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(Asope) STEP 2 > Internal Medicine World > Flashcards

Internal Medicine World Flashcards

1
Q

what are situations in which oxalate absorption is increased and can lead to kidney stones ( flank pain on one side)

A

intestinal diseases that cause fat malabsorption (Crohns)

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2
Q

how to treat nonexertional heat stroke

A

evaporative cooling, do not do ice water immersion this can kill the patient

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3
Q

t wave inversion can be a sign of what

A

left ventricular hypertrophy

or ischemia

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4
Q

what is a weird finding that one can see with coarctation of the aorta

A

epistaxis

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5
Q

what is the typical presentation of PaCO2 in the event of asthmatic attack

A

the patient hyperventilates causing a low Co2 and respiratory Alkalosis

on arterial blood gas the PaCO2 level will be normal which is dangerous because this means respiratory failure is coming

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6
Q

what are the first steps in curing sleep apnea

A
  1. weight loss
  2. avoidance of sedative and alcohol
  3. coaching px to not sleep in supine position
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7
Q

polysomnogrophy is ?

A

sleep stay test

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8
Q

definition of hazard ratio

A

chances that an event is more likely to occur in treatment group instead of control group

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9
Q

definition of hazard rate

A

chances of an event occurring in one study group during a set period

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10
Q

hazard ratio <1

A

indicates that the event is more likely to occur in control group

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11
Q

hazard ratio >1

A

event is more likely to occur in treatment group

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12
Q

what is the lesion difference between the conus medularis and caudal equine

A

cona medularis : lower and upper motor neuron issues (part of spinal cord)

CES: only lower motor neurons problems

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13
Q

management for both conus medularis and CES

A
  1. MRI
  2. IV glucocorticoids
  3. neurological evaluation
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14
Q

a crescendo-decrescendo murmur heard along the left sternal border without carotid radiation is a description of what

A

HOCM (inter ventricular septal hypertrophy)

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15
Q

where is the location of the aortic stenosis murmur

A

right 2nd intercostal space

carotid radiation will be present

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16
Q

formula for anion gap

A

AG= sodium - (chloride + bicarb)

normal: 10-14

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17
Q

causes of high anion gap

A 
M-methanol
U-uremia
D-DKA
P-propelyene glycol / paraldehyde
I- isoniazid/iron
L- lactic acidosis
E- ethylene glycol
s- aspirin
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18
Q

what is the management for someone experiencing postcoital lactic acidosis (after seizure)

A

it usually corrects itself within 90 min so just watch and repeat labs in 2 hours

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19
Q

a brain that has a seizure for >5 min is at increased risk for

A

cortical laminar necrosis due to it being the site of excitatory cytotoxicity during the attack

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20
Q

an ECG reading that shows diffuse st elevation in multiple leads and depressed P-R in limb and precocial leads is suggestive of

A

acute pericarditis

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21
Q

what is Takotsubo Caridomyopathy

A

when there is an older patient who has undergone some kind of stress or medical illness and there is ST elevation on ECG, chest pain and elevated cardiac enzymes as seen in MI, BUT the difference is that when angiography is performed, there is ballooning of the left ventricle as opposed to arterial stenosis which is present in MI

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22
Q

Takotsubo in Japanese means

A

octopus pot

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23
Q

what is refeeding syndrome characterized by

A 
hypophosphatemia
px can present with:
- edema
- seizure
- heart failure
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24
Q

what is the first management step for a solitary pulmonary nodule

A

get an older CXR to see if the lesion has grown, if there is no previous CXR use a CT

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25
Q

acute rejection of organs is best treated with what

A

IV steroids

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26
Q

name some causes of post-op transplant rejection

A 
cyclosporine toxicity
urethral obstruction
acute rejection
vascular obstruction
acute tubular necrosis
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27
Q

digitalis toxicity will show what on ECG

A

atrial tachycardia with AV block

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28
Q

someone with diffuse axonal injury like after a car accident will show what in CT

A

numerous punctuate hemorrhages with blurring of the grey and white matter interface

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29
Q

what is the more sensitive test for diagnosing diffuse axonal injury, MRI or CT?

A

MRI

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30
Q

what is Lhermitte sign?

A

in patients with MS, it is a startling intense burst of pain like an electric shock that runs down your back into your arms and legs when you move your neck (usually seen when MS is first diagnosed in a px)

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31
Q

uhthoff phenomena?

A

this is when some px’s with MS feel their symptoms worse in warm weather (like moving to Arizona)
*one of the 1st signs of MS

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32
Q

first step to diagnose MS patients

A

MRI of the brain and spine to rule in (T2 weighted)

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33
Q

second line way to diagnose MS

A

LP to detect oligoclonal IgG bands in the CSF

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34
Q

what is it called when HTN, bradycardia and respiratory depression are seen in the case of intracranial HTN

A

Cushing Reflex (marks brainstem compression)

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35
Q

leukemia reaction occurs in response to

A

severe infection

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36
Q

what does leukemia reaction present with to help differentiate it from CML

A
  • high alkaline phosphatase level
  • metamyelocytes>myelocyts
  • lack of absolute basophilia
  • leukocyte count <100,000
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37
Q

diagnosis of adrenal insufficiency should include what two things

A

8am serum cortisol test

ACTH stimulation test

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38
Q

what is enthestis

A

tenderness where the ligament and tendon attach to the bone (common in Achilles) seen in Ankylosing Spondylitis

