Med shelf review Flashcards
(118 cards)
0
Q
Ppd positives?
A
- 15 normal ppl
- 10 exposed ppl –> ex. Pts with sillicosis
- 5 immunocompromised
1
Q
Sillacosis
A
- from breathing in dust
- see hilar infiltrates on xray
- from deposits of sillicone on the hilar lymph nodes
- “egg shell” calcifications –> see a white border around them on xray and ct scan
2
Q
What to do with pt before starting TNF-alpha blockers?
A
- PPD > 5 mm –> do chest X ray
- even if xray is negative, tx with isoniazide for 9 mnths
- then you can give drug after 3 mnths
3
Q
Who is in the group considered exposed to TB?
A
- Healthcare workers
- Homless shelter
- Sillicosis pts
- Nursing home workers
Etc!
4
Q
2 step PPD?
A
- give one test
- give a second test in two weeks
- given 2 times bc might be in a window of not being symptomatic, or bc it is a delayed hypersensitivity rxn and first test might “prime” them
5
Q
diffuse pattern in lungs?
A
- seen in both lungs
- not in lobar pattern
- when you see this it means something was spread via blood, rather than air
- ex. Milliary TB, pneumoconiosis, histoplasmosis, varicella pneumonia, etc.
6
Q
Shaggy heart
A
- asbestos exposure
- also see plural plaques –> not a precancerous! Only shows exposure!
7
Q
Exposure to asbestosis & lung cancer
A
-exposure increases risk
8
Q
Ferrugionous bodies?
A
- asbestos fibers covered by iron
- look like dumbbells
9
Q
Ulnar deviation
A
-RA
10
Q
RA and lungs?
A
- exudative pleural effusion –> do pleuralcentesis –> pleural fluid protein is > 0.5, glucose will be very low, & acidemic pH
- rheumatoid nodules
11
Q
Bouchards nodes
A
-PIP
12
Q
Psoriasis hand ssx?
A
- Pitting of nails
- Sausage fingers
- Scaly lesions
- Pencil in cup on Xray
13
Q
Uric acid crystals in urine?
A
- RHOMBOID crystals!!!
- ONLY the joint fluid will have neg birefringement crystals
14
Q
Clubbing: found in?
A
- Pulmonary fibrosis –> on exam hear inspiratory velcro-like crackles
15
Q
Spiral CT?
A
- rotates and gets spiral slices of the lungs
- this will allow you too see more solitary nodules or PE, etc.
- “like curly fries!”
16
Q
Why use contrast with CT in lungs?
A
- look at something in the vessels
- ex: look for PE, hilar lymph nodes, plura
17
Q
How to help protect kidneys from contrast?
A
- HYDRATE
- Stop kidney toxic drugs before
- Sodium bicarb can be used to help draw out the contrast
18
Q
Lung mass/abscess + pain in long bones (see elevation of the periosteum)?
A
- hypertrophic pulmonary osteoarthropaty (HPOA)
- can be seen with some cancers
19
Q
Pt with CRESt w/ shortness of breath?
A
- pulmonary HTN
- normal spirometry
- normal lung volumes
- decreased diffusion capacity bc have thickening (onion skinning) of the vessels - Interstitial lung disease
- fibrosis secondary to CREST
- have Scl-70 in serum
20
Q
Xantholasma and arcus?
A
-do Lipid pannel!
21
Q
Arcus?
A
- ring around iris
- seen with hyperlipidemia
22
Q
Dermatomyositis?
A
- Goltrans papules
- Heliotrophic rash
- Proximal muscle weakness
- Shaul sign
23
Q
Varicellis zoster: where does the virus lie dormant?
A
-dorsal root ganglion
24
Syphillius pt given penicillin gets high fever, rash, etc?
- jaichurs-hymer rxn (sp?)
| - occurs bc of lysis of the spirochetes
25
Lung dz that gets worse with tx at first?
- pnemocystis pneumoniae in a pt with a PO2 < 70
| - give sterroids to help diminish this
26
Plummer-winson dz findings?
1. Kolknicyea
2. Smooth tongue
3. Spoon nails (?)
4. Esophageal webs --> higher risk for esophageal cancer
27
Hypersegmentation of neutrophils?
- more than 5
- B12 or folate deficiency --> tx for both
- can get neuropathy!
28
Tea and toast diet, what vitamin should be added?
- vitamin D!
- cant absorb calcium without D!
- also can be related to many other diseases if deficient
29
Petechi, easy bleeding with brushing teeth?
- auer rods can be seen! AML!
| - easy bleeding bc of DIC
30
Howel jolly bodies?
- nuclear reminants on wright stain
- seen in pts without spleen!
- want to give these pts pneumo vaccine!
31
Heinz bodies?
- denatured hemoglobin
- wont stain on wright stains!
- need to do crystal violet stain!
