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Medicine Flashcards

1
Q

Gram pos filamentous rod

A

Actinomyces

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2
Q

What bug causes Craniofacial infections after dental procedures?

A

Actinomyces

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3
Q

What are 3 features of actinomyces infections?

A
  1. Abscess formation
  2. Sinus tracts
  3. Sulfur granules
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4
Q

What is the best abx for actinomyces infections

A

Penicillin

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5
Q

What are 4 EKG findings in ischemia?

A
  1. ST changes
  2. New LBBB
  3. T-wave inversions
  4. Pathologic Q waves
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6
Q

What lung cancer is associated with SIADH?

A

Small cell

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7
Q

What is the initial therapy for SIADH and why? What if severe?

A

Water restriction (if serum Na >120 and pt asx) to increase serum sodium, but can give hypertonic saline + furosemide if pt develops symptoms of hyponatremia

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8
Q

What are sx of severe hyponatremia?

A

Lethargy
Altered mental status
Seizures
Coma

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9
Q

How do you differentiate between folate and vitb12 deficiencies

A

Folate – elevated homocysteine, normal MMA levels, no neuro sx
VitB12 – elevated homocysteine, elevated MMA levels, neuro sx

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10
Q

What is the initial treatment of tachycardia or afib secondary to hyperthyroidism?

A

Beta blocker (if HD stable) or cardioversion (if unstable)

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11
Q

inflammation, fibrosis and segmental constriction and dilation of infra and extrahepatic bile ducts

A

Primary sclerosing cholangitis

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12
Q

Dx test for primary sclerosing cholangitis

A

ERCP or MRCP

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13
Q

Decreased ceruloplasmin

A

Wilson’s disease

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14
Q

Elevated CA 19-9

A

Cholangiocarcinoma
Colon cancer
Pancreatic cancer

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15
Q

Positive antimitochondrial antibodies

A

Primary biliary cholangitis

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16
Q

What Antibody is found in primary biliary cholangitis?

A

Antimitochondrial Antibody

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17
Q

Dx test for Wilson’s disease

A

Low plasma ceruloplasmin

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18
Q

Nonsuppartive granulomatous destruction of intrahepatic bile ducts

A

Primary biliary cholangitis

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19
Q

treatment of Hodgkin Lymphoma

A

BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone

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20
Q

Adverse effect of doxorubicin

A

Cardiotoxicity

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21
Q

Which chemotherapy agent is associated with cardiomyopathy?

A

Doxorubicin

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22
Q

Adverse effect of bleomycin

A

Pulmonary fibrosis

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23
Q

What chemotherapeutic agent is associated with pulmonary fibrosis?

A

Bleomycin

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24
Q

What are the 2 side effects of vincristine?

A

Areflexia

Peripheral neuritis

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25
Q

Which chemotherapeutic agent is associated with peripheral neuritis

A

Vincristine

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26
Q

Most common cause of Endocarditis in IV drug users

A

Staph aureus

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27
Q

Features of acute hypocalcemia

A

Tetany
Seizures
Papilledema

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28
Q

Features of chronic hypocalcemia

A

Dental problems
Cataracts
Basal ganglia calcification
Extrapyramidal symptoms

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29
Q

Ferruginous bodies are associated with what

A

Asbestosis

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30
Q

Asbestos exposure increases risk of what?

A

Bronchogenic carcinoma

Mesothelioma

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31
Q

What causes calcified pleural plaques

A

Asbestosis

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32
Q

Acid base disturbance in aspirin toxicity

A

Combined AG metabolic acidosis and respiratory alkalosis

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33
Q

Isoprotenerol

A

Nonselective B1 and B2 agonist

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34
Q

2 examples of nonselective alpha and beta blockade

A

Labetalol

Carvedilol

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35
Q

Diffuse alveolar damage causing increased alveolar capillary permeability

A

ARDS

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36
Q

Bronchiectasis

A

Dilated airways caused by chronic necrotizing pulmonary infections, obstructions or congenital anomalies causing dyspnea, purulent cough and hemoptysis

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37
Q

what is the treatment of chronic granulomatous disease?

A

IFN-y

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38
Q

What 5 diseases is IFN-a used for?