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39
Q

molluscum contagiosum is caused by what virus

A

pox virus

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40
Q

what are scrotal varicoceles a clue to in a male patient who is experiencing blood in urine and fatigue

A

renal cell carcinoma

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41
Q

WHTA IS the triad of renal cell carcinoma

A

flank pain
palpable abdominal mass
hematuria

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42
Q

a varicocele that fails to empty when the patient is recumbent is a good sign of

A

RCC; the tumor is blocking where the gonadal vein meets the renal vein

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43
Q

after pain reduction what is the first treatment of choice for Aortic dissection

A

beta blocker

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44
Q

3 steps to aortic dissection management

A
  1. dec. LV contractility
  2. Dec. systolic BP to 100-120
  3. ain reduction
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45
Q

treatment for de Quarvian thyroiditis

A

B Blocker and NSAIDS

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46
Q

1st line therapy for BPH

A

alpha blockers

tamulosin and terazosin

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47
Q

valproic acid a common antisezuire med can cause?

A

acute pancreatitis

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48
Q

rupture of a popliteal cyst can cause pain being the knee and in the calf and can resemble the pain of?

A

venous thrombosis

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49
Q

what is the first line AB to check for SLE

A

ANA

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50
Q

what is the 2nd AB to test for SLE

A

anti double stranded and anti smith

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51
Q

pharmacological vasodilator stress testing (adenosine) causes a marked increased in blood flow in what arteries

A

In the normal vessels and there is a decreases in the diseased vessels

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52
Q

Vasospastic angina typically occurs at what time of the day

A

Night

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53
Q

What will ECG show during vasospastic angina episode

A

ST Elevation

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54
Q

First line treatment for vasospastic angina

A

CCB to open up e vessels

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55
Q

What medication is given to people with vasospastic angina to limit myocardial ischemia once an episode occurs

A

Sublingual NO

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56
Q

Why should you not give someone aspirin if they have vasospastic angina

A

Because it can inhibit prostacyclin production and worsen vasospasm

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57
Q

What is cilostazol

A

Phosphdiesterase three inhibitor that treats intermittent claudication

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58
Q

What does Ranolazone treat

A

Stable angina by decreasing the calcium in the heart by inhibiting the late phase sodium influx into dead heart cells

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59
Q

Patients who you suspect to have HTN should get what initial lab work?

A

UA-hematuria?
Chemistry panel
Lipid profile
Baseline ECG

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60
Q

Because of the side effects of amiodarone, a patient on this drug should always have what tests dons

A

Pulmonary function

Thyroid tests

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61
Q

How does mesenteric ischemia present

A

Severe periumbilical abdominal pain

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62
Q

Name four drugs that can increases the amount of digoxin

A

Amiodarone
Propefenone
Verapimil
Quinidine

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63
Q

What is the presentation of acute digoxin toxicity

A

Anorexia
Nausea
Vomiting
Abdominal pain

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64
Q

Chronic digoxin toxicity looks like

A

Changes in color vision
Scotomas
Blind

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65
Q

What are Hodgkin survivors at ris for

A 
Cardiac disease (constrictive pericarditis) due to radiation therapy in the mediastinum 
Can present 10-20 years later
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66
Q

What is the initial therapy to control heart rate and hyperadrenergic symptoms

A

Beta blocker

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67
Q

Why is propranolol good to use in hyperthyroid patients

A

Decreases the conversion of T4 to T3

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68
Q

What heart problem is adenosine used to treat because of its short action

A

Supra ventricular tachycardia in whom diagnosis is unclear

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69
Q

What is situational (postmicturition) syncope?

A

It is a reflex syncope that is associated with triggers like peeing pooping or coughing all due to cardioinhibitory and vasodepressor response

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70
Q

Genetic inheritance of hypertrophic cardiomyopathy

A

AD

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71
Q

What are the genetic mutations seen in HCm

A

Cardiac myosin binding protein c gene

Cardiac beta myosin heavy chain gene

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72
Q

What is the difference between acute atriel occlusion in the left and venous thrombosis

A

The pain in DVT is dull and aching instead of the severe sudden onset pain seen in acute aterial occlusion

DVT won’t have pulseleness but arterial occlusion

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73
Q

What do you pair ccb with to stop peripheral edema in the legs from happening

A

Acei

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74
Q

What cardiac abnormality can Lyme disease cause

A

AV BLOCK

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75
Q

An increase in LV size bringing the apex closer to the chest wall when the patient lays on their side is associated with

A

Aortic regurgitation

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76
Q

Common causes of AR in America

A

Aortic root dilation

Congenital bicuspid valve

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77
Q

What specifically causes the water hammer pulse in aortic regurgitation

A

Wide pulse pressure ( large systolic, low diastolic)

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78
Q

what do pregnant mothers in their last trimester need to receive and why

A

they need vitamin K supplementation because phenytoin depletes the vitamin K in the fetus

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79
Q

what do you give to treat warfarin induced skin necrosis

A

concentrated protein C

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80
Q

how to diagnose pertussis

A

PCR of the nasopharynx

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81
Q

treatment for cat bites

A

amoxicillin/clavulante

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82
Q

first line treatment for RLS

A

dopamine (pramipexole)

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83
Q

Treatment for scute bacterial prostatis

A

TMP-SMX

FLOROQUINOLONES (levofloxacin, ciprofloxacin)

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84
Q

Treatment for chronic prostatitis

A

FLOROQUINOLONES

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85
Q

myalgia, proximal muscle weakness and elevated CK seen in a patient?

