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)
2
Q
how to treat nonexertional heat stroke
A
evaporative cooling, do not do ice water immersion this can kill the patient
3
Q
t wave inversion can be a sign of what
A
left ventricular hypertrophy
or ischemia
4
Q
what is a weird finding that one can see with coarctation of the aorta
A
epistaxis
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
6
Q
what are the first steps in curing sleep apnea
A
- weight loss
- avoidance of sedative and alcohol
- coaching px to not sleep in supine position
7
Q
polysomnogrophy is ?
A
sleep stay test
8
Q
definition of hazard ratio
A
chances that an event is more likely to occur in treatment group instead of control group
9
Q
definition of hazard rate
A
chances of an event occurring in one study group during a set period
10
Q
hazard ratio <1
A
indicates that the event is more likely to occur in control group
11
Q
hazard ratio >1
A
event is more likely to occur in treatment group
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
13
Q
management for both conus medularis and CES
A
- MRI
- IV glucocorticoids
- neurological evaluation
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)
15
Q
where is the location of the aortic stenosis murmur
A
right 2nd intercostal space
carotid radiation will be present
16
Q
formula for anion gap
A
AG= sodium - (chloride + bicarb)
normal: 10-14
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
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
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
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
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
22
Q
Takotsubo in Japanese means
A
octopus pot
23
Q
what is refeeding syndrome characterized by
A
hypophosphatemia px can present with: - edema - seizure - heart failure
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
25
acute rejection of organs is best treated with what
IV steroids
26
name some causes of post-op transplant rejection
```
cyclosporine toxicity
urethral obstruction
acute rejection
vascular obstruction
acute tubular necrosis
```
27
digitalis toxicity will show what on ECG
atrial tachycardia with AV block
28
someone with diffuse axonal injury like after a car accident will show what in CT
numerous punctuate hemorrhages with blurring of the grey and white matter interface
29
what is the more sensitive test for diagnosing diffuse axonal injury, MRI or CT?
MRI
30
what is Lhermitte sign?
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)
31
uhthoff phenomena?
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
32
first step to diagnose MS patients
MRI of the brain and spine to rule in (T2 weighted)
33
second line way to diagnose MS
LP to detect oligoclonal IgG bands in the CSF
34
what is it called when HTN, bradycardia and respiratory depression are seen in the case of intracranial HTN
Cushing Reflex (marks brainstem compression)
35
leukemia reaction occurs in response to
severe infection
36
what does leukemia reaction present with to help differentiate it from CML
- high alkaline phosphatase level
- metamyelocytes>myelocyts
- lack of absolute basophilia
- leukocyte count <100,000
37
diagnosis of adrenal insufficiency should include what two things
8am serum cortisol test
| ACTH stimulation test
38
what is enthestis
tenderness where the ligament and tendon attach to the bone (common in Achilles) seen in Ankylosing Spondylitis
39
molluscum contagiosum is caused by what virus
pox virus
40
what are scrotal varicoceles a clue to in a male patient who is experiencing blood in urine and fatigue
renal cell carcinoma
41
WHTA IS the triad of renal cell carcinoma
flank pain
palpable abdominal mass
hematuria
42
a varicocele that fails to empty when the patient is recumbent is a good sign of
RCC; the tumor is blocking where the gonadal vein meets the renal vein
43
after pain reduction what is the first treatment of choice for Aortic dissection
beta blocker
44
3 steps to aortic dissection management
1. dec. LV contractility
2. Dec. systolic BP to 100-120
3. ain reduction
45
treatment for de Quarvian thyroiditis
B Blocker and NSAIDS
46
1st line therapy for BPH
alpha blockers
| tamulosin and terazosin
47
valproic acid a common antisezuire med can cause?
acute pancreatitis
48
rupture of a popliteal cyst can cause pain being the knee and in the calf and can resemble the pain of?