A 
Hep B
Hep C
Kaposi sarcoma 
Malignant melanoma 
Leukemia
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39
Q

What is IL11 used to treat?

A

Thrombocytopenia

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40
Q

What 2 diseases is IL2 used to treat?

A

Metastatic RCC

Metastatic melanoma

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41
Q

Abdominal pain, diarrhea, bloating all relieved with bowel movements

A

IBS

42
Q

Treatment of IBS

A 
High fiber diet
Water intake 
Exercise 
Avoid caffeine 
Antidiarrheals (loperamide) acutely
43
Q

What drug can be used to treat gastroparesis?

A

Erythromycin

44
Q

What is bismuth used for?

A

Peptic ulcers

45
Q

What are 4 indications for treatment with octreotide?

A

Acromegaly
Carcinoid tumors
VIPomas
Esophageal variceal bleeds

46
Q

What is the mechanism of action of aspirin?

A

Irreversibly inhibits COX1 and COX2 preventing conversion of arachidonic acid to thromboxane which mediate platelet aggregation

47
Q

Which heart sound is associated with longstanding HTN?

A

S4

48
Q

Which heart sound is benign in patients under 40?

A

S3

49
Q

Which heart sound is associated with CHF?

A

S3

50
Q

What is the diagnosis – headache, fever, hypesthesia in eye, photophobia, keratitis, crusted lesions on face

A

Herpes zoster ophthalmicus

51
Q

What is the best treatment of herpes zoster ophthalmicus

A

IV acyclovir, valacyclovir or famciclovir

52
Q

What is a feared complication of untreated herpes zoster ophthalmicus

A

Acute retinal necrosis

53
Q

What are the iron studies in iron-deficiency anemia?

A

Serum iron low
Ferritin low
Transferrin saturation low
TIBC high

54
Q

What are the iron studies in hemochromatosis?

A

Serum iron high
Ferritin high
Transferrin saturation high
TIBC low

55
Q

What are the iron studies in anemia of chronic disease?

A

Serum iron low
Ferritin high
Transferrin saturation low
TIBC low

56
Q

What vitamin deficiency condition is associated with celiac sprue?

A

Iron deficiency anemia

57
Q

What is the treatment of iron deficiency anemia?

A

PO Iron sulfate

58
Q

A pt with Crohns presents with periumbilical pain, N/V, fever, weight loss, and palpable RLQ mass. Diagnosis and next best step?

A

Abscess

CT Abd with PO and IV contrast

59
Q

What is a complication of hepatic adenomas?

A

Rupture causing intraperitoneal hemorrhage and shock

60
Q

What is the next best step in diagnosing hepatic adenoma?

A

Ultrasound then CT

61
Q

What is the treatment of hepatic adenomas?

A

Watchful wait, unless there is a danger of rupture, pt is symptomatic or it involves most of the liver the surgical resection

62
Q

Liver lesion that is well-circumscribed with a fibrous capsule and hemorrhagic core

A

Hepatic adenoma

63
Q

Which microbe can cause bilateral adrenal calcification and insufficiency?

A

TB

64
Q

MCC of adrenal insufficiency

A

Rapid discontinuation of chronic steroids

65
Q

What is the gold standard treatment of active TB?

A

RIPE for 6 months followed by rifampin and isoniazid for another 6 months

66
Q

What is the diagnostic test for suspected TB?

A

CXR then sputum acid fast then confirm with sputum culture

67
Q

What 3 findings could be seen on CXR in a patient with TB and what do they indicate?

A

Apical cavitary lesions – reactivated TB
Hilar and lower lobe nodes (Ghon) – primary TB
Multiple, fine, nodular densities – miliary TB

68
Q

What is the treatment for an asymptomatic patient with positive PPD?

A

Isoniazid for 9 months

69
Q

What is the BEST treatment for Lyme Disease?

A

Doxycycline (except in kids <8, pregnant women)

70
Q

Why shouldn’t doxycycline be used in children?

A

Causes discolored teeth ad delayed bone growth

71
Q

What symptoms occur in Stage 1 Lyme Disease?

A

Fever, rash, chills, fatigue, malaise

72
Q

What symptoms occur in Stage 2 Lyme Disease? When?

