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Primary Care > Medicine Qbank > Flashcards

Medicine Qbank Flashcards

1
Q

A1c in diabetes

A

> 6.5

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2
Q

A1c prediabetes

A

5.7-6.4

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3
Q

give in ischemic strokes

A

fibrinolytics (tPA) within 3-4.5 hours

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4
Q

treat acute limb ischemia

A

direct arterialial fibrinolytics or emboletomy

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5
Q

confidence interval 95%

A

p-value >.05

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6
Q

confidenceinterval 99%

A

p>.01

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7
Q

wider confidence intervals

A

more likely the null is in it, smaller sample sizes

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8
Q

positive anti HBsAg

A

immune to hep B

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9
Q

negative HBSAg

A

Hep B negative

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10
Q

fever, leukoctosis, n/v, murphy’s sign, RUQ pain radiates to right shoulder

A

acute cholestystis (leads to acute gallbladder infxn in 50-70% of cases)

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11
Q

onset over 40, assymetrical

A

secondary raynaud’s (vascular or autoimmune, check ANA, Rh factor)

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12
Q

gout prevention

A

indomethacin, decrease alcohol, decrease purines

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13
Q

warm water pruritis, headache, dizziness, splenomegaly

A

polycythemia vera (low EPO, hyper viscocity)

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14
Q

to increase appetite in cancer pts

A

progesterone analogs

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15
Q

tx atypical bipolar and trigeminal neuralgia

A

carbamazamine

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16
Q

compare likelihood of adverse events in 2 drugs

A

compare hazard ratios

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17
Q

treatment for restless legs

A

dopamine agonists: pramipexole, ropinorole

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18
Q

restless legs plus insomnia, pain, anxiety

A

gabapentin (alpha2delta calcium channel ligand)

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19
Q

pulsus paradoxus, hypotension, distended neck veins

A

tamponade

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20
Q

pleuritic chest pain, friction rub, diffuse ST elevation

A

pericarditis

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21
Q

pleuritic chest pain, friction rub, no ST elevation

A

uremic pericarditis, tx: dialysis

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22
Q

HIV initial test

A

anyone 16-65, anyone positive for TB, STI

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23
Q

HIV test annually

A

IVDU, MSM, prostitution, HIV positive partner, more that 1 partner since last test, homeless shelter, prison

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24
Q

over 40, indolent progressive anterior hip pain, worse w/exercise, relieved by rest

A

osteoarthritis

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25
Q

food poisoning: vomitting only

A

staph aureus, bacillus cereus, norovirus

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26
Q

food poisoning: watery diarrhea

A

c. perfringens, eneterotoxin e.coli, enteric viruses, crytposporidium, cyclospora, tapeworms

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27
Q

bloody diarrhea

A

salmonella, campylobacter, shiga-toxic e.coli, enterobacter, vibrio, yersinia

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28
Q

food poisoning: descending paralysis

A

botulism

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29
Q

food poisoning: parasthesias

A

ciguatera

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30
Q

food poisoning: flushing, urticaria

A

scrombroid

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31
Q

food poisoning: meningitis

A

listeria

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32
Q

cellulitis, sepsis

A

vibrio vulnifaesus

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33
Q

food poisoning: jaundice

A

hepA

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34
Q

fever, arthralgia

A

brucellosis

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35
Q

low-risk lung nodule

A

rounded, opacity,

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36
Q

high risk nodule

A

> 60y, irregular margins,

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37
Q

nontender firm hyperpigmented nodule, less than 1 cm, dimples when pinched

A

dermatofibroma

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38
Q

pearly nodule in sunexposed area w/small telangiectasias

A

bal cell carcinoma

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39
Q

multicentric red, purple, brown nodules, macules, papules

A

karposi sarcoma (HHV8)

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40
Q

high output heart failure

A

anemia, hyperthyroidism, beriberi, paget’s, AV fistula

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41
Q

rheumatoid arthritis preserves

A

dips

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42
Q

rheumatiod arthritis tests

A

antiCCP, IgM RhF, high CSR, ESR

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43
Q

rheumatoid arthrihritis and surgery

A

cervical xray befor intubation (osteoporosis, subluxation)

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44
Q

postop pneumonaia

A

VAP! gram stain, culture, aempiric abx

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45
Q

lupus limited to skin, joints tx

A

hydroxychlorquine

may cause retinopathy

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46
Q

fatigue in TB tx

A

isoniazid, sideroblastic anemia

also in B6 deficiency! give pyridoxine

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47
Q

tx megaloblastic anemia

A

folate and B12

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48
Q

bone deformity, hearing loss, increase alk pkos, lytic/sclerotic bone lesions

A

paget’s

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49
Q

pagets tx

A

bisphosphonates

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50
Q

excess mineralization of periosteum

A

excess vit A

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51
Q

excess deposition of poorly mineralized ostium

A

low vit D

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52
Q

androgen excess, oligo or anovulation, cysts on ovaries, no other endocrine explanation

A

polycystic ovarian syndrome. dx with two criteria (hyperadnrogenism, irregular menses, pelvic US)

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53
Q

steriod infertility

A

low GnRH, LH, FSH

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54
Q

tx polycystic ovarian syndrome

A

wt loss, OTCs (for hyperandrogenism, mentrual dysfucntion) metformin for DMII (fasting over 140, oral >200), clomiphene to induce ovulation

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55
Q

skin blisters enlarge and rupture

A

impetigo

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56
Q

normal skin turns into lizard

A

ichthyosis

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57
Q

silver scales on elbows, knees, scalp, trunk

A

psoriasis

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58
Q

most syphilis tx

A

penicillin

doxycyclin if allergic

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59
Q

tertiary syphilis tx

A

penicillin for two weeks

ceftriaxone if allergic

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60
Q

syphilis in pregnancy

A

penicillin, desensitive if allergic

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61
Q

increased pth, low normal Ca

A

seconday hyperparathyroidism, as in ckd

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62
Q

most common hyperparathyroidism, low or normal PTH

A

primary hyperparathyroidism

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63
Q

hypercalcemia with suprreessed PTH, 2/2 extrarenal vitamin D conversion

A

sarcoid

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64
Q

weight loss, chronic abdominal pain, food aversion, bruit fifty percent

A

mesenteric ischemia

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65
Q

hearts in marfan’s

A

aortic dilitation, regurg (early diastolic decrescendo murmur),dissection

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66
Q

fever, leukocytosis, LUQ abdominal pain, hx of mitral prolapse, +/- splenomegaly

A

infective endocarditis (staph, strep, salmonella)

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67
Q

painless, white-yellow retinal patches, hemorrhages, CD

A

CMV retinitis, tx genciclovir, foscarnet

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68
Q

fluffy white necrosis in retina

A

ocular toxoplasmosis

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69
Q

dendritic ulcer in eye (acute painful necrosis)

A

herpes simplex keratinitis

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70
Q

benigh cotton wool spots on retina

A

HIV retinopathy

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71
Q

burning pain in eyes, fever, malaise, vesiculr rash in V1 distribution

A

herpes zoster opthamicus

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72
Q

post seizure BMP

A

anion gap acidosis (lactic acidosis), resolves in 60-90 min

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73
Q

tx MALT lymphoma, no mets

A

omeprazole, clarithromycin, amoxicillin (for h. pylori!)

