Medicine 2 Flashcards
1
Q
Upper and lower respiratory tract granulomatous inflammation and glomerulonephritis in a 30-50 year old, anemia, fever, wt loss, cough. What is this?
A
Granulomatosis with polyangiitis
2
Q
Dx of granulomatosis with polyangiitis
A
P-Anca and mpo anca
Also skin, kidney or liver biopsy
3
Q
Tx of empyema
A
Prolonged antibiotics (2-4 weeks) and drainage
4
Q
Does hodgkin lymphoma often develop secondary malignancy
A
Yes
5
Q
Bronchogenic cysts are found in the __ mediastinum whereas thymomas are found in the ___ mediastinum
A
Middle; anterior
6
Q
Mechanism of theophylline and use
A
Nonselective phosphodiesterase inhibitor; reduces inflammation
Relaxes bronchial smooth muscle
7
Q
Theophylline is metabolized in the
A
Liver
8
Q
What happens in theophylline toxicity?
A
Cns stimulation (headaches, insomnia, seizures)
Also n/v, arrythmia
9
Q
What does ciprofloxacin do to theophylline
A
Decreases its clearance
10
Q
Recurrent pneumonia in the same anatomic region of the lung raises suspicion for
A
Localized airway obstruction which can lead to impaired bacterial clearance
11
Q
Fever, pleuritic chest pain, hemoptysis, and nodules with surrounding ground glass opacities (halos) on ct scan
A
Pulmonary aspergillosis
12
Q
Exercise induced bronchoconstriction (eg in asthma) is due to what mechanism?
A
Response to mast cell degranulation triggered by passage of high volumes of dry, cold air
13
Q
Abg findings in copd exacerbation (respiratory ___)
A
Respiratory acidosis and hypoxia
14
Q
Tachypnea causes __capnia and respiratory ___ in chf exacerbation
A
Hypo; alkalosis
15
Q
Recurrent episodes of dyspnea, fever, tenacious sputum production, hemoptysis, crackles and digital clubbing are consistent with an exacerbation of
A
Bronchiectasis
16
Q
Pathophys of bronchiectasis
A
Bronchial thickening and dilation due to a recurrent cycle of infection, inflammation and tissue damage
17
Q
Impaired mucocilliary clearance in cystic fibrosis typically leads to bronchiectasis typically located in the ___
A
Upper lobe
18
Q
Is tactile fremitus increased or decreased in pleural effusion?
A
Decreased
19
Q
Dx of bronchiectasis
A
High res ct
20
Q
Peripheral lung cancers
A
Adenocarcinoma and large cell carcinoma
21
Q
Central lung cancers
A
Squamous cell carcinoma and small cell carcinoma
22
Q
What kind of lung cancer is associated with hypercalcemia
A
Squamous cell
23
Q
Acei therapy leads to the accumulation of what molecules
A
Kinins and substance p
24
Q
Pts with chronic cough not responsive to antihistamine therapy should get
A
Pfts
25
What does svt stand for
Supraventricular tachycardia
26
Why do you use adenosine to treat svt?
Causes transient heart block in the av node and arterial dilation where endothelium is not separated from tunica media by atherosclerotic plaque (allows docs to test for blockages in coronary arteries)
27
Is adenosine contraindicated in folks with asthma
Yes
28
The cell to cell conduction of depolarization through the myocardium is carried by fast moving ___ ions
Sodium
29
The wave of depolarization makes the interior of the myocytes ___ and stimulates them to contract
Positive
30
Repolarization causes the interior myocytes to regain their resting ___ charge
Negative
31
Slow conduction through the av node is carried by the ____ ions
Calcium
32
Repolarization is accomplished by ___ ions leaving the myocytes
Potassium
33
Qt interval represents the duration of ventricular ___
Systole, hence why long qt syndrome pts are vulnerable to rapid ventricular rhythms
34
___ions cause myocyte contraction
Calcium
35
What do you use for immediate anticoagulation in someone with a pe with renal insufficiency?
Unfractionated heparin
36
Why can’t you use enoxaparin, fondaparinux or rivaroxaban in pts with poor renal function?
They are factor x inhibitors that are cleared Renally. If they can’t be cleared they will stay there and increase bleeding risk
37
When to suspect alpha antitrypsin deficiency?
In pts who lack typical risk factors for copd (eg young) or with atypical features (basilar predominant dz)
38
Beta 2 agonists do what ti potassium levels?
Decrease them by driving potassium into cells
Can cause hypokalemia: muscle weakness, arrythmia, ekg changes
39
Inhaled anti ___ agents such as ipratropium are the mainstay sx management of copd
Muscarinic
40
Nonseminomatous germ cell tumors produce what two things?
