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UWorld Facts and Information > Medicine > Flashcards

Medicine Flashcards

1
Q

Most common cause of odynophagia/dysphagia in HIV patient

A

candidal esophagitis (presents w/thrush)

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2
Q

Tx of candidal esophagitis

A

1 - 2 week course of fluconazole + biopsy if refractory

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3
Q

HIV patients with severe odynophagia without oral thrush

A

ulcerative esophagitis from CMV

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4
Q

Tx of CMV ulcerative esophagitis

A

ganciclovir

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5
Q

Presentation of CMV ulcerative esophagitis

A

focal substernal burning pain with odynophagia + large, shallow, superficial ulcerations (linear) + intranuclear and intracytoplasmic inclusions + distal esophagus

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6
Q

Tx of apthous ulcers

A

prednisone

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7
Q

Presentation of HSV esophagitis

A

multiple, small, well-circumscribed volcano-like ulcers + ballooning degeneration and eosinophilic intranuclear inclusions

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8
Q

Tx of HSV esophagitis

A

acyclovir

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9
Q

Malaria ppx for ovale and vivax (Korea)

A

primaquine

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10
Q

Malaria ppx for p falciparum (Africa, S. Asia, Amazon)

A

mefloquine, atovaquone-proguanil, or doxycycline

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11
Q

Malaria ppx during pregnancy

A

mefloquine

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12
Q

Adverse Effect of mefloquine

A

neuropsychiatric

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13
Q

Presentation of Crohn’s

A

esophagus to anus, skip lesions, c/b strictures, anal fissures, intestinal fistula

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14
Q

Lab findings of every chronic inflammatory disease can include…

A

anemia and thrombocytosis

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15
Q

_____ is associated w/diarrhea and weight loss but does not cause significant abdominal pain and leukocytosis.

A

Celiac disease

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16
Q

Diverticulitis is associated w/ constipation or diarrhea?

A

constipation

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17
Q

UC or Crohn’s is associated with bloody diarrhea?

A

UC

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18
Q

Suspect ____ in a young patient with chronic diarrhea, abdominal pain, and weight loss

A

IBD

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19
Q

Most commonly involved bones in Paget’s disease of bone/osteitis deformans

A

femur, axial skeleton, skull

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20
Q

How does osteitis deformans lead to deafness?

A

hypertrophy of the skull compresses vestibulocochlear nerve

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21
Q

Lab abnormalities in Paget’s disease/osteitis deformans

A

normal calcium/phosphate
elevated alk phos from bone degradation
elevated hydroxyproline, deoxypyridinoline, N/C telopeptide AKA bone degradation markers

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22
Q

_______ is associated with hypercalcemia, hypophosphatemia, and increased alkphos

A

hyperparathyroidism

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23
Q

Hypercalcemia in the setting of normal phosphate and alkphos my be observed in ______

A

milk-alkali sydnrome

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24
Q

Serum _____ is decreased in immune complex-mediated kidney disease such as SLE and poststrep glomerulonephritis

A

C3 is reduced because immune complex deposition triggers complement cascade AKA consumptive deficiency

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25
Q

IgE mediated kidney disease occurs in _____

A

allergic interstitial nephritis (e.g. methicillin induced nephritis)

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26
Q

In what disease do cytotoxic antibodies cause kidney damage?

A

goodpasture’s

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27
Q

In what disease does delayed hypersensitivity cause kidney damage?

A

non-specific chronic glomerulonephritis

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28
Q

RA affects ___ joints

A

MCP and PIP

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29
Q

Gout: poly vs monoarticular

A

80% monoarticular

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30
Q

Characteristic radiographic findings in hemochromatosis-associated arthropathy

A

squared off bone ends and hook like osteophytes in second and third MCP

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31
Q

OA affects ____ hand joints

A

DIP

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32
Q

Major radiographic findings of OA in hands

A

joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts

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33
Q

Clinical features of PSC

A

fatigue and pruritis + underlying IBD (UC)

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34
Q

Biopsy findings of PSC

A

fibrous obliteration of small bile ducts with onion skin concentric replacement w/ connective tissue

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35
Q

5 complications of PSC

A

intra/extrahepatic biliary stricture
cholangitis/cholelithiasis (cholesterol and pigment stones)
cholangiocarcinoma
cholestasis (reduced fat soluble vitamins and osteoporosis)
colon cancer
+/- portal hypertension and liver failure

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36
Q

Lab findings of PSC

A 
elevated liver function tests but <300
severely elevated alkphos and bilirubin
hypergammaglobulinemia
increased serum IgM
atypical perinuclear antineutrophil cytoplasmic antibodies
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37
Q

Dx of PSC

A

cholangiogram (ERCP/MRCP) showing multifocal narrowing w/intra/extrahepatic duct dilation AKA beading or liver biospy

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38
Q

Presentation of acute bacterial cholangitis

A

severe jaundice, fever, RUQ pain, leukocytosis

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39
Q

Women get PBC/PSC

A

PBC

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40
Q

Association of PBC w/ IBD

A

none

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41
Q

Adverse effects of digoxin

A

GI (anorexia, n/v)
Bidirectional ventricular tachycardia
Accelerated junctional rhythms

*verapamil reduces renal clearance of digoxin and increases toxicity

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42
Q

Presentation of pancreatitis

A

abdominal pain radiating to back

n/v

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43
Q

Presentation of mesenteric ischemia

A

severe abdominal pain out of proportion to exam w/ risk factor like afib

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44
Q

Clinical signs of AVF

A 
widened pulse pressure
strong peripheral arterial pulsation (brisk carotid upstroke)
systolic flow murmur
tachycardia
flushed extremities
displaced PMI 
LVH on EKG
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45
Q

Cardiac consequence of AVF

A

increased preload, decreased SVR –> increased CO

increased HR to meet oxygen requirements of peripheral tissues

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46
Q

Causes of high-output heart failure

A

thyrotoxicosis, AVF, paget’s disease, anemia, thiamine deficiency

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47
Q

Dx of AVF

A

doppler u/s

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48
Q

Risk factors for acute diverticulitis

A

constipation and low fiber intake

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49
Q

Tx of diverticulitis

A

IV antibiotics

CT those who are refractory to abx in case of complication (abcess, fistula, perforation)

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50
Q

Tx of progressive pain in pt w/prostate cancer and bony mets?

A
  1. orchiectomy/androgen ablation

2. radiation

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51
Q

How effective is cervical cordotomy in controlling axial pain/pain in UE?

A

not effective

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52
Q

Aspirin sensitivity syndrome is believed to be a _______ reaction

A

pseudo-allergic reaction –> results from prostaglandin/leukotriene misbalance

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53
Q

Tx of aspirin sensitivity syndrome

A

leukotriene receptor antagonist

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54
Q

Presentation of aspirin sensitivity syndrome

A

hx aspirin ingestion
persistent nasal blockage
episodes of bronchoconstriction w/ periodic breathing difficulty +wheezing

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55
Q

Transmission of HepB

A

sex, IV drugs

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56
Q

What is fulminant hepatic failure?

A

hepatic encephalopathy w/in 8 weeks of onset of acute liver failure

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57
Q

Tx of FHF

A
  1. TRANSPLANT

2. fresh frozen plasma + Vit K to manage coagulopathy

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58
Q

Tx of acute HepB

A

interferon + lamivudine

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59
Q

Presentation of HP

A

cough, breathlessness, fever, malaise 4-6 hours after antigen exposure

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60
Q

Chronic findings in HP

A

ground glass opacities w/honeycombing fibrosis w/haziness of the lower lung fields
weight loss, clubbing

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61
Q

Tx of essential tremor

A

beta-blockers

primidone AKA phenobarb

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62
Q

Adverse effect of primidone

A

acute intermittent porphyria presents as abdominal pain, neurologic, and psychiatric abnormalities

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63
Q

Dx of acute intermittent porphyria

A

urine porphobilinogen

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64
Q

How effective is diazepam in treating essential tremor?

A

not.

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65
Q

Mutation associated with primary polycythemia vera

A

JAK2 V617F

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66
Q

Are serum epo levels high or low in polycythemia vera?

A

low b/c primary PCV is epo-independent RBC production

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67
Q

Presentation of polycythemia vera

A

headache, dizziness, visual disturbances, pruritis (from mast cell dengranulation), peptic ulcer (histamine), hypertension from blood volume, facial plethora, splenomegaly, hepatomegaly

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68
Q

Lab findings in polycythemia vera

A

elevated hgb/hct/platelets/wbc, thrombosis, bleeding, normal o2 sat, hypercellular bone marrow, normal/low ESR, low iron

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69
Q

BCR-ABL is usually seen in

A

CML

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70
Q

Does CML cause elevated hgb/leukocytosis/thrombocytosis?

