Medicine Shelf Exam Flashcards
1
Q
Goodpastures Disease
A
Young adult male, nephritic proteinuria, acute renal failure, urinary sediment w/ dysmorphic RBC.
Caused by Antibodies to alpha-3 chain of type IV collagen in alveolar and glomerular basement membranes. LUNG AND RENAL SXS, hemoptysis
Renal biopsy shoes linear IgG deposition along BM. Systemic sxs uncommon.
2
Q
Pneumocystic pneumonia
A
PCP – HIV w/ CD4
3
Q
Which electrolyte needs to be corrected in alcoholics in order to successfully fix hypokalemia?
A
Magnesium
4
Q
Sxs of hypophosphatemia
A
weakness, rhabdo, paresthesias, respiratory failure
5
Q
Common electrolyte abnormalities in alcoholics
A
low K low Mg, low hosphate. Hypomag causes refractory hypoK.
6
Q
Complications of PEEP?
A
Alveolar damage, tension pneumo, hypotension when high pressure applied.
7
Q
What is atelectasis?
A
all or part of a lung becomes airless/ collapes
8
Q
Organisms implicated in epiglottitis?
A
H flu and Strep pyogenes (GAS)
9
Q
What is a hazard ratio?
A
ratio of event rate occurring in treatment arm versus non treatment arm. Ratio less than one means tx arm had lower event rate.
10
Q
What is factorial design study?
A
Two or more experimental interventions each w/ two or more variables studied independently.
11
Q
Most common side effect of radioiodine therapy for graves?
A
Hypothyroidism. Like 80 percent get it.
Also worsening opthalmopathy is bad too. Can be prevented w/ corticosteroid tx before and after.
12
Q
tx for stable chronic angina?
A
Beta blocker FIRST LINE - reduce myocardial oxygen demand
Ca blocker can combine w/ beta blocker if angina persists. Causes peripheral and coronary vasodilation.
Nitrates; ACUTE
Pr
13
Q
Preventive tx w/ angina?
A
aspirin, statin, smoking cessation, BP and DM control, exercise weight loss
14
Q
Conditions associated w/ Erythema Nodosum?
A
Recent strep infx, sarcoidosis, TB, histoplasmosis, IBD. Sarcoid most common in AA women.
15
Q
What is erythema nodosum?
A
painful subQ nodule on anterior surface of lower legs
16
Q
Things associated w/ sarcoidosis?
A
Cough arthritis, uveitis, hilar adenoathy, and erythema nodosum (shin lesions)
17
Q
What is thyrotoxicosis?
A
increased thyroid hormone w/ suppressed TSH, radioactive iodine uptake in nodule. Toxic adenoma
18
Q
What causes molluscum?
A
poxvirus. Usually skin colored papules w/ central pit
19
Q
How do viral URI and influenza present differently?
A
Flu usually starts abruptly, URI is stepwise. Flu has myalgias, posssible fever, HA.
20
Q
Nitroglycerin MOA?
A
Dilation of veins (capacitance vessels) this decreases preload and decrease heart size, decrease oxygen requirement of the heart. Can alsy dilate arteries but less significant for anginal pain.
21
Q
sxs of zinc deficiency?
A
aloecia, abnormal taste, bullous, pustulous leasions surrounding body orifices or extremities, impaired wound healing
22
Q
Celiac sxs?
A
diarrhea, weight loss, fatigue, can lead to malabsorption of vitamin D, K , B12, folate, calcium, zing
23
Q
vitamin a deficiency?
A
blindness, dry skin, imaired immunity
24
Q
sxs of selenium deficiency?
A
cardiomyopathy
25
Likely complication of GCA?
Aortic aneurysm
26
Sxs of GCA?
headache, jaw claudication, muscle fatigue / polymyalgia, visual disturbance. high ESR
27
Important causes of membranous glomerulonephritis?
hep B, C, syphilis, gold, penicillamine, SLE, rheumatoid arthritis
28
Management of acute COPD exacerbation?
Oxygen, albuterol/ipratropium, IV steroids, Abx if >1 cardinal symptom, NPPV for severe, intubation if necessary
29
Cardinal sxs of COPD exacerbation
Increased dyspnea, increased cough, increased sputum production (change in color/volume)
30
what's cromolyn?
mast cell stabilizer (prevents histamine release and leukotrienes) used for asthma.
31
Salmeterol?
long acting beta two agonist used in maintenance therapy of COPD, not for acute exacerbation.
32
Tropical sprue?
chronic diarrheal illness, malabs of nutrients esp B12 and folate, metaloblastic anemia. Fatty diarrhea, cramps, gas, fatigue, weight loss. small intestine biopsy shows villus blunting and infiltration of chronic inflammatory cells, lymphocytes, plasma cells, eosinophils.
33
epidermal inclusion cyst?
benign nodule w/ normal epidermis that produces keratin. It's hard. May develop inflammation w/ rupture and involvement or surrounding tissue.
Dx: cliically, dome shapped, firm, movable cyst/nodule w/ central unctum (pore like opening). Some can have discharge. Some can resolve spontaneously. `
34
dermatofibroma?
benign fibroblast proliferation, firm, hyperpigented nodule on lower extremities. Have "dimple" or "buttonhole sign" when pinched.
35
Management of STEMI?
nitrates (caution w/ hypotension, RV infarction, severe aortic stenosis)
antiplatelets
anticoag
beta blockers -- contraindicated in overt heart failure
Prompt reperfusion with PCI
Statin ASAP
36
Imipramine / amytriptiline overdose? (TCA)
Has anticholinergic effects, can cause sinus brady/hypotension, prolonged intervals., anticicholinergic toxicity (hyperthermia, dilated pupils, cardiac toxicity.) risk of vtach 2/2 widening QRS.
37
Imipramine/amitryptiline overdose (TCA) treatment
Bicarb - given if QRS is widened >100 ms give sodium bicarbonate, increases serum pH and extracellular sodium. Increased pH decreases drug avidity for sodium channels
38
Salicylate / aspirin overdose tx:
urine alkalinization w/ sodium bicarb to increase asirin excretion
39
Isolated systolic HTN
usually in elderly, 2/2 decreased elasticity of artery wall. Tx: thiazide, ACE I, or long acting calcium channel blocker for initial tx.
40
Most common head/neck cancer?
Squamous cell carcinoma. Hard unilateral LN. Biopsy stat.
41
lymph nodes most often affected in EBV?
posterior cervical chain
42
EKG of afib?
Absent P wave, replaced by tiny fibrillatory waves, irregularly irregular R-R interval, and narrow QRS. The pulmonary veins are most frequent location of ectopic foci that cause AF. Can ablate the tissue around PV
43
WPW syndrome causes?
accessory atrioventricular bypass tract can cause reentrant loop pattern and AVRT. Will see delta waves on WPW.
44
AVnRT caused by?
reentrant circuit formed by two separate conducting pathways (one fast and one slow) in the AV node. Characterized by sudden onset/stop, 10-250 /min, regular, no p waves to be discerned.
45
Most common cause of A flutter?
reentrant circuit around tricuspid annulus, "cavotricuspid isthmus". Rapid sawtooth waves on EKG.
46
bad things w/ Lyme disease
```
Carditis (AV block)
Neuro: cranial nerve palsy, esp VII
Muscles: arhtralgia
conjunctivitis
Skin
Adenopathy
Long term: Encephalomyelitis, peripheral nueropathy
```
47
disseminated gonorrhea sxs
vesculopustular dermatitis, reactive arhtiritis, migratory asymmetric polyarhtralgia. Rash rarely involves face
48
recommended vaccines for chronic liver dz
Td q 10 years (give one Tdap?), flu annual, pneumo PPSV23 once then follow w/ PCV13 and PPSV23 at age 65, Hep A, and Hep B
49
risk factors for avascular necrosis
steroids, alcohol, lupus, APA, hemoglobinopathies, infx, renal transplant.
Groin pain w/ weight bearing, worse on hip abduction and internal rotation. Normal ESR/CRP. MRI most sensiive
50
Babesiosis?
caused by tick bite w/ babesia. Northeast US. Enters RBC and causes hemolysis. Leads to jaundice, hemoglobinuria, renal failure, etc. No rash. Giemsa stain can dx. Use: quinine clinda and atovaquone-azithro.
51
Ehrlichiosis?
Spotless rocky mountain spotted fever, tick borne. Leukopenia and thrombocytopenia, fever/malaise, HA, N/V.
52
Q fever?
zoonosis, caused by coxiella burnetii. Infected by cattle/goat/sheep usually in meat workers and fets. flu, hepatitis, pneumo
53
Lynch syndrome?
Hereditary non-polyposisi colorectal cancer (HNPCC). Risk for colon cancer and endometrial carcinoma
54
Diffuse esophageal spasms / motility disorders, sxs & tx
spontaneous pain, odynophagia for cold and hot food. Nitroglycerin helps. Nitrates relax the esophagus! Dx w/ esophageal manometry showing non-peristaltic high amplitude contractions.
55
amlodipine
calcium channel blocker (norvasc) used for tx of HTN
56
Secondary adrenal insufficiency, cause & sxs
Usually chronic steroid therapy. Cortisol is down, ACTH is down, aldo is normal. No hyperpigmentation or hyperkalemia. Possible hypontatremia
57
Primary adrenal insufficiency
Autoimmune, causes low cortisol and aldo, elevated ACTH. Causes severe sxs, hyperpigmentation, hyperkalemia, hyponatremia, hypotension.
Aldo deficiency can cause sodium wasting and lead to hyponatremia.
58
Coccidiomycosis?
Southwest US (think Arizona, California), central/south america. Primay pulmonary infection. Cutaneous findings of erythema multiforme and erythema nodosum, arthralgias.
59
Blastomycosis
south and north central US. Lungs, skin, bone, joint, and prostate involvement. Rare in immunocompetent
60
Invasive aspergillosis
happens in immunocompromised(on immune modulating therapies, AIDS), invasive pulmonary disease p/w fever, cough, dyspnea, hemoptysis. Cavitary lesions on chest x ray. CT shows pul mondules w/ halo sign or air crescent
61
Sporotrichosis
Subcutaneous skin infection
62
Cryptococcus
Meningoencephalitis in HIV patients w/ CD4 pulmonary phase --> meningoencephalitis.
63
Diabetes insipidus
Central: decreased ADH from pituitary, or
nephrogenic (normal ADH w/ renal ADH resistance.) Central DI patients have problem w/ thirst and have high serum sodium >150. Nephrogenic DI can have intact thirst w/ lower sodium. ~145
Desmopressin to distinguish between nephrogenic vs. central. Central will cause ADH release and urine will concentrate. If nephrogenic won't help. . Tx w/ intranasal desmopressin.
64
Primary polydipsia
Person just wants to drink a tons of water for no good reason. Intact ADH, ability to concentrate urine but just drinks too much.
