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Medicine 1 Flashcards

1
Q

3 Stages with Chronic HepB Infection with Serum Studies to Define Each

A
  1. Immune Tolerant
    - HBV DNA / HBsAg +
    - ALT nl, b/c no liver inflammation
  2. Immune Active/Clearance
    - HBV DNA / HBsAg +
    - ALT elevated b/c liver inflammation 2/2 immune rxn
  3. Immune Carrier
    - Requires 3x nl HBV DNA AND 3x nl ALT in 12 months
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2
Q

HOCM Tx

A

Beta blockers = decrease HR = increase diastole = increase filling

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3
Q

Type 1 (Distal) RTA:

  • Paph
  • Serum K
  • Urine pH
  • Association / Disease
A
  • Paph: Failure to secrete H
  • Serum K: low
  • Urine pH: high
  • Association / Disease: Stones
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4
Q

Type 2 (Proximal) RTA:

  • Paph
  • Serum K
  • Urine pH
  • Association / Disease
A
  • Paph: failure to reabsorb HCO3
  • Serum K: low
  • Urine pH: normal b/c acidification in distal tubule maintained
  • Association / Disease: bones/fancones
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5
Q

Type 4 RTA:

  • Paph
  • Serum K
  • Urine pH
  • Association / Disease
A
  • Paph: defect in Na/K tx or Aldosterone
  • Serum K: high
  • Urine pH: high/normal
  • Association / Disease: hypoaldosterone
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6
Q

4 Steps in Management of Ascites

A
  1. Fluid/Na Restriction
  2. Spironolactone > Lasix
  3. Frequent Therapeutic Taps
  4. Peritoneal-Jugular Shunt / TIPS (Refractory Ascites)
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7
Q

Define Massive Hemoptysis.

A

Massive = ≥100c/hr or 600cc/day

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8
Q

What determines if CDiff is Mild/Moderate vs. Severe?

A

WBC >15k

Cr >1.5x baseline

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9
Q

CYP Inducers (8)

A

Inducers = Mrs. Barb Steals Phen and Refuses Greasy Carbs Chronic

  • Modafenil
  • Barbiturates
  • St. John Wart
  • Phenytoin
  • Rifampin
  • Griseofulvin
  • Carbamazepine
  • Chronic EtOH
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10
Q

CYP inhibitors (12)

A

MAGIC RACKS in GQ

  • Macrolide
  • Amiodarone
  • Grapefruit Juice
  • INH
  • Cipro
  • Ritonivir
  • Acute EtOH
  • Cimetidine
  • Ketoconazole
  • Sulfas
  • Gemfibrozil
  • Quinidine
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11
Q

Describe Eye Findings in Vitreous Hemorrhage

A

new onset floaters / difficult to visualize fundus / 2nd MCC - diabetic retinopathy

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12
Q

Describe Eye Findings in Retinal Detachment

A

new onset flashes of light / MCC 2/2 vitreous detachment

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13
Q

Describe Eye Findings in CRAO

A

pale optic disk, cherry red fovea, boxcar veins

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14
Q

Describe Eye Findings in CRVO

A

dilated tortutous veins, cotton wool spots, retinal hemorrhage

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15
Q

Describe Eye Findings in AMD

A

b/l progressive loss of CENTRAL vision / first sign is distortion of vertical lines

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16
Q

Describe Eye Findings in choroidal rupture

A

2/2 trauma, hemorrhage with crescenting around optic nerve

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17
Q

Describe Eye Findings in amaurosis fugax

A

pale retina 2/2 to emboli from carotids

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18
Q

Eye findings in Primary Open Angle Glaucoma

A

cupping of optic disk / “increase cup-disk ratio”

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19
Q

Describe Eye Findings in DM (3) + HTN (3)

A

DM

  1. Early: hard exudates, aneurysms, bleeding
  2. Progressive: Cotton Wool Spots
  3. Late: neovascularization

HTN

  1. Arterial Narrowing
  2. Cu/Silver Wiring
  3. Cotton Wool Spots
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20
Q