A

leukocytosis and thrombocytosis but not hgb elevation

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71
Q

Extreme fatigue, malaise, sore throat, fever, maculopapular rash +/- posterior cervical lymphadenopathy and palatal petichiae and splenomegaly

A

mono

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72
Q

Lab findings in mono

A

leukocytosis w/variant/atypical lymphocytes + heterophile antibodies (may be negative early in illness)

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73
Q

Peripheral smear finding in ALL

A

blasts (easy to remember: young cells in young people)

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74
Q

Peripheral smear findings in CLL

A

mature small lymphocytes (remember: little old cells in little old people) –> leukemia of old age

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75
Q

Findings in CML

A

leukocytosis, basophilia, thrombocytosis, splenomegaly (no lymphadenopathy)

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76
Q

Peripheral smear findings in hodgkin’s

A

normal blood smear, reed-sternberg cells in lymph node biospy

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77
Q

Cutaneous tumor with dome-shaped nodule and central keratinous plug

A

Keratoacanthoma

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78
Q

Cutaneous golf-ball size lesion

A

lipoma

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79
Q

Inflammatory ring-like skin lesions with peripheral scaling

A

fungal infection like tinea

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80
Q

Stuck on skin lesion, well circumscribed, scaley, hyperpigmented on trunk, face and UE

A

seborrheic keratosis

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81
Q

Clinical presentation of GBS

A

symmetric, ascending weakness w/ absent DTR after recent infectious illness
can have bulbar symptoms like dysphasia and respiratory compromise
mild sensory paresthesias and ataxia possible

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82
Q

Dx of GBS

A

LP: elevated CSF protein w/normal WBC AKA albuminocytologic dissociation
electromyogram

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83
Q

elevated CSF protein w/normal WBC

A

albuminocytologic dissociation feature of GBS

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84
Q

Tx of GBS

A

supportive care

IVIG or plasmapheresis

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85
Q

Tx of myasthenia gravis

A

cyclosporine

pyridostigmine

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86
Q

Clinical presentation of myasthenia gravis

A

often ocular symptoms (ptosis/diplopia) and fluctuating muscle weakness worse late in the day w/normal DTR

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87
Q

Findings in HSV encephalitis

A

AMS ,focal deficits, seizures, fever, lymphocytic pleocytosis on LP

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88
Q

Tx of HSV encephalitis

A

iv acylcovir

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89
Q

Tx of AML

A

riluzole

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90
Q

Which bug is classically associated with GBS?

A

c. jejuni

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91
Q

Serum findings in Vitamin D deficiency

A

low calcium and phosphate –> secondary hyperparathyroidism which brings calcium back up closer to normal and leads to further phosphate dumping to worsen hypophosphatemia

also low vitamin d and elevated alkphos

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92
Q

X ray findings in vitamin D deficiency

A

osteomalacia: decreased bone density w/ cortical thinning, codfish vertebral bodies and pseudofractures

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93
Q

Serum findings in primary hyperparathyroidism

A

elevated pth, elevated calcium, decreased phosphate

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94
Q

Serum findings in hypoparathyroidism

A

low calcium, low pth, high phosphate

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95
Q

Difference in presentation of osteoporosis and osteomalacia

A

osteomalcia: complaints of bone pain and muscle weakness w/xray findings of decreased bone density and pseudofractures

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96
Q

Presentation of respiratory TB

A

fever, night sweats, weight loss, cough +/- blood, CXR w/apical cavitary lesions +/- AFB stain

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97
Q

Most likely cause of ascites

A

cirrhosis from alcohol liver dz and hepC

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98
Q

Signs and symptoms of cirrhosis

A

asterixis, milkmaid sign, jaundice, terry’s nails, palmar erythema, caput medusae, pruritis, confusion, spider angiomas, fluid wave/ascites, pleural effusion (low breath sounds), splenomegaly, decreased leukocytes (get stuck in spleen)

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99
Q

Most common cause of SAH

A

ruptured berry aneurysm

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100
Q

Clinical features of SAH

A

severe thunderclap headache @ onset of neurologic symptoms (focal deficits uncommon)
meningeal irritation w/neck stiffness

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101
Q

Complications of SAH

A 
rebleeding (24h)
vasospasm (after 3 days)
hydrocephalus/increased intracranial pressure
seizure
hyponatremia from SIADH
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102
Q

Dx of SAH

A

noncontrast head CT w/ lp (xanthochromia after 6 hours onset) +/-cerebral angiography

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103
Q

Tx of SAH

A

coil w/ stent

nimodipine and hyperdynamic tx to reduce vasospasm

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104
Q

When does Todd’s palsy typically occur?

A

after focal motor seizure

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105
Q

_____ is the major cause of delayed morbidity and mortality in SAH and can result in cerebral infarct

A

vasospasm

give nimodipine

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106
Q

Presentation of subacute hydrocephalus post SAH

A

headache w/ progressive mental decline and multiple neurologic deficits from compression–> usually not unilateral

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107
Q

What kind of reaction is anaphylaxis?

A

Type 1 hypersensitivity w/ preformed IgE from previous exposure

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108
Q

Tx of anaphylaxis

A

epi (bronchodilation and vasoconstriction)

w/adjunct bronchodilator, anithistamine, steroid, more vasoconstrictors (dopamine)

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109
Q

Effect of increased pH on calcium

A

increase in albumin bound calcium (decrease in io calcium) –> features of hypocalcemia like crampy pain, paresthesias, carpopedal spasm)

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110
Q

Can you have signs of hypocalcemia w/a normal total calcium?

A

yes–> e.g. if you increase pH and reduce io calcium b/c it gets bound up w/albumin

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111
Q

Major causes of secondary bacterial PNA

A

strep pneumo, staph aureus, hflu

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112
Q

Which cause of secondary bacterial PNA can cause post-viral URI necrotizing pulmonary bronchopneumonia w/ nodular infiltrates and cavitary abscesses?

A

Staph aureus

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113
Q

What’s a positive ppd?

A

> 5 in HIV+, recent contact w/TB+ person, signs of TB on CXR, organ transplant/immunocompromised
10 in recent immigrants, IV drugs, high-risk settings, diabetes, CKD, malignancy, fibrotic lung disease, kids
15 healthy people

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114
Q

Tx of +PPD w/normal CXR

A

tx for latent tb: daily INH for six months or INH +pyridoxine for 9 months

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115
Q

Tx for active TB

A

INH + rifampin + pyrazinamide for 8 weeks followed by 5 months of INH and rifampin

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116
Q

Can cocaine cause ST elevations

A

yes via coronary vasospasm–> tx for STEMI

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117
Q

Can cocaine cause dissection

A

yes

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118
Q

What causes grave’s opthalmopathy

A

autoimmune attack on EOM w/ lymphocytic infiltrate and causing edema, proliferation of fibroblasts, deposition of gag’s which pushes out the eye–> associated with sandy/gritty eyes b/c of corneal exposure

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119
Q

Do thyroid hormone levels cause protopsis?

A

no –> graves causes lymphocytic infiltrate in EOMs that causes exopthalmos

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120
Q

Hypernatremia w/ urine osmolality < serum osmolality suggests

A

diabetes insipidus (dilute urine aka dumping water even w/hypernatremia)

central: usually higher [Na] b/c no thirst mechanism
- ->differentiate central and nephrogenic w/ desmopressin –> nephrogenic won’t respond

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121
Q

How do we differentiate DI from primary polydipsia

A

water deprivation test- -> if urine osmolality increases, it’s primary polydipsia

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122
Q

Tx of SIADH

A

demeclocylcine –> inserts aquaporins in cortical collecting tubule –> dilutes urine

can also use tolvaptan but has lots of adverse effects

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123
Q

Tx of nephrogenic DI

A

HCTZ

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124
Q

Tx of central DI

A

desmopressin

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125
Q

RUQ pain + n/v + fever + abdominal crepitus w/o peritonitis + air fluid levels in gallbladder + curvilinear gas shadowing in gallbladder

A

emphysematous cholecystitis –> gas forming bacteria (clostridium ,ecoli, staph, strep, psuedo, klebsiella) in older men

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126
Q

Risk factors for emphysematous cholecystitis

A

vascular compromise of cystic artery, immunosuppression, gallstones, infection w/gas forming bugs

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127
Q

Tx of emphysematous cholecystitis

A

fluid/electrolytes, chole, pip tazo or quinolone + flagyl

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128
Q

u/s findings in pt w/acute calculous cholecystitis

A

gallstones w/o air fluid levels or gas shadowing

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129
Q

radiographic finding in peptic ulcer perf

A

free air under diaphragm

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130
Q

Charcot’s triad

A

jaundice, fever, RUQ pain = acute cholangitis due to biliary tract obstruction and post-obstructive infection

can be due to choledocholithiasis, biliary stenting, malignancy –> alk phos and wbc elevated

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131
Q

Hypercalcemia + lung malignancy = what cancer?

A

squamous cell AKA sCa++mous cell –> from pthrp which causes increased bone resorption and increased renal resorption in distal tubule

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132
Q

Paraneoplastic phenomena common in small cell lung cancer

A

siadh and acth production

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133
Q

Lung cancer associated w/hypertrophic pulmonary osteoarthropathy

A

adenocarcinoma

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134
Q

Tx of stroke w/ presentation 3-4 hours after symptom onset and no contraindictations

A

IV alteplase

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135
Q

Tx of stroke w/o prior antiplatelet tx

A

aspirin

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136
Q

Tx of stroke on aspirin tx

A

apsirin + dipyridamole or clopidogrel

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137
Q

Tx of stroke on aspirin tx w/ large intracranial atherosclerosis

A

aspirin + clopidogrel

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138
Q

Tx of stroke w/ afib

A

long term warfarin or dabigatran or rivaroxaban

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139
Q

Does early anticoagulation reduce risk of recurrent stroke?

A

nope (even in those w/afib) …don’t give heparin

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140
Q

What is the only tx that is effective in reducing risk of early recurrent stroke?

A

aspirin –> give w/in 24 hours in ischemic stroke

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141
Q

What should we think if a pt w/ COPD has clubbing

A

probs has cancer –> COPD doesn’t usually have clubbing on its own

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142
Q

Skin findings in acute meningococcemia

A

petechial rash that progressis to ecchymosis, bullae, vesciles, and gangrenous necrosis + fever, n/v, myalgias, meningeal signs

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143
Q

Clinical findings in TSS

A

fever, hypotension, diffuse macular erythroderma, skin desquamation (1-2 weeks after), multi organ system failure

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144
Q

What toxin causes TSS

A

staph TSS toxin 1–> T cell activation and cytokine megahurricane

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145
Q

Why does Sjogren’s cause firmness and enlargement of salivary glands?

A

lymphocytic infiltration

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146
Q

Which disease? Ro/SSA and La/SSB abs

A

sjogrens

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147
Q

Which disease? ama abs

A

PBC

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148
Q

Clinical findings in sjogren’s

A

dry mouth/eyes AKA keratoconjunctivitis sicca and xerostomia

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149
Q

Tx of nephrolithiasis in pt’s w/normal renal function

A

NSAIDs + fluid…narcotics cause n/v

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150
Q

Tx of hyperkalemia

A
  1. calcium gluconate for arrhythmia
  2. insulin/beta agonist for cellular shift
  3. kayexalate aka sodium polystyrene sulfonate to poop it out
  4. low k diet
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151
Q

What common medications cause sinus brady?