65
Treatment for SIADH?
Demeclocycline --> inhibits ADH mediated aquaporin insertion in collecting tubule to help dilute urine.
66
Treatment for nephrogenic DI?
hydrochlorothiazide. Increases proximal water and sodium resorption
67
Ulcerative colitis features (colonic + extracolonic)
20's/30's, bloody diarrhea, lower abd pain, tenesmus. Skin findings like erythema nodosum, pyoderma gangrenosum, arthritis, cholangitis. P-ANCA is positive. Arthritis is similar to ankylosing spondylitis (low back)
assAnkylosing spondy and IBD both associated with HLA-B27. +p-ANCA even though no vasculitis.
68
Whipple disease
multisystemic disease, caused by tropheryma whippelii, malabsorptive diarrhea, weight loss, skin hyperpigmentation, migratory arthritis, lymphadenopathy, fever. PAS+ small bowel biopsy
69
Celiac antibody findings
anti-endomysial and anti-transglutaminase. Characteristic cutaneous findings is dermatitis herpetiformis
70
primary aldosteronism sxs
hypokalemia, slight hypernatremia, hypertension w/ adrenal incidentaloma
71
pheochromocytoma sxs
elevated BP w/ tachy, pounding A, plapitation, diaphoresis, HTN w/ adrenal incidentaloma
72
high plasma aldo/renin ratio >20:1?
primary aldosteronism. Resistant HTN, hypokalemia.
73
urinary excretion of vanillylmandelic acid?
pheochromocytoma.
74
rib notching on x ray?
coarctation of aorta 2/2 enlarged collateral intercostal vessels
75
renovascular htn tip off:
diffuse athero, asymmetric kidney, recurrent flash pulm edema, elevation in Cr 30% from BL after ACE I or ARB. Abd bruit.
76
causes of esophagitis in HIV (painful swallowing, substernal burning)
candida, HSV (ovoid ulcers, vesicles), CMV (deep, linear ulcers), idiopathic
77
CMV mononucleosis
looks like mono, smells like mono, but heterophile AB negative and atypical lymphocytes w/ vacuolated appearance. Usually no pharyngitis or lymphadenopathy.
78
CLL pathology?
smudge cells and mature appearing small lymphocytes
79
Light's criteria for exudative pleural effusion
protein/serum protein ratio >0.5
Pleural fluid LDH/serum LDH ratio >0.6
Pleural LDH > 2/3 of upper limit of normal for serum LDh
80
Causes of exudative effusion
infection, malignancy, PE, connective tissue disease, iatrogenic. Occurs 2/2 inflammation and increased capillary and pleural membrane pemeability or impaired lymph drainage of pleural space
81
Transudative pleural effusion
hypoalbuminemia and CHF, typically bilaterall/symmetrical and w/ few red or WBC.
82
acid base disturbance in PE?
respiratory alkalosis -- hyperventilation as patient tries to overcome hypoxia and V/Q mismatch.
83
inflammatory, symmetric arthritis, quick resolution
viral arthritis, 2/2 parvo, hep, HIV, Mmumps and rubella etc. Can get positive RF and ANA.
84
Septic and crystalline arthritis sxs
monoarticular, usually the knee. use joint aspiration to differentiate
85
Rheumatoid arthritis
symmetric, inflammatory. Chronic, doesn't resolve quickly
86
SLE arthritis
symmetric, inflammatory
87
Osteoarthritis
noninflammatory, no fever.
88
Sarcoid arthritis
polyarthritis, usually ankles/knees
89
Rubella sxs
Fever, conjunctivitis, coryza, cervical lymphadenopathy, FAST cephalocaudal spread of blanching erythematous maculopapular rash that spares hands/feet. Young women get arthralgias too. Dx w/ PCR and rubella seriology IgM IgG. Tx is supportive
90
rash of secondary syphilis
involves trunk and extremities, including palms and soles (not like rubella)
91
treatment of acne (comedonal, inflammatory, and nodular)
comedonal: topical retinoids, salicylic acid
inflammatory: topical retinoids, benzoyl perox, abx like erythro and clinda, severe oral abx
nodular: topical retinoid, benzoyl, oral abx if severe. if unresponsive severe, oral isotertinoin
92
gout prevention
lower alcohol is a big one, lower BMI, low fat diet, decrease seafood/red meat intake, vegie protein is good, avoid organ rich foods like liver, avoid beer and diuretics if possible. quit smoking
only use urate lowering meds for those w/ recurrence.
93
Causes of ILD
sarcoid, amyloid, alveolar proteinosis, vasculitis (eg wegeners), infx, occupational (silicon), connective tissue dz (SLE, scleroderma), idiopathic
94
PFT findings in ILD
Normal or increased FEV1/FVC ratio, decreased CO diffusion, decreased lung capacity, decreased residual volume. V/Q mismatch (restrictive lung pattern)
95
A-a gradient
difference between alveolar concentration of oxygen and arterial concentration. AA mismtch can happen in pulmonary fibrosis, but resting arterial blood gas may be normal or only mildly hypoxic
96
ILD pathophys
excessive collagen deposition in peri-alveolar tissue leading to decreased lung volume w/ preserved or increased FEV1/FVC ratio.
97
Calcium phosphate kidney stone
primary hyperparathyroid and RTA
98
Uric acid stone
dehydration, acidic urine
99
Cysteine stones
due to IEMs 2/2 increased cysteine excretion
100
struvite
proteus/klebs high ph urine w/ recurrent UTI
101
features and tx of 2ndary raynauds
2/2 connective tissue disease/occlusive vascular condition, hyperviscosity. Usually men >40, tissue injury/digital ulcers. Treat with CCB (nifedipine and amlodipine) and aspirin and treat underlying disorder.
send ANA and RF, ESR and complement levels
102
primary raynauds
no underlying cause, usually young women, negative ANA and ESR. CB for persisting sxs
103
antibodies in systemic sclerosis
ANA and antitopoisomerase-1
104
Buerger's disease
aka thromboangitis obliterans, vasculitis that affects small and medium sized arteries of young smokers. P/w distal extremity ischemia, ulcers, gangrene. Usually diagnosed as exclusion after systemic dz have been ruled out.
105
type of cancer in distal esophagus?
adenocarcinoma, arises from Barrett. Risk factors include reflux, obesity. Sxs are CP, weight loss, dysphagia
106
Type of cancer anywhere in esophagus?
squamous cell carcinoma. RF include smoking alcohol and caustic injury.
107
ABG in COPD exacerbation?
resiratory acidosis and hypoxia. You'd be holding on to C2.
108
Bath salts
synthetic cathinones that are amphetamine analogs. Can cause people to go cray cray via inhibition of reuptake of NE dop and 5HT. Severe tgitation, combative, psychosis, delirium, myoclonus, seizures. Long duration. Do not show up on routine toxicology
109
severe MDMA intox
significant hyperthermia
110
PCP intox
psychomotor agitation, combative, low pain perception, hallucination, HTN tachy and nystagmus. Included in utox.
111
What's a VIPoma?
rare tumor of pancreas, produces vasoacive intestinal peptide. Binds to intestinal epithelial cells to increase fluid/electrolyte secretion
112
Sxs of VIPoma
water diarrhea, low acid secretion, flushing, N/V, muscle cramps/weakness, hypokalemia!!!! hypercalcemia, hyperglycemia, abd CT shows pancreatic tail tumor. Lots of water loss = volume depletion
Can have hyperparathyroidism concurrently as part of multiple endcorine neoplasia (MEN)
113
VIPoma tx
IV volume repletion, octreotide to decrease diarrhea, possible hepatic resection in pts w/ mets
114
Carcinoid syndrome?
causes flushing, diarrhea, bronchospasm. Nearly 80% of carcinoid tumors occur in small intestine
115
Gastrinoma?
Can occur in a few places including pancreas. Cause increased gastrin release w/ multiple gastric ulcers and dyspepsia (Zollinger-Ellison syndrome).
116
med tx for diabetic neuropathy?
amytriptyline, gabapentin, NSAIDS (if kidney fnx in tact)
| TCAs can worsen urinary sxs and cause orthostasis
117
Autosomal Dominant Polycystic Kidney Disease
hypertension, palpable masses, microhematturia. Intracranial berry aneurysms are common complications. Other complications include hepatic cysts, valvular heart disease, diverticula, hernias.
118
Cervical spondylosis
General term for degenerative changes in the neck. Causes chronic neck pain, limited rotation due to osteoarthritis and musce spasm. From osteophytes. Can cause hypertrophic vertebral bodies.
119
meds implicated in crystal induced kidney injury (tubular obstruction)
acyclovir, sulfonadmides, methotrexate, ethylene glycol, protease inhibitors (ex: HIV meds like ritonavir).
120
clinical fts of acute interstitial nephritis (AIN) and some associated meds that cause it
beta lactams, PPIs. Usually 7-10 days after exposure. Causes skin rash, eosinophilia, eosinophiliuria, pyrua
121
Addison's disease
autoimmune destruction of adrenals. Low mineralcorticoids, leading to low aldo--> low Na2+ and thus retention of potassium leading to hyperK. Weight loss, N/V, abd pain, diarrhea, hyperpigmentation, low BP, vitiligo. In most cases hyperk is accompanied by mild hyperchloremic acidosis.
122
Etiology of primary adrenal insufficiency
autoimmune, infx like TB, HIV, fungal, hemorrhagic infarction, mets
123
clinical presentation of acute adrenal insufficiency
shock, abd tenderness, unexplained fever, N/V, weight loss, anorexia, hypoNa, hyperK, hyperCa, eosinophilia
124
clinical presentation of chronic adrenal insufficiency
fatigue, weakness, anorexia, GI, weight loss, hyperpigmentation or vitiligo, hypotension, hypona, hyperk, hyperca, anemia, eosinophilia.
125
low cortisol, high ACTH
primary adrenal insufficiency
126
extrapulmonary sites for TB
liver, spleen, kidney, bone, adrenal gland
127
causes of elevated anion gap metabolic acidosis
ketoacidosis (etoh, dm, starv), intox (methanol, salicylate, eth glycol, isoniazid, metformin) tissue hypoxia, renal failure
128
in hypoaldo, why do you get metabolic acidosis?
sodium losses while simultaneous retention of potassium/H+
129
Jarisch-Herxheimer rxn
can develop in tx of syphilis. When tx w/ penicillin, spirochetees die rapidly leading to release of antigen/ab complex in blood and consequent immunologic rxn which seems ike accute syphillis flar.
130
Two major side effects of isoniazid
peripheral neuropathy and hepatitis
131
diagnostic step in signs/sxs of adrenal insufficiency?
cosyntropin stimulation test w/ cortisol and ACTH levels. Can tell you primary vs secondary or tertiary.
132
what is cosyntropin?