A

hypothyroid myopathy

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86
Q

people who start taking OCP estrogen pills and who have hypothyroidism experience what?

A

estrogen increases the amount of TBG so that means more thyroid hormone binds to TBG meaning that less is available to the body, so the patient will need to increase their dose of levothyroxine

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87
Q

what is the treatment called that lasers the gallstones in the gall bladder for people who cannot tolerate surgery

A

lithotripsy

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88
Q

drug treatment for dermatitis herpetiformis

A

dapsone

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89
Q

drug treatment for severe legionella pneumonia

A

floroquinolones (levofloxacin)

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90
Q

three cancers seen in Lynch syndrome

A

colorectal
endometrial
ovarian

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91
Q

three cancers seen in familial adenomatous polyposis

A

colorectal
demoed and osteomas
brian tumors

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92
Q

three cancers seen in von hippie landau

A

hemanigioblastoma
clear cell renal carcinoma
pheochromocytoma

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93
Q

how does IV acyclovir cause AKI

A

it is not soluble in the urine so it forms crystals and this blocks the renal tubules

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94
Q

how to treat emergent central artery occlusion of the eye

A

massage the eye and give high dose O2

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95
Q

pleural ph is usually

A

7.6

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96
Q

exudative fluid in pleura will have a ph of

A

7.3-7.4

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97
Q

transudative fluid in the pleura will have a ph of

A

7.4-7.55

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98
Q

when can you give the hPV shot up to in women? in men?

A

26

21`

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99
Q

gram stain with many neutrophils but no organism seen and hyponatremia, g.i. symptoms seen in the patient is suggestive of what bacteria

A

legionella

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100
Q

describe pseudodementia

A

this is when older patients who are depressed start forgetting things

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101
Q

up to 40% of patients with polycythemia vera have

A

gout

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102
Q

Polycythemia vera is characterized by what

A

increased cell turnover because of hyperproliferatino of all cell lines

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103
Q

what do you give to treat hyponatremia due to Addison disease

A

iv hydrocortisone

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104
Q

describe the pathogenesis of aspirin exacerbate respiratory distress

A

there is an increase production of leukotrienes because aspirin shuts of the prostaglandin pathway.

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105
Q

wat is the medication used to treat benzo overdose

A

flumazinil

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106
Q

hematuria that begins five days after an URI or pharyngeal illness is associated with what disease

A

IgA Nephropathy

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107
Q

what is one of the first signs of macular degeneration

A

distortion of straight lines making them appear wavy

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108
Q

when do you do a urine culture on someone with a UTI

A

if initial treatment fails

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109
Q

what is the nerve that gives general sensation over the face

A

trigeminal (V)

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110
Q

Most common cause of COPD EXACERBATION

A

URI

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111
Q

What is the first way to treat drug induced interstitial nephritis

A

Stop the offending drug

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112
Q

lesions in the CNS above the pons to the CN 7 can result in?

A

heminaesthesia ( cannot feel one side)
hemiparesis ( cannot move one side)
dysarthria (slurred or slow speech) `

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113
Q

peripheral neuropathy of CN 7 (lesions below the pons) can result in what symptoms

A

inability to raise eyebrow on affected side
drooping of the mouth
disappearance of the nasolabial fold

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114
Q

someone who has prostatitis and is being treated but still has a fever despite treatments means that they probably have what

A

prostatic abscess (Do pelvic CT to see)

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115
Q

a patient comes in and has been taking a medication for four years and her RA has gotten significantly better. her MCV is 104, which drug is she taking

A

methotrexate ( UDE is macrocytic anemia)

- a more serious UDE is pancytopenia

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116
Q

how does methotrexate work

A

inhibits dihydrofolate reductase

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117
Q

why add folic acid to treatment regimens using methotrexate

A

because methotrexate decreases the utilization of folic acid by the body and this cn cause all the symptoms, add folic acid to avoid things like microcytic anemia, stomach pain and rash

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118
Q

what is the anti RA drug that causes side effects of hemolysis in G6PD people, GI problems and visual disturbances

A

HYdroxychloroquine

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119
Q

osteonecrosis of the femoral head that is worsened with activity (weight bearing) in people with SLE on steroids is what disease

A

avascular necrosis

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120
Q

most sensitive test for vascular necrosis in the beginning

A

MRI

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121
Q

survival benefits from using home oxygen are significant when it is used for more then how many hours a day

A

15

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122
Q

SaO2 of home O2 should be kept at what percent during sleep, walking and normal life

A

90%

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123
Q

hodgkin lymphoma occurs in younger people and those who are treated with chemo before the age of 30 are likely to develop

A

secondary malignancies

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124
Q

first line treatment for RA

A

methotrexate

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125
Q

patients who do not respond to methotrexate after 6 months should be switched to

A

TNF alpha inhibitor (eternacept or infliximab )

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126
Q

what is the common screening test for multiple myeloma that detects M spike

A

plasma electrophoresis

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127
Q

the following symptoms are indicative of :
back pain
older man
osteolytic lesions in the bone

A

Multiple Myeloma

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128
Q

explain mixed cryoglobulinemia syndrome

A

when there is deposition of immune complexes in small and medium vessels leading to vessel damage and end organ damage.

