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Lectures Flashcards

1
Q

Thyroiditis

A

Destruction of thyroid gland

Painless - autoimmune or post viral
Postpartum - autoimmune
Subacute - painful, post viral
Suppurative 
Radiation
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2
Q

Medication induced thyrotoxicosis

A

Amiodarone - has iodine in it (increased production) also is directly toxic
Lithium - hypothyroidism is more common
Contrast - has iodine in it (increased production)
Exogenous thyroid hormone - psychiatrists do this

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3
Q

Atrial tachycardia treatment

A

Ablation

Metoprolol or flecainide second choice

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4
Q

Ventricular tachycardia etiology

A

Reentry

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5
Q

ARVC

A 
Epsilon waves
Inherited myocardial disease
Fibrofatty replacement of the RV
Autosomal dominant, more common in men, Mediterranean 
No sports - accelerates progression
First degree relative screening
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6
Q

Giant cell myocarditis

A

Eosinophils
T cell dysregulation
Diagnose with biopsy
Immunosuppression, transplant

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7
Q

Ornithine transcarbamylase deficiency

A

Isolated hyperammonemia
Dialysis or ammonul
Arginine and citrulline supplementation - urea cycle intermediates
Diagnosis with urine orotic acid, genetics

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8
Q

Mitral stenosis severity

A

Rate matters

Gradient >10 is severe

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9
Q

HIT

A 
Platelet factor 4
~10 days after heparin
Warfarin
Argatroban
Bivalrudin
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10
Q

Rheumatic afib

A

Very high thrombotic risk

Warfarin w INR goal 2.5-3.5

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11
Q

Gitelman syndrome

A

Urine high k high na high cl high mag low calcium

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12
Q

Scleroderma renal crisis

A

Htn, maha, nephritis

Ace inhibitor

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13
Q

LMN weakness differential

A 
Anterior horn:
WNV
ALS
Lead
Polio

Spinal nerve

Peripheral neuropathy - GBS, amyloid, DM

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14
Q

Muscle weakness ddx

A

Electrolyte - Mg Phos K Ca
Medications - statins, steroids, linezolid, colchicine, hydroxychloroquine
Inflammatory - dermatomyositis, polymyositis, inclusion body
Endocrine - hypothyroid, Cushing
Toxins - alcohol

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15
Q

Dermatomyositis and polymyositis

A 
Proximal weakness
Ck
Ana
Jo-1
Mi-2 (dermatomyositis)
Assoc with malignancy, scleroderma, mctd (dermatomyositis)

Steroids, azathioprine, mtx

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16
Q

Inclusion body myositis

A

Insidious onset
Prox and distal weakness
Asymmetric
Dysphagia - cricopharyngeal muscle

cN1A antibody
Mild CK elevation

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17
Q

Necrotizing myositis

A

Anti-SRP
Anti-hmgcr (statins)
Negative

Risk: statins, paraneoplastic, rheum

No infiltrate on biopsy

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18
Q

Spirometer study quality

A

6 seconds or plateau of exhalation

19
Q

Spirometry obstruction

A

FEV1/FVC < 0.70
FVC > lln
Bronchodilator response increase by 12% and 200 cc

20
Q

Spirometry restriction

A

Can’t diagnose by itself
FVC < LLN
Confirm with lung volumes

21
Q

Obstructive Lung disease severity

A

%FEV
Mild >80
Mod 50
Severe 30

22
Q

Intrathoracic vs extrathoracic central airway obstruction

A

Intrathoracic - flattening expiration

Extrathoracic - flattening inspiration

23
Q

Lung volumes

A

Up obstruction

Down restriction

24
Q

DLCO

A

Area available for gas exchange
Low - emphysema, ild, lobectomy, anemia, pulmonary hypertension, vasculitis

High - L-R shunt, high CO, polycythemia, DAH

25
Q

Neurocystercercosis treatment

A

Albendazole

26
Q

Anti phospholipid clues

A

Mild thrombocytopenia
Prolonged PTT
Livedo reticularis

27
Q

Antiphospholipid antibody testing

A

Lupus anticoagulant (Russel viper venom) test falsely positive if anticoagulated

Other tests are beta 2 glycoprotein and cardiolipin

To diagnose you need antibodies and thrombosis or pregnancy event

28
Q

Hypertensive emergency treatment options

A

Aortic dissection - esmolol
Pulmonary edema - nipride
NSTEMI - nitroglycerin

29
Q

Sjogren’s patient with new parotid swelling

A

Lymphoma

30
Q

Igg4

A 
Fibroinflammatory
All organs involved
Lymph nodes, parotid
Retroperitoneal fibrosis, aortitis 
Sausage pancreas
Plasmocytic infiltration B cells, cd4 T cells, eos

Treat with steroids

31
Q

Hypermagnesemia

A

Distributive shock

Don’t give mag citrate to old people or esrd

32
Q

Ecthyma gangrenosum

A

Pseudomonas bacteremia

Rapidly progressive
Fever
Bullae

33
Q

Hook osteophytes

A

Hemochromatosis

34
Q

Primary spontaneous pneumothorax treatment

A

Observe if less than 2 cm

Needle if more than 2 cm

35
Q

Diet for calcium oxalate stones

A

Increase dietary calcium

Low protein
Low sodium
High citrate

36
Q

Lupus nephritis classifications

A 
I - normal
II - mesangiocapillary
III - focal sclerosis
IV - diffuse sclerosis
V - membranous
VI - burnt out

Immunosuppression for 3 and 4

37
Q

Sodium and skin

A

Glycosaminoglycans buffer sodium
7 day circadian rhythm

Extensive burns end up with aldosterone mechanism alone - salt sensitive labile blood pressure

38
Q

Methanol vs ethylene glycol

A

Methanol causes vision changes

39
Q

Aspergillus in lung

A

Fungal ball w halo sign

Galactomannan and beta d glucan, not sensitive

40
Q

Rheumatoid ILD

A

Men more likely
Smoking more likely
Monitor if asymptomatic
Steroids MMF cytoxan if symptomatic

41
Q

RA vasculitis

A

25-30% of patients
Medium vessels
Cutaneous (scleritis, aortitis, GN)
Rituxan or cytoxan

42
Q

RA lymphoma

A

DLBCL

43
Q

Felty syndrome

A 
NHL risk up
RA plus neutropenia plus splenomegaly
Low complements
High immunoglobulins
Methotrexate, rituximab
If ANC <1000 can give GSF stimulation

Atabacept for inadequate response

Splenectomy if medical management fails

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