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Medicine Flashcards

1
Q

Differentiate transudate vs exudate

A

Light’s Criteria

≥ one of following for exudate:

1) pleural fluid protein: serum protein ratio > 0.5
2) Pleural fluid LDH:serum LDH > 0.6
3) Pleural fluid LDH > 2/3rds of upper limit normal

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2
Q

S&S, Management,Rx HSV Encephalitis

A

S&S: high fever, gustatory hallucinations, confusion

Do lumbar puncture (look for RBCs)

order PCR for HSV protein of CSF and commence IV acyclovir immediately before results come back.

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3
Q

S/E Thiazides

A
  • Mnemonic (HyperGLUC)

hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia

hypokalemia (due to compensatory aldoseterone release from drop blood volume)
hypotension

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4
Q

Statin Follow-Up

A

Lipids and Liver enzymes q 4-6 months or if pts complains of jaundice, RUQ pain,dark urine

CK at baseline and if pt complains of myalgia

D/C statin if CK > 10x upper limit of normal

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5
Q

Define Hemochromatosis

A

excess iron storage, which causes multiorgan system dysfunction with total body stores of iron increased to 20-40 g (normal 1g)

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6
Q

Tetrad Hemochromatosis

A

The classic tetrad of manifestations resulting from hemochromatosis consists of (1) cirrhosis, (2) diabetes mellitus, (3) hyperpigmentation of the skin, and (4) cardiac failure

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7
Q

New York Heart Assocation Classification HR Failure

A

Class 1 - No limitation during ordinary activity

Class 2 - slight limitation during ordinary activity

Class 3 - marked limitation of normal activities without symptoms at rest

Class 4 - unable to undertake physical activity without symptoms; symptoms may be present at rest

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8
Q

S/E of CCB

A

Dizziness, nausea, hypotension, cough, pulmonary edema

(all due to vasodilatory effects)

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9
Q

Treatment of acute pulmonary edema

A

LMNOP

first treat underlying ppting factors (e.g. ischemia, arrhythmia)

L - Lasix (furosemide) 40-500 mg IV

M -morphine 2-4 mg IV- decreases anxiety and preload (venodilation)

N- nitroglycerin- topical/IV/SL (decreases preload)

0-oxygen

P- positive airway pressure (CPAP/BiPAP)- decreases preload and need for ventilation

P - position - sit patient up with legs hanging down unless patient is hypotensive

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10
Q

5 Most Common Causes of CHF

A
  1. Coronary Hrt Disease (60-70%)
  2. HTN
  3. Idiopathic (often dilated cardiomyopathy)
  4. Valvular (AS, MR, AR)
  5. Alcohol (dilated cardiomyopathy)
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11
Q

What is Metabolic Syndrome

A

obesity, lipid abnormalities, hypertenion, hyperglycemia

Rx: exercise, weight loss, dietary changes

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12
Q

Orthostatic proteinuria

A

Benign condition in adolescents and young adults characterized by proteinuria < 2 g in the upright postion and not supine position and normal creatinine clearance.

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13
Q

Viral Meninigits - CSF characteristics

A

Pressure normal

Glucose normal (low in Bacterial)

Protein elevated

Cell count < 300 (high in bacterial)

Chloride normal (low in tuberculous meningitis)

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14
Q

Best diagnostic test for Vitamin D deficiency

A

Measure levels of 25 hydroxyvitamin D

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15
Q

3 commonly used analgesics for pain control in the ICU

A

Fentanyk

Morphine sulphate

Hydromorphone

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16
Q

Antibiotic of choice for bacterial meningitis

A

Ceftriazone - thrid generation cephalosporin has good penetrance into the CSF and is most likely to hit the offending agent

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17
Q

Analgesic to avoid in geriatric patients

A

Propoxyphene is to be avoided in geriatric patients as efficacy is similar to aspirin or acetominophen but drug accumulation, ataxia, dizziness, neurotoxic effects result in morbidity

Oxycodone, hydrocodone, hydromorphone and acetominophen are acceptable for use in geriatric patients

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18
Q

Wernicke encephalopathy vs Korsakoff syndrome

A

Wernicke - psychomotor slowing or pathy, ataxia, impaired consciousness (confusion), opthalmoplegia (horizontal nystagmus, bilateral abducens palsy) - traid in bold

Korsakoff - mental confusion, dysphonia, confabulation and impaired memory of recent events. Can develop after repeated episodes of Wernicke

Treatment - 50-100 mg IM or IV thiamine for several days followed by 10-20 mg once/day until therapeutic dose reached

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19
Q

Best starting dose for Parkinsons

A

Carbidopa : levodopa

25mg/100mg 3 x/day

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20
Q

DDx of T wave Inversion

A

myocardial infarction, myocarditis, old pericarditis, myocardial contusion, digoxin toxicity

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21
Q

S&S Celiac disease

A
  1. Characteristic bulky, fowl smelling stools
  2. loss of muscle mass or subcutaneous fat
  3. Pallor - due to iron deficiency anemia
  4. bone pain - due to osteomalacia
  5. easy bruising - due to vitamin K deficiency
  6. hyperkeratosis - due to vitamin A deficiency
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22
Q