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129
Q

how does mixed cryoglobulinemia present

A
  • non blanching palpable purpura
  • arthralgias
  • renal disease
  • liver involvement (elevated transaminases)
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130
Q

what are the two conditions that mixed cryoglobunimeia are associated with

A

HCV and SLE

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131
Q

why do patients with obstructive sleep apnea have increased hematocrit

A

because their hypoxic episodes at night causes the kidneys to stimulate EPO and increase the RBC count

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132
Q

relative polycythemia is due to?

A

reduced plasma volume

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133
Q

absolute polycythemia is due to

A

increased RBC mass

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134
Q

main symptom difference between EBV mono and IM like syndrome from CMV

A

IM Like syndrome from EMV won’t have pharyngitis

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135
Q

what is the main pathophysiologic mechanism behind vitamin B12 deficiency

A

impaired DNA synthesis (purines-thymidine) can’t be made

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136
Q

premature atrial contractions are what kind of arrhythmia

A

benign

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137
Q

cholesterol embolism can occur after cardiac cath and causes

A

livido reticular in the legs and pancreatitis

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138
Q

patient with HTN and undetectable renin system has

A

primary hyperaldosteronism

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139
Q

why does the renin system not work in primary hyperaldosteronism

A

because of feedback inhibition

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140
Q

the hypokalemia seen in primary hyperaldosteronism can be worsened with the use of what drugs

A

diuretics

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141
Q

never use what asthma medicine alone

A

LABA always use with ICS

142
Q

common cause of secondary baceteriL Pneumonia after viral infection

A

S Aureus

143
Q

TG >1000 can cause acute pancreatitis and what skin problem

A

eruptive xanthomas

144
Q

describe the symptoms of trichinellosis

A

the intestinal phase presents first and there will be nausea, vomiting and diarrhea and that will be followed with the symptoms of 1. periorbital edema 2. eosinophilia

  1. myositis
  2. splinter hemorrhages
145
Q

what is the treatment for aspergillus

A

voriconazole and capsofungin

146
Q

CT scan of aspergillus shows

A

ground glass nodules

147
Q

nonseminomatous germ cell tumors produce what markers

A

b-HCG and AFP

148
Q

when do you stop giving mammograms patients

A

after the age of 70

149
Q

how should patients with right ventricular MI be managed and why?

A

they should be given an iv bolus of normal saline because these patients can experience profound hop tension because of decreased right ventricular reload

150
Q

what medication do you want to avoid giving to someone with Right Ventricular MI

A

nitrates because they vasodialte and in this problem there is already an issue with the right ventricle getting enough blood to keep pumping the heart, NO would worsen this

151
Q

what is the early side effect of levodopa and carbidopa

A

hallucinations

152
Q

long term side effects of levodopa and carbidopa

A

choreiform dyskinesia

153
Q

what are the UDE of amantidine

A

livedo reticularis

154
Q

UDE of COMT inhibitors (entacopone and tolcapone)

A

Dyskinesia

155
Q

UDE of MAO B Inhibitors (Seligiline)

A

insomnia and confusion

156
Q

name the 4 dopamine agonist drugs

A

iproapomorphine
bromocriptine
pramipexole
ropinirole

157
Q

prophylaxis antibiotics for meningococcal meningitis

A

rifampin and cipro

158
Q

patients with liver dysfunction who receive a blood transfusion are likely to experience what and why

A

hypocalcemia, because citrate is in the transfused blood and normal liver people usually clear this but it accumulates in liver failure patients and binds calcium, depleting it

159
Q

substances that can chelate calcium in the blood

A

foscarnet
lactate
EDTA

160
Q

how can hyperventilation cause hypocalcemia

A

because respiratory alkalosis occurs causing more free calcium to bind to albumin, decreasing the amount of ionized calcium in the body

161
Q

when treating severe preeclampsia and eclampsia with the infusion of magnesium what UDE can occur

A

hypocalcemia recuasse high Mg2+ inhibits parathyroid hormone

162
Q

tx for CAP inpatient

A
  1. floroquinolones (moxifloxacin)
    or
  2. ceftriaxone + azithromycin
163
Q

tx for CAP outpatient

A
  1. Macrolide (azithromyicin) or Doxocycline
    or
  2. Floroquinolone (moxifloxacin) or beta lactam (ceftriaxone) + macrolide
164
Q

tx of CAP ICU

A
  1. beta latam (ceftriaxone) + macrolide (azithromycin)
    or
  2. beta lactam + floroquinolone (moxiflixacin)
165
Q

lab findings for pagets disease of the bone include

A

high alk phos
high urine hydroxyproline
normal calcium and phosphorus

166
Q

what is the first line of treatment for a patient with arterial occlusion of an extremity due to AF

