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Medicine Flashcards

1
Q

Elevated BUN/Cr > 20:1 indicates?

A

Prerenal AKI

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2
Q

Describe the physiology of RAA axis and prerenal AKI leading to elevated BUN/Cr > 20:1

A

Decreased renal blood flow -> decreased GFR -> Increased Renin -> elevated angiotensinogen ->Angiotensin I -> Angiotensin II -> sodium retention -> aldo production -> vasoconstriction

With the reabsorption of sodium, urea is passively reabsorbed.

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3
Q

If decreased renal perfusion is prolonged, this can lead to?

A

Acute tubular necrosis

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4
Q

Etiologies of prerenal acute kidney injury

A

Decreased renal perfusion

  • true volume depletion
  • decreased circulating volume (heart failure, cirrhosis)
  • sepsis, pancreatitis
  • renal artery stenosis
  • afferent arteriole vasoconstriction (NSAIDs)
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5
Q

NSAIDs constrict the?

A

afferent arteriole

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6
Q

What will the FENA be with prerenal AKI?

A

FENA < 1%

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7
Q

Ciprofloxacin can cause what type of kidney injury?

A

Acute interstitial nephritis

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8
Q

What other findings will you typically see with AIN drug reaction?

A

skin findings and WBC casts

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9
Q

Nodular glomeruloscerosis occurs in?

A

diabetic nephropathy

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10
Q

What are the osmotic and non-osmotic stimuli for ADH secretion?

A

Osmotic: serum osmolality > 285

Nonosmotic: nausea, pain, physical/emotional stress, hypotesion, hypovolemia, hypoxia, hypogycemia

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11
Q

The elderly, especially demented patients, are particularly susceptible to what type of kidney injury?

A

Prerenal

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12
Q

Name common pathogens for UTI/Pyelo

A

E.coli (80%)
Proteus
Klebsiella Pneumoniae
Staph Saphrophyticus

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13
Q

The presence of urinary alkalization (pH >8) raise suspicion for what types of UTI pathogens?

A

Urease-producing bacteria like PROTEUS (most commonly) or KLEBSIELLA

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14
Q

How do urease producing organisms alkalinize the pH?

A

Split urea into ammonia and CO2. Ammonia converts into ammonium and alkalinizes urine.

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15
Q

High urine pH increases the likelihood of developing what type of stone? why?

A

STRUVITE stone (magnesium/ammonium phosphate) because alkalinization reduces solubility of phosphate

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16
Q

Corkscrew pattern on esophagram can be indicative of?

A

Esophageal spasm

not sensitive or specific finding

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17
Q

Treatment for esophageal spasm?

A

calcium channel blockers
Nitrates
Tricyclics

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18
Q

Impaired inhibitory innervation of esophagus can lead to?

A

diffuse esophageal spasms

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19
Q

Esophageal manometry for esophageal spasms would show?

A

multiple simultaneous contractions

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20
Q

Food impaction, dysphagia, heartburn that does not respond to standard meds?

A

EoE

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21
Q

Endoscopy reveals esophageal rings and strictures- what is the dx?

A

EoE

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22
Q

Globus sensation (feeling that something is stuck in your throat) is worse when swallowing _______ and is typically associated with ______

A

saliva

anxiety

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23
Q

What HBV markers will be positive in the early phase?

A

HBsAg, HBeAg, IgM anti-HBc, HBV DNA

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24
Q

What HBV markers are positive in the window phase?

A

IgM anti-HBc and HBV DNA

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25
Q

HBV markers in recovery phase?

A

IgG anti HBc, Anti HBs, Anti HBe, (+/- HBV DNA)

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26
Q

Chronic HBV carrier markers?

A

HBsAg, IgG anti HBc

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27
Q

Vaccinated for HBV?

A

anti-HBs

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28
Q

What markers for acute flare of chronic HBV

A

chronic markers plus HBeAg and IgM anti-HBc

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29
Q

Immune due to natural HBV infection?

A

IgG anti-HBc and Anti HBs

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30
Q

Among healthy adults, acute HBV infection is self limited in what percent of cases

A

95%

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31
Q

Following acute exposure to HBV, HBsAg can be seen alone for ______ before symptoms

A

1-2 weeks

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32
Q

In most patients with drug induced liver injury, what other symptoms are present?

A

rash, arthralgias, fever, leukocytosis, eosinophilia

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33
Q

Extrahypatic manifestations of drug induced liver injury are characteristically absent for what drug?

A

Isoniazid

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34
Q

Cholestasis leading to liver injury is caused by what drugs?

A

chlorpromazine, nitrofurantoin, erythromycin, anabolic steroid

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35
Q

Fatty liver is caused by what meds?

A

tetracycline, valproate, anti-retrovirals

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36
Q

Hepatitis is caused by what meds?

A

halothane, phenytoin, isoniazid, alpha-methyldopa

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37
Q

toxic-fulminant liver failure is caused by what meds?

A

carbon tetra chloride, acetaminophen

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38
Q

granulomatous liver injury is caused by

A

allopurinol, phenylbutazone

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39
Q

oral contraceptives cause abnormalities in _______ without causing signs of necrosis or fatty change

A

LFTs

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40
Q

TB hepatitis would be characterized by ____ on liver biopsy

A

granulomas

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41
Q

An elevated PCWP in addition to elevated pulm artery and right atrial pressures suggests?

A

left sided heart failure leading to right sided heart failure

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42
Q

Elevated PA and RA pressurs with normal PCWP suggest?

A

elevated pulm pressures are due to an intrinsic pulmonary process

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43
Q

Obstructive shock can be acutely caused by a?

A

PE

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44
Q

Treatment for HER2 positive breast carcinoma

A

Trastuzumab

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45
Q

known adverse affect of Trastuzumab?

A

Cardiotoxicity (asymptomatic decline in LVEF)

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46
Q

Cardiotoxicity effects of trastuzumab increase when used in combo with what chemo drug that is also cardiotoxic?

A

Doxorubicin

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47
Q

Prior to initiating traztuzumab, patients should undergo what test?

A

baseline cardiac function testing with ECHO

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48
Q

Anthracycline chemo-induced cardiotoxicity does what damage to heart? is it reversible?

A

Myocyte necrosis and destruction (fibrosis)

Progression to overt clinical heart failure (less likely reversible)

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49
Q

Is trastuzumab cardiotoxicity reversible?

A

Yes usually

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50
Q

Baseline audiometry for concerns of ototoxicity should be performed before what types of chemo?

A

cisplatin and carboplatin

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51
Q

What treatments for breast cancer increase risk of osteoporosis? what mechanism?

A

Aromatase inhibitors (anastrozole, letrozole) (used to treat estrogen receptor positive breast cancer)

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52
Q

Tamoxifen (used in treatment of estrogen receptor positive breast cancer) increases the risk of?

A

venous thromboembolism

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53
Q

Bleomycin can cause?

A

pulmonary fibrosis. PFT testing should be obstained before bleomycin therapy

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54
Q

TNF-alpha inhibitors can cause reactivation of?

A

latent TB

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55
Q

cholestatic pattern of LFTs

A

predominantly elevated alk-phos with smaller increases in aminotransferases

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56
Q

Presbycusis

A

sensorineural hearing loss that occurs with aging

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57
Q

Describe onset and presenting symptom development of presbycusis

A

starts in 6th decade of life, symmetrical, high-frequency hearing impairment, difficulty hearing in crowded and noisy places

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58
Q

Otosclerosis

A

chronic conductive hearing loss associated with bony overgrowth of stapes (low-frequency hearing loss in middle aged individuals)

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59
Q

Middle ear effusion is seen in patients with? and usually produces?