A

dig, beta blockers, ca channel blockers

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152
Q

1st and 2nd step in tx of sinus brady

A

IV atropine –> immediate increase in hr by reducing vagal input
transcutaneous pacing
only give epi if hemodynamically unstable

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153
Q

What is the role of adenosine in tx of arrhythmias?

A

helps identify supraventricular tachycardia by causing temporary av block

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154
Q

Tx of sinus brady in hemodynamically compromised

A

epi

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155
Q

Role of amiodarone in tx of arrhythmias?

A

supraventricular and ventricular tachycardias –> slows SA and AV node

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156
Q

De Quervain tenosynovitis

A

inflammation of pollicus tendons in mothers who hold their babies with thumb outstretched –> can elicit tenderness at radial side of wrist at base of hand

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157
Q

Pain w/ radial flexion of wrist and point tenderness over trapezium

A

flexor carpii radialis tenosynovitis

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158
Q

Multiple rib fractures + respiratory distress = consider ____

A

flail chest (esp if there is a visible lung contusion + fractures on CXR)

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159
Q

CXR appearance of esophageal rupture

A

subq crepitus in chest w/ pneumomediastinum

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160
Q

Classical feature of stage 1 hepatic encephalopathy

A

altered sleep pattern –> progress to stage 4 (stupor and coma) w/ addition of typical symptoms of HE

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161
Q

What can trigger hepatic encephalopathy?

A

anything that puts a load on the liver: hypoxia, toxins (like opiates), hypoglycemia, excess nitrogen load, gi bleeding, hypovolemia, infection, surgical shunting

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162
Q

Symptoms that help distinguish Legionella from other causes of CAP

A

high fever, GI symptoms, neurologic

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163
Q

Gram stain of legionella typically shows:

A

neutrophils w/no organisms (hard to stain)

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164
Q

Definitive dx of legionella CAP

A

growth on charcoal agar, urinary antigen testing

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165
Q

Tx of legionella CAP

A

azithromycin or levoflox

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166
Q

Ab of choice in aspiration pneumonia

A

clindamycin

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167
Q

Tx of pulmonary cryptococcal infection

A

fluconazole

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168
Q

Earliest renal abnormality in diabetic

A

hyperfiltration

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169
Q

Why do ACE-I help in diabetic nephropathy?

A

reduce glomerular hypertension –> reduce renal damage

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170
Q

Progression of diabetic nephropathy

A

glomerular hyperfiltration –> GBM thickening –> mesangial expansion –> nodular sclerosis

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171
Q

First quantifiable change in diabetic nephropathy

A

GBM thickening

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172
Q

Describe the pathogenesis of HIT

A

heparin + IgG + PF4 + platelet –> early activation of splenic macrophages to clear platelets + activation of platelets

== thrombocytopenia + arterial/venous thrombosis

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173
Q

Spontaneous hemarthrosis =

A

hemophilia

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174
Q

Most common cause of hemarthrosis

A

trauma > vascular damage > hemophilia

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175
Q

________ is characterized by fluctuating cognitive impairment and bizarre visual hallucinations +/-motor features of parkinson’s

A

lewy body dementia

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176
Q

_____ is a progressive dementia with initial memory loss, language difficulty, apraxia, followed by impaired judgement and personality changes.

A

Alzheimer’s

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177
Q

Associations with alzheimer’s

A

age, female, family hx, head trauma, downs

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178
Q

______ dementia is characterized by motor and sensory dysfunction.

A

multi infarct

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179
Q

Association’s with multi infarct dementia

A

age, male, black, smoking, htn, diabetes, vasculitis

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180
Q

_____ is associated with general cortical involvement + decrease in concentration + memory loss + dysarthria, tremors, irritability, mild headaches + personality changes (irresponsibility, confusion, psychosis)

A

neurosyphilis

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181
Q

______ dementia is associated with personality changes, compulsions, hyperorality, and impaired memory.

A

frontotemporal/pick’s

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182
Q

Dx of DKA

A

glucose > 250, ph < 7.3/bicarb < 15-20, detection of plasma ketones

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183
Q

Tx of DKA

A

normal saline + insulin, K –> D5/.45 saline once hemodynamically stable

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184
Q

Indications for bicarb

A

sever acidosis < 5, or severe hypokalemia

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185
Q

Risk of giving bicarb

A

cerebral edema and left shift of oxygen curve causing poor tissue oxygenation

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186
Q

Tx of stye

A

warm compress –> I/D if refractory 48 hours

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187
Q

Tx of chalazion

A

(granulomatous inflammation of meibomian gland) –> incision and curettage

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188
Q

Weight loss + diabetes + diarrhea + anemia + necrolytic migratory erythema (coalescing plaques/papules that form large painful inflammatory blisters w/crusting and central clearing in perineum, extremities, and face)

A

glucagonoma

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189
Q

Dx of glucagonoma

A

glucagon levels > 500 pg/mL

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190
Q

Why is FNA of testicular masses contraindicated

A

spillage of cancer cells into lymphatics and blood vessels

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191
Q

Symptoms of theophylline toxicity

A

headache, insomnia, seizures, GI (n/v), arrhythmia in context of drugs affecting cytochrome oxidase (cipro, erythro, clarithro, verapamil, cimetidine) or illness (cirrhosis, resp + fever)

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192
Q

What marker is elevated w/pheo?

A

plasma fractionated metanephrines

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193
Q

Clinical presentation of pheo

A

headache, sweating, tachycardia, paroxysmal hypertension

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194
Q

LFT abnormality w/o evidence of necrosis or fatty changes in a woman

A

ocp

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195
Q

Dx of Type 1 autoimmune hepatitis

A

ANA +/- SMA

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196
Q

2 hematologic complications of mono

A
  1. AIHA
  2. thrombocytopenia

–> cross reactivity of EBV antibodies –> IgM cold agglutinin (coombs test positive) mediated destruction of rbcs/platelets 2-3 weeks after symptoms

*splenic rupture is another complication

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197
Q

Sore throat w/ pseudomembrane formation

A

Cornyebacterium infection –> c/b dilated cardiomyopathy

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198
Q

Fatigue + hyperpigmentation + hypotension + eosinophilia + hyponatremia +hyperkalemia

How do we dx this?

A

primary adrenal insufficiency (Addison’s, infections, surgical, hemorrhage, mets)

  1. basal morning cortisol
  2. ACTH
  3. cosyntropin (ACTH analogue –> measure cortisol response –> low in primary AI)
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199
Q

Dx of cushing’s

A

24 hour urinary cortisol + low-dose dexamethasone suppression test

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200
Q

Which vaccines are live and contraindicated in HIV patients?

A

BCG, anthrax, oral typhoid, intranasal influenza, oral polio

*MMR, varicella, yellow fever and zostercan be given if CD4>200 and no history of AIDS defining illness

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201
Q

Single or multiple rounded dome shaped papules w/central umbilication on face, lower abdomen, genitals

A

molluscum contagiosum

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202
Q

Pruritis, papules, and vesicles over elbows, knees, buttocks, posterior neck, and scalp

A

dermatitis herpetiformis

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203
Q

Genetic associations with dermatitis herpetiformis

A

HLA B88, Dr3 and DQw2

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204
Q

Superficial aggregated small vesicles, papules, pustules over trunk with itching and burning in hot/moist climate

A

milaria

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205
Q

Bright red, friable, exophytic nodules in HIV infected patient

A

bacillary angiomatosis

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206
Q

Tx of bacillary angiomatosis

A

oral erythromycin

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207
Q

What kind of disorders are associated with gout due to increased catabolism/turnover of purines?

A

myeloproliferative

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208
Q

Gout crystals are ____ birefringent

A

-

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209
Q

Bloody diarrhea + flask shaped colonic ulcers + trophozoites on stool exam

A

E. histolytica

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210
Q

Charcot’s joint

A

neurogenic arthropathy usually due to diabetic neuropathy

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211
Q

Rat bit lesion on xray

A

gout –> punch out erosion w/overhanging rim of cortical bone

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212
Q

Common causes of avascular necrosis

A

steroids, trauma, lupus, sickle cell

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213
Q

Optho manifestations of sarcoid

A

anterior uveitis, posterior uveitis

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214
Q

Lofgren’s syndrome

A 
manifestation of sarcoid:
erythema nodosum
hilar adenopathy
migratory polyarthralgias
fever
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215
Q

Cardiac analog to Raynaud’s

A

Printzmetal’s angina: coronary artery vasospasm triggered by cold, exercise, stress –> usually presents in middle of night w/transient ST elevation

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216
Q

Tx of Printzmetal’s angina

A

calcium channel blockers and nitrates

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217
Q

Tx of sickle cell stroke

A

exchange transfusion + hdyroxurea (reduces HgbF)

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218
Q

Microcytic/hypochromic anemia w/elevated serum iron and decreased TIBC.

A

sideroblastic –> dimorphic RBCs (normo and hypochromic)

*ringed sideroblasts on bone marrow biospy

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219
Q

Tx of sideroblastic anemia

A

B6/pyridoxine

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220
Q

Common drug cause of sideroblastic anemia

A

isoniazid

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221
Q

Intermittent but chhronic abdominal pain + weight loss + alcohol use + diarrhea

A

chronic pancreatitis

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222
Q

Preferred screening test for HIV infection

A

ELISA

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223
Q

What marker is + in UC?

