Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > Medicine Part 2 > Flashcards

Medicine Part 2 Flashcards

1
Q

Most common causes of ESRD

A

Diabetes

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is ESRD defined?

A

Not by BUN or Cr

Loss of kidney function leading to clinical and lab findings of uremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Calciphylaxis

A

Hyperphosphatemia –> calcium adn PO4 precipitate –> vascular calcifications –> skin lesions/necrosis!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Absolute indications for dialysis

A

AEIOU

Acidosis

Electrolytes - HYPERkalemia

Intoxications - methanol, eth glycol, lithium, aspirin

Overload - hypervolemia that can’t be solved

Uremia - based on clinical presentation, like pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Microscopic hematuria usually

A

glomerular in origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Gross painless hematuria usually

A

Bladder or kidney cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hematuria

A

> 3 erythrocytes / HPF on UA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Order to evaluate proteinuria

A

Urine dipstick - specific for albumin

UA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dipstick + blood

UA no RBC

What is it?

A

Hemoglobinuria

Myoglobinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Proteinuria

A

> 150 mg protein/days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Glomerular d/o vs tubular d/o

A

In glomerular but not in tubular:

  • need biopsy usually
  • steroids and immunosuppressive meds for tx

In tubular but not in glomerular:

  • acute presentation,
  • caused by toxins
  • does not cause nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acute Interstitial Nephritis

  • features
  • seen on labs
  • causes
A

Polyruia and sterile pyruria (maybe some WBC casts) are early manifestations

acute interstitial renal inflammation + pyuria + eosinophils (hypersensitivity) + azotemia

happens after drugs 
METHICILLIN #1
NSADs
captopril
penicillins
sulfonamides
rifampin
TMP
cephalosporins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AIN treatment

A

Remove offending agent

Steroids if still getting worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acute tubular necrosis

  • causes
  • stages
A

Toxic (#1 aminoglycosides) or Ischemic (more serious, prerenal azotemia usually (shock, sepsis) or crush injury w/ myoglobinuria) → granular casts (muddy brown)

o This is medullary necrosis and ATN is limited to outer medullar segments b/c renal medulla is susceptible to ischemic injury b/c low medullary blood flow → glomeruli look normal

o Stages: (1) inciting event → (2) Maintenance (oliguric, risk of hyperkalemia & met acidosis) → (3) Recovery (polyuric, risk of hypoK)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nephrotic syndrome

- features

A

o Hyperlipidemia b/c increased hepatic lipoprotein synth – but only LDL; HDL will decrease!
o Hypoagammaglobinemia = increased risk infection
o Hypoalbuminemia = edema
o Hypercoagulable = loss antithrombin 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Minimal change disease

A

-only lose albumin, not all globulins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diffuse cortical necrosis

A

usually due to hypOperfusion of kidney (vasospasm, DIC, abruption placentae, septic shock), medulla spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Renal papillary necrosis

  • what is it
  • causes
  • dx
A

necrosis of renal papillae (supplied by vasa recta) = hematuria, proteinuria

o “POSTCARDS” = Pyelonephritis, Obstruction, Sickle Cell, TB, Cirrhosis, Analgesic abuse (phenacetin, acetaminophen, aspirin), Renal transplant rejection, Diabetes (#1), Systemic vasculitis

o DACS = Diabetes Mellitus (#1), Acute pyelonephritis, Chronic phenacetin use (acetaminophen), Sickle Cell

Dx w/ ecretory urogram - note change in papilla or medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute renal failure

A

↓ renal function → ↓GFR → INCREASE BUN and Creatinine (azotemia)

will also have met acidosis!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Chronic renal failure

A 
Hyper K (#1 COD b/c arrhythmia)
Metabolic ACIDosis (increase H+, ↓ bicarb)
Uremia
Anemia
renal osteodystrophy
dyslipidemia
Na/H2O retention
growth retardation in children;

FREE Ca will be decreased b/c increase in PO4 will bind up the free Ca in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Renal tubular acidosis

A

D/o of renal tubules –> nonanion gap HYPER Cl metabolic acidosis

Glomerular function OK

decrease in acid excreted in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Type 1 RTA

- what is it?

A

Distal

Can’t secrete H+ at distal tubule –> new bicarb cannot be made

Urine pH does not go below 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Type 1 RTA