A

serious otitis media and produces tinnitus and sensation of pressure in addition to conductive loss

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60
Q

Meniere’s disease

A

tinnitus, vertigo, sensorineural hearing loss

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61
Q

Dressler’s syndrome (post-MI pericarditis) usually occurs how long after MI?

A

usually occurs within 1-6 weeks after MI

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62
Q

First line agents for viral pericarditis or idiopathic?

A

NSAIDs and/or colchicine

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63
Q

Leser-Trelat sign

A

sudden onset of multiple SKs indicating occult internal malignancy

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64
Q

acrochordon is a ?

A

skin tag

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65
Q

Systemic sclerosis (SSc)

A

Disease characterized by progressive tissue fibrosis and vascular dysfunction

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66
Q

Clinical features of systemic sclerosis

A

Systemic: fatigue, weakness
skin: telangiectasia, sclerodactyly, digital ulcers, calcinosis cutis
Ext: arthralgias, myalgias, contractures
GI: esoph dysmotility, dysphagia, dyspepsia
Vasc: raynauds

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67
Q

Serology for systemic sclerosis

A

ANA
Anti-topoisomerase I (anti-Scl-70) antibody
Anticentromere antibody

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68
Q

In patients with systemic sclerosis, esophageal manometry will show?

A

hypomotility and incompetence of LES

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69
Q

Atrophy and fibrosis of smooth muscle in lower esophageal sphincter can be seen in what disease? (associated with other systemic skin, GI, vasc issues)

A

systemic sclerosis

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70
Q

How can you differentiate polymyositis (which can also have esophageal dysmotility issues) and systemic sclerosis

A

Polymyositis: symmetric proximal muscle weakness (Not distal arthralgias!)

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71
Q

How to differentiate achalasia from systemic sclerosis

A

Achalasia shows increased LES pressure and incompelte relaxation, whereas SSc causes decreased LES pressure

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72
Q

Blastomycosis occurs?

A

south/south-central states
Mississippi + Ohio River Valley
Upper midwest
Great lakes

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73
Q

Blasto skin lesions have this characteristic appearance?

A

heaped up verrucous/nodular lesions with violaceous hue

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74
Q

Actinomyces and Nocardia are gram positive ___

A

rods

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75
Q

Characteristic granular yellow pus “sulfur granules” and abscesses

A

Actinomyces

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76
Q

Skin manifestations of coccidiomycosis?

A

uncommon but include erythema nodosum and erythema multiforme

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77
Q

Disseminated Blastomycosis can occur in immmunocompromised and immunocompetent individuals? True/false

A

True

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78
Q

Disseminated histoplasmosis can occur in immunocompromised and immunocompetent individuals? true/false

A

false- extremely rare in immunocompetent

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79
Q

Anterior cerebral artery stroke is characterized by?

A

contralateral motor or sensory deficits (more pronounced in lower limb than upper limb)
Abulia (lack of will/initiative)
Dyspraxia, emotional disturbance, urinary incontinence

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80
Q

conns syndrome is usually due to ?

A

adrenal adenoma or bilateral adrenal hyperplasia

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81
Q

What are causes of secondary hyperaldosteronism?

A

renovascular htn
malignant htn
renin-secreting tumor (rare)
diuretic use

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82
Q

What drug can be used in patients with ypervolemia and metabolic alkalosis?

A

Acetazolamide

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83
Q

Function of Acetazolamide

A

diuretic that inhibits proximal renal bicarb reabsorption

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84
Q

Acute treatments for low back pain?

A

maintain moderate activity
NSAIDs or acetaminophen
Muscle relaxants, spinal manipulation, brief course of opioids

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85
Q

Treatment for chronic low back pain

A

Intermittent NSAIDs / acetaminophen
Exercise therapy (stretch/strength, aerobic)
TCAs, duloxetine

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86
Q

Secondary prevention for low back pain

A

education, exercise therapy

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87
Q

chronic back pain is defined as?

A

12 weeks or more

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88
Q

are back braces effective for prevention or treatment of LBP?

A

No

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89
Q

Regular vaccination schedule for meningococcal?

A

Primary vaccination at age 11-12

Booster at 16-21 (if primary at age less than 16)

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90
Q

Primary vaccination for meningococcal for people greater than 18 should still be given if they have what risk factors?

A

complement deficiency

functional or anatomic asplenia

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91
Q

which flu vaccine is inactivated?

A

IM

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92
Q

rhino-orbital cerebral mucormycosis is usually caused by?

A

Rhizopus species

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93
Q

Risk factors for rhino-orbital-cerebral mucormycosis

A

Diabetes mellitus (ketoacidosis), Hematologic malignancy, solid organ or stem cell transplant

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94
Q

manifestations of mucormycosis

A

acute/aggressive
fever, nasal congestion, purulent nasal discharge, headache, sinus pain
necrotic invasion of palate, orbit, brain

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95
Q

diagnosis of mucormycosis is made by?

A

sinus endoscopy with biopsy/culture

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96
Q

treatment of mucormycosis?

A

surgical debridement
liposomal amphotericin B
Elimination of risk factors

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97
Q

slow growing bacteria of oral cavity that may cause painless, slow-growing mass with draining sinus tracts on or near jaw

A

Actinomyces

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98
Q

endophthalmitis manifests as and commonly caused by

A

acute ocular pain and decreased visual acuity after eye trauma or surgery.

caused by pseudomonas

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99
Q

Treatment for pregnant women, lactating patients or children < 8 years old with lyme disease?

A

amoxicillin

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100
Q

Serum triglyceride levels generally must be > ______ to be considered as a potential cause of pancreatitis

A

> 1,000

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101
Q

Pancreatitis with an elevated ALT > 150 suggests?

A

biliary pancreatitis

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102
Q

What study is done to evaluate biliary pancreatitis?

A

ERCP

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103
Q

ERCP should also be considered in patients with > ____ episode of acute pancreatitis of unknown cause

A

1

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104
Q

List the common causes of vertigo

A 
Meniere disease
BPV
Vestibular neuritis
Migraine
Brainstem/cerebellar stroke
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105
Q

Meniere disease presents as?

A

recurrent episodes of vertigo lasting 20 minutes to several hours. sensorineural hearing loss. tinnitus or feeling full in ear.

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106
Q

BPPV

A

brief episodes triggered by head movement. Dix-hallpike maneuver causes nystagmus

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107
Q

Vestibular neuritis

labyrinthitis

A

acute, single episode that can last days. often follows virus. abnormal head-thrust test

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108
Q

migraine

A

vertigo associated with HA or other migraine features (Resolve completely in between)

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109
Q

Brainstem/cerebellar stroke vertigo

A

sudden-onset, persistent vertigo usually other neuro symptoms

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110
Q

endolymphatic hydrops

A

increased volume and pressure of endolymph -> Menieres disease

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111
Q

initial management for menieres disease

A

restriction of Na, caffeine, nicotine, alcohol. diuretics considered for long-term management. benzo, anti-histamine, anti-emetics can relieve acute symptoms

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112
Q

Common causes of nephrotic syndrome in adults?

A

membranous glomerulonephropathy
focal segmental glomerulosclerosis
minimal change
amyloidosis

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113
Q

Clues that amyloidosis may be cause of nephrotic syndrome?

A

history of other autoimmune disease (RA, enlarged kidneys, hepatomegaly)

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114
Q

randomly arranged thin fibrils on microscopy in a patient with nephrotic syndrome signals?

A

Amyloidosis

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115
Q

AL (light chain) amyloidosis is associated with ?

A

multiple myeloma

waldenstrome macroglobulinemia

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116
Q

AA amyloidosis is associated with?

