Medicine 1 Flashcards
3 Stages with Chronic HepB Infection with Serum Studies to Define Each
- Immune Tolerant
- HBV DNA / HBsAg +
- ALT nl, b/c no liver inflammation - Immune Active/Clearance
- HBV DNA / HBsAg +
- ALT elevated b/c liver inflammation 2/2 immune rxn - Immune Carrier
- Requires 3x nl HBV DNA AND 3x nl ALT in 12 months
HOCM Tx
Beta blockers = decrease HR = increase diastole = increase filling
Type 1 (Distal) RTA:
- Paph
- Serum K
- Urine pH
- Association / Disease
- Paph: Failure to secrete H
- Serum K: low
- Urine pH: high
- Association / Disease: Stones
Type 2 (Proximal) RTA:
- Paph
- Serum K
- Urine pH
- Association / Disease
- Paph: failure to reabsorb HCO3
- Serum K: low
- Urine pH: normal b/c acidification in distal tubule maintained
- Association / Disease: bones/fancones
Type 4 RTA:
- Paph
- Serum K
- Urine pH
- Association / Disease
- Paph: defect in Na/K tx or Aldosterone
- Serum K: high
- Urine pH: high/normal
- Association / Disease: hypoaldosterone
4 Steps in Management of Ascites
- Fluid/Na Restriction
- Spironolactone > Lasix
- Frequent Therapeutic Taps
- Peritoneal-Jugular Shunt / TIPS (Refractory Ascites)
Define Massive Hemoptysis.
Massive = ≥100c/hr or 600cc/day
What determines if CDiff is Mild/Moderate vs. Severe?
WBC >15k
Cr >1.5x baseline
CYP Inducers (8)
Inducers = Mrs. Barb Steals Phen and Refuses Greasy Carbs Chronic
- Modafenil
- Barbiturates
- St. John Wart
- Phenytoin
- Rifampin
- Griseofulvin
- Carbamazepine
- Chronic EtOH
CYP inhibitors (12)
MAGIC RACKS in GQ
- Macrolide
- Amiodarone
- Grapefruit Juice
- INH
- Cipro
- Ritonivir
- Acute EtOH
- Cimetidine
- Ketoconazole
- Sulfas
- Gemfibrozil
- Quinidine
Describe Eye Findings in Vitreous Hemorrhage
new onset floaters / difficult to visualize fundus / 2nd MCC - diabetic retinopathy
Describe Eye Findings in Retinal Detachment
new onset flashes of light / MCC 2/2 vitreous detachment
Describe Eye Findings in CRAO
pale optic disk, cherry red fovea, boxcar veins
Describe Eye Findings in CRVO
dilated tortutous veins, cotton wool spots, retinal hemorrhage
Describe Eye Findings in AMD
b/l progressive loss of CENTRAL vision / first sign is distortion of vertical lines
Describe Eye Findings in choroidal rupture
2/2 trauma, hemorrhage with crescenting around optic nerve
Describe Eye Findings in amaurosis fugax
pale retina 2/2 to emboli from carotids
Eye findings in Primary Open Angle Glaucoma
cupping of optic disk / “increase cup-disk ratio”
Describe Eye Findings in DM (3) + HTN (3)
DM
- Early: hard exudates, aneurysms, bleeding
- Progressive: Cotton Wool Spots
- Late: neovascularization
HTN
- Arterial Narrowing
- Cu/Silver Wiring
- Cotton Wool Spots
HSV vs. CMV Retinitis in HIV
- 1st Line Treatment for CMV retinitis
- 3x 2nd Line Rx
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
HSV Keratitis
- Epidemiology
- Exacerbating Factor
- Eye Finding
- Tx
- vs. Zoster Opthalmitcus
- 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
5 Indications for Imaging in Back Pain
3 Things Causing Pain with Percussion of Back
Image Back Pain
- IVDU
- Malignancy
- Chronic Steroid Use
- Constitutional Symptoms
- New Neuro Symptoms
Percussion = Pain:
- Abscess
- Metastatic / Lytic Lesion
- Compression Fracture
Chronic Pancreatitis
- MCC
- Presentation (Triad)
- Confirmation Test
- Treatment (NBME**)
MCC = Chronic EtOHism
Presentation
- Chronic Epigastric Pain
- Steatorrhea (2/2 xExocrine Function)
- DM (2/2 xEndocrine Function)
Confirm: CT with Pancreatic Calcifications
Treatment: replace pancreatic enzymes
RA patient suddenly develops trigger finger. Paph?
Tenosynovitis of Palm
2 Patient populations with increased risk of atlanto-axial instability?
- Downs Syndrome
2. RA Patients
(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.
Why increase Estrogen in cirrhotics? 4 Consequences?
- Increased Estrogen b/c decrease E metabolism
- Consequences
- Palmar Erythema
- Spider Angiomata
- Gynecomastia
- Testicular Atrophy
Diagnostic test in possible amebic liver cyst?
