Medicine 1 Flashcards
What are some medications that may cause idiopathic intracranial hypertension (aka pseudomotir cerebri)? (2)
tetracyclines
hypervitaminosis A (retinoids)
A patient presents with dyspnea, orthopnea, paroxysmal nocturnal, and hemoptysis. She recently immigrated from Cambodia 2 years ago. She is diagosed with mitral valve stenosis. How does long-standing MS cause these symptoms?
Dyspnea - decreased blood flow to ventricle –> systemic circulation
orthopnea and PND - increased atrial pressure causes pulmonary vascular congestion –> pulmonary edema
hemoptysis - incrased atrial pressure causes polmonary vascular congestion –> polumoary edema and pushing RBC into fluid
What is tonometry?
procedure that determines intraocular pressure
A man reports something flew into his eye while using his hand-held drill. He claims he can feel something in his eye. After grossly examining his eye and not seeing anything, what would you do next?
fluoresceuin examination
allows for better visualization of globe
What happens when you increase the cutoff value? Decrease?
Think of true negatives as “specificity” and true positives as “sensitivity”. If the cutoff point increases, you increase the specificity. If the cutoff point decreases, you increase the sensitivity.
How are the different classes of asthma classified? How are they treated?
S. I. L. I. I. O
SABA, LDIC, LABA, IDIC, HDIC, O2
How does nitroglycerine relieve pain in cardiac patients?
Decreases ventricular preload resulting in decreased ventricular wall stress. This, after other downstream effects, causes a decrease in O2 demand therfore stopping pain.
What is normal ejection fraction?
55%+
What is a side effect of nitroprusside (commonly used for hypertensive emergencies)? What are common findings of this side effect?
cyanide accumulation/poisoning
Skin flushing (early) –> cyanosis (later)
altered mental status
tachypnea (early) –> repiratory depression (later)
Abdominal pain, nausea, vomiting
Why does warfarin increase hypercoagulability in the beginning of therapy?
Warfarin quickly decreases protein C concentratins within the first day while other procoagulant factor concentrations take days to decrease
What are the 3 types of renal tubular acidosis?
At what Hb concentration should someone recieve packed RBCs? Platelets?
Hb <7d/dL
<10,000/mm^3 OR 50,000/mm^3 if actively bleeding
Can acute BPH cause AKI?
Not generally. However, chronic obstruction from BPH can cause AKI
What should when a patient presents with acutely elevated creatinine?
renal ultrasound to assess for hydronephrosis and other causes of obstrutions
What causes subclavian steal syndrome?
stenosis or occlusion of the subclavian syndrome causing blood to be “stolen” from the vertebral artery
What is the distribution of mean, median, and mode for negatively skewed, normal distribution, positively skewed bell curves?
What causes the resting tremor in parkinson’s?
neuron degeneration in the basal ganglia (specifically the SN)
What are the clinical features of acute angle-closure glaucoma? What drugs can cause it?
acute HA, nausea, blurry vision, sluggish/dilated pupil with poor light response, corneal edema/cloudiness, conjunctival redness
drugs that dilate the pupil and cause closure (e.g. anti-cholinergics/antimuscarinics)
emphysema, chronic bronchitis, and asthma all show a decreased FEV1/FVC (<70%) and a decreased FEV1 (due to air trapping). How do they differ with DLCO?
Emphysema = decreased
Chronic bronchitis = normal
Asthma = increased
Define primary polydipsia, central DI, and nephrogenic DI. How will water deprivation affect urine osmolality? How will desmopressin affect urine osmolality in central and nephrogenic DI?
Primary polydipsia is commonly cause by psychiatric disorders where a patient is always drinking water. Urine osmolality will increase
Central DI is the inability to synthesize/secrete ADH. Urine osmolality will be low (dilute). Desmopressin will result in an increase in urine osmolality
Nephrogenic DI is when the kidneys do not respond to the presence of ADH. Urine osmolality will be low. Desmopressin will not have or will have a small effect on urine osmolality
How should patients with hypercalcemia be treated?