- effects of it

A

Decrease ECF

Hypo K, HYPER Cl, met acidosis

Renal stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Type 1 RTA

- causes

A

MM

Nephorcalcinosis

Amphotericin B

Lupus, Sjorgen’s

Medullary sponge kidney

Analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Type 2 RTA | - waht is it?
Proximal Can't reabsorb HCO3 at PCT --> more bicarb excreted in urine
26
Type 2 RTA | - effects
Hypo K, HYPER Cl, met acid NO KIDNEY STONES
27
Type 2 RTA | - causes
``` Fanconi's syndrome Wilson's Lead toxicity Amyloid MM ```
28
Type 4 RTA
Hypoaldo or resistant to aldo Decreased Na absorbtion + decreased H and K secretion in DCT HYPERkalemia (not hypo) + acidic urine + met acidosis
29
Hartnup syndrome
AR defective aa transporter Tryptophan can't be reabsorbed --> NAD deficiency Dermatitis, diarrhea, ataxia, psych disturbances (all like pellagra) Supplement w/ NAD if symptomatic
30
Fanconi's syndrome
PCT dysfunction can't transport - glucose - aa - Na - K - PO4 - uric acid - bicabr Results in - rickets - osteomalacia, osteoporosis - polyuria, - dehydration - type 2 RTA - hypercalciuria - hypo K
31
Dx ADPKD
Ultrasound Can use CT and MRI
32
Extrarenal involvement of ARPKD
Liver - protal HTN, cholangitis Pulm insufficiency - pulm hypoplasia + enlarged kidneys - mostly because not enough amniotic fluid Potter syndrome
33
Medullary sponge kidney
Cystic dilation of CD can be assoc w/ hyper PTH and parathyroid adenoma Benign; some stones and more UTI sometimes
34
Dx medullary sponge kidney
Intravenous pyelogram - inject contrast to see on xray
35
Renal artery stenosis | - causes
Atherosclerosis (31) Fibromuscular dysplasia - usually in young fems - bilateral in 50% ppl
36
Dx renal artery stenosis
Renal arteriogram - DO NOT USE FOR RENAL FAILURE. Contrast can be nephrtoxic MRA - ok for renal failure
37
Renal vein thrombosis | - when is it seen?
RCC invasion Nephrotic syndrome Preggers/OCP
38
Dx renal vein thrombosis
renal venography IVP
39
Where does sickling of sickle cell most commonly occur in kidney?
Renal papille Can get papillary necrosis, renal fail, lots of UTIs ACEI can help
40
Causes of hyperoxaluria
Steatorrhea Small bowel disease Crohns Pyridoxine deficiency
41
Initial test to dx urinary tract obstruction
Renal ultrasound
42
Gold standard to dx urinary tract obstruction
Intravenous urogram (IVP) NOT for preggers, allergies to contrast
43
PSA DRE Transrectal ultrasonography (TRUS) - what do you do with these results when screening for prostate cancer?
PSA > 10 ---> Do TRUS w/ biopsy DRE abnormal ---> Do TRUS w/ biopsy PSA < 4 + DRE (-) -----> annual f/u 4.1 < PSA < 10 + DRE (-) -----> biopsy
44
DRE of prostate cancer
Prostate hard, nodular, irregular
45
PSA of cancer vs PSA normal
PSA cancer usually bound by plasma proteins PSA normal usual free in plasma
46
Risks for RCC
``` Cigarettes Phenacetin analgesics ADPKD Chronic dialysis Mercury Cadmium HTN ```
47
Dx RCC
Renal US only detects mass ``` Abdominal CT (w/ and w/o contrast) - for dx and staging ```
48
Tx RCC
Radical nephrectomy Take out: kidney adrenal Gerota's fascia
49
Transitional cell caricinoma
Can be anywhere along kidneys --> ureter Mostly in bladder Frequently recurs
50
TCC risk factors
Pee SAC Phenacetin Smoking (#1) Aniline dyes Cyclophosphamide
51
Dx TCC
Cystoscopy + biopsy (definitive)
52
Staging of TCC
CXR CT scan
53
Testicular cancers | - Germ cell tumors
Most common Seminomas - radiosensitive, slow growing Embryonal - very malignant, mets early Choriocarcionma - most aggressive, mets always Teratoma - usually no mets Yolk sac - rare, usually in kids
54
Testicular vs. scrotal cancers
Testicular cancers usually always malignant Scrotal cancers usually benign
55
Testicular cancers | - Non germ cell tumors
Usually benign, less common Leydig cells - benign, tx w/ surgery - secrete estrogens and androgens --> precocious puberty Sertoli cells - usually benign
56
Testicular cancer risk factors
Cryptochidism (risk still there w/ correction) Kleingelter's
57
Testicular ca tumor markers
B HCG - increased in choriocarcinoma AFP - increased in embryonal tumors US to try and localize tumor
58
DDx of testicular mass
Cancer Varicocele Torsion Spermatocele Hydrocele Epididymitis Lymphoma
59
Tx testicular cancer
Inguinal (not scrotal) excision of testicle CT scan to stage BHCG and AFP measurements
60
Penile cancer assoc
HSV HPV 18
61
Testicular torsion
Surgical emergency After 6 hrs, may have infarction and no longer save testicle
62
Epididymitis
Infection of epididymis Usually E coli Gonorrhea, Chlamydia in sex active Fever Less acute onset vs. torsion
63
Total body water
60-40-20 60% body wt = water 40% = ICF 20% = ECF - 15% = interstitial 5% = plasma
64
What is impt to track to assess volume status?
Urine output Normal kids = > 1 mL/kg/hr Normal adults = 0.5-1 mL/kg/hr
65
Anascara
extreme generalized edema
66
Fluid replacement therapy options
NS - increase intravascular volume if dehydrated - not great for CHF D51/2NS = 5% dextrose, 1/2 NS - standard maintenance fluid - dextrose to inhibit muscle breakdown D5W - dilute powdered meds - only some stays intravascular b/c diffuses into TBW compartment; not great to replenish intravascular Lactated ringer's solution - good to replacing intravascular volume - NOT a maintenance fluid - common trauma resuscitation - DO NOT USE if hyperkalemia is concern b/c has K
67
Calculation of maintenance fluids
100.50.20 rule For 70 kg man: 10 kg x 100 10kg x 50 50 kg x 20 Total: 2500 2500/24 = 104 mL/hr
68
Changes in Na concentration = ? Changes in Na content =
Concentration --> reflection of water homeostaiss Content --> reflection of Na homeostasis
69
Hyper/hyponatremia vs Hypo/hypervolemia
Hyper/hyponatremia caused by too little/too much WATER Hyper/hypovolemia caused by too much/too little Na
70
Hypo Na symptoms
Usually neuro sx Headache, delirium, irritability Muscle twitching, weakness Hyperactive deep tendon reflexes Seizures, coma N/V, watery diarrhea HTN b/c increased ICP Oliguria
71
Tx hyponatremia | - hypotonic hyponatremia
Mild (120-130) - withhold free water Moderate (110-120) - loop diuretics + saline Severe (< 110) - hypertonic saline increasing serum Na by 1-2 mEq/L/hr
72
Risks of correcting hypoNa too fast
Central pontine demyelination
73
Risks of correcting hyper Na too fast
cerebral edema
74
Hyper Na symptoms
Neuro sx usually AMS restlessness Weakness Focal neuro deficits
75
What should be given to differentiate nephrogenic from central DI if DI suspected?
DesmopressiN
76
Hypoalbuminemia, Ca is low. But ionized Ca is normal. How do you est ionized Ca
Total Ca - (serum albumin * 0.8)
77
What alters Ca binding to albumin?
pH changes Increase pH --> increase binding of Ca - decrease ionized Ca - total Ca ok
78
Causes of decreased Ca
``` Hypo PTH Acute pancreatitis Renal insufficiency Hyper PO4 Pseuhypoparathyroidism Hypo Mg Vit D deficiency Malabsorb Blood transfusion w/ citrated blood Osteoblastic mets Hypoalbuminemia DiGeorge ```
79
Features of decreased Ca
``` Rickets, osteomalacia Tetany - Chovstek's, Trousseau's sign Seizures Basal ganglia calcifications Arrhythmias ``` PROLONGED QT`
80
Causes of increased Ca
Hyper PTH Renal failure (usually hypo Ca but can be hyper w/ high enough PTH) Acromegaly Addison's Metastatic ca MM PTH paraneoplastic Vit D intox Milk alkali syndrome Thiazides,, lithium Sarcoidosis Familial hypocalciuric hypercalcemia
81
Features of increased Ca
``` Stones Bones Groans Psych overtones ---> All increased PTH signs ``` POlydipsia, polyuria HTN Wt loss SHORT QT
82
1st step in management of hyper Ca
Increase urinary excretion via IV fluids Diuretics (furosemide) to stop Ca reabsorb
83
What can you use to quickly tell why someone is hypokalemic?
Presence or absence of HTN HTN - aldo increased - causes K wasting No HTN - GI or renal loss of K
84
Hypo K EKG
Flattened T wave/ T wave inversion U wave
85
Does dig cause hyper or hypo K? What predisposes to dig toxicity
Causes HYPER K Hypokalemia predisposes - allows Dig to bind more to Na/K pump
86
Features of hypo K
``` Arrhythmias Muscle weakness, paralysis, cramps Paralytic ileus Polyuria adn polydipsia N/V ```
87
How best to replete K?
KCl 10 mEq KCl increases K by 0.1 mEq/L Add lidocaine so KCl doesn't burn as much
88
How fast can you infuse K?
10 meq/hr in periph IV line | 20 meq/hr in central line
89
When do you correct hypo Mg first?
In both hypo K and Ca
90
How does hyper K affect kidneys to worsen acidosis?
Inhibits renal ammonia synthesis and reabsorb Net acid excretion is impaired! Metabolic acidosis Further makes K move out of cells
91
Hyper K EKG
Peaked T waves Prolonged PR interval Widen QRS --> eventually get QRS merge w/ T wave producing sine pattern --> Vfib
92
Tx Hyper K
IV calcium - decreases membrane excitability - be careful giving this to pts on dig b/c can worsen toxicity Shift K into cell - glucose + insulin (fastest) - sodium bicarb (for emergencies) Remove K from body - Kayexalate (exchange resin) - hemodialysis - diuretics
93
Where is most of Mg in body?
Bones
94
Where is most of K in body?
Intracellular
95
Where is most of Na in body?
Extracellular
96
Causes hypo Mg
Malabsorb Fasting Fistulas TPN Alcoholism ``` SIADH Diuretics Bartter;s syndrome Gentamicin, amphotericin B, cisplatin, PPIs Renal transplant ``` DKA, burns, lactation
97
Hypo Mg features
``` Muscle twitching Weakness Tremors Hyperreflexes Seizures AMS ``` Hypo K and Ca
98
Hypo Mg EKG
Prolonged QT T wave flattening Torsades
99
Causes of hyper Mg
Renal failure Burns, trauma, ECF volume deficit Mg-laxatives, antacids Adrenal insufficiency Adnreal insufficiency Rhabdomyolysis
100
Hyper Mg features
``` Nausea Facial paresthesias Deep tendon reflex LOSS Respiratory depression Coma ```
101
Hyper Mg EKG
Like hyper K Increased PR Widened QRS Elecated T
102
Tx hyper Mg
No Mg IV calcium gluconate Saline + furosemide Dialysis Intubation if respiratory depression
103
Where is most of PO4 in body?
Bones
104
Causes of decreased PO4
DKA | Alcohol abuse
105
Hypo PO4 clinical features
Encephalopathy COnfusion Seizures Paresthesias Weakness Myalgias Rickets Hemolysis RBC dysfunction Cardiomyopathy b/c low ATP Rhabdomyolysis
106
Hyper PO4 causes
``` Renal insufficiency Bisphosphoates Hypo PTH Vit D intoxication Tumor calcinosis Rhabdo cell lysis acidosis ```
107
Hyper PO4 features
Metastatic calcification + soft tissue calcifications Neuro changes from decreased Ca
108
Tx hyper PO4
PO4 binding antacids (Al OH or carbonate) Hemodialysis
109
Which bicarb value is more reliable? | - serum vs. ABG?
Serum (venous) CO2
110
Salicylate OD acid base status
Respiratory Alkalosis | Metabolic acidosis
111
Causes of renal loss of bicarb
Proximal tubular acidosis - MM - cystinosis - Wilsons Distal tubular acidosis - can't make HCO3 - SLE, sjogren's, amphotericin B Acetazolamide
112
Causes of GI loss of bicarb
Diarrhea Pancreatic fistulas Small bowel fistulas Ureterosigmoidostomy
113
Danger to tx acidosis w/ bicarb
Bicarb takes 24 hrs to get to brain Hyperventilation is continuing though PaCO2 low while HCO3 increases - dangerous
114
What can be used to clinically detect endogenous depression?
Dexamethasone suppression test 50% of pts w/ depression, DST will be abnormal
115
Hallmark of prolonged seizures
Cortical laminar necrosis Can lead to persistent neuro deficits and recurrent seizures
116
Status epilepticus
Any 1 seizure > 5 mins Cluster of seizures w/ pt not recovering normal mental stauts in between
117
Initial TB infection - what does it look like on CXR?
Peripheral pulmonary focus - Gohn focus remains as calcified granuloma Mediastinal or hilar lymphadenopathy on CXR
118
Hyposthenuria
Found in pts w/ sicklle cell + trait Thought to result from RBC sickling in vasa rectae of inner medulla which impairs countercurrent exchange and free water reabsorb
119
Proximal muscle weakness Spares muscles of mastication and facial expression Dysphagia possible What is this?