Serology for E. Histiolytica
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
W/u Suspected Meningitis (3)
W/u Suspected Meningitis:
- BCx
- CTH (except in
Give MC Bugs and Empiric Treatment
- 2-50y/o
*PC, NM, H. Flu –> Vanc + 3rd Gen Ceph
Give MC Bugs and Empiric Treatment
-IC + 50
*PC, NM, H. Flu + LISTERIA –> Vanc + 3rd Gen Ceph + AMP
Give MC Bugs and Empiric Treatment
- NSG/Shunt/Skull Trauma
*GNR, Staph, Coag- Staph –> Vanc + Cefipime
Provoked vs. Unprovoked DVT Management
- Duration
- Goal INR
Provoked = 3 months Unprovoked = 6-12 months
INR 2-3 for both
∆Lytes in Vomiting Explanation
Vomit = HypoKalemic, HypoChloremic, Metabolic Alkalosis
- Low K/Cl = direct loss of vomit
- Low H = loss of vomit + contraction alkalosis
Contents and Indications for Giving:
- pRBC (2 Indications)
- Contents = RBC
- Indications = Hb
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
Contents and Indications for Giving:
- Cryo (3 Indications)
Cryo
- Contents = Factor 8, vWF, Fibrinogen
- Give when these are low
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)
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
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.
MC Primary Immunodeficiency?
IgA Deficiency; think anaphylaxis to blood products
DiGeorge is x3rd + 4th Pharyngeal Pouches. What comes from each?
3rd = Thymus + INFERIOR Parathyroids 4th = SUPERIOR parathyroids
Patient with HIV needs PCP PPx, but can’t tolerate sulfas. 3 Alternate Rx?
- Dapsone
- Inhaled Pentamidine
- Atorvaquone
(T/F) HIV Patient with any opportunistic infections / AIDS defining illness has “AIDS” as soon as CD4
True
2 Pathogens that cause chronic diarrhea only in AIDS patients?
Cryptosporidium
Isospora
2 Tests to ID Isolated Alk Phos to
- Liver
- Gallbladder
- Liver = 5’ Nucleotidase
- Gallbladder = GGT
What ∆Lytes (2) seen with DKA/HHNKS
HypoK
HypoPO4
(T/F) HIV patients need PPx for Toxo?
True = Bactrim
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
Indications for CT with Pyelonephritis (4)
- Persistent Symptoms despite ABx
- Complicated Pyelo (abscess, etc)
- Nephrolithiasis
- Unusual Urine (Gross Hematuria)
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)
6 Malignancies a/w EBV
Primary CNS Lymphoma (HIV) Oral Hairy Leukoplakia (HIV) Burkitt's Lymphoma Hodgkin's Lymphoma Nasopharyngeal Caricnoma Immunoblastic Lymphoma (BMT)
(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.
Rabies
- Reservoir (2)
- Presentations (2)
Reservoir = Bats + Raccoon
Presentations
- Encephalitis (think aerophobia / hydrophobia = pharynx spasm)
- Ascending Flaccid Paralysis
Basophilic Stippling (4) vs. Target Cells (4)
Basophilic Stippling = MALT
- Macrocytic Anemia
- ACD
- Lead Poison
- Thal
Target Cells = HALT
- HbC
- Asplenia
- Liver Disease
- Thal
- Definition of Acute Liver Failure (3) and MCC (3)
- Stipulation for “Fulminant Hepatic Failure”
- Single best prognostic indicator of ALF/FHF
- Tx of FHF
- 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
- Stipulation for “Fulminant Hepatic Failure”
- Onset of encephalopathy within 8 weeks of ALF - Single best prognostic indicator of ALF/FHF
- PT/INR - Tx of FHF = immediate liver transplant
Recall vs. Observer Bias
- Recall: knowledge of OUTCOME ∆info RECALLED
- Observer: knowledge of STUDY ∆info REPORTED
Susceptibility vs. Performance Bias
- Susceptibility: Tx given ∆with severity of disease
- Performance: Tx given ∆2/2 error in procedure
(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
Best Screening for Acute HBV Infection?
- HbSAg
2. Anti-HBc IgM
Which sCHF and dCHF can be reversed?
sCHF = EtOH; reversible with EtOH cessation dCHF = Hemocrhomatosis; reversible with phlebotomy
4 EColi Diarrheas
- Paph
- Presentation
**What is unique about EHEC’s presentation compared to the other bloody diarrhea bugs (YCASES?)
- ETEC = Traveler’s Diarrhea
- 2/2 Heat Labile + Stabile Toxin - EPEC = blunts aPical villi = diarrhea in Peds
- EIEC = invasive, produces Bloody Diarrhea
- 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
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
Tx for Molluscum in IC Patients (2)?
Curretage
Liquid N2