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74
Q

proton pump inhibitor for heartburn, ulcers, GERD

A

omeprazole

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75
Q

women >50, widespread pain, weakness, elevated ESR, creatine kinase and other muscle enzymes

A

fibromyalgia

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76
Q

symmetrical proximal weakness sparing hips, shoulders

A

polymyositis

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77
Q

myalgia associated w/temporal artertis

A

polymyalgia rheumatica

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78
Q

no goiter or exopthalmos, low TSH, high T3, T4, low thyroglobulin

A

exogenous thyrotoxicosis

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79
Q

leads to Barrett’s esophagus, adenocarinoma of esophagus

A

GERD

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80
Q

reticular nodular opacites on CXR, fibrosisor honeycomb on CT

A

interstitial lung dz

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81
Q

PFTs in interstitial lung dz

A

increased FEV1/FEC, decreased TLC, impaired gas exchange, high alveolor/arterial gradient

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82
Q

fremitus in lobar pneomonia

A

increased over consolidation

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83
Q

renal failure w/o response to fluid

A

hepatorenal syndrome, need liver xplant

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84
Q

ascites w/PMN>250, SAAG>1.1

A

bacterial perotinitis (gram neg: e.coli, klebsiella)

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85
Q

tx bacterial perotinitis

A

empiric w/cephalosporins, fluoroquinolones for weekly prophylaxis

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86
Q

mild asthma:

A

albuterol only

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87
Q

moderate asthma: weekly >2, monthly

A

add inhaled steriods (AE: thrush!)

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88
Q

severe asthma: daily symptoms, frequent awakenings

A

add long acting b2 blockers

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89
Q

leukocytosis w/elevated alk phos

A

leukemoid reaction (infection, inflammation)

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90
Q

leuocytosis w/o elevated alk phos

A

CML

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91
Q

sudden SOB in COPD

A

spontaneuos pneumothorax (dilated alveolar blebs)

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92
Q

eggshell cysts in dog owner

A

hydatid cysts, echinococcus granulosus

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93
Q

tx symptomatic idiopathic pulmonary hypertension

A

bosetan, sildenafil, prostanoids

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94
Q

class I antiarrhythmics

A

block Ca channels

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95
Q

antiarrhythmics causing wide QRS w/exertion

A

class 1C: flecainide, propafenone

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96
Q

new onset afib, most common cause

A

hyperthyroidism

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97
Q

inhibits Na/K ATPase, causes bradyarrhythmia in young, ventricular ectopy and tachyarrhythmia in old

A

digoxin

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98
Q

middle age woman, OCP hx, benign hepatic mass (rare)

A

benign epithelial adenoma

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99
Q

most common hepatic tumor

A

mets! multiple masses, atypical cells

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100
Q

exopthalmos in Graves

A

antithyrotropin Abs lead to tissue expansion, worsens with radioactve iodine

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101
Q

thyroidectomy risk

A

recurrent laryngeal nerve damage

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102
Q

adverse effects of hyperthyroid drugs

A

thionamides. agranulocytosis; tertagen, cholectasis (methimazole); hepatic failure, ANCA vasculitis (propylthiourcil)

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103
Q

antihistamines and heat stroke

A

anticholinergics decrease heat dissipation

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104
Q

P-ANCA, ankylosing spondyitis-type arthritis, diarrhea

A

IBS/UC

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105
Q

diarrhea, wt loss, migratory arthritis

A

t. whippelii

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106
Q

frothy foul-smelling steatorrhea

A

giardia

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107
Q

exertional syncope associated murmur

A

aortic stenosis: systolic ejection

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108
Q

capillary pulsations in fingers and lips

A

aortic regurg

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109
Q

late diastolic murmur, opening snap

A

mitral stenosis (pulmonary edema, a.fib)

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110
Q

holosystolic, apical, radiates to axilla

A

mitral regurg

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111
Q

aneorbic, gram +, filamentous branching bacteria that colonized the mouth

A

actinomyces

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112
Q

actinomyces tx

A

high dose penicillin

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113
Q

aneorobic gram +, partially acid fast filamentous rod that infecs brain, soft tissue, skin and lungs in immunocompromised pt

A

nocardia. cavity lesions!

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114
Q

nocardia tx

A

trimethoprim-sulfamethoxazole

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115
Q

serum alpha-fetoprotein elevatin

A

hepatocellular carcinoma

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116
Q

looks like mono, no lyphadenopathy, negative heterophile antibody, large basophils with vacuolated appearance

A

CMV mononucleosis

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117
Q

leukocytosis, splenoegaly, smudge cells in pt over 60

A

CLL

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118
Q

“succussion splash”

A

gastric outlet obstruction

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119
Q

pneumonia, CXR shows solid mass w/radiolucent crescent (Monod’s sign)

A

aspergillosis (immuncomprise)

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120
Q

atypical pneumonia, bilateral diffuse interstitial infiltrates beginning perihilar

A

pneumocystis jiroveci

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121
Q

painful ulcer with purulent base, violaceus border, in pt with systemic illness such as IBS, rheumatoid arthritis, hematologic conditions

A

pyroderma gangrenosum

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122
Q

multiple tender nodes or plaques on lower extremeties, do not ulcerate, resolve w/out scarring. associated w/meds, infections, or autoimmune dz

A

erythema nodosum

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123
Q

inflammatory scarring nodules at axilla, groin, or scalp

A

hidradentis suppurativa (acne inversa)

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124
Q

fungal infection from breaks in skin, from rose bushes or plant material

A

sporotrichosis

fungus spreads along lymphatics, forming subcutaneous nodules and ulcers

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125
Q

maculopapular rashes on palms and soles, ulcers on mucous membranes

A

secondary syphilis

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126
Q

ring-shaped scaly patches with central clearing and distint borders

A

tenea corporis, treat w/antifungal lotions (2% terbinafine) or systemic antifungal (griseofluvin)

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127
Q

treat diabetic neuropathy

A

gabapentin, TCAs (amitriptyline, desipramine, nortriptyline), or NSAIDs

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128
Q

resistant HTN, abdominal bruit

A

renal artery stenosis (also assymetric kidneys, increased creatinine)

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129
Q

resistant HTN, high plasma adosterone renin level, hypokalemia

A

primary aldosteronism

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130
Q

resistant HTN, increased 24hr free cortisol

A

Cushings, usually other symptoms (central obesity, facial plethora, muscle wasting, hirsutism)

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131
Q

resistant HTN, headaches, palpitations, diaphoresis, urinary vanillylmandelic acid

A

pheochromocytoma

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132
Q

resistan HTN (usually in child), continuous machinary murmur, rib notching on CXR

A

coarctation of aorta

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133
Q

ecchymosis w/leukopenia and anemia

A

bone marrow failure (thrombocytopenia)