Polymyositis/Dermatomyositis Muscle biopsy to dx
120
Large blunt hyphae Thick walled budding spores What is this?
Malassezia furfur Causes tinea versicolor
121
Hypopogmented macules that do not tan Do not appear scaly Scale on scraping What is this? How to tx?
Tinea versicolor Topical selenium sulfide ltion Ketoconazole shampoo
122
What do you expect in any pt w/ hx of cancer or fever who p/w back pain and neuro sx, particularly loss of bowel or bladder function? How do you confirm dx? What should you do 1st?
Compression of thecal sac MRI to confirm Glucocoritoicds (dexamethasone) to start asap so decrease risk of permanent neuro damage
123
Low leukocyte alk phos + leukocytosis
CML
124
Most impt modifiable factors for decreasing HTN
Wt control > physical activity > Na restrict > moderation of EtOH consumption
125
Waldenstroms macroglobulinemia
Plasma cell neoplasm IgM spike --> hyperviscosity ``` Hepatosplenomegaly, lymphadenopathy Anemia --> tiredness Increased bleeding Night sweats headaches Dizziness Visual problems (retinal v engorgement) Pain and numbess in extremities --> demyelinating sensorimotor neuropathy ```
126
MM vs. Waldernstroms
MM has IgA or IgG Doesn't have hyperviscosity
127
Big danger of pancreatic necrosis
Locally released pancreatic enzymes can increase vascular permeability w/in and around pancreas Large volume of plasma into retroperitoneum Hypotension mainly due to increase in vascular permeatbility!!!
128
Valvular consequence of aortic dissection Best way to dx AD
Aortic regurg Transesophageal echo (more than MRI b/c MRI is long)
129
Contraindicaitons to liver transplant
Irreversible cardio-pulm dz causing prohibitive risk incurable or recent malignancy outside of liver Active EtOH or IVDU
130
During acute asthma, what is one indicator of severe attack
Normal PaCO2 Should be decreased b/c hyperventilate Normal to increased = CO2 retention b/c severe obstruct and/or respiratory muscle fatigue
131
How do you improve ARDS oxygenation
Increase PEEP w/ low tidal volumes on ventilator setting
132
How does a person get infected w/ cystercosis
If eat larvae in undercooked pork, will get intestinal infection If eat eggs from human feces, cystercercosis happens - larvae will invade intestinal wall adn can go to muscle, brain, subQ tissue, eye NOT GOTTEN BY EATING INFECTED PORK AS THE ONLY WAY - POOP OF HUMAN!
133
When is AS symptomatic?
Valve area < 1 cm2
134
Systemic effects of sarcoidosis
ACE increase | Increase vitamin D
135
Antiphospholipid syndrome features
Arterial and venous thromoboses Thrombocytopenia Prolonged PTT Avoid preggers loss w/ LMWH
136
Signs of glucocorticoid deficiency
Weakness Fatigue Loss of appetite Eosinophilia
137
Presentations of P vera
``` HTN Increased peptic ulceration Gouty arthritis Plethoric face Splenomegaly Hypercellular bone marrow ```
138
Earliest renal abnormality in pts w/ DM
Glomerular hyperfiltration ACEi reduce intraglomerular HTN --> decrease glomerular damage This can eventually cause thickening of glomerular BM --> nodular sclerosis
139
Pneumonia + GI sx + elevated LFTs What is this? How do you tx?
Legionella pneumoniae Quinolone or macrolide ot tx
140
What is infection w/ Moraxella catarrhalis commonly assoc w/
COPD
141
PFTs in IPF
Decreased TLC normal FEV1/FVC Diffusing capacity decreased Increased Aa gradient
142
Diagnostic criteria for ARDS
Acute onset PaO2/FiO2 < 200 Bilateral infiltrates on CXR Swann Ganz P < 18 mm Hg
143
What should FiO2 be if person is adequately venetillated to prevent O2 toxicity to lungs?
below 60% Increase PEEP as needed to maintain adequate O2 after FiO2 lowered
144
Bilateral trigeminal neuralgia Transient muscle weakness What is this most likely?
MS! MS is one of few conditions presenting w/ bilatearl trigminal neuraligia
145
Systemic issue w/ L sided endocarditis
Can send septic emboli to regions rich in blood supply (brain, kidney, livre, spleen) R sided endocarditis more likely to cause septic pulm emboli
146
Lab values for portal HTN causing splenomegaly
Anemia | Thrombocytopenia
147
Expansile adn eccentric lytic area (soap bubble) in epiphysis Pain, swelling, decreased ROM Most get pathologic fractures
Giant cell tumor
148
How do you diagnose a pheochromocytoma?
CT scan MRI better for extra adrenal catecholamine secretion Mibg scan if cr shows nothing
149
Any wide complex tachyarrhythmia is what until proven otherwise?
Ventricular tachycardia
150
In an MI, what is your long term prognosis most influenced by? What do you do to achieve this? How quickly?
Duration of time that lapses before coronary blood flow restored Use Percutaneous transluminal coronary angioplasty and fibrinolysis - PCTA better - should be done w/in 90 mins Fibrinolytics should be done w/in 30 mints
151
Erythematous rash and maculopapular Starts on face --> trunk and extremities Lymphadenopathy (occipital and posterior cervical) Arthritis in adult women Maybe some conjunctivitis What is this?
Rubella Measles does not have arthritis
152
What are cholesterol emboli usually preceded by?
Angiography Plaque is disrupted by catheter or guidewire
153
``` Blue toe syndrome Livedo reticularis (reddish-cyanotic reticular discoloration of skin) Acute renal failure Ab pain Sometime pancreatitis Eosinophils in blood DECREASED COMPLEMENT LEVELS ```
Cholesterol emboli
154
Infarction of - medial vermis of cerebellum - lateral cerebellum
Medial - severe vertigo - nystagmus Lateral - dizziness - ataxia - weakness - tendedncy to sway towards side of lesion
155
Dizziness Hearing loss Tinnitus
Meniere's disease
156
Pathophys of benign positional vertigo
Ca crystals in inner ear shift position Nystagmus Nausea Vomitting
157
4 cardinal symptoms of rest less syndrome
Uncomfortable sensation/urge to move legs Discomfort worse at night/sleep Discomfort worse at rest Discomfort helped by mvmt of affected limbs
158
Pathophys of RLS
Abnormalities of dopaminergic transmission in CNS
159
What vaccines should pts w/ chronic liver disease get?
``` Tdap (every 10) Influenza Pneumococcal vaccine (every 5) Hep A Hep B ```
160
Major causes of vit K deficiency
Inadequate diet intake Intestinal malabsorb Loss of storage sites due to hepatocellular disease
161
How long does vit K storage last?
30 day acutely sick - 7-10 days
162
Hemolytic uremic syndrome
Often follows diarrhea Thrombocytopenia MAHA Fever Renal failure (rather than neuro sx of TTP) Shiga-toxin binds to the globotriaosylceramide (Gb3) receptor on the surface of the glomerular endothelium This action includes a cascade of signaling events leading to apoptosis and binding of leukocytes to endothelial cells. The Shiga-toxin-activated endothelial cells then become thrombogenic (clot-producing) Additionally, the binding action of Shiga-toxin inactivates a metalloproteinase called ADAMTS13
163
What should all pts w/ significant bladder outlet obstruction get?
Foley catheter Prolonged obstruction > 2 weeks can results in permanent kidney damage
164
How do you best view an acoustic neuroma?
MRI w/ contrast
165
DO NOT miss this as reason for hyperkalemia in an asymptomatic pt
Pseudohyperkalemia | - venipuncture can hemolyze RBC --> cause K to be released
166
When do you tx hyperkalemia? How do you do it?
If cardiac toxicity (EKG shows), muscular paralysis, K > 6,5 + Ca gluconate to stabilize myocardial membrane - push K into cells w/ insulin and/or B-agonists - can also use Na Bicarb to shift into cells
167
Nonhealing ulcer Scaling plaque w/ central ulceration Biopsy shows polygonal cells w/ atypical nuclei at all levels of epi w/ zones of keritnization What is this?
Squamous cell carcinoma of skin Sunlight is risk factor
168
``` Personality changes Compulsive behaviors Impaired memory Visuospatial functions intact + family hx in some ``` What is this?
Frontotemporal dementia (Pick's disease)
169
Fluctuating cognitive impairment Bizarre, visual hallucinations Some parkinsonism but poor response to D agonist therapy What is this?
Lewy body dementia
170
Eczematous lesion on breast Biopsy = large cells that appear to be surrounded by clear halos What is this?
Paget's disease of breast Usually represents underlying adenocarcinoma Halo cells b/c cancer cells become retracted from adjacent keratinocytes
171
Corneal sensation is via which nerve?
CN 5 - Trigeminal
172
3 most common causes of chronic cough (> 8 weeks)
Post nasal drip Asthma GERD
173
Steps to tx ascites
Na and water restriction Spironolactone Loop diuretic (not more than 1 L/day of diuresis) Frequent abdominal paracentesis (2-4L/day if renal function ok)
174
When are vascular shunts for liver cirrhosis indicated?
Symptomatic varices Side to side porto caval shunt to help ascites but worsens encephalopathy Peritoneo jugular shunt tx ascites
175
Indications for hemodialysis
Refractory hyper K Volume overload/pulm edema NOT responding to diuretics Refractory met acidosis (pH < 7.2) Uremic pericarditis Uremic encephalopathy or neuropathy Coagulopathy due to renal failure
176
Best to tx frostbite
Rapid re-warming w/ warm water (40-44) Result in less tissue damage than slow rewarming
177
Osgood Schlatter disease
Overuse injury caused by repetitive strain Young kids w/ rapid growth spurt Avulsion of apophysis of tibial tubercle
178
#1 COD in dialysis pts
Cardiovascular disease
179
GERD hx | - progressive dysphagia to solids w/o anorexia or wt loss
Benign strictures
180
GERD hx - progressive dysphagia to solids w/ anorexia or wt loss - GERD for > 20 years
Adenocarcionma of esophagus
181
Charcot's joint
Neurogenic arthropathy Usually in diabetic neuropathy Complication of neuropathy and repeated joint trauma Affects wt bearing joints --> functional limitation, deformity, degenerative joint disease
182
Persistent ST segment elevation after recent MI and deep Q waves in same leads
Ventricular aneurysm
183
Causes of pulsus paradoxus
Cardiac tampanode ASthma COPD --> in pulm conditions b/c extra negative pressure gets more blood into lungs, further decreasing LV preload
184
What prevents development of pulsus paradoxus even in presence of pericardial effusion and cardiac tamponade?
Signficiant arotic regurg -- causes large increase in LVEDP preventing septum shift
185
Pts w/ hyper PTH increased risk of developing what arthropathy?
Pseudogout - CPPD deposition
186
Dx lactose intolerance
Lactose hydrogen breath test Increase H level after eat lactose --> indicates bacterial carb metabolism (as lactose no absorbed by gut so bacteria get to it)
187
Waddling gait
Muscular dystrophy | - weakness of gluteal muscles
188
Spastic gait
Lesions of UMN Slow, stiff, effortful movements
189
Wide based high stepping gait
Loss of proprioception Dorsal roots or posterior column damage
190
Pathology of angioedema
C1 inhibitor deficiency, dysfunction or destruction Leads to increased C2b and bradykinin = edema producing factors C4 levels are depressed
191
erythema nodosum - what is it?
Infection of fat cells It is a panniculitis
192
When are you at risk for hypocalcemia due to citrate chelation
If transfuse > 1 unit/5 min Live failure b/c liver processes citrate
193
Definition of HTN - in gen pop - in diabetics and renal disease
Gen pop > 140/90 Diabetes and renal disease > 130/80
194
Emergency eval of headache
Noncontrast CT to rule of ICH Small bleeds may not show up - LP can be done if high suspicion and no bleed shown
195
Which headache is most responsive to ppx?
Cluster headaches -- use verapamil
196
Pt w/ migraines but do not respond to drugs for tx migraines. What are they?
Rebound analgesic headaches Try and wean from analgesics!
197
Do you need antibiotics for bronchitis?
NO! Usually viral
198
Causes of laryngitis
Usually viral Moraxella catarrhalis, H influenzae
199
Sore throat Ddx
Viral infection Tonsilitis Strep throat Mononucleosis
200
When should a pt w/ GERD be screened for Barrett's
Symptomatic for at least 5 yrs
201
What Pulm finding are you at risk for w/ GERD?
