Med 1 Flashcards
2 hour cutoff for impaired glucose tolerance
140
preDM indication for metformin
impaired FG and Impaired glucose tolerance
tx DKA vs HHS
DKA: insulin drip
HHS: IV fluids
statin indication if no DM
if 10 yr risk>7.5%
cutoff hyperlipidemia
total cholesterol 200
LVH with EKG
S1 + R5 = >35
QT cutoff math
70 bpm, qt<.4
for every 10 bm, subtract .02
vitamin D cutoff
30
t wave inversion =
ischemia
q’s in V1-V4
part of heart and artery
anterior
LAD
q’s in I, AVL, maybe 5 or 6
heart and artery
lateral
circumflex coronary artery
q’s in II, III, AVF
heart and artery
inferior leads = inferior
RCA or descending branch.
large R, ST depression in V1,V2
heart and artery
posterior
RCA
normal PR
less than .2 (less than 1 big box)
normal QRS
less than .12 (3 boxes)
Saag cutoff and significance
1.1
Greater is portal htn.
2 types microscopic colitis
Lymphatic and collagenous.
Sensitivity =
Tp/sick
Specificity =
Tn/healthy
Lrs of 2,5,10 increase dz by
15, 30, 45
Stage 2 htn (2)
Greater than 160 sys or 100 dia
Sirs (4) include number necessary
2 of: Fever WBC Tachypnea or paco2 less than 32 Tachycardia
Sepsis (2)
Sirs + source of infection
Severe sepsis
Sepsis + hypotension or lactic acidosis
Septic shock
Severe sepsis despite aggressive fluids
If rta, urine gap is
A positive number.
Osm equation
2Na + glucose/18 + BUN/2.8
Osm gap normal
10
Osm gap significance
Alcohols
Normal range for blood osm
275-295
Cutoff urine k for hypokalemia investigation
20
Above suggests renal losses
Migraine prophylaxis tx
Propranolol if more than 2 a week.
RTA type 1
location
urine pH
tx
distal tubule
>5.5
bicarb
RTA type 2
location
tx
proximal tubule
thiazide
RTA type 4
hallmark
tx
hyperkalemia (classically hyporeninemic hypoaldosteronemic diabetic)
fludrocortisone
Cutoff for concerning PSA velocity
Greater than .75
P waves change shape
More than vs less than 100
More than 100 = multifocal atrial tachycardia
Less than 100 = wandering pacemaker
20 to 40 BPM with wide qrs
Ventricular escape
Pause than long qrs
Ventricular escape
No p wave or p wave inverted following.
Junctional rhythm
Tachycardia like sinus 160 to 200
Svt
Tactile fremitus (2)
Increased if lobar
Decreased if effusion
side effect of niacin besides pruritis (2 labs)
+glucose
+uric acid
side effect fibrates
+myositis with statins
side effect cholestyramine
flatus and abd. cramping
problem with ezetimibe.
well tolerated and nearly useless
normal R wave progression in precordial leads
gets bigger 1-5
interrupted in RVH. V1 R ends up being bigger than S. V6 S wave ends up being bigger than R.
2 drugs you may NOT use in hypertrophic cardiomyopathy but you may use in dilated cardiomyopathy.
Digoxin and spironolactone.
5 indications for dialysis
Aeiou
Acidosis Electrolytes Intoxication Overload Uremia
Metabolic acidosis
Determining appropriate resp compensation
Appropriate pco2 = 1.5hco + 8
3 work ups for acid base
Check ag
Check compensation
Check delta gap
Strep pneumo vaccines before and after 65.
Before equals one dose plus another 5 years later. After 65 is just one dose.
pleural fusion analysis
2 labs
in exudate or pseudoexudate
protein >3
LDH>200
pleural fusion analysis
transudate vs pseudoexudate (CHF)
cholesterol <50 is the hallmark of true transudates
Lab difference in primary vs secondary hyperPTH
2 has low calc, high phosphate.
