Medicine 2 Flashcards
1
Q
MCC Adrenal Failure
- USA
- WW
- Overall
A
- USA = AI Adrenal Destruction
- WW = Diss TB
- Overall = Chronic Steroid Use –> Withdrawal (produces TERTIARY = CENTRAL HYPOADRENALISM with low ACTH, low cortisol and normal aldosterone)
2
Q
Ortner’s Syndrome
A
Hoarse voice 2/2 LA enlargement; look for elevation of L primary bronchus too
3
Q
Malaria
- Bug
- Reservoir
- P/w (2) and Why
- 2 Protected Populations
- Dx
- Vs. Babesiosis?
A
- Bug: Plasmodium (Vivax, Ovale, Malariae, Falciparum)
- Reservoir: ANOPHELES Mosquito
- P/w (2) and Why: Cyclical FEVERS + HA as leave liver –> RBC
- 2 Protected Populations: Sickle Cell (not favorable RBC) + Prior Infection
- Dx: Thick and thin blood smear with Gimesa+ stain
- Vs. Babesiosis? Caused by IXODES deer tic and found in USA NE area; causes similar presentation
4
Q
Histoplasmosis
- Microbiology
- Location
- Presentation / Dx / Tx
A
- Micro: Histo hides in macrophages, this is why disseminated infection produces hepatosplenomegaly + palate ulcers
- Location = Ohio + MS River Valleys, caves + bats
- Fx: Diss infection as above; tx with Ampho B + Itraconazole
5
Q
Blastomycosis
- Microbiology
- Location
- Presentation / Dx / Tx
A
- Micro: Broad Based Budding Yeast
- Location = E of MS River
- Fx: Disseminated = Pancytopenia (bone) + skin problems (warty like lesions + ulcers)
- Tx: PO Itraconazole (mild) –> Severe with Amphotericin B
6
Q
Coccidiomycosis
- Microbiology
- Location
- Presentation / Dx / Tx
A
- Micro = Endospore spherules
- Location = SW USA
- Fx = Valley Feve
7
Q
Paracoccidio
- Microbiology
- Location
- Presentation / Dx / Tx
A
- Micro: Captain’s Wheel Appearance
- Fx: Latin America
8
Q
gluten sensitive; IgA Ab to gliadin, Dermatitis Herpetiformis. Dx gold standard = biopsy with villous flattening
A
Celiac
9
Q
as Celiac, need h/o of living in endemic area
A
Tropical Sprue
10
Q
SI bacterial overgrowth
A
the little SI bacteria are overtaken by other growth 2/2 ∆anatomy or ∆gastric motility; diagnose with jejunal aspirate >10*5 bacteria, Tx = Rifaxamin/Augmentin
11
Q
Whipple dz
A
PAS+ cells in old white men
12
Q
MCCOD in Dialysis
A
Cardiovascular Disease
13
Q
Nasal Septal Perforation
- P/w
- 4 MCC
A
P/w = Persistent whistling noise
4 MCC
- S/p Rhinoplasty
- Trauma (nose picking)
- Wegener’s (ELK)
- Cocaine
14
Q
MoA + ADE
- Didanosine
- Abacavir
- Indinavir
- Nevirapine
- Lamivudine
- Efavirenz
General AADE for
- NRTI
- NNRTI
A
- Didanosine (NRTI) = Pancreatitis
- Abacavir (NRTI) = Hypersensitivity
- Indinavir (Protease I, all end in -navir) = Needle Shaped Crystals
- Nevirapine (NNRTI) = Liver Failure
- Lamivudine = Liver Failure
- Efavirenz (NNRTI) = Vivid Dreams/Hallucinations
General AADE for
- NRTI (all end in -ine except Abacavir) = Lactic Acidosis
- NNRTI (Nevirapine, Efavirin) = SJS
15
Q
Flagyl Indications (7)
A
GET GAP on metRo
- Giardia
- Entoamoeba
- Trich
- Gard. (BV)
- Anaerobes
- (H) Pylori
- Rosacea
16
Q
Caution in Using Nitroglycerin (4)
A
- Aortic Stenosis
- Right Ventricular Infarct
- With PDE-I (Sildenafil; also watch PDE and alpha-blocker use)
- Hypotension
17
Q
MoA Plavix
A
PGy-12 Receptor Blocker
18
Q
MEN Syndromes and PT-adenoma vs. hyperplasia?