ACTH synthetic analogue for pdiagnostic purposes in adrenal insufficiency
133
most important risk factor for bladder cancer?
psmoking
134
Positive predictive value:
proportion of subjects w/ positive test who actually have the disease.
PPV = TP/TP+FP
NPV= TN/TN+FN
135
Sxs of hyperthyroid
proximal muscle weakness, can cause myopathy. Fatigue, anxiety, tremor, weight loss, tachycardia.
136
medication for raising HDL and lowering triglycerides
niacin (nicotinic acid)
137
Echinococcosis
parasitic dz caused by tapeworm. Can cause liver cysts w/ daughter cysts. Majority associated w sheeps.
138
cause of Kaposi sarcoma
HHV8, . Brown macules found in HIV+ pts
139
dermatofibroma
dimple sign
140
cause of pyogenic spinal osteomyelitis
usually s. aureus, can also be G- bacilli. Can spread from UTI.
141
anion gap formula
sodium - bicarb - chloride
142
on mech ventilation, pO2 and pCO2 mostly affected by?
pO2: FiO2 and PEEP.
pCO2: RR and TV
Goal is maintain PO2 > 60. Early goals of ventilation are to decrease FiO2 to nontoxic levels
143
tx of echinococcus liver cyst
unlike E histolytica, these can be aspirated + albendazole.
E histolytica is metronidazole only.
144
Human monocyte ehrlichiosis
south east US, flu like illness w/ confusion
"RMSF w/out spots"
leukopenia and thrombocytopenia, elevated LFTs. dx w/ intracytoplasmic morulae in monocytes. give DOXYCYCLINE
145
medication that treats neurologic and cardiac Lyme
ceftriaxone
146
osteomalacia causes
malabsorption, intestinal bypass, celiac, liver and kidney disease
147
dx of osteomalacia
high alk phos and pth
slow calcium and phos, low urinary calcium
low vitamind D
148
paget's disease
accelerated focal bone remodeling. normal ca/phos/pth, but markers of bone resorption high like c and n telopeptide, alk phos.
149
prolactinoma therapy
cabergoline or bromocriptine (dopamine agonist)
150
tx for hyperthyroid afib
beta blocker until you can control the hyperthyroidism
151
Trousseau's syndrome
"migratory superficial thrombophlebitis". Hypercoagulable disorder w/ unexplained superficial venous thrombi at unsual sites (arm, chest). Often accompanies an occult visceral malignancy. Often associated w/ pancreas cancer.
152
phenytoin deficiency*
folate. megaloblastic anemia!!
153
pancoast tumor?
usually non small cell lung cancer in superior pulmonary sulcus, can cause horners and compress the brachial plexu.
154
ring shaped lesions w/ scaly patches
tinea corporis, often trichophyton rubrun
155
salmon colored patches, silvery scale, peeling on extensor surfaces
psoriasis
156
secondary syphilis skin lesions?
maculopapulor, usually palms and soles
157
TCA overdose seizure tx
GABA agonist like benzo
158
tx for delerium 2/2 anticholinergics (ie atropine, diphenhydramine)?
physostigmine.
159
why are people hypercoagulable w/ nephrotic syndrome?
possible loss of antithrombin III in urine. Usually affects renal veins.
160
MI causes what kind of "immediate" arrhythmia most frequently? What kind of delayed?
immediate: ventricular reentry
delayed: abnormal automaticity
161
asystole?
complete absense of electrical or cardiac activity
162
pancreatic cancer sxs
painless jaundice, double duct sign on imaging. Causes back up of bile. Most pancreatic cancers in the head of the pancreas. Cancers in the body or tail present w/ pain but no jaundice.
163
causes of acute pancreatitis
```
I GET SMASHED
Idiopathic,
gall stones,
ethanol,
tumors,
scorpion,
microbiological,
autoimmine (sle, polyarteritis nodosa, crohns)
surgery or trauma
hypertriglyceridemia
emboli or ischemia
drugs (azathioprine, abx, valproate, others)
```
tx w/ lots of fluids!!!
164
cardiac cath complications
livedo reticularis, AKI, pancreatitis, mesenteric ischemia
165
muddy brown casts
ATN
166
broad and waxy casts in urine
chronic renal failure 2/2 dilated tubules of enlarged nephrons
167
RBC casts
glomerularnephritis orr vasculitis
168
WBC casts
interstitial nephritis and pyelo
169
fatty casts in urine
nephrotic syndrome.
170
hyaline casts in urine
protein passing unchanged along UT, may be in in asymptomatic people w/ prerenal azotemia.
171
sxs of ASA overdose
respiratory alkalosis, then anion gap met acidosis. GI pain, tinnitus, fever, tachypnea, GI irritation
172
Winter's formula
tells you if you have appropriate acid/base compesation, helps determine if there's one process going on or multiple processes.
173
tx for tylenol overdose
ore than 7.5 grams, less than four hours, give charcoal and check levels. Any evidence of liver injury give N-acetylcystein and monitor for liver injury.
174
G6P dehydrogenase deficiency causes
bite cells w/ heinz bodies, hemolysis, sxs include pallor, jaundice or dark urine, abd pain
175
Holt Oram syndrome
upper limb defects (radius, carpal bones) and atrial septal defect. Means "hand-heart). Often w/ atrial septal defect can hear wide, fixed splitting of S2.
176
clinical findings of aortic dissection
can cause aortic regurge and diastolic murmur.
177
tx for graves
radioactive iodine therapy. contraindications are pregnancy and severe opthalmopathy
178
ulcerated pearly nodule w/ rolled border
basal cell carcinoma. most common in US.
179
four causes of diarrhea in AIDS patients
180
Lambert Eaton
paraneoplastic syndrome: proximal muscle weakness, autonomic dysfunction, CN involvement and diminished DTRs 2/2 cancer, usually lung cancer
181
dermatomyositis
can be a paraneoplastic syndrome, causes muscle fiber injury. Skin findings, esophageal dysmotility, symmetrical/proximal muscle weakness, ILD
182
3 paraneoplastic syndromes associated w/ lung cancer
dermatomyositis/polymyositis (muscle fiber)
Lambert eaton (presynaptic membrane calcium channels)
Myasthenia (acetylcholine receptor in postsynaptic membrane)
183
w/out a spleen, what's impaired in the immune system?
phagocytosis (dendritic cells in the white pulp of spleen)
184
what's impaired in chronic granulomatous disease?
x linked recessive, defect in NADPH oxidase
185
impairment in SCID?
number of circulating lymphocytes, usually AR defect in adenosine deaminase
186
BPH tx and their MOA
finasteride - five alpha reductase
| tamulosin - alpha 1 blocker
187
COPD features
increased pulmonary complailnce due to loss of elastic tissue
airflow limitation w/ reduced inspiratory and expir. flow rates
hyperinflation leads to increased thoracic wall recoil and diaphragm flattening.
flat diaphragm causes increased WOB
188
narcolepsy treatment
methylphenidate
189
diverticulosis highly associated with?
constipation! Give them fiber.
190
what is prevalence?
incidence x time. You can have stable incidence w/ rising prevalence.
191
Ramsay Hunt syndrome
form of herpes zoster infx that causes bells palsy, vesicles seen on outer ear
192
do what if patient has likely DVT?
compression ultrasonography. If not, then do d dimer.
193
5 common viruses implicated in viral myocarditis?
coxsackie B, parvo, HHV6, adeno, entero
194
concentric cardiac hypertrophy caused by?
chronic pressure overload, like aortic stenosis or untreated HTN
195
eccentric cardiac hypertrophy due to?
chronic volume overload like valvular regurgitation.
196
cor pulmonale?
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197
signs/sxs of mixed essential cryoglobulinemia?
palpable purura, proteinuria, hematuria, arthralgias, hepatosplenomegaly, low complement. Related to HCV
198
SLE antibodies:
ANA, anti-DNA and Anti-Sm
199
microscopic polyangitis:
abd pain, hematuria, urinary sedient, purpura. Serology usually negative except ANCA, comlement normal
200
restrictive lung disease
low FEV1 but preserved ratio. This includes obesity and COPD. FVC is decreased below 80%
201
obstructive lung disease
asthma. Shows reversibility w/ broncho dilators (COPD does not show complete reversibility) DLCO in asthma is usually normal but increased in COPD. decreased FEV1/FVC ratio
202
colonoscopy frequency?
10 years unless polyps, then 3-5
203
DEXA screening?
women over sixty five, maybe younger if other risk factors for osteoporosis
204
Sjogren syndrome
autoimmune, women in their 5th/6th decade. Clinical findings include dry eyes and dry mouth, dental caries, dysphagia (lack normal amounts of saliva).
205
milk-alkali syndrome
caused by taking calcium supplements and alkalnic things like antacids. Copyright (c) UWorld, Please do not save, print, cut, copy or paste anything while a test is active.
206
symptoms of hypercalcemia
polyuria, polydipsia, nausea, vomiting, constipation.
207
2ndar and Tertiary hyperparathyroid
pts w/ CKD have decreased renal Vitamin D production leading to low calcium, hyperphos, and compensatory PTH rise (secondary HPTH). Some will develop parathyroid hyperplasia w/ autonomus PTH production and resulting hypercalciemia (tertiary).
208
how can sarcoid cause hypercalcemia?
increases conversation of 25 vitamin D to 1, 25 in granulomatous tissue. Lymphoma can do this too. You'd see higher levels of 1,25 dihydroxy vitamin D
209
lupus nephritis sxs/signs
photosensitive skin, thrombocytopenia, glomerulonephritis w/ erythrocyte casts, proteinuria, HTN with low complement. Can also affect CNS, cause strokes/seizures, headaches.
positive ANA, anti-dsDNA, anti-sm. Immune inflammatory reaction activates complement system causing them to decrease.
Can also get nephrotic syndrome w/ out low complement.
210
signs of drug induced interstitial nephritis
WBC casts and eosinophiliuria. Fever, rash eosinophilia.
211
Granulomatosis w/ angiitis
commonly involves ear, nose, throag, pulm, can present sometimes w/ renal involvement and nephritic syndrome. Normal complement
212
hemolytic uremic syndrome
usually after infection w/ shigella or e coli. Present w/ schistocytes, low platelets, frenal failure, usually from thrombotic angiopathy. R
213
poststrep glomerulonephritis
HTN, acute renal failure, RBC casts in urine, low C3.
214
which hormone prevents endometrial hyperplasia
progestin
215
first line tx for PCOS
OCPs
216
first line tx for ovulation induction in PCOS
clomiphene citrate
217
when do we use spirinolactone in PCOS?
since it can cause low androgens in developing fetus, it shouldn't be used in women of chilbearing age unless they have an OC contraindication.
218
how can you tell between exogenous vs endogenous insulin?
endogenous requires cleavage of peptide, so if someone is giving themselves insulin you won't see any c peptide in the blood
219
clinical features of amyloidosis
Epidemiology: arhthritis (ex: RA), chronic infx like TB, osteo, bronciectasis), IBD (crohns), malignancy, vasculitis.