venous thrombosis
49
what is the first line AB to check for SLE
ANA
50
what is the 2nd AB to test for SLE
anti double stranded and anti smith
51
pharmacological vasodilator stress testing (adenosine) causes a marked increased in blood flow in what arteries
In the normal vessels and there is a decreases in the diseased vessels
52
Vasospastic angina typically occurs at what time of the day
Night
53
What will ECG show during vasospastic angina episode
ST Elevation
54
First line treatment for vasospastic angina
CCB to open up e vessels
55
What medication is given to people with vasospastic angina to limit myocardial ischemia once an episode occurs
Sublingual NO
56
Why should you not give someone aspirin if they have vasospastic angina
Because it can inhibit prostacyclin production and worsen vasospasm
57
What is cilostazol
Phosphdiesterase three inhibitor that treats intermittent claudication
58
What does Ranolazone treat
Stable angina by decreasing the calcium in the heart by inhibiting the late phase sodium influx into dead heart cells
59
Patients who you suspect to have HTN should get what initial lab work?
UA-hematuria?
Chemistry panel
Lipid profile
Baseline ECG
60
Because of the side effects of amiodarone, a patient on this drug should always have what tests dons
Pulmonary function
| Thyroid tests
61
How does mesenteric ischemia present
Severe periumbilical abdominal pain
62
Name four drugs that can increases the amount of digoxin
Amiodarone
Propefenone
Verapimil
Quinidine
63
What is the presentation of acute digoxin toxicity
Anorexia
Nausea
Vomiting
Abdominal pain
64
Chronic digoxin toxicity looks like
Changes in color vision
Scotomas
Blind
65
What are Hodgkin survivors at ris for
```
Cardiac disease (constrictive pericarditis) due to radiation therapy in the mediastinum
Can present 10-20 years later
```
66
What is the initial therapy to control heart rate and hyperadrenergic symptoms
Beta blocker
67
Why is propranolol good to use in hyperthyroid patients
Decreases the conversion of T4 to T3
68
What heart problem is adenosine used to treat because of its short action
Supra ventricular tachycardia in whom diagnosis is unclear
69
What is situational (postmicturition) syncope?
It is a reflex syncope that is associated with triggers like peeing pooping or coughing all due to cardioinhibitory and vasodepressor response
70
Genetic inheritance of hypertrophic cardiomyopathy
AD
71
What are the genetic mutations seen in HCm
Cardiac myosin binding protein c gene
| Cardiac beta myosin heavy chain gene
72
What is the difference between acute atriel occlusion in the left and venous thrombosis
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
73
What do you pair ccb with to stop peripheral edema in the legs from happening
Acei
74
What cardiac abnormality can Lyme disease cause
AV BLOCK
75
An increase in LV size bringing the apex closer to the chest wall when the patient lays on their side is associated with
Aortic regurgitation
76
Common causes of AR in America
Aortic root dilation
| Congenital bicuspid valve
77
What specifically causes the water hammer pulse in aortic regurgitation
Wide pulse pressure ( large systolic, low diastolic)
78
what do pregnant mothers in their last trimester need to receive and why
they need vitamin K supplementation because phenytoin depletes the vitamin K in the fetus
79
what do you give to treat warfarin induced skin necrosis
concentrated protein C
80
how to diagnose pertussis
PCR of the nasopharynx
81
treatment for cat bites
amoxicillin/clavulante
82
first line treatment for RLS
dopamine (pramipexole)
83
Treatment for scute bacterial prostatis
TMP-SMX
| FLOROQUINOLONES (levofloxacin, ciprofloxacin)
84
Treatment for chronic prostatitis
FLOROQUINOLONES
85
myalgia, proximal muscle weakness and elevated CK seen in a patient?
hypothyroid myopathy
86
people who start taking OCP estrogen pills and who have hypothyroidism experience what?