HSV vs. CMV Retinitis in HIV

  • 1st Line Treatment for CMV retinitis
  • 3x 2nd Line Rx
A

HSV: p/w PAINFUL vision loss 2/2 central necrosis of retina
CMV: p/w PAINLESS vision loss 2/2 fluff/granular deposits on retina with hemorrhages* (Occurs with CD4

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21
Q

HSV Keratitis

  • Epidemiology
  • Exacerbating Factor
  • Eye Finding
  • Tx
  • vs. Zoster Opthalmitcus
A
  • Epidemiology: MC Corneal Blindness
  • Exacerbating Factor: Sun exposure (like all HSV, need stress)
  • Eye Finding: Dendritic Ulcers +/- Corneal Vesicles
  • Tx: Topical/PO Acyclovir
  • vs. Zoster Opthalmitcus: Same eye, but zoster has rash on skin
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22
Q

5 Indications for Imaging in Back Pain

3 Things Causing Pain with Percussion of Back

A

Image Back Pain

  1. IVDU
  2. Malignancy
  3. Chronic Steroid Use
  4. Constitutional Symptoms
  5. New Neuro Symptoms

Percussion = Pain:

  1. Abscess
  2. Metastatic / Lytic Lesion
  3. Compression Fracture
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23
Q

Chronic Pancreatitis

  • MCC
  • Presentation (Triad)
  • Confirmation Test
  • Treatment (NBME**)
A

MCC = Chronic EtOHism

Presentation

  1. Chronic Epigastric Pain
  2. Steatorrhea (2/2 xExocrine Function)
  3. DM (2/2 xEndocrine Function)

Confirm: CT with Pancreatic Calcifications

Treatment: replace pancreatic enzymes

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24
Q

RA patient suddenly develops trigger finger. Paph?