REcurrent aspirationi pneumonia you can find lipid laden macrophages in cytology
202
Need ppx for dental procedures for these groups
* Prosthetic cardiac valves * History of prior infective endocarditis * Unrepaired cyanotic congenital heart disease * Completely repaired congenital heart disease for 6 months following repair * Repaired congenital heart disease with residual defects or abnormalities * Cardiac transplantation recipients with cardiac valvulopathy
203
How to tx small focal breast cancer
Lumpectomy w/ sentinel lymph node biopsy Irradiation
204
1st degree family hx colorectal cancer - what's the screening procedure?
Age 40 OR 10 yrs younger than 1st diagnosis
205
1st degree heart block
First-degree atrioventricular block is diagnosed when the PR interval is greater than 0.20 sec
206
EKG of WPW
PR interval (<0.11 sec), prolonged QRS duration, and slurred onset of the QRS (delta wave) complex.
207
Chronic alcoholism pts have risk of what electrolyte abnormality if they get admitted?
Hypo phosphate Can be normal on admissions and decrease over first 12 to 24 hrs. Possibly because of IV glucose admin
208
Manifestation of rapid decrease in phosphate
Confusion Rhabdomyolysis Hemolytic anemia Muscle weakness
209
Tx gallstone pancreatitis
ERCP with sphincterotomy and stone extraction
210
Orthostatic prteinuria
Increase in urinary protein excretion only in uprivht psiion Most common in yong adults or children
211
Urine aniongap formula Normal value
= (U sodium + U potassium) - U chloride
212
How do you tell if metabolic acidosis is of renal or extrarenal origin just by labs?
Extrarenal causes of metabolic acidosis are associated with an appropriate increase in net acid excretion primarily reflected by high levels of urine ammonium excretion, whereas kidney causes of this condition are associated with low net acid excretion and decreased urine ammonium levels. Can get Urine ammoium w/ urine anion gap Metabolic acidosis of extrarenal origin is suggested by a large, negative UAG caused by significantly increased urine ammonium excretion. Conversely, metabolic acidosis of kidney origin is suggested by a positive UAG related to minimal urine ammonium excretion.
213
If pt w/ polymyagia rheumatica has a prednisone taper 2x but keeps getting flares, what should be done?
Add steroid sparing agent and incease prednisone Example ismethoteate.
214
When do you need a TTE for a murmur?
3/6 or greater systolic murmur Diastolic murmur Continuous murmur New murmur if last PE was healthy
215
PR interval length
120 to 200ms No more than 1 large box
216
QRS length
80 to 120ms 3 small boxes
217
QT interval
< 1/2 of R-R interval
218
How to tell the earliest if someone has rheumatoid arthritis?
A radiograph showing marginal joint erosions would most likely support a diagnosis of rheumatoid arthritis (RA). Erosions of cartilage and bone are cardinal features of RA. Erosions and joint-space narrowing may develop as early as 2 to 3 mos
219
Where do you find rheumatoid factor?
RA Hep C
220
Histo of Acute promyelocytic anemia
predominant cell is a large immature granulocyte with multiple granules overlying the cytoplasm and nucleus.
221
AML diagnosis
The diagnosis of AML is confirmed by a bone marrow aspirate showing hypercellular marrow containing greater than 20% to 30% myeloblasts. Once the diagnosis of acute leukemia is established, the classification is based on the morphology of the immature cells. The presence of Auer rods confirms the myeloid nature of the leukemia.
222
ALL features
lymphocytosis, neutropenia, anemia, thrombocytopenia, lymphadenopathy, and hepatosplenomegaly at presentation. An increased number of lymphoblasts found on bone marrow examination are suspicious for the diagnosis.
223
When to screen for asymptomatic bacteruria
pregnant women before urologic surgery
224
Pt w/ TB - suggestive pleural effusion. How do you best evaluate next?
Pleural biopsy
225
Is a duodenal ulcer cancerous?
No
226
Most common causes of gastric ulcers
NSAIDs H pylori
227
Diabetic retinopathy classifications
nonproliferative (with hard exudates, microaneurysms, and minor hemorrhages), which is not associated with visual decline proliferative (with “cotton-wool spots” and neovascularization), which is associated with loss of vision.
228
The presence of hypotension, hyponatremia, and a decreased urine sodium excretion accompanied by a bland urine sediment raises suspicion for.....
Prerenal azotemia
229
Tumor lysis syndrome may manifest as what electrolyte abnormalities?
hyperkalemia hyperphosphatemia hyperuricemia.
230
Meniscal tear vs. ligament injuries (ACL)
Swelling faster in ligament injuries
231
Click/knock of joint w/ loose cartilage Pain on walking What could have happened? what tests do you do to figure this out?
Meniscal tear Pain along the joint line is 76% sensitive for a meniscal tear an audible pop or snap on the McMurray test is 97% specific for a meniscal tear.
232
McMurray test
Maximally flexing the hip and knee and applying abduction (valgus) force to the knee while externally rotating the foot and passively extending the knee
233
Suspect common bile duct stone for sx of pancreatitis and jaundice. But none seen on US. What do you think it is?
Abdominal ultrasonography has a sensitivity of only 50% to 75% for choledocholithiasis, and a common duct stone should be suspected in the correct clinical situation even when ultrasonography does not show a stone
234
Suspected osteomyelitis - you cultured the ulcer ontop of the wound and it shows X bacteria. What do you do next?
Cx from sinus tract or ulcer base don't reflect bacterial etiology of underlying osteo DO A BONE BIOPSY! Then do antibiotic therapy The one exception is Staphylococcus aureus, which, if found in superficial cultures, correlates well with findings on deep cultures
235
Cardiac events in pts w/ long QT syndrome
Cardiac events in patients with LQTS include syncope and cardiac arrest due to torsade de pointes ventricular tachycardia.
236
Risk factors Long QT
``` female sex hypokalemia hypomagnesemia structural heart disease previous QT-interval prolongation history of drug-induced arrhythmia ```
237
Familial syncope...causes?
Long QT syndrome
238
When do you consider HIT?
HIT/T should be considered in any patient with an otherwise unexplained decrease in the platelet count and/or a new thrombotic event 5 to 10 days after initiation of heparin therapy.
239
Gold std diagnose HIT
14C-serotonin release assay (SRA)
240
Abnormal uterine bleeding - what types
infrequent menses, excessive flow, prolonged duration of menses, intermenstrual bleeding, and postmenopausal bleeding.
241
Asthma exacerbation - signs of respiratory failure
Slightly elevated or even normal Paco2 levels often indicate impending respiratory failure rather than recovery, pulse oximetry less than 95%, respiration rate greater than 30/min, and heart rate greater than 120/min
242
Dx ankylosing spoindyliis
MRI of sacroiliac joints
243
If pt w/ CRF is without fluid overload, hyperkalemia, metabolic acidosis, or uremic symptoms, what do you do for them?
Keep them on meds Hemodialysis or Kidney replacement therapy can be delayed . Transplantation in patients who have not yet been treated with hemodialysis is associated with better patient and allograft outcomes.
244
Whaty is the most appropriate option patient with continued anginal symptoms despite optimal medical therapy.
Coronary angiograph
245
Coronary revascularization is beneficial in patients with chronic stable angina and the following conditions
angina pectoris refractory to medical therapy; a large area of ischemic myocardium and high-risk criteria on stress testing; high-risk coronary anatomy, including left main coronary artery stenosis or three-vessel disease; and significant coronary artery disease with reduced left ventricular systolic function
246
Risk factors for legionnaires disease include
smoking, diabetes mellitus, hematologic malignancy, other types of cancer, chronic kidney disease, and HIV infection.
247
Test for legionella?
Leginoella urinary antigen test
248
The patient is having a moderate to severe exacerbation of chronic obstructive pulmonary disease (COPD)...what do you do?
should be placed on noninvasive positive-pressure ventilation (NPPV). A landmark study found that NPPV reduced the need for intubation, the length of hospital stay, and the mortality rate in such patients.
249
Contraindications to NPPV include
impending respiratory arrest, cardiovascular instability, altered mental status, high aspiration risk, production of copious secretions, and extreme obesity, as well as surgery, trauma, or deformity of the face or upper airway.
250
What do you suspect in patients with explosive onset, widespread psoriasis and the occurrence of dactylitis; marked distal interphalangeal (DIP) joint involvement; asymmetric joint involvement; symptoms of enthesitis; or joint ankylosis.
HIV-related psoriatic arthritis
251
Diarrhea + N/V Cause?
VIral gastroenteritis Food poisoning
252
Diarrhea + fever + blood in stool
Shigella Campylobacter Salmonella E. coli
253
Diarrhea + no fever + no blood
VIruses (rotavirus) Entertoxic E coli Food poisoning (Staph aureus, C. perfringens)
254
Fecal leukocytes in
``` C diff Camylobacter Salmonella Shigella EIEcoli ```
255
Endocrine causes of conspitation
hypo TH Hyper Ca Hypo K Uremia Dehydration
256
#1 way decrease SBP
Reduce BMI
257
Severe diarrhea electolyte disturbancce
Metabolic acidosis Hypo K
258
Vomiting electrolyte disturbance
Metabolic alkalosis Hypo K
259
Positive straight leg test means...
Nerve root compression
260
If low back pain in the absence of progressive neuro deficits, osteoporosis, steoird use, constitutional sx, hx of malignancy, recent trauma, IV drug use, is refractory to conservative tx for at least how many months, what should you do next?
3 months MRI
261
Osteochondritis dissecans
Area of necrotic bone and degenerative changes in overlying cartalage Bone and cartilage can separate and become loose --> pain, catching and popping
262
Plica syndrome
Dx of exclusion Usually in atheletes w/ overuse injuries
263
Most common ankle ligament injured
Anterior talofibular ligament
264
Trochanteric bursitis
Common cause of lateral hip pain Very painful on palpation Tx w/ NSAIDs
265
Tests for carpal tunnel syndrome
Tinel's sign - tap over median N @ wrist --> paresthesias Phalen's test - palmar flexion of wrist for 1 min --> paresthesias
266
Definitive dx of carpal tunnel
Electomyography and nerve conduction velocity study
267
Cartilage vs. bone --> which one has nerve endings?
Bone! That's why in arthritis, wear down cartilage and don't notice but will notice once bone starts rubbing against each other!
268
Where is pain of osteoarthritis of hip?
In groin Can radiate to anterior thigh
269
Where do you hold the cane for L knee pain?
R hand
270
Is there a correlation b/n x ray osteoarthritis and severeity of disease?
No
271
Type 1 vs type 2 osteoporosis
Type 1 - more trabecular bone loss Type 2 - = trabecular and cortical bone loss
272
Calcitonin effects
No help w/ hip Helps w/ spine (lumbar)
273
Which osteoporotic fracture has highest morbidity and mortality?
Hip
274
SENSORINEURAL HEARING LOSS PATHOPHYS
DEGENERATION OF SENSORY CELLS AND NERVE FIBERS AT BASE OF COCHLEA
275
Screening for ab aortic aneurysm
w/ US at age 65 in all men w/ smoking hx - only 1 test needed, no repeat if normal
276
Osteoporosis screening
DEXA scan starting at 65
277
RBBB
Wide QRS rSr in chest leads Wide S in lead I
278
LBBB
Wide QRS No Q in I, V5, V6 Notched R in I, V5, V6
279
Q waves pathologic if
> 0.04 s wide > 25% height of QRS
280
T wave inversions in
``` MI Pericarditis Cardiomyopathy INtracranial bleed Acidosis LBB LVH ```
281
Peaked T waves in
early MI Hyper K Hyper Mg
282
To do ASAP after putting in central venous line
CXR to check for pneumothorax
283
Causes of rales
fluid in lungs atelectasis pneumonia, CHF, ILD
284
Causes of wheezes