A

Joint pain, facial nerve palsy, heart block (4-6 weeks)

73
Q

What symptoms occur in Stage 3 Lyme Disease? When?

A

Arthritis, synovitis, subacute encephalitis (Months-years)

74
Q

What is the mechanism of action of doxycycline?

A

Inhibits Attachment of amino-acyl tRNA and halts translation

75
Q

What are 4 adverse effects of doxycycline?

A

GI upset
Photosensitivity
Discolored teeth
Inhibited bone growth

76
Q

What is the treatment of Lyme Disease in kids?

A

Amoxicillin if <8 (macrolide if penicillin allergy)

Doxycycline if >8

77
Q

What is the treatment of advanced or disseminated Lyme disease?

A

IV ceftriaxone or penicillin for 2-4 weeks

78
Q

What drug is associated with Gray baby syndrome

A

Chloramphenicol

79
Q

What antibiotic is associated with ototoxicity?

A

Aminoglycosides

80
Q

What antibiotic is associated with a metallic taste i mouth?

A

Metronidazole

81
Q

What is the mechanism of action of heparin?

A

Binds to and increases activity of anti-thrombin III

82
Q

What is the mechanism of HIT and when is the onset?

A

Heparin binds to PF4 and antibodies are generated against heparin-PF4-platelet complexes causing destruction, starts 5-14 days after starting heparin

83
Q

What is the criteria for diagnosing HIT?

A

Drop in platelet count >30% within 5-10 days of starting heparin, increased bleeding time with normal PT/PTT

84
Q

What are symptoms of HIT?

A

Fever, chills, dyspnea, bleeding, DVT/PE, skin necrosis, stroke

85
Q

How is HIT treated?

A
  1. Stop heparin
  2. Start direct thrombin inhibitor (argatroban, bivalirudin)
  3. Transition to warfarin when plts up
86
Q

For which 4 drugs would you need to monitor the absolute neutrophil count?

A

Clozapine
Ganciclovir
PTU
Methimazole

87
Q

What is the pathophysiology of DKA?

A

Stressor/insulin non-compliance –> hyperglycemia, loss of insulin –> breakdown of fatty acids –> ketogenesis, increased glucagon, GH, E/NE

88
Q

Diagnostic criteria for DKA

A

BG >250
PH < 7.3
bicarbonate < 15
Ketonuria or ketonemia

89
Q

What lab test do you follow during treatment of DKA?

A

Anion gap

90
Q

What is the treatment of DKA?

A

IVF
Insulin + glucose
Replete K and PO4

91
Q

What are the causes of acute pancreatitis?

A

PANCREATITIS – posterior perf peptic ulcer, Alcohol, neoplasm, cholelithiasis, renal disease, ERCP, anorexia, trauma, infections, toxins/drugs (thiazides, AZT, protease inhibitors), incineration, stings (scorpion), hypertriglyceridemia

92
Q

What is a potential finding on KUB in acute pancreatitis?

A

Sentinel loop – isolated dilated loop of small bowel from nearby inflammation

93
Q

What finding can be seen on CXR with acute pancreatitis?

A

Left-sided pleural effusion

94
Q

What are the Ranson criteria used for?

A

Determining prognosis of acute pancreatitis

95
Q

What is the treatment of acute pancreatitis?

A

IVF
NPO
NG tube decompression
Pain control

96
Q

What are 6 complications of acute pancreatitis?

A 
ARDS
Mediastinal abscess 
Atelectasis
Pleural effusion
Pseudocyst
Splenic vein thrombosis
97
Q

What is Goodpasture Syndrome?

A

Antibodies against GBM and alveolar basement membrane following upper respiratory infection

98
Q

Fever, cough, hemoptysis, arthralgias, peripheral edema, high blood pressure after a recent upper respiratory infection

A

Goodpasture’s syndrome

99
Q

How is the diagnosis of Goodpasture Syndrome made?

A
  1. CXR (diffuse opacities)
  2. Anti-GBM antibodies in blood
  3. Kidney biopsy showing linear staining on IF
100
Q

What is the treatment of Goodpasture Syndrome?

A
  1. Airway protection
  2. Plasmapheresis to remove antibodies
  3. Corticosteroids + cyclophosphamide

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