Medicine Clerkship Flashcards
1
Q
Doxazosin
A
Alpha-1 selective blocker used to tx hypertension and BPH
2
Q
Doxazosin and sildenaphil
A
Give at least 4 hours apart to reduce the risk of hypotension.
3
Q
MEN 2
A
Both: medullary carcinoma of the thyroid and pheo.
2A: hyperparathyroidism
2B: mucosal neuromas and marfanoid habitus
4
Q
MEN 1
A
3 P’s: pitutary adenoma, pancreatic islet cell tumor, hyperparathyroidism
5
Q
Choriocarcinoma in males (associated hormone)
A
beta-hCG
6
Q
Hormone elevation in teratoma
A
Increase in AFP or beta-cCG
7
Q
Hormone elevation in seminomas
A
Serum tumor markers are usually normal (beta-hCG may be elevated)
8
Q
Hormone elevation in Yolk sac tumor
A
AFP
9
Q
What happens to LH and FSH in Leydig cell tumor?
A
Leydig cell tumors cause increased estrogen production –> inhibition of LH and FSH
10
Q
B12 and Folic acid supplementation in strict vegetarians
A
Suspect B12 deficiency if there are neurological complications and anemia. Folic acid will correct the anemia but NOT THE NEUROLOGIC COMPLICATIONS!
11
Q
Characteristics of Hairy cell leukemia
A
Lymphocytes have fine, hair-like, irregular projections. Stains with tartrate-resistant acid phosphatase (TRAP).
12
Q
Treatment for hairy cell leukemia
A
Cladribine
13
Q
What happens to the bone marrow in hair cell leukemia
A
It becomes fibrotic, leading to dry taps
14
Q
“Soap bubble appearnace” on x-ray
A
GIANT CELL TUMOR OF BONE
15
Q
Treatment of CML
A
Imatinib –> binds the ATP binding site of the BCR-ABL protein (prohibiting the conformation change to its active form)
16
Q
What is the mutation of CML?
A
reciprocal translocation of chromosome 9 & 22 containing the BCR/ABL fusion gene
17
Q
What is used to treat HER2+ breast cancer?
A
Trastuzamab
18
Q
Major side effect of trastuzumab
A
cardiac toxicity (get an ECHO before beginning treatment)
19
Q
Differential for microcytic/hypochromic anemia
A
- Iron deficiency
- Defective utilization of storage iron (anemia of chronic disease)
- Reduced globin (thalassemias)
- Reduced heme synthesis (pb poisoning, sideroblastic anemia)
20
Q
Iron studies in iron-deficiency anemia
A
Depressed serum iron, increased TIBC, decreased serum ferritin
21
Q
Iron studies in thalassemias
A
Normal to high serum iron and ferritin levels
22
Q
Iron studies in Anemia of chronic disease
A
Below normal TIBC; normal or increased serum ferritin level
23
Q
Iron studies in sideroblastic anemia
A
Normal to high serum iron and ferritin values
24
Q
How can the level of HER2 expression be determined in breast cancer?
A
Immunohistochemical staining of FISH
–positvely predicts a positive response to trastuzumab and anthracycline chemo
25
Pagophagia
Pica for ice (quite specific for iron deficiency anemia)
26
Why are post-splenectomy patients at risk for sepsis?
They are at increased risk for sepsis from encapsulated organisms due to impaired antibody-mediated opsonization in phagocytosis
27
What does tamoxifen increase the risk of?
Endometrial cancer and venous thrombosis
28
Shat drugs can cause folic acid deficiency?
- -Antiepileptic drugs (phenytoin, primidone, phenobarbital)
- trimethoprim
- methotrexate
29
How can blood transfusions cause paresthesias?
Packed cells contain citrate, which can chelate serum calcuium
30
Does hypocalcemia or hypercalcemia cause paresthesias?
Hypocalcemia
31
What is the drug of choice for mild to moderate hypercalcemia due to malignancy?
Bisphophonates (IV fluids and furosemid are used in the treatment of hypercalcemic crisis)
32
Waht is the cause of senile purpura (bruising on extensor surfaces of old people)?
