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Primary Care > Medicine Qbank 2 > Flashcards

Medicine Qbank 2 Flashcards

1
Q

risk factors for squamous cell caricoma

A

sun exposure! less important: arsenic, aromatic hydrocarbons, chronic osteomyelitis, chronic scars

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2
Q

methotrexate AE

A

macrocytic anemia. folate may help. DMARD inhibits dihydrofolate reductase leads to heme tox, including also pancytopenia. other AE: nausea, stomatitis, hepatotox, interstitial lung dx and alopecia and fever.

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3
Q

hydroxychloroquine AE

A

GI, visual disturbances, hemolysis in G6P def. (DMARD)

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4
Q

cyclosporine AE

A

immunosuppressant: viral infection, lymphoma, nephrotox

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5
Q

Azathioprine AE

A

pancreatitis, liver tox, dose-dependent bone marrow suppression

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6
Q

best method of improved survival in COPD

A

supplemental oxygen (vaccines also help)

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7
Q

indications for oxygen in COPD

A

PaO255, or evidence of for pulmonale

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8
Q

enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs

A

cor pulmonale

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9
Q

most common cause of pneumonia in pt w/HIV

A

pneumococcus

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10
Q

infections causing pancreatitis

A

CMV, legionella, aspergillus (uncommon)

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11
Q

sulfonylureas AE

A

wt gain, hypoglycemia (generally added in metformin failure)

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12
Q

TZDs AE

A

wt gain, CHF, edema, bone fracture, bladder cancer (low risk of hypoglycemia, can be used in renal insufficiency)

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13
Q

Insulin AE

A

wt gain, hypoglycemia (added in metformin failure w/A1c>8.5)

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14
Q

DPP-IVi AE (sitigliptin)

A

not much. wt neutral, low risk of hypoglycemia, can be used in renal insufficiency

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15
Q

GLP-1 receptor agonist AE (exenatide, liraglutide)

A

associated w/acute pancreatitis. wt loss! low risk of hypoglycemia. possible second agent in metformin failure.

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16
Q

acute onset back pain, positive straight leg raise

A

herniated disk. early mobilization, muscle relaxants and NSAIDs

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17
Q

used in patients with osteoporosis and possible vertebral crush fractures

A

plain roentgenogram (x-ray)

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18
Q

IgA anti-endomysial and anti-tissue transglutaminase antibodies

A

predictive of celiac (absent in selective IgA deficiency)

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19
Q

worsening chest pain after endoscopy; left-sided pleural effusion

A

suspicious for esophageal rupture! water-soluble esophagram (may also see pneumothorax, pneumomedistinum)

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20
Q

HBsAg

A

persists for six months in chronic HBV

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21
Q

HBeAg

A

evidence of replication, increased infectivity (Immune tolerance and immune clearance phases, not later)

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22
Q

Anti-HBe

A

marks decline of replication

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23
Q

IgM anti-HBc

A

first antibody in acute infection

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24
Q

IgG anti-HBc

A

indicated prior or ongoing infection

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25
Q

confirm inactive HBV carrier status

A

3 normal ALT levels and 2-3 normal HBV DNA tests over one year

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26
Q

high in tumor lysis syndrome

A

potassium, phosphate and urea. allopurinol may reduce acute irate nephropathy

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27
Q

granulomatous dz, hyperkalemia, hypoglycemia, eosinophila

A

adrenal insufficiency; normal anion gap acidosis (TB causes Addisons’s!)