A

pANCA

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224
Q

Extracolonic manifestations of UC

A

episcleritis, ankylosing spondylitis, cholangitis, erythema nodosum, pyoderma gangrenosum

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225
Q

Serologic finding in celiac disease

A

anti-endomysial and anti-transglutaminase

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226
Q

Characteristic cutaneous finding celiac disease

A

dermatitis herpetiformis

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227
Q

Protean disease with chronic malabsorptive diarrhea + weight loss + migratory non-deforming arthritis + lymphadenopathy + fever

A

Whipple’s disease : tropheryma whippelii

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228
Q

HLA association with IBD

A

HLA B27

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229
Q

hyponatremia + serum osmolality > 290

A

hyperglycemia or renal failure

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230
Q

hyponatremia + low serum osmolality < 100 + urine osmolality < 100

A

primary polydipsia, malnutrition

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231
Q

hyponatremia + normal serum osmolality + high [sodium]>25

A

siadh, adrenal insufficiency, hypothyroidism

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232
Q

hyponatremia + normal serum osmolality + low urinary [sodium ]

A

volume depletion, chf, cirrhosis

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233
Q

Tx of SIADH

A

mild: fluid restriction, oral salt tablets, loop
moderate: hypertonic saline
severe: hypertonic saline +/- vasopressin antagonists (conivaptan)

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234
Q

Key difference in GBS and tickborne paralysis

A

GBS has autonomic involvement

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235
Q

Descending paralysis w/early cranial nerve involvement

A

botulism

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236
Q

Rapidly ascending paralysis w/o fever/sensory abnormality, normal CSF exam

A

tickborne

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237
Q

anion gap metabolic acidosis + n/v + epigastric pain + hyperemic optic disk

A

methanol poisoning

238
Q

anion gap metabolic acidosis + n/v + episgastric pain + renal dysfunction

A

ethylene glycol poisoning

239
Q

anion gap metabolic acidosis + tinnitus + fever + hyperventilation (+/- respiratory alkalosis)

A

aspirin overdose

240
Q

Consequences of methanol poisoning

A

vision loss and coma

241
Q

Ocular manifestation of Marfan’s

A

ectopia lentis

242
Q

Murmur associated with Marfan’s

A

early decrecendo diastolic: aortic regurg in context of aortic root dilation

243
Q

Holt-Oram syndrome is associated with what heart sound?

A

wide and fixed splitting of S2 –> heart hand syndrome associated with upper limb defects and asd

244
Q

PE finding associated with severe aortic stenosis

A

pulsus parvus et tardus

systolic murmur

245
Q

MOA of digoxin

A

increases AV nodal refractoriness and slows ventricular rate in fib and flutter

246
Q

What is the role of digoxin in management of premature atrial beats

A

none

247
Q

What kind of arrhythmias are treated with lidocaine?

A

ventricular

248
Q

Impaired swallowing among patients with advanced dementia is often due to what abnormality?

A

impaired epiglottic reflex

249
Q

What kind of UTI leads to urinary alkalinization?

A

proteus mirabilis

250
Q

What kind of stones form in alkaline urine?

A

struvite –> bacteria + protein + leukocytes –> staghorn

251
Q

How does opioid intoxication present?

A

miosis, depressed mental status, decrased respiratory rate, decreased bowel sounds, hypotension, and bradycardia

252
Q

What is the best predictor of intoxication in opioid intoxication?

A

decreased respiratory rate

253
Q

____ is a common cause of lactic acidosis in patients with atherosclerotic disease, atrial fibrillation.

A

bowel ischemia

254
Q

When do acute appendicitis and peptic ulcer formation lead to severe acidosis?

A

when the patient becomes hypotensive

255
Q

What is a cheap and effective test for determining level of activity of Paget’s disease in managed patients?

A

alk phos

256
Q

What is the preferred therapy for those with metabolically active Paget’s disease?

A

bisophosphonates –> inhibit osteoclasts

257
Q

How do patients w/paget’s respond to bisphosphonates?

A

clinical reduction in bone pain before reduction in alkphos

258
Q

At what point in clinical course is it recommended we treat pagets disease?

A

once symptomatic

259
Q

When do we treat paget’s with calcitonin?

A

if refractory to bisphosphonates

260
Q

______ is an anti-TNF effective in treating RA, psoriasis, AS, and Crohn’s.

A

infliximab

261
Q

Most common non-neoplastic polyps of the colon

A

hyperplastic (from mucosal proliferation)

262
Q

What are 2 kinds of hamartomatous colonic polyps?

A

both non-malignant: juvenile, peutz-jegher

263
Q

Most common polyp found in the colon

A

adenoma (premalignant) –> <1% become malignant

264
Q

What factors affect the probability of adenomatous colon polyp progressing to cancer?

A

gross appearance, histology, and size

  1. sessile polyps are worse
  2. villous are 3x more likely than tubular to become malignant: villous> tubulovillous > tubular
  3. larger is worse (e.g. >2.5 cm)
265
Q

What kind of colonic polyps should be removed?

A

adenomas (pre-malignant) and juvenile polyps (bleeding risk)

266
Q

Most common cause of non-traumatic SAH

A

ruptured saccular/berry aneurysms

267
Q

Patients with suspected SAH and negative CT should undergo ______

A

LP

268
Q

What kind of CT is used to evaluate SAH?

A

non-contrast

269
Q

What lp findings are highly suggestive of SAH?

A

elevated opening pressure and xanthochromia

270
Q

This arterial cause of intracerebral hemorrhage is typically lobar in location.

A

amyloid angiopathy –> pts >75 w/ amyloid mediated arteriopathy

271
Q

What kind of cerebral hemorrhages are associated with hypertension?

A

intraparenchymal or intracerebral (basal ganglia, thalamus) are most common though it is a risk factor for aneurysm formation/rupture

272
Q

_____ presents with thunderclap headache (worsened with lying flat) associated with vision changes and nausea w/ slit-like lateral ventricles on CT and elevated opening pressure on LP.

A

idiopathic intracranial hypertension

273
Q

This venous cause of intracerebral hemorrhage is typically lobar in location.

A

venous sinus thrombosis causes lobar intracerebral/intraparenchymal hemorrhages along path of major cerebral draining veins due to backup pressure

274
Q

Patients presenting with worsening headache over several days are likely to have this kind of intraparenchymal hemorrhage.

A

venous sinus thrombosis

275
Q

Impairment in kidney’s ability to concentrate urine presenting with nocturia.

A

hyposthenuria –> found in apteints with sickle cell –> impaires countercurrent exchange and free water resorption

276
Q

Recurrent childhood UTIs suggest

A

vesicouteral reflux

277
Q

Sediment findings in FSGS

A

red blood cell casts

278
Q

Diffuse telangiectasias, recurrent epistaxis, and widespread AVMs aka nosebleeds and oral lesions

A

hereditary telangiectasia/osler-weber-rendu

AVMs present in mucous membranes, skin, gi, liver, brain, lung –> pulmonary avms can cause right left shunt causing hypoxemia and reactive polycythemia and sometimes fatal hemoptysis

279
Q

Median age for patients with polycythemia vera

A

60

280
Q

Are telangiectasias and digital clubbing seen in polycythemia vera?

A

no

281
Q

Most likely cause of macrocytic anemia in patient with sickle cell disease.

A

folate deficiency

hemolysis of reds causes bone marrow proliferation of red that leads to consumptive folate deficiency

282
Q

Name a few drugs that cause macrocytic anemia

A

hydroxyurea, phenytoin, methotrexate, trimethoprim

283
Q

What is hyperhemolytic crisis?

A

acute severe anemia with marked reticulocytosis in sickle cell

usually SCD is chronic and has a normal reticulocytosis

284
Q

Basic pathophys of GVHD

A

recognition of host HLA antigens by donor t cells and consequent cell-mediated response

285
Q

Target organs of GVHD

A

skin (maculopapular rash on palms.soles/face), intestine (bloody diarrhea), hepatitis

286
Q

Basic pathophys of graft rejection

A

activation of host t lymphocytes –> causes depression in myelopoiesis leading neutropenia and infection risk

287
Q

__________ is the mechanism responsible for the development of immunoblastic lymphoma in patients who underwent bone marrow transplant.

A

EBV induced lymphocyte proliferation

288
Q

_____ is an effective migraine treatment but must be started early in the course before symptoms become severe to be of benefit.

A

triptans

289
Q

_____ is an effective migraine treatment (IV) that helps with vomiting tendency especially.

A

prochlorperazine or metoclopramide –> IV antiemetics

290
Q

_____ is effective for migraine prophylaxis but is not helpful in the acute setting.

A

amitryptyline or propanolol

291
Q

Acute presentation of CO poisoning

A

headache, nausea, vomiting, abdominal discomfort, confusion, coma, w/pinkish-red skin hue

292
Q

Dx of CO poisoning

A

carboxyhemoglobin levels

293
Q

Tx of CO poisoning

A

hyperbaric oxygen administration

294
Q

Burning of _____ can cause cyanide inhalation.

A

rubber or plastic (not wood)

295
Q

_____ is characteristic of cyanide inhalation.

A

bitter almond breath

296
Q

3 imaging modalities to confirm Crohn’s disease

A
  1. abdominal CT
  2. small bowel fluroscopy
  3. endoscopy
297
Q

____ can be seen histologically in up to 30% of Crohn’s patients.

A

granulomas in oral apthous ulcers

298
Q

Folic acid deficiency can cause: oral ulcers or abdominal pain?

A

oral ulcers

299
Q

CSF findings in viral encephalitis

A

elevated whites (lymphocyte predominant), normal glucose, elevated protein –>dx w/presence of viral DNA in CSF

300
Q

MRI findings in viral encephalitis

A

temporal lobe abnormalities

301
Q

_____ viruses most commonly cause encephalitis in immunocompetent adults

A

herpes (simplex, varicella, EBV)

302
Q

Physical exam findings in viral encephalitis

A

hemiparesis, cranial nerve palsy, exaggerated DTRs

303
Q

_____ is used for induction therapy in patients with cryptococcal meningitis

A

IV amphotericin + flucytosine

304
Q

What kind of patients typically get cryptococcal meningitis?