A

chronic inflamm conditions (RA, IBD)

chronic infection (osteomyelitis, TB)

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117
Q

Preventive and abortive treatment for vasospastic angina?

A

CCB- preventive (Diltiazem!)

Sublingual nitroglycerin - abortive

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118
Q

Why should aspirin be avoided in patients with vasospastic angina?

A

it can inhibit prostacyclin production and worsen coronary atery vasospasm

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119
Q

Cilostazol is used for? mechanism?

A

phosphodiesterase III inhibitor that causes arterial vasodilation and inhibits platelet agg (used for lower ext claudication)

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120
Q

What type of coronary vasospasm are benzos helpful for?

A

Cocaine-induced

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121
Q

Main danger associated with CPK levels greater than 20,000 is?

A

acute renal tubular necrosis due to myoglobinuria

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122
Q

Acute hemolytic transfusion reaction

A

Develops within 1 hour of transfusion. ABO incompatibility. fever, chills, hemoglobinuria, flank pain, discomfort at infusion site

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123
Q

How to diagnose acute hemolytic transfusion reaction by ABO incompatibility>

A

positive direct Coombs test, pink plasma (plasma free hgb > 25)

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124
Q

What is the preferred medication for HTN associated with ADPKD?

A

ACE inhibitors

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125
Q

Captopril radionuclide renal scan is occasionally used to diagnose?

A

suspected renovascular disease or renal artery stenosis

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126
Q

Amiodorone is a class III antiarrhythmic drug often used for management of?

A

ventricular arrhythmias

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127
Q

AV conduction delay occurs when? typically caused by?

A

occurs when conduction through AV node is slowed. B-blockers or ischemic heart disease. typically results in bradycardia

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128
Q

syncope in a young patient with a crescendo/decrescendo murmur at left lower sternal border is most likely due to?

A

HOCM

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129
Q

When should you suspect cardiac amyloidosis? (form of restrictive cardiomyopathy)

A

patients who have manifestations of LVH, CHF in the absence of a htn history.

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130
Q

Asymptomatic proteinuria, waxy skin, anemia, easy bruising, enlarged tongue, neuropathy can be signs of?

A

AA

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131
Q

Negative pressure pulmonary edema occurs when?

A

When a patient has upper airway obstruction (laryngospasm after extubation)

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132
Q

Angiotensinogen causes the _____ arteriole to constrict thus increasing GFR

A

efferent

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133
Q

Insulin resistance and GI malignancy are associated with what skin process?

A

Acanthosis Nigricans

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134
Q

Insulin resistance, pregnancy, crohn disease are associated with what skin process?

A

skin tags

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135
Q

Hep C is associated with what skin processes

A

porphyria cutanea tarda

cutaneous leukocytoclastic vasculitis (palpable purpura)

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136
Q

celiac disease skin rash?

A

dermatitis herpetiformis

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137
Q

HIV infection is ass with what skin process

A

sudden-onset severe psoriasis
recurrent herpes zoster
disseminated molluscum
seborrheic dermatitis

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138
Q

PArkinson disease ass skin rash?

A

seborrheic dermatitis

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139
Q

IBD associated skin disease

A

pyoderma gangrenosum

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140
Q

sudden appearance of acanthosis nigricans in middle aged or elderly patients is suggestive of

A

underlying malignancy

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141
Q

Recent travel, cruise, hotel stay, contaminated potable water (nursing homes) and patient presenting with pneumonia should make you suspicious for?

A

Legionella

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142
Q

clinical vital sign and presenting symptom clues and lab clues for legionella

A 
Fever > 39 (102.2)
Bradycardia relative to high fever
neuro symptoms (confusion)
GI symptoms (diarrhea)
Hyponatremia
hepatic dysfunction
hematuria, proteinuria
gram stain showing neutrophils but few organisms
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143
Q

relative bradycardia despite high fever is classic for?

A

Legionella

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144
Q

how can you test for legionella?

A

urine antigen test

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145
Q

therapy for legionella

A

macrolide or flouroquinolone

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146
Q

myasthenia gravis presenting symptoms

A

fluctuating fatigable muscle weakness that worsens with repetitive motions

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147
Q

cause of MG?

A

caused by autoantibodies originating in the thymus directed against nicotinic acetylcholine receptors at neuromusclar junction

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148
Q

decreased acetylcholine release from presynaptic terminal of motor neuron?

A

botulism

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149
Q

degeneration of neurons within myenteric plexus?

A

achalasia

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150
Q

inflammatory demyelination of axons in CNS

A

MS

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151
Q

progressive degeneration and death of motor neurons

A

ALS

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152
Q

contact lens-associated keratitis

A

Medical emergency! due to gram negative organisms such as Pseudomonas and Serratia

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153
Q

Keratitis includes involvement of the

A

cornea

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154
Q

chylothorax causes an exudative or transudative effusion?

A

exudative- high in cholesterol content and milky white in appearance

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155
Q

Recurrent bacterial infections in an adult should raise suspicion for?

A

Common variable immunodeficiency

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156
Q

How to test for CVID

A

Quantitative measurement of serum immunoglobulin

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157
Q

Manifestations of CVID

A

recurrent pneumonia, sinusitis, otitis, GI (salmonella, campy), autoimmune disease, chronic lung dsiease,

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158
Q

CVID with have low IgG and low IgA/IgM but the IgG will be lowest. true/false?

A

true

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159
Q

Treatment for CVID?

A

immunoglobulin replacement therapy

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160
Q

most diagnosis of CVID occur from what age?

A

20-45

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161
Q

low CD4 lymphocyte counts occur in ?

A

DiGeorge syndrome and HIV

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162
Q

signs of laxative abuse?

A

women, healthcare field, 10-20 BMs day, diarrhea awakens you from sleep.

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163
Q

how do you diagnose laxative abuse?

A

positive stool screen for diphenolic (bisacodyl)

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164
Q

Colonoscopy with laxative abuse will show?

A

melanosis coli- dark brown discoloration of colon with pale patches of lymph follicles that give the appearnace of alligator skin.

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165
Q

If melanosis coli is not seen on colonscopy what can you look for?

A

pigment in macrophages of lamina propria

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166
Q

“tea-colored stool”

A

VIPoma

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167
Q

management of HOCM

A

avoid volume depletion
BB, CCBs
surgery if symptoms persist

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168
Q

what are the 3 main categories of diabetic retinopathy?

A
  1. background/simple
  2. pre-proliferative
  3. proliferative or malignant
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169
Q

background simple/retinopathy:

A

microaneurysms, hemorrhage, exudate, retinal edema

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170
Q

pre-proliferative

A

cotton wool spots plus background

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171
Q

proliferative

A

newly formed vessels plus cotton wool spots plus background

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172
Q

Abx therapy for prostatitis?

A

TMP-SMX or Fluoroquinolone for 4-6 weeks

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173
Q

Idiopathic intracranial htn (pseudotumor cerebri) is most common in?

A

young obese women

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174
Q

what drugs can cause IIH

A

growth hormone, tetracyclines, minocycline, doxycycline, Vit A derivatives

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175
Q

Thrombotic Thrombocytopenic Purpura pathophysiology

A

life threatening disorder of microvasculature characterized by formation of small vessel thrombi (that consume platelets, shear RBCs and often cause renal and CNS damage.

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176
Q

What is the pentad of TTP?

A

thrombocytopenia, microangiopathic hemolytic anemia, renal insufficiency neuro changes, fever

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177
Q

TTP is caused by?

A

aquired autoantibody to ADAMTS13- plasma protease that cleaves vWF off endothelial surface. So vWF multimers accumulate on endothelial wall and trap platelets at areas of high shearing force -> lead to thrombi formation

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178
Q

TTP is most commonly seen in?