- can have normal G6PD levels during a crisis, bc the deficient ones are destroyed and the normal ones are left behind
- can see bite cells too!
32
Fever, uktrred mental status, renal failure, low platelets, and schistocytes?
-thrombotic thrombocytopenic purpura
33
Anemia, renal failure, bone pain, hypercalcemia, rollot cells and plasma cells?
- multiple myeloma
| - plamsa cells only seen in PERIPHERAL smears, not in martow
34
Schitsocytes?
1. Artificial valve
| 2. TTP
35
DIC v. TTP?
- lab test: ptppt !!!!!!!!!
- DIC would be elelvated
- TTP would be normal
36
TTP tx?
- plasmaphoresis!!!!!!
| - mortality of untreated = 95% !!!!!
37
CMV
1. Reed sternber cells = eye looking back at you
38
Macroglossia + ridging on tounge + enlarged uvula + micrognathia
-obstructive sleep apnea!!!!
39
Apnea
-stop breathing for 10 sec
40
Normal # of apnea events per hour?
-5!
41
Indicators for dialysis?
1. Uremic pericarditis
2. Uremic encephalopathy
3. Hyperkalemia that cant be medically tx --> give kalexelate (can be associated with colonic necrosis) can give beta-agonists, give insulin with glucose (push into cells)
4. Overdose with small volume of distribution (not that lipid soluble) --> ex. Lithium toxic
5. Refractory acidosis
6. Fluid overload
42
Warfarin induced necrosis?
- warfarin reduces protein C &S first! --> they become more thrombogenic at first, so give heparin too!
- heparin acts through anithrombin 3
- can happen in breast, thigh, etc.
- dont stop heparin before 3 days! You need the overlap!!
43
Voccal cords moving in the wrong direction?
- paradoxical vocal cord mvmnt
- tx: speech therapy
- many are treated as asthmatics and dont actually have asthma!
- but, many do have asthma too!
- make sure to listen to trachea! You will head more of a stridor!
44
Fever, arthralgia, raised red tender lesions on shins (erythema nodosum), hilar adenenopathy?
- lofgren's syndrome
- sarcoisdosis
- usually benign --> rarely reappears when it goes into remission!
45
Erythema nodosum: causes?
1. Pregnancy
2. Sarcoidosis
3. Diabetes
4. Etc!
46
White out of a lung on Xray?
- causes;
1. Pneumonia
2. Hemothorax
3. Collapse --> see crowding on ribs
4. Thorocotomy
5. Congential absence of lung
47
T's of widened mediastinum
1. Thymoma
2. Teratoma
3. Thyromegaly
4. Terrible lymphoma
5. Terrosit attack with anthrax
6. ?
48
Loculated effusions?
-staoh
49
Brain and lung lesions?
-nocardiosis
50
Atypical pneumonia + bulging red eardrum?
- mycoplasma pneumonia
| - tx: macrolides
51
Legionella pneumonia: dx?
- urine test
| - only tests serum 1, but that is the most common!
52
Absolute contraindication to nicotine tx?
-life threatening arrhythmias!
53
S1q3t3?
-can be due to any cause of cor pulmonale
54
Ekg in PE?
1. Normal
| 2. Or sinus tachy!
55
D-dimer test: false positives?
1. Pregnancy
2. Trauma
3. Recent dvt
* *negative = rules out diesase!!
56
Stage 1 of sracoid?
-just hilar lymphadenopathy
57
Stage 2 sarcoid?
- parenchyma involvement
| - hilar lymphadenop
58
Stage 3 sarcoid?
-ONLY parenchyma involvement
59
Stage 4 sarcoid?
-end stage lung disease
60
Number needed to treat?
- controlled rate - risk rate = absolute risk reduction
| - = 1/absolute risk reduction
61
Staph microbio
- clusters
| - gram positive
62
Strep pneumo micro
- gram positive
- dipplococci
- encapsulated --> clearing around diplocci
63
H. Influenza micro
-gram negative in long chains
64
Morexella micro
-gram negative, intracellular
65
Drug of choice for H. Flu
- cephalosporins
| - usually resistant to ampicillin
66
Klebsiella micro
- gram negative rod
| - encapsulated
67
What is seen on xray with klebsiella pneumonia?
- lobar pneumonia
| - bulging fissure
68
N. Meningitis micro
-gram neg dipplococci
69
Pustual in hand, think?
-Disseminated N. Gonnococci
70
C. Diff tx
-ORAL vanco or metroniazole
71
Elderly person with meningitis picture, add what to tx?
-something to cover listeria
72
Non-septae hyphe
-mucor mycosis
73
Septal hyphae?
-aspergillious
74
Above diaphragm
-clinda
75
Below diaphragm
-metroniazole
76
If micro is looking back at you?
-CMV
77
Hypersegmented neutrophils?