Asthma
285
Causes of rhonchi
Chronic bronchitis Snoring quality, low pitch, due to lots of mucus
286
Type 1 error
Null hypothesis rejected even though it is true FALSE +
287
Type 2 error
Null hypothesis not rejected even though it is false False -
288
Effects of increase mineralocorticoid secretion
Increased tubular reabsorb of Na and HCO3 Loss of Cl in urine Metabolic alkalosis and expansion of ECF
289
PaCO2 mainly determined by
Respiratory rate Tidal volume
290
How much does 1 unit of packed RBC increase Hb level?
Hb increase by 1 Hct increased by 3 Hb x 3 = Hct
291
FFP
All clotting factors NO RBCs, WBCs, platelets
292
Cryoprecipitate
Factor 8 Fibriongen For hemophili A, DIC, vWD
293
Dx beta thalassemia
Hemoglobin electrophoresis - increase HbF and HbA2 Periph blood smear - microcytic - hypochromic - target cells maybe
294
Tx thalassemias
frequent PRBC transfusions
295
Clinical features of b-thalassemia
Anemia Hepatosplenomegaly Expansion of marrow space Crew cut skull
296
Sideroblastic anemia - what is it? - causes? - tx?
Abnormality in RBC iron metabolism Hereditary or acquired Chloamphenicol INH Alcohol Lead Collagen vascular disease Myelodysplasia Tx w/ removing offending agent, B6
297
Consequence of aplastic anemia
Transform into leukemia Increased infections
298
Causes of B12 deficiency
Pernicious anemia Gastrectomy Vegans Alcoholism Crohn's disease Diphyllobothrium latum SIBO
299
Causes of folate deficiency
Tea and toast diet Alcoholism Long term antibiotic use Increased Demand Preggers Hemolysis MTX, phenytoin Hemodialysis
300
Signs of intravascular hemolytic anemia
Dark urine color (hemoglobinuria) Schistocytes Low haptoglobin Increased LDH
301
Signs of extravascular hemolytic anemia
Spherocytes or helmet cells Increased LDH Increased unconjugated bilirubin --> jaundice
302
What does sickle cell survival correlate with?
Frequency of vaso occlusive crises More = shorter lifespan
303
Aplastic crisis in sickle cell - precipitants - tx
Caused by virus (eg parvo B19) Tx blood transfusion
304
Splenic sequestration crisis
Sudden pooling of blood into spleen --> splenomegaly + hypovolemic shock Happens in sickle cell adn beta thal More common in kids b/c they ahve intact spleens
305
Consequences of sickle cells
``` Painful bone crises Dactylitis Acute chest syndrome (repeated episodes of pulmonary infarctions) Splenic infarctions Avascular necrosis of joints (hip, shoulder) Priapism Renal papillary necrosis w/ hematuria Chronic leg culcers b/c vaso occlusion Ab crises Infections w/ H influenzae, strep pneumo Salmonella osteo ```
306
Manage painful crises
Hydration Morphine for pain Keep pt warm Supplemental O2 if hypoxic
307
When do you do blood transfusion for sickle cell?
Acute chest syndrome Stroke Unresponsive priapism Cardiac decomp
308
Paroxysmal noctual hemoglobinuria
Deficiency of anchor proteins linking complement-inactivating proteins to blood cell membranes Intravascular hemolysis Pancytopenia
309
Dx PNH
Ham's test - pt cell incubated in acidified serum --> triggers alternative complement --> lysis of PNH cells Sugar water test - mix pt's serum in sucrose --> hemolysis if PNH Flow cytometry to detect CD55 or 59
310
Tx PNH
Glucocorticoids (prednisone) | - most don't respond
311
Platelet disorders
``` ITP TTP HIT Bernard Soulier Glanzmann's ```
312
Idiopathic thromocytopenic purpura - what is it - clinical features - dx - tx
IgG antibodies on platelets --> removed by spleen Minimal bleeding NO splenomegaly Dx - plt count < 20,000 - low periph platelets - increased megakaryocytes Tx - steroids - IV immunoglobulin - splenomgaly - plt transfusions - romiplastim, eltrombopag
313
Thrombotic thrombocytopenic purpura - what is it - clinical features - tx
Plt consumption disorder Plt count decreased PT, PTT normal TTP = HUS + fever + AMS Features - hemolytic anemia - thrombocytopenia - renal failure - fever - neuro signs Tx - plasmapheresis - steroids, splenectomy - NO plt transfusions
314
Bernard Soulier
AR Deficiency in GpIb Plts large, plt count low
315
Glanzman's thrombathenia
AR Deficiency in GpIIb-IIIa Plt count NORMAL
316
Thrombin time
Measure of fibrinogen concentration
317
Bleeding time
Reflects plt function
318
Of clotting factors, which has shortest 1/2 life? How does this affect PT or PTT
Factor 7 PT increases 1st with clotting factor deficiency
319
Inherited hypercoagulable states
AT 3 deficiency (AD) Antiphospholipid antibody syndrome (acquired) Protein C deficiency (AD) Proetin S deficiency Factor 5 leiden (protein C can't activate factor 5) Prothrombin gene mutation Hyperhomocysteinemia
320
How long are you hypercoagulable for preggers?
All of preggers 2 months postpartum
321
Highest incidence of cancers in men
Prostate > lung > colon
322
Higher mortality cancers in men
Lung > prostate > colon
323
Highest incidence of cancers in women
Breast > lung > colon
324
Highest death cancers in women
Lung > breast > colon
325
Oncologic emergies needing immediate tx
Hyper Ca - fluids, diuretics, bisphosphanates Spinal cord compression - steroids, MRI Pericardial tamponade - pericardiocentesis Tumor lysis syndrome - IV fluids - tx electrolyte abnormalities
326
DCIS vs LCIS - which is palpable?
DCIS
327
1st step for breast mass in woman > 30
Biopsy
328
When do you need chemo after removing breast lump?
Don't need it for small lesions (< 1cm) w/o lymph node involvement
329
Indicates poor prognosis staging in CLL
Thrombocyotpenia
330
Dx MM
> 10% abnormal plasma cells in bone marrow + 1 of the following: M protein in serum M protein in urine Lytic bone lesions
331
Waldenstrom's macroglobulinemia
Malignant prolif of plasmocytoid lymphocytes IgM No bone lesions NO cure
332
Dx Hodgkin's lymphoma
Biopsy of lymph node shows Reed Sternberg cells
333
Clinical features of Hodgkin's lymphoma
Painless lymphadenopathy Constitutional symptoms (poorer prognosis) Spread continuity from 1 lymph node to adjacent lymph node Pruritus Cough
334
Myelodysplastic syndrome
Acquired clonal blood d/o Ineffective hematopoiesis Apoptosis of myloid precursors Results in pancytopenia despite normal or hypercelllular bone marrow
335
Abnormalities of myelodysplastic syndromes
Low retic count Howell Jolly bodies Basophilic stippling Ringed sideroblasts
336
Tx myelodysplastic syndrome
RBC and plt transfusions EPO GCSF Vit B6, 12 folate for cell turnover
337
Essential thrombocythemia
Plt > 600,000 Dx of exclusion Splenomegaly Pseudohyper K Elevated bleeding time Increased megakaryocytes in bone marrow
338
Normal pulse in setting of high fever is suggestive of...
atypical CAP
339
Approach to CAP
Lower vs. upper? - nasal discharge, sore throat --> usually upper If lower, is it PNA vs. bronchitis? - CXR to tell
340
If CXR not suggestive of PNA, what do you do
DO NOT tx w/ antibiotics
341
False negative CXR for PNA in...
Neutropenia Dehydration PCP Early disease
342
PNA hints - alcoholics - immigrants - nursing home - HIV + - transplant recipients
Alcoholics - Klebs Immigrants - TB Nursing home - Pseudomonas HIV - PCP, M TB Transplant - Legionella
343
If suspect PNA is the following, how do you test? TB PCP Legionella
TB - acid fast PCP - silver stain Legionella - urinary antigen
344
When do you admit for PNA?
If pt is hypoxic or hypotensive
345
Parts of lungs most affected by aspiration lung abscess
Posterior segments of upper lobes Superior segments of lower lobes Right lung more affected
346
CXR of lung abscess
Thick walled cavitation w/ air fluid levels
347
Who is contagious w/ TB
Active TB Primary TB NOT contagious
348
Radiologic findings in primary TB
Ghon's complex - calcified primary focus w/ assoc lymph node Ranke's complex - Ghon complex --> fibrosis and calcification
349
Primary Tb
usually asymptomatic | May have pleural effusion
350
Secondary (active) TB
Constitutional sx Dry cough --> purulent sputum Apical rales
351
Definitive dx of TB
Sputum culture PCR
352
PPD
DO NOT use to dx active TB - only for latent TB If pt is symptomatic or has abnormal CXR, order sputum acid-fast test, not PPD Positive PPD: No risk factors: >= 15 High risK> 10 mm HIV, acitve TB close contacts : 5 mm
353
If person had BCG vaccine and positive PPD, what do you do?
INH for 9 months no matter what!
354
When do you stop TB tx as a result of adverse effects?
If liver transaminases rise to 3-5x upper limit of normal
355
Kerning's sign
Can't fully extend knees when supine Irritate meninges
356
Brudzinski's sign
Flex legs adn thighs that is brough on by passive flexion of neck Irritate meninges
357
Dx meningitis
LP Do a CT scan 1st Get blood cx before start abx
358
Best way to Dx viral encephalitis
CSF PCR
359
Best way to Dx encephalitis
MRI of brain
360
Transmission - Hep A - Hep B - Hep C - Hep D - Hep E
A, E - fecal oral B - sex, parenteral C - parenteral D - w/ hep B
361
If transaminases are really elevated, what do you think of?
Viral hepatitis Shock liver Drug induced hepatitis
362
Symmetric descending flaccid paralysis
Botulism
363
Dx botulism
ID toxin in serum, stool, or gastric contents
364
How does a UTI happen?
Colonization of vaginal area by pathogens from fecal flora ``` E. coli Staph saprophyticus Enterococcus Klebs Proteus ```
365
You suspect HUS in someone. What do you do next? How do you tx?
Peripheral blood smear to diagnose Tx is supportive Do not use abx May need dialysis if ARF, PRBC for anemia Only do platelet transfusion if bad. Otherwise can make worse
366
Do we recommened screening for early stage lung cancer even if pt smokes?
NO
367
How to dx acute parvovirusB19 infection?
IgM Abs
368
Transient aplastic crisis in pts w/ chronic hemolytic anemia - what do you think happened?
Parvo B19 infection
369
Pink pearly nodules w/ telangiectasias + flecksof melanin pigment What is this? How to tx?
Basal cell carcinoma Superficial lesions tx w/ curettage, imiquimod, cryotherapy, or excision
370
How do ou improve survival in severe sepsis?
Agggressive fluid rescussitation If lactic acid resolves in 6 hrs, good for survival 5-6L fluids/6hrs.
371
Causes of prostatitis
Usually gm - ``` E coli Klebs Proteus Pseudomonas Enterobacter Serratia ```
372
Which is worse - acute vs chronic prostattis? | - how do you tell what it is?
Acute ``` Acute - prostate tender - fever - pt looks ill DO NOT MASSAGE THE PROSTATE as can cuse bacteremia WBC in UA, U cx always + for bacteria ``` Chronic - prostate may not be tender - pt doesn't look ill - WBC in UA, U Cx may or may not be +
373
Most common STD? Most cmmon bacterial STD?
STD - HPV Bacterial STD - chlamydia
374
Leading cause of infertility in women
Chlamydia b/c of tubal scarring
375
Complication of gonorrhea and chlamydia
Infertility Fitz-hugh curtis syndrome
376
When do you do csection for hIV + mom?
Viral load > 1000 copies
377
Best indicator of status of immune system ad risk for opportunistic infections and disease progressio
CD4 count >500, immune system normal
378
Best indicator of adequacy and response to antiretrovirals?
Viral load (HIV-1 RNA levels)
379
Leading cause of death in pts w/ AIDS
PCP
380
When at increased risk for CMV or MAC w/ HIV?
CD4 < 50
381
Dx cryptococcal meningitis
CSF ID tain w/ india ink
382
When do you see esophageal candidiasis in HIV?
CD 4 < 100
383
How long to seroconvert to HIV +
3-7 weeks
384
When does ELISA become + for HIV?
1-12 weeks after infection If negative, usually doesn't have HIV
385
When do you say someon has AIDS?
CD4 < 200
386
PCP signs
Dyspnea, dry cough, fever CD4 < 200 CXR = bilateral interstitial infiltrates Increased LDL Hypoxia Bronch to dx fully
387
When do start px for MAC in HIV?
CD4 < 100
388
Where does HSV stay latent?
dorsal root ganglia
389
Reactivaton of HSV assoc w/
stress fever infection sun exposure
390
How to tx herpetic whitlow?
Acyclovir DO NOT incise and drain
391
Dx herpes
Tzanck smear - quickest - shwes multinucleated giant cells Cultur of HSV is gold standard (2-3 days) ELISA
392
Most common presentations of syphillis