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28
Q

Calculate anion gap

A

Sodium - (Chloride+Bicarb). 12 is normal

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29
Q

tachycardia, hypertension, arrhythmias, high fever, tremor and lid lag

A

thyroid storm (can be postop, trauma, infection, iodine contrast or childbirth)

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30
Q

tachycardia, high fever, hypercarbia, muscle rigidity, elevated CK, hyperkalemia

A

malignant hyperthermia, tx dantrolene IV

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31
Q

euvolemic hyponatremia, decreased serum osmolarity, elevated urine osmolarity, high urine sodium

A

SIADH (fails to correct)

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32
Q

total body water overload, depleted intravascular volume, low urine sodium

A

low albumin, in advanced liver dz, particularly cirrhosis

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33
Q

ADH

A

acts on distal tubule to increase free water resorption. excess causes hyponatremia

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34
Q

associated with poor prognosis in PE

A

afib, low O2 sat

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35
Q

cardiac tamponade triad (and EKG)

A

distant heart sounds, hypotension and distanced neck veins; electrical alternans

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36
Q

vomiting and pain, not typically diarrhea, rapid onset (preformed toxin)

A

s.aureus

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37
Q

brief illness, watery diarrhea, cramps and fever, undercooked or unfridgerated food

A

c. perfringens

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38
Q

associated with shellfish, may cause invasive disease in immunocompromised or pts with liver dz

A

vibrio vulnificus

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39
Q

watery or bloody, undercooked beef, bovine feces

A

e. coli

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40
Q

bloody, associated with contaminated food, water outside of US

A

shigella

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41
Q

bloody, often in children and young adults, raw/undercooked meat

A

campylobacter

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42
Q

most common cause of bloody diarrhea w/o fever

A

e.coli

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43
Q

antibiotics in enterohemorrhagic e.coli

A

no! may increase risk of hemolytic uremic syndrome

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44
Q

high dose dexamethasone does not suppress plasma cortisol levels

A

ectopic ACTH syndrome

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45
Q

ACTH independent Cushing’s

A

exogenous glucocorticoids, adrenal adenoma, or primary pigmented nodular adrenocortical hyperplasia

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46
Q

ACTH dependent Cushing’s

A

ACTH-producing pituitary adenoma (cushing’s dz), ectopic ATCH, ectopic corticotropin-releasing hormone

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47
Q

rapid onset hypertension, metabolic alkalosis, hyperglycemia, hyperkalemia, and proximal muscle weakness

A

cushing’s syndrome from ectopic ATCH. malignancies (small-cell lung, pancreatic), does not suppress with high dose dexamethasone

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48
Q

loop diuretics (furosemide) AE

A

ototoxicity (reversible or irreversible hearing loss, tinnitus), esp. w/aminoglycosides or in pts with renal failure

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49
Q

hydrochlorothiazide AE

A

orthostatic hypotension, photosensitivity, hypercalcemia,

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50
Q

sildenafil (phosphodiesterase inhibitor) contrindications

A

pt on nitrates, with four-hour interval with alpha-blockers (doxasozin, for BPH) to avoid hypotension

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51
Q

odds ratio can be calculated, but incidence cannot

A

case-control study (two groups, one w/dz, comparison of exposure to risk factors)

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52
Q

s. bovis subtype associated with colon cancer

A

biotype 1, S gallolyticus

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53
Q

mammogram guidelines

A

women 50-75, every two years

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54
Q

pap smear guidelines

A

women 21-65, every three years

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55
Q

colonoscopy guidelines

A

50-75, every 10, or fetal occult blood every 1

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56
Q

lipid panel guideline

A

men over 35, every 5 years, women at increased risk at 45

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57
Q

hypertension screening

A

18+, BP every 2 years

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58
Q

DEXA guidelines

A

women +65, uncertain interval

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59
Q

antibiotics for human bite, “fight bite”

A

amoxicillin-clavulanate. polymicrobial coverage: gram positives, negatives and (beta-lactam producing) anaerobes.