A

HIV/immunocompromised

305
Q

CSF abnormality in cryptococcal meningitis

A

markedly elevated opening pressure –> symptoms mostly due to pressure from capsular swelling

306
Q

Empiric tx for bacterial meningitis

A

IV CTX and vanc (and ampicillin in adults >50)

307
Q

CSF findings in bacterial meningitis

A

elevated whites with neutrophils, low glucose, elevated protein (>250)

308
Q

Suspected viral encephalitis. Empiric tx or MRI first?

A

empiric tx first then MRI

309
Q

Chlordiazepoxide

A

tx for alcohol withdrawal in hospitalized patients

310
Q

EtOH withdrawal symptoms

A

tremulousness, anxiety, headache, palpitations –> fever, hypertension, delirium tremens

311
Q

The first step in ventilator management of ventilated ARDS patients is to decrease _____

A

FiO2 to non-toxic values –> can increase PEEP to compensate if necessary

312
Q

Spherocytes without central pallor are seen in what conditions?

A

AIHA and hereditary spherocytosis

313
Q

How do we distinguish between AIHA and hereditary spherocytosis?

A

AIHA: - fam history, + coombs test
HS: + fam history, - coombs test, + osmotic fragility

314
Q

If Coombs test - and still suspect AIHA what do you do?

A

microcoombs test

315
Q

Tx of warm agglutin vs cold agglutin AIHA

A

warm: steroids, rituximab, splenectomy
cold: warming the body, supportive care, RBC transfusions

warm is usually autoimmune, cold is more likely infectious

316
Q

______ is caused by a defect in cell membrane anchor that leads to complement-mediated hemolysis w/- coombs but evidence of venous thrombosis and sometimes episodic intravascular hemolysis.

A

paroxysmal nocturnal hemoglobinuria

317
Q

Heinz bodies

A

G6PD deficiency –> X linked hemolytic anemia often triggered by drug ingestion

318
Q

Anemia + splenomegaly + chills and shiveing followed by highgrade fever followed by diaphoresis and resolution of fever

A

falciparum malaria

*other kinds of malaria have cyclical fever

319
Q

____ malaria causes fever every 72 hours

A

p malariae

vs. 48 hours for vivax and ovale and just once for falciparum

320
Q

Top 3 risk factors for NASH

A
  1. obesity
  2. diabetes
  3. hypertriglyceridemia
321
Q

Meds that increase risk of NASH

A

steroids, amiodarone, diltiazem, tamoxifen, HAART, TPN

322
Q

Pathophys progression of NASH

A

insulin resistance –> accumulation of fat in liver –> steatohepatitis/fibrosis due to lipid peroxidation and oxidative stress

323
Q

Tx of NASH

A

primarily controlling underlying conditions, ursodeoxycholic acid to lower transaminase levels

324
Q

Lab findings in NASH

A

AST:ALT <1, mild elevation in liver enzymes

325
Q

Portal tract infiltration by lymphocytes, macrophages, plasma cells, eosinophils w/ noncaseating granulomas and progressive destruction leading to clinical presentation of jaundice and pruritis

A

PBC –> AMA+

*ultimately with portral tract scarring and bridging fibrosis leading to cirrhosis

326
Q

hepatitis w/ lymphocytes and plasma cells + ASMA/ANA

A

autoimmune hepatitis

327
Q

Dx of acute pancreatitis

A

2/3

  1. acute onset of severe epigastric pain w/ radiation to back
  2. amylase or lipase >3x upper limit of normal
  3. focal or diffuse pancreatic enlargement on imaging
328
Q

Increasing sample size increases _____ which is signified by a tighter confidence interval.

A

precision

329
Q

Most common pancreatic cancer

A

adeno

330
Q

Hereditary risk factors for pancreatic adenocarcinoma

A

1st degree relatives with pancreatic cancer, hereditary pancreatitis, germline mutations (BRCA1/2, Peutz-Jegher syndrome)

331
Q

Most consistent reversible risk factor for pancreatic cancer

A

cigarette smoking

332
Q

Most common cause of acquired angioedema

A

ACE I

333
Q

1st step in management of angioedema

A

stop ACE I immediately, check airway compromise and vasomotor instability, consider subQ epi admin if vasomotor instability, if obstruction refractory to epi, emergency tracheostomy

334
Q

megaloblastic macrocytic anemia with glossitis and neurologic changes

A

B12 deficiency

335
Q

Common causes of B12 deficiency

A

total/partial gastrectomy, pernicious anemia, gastritis, elderly age w/poor absorption

336
Q

RBC membrane instability is mechanism behind anemia seen in ______

A

hereditary spherocytosis

337
Q

Impaired hemoglobin synthesis is mechanism behind _____ anemia

A

iron deficiency

also thalassemia and sickle cell

338
Q

Impaired glutathione synthesis is mechanism behind _____

A

G6PD

339
Q

After ____% loss of pancreatic function, patients develop fat and protein malabsorption

A

90

340
Q

Diff dx of steatorrhea

A
  1. most common = chronic pancreatitis due to alcohol
  2. pancreatic insufficiency
  3. bile salt dysfunction (as in crohn’s, ileal resection)
  4. celiac
341
Q

___ stain on spot stool specimen can confirm steatorrhea

A

sudan

342
Q

Thrombosis of ______ can occur after TPN lines

A

subclavian or SVC

343
Q

Management of TPN line thrombosis

A
  1. remove line
  2. duplex ultrasound to document thrombus
  3. short-term anticoagulation
  4. elevation of arm and heat application
344
Q

White granular patch or plaque over buccal mucosa in patient with history of alcohol and tobacco use

A

leuokplakia –> reactive precancerous lesion that represents hyperplasia of squamous epithelium

345
Q

T/F leukoplakias tend to resolve within a few weeks of ceasing tobacco use

A

T

346
Q

_____ is the most common cause of oral ulcers

A

recurrent apthous stomatitis

347
Q

How can you distinguish between thrush and leukoplakia?

A

plaque of candidiasis can be scraped off with tongue depressor

348
Q

multiple vesicular lesions with erythematous and inflammatory base and erythematous border within the oral cavity and perioral area caused by HSV1

A

gingivostomatitis

349
Q

Clinical findings in brain death

A
  1. absent corneal reflex
  2. absent gag reflex
  3. absent oculovestibular reflex
  4. fixed and dilated pupils
  5. patient won’t breath spontaneously when ventilator is turned off for 10 minutes
350
Q

What must happen in brain death before patient is taken off ventilator?

A

confirmation with another physician

351
Q

Lab findings in Paget’s disease of bone

A

normal calcium and phosphate

elevated alk phos + urinary bone markers like hydroxyproline

352
Q

bone resorption/sclerosis + recent hearing loss

A

paget’s disease of bone

353
Q

Immediate management of GCA

A

empiric IV prednisone

354
Q

stiffness/pain of shoulder + pelvic girdle

A

polymyalgia rheumatica –> increased risk of GCA

355
Q

Tx of polymylalgia rheumatica

A

low dose steroids + screening for GCA

356
Q

Acetazolamide is used to tx:

A

open-angle glaucoma and benign intracranial hypertension

357
Q

Symptoms of opioid withdrawal

A

nausea, vomiting, cramps, diarrhea, dysphoria, restlessness, rhinorrhea, lacrimation, myalgias, arthralgias

mydriasis, piloerection, hyperactive bowel sounds

358
Q

Tx of choice for opioid withdrawal

A

oral/im methadone

359
Q

Lab findings of anemia of chronic disease

A

normal/decreased MCV + decreased serum iron + decreased TIBC + mildly decreased transferrin w/ normal - high ferritin

  • iron trapping in macrophages leads to reduced serum iron and poor iron availability + poor epo response
360
Q

First line tx of RA

A

hydroxychloroquine, methrotrexate, TNF inhibitors (infliximab, etandercept)

361
Q

Definitive treatment for hereditary spherocytosis

A

splenectomy

362
Q

Drug of choice in treating PBC

A

ursodeoxycholic acid –> slows disease progression and relieves symptoms

  • methotrexate and colchicine have moderate benefit
  • cholestyramine is second line but is only symptomatic tx
363
Q

Tx of advanced PBC

A

liver transplant

364
Q

____ typically cause slowly progressive dysphagia to solid foods w/o anorexia or weight loss and can eventually block reflux leading to improvement of heartburn symptoms

A

peptic esophageal strictures –> symmetric circumferential narrowings on endoscopy

365
Q

Causes of peptic strictures

A
  1. gerd
  2. radiation
  3. scleroderma
  4. caustic ingestions
366
Q

Best test for diagnosing and evaluating abdomen of patients in acute episode of diverticulitis

A

CT

367
Q

_____ stroke is usually accompanied by a sudden dramatic onset of severe headache.

A

SAH

368
Q

___ stroke usually is accompanied by previous TIAs

A

ischemic

369
Q

____ stroke is characterized by focal neurologic signs over minutes or hours

A

hemorrhagic stroke

370
Q

Most important risk factor for hemorrhagic stroke

A

hypertension

371
Q

+ PPD in HIV patient

A

5mm or more induration w/in 48-72 hours of intradermal injection of 5 tuberculin units

372
Q

ppx of tb in hiv patients

A

9 months of isoniazid

+w/pyridoxine to prevent neuropathy from isoniazid
+ regular liver function tests to check for isoniazid hepatitis

  • can also use pyrazinamide w/rifampin or rifabutin for 2 months or rifampin alone for 4 months
373
Q

defective mineralization of bone matrix is called

A

osteomalacia

374
Q

hypocalcemia + hypophosphatemia + elevated alk phos + elevated PTH

A

osteomalacia

*also low 25 vitamin d and low urinary calcium w/ bilateral and symmetric pseudofractures (looser zones)

375
Q

Characteristic radiologic finding in osteomalacia

A

looser zones - bilateral and symmetric pseudofractures

also codfish vertebral bodies and bone density decreased with thinning of cortex

376
Q

Causes of osteomalacia

A

severe vitamin d deficiency, malabsorption, intestinal bypass, celiac sprue, chronic liver/kidney disease, RTA proximal type 2, inadequate calcium intake

377
Q

____ is a dopamine receptor antagonist used to treat nausea, vomiting, and gastroparesis.

A

metoclopromide

378
Q

Side effects of metoclopromide

A

agitation, loose stool, tardive dyskinesia, dystonic reaction, parkinsonism, neuroleptic malignant syndrome

379
Q

Tx of dystonic reaction

A

discontinue med, administer benztropine or diphenhydramine

380
Q

pulmonary cavitation + acid fast, filamentous, branching rods

A

nocardia

381
Q

tx of nocardia

A

bactrim

382
Q

3 most common causes of constrictive pericarditis

A

cardiac sx, radiation, viral pericarditis

383
Q

Thoracic duct obstruction leads to what kind of edema?