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
87
what is the treatment called that lasers the gallstones in the gall bladder for people who cannot tolerate surgery
lithotripsy
88
drug treatment for dermatitis herpetiformis
dapsone
89
drug treatment for severe legionella pneumonia
floroquinolones (levofloxacin)
90
three cancers seen in Lynch syndrome
colorectal
endometrial
ovarian
91
three cancers seen in familial adenomatous polyposis
colorectal
demoed and osteomas
brian tumors
92
three cancers seen in von hippie landau
hemanigioblastoma
clear cell renal carcinoma
pheochromocytoma
93
how does IV acyclovir cause AKI
it is not soluble in the urine so it forms crystals and this blocks the renal tubules
94
how to treat emergent central artery occlusion of the eye
massage the eye and give high dose O2
95
pleural ph is usually
7.6
96
exudative fluid in pleura will have a ph of
7.3-7.4
97
transudative fluid in the pleura will have a ph of
7.4-7.55
98
when can you give the hPV shot up to in women? in men?
26
| 21`
99
gram stain with many neutrophils but no organism seen and hyponatremia, g.i. symptoms seen in the patient is suggestive of what bacteria
legionella
100
describe pseudodementia
this is when older patients who are depressed start forgetting things
101
up to 40% of patients with polycythemia vera have
gout
102
Polycythemia vera is characterized by what
increased cell turnover because of hyperproliferatino of all cell lines
103
what do you give to treat hyponatremia due to Addison disease
iv hydrocortisone
104
describe the pathogenesis of aspirin exacerbate respiratory distress
there is an increase production of leukotrienes because aspirin shuts of the prostaglandin pathway.
105
wat is the medication used to treat benzo overdose
flumazinil
106
hematuria that begins five days after an URI or pharyngeal illness is associated with what disease
IgA Nephropathy
107
what is one of the first signs of macular degeneration
distortion of straight lines making them appear wavy
108
when do you do a urine culture on someone with a UTI
if initial treatment fails
109
what is the nerve that gives general sensation over the face
trigeminal (V)
110
Most common cause of COPD EXACERBATION
URI
111
What is the first way to treat drug induced interstitial nephritis
Stop the offending drug
112
lesions in the CNS above the pons to the CN 7 can result in?
heminaesthesia ( cannot feel one side)
hemiparesis ( cannot move one side)
dysarthria (slurred or slow speech) `
113
peripheral neuropathy of CN 7 (lesions below the pons) can result in what symptoms
inability to raise eyebrow on affected side
drooping of the mouth
disappearance of the nasolabial fold
114
someone who has prostatitis and is being treated but still has a fever despite treatments means that they probably have what
prostatic abscess (Do pelvic CT to see)
115
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
methotrexate ( UDE is macrocytic anemia)
| - a more serious UDE is pancytopenia
116
how does methotrexate work
inhibits dihydrofolate reductase
117
why add folic acid to treatment regimens using methotrexate
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
118
what is the anti RA drug that causes side effects of hemolysis in G6PD people, GI problems and visual disturbances
HYdroxychloroquine
119
osteonecrosis of the femoral head that is worsened with activity (weight bearing) in people with SLE on steroids is what disease
avascular necrosis
120
most sensitive test for vascular necrosis in the beginning
MRI
121
survival benefits from using home oxygen are significant when it is used for more then how many hours a day
15
122
SaO2 of home O2 should be kept at what percent during sleep, walking and normal life
90%
123
hodgkin lymphoma occurs in younger people and those who are treated with chemo before the age of 30 are likely to develop
secondary malignancies
124
first line treatment for RA
methotrexate
125
patients who do not respond to methotrexate after 6 months should be switched to
TNF alpha inhibitor (eternacept or infliximab )
126
what is the common screening test for multiple myeloma that detects M spike
plasma electrophoresis
127
the following symptoms are indicative of :
back pain
older man
osteolytic lesions in the bone
Multiple Myeloma
128
explain mixed cryoglobulinemia syndrome
when there is deposition of immune complexes in small and medium vessels leading to vessel damage and end organ damage.
