Medicine Qbank Flashcards
1
Q
2 options for chest pain at rest and no ST-elevation on EKG
A
- Unstable angina 2. NSTEMI (see elevated biomarkers)
2
Q
Acute pericarditis is diagnosed by
A
2 of the 3: 1. pleuritic chest pain 2. friction rub 3. diffuse concordant ST-segment elevation on EKG.
3
Q
EKG findings of acute pericarditis?
A
(non-diagnostic in 50% of pts): diffuse ST-seg elevation
4
Q
What is the preferred tx for STEMI?
A
Percutaneous angioplasty and stent (lower 30-day mortality compared to thrombolytic)
5
Q
2 ways to get relief from angina pectoralis pain
A
- rest 2. nitroglycerin
6
Q
Pt with R-side STEMI has low bp. What is the first step in management?
A
Fluid bolus to improve filling (diastolic problem). If fails, try inotropic support like dobutamine (not first since can extend infarct). Don’t give B blocker as bradycard worsesns HD instability. Don’t give nitroglycerin as venodilation impairs RV filling
7
Q
What is empiric therapy for GERD?
A
PPI
8
Q
MSSA peritoneal infx abx?
A
Clinda
9
Q
What is appropriate therapeutic INR?
A
Normal range for pts not on any meds is 0.8 - 1.2
For pts w/ idiopathic VTE or afib, 2 - 3.
For pts w/ prosthetic heart valves, 2.5 - 3.5.
10
Q
Abx for cat scratch disease?
A
PO azithromycin for Bartonella henselae
11
Q
What is bone/joint related abnormality 2/2 steroid use?
A
Osteonecrosis of right femoral head = osteochondritis dessicans
12
Q
First degree heart block types
A
AV block w/ normal QRS: oft due to delayed AV nodal conduction, no further eval needed
# w/ prolonged QRS: likely conduction delay bleow AV node –> need electrophys test as may unpredictably progress to advanced 2nd degree or complete heart block
13
Q
What is pathogenesis of renal vein thrombosis as a complication of nephrotic syndrome?
A
Lose antithrombin (which is activated by heparin) III in urine –> incr risk of venous/arterial thrombosis. Sx: sudden onset abd pain, fever, hematuria. Most common w/ membranous glomerulonephritis
14
Q
“Tea and toast”
A
Folic acid
15
Q
What are signs/sx of eosinophilic pneumonia?
A
Gradual asthma-like sx, hear diffuse wheezes, fine inspiratory crackles (bronchial/interstiial involvement)
16
Q
Dx of aspirin exacerbated respiratory disease (AERD) w/ (3)
A
- asthma 2. chronic rhinosinusitis w/ nasal polyposis 3. bronchospasm or nasal congestion after asa/NSAIDS
17
Q
Shunt causes what sort of acid-base disorder?
A
Respiratory acidosis
18
Q
V/Q mismatch causes what sort of acid-base disorder?
A
Due to decrease in PaCO2, compensatory tachypnea –> resp alk
19
Q
What are 4 causes of V/Q mismatch?
A
Pulm emb, atelectasis, pleural effusion, pulm edema
20
Q
First line tx for prolactinoma?
A
Dopaminergic agents - cabergoline
21
Q
Cutoff for pituitary tumor microadenoma?
A
22
Q
Treatment of hyperkalemia w/ EKG changes?
A
- administer IV Ca gluconate to stabilize cardiac membrane
- Lower serum K by driving intracellularly - insulin and glucose, Na bicarb, beta2 (albuterol) - “Get In Bye Bye”
- Eliminate excess K from body via kayexalate
23
Q
What is the mech of nitroglycerine in pain relief of angina?
A
Dilation of veins
24
Q
Which risk factor has strongest assoc w/ aortic dissection?
A
Htn
25
Where is the most common site of htn hemorrhage of brain?
Putamen. Internal capsule usu involved --> contralat dense hemiparesis
26
Rx for Nocardia?
TMP-SMX
27
How do you diagnose leprosy?
Skin biopsy --> acid-fast bacilli
28
Asian paitent, hypopigmented patch of skin --> suspect
Leprosy
29
What are the 3 etiologies of acute urinary retention in the elderly?
1. Obstruction (BPH or carcinoma) 2. Neurogenic bladder 3. Detrusor muscle underactivity
30
What are 4 etiologies of overflow incontinence from acontractile bladder?
1. Diabetic neuropathy, 2. MS, 3. anesthetic drugs, 4. drugs
31
What's suspected w/ large amt of blood on UA but few RBCs?
Rhabdomyolysis (which --> acute renal failure)
32
What are classic sx of disk prolapse?
Unilateral radicular pain in dermatomal distribution
33
What are sx of cauda equina syndrome?
Saddle anesthesia, lose of sphincter tone, bladder atony w/ overflow incontinence, bilat sciatica
34
Sx detrusor instability?
Incontiencne preceded by sudden urinary urgency
35
Sx hypertonic bladder?
Constant urine dribbling 2/2 unremitting contraction of bladder
36
Imaging study of choice for suspicion of pancreatic ca?
If jaundice - start w/ u/s. If no jaundice but epigastric pain and weight loss - start with CT.
37
Varying amplitude of QRS complexes is called what?
Electrical alternans: pathognomonic for pericardial effusion
38
What is procainamide used for?
Class Ia, used to treat SV and V arrhythmias, particularly Wolff-Parkinson-White
39
How is SLE arthritis diff from RA?
Both affect MCP and PIP, but SLE arthritis is non-deformig
40
When is parathyroidectomy recommended for asymptomatic patients with primary hyperparathyroidism?
1. Serum calcium level >= 1 mg/dL above upper limit of normal 2. Age
41
How do you distinguish btw primary hyperpara vs. familial hypocalciuric hypercalcemia?
