conditions (probably there are more examples)
1) severe anemia; 2) hyperthyroid; 3) beriberi; 4) Paget disease; 5) AV fistulas
Erythromycin is primarily used as an antibiotic, but it also functions as a __ agonist and can help tx __ secondary to __.
motilin receptor; nausea; gastroparesis
___ have similar efficacy to warfarin in tx of acute venous thromboembolism and do not increase the risk of bleeding complications.. These drugs do not require lab monitoring or overlap therapy with heparin.
Oral direct Xa inhibitors (rivaroxaban, apixaban)
Spontaneous rupture of the esophagus (Boerhave syndrome) typically occurs aftere severe retching and vomiting. Chest XR can reveal unilateral pleural effusion typically with a high amylase content. __ or __ confirms the diagnosis.
CT or contrast esophagography with Gastrografin
Name the classic triad for disseminated gonococcal infxn
1) polyarthralgia; 2) tenosynovitis; 3) painless vesiculopustular skin lesions
Hyposthenuria is found in patients with __ disease (and also ___), and is impairment in the kidney’s ability to ___
sickle cell disease; sickle cell trait; concentrate urine (likely due to red blood cell sickling in the vasa rectae of the inner medulla, which impairs countercurrent exchange and free water reabsorption)
Acyclovir can cause __ if adequate hydration is not also provided
crystalline nephropathy
Name the medical therapy shown to improve morbidity and mortality in patients with known coronary heart disease (5)
1) dual anti-platelet therapy (DAPT = aspirin and P2y12 receptor blockers like clopidogrel, prasugrel, ticagrelor); 2) beta blockers; 3) ACEi’s or ARBs; 4) Statins (HMG-CoA reductase inhibitors); 5) Aldosterone antagonists (spirinolactone, eplerenone)
Name 5 characteristic presentations of a pancoast tumor (superior pulmonary sulcus)
1) arm/shoulder pain/paresthesias due to brachial plexus compression (typically ulnar distribution); 2) Horner’s due to sympathetic trunk involvement; 3) Hoarseness due to recurrent laryngeal nerve involvement; 4) SVC syndrome; 5) weight loss
Hypothyroidism causes hypertension due to __. Hyperthyroidism causes hypertension due to __.
increase in SVR; positive inotropic and chronotropic effects (increase in contractility and heart rate –> inc in CO) (hyperthyroid actually decreases SVR)
___ is a condition that classically affects new mothers who hold their infants with the thumb outstretched (abducted or extended. The abductor pollicis longus and extensor pollicis brevis tendons are affected. Passive stretch of these tendons elicit pain.
De Quervain tenosynovitis
Metabolic syndrome is diagnosed when at least 3 of the following 5 are met:
1) abdominal obesity (waist circumf gt 40 inches in men and 35 inches in women); 2) Fasting glucose gt 100-110; 3) BP gt 130/80; 4) Triglycerides gt 150; 5) HDL cholesterol (men lt 40; women lt 50)
Hyalinosis that affects both afferent and efferent arterioles (renal) is pathognomonic of ___.
Diabetic nephropathy
Crescent formation on light microscopy (renal) is the charactersitic finding in ___
rapidly progressive glomerulonephritis
Name the 4 medications shown to improve long term survival in pts with LV systolic dysfunction
1) Beta blockers, 2) ACE/ARBS, 3) mineralocorticoid receptor antagonists (eplerenone, spirinolactone), 4) hydralazine + nitrates in African American pts
Inc/Dec: Cardiogenic shock: RA pressure (preload), PCWP (preload), cardiac index (pump function), SVR (afterload), MvO2 (mixed venous oxygen saturation)
RA pressure = inc; PCWP = inc; Cardiac index = dec; SVR = inc; MvO2 = dec
Inc/Dec: Hypoveolemic shock: RAP, PCWP, CI, SVR, MvO2
RAP = dec; PCWP = dec; CI = dec; SVR = inc; MvO2 = dec
Inc/Dec: Septic shock: RAP, PCWP, CI, SVR, MvO2
RAP = normal or dec; PCWP = normal or dec; CI = inc; SVR = dec; MvO2 = inc
Hypomagnesemia is an important cause of ___, particulalry in alcoholics. It causes decreased release release of __ and __ resistance
hypocalcemia; PTH; PTH
hypoparathyroidism induced by low magnesium is NOT associated with elevated phosphorous levels
Hepatic hydrothorax generally results in __ and is thought to occur due to __.