A

Tenosynovitis of Palm

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25
2 Patient populations with increased risk of atlanto-axial instability?
1. Downs Syndrome | 2. RA Patients
26
(T/F) Hypoalbuminemia can cause perioral numbing and Chovstek sign?
FALSE. Hypoalbuminemia can cause low TOTAL, but not low IONIZED Ca, which is what will produce these symptoms.
27
Why increase Estrogen in cirrhotics? 4 Consequences?
1. Increased Estrogen b/c decrease E metabolism 2. Consequences - Palmar Erythema - Spider Angiomata - Gynecomastia - Testicular Atrophy
28
Diagnostic test in possible amebic liver cyst?
Serology for E. Histiolytica
29
What is Friedlander's PNA? - Encapsulated Bugs (8) - Hint for growth of Friedlander's Bug
Klebsiella PNA - Grows in Mucoid Colonies - Encapsulated Bugs = SHIN SKES *PC, HFlu, NM, Salmonella, Kleb, EColi, Group A S
30
W/u Suspected Meningitis (3)
W/u Suspected Meningitis: 1. BCx 2. CTH (except in
31
Give MC Bugs and Empiric Treatment | - 2-50y/o
*PC, NM, H. Flu --> Vanc + 3rd Gen Ceph
32
Give MC Bugs and Empiric Treatment | -IC + 50
*PC, NM, H. Flu + LISTERIA --> Vanc + 3rd Gen Ceph + AMP
33
Give MC Bugs and Empiric Treatment | - NSG/Shunt/Skull Trauma
*GNR, Staph, Coag- Staph --> Vanc + Cefipime
34
Provoked vs. Unprovoked DVT Management - Duration - Goal INR
``` Provoked = 3 months Unprovoked = 6-12 months ``` INR 2-3 for both
35
∆Lytes in Vomiting Explanation
Vomit = HypoKalemic, HypoChloremic, Metabolic Alkalosis - Low K/Cl = direct loss of vomit - Low H = loss of vomit + contraction alkalosis
36
Contents and Indications for Giving: | - pRBC (2 Indications)
- Contents = RBC | - Indications = Hb
37
Contents and Indications for Giving: | - FFP (3 Indications)
- Contents = all clotting factors - Give = DIC, Liver Dz or Warfarin OD * this includes chronic liver disease patients who have acquired VitK Deficiency
38
Contents and Indications for Giving: | - Cryo (3 Indications)
Cryo - Contents = Factor 8, vWF, Fibrinogen - Give when these are low
39
Give Liver Histology with: - ASA Toxicity / Reyes - Acute Viral Hepatitis / INH Toxicity - Heavy EtOH Use vs. EtOH Hepatitis - Chronic Viral Hepatitis - NASH
- ASA Toxicity / Reyes = Fatty vacuolization - Acute Viral Hepatitis / INH Toxicity = Panlobular monocellular infiltrate with necrosis - Heavy EtOH Use vs. EtOH Hepatitis: Steatosis --> PMN + multicellular infiltrate with necrosis, Mallorgy Bodies - Chronic Viral Hepatitis: fibrosis/piecemeal necrosis - NASH: looks just like EtOH, which is why we say "non-alcoholic)
40
Hereditary vs. Acquired Angioedema - Paph - C4 Levels vs. C1q Levels - Tx of Each
Hereditary Angioedema - AD deficiency in C1 esterase inhibitor - C4 levels are LOW, C1q are NORMAL - Tx = Danazol / Androgen = increase hepatic synth of C1 esterase inhibitor Acquired Angioedema - Paph = ACE-I blocks ACE's destruction of bradykinin = increase kinins - CV levels are LOW, C1q are LOW - Tx: Switch to ARB
41
Sexually active patient with sore throat and mono-like illness is tested HIV-. Most likely cause of symptoms.
HIV! He just hasn't seroconverted. Recall, HIV initially presents with mono type symptoms.
42
MC Primary Immunodeficiency?
IgA Deficiency; think anaphylaxis to blood products
43
DiGeorge is x3rd + 4th Pharyngeal Pouches. What comes from each?
``` 3rd = Thymus + INFERIOR Parathyroids 4th = SUPERIOR parathyroids ```
44
Patient with HIV needs PCP PPx, but can't tolerate sulfas. 3 Alternate Rx?
1. Dapsone 2. Inhaled Pentamidine 3. Atorvaquone
45
(T/F) HIV Patient with any opportunistic infections / AIDS defining illness has "AIDS" as soon as CD4
True
46
2 Pathogens that cause chronic diarrhea only in AIDS patients?
Cryptosporidium | Isospora
47
2 Tests to ID Isolated Alk Phos to - Liver - Gallbladder
- Liver = 5' Nucleotidase | - Gallbladder = GGT
48
What ∆Lytes (2) seen with DKA/HHNKS
HypoK | HypoPO4
49
(T/F) HIV patients need PPx for Toxo?
True = Bactrim
50
Mechanism of Carpal Tunnel - Pregnancy - Hypothyroid - Amyloid - Acromegaly - Rhuematoid