A

IV infusion of heparin immediately

167
Q

what are the 6 P’s associated with arterial occlusion of extremities

A 
Pulselesness
Pallor
Poikilothermia (cool)
Pain
Paralysis 
Parathesia
168
Q

what does leukocyte esterase signify in the urine

A

pyuria

169
Q

what does nitrates signify in the urine

A

E. Coli species

170
Q

because urine dipstick test have a lot of false negatives, what test should be followed after a negative dipstick in a patient that is suspected to have a UTI

A

urine culture

171
Q

what is the most common cause of an isolated asymptomatic elevation in alkaline phosphatase

A

Pagets disease of the bone

172
Q

small cell carcinoma of the lung has an increase in what hormone

A

ACTH

173
Q

squamous cell carcinoma of the lung has an increase in what

A

calcium

174
Q

preferred first line medication for fibromyalgia

A

amitriptyline (TCA)

175
Q

what test should be ordered for a patient who has erythema nodosum (painful red nodules on the lower leg)

A

chest x ray to rule out sarcodosis

176
Q

what are the two different medications that can be given to lower ammonia levels in patients with hepatic encephalopathy

A

lactulose and rifaximin

177
Q

what drug do you give to people with HE who cannot respond to lactulose or rifaxmin

A

neomycin

178
Q

what does hypomagneisum do to PTH

A

it decreases it and causes hypocalcemia

179
Q

main side effects of azathoprine

A

diarrhea
leukopenia
hepatotoxicity

180
Q

side effects of mycophenolate

A

bone marrow suppression

181
Q

side effect the sets cyclosporine apart from other immunosuppressants

A

gingival hyperplasia and hirtuism

182
Q

AV conduction block in the presence of infective endocarditis is usually due to

A

Perivalvular abscess

183
Q

What is the best treatment to quickly stop cluster headache without causing side effects

A

100% oxygen

184
Q

What are the contraindication of treating cluster headache with sumatriptan

A

Ischemic heart disease and pregnancy

185
Q

What medications should be started soon after first attack of cluster headache to act as prophylaxis

A

Verapamil and lithium

186
Q

What is the treatment for trigeminal neuralgia

A

Carbamazepine

187
Q

Dihydroergotamine is used to treat!

A

Pulsation Migrane headaches

188
Q

Tx for tension headache

A

NSAID

189
Q

What is a good treatment for central retinal artery occlusion as a way to move embolism and increase outflow of aqueous humor

A

Orbital massage

190
Q

Is family consent needed to discontinue mechanical ventilation in a brain dead person

A

No

191
Q

What is the most common extraintestinal manifestation of UC

A

Arthritis

192
Q

What is the treatment for cutaneous larva migrans (hookworm in soil)

A

Ivermectin

193
Q

A red papule on the inside of someone’s thigh that has central clearing and could turn into a necrotic Eschar is what kind of lesion

A

Brown recluse spider bite

194
Q

What drug causes bronchodilator in severe life threatening asthma attakcsb

A

Iv magnesium sulfate

195
Q

What is the PDE inhibitor with anti inflammatory properties that helps decreases mucocilary malfunction and pulmonary remodeling

A

Roflumilast

196
Q

Infectious epiglottis is due to

A

H.Influenza type b

197
Q

How to tell Ludwig angina from epiglottitis

A

Elevation of the floor of the Oropharynx is seen in Ludwig

198
Q

Common side effect of methylprednisone

A

Leukocytosis with neutrophile predominance

199
Q

Serum chromogranin A is a marker for

A

Neuroendocrine tumors

200
Q

What is in the triple therapy treatment for h pylori

A

Ppi
Amoxicillin
Clarithromycin

201
Q

Gastric levels >1000 is a sign of

A

ZES

202
Q

Suspected ZES with normal gastric levels should be evaluated by

A

Secretin stimulation test

203
Q

Mean=median=mode is

A

Normal distribution

204
Q

Two main diseases that present with Charcot joint

A

Diabetes

B12 def

205
Q

Autoantibodies to hemidesmosomes

A

Bullous pemphigoid

206
Q

Treatment for bullous pemphigoid

A

Topical steroid “clobetasol

207
Q

What disease is associated with a false positive VDRL, prolonged PTT and thrombocytopenia and repeated miscarriages

A

Antiphospholipid antibody syndrome

208
Q

antimuscarinc drug used to increase detrusor muscle function and avoid leak incontincenve

A

oxybutinin

209
Q

what is the process that causes pseudo gout

A

the release of calcium pyrophosphate dehydrate crystals from chondrocalcinosis joints ( calcification of the articular cartilage)

210
Q

rhomboid-shaped postiive birefringent crystals is

A

pseudo gout

211
Q

needle shaped negatively birefringent crystals

A

gout

212
Q

why do people with CKD have bleeding from IV sites

A

because of uremic coagulopathy which is the dysfunction of the platelets in the patient due to uremia amount this is usually lessened with the use dialysis

213
Q

what two medications can cause an exacerbation of pehochromocytoma symptoms

A

anesthesia and beta blockers

214
Q

patients with disseminated histoplasmosis are first treated with _______ and then after 1-2 weeks the treatment changes too______?

