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MS3 > Med > Flashcards

Med Flashcards

1
Q

how to manage acetaminophen overdose?

A
  • if less than 4 hours, give charcoal
    obtain acetaminophen serum levels to determine if pt needs N acetylecysteine via Rumack Matthew nomogram.
    pt can be asymptomatic for first 24 hours, and liver failure can ensue
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2
Q

environmental risks for pancreatic ca

A
  • smoking
  • nonheriditary pancreatitis
  • obesity + sedentary
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3
Q

parapneumonic effusion characteristics

A
  • low glucose <60
  • low pH <7.2
  • high protein
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4
Q

interstitial lung disease due to Idiopathic pulmonary fibrosis

A

TLC is decreased
DLCO is decreased
FEV1/FVC is normal

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5
Q

meds that cause hyperkalemia

A 
ACEi and ARBS 
cardiac glycosides (digoxin) 
B blocker
K sparing dieuretics 
NSAIDS
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6
Q

how to tell apart venous vs arterial causes for ischemia

A

venous- red, tender/ painful, not as acute,

arterial- pulseless, acute, sharp pain

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7
Q

what are the 6 Ps of acute arterial occlusion

A 
pain 
pallor 
paresthesia 
pulselessness
poikilothermia 
paralysis
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8
Q

arterial thrombosis vs emboli

A

emboli is from the heart

thrombus is originated locally

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9
Q

nail changes+ joint deformities + skin plaque

A

Psoriatic Arthritis

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10
Q

what is the guidelines for PCI after STEMI

A

within 12 hrs of symptom onset
within 90 mins of medical contact at a medical center with PCI
within 120 mins of medical contact at medical center w/o PCI

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11
Q

acute STEMI treatment

A

PCI, O2, aspirin P2Y12 inhibitor, NG, BB, anticoagulation

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12
Q

synchronized cardioversion vs unsynchronized cardioversion

A

synch: persistent tachyarrhythmia which shows signs of hemodynamic instability, ex-hypotension
unsynch: for pulseless tachyarhythmia

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13
Q

how to work up bright red blood in stool

A

under 40 yo: anoscopy
40-50 : sigmoidoscopy
50+ : colonoscopy

** assuming no other risk factors

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14
Q

Crohn’s labs

A

leukocytosis, thrombocytosis, elevated ESR

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15
Q

how does adding estrogen pills affect a pt’s levothyroxine dose

A

oral estrogen pill (patches dont do the same!) cause decreased clearance of TBG, which causes lower concentrations of free T4 in a pt who doesn’t have endogenous thyroid function to compensate. So need to provide increase levothyroxine dose

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16
Q

whats the first step if epidural spinal cord compression is suspected (even if its by cancer)?

A

IV glucocorticoids even before MRI imaging

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17
Q

how to work up bright red blood in stool

A

under 40 yo: anoscopy
40-50 : sigmoidoscopy
50+ : colonoscopy

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18
Q

how to treat latent TB

A

Isoniazid and pyridoxine

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19
Q

what is HIT and what are its dangers?

A

-antibody mediated thrombocytopenia
can cause increased clot risk
stop heparin and start agatroban or fondaparinaux

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20
Q

whats the first step if epidural spinal cord compression is suspected (even if its by cancer)?

A

IV glucocorticoids even before imaging

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21
Q

what does a ventricular aneurysm look like on EKG?

A

usually few months post MI, scar tissue forms convexity, leading to aneurysm
looks like deep Q waves, and persistent ST elevation

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22
Q

dermatomyositis pts have increased risk of ___

A

malignancy

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23
Q

post ictal anion gap, what is it? whats the management?

A
  • anion gap due to lactic acidosis

- should resolve in 90 min so repeat abg in 2 hr.

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24
Q

how to tell the difference about the etiology of a rash from amoxicillin ?

A
  • due to EBV: occurs 24 hours+ after dose

- due to HSType1: occurs immediately after.

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25
Q

whats the difference between direct current cardioversion and defibrillation? whats the indication for each?

A

direct current= synchronized. Gives shock to QRS, used in afib with pulse
defib= unsynchronized, given generalized shock not specific to point at cardiac cycle, used for pulseless or Vfib

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26
Q

widened mediastinum, deviated trachea, widened aortic knob on XRAY is indicative of

A

descending aortic aneurysm most commonly due to atherosclerosis

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27
Q

what are the symptoms of cushings myopathy?

A

muscle atrophy, hirsutism, bone loss, wt gain, htt

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28
Q

whats the pathophys of B12 in megaloblastic anemia?

A

B12 is needed to synthesize thymidylate and purine molecules. defective dna synthesis leads to slow maturation of RBC causing megaloblastic anemia. LDH and indirect bilirubin is also elevated from hemolysis

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29
Q

how to tell apart primary and secondary hypoaldosteronism

A

general symptoms: fatigue, anorexia/abdominal pain,
primary (adrenal): hyperpigmentation (high ACTH), hypotension (low EPI, NE)
secondary (pituitary): no hyperpig, no mineralocorticoid effects like hyperkalemia or hypotension bc thats regulated by RAAS.