Electrolyte that parallels vitamin d
Calcium
Ca normal value range
8.4 to 10.2
Normal phosphorus range
3.0 to 4.5
Find out 24 hour urine protein quickly
Urine albumin/creatinine ratio
Calculating delta gap
Corrected hco3 (25) should = hco3 actual + delta anion gap
Expected renal compensation for a respiratory acid base disorder (2)
HCO3 up 1 down 2
Acute up 1 per 10 mmhg co2 up. Down 2
Chronic up 4 per 10 mmhg co2
2 side effects acetazolamide
Hypokalemia
Metabolic acidosis
Cutoff for concerning K level in urine
20
tx acute ex CHF
LMNOP (Loop diuretics, Morphine, Nitrates, Oxygen, Positioning/Pressors
Use of spironolactone in chf (what classes of chf)
Class 3 or 4 only
Urine na >40 type of arf
Postrenal
Fena cut offs (3)
Less than 1 prerenal
Greater than 2 renal
Greater than 4 postrenal
Rbc casts
Glomerulonephritis
recurrent sinopulmonary infections in adults
normal # B cells, decreased output of B cells (abs)
+giardiasis, risk of lymphoma
CVID
tx CVID
IVIG
hypomagnesemia causes
gland disorder
lyte change
hypoPTH
+Ca renal loss
2 CV changes with hypercalcemia
short QT
HTN
test to locate pheochromocytoma outside of adrenals
MIBG scanning
criteria for O2 use in COPD (2)
pO2 below 55
sat below 88%
60 and 90 if right sided heart failure signs
pneumonia pathogen associated with hoarseness
Chlamydophila
tx of wpw
procainamide
NOTHING to slow AV node
SVT 1st tx
carotid massage
electrical alternans association
tamponade
if you suspect pe, 1st step
give heparin
2 pressures w/pulmonary wedge pressure
pulmonary htn vs chf
pwp normal if pulmonary htn
high if chf
low glucose in transudative effusion
RA
Persistent ST elevation 1mo after MI + systolic MR murmur?
ventricular wall aneurysm
cannon a-waves (2)
vfib or 3rd degree heart block
best prognostic indicator COPD
FEV1
acute clubbing in COPD
lung malignancy
asthma person with normalizing (lower going up) pco2
danger. intubate.
thermophillic actinomyces with patchy lower lobe inflitrates
hypersensitivity pneumonitis (farmer’s lung)
lung cancer with peripheral cavitation and distant mets
large cell
antimitochondrial ab
pbc
dx of prinzmetal’s angina
ergonavine stimulation test
SEM louder w/ valsalva, softer w/ squatting or handgrip.
HOCM
old smoker with COPD
pneumonia pathogen
H. flu
tx with 2nd, 3rd gene cephalosporins
HAART started (2, cd4 count and viral load)
CD4 less than 350
Or
Viral load greater than 55k
aids drug w/pancreatitis
didanosine
HS rash, fever, n/v, muscle aches, SOB in 1st6wks. D/C and never use again! AIDS drug
abacavir
AIDS drug
Nephrolithiasis and hyperbilirubinemia
indinavir
Sleepy, confused, psycho AIDS drug
efavirenz
AIDS patient with MS-like presentation
PML (JC polymoma virus)
paralysis, ileus, ST depression, U waves.
hypokalemia
most common cause type 1 & 2 RTA (1 each)
lithium
myeloma
electrolytes in types 1 & 2 RTA (1)
hypoK
tx for RTA types 1,2,4
bicarb
diuretic
fludrocortisone
main problem in type 1 or 2 RTA (2)
type 1 cannot excrete H+
type 2 cannot reabsorb HCO3
definition ARF
greater than 25% or 0.5 rise in creatinine over baseline.
confusion, pericarditis, itchiness, increased bleeding
uremia
nephritis 1-2 days vs 1-2 weeks after infection
Berger’s
Post SC GN
Cardiac patient s/p ticlopidinew/ renal failure, MAHA, ↓plts, fever and AMS.