A
MEN1 = Adenoma MEN2 = Hyperplasia
19
Q
Ca and PTH Levels in:
- Familial HyperCa HypoCaUria
- PseudohypoPTH (Albrights)
A
FHH: Mutation in Ca Sensing Receptor in PTH Gland
- Increase Ca
- Increase PTH
PseudohypoPTH (Albrights): xEnd Organ Damage to Ca
- Low Ca
- Increase PTH
20
Q
How to approach Acetaminophen OD?
A
- Activated Charcoal ≤4 hours s/p ingestion
2. Plot Acetaminophen level @4hrs on Rumack-Matthew Nomogram
21
Q
CO tox
- Risks
- P/w
- SaO2
- Tx
A
- Risks: space heater, garage
- P/w: Cherry Red Skin, High HCT
- SaO2: normal b/c COHb
- Tx: Hyperbaric (100%) O2
22
Q
Methemoglobinemia
- Risks
- P/w
- SaO2
- Tx
A
- Risks: Rx (Sulfas, nitrates, dapsone)
- P/w: Chocoloate Brown Blood
- SaO2: normal
- Tx: Methylene Blue
23
Q
CN Toxicity
- Risks
- P/w
- SaO2
- Tx
A
- Risks: nitroprusside, burning plastic
- P/w: Pink skin, burnt almond smell
- Tx: Amyl Nitrate (induce methem) –> sodium thiosulfate
24
Q
(T/F) In atrial fibrillation with dilated ventricle, digoxin is treatment of choice?
A
FALSE. Dilated ventricle is 2/2 to atrial fibrillation, control the afibb with typical RATE control
25
Pulsus Bisferiens Def + 2Dz
Defined as biphasic systolic pulse with midsystolic dip. Seen in:
- Aortic Regurge
- HOCM
26
2 Stones that PPT in low pH and 2 Treatments
Uric Acid + Ca Oxalate
Give K Citrate + NaHCO3
27
2 CHF Exacerbation Protocols
What is never included?
1. CHF with nl/high BP
- O2 + Lasix + Nitroglycerin
2. CHF with low BP
- O2 + Lasix + NorEpi Pressor
Never included = beta blocker (in acute CHF exacerbation, increase survival for chronic management)
28
Chondrocalcinosis - 2 DZ?
1. CPPD (Pseudogout) ~ wrap around patella
| 2. Hemochromatosis
29
4 Steps in Progression of Diabetic Nephropathy
What is key treatment and why?
1. Glomerular Hyperfiltration
2. GBM Thickening
3. Mesangial Expansion
4. Glomerulosclerosis (KW Nodules)
Give ACE-I to decrease efferent arteriole constriction = decrease glomerular HTN = decrease progression of disease
30
3 MC Malignancies found in Malignant Effusions?
1. Lung
2. Breast
3. Lymphoma
31
Chalazion
- Def
- P/w
- Management
Def: chronic granulomatous inflammation of meibomian gland 2/2 obstruction
P/w: rubbery lesion on eyelid
Mgmt: warm compresses (Same as Stye = Hodeolum) --> I+D --> BIOPSY (increase risk for conversion to carcinoma)
32
Gold Standard PNA Dx in Outpatient Setting
CXR (≠Sputum Culture)
33
4 ARDS Criteria
1. New Onset
2. Noncardiogenic (nl PCWP)
3. B/l Fluffy Infiltrates on CXR
4. Hypoxia (P/F Ratio)
-
34
Beck's Triad
Underlying Physiology
Triad = JVD, Muffled Heart Sounds, Hypotension
Decrease PRELOAD
35
2 Neuro Signs for Immediate Back Imaging in DM?
UMN Signs or Motor Weakness
DM are at increase risk for abscess
36
Triad of EPO Abuse
HA, HTN and Flu Symptoms
37
Cystercercosis
- Bug
- Intermediate vs. Definitive Host
- Transmission
- 3 Organs
- Bug = Taenia Solium (pork tapeworm)
- Humans are only definitive host (only humans can become infected)
- Intermediate: pig (can eat eggs and not beome infected)
- Transmission: when humans eat eggs they become infected
- 3 Organs: Skeletal Muscle, Eye, Brain (Scolex)
38
How does insulin resistance cause NALFD?