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30
Q

hypertrophic cardiomyopathy is inherited in what fashion?

A

AD

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31
Q

what are the characteristics of HCM

A

young man, exertional dyspnea, systolic ejection murmur (crescendo decrescendo) at LLSB which is made better by increasing preload aka squat

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32
Q

whats the difference between DHEA and DHEAS

A 
DHEA= both ovaries and adrenals make 
DHEAS= only adrenals make
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33
Q

bicuspid aortic valve murmur for regurg?

A
  • early decrescendo diastolic murmur, best heard with pt sitting up, leaning forward, breath held at end expiration
    LLSB at 3/4th ICS
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34
Q

AAA suspicion? best imaging for diagnosis?

A

US

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35
Q

kidney stone suspicion? best imaging for diagnosis?

A

US or CT noncontrast

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36
Q

Erlichiosis?

A

“rocky mt fever without the spots”
tick bite, tx= doxy
elevated LFTs, alt mental status, leukopenia/thrombocytopenia

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37
Q

how to measure osmolal gap? what does it indicate?

A

osmolal gap= 2Na + glucose/18+ BUN/2.8
if this is elevated from the measured osmolal gap AND you have anion gap= consider ETHANOL,ETHYLENE GLYCOL, and METHANOL as sources

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38
Q

how to differentiate folate vs B12 def via labs

A

folate:only elevated homocyteine (bc homocysteine becomes methionine with B12 and folate)
B12: elevated homocysteine, and elevated methylmalonic acid (B12 converts methylmalonic to succinyl coa)

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39
Q

how to manage hypercalcemia?

A

normal saline infusion, calcitonin- acute effects

bisphosph- can decrease ca over 2-4 days

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40
Q

how to work up suspicion of hypoaldosteronism?

A
  1. ) morning cortisol level
  2. ) plasma ACTH (can take a while to come back)
  3. ) ACTH stimulation test
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41
Q

how do you know if metabolic acidosis will respond to saline or not?

A
  • responsive: low urine chloride (<20), etiology of MA s usually due to low intake/vomitting
  • resistant: normal urine chloride
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42
Q

what is Light’s criteria?

A

pleural fluid:serum protein is >0.5
pleural LDH: serum LDH >0.6
pleural LDH > 2/3 ULN serum LDH

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43
Q

what is SAAG?

A

“serum to ascites albumin gradient” can help differentiate btw portal htt and nonportal htt causes of ascites.
if the serum albumin:ascites albumin is >1.1 its due to portal htt causes

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44
Q

how do sodium levels correlate with HF?

A

hyponatremia correlates with severity of CHF

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45
Q

actinomyces tx

A

penicillin

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46
Q

how to differentiate primary hyperparathyroidism and familial hypercalcemia hypocalcuria syndrome?

A
  • primary hyperparathy: has normal urine Ca to creat clearance ratio
  • familial: has a decreased urine Ca to creat cx ratio
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47
Q

what is a cardiac manifestation of carcinoid?

A
  • fibrous plaques on the tricuspid, causing TR
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48
Q

what medicine do you avoid in STEMI due to cocaine abuse ?

A
  • do not give B Blocker
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49
Q

air under the diaphragm

A
  • pneumoperitonitis, PUD
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50
Q

how to manage caustic ingestion

A

clean skin, change clothes
get xray
do endoscopy

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51
Q

how to tell apart Grave’s and painless thyroiditis?

A
  • grave’s shows increased uptake of radioactive iodide, painless thyroiditis doesnt bc its releasing preformed T3
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52
Q

PSGN vs IgA nephropathy

A

both follow URI
IgA is 5 days after, occurs in young men, nl C3 C4 levels
PSGN is 10-21 days after, occurs in children decreased C3 levels

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53
Q

cardiac myxoma vs myxomatous valve degen

A

myxoma= benign tumor

myxomatous valve degen= etiology of MVP

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54
Q

concerning solitary pulm nodule vs nonconcerning solitary

A

> 0.8 cm, smoker, spiculated is concerning

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55
Q

duodenal ulcer

A

cause= Hpylori, NSAID

better with food

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56
Q

heart failure following URI

A

dilated cardiomyopathy due to acute myocarditis

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57
Q

diabetic gastroparesis

A

delayed gastric emptying with sx of anorexia,nausea, vom, and poor glycemic control
tx- prokinetics like metoclopromide,erythromycin, cisparide

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58
Q

T/F ACL and MCL have hemarthrosis

A

F, only ACL has this.

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59
Q

HCM medication

A

metoprolol 1st line

Ca ch blocker 2nd line

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60
Q

leads for inferior wall MIs

A

II, III, AVF

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61
Q

leads for posterior wall MI

A

V1, V2

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62
Q

only C3 deposits on basement wall is indicative of

A

membranoproliferative GN, IgG against C3 convertase causes excess levels of C3/ complement activation

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63
Q

suspicion for IE, what next?

A

do 3 blood cultures

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64
Q

clinical symptoms of gonoccocemia?