With PH, 24 hr urinary ca >250 mg. With familial,
42
Varicoceles that don't empty when pt is recurrent are due to
Tumor obstruction of gonadal vein, increased suspicion for mass obstruction to venous flow
43
New-onset thrombocytopenia, arterial thrombosis (cold extremity), and/or >50% drop in platelet count 2/2 to which drug for DVT?
Heparin --> HIT. Type 1: Due to nonimmune direct effect of heparin on platelet acctivation, happens w/in 2 days. Type 2: Immune-mediated
44
What is a factorial study design?
Involes 2 or more experimental interventions, ea w/ 2 or more variables studied independently
45
Can steroid use increase Hct?
Yes! So don't think epo use if a pt has gynecomastia
46
Typical sx of digoxin tox?
N/v, decr appetite, confusion, weakness, arrythmias. Can be triggered by volume depletion, renal injury.
# Get blood drug level, EKG, and INR
47
What is a TACE procedure?
Limit blood supply to tumors
48
What is rifaximin used for?
Based on rifamycin, poor GI absorption. Used for traveler's diarrhea, hepatic encephalopathy
49
What are the presenting signs/sx of DKA?
N/V, thirst, increased urination, abd pain. Labs show anion gap metabolic acidosis
50
Diagnosis of DK is made by
1. Blood glucose >250, 2. pH
51
What is pseudodementia/reversible cognitive impairment?
Severe depression presenting w/ features similar to dementia. For most, return to baseline w/ rx of dementia
52
Why are patients w/ RA at increased risk for osteoporosis?
Incr proinflammatory cytokines, glucocorticoids, and lack of phys activity --> local/generalized loss of bone
53
What are the 2 dz associations of steitis fibrosa cystica?
aka von recklinhausen disease. Parathryoid carcinoma, hyperparathyroidism
54
Pts w/ GCA (giant cell arteritis) have what phys exam?
Scalp tenderness, decr temporal artery pulse
55
What is a complication of GCA that warrants monitoring?
Aortic aneurysms - need serial cxr's
56
What are the criteria for drainage of a pseudocyst?
1. Persists >6wk 2. > 5cm diameter 3. Secondary infx
57
What is within a pseudocyst?
Enzyme-rich fluid, tissue, debris
58
Arortic artery dissection can extend into
1. Carotid arteries (stroke), 2. renal arteries (AKI), 3. aortic valve (aortic regurge), and/or 4. pericardium (tamponade)
59
Firm, hyperpigmented nodule that has central dimpling when area is pinched
Dermatofibroma
60
What is the mech of coagulation in antiphospholipid sydnrome?
Unknown
61
Which lab value is changed in antiphospholipid syndrome?
Prolonged PTT. 20-40% pts may have thrombocytopenia
62
What dz defined by inflammation of one eye after penetrating injury to the other?
Sympathetic ophthalmia = spared eye injury. Caused by recognition/uncovering of "hidden" antigens
63
Side effect of hydroxychloroquine?
GI disress, visual disturbance, in G6PD pts, hemolysis
64
Side effect of mtx?
Macrocytic anemia (everything is bigger in mTX) Nausea, stomatitis, rash, hepatotoxicity, interst lung dz, alopecia, fever.
65
What are the pulses associated with aortic regurge?
Bounding pulse
66
What are the pulses assoc with aortic steosis?
Pulsus parvus = decreased pulse amplitude and tardus = delayed pulse upstroke
67
If a test result is negative, the prob of having dz is
1 - negative predictive value
68
Labs of CML?
Leukocytosis w/ left shift (myelomonocytes, neutrophils, etc), basophilia, marked splenomegaly
69
What STD swcreening for all pts (even asymptomatic)?
HIV
70
Which org causes acute retinal necrosis syndrome in HIV+?
HSV & VZV - can cause pain, keratitis, uveitis, necrosis
71
Which org causes benign retinitis in HIV+?
CMV
72
What are ECG findings of afib with RVR?
Narrow-complex tachy, irregularly irregular, no organized P waves
73
What is lidocaine used for in cardiology?
Antiarrhythmic for ventricular arrythmia
74
What is paroxysmal supraventricular tachycardia?
Sudden-onset, regular, narrow-complex tachycardia. Use adnosine or carotid sinus massage
75
Cerebral lesions cause gaze deviation_
toward side of the lesion
76
Pontine and thalamic lesions cause gaze deviation_
Away from side of the lesion
77
Sx of ruptured berry aneurysm?
H/a, impaired arousal, seizure, meningismus
78
Describe lab values of SIADH
Euvolemic hyponatremia, decr serum osm, incr urine osm
79
Pleural effusion on R suggests
Hepatoic hydrothorax 2/2 cirrhosis
80
Moderately elevated AST, ALT, alk phos suggestive of
1. infiltratitive (ie. cancer) 2. cholestatic dz
81
What are blood test signs of cirrhosis?
Thrombocytopenia, coagulopathy
82
What can cause refractory hypokalemia despite repletion?
Hypomag
83
What is the rx for mild hypovolemic hypernatremia?
5% dextrose in 0.45% NS
84
What is the rx for severe hypovolemic hypernatremia?
9% NS (will still be hypotonic in comparison)
85
What is the rx for hypervolemic hypernatremia?
5% dextrose in water
86
What is the goal rate of sodium correction?
no more than 1 mEq/L/h
87
Which 3 labs are elevated in rhabdo?
CK, myoglobin, K+
88
What are 2 risk factors for rhabdo?
1. immobilization (direct msucle damage) 2. cocaine vasoconstricts --> ischemia, seizure, agitation, hyperpyrexia, myocyte toxicity --> muscle breakdown
89
Are cholesterol stones visible on xr?
No, they're radiolucent.
90
What is pathophysiology of pernicious anemia?