A

amphotericin B

Itraconazole

215
Q

name of the prothrombic immunoglobulin that causes increases PTT and is associated SLE

A

antiphospholipid AB

216
Q

pneumocystis isn’t seen in HIV patients until the CD4 drops below ____?

A

200

217
Q

even though oral doxycycline treats Lyme disease what treats early and late lyme disease

A

ceftriaxone

218
Q

how to treat pregnant women and children with lyme disease since they cannot have doxycycline

A

ampicillin

219
Q

the greater the prevalence, the greater the ____?

A

PPV

220
Q

three things you should look for in someone who presents with pseudo gout

A

hemochromatosis
hyperparathyroidism
hypothyroidism

221
Q

UDE of furosemide

A

OTOTOXIC (hearing loss)

222
Q

HCTZ side effects

A

photosensitivity

orthostatic hypotension

223
Q

an aute inflammation of the GB without any stones that mainly happens to patients in hospitals who are critically ill is called

A

Acalculous Cholecysitis

224
Q

dilated submucosal veins and atriovenous malformations that have painless bleeding on the right side of the colon that is highly associated with aortic stenosis is called

A

angiodysplasia of the colon

225
Q

what can PEEP cause in the setting of decreased central venous pressure ( hypovolemic shock)

A

it causes an increase in intrathoracic pressure which can compress the IVC and this can cause decreased preload to the right side of the heart, decreasing cardiac output and leading to cardiac arrest

226
Q

infants who have viral meningitis usually are infected with what viruses

A

echovirus

cocksackie virus

227
Q

what is the most common cause of bacterial meningitis

A

S. Pneumonia

228
Q

what is the most common cause of death in dialysis patients

A

cardiovascular disease

229
Q

acute limb ischemia that is due to systemic embolism from the hear requires the work up of vascular surgery consult, immediate anticoagulation and ___?

A

transthorasic ECHO!

230
Q 
name the events that these medications counter in HIV patients:
Acyclovir
Albendazole
Ganciclovir
TMP-SMX
Azithromyicn
Fluconazole 
Isoniazid
A
  1. HSV encephalopathy
  2. Neurocysterciosis
  3. CMV
  4. P. Jirovecci and Toxoplasma (CD4<100)
  5. MAC (CD4<50)
  6. Cocciodydies
  7. TB
231
Q

what contains vitamin K clotting factors and offers a RAPID referral of warfarin effects

A

Prothrombin Complex Concentrate

232
Q

why should you avoid LP in people with intracranial hemorrhage?

A

because there is a risk of causing herniation because of the increased ICP

233
Q

what is the medication that cause reversal of HEparin

A

protamine sulfate

234
Q

tranexemic acid is used for?

A

the treatment of heavy menstrual bleeding and to prevent bleeding in surgery

235
Q

fixed splitting of S2 is seen in

A

ASD

236
Q

pulses parvus (decreased pulse amplitude) and tardus (delayed pulse upstroke) is related to

A

AS

237
Q

what is cerebellar degeneration from excessive alcohol consumption caused by

A

degeneration of the purkinje cells by alcohol in the cerebellar vermis

238
Q

workers who work with antique woods get what kind of positing

A

arsenic

239
Q

hypopigmentation/ hyper pigmentation of the skin occurs when in arsenic poisoning and hyperkeratosis of the plasma and soles occurs when?

A

early

late

240
Q

cancer related anorexic patients who need to eat benefit from what medical treatment

A

progestogen analogies (megestrol acetate) or corticosteroids

241
Q

nonalcoholic fatty liver disease can be due to

A

insulin resistance which makes the liver have to take up fatty acids instead of glucose and this causes the liver to go through oxidative stress and produce inflammatory cytokines

242
Q

How to be able to tell that a patient is having a ventricular aneurysm after MI

A

persistent ST segment elevation with DEEEP Q waves

243
Q

papillary muscle rupture after MI occurs after how many days

A

2-7

244
Q

patients with HIV that have significant pain with swallowing but no difficulty swallowing and no thrush have what kind of esophagitis

A

viral esophagitis

245
Q

name some medications that can cause “pill esophagitis”

A

bisphosphanates
NSAIDS
tetracyclines
potassium chloride

246
Q

circular or ovoid vesicular lesions in the esophagus of HIV person

A

HSV esophagitis

247
Q

linear distal and large esophageal ulcers in a patient with HIV

A

CMV esophagitis

248
Q

3 D’s of Pellagra

A

dementia
diarrhea
dermatitis

249
Q

naicin can be made by…

A

tryptophan

250
Q

pellagra can be seen in what two diseases and why

A 
Carcinoid Syndrome (depletion of tryptophan)
Hartnup Disease (congenital tryptophan absoprtion problem)
251
Q

long term treatment of what drug can lead to interference of the metabolism of tryptophan causing Pellagra

A

isoniazid

252
Q

what is the difference between two sample z test and tw sample t test

A

z test compares two populations and t test compares two means

253
Q

a patient with painless muscle weakness associated with weight gain, bone loss, HTN and hirtuism is consistent with what disease

A

hypercortisolism (Cushing Disease)

254
Q

describe how cushing syndrome causes is muscle problems

A

cortisol directly affects the muscles causing muscle atrophy

255
Q

what is the treatment for E. Hystolitica (Amebiasis of the liver)

A

metronidazole to treat the abscess and paromomycin to treat the intestinal colonization

256
Q

what is proximla muscle weakness

A

climbing stairs
getting up from a chair or in and out of care
working with arms over head (combing hair)

257
Q

proximal muscle weakness,dysphagia, elevated CK and patient in her 40-50s is?