TTP
tx TTP
plasmaphoresis
don’t give platelets
neurologic and renal symptoms, fever, thrombocytopenia,
and microangiopathic hemolytic anemia
TTP
substance increased in B12 anemias
methylmalonic acid
2 bleeding factors not made by liver
8, vWF
made in endothelium
thrombotic skin necrosis with hemorrhage
following administration of warfarin is a sign of
protein C or S deficiency
acute tx (2) for gout
Indomethacin + colchicine (steroids if kidneys suck).
anti-RNP
MCTD
thyroid cancer:
Spreads via blood, must surgically excise whole thyroid!
follicular (but papillary is most common type)
size cutoff for excising adrenal nonfunction nodule
6 cm
Sestamibi scan.
used to locate parathyroid adenomas
EEG 3 Hz spike-and-wave.
absence
tx: ethosuccimide
EEG triphasic bursts
CJD
EEG diffuse background slowing
delirium
psychosis has no EEG change
EEG hypsarrhythmia
infantile spasms
tx with ACTH
test of choice for GERD
24 pH monitoring
best test for zollinger-ellison syndrome
secretin stimulation test
toxicity of carbepenems
seizures
hallmark high lab of PCP
LDH
most common EKG change in PE
nonspecific ST-T changes.
more common than S1Q3T3
definition ARDS
pO2/FIO2 ratio below 200
FIO2 of room air = .21 or the fraction of oxygen
migratory superficial thrombophlebitis
name and sign of?
Trousseau’s Syndrome
Pancreas or other cancer
5 days - 3 months post-MI
persistent ST-segment elevation and deep Q waves in same leads
ventricular aneurysm
vitamin that reduced morbidity, mortality in measles
vitamin A
umbilicated vesicular rash over atopic dermatitis
eczema herpeticum
main side effect of lamotrigine (and 2 indications)
bipolar and epilepsy
major side effect = rash
prevention of chlamydial conjunctivitis vs gonococcal (ophthalmia neonatorum) to neonates
chlamydia = prenatal testing gonoccal = erythromycin
phenelzine, class
MAO inhibitor (anti-depressant)
HIV-related nephropathy
FSGS
Case control vs retrospective cohort
Case control. Have group look back on risk factors
ret cohort. Review past records to study incidence
blood abnormality with obstructive sleep apnea
polycythemia
most serious side effect of hydroxyxhloroquine
retinopathy
get eye exam q6 mo.
D-dimer cutoff for excluding PE
500
elderly patient with anemia, renal failure and hypercalcemia
multiple myeloma
rapidly progressing dementia
sharp complexes on EEG
Creutzfeld-Jacob dz
D-xylose test
test for small bowel malabsorption (celiac, for example), esp. proximal small bowel
dacrocystitis
infection of lacrimal sac
chalazion vs hordolum
chalazion = hard painless nodule (granuloma or meibomian gland) hordeolum = abscess of upper/lower eyelid
first calculaton with hypernatremia, hypokalemia
aldosterone/renin ratio
tx of chorioamniotis (2)
abx delivery (NOT C-SECTION)
diabetic patient with sudden vision loss with floaters
vitreous hemorhage
most significant reversible cause pancreatic cancer
smoking
drug for hairy cell leukemia
cladribine (purine analog)
electrolyte contraindication for succinylcholine
hyper K (or risk for hyper K = burn/crush, etc
antidote for mg toxicity
ca gluconate
angular chelisos, glossitis, anemia, seborrheic dermatitis
vitamin deficiency?
B2 riboflavin
cheilosis w/ mood changes (irritability, confusion, depression)
vitamin deficiency?
B6 pyridoxine
fena greater than 2?
less than 1?
greater than 2 = ATN
less than 1 = prerenal
1 risk factor for emphysematous pyelonephritis
DM
tx of duodenal hematoma from blunt abdominal injury
suck and drip
most common cause of Guillian Barre Syndrome
campylobacter jejuni infection
criteria for SBP dx or peritonitis
WBC above 250
most common location choriocarcinoma metastasis
lungs
tx for HIV needles stick
immediate 3 drug therapy
etiology of lytic lesions in cancers
+PTHrP
cutoff of gestational age with lung immaturity requiring investigation
less than 34 weeks
2 types of monitoring if on amiodarone
hepatic
thyroid
hallmark rhythm of digitalis toxicity
atrial tachycardia
due to +ectopy and +vagal tone
risk if asymptomatic UTI not treated in pregnant pt
becomes pyelonephritis
pseudocyesis
fake pregnancy, a conversion disorder
what to do if find a diastolic murmur on PEx
work it up!