A
  • 2-10 pustules, tenosynovitis, arthralgias
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65
Q

wide complex ventricular tachy management

A

if stable give amiodarone

if unstable give electric cardioversion

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66
Q

TMPSMX common metabolic side effect

A

HYPERkalemia

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67
Q

management of acute LE arterial occlusion

A

anticoagulant like IV heparin BEFORE imaging

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68
Q

common extraarticular manifestation of ankylosing spondylitis?

A

ant uveitis

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69
Q

how does sodium bicarb prevent TCA overdose toxicity?

A

TCA can bind fast sodium channels in the heart causing arrhythmia and death. the bicarb alkalinizes the blood and the NA displaces TCA from the heart

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70
Q

LFT elevation in pt being treated for TB

A

INH hepatitis, mild and self limited, keep doing the treatment

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71
Q

hyperkalemia with stroke and cardiac abnormalities whats the tx?

A

IV calcium gluconate

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72
Q

afib ectopic beat origin?

A

Pulmonary Veins

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73
Q

Atrial flutter beat origin?

A

tricuspid annulus

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74
Q

to fix hypokalemia you need to fix what?

A

HYPOMAGNESEMIA

magnesium is needed to block ROMK channels in the kidney, these channels excrete K+

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75
Q

paget disease labs

A

elevated urine hydroxyproline, phosporus, calcium
normal serum calcium, phosphorus
elevated serum alk phosph

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76
Q

prostate ca bone lesions vs MM bone lesions

A

osteoblastic vs osteolytic

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77
Q

whats hhs?

A

hyperosomotic hyperglycemic state happens in type 2 diabetics with little ketoacidosis. there is also neurologic defecits due to hyperosmolar state

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78
Q

whats the etiology of spondylarthritis in <40 yo male

A

inflammatory of the ligamentous insertion leading to articular damage of the SI jt etc.

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79
Q

hypothyroid metabolic abnormalities

A

hyponatremia, hyperlipidemia, elevated Cr, elevated transam, hypertriglyceridemis

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80
Q

whats a factorial design study group

A

2+ interventions, with 2+ independently studied variables

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81
Q

what is a blood abnormality seen in EBV

A

2-3 wks following infection pt may have hemolysis induced anemia and thrombocytopenia with elevated bilis

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82
Q

signs of desseminated mycobacterium avium complex? ppx?

A
  • fever cough nightsweats in HIV CD<50, splenomegaly

- ppx- azithromycin

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83
Q

what pain meds are not effective in osteoarthritis?

A 
acetaminophen 
opiods (oxycodone)
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84
Q

what electrolyte abnormalities does furosemide cause?

A

hypomagnesemia, hypokalemia

which can lead to Vtach

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85
Q

WPW AFIB tx

A

procainamide

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86
Q

pericarditis ekg

A

diffuse ST elevation except avR which shows depression

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87
Q

Dressler’s syndrome

A

pericarditis 2-3 wks following MI

tx= NSAIDs

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88
Q

hemochromatosis signs

A

diabetes, hepatomegaly, jt pain with calcinosis

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89
Q

leukemoid vs CML vs AML

A

leukemoid - metamyelocyte
CML- myelocyte
AML- myeloblast

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90
Q

leukemoid vs CML

A

leukemoid- high LAP

CML - low LAP

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91
Q

what anticoagulants are contraindicated in kidney disease?

A

LWMHeparin (enoxaparin), Fondaparinaux, rivaroxaban

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92
Q

what medication can cause asthma, chronic rhinusitis like symptoms

A

Aspirin

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93
Q

primary biliary cholangitis side effects?

A
  • osteomalacia/porosis

- HCC

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94
Q

how to manage variceal bleed

A
  1. fluid
  2. antibiotics
  3. OCREOTIDE
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95
Q

warts on the foot, palm, or genitals think..

A

HPV

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96
Q

chronic prostatitis symptoms

A
  • perineal pain
  • pain with ejaculation
  • back pain
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97
Q

splenic abscess is most commonly caused by

A

IE

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98
Q

AVNRT

A

a type of paroxysmal supraventricular tachy, seen in young people with nl hearts. 2 conduction pathways in the AV node, one slow and one fast, if a PAC happens at just the right moment, the slow pathway can ALSO be activated causing a slow-fast loop

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99
Q

RVMI leading to cardiogenic shock, whats the treatment

A

problem is with preload, give a BOLUS

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100
Q

CHF renal response

A

notes decreased RBF, so constricts aff and eff arterioles to maintain GFR
RAAS activated, so decreased Na delivery to CD

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101
Q

suspecting achalasia, whats next?

A

do endoscopy to rule out pseudoachalasia (due to tumor)

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102
Q

polysaccharide conjugation vs toxin(protein)- polysaccharide conjugation?

A

just polysaccharide causes t-cell independent B cell response
but conjugating to a protein, allows t-cell dependent B cell response

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103
Q

vfib tx is_____

vtach tx is _____

A

defib for vfib

synchronized cardioversion for vtach

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104
Q

Spontaneous Bacterial Peritonitis?

A

cirrhosis w/ mental status changes or fever

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105
Q

hemolytic anemia with evidence of thrombosis (cerebral veins or intra-abdominal)

A

paroxysmal nocturnal hemoglobinuria, usually presents in 4th decade of life

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106
Q

what are the electroyte abnormalities in TLS?