- Pregnancy: E-mediated fluid retention - Hypothyroid: increase deposition of myxoma - Amyloid: amyloid deposition - Acromegaly: tendon hyperplasia - Rhuematoid: synovial hyperplasia
51
Indications for CT with Pyelonephritis (4)
1. Persistent Symptoms despite ABx 2. Complicated Pyelo (abscess, etc) 3. Nephrolithiasis 4. Unusual Urine (Gross Hematuria)
52
Osteoid Osteoma vs. Giant Cell Tumor of Bone Fx + Management
Osteoid Osteoma - Think PM pain responsive to NSAID - Treatment = NSAID / Sx GCTB - Think female with epiphyseal lytic "SOAB BUBBLE" lesion - Treatment = Surgery (Curretage + Graft)
53
6 Malignancies a/w EBV
``` Primary CNS Lymphoma (HIV) Oral Hairy Leukoplakia (HIV) Burkitt's Lymphoma Hodgkin's Lymphoma Nasopharyngeal Caricnoma Immunoblastic Lymphoma (BMT) ```
54
(T/F) Aminoglycoside induced renal damage will produce urine with eosinophils and WBC casts.
False, this urine describes AIN 2/2 PCN/sulfa/cephs. Aminoglycosides causes AKI so you'll see EPITHELIAL casts and NO WBC.
55
Rabies - Reservoir (2) - Presentations (2)
Reservoir = Bats + Raccoon Presentations 1. Encephalitis (think aerophobia / hydrophobia = pharynx spasm) 2. Ascending Flaccid Paralysis
56
Basophilic Stippling (4) vs. Target Cells (4)
Basophilic Stippling = MALT - Macrocytic Anemia - ACD - Lead Poison - Thal Target Cells = HALT - HbC - Asplenia - Liver Disease - Thal
57
1. Definition of Acute Liver Failure (3) and MCC (3) 2. Stipulation for "Fulminant Hepatic Failure" 3. Single best prognostic indicator of ALF/FHF 4. Tx of FHF
1. Definition of Acute Liver Failure (3) and MCC (3) - Hepatic Injury (AST/ALT >10x ULN) - Encephalopathy - xSynthetic Function (INR >1.5) *MCC = Ischemic (Shock Liver), Toxin (≠EtOH) and Viral 2. Stipulation for "Fulminant Hepatic Failure" - Onset of encephalopathy within 8 weeks of ALF 3. Single best prognostic indicator of ALF/FHF - PT/INR 4. Tx of FHF = immediate liver transplant
58
Recall vs. Observer Bias
- Recall: knowledge of OUTCOME ∆info RECALLED | - Observer: knowledge of STUDY ∆info REPORTED
59
Susceptibility vs. Performance Bias
- Susceptibility: Tx given ∆with severity of disease | - Performance: Tx given ∆2/2 error in procedure
60
(T/F) Both bronchogenic carcinoma and mesothelioma will have plaques on CXR.
True, but: - If Mass/Cavitary Lesion = Bronchogenic - If Effusion and NO Mass = Mesothelioma
61
Best Screening for Acute HBV Infection?
1. HbSAg | 2. Anti-HBc IgM
62
Which sCHF and dCHF can be reversed?
``` sCHF = EtOH; reversible with EtOH cessation dCHF = Hemocrhomatosis; reversible with phlebotomy ```
63
4 EColi Diarrheas - Paph - Presentation **What is unique about EHEC's presentation compared to the other bloody diarrhea bugs (YCASES?)
1. ETEC = Traveler's Diarrhea - 2/2 Heat Labile + Stabile Toxin 2. EPEC = blunts aPical villi = diarrhea in Peds 3. EIEC = invasive, produces Bloody Diarrhea 4. EHEC = 2/2 Shiga-like toxin (o157:h7) 2/2 ingestion of undercooked beef --> Triad of Anemia/Thrombocytopenia/ARF (HUS) after bloody diarrhea ***B/c it is TOXIN mediated = NO FEVER
64
Infective Endocarditis - When to suspect? - 1st Step - Empiric Rx? - Rx when confirmed Staph vs. Strep? - MC Acute/Native vs. Subacute/Damaged Valve - Who gets Enteroccus vs. Strep Bovis - Duke Major Criteria - Duke Minor Criteria (6) - Complication = Fever, Leuk and LUQ Pain + Tx
- When to suspect? = Fever + New Murmur - 1st Step = 3x BCx from separate lines - Empiric Rx? = Vanc (Staph, Strep and Entero Coverage) - Rx when confirmed Staph = Home IV Vanc, strep = Ceftriaxone or PCN IV - MC Acute/Native = Staph - vs. Subacute/Damaged Valve = Strep - Who gets Enteroccus (UTI/urinary tract instrumentation) - vs. Strep Bovis (CRC --> Colonoscopy) - Duke Major Criteria: BC+, TEE-evidence of Endocardial Damage - Duke Minor Criteria (6): BC+, Fever, Predisposing Factor, IVDU, Embolic Event / Immune Event - Complication = Fever, Leuk and LUQ Pain + Tx = Splenic Abscess (Embolic Event); Tx = Splenectomy
65
Tx for Molluscum in IC Patients (2)?
Curretage | Liquid N2

Step 2 CK (8 decks)

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