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134
Q

mild DM, necrolytic migratory erythema, weight loss, diarrhea, anemia

A

glucagonoma

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135
Q

chronic hypercapnia (leading to respiratory acidosis, compensatory renal bicarb retention and chloride loss), hypoxia, respiratory failure, secondary erythorcytosis, PHTN, and cor pulmonale

A

obesity hypoventilation syndrome

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136
Q

pain with active shoulder motion, tender in passive internal rotation, forward flexion

A

subacromial bursitis

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137
Q

lateral epicondyle pain

A

tennis elbow

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138
Q

inflammatory mediators damage alveoli. dyspnea, tachypnea, hypoxemia, bilateral alveolar infiltrates

A

ARDS (setting of sepsis, severe bleeding or infection, toxic ingestion or burns)

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139
Q

ARDS tx

A

low tidal volumes, PEEP, FiO2 at nontoxic levels (

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140
Q

indication for packed RBCs

A

never if hgb>10, always if hgb

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141
Q

PEEP complications

A

barotrauma, tension pneumothorax

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142
Q

exertional dyspnea, elevated JVP, pulsatile hepatomegaly, signs of fluid overload

A

constrictive pericarditis

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143
Q

most common cause of tricuspid stenosis

A

rheumatic heart dz

aortic stenosis is most commonly senile calcific or bicupid aortic valve

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144
Q

painful abcess associated with hair follicle

A

furunculosis

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145
Q

acute well-defined erythematous plaques with satellite vesicles in axilla, groin, skin folds

A

intertrigo

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146
Q

elevated BNP and S3 signal

A

increased cardia filling pressures. cough, SOB, CHF

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147
Q

risky polyps

A

villous adenoma, sessile adenoma, siza>2.5

less than 5% of adenomas become malignant

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148
Q

white granular patch on buccal mucosa

A

leukoplakia (reactive precancerous squamous epithelium)

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149
Q

steatorrhea and vit. D deficiency

A

vitamin deficiency from malabsorption (as in celiac)

hypocalcemia, low phosphorous, eleated PTH

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150
Q

CHF 2/2 to alcoholism tx

A

no more EtOH

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151
Q

hallmark: intestinal villous atrophy

A 
celiac dz
(also minor abdominal pains, Fe anemia, increased transaminases, arthritis, neuro symptoms)
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152
Q

hallmark: anal fistula

A

Crohn’s

also arthritis, skin disorders, nephrolithiasis

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153
Q

abdominal symptoms >3 days/month, >3 months, plus feeling better after BM

A

IBS

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154
Q

rectal bleeding, awakening for BM, wt loss, abnormal labs

A

not IBS

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155
Q

most likely to be hypothyroid after radioactive iodine test

A

Graves

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156
Q

common causes of priapism

A

sickle cell or leukemia (kids)
trauma (laceration of cavernous artery)
neuro (spinal cord injury, cauda equina)
meds: trazadone, prazosin

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157
Q

deep linear ulcers in esophagus

A

CMV esophagitis

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158
Q

candida esophagitis tx

A

fluconazole

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159
Q

progressive bilateral loss of central vision, straight lines appear wavy

A

macular degeneration

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160
Q

markers of resolving DKA

A

anion gap, beta-hydroxybutyrate levels

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161
Q

splenic rupture risk in mono

A

avoid sports for >3 weeks (can’t feel spleen in athletes)

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162
Q

induced hypokalemia after starting thiazide diuretic

A

primary hyperaldosteronism (may also have spontaneous hypokalemia)

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163
Q

biopsy a lymph node when

A

> 2cm (firm, nonmobile too)

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164
Q

AE: hemorrhagic cystitis, bladder carcinoma, sterility, myelosuppression

A

cyclophosphomide (2nd line SLE, vasculitis, cancers)

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165
Q

AE: cochlear dysfuntion

A

cisplatin, carboplatin (testicular, ovarian and bladder cancer), aminoglycosides (gram neg antinbacterial agent Gentamycin)

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166
Q

AE: optic neuritis

A

hydroxychoroquine (SLE, malaria, arthritis), ethambutol (TB)

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167
Q

AE: peripheral neuropathy

A

phenytoin, isoniazid, vincristine (leukemia), heavy metals, alcoholism

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168
Q

AE: Raynaud’s

A

beta-blockers, ergotamine (migraines)

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169
Q

AE: thyroid dysfunction

A

amiodarone(III antiarrhythmic, prolonges phase 3 of repolarization), lithium

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170
Q

AE: gout

A

cyclosporine (immune suppressant, xplant)

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171
Q

common cause of lower GI hemorrhage in elderly

A

diverticulosis

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172
Q

cardiac cath indications

A

STEMI (thrombolytics if not available), unresolving severe chest pain

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173
Q

tx cocaine induced chest pain

A

IV benzos, aspirin, nitroglycerin, Ca channel blockers (not beta-blockers!)

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174
Q

PE in renal insufficiency

A

unfractionated heparin!

warfarin takes 5-7 days to level, low-molecular weight heparin, fondaparinux, and rivoxaban are contraindicated

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175
Q

recurrent genital ulcers, oral ulcers, eye lesions, and skin lesions

A

behcet’s syndrome

turkish, asian, middle eastern

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176
Q

bilateral ankle arthritis plus bilateral hilar adenopathy, anterior or posterior uveitis

A

sarcoidosis. also skin lesions (erythema nodosum), cough, dyspnea, chest pain in Africa-American women in 20s-30s

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177
Q

urethritis, conjuctivitis, arthritis and mucocutanous lesions, can follow STIs

A

reactive arthritis

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178
Q

cyanide (fires!) causes lactic acidosis by, and tx

A

blocking oxphos by binding iron on cytochrome oxidase 3, promoting anearobic metabolism. tx: sodium thiosulfate!

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179
Q

live vaccines in HIV

A

contraindicated in CD4

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180
Q

hemorrhagic pustules evolving into necrotic ulcers in the setting of neutropenia

A 
ecthyma gangrenosum
(pseudomonas aeruginosa)
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181
Q

multisystem involvement post-cath: renal failure, livedo reticularis, blue toe, cerebral or intestinal ischemia, Hollenhorst plaques

A

cholesterol embolization

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182
Q

muddy brown granular/epithelial casts, resolves w/in 3-5 days

A

contrast induced nephropathy

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183
Q

active urinary sediment w/hematuria and red cell casts; rapid onset renal failure

A

cresentic glomerulonephritis

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184
Q

endocarditis after dental procedures

A

viridans group strep: s. mitis, s. sanguis, s. salivarius, s. mutans (most common, also causes dental caries)

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185
Q

endocarditis in DM, carcinoma, alcoholism, liver failure, and IV drug use

A

group B strep

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186
Q

bacteremia associated w/colon cancer

A

S. bovis (normal GI inhabitant)

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187
Q

Prosthetic valve or umbilical venous catheter endocarditis

A

S.epidermidis

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188
Q

old men after genitourinary procedures, young women after obstetric procedures endocarditis

A

enterococci

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189
Q

weakness and small cell carinoma of lung

A

lambert-eaton syndrome: autoantibodies against voltage-gated Ca channels in presynaptic motor terminal

190
Q

pneumonia plus erythema multiform (dusky red target-shaped lesions)