IV fluids to dilute the calcium
Calcitonin to help inhibit calcium resorptin via bones
bisphosphonate (delayed effect; 2-4 days later)
Name the three features of polyps that increase the risk of malignant progression
Villous features
size 1cm or greater
3 polyps of more
In patients with hypovolemia, what happens to renin secretion, efferent arteriolar resistance, and tubular resorption?
renin secretion increases (kidneys sense hypoperfusion)
increased efferent arteriolar resistance (increases GFR and BP)
increased tubular reabsorption (renin increases aldosterone which increases tubular reabsorption)
What are common causes of hypocalcemia associated with low PTH? Hypocalcemia associated with high PTH?
Most common cause of hypocalcemia with low PTH is surgery
Causes of hypocalcemia with high PTH is vitamin D deficiency and CKD which can be confirmed with serum 25-hydroxy vit D levels and renal function tests
What is a common bacterial opportunistic infection and viral opportunistic infection seen in immunocomprimised and immunosuppressed? What drugs should be added for protection?
penumocystis penumonia - TMP-SMX (Bactrim)
CMV - gancyclovir or valgancyclovir
What organism causes erysipelas?
streptococcus pyogenes (GAS)
How do you diagnose carpal tunnel?
nerve conduction studies
in a patient with a bradyarrhythmia, what would you give to speed it up?
antimuscarinic
if you suspect someone has avascular necrosis and Xray is normal, what should you order?
MRI
What is the treatment for a kidney stone 4mm or less?
adequate hydration (fluid intake >2L/day)
In anaphylaxis, how should epinephrine be delivered? What if this route of delivery fails?
intramuscular epi. IV epinephrine is for those who fail to responde to intramuscular epi
What are the signs/sx of CO poisening?
Pinkish-red skin hue, HA, nausea, vomiting, confusion, abdominal discomfort
What is a bronchogenic cyst? Where are they typically found? Where are thymomas found?
congenital anomaly of the forgut that results in cyst formation which commonly present in the middle of the mediastinum
thymomas are found in the aterior fo the mediastinum
What does the pronator drift test for?
upper motor neuron damage/lesion in the pyramidal tract
A patient has meningococcal meningitis and requests to go home and be treated there. What should you do?
fuck that guy! He’s staying in the hospital cuz that shit is contagious
When a patient has steatorhhea and also complains of bone pain, what would his PTH, phosphate, and calcium levels be?
steatorrhea means he has malabsorption of fat. Vitamins ADEK are fat soluble and would not be absorbed. The lack of vit D is what would cause the bone pain as Ca2+ is being drawn from broken down bone. Vitamin D is responsible for calcium absorption in the gut and in renal tubules.
High PTH, low phosphate, low calcium
What lab test can identify nephropathy?
random protein/creatinine ratio
What is the difference in PE findings between cellulitis and erysipelas?
cellulitis is deep and skin will be flat with poor demarcation
erysipelas is a superficial skin infection and will have raised skin with well demarcated edges
What are CRAB symptoms in multiple myeloma?
hyperCalcemia
- *R**enal involvement
- *A**nemia
- *Bone lytic lesions/B**ack pain
What is sympathetic ophthalmia (aka spared eye injury)?
immune-mediated inflammation of one eye (the sympathetic eye) after a penetrating injury to the other eye.
Pathophysiological mechanism is believed to be the uncovering of ‘hidden’ antigens
How does pyoderma gangrenosum evolve? What diseases is it associated with? How do you treat it?
starts as an inflammatory papule, pustule, or nodule and progresses to form an expanding ulcer with a purulent base and an irregular, violaceous border. Usually presents on the trunk or lower extremities.
associated with IBD, RA, and malignancy
treat with local or systemic glucocorticoids
What is dacryocystitis? Which bugs typically cause it?
infection of the lacrimal sac (inner aspect of eye)
staph aureus and strep
What are the manifestation os waldenstrom macroglobulinemia?
hyperviscocity syndrome (diplopia, tinnitus, HA, dilated/segmented fundoscopic findings causing vision problems)
neuropathy (electric sensation)
hepatosplenomagaly
anemia
thrombocytopenia
How do you treat dermatitis herpetiformis?
oral dapsone and gluten free diet
How do you treat bollous pemphigoid?
topical clobetasol (steroid)
What causes hemi-neglect syndrome?
infarct of the non-dominant parietal lobe
In osteomalacia, what would lab values look like for alkaline phosphatase, PTH, serum calcium, serum phosphorus, urinary calcium, and 25-OH-D?