Clinical: nephrotic syndrome, cardiomyopathy, hepatomegaly, peripheral neurop, organ enlargement, bleeding diathesis, waxy thickening of skin. Dx w/ fat pad bx
220
treatment of amyloidosis (AA)
colchicine ( and underlying condition)
221
polycystic kidney disease present w/:
flank pain, hematuria, renal failure, HTN, large kidneys
222
MI vs PE can cause what on ekg?
MI: left BBB
PE: RBBB
223
what kinds of cancer do you see pericardial effusion?
mostly lung and lymphoma. Can cause tamponade
224
baker cyst
develop as a result of excessive fluid production by inflamed synovium, seen in RA, osteoarthritis, and cartilage tears. can be seen in popliteal bursa
225
digitalis toxicity causes what arrhythmia?
atrial tachycardia w/ AV block. Will also see inverted T waves.
226
first enzyme activated in aute pancreatitis
trypsin
227
most common cause of acute pancreatitis
alcohol and gallstones!`
228
periumbilical and flank hemorrhage?
think acute pancreatitis
229
reason for amylase to stay elevated after pancreatitis?
pancreatic pseudocyst
230
pancreatic adenocarcinoma risk factors
smoking, chronic pancreatitis. disease of the elderly.
can cause secondary diabetes if in tail/body.
also migratory thrombophlebitis
ca-19 9 is marker in blood
231
side effect of cholestyromine
cholesterol stones in GB - radiolucent
232
cholecystitis radiates where?
right scapula
233
what is porcelain gallbladder
appears on Xray as chronic cholescystitis
234
imaging of chronic pancreatitis
dystrophic calcification
| increased risk for pancreatic carcinoma
235
ascending cholangitis usually caused by?
gram negative enteric bacteria
| increased incidence w/ choledocholithiasis
236
gallbladder carcinoma
p/w cholecystitis in ELDERLY woman -- poor prognosis. They usually get cholecystitis when younger so if they're super old suspect cancer
237
extravascular hemolysis increases risk of what stones?
pigmented gallstones.
you'll see lots of urobilinogen in DARK URINE
238
dubin johnson syndrome
conjugated bilirubin builds up in cell, deficiency of bilirubin canalicular trasnport. LIVER IS VERY DARK.
rotor syndrome similar, but liver not dark
239
obstructive jaundice sxs
dark urine (bilirubinuria), pale stool, pruritis (from bile acids building up), will also see hypercholesterolemia and xanthomas, steatorrhea w/ malabsorption of fat soluble vitamins.
240
viral hepatitis
inflammation of hepatocytes, increase in both direct and indirect bilirubin. Dark urin due to conjucated bilirubinemia. Urine urobilinogen will actually be normal or decreased.
241
viral hepatitis causes
Hep, EBV, CMV
242
acute hepatitis
jaundice (mixed CB and UCB) w/ dark urine (too much CB), fever, malaise, anusea.
Elevated ALT>AST,
243
chronic hepatitis
>6 months
| inflammation involves portal tracts. not much in the lobules.
244
Hep E/A
fecal oral, both acute, not chronic.
IgM - active. HEV in pregnant woman is associated w/ fmulminant hepatitis and liver failure. HEV commonly from water/seafood undercooked.
245
HBV
only 20% go on to be chronic
HbsAG key marker of infection. First marker to rise. If present for >6 months, defines chronic. IgM against core is high during acute phase. During window face, only IgM. Then IgG picks up. IgG surface antibody - protective. Envelope antigen --> can trasmit to other peol
246
Hep C
hep c RNA is marker of infection
247
hep D
requires HBV for infection.
248
Cirrhosis caused by what process
fibrosis mediated by stellate cell secreting TGF beta. Lie beneath endothelial cells that line sinusoids.
249
portal HTN causes
ascites, congestive splenomegaly/hypersplenism (can consume red cells and platelets), portosystemic shunts (caput medusae, for example), hepatorenal syndrome
250
decreased detox in hepatitis
AMS, asterixis, coma,
gynecomastia, spider angiomata and palmar erythema due to excess esttrogen
jaundice
251
Use which to follow coagulopathy
PT shows effect of cirrhosis
252
Alcohol related liver disease
damage of hepatic parenchuyma:
1) fatty liver (reversible!)
2) alcoholic hepatitis, chemical injury to hepatocytes seen w/ binge drinking (acetaldehyde). MALLORY BODIES. damaged IF in the hepatocytes.
253
Presentation of alcoholic hep
AST>ALT. Painful hepatomegaly, mitochondria causes AST elevation.
254
NAFLD
obesity, ALT>AST. Diagnosis of exclusion to make sure alcohol not involved.
255
Hemochromatosis
excess iron deposition in organs, hemosiderosis --> damage is called hemochromatosis. Damage mediated by generation of free radicals. Primary or secondary, mutations in HFE gene, C282Y.
In secondary - transfusion
256
presentation of hemochromatosis
cirrhosis, DM, bronze skin, cardiac arrhtyhmia, gonadal dysfunction
high ferritin, low TBC, high iron, high percent saturation
biopsy: brown pigment in hepatocytes. Use prussian blue stain, turns iron blue but won't touch lipofuchsin
tx: phlebotomy
257
Wilson disease
can't put copper into ceruloplasmin. Copper builds out in hepatocytes -- leaks and goes into tissues. Presents in kids w/ cirrhosis, neurological manifestations like chorea, KF rings, tx w/ D penicillamine
258
labs of wilson disease
high urine copper
| low serum ceruloplasmin
259
PBC
autoimmune. granulomatous destruction of intrahepatic bile duct, avg age forty
mostly in women
antimitochondrial antibody
obstrctive jaundice, cirrhosis
260
PSC
inflammation and fibrosis of intranepatic and extrahepatic bile ducts
periductal fibrosis/onion skin
p-ANCA positive, associated with ulcerative colitis.
261
presentation of PSC
obsrucive jaundice
| cirrhosis, increased risk for cholangiocarcionma
262
Reye syndrome
fulminant liver failure and encephalopathy in kids w/ viral illness who take aspirin, causes mitochondrial damage of hepatocytes
hypoglycemia high liver enzymes, NV, may progress to coma/death.
HOWEVER you SHOULD give aspirin in Kawasaki's!
263
Hepatic adenoma
Benign hepatocyte, associated w/ OCP use, resolves if you stop. Risk of rupture and intraperitoneal hemmorage expecially during pregnancy
264
risk factors for HCC
chronic hep, cirrhosis, aflatoxins derived from aspergillus. induce p53 mutation.
increased risk for budd-chiari syndrome. Thrombosis of hepatic vein, leads to necrotic damage of the liver
serum tumor marker: alpha fetoprotein
265
mets to liver
colon, pancreas, lung, breast. Multiple nodules in liver, hepatomegaly w nodular free edge.
266
Pituitary adenoma
functional if produces hormones,
bitemporal hemianopsia, hypopituitarism if nonfunctional bcaus it presses on it, headache.
functional: most common is
267
prolactinoma
prolactinoma. low libido, HA, milk, inhibits GNRH so you don't get LH/FSH so you get amenorrhea in women. Bros don't get milk but they get gynecomastia.
treat w/ dopamin agonist. like bromocriptine.or surgery
268
GH adenoma
giganitism in kids, acromegaly in adults. secondary diabetes is often present . Growth of tongue and heart. can die from cardiac problems.
Dx: elevated GH and IGF-1. Oral glucose does not suppress GH release
Tx: octreotide. somatostatin analog, blocks response of AP to GHRH
269
cause of hypopituitary
apoplexy - bleeding into pituitary.
crangiopharyngioma in kids.
sheehan -
270
sheehan
pregnancy ; gland doubles and is susceptible to infarction if lose too much blood.
poor lactation and loss of pubic hair - sheehan
271
empty sella
leakage of CSF into the sella is one mechanism, causing pressure on the pituitary sitting in there and damages it.
272
Nephrotic syndrome in lymphoma?
Minimal change disease
273
Nephrotic syndrome in most malignancies?
Membranous nephropathy
Also NSAIDs SLE and hep b
274
Crescentic glomerular disease
AlKI hematuria hypertension
Associated with autoimmune disease
275
A few Causes of hypoK
Increased aldosterone activity
Beta agonists
Low blood pH
Insulin
276
pH of normal pleural fluid vs transudative vs exudative
normal: 7.6
trans: 7.4-7.55
exud: 7.3-7.45
277
signs of massive PE
JVD, hhypotension, RBBB
278
Leukocyte alkaline phosphate score
Differentiates between CML and leukemoid reaction. Will be low in CML because neutrophils are abnormal
279
Obstructive lung disease characteristics
low FEV1/FVC
if increased FEV1 after bronchodilators, it's asthma. If no change it's COPD
will also see elevated residual volume in COPD
280
Elevated in thalassemia?
HbA2
281
signs of marijuana intox
dry mouth, red eyes, increased appetite, tachy
282
signs of massive PE
JVD, hhypotension, RBBB
283
clinical features of scleroderma
fatigue, joint pain/stiffness
skin: telangiectasia, digital ulcers, raynaud
GI: dysphagia, gi bleed, dyspepsia, loss of smooth muscle to fibrosis
Pulm: Pulm fibrosis, arterial hypertension
renal crisis
thrombocytopenia
cardiac: myocarditis, pericarditis
284
Obstructive lung disease characteristics
low FEV1/FVC
| if increased FEV1 after bronchodilators, it's asthma. If no change it's COPD
285
GI probs in HIV patients
cryptosporidium, MAC (in CD4
286
signs of cocaine intox
dilated pupils, tachy, euophoria, alertness, vigilance. Cocaine w/drawal associated w/ increased appetite
287
clinical features of scleroderma
fatigue, joint pain/stiffness
skin: telangiectasia, digital ulcers, raynaud
GI: dysphagia, gi bleed, dyspepsia, loss of smooth muscle to fibrosis
Pulm: Pulm fibrosis, arterial hypertension
renal crisis
thrombocytopenia
cardiac: myocarditis, pericarditis
288
achalasia:
dysphagia and regurtitation of undigested food due to aperistalsis in the distal esophagus.