A

mycoplasma pneumoniae

most common atypical pneumonia

191
Q

diffuse ST elevations, esp. w/PR depressions, 3-7 days after MI

A

acute pericarditis

192
Q

AE: edema in face, mouth, lips, tongue, glottis, larynx

A

ACE inhibitors (enalapril, captopril, lisinopril)

193
Q

AE: thrombotic thrombocytopenic purpura

A

clopidogrel (blood thinner)

194
Q

AE: hepatoxicity, myopathy

195
Q

Tdap indications

A

in adults with HIV (and Td booster every 10 years), in every pregnancy. (Everyone gets Tdap as children, then Td booster every 10)

196
Q

Rule out PE

197
Q

Wells criteria immobility

A

3 days, or surgery w/in 4 weeks. long flights don’t count for wells but are a risk factor

198
Q

chest and neck pain, mediastinal widening

A

aortic dissection (dx: transesophageal echo)

199
Q

DIP involvement, nail involvement, morning stiffness, sausage fingers

A

psoriatic arthritis

200
Q

gottron’s papules (scaley violaceous plaques) on MCPs

A

dermatomyositis

201
Q

DIP involvement, worse with activity, improves with rest

A

osteoarthritis

202
Q

mismatched perfusion/ventilation defect

A

diagnostic of PE, present only 50%

203
Q

mixing the effect of an exposure with the effect of an extraneous factor

A

confounding (related to exposure and outcome of interest)

204
Q

treatment for necrotizing otitis externa

A 
IV ciprofloxacin
(pseudomonas)
205
Q

presents as insensate hypopigmented plaque

A

leprosy. dx with acid-fast bacilli on biopsy

206
Q

causes dry cough due to decreased degradation of bradykinin and substance P

A

ACE inhibitors

207
Q

recommended in pts with microalbuminuria, even if BP is normal

A

ACE inhibitors. reduce urinary albumin secretion, slows progression of renal damage

208
Q

hyperpigmentation, DM, arthralgias, cardiomyopathy, conduction abnormalities, hypogandism, cirrhosis, pseudo-gout

A

hereditary hemochromatosis
(abnormal Fe deposition; also susceptible to listeria, vibrio vulnificus, yersinia) tx is phebotomy (can lead to hepatocellular carcinoma 20-200x normal rates)

209
Q

most common causes of acute pancreatitis

A

gallstones, alcohol, hypertriglyceridemia, recent ERCP. use ultrasuond to detect gallstones

210
Q

cholinomimetic agent that stimulates contraction of the bowels

A

carbachol (treats ileus)

211
Q

low PTH, severe hypercalcemia (>13)

A

hypercalcemia of malignancy

212
Q

new mother, inflammation of abductor pollicus longus, extensor pollicus brevis

A

de quervian tenosynovitis (pain when squeezing thumb in fingers, “finkelstein test”)

213
Q

pain over palmar aspect of first metacarpophalangeal joint, locking of thumb in flexion

A

trigger thumb

214
Q

pain localized to anatomical snuffbox

A

scaphoid fracture, often from fall

215
Q

pain with radial flexion of wrist, point tenderness over trapezium

A

flexor carpi radialis tensynovitis

216
Q

tx uncomplicated cystitis

A

nitrofurantoin for 5 days (avoid in pyelo, Cr clearance20%)

217
Q

tx complicated cystitis (DM, renal failure, obstruction, indwelling catheter, immunosuppression, hospital aquired)

A

fluoroquinolones (ciprofloxacin, levofloxacin), 5-14 days, ampicillin/gentamicin if severe. obtain culutre

218
Q

tx complicated cystitis (pregnant)

A

NOT fluorquinolone (ciprofloxacin, levofloxacin). Consider nitrofurantoim, amoxicillin, cephalexin

219
Q

tx pyelonephritis

A

fluoroquinolone (cipro, levofloxacin) in outpatient, IV fluorquinolones, aminoglycosides, +/- ampicillin if inpatient

220
Q

hypotension, new onset JVP and RBBB

A

indicate right heart strain, seen in massive PE

221
Q

hypokalemia, alkalosis and normotension

A

vomitting, diuretic abuse, Bartter syndrome (thick ascedning limb of loop of henley(like loop diuretics), Gitelman’ syndrome (like thiazide diuretics)

222
Q

overproliferation of plasma cells in bone marrow

A

multiple myeloma. (Bence Jones proteins in urine, rouleaux RBCs. Often presents with lytic lesions, hypercalemia, and renal failure in 50%.)

223
Q

increased bone marrow cellularity with megakaryocytic hyperplasia

A

essential thrombocytosis

224
Q

hypoplastic fat-filled marrow with no abnormal cells

A

aplastic anemia

225
Q

incidentally isolated elevated alkphos in elderly patient

A

paget’s dz

226
Q

life threating cause of severe mitral regurg 2-5 days after MI

A

papillary muscle rupture. does not cause persistent ST elevation

227
Q

low voltage QRS, electrical alternans on EKG

A

pericardial effusion (early after MI)

228
Q

persistent ST elevation with deep Q waves in same lead

A

ventricular aneurysm (5 days to 3months post-MI)

229
Q

hemolytic anemia following oxidative stress (infections, sulpha drugs, fava beans

A

G-6-P dehydrogenase deficiency.

X-linked, asain, african or middle eastern men, bite cells with Heinz bodies, negative Coombs. tx is supportive

230
Q

p-ANCA in ulcerative colitis

231
Q

hot potato voice, deviated uvula

A

peritonsillar abscess. tx: aspirate IV antibiotics

232
Q

sudden elevated HR (160-220) relieved by vagal maneuvers

A

paroxysmal supraventricular tachycardia. healthy hearts. results from accessort conduction pathways through the AV node

233
Q

best evaluation of undiagnosed plural effusion

A

thoracentesis, except in patients with clear evidence of CHF

234
Q

unexplained hemolytic anemia in patient with renal failure and neurological symptoms, fragmented cells in smear

A

TTP-HUS. plasmaphoresis is tx.

235
Q

AE: subclinical hepatic injury

A

isoniazid (TB). Usually self-limiting

236
Q

decreased esophageal peristalsis, poor relaxation of LES, “bird’s beak” on barium

A

achalasia. mostly primary, sometimes secondary to Chagas, esophageal cancer

237
Q

popping sensation, rapid swelling (effusion, hemarthrosis)

A

ACL injury. knee is lax to pulling tibia forward relative to femur (Lachman test, anterior drawer sign)

238
Q

twisting injury, little swelling, laxity when foot is abducted with the knee stationary (valgus stress test)

239
Q

swelling in posterior knee and calf in older people, associated with osteoarthritis

A

rupture of popliteal (baker’s) cyst

240
Q

megacolon/mega-esophagus, heart disease (CHF)

A

Chagas. protozoal disease in Latin America cuased by Trypanosoma cruzi.