Autoimmune disorder. Anti-intrinsic factor antibodies
91
True cirrhosis is characterized by the presence of
regenerative nodules
92
What are the 3 stages to alcoholic liver dz?
1. Fatty liver 2. Alcoholic hepatitis (Mallory bodies, neutrophil infiltration, liver cell necrosis, perivenular distribution of inflammation). 3. Cirrhosis
93
What is vitamin def seen with serotonin syndrome?
Niacin (due to decr tryptophan used to make serotonin instead)
94
How can AKI cause metabolic acidosis?
Non-anion gap: 1. impaired H+ secretion 2. ammonia generation 3. bicarb reabsorption. # anion gap: retention of uremic toxins --> encephalopathy
95
How does GI bleed cause elevated BUN?
Metabolism of blood proteins --> urea. Pts have NORMAL anion gap compared to AKI --> uremic toxins
96
What are the 2 interventions tha decrease mortality in COPD?
Home O2, smoking cessation
97
Odds ratio from case-control studies is a good approximation of
Relative risk if the outcome is uncommon (rare disease assumption)
98
Young obese female with a headache
Suspect benign intracranial hypertention w/ nl MRI and CSF. Aka pseudotumor cerebri. Caused by impaired absorption of CSF
99
What are neuro signs for pseudotumor cerebri?
Papilledemia, visual field defects, sometimes CN VI palsy
100
What is the most significant complication of pseudotumor cerebri?
Blindness
101
Pts with new thrombocytopenia should get what lab test?
HIV, HCV
102
What are clinical findings in chronic HIV infx?
Oral candida, Peripheral neuropathy, FUO, LAD, etc
103
Sx of delayed sleep phase syndrome?
Pts describe selves as night owls, chronic problems sleeping at socially accepted time, normal when allowed to set own schedule
104
Pt w/ stone. Urinalysis shows hexagonal crystals. Urinary cyanide nitroprusside is +. Stones are hard and radioopaque. What is cause?
Cystinuria: abn amino acid transport in renal tubular and intestinal epithelium
105
Ddx for fever, night sweats, productive cough, weight loss
1. chronic infx 2. malignancy 3. rheum
106
Fever, weight loss, lytic bone lesions, well-circumscribed, verrucous, crusted skin lesions
Blasto
107
Eyes: microaneurysms and hemorrhages, macular edema
DM retinopathy
108
Eyes: multiple sores in macular region or new blood vessels that leak/bleed/scar the retina
Macular degeneration
109
What is a lab abnormality caused by hypothyroidism?
Hyperlipidemia - met imbalance
# Hyponatremia - decreased free water clearance
# elevated CK and AST and ALT
110
Complicated pleural effusion defined as
pH
111
HHS typically presents with (3)
1. hyperosm 2. vol depletion 3. severe hypoglycemia w/o ketone
112
How does dehydration cause HHS?
Decr GFR (decr glucose excretion) --> activate counter-reg hormones (incr glucose production, impair utilization) --> hyperglycemia (pts have enough insulin to prevent ketosis)
113
Dx of HHS
Serum glucose >600, plasma osm >320, absent ketons
114
What is Zollinger-Ellison?
Gastrin-secreting tumor of pancreas/duodenum. Acid hypersecretion --> ulcers in distal duodenum, jejunum
115
What is the most common cause of hc-associated endocard?
Staph
116
Bug of endocard after nosocomial UTI?
Enterococci
117
What is #1 cause of death in endocarditits?
CHF
118
What are the 2 preferred therapies for hep B?
(Check hep B viral load!) 1. Entecavir, 2. Tenofovir
119
Which patients are less likely to respond to hep B therapy?
Pts w/ normal ALT
120
When do you use interferon for hep B?
Younger pts w/ compensated liver dz, short-term
121
Rhizopus found where in DM pts?
Paranasal sinuses, extend to orbit and brain
122
Granulations in L ear canal, facial asymmetry, downward deviating side of mouth concerning for
Malignant otitis externa --> osteo of skull, CN damage
123
Unilateral acoustic neuroma after 40 y.o. assoc w/
NOTHING
124
Daily oral theophylline used as
Alt adjunctive for any form of asthma except mild intermittent
125
Which meds may cause NMS?
Typical and atypical antipsych
126
All pts complaining of wheezing and other complaints of asthma should be screened for
GERD, as 75% of asthma pts also have GERD
127
Think GERD-induced asthma if
Sx worse after meals, exercise, laying down
128
Antidote for CN poisoning?
Hydroxocobalamin or sodium thiosulfate
129
Which antibodies (2) for celiac?
Anti-endomysial and anti-tissue transglutaminase
130
Long-term NSAIDS can cause these 2 conditions
1. CKD 2/2 tubulointerstitial nephritis 2. hematuria 2/2 papillary necrosis
131
Difference in murmurs of papillary muscle rupture vs. ventricular septal rupture
Both have pansystolic murmur. Papillary rupture - heard loudest at apex w/ radiation to axilla (mitral regurge). Ventricular septal rupture - best heard at L sternal border, oft accomp thrill
132
Ddx of peripheral edema
CHF
# Liver dz
# Renal dz
# Venous insufficiency
# Side effect of dihydropyridine CCB (amlodipine)
133
Bloody diarrhea in HIV pt?
CMV colitis - see ulcers
134
Cutoff size for lung nodule just to warrant obs
3cm or less
135
What are the most common causes of AL and AA amyloid?
AL => MM. AA => RA.
136
Lumbar spinal stenosis is painful with
walking and lumbar extension
137
Lumbar disk herniation is painful with
siting and lumbar flexion
138
Causes of digital clubbing
Malignancy, CF, R-to-L cardiac shunts
139
Change in Ca2+ 2/2 alkalosis?