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60
Q

clindamycin covers

A

gram-positives and anaerobes

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61
Q

ciprofloxacin cover

A

gram-positives and negative, not anaerobes

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62
Q

drug of choice for legionnaire’s dz, outpatient CAP

A

erythromycin

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63
Q

causes red-orange discoloration of body fluids

A

rifampin. antibiotic, mycobacteria coverage (TB, leprosy), tick-bourne illnesses in pts who can’t take doxycyline

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64
Q

inflammation, fibrosis and stricture of hepatic ducts in patients with UC (more often) and Crohn’s

A

primary sclerosing cholangitis. see beading on imaging, onion skins on histology

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65
Q

fever, malaise, wt loss, neuropathy, arthralgias, livedo reticularis , renal dz, necrotic inflammation of medium-sized arteries

A

PAN, polyarteritis nodosa

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66
Q

primary biliary cirrhosis v. primary sclerosing cholangitis

A

PBC is women, 9:1. PSC is associated with UC

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67
Q

travel to endemic area followed by dysentery and RUQ pain

A

amebic liver dz! single cyst in right lobe of liver, protozoa: entameoba histolytic. Mexico!

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68
Q

signs of liver abscess after surgery, GI illness, acute appendicitis

A

pyogenic liver cyst. severe presentation

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69
Q

most beneficial therapy to reduce progression to diabetic nephropathy

A

blood pressure control

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70
Q

DM statin recommendations

A

all diabetes 40-75

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71
Q

hypercalcemia in paralysis

A

immobilization leads to osteoclast activation and hypercalcemia. tx bisphosponates

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72
Q

altered mentation, lethargy, weakness, hyperosmolarity, volume depletion, severe hyperglycemia without ketosis

A

HHS. serum glucose >600! when insulin is just controlled enough to prevent ketosis but not hyperglycemia

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73
Q

diarrhea, tricuspid murmur?

A

Carcinoid! Small intestine, proximal colon, or lung, mets to liver!

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74
Q

elevated urine 5-hydroxyindoleacetic acid, increased chromogranin A

A

confirm carcinoid dx

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75
Q

primary treatment for all prolactinomas

A

dopaminergic agents: bromocriptine, caberogoline). normalizes prolactin and reduces tumor size

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76
Q

most cellulitis

A

s. aureus

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77
Q

tx staph cellutlitis

A

IV hafcillin, cefazolin, vanc if MRSA

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78
Q

abnormal thyroid levels in acute severe illness (T3 lower than T4)

A

sick euthyroid (decreased calories + increased cytokines: IL1, IL6)

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79
Q

Rh-, HLA B27

A

ankylosing spondylitis, reactive arthritis, enteropathic spondylitis (UC, IBD, Crohn’s), psoriatic arthritis, JIA

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80
Q

proteinuria, arthritis, wt loss, fatigue, rash, serotitis, neuro sx

A

SLE

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81
Q

painless subcutaneous nodules at pressure points (olecranon)

A

rheumatoid arthiritis, gout

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82
Q

associated w/PPi use, anti-histamines

A

c. diff

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83
Q

positive urea breath test

A

h. pylori (epigastric pain, early saiety)

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84
Q

c. diff test

A

assay for bacteria toxin A and B

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85
Q

steatorrhea, malabsorption, anti-tissue transaminase Ab

A

celiac

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86
Q

increased serum gastrin levels

A

gastroma, zollinger-ellison syndrome

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87
Q

GERD, diarrhea, and duodenal ulcers in young or med-age adults

A

zollinger-ellison syndrome

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88
Q

tx TCA OD

A

sodium bicarb (if QRS>100), benzos (if seizure)

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89
Q

tx anticholinergic OD (atropine, diphenhydramine)

A

physiostigmine

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90
Q

80% of US cirrhosis

A

HCV or EtOH cirrhosis

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91
Q

anasarca (generalized edema), ascites, thrombosis

A

nephrotic syndrome

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92
Q

paradoxical embolism

A

PFD, VSD allow embolus from venous circulation

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93
Q

lung lesion stable for >2 years

A

noncancerous (when no prior image available, get chest CT)

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94
Q

antinuclear antibodies

A

collagen vascular diseases, SLE, type 1 autoimmune hepatitis

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95
Q

anti-smooth muscle Ab, antiLKM

A

acute and chronic active hepatitis (highest in chronic active)