241
Q

frostbite tx

A

rewarming with water, no initial attempts to debride tissue

242
Q

retrosternal pain and crepitus in suprasternal notch

A

pneumomediastinum from esophageal rupture, seen in chronic alcoholics, or after esophageal instrumentation

243
Q

source of 90% of acute PE

A

proximal deep veins (iliac, femoral, popliteal veins)

244
Q

patients at increased risk of upper extremity venous thromboemboli

A

patients with indwelling catheters

245
Q

renal vein thrombi in patients with

A

nephrotc syndrome. (PE in nephrotic syndrome 10-30%)

246
Q

bronchial lavage most useful in

A

suspected malignancy and opprotunistic infection

247
Q

dx interstitial pulmonary fibrosis and interstitial lung disease caused by rheumatoid arthritis

A

lung biospy

248
Q

high-pitched diastolic decresendo murmur, wide pulse pressure, uncomfortable awareness of heartbeat lying on left side

A

aortic regurg. increased left ventricular end diastolic volume leads to hypertropy and ventricular enlargement

249
Q

“water hammer” pulSE

A

aortic regurg. rapid upstroke followed by rapid collapse of peripheral pulse

250
Q

chemicals in eye

A

immeadiately wash with copious amounts of water

251
Q

mucolytic used in cystic fibrosis

A

acetylcysteine

252
Q

tx COPD exacerbation

A

supplemental O2 (to 88-92%), inhaled bronchodilators (B2 agonists and anticholinergics), antibiotics and ssytemic glucocorticoids

253
Q

absent P waves, narrow QRS, irregularly irregular

A

afib (originates in ectopic foci from myocardial sleeves on pulmonary veins)

254
Q

afib, low bp, crackles in both lungs

A

DC cardioversion

255
Q

tx symptomatic bradycardia

A

transcutaneous pacing

256
Q

rate control in hemodynamically stable afib

A

amiodarone, quinidine, digoxin

257
Q

tx ventricular arrhythmias

258
Q

murmurs to always explore with transthoracic ehco

A

diastolic and continuous murmurs, loud systolic murmurs

259
Q

midsystolic soft murmurs in asymptomatic patients

A

no further workup

260
Q

dysphagia, coughing, regurgitation, halitosis and a neck mass

A

zenker (pharyngoesophageal) diverticulum. cricopharyngeal hernia caused by esophageal sphincter dysfunction, esophageal dysmotility. dx with barium swallow (contrast esophagram), tx with surgery

261
Q

dysphagia, stomatitis, metabolic abnormalities (Fe deficiency)

A

upper esophageal webs (Plummer vinson syndrome)

262
Q

reciprocal translocation on chromosomes 9 and 22

A

form the philedephia chrmosome containing BCR/ABL fusion gene, found in chronic myloid leukemia

263
Q

tx CML

A

tyrosine kinase inhibitors, with inhibit BCR/ABL

264
Q

headaches, jaw claudication, amaurosis fugax

A

giant cell arteritis

265
Q

tx GCA and acute vision loss

A

high-dose IV corticosteroids

266
Q

treats open angle glaucoma and benign intracranial hypertension

A

acetazolamide

267
Q

tx polymyalgia rheumatica without evidence of GCA

A

low-dose prednisone (10-20mg daily)

268
Q

steriod-sparing second-line tx for temporal arteritis

A

methotrexate (anti-rheumatic drug, AE include macrocytic anemia)

269
Q

human herpesvirus 8

A

karposi’s sarcoma. asympotomatic, elliptical, linear arrangment. Legs, face, oral cavity and gentials.

270
Q

asymptomatic, centraly-umbilicated papules on the face, neck, and anogenital areas

A

molluscum contagiosum (poxvirus)

271
Q

obtunded, decreased bowel sounds, hypotension, hypothermia, bradypnea

A

opioid intox, even with normal pupils. Give naloxone.

272
Q

intoxication presenting with bradycardia and hypotension, possibly wheeze

A

beta-blockers. reverse with glucagon

273
Q

30s, hemoglobinuria, fatigue and dyspnea from anemia, hypercoaguable state (including portal vein thrombosis)

A

paroxysmalnoctural hemoglobinura, dx with flow cyotometry (CD55 and CD59 absent from RBCs)

274
Q

multi-system illness: arthralgias, wt loss, fever, diarrhea, abdominal pain

A

whipple’s disease (bacillus Tropheryma whippelii)

275
Q

PAS-positive material in the lamina propria of the small intestine

A

whipple’s disease

276
Q

performed on active genital lesions to diagnose HSV

A

Tzanck smear

277
Q

intracellular gram negative diplococci on pelvic

278
Q

tx gonorrhea

A

ceftriaxone for gonorrhea, aslo azithromycin for chlamydia!

279
Q

test patients with pelvic inflammatory disease

A

HIV, RPR for syphilis, pap smear and hep B surface antigen, hep C serology if IV drug user

280
Q

recent onset confusion, fever, muscle rigidity, diaphoresis, elevated CK

A

NMS, tx dantrolene (muscle relxant), bromocriptine (a dopamine agonist), and amantadine (antiviral drug with dopaminergic properties)

281
Q

rash, high fever (>104), cranial-caudal spread of rash over a few days

282
Q

tenosynovitis, dermatitis, and migratory asymmetric polyarthralgias. Rash is vesiculopustular, few in number, and rarely involves the face

A

desseminated gonococcal infection

283
Q

febrile prodrome followed by erythematous macular rash that starts over wrists and ankles, involves palms and soles, and spreads centrally

A

rocky mountain spotted fever

284
Q

fever and maculopapular rash involving entire trunk and extremities, including palms ans soles

A

secondary syphilis

285
Q

fevere, lymphadenopathy, followed by cranial to caudal rash sparing palms and soles

A

rubella. in adult women can lead to a month of postdromal arthritis.

286
Q

rubella in pregnancy

A

active infection can cause dangerous and permanent birth defects

287
Q

cavitary lesions in HIV pts in southwestern USA

A

coccidioidomycosis

288
Q

increases with increasing severity of hypovolemia

A

BUN/serum Cr (sensitive, not specific)

289
Q

pulsatile abdominal mass, sometimes a systolic bruit

A

abdominal aortic aneurysm

290
Q

systolic-diastolic abdominal bruit

A

renal artery stenosis

291
Q

varied blood pressure in each arm accompanied by tearing chest pain

A

aortic dissection

292
Q

pt with chronic afib presents with diarrhea, nausea and fatigue

A

digoxin toxicity. also change in vision, scotomata, blindness. sometimes incited by volume depletion.

293
Q

variceal bleeding prophylaxis

A

beta-blockers

294
Q

variceal bleeding tx

A

octrotide (long-acting somatostatin analog that causes splanchnic vasoconstriction and reduces portal blood flow by inhibiting release of glucagon

295
Q

wedged-shaped pleural-based opacification

A

pulmonary embolism (v. nonwedge consolidations in bacterial pneumonia, round or spiculated in cancer). embolism is more frequent in dehydrated state. hemoptysis.