129
how does mixed cryoglobulinemia present
- non blanching palpable purpura
- arthralgias
- renal disease
- liver involvement (elevated transaminases)
130
what are the two conditions that mixed cryoglobunimeia are associated with
HCV and SLE
131
why do patients with obstructive sleep apnea have increased hematocrit
because their hypoxic episodes at night causes the kidneys to stimulate EPO and increase the RBC count
132
relative polycythemia is due to?
reduced plasma volume
133
absolute polycythemia is due to
increased RBC mass
134
main symptom difference between EBV mono and IM like syndrome from CMV
IM Like syndrome from EMV won't have pharyngitis
135
what is the main pathophysiologic mechanism behind vitamin B12 deficiency
impaired DNA synthesis (purines-thymidine) can't be made
136
premature atrial contractions are what kind of arrhythmia
benign
137
cholesterol embolism can occur after cardiac cath and causes
livido reticular in the legs and pancreatitis
138
patient with HTN and undetectable renin system has
primary hyperaldosteronism
139
why does the renin system not work in primary hyperaldosteronism
because of feedback inhibition
140
the hypokalemia seen in primary hyperaldosteronism can be worsened with the use of what drugs
diuretics
141
never use what asthma medicine alone
LABA always use with ICS
142
common cause of secondary baceteriL Pneumonia after viral infection
S Aureus
143
TG >1000 can cause acute pancreatitis and what skin problem
eruptive xanthomas
144
describe the symptoms of trichinellosis
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
3. myositis
4. splinter hemorrhages
145
what is the treatment for aspergillus
voriconazole and capsofungin
146
CT scan of aspergillus shows
ground glass nodules
147
nonseminomatous germ cell tumors produce what markers
b-HCG and AFP
148
when do you stop giving mammograms patients
after the age of 70
149
how should patients with right ventricular MI be managed and why?
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
what medication do you want to avoid giving to someone with Right Ventricular MI
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
what is the early side effect of levodopa and carbidopa
hallucinations
152
long term side effects of levodopa and carbidopa
choreiform dyskinesia
153
what are the UDE of amantidine
livedo reticularis
154
UDE of COMT inhibitors (entacopone and tolcapone)
Dyskinesia
155
UDE of MAO B Inhibitors (Seligiline)
insomnia and confusion
156
name the 4 dopamine agonist drugs
iproapomorphine
bromocriptine
pramipexole
ropinirole
157
prophylaxis antibiotics for meningococcal meningitis
rifampin and cipro
158
patients with liver dysfunction who receive a blood transfusion are likely to experience what and why
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
substances that can chelate calcium in the blood
foscarnet
lactate
EDTA
160
how can hyperventilation cause hypocalcemia
because respiratory alkalosis occurs causing more free calcium to bind to albumin, decreasing the amount of ionized calcium in the body
161
when treating severe preeclampsia and eclampsia with the infusion of magnesium what UDE can occur
hypocalcemia recuasse high Mg2+ inhibits parathyroid hormone
162
tx for CAP inpatient
1. floroquinolones (moxifloxacin)
or
2. ceftriaxone + azithromycin
163
tx for CAP outpatient
1. Macrolide (azithromyicin) or Doxocycline
or
2. Floroquinolone (moxifloxacin) or beta lactam (ceftriaxone) + macrolide
164
tx of CAP ICU
1. beta latam (ceftriaxone) + macrolide (azithromycin)
or
2. beta lactam + floroquinolone (moxiflixacin)
165
lab findings for pagets disease of the bone include
high alk phos
high urine hydroxyproline
normal calcium and phosphorus
166
what is the first line of treatment for a patient with arterial occlusion of an extremity due to AF
IV infusion of heparin immediately
167
what are the 6 P's associated with arterial occlusion of extremities
```
Pulselesness
Pallor
Poikilothermia (cool)
Pain
Paralysis
Parathesia
```
168
what does leukocyte esterase signify in the urine
pyuria
169
what does nitrates signify in the urine
E. Coli species
170
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
urine culture
171
what is the most common cause of an isolated asymptomatic elevation in alkaline phosphatase
Pagets disease of the bone
172
small cell carcinoma of the lung has an increase in what hormone
ACTH
173
squamous cell carcinoma of the lung has an increase in what
calcium
174
preferred first line medication for fibromyalgia
amitriptyline (TCA)
175
what test should be ordered for a patient who has erythema nodosum (painful red nodules on the lower leg)
chest x ray to rule out sarcodosis
176
what are the two different medications that can be given to lower ammonia levels in patients with hepatic encephalopathy
lactulose and rifaximin
177
what drug do you give to people with HE who cannot respond to lactulose or rifaxmin
neomycin
178
what does hypomagneisum do to PTH
it decreases it and causes hypocalcemia
179
main side effects of azathoprine
diarrhea
leukopenia
hepatotoxicity
180
side effects of mycophenolate
bone marrow suppression
181
side effect the sets cyclosporine apart from other immunosuppressants
gingival hyperplasia and hirtuism
182
AV conduction block in the presence of infective endocarditis is usually due to
Perivalvular abscess
183
What is the best treatment to quickly stop cluster headache without causing side effects
100% oxygen
184
What are the contraindication of treating cluster headache with sumatriptan
Ischemic heart disease and pregnancy
185
What medications should be started soon after first attack of cluster headache to act as prophylaxis
Verapamil and lithium
186
What is the treatment for trigeminal neuralgia
Carbamazepine
187
Dihydroergotamine is used to treat!