Chancre Inguinal lymphadenopathy Maculopapular rash of 2ndary syphilis
393
Dx syphilis
NOntreponemal test - RPR, VDRL - very sensitive - if +, confirm w/ specific treponemal test - can be + w/ SLE Treponemal test - FTA-abs, MHA-tp - more specific - not for screening, just to confirm
394
Lymphogranuloma venereum
STD by C. trachomatis Painless ucer at site of inoculation --> tender inguinal lymphadenopathy few wks later --> constitutional sx
395
How to dx cellulitis?
Clinical! It is inflammation of skin adn subQ tissue
396
When is cellulitis med emergency?
Orbital involvement
397
Likely cause of cellulitis if caused by break in skin
Group A srep
398
Likely cause of cellulitis if caused by wounds, abscesses
Staph aureus
399
Likely cause of cellulitis if caused by immersion in water
Pseudomonas Aeromonas Vibrio vulnificus
400
Likely cause of cellulitis if caused by acute insusitis
H. influenzae
401
Erysipelas - what is it - tx
Celluitis confined to dermis and lymphatics Usually caused by group A strep Tx IM penicllin or erythromycin
402
Necrotizing fascitis - what is it - common causes - clinical features
Infectio of deep soft tissues rapidly tracking along fascial planes Strep pyogenes Clostridium perfringens Fever and pain out of proportion to appearance of skin Tissue necrosis Crepitus
403
Lymphadenitis
Inflammation of lymph node usually due to local skin or soft tissue bcterial infection Tender lymph nodes, red streaking of skin from wund or area of cellulitis
404
Dx of tetanus
Clinical
405
Tx tetanus
Neutralize unbound toxin w/ passive immunization Give 1 dose IM tetanus immune globulin + active immunizaton w/ Tdap
406
When do you give tetanus immunoglobulin?
If suspect pt is not immunzed for tetanus and has a bad woud. Don't need it in minor wounds for these ppl
407
When do you give tetanus/diptheria toxoid
If suspect pt is not immunized for tetanus and has clean, minor wound or worse
408
Common osteo bugs in catheter septicemia
Staph aureus
409
Common osteo bugs in prosthetic joint
Coag-negative staph
410
Common osteo bugs in diabetic foot ulcer
polymicrobial
411
Common osteo bugs in nosocomial
pseudomonas
412
Common osteo bugs in IV drug use, neutropenia
Fungal Pseudomonas
413
Common osteo bugs in sickle cell
Salmonella
414
Common osteo bugs in vertebrae
M. TB Pott's disease
415
How do you use ESR for osteo?
Monitor response to therapy
416
Best way to dx osteo
Needle aspiration of infected bone MRI
417
Most common joint affected in septic arthritis
Knee
418
What do you do for septic arthritis?
Joint aspiration + analyze synovial fluid Tx immediately if suspect - do not delay starting abx
419
Most impt tests to confirm clinical suspicion of Lyme disease
ELISA Western blott to confirm
420
Pathophys of RMSF
Rickettsia rickettsii multiply in vascular endothelium adn spred to diff layers of vasculature Damage endothelium --> increased vascular perm --> activate complement, microhemorrhages, microinfarcts Dx is clinical
421
``` Fever patterns of P falciparum P ovale P vivax P malariae ```
P falciparum --> constant P ovale, vivax --> every 48 hr spike P malariae --> every 72 hrs spike
422
How do you screen for HCC? How can you dx w/o Bx?
Ultrasound Patients with a compatible ultrasound imaging study and a subsequent serum α-fetoprotein level greater than 500 ng/mL (500 µg/L) can be diagnosed with hepatocellular carcinoma without a biopsy.
423
Corrected [HCO3]
= measured [HCO3] + (measured anion gap – 12)
424
Dx diffuse parenchymal lung disease
High-resolution CT (HRCT) is more sensitive than chest x-ray for DPLD and reveals ground-glass and reticular linear opacities, subpleural cysts, and honeycombing in patients with advanced disease.
425
Mycobacterium avium intracellulare
causes fevers, diarrhea, malabsorption and anorexia, and can disseminate to the bone marrow Always consider in HIV pts w/ diarrhea
426
Bronchial breath sounds - meaning
when bronchial breath sounds are heard in a location other than the trachea, it is suggestive of pulmonary consolidation
427
V/Q mismatch examples
pneumonia, pulmonary edema, and COPD/asthma
428
Pulmonary shunt - what is it - examples
extreme form of V/Q mismatch where there is no ventilation. This is clinically recognized when a patient who is hypoxic fails to respond to oxygen. right-to-left intracardiac shunt acute respiratory distress syndrome (ARDS)
429
PTT and BT affected. What does this person have?
von Willebrand disease is one of the few hemostatic disorders characterized by both a platelet and coagulation defect due to a reduction or defect in von Willebrand factor (vWF), which supports platelet adhesion and also serves as a carrier protein for factor VIII. The diagnosis is confirmed by measuring the vWF antigen level and activity.
430
The three classic findings in chronic pancreatitis are
abdominal pain that is usually mid-epigastric, postprandial diarrhea, diabetes mellitus secondary to pancreatic endocrine insufficiency. Dx w/ CT The presence of pancreatic calcifications on radiographs confirms the diagnosis.
431
A patient with a breast mass requires
triple assessment: palpation, mammography ultrasonography (if BI-RADS 1-3, skip to biopsy if 4,5) ---> distinguishes cystic from solid mass biopsy (FNA) or aspiration
432
5 major cardiovascular risk factors
cigarette smoking, hypertension, older age (men ≥45 years; women ≥55 years), low HDL-cholesterol level (<65 years).
433
Goal LDL in pts w/ 0-1 cardio risk factors
below 160 mg/dL (4.1 mmol/L).
434
Allergic bronchopulmonary aspergillosis
typ 1 HS rxn Asthma Eosinophilia
435
Pulmonary aspergilloma
Inhale spores into lung Chronic cough, hemoptysis Can resolve spontaneously; may need lung lobectomy
436
invasive aspergillosis
hyphae invade lung vasculature --> thrombosis and infarction Immunocomp at risk Diffuse bilateral pulm infiltrates
437
Dx aspergillosis
Fungus ball on CXR Sputum has aspergillosis Blood cx not helpful
438
What is characteristic of tissue biopsy of cryptococcus?
Lack of inflammatory response
439
What should you be suspicious of for persistent fever in ICU?
Fungal infection Antimicrobial resistance Needing surgery (abscess) Drug fever
440
Top causes fever of unknown oritin
Infection - TB, endocarditis, HIV Neoplasms - lymphoma, leukemia
441
How many organs must be involved to be TSS?
3 ``` Renal GI Heme MS CNS ```
442
Before starting oral retinoids, what do you ABSOLUTELY need to do for fems?
Get 2 negative pregnancy tests Use 2 forms of BC for 1 month before starting med through 1 month after stopping med
443
How do you tell between SCC and keratoacanthoma
Keratoacantoma grows SUPER FAST
444
Hypersensitivity of allergic contact dermatitis
Type 4 Eg poison ivy
445
Is pityriasis rosea contagious?
NO
446
Multiple round/oval patches appear than generalized rash w/ multiple oval shaped lesions. What is this?
Pityriasis rosea Usually not on face
447
Common infectious cause of erythema multiforme
HSV Acyclovir can help prevent HSV assoc EM
448
What should you always rule out when child presents w/ molluscum contagiosum?
Child abuse It is highly contagious, may have sex abse
449
Marjolin's ulcer
SCC arising from chronic wound such as previous burn scar Usually very aggressive
450
Who has better prognosis for malignant melanoma - men or women?
Women
451
Most impt indicator of melanoma prognosis
Depth of invasion
452
Angioedema vs. urticaria
Angioedema is deeper in skin (deep skin/subQ) Angioedema is more tender and burning vs. pruritic b/c fewer mast cells/sensory N endings in deeper tissues
453
Hypersensitivity rxns 1-4
1 - IgE 2 - IgG (Goodpastures, pemphigus vulgaris) 3 - Antigen-Ab complex (SLE, serum sickness) 4 - T cell mediated (poison ivy, TB)
454
How long dos it take for a drug allergy to appear?
1 month Usually not less than 1 week
455
Diagnose cobalamin deficiency in a patient with a low-normal vitamin B12 level with...
methylmalonic acid and homocysteine measurements. Levels of methylmalonic acid and homocysteine become elevated in patients with vitamin B12 deficiency before serum vitamin B12 levels decrease below the normal range
456
How do you get hypo Ca in acute pancreatitis?
Acute pancreatitis can generate free fatty acids that chelate insoluble Ca salts --> hypo Ca This is saponification
457
All pts w/ acute monoarthritis should be suspected to have....
Septic arthritis Arthrocentesis to dx usually manifests as acute monoarthritis and is characterized by pain on passive range of motion in the absence of known trauma.
458
MRI of joints is useful when?
detecting avascular necrosis soft-tissue masses collections of fluid not visualized by other imaging modalities
459
peripheral blood smear showing few, but large, platelets supports the presence of
a young population of platelets, consistent with increased turnover. ITP!
460
For parapneumonic effusion, what situations/characteristics are abx not enough? How else do you tx?
the presence of loculated pleural fluid, pleural fluid with a pH less than 7.20, pleural fluid with a glucose < 60 mg/dL lactate dehydrogenase > 1000 U/L, positive pleural fluid Gram stain or culture, presence of gross pus in the pleural space Chest tube or catheter drainage to tx too
461
Drug induced lung toxicity
``` hypersensitivity-type reaction, with presenting symptoms of fatigue, low-grade fever, cough. ``` Peripheral blood eosinophilia may be present. AMIODARONE is a common cause Acute eosinophilic pneumophilia is MUCH FASTER progressing than this so can r/o if disease has been around for awhile
462
How does handgrip help HOCM murmur?
increasing afterload and decreasing the relative pressure gradient across the left ventricular outflow tract.
463
Aortic stenosis vs. HOCM - differences
HOCM is associated with rapid upstrokes of the carotid arteries, aortic stenosis, is associated with a carotid artery pulsation that has a slow up-rise and is diminished in volume. murmur of aortic stenosis decreases with the Valsalva maneuver.
464
decreased anion gap in the presence of anemia, proteinuria, hypercalcemia, and renal failure suggests
Multiple myeloma
465
How does low anion gap happen in MM?
Most unmeasured anions consist of albumin. Therefore, the presence of either a low albumin level or an unmeasured cationic light chain, which occurs in multiple myeloma, results in a low anion gap.
466
Milk alkali
characterized by hypercalcemia caused by repeated ingestion of calcium and absorbable alkali Often w/ excess milk and antacids for dyspepsia
467
Glomerular vs. nonglomerular hematuria
RBC casts in glomerular Normal RBC in nonglomerular
468
Evaluate persistent hematuria with
cystoscopy
469
The best way to screen for hearing loss is the
whispered voice test.
470
dyspnea at rest or on exertion, platypnea, and hypoxemia in the setting of chronic liver disease.
hepatopulmonary syndrome The hypoxemia results from pulmonary vascular dilatation with intrapulmonary shunt and ventilation-perfusion mismatch, which may worsen when the individual is in an upright position. CXR is nl
471
Cells of sickle cell
Sickle cell Target RBC
472
Criteria for Type 2 DM
fasting plasma glucose level of at least 126 mg/dL a random plasma glucose level of at least 200 mg/dL and symptoms of hyperglycemia (for example, polyuria, polydipsia, or blurred vision), or a 2-hour oral glucose tolerance test (OGTT) result of at least 200 mg/dL
473
Impaired fasting glucose is diagnosed when
the fasting plasma glucose level is in the range of 100 to 125 mg/dL
474
impaired glucose tolerance
plasma glucose level at the 2-hour mark of an OGTT is 140 to 199 mg/dL
475
Imaging results of ischemic colitis What is a definitive diagnosis?
Thickened bowel wall on CT The finding of patchy segmental ulcerations on colonoscopy in a patient with a compatible history establishes the diagnosis.
476
Management of hyperglycemic hyperosmolar syndrome mainly involves