289
GI probs in HIV patients
cryptosporidium, MAC (in CD4
290
sxs of primary adrenal insufficiency
pigmented skin, low BP, hyponatremia, hyperkalemia.
hyperchloremic acidosis
- elevated ACTH stimulates melanocytes causing hyperpigmentation
291
staph aureus food poisoning?
dairy, salad, meat, eggs. N/V, diarrhea,abd pain. Due to preformed toxin so it's quick after ingestion
292
sleep disorder characterized by inability to stay awake in the evening (after like 7 pm)
advanced sleep phase disorder
293
de quervain tenosynovitis
classically affects no meothers holding their infants with the thumb outstretched, causes inflammation to APL and EPB tendons as they pass through radial styloid process
294
sxs of primary adrenal insufficiency
pigmented skin, low BP, hyponatremia, hyperkalemia.
hyperchloremic acidosis
- elevated ACTH stimulates melanocytes causing hyperpigmentation
295
four complications of acute pancreatitis
pleural effusion
ileus
ARDS
pancreatic pseudocyst/abscess
they get some relief when they lean forwards
296
formula for anion gap
sodium - bicarb - chloride
297
presbycusis
sensorineural hearing loss of old age
298
signs of tmponade
JVD, low voltage QRS, enlarged cardiac silhouette, hypotension
299
otosclerosis
chronic conducive hearing loss associated w/ bony overgrowth of the stapes
300
cause of leukemoid rxn
severe infection. Causes leuks>50K, metamyelocytes>myelocytes (more mature), no absolute basophiolia.
CML has way higher leuks, low LAP score, and more metamyelocytes than myelocytes (less mature). Also has absolute basophilia, whereas leukemoid does not.
301
signs of tmponade
JVD, low voltage QRS, enlarged cardiac silhouette, hypotension
302
LH/FSH levels in prolactinoma?
low! They get suppressed, so then you get low too.
303
cause of leukemoid rxn
severe infection. Causes leuks>50K, metamyelocytes>myelocytes (more mature), no absolute basophiolia.
CML has way higher leuks, low LAP score, and more metamyelocytes than myelocytes (less mature). Also has absolute basophilia, whereas leukemoid does not.
304
what are LATE neutrophil precursors?
bands, metamyelocytes.
Myelocytes and promyelocytes are younger/less mature.
305
cells involved in severe drug rxn?
often basophils and mast cells
306
main substrates for gluconeogenesis?
amino acids, lactate, glycerol 3-phosphate (from fat). Alanine is major gluconeogenic aa in the liver and is converted to pyruvate.
307
hemobilia
bleeding in the biliary tree, uncommon cause of GI hemorrhage. Usually after abd trauma or surgery
308
holosystolic murmur at apex w/ radiation to axilla?
mitral regurge
common clinical features include exertional dyspnea, fatigue, a fib, and heart failure signs
309
main substrates for gluconeogenesis?
amino acids, lactate, glycerol 3-phosphate (from fat). Alanine is major gluconeogenic aa in the liver and is converted to pyruvate.
310
treatment for anorexia in cancer
progesterone analogues like megestrol acetate.
311
holosystolic murmur at apex w/ radiation to axilla?
mitral regurge
common clinical features include exertional dyspnea, fatigue, a fib, and heart failure signs
312
dyspepsia?
fullness or discomfort after eating, often associated w/ nausea and sxs of GERD like heartburn. Definitive dx often requires endoscopy but should be saved for patients w/ alarm symmptoms (weigh tloss, bleeding, anemia, vomiting, early satiety). most can get tested for H pylori and given PPI
313
intermittent cramping RUQ ain
gallstones/biliary disease. dx w/ ultrasound
314
hepatic adenoma
women on long term OCP
315
hepatocellular carcinoma
systemic sxs, chronic hepatitis or cirrhosis, elevated alfa fetoprotein
316
gout crystals
negatively birefringent
common complication of myeloproliferative disorders due 2 excessive turnover or purines that result in more uric acid production
317
sxs of polycythemia vera
pruritis after hot baths, headaches, hepatoslenomegaly, can also cause gout (up to 40%).
318
pseudogout
Usually affects large joints like knee. Crystals are positively birefringent.
chondrocalcinosis and calcium pyrophosphate dihydrate deposition often 2/2 hyperPTH. Can also be caused by hemochromatosis
319
paget's disease
can cause bone probs
| elevated alk phos
320
androgen produced predominantly by the adrenal?
DHEA-S
321
serum PTH, calcium, and phosphorus in osteomalacia
low Ca, low Phos, elevated PTH
due to decreased intestinal calcium and phos absorption --> secondary hyperparathyroidism
due to low 25-OH vitamin D.
322
paget's disease
can cause
| elevated alk phos
323
triggers for bronchoconstriction in pts w/ asthma?
beta blockers and aspirin
324
pulsus paradoxus indicates?
tamponade. exaggerated decrease (>10) in arterial BP w/ inspiration
325
systolic ejection murmur that radiates to carotids, decrescendo
Aortic stenosis.
palpation of peripheral pulses reveals pulsus parvus et tardus (rises gradually and has delayed peak).
326
triggers for bronchoconstriction in pts w/ asthma?
beta blockers and aspirin
327
name three direct thrombin inhibitors
dabigatran, bivalirudin, argatroban
328
name 3 factor xa inhibitors
rivaroxaban, apixaban, fondaparinux
329
treatment for high triglycerides
niacin! side effect causes prostaglandin, flushing and itching. take aspirin like 39 mins before.
330
clinical features of bronchiectasis
cough w/ lots of sputum production, rhinosinusitis, dyspnea, hemoptysis, pleurisy, wheezing, clubbing.. Cough often response to abx. But comes back!
331
etiologies of bronchiectasis
obstruction (e.g., cancer) of airway, congenital (CF, alpha 1 antitrypsin), immunodeficiency, post infx, rheumatic (RA, sjogren), toxic
dx w/ CT, shows bronchial dilation and wall thickening. then you can analyze sputum and stuff.
332
hairy cell leukemia
Type of B lymphocyte derived chronic leukmia. Lymphocytes - on tartrate resistant acid phosphatase (TRAP) stain, have fine hairy projections. Fibrotic bone marrow.
Tx: Cladribine, toxic to bone marrow
333
non-Hodgkin's lymphoma regimen
CHOP
334
chronic lymphocytic leukemia regimen
Chlorambucil and prednisone.
335
features of narcolepsy
poor REM sleep, excessive sleepiness but they also suffer from cataplexy, sleep attacks, hallucinations, and sleep paralysis
336
Pickwickian syndrome
obesity hypoventilation syndrome
| chronically elevated PaCO2 and low PaO2
337
tinea versicolor
caused by malassezia globosa in hot/humid weather
- hypopigmentation, or hyper, or midly red.
- can have fine scale, can have pruritis. Usually on trunk.
Dx: KOH prep shows "spaghetti and meatballs"
Tx: ketoconazole, or selenium sulfide
338
Pityriasis rosea
oval, fawn colored plaques, "christmas tree patern". Herald patch followed by eruption 1-2 weeks later
339
Tinea corporis
ringworm, ring shaped lesions w/ scaly border and central clearing
340
Seborrheic dermatitis
dry scales w/ underlying erythema. Scalp, central face, presternal, etc commonly involved. No changes in pigmentation
341
Vitiligo
total depigmentation around mouth or fingertips
342
Pituitary causes of hypopituitarism
adenoma, mass, infiltration (hemochromatosis, lymphocytic hypophysitis), hemorrhage (pituitary apoplexy), infarct (sheehan)
343
signs of ACTH deficiency
secondary adrenal insufficiency: postural hypotension, tachy, fatigue, weight loss, hypoglycemia, eosinophilia
344
pts w/ gonnorrhea/chlamydia should also be tested for?
HIV, RPR, pap, hep BSAg
345
tzanck smear?
diagnose HSV on active genital lesions
346
initial tx for chronic venous disease
leg elevation, exercise, compression stockings
347
heart sound heard in most patients during acute phase of MI
s4
348
signs of neurogenic claudication
posture dependent, lumbar extension worsens pain (downhill), lumbar flexion relieves pain (bend forward), LE numbness, weakness, tingling, low back pain
349
Signs of vascular claudication
depends on exertion, relieved w/ rest, not w/ bending forwards, LE cramping/tight, no significant lower E weakness, decreased pulses, cool extremities. Dx w/ ankle brachial index
350
treatment of choice in pts w/ ventricular fibrillation and pulseless VT
early defibrillation
351
treatment of cardiac arrest w/ PEA?
first line is IV epi or vasopressin. Second line is IV lidocaine
352
when do we used synchronized cardioversion?
symptomatic or sustained monomorphic VT (unresponsive to antiarrhythmics) and hemodynamically unstable a fib w/ RVR
353
areas of chloroquine resistant P falciparum and 3 tx options
sub saharan, southeast asia.
Use atovaquone-proguanil (LFTs)
Doxy (Gi probs, sun sensitivity)
Mefloquine (PREGNANCY! USE THIS) w/ neurospych effects
354
areas w/out p falciparum
primaquine
south america, mexico, okorea
primaquine can cause hemolysis in patients with G6PD
355
organism responsible for endocarditis on prosthetic valves, IV catheters, implanted devices, drug users?
s aureus
356
organism responsible for IE 2/2 dental and resp tract biopsy?
strep viridans
357
organism responsible for endocaritis from valves, pacemakers, etc?
coag negative staph
| aka staph epidermidis
358
IE organism in IBD?
strep bovis
359
coxiella burnetii
rickettsia that cause Q fever from livestock,
360
features of post strep GN
10-20 days after strep throat or skin infx. Periorbital swelling, hematuria, oliguria. LOW C3 complement.
361
features of drug induced interstitial nephritis
Drugs like penicillins, cephalosporins, sulfonamides, rash, arthralgia.
eosinophilia, sterile pyruaia, WBC casts
362
features of IgA nephropathy
hematuria after URI, normal complement.
363
features of membranoproliferative glomerulonephritis
uncommon. causes hematuria and low complement.
364
serious complication of warfarin?
skin necrosis
sometimes associated w/ Protein C deficiency. Involves breasts, butt thighs abd
bullae and skin necrosis. GIVE VITAMIN K
365
pyoderma gangrenosum
ulcerative skin lesion, often "bite like" w/ small papule or pustule. Pain . malaise and arthralgia
366
hypernatremia tx
if volume down: normal saline until euvolemic then d5%
| if euvolemic, straight to 5% dextrose of FWB
367
kidney SE of lithium?
nephrogenic diabetes insipidus (inadquate ADH response)
368
what is a water deprivation test?
differentiates between central vs nephrogenic DI.
| don't drink, can use desmopressin to see if they respond (central) or not (nephrogeni)
369
SE of protease inhibitors (HIV) like indinavir
crystal induced nephropathy
370
SE of didanosine (HIV tx)
pancreatitis
371
abacavir SE
hypersensitivity syndrome
372
NRTI (hiv med) SE?
lactic acidosis
373
SE of NNRTI ?
stevens jonson
374
Nevirapine (hiv med) se?
liver failure
375
pericardial effusion EKG signs?
electrical alternans (varying size of QRS complex) due to heart swinging back and forth in the fluid
376
antiarrhthmic used in WPW
procainamide
377
synchronized direct current cardioversion used for what?
a fib, a flutter, stable monomorphic vtach
378
sxs of reactive arthritis
1-4 weeks after GI or GU infx with oligoarthritis, conjunctivitis, and oral lesions
379
difference between TEN and SJS?