Incr in Ca2+ bound to albumin
140
Cervical LN > 2.0 cm associated with
greater likelihood of malignancy or granulomatous dz
141
Otosclerosis - hearing loss due to bony overgrowth of stapes - charcteristic
Low-freq hearing loss, in middle-aged individuals
142
Murmur worsens in pts with hypertrophic cardiomyopathy w/ maneuvers that
decrease preload --> smaller LV volume --> more obstruction
143
What are first line agents for hypertrophic cardiomyopathy?
BB or CCB to slow the heart and prolong diastole
144
MOA of nitrates?
"lmNOP" - Nitrates lOse Preload - primary venodilator
145
MOA of digoxin?
Positive inotrope
146
Upper vs. lower throacic spinal cord?
Dermatomes: upper = nipples, lower = umbilicus
147
Does hyper or hypocalcium cause stones?
Both!! Decr dietary ca --> Incr oxalate absorption in gut --> incr excretion in urine that binds to urinary Ca
148
Subacromial bursitis is seen with and presents as
Result of repetitive overhead motion of arm, pain w/ internal rotation and forward flexion of shoulder
149
What are the criteria for Behcet's syndrome?
Recurrent oral ulcers and 2 of the following: recurr genital ulcers, eye lesions (uveitis), retinal vascularization, skin lesions, +pathergy test
150
Pts w/ CKD have hypocalcemia
Because unable to form 1,25 vit D --> decr intestinal absorption of Ca
151
Anterior uveitis vs. keratitis vs. episcleritis
Anterior uveitis: conjuctival inflammation, but cornea usu spared
# Episcleritis: common cause of red eye that's localized, patchy, mild pain and d/c. Doesn't affect vision or cornea
Conjunctivitis = no cornea. Keratitis = yes cornea
152
Positive straight leg test suggests
Disk herniation
153
Perianal area is not intact
Cauda equina syndrome (S2-S4). S for Sly wink
154
Characteristics of analgesic abuse nephropathy
Primarily tubulointerstitial, focal glomerulosclerosis
155
Signs/sx of ADPKD
Most asymptomatic. But hematuria, flank pain, htn, proteinuria, CKD, palpable abd mass
156
Tx for ADPKD?
Follow BP and renal fn. Prefer ACE inhibitors.
157
UC is associated with this other autoimmune dz
Primary sclerosing cholangitis (90% of PSC have IBD)
158
Presentation of polyarteritis nodosa?
Systemic (fever, malaise, weight loss), neuropathy, hep B assoc, arthralgias/myalgias, cutaneous (livedo reticularis), renal dz
159
Which autoimmune condition of common bile duct more common in women?
pBc before pSc
160
What are seen with thrombotic microangiopathy?
Commonly seen with TTP, HUS, and DIC. Pts have thrombocytopenia and microangiopathic hemolytic anemia.
161
Mild thrombocytopenia, giant platelets, bleeding out of proportion to degree of thombocytopenia
Bernard-Soulier syndrome
162
What do nitrites and LE detect?
LE = pyuria. Nitrites = E. coli
163
Exertional sx, delayed/diminished carotid pulse (pulsus parvus et tardus), audible S4
Aortic stenosis
164
What are major side effects of cyclosporine?
Nephrtox, htn, neurotox, glucose intolerance, infx, malignancy, gingival hypertrophy, hirsutism, GI manifestations
165
What are major side effects of tacrolimus?
Nephrotox, hyperkalemia, higher risk of neurotox, diarrhea, glucose intolerance, NOT hirsuitism or gum hypertrophy
166
What are major side effects of azathioprine?
Dose-related diarrhea, leukopenia, hepatotox
167
What is the major toxicity of mycophenolate?
BM suppression
168
Why hypoxia in astham exacerbation?
Hyperventilation --> V/Q mismatch --> decr pO2
169
pCO2 levels in asthma exacerbation are_
Low initially with tachypnea, then normal/high w/ retention or muscle fatigue
170
Chlordiazepoxide is used for
Treating EtOH withdrawal in hospitalized pts
171
Naloxone is used for
Narcotic overdose
172
Why UTI in young infants?
Bacteria can disseminate hematogenously to the kidneys via renal artery
173
What are the signs of impending strangulation in an SBO that warrant surgical exploration?
Fever, tachycardia, leukocytosis, metabolic acidosis
174
What is lidocaine used for?
Ventricular arrhythmias. When used ppx, it may decr frequency of VPB and risk of vfib, but overall prognosis unaffected, and can incr risk of asystole
175
Lewy body dementia vs. Alzheimer's dimentia
Lewy body: fluctuating cognitive impairment, visual hallucination
# Alz: memory loss --> impaired judgment, personality changes --> +/- psychosis
176
Tx for Prinzmetal's angina?
CCB or nitrate
177
What are the most common causes of AR?
Rheumatic heart dz, aortic root dilation, congen bicuspid valve
178
What is the characteristic water hammer pulse of AR?
Rapid, abrupt upstroke w/ rapid collapse of periph pulse. Due to wide pulse pressure
179
What predisposes patients to molluscum contagiosum?
Cellular immunodef, corticosteroid use, chemo
180
What are the electrolyte abnormalities of tumor lysis syndrome?
HypER phos and K as they're intracellular, hyPO calc as it is bound to excess phos
181
Why are typical EKG features of acute pericarditis absent in uremic pericarditis?
Lack of involvement of epicardium
182
What are the typical ECG features of acute pericarditis?
Diffuse concave upwards Stsegment elevation, PR depression
183
What are the indications for urgent dialysis?
"AEIOU"
# Acidosis - met acidosis pH 6.5) hyperK
# Ingestion - toxic alcohols, salicylate, lithium, valproate
# Overload - vol overload refractory to diuretics
# Uremia - sympatomatic (encephalopathy, pericarditis, bleed)
184
What's initial tx of choice for acute viral/idiopathic pericarditis?