A

polymyositis

258
Q

anti-Jo-1 AB are seen in

A

polymyositis

259
Q

patients with polymyositis should be screened for

A

cancer because this is a paraneoplastic syndrome

260
Q

beta interferon is used to treat?

A

MS

261
Q

pyridostogmine is used to treat?

A

myasthenia gravis

262
Q

cyclobenzaprine is used to treat?

A

muscle spasms associated with lumbar pain

263
Q

tx for polymysitis

A

glucocorticoids

264
Q

treatment for toxic megacolon

A

steroids

265
Q

women with von Willebrand disease have what main UDE

A

menorrhagia

266
Q

intial tx for hyperthyroidism

A

B Blocker

267
Q

how can people with hyperthyroidism end up with hypercalcuria (calcium in the urine/calcium wasting)

A

because hyperthyroidism causes increased osteoclastic activity and bone remodeling so calcium is released into the system which turns off PTH and turns of the absorption of calcium from the gut, this leads to increased excretion of calcium by the kidneys (trying to fix the high calcium level) and low serum calcium

268
Q

berry anyerusim in the PCA cause what signs

A

compression of the occulomoter nerve causing ipsilateral mydriasis, ptosis and down and out deviation of the eye

269
Q

berry anyerism in the ACA causes

A

compression on the optic chiasm and causes bitemporal hemianopia

270
Q

bacteria that commonly cause catheter associated UTI

A

e. Coli
enterococcus
candida
pseudomonas auergionsa

271
Q

holosystolic murmur that increases with inspiration is common of

A

tricuspid involvemnt in inefective endocarditis

272
Q

IV drug users are susceptible to what heart probkem

A

bacterial endocarditis in the right heart

273
Q

S4 sound is heard when

A

in ventricles with decreased compliance (less stretch/ridgid)

274
Q

patients with worsening CHF will have what lung sign

A

bibasilar crackles

275
Q

what is a frequent source of nosebleeds in pregnany

A

pyogenic granulommas which are very vascular and are usually in the anterior nasal septum

276
Q

ventricles in someone with normal pressure hydrocephalus looks like

A

dialated

277
Q

formula for anion gap

A

AG=Na-(HCO3+Cl)

278
Q

normal anion gap is

A

6-12

279
Q

scaly papules or plaques mainly on faired skinned people

A

actinic keratosis

280
Q

actinic keratosis can change into

A

squamous cell carcinoma

281
Q

actinic keratosis occurs beuase of

A

sun exposure

282
Q

treatment of actinic keratosis

A

cryotherapy

283
Q

scaly, oily, eryhtematous rash that affects the skinfolds around the nosem eyebrows, ears and scalp is

A

seborrheic dermatitis

284
Q

benign pigmented lesion with a well demarcated border and velvety /appearance or greasy surface “stuck on” is

A

seborrheic keratois

285
Q

how to diagnose fibromuscular dysplasia

A

CT angiography of the abdomen or duplex US

286
Q

how does high aldosterone affect renin?

A

it decreases it with negative feedback, the point of renin is to increase BP so if there is alot of aldo, one can assume there is more fluid in the body becuase with salt comes water

287
Q

first line treatment for DM

A

metformin

288
Q

what to remember about sulfonyureas

A

second drug added if metofrmin assent working

weight gain and hypoglycemia are the main side effects

289
Q

diabetic drug that can be used in renal insufficiency

A

TDZ

290
Q

side effects of TDZ

A

weight gain
CHF
broken bones
edema

291
Q

when to use TDz

A

only if the patient cannot tolerate metformin or sulonyureas

292
Q

diabetic drug that is a good second agent to metformin and is great for WEIGHT LOSS

A

GLP1-Agonist (exenatide and liragulitide)

293
Q

there is an increased risk of what with the use of floroquinolones

A

tendon rupture or retinopathy

294
Q

most common predisposing factor to aortic dissection

A

systemin HTN

295
Q

common heart complication in marfnas

A

aortic dissection

296
Q

low CO, low BP, high PCWP, High SVR are associated with what kind of shock

A

cariogenic

297
Q

patients with cirrhosis and vatical bleeding should be given what two prophylactic drugs

A

antibiotics ( to prevent spontaneous bacterial peritonitis)

octreotide ( to reduce vatical hemorrhage)

298
Q

what is treatment for diabetic retinopathy

A

Argon lasar photocoagulation

299
Q

visual impairment in diabetes is due to

A

macular edema

300
Q

treatment for essential tremors

A

beta blockers

301
Q

essential tremors are usually

A

bilateral

302
Q

TB is a common cause of what disease

A

adrenal insufficiency

303
Q

where are RBCs destroyed in extravascular hemolysis

A

the spleen or LN this is why haptoglobin is normal levels and LDH is only slightly increased

304
Q

what is the initial treatment for hypovolemic hypernatremia

A

saline (0.9%)

305
Q

5% dextrose is the treatment for what

A

hypervolemic hypernatremic patients

306
Q

mild cases of hypovolemic hypernatremia is

A

5% dextrose in 0.45% saline

307
Q

how long can delirium due to bath salts last

A

days to weeks

308
Q

applying an ice pack to an eye with ptosis and it improving for several minuets is a sign of

A

myasthenia gravis

309
Q

how does an ice pack improve ptsosi in MG

A

the cold helps to stop the breakdown of Ach in the NMJ

310
Q

what kind of medication is chlordiazepoxide?