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96
Q

anti-smith

A

SLE (high specificity, but only present in 30-50%)

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97
Q

P-ANCA

A

churg-strauss, microscopic polyangitis

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98
Q

anti-mitochondrial Ab

A

90% of PBC

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99
Q

enthesitia

A

pain where tendons and ligaments connect to bones: heels, tibial tuberousities, iliac crests. In HLA-B27s: AS, psoriatic and reactive arthritis)

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100
Q

endotrachial tube misplacement v. tension pneumothorax

A

tension pneumo has significant hypotension

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101
Q

normal response to calcium infusion test

A

decreased urine phosphate excretion, 2/2 PTH inhbition (does not occur in hyperPTH)

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102
Q

calcium infusion test: sharp rise in gastrin

A

gastrinoma (pancreatic islet cell tumor) (also diarrhea, ulcers in multiple sites, thickened gastric folds on endoscopy)

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103
Q

hyperPTH, chronic atrophic gastritis, chronic PPI use

A

can lead to carcinoid tumors

104
Q

HA, n/v, confusion, pink-red skin

A

CO poisoning. tx (O2 until CO levels drop below 10%)

105
Q

fever, chills, flank pain, DIC, Coombs +, pink plasma, 1 hr after transfusion

A

acute hemolytic transfusion reaction, 2/2 ABO mismatch. (fluids, dopamine, mannitol, FFP for bleeding)

106
Q

anaphylaxis, angioedema, respiratory depression after transfusion

A

IgA deficiency

107
Q

fever, chills, and malaise I hour after transfusion

A

febrile non-hemolytic tranfusion reaction. supportive tx

108
Q

70% of mitral stenosis causes

A

afib from left ventricular dilitation

109
Q

hypopigmented scaling patches, grow in heat/humidity, KOH shows hyphae and yeast spaghetti and meatballs

A

tinea versicolor. tx selenium sulfide, ketoconazole,

110
Q

herald patch, christmas tree patterned fawn ovals 2cm in diameter

A

pityriasis rosea

111
Q

ring worm

A

tinea corpus

112
Q

total depigmentation

113
Q

common AE of Ca-channel blockers (-dipines)

A

peripheral edema (also dizziness, tachy/bradycardia, constipation, gingival overgrowth)

114
Q

HPA axis

A

CRH from hypothalamus stimulaters ACTH from anterior pituitary, stimulates cortisol release from adrenal cortex, which inhibits CRH and ACTH

115
Q

cortisol released in response to

A

stress, low glucose

116
Q

cortisol fxn

A

stimulates glocose formation, suppresses immune responses, aid metabolism, decrease bone formation

117
Q

high ACTH, low aldo, hyponatremia, hyperkalemia

A

primary adrenal insufficiency (note aldo comes from outer adrenal cortex)

118
Q

Conn’s syndrome

A

primary hyperaldosteronism: high aldo, high bicarb, low renin

119
Q

dysphagia of solids and liquids

A

motility issue. dx w/barium swallow, +/- manometry

120
Q

dysphagia of solids progressing to liquids

A

mechanical issue. dx with endoscopy, unless trauma/cancer, then barium swallow +/- endoscopy

121
Q

nonspecific systemic symptoms and splenomegaly in HIV w/CD4

A

think MAC. tx azithromycin (prophylax under 50)

122
Q

hypo or euthyroid, heterogenous iodine uptake

A

hashimoto’s

123
Q

hyperthyroid, diffuse increased uptake

A

+eye involvement, pretibial mixedema. Graves

124
Q

hyperthyroid with patchy uptake

A

multinodular goiter

125
Q

hyperthyroid, uptake in nodule only, thyrotoxicosis

A

toxic adenoma

126
Q

for GI protection with ASA

A

famotide (pepcid, H2 antagonist)

127
Q

to prevent and treat stomach ulcers (NSAID use)