A

young adults

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179
Q

thrombocytopenia, indirect bili elevation, AST, ALT, LDH elevation should always raise suspision for>

A

TTP

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180
Q

What will be seen on peripheral blood smear in work up of TTP?

A

Schistocytes

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181
Q

systolic-diastolic abdominal bruit is a specific finding for?

A

RAS

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182
Q

how do you confirm diagnosis of primary biliary cholangitis?

A

anti-mitochondrial antibody

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183
Q

antismooth antibody?

A

autoimmune hepatitis

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184
Q

drug-induced acne is a common side effect of?

A

steroids

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185
Q

HIV infected patient with altered mental status, EBV DNA in CSF and solitary, weakly ring enhancing periventricular mass on MRI? suspect?

A

Primary CNS lymphoma

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186
Q

Presence of EBV in DNA in the CSF is specific for?

A

CNS lymphoma

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187
Q

Is a positive toxo seroloy specific for toxo?

A

no its common in normal subjects in US.

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188
Q

progressive multifocal leukoencephalopathy lesions are? enhancing/non-enhancing?

A

non-enhancing

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189
Q

How do you treat hypovolemic hypernatremia?

A

.9 IV normal saline

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190
Q

Euvolemic hypernatremia can be treated with?

A

5% dextrose in water

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191
Q

Serum sodium should be corrected at what rate?

A

.5mEq/L/hr (dont exceed 12 mEq/L/24 hour)

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192
Q

What will happen if sodium is corrected too quickly

A

cerebral edema

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193
Q

if NSAIDs are not working for cancer related pain, what should be offered next for severe pain?

A

short acting opioids (morphine, hydromorphone, oxycodone)

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194
Q

Classic triad of trichinellosis

A

periorbital edema, myositis, eosinophilia

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195
Q

Trichinellosis

A

parasitic infection caused by roundworm trichinella. (occurs after ingesting undercooked meat- pork)
Patients develop GI pain, subungual splinter hemorrhages, conjunctival and retinal hemorrhage, periorbital edema, chemosis.

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196
Q

Lab studies show what in cases of trichinellosis?

A

eosinophilia, elevated CK, leukocytosis.

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197
Q

For an unprovoked first-time thrombus in young (<45) patients or those with an unusual site of thrombus, what disease should you test for?

A

Factor V Leiden (most common inherited hypercoag disease in Whites)

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198
Q

Factor V leiden mechanism?

A

activated protein C resistance (protein C is an innate anticoagulant) This leads to slowed degradation of procoagulant factor V

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199
Q

How do you treat hemophilia A?

A

Administer factor VIII or Desmopressin if Hemophilia A is mild

200
Q

Treatment for hemophilia B?

A

Factor IX

201
Q

Unilateral visual impairment that is sudden and often upon wakening in the morning

A

Retinal vein occlusion

202
Q

disc swelling, venous dilation and tortuosity, retinal hemorrhages and cotton wool spots on opthalmoscope exam?

A

Central retinal vein occlusion

203
Q

Central vision is affected in?

A

macular degeneration

204
Q

Smoking increases the risk of what eye disease?

A

macular degeneration

205
Q

Unilateral blurred vision that progressively worsens?

A

Retinal detachment

206
Q

gradual loss of peripheral vision, resulting in tunnel vision. Ophthalmoscopy shows pathologic cupping of optic disc.

A

open angle glaucoma

207
Q

Clinical htn clues to renovascular disease

A
  • resistant htn (uncontrolled despite 3 drug regimen)
  • malignant htn (end organ damage)
  • onset of severe htn (>180/120) after age 55
  • severe htn with diffuse atherosclerosis
  • recurrent flash pulmonary edema
208
Q

Is an abdominal bruit typically present with aortic aneurysm?

A

NO

209
Q

Hypertension or hypotension more common with acute aortic dissection

A

hypertension

210
Q

primary biliary cirrhosis

A

chronic liver disease characterized by autoimmune destruction of INTRAhepatic bile ducts

211
Q

Autoimmune hepatitis is associated with elevated titers of?

A

ANA and anti-smooth antibodies

212
Q

Acute papular (monomorphic) inflammatory rash might be consistent with?

A

drug-induced acne

213
Q

drug induced acne is often associted with?

A

glucocorticoids

214
Q

Predisposing factors for osteoarthritis?

A

age, obesity, DM

215
Q

Where is the pain of hip osteo felt?

A

groin, buttock, pelvis and can radiate to lower thigh

216
Q

Meralgia paresthetica

A

compression of lateral femoral cutaneous nerve at waist- causes burning and paresthesias at lateral thigh

217
Q

Pain localized to the lateral hip and worsened by direct pressure?

A

Trochanteric bursitis

218
Q

Treat hypovolemic hypernatremia without symptoms with?

A

5% dextrose

219
Q

Treat hypovolemic hypernatremia with symptoms with?

A

.9% saline until euvolemic then 5% dextrose

220
Q

Hemodialysis is indicated for serum lithium level > ____

A

4

221
Q

Lithium level > ____ plus signs of lithium toxicity (seizures, depressed mental status)

A

2.5

222
Q

why use a water deprivation test?

A

differentiate between central (decreased ADH from pituitary) and nephrogenic (normal ADH with renal ADH resistance)

223
Q

describe water deprivation test

A

-no water 2-3 hours prior to test
-measure urine volume and osmolality every hour
-serum sodium and osmolality every 2 hours
-once plasma osm >295
or plasma Na > 145 -> GIVE DESMOPRESSIN
-Monitor urine Osm anm and volume

224
Q

If urine Osm > 600 on water dep test what is diagnosis?

A

primary polydipsia

225
Q

How do you diagnose central DI on water deprivation?

A

increase urine osm 50-100%

226
Q

how do you diagnose nephrogenic DI on water deprivation?

A

small or no increase in urine Osm

227
Q

ascariasis

A

lung phase with nonproductive cough or worms obstructing small bowel or bile ducts

228
Q

dengue fever

A

fever, HA, retro-orbital pain, rash, myalgia, arthralgia (hemorrhage in skin or nose)

229
Q

typhoid fever

A

presents in progressive manner with fever in 1st week. abdominal pain and salmon rash in 2nd week.
hepatosplenomegaly w/ abdominal perf, bleeding during 3rd week.

230
Q

herpetic whitlow

A

viral infection of hand caused by HSV

231
Q

MEN 1 syndrome manifestations

A

pituitary adenomas
Primary hyperparathyroidism
pancreatic/GI neuroendocrine tumors

232
Q

The most common esophagitis in patients with advanced HIV, especially with CD4 counts < 50-100?

A

Candida!

233
Q

In patients with HIV esophagitis whose predminant symptom is severe odynophagia (pain) without (dysphagia)- difficulty swalling - > what is most likely diagnosis?

A

viral esophagitis is more likely than candida

234
Q

Most common viruses to cause esophagitis in HIV patients?

A

HSV and CMV

235
Q

How to differentiate HSV and CMV lesions on GI endoscopy?

A

HSV lesions- circular or ovoid vesucular and ulcerated

CMV- large, linear, distal esoph ulcers

236
Q

antibody against acetylcholine receptor in postsynaptic membrane?

A

myasthenia gravis

237
Q

antibody against presynaptic membrane voltage gated calcium channels

A

Lambert-Eaton

238
Q

Muscle fiber injury that caues symmetrical and more proximal muscle weakness

A

dermatomyositis/polymyositis

239
Q

50% of cases of lambert eaton syndrome are associated with what malignancy?