- megaloblastic anemia
| - also in: chronic infections, liver dz, etc.
78
Auer rods
-AML
79
Philadelphia chromosome?
-CML
80
Smudge cell
-CLL
81
Atypical lymphocytes?
-infectious mono
82
Purple Inclusion bodies in neutrophils?
- toxic granulations
- marker of severity of disease
- can occur in severe bacterial infections --> sepsis
- can also be seen in pregnant women
- also seen with doli bodies
83
Basophilic stippiling
- thalasemmia
- heavy meatl poisoning
- lead poisoning
84
Microcytosis, How do you know?
--rbc is smaller than lymphocyte nucleous
85
Varied size, shape, and color of RBCs?
- seen in transfused pts
| - or pts being treated for a deficicncy (ex. Iron)
86
Spoon nails, glososis, microcytosis?
-plummer wilson syndrome --> higher change of esophageal cancer
87
Heniz bodies?
- can NOT be seen on a right stain!
- its an inclusion body
- denatured hemoglobin
- see bite cells too
- G6PD deficicncy --> sometimes the g6pd levels are NORMAL
88
Young woman, fever, jaundice, normal PT/PTT? Tx?
- TTP
| - give plasmapheresis!!!
89
Tx for acute chest syndrome that hasnt responded to meds or oxygen?
-transfusion!!!!
90
Where does roullox occur?
- only PERIPHERALLY!!!
- wont be seen in marrow!!!
- seen in multiple myeloma!
91
Minimally painful leg ulcers?
- Pyoderma gangrenosum
- associated with a variety of disease: inflammatory bowel dz, chronic hepatitis, RA, etc.
- steroids are tx!
92
Endocarditis dx?
1. Blood cultures
| 2. Echo
93
Purple toes?
- Cholesterol emboli
| - had recent angio
94
Splinter hemorrhages?
-various causes, esp endocarditis
95
Wegener's granulomatosis, best bx?
- lung biopsy
| - gives highest yeild!!
96
Association hep B and vasculitis?
-PAN
97
Hep C association?
-cryiglobulinemia
98
HIV association
-seronegative rheumatic syndrome
99
Cherry red spot can be seen in what adult conidtion?
-retinal artery inclusions --> opthamologic emergency!
100
Retinal vein occlusion
-get a hemorrhage
101
Bilateral ear swelling and cough & cartilage deformities?
- relapsing polychondritis
| - can have saddle nose, cauliflower like ears, horseness (bc cartilage in throat)
102
Keratoderma blennorrhagica
- can be seen in reactive (writers) syndrome
| - looks like syphillus, etc
103
Buldging eardrum infcetion with
-mycoplasma
104
Shall sign
-dermatomyositis
105
Livedo reticularis?
- cholesterol emboli
| - SLE, etc
106
Hypertrophic osteoarthropathy?
- clubbing
| - associated with chronic lung dz, lung malignancy, other tumors
107
Uric acid seen in urine
-rhomboid
108
Urine crystals that look like little envelopes?
- ethylene glycol
| - calcium oxylate crystals
109
Pts that ingest ethylene glycol, why acidotic?
-
110
Methynol ingestion sx
-blindness
111
Indications for steroids in sarcoid?
1. Involvement of organs that can cause irreversible damage --> eyes, neuro, heart, etc.
2. Lower stages, if Symptomatic, but have a way to measure improvement
112
Stages of sarcoid?
- zero = none
- one = hilar adenopathy alone
- two = interstitial + adenopathy
- three = restirictive lung dz
- four = diffuse invlvment
113
Procedure to reinflate atalectasis that id secondary to mucous plug?
-broncoscopy to take out mucous plug from asthma
114
Pericardial effusion ddx?
1. V-vascular: MI (rupture of ventricular wall or dressler syndrome)
2. I -infections: viral (esp coccsacci), bacteria (staph-post op, strep-rheumatic fever, h. Flu, TB-most likely), fungal (esp in immunocomp, candida)
3. C - collegen/vasc: lupus,RA, other rheum dz
4. T -trauma: penetrating wounds, blunt force trauma
5. I - iatrogenic: central line, etc.
6. M - misc, or metastatic: lung, breast, lymphoma --> 3 most common!
- Misc: chronic renal failure, severe hypoTH
115
Tamponade ssx?
1. JVD
2. Narrow pulse pressure
3. HypoTN
4. Pulsus paradoxus --> put bp on and deflate normal and hear noise over 30 mm
5. Tachypenia
6. Tachycardia
116
Tamponade tx?
-pericardiocentesis --> only need to take out a little fluid to stabilize the fluid
117
Lung abscess bugs & tx
- mouth flora, anaerobes --> use clindamycin
- do serial xrays
- monitor yearly with xrays to watch for fungus balls or fibrosis when the infection is cured