A

omeprazole (first line), misoprostol (induces abortion, diarrhea. take 4x daily)

128
Q

chronic active HBV

A

50% leads to cirrhosis, 50% of cirrotics get HCC

129
Q

tx high viral load in HBV (HBeAg + and >20000, HBeAg - and >2000, or fibrosis on biopsy)

A

entecavir, tenofovir, PEG IFNaplha-2a

130
Q

crypt abscesses

A

UC (also fever, colicky ab pain, blood in stoll)

131
Q

pain, bullae and sores on breasts, butt, thighs or ab

A

warfarin necrosis

132
Q

benign epithelial tumors in R. hepatic lobe

A

hepatocaricoma. rare, women, OCP

133
Q

+PPD in HIV

A

> 5mm, give isoniazid for nine months, w/pyridoxine to prevent necrosis

134
Q

VIII + IX deficiency

A

hemophilia! X-linked, frequent hemarthrosis w/o trauma, hematuria w/normal renal fxn

135
Q

AD, mucosal bleeding, menorrhagia

A

Von Willebrand dz, most common hereditary bleeding syndrome

136
Q

binds to proteins, VIII in particular, platelets, and collagen exposed in endothelial cells

A

Von Willebrand factor

137
Q

fast-growing volcanic nodule, low grade, originates from hair follicle

A

keratoacanthoma. tx like squamous cell carinoma

138
Q

seborrhic keratosis

A

moles! explosion can mean occult malignancy (Leser-Trelat sign)

139
Q

leser-trelat sign

A

mole explosion signalling GI adenocarcinomas (less so breast, lung, urinary cancers)

140
Q

bronchial breath sounds, dull to percussion, egophany, whisper pectoriloquy

A

consolidation, as in CAP

141
Q

tx paroxysmal nocturia hematuria

A

eculizumab (monoclonal Ab inhibits complement activation)

142
Q

acute limb ischemia after MI

A

left ventricular thrombus

143
Q

heel pain in the a.m.

A

plantar fasciitis

144
Q

numbness or pain and clicking between 3rd and 4th toe (mulder’s sign)

A

morton neuroma (not really a neuroma, a tissue thickening)

145
Q

burning, numbness and aching in distal plantar surface of foot

A

tarsal tunnel syndrome

146
Q

aztreonam covers

A

gram negatives, including pseudomonas

147
Q

tx pulmonary abscess from anaerobic oral flora

A

clindamycin

148
Q

acid-fast rods

A

mycobacteria (TB)

149
Q

shoulder pain, Horner’s syndrome, weak hand muscles, pain and paraesthias

A

Pancoast tumor, superior sulcus of lung. (also wt loss, supraclavicular lymph node enlargement

150
Q

T score osteoporosis

A

Lower than -2.5

151
Q

T score osteopenia

A

-1 to -2.5

152
Q

increased alk phos and + GGT

A

liver. if GGT -, think bone

153
Q

inhibits thromboxin A2 by inhibiting cycloxygenase 1

A

aspirin (anti-platelet)

154
Q

blocks adenosine disphosphate receptors on surface of platelets

A

clopidogrel (anti-platelet)

155
Q

activates antithrombin III, which inactivates IIa (thrombin), IXa and X

156
Q

inhibits 3-hydroxy-3-methylglutonyl coenzyme reductase

157
Q

inhibits sythesis of vit. K-dependent coag factors

158
Q

K dependent coag factors

A

II, VII, IX, X, C & S

159
Q

hypocalcemia w/normal or low PTH: surgical

A

parathyroidectomy, thyroidectomy, radical neck surgery

160
Q

hypocalcemia w/normal or low PTH: autiimmune

A

polyglandular autoimmune syndrome

161
Q

hypocalcemia w/normal or low PTH: infilterative dz

A

metastatic cancer, wilson’s, hemochromatosis

162
Q

hypcalcemia w/increased PTH

A

low vitamin D, CKD, sepsis, pancreatitis, tumor lysis syndrome

163
Q

hypercalcemia + increased total protein

A

SPEP for MM

164
Q

mucucutaneous lesions, flaccid bullae, IgG

A

pemphigus vulgaris (autoAb against desmoglein, an adehesion molecule)