Pulsation Migrane headaches
188
Tx for tension headache
NSAID
189
What is a good treatment for central retinal artery occlusion as a way to move embolism and increase outflow of aqueous humor
Orbital massage
190
Is family consent needed to discontinue mechanical ventilation in a brain dead person
No
191
What is the most common extraintestinal manifestation of UC
Arthritis
192
What is the treatment for cutaneous larva migrans (hookworm in soil)
Ivermectin
193
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
Brown recluse spider bite
194
What drug causes bronchodilator in severe life threatening asthma attakcsb
Iv magnesium sulfate
195
What is the PDE inhibitor with anti inflammatory properties that helps decreases mucocilary malfunction and pulmonary remodeling
Roflumilast
196
Infectious epiglottis is due to
H.Influenza type b
197
How to tell Ludwig angina from epiglottitis
Elevation of the floor of the Oropharynx is seen in Ludwig
198
Common side effect of methylprednisone
Leukocytosis with neutrophile predominance
199
Serum chromogranin A is a marker for
Neuroendocrine tumors
200
What is in the triple therapy treatment for h pylori
Ppi
Amoxicillin
Clarithromycin
201
Gastric levels >1000 is a sign of
ZES
202
Suspected ZES with normal gastric levels should be evaluated by
Secretin stimulation test
203
Mean=median=mode is
Normal distribution
204
Two main diseases that present with Charcot joint
Diabetes
| B12 def
205
Autoantibodies to hemidesmosomes
Bullous pemphigoid
206
Treatment for bullous pemphigoid
Topical steroid "clobetasol
207
What disease is associated with a false positive VDRL, prolonged PTT and thrombocytopenia and repeated miscarriages
Antiphospholipid antibody syndrome
208
antimuscarinc drug used to increase detrusor muscle function and avoid leak incontincenve
oxybutinin
209
what is the process that causes pseudo gout
the release of calcium pyrophosphate dehydrate crystals from chondrocalcinosis joints ( calcification of the articular cartilage)
210
rhomboid-shaped postiive birefringent crystals is
pseudo gout
211
needle shaped negatively birefringent crystals
gout
212
why do people with CKD have bleeding from IV sites
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
what two medications can cause an exacerbation of pehochromocytoma symptoms
anesthesia and beta blockers
214
patients with disseminated histoplasmosis are first treated with _______ and then after 1-2 weeks the treatment changes too______?
amphotericin B
| Itraconazole
215
name of the prothrombic immunoglobulin that causes increases PTT and is associated SLE
antiphospholipid AB
216
pneumocystis isn't seen in HIV patients until the CD4 drops below ____?
200
217
even though oral doxycycline treats Lyme disease what treats early and late lyme disease
ceftriaxone
218
how to treat pregnant women and children with lyme disease since they cannot have doxycycline
ampicillin
219
the greater the prevalence, the greater the ____?