Ten involves >30% of body surface area
380
erythema multiforme
target like lesions usually after HSV infx
381
causes of secondary hypertension
```
renal parenchymal disease
renovascular disease
primary aldo
pheo
cushing
hypothyroid
primary hyperparathyroid
coarctation of aorta
```
382
what cancer is associated w/ ectopic ACTH production
small cell lung cancer --> cushings
383
dexamethasone suppression test?
helps determine wehter elevated ACTH is pituitary or ectopic
384
primary HIV infection can resemble what?
EBC. Rash and diarrhea less common in mono and tonsillar exudates uncommon in primry HIV
385
test for hyperaldo?
(PRA/PRC) = aldo/renin activity ratio (comes from cortex)
>20:1 suggests primary hyperaldo
prompts CT of adrenals or MR of abdomen
ADRENAL VEIN SAMPLING
if no adenoma -- bilateral adrenal hyperplasia
386
adrenal cortex mnemonic
salt-sugar-sex (G-F-R)
387
management for bilateral adrenal hyperplasia
spironolactone or eplerenone
388
renovascular disease / renal artery stenosis
- fibromuscular dysplasia (young women)
- also can be 2/2 atherosclerosis
- dx: doppler of renal arteries or angiography
389
fibromuscular dysplasia
renal vascular disease, non atherosclerotic narrowing of renal arteries - in young 30 female patients.
390
drugs that cause hypertension
NSAIDs, ephedirne,
391
CXR showing widened mediastinum
aortic dissection
392
pulsus paradoxis
sign of cardiac tamponade
393
sxs of papillary muscle dysfunction?
left sided heart failure due to mitral regurge 2/2 MI
394
triggers for hyperbilirubinemia in gilbers
hemolysis, fasting, or fat free diet, physical exertion, fever, stress, fatigue
395
Crigler Najjar type one
AR, causing severe jaundice and kernicterus in infants. Liver transplant is only curative option
396
crigler najjar type two
milder version than type one, survival into adult hood w/ out kernicteris. giving PHENOBARBITAL reduces serum bili.
397
Rotor syndrome
benign, defect of hepatic storange of conjugated bili leading to plasma leakage. LFTs normal, treatment unnecessary
398
Five types of chest pain and their features: CAD, pleurisy, aortic, esophageal, chest wall
```
CAD: exertion, relieved w/ nitro
Pleuritic: pericarditis worse when flat, sharp/stabbing, worse w/ inspiration
Aortic: Sudden, tearing, back
Esoph: Nocturnal
CW: repetive activity, worse w/ movement
```
399
most common behavioral risk factor for TB?
substance abuse!
shows upper lobe cavitatry lesions
mycobacteria!
400
pneumocystis pneumonia
subacute fever, dyspnea, cough in patients CD4
401
what do HIV patients have a lower risk for?
autoimmune granulomatous diseases like sarcoid
402
hydroxychloroquine side effect
retinopathy - ophthalmologic evaluation necessary
TNF and IL1 suppressor
403
two drugs that cause ototoxicity
aminoglycosides and platinum chemo
404
features of thyroid storm
high fever, tachy, HTN, CHF, arrhythmia, delirium, goiter lid lag, tremor, NV/V, jaundice
405
treatment of thyroid storm
propanolol, PTU
| glucocorticoids to decrease T4 to T3 conversion
406
causes of thyroid storm
surgery, trauma, infx in people with unddiagnosed or inadequately treated hyperthyroid
407
clinical features of malignant hypertension
hypercarbia, sinus tachy, muscle rigidity, high CK, hyperkalemia, hyperthermia
408
features of metabolic syndrome
HTN, impaired fasting glucose, abdominal obesity, dyslipidemia - insulin resistance plays a significant role
409
6 organ systems effected by sarcoid
```
lungs
skin
eyes (uveitis)
liver
kidney
heart
- also lymph nodes
especially in young aftrican american women
```
410
cor pulmonale etiologies
COPD (most common), ILD, pulmonary vascular disease, OSH
411
cor pulmonale sxs
DOE, fatigue, exertional syncope and angina
on exam: edema, JVP w/ prominent A wave, loud S2, right sided heave, pulsatile liver from congestion, tricuspid regurg
412
Cor pulmonale EKG
RBBB, RAD, RVH, RA enlargement
413
what is cor pulmonale?
impaired function of the RV caused by pulmonary hypertension from underlying lung disease, vascular disease, or OSH.
note: r sided heart failure 2/2 left is NOT considered cor pulmonale
414
chronic liver disease associated sxs:
palmar erythema, spider angiomata, caput medusae, gynecomastia
415
what does pulmonary capillary wedge pressure estimate?
left ventricular end diastolic pressure, it's elevated in people w/ LV systolic or diastolic function. Usually these patients have pulmonary edema
416
signs of right sided heart failure:
JVP, S3, tricuspid regurge, hepatomegaly w/ pulsatile liver, LE edema or pleural effusion
echo shows signs of Right heart pressure elevation and right cath will show pulmonary systolic greater than 25
417
"hot potato voice" and uvula deviation
peritonsillar abscess, drain it! and IV abx
418
sxs of epiglottitis
dysphagia, muffled voice, but unlikely to have uvula deviation w/ unilateral lymphadenopaathy
419
sxs of hypercalcemia
fatigue, constipation, calcium kidney stone
420
pseudogout?
caused by calcium pyrophosphate dihydrate (CPPD) crystals in joint space, common for HPT w/ chronic hypercalcemia. p/w knee pain, with RHOMBOID shaped crystals
421
gout crystals?
needle shaped w/ negative birefringence
422
sxs of acute cholangitis
fever, jaundice, RUQ pain (charcot triad)
confusion and hypotension (reynolds pentad)
liver failure, AKI
423
Dx of acute cholangitis
increased alk phos, biliary dilation on US or CT, GGT, high direct bili
424
tx of acute cholangitis
supportive care, abx, biliary drainage.
425
tx for alcohol w/drawal
chlordiazepoxide
| other benzos
426
prinzmetal's angina
pain wakes you up from sleep. caused by coronary vasopspasm, typically in young females, smoking biggest risk. Tx includes CCB or nitrates like diltiazem. transient ST elevation on ECG
427
tx for thrombolysis in STEMI
percutaneous coronary intervention, if not, STREPTOKINASE
428
what is panendoscopy
esophagoscopy, bronchoscopy, laryngoscopy to detect primary HEENT tumors
429
type of cancer in neck?
often squamous cell carcinoma, associated w/ smoking and booze
430
type of metastatic breast cancer?
usually metastatic adenocarcinoma
431
sxs of SVC syndrome
dyspnea, venous congestion, head/neck/arm swelling. Usually from small cell lung cancer or non-hodgkin lymphoma.
432
Beck's triad
JVD, distant heart souds, hypotension = cardiac tamponade
433
pyoderma gangrenosum
neutrophilic ulcerative skin disease. Most have underlying systemic disorder like IBD, RA, or heme conditions like AML. Skin biopsy
Tx: systemic corticosteroids
434
Ecthyma gangrenosum
hemorrhagic pustules and nectoric ulcers. Usually from PSEUDOMONAS, in s/o neutropenia
435
Hidradenitis suppurativa
axilla, groin or scalp lesions, inflammatory nodules/abscesses w/ purulent drainage
436
sporotrichosis
fungal skin infx acquired usually from rose bushes or other plans. Small papule usually and or arm, can ulcerate and spread via lymphatics
437
immediate tx for aortic dissection
labetalol. lowers BP and heart rate to minimize stress on aortic wall
438
what is a stanford type B aortic dissection?
descending aorta only, can usually be managed w/ medical therapy alon
439
hydrlazine and nifedipine can both do what?
vasodilate
440
what is streptokinase
thrombolytic
441
disruption of tunica albuginea
penile fracture
442
how does prevalence influence PPV?
higher prevalence leads to greater PPV
lower prevalence leads to leads to higher false positive rates
443
tx for polymyalgia rheumatica
low dose prednisone
444
how do FM and polymyalgia rheumatica differ?
PR has elevated ESR, FM is not an inflammatory condition
445
FM treatment for patients who don't improve w/ exercise
duloxetine, TCAs
446
colon cancer screening in pts w/ high risk?
IBD: 8 yrs post dx, q1-2 years
FAP: age 10-12, every year
Lynch: age 20 q1-2
family hx of CRC or polyps: q3-5 yrs after age 40 or 10 yrs before earliest onset
447
foot stress fracture sxs
insidious, focal navicular pain, females w/ eating disorder/athletes
448
plantar fascitis
plantar surface of hel
449
morton neuroma
common in runners. numbness/ain between 3rd/4th toes, clicking sensation when palpating space between toes while squeezing joints
450
tarsal tunnel syndrome
compression of tibial nerve at ankle, burning/numbness/achking of distal plantar surface of toes
451
drugs commonly associated w/ SJS
sulfa, NSAIDs, anticonvulsants, allopurinol
452
impetigo
caused by staph aureus, red macules/papules w/ honey colored crust
453
what movement improves acute pericarditis pain
leaning forward
454
TB skin cutoffs
15 w/ no exposures
10 if higher risk
5 if HIV/txplant/known exposure
455
therapy for active pulmonary TB
isoniazid, rifampin, ethambultol, pyrazinamide for two months. then follow w/ I/R for another four months
456
kind of drug is pyridamole
antiplatelet
457
meds to hold in cardiac stress test
Beta blockers, CCB, nitrates, and if vasoldilator stress test hold dipyridamole and caffeine (12 hours only). Can continue ACE I, ARB, digoxin, statin, diuretic
458
antibody test for drug induced lupus?
anti-histone; except not for minocycline induced
459
antibody useful in distinguishing RA from SLE in joint symptom predominance?
anti-cyclic citrullinated ABs
460
Features of blastomycosis
```
FUNGAL
Lung: pneumo
Skin: warts/violaceous nodules/ulcers
Bone: Osteomyelitis
GU: prostatitis, epididymo orchitis
CNS: meningitis/eidural/brain abscess
```
disseminated disease can occur in pts w/ out immunosuppression
south/south central, mississippi and ohio, upper midwest, great lakes and canada
461
nocardia infection:
GPosR, , weakly acid fast. presents as subacute pneumo, mimics TB. usually immunocompromised
462
Actinomyces
GPosR, causes abscesses at head and neck w/ granular yellow pus "sulfur granules"
463
fungal infection in desert southwest and central valley of calfornia?
coccidiomycosis
464
mississippi and ohio river valley mycosis?
histoplasmosis
| usually disseminated papular crusigng skin lesions in immunocompromised
465
fungal infx from central US?
blastomycosis.
| causes well circumscribed verrucous nodules and plaques tat become microabscesses
466
diagnosis of what type of pleural effusion?
thoracocentesis to determine exudative vs transudative.
unless they have obvious heart failure then you don't
467
wat do you do if thoracocentesis is not diagnostic for a pleural effusion?
bronchoscopy but it requires sedation and is more invasive
468
sxs of digoxin toxicity
anorexia, N/V, abd pain, LIFE THREATENING ARRHYTHMIA, fatigue, confusion, weakness, color vision alterations
469
tx for systemic cellulitis
IV nafcillin. don't use penicillin G cause it's probably resistant. Cefazolin is also a tx of choice
470
what do negative birefringent (gout) crystals look like on photo?
yellow when parallel, blue when perpendicular
| needle shaped
471
neuropathic (charcot) arthropathy?
destructive arthritis in patients w/ longstanding diabetes who have peripheral neuropathy and vasculopathy. Ankle involvement more common than knee. no crystals
472
sarcoid arthritis features
usually ankles, symmetric. gradual onset, noncaseating granulomas in synovial membrane
473
when you retain bicarb what electrolyte goes down?
chloride!