Increase insulin resistance = increase peripheral lipolysis = increase Fatty acid delivery to liver = increase fatty oxidation = inflammation
39
Older patient with known presbyopia is peeing a lot and suddenly their vision gets better?
Look for New DM. Persistent hyperglycemia = corrects presbyopia
40
Corneal arcus in young person?
Think Familial HyperCholesterolemia
41
Whats the difference in Metabolic Syndrome Key Features and CAD Risk Factors (used in LDL goals too?)
Met Syndrome = SHODDy
CAD Risk = SHAFDy
* Age: >45 men, >55 women
* FMHx CAD:
42
What 3 things increase HDL?
Moderate Alcohol Consumption
Exercise
Estrogen
43
Tx of Viral vs. Allergic vs. Bacterial Conjunctivitis?
Allergic (itchiness + B/L) = Topical Antihistamines / Mast Cell Stabilizers / Vasoconstrictors
Viral (no itch + U/L + close contacts) = hand washing
Bacterial = ABx
***High Yield: Viral/bacterial are U/L and use the discharge to tell the difference. B/L = Allergic!!!
44
(T/F) Topical Steroids should be given on the eye?
FALSE FALSE FALSE
- Increase cataracts / glaucoma
- Worsen HSV / Fungal keratitis
45
Who gets UV keratitis? (3)
| Treatment? (2)
UV Keratitis = welders, skiers (snow blind) and tanners
Tx = Patch the eye +/- Topical Abx
46
What high yield DZ is associated with CRAO?
Temporal Arteritis
47
What is presbyopia? What is treatment?
What is the disease associated with ∆corneal shape?
Loss of lens elasticity --> cannot accommodate (holding objects @distance to see) --> need bifocals for NEAR Vision
Don't confuse with ∆Corneal shape = astigmatism; blurry vision regardless of distance
48
Massive PE Definition (2) + Unique Treatment
1. PE with Hypotension
2. PE with Acute Heart Strain as evidence by JVD (b/c RV dilation) or RBBB
Unique Treatment = candidate for fibrinolytic therapy
49
- MCC Folate Deficiency
| - 3 Rx Causing Folate Deficiency
- MCC Folate Deficiency: EtOHism (Nutritional)
| - 3 Rx Causing Folate Deficiency: MTX, Trimethoprim (DHFR) and Phenytoin (xIntestinal Absorption)
50
cANCA vs. pANCA Targets
```
cANCA = anti proteinase 3
pANCA = anti MPO
```
51
Casts
- Muddy Brown
- RBC
- WBC
- Fatty
- Waxy
- Epithelial
- Muddy Brown: ATN
- RBC: Glomerular Damage / Nephritic Syndrome
- WBC: AIN (PCN, Sulfa, Ceflacor) / Pyelo
- Fatty: Nephrotic Syndrome
- Waxy: Chronic Renal Disease
- Epithelial: Acute INTRARENAL Injury (Aminoglycoside)
52
Hypersensitivity Pneumonitis
- Definition
- P/w
- 2 Examples
- Treatment
- Def: inflammation of lung parenchyma 2/2 antigen exposure (vs. PNA = infectious inflammation)
- P/w: Fever, Cough, SOB (recurrent mini-PNA)
- 2 Examples: Farmer's Lung + Bird Fancier's Lung
- Tx: Avoid exposure to antigen
53
2 Associations with Reactive Arthritis (other than triad)
Treatment of Reactive Arthritis
Associations = PO Ulcers + Enthesitis
Tx = NSAID
54
3 Predictors of AAA Expansion / Rupture
1. Size >5.5 cm
2. Active Cig Smoking
3. Rate of expansion >.5cm/6mo or ≥1.0 cm/yr
55
4 Fx of Legionella PNA
1. PNA
2. Watery Diarrhea
3. HypoNa
4. Elevated LFTs
56
Clubbing: 2/2 low O2 or 2/2 malignancy?
Depends; in cyanotic heart, pHTN, CF = chronic hypoxia. BUT, in COPD = 2/2 HOA = Malignancy
57
W/u Testicular Mass (1)
ULTRASOUND IS ALL THAT IS NEEDED!!!! No biopsy / FNA b/c of seeding theory. This is a cancer that you shoot (operate) first and ask questions later.
58
5 ∆Lifestyle for High BP?
1. Weight Loss
2. DASH Diet
3. Regular Exercise
4. Low Salt Diet
5. xEtOH