transudative pleural effusions; small defects in the diaphragm (ascites moves in to pleural space)
Potassium iodide inhibits __ and __. It is used mainly for __ and __.
thyroid hormone synthesis; release; prepartaion for thyroidectomy in Graves’ for treating thyroid storm
CHA2DS2-VASc score is used to determine __ risk in pts with __. If you have a score greater than or equal to __ you should be on __. What does it stand for?
thromboembolic risk; atrial fibrillation; 2; anticoagulation;
CHF, Hypertension, Age gt/= 75, Diabetes, Stroke/TIA/thromboembolism, Vascular disease, Age 65-74, Sex category (female)
(Age gt 75 and Stroke are worth 2 points)
___ is the arrhythmia most specific for digitalis toxicity
Atrial tachycardia with AV block
Aortic regurgitation produces an early __ murmur and can be associated with several physical signs caused by a __ pulse including __ (aka “___”) peripheral pulses
diastolic; hyperdynamic; bounding; water hammer
Physical exam findings for severe aortic stenosis include these 3
1) pulsus parvus and tardus (slow rising/delayed and weak carotid pulse); 2) single and soft second heart sound (S2); 3) mid to late peaking systolic murmur (w/max intesnity at 2nd right intercostal space radiating to carotids)
Ventilation = __ x __
respiratory rate; tidal volume
In general, tidal volumes should be about __ of ideal body weight
6 ml/kg
Mutations in these 2 genes are responsible for 70% of identifiable mutations in pts with HoCM
cardiac myosin binding protein C gene and cardiac beta-myosin heavy chain gene
Enthesitis is characterized by inflammation and pain at sites of __. It is a common finding in __ and other __.
tendon and ligament attachment to bone; ankylosing spondylitis; spondyloarthropathies
Patients with SIADH characterstically are hyponatremic, have serum osmolality of __, urine osmolality of __, and are __volemic.
less than 275; greater than 100; euvolemic
All pts with acute exacerbation of COPD should receieve these three drugs.
inhaled bronchodilators - albuterol (B2 agonists) and ipratroprium (anti cholinergics) AND systemic glucocorticoids (oral or IV)
In addition to inhaled bronchodilators and systemic glucocorticoids, __, __, and __ should be given if indicated to pts with COPD exacerbation
antibiotics (doxy or azithro), supplemental oxygen (as needed to maintain 88-92%), and ventilatory support
Addison’s disease (primary adrenal insufficiency) causes aldosterone deficiency and presents with a ___ gap and __kalemic, __natremic metabolic ___.
non-anion gap hyperkalemic hyponatremic metabolic acidosis
The best markers indicating resolution of DKA are the __ and __.
serum anion gap; beta-hydroxybutyrate levels (predominant ketone in DKA)
The diagnosis of acute liver failure requires these 3 things
1) elevated aminotransferases (often gt 1000); 2) signs of hepatic encephalopathy (HE); 3) impaired hepatic synthethic function (defined as INR gt/= 1.5)
(the presence of HE differentiates ALF from acute hepatitis)
What are the two most common causes of acute liver failure?
Drug toxicity (eg acetaminophen overdose) and acute viral hepatitis (other causes include autoimmune hepatitis, ischemia, wilson disease, and malignant infiltration of the liver)
A1AT deficiency causes __ emphysema with greater destruction in the __ lobes. Smoking causes __ emphysema with greater destruction in the __ lobes.
AAT: panacinar in lower lobes
smoking: centriacinar in upper lobes
High leukocyte alkaline phosphatase (LAP) score suggests ___.
leukemoid reaction (not cancer!)
Glucocorticoids cause a leukocytosis mainly through mobilization of __ and an increase in the number of circulating __.
marginated neutrophils; neutrophils
(they decrease the number of circulating lymphocytes and eosinophils by increased apoptosis, increased emigration into tissues, and dec production)
What is the triad of wernicke’s encephalopathy? What are the two other symptoms you add for Korsakoff’s?
ataxia, opthalmoplegia, and confusion (AMS); confabulation and amnesia
___ is a disorder of the inner ear characterized by increased volume and pressure of endolymph (endolymphatic hydrops). Clinical features include __, __, and __.
Meniere disease; tinnitus, episodic vertigo, sensorineural hearing loss