NSAID + colchicine
185
What are the types of antipsychotic extrapyramidal effects?
Acute dystonia - sustained twisting/abnormal
# Akathisia - subjective restlessness
# Parkinsonism - gradual-onset tremor, rigidity, bradykinesia
186
Permethrin cream is used for this skin condition
Scabies
187
Dapsone is used for this skin condition
Dermatitis herpetiformis, leprosy (when combined with rifampin)
188
Tx of choice for uric acid stones?
Potassium citrate to alkalinize urine
189
What are sx of intracranial htn?
Headache (worse @ pm, change w/ position), n/v, mental status changes
190
What are signs of brainstem compression?
Cushing reflex: 1. htn, 2. bradycard, 3. resp depression
191
What are causes of intracranial htn?
increased volume of any of 1. brain parenchyma 2. CSF 3. blood
192
What can be used for SIADH unresponsive to fluid restriction and high salt intake?
Demeclocycline
193
What is Felty syndrome?
Clinical disorder seen in pts w/ >10 yrs of RA - neutropenia AND splenomegaly
194
What is De Quervain tenosnovitis?
Classically effects new mothers (she made the Daquiri in Vain). Effects abductor pollicis longus and extensor pollicis brevis --> stretch elicits pain. Due to thumb abducted + extended
195
What is cardiac asthma?
Wheezing due to heart failure
196
Pt w/ SOB w/ ABG showing hypoxia, hypocapnia, and resp alk
Most likely 2/2 CHF (rather than COPD, which is resp acidosis)
197
ABG for PE?
Hypoxemia, resp alkalosis, widened A-a gradient
198
Patients with worsening CHF will have these PE signs
Decreased breath sounds at bases from pleural effusions, bibasilar crackles, wheezing
199
What is the neoplasm assoc w/ MG?
Thymoma
200
How to distinuguish MG from muscle problem?
Normal CK w/ MG
201
Transcutaneous pacing is used for management of
symptomatic bradycardia
202
What are 2 options for pharm cardioversion?
amiodarone and quinidine
203
Where's most frequent loc of ectopic foci that cause AFib?
Pulm veins
204
Where's most frequent cause of aflutter (anatomically)?
Reentrant circuit around tricuspid annulus
205
Define AVNRT (atrioventricular nodal reentry tachycardia)
Reentrant circuit made by 2 separate conducting pathways w/in AV node. = Paroxysmal SVT
206
What causes hydatid cyst (round big cyst w/ daughter cysts within, in the liver)
E. granulosus (a type of tapeworm due to sheep strain)
207
What is the cause of trigeminal neuralgia?
Unknown. Tx: carbamazepine
208
What is carotidynia?
Neurologic condition caused by inflamm of carotids and vagus
209
0.1-0.5% pts w/ hep B will develop fulminant hepatic failure, defined as
Hepatic encephalopathy that develops w/in 8 weeks of onset of acute liver failure. Tx: emergent liver transplnt.
210
Use FFP for
Active bleeding, not ppx
211
What is used in tx of acute hep B?
Interferon alpha, Lamivudine
212
Lab values in microangiopathic hemolytic anemia, prosthetic distruction?
Decr haptoglobin, incr LDH, incr bili
213
Screening recommendation for osteoporosis?
One-time bone scan for all women >= 65. Repeat scanning protocols unclear atm
214
What is Winter's formula?
Arterial pCO2 = 1.5*HCO3 + 8 +/- 2
215
Elderly patient with bone pain, renal failure, hypercalcemia
Multiple myeloma until proven otherwise. Paraproteinemia
216
What is a hepatic hydrothorax?
Plerual effusions in liver patients not secondary to underlying cardiac or pulmonary abnormality. Thought to occur 2/2 small defects in diaphragm --> permit abd ascites to pass into pleural. Rx: diuretics_ TIPS_ liver transplant
217
Lambert-Eaton causes not only musc weakness but also
Loss of DTR
218
How does stress triger HHS?
Incr serum cortisol and catecholamine levels, which are insulin counterregulatory hormones
219
Young healthy patient who develops CHF
Viral myocarditis (esp Coxsackie B)
220
How does pneumocystis penumonia present?
Dry cough, dyspnea. Cxr usu demonstrates bilateral diffuse infiltrates, pleural effusion not a common finding
221
What are secondary causes of restless legs syndrome?
Iron deficiency anemia
# Uremia (ESRD, CKD)
# DM
# MS, Parkinson
# Pregnancy
# Drugs - entidepressants, metoclopramide (dopamine antag)
222
What is the tx for persistent-severe symptoms of restless legs?
First-line: dopamine. Alternate: alpha-2-delta ca channel ligands
223
What is the most common cause of chronic MR in developed countries?
Mitral valve prolapse, due to myxomatous degen of MV leaflets/chordae. May also be 2/2 calcification in elderly
224
Pts w/ paget disease of bone usu asymptomatic, but may show
H/a, deafness, neuropathy (2/2 nerve impingement), bone pain
225
TIPS is used to
Reduce portal pressure
226
How can proteinuria develop from endocarditis?
Immune complex dz or septic emboli
227
Todd's palsy is usually preceded by
a focal motor seizure
228
What are common drugs (2) that may trigger asthma?
Aspirin and beta block
229
What is the tx of choice for renal artery stenosis 2/2 fibromuscular dysplasia?
Percutaneous angioplasty w/ stent placement
230
Canon waves
AV block (ie. 3rd degree)
231
Where in the axial skeleton does RA affect?
Cervical spine joints
232
What are the sx of vascular dementia (aka stroke)?
Stepwise decline, early executive dysfunction, cerebral infarct or other deep white matter changes on neuroimaging
233
Lentigo simplex
Due to intraepidermal melanocyte hyperplasia
234
Mole screening mnemonic
Asymmetry, Border irregularities, Color variegations, D >6mm, Enlargement
235
What is uremic coagulopathy?