A
  • hypocalcemia

- hyperkalemia, hyperpotassium, hyperuricemia

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107
Q

when giving Nirtoprusside watch out for?

A

cyanide toxicity

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108
Q

cardiac tamponade symptoms

A

Beck’s triad: distended jugular, muffled heart sounds, hypotension

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109
Q

the proper diagnosis of a “night owl” is?

A

Delayed Sleep Wake Disorder

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110
Q

what are haustra? what do they indicate?

A
  • thick indentations/markings that do not extend the entire lumen
  • toxic megacolon
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111
Q

IDA vs ACD in labs?

A

both have low iron

but check the ferritin! ACD has high to normal ferritin, IDA has low ferritin

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112
Q

Anti phospholipid syndrome lab abnormalities

A

a prolonged PT and PTT are a LAB ERROR common in this syndrome bc Lupus Anticoagulant binds the phosphorus in assays.

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113
Q

patellofemoral pain syndrome

A

seen in young female athletes, due to overuse, PE shows tenderness at patella, tx- strengthening exercises

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114
Q

how does false positive relate to specificity?

A

1-specificity= FP

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115
Q

when mech ventilating someone whats the target FiO2

A

FiO2 is weaned to less than 60 as quickly as possible

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116
Q

why can hepatic encephalopathy be worsened in pts with on dieuretics

A

hypokalemia and metabolic alkalosis can worsen HE

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117
Q

what are the HIV prophylaxis?

A

<200, TMPSMX
<50 Azithromycin for MAC
<150 and in a histoplasma endemic area, do Itraconazole

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118
Q

whats a reason RBC will be seen on UA but not urine sediment

A

UA cant diff btw myoglobin and hemoglobin but urine sediment can, so causes of increased myoglobin in urine is likely culprit

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119
Q

some type of nephrotic syndrome followed by sudden kidney pain, fever, and gross hematuria

A

caused by renal vein thrombosis. most commonly seen in membranous glomerulopathy

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120
Q

whats the multiple myeloma picture?

A

hypercalcemia (causes constipation and fatigue), anemia, back pain

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121
Q

60+ yo with painless rectal bleeding likely due to?

A

angiodysplasia

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122
Q

mediastinal mass with elevated AFP and bHCG is

A

nonseminomatous germ cell tumor (bc afp is high)

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123
Q

rouleaux RBC seen in?

A

MM

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124
Q

febrile nonhemolyticreaction to transfusion occurs 1-6 hrs after?

A

due to cytokines released by leukocytes can be prevented by leukoreduction

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125
Q

pt with megaloblastic anemia gets folate supplementation what remains?

A

hematologic abnormalities like megaloblasts will no longer be seen with folate supp. But neurologic abnormalities can get worse.

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126
Q

what are the signs on PE of aortic stenosis

A

pulsus parvus et tardus
mid to late peaking of systolic murmur
presence of soft and SINGLE second heart sound.

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127
Q

scrotal varicocele, polycythemia, hemturia is most likely is caused by

A

RCC

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128
Q

why does SLE cause pancytopenia

A

peripheral immune destruction

129
Q

transudate, exudate, vs normal pleural fluid pH

A

nl pleural fluid pH= 7.6
transudate = 7.4-7.55
exudate= 7.3-7.4

130
Q

diverticulitis has urinary symptoms T/F?

A

T , it can irritate the bladder

131
Q

how long does a tick need to attach to treat for lyme?

A

36 hours

132
Q

sodium correction..
HIGH to LOW
LOW to HIGH

A

High to Low the brain will blow , cerebral edema

Low to high, the pons will die

133
Q

how to treat symptomatic bradycardia?

A

IV atropine

then if that doesn’t work dopamine or epi

134
Q

tachy, lid lag, tremor and htt following surgery is caused by?

A

thyroid storm

135
Q

esophageal varices management

A

B blocker

136
Q

S. viridans vs S aureus

A

S.viridans is subacute,

S.aureus is acute

137
Q

work up for acromegaly suspicion?

A

IGF1 first, if elevated do oral glucose suppression test and check for GH supression

138
Q

if medullary thyroid cancer is suspected, what else should you test for?

A

could be in the MEN2/2b, which is associated with pheochromocytoma, check for urine metanephrines, this could be a risk if pt needs surgery.

139
Q

dermatofibroma vs epidermal inclusion cyst

A

dermatofibroma most commonly on lower extremities, often hyperpigmented
EIC- central punctum, skin color, on trunk, UE, and face

140
Q

MI <12 mo after stent placement

A

most likely due to stent thrombosis bc the pt was not adhering to anti platelet medications

141
Q

what is hepatorenal syndrome

A

cirrhosis of the liver causes increased NO production, causing splanchnic vasodilation, so the RBF is decreased, in response to this renal hypoperfusion, the RAAS is activated, causing decreased urine output

142
Q

enlarged thyroid with face/UE congestion?

A

thyroid lymphoma- this often has a rapidly growing thyroid, which extends into the retrosternal space and causes facial plethora and other signs of congestion

143
Q

RA 1st line medication?