Increased alkaline phosphatase
increased PTH
decreased or inappropriately low serum Ca2+
decreased serum phosphorus
decreased urinary calcium
decreased 25 OH-D
How do you determine a transudative vs exudative effusion?
Why does Zollinger-Ellison syndrome cause impaired fat absorption and diarrhea?
Zollinger-Ellison syndrome causes excess secretion of gastrin, which results in increased acid secretion. This increased acid production decreases the pH in the duodenum inactivating pancreatic enzymes leading to diarrhea and fat malabsorption
What is pseudogout (crystal composition and cause)? What type of crystals?
pseudogout is caused by calcium pyrophosphate dihydrate (CPPD) and is a common complication of high serum calcium
rhomboid-shaped crystals
What are common symptoms of meniere disease?
vertigo, sensorineural hearing loss, tinnitus
in a craniopharyngioma, all pituitary hormones would be affected. Would aldosterone levels be lower as well?
no
the RAAS cycle initiated by the kidneys would maintain levels
What are the distinguishing features between myasthenia gravis, lambert-eaton syndrome, and dermatomyositis/polymyositis?
What is the emergency treatment for central retinal artery occlusion?
occular massage to try and dislodge the embolus to a point further dow the arterial circulation to improve retinal perfusion and high flow oxygen
What is the treatment for a simple renal cyst?
reassurance
What are clinical features of Behcet disease?
Recurrent, painful oral aphthous ulcers
Genital ulcers
Eye lesions (e.g. uveitis)
Skin lesions (erythema nodosum, acneiform lesions)
Thrombosis
What is the mechanism of hydroxychloroquine? Adverse effect?
TNF and IL-1 suppression
retinopathy
What is euthyroid sick syndrome?
classic is normal TSH and T4 and ELEVATED T3
What type of imaging do you get to diagnose toxic megacolon?
abdominal Xray
barium enema is contraindicated as the bowel may be perforated and you don’t want to get the contrast into the abdominal cavity
Can you give live vaccines to HIV patients with a CD4 count >200?
yes
Can’t if CD4 <200
What is the preferred methd for HIV screening?
HIV p24 antigens and HIV antibodies
What is the most common cause of spontaneous lobar hemorrhage, particularly in adults? children?
adults = cerebral amyloid angiopathy
Arteriovenous malformation
What are symptoms of chronic arsenic toxicity?
sensorimotor neuropathy
skin lesions (hypo and hyperpigmented, hyperkeratotic)
pancytopenia
mild transaminitis
What is the best treatment for metabolic alkalosis?
treat underlying cause
give notmal saline to correct
in an individual with infective endocarditis who has NOT used IV drugs and has never had RF, what type of murmur would be present?
mitral regurgitation
(mitral stenosis in RF; tricuspid regurgistation with IVDU)
how do you test for acromegaly?
1) test to see if IGF-1 levels are normal (secreted by liver)
2) if normal no worries - if abnormal do oral glucose suppression of GH
3) if adeqate supression no worries - if inadequate suppression do an MRI
3) if normal pituitary cause is extrapituitary - if pituitary mass surgery vs medical management
does limited sodium intake help prevent calcium stones?
yes. decreased sodium intake will cause increased Na+/Ca2+ reabsorption
How do you diagnose leprosy?
Biopsy lesion edge
How does sodium bicarbonate treat TCA overdose?
sodium bicarb 1) increases pH which decreases the effectiveness of the TCA binding capacity to sodium channels and 2) increases serum sodium levels which increases the electrochemical gradient further affecting the ability of TCAs to bind to sodium channels
What is the treatment for MS exacerbation? What if first line does not work?
glucocorticoids
plasmapheresis is done if patient does not respond to steroids
What are the criteria for initiating long-term home oxygen therapy in COPD patients?
Resting PaO2 55mmHg or less
OR
resting SaO2 88% or less
If a patient has hammer or claw toe deformity, what type of issue do they likely have?
diabetic peripheral neuropathy
What is the treatment for carotid artery stenosis?
symptomatic patients recieve carotid endarterectomy (generally 70-99% stenosis)
asymptomstic patients recieve carotid endarterectomy with 80-99% stenosis OR antiplatelet and statin <80%