Abnormal hemostasis in pts w/ CKD. Several uremic toxins have been implicated in pathogenesis of platelet dysfunction (chiefly guanidinosuccinic acid) --> platelet DYSFUNCTION
# DDAVP is tx of choice
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Are platelet counts affected in DIC?
Yes --> low platelets
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Tx of Lyme?
Doxy, UNLESS children or pregnant/lactating women --> amoxicillin
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Pulsitile h/a associated with nausea, awaken pt from sleep
Pseudotumor cerebri = idiopathic intracranial htn. Pts have no focal neuo signs (except CN VI palsy), norm CSF.
# Tx = acetazolamide
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Is there a screening test for ovarian cancer?
Pelvic u/s and CA125 antigen only for symptomatic pts
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What are most common signs of hemophilia?
Recurrent hemarthrosis, sk musc hemorrhage, +/- hematuria
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How can vasospasm after a subarachnoid hemorrhage (SAH) be prevented?
Nimodipine
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A woman w/ irregular vaginal bleeding, enlarged uterus, and pelvic pain post-partum.
Suspect gestational trophoblastic dz (which includes choriocarcinoma vs. gestational trophoblastic neoplasia). Choriocarcinoma is highly metastatic to lungs.
# Detect with beta-HCG
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In treating a pt w/ both sildenafil and alpha-block, separate by at least 4 hrs to
reduce risk of hypotn
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What skin condition has dimpling in the center when area is pinched?
Dermatofibroma
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Warm, swollen limb after starting heparin
HIT - usu occurs 5-10 d after starting heparin, and pts are prone to thrombosis (venous > arterial)
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What test is effective in screening for pancreatic ca in asymptomatic adults?
Nothing :(
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Multiple episodes of thrombosis w/o clear precipitate should raise concern for hypercoag 2/2_
If young: genetic defect. Otherwise: primary malignancy (particularly visceral adenocarcinomas (gastric, pancreatic, ovarian)
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What is preferred screening test for MEN 2?
PCA-based genetic testing with peripheral blood
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What is a pathologic abnormality seen in UC and Crohn's?
Neutrophilic cryptitis (transmural in Crohn's). Also, while usu presents around age 20, 2nd peak ~60 (bimodal)
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Common signs/sx of malignant hyperthermia?
Hypercarbia, sinus tachy, musc rigidity, high CK, hyperthermia
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Common signs/sx of thyroid storm?
Tachycard, htn, arrythmias. High fever, tremor, AMS, lid lag.
# May see in pts after acute illness, iodine contrast, surgery
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Modified CHADS2 score?
CHA2DS2VASc. V=vascular dz, A65-74 (vs. first A is >74), Sex
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How does acute pancreatitis cause ARDS?
Pancreatitis --> incr [pancreatic enzymes] --> leak across pulm capillaries --> damage surfactant in alveoli
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ARDS is dx of exclusion. What test is needed?
Echo needed to exclude hydrostatic pulm edema in pts w/o ARDS risk factors
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Circopharyngeal dysfunction
Due to failure of cricopharyngeus to relax during swallowing. Sx: choking, food-sticking, pain w/ swallow. Dx: video fluoroscopic swallow study
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Accurate = this other term
Valid
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Specificity and sensitivity are measures of
Validity
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5 causes of dilated HF?
Viral, Ischemic, EtOH (reversible), Cocaine, Chagas. "Don_t touch that TV dial as Miami VICCE is on."
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3 causes of diastolic HF?
Htn, hemochromatosis (reversible), amyloid
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Prinzmetal's angina is assoc with which 2 other vasospasms?
Raynauds, mgraine h/a
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EKG of Prinzmetal's?
Transient ST elevations (vs. ST dep seen in unstable angina)
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Tx of Prinzmetal's?
CCB or nitrates
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What is intermittent claudication?
Leg pain occuring w/ exercise 2/2 atherosclerotic narrowing of arteries feeding leg - similar mech to typical angina
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What are 2 complications of mono?
1. Autoimmune hemolytic anemia 2. Thrombocytopenia
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Diffuse, confluent erythematous macules on trunk and extremities
TSS
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What is the 1st line therapy for torsades - HD stable?
Mg SO4
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CSF of Guillain Barre?
Incr protein, everything else normal.
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Tx for Guillain Barre?
IVIG or plasmapheresis
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Elevated EKG voltage
LVH
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New htn tx options
1. D/c offending agents (ie. OCP can cause htn) 2. Consider diet and exercise (but less effective in nonobese) 3. low-dose HCTZ
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Why is NaHCO3 used ot treat cardiac toxicity in TCA o/d?
1. Incr serum pH and 2. extracellular Na to alleviate cardio-depressant action on Na channels
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What is a common side effect of methotrexate (a dz-mod drug)
Macrocytic anemia
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What is normal JVP?
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What is MOA of ursodeoxycholic acid for cholelithiasis?
Bile salt. It reduces hepatic secretion and intestinal reabsorption of cholesterol. Used to disolve small gallstones
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Preferred treatment for Graves, and contra?
Radioactive iodine therapy. Pregnancy, severe ophthalmopathy
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Blood smear shows spherocytotis. Ddx?
Autoimmune hemolytic anemia vs. hereditary spherocytosis
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LE DVTs are divided into 2 categories:
1. Proximal deep veins (iliac, femoral, popliteal) cause >90% of acute Pes. 2. Calf veins
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What med can be used in cystitis but not pyelo?
Nitrofurantoin
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What is Whipple's dz?
Infection that can cause multi-systemic illness. Can cause (non-GI): chronic cough, myocard/valvular involvement, arthritis
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PAS + material in lamina propria of small intestine
Whipple's dz
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Steps for melanoma.