474
pathognomonic finding of crohn's > UC
noncaseating granulomas
also UC always involves rectum, whereas rectum is usually spared in crohns
475
Presentation of acute limb ischemia
The 6 Ps: Pain, pallor, poikilothermia (cool extremity), paresthesia, pulselessness, and paralysis. Usually from thromboembolic occlusion 2/2 a fib
476
ankle brachial index
often used as screening tool in patients w/ suspected PAD to compare ratio of systolic pressure in ankle to that in the arm
477
four causes of hypovolemic hyponatremia
volume depleition (acute blood loss), primary adrenal insufficiency, GI losses, renal losses (ie diuretics)
478
four causes of euvolemic hyponatremia
SIADH, primary polydipsia, 2ndary adrenal insufficiency, hypothyroid
479
three causes of hypervolemic yponatremia
CHF, cirrhosis, CKD or nephrotic syndrome
480
what primarily controls ADH secretion?
plasma osmolarity, or significant hypovolemi
481
tx for stable recurrent or refractory wide complex tachycardia?
IV amiodorone or procainamide, but don't use inp atients with hypotesion or hemodynamic instability
482
when do we use unsynchroinzed cardioversion
cardiac arrest, pulseless ventricular tachycardia,
483
major side effect of heparin
autoimmune disorder, type 2 HIT- heparin induced thrombocytopenia
switch to argatroban or fondaparinux
dx: serotonin release assay
484
features of inferior MI
ST elevation in inferior leads, papillary muscle dispplacement leading to MR and pulmonary edema
leads to elevated LV end diastolic pressure or filling pressure
485
what are achalasia and pseudoachalasia
achalasia - loss of peristalsis in distal esophagus w/ lack of LES relaxation 2/2 denervation
Pseudoachalasia - narrowing of esophagus due to esophageal cancer (not denervation)
486
when do you use esophageal pH monitoring?
to confirm GERD in pts w/ GERD symptoms but who fail PPI therapy.
487
what is laparascopic myomotomy?
tx of choice for pts w/ achalasia who are at low surgical risk.
488
dubin johnson syndrome and rotor syndrome
conjugated hyperbilirubinemia w/ normal ALT/AST and alk phos
489
rotor syndrome
rare, benign hereditary condition w/ chronic conjugated hyperbili due to defect in hepatic secretion of conjugated bilirubin.. No tx needed.
490
elevated unconjugated bilirubin shows up in urine how?
urobilinogen
USUALLY no bilirubin is seen on UA, but if there is a plasma buildup of conjugated bili, it can leak into urin and cause + bilirubin assay
491
what does hemolysis do to bilirubin
elevated unconjugated with positive urobilinogen assay and negative bilirubin assay
492
tx for giardia
metronidazole
| cipro for travelers e coli
493
testing to rule out tropical sprue?
upper endoscopy w/ small bowel biopsy
494
main effects of thyrotoxicosis
T3 increases crdic activity and increses sensitivity to circulating catecholmines. by increasing expression of beta 1 drenergic receptor activity
495
treatment with KOH (lye) poisoning
will be neutraolized in stomach so only really worry about the esophagus -- do endoscopy and take serial X rays of chest to monitor for perforation.
496
leukoplakia
reactive precancerous lesion in the mouth representing squamous epithelial hyperplasia. white granular patch or placque over buccal mucosa. doesn't scrape
497
aphthous stomatitis
canker sores
498
best non medication treatment for HTN
weight loss. 5-20 systolic drops per 10kg loss
499
tx for suspected variceal hemorrhage
volume
IV octreotide
Abx
if continued bleeding-->urgent endoscopic therapy including baloon tamponade (temporary), TIPs or shunt surgery
500
octreotide
somatostatin analogue that inhibits the release of vasodilator hormones, leading to indirectly to splanchnic vasoconstriction and decreased portal flow
can be used in immediate tx of esoph variceal bleed
501
cystinuria
impaired amino acid transport of basic amino acids, leads to cystein stones and positive cyanide nitroprusside test
502
hexagon urinary stones
cysteine
503
urinary cyanide nitroprusside test
cystetine stones
504
acute tx of a fib in pts w/ WPW
hemodynamically unstble: cardioversion
| stable: procainamide
505
adenosine does what?
AV nod blocking.
506
indication for lidocaine in arrhythmi?
ventricular arrythmias
507
hyperaldo screening test
PAC/PRA ratio (aldo over renin activity). Over twenty suggests primary hyperaldo. Then try w/ drenal suppression testing. Tehn adrenal imagine w/ CT If no mass, then adrenal vein sampling. Surgery for adenoma, medical therapy for hyperplasia
508
lambert eaton syndrome
progressively worsening proximal muscle weakness, fatigue, ptosis, autonomic dysfunction. associated w/ lung cancer
509
dx pheo?
plasma free metanephrines
510
pericardial knock
sound heard in mid diastole associated w/ constrictive pericarditis
511
calcifications on pericardium
constrictive pericarditis
512
sxs of constrictive pericarditis
R heart failure, progressive edema, ascites, JVD, pericardial knock (middiastolic) and pericardial calcifications on CXR
513
melanosis coli
dark discoloration of the colon w/ lymph patches shining through, characteristic of factitious diarrhea 2/2 lax abuse
514
signs of worsening liver failure
worsening PT/INR and bilirubin, encephlopathy INR single most important prognostic indicator
515
medical tx for hypertrophic cardiomyopathy
beta blockers, CCB like diltiazem is good second line
DONT GIVE nitrates cause they decrease preload which excerbates the problem
516
pulsus paradoxus
NORMALLY systemic arterial pressure falls
517
left circumflex artery ECG leads
V4-V6
518
dual antiplatelet therapy
DAPT - aspirin plu P2Y12 receptor blocker (ex: clopidogrel, ticagrelor, prasugrel)
519
PPE-5 inhibitors
contraindicated in patients on nitrates for risk of hypotension. Ex: milrinone
520
pneumaturia
air in the urine, cna happen 2/2 colovesical fistula
521
malignant otitis externa
severe infx in elderly dibeteics mostly 2/2 pseudomonas. Ear pain/drainage, granulation tissue, can lead to osteomyelitis of skull and CN damage. tx cipro
522
rhizopus infection
in poorly controlled diaabetics, begin in paranasal sinuses and extend to orbit and brain
523
cyclosporine side effects
```
nephrotoxicity is most serious. rarely HUS
Hypertension (renal vasoconstriction) tx w/ CCB
Neurotox
Glucose intolerance
Infxn
Malignncy (squamous cel carcinoma)
Gingivial hypertrophy
GI manifestations
```
524
what SE does cyclosporine have that tacro doesnt?
hirsuitism and gu hyperlasia
has higher incidence of neurotix and diarrhea
525
MOA of azathioprine
purine analog, inhibits purine synth
SE: diarrhea, leukopeni, heypatotox
526
MOA of cyclosporine and tacro
calcineurin inhibitors
527
Major toxicity of azothioprine
dose related diarrhea, leukopenia, hepatotox
528
major side effect of mycophenolate
Marrow suppression
| prevents purine synthesis
529
rhizopus causes what infx
mucormycosis - requires debridement and IV amphotericin
530
best tx for duodenal ulcers
abx and PPIs (omeprazole, pantoprazole).
DUs are worse on empty stomach and get better with eating, this is oppositive of gastric
531
when do you do selective vagotomy
when hpylori and ppi treatment don't work for gastric ulcers
532
in aftermath of MI what have ACE I's been shown to do?
limit ventricular remodeling.
533
isosorbide dinitrate
long acting nitrate to help with angiinal pain
534
strep mutans
viridans group strep, usually highly susceptible to penicillin, can be treated w/ IV Pen G or ceftriaxone.
535
infective endocarditis tx
four weeks of iv antibiotics
536
how does demclocycline work?
decreases renal responsiveness to ADH at the collecting tubule.
537
allergic rhinitis
type I HSR, eosinophils
associated w/ asthma and eczema
NASAL POLYPS seen in repeated rhinitis. If you see kids w/ nasal polyps test them for CF
538
nasal polyps in adults
think of Aspirin intolerant asthma
539
nasopharyngeal carcinoma
epithelial, associated w/ EBV
african children and chinese adults most comon
enlarged cervical LN
bx shows pleomorphic keratin positive epithelial cells in BG of lymphos
540
croup caused by?
parainfluenza, barking cough
541
laryngeal papilloma
benign papillary tumor of vocal cord, HPV 6 and 11, single in adults and multiple in kids
p/w hoarseness
542
laryngeal carcinoma
squamous cell, alcohol and tobacco
| p/w hoarse, cough and stridor
543
lobar and bronchopnenumonia
usually bacteria
| lobar: strep pneumo and klebsiella pneumo
544
interstitial pneumonia aka atypical
```
usually viral, mild sxs
- mycoplasma pneumo - can cause AIHA (IgM), no gram
- chlamydia
RSV,
CMV - post txplant
```
545
klebsiella pneumo
usually in elderly in nursing homes, alcoholics, diabetics. thick mucoid capsules in gelatinous sputum (currant jelly) often w/ abscess
546
lung stem cell
type II pneumocyte
547
causes of broncho pneumonia
```
s. aureus (abscess and empyema)
h flu (COPD)
pseudomonas (esp CF pts)
moraxella (COPD or CAP)
legionella - water source, silver stain intracellular organism
```
548
coxiella pneumo
Q fever (high fever) atypical pneumo in famrers and vets from spores, heat resistant spore, no rash
549
aspiration pneumo
alcoholics, comatose, usually anaerobes from oropharynx
bacterioides, fusobacterium, peptococsu
usually RLL and abscess
550
ghon complex
calcified subpleural nodules from primary TB
551
TB high yield spread
meninges - base of brain
Cervical LN -
Kidney - sterile pyruia
Lumbar vertebrae - pott disease
552
FVC
ie how much you would blow out candles on a birthday cake
553
airway obstruction
low FVC, lower FEV1, low ratio, increased TLC (air traping)
554
Chronic bronchitis
productive cough for at least 3 months over a minimum of two years. TONS of mucus. Smoking related.
cyanosis, increased PaCO2 and decreased PaO2
increased risk of cor pulmonale
555
Reid index
how much of the lung bronchi are mucinous vs epithelium. is high >50% in chronic bronchitis
556
emphysema
destruction of alveolar air sacs a loss of elastic recoil leading to air trapping
caused by imbalance of proteases and antiproteases (alpha 1 antitrypsin)
centriacinar (smokers, upper lobes) vs panacinar (A1AT deficiency, lower lobes)
two causes: 1) smokers
2) alpha 1 antitrypsin deficiency PAS+ globules in liver
557
clinical features of emphysema
dyspnea w/ minimal sputum. pursed lips "Pink puffer" to create backpressure and keep airway open. Barrel chest
FRC is increased because you lose elastic recoil of lung and chest wall pulls out
558
asthma pathogenesis
TH2 cells secrete IL4, IL5, IL10. IgE class switch from Ig4, Il-5 brings in eos. IL 10 induces TH2 activity.