165
Q

pruritic papules on butt, elbows, knees, scalp, granular IgA deposits

A

dermatitis herpetiformis (associated with gluten sensitivity enteropathy

166
Q

malcules, vesicles and bullae w/honey colored crust, leave red denuded areas when removed

A

bullous impetigo (staph, strep or both)

167
Q

benign pruritic tense blisters, rarely oral

A

bulous pemphigoid (IgG + C3 in dermal/empidermal jxn)

168
Q

variant (prinzmetal’s) angina tx

A

Ca channel blockers (diltiazem), and nitrates. BBs worsen vasospasm, aspirin worsens vasospasm via prostacyclin activation

169
Q

eval for bladder cancer

A

contrast CT, cytoscopy (in painloess hematuria, smokers, chemical exposures, cyclophosphamide)

170
Q

gross hematuria, flank pain, kidney cysts, UTIs, stones

A

ADPCK. family history, ESRD by 60

171
Q

bilateral hilar adenopathy +/- parenchymal reticular opacities

A

sarcoidosis!

172
Q

TCA mechanism

A

inhibit fast Na channels in His-Purkinje system

173
Q

TCA OD tx

A

bicarb if QRS>100. Increasing serum pH lowers drug affinity for Na channels

174
Q

bicarb in aspirin OD

A

urine alkalinization increases sacycilate excretion

175
Q

occupies mast cell and basophil receptors oin drug-induced hypersensitivity rxn

176
Q

polymorphous maculopapular rash 24hrs after amoxicillin or other antibiotics

A

in mono! EBV

177
Q

progressive hip or joint pain w/out restricted movemnt in SLE, steroid use, alcoholism, or hemoglobinopathies

A

avascular necrosis of femoral head

178
Q

most common testicular cord stroma tumor

A

Leydig cell: prinicple source of testorsterone, can also make estrogen. makes estrogen in tumor, suppressing LH/FSH. gives adults gynocomastia (rare) and children precocious puberty (common)

179
Q

tumor w/increased bHCG

A

choriocarcinoma

180
Q

tumor w/increased AFP or bHCG

181
Q

tumor with normal or elevated bHCG

182
Q

tumor w/increased AFP

A

yolk sac tumor

183
Q

low back pain, decreased mobility, pain w/standing, walking and lying down; tenderness at affected level

A

acute compression fracture

184
Q

onset at acute event, pain relieved with rest, paraspinal pain, but not with vertebral palpation

A

ligamentous back sprain

185
Q

low PaCO2

A

respiratory alkalosis

186
Q

expected PaCO2 in respiratory compensation for primary metabolic acidosis

A

1.5*(bicarb) +8

187
Q

Mensa

A

used to prevent hemorrhagic cystis caused by chemo drugs (like cyclophosphomide)

188
Q

important in probenecid therapy (gout)

A

adequate hydration to prevent uric acid kidney stones

189
Q

multiple ring-enhancing lesions in HIV pt

A

toxoplasmosis!

190
Q

toxoplasmosis tx

A

sulfadiazine and pyrimethamine

191
Q

toxoplasmosis prophylaxis

A

trimethoprim-sulfamethazole

192
Q

cerebral cysts, +/- scolex

A

neurocysticercosis, from tenia solium (pork tapeworm) eggs. common cause of aquired epilepsy in poor countries

193
Q

HPV vaccine recommedations

A

11-21 for men, 11-26 for women

194
Q

Pap recommendations

A

every three years in twenties, every three years from 20-65 or every five years if combo HPV test