296
Q

notorious for causing refractory hypokalemia in alcoholics, folks on diuretics

A

hypomagnesemia. Alcoholics also have hypoalbuminemia, which may cause spurious hypocalcemia)

297
Q

nagging epigastric pain worse at night, food intolerance, weight loss, enlarged nontender gallbladder

A

biliary obstruction (intra- and extrahepatic duct dilation) consistent w/pancreatic cancer

298
Q

initially unilateral, watery discharge, scant stringy mucus, burning, follicular or bumpy injection

A

viral conjunctivits

299
Q

initially unilateral, purulent unremitting discharge, diffuse injection, fever

A

bacterial conjunctivitis

300
Q

bilateral, water mucus, itching, diffuse injection, conjunctiva edema

A

allergic conjunctivitis

301
Q

severe eye allergy, prolonged course, potential corneal damage

A

atopic keratoconjunctivitis

302
Q

invasive globe infection 2/2 trauma, purulent haziness

A

endophthalmitis

303
Q

vasculitis of medium sized arteries in young children. conjunctivitis, fever, lymphadenopathy and mucocutaneous inflammation, general rash

A

kawasaki disease

304
Q

slurred upsloping R waves, atrioventricular reentrant tachycardia

A

wolff-parkinson-white (accessory Av bypass tract)

305
Q

sudden onset and termination, rapid rate (140-250), regular rhythm, narrow QRS, absent P waves

A

AV nodal reentry tachycardia

306
Q

rapid sawtooth flutter waves

A

atrial flutter (most commonly from reentry circuit around tricuspid annulus)

307
Q

multiple rib fractures, respiratory distress

A

flail chest (tx pain control, supplemental oxygen, positive pressure ventilation)

308
Q

abdominal pain, nausea, diarrhea, followed in a few weeks by fever, myositis, subungual, retinal and conjunctival hemorrhages, periorbital edema and chemosis

A

trichinellosis, roundworm in undercooked pork. Also look for eosinophilia!

309
Q

intestinal symptoms, eosinophilia, + nonproductive cough

310
Q

4-5 days to develop fever, headache, retroorbital pain, myalgias, arthralgias

A

dengue fever. may also be hemorrhagic in skin, nose.

311
Q

progressive fever, abdominal pain and salmon rash, to hepatosplenomegaly with intestinal bleeding, perforation

312
Q

Light’s criteria for exudate

A

fluid/serum protein ratio>.5, LDH ratio>.6, or fluid LDH >2/3 normal limit of normal

313
Q

cause exudative plural effusion

A

infection, autoimmune, neoplasm (all via increased capillary permeability)

314
Q

transudative pleural effusions, as in liver failure

A

decreased plasma oncotic pressure

315
Q

transudative pleural effusions, as in CHF

A

elevated hydrostatic pressure

316
Q

attributable risk percent (ARP)

A

(risk in exposed-risk in unexposed)/risk in exposed. So if a factor causes a 4x risk, then ARP is (4-1)/4=75%

317
Q

epithelial necrosis in colon

A

ischemic colitis (acute presentation, mild elevation in inflammatory markers)

318
Q

pancolitis with fibrinous pseudomembranes

A

c.diff colitis (recent antibiotic use)

319
Q

neutrophilic cryptosis, erthymous friable mucosa, inflammation marker elevation, subacute abdominal pain with bloody stool.

A

inflammatory bowel disease. presents in 20s, second peak in 60s.

320
Q

intense pruritis, esp. at night, hepatosplenomegaly and xanthomatous lesions. middle aged-women, insidious onset.

A

primary biliary cirrhosis. autoimmune destruction of intrahepatic ducts and cholestatis. confirm with anti-mitochondrial antibody test!

321
Q

primary biliary cirrhosis tx

A

ursodeoxycholic acid first line (relieves symptoms and lengthens survival. methotraxate, colchincine some evidence as secondline), transplant required in 7-10years

322
Q

second-line drug to control symptoms of primary biliary cirrhosis

A

cholestyramine (forms nonabsorbable complex with bile acids in small intestine, increasing loss of cholesterol and bile acids)

323
Q

respiratory support in AECOPD

A

noninvasive positive-pressure ventilation. reduced work of breathing, improves alveolar ventilation, dereases mortality and nosocomial infections. (intubation required if failed for two hours)

324
Q

melena + nocturnal pain relieved by eating

A

duodenal ulcer disease (90% have h. pylori!)

325
Q

women under 50 w/early severe hypertension, resistant to treatment, w/symptoms of carotid or vertebral artery involvement, or abdominal bruit

A

fibromuscular dysplasia! look for family hx of strokes, increased Cr on ACE inhibitor, secondary hyperaldosteronism (from decreased perfusion to kidneys), aldosterone to renin ration is

326
Q

hypertension, hypokalemia, plasma aldosterone >15, renin suppressed (aldo:renin >20)

A

primary hyperaldosteronism

327
Q

soft left-sided scrotal mass that worsens with standing and valsalva, does not transilluminate

A

varicoclele (dilated pampiniform plexus). much more common than femoral hernias (older women)

328
Q

hypertension and hypokalemia: high renin, high aldosterone

A

secondary hyperaldo: renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretics

329
Q

hypertension and hypokalemia: low renin, high aldosterone

A

primary hyperaldo: aldo producing tumor, bilateral adrenal hyperplasia

330
Q

hypertension and hypokalemia: low renin, low aldosterone

A

non-aldosterone causes: congenital adrenal hyperplasia, deoxycorticosterone-producing adrenal tumor, cushing syndrome, exogenous mineralcorticoids

331
Q

aldosterone effects

A

saves sodium, loses potassium and H+, leading to metabolic alkalosis (low K also causes increased bicarb reabsorption, whih leads to alkalosis too)

332
Q

hyperkalemia in DKA

A

parodoxical: body has depleted K 2/2 osmotic diuresis and increased GI losses, but K shifts extracellularly in exchange for iron, and isulin-dependent K entry into cells is impaired. SO replace K (

333
Q

painful hyperkeratotic papules on sole of foot

A

plantar warts (HPV)

334
Q

constipation, fatigue, excess urinary, abdominal pain, urinary stones, mental status changes.

A

and osteoporosis! it’s hypercalcemia. hyperparathyroidism increases Ca and decreases phosphorus. Can lead to pseudogout

335
Q

rhomboid crystals with positive birefringence

A

pseudogout. acute onset, painful monoarthopathy affecting knee. caused by calcium pyrophosphate dihydrate deposition

336
Q

crystals in the shape of coffin-lids

A

struvite crystals, from nephrolithiasis caused by chronic UTIs caused by ureases producing organisms

337
Q

needle-shaped crystals w/negative birefringence

338
Q

polymorphonuclear cells with gram positive cocci in joint aspirate

A

septic arthritis

339
Q

lymphocytes and budding yeast in joint aspirate

A

fungal arthritis, rare, slowly progressive monoarthritis in knee

340
Q

fever, chills, malaise, dyspnea, fine diffuse crackles, diffuse reticular or ground glass opacities on x-ray

A

hypersensitivity pneumonitis

341
Q

cardiomegaly, cephalization of pulmary vessels, kerley B lines and pleural effusions on XR

A

pulmonary venous congestion (CHF)

342
Q

headache, nausea, eye pain, and nonreactive mid-dilated pupil

A

acute angle-closure glaucoma

dx w/optho consult for tonometry

343
Q

exudative effusions with low glucose content

A

empyema, due to high metabolic activity of leukocytes and bacteria within the pleural fluid (transudative)