A

small cell lung cancer

240
Q

diminished or absent deep-tendon reflexes in conjunction with proximal muscle weakness indicates what disease?

A

lambert eaton

241
Q

Acute inflammatory demyelinating polyneuropathy?

A

Guillain-Barre

242
Q

CNS inflammation and demyelination?

A

MS

243
Q

upper and lower motor neuron degeneration

A

ALS

244
Q

Dyspnea, PND, hemoptysus afib, voice hoarseness - can be clinical features of what valve issue?

A

mitral stenosis

245
Q

On physical exam what skin finding can you see with mitral stenosis?

A

mitral facies (pink-purple patches on cheeks)

246
Q

In a young patient from a developing country, presentation of progressive SOB, nocturnal cough and hemoptysis is highly suggestive of

A

Rheumatic mitral stenosis

247
Q

Three major mechanical complications of MI?

A

Papillary muscle rupture
Left ventricular free wall rupture
Interventricular septum rupture

248
Q

Adverse effects of antithyroid drugs (methimazole and propylthiuracil)

A

Methimazole: 1st trimester teratogen, cholestasis

Propylthiouracil: hetpatic failure, ANCA vasculitis

AGRANULOCYTOSIS for both

249
Q

Risks of radioiodine ablation for hyperthyroidism?

A

permanent hypothyroid
worsening of ophthalmopathy
radiation side effects

250
Q

most common adverse effect associated with use of any inhaled corticosteroid is

A

oropharyngeal candidiasis

251
Q

Adverse cardiovascular effects of phosphodiesterase inhibitors (sildenafil)

A

Hypotension (esp if used with nitraets and alpha blockers)

252
Q

Ocular effects of phosphodiesterase inhibitors

A

blue discoloration of vision

anterior ischemic optic neuropathy

253
Q

GU effects of phosphodiesterase inhibitors

A

priapism

254
Q

Another name for mucosal tear at the GE junction?

A

mallory-weiss tear

255
Q

Anemia types with decreased MCV

A
  • Iron deficiency
  • Lead
  • Thalassemia
  • Sideroblastic anemia
256
Q

Anemia with increased MCV?

A
  • B12

- Folate

257
Q

How do you differentiate anemia types with normal MCV?

A

Order reticulocyte count

258
Q

Normal MCV anemias with low reticulocyte count?

A
  • leukemia
  • aplastic anemia
  • infection
  • medications
259
Q

normal MCV anemia with increased retic count?

A

-hemorrhage
-hemolysis
(Intrinsic: inherited defects of hemoglobin, RBC membrane, enzymes)

(Extrinsic: autoimmune, paroxysmal nocturanl hemoglobinuria)

260
Q

Disorder with increased mean corpuscular hemoglobin concentration
(MCHC), hemolytic anemia, jaundice, splenomegaly

A

Hereditary spherocytosis

261
Q

Does drug induced immune hemolytic anemia have a positive or negative Coombs test?

A

positive

262
Q

What complication of chronic hemolytic anemia can lead to a megalobblastic anemia picture?

A

folate deficiency because hemolysis process consumes folate

263
Q

Acute cholecystitis from pigmented gallstones in a northern european person?

A

think hemolysis. think hereditary spherocytosis

264
Q

How can you differentiate osmotic from secretory diarrhea?

A

stool osmotic gap

Osmotic- elevated osmotic gap

265
Q

Type 2 heparin-induced thrombocytopenia (HIT) clinical presentation

A

a drop in platelets by > 50% or a new thrombus within 5-10 days of hep administration

thrombocytopenia and thrombus

266
Q

management of suspected HIT

A

discontinue all heparin products immediately. anticoag initiated with non-hep medication (argatroban and fondaparinux)

267
Q

diagnosis of HIT?

A

serotonin release assay (gold standard)

high-titer immunoassay of blood

268
Q

of diseased subjects/overall subjects at risk calculates?

A

RISK

269
Q

PEEP is calculated using what maneuvar?

A

end-expiratory hold maneuvar

270
Q

Plateau pressure is measured during an?

A

inspiratory hold maneuvar (pulm airflow and resistive pressure are both at 0)

271
Q

Plateau pressure equals

A

elastic pressure + PEEP

272
Q

Pathology of increased peak pressure with normal plateau pressure

A

bronchospasm, mucus plug

273
Q

increased peak pressure with increased plateau pressure

A

pneumothorax, pulm edema, pneumonia, atelectasis, right mainstem intubation

274
Q

Cyanide toxicity is a risk in what patients?

A

prolonged infusions or higher does of nitroprusside

275
Q

in HTN emergencies, MAP should be lowered by ___ in 1st hour and ____ in next 23 hours

A

10-20%

5-15%

276
Q

Broad casts and waxy casts are seen in patients with?

A

chronic renal failure

277
Q

Muddy brown casts

A

ATN

278
Q

RBC casts

A

glomerulonephritis

279
Q

WBC casts

A

AIN, pyelo

280
Q

Fatty casts

A

nephrotic syndrome

281
Q

broad and waxy casts

A

chronic renal failure

282
Q

acute back pain and point tenderness after lifting suggests?

A

vertebral compression fractrue

283
Q

Positive straight leg raise indicates?

A

radicular pain- herniated disc

284
Q

Lumbar spinal stenosis improves with?

A

leaning forward or lying down

285
Q

chondrocalcinosis (calcification of articuar cartilage) is associated with?

A

pseudogout

286
Q

Heberden nodes

A

enlarged bony spurs that occur at DIP joints in osteoarthritis

287
Q

flashes of light, spots in visual field, curtain coming down over eye is indicative of?

A

retinal detachment

288
Q

With retinal detachment, opthalmoscopic exam reveals?

A

grey, elevated retina

289
Q

opthalmoscopic exam with pallor of optic disc, cherry red fovea, boxcar segment of blood in retinal veins and painless loss of vision in one eye

A

Central retinal artery occlusion

290
Q

painless progressive blurring of central vision with central scotoma, abnoral vessels in retina,

A

exudative macular degeneration

291
Q

OA affects what joints in the hand?

A

DIP and PIP

292
Q

progressive fibrosis of palmar fascia with nodule or thickening?

A

dupuytren contracture

293
Q

charcot joint

A

decreased sensation in lower extremity (patients unknowingly traumatize weight bearing joints)

294
Q

RA involves what joints?

A

MCP

295
Q

traumatic deceleration injury can cause what significant cause of morbidity?

A

diffuse axonal injury

296
Q

numerous punctate hemorrhage and blurring of grey white interface on CT is indicative of?

A

diffuse axonal injury

297
Q

biconvex collection on CT ?

A

epidural

298
Q

crescentic collection on CT

A

subdural

299
Q

Behcet disease presents as?

A

multiple oral/genital ulcers

uveitis

300
Q

Felty syndrome

A

advanced RA. splenomegaly and neutropenia

301
Q

MMR, zoster, varicella are contraindicated if CD4 count is < _______

A

200

302
Q

What vaccines should HIV patients receive?

A 
HBV if no immunity
HAV if chronic liver disease, MSM, IV drugs
HPV if not given
Influenza (IM)
Meningococcus (if not received)
Pneumococcus (PCV13 one and PPSV23 8 weeks later) 
Tdap once and Td every 10 years
Varicella if not immune and CD > 200
303
Q

management of COPD exacerbation

A 
Oxygen with target O2: 88-92%
Inhaled bronchodilator
systemic glucocorticoid
Antibiotics if > 2 cardinal symptoms
Oseltamivir if evidence of influenza
NPPV if vent failure
Trach intubation if needed
304
Q

cardinal symptoms that indicate giving abx to COPD patients?

A

mod to sever exacerbation. increased sputum. mech ventilation requirement.