Perivascular connective tissue atrophy
33
What is seen on peripheral smear with lead poisoning?
Basophilic stippling
34
Treatment for lead poisoning?
Lead chelator (EDTA or succimer)
35
TTP
Consumptive thrombocytopenia caused by widespread platelet thrombi that form in the microcirculation.
1. Thrombocytopenia
2. Microangiopathic hemolytic anemia
3. Fever
4. Neurological signs
36
HUS
Similar to TTP:
1. Thrombocytopenia
2. Microangiopathic hemolytic anemia
3. Fever
4. Renal failure (NOT neurological signs)
37
What type of breast cancer is associated with Paget's disease of the breast?
Adenocarcinoma
38
What type of cancer is the vast majority of head and neck cancer?
Squamous Cell Carcinoma
39
What does heparin induced thrombocytopenia increase your risk for?
Arterial and venous clots (this is paradoxical)
40
S/sx of obstructive sleep apnea?
excessive daytime sleepiness, snoring, morning headaches, impotence, arterial hypertension. OSA --> short term hypoxemia, which is sensed by the kidneys --> increased EPO!!
41
What is the cause of acquired sideroblastic anemia?
Defective heme synthesis
42
What vitamin must be administered with INH?
Pyridoxine
43
Diagnosis in a patient with new-onset diabetes, arthropathy, and hepatomegaly?
hemochromatosis
44
What is the role of G6PD in RBCs?
G6PD is the enzyme involved in creating NADPH (a cofactor for glutathione, which prevents the oxidation of hemoglobin)
45
What are the characteristics of paroxysmal nocturnal hemoglobinuria?
Combination of:
1. hemolytic anemia
2. venous thrombosis
3. diminished hematopoiesis (anemia)
46
What is the treatment of MALT without any METS?
Eradicate H. Pylori (omperazole, clarithromycin, amoxicillin)
47
Trousseau's syndrome
Migratory thrombophlebitis (pain, itching, red streaks, cord like veins). It is typically in the chest and arms. Suggestive of underlying malignancy (esp adenocarcinoma)
48
Treatment of FAP?
Procto-colectomy at the time of diagnosis (100% go to colon cancer)
49
What does protein electrophoresis reveal for Waldenstrom's Macroglobulinemia?
IgM Spike
50
Differential diagnosis for a mediastinal mass?
4 T's: Thymoma, teratoma, thyroid neoplasm, and terrible lymphoma
51
What bone cancer has Codman's Triangle (periosteum lifted)
Osteosarcoma
52
Radiographic findings for osteosarcoma
1. Codman's Triangle
| 2. Sunburst Appearance
53
Waht is the characteristic radiographic findings in Ewing Sarcoma?
Onion Skinning
54
What is the characteristic radiographic finding for Giant Cell Tumor?
Soap Bubble Appearance
55
Soap Bubble Appearance
Giant Cell Tumor of Bone
56
Onion skinning on radiography
Ewing Sarcoma
57
Smudge Cells
Characteristic for CLL
58
What is the classic triad of glucagonoma?
Hyperglycemia, necrotizing dermatitis, and weight loss
59
Necrolytic Migratory Erythema
Erythematous, scaly plaques on the face and buttocks associated with glucagonoma.
60
Leukocyte Alkaline Phosphatase
Typically elevated in leukemoid reactions and low in CML
61
What is seen on bone marrow examination in multiple myeloma?
Overproliferation of plasma cells
62
What is the treatment for stroke secondary to sickle cell crisis?
Exchange transfusion
63
What is the first line treatment for a patient with severe symptomatic hypercalcemia?
Vigorous hydration with IV Normal Saline
64
What is the effect of aldosterone on sodium and potassium?
Aldosterone Saves Sodium and loses potassium
65
How does diabetes insipidus present?
Polyuria, polydipsia, and excretion of dilute urine in the presence of elevated serum osmolality
66
How does primary polydipsia present?
From excessive water drinking: both plasma and urine are diluted
67
How does SIADH present?