344
Q

cause of hypocalcemia in malnutrition

A

hypomagnesemia, leads to decreases PTH and PTH resistance

345
Q

serum Ca and albumin

A

serum calcium falls .8 for every 1gm/L decrease in albumin

346
Q

chronic cough, hemoptysis, intermittent fevers +/- weight loss, upper lobe cavitary lesion

347
Q

tx CMV infections

A

ganicyclovir

348
Q

tx influenza (within 48 hrs)

A

oseltamivir, zanamir (neuroamidase inhibitors); rimanatdine, amantadine (influenza A only)

349
Q

nucleotide analog used to treat HIV

350
Q

protease inhibitor used to treat HI

351
Q

tx herpes simplex and varicella zoster

A

valacyclovir (acyclovir is cheaper, also effective)

352
Q

nonnucleoside reverse transcriptase inhibitor used to treat HIV

A

nevirapine

353
Q

most common cause of hemoptysis in patients who have smoked

A

pulmonary airway dz (chronic bronchitis, bronchogenic carcinoma, bronchiectasis)

354
Q

common cause of aseptic menningitis

A

coxsackie or echovirus

355
Q

20% of cocaine overdoses are complicated by

A

rhabdomyolysis

356
Q

main danger of CPK>20,000

A

acute tubular necrosis

357
Q

great lakes, Mississippi and Ohio river basins, Wisconsin most of all

A

blastomycosis

358
Q

months of low-grade fever, night sweat, productive cough, ulcerated skin lesions, bone lesions

A

blastomycosis, fungal infection with CXR resembling TB, histoplasmosis (great lakes, Mississippi and Ohio river basins, Wisconsin most of all). broad-based budding yeasts grow from sputum

359
Q

fever, cough and night sweats in the southwestern US

A

coccidiomycosis

360
Q

blastomycosis tx:

A

Itraconazole or Ampho

361
Q

sensitivity equation

A

true positives / (true positives+false negatives)

362
Q

specificity equation

A

true negatives / (true negatives+false positives)

363
Q

mean corpusular volume over 100

A

macrocytic anemia

364
Q

progressive symmetric polyneuropathy great in legs than arms

A

subacute combined degeneration (vitamin B12 deficiency! also see peripheral neuropathy, memory loss and dementia)

365
Q

increased methylmalonic acid

A

decreased vitamin D! think malnutrition, malabsorption, neuro deficits

366
Q

D-lactic acidosis

A

pts with short-bowel syndrome. often asymptomatic, sometimes confusion, atxia and dysarthria durning carbo-loading.

367
Q

macrocytic anemia, polyneuropathy (reduced deep-tendon reflexes, delayed relaxation phase)

A

hypothyroidism

368
Q

microcytic anemia with reduced transferrin saturation

A

iron deficiency anemia (as in GI malabsorption)

369
Q

flank pain, hematuria, AKI, calcium oxolate crystals

A

ethylene glycol poisoning

370
Q

tx anti-freeze intoxication

A

fomepizole (competitive inhibitor of alcohol dehydrogenase) or ethanol; sodium bicarb for acidosis, hemodialysis if needed

371
Q

tx dapsone, anesthetic OD (cyanosis, respiratory depression)

A

methylene blue

372
Q

tx tylenol overdose

A

N-acetylcysteine

373
Q

geneti syndromes associated with pancreatic cancer

A

Peutz-Jeghers, Lynch syndrome

374
Q

first line tx for stable patients with torsades

A

IV magnesium

375
Q

all pts with tachycardia causing hemodynami instability or poor perfusion

A

immeadiate synchronized DC cardioversion

376
Q

stable SVT tx

A

vagal maneuvers, or IV adensoine, or Ca channel blockers (verapamil)

377
Q

don’t use amiodarone, procainamide, or other IV antiarrhymthics

A

in unstable or narrow-complexed tachycardia

378
Q

hypochromic/microcytic anemia w/depressed iron and ferritin

A

check for bleeding! GI blood loss is the most common cause of Fe-deficiency anemia in men and postmenopausal women

379
Q

classic manifestation of malaria

A

headaches, cyclic fevers, chills, diaphoresis, anemia, thrombocytopenia (most common cause of fever in returning traveler)

380
Q

looks like malaria in traveler to northeastern or midwester US

A

babesiosis (ticks)

381
Q

East African travel, fevers, chancre, myocarditis, CNS effects

A

trypanosomiasis (sleeping sickness, from tsetse fly)

382
Q

fever, facial pain, necrosis in nasal passage, chemosis, proptosis in eye

A

mucormycosis. most often fungal (rhizopus). Tx: debridement, amphotercin B

383
Q

positive predictive value equation

A

true positives/positive calls

384
Q

tx digoxin toxicity (disturbed color perception, arrhythmias, fatigue, anorexia, nausea, blurred vision)

A

digoxin-specific antibody

385
Q

bone conduction>air conduction in Rinne

A

conductive hearing loss. common cause in young adults is otosclerosis

386
Q

dx bronchiectasis (cough, mucopurulent sputum, hemoptysis that responds to abx)

A

CT chest! CXR is not sufficient

387
Q

most common lung cancer (in smokers and non)

A

adenocarcinoma (peripheral, associated with clubbing, hypertrophic osteoarthropathy)

388
Q

lung cancer associated with central local, necrosis and cavitiation, hypercalcemia

A

squamous cell carcinoma (second most common)

389
Q

lung cancer associated with central locale, cushings, SIADH, lambert-eaton

A

small cell carcinoma

390
Q

lung cancer associated withperipheral locale, gynecomastia, galactorrhea

A

large cell carcinoma

391
Q

marked severe hypertension associated with malignant hypertension or hypertensive encephalopathy

A

hypertensive emergency

392
Q

severe hypertension (usuallyt >180/120) associated with retinal hemorrhages, exudates, or pailledema

A

malignant hypertension

393
Q

nodular pulmonary infiltrate with cavitation in IV drug user

A

staph aureus endocarditis embolized to lungs

394
Q

pain with abdominal palpitation with legs raised from table

A

Carnett’s sign: source of pain is in abdominal wall (hematoma)

395
Q

tx papulopustular roscacea

A

topical: azeliac acid, oral: low dose doxycyline

396
Q

uric acid levels to prevent joint damage in gout

397
Q

normal aA gradient, normal PaCO2, corrects with O2

A

reduced inspired O2 tension (high altitude)

398
Q

normal Aa gradient, increased PaCO2, corrects with O2

A

hypoventilation (CNS depression)

399
Q

increased Aa gradient, normal PaCO2, corrects with O2

A

diffusion limitation (interstitial lung dz)

400
Q

increased Aa gradient, normal PaCO2, does not correct with oxygen

A

shunt (intercardiac, extensive ARDS)

401
Q

increased Aa gradient, normal or high PaCO2, corrects with O2

A

V/Q mismatch (obstruction, atelectasis, pulmonary edema and pneumonia)

402
Q

bacille Calmette-Guerin

A

live TB vaccine (adverse effects in advanced HIV)

403
Q

dropped QRS

A

Mobitz I heart block. Constant P-P interval, increasing PR interval. Impaired AV nodal conduction.