If depth of lession 1mm depth --> sentinel LN study
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Use dependence with 1C antiarrhythmics?
Decr in impulse conduction w/ incr HR --> Widening QRS
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Use dependence with IV antiarrhythmics?
Prolonged refractory pd of AV node --> incr PR interval
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Development of CHF from MI?
After MI, ventricular remodeling occurs --> dilation of LV w/ thinning of ventricular walls --> CHF. ACE inhibitors inhibit this, thus start w/in 24h of pt's MI.
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Ppx for transplant pts (4)?
1. PO TMP-SMX --> prevent Pneumocystis pneumonia (PCP)
2. Vacc vs. influenza
3. Pneumococcus
4. Hep B
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Workup for dysphagia?
Upper GI endoscopy --> barium swallow. Unless motility disorder, then barium swallow first --> esophageal motility study
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Pt has tender, erythematous, palpable cord-like veins on L arm and upper chest. Indicates
Superficial thrombophlebitis = Trousseau's syndrome. Hypercoag d/o as seen w/ ca of pancreas (most common), lung, prostate, stomach, colon, acute leukemia.
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Causes of non-menstrual TSS
Surgical wound infx, sinusitis, septorhinoplasty
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What meds should be held prior to a stress test?
1. BB, 2. CCB, 3. Nitrates
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Common cause of non-asthma wheezing
Bronchitis
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What is a common side effect of chloroquine?
Eye (retinopathy, corneal damage)
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What are some signs of hypertensive emergency involving kidneys and heart?
Renal failure, signs of congestive heart failure
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Metabolism of nitroprusside releases_
NO and CN ions
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CN toxicity sx
AMS, lactic acidosis, seizures, coma
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What is most common cause of nursing home pneumonia?
S. pneumo
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Myocytes causing esophageal spasm (which is a type of motility disorder) can be relaxed by (2)
Nitrates, CCB
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What does pulmonary capillary wedge pressure measure?
LA pressure - aka preload
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Weakness, tremors, palp, h/a after albuterol treatment?
B2 agonists drive K into cell --> may cause hypokalemia
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T/F: In ARDS, pulm arterial pressure is increased.
True in 25% pts with ARDS - due to hypoxic vasoconstriction, compression of vascular structures from pos pressure, and lung parenchymal distruction
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What are the presentation signs for MM?
CRAB: # hyperCalcemia, # Renal impairment, # Anemia, # Bones - pain, lesions, fractures
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Pts w/ MM are at incr risk of infx b/c
1. Tot decr in fnl Ig and 2. Leukopenia as BM filled w/ plasma cell
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What is superior vena cava syndrome?
Impairment of blood drainage from head/neck/upper extr, usu 2/2 malignancy vs. thrombosis from indwelling cath
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What is the compensatory response of the kidney to bicarb retention in OSA?
Increased bicarb retention and decreased chloride
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Impaired bone mineralization due to
Most commonly, severe vit D deficiency (osteomalacia)
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Loss of distal peristalsis of esophagus
Scleroderma
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Lower esophageal sphincter doesn't relax
Achalasia
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If OA refractory to acetaminophen, consider
Ketorolac, colchicine
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Tx for nonallergic rhinitis (congestion, rhinorrhea, sneezing, post nasal drip w/o eye sx, no obvious allergic trigger)
Intranasal antihistamine, glucocorticoids, or both
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What is myasthenia crisis?
Char by diplopia, ptosis, weakness of proximal muscles, weakness of bulbar muscles and diaphragm --> resp distress. Tx: intubation, AChE inhib (pyridostigmine), add steroids + IVIG or plasmapheresis. Sx improve with edrophonium - worsens with MG cholinergic crisis
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3ad of mono
Fever, cervical lad (posterior), pharyngitis
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Fasciulations - UMN or LMN?
Lower!!!
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Spasticity, bulbar sx
UMN
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45 yo m w/ excessive wasting of extremity muscles, weakness began distally and asymmetrically. Difficulty with facial/throat movements. Fasciculations and hyperreflexia of all extremities.
ALS
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Hx of anticoagulation, sx of weakness/dizziness, and anemia/tachycardia should raise concerns for
Internal hemorrhage
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The risk of bleeding while on warfarin greatest in pts w/
DM, age >60, htn, EtOH abuse
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Enoxaparin (LMWH), fondaparinux, rivaroxaban can't be used in pts w/
Severe renal insufficiency (GFR incr anti-Xa activity and bleeding risk
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Diff btw CNIII neuropathy 2/2 DM vs. compression
Diabetes - affects only somatic fibers. Therefore accommodation and response to light remain intact.
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Membranoproliferative glomerulonephritis is assoc with this liver infx
Hep C
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Renal vein thrombosis presents with
Abd pain, hematuria
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Which med o/d can cause anti-cholinergic effects, and tx?
Diphenhydramine. Tx: physostigmine
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Sx of theophylline o/d
Seizure, hyperthermia, cardiac arrhythmia, hypotn
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Which rx decr frequency of relapse and reduces diability in pts w/ relapsing-remitting form of MS?
Interferon-beta. What is used in acute attack? High dose steroids
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Causes of v. high AST and ALT?
Think toxin, viral, ischemic
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3ad of ascending cholangitis? (Charcot's 3ad)
Fever, severe jaundice, RUQ abd pain. Think of Ms. Gill!
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5ad of ascending cholangitis?
Charcot triad + confusion and hypotn = Reynold's 5ad
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What is the diagnostic test of choice for MS?
MRI. Then CSF (not serum) will show oligoclonal IgG bands in >95% pts
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What are signs of post-transfusion acute hemolysis?
Fever, chills, flank pain, hemoglobinuira w/in 1 hr of transfusion, may progress to renal failure, DIC. +Coombs, plasma free Hb >=25
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Tx options for Legionella?