Hyponatremia, low serum osmolality, and inappropriately high urine osmolality.
68
What beta blockers can be used to treat pheo?
Labetolol- because it has both alpha- and beta-blocking activity
69
What are the 4 main conditions that present with hypokalemia, alkalosis, and normotension?
1. Surreptitious vomiting
2. Diuretic abuse (urine chloride is HIGH)
3. Bartter Syndrome (urine chloride is HIGH)
4. Gitelman's Syndrome
70
What is the most common cause of death in acromegaly?
Congestive Cardiac Failure
71
What are the characteristics of primary hyperaldosteronism?
hypertension, hypokalemia, metabolic alkalosis, suppressed plasma renin activity, and elevated plasma aldosterone
72
How do you calculate the serum osmolality?
2(serum Na) + blood glucose/18 + BUN/2.8
73
Orphan Annie Nuclei
Associated with papillary thyroid cancer
74
Papillary thyroid cancer
Orphan Annie nuclei are present. This is usually a solitary thyroid nodule or neck mass. GOOD PROGNOSIS.
75
What happens to Ca when there is an increase in pH?
An increase in extracellular pH causes an increase in the affinity of serum albumin to calcium --> decreased free calcium
76
Somogyi Effect
When nocturnal hypoglycemia leads to morning hyperglycemia (low glucose leads to an increase in the levels of counterregulartory hormones (epinephrine NE, and glucagon)
77
Increasing hat size in an old male
Paget's Disease of the bone (problem with remodeling)
78
What is the most common pituitary tumor?
lactotroph adenoma
79
What hormone do lactotroph adenomas produce?
Prolactin
80
Treatment for severe symptomatic hyponatremia
Hypertonic (3%) saline
81
How is non-ketotic hyperglycemic coma treated?
Fluid replacement with normal saline
82
What causes the hypertension in thyrotoxicosis?
The hyperdynamic circulation
83
What is a positive anti-thyroperoxidase (TPO) antibodies associated with?
Hashimoto's thyroiditis
84
What cancer are you at increased risk for after Hashiomoto's Thyroiditis?
Thyroid Lymphoma
85
Sick euthyroid syndrome
Abnormal thyroid function tests in an acute, severe illness. Usually results in a fall in total and free T3 levels with normal T4 and TSH levels "low T3 syndrome"
86
What thyroid cancer is associated with secretion of calcitonin?
Medullary cancer of the thyroid
87
What thyroid cancer has Hurthle Cells?
Follicular and Papillary Cancers
88
What thyroid cancer has psomma bodies?
Papillary thyroid cancer (most common thyroid malignancy)
89
What is the effect of vitamin D deficiency on bone architecture?
Causes defective mineralization of bone (from decreased availability of Ca and Phos at mineralization sites)
90
What is the difference between osteomalacia and rickets?
Osteomalacia (vit d deficiency in adults) results from defective mineralization of bone while rickets results from defective mineralization of bone and cartilage
91
How is acromegaly diagnosed?
Measure GH levels following an oral glucose load (most ind suppress GH with glucose, whereas patients with acromegaly have increased GH with glucose)
92
What is used for prevention of gout?
allopurinol and probenecid
93
What is used for the treatment of gout?
Colchicine, NSAIDs, and steroids
94
What is the most common cause of prosthetic joint septic arthritis?
S. Aureus
95
What is the range in synovial WBC count in septic arthritis?
50,000-150,000 (a WBC count of 10,000-50,000 may be found in crystal-induced arthritis)
96
What does osteoarthritis look like on Xray?
Joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts (most commonly in the DIP joints)
97
What is the main mechanism of kidney damage in SLE?
immune complex-mediated damage
98
What are the predisposing factors for avascular necrosis?
1. chronic corticosteroid therapy
2. alcoholism
3. hemoglobinopathies
99
How is avascular necrosis of the hip diagnosed (gold standard)?
MRI
100
What are the crystals in pseudogout?
Rhomboid, positively birefringent
101
What are the crystals in gout?
Needle-shaped and negatively birefringent
102
What is the first line treatment for rheumatoid arthritis?
