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Step 2 CK > Medicine #2 > Flashcards

Medicine #2 Flashcards

1
Q

familial hypocalciuric hypercalcemia

A

hypercalcemia with an elevated PTH but low urinary calcium excretion (<100)

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2
Q

Indications for parathyroidectomy

A
  1. Age < 50 as likely to have complications later in life
  2. Symptomatic hypercalcemia
  3. risk for complications (serum Ca > 1mg/dL above normal), urine calcium excretion > 400
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3
Q

most common presentation of primary hyperparathyroidism?

A

aymptomatic hypercalcemia with elevated parathyroid level

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4
Q

How would you position a patient with left sided lobar pneumonia? why?

A

Lye patient on their right side. gravity causes more blood to flow to right side (the side with better ventilation. This improves V/Q mismatch)

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5
Q

Dead space ventilation (area of ventilated lung not perfused with blood) occurs in what acute process?

A

PE

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6
Q

carboxyhemoglobin from CO posioning shifts the oxygen dissociation curve to the _____? causing?

A

left. impairing ability of heme to unload oxygen at the tissue level resulting in tissue hypoxia.

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7
Q

Why do patients with CO poisoning often have secondary polycythemia?

A

Kidney responds to tissue hypoxia by producing more EPO and more RBCs are made.

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8
Q

Why cant pulse ox be used in the diagnosis of CO posioning

A

it doesn’t differentiate between carboxyhemoglobin and oxyhemoglobin

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9
Q

Babesiosis presentation

A

flu-like (fever, chills, malaise) anemia, intravas hemolysis, thrombocytopenia)

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10
Q

babesiosis diagnosis

A

peripheral blood smear (intraerythrocytic rings) “maltese cross”

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11
Q

Treatment for babesiosis

A

7-10 days atovaquone plus azithromycin

quinine plus clindamycnin (severe)

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12
Q

Erlichiosis

A

tick borne illness that causes nonspecific symptoms (fever, myalgias, HA, leukopenia, thrombocytopenia)

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13
Q

tourniquet test

A

helps diagnose dengue fever

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14
Q

Lab testing in Paget disease shows?

A

elevate alk phos
elevated bone turnover markers (PINP, urine hydroxyproline)
Nml calcium and phosphorus

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15
Q

target BP for patients with diabetic nephropathy?

A

130/80

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16
Q

most beneficial therapy to reduce progression of diabetic nephropathy is?

A

strict BP control

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17
Q

axonopathy of large and small nerve fibers occurs in what disease process?

A

DM

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18
Q

small fiber axonopathy symptoms?

A

pain, paresthesias, allodynia

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19
Q

large fiber axonopathy symptoms?

A

numbness, loss of proprioception, vibration sense, diminished ankle reflex

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20
Q

hypercalcemia of malignancy

A

severe, symptomatic hypercalcemia due to release of parathyroid hormone related protein by tumor cells

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21
Q

Neurocysticercosis is caused by? symptoms?

A

Taenia solium pork tapework. seizure and signs of increased ICP.

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22
Q

Treatment of patients with neurocysticercosis?

A

antiepileptic: phenytoin
antiparasite: albendazole
corticosteroid for brain inflammation

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23
Q

infectious oocytes in feline feces?

A

toxoplasmosis

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24
Q

neurotropic virus acquired from infectious animal bite?

A

rabies

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25
Q

Treatment for legionella

A

flouroquinolone or newer macrolide

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26
Q

Management of stable and unstable patients with WPW and Afib with RVR?

A

stable: procainamide
unstable: electrical cardioversion

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27
Q

Why shouldn’t you use AV nodal blocking agents (adenosine, B-blockers, CCBs, Dig) in patients with WPW and Afib?

A

can promote conduction across accessory pathway and lead to transition into Vfib.

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28
Q

Management of cocaine toxicity?

A

IV benzo, aspirin, nitro and CCBs

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29
Q

why are B-blockers contraindicated in cocaine tox?

A

unopposed alpha adrenergic stimulation

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30
Q

Mees lines (horizontal striation of fingernails) is characteristic of?

A

aresenic toxicity

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31
Q

dimercaprol can treat ____ toxicity

A

aresenic

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32
Q

acute arsenic toxicity can cause?

_____ is a very early manifestation of arsenic poison

A

pancytopenia and hepatitis

hypo/hyperpigmentation

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33
Q

fever, back pain, focal spinal tenderness, increased muscle spasm, suggests?

A

vertebral osteomyelitis

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34
Q

how do you diagnose vertebral osteomyelitis?

A

CBC, blood cultures (+ in 50-70%), ESR and CRP will be elevated, leukocyte count (normal or high),

*MRI is diagnostic study

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35
Q

What is needed to confirm diagnosis of osteomyelitis?

A

CT guiged aspiration and culture of infected interverbral space

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36
Q

preferred diagnostic test for aortic dissection in hemodynamically stable patients with good kidneys?

preferred test in unstable patients with kidney injury?

A

CT angio

TEE

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37
Q

Edema caused by glomerular nephritis is caused by what mechanism?

A

decreased GFR and retention of Na and water by the kidneys

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38
Q

antidote for cyanide poisoning

A

hydroxycobalamin or sodium thiosulfate

Nitrites to induce methemoglobinemia because cyanide binds avidly to Fe#+

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39
Q

when does methemoglobinemia occur?

A

exposure to oxidizing agents (oxidizing Fee2+ to Fe3+) (left shift in O2 dissociation curve)

dapsone, nitrates, topical/local anesthetics

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40
Q

List common causes of diarrhea in patients with HIV/AIDS

A

Cryptosporidium
Microsporidium
MAC
CMV

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41
Q

CD4 count and symptoms for HIV associated: Crypto

A

CD < 180

Severe watery diarrhea
low grade fever
weight loss

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42
Q

CD4 count and symptoms for HIV associated microsporidium diarrhea

A

CD < 100

watery diarrhea
crampy abd pain
weight loss
**fever rare

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43
Q

CD4 count and symptoms for HIV assocated MAC diarrhea

A

CD4 < 50
watery
*high fever (39, 102.2)
weight loss

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44
Q

CD4 and symptoms for HIV associated CMV diarrhea?

A

CD4 < 50

frequent, small volume** diarrhea
hematochezia**
abd pain
low grade fever
weight loss
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45
Q

Thyrotoxicosis with normal or increased radioactive iodine uptake?

A

graves disease; toxic multinodular goiter; toxic nodule

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46
Q

painless thyroiditis is considered a variant of ______ and is associated with what autoantibodies?

A

hashimotos. thyroid peroxidase autoantibodies

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47
Q

Multiple system atrophy (Shy-drager syndrome)

A

degenerative disease characterized by Parkinsonism, autonomic dysfunction, widespread neuro sings

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48
Q

Person with parkinson’s experiences orthostatic hypotension, impotence, incontinence - consider what diagnosis?

A

Multiple system atrophy

Shy-Drager Syndrome

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49
Q

In a women < 50 with 1 of the following you should consider:

  • severe or resistent htn
  • onset of htn before 35
  • increase in creatinine after starting ACE, ARB
  • systolic-distolic epigastric bruit
A

FIbromuscular dysplasia

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50
Q

Adrenal vein sampling differentiates between?

A

adrenal hyperplasia and adenoma (primary hyperaldo)

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51
Q

Type I HIT (non-immune) usually presents ___ days after HEP exp

A

2 days

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52
Q

Type II HIT (autoimmune antibodies to platelet factor 4) (PF4)- presents _____ days after Hep exp

A

5-10 days

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53
Q

Diagnosis of ankylosing spondylitis?

A

x-ray of pelvis or MRI if x-ray doesn’t show anything

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54
Q

associated with JAK2 mutation

A

polycythemia vera

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55
Q

Treatment for Polycythemia vera?

A

serial phlebotomy

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56
Q

What ventilator strategy improves mortality in patients with ARDS

A

low tidal volume ventilation

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57
Q

coverage for human bite wounds?

A

amoxicillin-clavulanate

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58
Q

Mixed cryoglobulinemia is an immune complex disorder commonly associated with what illnesses?

A

Chronic Hep C, Hep B, HIV

and SLE

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59
Q

mixed cryooglobulinemia syndrome is caused by?

presents with?

A

immune complex deposition into small-medium size blood vessels

presents with fatigue, palpable purpura, arthralgia, renal disease, peripheral neuropathy, htn.

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60
Q

C4 levels in mixed cryoglobulinemia are?

A

low

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61
Q

Cryoglobulinemia type I is associated with what diseases?

A 
Lymphoproliferative disease (multiple myeloma)
Hematologic disease
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62
Q

Clinical findings in cryoglobulinemia type I

A

asymptomatic, hyperviscosity (burry vision, thrombosis, raynauds), levido reticularis

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63
Q

complement levels in cryoglobulinemia type I?

A

normal

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64
Q

Why are patients on TPN or prolonged fasting more likely to get gallstones?

A

The normal stimulus for CCK release and gallbladder contraction is absent

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65
Q

How does a small bowel resection contribute to the formation of gallstones?

A

decreased enterohepatic circulation of bile acids. this means bile becomes supersaturated with cholesterol.

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66
Q

What is the mechanism for gallstone formation during pregnancy and OCP users.

A

Estrogen-induced increase in cholesterol secretion

Also in pregnancy progesterone causes reduction in bile acid secretion and slows gallbladder emptying

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67
Q

An elevated serum alk phos level in a patient with UC should raise suspicion for?

A

PSC

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68
Q

What are the most common causes of PTH independent hypercalcemia?

A

malignancy, Vit D toxicity, extrarenal conversion of 25-hydroxyvitamin D to 1,25 dihydroxyvitamin D in Sarcoidosis

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69
Q

Most common PTH dependent causes of hypercalcemia?

A

primary hyperparathyroidism

tertiary hyperparathyroidism

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70
Q

What is secondary hyperparathyroidism? it is commonly seen in what disease? why?

A

increased secretion of PTH in response to hypocalcemia

chronic kidney disease due to inadequate phos excretion and decreased 1,25-hydroxy vitamin D levels

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71
Q

abdominal pain, vomiting, diarrhea often with neuro symptoms of agitation, paresthesias, confusion and chronically elevated LFTs

A

acute intermittent porphyria

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72
Q

Describe recommendations for PCV13 and PPSV23 vaccines

A
  • PCV13 vaccination is recommended for all adults > 65 followed at a later time by the PPSV23
  • Sequential PCV13 and PPSV23 are rec for < 65 with (csf leak, cochlear imlpant, sickle cell, asplenia, immunocompromise, CKD)
  • For adults < 65 with other chronic diseases (heart, lung, DM, smoking) - PPSV23 is recommended
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73
Q

describe recs for Tdap/Td

A

Adults ahsould receive a one time Tdap vaccine in place of Td. Then Td every 10 years.

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74
Q

Attributal risk percent is calculated by?

A

subtract risk in unexposed population from the risk in the exposed population. Divide the result by risk in exposed pop.

or RR-1/RR

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75
Q

mechanism of systolic hypertension in thyrotoxicosis?

A

hyperdynamic circulation from increased HR and myocardial contractility

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76
Q

Thyrotoxicosis causes an increased sensitivity to?

A

catecholamines via upregulation of B1 receptors

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77
Q

hypothyroidism causes elevated BP through

A

increase in systemic vascular resistance

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78
Q

gold standard confirmatory teset for type 2 HIT?

A

serotonin release assay

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79
Q

Therapy for type II HIT

A
  • Stop ALL Hep products

- Start a direct thrombin inhibitor (argatroban) or fondaparinux

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80
Q

aspirin toxicity causes what acid base disturbance?

A

mixed respiratory alkalosis and metabolic acidosis

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81
Q

3 cardinal signs of Parkinson’s disease?

how do you diagnose it?

A

Resting tremor, rigidity, bradykinesia

At least 2 of these signs on physical exam

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82
Q

Accumulation of alpha-synuclein in substantia nigra?

A

Parkinson’s

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83
Q

hydroxyurea as a treatment for sickle cell disease? what is MOA?

A

increase hemoglobin F

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84
Q

USPSTF screening recs for AAA?

A

screen male active or former smokers 65-75 1X

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85
Q

Indications for carotid endarterectomy in men?

A

asymptomatic: 60-99% stenosis

symptomatic
50-69% stenotic
70-99% stenotic

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86
Q

Indications for carotid endarterectomy in women?

A

70-90% both symptomatic and asymptomatic

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87
Q

oral leukoplakia

A

reactive precancerous lesion representing hyperplasia of squamous epithelium

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88
Q

oral leukoplakia may progress to?

A

squamous cell carcinoma

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89
Q

What is first line treatment for increasing appetite in cancer patients with anorexia/cachexia syndrome?

A

Progesterone analogue: megestrol acetate

Or steroids

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90
Q

Good treatment for cachexia in advanced HIV?

A

Dronabinol (synthetic cannabinoid)

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91
Q

Rapidly progressive dementia
myoclonus, akinetic mutism, cerebellar or visual disturbance, hypokinesia, periodic sharp wave complexes on EEG, positive 14-3-3 CSF assay is indicative of?

A

Creutzfeld Jakob disease

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92
Q

Gold standard diagnosis for creutzfeld jakob?

A

brain biopsy***

or PRNP gene mutations

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93
Q

Spongiform changes on postmortem brain biopsy?

A

creutzfeld jakob

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94
Q

Bi or tri phasic sharp wave complexes on EEG typical of?

A

Creutzfeld Jakob

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95
Q

Contraindications to subcutaneous sumitriptan?

A

ischemic cardiac disease, pregnancy

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96
Q

Treatments for cluster HA?

A

100% oxygen by facemask

Subcutaneous sumitriptan

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97
Q

acute, severe periorbital pain with autonomic manifestations (ipsilateral miosis, conjunctival injection, lacrimation) =

A

cluster HA

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98
Q

Prophylactic management of cluster HA?

A

Verapamil

Lithium

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99
Q

Treatment for pseudotumor cerebri?

A

Acetazolamide

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100
Q

orbital massage is good management for?

A

central retinal artery occlusion (unilateral acute painless vision loss)

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101
Q

Mycosis of the desert southwest that causes CAP, arthralgias, erythema nodosum, erythema multiform

A

Coccidiodes

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102
Q

Appropriate management of patient with post-ictal lactic acidosis?

A

repeat chemistry panel in 2 hours

lactic acidosis typically resolves without treatment in 90 minutes

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103
Q

Peak prevelance of influenza?

A

January and February

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104
Q

presentation of influenza?

A

abrupt fever, malaise, myalgia, HA, rhinorrhea sore throat, nonproductive cough

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105
Q

Who should receive antiviral therapy for flu?

A

Those with risk factors (age 65, chronic medical problems, pregnancy) or those w/o risk factors who come to office within 48 hours of symptom onset

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106
Q

Compare and contrase a viral URI with Influenza according to
symptom onset:
URI symp:
systemic symp:

A

onset: viral URI is slow, stepwise, migratory. Influenza is abrupt and dramatic onset

URI symp: viral URI with rhinorrhea, coryza, sneezing, mild pharyngitis. Flu URI symp are often mild

Systemic symp: Viral URI w/ mild. Flu with prominent fever, myalgia, HA

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107
Q

Patient < 40 with minimal bright red blood per rectum should have what test?

A

Anoscopy

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108
Q

Patient <40 with bright red blood and nothing seen on anoscopy should have?

A

sigmoidoscopy or colonoscopy

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109
Q

Patients 40-49 with bright red blood per rectum without red flags should have what test

A

sigmoid or colonoscopy

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110
Q

patients >50 or any age with red flags and with bright red blood should have what test?

A

colonoscopy

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111
Q

Presentation of CLL

A

elderly with mean age of 70, often asymptomatic. can have extreme fatigue, B symptoms (night sweats, fevers), infection, weight loss. lymphadenopathy. hepatosplenomegaly.

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112
Q

Diagnostic tests for CLL

A

CBC with dramatic lymphocytosis and mature lymphocytes and smudge cells on peripheral smear

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113
Q

smudge cells are pathognomonic for?

A

CLL

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114
Q

CML

A

myeloproliferative dsiease of neutrophils .

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115
Q

Hairy cell leukemia presentation

A

splenomegaly and pancytopenia

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116
Q

hodgkin lymphoma presentation

A

painless lymphadenopathy with B symptoms (night sweats, fevers) with normal CBC and peripheral blood smear

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117
Q

chronic prostatitis/chronic pelvic pain syndrome is?

A

pelvic pain of perineum/testes for >3 months without a cause. presents with voiding difficulty, pain with ejaculation or blood in semen.

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118
Q

etiology of chronic prostatitis/chronic pelvic pain syndrome?

A

Etiology unclear. due to NONinfectious chronic prostate inflammation

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119
Q

Management of chronic prostatitis/pelvic pain syndrome?

A

alpha blockers (tamsulosin)
5 alpha reductase inhibitors (finasteride)
Antibiotics (cipro)

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120
Q

Epididymitis

A

bacterial sequestration in epididymis presents with irritation with voiding, scrotal pain, scrotal swelling, tenderness and purulent urethral discharge

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121
Q

FFP contains? and is used when?

A

clotting factors and plasma proteins. indicated for severe coagulopathy

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122
Q

ST depression in leads V1 and V2 is suggestive of?

A

posterior wall MI

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123
Q

RCA supplies blood to the _____ node and can cause ______ block

A

AV node

AV nodal block

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124
Q

In COPD, FRC is higher or lower?

A

higher - new pressure equillibrium is reached at higher lung volumes

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125
Q

3 treatments for Graves Disease

A

antithyroid drugs (methimazole, propylthiouracil)

radioactive iodine

thyroidectomy

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126
Q

When is potassium iodide used?

A

preparation for thyroidectomy in graves disease or for treatment of thyroid storm.

It inhibits thyroid hormone synthesis

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127
Q

Best management for bone pain in patients with prostate cancer who have undergone orchiectomy?

A

Radiation therapy

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128
Q

What should the SAAG be in patients with SBP?

A

> 1.1

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129
Q

treatment for SBP?

A

third gen cephalosporin

Flouroquinolones

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130
Q

brain death is a legally acceptable definition of?

A

death

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131
Q

does life support need to be continued when a patient is deemed brain dead? do you need family permission to decide?

A

no, no

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132
Q

Classify mild, moderate, severe hypothermia?

A

mild: 32-35 (90-95)
tachypenia, tachycardia, shivering

mod: 28-32 (82-90_
brady, lethargy hypoventilation, atrial arrhythmia, decreased shivers

severe: <28 or <82
coma, card collapse, V-arrhythmia

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133
Q

General treatment for hypothermia

A

warmed (42C) 107F crystalloid for hypotension

endotracheal intubation if comatose

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134
Q

Rewarming techniques for mild, mod, severe hypothermia

A

mild: passive external (remove wet clothes, cover with blankets)
mod: active external. (warm blankets, heating pads, warm bath)
severe: active internal (warmed pleural or peritoneal irrigation, warmed humidified oxygen)

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135
Q

Does hypothermic bradycardia respond to atropine or cardiac pacing? why/why not?

A

NO. decreased reactivity of cardiac pacemaker cells

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136
Q

hypothermia caused by myxedema is treated with?

A

levothyroxine

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137
Q

excessive production of monoclonal IgM antibody?

A

Waldenstrom macroglobulinemia

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138
Q

Bone marrow biopsy confirmation of waldenstrom macroglobulinemia will show?

A

> 10% clonal B cells

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139
Q

Periphral blood smear in waldenstroms will show?

A

rouleaux formation or erythrocyte agglutination

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140
Q

presentation of waldenstroms?

A

hyperviscosity syndrome (diploplia, tinnitus, HA, dilated fundoscopic findings, neuropathy, hepatosplenomegaly, anemoa, thrombocytopenia.

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141
Q

how to differentiate MGUS from Waldenstroms?

A

MGUS (monoclonal IgM spikes are smaller <3), bone marrow biopsy shows < 10% monoclonal cells, and no end organ effects!

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142
Q

monoclonal IgG or IgA light chain spike is characteristic of?

A

multiple myeloma

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143
Q

RA predisposes patients to 2X risk for developing?

A

osteoporosis

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144
Q

Polymyalgia rheumatica presents as?

A 
Age >50
Bilateral pain and morning stiffness > 1 month
Involvement of neck or torso
Shoulders or proximal arms
Proximal thigh or hip
Constitutional symptoms
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145
Q

Lab studies in polymyalgia rheumatica

A

ESR > 40, sometimes > 100
Elevated CRP
Normocytic anemia

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146
Q

Treatment for polymyalgia rheumatica?

A

Response to glucocorticoids

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147
Q

Polymyalgia rheumatica is associated with?

A

Giant Cell Arteritis

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148
Q

non-gonococcal urethritis, asymmetric oligoarthritis and conjunctivitis, mucocutaneous lesions and enthesitis (achilles tendon pain) are common in?

A

Reactive arthritis

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149
Q

Management for reactive arthritis?

A

NSAIDs

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150
Q

Common causes of priapism?

A
  1. sickle cell disease and leukemia
  2. perineal or genital trauma (laceration of cavernous artery)
  3. neuro lesios
  4. medications- trazodone, prazosin
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151
Q

Most common cause of priapism is?

A

Prazosin

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152
Q

What 3 conditions cause >90% of chronic cough (>8 weeks) in non-smokers?

A

Post-nasal drip
GERD
Asthma

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153
Q

Treatment of post-nasal drip?

A

first-gen antihistamine (chlorpheniramine)

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154
Q

Recommendation for mammogram screening?

A

biennial (every 2 years) for women aged 50-74

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155
Q

Screening for mammography is not necessary beyond age?

A

75

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156
Q

cholesterol screening guidelines?

A

men at avg risk starting at 35 and women at inreased risk at 45 (5 year intervals)

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157
Q

smokers with asbestos exposure have a 59 fold increase of having what cancer?

A

bronchogenic carcinoma

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158
Q

More common for patients with asbestos exposure to have mesothelioma or bronchogenic carcinoma?

A

bronchogenic carcinoma

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159
Q

Does testosterone level increase with anabolic steroid use?

A

Anabolic steroids are not picked up as testosterone on screening. Likely see normal or low T levels with low FSH/LH levels due to suppression by GnRH.

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160
Q

inherited disorder characterized by teste fibrosis, azoospermia, gynecomastia, decreased intelligence, high FSH and LH

A

Klinefelter syndrome

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161
Q

testicle atrophy, muscular atropy, weakness, low T level, high FSH and LH

A

myotonic dystrophy

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162
Q

Type B adverse drug reaction that is dose independent and causes mental status change, rigidity, fever, autonomic dysreg?

A

neuroleptic malignant syndrome

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163
Q

Lamotrigine causing stevens johnson syndome dose dependent or dose independent?

A

dose independent

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164
Q

how do vagal maneuvars help stop AVNRT?

A

increase parasympathetic tone and result in slowing of conduction through AV node (increase in AV node refractory period)

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165
Q

When is PT appropriate for back pain?

A

when it has persisted 6-12 weeks. most patients with acute pain <4-6 weeks haev back pain that improves without intervention and symptomatic NSAID or acetaminophen treatment is best

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166
Q

Factor in an experiment that has properties linking it to an exposure and the outcome?

A

Confounding variable

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167
Q

Treatment for myasthenia crisis (generalized and oropharyngeal weakness with resp insufficiency and dyspnea)?

A

Plasmapharesis or IVIG and corticosteroids

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168
Q

Anterior cord syndrome

A

injury to anterior spinal artery affecting anterior 2/3 of spinal cord. Bilateral hemiparesis at level of injury and diminished pain and temp 1-2 levels below the corresponding level. Intact vibration and proprioception!

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169
Q

Central cord syndrome

A

decreased sensation and motor function in the arms. relative sparing of the legs. (occurs with forced hyperextension- fall, whiplash)
often seen in elderly with cervical spondylotic myelopathy

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170
Q

Brown-Sequard Syndrome occurs with what types of injuries?

A

stab wound, cord compression, hemisection of spinal cord

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171
Q

Findings in Brown-Sequard syndrome?

A

Ipsilateral hemiparesis
Ipsilateral loss of proprioception, vibration, ight touch
Contralateral diminished pain and temp** (1-2 levels below cord injury)

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172
Q

Protozoan Trypanosoma cruzi?

A

Chagas disease- megaesophagus, megacolon, cardiac dysfunction

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173
Q

hepatic hydrothorax?

A

hydrothorax due to cirrhosis occuring on the right side of the lung

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174
Q

most common cause of community acquired bacterial meningitis?

A

Strep Pneumonia

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175
Q

In a patient of African descent, what tests should be used to scren for hemoglobinopathies?

A

CBC and hemoglobin electrophoresis

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176
Q

In a patient of non-African descent, what screening test is needed to check for hemoglobinopathies?

A

CBC

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177
Q

Pes anserinus pain syndrome

A

localized pian over anteromedial tibia (anserine bursa) valgus stress does not aggrevate pain

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178
Q

Name causes of renal transplant dysfunction in early post-operative period

A 
ureteral obstruction
acute rejection
cyclosporine toxicity
vascular obstruction
acute tubular necrosis
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179
Q

How do you treat acute rejection of renal transplant?

A

IV steroids

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180
Q

Amikacen is an aminoglycoside. what serious side effect do you need to monitor for with all aminoglcosides?

A

Nephrotoxicity

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181
Q

Nafcillin can cause what kidney injury?

A

AIN

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182
Q

Cancers in tail of pancreas presents w/w.o abd pain and w/w.o jaundice?

A

With abdominal pain and without jaundice

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183
Q

Characteristic imaging findings for cancer of head of pancreas?

A

intra and extra hepatic biliary tract dilation

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184
Q

Viral conjunctivitis (pink eye) presents as? management?

A

conjunctival inflammation, watery discharge, often in setting of URI. often seen in kids and caregivers in late summer and early fall. often adenovirus.

Manage with warm or cold compresses +/- antihistamine or decongestant drops

185
Q

Bacterial conjunctivitis

A

more severe pain. grossly purulent exudate. treat with erythromycin ointment, polymxin-trimethoprim drops, azithromycin crops.

186
Q

preferred treatment for bacterial conjunctivitis in contact lens wearers?

A

fluoroquinolones

187
Q

Mast cell stabilizing agents (olopatadine and azelastine) are indicated for treatment of?

A

allergic conjunctivitis

188
Q

The measure of random error in a study is?

A

Precision

189
Q

How can you measure a studies precision?

A

narrow confidence interval = more precision

190
Q

How can you increase the precision of a study?

A

increase the sample size

191
Q

Most common causes of bloody diarrhea?

most common cause in absence of fever?

A

E.coli, shigella, campylobacter

E.coli

192
Q

How can you confirm diagnosis of EHEC?

A

Shiga toxin in stool

193
Q

Widened pulse pressure, strong carotid upstroke, systolic flow murmur, tachy and flushed extremities should make you think of?

A

arteriovenous fistula

194
Q

Name causes of high output cardiac failure?

A

thyrotoxicosis
Paget disease
Anemia
Thiamine deficiency

195
Q

Multiple and refractory peptic ulcers, ulcers distal to duodenum, chronic diarrhea should make you think of?

A

Zollinger-Ellison Syndrome

196
Q

How does Z-E syndrome lead to diarrhea and steatorrhea?

A

excess gastric acid in small intestine can inactivate pancreatic enzymes and injure mucosal brush border

197
Q

overdose causing nausea, fever, abd pain, tinnitus and vertigo, tachypnea?

A

Aspirin

198
Q

Trihexyphenidyl

A

anticholinergic used to treat tremor in parkinson’s disease

199
Q

Pathogenesis of tabes dorsalis?

A

Treponema pallidum spirochetes directly damage dorsal sensory roots

200
Q

sensory ataxia, lancinating pains, neurogenic urinary incontinence, argyll robertson pupils, reduced/absent DTRs?

A

Late neurosyphillis, tabes dorsalis

201
Q

Risk factors for c.diff

A

recent abx use
advanced age >65
PPI use (acid suppression)

202
Q

Condition that classically affects new moms who hold infants with their thumbs outstretched

A

De Quervain Tenosynovitis

203
Q

Trigger thumb results in pain when?

A

thumb in flexion and it hurts over the palmar aspect of first MCP

204
Q

Causes of papillary necrosis

NSAID

A 
NSAIDs
Sickle Cell
Analgesic abuse
Infection
Diabetes
205
Q

Causes of AIN

A

Drugs: Penicillins, TMP-SMX, cephalosporins, NSAIDs, rifampin

206
Q

Keratoacanthoma

A

cutaneous tumor- presents as dome shaped nodules with central keratinous plug (typically benign)

207
Q

How can you differentiate MAC and CMV diarrhea in HIV?

A

MAC: watery, high fevers > 102!

CMV: frequent small volume diarrhea, hematochezia, abd pain, (low grade fever**)

208
Q

how to diagnose CMV diarrhea in HIV?

A

colonoscopy with biopsy. eosinophilic and basophilic inclusions

209
Q

Patients with graves ophthalmopathy, including proptosis, should not be treated with? IF they are, they should also be given?

what is the preferred treatment for ophthalmopathy patients?

A

radioactive iodine therapy

glucocorticoids with therapy

thyroidectomy

210
Q

Risks of hyperthyroid drug therapy

A

agranulocytosis

methimazole: teratogen in1st trimester; cholestatic
propylthiouracil: hepatic failure, ANCA-associated vasculitis

211
Q

Common causes of aortic regurg?

A

aortic root dilation: marfan, syphilis
postinflammatory (rheumatic heart disease, endocarditis)
congenital bicuspid aortic valve

212
Q

Patients with early syphilis who have penicillin allergy receive alternate treatment with?

A

oral doxycycline

213
Q

best initial test when you suspect squamous cell carcinoma of the mucosa of the head and neck?

A

panendoscopy (esoohagus, bronchus, larynx)

214
Q

Hypoxemia PaO2/FiO2 ratio < 300?

A

RDS

215
Q

Low TV, high PEEP, high FiO2 is good management for?

A

RDS

216
Q

Treatment for Pagets disease

A

bisphosphonates

217
Q

Acalculous cholecystitis

most often seen in?

A

acute inflammation of gallbladder in absence of gallstones

seen in hospitalized patients who are critically ill

218
Q

Risk factors for acalculous cholecystitis

A

recent surgery (esp cardiopulm, aortic, abdominal),
severe trauma
extensive burn
sepsis/shock
prolonged fasting/TPN because all of these conditions lead to gallbladder stasis or ischemia

219
Q

treatment for acalculous cholecystitis?

A

enteric abx coverage
cholecystostomy for initial drainage
cholecystectomy once clinically stable

220
Q

Cullen sign

A

periumbilical bluish coloration indicating hemoperitoneum that is a sign of severe pancreatitis

221
Q

Grey-Turner sign

A

reddish-brown coloration around flanks- indicating retroperitoneal bleed

222
Q

Causes of recurrent pneumonia?

A

local airway obstruction

  • extrinsic bronchial compression (neoplasm, adenopathy)
  • intrinsic bronchial obstruction (bronchiectasis, foreign body)

Recurrent aspiration
-seizure, alcoholism, GERD, dysphagia

223
Q

how does common variable immunodeficiency present?

A

In adulthood with recurrent infections of the lung and respiratory tract

224
Q

most common causes of encephalitis in immunocompetent adults?

A

herpes, varicella, EBV

225
Q

Bone pain, fractures
weight loss, fatigue
recurrent infections

think of?

A

multiple myeloma

226
Q

long term therapy for asthma vs COPD?

A

inhaled corticosteroids for asthma. long acting anti-cholinergic inhaler for COPD

227
Q

most efficient test to differntiate asthma from COPD?

A

spirometry before and after bronchodilator

228
Q

Most common site of ulnar nerve entrapment?

A

Elbow. Ulnar nerve lies at the medial epicondylar groove.

229
Q

Hemi-neglect syndrome is caused by a lesion of the _____ lobe

A

right (non-dominant) parietal lobe

230
Q

The higher the prevalence of a disease, the greater the?

A

PPV

231
Q

What is the prob that a patient with a positive test result actually has the disease? - this measures?

A

PPV

232
Q

muffled voice and deviation of uvula suggest?

A

peritonsillar abscess

233
Q

emergency laryngoscopy is required in patients with?

A

epiglottitis

234
Q

Entamoeba histolytica

A

protozoan found in developing countries transmitted through consumption of contaminated food and water

235
Q

clinical manifestations of entamoeba histolytica?

A

most asymptomatic. 10% develop colitis or extraintestinal (liver, pleura, brain) disease

236
Q

most common form of extraintestinal disease for E. histolytica

A

amebic liver abscess that is seen as a single subcapsular cyst on CT

237
Q

Treatment for E. hystolitica?

A

Metronidazole and intraluminal paromomycin

238
Q

Echinococcus granulosis can cause? presentation

A

hydatid liver cyst (fever is rare, patients asymptomatic for years)

239
Q

40-50 year old with behavioral disturbances and sudden jerky movements?

A

Huntington’s

240
Q

atrophy of lenticular nucleus?

A

wilsons disease

241
Q

atrophy of caudate nucleus

A

huntingtons disease

242
Q

D-xylose test?

What is it used for?

A

Differentiate between celiac disease and enzyme deficiency related malabsorption syndromes.

D-xylose is absorbed in small intestine without any degradation by enzymes needed and excreted in urine. Patients with celiac disease cannot absorb the D-xylose in the intestine so urinary and venous blood levels will be low.

Patients with enzyme deficiency (pancreas related) absorb D-xylose normally.

243
Q

When can you see a false positive D-xylose test?

A

delayed gastric emptying or impaired GFR, small intestinal bacterial overgrowth

244
Q

amyloid angiopathy is the most common cause of?

A

spontaneous lobar hemorrhage in adults >60

B-amyloid deposition in walls of medium/small arteries

245
Q

most common cause of intracranial hemorrhage in kids?

A

AV malformation

246
Q

rupture of bridging veins?

A

subdural hematoma crescent shaped

247
Q

meningeal artery tear?

A

epidural hematoma biconvex pattern

248
Q

management of acute attack of MS?

A

IV glucocorticoids. methylprednisolone.

plasma exchange if patients dont respond

249
Q

long term management of MS?

A

interferon beta, natalizumab, glatiramer

250
Q

management of anticholinergic overdose?

A

physostigmine (cholinesterase inhibitor)

251
Q

Cause of nephrotic syndrome in african american, hispanic, obese, HIV, heroin users

A

focal segmental glomerulosclerosis

252
Q

cause of nephrotic syndrome in patients using NSAIDs or with lymphoma?

A

minimal change disease

253
Q

most common form of nephropathy associated with malignancies?

A

membranous glomerulonephropathy

usually solid cancers- lung, colon, prostate, breast

254
Q

Nephrotic syndrome due to amyoidosis is seen with what malignancy?

A

multiple myeloma

255
Q

hep C, B and chronic bacterial and autoimmune infections associated with what type of nephropathy?

A

membranoproliferative

256
Q

Associated symptoms of cluster headache include?

A

sweating, facial flushing, nasal congestion, lacrimation, pupillary changes

257
Q

Adenomas are considered malignant/non-malignant?

A

malignant

258
Q

Which adenomatous polyps should concern you for higher malignant potential?

A

> 1cm n size, high grade of dysplasia, villious features or sessile features or a high number (>3 concurrent adenomas)

259
Q

hyperplastic polyps, hemartomatous polyps (juvenile, peutz-jeghers, inflammatory pseudopolyps, lipomas, lympoid aggregates are all malignant/non-malignant

A

non-malignant

260
Q

mitral stenosis is most commonly due to?

A

rheumatic heart disease

261
Q

what changes might you see on cxray with a patient with mitral stenosis?

A

elevated main stem bronchus due to LAE

262
Q 
Thrombocytopenia
microangiopathic hemolytic anemia
renal insufficiency
neuro changes
fever
A

TTP

263
Q

Treatment for TTP?

A

plasma exchange

264
Q

Without emergent plasma exchange, the mortality rate for TTP is?

A

90%

265
Q

CT scan with small kidneys and bilateral renal papillary calcifications?

A

Analgesic nephropathy

266
Q

Chronic tubulointerstitial nephritis and papillary necrosis occur due to?

A

analgesic overuse

267
Q

CYP450 inhibitors increase or decrease effects of warfarin?

A

increase

268
Q

CYP450 inhibitors?

A

acetaminophen, NSAIDs, abx, antifungals amiodorone cranberry juice, Vit E, omeprazole, thyroid, SSRI

269
Q

Lateral epicondylitis is due to overuse of ______?

A

extensor muscles

270
Q

Pain with lateral epicondylitis occurs with?

A

Passive wrist flexion and resisted wrist extension or supination

271
Q

management for lateral epicondylitis

A

activity modification, NSAIDs, counterforce bracing

272
Q

Posterolaeral elbow pain is found in _____ syndrome?

A

radial tunnel

273
Q

Decreased cortisol, decreased aldo, increased ACTH, hyperpigmentation, hyonatremia, hyperkalemia, hypotension signify what disorder?

A

Primary adrenal insufficiency

274
Q

decreased cortisol, decreased ACTH, normal aldo indicate?

A

central adrenal insufficiency

275
Q

Lyphocytic hyophysitis (lymphocytic infiltration of pituitary gland) and Sheehan Syndrome (pituitary infarct) are common causes of?

A

Secondary adrenal insufficiency post-partum

276
Q

Most common cause of secondary adrenal insufficiency is?

A

chronic glucocorticoid therapy

277
Q

Appropriate initial response for persistent bradycardia with hypotension, shock, AMS, chest discomfort, heart failure

A

IV atropine (.5mg bolus) evry 3-5 mins

278
Q

If patients with bradycardia have no response to atropine, what are the next steps?

A

Transcutaneous pacing OR IV dopamine or IV epi

279
Q

Glucagon is effective in treating toxicity for?

A

B-block and CCB

280
Q

Ecthyma gangrenosum

A

hemorrhagic pustules with surrounding erythema that evolve into necrotic ulcers

Due to psedomonas aeruginosa typically in setting of profound neutropenia

281
Q

Compression of spinal nerve roots leading to decrease in anal sphincter tone?

A

cauda equina syndrome

282
Q

A cauda equina lesion causes upper or lower motor neuron symptoms?

A

lower motor neuron symptoms because nerve roots are part of peripheral nervous system

283
Q

Where does the spinal cord end in adults?

A

L1-L2

284
Q

biateral severe radicular pain, saddle hypoanesthesia, asymmetric motor weaknes, hyporeflexia and bladder dysfunction should make you think of?

A

Cauda equina! (contrast with conus medullaris which will show symmetric motor weakness and hyperreflexia)

285
Q

With conus medullaris syndrome, numbness is confined to the _____?

A

perianal area

286
Q

organophosphate poisoning?

A

acetylcholinesterase is non-functional leading to symptoms of cholinergic excess

287
Q

what should be given to counteract the effects of organophosphate poisioning?

A

Atropine

288
Q

First thing you should do for someone with organophosphate poison?

A

remove clothing and wash body so poison stops being absorbed through skin

289
Q

Physostigmine’s mechanism of action?

A

acetylcholinesterase inhibitor

290
Q

Lisch nodule

A

golden brown spots in eyes- indicative of NF1

291
Q

Cafe-au-lait spots, lisch nodules, freckling in skin folds is suggestive of?

A

NF1

292
Q

Optic pathway glioma tumors can grow large enough to compress optic nerve and cause decreased visual acuity and proptosis. these tumors are associate with?

A

NF1

293
Q

bilateral acoustic neuromas are associated with?

A

NF2

294
Q

how can you differentiate between cardiac and liver disease related causes of lower extremity edema?

A

hepatojugular reflex

295
Q

IV fluid management of DKA and HHS?

A

normal saline initially

Add 5% dextrose when serum glucose is < 200

296
Q

Insulin management for DKA and HHS?

A

-Initial continuous IV insulin infusion
Switch to SQ (basal bolus) insulin when BG <200, able to eat, anion gap is < 12, serum bicarb >15
Overlap SQ and IV insulin by 1-2 hours

297
Q

Potassium management in DKI

A

Add IV K for K <5.2

Hold insulin for serum K < 3.3

298
Q

When to consider bicarb in DKA?

A

pH < 6.9, plasma bicarb < 5

299
Q

Anion gap =

A

Na - (Cl + Bicarb)

300
Q

Why can patients with DKA have pseudohyponatremia?

A

due to hyperglycemia (use corrected Na) (observed sodium + 2meQ for every 100mg glucose is over 100)

301
Q

external hodeolum (stye) etiology and treatment

A

acute inflammatory disorder of eyelash follicle, tear gland often due to infectious staph aureus. warm compress. if persistes >1-2 weeks or is growing large- may require incision and drainage

302
Q

Hypertension
hyperglycemia
weight gain may suggest?

A

Cushing syndrome

303
Q

common causes of cushing syndrome?

A

glucocorticoid intake, ACTH producing pituitary adenoma, ectopic ACTH production

304
Q

Associated hypokalemia with Cushing’s features suggests what as the etiology?

A

ACTH producing tumor

305
Q

Initial testing for hypercortisolism can include?

A

24 hour urine free cortisol
late night salivary cortisol
low-dose DEX suppression test

306
Q

After you establish hypercortisolism, what should next test be?

A

ACTH level

307
Q

Patients with elevated ACTH should have what test done next? What will it tell you?

A

High dose DEX suppression test

Determine whether ACTH production is pituitary (Dex will suppress it) or ectopic (Dex will not suppress it)

308
Q

How can hypothyroidism cause hypertension?

A

Increased NE and Aldo leading to increased vasc resistance

309
Q

What organisms are most responsible for infections following deep puncture wounds?

A

Staph aureus and Pseudomonas aeruginosa

310
Q

Treatment for deep wound infection with pseudomonas?

A

Cipro, Pip-Tazo and debridement

311
Q

broad based budding yeast

A

blastomycosis

312
Q

Treatment for blastomycosis?

A

itraconazole or amphotericin B

313
Q

Osteosarcoma most often affects ?

A

adolescents. distal femur.

314
Q

1st line treatment for B-block overdose?

Treatment for refractory hypotension in B-block overdose?

A

secure airway, IV fluids and atropine

IV glucagon

315
Q

What two arrhythmias should be managed with immediate defibrillation?

A

V.fib or pulseless VTach

316
Q

Vtach with a pulse should be managed with?

A

synchronized cardioversion

317
Q

When is low dose chest CT recommended yearly for lung cancer screening?

A

patients 55-80 with 30 pack year smoking history and who are currently smoking or quit < 15 years ago

318
Q

Isolated thrombocytopenia without anemia or leukopenia?

A

idiopathic thrombocytopenic purpura (ITP)

319
Q

Thrombocytopenia can be the presenting finding in 5-10% of patients with?

A

HIV

320
Q

Before diagnosing ITP, always test for?

A

HIV and Hep C

321
Q

postcholecystectomy syndrome. definition, etiology

A

persistent abdominal pain or nausea that occurs either postoperatively or months to years later.

due to biliary (retained common bile duct or cystic duct stone, biliary dyskinesia (sphincter of Oddi dysfunction)

extra-biliary (pancreatitis, peptic ulcer, coronary artery disease)

322
Q

next step in evaluation of suspected postcholecystectomy syndrome?

A

ERCP

323
Q

anti-mitochondrial antibodies are elevated in?

A

primary biliary cirrhosis

324
Q

Cortical laminar necrosis is the hallmark of ?

A

prolonged seizures. status epilepticus can cause permanent injury due to excitatory toxicity.

325
Q

postoperative endophthalmitis

A

most common form of endophthalmitis. swollen eyelids, conjunctiva, corneal edema and infection.

326
Q

calcinosis cutis

A

deposition of calcium and phosphorus in the skin. Scattered whitish papules, plaques, nodules.

327
Q

most common behavioral risk factor for TB?

A

substance abuse

328
Q

cancers that metastasize to the spine?

A

lung, breast, prostate, multiple myeloma

329
Q

In a patient with suspected epidural spinal cord compression, what should be given right away and without delay

A

IV glucocorticoids

330
Q

What do you need to worry about when stopping chronic steroid treatment?

A

hypothalamic-pituitary-adrenal axis insufficiency. normal HPA axis function may not return fully for up to 6-12 months

331
Q

Why are aldo levels normal in central adrenal insufficiency?

A

aldo is regulated primarily by RAAS

332
Q

Treatment for Toxoplasma gondii encephalitis?

A

Sulfadiazine and Pyrimethamine plus leucovorin

Prophylaxis with TMP-SMX

333
Q

mixture of enhancing and non-enhancing calcified lesions after traveling to south america?

A

Neurocystercosis

334
Q

Treatment for Neurocystercosis?

A

Albendazole

335
Q

Treatment for cryptococcal meningitis?

A

Amphotericin B and Flucytosine

336
Q

Clarithromycin and ethambutol are used to treat?

A

MAC

337
Q

Treat narrow complex QRS tachycardia with?

A

IV adenosine

can use vagal manuevars

338
Q

Likely microbe implicated in endocarditis for patients with nosocomial urinary tract infections?

A

Enterococcus

339
Q

_______ is the most common cause of healthcare associated endocarditis

A

staph infection

340
Q

_____ is the most common cause of community acquired IE?

A

strep

341
Q

Strep bovis endocarditis should make you think of?

A

colon carcinoma. IBD

342
Q

suspected pathogen involved in infective endocarditis after respiratory tract biopsy?

A

strep viridans

343
Q

coxiella burnetti causes?

A

Q fever via inhalation of contaminated aerosols from livestock or unpasteurized milk

344
Q

skin papule with ulceration and nonpurulent odorless drainage

A

sporotrichosis

345
Q

treatment for sporotrichosis?

A

3-6 months of oral itraconazole

346
Q

Diagnosis of sporotrichosis requires?

A

aspiration or biopsy with culture

347
Q

cisplatin and carboplatin side effect?

A

cochlear dysfunction

348
Q

hypertrophic osteoarthropathy

A

digital clubbing is accompanied by sudden onset arthropathy commonly affecting wrists and hands

349
Q

Development of a new conduction abnormality in patients with endocarditis should raise suspicion for?

A

perivalvular abscess

350
Q

Tricuspid endocarditis typically presents with what type of murmur?

A

Tricuspid regurg. Systolic murmur accentuated with inspiration

351
Q

Nondihydropyridine CCBs are

A

Diltiazem and Verapamil

Decrease heart rate and contractility

352
Q

Dihydropyridine CCBs

A

amlodipine and felodipine increase myocardial O2 supply through coronary artery vasodilation and reduce demand through systemic arterial vasodilation and a reduction in cardiac afterload

(monotherapy with these can result in reflex tachy)

353
Q

Ranolazine

A

alternative therapy for angina refractory to B-blockers, CCBs, Nitrates (It decreased myocardial calcium influx)

354
Q

facial plethora, ruddy cyanosis should make you think of?

A

Increased hematocrit. polycythemia vera

355
Q

If a patient requires more glycemic control, what drugs other than metformin can you give them that will also help with weight loss?

A

GLP-1 agonists (exenatide, liraglutide)

356
Q

side effects of sulfonyureas

A

weight gain and hypoglycemia

357
Q

GLP-1 agonist risks?

A

acute pancreatitis

358
Q

When should you add insulin to metformin?

A

HBA1c > 8.5 %

359
Q

how to calculate serum osm?

A

(2X serum Na) + (glucose/18) +(BUN/2.8)

360
Q

number needed to treat is calculated as?

A

1/ARR

1/absolute risk reduction

361
Q

treatment for dermatitis herpetiformis other than cutting gluten from diet?

A

dapsone

362
Q

splenomegaly, anemia, thrombocytopenia, leukocytosis and blood smear showing WBC with thin projections

A

hairy cellleukemia

363
Q

reciprocal translocation of chromosome 9 and 22 forming BCR -ABL fusion gene

A

CML

364
Q

BCR_ABL fusion gene creates a constitutively active _____

A

tyrosine kinase

365
Q

imatinib

A

tyrosine kinase inhibitor used to treat CML

366
Q

Most common complication of influenza?

A

2ndary bacterial pnuemonia

367
Q

most common organisms leading to 2ndary bacterial pneumonia post influenza?

A

staph aureus and strep pneumo

368
Q

How do you measure a tests validity?

A

sensitivity and specificity

369
Q

Chronic hyperthyroid myopathy

A

proximal muscle weakness and possible muscle atrophy with other clinical features of hyperthyroid

370
Q

How does acute HIV present?

A

Mono like- fever, night sweats, lymphadenopathy, arthralgias, diarrhea, painful mucocutaneous ulcers, skin rash

371
Q

oliguria is defined as?

A
372
Q

Management for SIADH mild and severe cases?

A

Fluid restriction +/- salt tablets

Hypertonic (3%) saline for severe hyponatremia

373
Q

How to differentiatie SIADH (euvolemic) from hypovolemic hyponatremia?

A

In SIADH, urine sodium concentration will be elevated where as with hypovolemia, people will be reabsorbing sodium

374
Q

Why does restricting sodium intact, decrease likelihood of developing Ca kidney stones?

A

Low sodium promotes calcium reabsorption

high sodium promotes calcium excretion

375
Q

Why is restricting calcium not a great idea for calcium stone formers?

A

calcium restriction can increase free oxalate absorption leading to calcium oxalate stone formation.

376
Q

Increased vitamin C increases?

A

hyperoxaluria

377
Q

Appropriate treatment for ehrlichiosis

A

doxycycline

378
Q

Why can pulsus paradoxus be seen in severe asthma and COPD?

A

Drops in intrathoracic pressure are greatly exaggerated and this causes pooling of blood in pulmonary vasculatrure leading to decreased LV preload

379
Q

What is a well known complication of giant cell arteritis?

A

Aortic aneurysm so patients with GCA should be followed with serial chest x-rays

380
Q

Anti-Jo1 and anti-mi-2 are classic antibodies associated with?

A

Dermatomyositis

381
Q

Screening for ______ should be done for patients with dermatomyositis?

A

Internal malignancies

382
Q

Why are patients with crohns disease or any malabsorptive disease predisposed to kidney stones?

A

hyperoxaluria. typically calcium binds oxalate in the gut and prevents it from being reabsorbed. In patients with fat malabsorption, calcium binds the fat and leaves free oxalate.

383
Q

Indications for urgent dialysis?

A

Acidosis: pH <7.1 and refractory to therapy
Electrolyte: ECG or ventricular arrhythmias due to hyperkalemia
K>6.5 refractory to med therapy
Ingestion: toxic alcohols (methanol, ethylene glycol), salicylate, lithium, valproate, carbamazepine
Overload: volume refractory to diuretics
Uremia: encephalopathy, pericarditis, bleeding

384
Q

causes of asterixis?

A

hepatic encephalopathy, uremic encephalopathy, hypercapnia

385
Q

Approach to hypocalcemia?

A
  1. correct serum Ca for albumin
  2. Is mag low? Is it due to a drug? Is there a recent blood transfusion?
  3. Measure PTH
386
Q

Causes of low or normal PTH with hypocalcemia?

A

Surgical
Autoimmune: polyglandular autoimmune syndrome
Infiltrative disease: metastatic cancer, Wilson’s disease, Hemochromatosis

387
Q

Elevated PTH and hypocalcemia causes?

A 
Vitamin D deficiency
Chronic Kidney disease
Pancreatitis
Sepsis
Tumor lysis
388
Q

How do you diagnose vit D deficiency?

A

Check 25-hydroxy vitamin D

389
Q

what are the cancers with osteoblastic mets that can cause hypocalcemia?

A

breast, prostate

390
Q

hydatid cysts are caused by infection with? what is the host?

A

echinococcus granulosis. Dogs.

391
Q

Hepatic cyst with eggshell calcification is highly suggestive of?

A

hydatid cyst- echinococcus

392
Q

Treatment for hydatid cyst?

A

surgical resection with albendazole

393
Q

exudative pleural effusion with low pH, high amylas is indicative of?

A

boerhaaves

394
Q

antismooth titers are sensitive and specific for?

A

autoimmune hepatitis

395
Q

antimitochondiral antibodies indicate?

A

primary biliary cirrhosis

396
Q

Most common meds to cause hyperkalemia?

A

non-selective B-blockers, K sparing diuretics (amiloride), ACE, ARB, NSAIDs, Digoxin

397
Q

When should you give calcium gluconate or IV insulin for hyperkalemia?

A

K >7 or symptomatic or ECG changes

398
Q

Dig toxicity presents as?

A

anorexia, nausea, vomiting, abd pain, fatigue, confusion, weakness, color vision changes

399
Q

how can amiodorone lead to Dig toxicity?

A

Amiodarone increases serum levels of digoxin. Dig dose should be decreased by 25-50% before dual therapy

400
Q

epitrochlear LAD is pathognomonic for?

A

2ndary syphillis

401
Q

how do you measure adequate treatment of syphilis?

A

4 fold decrease in serologic titers at 6-12 months

402
Q

secondary syphilis is characterized by?

A

widespread LAD, grey mucous patches, raised genital papules (condyloma lata), diffuse maculopapular rash that involves palms and soles, malaise, sore throat, headache

403
Q

destruction of melanocytes is also known as?

A

Vitiligo

404
Q

1st line intervention for vitiligo?

A

topical or oral steroids

405
Q

Idiopathic guttate hypomelanosis

A

common finding with aging. small macules in sun exposed areas

406
Q

Piebaldism

A

autosomal dominant disorder characterized by patchy absence of melanocytes confined to head and trunk

407
Q

broad flat T waves, U waves, ST depression in setting of weakness is likely due to?

A

hypokalemia

408
Q

Euthyroid sick syndrome

A

any patient with an acute, severe illness may have abnormal thyroid funciton tests (low T3) with normal T4 and TSH

409
Q

Immune thrombocytopenia

idiopathic thrombocytopenic purpura

A

autoimmune disorder presenting with increased platelet destruction due to IgG antibodies against platelet membrane proteins

410
Q

Bernarnd-Soulier syndrome

A

autosomal recessive disorder with absent receptor for vWF. circulating “giant” platelets, severe platelet dysfunction, bleeding out of proportion to degree of thrombocytopenia

411
Q

Which drugs cause ototoxicity and can also cause damage to motion sensitive hair cells in the inner ear to cause selective vestibular damage?

A

aminoglycosides (gentamicin specifically causes vestibular issues)

412
Q

cardiac myxomas are most often located?

A

80% in LA

413
Q

Patients with antiphospholipid antibody syndrome should be started on what medication when they are pregnant?

A

Low molec weight heparin and aspirin

414
Q

Long term management of Antiphoslipid syndrome in patients who are not pregnant?

A

Warfarin

415
Q

Significant HTN with primary hyperparathyroid syndrome might suggest what disease?

A

MEN 2 with pheochromocytoma

416
Q

Patients with bone pain, kidney stones, psych symptoms and high blood pressure? what is cause of HTN?

A

Primary HPT

417
Q

How does steatorrhea lead to hypocalcemia?

A

decreased absorption of fat soluble vitamins including vitamin D. So less Ca and Phos reabsorption from bowel. This leads to secondary hyperparathyroidism

418
Q

first line treatment or prophylaxis against MAC in HIV?

A

Azithromycin

419
Q

rapid increase in transaminases with modest elevation in Tbili and alk phos in setting of sepsis?

A

Shock liver

420
Q

patient with AIDS and neuro symptoms with nonenhancing white matter lesions?

A

progressive multifocal leukoencephalopathy

421
Q

progressive multifocal leukoencephalopathy is caused by? diagnosed how?

A

JC virus. CSF fluid evidence of JC virus by PCR

422
Q

well-defined enhancing focal lesion in a patient with HIV?

A

primary CNS lymphoma

423
Q

Donepezil, Rivastigmine, Galantamine MOA? treat?

A

acetylcholinesterase inhibitors. slow cognitive decline in Alzheimer’s

424
Q

diagnostic test of choice for Zenker diverticulum?

A

contrast esophagram

425
Q

acute confusion, hyperthermia, tachy and persistent epistaxis under direct sunlight? diagnosis?

A

heat stroke

426
Q

Forehead sparing with bells palsy is suggestive of a lesion where? why?

A

intracranial (above the facial nucleus in the pons) because there is bilateral upper-motor neuron innervation to forehead

427
Q

where is the lesion for bells palsy (full unilateral upper and lower facial paralysis)

A

peripheral neuropathy of CN VII (lesion below the pons)

428
Q

Splanchnic arterial dilation is the cause of what?

A

hepatorenal syndrome

Splanchnic vasodilation activates RAAS and induces local vasoconstriction with decreased perfusion and GFR

429
Q

hepatic hydrothorax

A

pleural effusion due to small defects in diaphragm. peritoneal fluid passes into the pleural space

430
Q

what therapy should you avoid in hepatic hydrothorax?

A

chest tube placement: it can result in large-volume protein, fluid and electrolyte losses

431
Q

Acyclovir, Sulfonamides, methotrexate, ethylene glycol, protease inhibitors can all cause what type of kidney injury?

A

Crystal Induced. crystal precipitates cause direct intratubular obstruction and diret renal tubular toxicity

432
Q

What obstructive disease may have an increased DLCO?

A

Asthma

433
Q

Treatment for papillary thyroid cancer?

A

surgical resection

434
Q

Why do patients at risk of thyroid cancer recurrence require thyroid hormone replacement?

A

TSH can stimulate growth of occult or metastatic disease

435
Q

focal dystonia of the SCM is also known as?

A

torticollis

436
Q

hemiballismus

A

unilateral violent arm flinging caused by damage to contralateral subthalamic nucleus

437
Q

culture negative urethritis should raise suspicion for?

A

chlamydial urethritis

438
Q

Fever and sore throat in a patient taking antithyroid drugs suggest?

A

agranulocytosis

439
Q

What therapy should be given for ischemic stroke that presents within 3.5-4 hours of symptom onset?

A

IV alteplase

440
Q

Therapy after ischemic stroke if patient not currently on any meds?

A

Aspirin

441
Q

Stroke already on aspirin therapy. what should be added?

A

aspirin + dipyridamole OR clopidogrel

442
Q

Spherocytes with central pallor should make you thin of what 2 conditions?

A
  • Autoimmune hemolytic anemia

- Hereditary spherocytosis

443
Q

How to differentiate AIHA from HS?

A

positive family history and negative coombs test suggests HS

444
Q

how do you differentiate intravasc vs extravasc hemolysis?

A

Intravasc: very high LDH, very low haptoglobin, elevated indirect bili

Extravasc: slightly elevated LDH, slightly elevated haptoglobin

445
Q

positive osmotic fragility test is significant for?

A

H. spherocytosis

446
Q

viral URI, cough lasting >5 days, sputum production is typical for? fever not typical

A

bronchitis

447
Q

bronchiectasis is associated with a history of?

A

recurrent respiratory tract infections

448
Q

history of recurrent stones since childhood, family history of stones, hexagonal crystals and positive urinary cyanide nitroprusside test =

A

Cystinuria (hard and radioopaque stones)

449
Q

What is the etiology of cystinuria?

A

amino acid transport abnormality

450
Q

Nodular glomerulosclerosis (with Kimmelstiel-Wilson nodules) is pathognomonic for?

A

Diabetic nephropathy

451
Q

breath sounds with lung consolidation?

A

increased (crackles and egophony present)

452
Q

What forms of anticoagulant are contraindicated in patients with severe renal insuficiency?

A

factor Xa inhibitors (fondaparinux and rivaroxaban)

453
Q

What diseases is primary biliary cholangitis associated with?

A

Hepatocellular carcinoma
Severe hyperlipidemia
Osteoporosis or Osteomalacia

454
Q

aliskiren is what type of drug

A

direct renin inhibitor

455
Q

characteristic CSF for HSV encephalitis

A

lymphocytic pleocytosis.

increased number of erythrocytes due to hemorrhagic destruction of temporal lobes and elevated protein

456
Q

1st line therapy for BPH?

what can be used in addition or as an alternate therapy for those who dont tolerate alpha blockers?

A

alpha-blockers

5-alpha reductase inhibitors (inhibit test conversion to dihydrotest and reduce prostate gland size)

457
Q

If a htn patient develops hypokalemia with diuretic use, suspect?

A

mild primary hyperaldosteronism

458
Q

What can you do to reduce CCB (dihydropyridine) associated lower extremitiy edema?

A

Add ACE inhibitor to regimen

Step 2 CK (26 decks)

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