PPV
220
three things you should look for in someone who presents with pseudo gout
hemochromatosis
hyperparathyroidism
hypothyroidism
221
UDE of furosemide
OTOTOXIC (hearing loss)
222
HCTZ side effects
photosensitivity
| orthostatic hypotension
223
an aute inflammation of the GB without any stones that mainly happens to patients in hospitals who are critically ill is called
Acalculous Cholecysitis
224
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
angiodysplasia of the colon
225
what can PEEP cause in the setting of decreased central venous pressure ( hypovolemic shock)
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
infants who have viral meningitis usually are infected with what viruses
echovirus
| cocksackie virus
227
what is the most common cause of bacterial meningitis
S. Pneumonia
228
what is the most common cause of death in dialysis patients
cardiovascular disease
229
acute limb ischemia that is due to systemic embolism from the hear requires the work up of vascular surgery consult, immediate anticoagulation and ___?
transthorasic ECHO!
230
```
name the events that these medications counter in HIV patients:
Acyclovir
Albendazole
Ganciclovir
TMP-SMX
Azithromyicn
Fluconazole
Isoniazid
```
1. HSV encephalopathy
2. Neurocysterciosis
3. CMV
4. P. Jirovecci and Toxoplasma (CD4<100)
5. MAC (CD4<50)
6. Cocciodydies
7. TB
231
what contains vitamin K clotting factors and offers a RAPID referral of warfarin effects
Prothrombin Complex Concentrate
232
why should you avoid LP in people with intracranial hemorrhage?
because there is a risk of causing herniation because of the increased ICP
233
what is the medication that cause reversal of HEparin
protamine sulfate
234
tranexemic acid is used for?
the treatment of heavy menstrual bleeding and to prevent bleeding in surgery
235
fixed splitting of S2 is seen in
ASD
236
pulses parvus (decreased pulse amplitude) and tardus (delayed pulse upstroke) is related to
AS
237
what is cerebellar degeneration from excessive alcohol consumption caused by
degeneration of the purkinje cells by alcohol in the cerebellar vermis
238
workers who work with antique woods get what kind of positing
arsenic
239
hypopigmentation/ hyper pigmentation of the skin occurs when in arsenic poisoning and hyperkeratosis of the plasma and soles occurs when?
early
| late
240
cancer related anorexic patients who need to eat benefit from what medical treatment
progestogen analogies (megestrol acetate) or corticosteroids
241
nonalcoholic fatty liver disease can be due to
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
How to be able to tell that a patient is having a ventricular aneurysm after MI
persistent ST segment elevation with DEEEP Q waves
243
papillary muscle rupture after MI occurs after how many days
2-7
244
patients with HIV that have significant pain with swallowing but no difficulty swallowing and no thrush have what kind of esophagitis
viral esophagitis
245
name some medications that can cause "pill esophagitis"
bisphosphanates
NSAIDS
tetracyclines
potassium chloride
246
circular or ovoid vesicular lesions in the esophagus of HIV person
HSV esophagitis
247
linear distal and large esophageal ulcers in a patient with HIV
CMV esophagitis
248
3 D's of Pellagra
dementia
diarrhea
dermatitis
249
naicin can be made by...
tryptophan
250
pellagra can be seen in what two diseases and why
```
Carcinoid Syndrome (depletion of tryptophan)
Hartnup Disease (congenital tryptophan absoprtion problem)
```
251
long term treatment of what drug can lead to interference of the metabolism of tryptophan causing Pellagra
isoniazid
252
what is the difference between two sample z test and tw sample t test
z test compares two populations and t test compares two means
253
a patient with painless muscle weakness associated with weight gain, bone loss, HTN and hirtuism is consistent with what disease
hypercortisolism (Cushing Disease)
254
describe how cushing syndrome causes is muscle problems
cortisol directly affects the muscles causing muscle atrophy
255
what is the treatment for E. Hystolitica (Amebiasis of the liver)
metronidazole to treat the abscess and paromomycin to treat the intestinal colonization
256
what is proximla muscle weakness
climbing stairs
getting up from a chair or in and out of care
working with arms over head (combing hair)
257
proximal muscle weakness,dysphagia, elevated CK and patient in her 40-50s is?
polymyositis
258
anti-Jo-1 AB are seen in
polymyositis
259
patients with polymyositis should be screened for
cancer because this is a paraneoplastic syndrome
260
beta interferon is used to treat?