Methotrexate
103
Enthesitis
Inflammation and pain at sites where tendons and ligaments attach to bone
104
What are the most common agents in cellulitis?
Group A Strep and S. Aureus
105
What joints are affected with rheumatoid arthritis?
MCPs, PIPs, wrists, and knees
106
Common findings for rotator cuff tear?
Pain worsened by pushing, pulling, lifting the arm above the head; limitations of mid arc abduction and external rotation
107
What diagnosis do you consider in a patient that appears to have RA but with acute onset, morning stiffness lasting <6 weeks?
Viral Arthritis (Parvovirus)
108
What is the most reliable index for monitoring the response to treatment in patients with DKA?
Arterial pH or anion gap
109
Melanosis Coli
Dark brown discoloration of the colon with lymph follicles shining through as pale patches. Seen with laxative abuse.
110
Organism in Cat Scratch Disease?
Bartonella henselae
111
What is the treatment of cat scratch disease?
5 days of azithromycin
112
What is the classic tetrad of multiple myeloma?
"CRAB:"
1. Calcium (hypercalcemia)
2. Renal Impairment
3. Anemia
4. Bones (bone pain, lytic lesions, fractures)
113
What is a common picture of an old plethoric male who complains of pruritus after bathing?
Polycythemia Vera
114
What percent of of the body is involved in Stevens Johnsons?
10%
115
What is Stevens Johnsons called if >30% of the body is involved?
Toxic Epidermal Necrolysis (TEN)
116
What is the cause of refractory hypokalemia in alcoholics?
Hypomagnesemia (important cofactor for potassium uptake and maintenance of intracellular potassium levels
117
What is the most common presentation of mesenteric ischemia (for boards)?
Pain out of proportion of the exam
118
What type of benign vascular tumor in children appear during the first weeks of life, grow rapidly, and regress by 5-8 yo?
Strawberry Hemangiomas (capillary hemangiomas)
119
What anti-opportunstic infection meds should transplant patients receive?
TMP-SMX, vaccines for influenza, pneumococcus, and hep B
120
What type of acid-base disturbance does aspirin toxicity cause?
Mixed respiratory alkalosis and metabolic acidosis (resp alk from increased respiratory drive and metabolic acidosis from the accumulation of salicylate and organic acids)
121
What antiretro viral can cause crystal-induced nephropathy?
Indinavir (protease inhibitor)
122
Common SE of didanosine (antiretro viral)
Induced Pancreatitis
123
Common SE the antiretroviral abacavir
hypersensitivity syndrome
124
Common SE the antiretroviral NRTI's as a class
lactic acidosis
125
Common SE the antiretroviral NNRTI's as a class
stevens-johnson
126
Common SE the antiretroviral nevirapine
liver failure
127
What type of lung cancer causes PTHrP?
Squamous Cell Carcinoma (sCa++mous)
128
How does PTH increase Ca in the blood?
It increases calcium resorption from the bones and increases renal calcium resorption in the distal tubule
129
Antibodies in primary biliary sclerosis
Anti mitochondrial
130
Antibodies in Sjögren's syndrome
Ro (ssa) and/or La (ssb)
131
What antvirals are ONLY active against influenza A?
Amantadine and rimantadine
132
What antivirals are activate against both influenza A and B?
Neuraminidase inhibotrs (zanamivir and oseltamivir)
133
What does ferritin represent?
Ferritin is representative of the body's iron stores
134
How is transferrin saturation calculated?
Iron/TIBC
135
What skin condition is associated with Parkinson's disease?
Seborrheic Dermatitis
136
What is the long term AE of cyclophosphamide?
Acute hemorrhagic cystitis and bladder carcinoma
137
What is the murmur associated with hypertrophic cardiomyopathy?
Crescendo-decrescendo murmur at the left lower sternal border; it increases during valsalva maneurver (due to decreased preload)
138
What happens to murmurs with valsalva?
They decrease; EXCEPT in hypertrophic cardiomyopathy (it increases in this)
139
What is chlordiazepoxide?
Librium- a benzodiazipine
140
What lung cancer is SIADH?