DDx of Erythema Nodosum

A

NODOSUM

No - no cause - idiopathic (40%)

Drugs (sulfonamides, OCP, etc)

O - Other infections (GAS+)

Sarcoidiosis

Ulcercerative COlitis and Crohn’s (C>UC)

Malignancy (leukemia, Hodgkin’s, lymphoma)

23
Q

Morphine S/Es and Uses

A

Uses:

1) Analgesia
2) Treatment of Diarrhea
3) Relief of Cought
4) Treatment of acute pulmonary edema: possibily due to vasodilatory effect

S/E

Miosis
Respiratory Depression (most common acute overdose S/E)
Histamine Release (bronchoconstriction, rash - never give morphine to asthmatic!)
Constipation
Vomiting and Nausea (40% patients)

Of all S/E: tolerance to constipation and meiosis does not develop

24
Q

Causes Interstitial Nephritis

A

70% drugs - cephalosporins, penicillins, sulfonamides, sulfomamide containing diuretics, NSAIDs, rifampin, phenytoin, allopurinol

25
Q

Contraindications to thrombolytics

A

Absolute
Active Bleeding or diathesis
Significant closed head or facial trauma within 3 months
Suspected aortic dissection
Prior intracranial hemorrhage
Ischemic stroke within 3 months

Relative
Pregnancy
Recent major surgery (< 3 wks)
Traumatic or prolonged CPR
Recent (within 4 weeks) internal bleed
Active peptic ulcer
Poorly controlled hypertension (180/100

26
Q

Causes of Torsades de Pointes

&

Rx

A

Etiology

Congentital long QT syndrome

Drugs: class IA (quinidine), class III (sotalol), phenothiazines (TCAs), erthromycin, quinolones, antihistamines

Electrolyte disturbances: hypokalemia, hypomagnesesemia

Nutritional deficiencies: causing above electrolyte problems

Rx:

magnesium sulfphate, temporary pacing, correct underlying cause of prolonged QT, cardioversion if hemodynamically unstable

27
Q

Drugs that cause lichenoid eruption - planus, puroule, polygonal, pruritic

A

GOLD

QUINIDINES

THIAZIDES

28
Q

How do you evaluate severeity of IBD

A

** Truelove and Witt’s Criteria**

Bowel’s open > 6 times/24 hrs

Plus any one of the following:
□ Hb< 10.5
□ ESR > 30
□ Pulse rate > 90

Temp > 37.5

29
Q

When to admit someone with syncope for workup

A

San Francisco Syncope Rule

○ Systolic BP < 90 mmHg
○ Patient c/o SOB
○ Hx of CHF
○ Hct < 30%
○ Abnormal EKG (any non-sinus rhythm or any new change
- >1 predicts serious outcome at 30 days, including death, arrhythmia, MI, PE, Stroke, SAH, need for transfusion, hospital admission –> sensitivity 98%, specificity 56%

If score 0, safe to discharge home with investigation as outpatient

30
Q

Drug causes of pancytopaenia

A

cytotoxics
antibiotics: trimethoprim, chloramphenicol
anti-rheumatoid: gold, penicillamine
carbimazole*
anti-epileptics: carbamazepine
sulphonylureas: tolbutamide

*causes both agranulocytosis and pancytopaenia

31
Q

DDx of Lymphadenopathy

A

Idiopathic

Infiltration
Primary carcinoma: lymphoma, leukaemia
Secondary carcinoma: e.g.: due to melanoma, thyroid carcinoma, breast, bowel, lung, prostate, kidney, or head and neck cancers

Non-infective
Sarcoidosis
Amyloidosis
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Eczema, psoriasis
Drugs, e.g.: phenytoin

Inflammation and infection
Local infection e.g.: pharyngitis
Bacterial: tuberculosis, syphillis, brucella
Viral: EBV, HIV, HSV, hepatitis
Other: toxoplasmosis

32
Q

Things to comment on when assessing a lump

A

3 S’s, 3 T’s, and 3 C’s:
3 S’s: site, size, shape
3 T’s: temperature, tenderness, tethering
3 C’s: colour, contour, consistency

33
Q

RIsk factors for melanoma

A

Family Hx (1-2nd degree relative)
Previous melanoma
Nevi (Dysplastic nevus syndrome or increased num benign nevi)
Exposure to sunlight at early age (most important)
Immunosuppressive traits (e.g. renal transplantation)
Pigment trais (blue eyes, fair/red hair, pale complexion)

34
Q

Types of Melanoma

A

Superficial spreading (80%) - often from dysplastic nevus. median age 44
Lentigo maligna - common in elderly. least likely to have vertical phase
Nodular - no radial growth. poor prognosis
Acral lentiginous. not related sun exposure, located palm, sole, underneath fingernail. Most often Asians and blacks. Poor prognosis, extremely aggressive