195
Q

Pap in HIV

A

twice in first year, then annually

196
Q

Pap in immunocompromised

A

annually after 21

197
Q

acanthosis nigricans associated dz

A

insulin resistance (DM, PCOS), GI cancer

198
Q

multiple skin tags associated dz

A

insulin resistance (DM, PCOS), pregnancy, perianal in Crohns

199
Q

porphyria cutanea tarda, palpable purpura associated dz

200
Q

dermatitis herpaformis associated dz

201
Q

sudden onset psoriasis, recurrent zoster, disseminated molluscum contagiosm

202
Q

severe seborrheic dermatitis associated dz

A

HIV, Parkisons (dandruff)

203
Q

pyoderma gangreosum associated dz

204
Q

retrosternal pain triggered by hot or cold foods, relieved by nitrates and Ca channel blockers

A

diffuse esophageal spasm , dx w/manometry

205
Q

100% sens and spec for AAA

A

ultrasound

206
Q

leading cause of ESRD in US

A

DM. HTN is second

207
Q

kidney biopsy: intimal thickening, luminal marrowing of renal arterioles w/sclerosis

A

HTN nephropathy

208
Q

kidney biopsy: increased extracellular matrix, basement membrane thicking, mesangial expansion, fibrosis

A

DM nephropathy

209
Q

deficiencies in celiac

A

D,K, B12, calcium, folate and zinc

210
Q

blindness, dry skin, impaired immunity

A

vitamin A deficeincy

211
Q

total parental nutrition deficincies

A

zinc, selenium

212
Q

from nuts, meat, fish; deficiency causes cardiomyopathy

A

selenium (low in TPN)

213
Q

alopecia, skin lesions, abnormal taste, impaired wound healing

A

zinc deficeincy (TPN, malabsorption)

214
Q

tx symptomatic premature atrial beats

A

BBs. Alcohol and tobacco are risk factors

215
Q

HIV derm condition, can cause disseminated/prolonged illness in CD4 counts

A

molluscum contagiosum. (poxvirus)

216
Q

young female athlete w/anterior knee pain when squatting, running, prolonged sitting, using stairs

A

patellofemoral syndrome (dx w/patellofemoral compression test)

217
Q

anterior knee pain in athletes, episodic with pain and tenderness at inferior patella

A

patellar tendonitis, “jumper’s knee”

218
Q

anterior knee pain in preadolescent athletes w/recent growth spurts; tenderness and swelling at tibial tubercle, relieved with rest.

A

Osgood-Schlatter disease

219
Q

punched out erosions with a rim of cortical bone

A

gouty arthritits

220
Q

periarticular osteopenia and joint margin erosions

A

RA, also the joints are warm; wrists, MCP and PIPs

221
Q

normal joint space with soft tissue swelling

A

infective arthritis. cell count >50,000

222
Q

calcification of cartilaginous structures

A

pseudogout

223
Q

narrowed joint space, osteophyte formation,

A

osteoarthritis

224
Q

hypothyroid metabolic abnormalities

A

hyperlipidemia! also hyponatremia, elevated CK and trasaminases.

225
Q

presents w/R-sided heart failure (edema, ascites, JVP), midsystolic sound, hepatic congestion (cardiac cirrhosis)

A

constrictive pericarditis. also pericardial knock, pericardial calcification on CXR

226
Q

swelling and edema in lower extremities, with normal JVP

A

inferior vena cava obstruction

227
Q

elevated upper body venous pressure, with facial swelling, and distented veins in neck or chest wall

A

superior vena cava syndrome

228
Q

effective in preventing PCP, toxo, nocardiosis, UTUs in transplant patients

A

trimethoprim-sulfamethazole

229
Q

common occupation for liver cyst

A

sheep farmer! echinococcous. (also from dogs). hyatid cysts, may have daughter cysts.