identifying the underlying precipitating illness and restoring a markedly contracted plasma volume. Insulin reduces glucose levels but should be administered only after expansion of the intravascular space has begun. Potassium should not be administered until urine output is verified, because these patients are prone to acute kidney injury.
477
Incidental asymptomatic adrenal mass - what do you do next?
Plasma-free metanephrine levels (for pheo) overnight dexamethasone suppression test (Cushing's) Adrenal incidentalomas unlikely to secrete aldo and screen if have HTN or hypo K
478
Acute chest syndrome in patients with sickle cell anemia should be managed by
exchange transfusion. Red blood cell exchange transfusions are performed to increase the hemoglobin A level to at least 50% and thereby decrease the percentage of abnormal sickle cells and prevent hemoglobin S polymerization and sickling. Will see pulm infiltrate on CXR for acute chest syndrome
479
Dark blue or black berry like lesions that are symmetric, elevated, and one color
Nodular melanoma Usually in older Tend to expand vertically rather than horiz
480
Goal LDL of pts with previous stroke or TIA
Less than 100
481
Who should get HPV vaccine?
All girls between 9 and 26 regardless of sex activity
482
Genital herpes lesions
Vesicles that ulcerated and are painful. | Can have crusted roof
483
Chancroid lesions
Deep ragged ulcers Purulent May have tender lymph nodes
484
Prosthetic joint infection
Pain is main sx Usually no fever or leukocytosis Arthrocentesis is gold std to dx
485
Zinc excess can cause...
Copper deficiency Copper def can look like b12 def and have demyelination
486
Patients with new-onset heart failure and angina should be evaluated with
cardiac catheterization and angiography if they are possible candidates for revascularization.
487
Patients with new-onset heart failure and angina should be evaluated with
cardiac catheterization and angiography if they are possible candidates for revascularization.
488
Sequelae of infective endocartitis
``` Fever Roth's spots (white spots on retina) Osler nodes (tender nodes on fingers or toes) Murmur Janeway lesions (painless erythematous lesions on palm) Anemia Nailbed Hemorrhage Emboli ```
489
HUS commonly manifests as
acute kidney injury (AKI) accompanied by thrombocytopenia and microangiopathic hemolytic anemia (schistocytes on peripheral blood smear).
490
When is prostate cancer screening beneficial?
Under 75 years old
491
how to reduce the risk of ventilator-associated pneumonia (VAP).
Semi-erect position Oral placement of endotracheal tubes better than nasal placement
492
Osteoporosis screening guidelines
Guidelines recommend that screening for osteoporosis begin at age 65 years for women. Women aged 60 to 64 years should be screened if they are at higher than average risk for osteoporosis. The most predictive risk factor for osteoporosis is weight below 70 kg (154 lb), as with this patient.
493
Pneumococcal vaccine is indicated for
persons age 65 years and older or for those younger than 65 years who live in long-term care facilities, or who have chronic illnesses, or who are Alaskan natives or American Indians.
494
Which acute hepatitis rarely causes symptoms?
C
495
cosyntropin stimulation test
is used to determine the adrenal reserve by measuring the response to a standard dose of synthetic adrenocorticotropic hormone. The test does not detect Cushing syndrome but, rather, adrenal insufficiency
496
the most common causes of cirrhosis in the United States
Alcohol and chronic hepatitis C infection are
497
drinks to cause alcoholic cirrhosis
6 alcoholic drinks per day for men 3 alcoholic drinks per day for women for 10 years
498
Bowen disease
SCC in situ Gradually enlarging Well demarcated erythematous scaly plaques can look like psoriasis, BCC, eczema
499
Cryptogenic organizing pneumonia
Alveolar filling opacities on CXR The tempo of the disease process is the key to differentiating COP from other interstitial lung diseases. COP is often acute or subacute, with symptom onset occurring within 2 months of presentation in the majority of patients. The presentation is so suggestive of an acute or subacute lower respiratory tract infection that patients have almost always been treated with and failed to respond to one or more courses of antibiotics before diagnosis.
500
How does a mixing study help w/ diagnosing disorders in coagulation?
The results of the mixing study will normalize in a patient with a factor deficiency but will remain abnormal if an inhibitor is present.
501
classic ekg finding for pe
s1q3t3
502
For what women is there no proven benefit to routine Pap testing to detect cancer.
In asymptomatic women who have had a complete vaginal hysterectomy for benign disease Still need it if did a complete vaginal hysterectomy but for a malignant disease reason Also need to screen if have cervix in still
503
1st step for tx hyper K
intravenous calcium gluconate THEN: Sodium bicarbonate and β-antagonists such as albuterol and glucose (with or without insulin) would facilitate intracellular potassium shift.
504
How do you tell DIC from HUS and TTP?
Neither TTP nor HUS is associated with elevations of the prothrombin or partial thromboplastin time or the D-dimer or depression of the fibrinogen level.
505
Do you tx salmonella diarrhea w/ abx?
No, only some cases (severly ill, young, immunocompromised) May prolong disease duration!
506
When do you do tests for lymphadenopathy?
patients with systemic symptoms, progressively enlarging lymph nodes, or persistently enlarged nodes for more than 2 weeks If lymph node < 2 cm, don't need to do tests!
507
How do you 1st manage prostate cancer screening?
physicians discuss potential, but uncertain, benefits and possible harms (complications of future diagnostic testing and therapies, including incontinence; erectile dysfunction; and bowel dysfunction) before ordering PSA testing
508
Osteoporosis is diagnosed by
the presence of fragility fractures (fracture secondary to minor trauma, such as falling from a standing position), or by a bone mineral density (BMD) T-score less than −2.5 in patients who have not experienced a fragility fracture.
509
AST vs ALT - which is more specific to liver tissue?
ALT
510
Cholestatic injury (cholestasis),
which consists of a lack of or an abnormality in the flow of bile, is indicated primarily by an elevation of serum alkaline phosphatase and relatively minimal elevations of AST and ALT.
511
only calcium channel blockers with demonstrated neutral effects on mortality in patients with heart failure.
Amlodipine and felodipine First-generation calcium channel blockers (such as nifedipine) have been shown to increase the risk of heart failure decompensation and hospitalization.
512
Pt with severe, rapidly progressive pneumonia, especially during influenza season...waht do you suspect? What should you give to tx?
Methicillin-resistant Staphylococcus aureus (MRSA) should be suspected cefotaxime, levofloxacin, and vancomycin.
513
Peptic ulcer in gastric antrum - what do you do?
Biopsies of all gastric ulcers should be performed, because even small, benign-appearing gastric ulcers may harbor malignancy Treatment for peptic ulcer disease is guided by the biopsy and presence of H. pylori infection.
514
How do you screen for bleeding d/o prior to surgery?
Clinical hx! In the absence of a personal or family history of abnormal bleeding, liver disease, significant alcohol use, malabsorption, or anticoagulation therapy, the likelihood of a bleeding disorder is low, and no further preoperative testing is required. Patients with any of these risk factors should be screened further by obtaining a prothrombin time (PT/INR), an activated partial thromboplastin time, and a platelet count.
515
The treatment for an acute STEMI is
either revascularization or thrombolytic therapy.
516
Thrombolytic agents are an alternative to primary PCI in suitable candidates with STEMI. How long before you give it?
Thrombolytics should be administered within 12 hours after the onset of chest pain; the earlier the administration, the better the outcome.
517
Progestin withdrawal challenge for secondary amenorrhea
If get menstural flow, indicates relatively normal estrogen no anatomical blockage Then this person has chronic anovulation
518
Patients with an elevated or rising serum PSA level noted during routine screening should...
undergo prostate biopsy, even if they are asymptomatic. Any rise greater than 0.75 ng/mL/year (0.75 µg/L/year) is considered abnormal and should be evaluated
519
Patients with new-onset urinary incontinence should first be evaluated for
transient, reversible causes, for which the mnemonic DIAPERS may be useful: Drugs, Infection, Atrophic vaginitis, Psychological (depression, delirium, dementia), Endocrine (hyperglycemia, hypercalcemia), Restricted mobility, Stool impaction.
520
anserine bursitis,
the diagnosis rests on the finding of focal tenderness on the upper, inner tibia, about 5 cm distal to the medial articular line of the knee
521
one of the leading causes of death in patients with polymyositis and dermatomyositis
ILD with progressive pulmonary fibrosis and secondary pulmonary arterial hypertension
522
When do you have an inferolateral MI
Left dominant circulation if your PDA comes off LCX. Will see st elevation in I avL V VI and II III aVF
523
What do you use for UTI in person with long QT?
Not fluoroquinolone, tmp smx, or nitrofurantoin. Use amoxicillin
524
If you have high suspicion that a person has lung cancer, what do you do next?
Sample lymph node to determine stage
525
Pt has neisseria meningitis meningitis. Best next step for infection control management?
Face mask because droplet precautions
526
Acute abdomen pain. What do you do first ?
Supine and upright ab radiographs to look for air fluid levels (bowel obstruct) or free peritoneal air (perforated viscus)
527
GI bleed of unknown origin, what can help you ID the source?
Upper endoscopy 1/3-2/3 soured of bleeds of obscure etiology are found in reach of upper endo
528
When can you not use adenosine nuclear perfusion stress test?
Pts with asthma , bronchospastic dz
529
When do you do ppx for cirrhotic pts for SBP? Med?
When hospitalized for gi bleed like varicies Give IV ceftriaxone
530
CRC screening methods
Annual home high-sensitivity FOBT, sampling two to three consecutive specimens, is a method recommended by the U.S. Preventive Services Task Force (USPSTF) for screening if the patient is willing to undergo colonoscopy if results are positive. colonoscopy every 10 years flexible sigmoidoscopy every 5 years combined with annual high-sensitivity FOBT every 3 years.
531
SLE vs rosacea or seborrheic dermatitis
SLE - The nasolabial folds are relatively protected from the sun, and the absence of the rash in this area helps to distinguish it from other common rashes of the face, including rosacea and seborrheic dermatitis.
532
In patients with trifascicular block, permanent pacer implantation is recommended for
intermittent third-degree atrioventricular block, type II second-degree atrioventricular block, and alternating bundle branch block. A pacer is not indicated for asymptomatic trifascicular block.
533
The “get up and go” test
Persons are timed in their ability to rise from a chair, walk 10 feet, turn, and then return to the chair. Most adults can complete this task in 10 seconds, most frail elderly persons, in 11 to 20 seconds. Those requiring more than 20 seconds should undergo a fall evaluation.
534
The most effective treatment for hepatorenal syndrome is
liver transplantation.
535
secondary amenorrhea - 1st lab tests to do
Laboratory evaluation is first directed toward ovarian failure, hyperprolactinemia, and thyroid disease. FSH (>20 = ovarian failure) prolactin, thyroid-stimulating hormone, and free thyroxine (T4) levels are generally measured.
536
Septic arthritis usually has leukocyte counts
greater than 50,000/µL (50 × 109/L) and a predominance of polymorphonuclear cells.