404
Q

impaired SA conduction

A

sick sinus syndrome. sinus pause/arrest, alternating brady/tachycardia

405
Q

RUQ radiating to right shoulder

A

acute cholecystitis

406
Q

complications of acute pancreatitis

A

pleural effusions, ARDS, ileus, renal failure

407
Q

fever, arthralgia, sore throat, lymphadenopathy, mucocutaneous lesions, diarrhea, wt. loss

408
Q

eyes in sarcoidosis

A

red, with chamber leukocytosis (uveitis)

409
Q

CNS depression, hypotension, hypothermia, bradycardia

A

myxedema coma, sever hypothyroidism

410
Q

hyperkalemia on EKG, + tx

A

peaked T waves, then lengthened PR, QRS, then sine wave. tx: calcium gluconate.

411
Q

clarithromycin and amlodipine

A

clarithromycin inhibits 3A4, increases amlopdipine levels

412
Q

azythromycin AE

A

long QT, fatal arrhythmias

413
Q

repeat colonoscopy after 8mm hyperplastic polyp

A

10y! If pt has one to two tubular adenomas, repeat in 5-10 years, if more, repeat in 3 years

414
Q

possible tx for Raynaud’s

A

nifedipine

415
Q

risk factors for long concussion recovery

A

60hr HA, or three lasting symptoms

416
Q

lower BP in legs than arms

A

ankle-branchial index, PAD

417
Q

pain in calf on abrupt dorsoflexion of foot with knee extended

A

Homan’s sign, DVT

418
Q

thickened skin on hands and feet, obliterated har follicles and glands, flexion contractures, Raynaud’s, mask-like faces, HTN (renal), PHTN, GERD

A

systemic sclerosis. cutaneous scleroderma (anti-nuclear antibodies), anti-neutrophil cytoplasmic antibodies

419
Q

Rh factor

A

rheumatoid arthritis, sjogrens, dermomyocytis, HCV

420
Q

c-ANCA

A

granulomatosis w/polyangitis

421
Q

p-ANCA

A

microscopic polyangitis nodosa, churg-strauss

422
Q

episodic flushing, wheezing, diarrhea, tricuspid regurg, telengectasias

A

carcinoid. slow-growing neuroendocrine tumor (distal small intestine, proximal colon, lung). Secrete serotonin, histamine, vasoactive intestinal peptide

423
Q

deficiency in carcinoid tumor

A

niacin (needs tryphophan, which is used for serotonin in carcinoid)

424
Q

low FEC1/FEV

A

obstructive lung dz

425
Q

low FEC1/FEV, increased FEV with bronchodilators

426
Q

low FEC1/FEV, no change in FEV with bronchodilators

427
Q

normal or high FEC1/FEV

A

restrictive lung dz

428
Q

normal or high FEC1/FEV, normal DLCO

A

chest wall weakness

429
Q

normal or high FEC1/FEV, low DLCO

A

interstitial lung disease

430
Q

initial tx afib

A

BBs, Ca channel blockers (adenosine), digoxin if in HF

431
Q

aortic stenosis in young

A

congential bicuspid aortic valve

432
Q

angina in aortic stenosis

A

LVH leads to increased myocardial oxygen demand

433
Q

acute toxic mucocutaneous disorder after new medication (antibiotics, tylenol, ibuprofen, sitiglipin, carbamazepine, lamotrogine, many others)

A

if 30%, toxic epidermal necrosis (TEN)

434
Q

sudden rash w/target lesions after infections (herpes simplex), drugs, other diseases (heme onc, collagen diseases)

A

erythema multiform. self-limiting

435
Q

warm sandpapery skin, diffuse rash, bullae, nikolsky’s sign, facial edema, perioral crusting

436
Q

pseudogout associated conditions

A

hemochromotosis, hyperPTH, hypothyroid, hypophosphotemia, Wilson’s, osteoarthritis

437
Q

next of kin consent to unplug brain-dead patient

438
Q

both SLE and steroid use

A

accelerate coronary atherosclerosis. Stress test if normal EKG

439
Q

JVC + Kussmaul’s sign + clear lungs

A

R. ventricular infarct. (fluids, avoid nitro, diuretics)

Kussmaul’s: JVD increases with inspiration

440
Q

PE on EKG

A

sinus tach, new onset RBBB, S1Q3T3

441
Q

variant angina EKG

A

transient ST elevations

442
Q

rare, incidentally found in southwestern native american women with hx of gallstones

A

gallbladder carcinoma. track remission w/CA9-19

443
Q

45* branching septated hyphae, rare budding bodies

A

aspergillus

444
Q

yeast with wide capsular halo, narrow-based unequal budding

A

cryptococcus

445
Q

empty-looking nonseptate hyphae with wide-angle branches

446
Q

saucer-shaped yeast forms

A

pneumocystis

447
Q

cigar-shaped yeast with unequal budding

A

sporothrix

448
Q

treat most yeasts

A

fluconazole/ketoconazole for superficial infection, ampho B if systemic

449
Q

gram positive cocci in chains

450
Q

gram positive cocci in clusters

451
Q

gram positve bacilli (thick)

A

clostridium

452
Q

gram positive bacilli (thin)

453
Q

gram + bacilli (branched)

A

actinomyces, nocardia

454
Q

some appear as poor-staining gram positive rods (beaded)

A

mycobacteria

455
Q

gram - diplococci

A

neiseria meningitidis

456
Q

thin gram - rods

457
Q

gram - coccobacilli

A

haemophilus

458
Q

gram - curved

A

vibrio, campylobacter

459
Q

PEEP levels in ARDS

A

up to 15, w/tidal volume ~6

460
Q

increased plasma free metaphendrines

A

pheochromocytoma (triad: HA, sweating, palpitations with tachycardia)

461
Q

acute arthritis is MCP, PIP and wrists

A

viral arthritis (usually parvo: shows slapped-cheek rash in kids)

462
Q

recent strep, lower limb polyarthritis, erythema marginatum, subcutaneous nodules

A

acute rheumatic fever

463
Q

duration for rheumatoid arthritis

464
Q

tx viral conjunctivitis

A

hot or cold compress, +/- antihistamines, decongestants (adenovirus)

465
Q

olopatadine, azelastine

A

mast cell stabilizing agents for allergic conjunctivitis

466
Q

who needs Td/Tdap

A

all adults. Tdap once, Td every ten

467
Q

PPSV23, 19-64y

A

chronic heart, lung or liver dz, DM, smokers alcoholics.

468
Q

PCV13, then PPSV23, 19-64y

A

CSF leak, cochlear implant, sickle cell, asplenia, HIV, malignancy, CKD

469
Q

PCV13, then PPSV23, >65y

A

all of ‘em. (6-12 months apart)

470
Q

HIV exposure

A

4 weeks of 3 drug PEP (tenofovir-emtricitabine + raltegravir), test for baseline status

471
Q

most common cause of myocarditis in the young

A

viral: coxsackie B

Primary Care (3 decks)

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