305
Q

Metabolic alkalosis can be categorized into what 2 branches

A

saline responsive

saline unresponsive

306
Q

saline responsive met alkalosis is often due to?

A

loss of gastric secretions (self-induced or spontaneous vomiting or nasogastric suctioning)

307
Q

Another way to divide metabolic alkalosis is based on?

A

urine chloride

high or low

308
Q

low urine chloride met alkalosis indicates?

A

vomiting

prior diuretic use

309
Q

all forms of RTA cause?

A

non-gap metabolic acidosis

310
Q

most common causes of secondary clubbing are?

A

lung malignancy and CF and right to left cardiac shunts

311
Q

When you see scrotal varicocele what should you consider on the diff dx?

A

RCC

312
Q

Left sided varicocele that fails to empty when patient is recumbent in a patient with hematuria - its important to consider?

A

RCC (gonadal vein empties into renal vein on left side)

313
Q

If PE or DVT with hemodynamic instability or life threatening ischemia- > what is first step?

A

thrombolytics unless contraindication

314
Q

if no hemodynamic instability or massive DVT with severe swelling that may cause ischemia what is first step?

A

anticoagulation unless contraindication

315
Q

esophageal webs cause dysphagia to solids? solids and liquids?

A

solids only

316
Q

Esophageal webs are associated with?

A

iron deficiency. Plumber vinson syndrome

317
Q

polymyositis affects what portion of the esophagus?

A

upper 3rd (striated muscle)

318
Q

diagnosis of AAT?

A

serm AAT levels and PFTs

319
Q

A PAC/PRA > 20 with plasma aldo > 15 suggests?

A

primary hyperaldosteronism

320
Q

If you suspect primary aldo, what test should you do?

A

adrenal suppression test. salt load and confirm inabilit to suppress aldo

321
Q

If you have (+) adrenal suppression test, you should then?

A

CT adrenals

322
Q

If CT does not reveal a discrete adrenal mass, what do you do next?

A

adrenal vein sampling

323
Q

Dex suppression test can diagnose?

A

cushing syndrome

324
Q

Approach to wide complex tachycardia. what is your first question to help diagnose?

A

Is there AV dissociation or fusion/capture beats?

325
Q

fusion beats are diagnostic of?

A

monomorphic ventricular tachycardia

326
Q

how do you treat patients with hemodynamically stable SMVT

A

IV amiodorone

327
Q

SVT is a narrow or wide complex tachy?

A

narrow.

328
Q

what is a good first step for SVT management?

A

carotid sinus massage or vagal maneuvars

329
Q

unstable Vtach management?

A

synchronized cardioversion

330
Q

Dig is used for rate control in what types of arrythmias?

A

SVTs

331
Q

Patients with vfib or pulseless VT should be managed with?

A

defibrillation (unsynchronized shock)

332
Q

serum/urine protein electrophoresis, peripheral blood smear, serum free light chain analysis are screening tests for?

A

multiple myeloma

333
Q

renal insufficiency, anemia and hypercalcemia should make you think about?

A

Multiple myeloma

334
Q

senile purpura (solar or actinic purpura) is caused by?

A

loss of elastic fibers in perivascular connective tissue

335
Q

Lymph node aspiration is used to diagnose?

A

Klebsiella granulomatis infection

336
Q

pathergy test (inserting needle into skin and checking the site 24-48 hours later for dvelopment of > 2mm papule) is used to test for ?

A

behcet syndrome (recurrent oral and genital ulcers)

337
Q

frontotemporal dementia (Pick’s disease) presnts with?

A

early personality changes

apathy, disinhibition, compulsive behavior

338
Q

dementia with lewy body presents as?

A

visual hallucinations**
spontaneous parkinsonism
fluctuating cognition

339
Q

normal pressure hydrocephalus prsents as?

A

ataxia
urinary incontinence
dilated ventricles on imaging

340
Q

prion disease presetns as

A

behavioral changes
rapid progression
myoclonus, seizures

341
Q

vascular dementia presents as?

A

stepwise decline

early executive dysfunction

342
Q

Fidaxomicin

A

bactericidal abx reserved for recurrent colitis

343
Q

c.diff with WBC < 15,000 can be treated with?

A

PO metronidazole

344
Q

c.diff with WBC > 15,000 treated with?

A

PO vancomycin (IV does not get into colon) w. or w.o IV metronidazole

345
Q

First step in evaluating solitary pulmonary nodule?

A

previous x-rays

346
Q

if a solid lesion revealed on imaging is stable for > 2 years then malignancy is?

A

ruled out and no further testing needed

347
Q

If there are no previous x-rays to compare with the solitary lung nodule, what should be done?

A

CT scan

348
Q

When would you get PET or biopsy of a solitary lung nodule?

A

when intermittent suspicion of malignancy

349
Q

Oligoclonal IgG bands on CSF analysis?

A

multiple sclerosis

350
Q

Albuminocytologic dissociation (elevated CSF protein with a normal cell count)

A

characteristic of Guillain-Barre syndrome

351
Q

14-3-3 protein in CSF?

A

neurodegenerative prion disease- Cruetzfeld Jakob

352
Q

studies have shown that what type of CPR improves outcomes for sudden cardiac arrest patients outside of hospital?

A

compression only CPR

353
Q

What is the strongest predictor of stent thrombosis in the first 12 months?

A

premature discontinuation of antiplatelet therapy

354
Q

presbyopia

A

common age related eye disorder resulting from decreased elasticity of the lens

355
Q

Presence of middle ear infusion without evidence of acute infection is indicative of?

A

serious otitis media in an HIV patient

356
Q

combination of liver diease and neuropsych symptoms (involuntary movements and tremors) in a young adult is highly suggestive of?

A

Wilson disease

357
Q

ichthyosis vulgaris

A

chronic, inherited skin disorder characterized by diffuse dermal scaling

358
Q

RA most commonly affects what part of the spine?

A

cervical

359
Q

Major duke criteria?

A
  1. blood culture positive for typical microorganism

2. echo showing valv vegetation

360
Q

Minor duke criteria

A
  1. predisposing cardiac lesion
  2. IV drug use
  3. Temp > 38
  4. Embolic phenom
  5. immune phenom
  6. positive blood culture
361
Q

How do you diagnose IE based on duke criteria?

A

DEFINITE: 2 major IE or 1 major and 3 minor

Possible: 1 major and 1 minor or 3 minor

362
Q

Spinal stenosis improves when you?

A

Flex spine. “lean over a shopping cart”

363
Q

bone pain that is constant and worse at night with point tenderness on exam?

A

metastasis to bone

364
Q

pronator drift is a sensitive and specific sign for ________

A

upper motor neuron or pyramidal tract lesions

365
Q

What is the first step you should take after you identify a thyroid nodule?

A

TSH level and thyroid US

366
Q

If cancer risk factors or specific US findings with thyroid nodule, what should you do next?

A

FNA

367
Q

a cold thyroid nodule indicates?

A

higher risk of cancer. should be evaulated with an FNA

368
Q

anti-thyroid peroxidase antibodies can identify what?

A

hashimoto thyroiditis

369
Q

Radionuclide scan is indicated in patients with low or high TSH?

A

low

370
Q

How do you diagnose a colovesical fistula?

A

abdominal CT with oral or rectal contrast (will show contrast media in bladder)

371
Q

Emphysematous pyelonephritis

A

pyelo due to gas-producing infection (typically in patients with diabetes)

372
Q

What abx is used in HIV patients with CD 4 < 50 to prevent MAC?

A

Azithromycin

373
Q

Patients with suspected acute stroke should initially receive what test? why?