A

lymphedema: firm, nonpitting that does nto cause skin changes like ulceration and dermatitis as in venous stasis

384
Q

Why are people with CKD more likely to bleed?

A

uremic coagulopathy –> defect in platelet-vessel/platelet interaction

*normal aptt, pt, tt, platelet count w/prolonged bleeding time

385
Q

Tx of uremic coagulopathy

A

ddavp (tx of choice), cryo, conjugated estrogen

*can’t use platelet transfusion because they will be inactivated

386
Q

How does ddavp work when treating uremic coagulopathy?

A

increases factor 8/vwf multimers from storage

387
Q

4 features of nephrotic syndrome

A
  1. proteinuria (>3-3.5 g/day)
  2. hypoalbuminemia
  3. edema
  4. hyperlipidemia and lipiduria
388
Q

Which renal disease cause nephrotic syndrome?

A
  1. minimal change
  2. membranous
  3. mesangial
  4. membranoproliferative
  5. fsgs
389
Q

Etiology of hypercoagulation in nephrotic syndrome

A

increased urinary loss of AT3, altered levels of protein C/S, increased platelet aggregation, hyperfibrinogenemia from hepatic synthesis, and impaired fibrinolysis

390
Q

Most common manifestation of nephrotic coagulopathy

A

renal vein thrombosis

391
Q

Why can nephrotic syndrome present with iron-resistent microcytic hypochromic anemia?

A

transferrin loss

392
Q

What life-threatening extrarenal manifestation occurs in adult polycystic kidney disease

A

rupture of brain aneurysm (and also AAA)

393
Q

Pulmonary hemorrhage occurs in the context of which renal syndromes?

A

good pasture’s and GPA (wegener)

394
Q

Currant jelly sputum + cavitation + empyema + GNR (encapsulated)

A

klebsiella

395
Q

GNR pneumonia with CF and bronchiectasis

A

pseudomonas

396
Q

-gram stain + cold agglutinins w/ interstitial pneumonia

A

mycoplasma pneumoniae

397
Q

Why don’t we use haloperidol in alcohol withdrawal?

A

doe snot have cross tolerance with alcohol and reduces seizure threshold

398
Q

Side effects of vancomycin

A

nephro and ototoxicity + red man syndrome

399
Q

Spinal levels associated with RA

A

cervical spine –> neck pain, stiffness, radicular pain due to subluxation and in bad cases, cord compression (can present with hyperreflexia or + babinski)

400
Q

Where do rheumatoid nodules occur

A

firm, nontender subQ nodules close to pressure points like elbows

401
Q

Polyarthralgia + tenosynovitis (pain in tendon sheaths) + painless veisculopustular skin lesions

A

disseminated gonococcal infection

402
Q

Petechial rash + high fever+ headache + n/v + photophobia

A

meningococcemia

403
Q

Arthralgias + fever+ sore throat + lymphadenopathy +mucocutaneous lesions + diarrhea + weight loss

A

acute HIV

404
Q

Migratory arthritis of large joints + erythema marginatum (raised and ring shaped lesions on trunk and extremities) + subQ nodules + cardities + syndenham chorea

A

acute rheumatic fever

405
Q

Most common organism for IE in IVDU

A

s. aureus

406
Q

Empiric tx of IE in IVDU

A

vancomycin

407
Q

red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, and full as a flask

A

flushing, dry mouth, hyperthermia, vision changes/mydriasis, delerium/confusion, urinary retention/constipation –> anticholinergic excess

+ headache, dizziness, tachycardia

408
Q

trihexyphenidyl

A

tx of parkinson’s –> can cause drug-induced/anticholinergic extrapyramidal symptoms

409
Q

What symptoms occur if levodopa is delivered without carbidopa?

A

nausea and vomiting

410
Q

Selegiline

A

MAOB inhibitor for tx of parkinson’s

  • can cause serotonin syndrome if used with SSRI or TCA
411
Q

Serotonin syndrome

A

agitation, confusion, tachycardia, muscle rigidity, seizures

412
Q

Bromocriptine

A

dopamine agonist for tx of parkinson’s

*can cause hypotension, nausea, constipation, headaches, dizziness

413
Q

Tx of benign essential tremor

A

propanolol

414
Q

Propanolol side effects

A

bradycardia, hypotension, somnolence, impotence

415
Q

high spiking quotidien fevers, salmon colored maculopapular rash, arthritis

A

adult still’s disease

416
Q

Tx of adult still’s disease

A

IL-1 blockers

417
Q

Which maneuvers worsen the murmur of hypertrophic cardiomyopathy?

A

valsalva and abrupt standing decrease preload –> increase intensity

418
Q

Which maneuvers decrease the murmur of hypertrophic cardiomyopathy?

A

isometric handgrip, squatting, leg elevation increase venous return/preload –> decreased intensity

419
Q

Location: ASD murmur

A

left second intercostal space

420
Q

Location: murmur of hypertrophic cardiomyopathy

A

apex and lower left sternal border

421
Q

Location: AR murmur

A

left sternal border 3/4 intercostal space

422
Q

Most common cause of AR in young adults in developed countries

A

bicuspid valve

423
Q

Most common cause of AR in young adults in developing countries

A

rheumatic heart disease

424
Q

Which HIV patients need ppx for MAC and what should they get?

A

cd4 azithromycin or clarithromycin

*rifabutin if allergies

425
Q

Which HIV patients need ppx for histo and what should they get?

A

cd4 itraconazole

426
Q

PPx for PCP in HIV patients

A

bactrim or pentamidine

427
Q

Acute vertigo is often due to dysfunction of the _____

A

labyrinth

428
Q

Patients with BPPV have vertigo related to ____

A

head positioning

429
Q

Nightime chest pain in youngfemales who smoke

A

printzmetal’s angina –> coronary vasospasm

430
Q

Tx of Printzmetal’s angina

A

ccbs (like diltiazem) or nitrates + stop smoking

431
Q

Why should aspirin be avoided in Printzmetal’s angina

A

can promote coronary vasospasm

432
Q

Why should nonselective beta blockers be avoided in Printzmetal’s angina

A

can promote coronary vasospasm

433
Q

Which fungus can present as cavitary lung lesions + cytopenia + lymphadenoopathy + HSM + fever/fatigue/weight loss

A

disseminated histo (central/southern US)

434
Q

Dx of histo in immunocompromised patients

A

histoplasma antigen assay of serum/urine –> fungal cultures take time and have lower sensitivity

435
Q

Tx of mild to moderate histo

A

itraconazole

436
Q

Tx of severe histo

A

IV liposomal amphotericin B 2 weeks followed by itraconazole for a year

437
Q

How do diuretics precipitate HHNK?

A

reduction of intravascular volume –> reduced GFR –> reduced glucose excretion

438
Q

Why does HHNK not present with ketones?

A

T2D have enough insulin to prevent ketone formation but not enough to regulate excess glucose surges in times of infection/drug-induced dysregulation

439
Q

Screening for colon cancer in UC

A
  1. should begin once disease has been present for 8 years
  2. maybe a longer interval if it’s only left colon
  3. repeat colonoscopy every 1-2 years
440
Q

Symptoms of hypokalemia

A

mild: weakness, fatigue, muscle cramps
severe: flaccid paralysis, hyporeflexia, tetany, rhabdo, arrhythmias

441
Q

ECG changes in hypokalemia

A

broad, flat T waves, u waves, ST depression, PVCs

442
Q

Most prevalent antibody in hashimoto’s thyroiditis

A

anti TPO and anti-thyroglobulin

443
Q

muddy brown granular casts

A

ATN

444
Q

broad and waxy casts

A

chronic renal failure –> tubules undergo hypertrophy b/c of reduced renal mass

445
Q

rbc casts

A

glomerular disease or vasculitis (e.g. glomerulonephritis)

446
Q

wbc casts

A

interstitial nephritis, pyelonephritis

447
Q

fatty casts

A

nephrotic syndrome

448
Q

hyaline casts

A

asymptomatic individuals, pre-renal azotemia

449
Q

Most sensitive and specific test for MI

A

troponin T

450
Q

Best test for recurrent MI within 10 days

A

CKMB –> troponin levels take up to 10 days to come down vs ckmb which takes 1-2 days

451
Q

Hydatid disease is due to infection w/_____

A

ecchinococcus (think dogs and sheep)

452
Q

eggshell calcification of hepatic cyst on CT

A

hydatid cyst

453
Q

Why do we not aspirate hydatid cysts?

A

risk of anaphylactic shock with spillage of cyst contents

454
Q

Tx of hydatid cysts

A

sx resection under cover of albendazole

455
Q

Hypertension in patients with thyrotoxicosis is predominantly systolic/diastolic and is caused by ______.

A

systolic and caused by hyperdynamic circulation

456
Q

____ causes isolated systolic hypertension and increased pulse pressure in elderly patients

A

decreased vascular compliance

457
Q

Hypertension in patients with hypothyroidism is predominantly systolic/diastolic and is caused by ______.

A

diastolic and caused by increased SVR

458
Q

reduced iron, increased TIBC, decreased ferritin

A

iron deficiency anemia

459
Q

general mechanism of lead poisoning and sideroblastic anemia

A

reduced heme synthesis

460
Q

general mechanism of thalassemias and hemoglobinopathy

A

reduced globin production

461
Q

general mechanism of anemia of chronic disease

A

defective utilization of storage iron

462
Q

general mechanism of iron deficiency anemia

A

decreased intake or increased blood loss

463
Q

Workup of megaloblastic anemia

A

folate level and schilling test

464
Q

Tx of COPD flare

A

albuterol, ipratropium, broad spectrum abs, 2 week cortisol taper, supplemental O2

465
Q

Danger of administering o2 to chronically hypoxic patients like those with COPD

A

suppresses hypoxia fueled respiratory drive

  1. increase in oxygenated hemoglobin has lower CO2 affinity (haldane effect) so more CO2 is released into tissues
  2. reversal of hypoxic vasoconstriction increases dead space ventilation and worsens V/Q mismatch

–> CO2 narcosis

466
Q

4 stages of chronic hepatitis b

A
  1. immune tolerance
  2. immune clearance
  3. inactive carrier
  4. HBeAg - chronic hepatitis
467
Q

Followup test for patients with active HepB in immune clearance to see how well they are doing?

A

ALT increases (but fluctuates) due to immune-mediated lysis of infected hepatocytes until HBeAg levels start decreasing –> monitor both until inactive carrier (3 normal ALT and 2-3 normal HBV DNA over 12 month period)

468
Q

Which phase of HepB infection is typically longer in those with perinatal infection?

A

immune tolerance phase –> high level of replication (+HBsAg and HBeAg) but minimal heaptocyte destruction (normal biopsy, transaminase levels)

469
Q

What is blue toe syndrome?

A

cholesterol emboli (typically post stent or in atherosclerotic dz) lead to small vessel occlusion

also can present with livedo reticularis (red/cyanotic reticular discoloration of skin), acute renal failure (from emboli to renal arteries), GI symptoms, pancreatitis

470
Q

Suggestive lab dx of cholesterol emboli

A

eosinophila in blood and urin with decreased complement levels

471
Q

Suspect ______ in a young obese female with a headache that is suggestive of brain tumor but with normal imaging and elevated CSF pressure + papilledema, visual field defects and/or VI palsy

A

benign intracranial hypertension/pseudotumor cerebri

  • can be preceded with glucocorticoid, vitamin A, OCP use
  • due to impaired absorption of CSF by arachnoid villi
472
Q

Tx of psuedotumor cerebri

A

weight loss and acetazolamide

*if refractory, shunting or optic nerve sheath fenestration to prevent blindness

473
Q

Recurrent respiratory tract infections + chronic cough + mucopurulent sputum +/- crackles/rhonchi/wheezes +/- hemoptysis

A

bronchiectasis

474
Q

Management: Rubbery, firm, mobile, painful breast mass in young woman

A
  1. aspiration
  2. if bloody or foul smelling –> cytology
  3. if clear –> watch and wait for 4-6 weeks

*likely fibrocystic and associated with menses

475
Q

Diarrhea due to ____ is typically four hours to four days after ingestion of seafood and can be watery or bloody.

A

vibrio parahaemolyticus

476
Q

Symptomatic relief of hyperthyroidism

A

proanolol –> best initial treatment for hyperthyroidism

477
Q

When is propylthiouracil used to tx hyperthyroidism?

A

when pregnant and can’t receive radioactive iodine –> however high risk of recurrence

478
Q

Cancer risk associated with pernicious anemia

A

chronic atrophic gastritis leading to inetstinal type gastric cancer and gastric carcinoid tumors

479
Q

Screening for gastric cancer among patients with pernicious anemia

A

periodic stool testing for blood

480
Q

Physical finding in AR

A

waterhammer pulse (bounding pulse) –> rapid increase in systolic pressure due to increased stroke volume + rapid decrease of diastolic pressure because of regurgitation into LV

481
Q

Pulsus paradoxus occurs in ___

A

tamponade –> fall in systemic arterial pressure by more than 10 mmHg during inspiration

482
Q

Pulsus parvus and pulsus tardus are associated with ____

A

AS

483
Q

Most common benign vascular tumors in adults

A

cherry hemangiomas –> always cutaneous

484
Q

Dilated vascular spaces with thin-walled endothelial cells presenting as soft blue compressible masses on skin, mucosa, deep tissues, and viscera

A

cavernous hemangioma

485
Q

Cavernous hemangiomas of thebrain and viscera are associated with ___ dz

A

von hippel lindau

486
Q

lymphatic cysts lined by thin endothelium presenting at birth on the neck and lateral chest wall

A

cystic hygromas

487
Q

cystic hygromas are associated with ____ syndrome

A

turner

488
Q

elevation of ____ leads to spider angiomas

A

estrogen

489
Q

_____ appear during the first weeks of life, grow rapidly, frequently regress by age 5-8 and are bright red near the epidermis and more purple when deeper

A

infantile/strawberry hemangiomas

490
Q

Acute hypercapnia causes cerebral vaso constriction/dilation

A

dilation to increase blood flow

491
Q

Goal oxyhemoglobin sat in patients w/acute on chronic respiratory failure

A

90 to 94 not >95 b/c of risk of worsening hypercapnia and CO2 narcosis

492
Q

EBV DNA in CSF is specific for ____

A

primary CNS lymphoma

493
Q

Imaging finding in AIDS dementia

A

cortical/subcortical atrophy and secondary ventricular enlargement

494
Q

Imaging of PML lesions

A

non-enhancing and without mass effect

495
Q

Suspect ______ in a HIV patient with AMS, EBV DNA in CSF, and a solitary, weakly ring enhancing periventricular mass on MRI.

A

primary CNS lymphoma

496
Q

Multiple Myeloma is caused by the proliferation of a single transformed plasma cell usually producing ____

A

IgG

497
Q

Classic findings in Multiple Myeloma

A 
CRAB
hypercalcemia
renal failure
anemia
back pain and bone lesions
498
Q

In what disease is increased marrow cellularity with megakaryocytic hyperplasia seen?

A

essential thrombocytosis

499
Q

What are the bone marrow findings of aplastic anemia?

A

hypoplastic fat filled marrow with no abnormal cells

500
Q

Hypocellular and fibrotic bone marrow is seen in ____ disorders

A

myelofibrotic

501
Q

Failure to achieve a spontaneous erection during the night and/or early morning is pathognomic of ____ ED

A

organic

502
Q

Venogenic ED may occur after disruption of the ______

A

tunica albuginea

503
Q

2 endocrine causes of ED

A
  1. hyperprolactinemia
  2. testosterone deficiency

diabetes mediates ED via systemic/vascular changes so it doesn’t count

504
Q

Microcytic anemia w/basophilic stippling associated with abdominal pain, constipation, fatigue, irritability, insomnia, hypertension, neuropathy, neuropscyhiatric disturbances, nephropathy.

A

lead poisoning

505
Q

Dx of lead poisoning

A

blood lead levels, cbc w/smear, x ray fluorescence to measure bone lead

506
Q

Tx of lead poisoning

A

chelation

507
Q

Woman with chronic headaches presenting with painless hematuria with normal rbcs & no casts on UA

A

papillary necrosis from analgesic nephropathy …i.e. chronic tubulointerestitial damage from analgesic-mediated vasoconstriction of vasa recta

508
Q

Renal colic + hematuria

A

nephrolithiasis

509
Q

Pathogens that cause >2weeks of secretory diarrhea after travel

A

crypto, cyclospora, giardia

510
Q

Which bug? nausea/vomiting/abdominal pain w/skin lesions after travel to subtropical/tropical areas

A

strongyloides stercoralis

511
Q

Most stones are _____

A

calcium oxalate/phosphate

512
Q

Most common cause of calcium stones

A

idiopathic hypercalciuria

513
Q

Tx algorithm for calcium stones

A
  1. increase fluid intake >3L/day
  2. normal or increased calcium diet
  3. dietary sodium restriction
  4. oxalate restriction (dark greens, chocolate, vit C)
  5. decreased dietary protein

*can add thiazide diuretics (decrease urinary calcium excretion vs. loops)

514
Q

Nephrotic syndrome predisposes patients to accelerated _____

A

atherosclerosis

515
Q

Is nephrotic syndrome associated with cobalamin deficiency?

A

no

516
Q

What is the mechanism of hypoparathyroidism in nephrotic syndrome?

A

there is none. vitamin d losses lead to increase in PTH to stabilize vitamin D levels

517
Q

How does nephrotic syndrome lead to monoclonal gammopathy?

A

it doesn’t. monoclonal gammopathy can lead to amyloidosis which can cause nephrotic syndrome

518
Q

How can we distinguish between cardiogenic/noncardiogenic pulmonary edema?

A

PCWP >18 suggests cardiogenic vs non cardiogenic

519
Q

What is the pathogenesis of ARDS?

A

systemic or major illness leads to cytokine storm which leads to increased alveolar capillary permeability and subsequent pulmonary edema

520
Q

gradual onset of cough/dyspnea/crackles/clubbing with decreased lung volume and basal interstitial prominence

A

IPF

521
Q

Tx of STEMI

A

MONAB: morphine, oxygen, nitrates, antiplatelet tx, beta blocker

522
Q

Contraindication for nitrate use in STEMI

A

aortic stenosis, recent PDEI use, RV infarct (reduction of preload prevents any CO in this case vs in LV infarct where cost/benefit favors unloading the LV because there is already loss of CO)

523
Q

What is the difference in how big left vs big right V infarcts present?

A

RV infarcts have clear lung sounds

Large LV infarcts will lead to pulmonary edema

524
Q

First step in tx of RV MI? What do you do if this doesn’t work?

A

IV fluids to increase RV stroke volume and enhance LV filling

*if fluids don’t work, give dobutamine for inotropy. may add dopamine if hypotensive because dobutamine can worsen hypotension if given alone

525
Q

When do you pace in the context of MI?

A

if you have atropine-refractory bradycardia

526
Q

Single most common cause of asymptomatic isolated elevation of alkphos in an elderly patient

A

Paget’s disease of bone

527
Q

First line therapy for chemo-induced nausea

A

serotonin (5HT3) antagonists like ondansetron

528
Q

Primary anticholinergic agent used to treat vomiting is _____

A

scopalamine

529
Q

Are lacunar strokes embolic?

A

No –> combo of microatheroma and lipohyalinosis (AKA small vessel hyalinosis)

530
Q

Most common site and presentation of lacunar stroke

A

posterior internal capsule producing pure motor stroke

*can have ataxic hemiparesis, pure sensory stroke, or combined sensory motor stroke w/o aphasia

531
Q

What do patients who have embolic stroke often experience before the stroke?

A

amaurosis fugax

532
Q

Lacunar strokes compromise ____% of ischemic strokes

A

25

533
Q

2 major risk factors for lacunar strokes

A

hypertension and diabetes

534
Q

Initial imagining study of choice in symptomatic patient being worked up for pancreatic cancer.

A

multiphase thincut spiral CT of abdomen

535
Q

Markers of response to tx for pancreatic cancer

A

CEA and CA 19-9

536
Q

What does the presence of hyponatremia in a pt with heart failure suggest?

A

severe hf.

high RAAS activation leads to water retention causing hyponatremia –> associated with lower survival –> water restriction
*low serum sodium associated with high: renin, aldo, ADH, norepi

537
Q

very high blood pressure, palpitations, abdominal pain, tremor, excessive sweating

A

pheochromocytoma (or general sympathetic hyperactivity)

538
Q

What is the danger of using beta blocker in tx of paroxysm of a pheochromocytoma?

A

blocking beta receptors leads to unopposed stimulation of vascular alpha receptors which causes catastrophic/rapid increase in BP –> block alpha first in pheochromocytoma paroxysm and then add beta blocker –> or use labetalol (1st line) which does both

539
Q

throbbing pain in pulp of finger with non-purulent vesicles and multinucleated giant cells on Tzanck smear

A

herpetic whitlow –> dentists/healthcare workers or people who already have genital or oral herpes

540
Q

Light criteria

A

defines exudate vs transudative effusion…at least one of:

  1. fluid protein/serum protein > .5
  2. fluid LDH/serum LDH >.6
  3. fluid LDH >2/3 upper limit of normal serum LDH
541
Q

Likely ABG finding in PE

A

widened AA gradient and respiratory alkalosis

542
Q

What kind of effusions are more common in PE?

A

exudative

543
Q

Gold standard for dx PE and diagnostic test of choice for dx PE

A

pulmonary angiography and helical CT

544
Q

Differential for exudative effusions

A

pneumonia, TB, malignancy, PE, connective tissue dz, iatrogenic

545
Q

Describe the pleural effusions of heart failure

A

bilateral, symmetrical, transudative w/ few RBCs and WBCs

546
Q

Describe the pleural effusions of heart failure

A

bilateral, symmetrical, transudative w/ few RBCs and WBCs

547
Q

What kind of hypersensitivity rxn is contact dermatitis?

A

4 e.g. poison ivy, nickel

548
Q

Chronic follicular occlusive disease most commonly affecting the intertriginous skin including axilla, groin, and inframammary regions appearing as painful inflammatory nodules and draining sinus tracts

A

suppurative hidradenitis

549
Q

Craniopharyngiomas are benign/malignant tumors arising from _____ and are more common in children/adults.

A

benign, rathke’s pouch, children

*bimodal distribution: children and 55-65

550
Q

Presentation of craniopharyngioma

A

grows above sella turcica and consists of multiple cysts with oily fluid

–> hypopituitarism (retarded growth in children and sexual dysfunction/amenorrhea in adults), with bitemporal blindness, headaches (from pressure)

551
Q

What is the distribution of alcohol and diabetic neuropathies?

A

glove and stocking (distal and symmetric)

552
Q

Loss of central vision (scotoma) with afferent pupillary defect suggests what pathology?

A

optic neuritis

553
Q

Dx of chlamydial urethritis

A

presence of mucopurulent urethral discharge + multiple sexual partners

*UA shows no bacteriuria, culture less than 100 colonies/mL

554
Q

vaginal discharge + pruritis + dyspareunia w/o dysuria

A

vaginitis

555
Q

dysuria + urinary frequency + suprapubic discomfort + urinary findings of bacteriuria

A

acute bacterial cystitis

556
Q

weakness + fatigue + loss of appetite + eosinophilia + cold intolerance + constipation + bradycardia

A

panhypopituitarism = glucocorticoid and thyroid deficiencies

low TSH, low T4, low cortisol, normal aldosterone (ACTH independent)

557
Q

Why does secondary (central) adrenal insufficiency not cause hyperpigmentation, hyperkalemia or salt wasting?

A

Aldosterone secretion from zona glomerulosa is ACTH independent

558
Q

Typical findings in cerebellar degeneration

A
  1. gait ataxia
  2. truncal ataxia
  3. nystagmus
  4. intention tremor/dysmetria
  5. dysdiadokinesia
  6. muscle hypotonia w/ pendular knee reflex
  • normal babinski b/c not UMN
559
Q

_____ phenomenon is seen in patients with hypertonia due to pyramidal tract disease and is velocity-dependent.

A

clasp knife –> velocity-dependent resistance to passive movement

560
Q

Differential: Fatigue + myalgias+ proximal muscle weakness + sluggish ankle reflexes + normal sed rate + elevated CK

A
  1. hypothyroid myopathy (unexplained elevation of CK)
  2. could be polymyositis but less likely than hypothyroid b/c pm is associated with raynauds, interstitial lung disease and presents with difficulty walkup stairs/getting out of chair, and with normal DTRs –>ANA won’t help until after TSH b/c ANA is elevated in hashimotos as well
561
Q

Meniere’s dz triad

A

episodes of vertigo, low-pitched tinnitus, and hearing loss

–> abnormal accumulation of endolymph w/in inner ear

562
Q

____ is the likely cause of vertigo if a patient also has the sensation of ear fullness.

A

Meniere’s disease

563
Q

Presentation of wallenberg syndrome

A

lateral medullary infarct

vertigo + gaze abnormalities + limb ataxia + sensory loss + horner’s

564
Q

Most common cause of SVC syndrome

A

malignancy (lung, NHL)

565
Q

Dx of malignancy in SVC syndrome

A

chest xray

566
Q

Beck’s triad in tamponade

A

jvd, distant heart sounds, hypotension

567
Q

increased iron, reduced TIBC, increased ferritin, but low MCV

A

thalassemia

568
Q

Most common histologic lesion in diabetic nephropathy? What is the histologic hallmark of diabetic nephropathy?

A

diffuse glomerulosclerosis

kimmelstiel-wilson nodules are pathognomic

569
Q

3 ways to slow progression of diabetic nephropathy

A
  1. strict glycemic control
  2. ACEI
  3. tx of htn
570
Q

Which nerve is lesioned if there is absence of corneal sensation?

A

V1

571
Q

Abnormal RInne test suggests _____ hearing loss

A

conductive (patient hears vibration longer on the mastoid than in the air)

572
Q

The weber test lateralizes to which side?

A

patients with conductive hearing loss lateralize to the affected ear because inner ear hears the sound better than the external ear whereas patients with sensorineural hearing loss lateralize to unaffected ear since inner ear cannot sense the vibration

573
Q

where is the lesion and what is it? + rinne with R Weber

A

left sensorineural loss

574
Q

where is the lesion and what is it? - L rinne with R Weber

A

left mixed hearing loss

575
Q

where is the lesion and what is it? - L rinne with L Weber

A

left conductive loss

576
Q

where is the lesion and what is it? - R rinne with R Weber

A

right conductive loss

577
Q

where is the lesion and what is it? - R rinne with R Weber

A

right mixed hearing loss

578
Q

Otosclerosis is a common cause of ____ hearing loss in adults, especially patients 20-30 w/ slight F predominance

A

conductive –> abnormal remodeling of otic capsule (autoimmune)

579
Q

What kind of hearing loss is caused by antibiotics and which one is notorious?

A

aminoglycosides–> sensorineural

580
Q

Acoustic neuroma/vestibular schwannoma causes ___hearing loss

A

sensorineural

581
Q

____ is sensorineural hearing loss that occurs w adults with advanced age

A

presbycusis

582
Q

hyponatremia with high serum osms >290

A

hyperglycemia or advanced renal failure

583
Q

hyponatremia with normal serum osm and low urine osms <100

A

primary polydipsia, malnutrition (beer drinkers potomania)

584
Q

hyponatremia with normal serum/urine osms but low urine sodium <25

A

volume depletion, chf, cirrhosis

585
Q

hyponatremia with normalish serum osms/urine osms but urine sodium>25

A

SIADH (urine osms>serum osms), adrenal insufficiency, hypothyroidism –> basically concentrated urine even with hyponatremia

586
Q

What’s the story on using beta blockers in patients with mild to moderate asthma?

A

use cardioselective beta blockers for a short term only and at lower doses (beta1)

587
Q

mononucleosis like syndrome + lack of pharyngitis + cervical lymphadenopathy + atypical lymohocytes and negative monospot has____

A

CMV mono

presents w/o pharyngitis or cervical lymphadenopathy

588
Q

How long must symptoms be present to dx chronic fatigue syndrome

A

6 months or longer

589
Q

characteristic cell in CLL

A

smudge cell (and mature appearing small lymphocytes)

590
Q

Presentation of scurvy

A

perifollicular hemorrhage, swollen gums, poor wound healing

591
Q

Findings in Vit E deficiency

A

RBC fragility, hyporeflexia, muscle weakness, blindness

592
Q

Tea and toast diet is associated with ____ deficency

A

folic acid

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