A

Methotrexate

144
Q

in aotic dissection whats the drug of choice?

A

Labetalol (or other IV beta blockers) not hydralazine or nitroprusside bc it can cause reflex sympathetics

145
Q

GCA cardiac side effect?

A

aortic aneurysm

146
Q

HHS treatment

A

NS saline for first few hours then 0.45% saline

147
Q

whats the algorithm for a hypernatremia work up?

A

if the pt is euvolemic- give free water orally
if the pt is hypovolemic and asymptomatic give 5% dextrose
if the pt is symptomatic give 0.9% saline, until euvolemic, and then give 5% dextrose

148
Q

when you step on a rusty nail whats the guidelines for tetanus care?

A

if youve had the 3 tetanus shots, and the wound is clean, you need a toxoid vacc if you havent for 10 yr, if the wound is dirty you need it if you havent had one in 5 yr
if you never got 3 vacc, and the wound is clean get the toxoid vacc, if its dirty you need the toxoid vacc and IVIG

149
Q

melena and food relieving abdominal pain is?

A

PUD in the duodenum

150
Q

signs of arsenic poisoning

A

stocking glove distribution sensory deficiency
pancytopenia
hepatitis
skin hyper and hypo-pigmentation

151
Q

hepatic hyperechoic lesion in young woman

A

hepatic adenoma

152
Q

what are the hyperestrinism signs of cirrhosis?

A

palmar erythema, spider angioma, gynecomastia, testicular atrophy, decreased body hair

153
Q

what are the PPD guidelines for TB

A

POSITIVE IF
>5 in HIV, immunocomp, previous TB
>10 in immigrant, IVDU
>15 in someone healthy with no risk

154
Q

why should pts on prednisone (or other glucocorticoids) receive TMPSMX

A

ppx for PJP

155
Q

what drug can cause peripheral edema

A

Ca channel blocker

156
Q

pts with porphyria cutanea tarda should be screened for?

A

Hep C

157
Q

babesiosus signs?

A

fever, malaise, intravascular hemolysis

158
Q

SVT vs VT ? tx?

A

SVT, regular and narrow complex tachycardia tx is adenosine

VT is wide QRS complex tachy, tx is amiodarone or lidocaine

159
Q

OA vs Rheumatoid Arthritis

A

OA is at DIP and PIP, you will see Heberden’s nodes and Bouchard nodes
RA mainly occurs at MCP

160
Q

alcoholic hepatitis labs show

A

AST, ALT are elevated but usually <300
AST:ALT >2
elevated TTG and ferritin

161
Q

fastest way to reverse hyperkalemia

A

Insulin + glucose or B antagonists will rapidly place potassium in cells

162
Q

what else do you need to treat hyperkalemia

A

calcium to stabilize the cardiac membrane

Kayexelate to excrete the K+

163
Q

homocysteine elevation concerns

A

can cause hypercoagulable state, make sure to decrease it! how? give B6 and folate (usually B12 not needed unless there is a defeciency)

164
Q

3 causes of hypocalcemia to consider before getting a PTH

A
  1. hypomagnesemia
  2. drugs
  3. recent blood transfusion
165
Q

what is obesity hypoventilation syndrome

A

BMI> 30

hypercapnia at daytime

166
Q

9;22

A

cml

167
Q

what is first degree AV block, management?

A

PR >0.20 (5small boxes)
if alone, do nothing just observe
if assn with prolonged QRS, do EP testing

168
Q

how to characterize and manage intermittent asthma

A

= 2 a wk daytime sx
<2/= 2 a month night time sx

SABA prn

169
Q

multilobar cavitary infiltrates after getting better from flu

A

bacterial superinfection, most likely S Aureus

170
Q

ISOLATED thrombocytopenia (without anemia) and normal PT and PTT is most likely

A

ITP, autoantibodies against platelet receptors

171
Q

PJP tx

A

TMP SMX

if pt has PaO2<70 or A-a gradient >35 corticosteroids added to TMPSMX have been shown to help mortality

172
Q

thrombotic thrombocytopenic purpura

A
  1. MAHA
  2. thrombocytopenia
  3. renal insuff
  4. neuro changes
  5. headache

note PT and PTT are normal unlike DIC

173
Q

TTP tx

A

plasma exchange

174
Q

PCT triggers

A

estrogen, alcohol

history of Hep C

175
Q

labs for salicylate tox

A

resp alk so PaCO2 is low
met acidosis soHCO3 is low
these are opposing so pH is near normal

176
Q

how to tell apart primary and secondary hyperparathyroidism

A

primary will have elevated ca

secondary will not have elevated ca

177
Q

NNT=

A

inverse of ARR

178
Q

an arc of echymosis on medial malleolus is indicative of

A

burst popliteal bursa

179
Q

howto treat hypernatremia

A

first IV 0.9% saline to become euvolemic, then 0.45% saline to replace the free water defecit

180
Q

loss to follow up is what kind of bias?