35
Q

DDx of Tetany

A

Hypocalcemia

Metabolic alkalosis (with hyperventilation)

Hypokalemia

Hypomagnesemia

36
Q

Signs of Acute Hypocalcemia

A

Paresthesia

Chvostek’s sign - percussion of facial nerve

Trousseau’s sign - blood pressure cuff

37
Q

Causes of a third nerve palsy

A

diabetes mellitus
vasculitis e.g. temporal arteritis, SLE
false localizing sign* due to uncal herniation through tentorium if raised ICP
posterior communicating artery aneurysm (pupil dilated)
cavernous sinus thrombosis
Weber’s syndrome: ipsilateral third nerve palsy with contralateral hemiplegia -caused by midbrain strokes
other possible causes: amyloid, multiple sclerosis

38
Q

Treatment for neuropathic pain:

Post-herptic neuralgia

Trigemminal neuralgia

Diabetes

A

Post herptic - amytryptilline, pregablin

Trigemminal - carbamazepine

DM - duloxetine

39
Q

Causes of Chorea

A

** Chorea is caused by damage to the basal ganglia, especially the caudate nucleus.**

Huntington’s disease, Wilson’s disease, ataxic telangiectasia
SLE, anti-phospholipid syndrome
rheumatic fever: Sydenham’s chorea
drugs: oral contraceptive pill, L-dopa, antipsychotics
neuroacanthocytosis
pregnancy: chorea gravidarum
thyrotoxicosis
polycythaemia rubra vera
carbon monoxide poisoning
cerebrovascular disease

40
Q

DDx of MS

A

CNS Infection (Lyme disease, HIV, syphillis)

CNS inflmmatory (SLE, sarcoidosis, Sjorgen’s)

CNS microvascular disease (HTN, DM, vasculitis)

Genetic disorder (leukodystrophy, hereditary myleopathy, mitochondrial disease)

Structrual or compressive conditions of the brain and spinal cord (cervical spondylosis, tumor, herniated disc, Chiari’s malformation)

Vitamin B12 deficiency

41
Q

Differential daignosis of unilateral vs bilateral facial nerve palsy

A

Unilateral - sarcoidosis, Guillian Barre, polio, Lyme

Bilateral - UMN (Stroke)

LMN (HIV, acoustic neuroma, Bells Palsy, Parotid tumors, MS, DM, Ramsay Hunt)

42
Q

Side effects of sodium valproate

A
  • gastrointestinal: nausea
  • increased appetite and weight gain
  • alopecia: regrowth may be curly
  • ataxia
  • tremor
  • hepatitis
  • pancreatitis
  • thromobcytopaenia
  • teratogenic
43
Q

Side effects of carbidopa

A

dyskinesia
‘on-off’ effect
postural hypotension
cardiac arrhythmias
nausea & vomiting
psychosis
reddish discolouration of urine upon standing

44
Q

Treatment of mild/moderate and severe acne rosacea

A
  • mild/moderate: topical metronidazole
  • severe/resistant: oral tetracycline
45
Q

Classify acne

A
  • mild: open and closed comedones with or without sparse inflammatory lesions
  • moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
  • severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
46
Q

Define onychomycosis and its causes

A

fungal infection of the nails. This may be caused by

  • dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
  • yeasts - such as Candida
  • non-dermatophyte moulds
47
Q

Secondary causes of Raynauds disease

A

connective tissue disorders: scleroderma (most common), rheumatoid arthritis, SLE
leukaemia
type I cryoglobulinaemia, cold agglutinins
use of vibrating tools
drugs: oral contraceptive pill, ergot
cervical rib

Treatment: Nifedipine

48
Q

Risk Factors for Pseudogout

A

hyperparathyroidism
hypothyroidism
haemochromatosis
acromegaly
low magnesium, low phosphate
Wilson’s disease

49
Q

Painless red eye

A

Central retinal artery occlusion (VTE)

Central vein occlusion

Vitreous Hemorrhage

Retinal Detachment

Ischemic neuropathy - Amaruosis fugax

50
Q

Vision manifestation of DM

A

DM retinopathy

Cataracts

EOM palsy

Ishcemic changes

51
Q

Causes of A. Fib

A

Cardiac
Valvular Hrt disease
Sick sinus syndrome
Cardiomyopathy
WPW
HTN

Extracardiac
C2H5OH (holiday heart)
Thryotoxicosis
Pheochromocytoma
Pulmonary (tissue around the pulmonary veins)
Sleep apnea
Obesity
Inflammation (CRP)

52
Q

Causes of Stevens Johnson Syndrome

A

idiopathic
bacteria: Mycoplasma, Streptococcus
viruses: herpes simplex virus, Orf
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill
connective tissue disease e.g. SLE
sarcoidosis
malignancy

53
Q

Side effects of isoretinoin

A

teratogenicity: females should ideally be using two forms of contraception (e.g. Combined oral contraceptive pill and condoms)
dry skin, eyes and lips: the most common side-effect of isotretinoin
low mood
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
benign intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason

UL Flashcards (8 decks)

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