protein cutoff for transudates vs exudates
+ than 3 g/dl (>.5 of serum) in exudates
LDH in exudates vs transudates
+ than 200 IU/L (>.6 or serum) in exudates
pH cutoff for exudates
acid in exudates (below 7.2)
class of medications to + appetite in hospice care
progesterone analogs
tx for fibromuscular dysplasia
angioplasty w/stent placement
GGT and ferritin levels in alcoholic liver dz (2)
increased
HCM maneuver to increase murmur
decrease preload (make LV smaller) = valsalva
pain on palpation of heels, iliac crests, tibial tuberositios
enthesitis
(inflammation of tendon attachments) - common feature of ankylosing spondylitis
2 side effects lithium
nephrogenic diabetes insipidus
hypothyroidism
cor pulmonale
isolated right heart failure, typically due to lung dz
anatomical location where DHEAS is produced (specific for)
adrenals
traveler w/pneumonia and hyponatremia
or liver disfunction, AMS, diarrhea too
legionella
initial tx of SIADH (if not severe enough for hypertonic IVF)
fluid restriction
Ab diff. in Waldenstom’s macroglobinuria vs multiple myeloma
IgM in Waldenstrom’s
IgG or IgA in MM
besides IgM, other hallmark of Walderstrom’s
hyperviscosity
liver dz assoc with ulcerative colitis
PSC
hallmark of histology of IBD
neutrophilic cryptitis
artery and nerve at risk with supracondylar humerus fx
brachial artery, median nerve
tx of anti-phospholipid ab
LMW heparin
2 causes of exertional syncope besides vtach
outlet obstruction:
aortic stenosis
hypertrophic cardiomyopathy
ACTH levels and cortisol levels in adrenal insufficiency (caused bu abruptly stopping steroids)
both low
contraindication for raloxifene
hypercoagulation (hx of DVT)
timing of ETOH withdrawl
1-2 days
toxicity with prolonged or high doses nitroprusside
cyanide
inheritance of hypertrophic cardiomyopathy
AD
sequelae for CF in adulthood as males
infertility (no vas)
renal artery stenosis effect on aldersterone
a form of secondary hyperaldosteronism
colonoscopy scheduled for UC
8 years after dx, then 1-2 years after
immunosupressant that gives hepatotoxicity, diarrhea, leukopenia
azathioprine
side effect mycophenolate
bone marrow suppression
M = Marrow
malaria prophylaxis if pregnant
mefloquine
type of poisoning with almond scent
cyanide
type of test for HIV screening
Ab and Ag
RNA only for +suspicion w/negative test
Antidote for anticholinergic meds
Physostigmine
electrolyte causing refractory hypoK in an alcoholic
Hypomagnesemia
if a relative risk =4, what is the attributable risk %
75%
RR-1/RR
biggest cause of B12 deficiency
pernicious anemia
MCHC level in spherocytosis
increased
medical tx of prolactinoma
cabergoline (dopamine agonist)
cutoff for hypertensive urgency
180/120
malignant htn is end-organ damage
tx for electrical abnormalities in TCA overdose
sodium bicarb
sx of retinitis in HIV pt (HSV vs CMV)
CMV retinitis is painless
abd. pain on one side, fever, gross hematuria
Renal Vein Thrombosis
Renal Vein thrombosis most associated w/what glomerular pathology?
membranous
COPD home O2 requirements include SaO2 less than 88 and Ht, PaO2 cutoffs are?
55!
Ht >55
PaO2
kussmaul’s sign
rise in JVP on inspiration. Sign of RHF
area of pathology in each of these:
lambert-eaton syndrome
myasthenia gravis
dermatomyositis
pre-synaptic membrane
post-synaptic membrane
muscle fibers