A

selection bias

181
Q

icthyosis vulgaris

A

diffusely scaly skin due to mutation in filaggrin gene

182
Q

shoulder stiffness with little pain is likely

A

adhesive capsulitis

183
Q

whats the BUN level for uremic pericarditis

A

BUN>60

184
Q

what does a low cardiac index mean

A

low myocardial contractility

185
Q

crypto meningitis tx

A

flucytosine and amphotericin B

186
Q

drug induced acne vs acne vulgaris

A

drug induced- no comedones, all are the same age, mainly upper back, shoulders and arms caused by glucocorticoids

187
Q

diarrhea and spondylarthritis

A

IBD arthritis

188
Q

TIGHT glycemic control decreases the risk of what

A

microvascular complications ex- retinopathy

189
Q

what findnig is suggestive of follicular thyroid cancer

A

invasion of the capsule and blood vessels

190
Q

mixed cryoglobulinemia syndrome vs TTP

A

MCS has PALPABLE purpura, RF+, arthralgia, renal dx, and peripheral neuropathy
TTP has NONpalpable purpura, renal dx, severe anemia and thrombocytopenia

191
Q

sore throat, muffled voice, and drooling

A

Epiglottitis

192
Q

how to differentiate COPD and asthma

A

does bronchodilator fully reverse (which means does FEV1 increase by >12)

193
Q

Polycythemia Vera

A

constitutively active JAK2, but low EPO

194
Q

hair loss due to stress ex pregnancy

A

telogen effluvium

195
Q

painful bladder syndrome =

A

interstitial cystitis

196
Q

anorexia in cancer pts tx

vs anorexia in HIV pt tx

A

cancer- progesterone anologue

HIV-cannaboid

197
Q

how to work up mild htn

A

urine analysis and chem panel, lipid profile, baseline EKG

198
Q

whats step1 and step2 of step up asthma therapy

A

step 1- SABA

step 2- SABA+ICS

199
Q

AAA screening

A

one time screening for men between 65-75 who are smoker or prior smoker

200
Q

what does thyroglobulin level tell you about hyperthyroidism

A

if its high, the thyroid hormone is endogenously produced

if its low, the hormone is exogenously entering

201
Q

how to monitor and measure DKA

A

follow anion gap

get betahydroxybutyrate assay

202
Q

pathophysiology of HIT

A
  • heparin causes a change to the platelet receptor, exposing a neoantigen, causing antibody mediating platelet activation
203
Q

when do you initiat fibrate therapy

A

when TG>1000

204
Q

gonococcal arthritis vs reactive arthritits

A

gonococcal- give antibiotics

reactive- give nsaids

205
Q

Malaria prophylaxis

A

Chloroquine in non-endemic areas ex: CentralAmerica or Carribean
Mefloquine etc in endemic areas like India and Africa

206
Q

miliary TB vs mycoplasma pneumo

A

both have retinculonodular patten
myco is 2-3 weeks
TB will last months

207
Q

what is AERD?

A

aspirin exacerbated respiratory disease

- taking NSAIDs causes asthma and chronic rhinusitis with nasal polyps

208
Q

management of febrile neutropenia without a cause?

A

<1500 neutrophils

need empiric tx with Pseudamonas coverage

209
Q

electrical alterans

A

pericarditis

210
Q

Osler Weber Rendeau

A

telengecttasia, avms
recurrent epistaxis
hypoxia

211
Q

Chikingunya

A

seen in carribean

fever, rash, thrombocytopenia, lympcytopenia, polyarthralgia

212
Q

acute MI causing pulmonary edema tx

A

furosemide

213
Q

uretral stones management

A

fluids, analgesics, and alpha blockers

214
Q

dermatitis herpetiforms is related to

A

celiac’s

215
Q

osmotic vs secretory diarrhea

A

secretory diarrhea- decreased stool osmotic gap, seen in infections and post abdominal surgery
osmotic diarrhea- elevated stool osmotic gap

216
Q

Bath salt intoxication

A

agitation, psychosis, elevated BP and tachy, seizures, neg urine tox, can last for a WEEK (vs PCP which is much more short acting)

217
Q

most common liver malignancy

A

mets

218
Q

cocaine MI, how to manage

A

O2
Benzo
consider NG and Ca Ch blocker
DO NOT USE BBLOCKER

219
Q

DEXA screen

A

women >65, or with risk factors

220
Q

cystinuria

A

hexagonal crystals
impaired AA transport
cyanide nitroprusside test for diagnostics

221
Q

SLE diagnostic tests

A
  • ANA high sensitivity

- Anti-dsDNA, anti SMITH high specificity

222
Q

motor (Morton’s) neuroma

A

plantar pain when toes are squeezed together

223
Q

Endocarditis can be RF pos

A

TRUE

224
Q

diarrhea in AIDS

A
  1. cryptosporidium (CD4<100), LOW temp

2. MAC (CD4<50) HIGH temp

225
Q

common meds that cause SIADH

A
  • SSRI
  • carbamazepine
  • NSAID
226
Q

hemachromatosis has elevated risk of what

A

HCC

227
Q

IgM M spike is

A

Waldenstrom Macroglobulinemia

228
Q

asbestos causes

A

bronchogenic carcinoma, (much more likely than mesothelioma)

229
Q

DeQuervain’s tenosynovitis

A

often seen in new moms (hold baby with thumb outstretched and abducted)
due to APL and EPB irritation

230
Q

acute rejection of organ

A

IV steroids

231
Q

Penicillin G vs V

A

V is oral

G is IV

232
Q

how to step up acne care for inflammatory acne

A

topic retinoids and benzoyl perox
topical antibiotics
oral antibiotics

233
Q

BCC vs SCC lip

A

BCC top lip

SCC bottom lip

234
Q

Trastuzumab, AE?