A

it is a benzodiazepine that treats alcohol withdrawal

311
Q

tracheal narrowing ais very characteristic of nd ulceration

A

granulomatosis with polyangitis

312
Q

miners and stone workers get what lung disease

A

sillicosis

313
Q

what is the systemic vasculitis that is characterized by upper and lower respiratory tract granulomatous inflammation and glomerulonephritis

A

granulomatosis with polyangitis

314
Q

first treatment for patients with hyperglycemic hyperosmolar nonketotic syndrome

A

aggressive infusion with normal saline because severe hyperglycemia causes osmotic diuresis causing the body to lose 8-10L of fluid.

315
Q

methamphetamines is associated with what change to the heart

A

cardiomyopathy

316
Q

what medication is used for severe left ventricular systolic dysfunction and cariogenic shock

A

dobutamine ( B1 agonist)

317
Q

in patients with obesity hypoventilation syndrome what is the result

A

chronic hypoxia and hypercapnia because the weight of the thoracic cavity won’t allow for good breathing. So the kidneys increase the amount of BICARB retention and decrease the reabsorption of chloride, leading to a metabolic alkalosis

318
Q

signs of BB overdose

A

wheezing
bradycardia
AV block
hypotension

319
Q

what medication has been successful in treating CCB and BB overdose because it increases cAMP

A

glucagon

320
Q

elevated opening pressure, low glucose, high protein, and low WBC suggests?

A

cryptococcal meningoencephalitis

321
Q

what heart murmur is associated with pacemaker placement

A

TR

322
Q

what kind of gifts can be accepted by pharmaceutical companies by physicians

A

non monetary small gifts of small value that benefit the patients (samples)

323
Q

main treatment for actinomycetes

A

penicillin 2-6 months

324
Q

treatment for Nocardia

A

TMP-SMX

325
Q

what medication breaks further breakdown of ethylene glycol

A

fomepizole or giving ethanol to distract ADH

326
Q

why does ethylene glycol ingestion cause flank pain

A

because it causes hypocalcemia and calcium oxalate crystal formation

327
Q

blastymicosis causes what on the skin

A

wart like lesions and skin ulcers

328
Q

when suspecting IE what is the next best step

A

get bacterial blood cultures

329
Q

a 50% drop in platelets and or a new thrombus in the 5-10 days after starting heparin makes you think

A

heparin induced thrombocytopenia

330
Q

what is the first medical treatment for pseudo tumor cerebra

A

aetozolamide (decreases CSF production)

331
Q

what test confirms the diagnosis of chlaymdial infection

A

nucleic acid amplification test

332
Q

treatment of choice for MG

A

pyridostigmine (ACHE INHIBTOR)

333
Q

patients who have longstanding RA, neutropenia and spleenomgaly have

A

felty syndrome

334
Q

treatment for TCA overdose

A

sodium bicarbonate

335
Q

what kind of drug is hydroxyzine

A

it is a antihistamine

336
Q

Lamotrigine is what kind of drug

A

anticonvulsant

337
Q

histoplasmosis mimics what disease

A

sarcordosis

338
Q

what should be considered in a patient who deteriorates after immunosuppressive therapy (therapy) who is thought to have sarcordiosis

A

histoplasmosis

339
Q

fungal disease that is found in rotting wood and soil and happens to immunocompromised patients and causes skin lesions, osteolytic bone lesions and may involve the prostate

A

blastomyces

340
Q

what is the most common cause of sudden death in people with MI

A

VFib

341
Q

how should patients with Vfib and pulsless VTach be managed

A

immediate defibrillation to restore heart perfusion

342
Q

if defibrillation doesn’t work for Vfib or Vtach then what do you do

A

give amiodarone or lidocaine if amiodarone is not available

343
Q 
patients with 
- atrial fib
- atrial flutter
- Vtach with pulse 
should be managed how
A

with synchronized cardio version

344
Q

an older patient with severe lymphocytosis ( high WBCs) hepatosplenomegaly, lymphadenopathy and anemia and thrombocytopenia is suggestive of

A

CLL

345
Q

how os CLL diagnosed

A

flow cytometry

346
Q

JAK 2 mutations is associated with what disease

A

myeloproliferative disease (polycythemia vera)

347
Q

what joint is most affected in psoriatic arthritis

A

distal interphalangeal joints

348
Q

neuropathic arthropathy (Charcot joint) in the lower limbs is associated with

A

syphillis
diabetes
alcoholism

349
Q

what is the med to treat pneumocystis pneumonia if the patient can’t take TMP SMX

A

pentmide

350
Q

tx for polycythemia vera

A

phlebotomy

(Asope) STEP 2 (8 decks)

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