537
Venous stasis vs cellulitis
Bilateral involvement, absence of fever or leukocytosis, hyperpigmentation due to hemosiderin deposition, and minimal pain help distinguish venous stasis dermatitis from cellulitis.
538
What is the peak expiratory flow rate for - mild - mod - severe - life threatening Athsma attack? When do you admit?
Mild > 70% --> home Mod 40-69% --> ER Severe < 40% --> inpt Life threatening < 25% --> inpt
539
acute cholangitis vs acute cholecystitis
Patients with acute cholecystitis may have right upper quadrant pain and gallstones, but the bilirubin level is usually not greater than 2 mg/dL (34.2 µmol/L), and aminotransferase levels are normal.
540
The four-point Centor criteria
\fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough often used as a prediction rule in patients with suspected GABHS infection. Patients with two Centor criteria have an intermediate probability for GABHS infection, and rapid streptococcal antigen testing (sensitivity of 88% and specificity of 94%) is a reasonable strategy for these patients. Patients with 0 or 1 criterion have a low (<3%) probability of GABHS, and neither testing nor antibiotic treatment is recommended. Antibiotics are not indicated for this patient before rapid streptococcal antigen testing is done to determine whether they are needed. If treatment is indicated, the antibiotic of choice is penicillin. Macrolide antibiotics and first- and second-generation cephalosporins are alternative choices for penicillin-allergic patients.
541
Best test to evaluate infrequent syncope
implantable loop recorder
542
The initial treatment in acute cocaine intoxicatino should include
sedation with lorazepam, administered intravenously or intramuscularly. Intravenous fluids should be administered to establish adequate urine output for possible rhabdomyolysis, and an electrocardiogram should be obtained to assess for myocardial ischemia.
543
When to start tx for gout?
Uric acid–lowering therapy typically is not initiated until a patient experiences two documented acute attacks.
544
What tx help to prevent disease flares in gout associated with changes in uric acid levels and may need to be continued until therapeutic serum uric acid levels have been achieved.
Prophylactic colchicine, low-dose corticosteroids (10 mg/d or less), or nonsteroidal anti-inflammatory drugs (NSAIDs) initiated at least 1 week before beginning or adjusting the dose of uric acid–lowering therapy
545
Polymyositis and dermatomyositis vs inclusion body myositis
IBM didn't respond to steroids Anti Jo1 in all
546
What do you use to treat scleroderma renal crisis?
Acei
547
Which thyroid cancers should use radioablation on?
Follicular | Papillary
548
The primary eligibility criterion for implantable cardioverter-defibrillator implantation for primary prevention of sudden cardiac death in the setting of heart failure is
left ventricular ejection fraction less than 35%
549
Hemachromatosis susceptible to these organisms
VYL Vibrio vulnificus Yersinia Listeria
550
The primary eligibility criterion for implantable cardioverter-defibrillator implantation for primary prevention of sudden cardiac death in the setting of heart failure is
left ventricular ejection fraction less than 35%
551
Hemachromatosis susceptible to these organisms
VYL Vibrio vulnificus Yersinia Listeria
552
What kind of tachy is WPW?
Atrioventricular reentrant tachy
553
Zoster vaccine is indicated in
all patients age 60 years and older without contraindications, regardless of history of prior varicella infection. The vaccine is more efficacious in preventing herpes zoster among adults 60 to 69 years of age than among those 70 years or older. On the other hand, the vaccine prevents postherpetic neuralgia to a greater extent among adults aged 70 years or more. A reported history of possible herpes zoster is not a contraindication to vaccination.
554
Septic shock
A subset of severe sepsis, defined as sepsis-induced hypotension despite adequate fluid resuscitation plus the presence of perfusion abnormalities. Patients receiving inotropic or vasopressor agents may no longer be hypotensive by the time they develop hypoperfusion abnormalities or organ dysfunction; however, they would still be considered to have septic shock
555
Severe sepsis
Sepsis associated with organ dysfunction, hypoperfusion, or hypotension.
556
Most patients with vertebral osteomyelitis have
back or neck pain that gradually worsens over weeks or months; fever is present in only 50% of patients leukocytosis is typically absent, the erythrocyte sedimentation rate is often greater that 100 mm/h. Always get blood cx and MRI imaging first. Blood cultures are positive in 75% of patients with vertebral osteomyelitis Then can start abx if infected and know organism
557
Sinoatrial node dysfunction .
comprises a collection of pathologic findings that result in bradycardia. These include sinus arrest, sinus exit block, and sinus bradycardia. Approximately 50% of patients with sinoatrial node dysfunction also have associated supraventricular tachycardia, most often atrial fibrillation or atrial flutter
558
Most patients with vertebral osteomyelitis have
back or neck pain that gradually worsens over weeks or months; fever is present in only 50% of patients leukocytosis is typically absent, the erythrocyte sedimentation rate is often greater that 100 mm/h. Always get blood cx and MRI imaging first. Then can start abx if infected and know organism
559
Coronary calcium testing may be considered in
asymptomatic persons with a 10% to 20% Framingham 10-year risk category (intermediate risk) and in young persons with a strong family history of premature cardiovascular disease.
560
Pheochromocytoma classic sx
classic triad of sudden severe headaches, diaphoresis, and palpitations carries a high degree of specificity (94%) and sensitivity (91%) for pheochromocytoma in hypertensive patients
561
Coarctation of teh aorta can ave murmurs in theback - how?
The systolic and diastolic murmurs noted over the back are related to collateral vessels, which also cause the sign of rib notching, seen on this patient's chest radiograph on the inferior surface of the posterior upper thoracic ribs bilaterally.
562
Pheochromocytoma classic sx
classic triad of sudden severe headaches, diaphoresis, and palpitations carries a high degree of specificity (94%) and sensitivity (91%) for pheochromocytoma in hypertensive patients
563
In considering surgical treatment for patients with back pain from radiculopathy or spinal stenosis, guidelines recommend referring patients after
a minimum of 3 months to 2 years of failed nonsurgical interventions. Failure is defined as progressive neurologic deficits and severe pain that is not responsive to conservative treatment
564
GERD diagnosis
Endoscopy if GERD sx + alarm sx (dysphagia) Response to empiric treatment with a proton pump inhibitor such as omeprazole would be sufficiently sensitive and specific to diagnose GERD Testing for H. pylori is not indicated for patients with GERD, because the presence or absence of H. pylori does not correlate with the presence or absence of GERD or guide therapy. Ambulatory esophageal pH monitoring is the gold standard for diagnosing GERD and is typically used in patients in whom the diagnosis is uncertain or who are unresponsive to empiric therapy.
565
The diagnosis of diabetic ketoacidosis is based on
a blood glucose level greater than 250 mg/dL (13.9 mmol/L), anion gap metabolic acidosis (arterial pH <7.30), a serum carbon dioxide level less than 15 meq/L (15 mmol/L), positive serum or urine ketone concentrations.
566
GERD diagnosis
Endoscopy if GERD sx + alarm sx (dysphagia) Response to empiric treatment with a proton pump inhibitor such as omeprazole would be sufficiently sensitive and specific to diagnose GERD Testing for H. pylori is not indicated for patients with GERD, because the presence or absence of H. pylori does not correlate with the presence or absence of GERD or guide therapy. Ambulatory esophageal pH monitoring is the gold standard for diagnosing GERD and is typically used in patients in whom the diagnosis is uncertain or who are unresponsive to empiric therapy.
567
Diagnose spinal cord compression due to bone metastases with
MRI scan. Radionuclide bone scanning is very sensitive for detecting bone metastases and has the advantage of visualizing the entire skeleton, but it has a high false-positive rate and provides no information about thecal sac compression.
568
the primary cause of morbidity in patients with systemic sclerosis;
Pulmonary disease PAH is among the most common manifestations of lung involvement in these patients Pulmonary function studies in patients with PAH usually reveal an isolated decreased DLCO in the setting of normal airflow and lung volumes
569
Cervicitis
is the presence of a mucopurulent cervical discharge or endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os. Cervicitis is commonly caused by either gonorrhea or chlamydial infection,
570
the primary cause of morbidity in patients with systemic sclerosis;
Pulmonary disease PAH is among the most common manifestations of lung involvement in these patients
571
Routinely screen sexually active women under the age of 25 years for
chlamydia, gonorrhea, and HIV
572
Treat acute sinusitis with
symptomatic measures Most cases of acute sinusitis are caused by a virus NO abx unless: symptoms lasting longer than 7 days, facial pain, purulent nasal discharge. The data as a whole suggest that if antibiotics are to be used, amoxicillin or doxycycline are adequate first-line agents.
573
Routinely screen sexually active women under the age of 25 years for
chlamydia, gonorrhea, and HIV
574
Which is worse, ingesting alkali or acidic solutions on your esophagus?
Alkali - causes liquefactive necrosis TRANSMURALLY acidic is only on the surface
575
Smoking cessation is associated with
a decreased rate of decline in lung function. | Improved lung function
576
What do you measure on ppd?
The induration—not the erythema—resulting within 48 to 72 hours is then measured.
577
stage 2 hypertension
systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg recommend initiating treatment with two medications in patients with stage 2 hypertension or those whose blood pressure is greater than 20 mm Hg systolic or 10 mm Hg diastolic above target. Low-dose hydrochlorothiazide and an angiotensin-converting enzyme (ACE) inhibitor
578
What do you measure on ppd?
The induration—not the erythema—resulting within 48 to 72 hours is then measured.
579
Ischemic colitis
older than 60 years and usually present with left lower quadrant pain, urgent defecation, and red or maroon rectal bleeding that does not require transfusion Colonoscopic findings are generally segmental and include hemorrhagic nodules, linear and circumferential ulceration, and gangrene vs mesenteric ischemia - in SI! - Severe abdominal pain is almost invariably present, but early physical examination findings are minimal, illustrating the classic teaching of “pain out of proportion to examination.”
580
Acute small bowel (mesenteric) ischemia
should be suspected in patients who have risk factors for embolism or thrombosis and who present with sudden-onset, severe abdominal pain that, in the early stage, is out of proportion to the physical examination findings
581
Ischemic colitis is
due to a temporary interruption in mesenteric blood flow and typically occurs in older individuals with significant cardiac and peripheral vascular disease; patients present with abdominal pain.
582
Fitz Hugh Curtis syndrome
RUQ pain and pelvic adenexal tenderness Gonococcal perihepatitis
583
To confirm that an elevated ALP is of liver origin,
measure other bile duct enzymes (γ-glutamyl transpeptidase, 5’-nucleotidase)
584
ALP indicates
cholestatic disease

Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions