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
Contraindications to thrombolytics
**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
Causes of Torsades de Pointes & Rx
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
Drugs that cause lichenoid eruption - planus, puroule, polygonal, pruritic
GOLD QUINIDINES THIAZIDES
28
How do you evaluate severeity of IBD
** 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
When to admit someone with syncope for workup
**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% ## Footnote If score 0, safe to discharge home with investigation as outpatient
30
Drug causes of pancytopaenia
cytotoxics antibiotics: trimethoprim, chloramphenicol anti-rheumatoid: gold, penicillamine carbimazole\* anti-epileptics: carbamazepine sulphonylureas: tolbutamide ## Footnote \*causes both agranulocytosis and pancytopaenia
31
DDx of Lymphadenopathy
**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
Things to comment on when assessing a lump
**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
RIsk factors for melanoma
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
Types of Melanoma
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
DDx of Tetany
Hypocalcemia Metabolic alkalosis (with hyperventilation) Hypokalemia Hypomagnesemia
36
Signs of Acute Hypocalcemia
Paresthesia Chvostek's sign - percussion of facial nerve Trousseau's sign - blood pressure cuff
37
Causes of a third nerve palsy
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
Treatment for neuropathic pain: Post-herptic neuralgia Trigemminal neuralgia Diabetes
Post herptic - amytryptilline, pregablin Trigemminal - carbamazepine DM - duloxetine
39
Causes of Chorea
** 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
DDx of MS
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
Differential daignosis of unilateral vs bilateral facial nerve palsy
Unilateral - sarcoidosis, Guillian Barre, polio, Lyme Bilateral - UMN (Stroke) LMN (HIV, acoustic neuroma, Bells Palsy, Parotid tumors, MS, DM, Ramsay Hunt)
42
Side effects of sodium valproate
* gastrointestinal: nausea * increased appetite and weight gain * alopecia: regrowth may be curly * ataxia * tremor * hepatitis * pancreatitis * thromobcytopaenia * teratogenic
43
Side effects of carbidopa
dyskinesia 'on-off' effect postural hypotension cardiac arrhythmias nausea & vomiting psychosis reddish discolouration of urine upon standing
44
Treatment of mild/moderate and severe acne rosacea
* mild/moderate: topical metronidazole * severe/resistant: oral tetracycline
45
Classify acne
* 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
Define onychomycosis and its causes
fungal infection of the nails. This may be caused by ## Footnote * dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases * yeasts - such as Candida * non-dermatophyte moulds
47
Secondary causes of Raynauds disease
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
Risk Factors for Pseudogout
hyperparathyroidism hypothyroidism haemochromatosis acromegaly low magnesium, low phosphate Wilson's disease
49
Painless red eye
Central retinal artery occlusion (VTE) Central vein occlusion Vitreous Hemorrhage Retinal Detachment Ischemic neuropathy - Amaruosis fugax
50
Vision manifestation of DM
DM retinopathy Cataracts EOM palsy Ishcemic changes
51
Causes of A. Fib
**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
Causes of Stevens Johnson Syndrome
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
Side effects of isoretinoin
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