A

CT scan of head w/o contrast

to rule out hemorrhage

374
Q

theophylline toxicity

A 
narrow therapeutic window. 
CNS stimulatino (HA, insomnia, seizure)
GI (n/v) 
Card tox (arrhythmia).
375
Q

What drug can decrease clearance of theophylline?

A

ciproflox

376
Q

trigeminal neuralgia is treated with ?

A

carbamazepine

377
Q

headache with acute, intermittent, severe retro-orbital pain

A

cluster

378
Q

HA with constant pressure in temp/orbital region

A

tension

379
Q

HA unilateral, pulsatile, throbbing ass with n/v

A

migraine

380
Q

A normal A-a gradient is?

A

< 15

381
Q

An A-a gradient > ____ is considered elevated regardless of age

A

30

382
Q

The A-a gradient is normal when the cause of hypoxemia is?

A

reduced inspired O2 or hypoventilation

383
Q

clinical features of mycoplasma pneumonia?

A

indolent HA, malaise, persistent dry cough**, pharyngitis, macular/vesicular rash

384
Q

Diagnostic lab studies for mycoplasma pneumonia?

A

normal leukocyte count
subclinical hemolytic anemia (cold agglutinins)
**Interstitial infiltrate (not lobar) (cxray)

385
Q

Abx used to treat mycoplasma pneumonia?

A

Azithromycin

386
Q

poor retention of study subjects falls under what type of bias?

A

selection

387
Q

attrition bias is a type of _____ bias where?

A

selection bias where patients are lost to follow up

388
Q

surveillance bias?

A

exposed group undergoes increased monitoring relative to general population and this increases disease diagnoses

389
Q

basic lab analysis or tests for patients initially diagnosed with HTN?

A

urinalysis (occult hematuria and/or protein creatinine ratio)

chemistry panel, lipid profile (risk for CAD), baseline ECG

390
Q

24 hour urine cortisol is used to evaluate?

A

Cushing syndrome

391
Q

Indications for statin therapy (Primary prevention)

A

Estimated 10 year risk of ASCVD: > 7.5%

392
Q

(Secondary prevention) and indication for statin therapy

A

Known ASCVD. (MI, stroke)

LDL > 190

393
Q

In patients with significant hyperkalemia who develop ECG changes what should you give?

A

IV calcium gluconate

394
Q

ECG findings found with hyperkalemia?

A

tall peaked T waves, PR prolongation, QRS widening, disappearance of P wave, conduction blocks, bradycardia

395
Q

Angiotensin II leads to a net increase or decrease in renal blood flow? why?

A

Net decrease! it constricts afferent and efferent arterioles

396
Q

how does angiotensin II increase GFR?

A

preferential vasoconstriction of efferent

397
Q

tumor lysis syndrome

A

develops in patients with aggressive heme malignancies who undergo chemo.

  1. hyperuricemia
  2. hyperkalemia and hyperphosphatemia
  3. hypocalcemia (due to phosphate binding)
398
Q

How can you prevent tumor lysis syndrome?

A

pretreatment with IV fluids and allopurinol

399
Q

adverse affects of hydroxychloroquine?

A

retinopathy with potential irreversible vision loss

400
Q

painless thyroiditis (silent thyroiditis)

A

acute thyrotoxicosis with mild thyroid gland enlargement and suppressed TSH

401
Q

radio-iodine uptake is increased/decreased with painless thyroiditis?

A

decreased (suggesting release of preformed thyroid hormone)

402
Q

In graves disease, radio-iodine uptake will be increased/decreased?

A

increased (increased synthesis of thyroid hormone)

403
Q

which types of thyroiditis (hyperthyroid) have spontaneous recovery?

A

painless thyroiditis and subacute thyroiditis

404
Q

what are the 2 most common bacterial pathogens causing solitary brain abscess?

A

Viridans strep
Staph aureus
gram negative

405
Q

Pathogenesis of brain abscesses?

A

direct from adjacent infection -> sinusitis, otitis, dental infection

hematogenous: endocarditis, osteomyelitis

406
Q

hypodense lesions in temportal lobe?

A

herpes encephalitis

407
Q

malignant otitis externa

A

severe infection typically seen in elderly diabetic patients most commonly caused by Pseudomonas aeruginosa

408
Q

granulation tissue seen in ear canal and ear pain and drainage that is not responsive to topical meds makes you think of?

A

malignant otitis externa

409
Q

In ARDS you want to maintain PaO2 at? and O2sat at?

A

PaO2: 55-80

O2sat: 88-95

410
Q

FiO2 levels

A

60%

411
Q

Diagnostic requirements for severe acute liver injury?

A 
ALT and AST > 1000
hepatic encephalopathy (confusion, asterixis)
Synthetic dysfunction (INR >1.5)
412
Q

upper lung lobe bronchiectasis is particularly characteristic of?

A

CF

413
Q

sialadenosis is often found in patients with?

A

advanced liver disease or malnutrition

414
Q

Without alveolar ventilation (inflammatory exudate filled alveoli in pneumonia) are you able to correct hypoxemia with increased concentration of FiO2?

A

NO

415
Q

Management for TCA overdose?

A

concern for CNS depression, hypotension and QRS prolongation. Secure ABCs. Administer sodium bicarb.

416
Q

most common complication of influenza in patients > 65

A

secondary bacterial pneumonia

417
Q

Young patients are at risk for secondary bacterial pneumonia after influenza with what pathogen?

A

CA-MRSA

418
Q

CA-MRSA pneumonia is characterized by?

A

severe necrotizing pneumonia that is rapidly progressive and often fatal. high fever, productive cough with hemoptysis, leukopenia, multilobar cavitary infiltrates

419
Q

fever, pleuritic chest pain, hemoptysis?

A

aspergillus

420
Q

corrected calcium equation =

A

(measured total calcium) + .8 (4 - serum albumin)

421
Q

most common form of drug induced chronic renal failure?

A

analgesic nephropathy

most commonly seen in women age (50-55) who habitually use (aspirin/naproxen)

422
Q

CA-19 is helpful as a postop monitoring tool for what type of cancer?

A

pancreatic cancer

423
Q

Sensory innervation of cornera comes from?

A

opthlamnic branch of trigeminal nerve (CN V)

424
Q

Clinical features of primary adrenal insufficiency

A

fatigue, weakness, anorexia/weight loss, salt craving, GI symptoms, hyperpigmentation, hypotension, hyponatremia, hypokalemia

425
Q

More common in african americans. asymptomatic initial stages followed by gradual loss of peripheral vision over period of years

A

Open angle glaucoma

426
Q

Open angle glaucoma exam findings

A

cupping of the optic disc

427
Q

Management of open angle glaucoma

A

Timolol eye drops

428
Q

osteonecrosis (aseptic necrosis)

of femoeral head is a common complication of?

A

sickle cell disease

429
Q

Clinical manifestations of avascular necrosis of the hip

A

groin pain on weight bearing
pain on hip abduction and internal rotation
no erythema, swelling, point tenderness

430
Q

decreased leukocytes due to viral suppression, and atypical lymphocytes on blood smear are a sign of?

A

EBV mono

431
Q

plasmodium vivax

A

organism responsible for malaria

432
Q

Osmolal gap causes of anion gap acidosis

A

ethylene glycol (calcium oxalate crystals)
methanol (blindness)
propylene glycol

433
Q

calculated serum osmolality =

A

2(Na) + Gluc/18 + BUN/2.8

434
Q

Osmole gap =

A

meausred serum osm - calculated serum osm

435
Q

mixed anion gap metabolic acidosis and resp alkalosis

A

Aspirin (salicylate tox)

436
Q

most common cause of nutritional folate deficiency in the US?