A

cardiotoxicity

235
Q

Warfarin induced skin necrosis

A

Protein C deficiency

236
Q

Marfan’s murmur

A

aortic regurg

237
Q

peripheral edema is a side-effect of what anti-hypertensive?

A

CCBs

238
Q

hydroxychloroquine

A

IL1 and TNFa suppressor, used for SLE, watch out for retinal damage

239
Q

Erisypelas

A

superficial skin only, ex: external ear, GAS

240
Q

most common cause of primary adrenal insuff

A

autoimmune adrenalitis

241
Q

digitialis toxicity arrhythmia

A
  • atrial tachycardia with AV block
242
Q

indicationfor HepC screen

A

IVDU or blood transfusion before 1992

243
Q

what gifts can you accept as a doctor?

A

small monetary value only if it benefits patient care

244
Q

actinic keratosis

A

scaly white papules usually on face/scalp/hands

risk of progression to SCC

245
Q

if you are sure that a pt has celiac’s but the IgA antiTTG is negative, whats the explantation

A

IgA deficiency

246
Q

how can supplemental O2 cause AE in COPD

A

causes CO2 retention while improving hypoxia. this causes acidosis in brain and cerebral vasodilation which can lead to sz

247
Q

crohn’s

A

skip lesions, transmural, rectal sparing, throughout bowels

noncaseating gran, fistula

248
Q

what can worsen ophthalmopathy in Gravs?

A

RAI tx by increasing levels of TRAB. give prednisone w RAI if opthalmopathy present or do surgery

249
Q

when you suspect CML what should you check to identify it is not leukemoid rx

A

high LAP, metamyelocytes> myelocyte is leukemoid

250
Q

small vs squamous cell paraneoplastic syndrome

A

small- SIADH, ACTH

squamous - PtHRP

251
Q

how to tell apart Mobitz type 1 vs type 2 block

A

type 1- PR interval gets long and longer then drop

type 2- PR interval is constant then drop

252
Q

UTI with urine pH basic

A

proteus

253
Q

primary hyperaldosteronism medical tx (although surgery is preferred)

A

Spironolactone

Epelerone

254
Q

how to tell ethylene glycol poisoning apart from methanol poisoning

A

methanol poisoning shows eye damage

ethylene glycol will show kidney damage

255
Q

longterm home oxygen therapy indication

A

PaO2<55
O2 ulse ox <88
HCT >55

256
Q

lyme disease tx in pregnancy pt

A

amoxicilin

257
Q

why are people with Crohn’s at greater risk for kidney stones?

A

malabsorption of Ca and fatty vitamins causes too much free oxalate. Hyper oxaluria, will cause oxalatestones

258
Q

arthritis, neutropenia, splenomegaly is what syndrome

A

Felty’s

259
Q

meniere’s pathophys

A

increased endolymph volume and pressure

260
Q

multiple ulcers, esp if present in jejunum should raise suspicion for?

A

gastrinoma (ZES)

261
Q

mediastinal mass by location

A

medial - bronchogenic cyst
anterior - thymoma
posterior - neurogenic

262
Q

types of MEN

A

MEN1- primary hyperPTH, pit tumor, panc tumor
MEN 2A- med thyroid ca, pheo + primary hyper PTH
MEN2B- med thy ca, pheo+ mucosal neuroma/marfinoid

263
Q

nephrotic syndrome has increased risk of what

A

atherosclerosis and hypercoagulbility

264
Q

isolated systolic htn

A

arterial stiffness

265
Q

lynch syndrome

A

CRC, endometrial ca, ovarian

266
Q

PMR and GCA

A

do not have to occur together
PMR tx is low dose steroids
if GCA is suspected do temporal A bipsy and give high dose steroids

267
Q

BPH management

A

1st line - alpha 1 blocker

can add 5 areductase inhibitor but takes months to effect

268
Q

nephrotic syndrome associated with malignancy?

A

membranous

269
Q

nephrotic syndrome associated with Hodgkin lymphoma

A

minimal change disease

270
Q

anaphylaxis to blood transfusion

A

IgA def

271
Q

osteomalacia

A

low phosphate, high Alk phosph, low to normal calcium

usually due to poor vit D absorbtion

272
Q

acute promyelocytic leukemia is related to

A

DIC

273
Q

Behcet syndrome

A

oral ulcers, genital ulcers, eye lesion, skin lesion, thrombosis

274
Q

zinc def

A

pustular rash around mouth
alopecia
hypogonadism
impaired taste

275
Q

primary biliary cholangitis vs primary sclerosing cholangitis

A

PBC-middle age women with pruiritus

PSC- men, UC,

276
Q

what murmur decreases with squatting

A

MVP

277
Q

loop diueretics cause what acid/base disturbance?