Small cell carcinoma
141
How do you diagnose UTI with urinalysis?
1. Nitrites
2. leukocyte esterase
3. >5 WBC/HPF
142
How is benzodiazepine overdose distinguished from opiod overdose?
Both present wiht slurred speech, unsteady gait, and drowsiness.
**Benzo OD lacks respiratory depression and lack of pupillary constriction
143
How can benzo and phenytoin OD be distinguished?
Phenytoin OD has nystagmus
144
What is the development of a palpable mass in the epigastrium 4 weeks after the onset of acute pancreatitis suggestive of?
Pseudocyst formation
145
What is the most sensitive test for disseminated histoplasmosis?
Antigen detection in the urine or serum
146
Treatment of choice for histoplasmosis
Itraconazole
147
Amaurosis fugax
Transient monocular blindness that only lasts a few minutes and is vascular in origin.
148
What is pseudotumor cerebri
Idiopathic intracranial hypertension
149
What HLA is associated with SLE?
HLA-DR2 and DR3
150
What are pregnant women with prior fetal loss and the presence of antiphospholipid antibodies treated with?
Low-dose heparin
151
How do you treat dermatomyositis and polymyositis?
Corticosteroids
152
What is the profile of a transudate?
1. Pleural:serum protein < 2/3 of the ULN
153
What should you avoid in acute angle glaucoma?
Atropine
154
What are the three major types of gallstones?
Cholesterol Stones
Pigment stones (composed of calcium bilirubinate)
Mixed stones
155
What is the treatment for a patient with hyperkalemia who develops significant EKG changes?
Calcium gluconate
156
What is the best initial test for SCC of the neck?
Panendoscopy (triple endoscopy = esophagoscopy, bronchoscopy, laryngoscopy) to detect the primary tumor, which is then biopsied.
157
What are spherocytes without central pallor typically seen in?
1. Hereditary Spherocytosis
2. Autoimmune Hemolytic Anemia
* *Both are extravascular hemolytic anemias
158
What is the difference between Hereditary Spherocytosis and Autoimmune Hemolytic Anemia?
Herediatary Spherocytosis has a strong family history (AD) & negative Coombs test while AIHA negative family history and positive Coombs test.
159
What is the best initial test for SCC of the neck?
Panendoscopy (triple endoscopy = esophagoscopy, bronchoscopy, laryngoscopy) to detect the primary tumor, which is then biopsied.
160
What are spherocytes without central pallor typically seen in?
1. Hereditary Spherocytosis
2. Autoimmune Hemolytic Anemia
* *Both are extravascular hemolytic anemias
161
What is the difference between Hereditary Spherocytosis and Autoimmune Hemolytic Anemia?
Herediatary Spherocytosis has a strong family history (AD) & negative Coombs test while AIHA negative family history and positive Coombs test.
162
How do you calculate corrected calcium?
Corrected Ca++ = 0.8 (normal albumin-measured albumin) + measured Ca++
163
What is Meniere's Disease?
Disorder of unclear etiology in which there is an abnormal accumulation of endolymph within the inner ear. characterized by vertigo + ear fullness
164
Where is plasmodium falciparum most common?
Sub-Saharan Africa and the Indian Subcontinent (India, Pakistan, and Bangladesh)
165
What is the drug of choice for plasmodium falciparum?
Mefloquine (plasmodium falciparum is chloroquine-resistant)
166
What is the prophylaxis and treatment for Plasmodium vivax or Plasmodium ovale?
Primaquine
167
Diagnosis for a patient with central scotoma, afferent pupillary defect, changes in color perception, and decreased visual acquity?
Optic Neuritis
168
What disease is optic neuritis associated with?
Multiple Sclerosis
169
What are gallstones made up of?
Cholesterol or calcium bilirubinate
170
SIRS Criteria
Fever greater than 38°C or hypothermia less than 36°C
Hyperventilation rate greater than 20 breaths per minute or PaCO2 lesson 32
Tachycardia > 90 bpm
Increased white blood cell count >12,000 cells/high-power field or 10% bands