230
Q

risk factors for pulmonary aspergillus

A

TB (likes cavitations for fungal balls!). Also, sarcoidosis, bronchiecttasis, bronchoial cysts and bullae, neoplasm

231
Q

lower lung pneumonia, can progress to abscess and empyema with chest wall extension and rib osteomyelitis

A

actinomyces

232
Q

rapidly developing hyperandrogenation with virilization

A

androgen secreting neoplasm of ovaries (high testosterone) or adrenals (high DHEAS)

233
Q

most common valvuar abnormality in patients with infective endocarditis

A

mitral valve dz

234
Q

low back and leg pain, worse with lumbar extension, persists while standing still

A

lumbar stenosis (degenerative, “neurogenic claudication”)

235
Q

test gives similar measures when repeated

A

reliable (validity and accuracy must be compared to some gold standard)

236
Q

pleural plaques on imaging, normal FEV1/FEC ratio

A

asbestosis

237
Q

elevated PCWP in the setting of dyspnea

A

confirms cardiac origin of symptoms

238
Q

pt with suspected sarcoid deteriorates after immunosuppressive therapy

A

histoplasmosis (esp in Mississippi and Ohio river valley)

239
Q

hyperbilirubinemia w/ elevated AST & ALT

A

viral, autoimmune, drug, ischemia, or alcoholic hepatits; hemachromotosis

240
Q

hyperbilirubinemia w/normal liver enzymes

A

Dubin-Johnson sydrome (AR hepatocyte defect, black liver pigmentation, no gallbladder visualization), Rotor’s syndrome (AR hepatocyte defect, normal liver and gallbladder).

241
Q

hyperbilirubinemia w/elevated alk phos only

A

gallstones, cholestatis of pregancy, malignancy, cholangiocarcinoma, PBC, PSC

242
Q

evaluate hyperbilirubinemia w/elevated alk phos only

A

ultrasound for gallstones!

243
Q

most common complication of PUD

A

hemorrhage. perforation, penetration, and obstruction also occur

244
Q

bone marrow transplant pt with lung and intestinal symptoms at 45 days

A

CMV; causes oneumonitis, upper and lower GI ulcers, bone marrow suppression, arthralgais, mylagias and esophagitus. dx with broncheolar lavage

245
Q

skin rash always, intestine, liver and lung (bronchiolitis obliterans) involvement in bone marrow transplant pt

246
Q

mass in anterior mediastinum

A

thymoma (young woman, myasthenia gravis), retrosternal thyroid, teratoma, lymphoma

247
Q

mass in posterior mediastinum

A

all neurogenic tumors (mingocele, eneteric cysts, lymphomas, diaphragmatic hernias, esophageal tumors, and aortic aneurysms). dx with MRI

248
Q

mass in middle mediastinum

A

bronchiogenic cysts (bening), tracheal tumors, pericardial cysts, lymphoma, aortic arch aneurysm)

249
Q

kidney disease plus upper and lower respiratory disease

A

Wegner’s (granulomatosis with polyangitis). dx with C-ANCA + and tissue biopsy; tx high dose steroids and cytotoxic agents

250
Q

kidneys in granulomatosis with polyangitis

A

rapidly progressive glomerularnephritis: renal insufficiency, microscopic hematuria, and RBC casts

251
Q

ascending aortic aneurysms are due to

A

cystic medial necrosis or connective tissue disorders

252
Q

descending aortic aneurysms are due to

A

atherosclerosis

253
Q

widened mediastinum, increased aoritc knob, tracheal deviation

A

thoracic aortic aneurysm

254
Q

maintaining normal pH in COPD (gradual increases in PCO2 resulting in respiratory acidosis)

A

increased renal bicarb retention

255
Q

firstline tx for sleep apnea

A

wt loss, avoiding sedatives and etoh, avoiding supine position

256
Q

strongest predictors of AAA rupture

A

large diameter, rapid expansion, and cigarette smoking

257
Q

indications for AAA repair

A

> 5.5 cm, or presence of symptoms (abdominal, back or flank pain, limb ischemia)

Primary Care (3 decks)

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