AFP and bhcg
41
Pleural effusion in the context of pleuritic pain and fever is likely what kind of effusion?
Exudative
42
How can inflammation or infection cause an exudative pleural effusion?
Inflammation or infection released cytokines which increase capillary permeability
43
Do you give abx in acute copd exacerbation?
Yes
44
Difference between Melena and hematochezia
Melena comes from above the ligament of treitz, hematochezia from below
Melena has been in the gi tract for longer
45
Why are extremities cool in cardiogenic shock
Increased peripheral vasc resistance shunts blood away from extremities to vital organs
46
Pts with distributive (septic) shock have ___ extremities
Warm
47
Ph of transudate
7.4-7.55
48
Ph of exudate
7.3-7.45
49
Three characteristics of exudate
- pleural fluid protein/serum protein ratio>0.5
- pleural fluid lactate dehydrogenase/serum ldh ratio >0.6
- pleural fluid LDH> 2/3 of the upper limit of normal serum ldh
50
Why do glucocorticoids cause a leukocytosis with neutrophilic predominance?
1. Mobilization of Marginated neutrophils
2. Stimulation of release of immature neutrophils from bone marrow
3. Inhibition of neutrophil apoptosis
(Gcs kill off lymphocytes and eosinophils)
51
What two things decrease vital capacity in severe copd?
Air trapping and airflow obstruction
52
Before intubating, what should you try in acute copd exacerbation if meds and oxygen have failed?
Peep
53
Dx of cap
Cxr
54
How do you increase oxygenation in a ventilated pt?
1. Increase the fraction of inspired oxygen (fio2) or
| 2. Increase peep
55
Pts presenting with foul smelling sputum, concurrent peridontal disease, and pulmonary infiltrates likely have ___ due to ___
Aspiration pneumonia due to alcoholism
56
Treatment of aspiration pneumonia
Abx with good anaerobic coverage (clinda, augmentin)
57
Most common pathogen of cap
S pneumo
58
Is afib associated with pe?
Yes
59
Zoster vaccine is indicated in patients older than
60
60
S gallolyticus is associated with what malignancy and what cardiac pathology?
Colon cancer and endocarditis
61
Screening test for hiv
Hiv p24 antigen and HIV antibodies
62
For pts with neg serological tests but high clinical suspicion of hiv, get what test?
Plasma HIV RNA testing
63
If the test question mentions a particular region/place think of
Fungal infections
64
How to test for histo?
Urine or serum rapid antigen test
65
Histoplasma is much __ than a red blood cell
Smaller
66
What skin thing is associated with histo
Erythema nodosum
67
How to treat systemic histo
Amphotericin
68
What kind of penia do you see with disseminated histo?
Pancytopenia
69
No growth on gram stain and urine culture in urethritis (culture negative), what etiology?
Chlamydia
70
Dx of chlamydia trachomatis urethritis
Nucleic acid amplification testing of first catch urine
71
Tx of chlamydia urethritis
Azithro or doxy
72
Polyarticular arthritis, fever, fatigue, and diarrhea in someone who works with kids
Likely parvo b19
73
Flulike illness with symmetric polyarthralgias, rash, period edema and cervical lymphadenopathy in someone just back from the Caribbean, South America or west Africa
Chikungunya fever
74
What fungus causes low grade fever and violaceous skin lesions with scrapings showing yeast? Present in upper Midwest and Mississippi valley?
Blasto
75
What kind of branching does aspergillosis hav?
Acute angle branching under 25 degrees
76
Are aspergillomas gravity dependent
Yes
77
Fever, polyarthralgia, pustular rash and high risk sexual behavior, think
Disseminated gonococcal infection
78
Most common complication of influenza? When do you suspect it?
Secondary bacterial pneumonia
Suspect in pt with worsening fever and pulm sx after initial improvement esp in older pts
79
Most common causes of secondary bacterial pneumonia
S aureus and strep pneumo
80
Borrelia is a??
Spirochete
| Tick borne dz
81
What stains do you use on borrelia
Wright and giemsa stain
82
What do you see in stage two of lymes dz?
Heart block due to myocarditis and bilateral facial nerve palsy (Bell’s palsy)
83
What do you see in stage three of lymes dz?
Arthritis of large joints (migratory poly arthritis) and cns effects (encephalopathy)
84
Treatment of lymes dz
Doxy in stage one
| Ceftriaxone for later presentations
85
Babesiosis can cause what kind of anemia? And thus what liver symptom?
Hemolytic anemia; jaundice
86
What kind of fevers do you get in babesiosis
Irregularly cycling fevers
87
What pts are at high risk for babesiosis
Asplenic pts (eg sickle cell pts)
88
Dx of babesiosis
Blood smear. Should see Maltese cross rbcs.
89
Tx of babesiosis
Atovaquone and azithromycin (macrolide)
90
What vaccines should you get for chronic liver dz?
Tdap, influenza, pneumococcal, hep a, hep b
91
How do you dx mono?
Heterophile antibody (monospot) test
92
What happens to pts with mono who are treated for strep throat with amoxicillin or ampicillin?
They get a maculopapular rash
93
Why can’t people with mono do contact sports?
Fear of splenic rupture since half of pts get splenomegaly
94
Cd4 count in pts who get pneumocystis jiroveci
200
95
Ground glass infiltrates on cxr and positive bronchoalveolar Lavage and high lactate dehydrogenase im a pt with cd4 count under 200
Pneumocystis jiroveci
96
Prophylaxis for pcp
Bactrim
97
Pts with gonococcal infection should be screened for what other stds?
Chlamydia, hiv, treponema pallidum, hep b
98
How to treat strep viridans
Penicillin g or iv ceftriaxone
99
Should hiv pts get the pneumococcal and vzv vaccines?
Yes
100
Tx for pcp?
Tmp-smx (bactrim) and prednisone
101
At what cd4 count does cmv become relevant in aids pts
50
102
At what cd4 count does crypto become relevant in aids pts
180
103
At what cd4 count does Mac become relevant in aids pts
50
104
Four causes of diarrhea in aids pts
Crypto, microsporidium, mac, cmv
105
What cause of diarrhea in aids pts is associated with high fever?
Mac
106
Tx for cmv
Ganciclovir
107
What two things cause esophagitis in aids pts
Herpes and cmv
108
Cmv esophagitis looks like
Deep linear lesions
109
Dx of crypto
Oocytes in stool, stains acid fast
110
New active phase hep b. What serology do you see?
HBsAg, maybe HBeAg, and IgM anti-HBc
| And hbv dna
111
Chronic hep b carrier. What serology do you see?
HBsAg and IgG anti-HBc
112
Vaccinated for hep b. What serology do you see?
Anti-HBs (surface hep b antibody)
113
Pseudomonas is a gram ___ ___
Negative rod
114
Can pseudomonas put chronic granulomatous dz pts at risk?
Yes
115
What is the most common cause of nosocomial pneumonia
Pseudomonas
116
Can pseudomonas cause osteomyelitis? In which pts?
Yes in diabetics and ivdu
117
What bug do you think of with burn pts
Pseudomonas
118
Ecthyma gangrenosum, aka black necrotic skin lesions, are associated with what bug?
Pseudomonas
119
Swimmers ear is associated with what bug?
Pseudomonas
120
Tx for pseudomonas
Zosyn, fourth gen cephalosporin, fluroquinolone Or aminoglycosides
121
Female comes in with pain with urination. Differential?
Cystitis
Urethritis (stds)
Vaginitis (candida, bv, trich, stds)
122
Diagnostic test for cystitis
Dipstick or ua (not a urine culture anymore for uncomplicated pts)
Looking for leukocyte esterase
123
Empiric mgmt of cystitis
```
Bactrim bid for three days
Or
Nitrofurantoin for 5-7 days
Or
Oral cephalosporin for 5-7 days
```
124
Strategies to deal with recurrent cystitis
Low dose post coital prophylaxis
Or
Chronic low dose prophylaxis if no understood triggers
125
What abx are inferior to others in tx of utis?
Augmentin
126
Do you usual have a fever with cystitis?
No; think pyelo if this is the case
127
Should you get a urine culture with pyelo?
Yes
128
How long do you treat for pyelo
10-14 days
129
If you are being treated for pyelo but the fever isn’t going away after 72hrs, what do you do?
If everything else is improving, continue on current course of tx
130
What are the protozoal causes of community acquired diarrhea?
Giardia, cryptosporidium, entamoeba histolytica
131
Can diarrhea from giardia last for weeks?
Yes
132
Tx for c diff
Severe dz: po vancomycin
| Non severe dz: metronidazole (flagyl)
133
Sinusitis vs viral uri?
Duration (10-14 days). Viral Uris will have resolved within that time frame.
134
Yellowish urethral discharge in a dude, think
Gonorrhea
135
Mgmt of bacterial sinusitis?
Augmentin, doxy
136
Only tx for gonococcal
Shot of ceftriaxone
And for chlamydia: 7 days of doxy Or one dose of azithro
137
Causes of painful ulcers
Hsv and h ducreyi
138
Painless genital ulcer major cause
Syphyllis
139
Acute hiv can present like what virus
Ebv
140
STD causing pharyngitis
Hiv, gonococcal
141
What should you use instead of doxy in lactating women and kids under 8? Why?
Amoxicillin; doxy causes discoloration of twenty and skeletal development issues
142
What is the most common cause of community acquired bacterial meningitis?
S pneumo
143
Three causes of issues with the posterior column
Diabetes, syphillis and vit b12 def
144
Two causes of monoarticular inflammatory arthritis
Infectious (gonococcal, septic, Lyme disease)
Crystalline (gout)
145
Cause of medial periarticular knee pain
Pes anserine bursitis (inflammation/trauma of the bursa at tendinous insertion)
146
Cause of lateral periarticular knee pain
It band
147
Cause of posterior periarticular knee pain
Popliteal (bakers) cyst
148
What tests should you order for suspected oa
CBC (rules out false pos or neg due to anemia), esr (neg test can increase specificity of dx), lfts (due to acetaminophen use), X-ray
149
Why dont you give a cc steroid shot on an infected joint?
Development of septic joint
150
What is the most common cause of fungal meningitis
Cryptococcus neoformans
151
3 symptoms of cryptococcus neoformans
Fever
Pneumonia
Meningitis
152
Hiv pt with fevers, headaches, and signs of elevated intracranial pressure (papilledema). Think of
Cryptococcus meningitis. Usually in pts with cd4 count below 100
153
Is papilledema seen in hiv pts with cmv?
No, retinitis is
154
Unexplained leukocytosis in hospitalized pts should raise suspicion for
C diff, even without diarrhea
155
Dx of cdiff
Stool studies for c diff toxin (pcr or enzyme immunoassay)
156
Hiv pts with cd4 counts below ___ should not receive live attenuated vaccines
200
157
Transplant recipients are at highest risk for which two opportunistic infections
Cmv and pcp
158
What strategy reduces risk of catheter associated uti
Clean intermittent catheterization
159
Legionnaires pneumonia is associated with hypo___ and diarrhea. Often with high fever and liver dysfunction.
Natremia
160
Tx of legionnaires
Fluoroquinolones or macrolides
161
Hospitalized pts with uti can be transitioned from broad spec abx to culture guided oral abx if sx are improved at ___hours
48
162
Cause of diarrhea in an aids pt where stools are frequent small volume and often bloody
Cmv
163
Sx of secondary syphillis
Diffuse rash (palms and soles), lymphadenopathy , condyloma lata, grey mucus patches, hepatitis
164
What two bugs are responsible for deep infections after puncture wounds
S aureus and pseudomonas
165
If a pt has febrile neutropenia what should you do
Start empiric monotherapy against pseudomonas (cefepime, pip tazo)
166
Hallmark of plasmodium malaria
Cyclical fever and rbc lysis
166
Dx of malaria
Blood smear
167
Taenia ___ has hooks on head on stool o and p
Solium
168
Swiss cheese on head ct and seizures
Neurocysticercosis
169
Tx of parasites
Praziquantel and albendazole
170
What is the longest tapeworm that can grow up to ten meters long
D. Latum, fish tapeworm
171
What kind of tapeworm causes a liver hydatid cyst with eggshell calcifications inside
Echinococcus granulosus
172
Uti with urinary alkalization (ph>8) raises suspicion for what bugs
Proteus mirabilis and klebsiella
173
What are three parasitic causes of travelers diarrhea
Crypto, cyclospora and giardia
174
Mgmt of mild infective endocarditis
Get min of threeblood cultures before starting abx
175
Most common cause of community acquired bacterial meningitis
S pneumo
176
Secondary bacterial pneumonia after flu is generally due to what bug
Staph aureus
177
Is ecoli gram negative
Yes
178
Strep pneumo is gram ___
Positive
179
Strep viridans is gram ___
Positive
180
Infective endocarditis in light of prosthetic valves is due to what bug?
S aureus or staph epidermis
181
Infective endocarditis in light of iv catheters is due to what bug?
S aureus Or staph epidermis
182
Infective endocarditis in light of implanted devices is due to what bug?
S aureus Or Staph epidermis
183
Infective endocarditis in light of ivdu is due to what bug?
S aureus
184
Infective endocarditis in light of gingival manipulation is due to what bug?
Viridans group strep
185
Infective endocarditis in light of resp tract incision or biopsy is due to what bug?
Viridans group strep
186
Infective endocarditis in light of nosocomial utis is due to what bug?
Enterococci
187
Infective endocarditis in light of colon carcinoma Or ibd is due to what bug?
Strep gallolyticus (s bovis)
188
Tx for infective endocarditis
Vanco for acute/empiric, for subacute treat based on culture