MS
261
pyridostogmine is used to treat?
myasthenia gravis
262
cyclobenzaprine is used to treat?
muscle spasms associated with lumbar pain
263
tx for polymysitis
glucocorticoids
264
treatment for toxic megacolon
steroids
265
women with von Willebrand disease have what main UDE
menorrhagia
266
intial tx for hyperthyroidism
B Blocker
267
how can people with hyperthyroidism end up with hypercalcuria (calcium in the urine/calcium wasting)
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
berry anyerusim in the PCA cause what signs
compression of the occulomoter nerve causing ipsilateral mydriasis, ptosis and down and out deviation of the eye
269
berry anyerism in the ACA causes
compression on the optic chiasm and causes bitemporal hemianopia
270
bacteria that commonly cause catheter associated UTI
e. Coli
enterococcus
candida
pseudomonas auergionsa
271
holosystolic murmur that increases with inspiration is common of
tricuspid involvemnt in inefective endocarditis
272
IV drug users are susceptible to what heart probkem
bacterial endocarditis in the right heart
273
S4 sound is heard when
in ventricles with decreased compliance (less stretch/ridgid)
274
patients with worsening CHF will have what lung sign
bibasilar crackles
275
what is a frequent source of nosebleeds in pregnany
pyogenic granulommas which are very vascular and are usually in the anterior nasal septum
276
ventricles in someone with normal pressure hydrocephalus looks like
dialated
277
formula for anion gap
AG=Na-(HCO3+Cl)
278
normal anion gap is
6-12
279
scaly papules or plaques mainly on faired skinned people
actinic keratosis
280
actinic keratosis can change into
squamous cell carcinoma
281
actinic keratosis occurs beuase of
sun exposure
282
treatment of actinic keratosis
cryotherapy
283
scaly, oily, eryhtematous rash that affects the skinfolds around the nosem eyebrows, ears and scalp is
seborrheic dermatitis
284
benign pigmented lesion with a well demarcated border and velvety /appearance or greasy surface "stuck on" is
seborrheic keratois
285
how to diagnose fibromuscular dysplasia
CT angiography of the abdomen or duplex US
286
how does high aldosterone affect renin?
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
first line treatment for DM
metformin
288
what to remember about sulfonyureas
second drug added if metofrmin assent working
weight gain and hypoglycemia are the main side effects
289
diabetic drug that can be used in renal insufficiency
TDZ
290
side effects of TDZ
weight gain
CHF
broken bones
edema
291
when to use TDz
only if the patient cannot tolerate metformin or sulonyureas
292
diabetic drug that is a good second agent to metformin and is great for WEIGHT LOSS
GLP1-Agonist (exenatide and liragulitide)
293
there is an increased risk of what with the use of floroquinolones
tendon rupture or retinopathy
294
most common predisposing factor to aortic dissection
systemin HTN
295
common heart complication in marfnas
aortic dissection
296
low CO, low BP, high PCWP, High SVR are associated with what kind of shock
cariogenic
297
patients with cirrhosis and vatical bleeding should be given what two prophylactic drugs
antibiotics ( to prevent spontaneous bacterial peritonitis)
| octreotide ( to reduce vatical hemorrhage)
298
what is treatment for diabetic retinopathy
Argon lasar photocoagulation
299
visual impairment in diabetes is due to
macular edema
300
treatment for essential tremors
beta blockers
301
essential tremors are usually
bilateral
302
TB is a common cause of what disease
adrenal insufficiency
303
where are RBCs destroyed in extravascular hemolysis
the spleen or LN this is why haptoglobin is normal levels and LDH is only slightly increased
304
what is the initial treatment for hypovolemic hypernatremia
saline (0.9%)
305
5% dextrose is the treatment for what
hypervolemic hypernatremic patients
306
mild cases of hypovolemic hypernatremia is
5% dextrose in 0.45% saline
307
how long can delirium due to bath salts last
days to weeks
308
applying an ice pack to an eye with ptosis and it improving for several minuets is a sign of
myasthenia gravis
309
how does an ice pack improve ptsosi in MG
the cold helps to stop the breakdown of Ach in the NMJ
310
what kind of medication is chlordiazepoxide?