A

metabolic alkalosis

278
Q

pathophys of hepatorenal syndrom

A

splanchnic vasodilation secondary to cirrhosis causes RAAS activation leading to decreased GFR

279
Q

cyclosporine vs tacrolimus ae

A

cyclosporine=hirsutism, gum hyperplasia, hyperkal, htn nephrotox,
tacrolimus- all of these except hirsutism, and gun hyperplasia

280
Q

most common kidney stone

A

ca oxalate

281
Q

sciatica tx

A

NSAIDs

282
Q

comedonal acne treatment

A

topical retinoids, salicylates,

283
Q

inflammatory acne

A

topical antibiotics/oral abs

284
Q

nodular cystic severe tx

A

oral isoretinoids.

285
Q

calcium correctionformula

A

= Ca + 0.8*(4-albumin)

286
Q

when to use hypertonic (3%) saline

A

when Na<120

287
Q

what acid base disorder can TB cause

A

nongap metabolic acidosis

288
Q

metabolic syndrome criteria

A
  1. abdominal obesity
  2. fasting sugars >100
  3. BP >130/80
  4. TG>150
  5. HDL <50
289
Q

how to check if respiratory compensation is enough for met acidosis

A

Winter’s formula = CO2 with comp=

1.5*(HCO3) + 8 +/- 2

290
Q

Factor V Leiden Def

A
  • AD mut in Factor V so that it can’t respond to Prot C leading to slow degradation of Factor V causing hypercoag state.
  • note, PT and aPTT may be normal
291
Q

when to start statins?

A

if ASCVD > 7.5%

292
Q

GI, confusion, pneumonia (after travel on cruise ship)

A

Legionella

293
Q

low T3, normal T4 and normal TSH

A

euthyroid sick sndrome

often seen following illness

294
Q

systemic sclerosis

A
  • anti-topomeriase
  • anti-RNA poly III
  • anti centromere ab
295
Q

carcinoid syndrome causes what deficiency?

A

Niacin deficiency bc more of tryptophan becomes serotonin and less becomes niacin

296
Q

PS13 then PP23 is for who?

just PPS23 is for who?

A

> 65, or with major medical condition like SCD

<65 if smoker or chronic heart or kidney dx

297
Q

Conn’s syndrome, what is the serum bicarb

A

HIGH bc hypokalemia causes excess bicarb reabs

298
Q

nocardia tx

A

TMPSMX

299
Q

Calcium kidney stones nutritional advice

A

increase water intake
decrease Na intake
dont change dietary Ca intake

300
Q

small fiber vs large fiber axonopathy

A
  • sm: POS symptoms - pain

- lg: NEG symptoms - numbness

301
Q

uremic coagulopathy

A

CKD causing platelet dysfunctions and increased bleeding time

302
Q

pulsus paradoxus

A

> 10 mmHg drop in BP
most likely cardiac tamp
can also be asthma or copd

303
Q

human bite wound tx

A

amoxicillin-clavulanate

-gram pos, gram neg, and beta lactamase pos

304
Q

Fibromuscular dysplasia affects?

A

renal and ICA

305
Q

how does pH affect calcium levels

A

Basic/HIGH pH- low ionized ca (bc most of it is sticking to albumin)
Acidic/Low pH- HIGH ionized Ca

306
Q

trousseau’s syndrome

A
  • migratory thrombophlebitis

- indicative of malignancy in abdomen usually pancreas

307
Q

PBC marker

A

anti-mitochondiral abs

308
Q

what does the D-xylulose test show

A

how much the villi are absorbing

  • can indicate Celiac’s
  • not dependent on enzymes so wont be different in lactose def or pancreatic enzyme def
309
Q

when can odds ratio equal risk ration

A

if incidence is low

310
Q

pleural effusion with high amylase

A

think esophageal perf

311
Q

thyroid hormone effect on bone?

A
  • increase osteoclast activity, can cause hypercalcemia, hypercalcuria, osteoporosis, and increased risk of bonce fracture
312
Q

confounding bias vs effect modification

A

the 3rd variable is related to both the result and whats being studied (smoking, alcohol, and cancer)
effect modification- the 3rd variable is related to only the result but not whats being studied (OCP, fam hx of brca, and brca)

313
Q

vitiligo etiology

A

autoimmune destruction of melanocytes

314
Q

diabetic med that helps in weight loss

A

GLP1 inhibitor

315
Q

TdP treatment

A

hemo stable- IV Mg

hemo unstable- defib

316
Q

after rbc transfusion

  1. DIC, abdominal/flank/injection site pain
  2. anaphlaxis
  3. fever
A
  1. ABOincompatible
  2. Iga def
  3. cytokines in blood
317
Q

colonoscopy for UC?

A

yes 8 years post diagnosis and then every 1-2 yrs

318
Q

FHH vs Phyperparathyroid

A

look at urine!
ca cx<0.01 its FHH
>0.02 its PPTH

319
Q

TMP-SMX can cause what electrolyte abnormality?

A

hyperkalemia

MS3 (6 decks)

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