A

alcoholism

437
Q

defective mineralization of organic bone matrix?

A

osteomalacia due to severe Vit D deficiency

Rickets in kids (defective mineralization at the growth plate)

438
Q

Vit D deficiency can be caused by?

A

malabsoprtion, intestinal bypass, celiacs, chronic liver or kidney disease

439
Q

what do you treat myesthenia gravis with?

A

acetylcholinesterase inhibitor (pyridostigmine)

440
Q

Treatment for unilateral adrenal adenoma?

bilateral adrenal hyperpasia?

A 
surgery (preferred)
Aldo antagonists (spironolactone, eplerenone)

hyperplasia: aldo antags

441
Q

What is a toxic dose of acetaminophen in adults? in kids?

A

> 7.5g adults

> 150mg/kg in kids

442
Q

When do you administer charcoal for acetiminophen ingestion?

A

When toxic ingestion of >7.5 or greater than 150mg/kg in kids and if its been <4 hours since ingestion

443
Q

anidote for acetiminophen tox?

A

N-acetylcysteine

444
Q

muscle and joint paints, retroorbital pain, rash, leukopenia after traveling to kenya

A

Dengue fever

445
Q

Etiology of primary adrenal insufficiency

A

Autoimmune
Infections (TB, HIV, dissemintated fungal)
Hemorrhagic infarct
Cancer

446
Q

risk for epiglotittis is much higher in which individuals?

A

non immunized (most often due to H flu

447
Q

What are the radiolucent stones?

A

uric acid stones

xanthine stones

448
Q

treatment for uric acid stones?

A

hydration
alkalinization of urine with PO potassium citrate
low purine diet

449
Q

Management of recurrent hypercalciuric stones?

A

hydrochlorothiazide (decreases urinary calcium excretion)

450
Q

Greatest risk factor for both ischemic and hemorrhagic stroke?

A

hypertension (4X the risk of CVA compared to normotensive)

451
Q

Presentation of rotator cuff impingement or tendinopathy

A
  • pain with abduction and external rotation
  • subacromial tenderness
  • positive impingement test
  • normal ROM
452
Q

Rotator cuff tear presentation

A

> 40 yoa (usualy after fall on outstretched arm)

weakness with external rotation

453
Q

adhesive capsulitis (frozen shoulder) presentation

A

decreased passive and active ROM

More stiff than painful

454
Q

Biceps tendinopathy/rupture presentation

A

sudden onset, audible pop, visible bulge
anterior shoulder pain
pain with lifting, carrying, overhead reaching
weakness less common

455
Q

glenohumeral osteoarthritis presentation

A

uncommon.
usually caused by trauma.
gradual onset of anterior/deep shoulder pain
decreased ROM

456
Q

Jarisch-Herxheimer reaction

A

Seen in patients with early Syphillis treated with antibiotic.
rapid destruction of spirochetes causes an acute febrile illness with myalgia, HA, rigors, sweats, worsened syphilitic rash (self limiting in 48 hours)

457
Q

Immune reconstitution inflammatory syndrome

A

occur in patients with HIV initiated on highly actie antiretroviral treatment-> paradoxical worsening of symptoms due to immune system improvement

458
Q

Lynch syndrome associated neoplasms

A

colorectal, endometrial, ovarian

459
Q

FAP associated neoplasm

A

colorectal
desmoid (CT) and osteoma
brain tumor

460
Q

von Hippel-Lindau syndrome associated neoplasms

A

hemangioblastoma
clear cell renal carcinoma
pheochromocytoma

461
Q

MEN 1 neoplass

A

pituitary
parathyroid
pancreas

462
Q

MEN 2 neoplasms

A

med thyroid
parathyroid
pheo

463
Q

For patients with lynch syndrome, what endometrial screening should they have?

A

annual endometrial biopsy at age 30-35

464
Q

If child bearing is complete, what prophylactic surgery should lynch syndrome patients have

A

oophorectomy and hysterectomy at age 40

465
Q

Criteria for long term O2 therapy in patients with COPD?

A

Resting PaO2 < 55 or SaO2 < 88%

PaO2 <59 or SaO2 <89 in patients iwth cor pulmonale, RHF, hematocrit > 55%

466
Q

Treatment for polymyositis (proximal muscle weakness and elevated CK)

A

Systemic glucocorticoids

467
Q

Definitive diagnostic test for polymyositis?

A

muscle biopsy showing endomysial infiltrate and patchy necrosis

468
Q

Beta interferon is used to treat?

A

MS

469
Q

Riluzole is used to treat

A

ALS

470
Q

Age of Zenker?

A

Age > 60.

471
Q

what causes ZD?

A

upper esophageal spincter dysfunction and esophageal dysmotility

472
Q

A common cause of a wide confidence interval that also decreases study power?

A

small sample size

473
Q

Treatment/management of aortic dissection

A

pain control: morphine
IV B-blockers
Sodium nitroprussife if SBP > 120
Urgent surgical repair

474
Q

Thick haustral markings that do not extend across the entire lumen should make you think about?

A

toxic megacolon

475
Q

How do you diagnose toxic megacolon?

A

plain abdominal x-ray and 3 or more of: fever > 38, pulse >120, WBC > 10,500 and anemia

476
Q

A ruptured ______ cyst can cause anaphylaxis with eventual shock

A

anaphylaxis

477
Q

Differential diagnosis of hyperadrogenism in females

A

PCOS, nonclassic CAH, ovarian/adrenal tumor, hyperprolactinemia, Cushing, Acromegaly

478
Q

rapid onset hirsutism suggests what diagnosis?

A

androgen-secreting neoplasm of ovaries or adrenal glands

479
Q

Women with suspected androgen producing tumor should be evaluated with?

A

serum testosterone and DHEAS

480
Q

Elevated T levels with normal DHEAS levels suggest _____ source for tumor

A

ovarian

481
Q

17-OHP is used to screen for?

A

CAH due to 21-hydroxylase

482
Q

Why might hgb be elevated in patients with excess T?

A

T stimulates erythropoiesis

483
Q

Polycythemia vera predisposes patients to developing______ due to clonal hyperproliferation of red cells, white cells, platelets

A

GOUT

484
Q

prutitis with hot baths, hepatosplenomegaly and gout? diagnosis-

A

Polycythemia vera

485
Q

Genetic deficiency of hypoxanthine -guanine transferase in a patient with self-injurious behavior

A

Lesch-Nyhan sydrome

486
Q

Prolactin levels should be > _____ to suggest prolactinoma vs a nonfunctioning adenoma

A

200

487
Q

therapy for afib due to hyperthyroidism?

A

beta blockers

propranolol (it also decreases conversion of T4 to T3)

488
Q

Most common cause of an isolated, asymptomatic elevation of alk phos in elderly patient?

A

PAGET disease of bone (osteitis deformans)

489
Q

what imaging modality is useful to stage paget disease?

A

radionuclide bone scan

490
Q

Treatment for paget dsiease

A

bisphosphonates

491
Q

Fever, weight loss rhinosinusitis and nectrotizing pulm vasculitis are commonly seen in what disease?

A

Wegener’s

492
Q

Ondansetron MOA

A

serotonin receptor antagonist

493
Q

serotonin receptor antagonists (ondansetron) are first line for?

A

chemo induced nausea

494
Q

What antibiotic can be used as a motilin agonist to treat nausea secondary to gastroparesis

A

Erythromycin

495
Q

How to treat symptomatic microprolactinoma or a macroprolactinoma > 10mm

A

DA agaonists (Cabergoline, Bromocriptine)

Resection for tumor > 3cm

Step 2 CK (26 decks)

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