Macrolides, fluoroquinolones
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Febrile illness with cervical lymphadenopathy. Can be mono vs. HIV. How to distinguish?
Mono - tonsillar exudate more common. HIV - rash, diarrhea more common
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Lab findings of bowel ischemia?
Leukocytosis, elevated amylase, metabolic acidosis from increased lactate
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What is first line treatment for stable angina?
Beta blocker. Can combine with CCB and niatrates for persistent
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What are side effects of metoclopromide?
Agitation, loose stool, extrapyramidal
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Positive predictive value =
TP / (TP + FP)
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What symptoms suggest agranulocytosis in pts taking PTU? Regular CBC is not recommended.
Fever, sore throat
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Med options for toxo?
1. Ppx: TMP-SMX. 2. Rx: Sulfadiazine, pyrimethamine
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Which lung cancer causes paraneoplastic ACTH or SIADH?
Small cell
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Which lung cancer causes hypercalcemia?
sCa2+mous
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Aspergilloma looks like
Mobile, intra-cavitary mass w/ air crescent in periphery
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Secondary malignancies are common in pts w/ PMH Hodgkin lymphoma 2/2 chemo and/or radiation in
Lung, br, thyroid, bone, GI, leukemia
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MMSE of less than_ suggests dementia
24
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Pt w/ mild DM, migratory erythema, diarrhea, anemia, weight loss
Glucagonoma
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Signs of benzo intoxication
Drowsiness, slurred speech, unsteady giat
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Important sign of opioid (ie. heroin) intoxication
Depressed RR
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What is metabolic syndrome that predisposes to hyperglyc?
Htn, dyslipidemia, abd obesity
345
Why folate def in pts with sc?
Pts compensate for hemolysis by increasing rbc production, recommend folate supp
346
What's alternative to penicillin for syphilis?
Doxy, unless preggers, then desensitizatoon
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What's most effective in lowering sbp?
dash diet
348
How to distinguish btw hematuria from glomeruli vs not?
Blood and protein with glomerular
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Risks for papillary necrosis?
mnemonic nsaid- nsaid, sickle cell, analgesic, infection(pyelo), diabetes
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Nephrotic syndrome in the setting of palpable kidneys, hepatomegaly, and ventricular hyper trophy given chronic inflammatory dz
Secondary amyloidosis
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Acute back pain and point tenderness after a fall
Vertebral compression
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What must be avoided in pts w/ cocaine cardiomyopathy?
BB
353
Lambert eeeeeaton affects which part of nerve?
Preeeesynaptic
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What is Alprazolam used for?
Short acting benzo to tx panic attacks, anxiety
355
What is amitriptyline used for?
Neuropathic pain, depression
356
Secondary amyloidosis (AA) can cause multi-organ dysfn. Tx?
Colchicine for both tx and ppx
357
Pts w/ nephrotic syndrome have incr risk of accelerated atherosclerosis b/c
Elevated LDL and/or low HDL, also hypercoagulable --> incr risk of stroke or MI. Put on statins!!
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Urinary impairment in pts w/ SCD?
Hyposthenuria - impairment in kidney's ability to concntrate urine. Sickling in vasa rectae of inner medulla --> impair countercurrent exchange and free water reabs
359
MOA of hyponatremia in adrenal insufficiency (2)?
1. Vol contraction 2/2 mineralocorticoid def and 2. incr vasopressin secretion 2/2 lack of cortisol suppression
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Initial tx of frostbite?
RAPID re-warming with warm water
361
First line tx for essential tremor?
Propranolol
362
First line tx for Parkinson's, esp in younger pts?
Trihexyphenidyl
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How to detect HER2 in br ca?
1. immunohistochemical staining 2. FISH
364
Lab values in Cushings?
Hypokalemia + hypernatremia. As corticosteroids will hav esome binding to aldosterone receptors in kidney
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Classic 3ad of disseminated gonococcal infx
1. Polyarthralgia 2. tenosynovitis 3. Painless skin lesions
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Why microcytic anemia in naproxen use?
Incr risk peptic ulcer/gastritis --> chronic GI blood loss --> Fe def
367
Dermatomyositis is also associated with this
Malignancy
368
What is most common neuro complication of Lymes?
Uni or bilateral CN VII palsy
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What can decr nephropathy in contrast-induced?
1. Non-ionic contrast agents 2. Adequate IVF 3. Acetylcysteine
370
Tx for MALT lymphoma w/o LN involvement
Treat for H. pylori - omeprazole PPI, clarithromycin, amoxicillin
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What do hep C pts need before starting tx?
Liver biopsy - best clinical predictor of dz progression, assess likelihood of response to tx. Pts w/ mod-severe inflamm/fibrosis have higher chance progressing to cirrhosis & respond better to tx
372
Meltzer's triad of polyclonal cryoglobulinemia?
Purpura, arthralgia, weakness
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What are the criteria for supplemental O2 in COPD?
1. PaO2 55%, 4. Cor pulmonale
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Which 4 abx commonly cause C. diff?
1. Fluoroquinolones 2. Penicillins 3. Cephalosporins 4. Clinda
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Why does polycythema frequently cause pruritis w/ hot bath?
Histamine release from incr number of circulating basophils
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In DIC, everything is elevated except (2)
1. Fibrinogen 2. Platelet count
377
What are some pulmonary-renal syndromes (5)?
1. Goodpastures (requires emergency plasmapheresis) 2. Wegener's 3. SLE nephritis 4. polyarteritis nodosa 5. RPGN
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What are options for afib rate control?
1. Beta blocker
2. Diltiazem
3. Digoxin
4. Verapamil
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What are options for afib rhythm control?
1. Amiodarone
2. Sotalol
3. Propafenone
4. Procainamide