it is a benzodiazepine that treats alcohol withdrawal
311
tracheal narrowing ais very characteristic of nd ulceration
granulomatosis with polyangitis
312
miners and stone workers get what lung disease
sillicosis
313
what is the systemic vasculitis that is characterized by upper and lower respiratory tract granulomatous inflammation and glomerulonephritis
granulomatosis with polyangitis
314
first treatment for patients with hyperglycemic hyperosmolar nonketotic syndrome
aggressive infusion with normal saline because severe hyperglycemia causes osmotic diuresis causing the body to lose 8-10L of fluid.
315
methamphetamines is associated with what change to the heart
cardiomyopathy
316
what medication is used for severe left ventricular systolic dysfunction and cariogenic shock
dobutamine ( B1 agonist)
317
in patients with obesity hypoventilation syndrome what is the result
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
signs of BB overdose
wheezing
bradycardia
AV block
hypotension
319
what medication has been successful in treating CCB and BB overdose because it increases cAMP
glucagon
320
elevated opening pressure, low glucose, high protein, and low WBC suggests?
cryptococcal meningoencephalitis
321
what heart murmur is associated with pacemaker placement
TR
322
what kind of gifts can be accepted by pharmaceutical companies by physicians
non monetary small gifts of small value that benefit the patients (samples)
323
main treatment for actinomycetes
penicillin 2-6 months
324
treatment for Nocardia
TMP-SMX
325
what medication breaks further breakdown of ethylene glycol
fomepizole or giving ethanol to distract ADH
326
why does ethylene glycol ingestion cause flank pain
because it causes hypocalcemia and calcium oxalate crystal formation
327
blastymicosis causes what on the skin
wart like lesions and skin ulcers
328
when suspecting IE what is the next best step
get bacterial blood cultures
329
a 50% drop in platelets and or a new thrombus in the 5-10 days after starting heparin makes you think
heparin induced thrombocytopenia
330
what is the first medical treatment for pseudo tumor cerebra
aetozolamide (decreases CSF production)
331
what test confirms the diagnosis of chlaymdial infection
nucleic acid amplification test
332
treatment of choice for MG
pyridostigmine (ACHE INHIBTOR)
333
patients who have longstanding RA, neutropenia and spleenomgaly have
felty syndrome
334
treatment for TCA overdose
sodium bicarbonate
335
what kind of drug is hydroxyzine
it is a antihistamine
336
Lamotrigine is what kind of drug
anticonvulsant
337
histoplasmosis mimics what disease
sarcordosis
338
what should be considered in a patient who deteriorates after immunosuppressive therapy (therapy) who is thought to have sarcordiosis
histoplasmosis
339
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
blastomyces
340
what is the most common cause of sudden death in people with MI
VFib
341
how should patients with Vfib and pulsless VTach be managed
immediate defibrillation to restore heart perfusion
342
if defibrillation doesn't work for Vfib or Vtach then what do you do
give amiodarone or lidocaine if amiodarone is not available
343
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patients with
- atrial fib
- atrial flutter
- Vtach with pulse
should be managed how
```
with synchronized cardio version
344
an older patient with severe lymphocytosis ( high WBCs) hepatosplenomegaly, lymphadenopathy and anemia and thrombocytopenia is suggestive of
CLL
345
how os CLL diagnosed
flow cytometry
346
JAK 2 mutations is associated with what disease
myeloproliferative disease (polycythemia vera)
347
what joint is most affected in psoriatic arthritis
distal interphalangeal joints
348
neuropathic arthropathy (Charcot joint) in the lower limbs is associated with
syphillis
diabetes
alcoholism
349
what is the med to treat pneumocystis pneumonia if the patient can't take TMP SMX
pentmide
350
tx for polycythemia vera
phlebotomy