IgE mediated activation of mast cells-->histamine.
charcot-leyden crystals!
559
Aspirin intolerant asthma
bronchospasm from aspirin! also get nasal polyps
560
Bronchiectasis
permanent dilation of bronchioles 2/2:
CF,
tumor,
necrotizing infx,
kartagener syndrome (cilia dyenin arm - situs inversus),
allergic bronchopulmonary aspergillosis --> seen in asthmatics and patients w/ CF
loss of airway tone --> air trapping
(ex: breathing through a straw versus out of a tube the size of your face)
561
kartagener syndrome
dynein problems leading to situs inversus and cilia probs
562
restrictive lung disease
problem with FILLING the lung
decreased total lung capacity
decreased FVC, decreased FEV 1
FEV/FVC is increased >80%
563
types of restrictive lung disease
```
usually interstitial
idiopathic pulmonary fibrosis
pneumoconioses
sarcoidoses
hypersensitivity pneumonitis
```
564
types of obstructive lung disease
problem EMPTYING the lung
| emphysema, asthma, chronic bornchitis, bronchiectasis
565
idiopathic pulmonary fibrosis
thick fibrosed interstitium, cyclical lung injury. 2/2 TGF beta from injured pneumocytes
must first exclude drug causes 2/2 drugs like bleomycin and amiodarone
566
IPF
fibrosis on lung CT, subpleural initially,
| tx lung translant
567
pneumoconioses
```
lung interstitial fibrosis 2/2 occupational exposure small particles , macrophage mediated
coal workers
silicosis
berylliosis
asbestosis
```
568
Caplan syndrome
black lung plus rheumatoid arthritis
569
anthrocosis
buildup of coal within the macrophages
570
silica in macrophages causes
SILCOSIS! impairs formation of phagolysosome
| only one that increases your risk of TB
571
beryilliosis
noncaseating granulomas in the lung, hilar ln, and systemic organs. Looks just like sarcoidosis. If they work at NASA or something
572
asbestosis
asbestos bodies long rod shaped particles, beading of iron. these peope much more likely to get lung cancer than mesothelioma but know bout them
573
sarcoidosis
noncaseating in multiple organs, classically in African american females
epithelioid histiocytes
*asteroid body looks like a little fluffy cloud.
leads to restricive lung disease
also involves uvea, skin, salivary/lacrimal glands (mimicrs sjogren)
elevated serum ACE, hypercalcemia (because granulomas can activate vitamin D),
574
hyersensitivity pneumonitis
granulomatous rxn in lung, often associated w/ birds
| eosinophils
575
BMPR2 inactivating mutation
familial pulmonary hypertension
576
causes of secondary pulmonary TN
hypoxemia, recurrent pulmonary embolism
577
ARDS
damage to alveolar capilary interface, protein rich fluid then leaks into and forms a hyaline membrane. Thickened diffusion barrier --> hypoxemia/cyanosis. Lung collapsing!
DIC, infection, shock, trauma.
ACTIVATING OF NEUTROPHILS type one and two pneumocytes damage
tx: address underlying cause, ventilation w/ PEEP
578
midwest coin lesion?
histoplasma vs cancer
579
bronchial hamartoma
lung tissue and cartilage, calcified on imagine - benign
580
non small cell tx
```
doesn't respond well to chemo, surgical resection is better
- adenocarcinoma
squamous cell carcinoma
large cell carcinoma
carcinoid tumor
```
581
small cell carcinoma
poorly differentiated, male smokers, SIADH, eaton lambert, , ACTH
582
squamous cell carcinoma lung
associated with PTHrP
583
lung adenocarcinoma
most common in non smokers and in female smokers. peripheral location in lung
584
large cell carcinoma
smoking, central or peripheral, poor porgnosis
585
bronchioloalveolar carcinoma
columnar cells, preexisting small airways, arises from clara scells, peripheral.. looks like pneumonia consolidation on imaging, excellent prognosis
586
carcinoid tumor fo lung
well differentiated neuroendocrine tumor. chromogranin positive, neuroendocrine. low grade malignancy. POLYP LIKE MASS IN BRONCHUS.
can rarely cause carcinoid syndrome
587
carcinoid syndrome
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usually from intestine can be from lung
588
most common sources of metastasis to lungs
breast and colon. more common than primary
589
lung likes to mets to what weird site?
adrenals
590
4 local complications of lung cancer
- pleural involvement -adeno
- SVC syndrome
- recurrent laryngeal or phrenic nerve compression
- pancoast tumor - horners
591
tension pneumothorax
air can go in but not out -put in chest tube
592
mesothelioma
presents w/ recurren pleural effusions, dyspnea, chest pain, tumor encases the lung
593
stable angina
reversible chest pain, only on exertion or w/ emotional distress (not at rest). represents reversible injury to myocytes >70 % stenosis
594
ekg changes in stable (and unstable) angina?
ST depression
| relieved by rest or nitroglycerin
595
unstable angina
chest pain that occurs at risk, incomplete occlusion of coronary artery. due to atherosclerotic rupture then thrombosis.
596
tx for prinzmetal angina
CCB or nitroglycerin
EKG shows ST elevation
597
MI
necrosis of cardiac myocytes, complete occlusion of coronary artery, can happen from vasculitis, vasosasm, clots, emboli
598
LAD coronary artery
most common involved in MI
599
troponin timing
rises 2-4 hours, peaks at 24, back to normal by 7-10 days
600
CK-MB timing
rises 4-6 hours after, peaks at 24, returns to normal by 72 hours
useful because we know if it's a second infarction
601
tx for MI
asa/heparin
O2
nitrates - dilate veins, decrease preload
beta blocker - arrhytmia is feared comlication
ACE I - decrease afterload, prevent increase in blood volume
602
2 post-MI complications
re perfusion of heart after MI can cause contraction band necrosis, contraction when you're putting Ca back
Reerfusion injury - oxygen caused free radicals and caused increase of troponins
603
papillary muscle fed by which artery?
right coronoary
appens day four to day seven if it ruptures
604
rupture of ventricular free wall 2/2 MI leads to:
cardiac tamponade
605
rupture of interventricular septum 2/2 MI leads to
shunt
606
rupture of papillary muscle leads to
mitral insufficiency
607
Dressler syndrome
inflammation in pericardium can lead to exposure of pericardium to the blood/immune system (was a previously protected antigen) leading to immune reaction to your own pericardium - pericarditis months after MI
608
Roth spots
retinal hemorrhages, ocular spots found on IE
609
gold standard dx for IE
transesophageal echo
610
second most common valve in IE
aortic in ppl w/ bicuspid aorta and stenosis
611
which valve more involved in ppl w/ IV drug use in IE
tricuspid regurge
612
pulsus parvus and tardus
delayed, slow pulses 2/2 aortic stenosis
613
exam findings of severe AS
pulsus parvus and tardus
mid to late peaking systolic murmur
soft S2
614
mid to late diastolic murmur at cardiac apex w/ opening snap
mitral stenosis
615
loud first heart sound heard in what valve prob?
mitral stenosis
616
antibiotic for human bites?
amoxicillin-clavulanate (gram +)
617
clindamycin coverage
gram positives and anaerobes. tx lung abscess, female genital tract
618
Cipro coverage
bad against anaerobes
619
tx for legionnaire disease
erythromycin
| also CAP
620
ascending aortic aneurysm associated with what heart sound
aortic regurgitation (diastolic murmur)
621
interstitial cystitis
painful bladder syndrome, , p/w increased frequency, urgency, bladder pain w/ filling, relief w/ voiding, dyspareunia
tx: none really, amitryptiline, behavior modification
622
stress incontinence
involuntary leakage of urine w/ exertion, sneezing, etc
623
SE of loop diuretics?
low K and low Mg
624
tx of lyme for those who can't take doxy
amoxicillin ie pregnant/lactating
| w/ neuro involvement that's when you use cef
625
Anterior MI vessel and leads
LAD, some or all of V1-V6
626
Inferior MI vessel and leads
RCA or LCX, II, III, VF
627
Posterior MI vessels and leads
LCX or RCA
Elevation in leads I and aVL (LCX)
Depressions in leads I and avL (RCA)
628
RCA occlusion leads
depression in I and VL
629
LCX posterior leads
ST elevation in leads I and aVL
630
right ventricle MI
1/2 of inferior MI
| RCA --> ST elevation in V4 to V6R
631
Mobitz II AV block
second degree 2:1 , two p waves for every QRS. can be seen in RCA infarct which supplies the AV node
632
EKG of acute pericarditis
PR depression and diffuse ST segment elevation
633
which artery usually p/w sudden cardiac death?
left main coronary artery
634
negative redicive value varies with what?
pretest probability of a disease
635
features of systemic sclerosis
skin findings of scleroderma, thickening of hands and feet that spreads, fenal involvement/edema, raynaud, serious GERD.
ANA will be present, anti-topoisomerase-1
636
antibodies associated w/ PBC?
antimitochondrial
637
antibodies associated w/ wegeners polyangiitis?
ani-neutrophil cytoplasmic antibodies
638
what is systemic sclerosis?
scleroderma w/ widespread organ involvement. Gerd, R heart failure, HTN2/2 kidnesy.
ana and anti-topoisomerase I abs
639
what should b offered to patients with molluscum (poxvirus)?
HIV testing.
640
cause of kaposi sarcoma?
coinfection w/ HIV and HHV8
641
painless genital ulcer w/ lymphadenopathy
syphilis
| dark field microscopy
642
renal cell carcinoma sxs
flank pain, hematuria, palpable abdominal renal mass, scrotal varicoceles (left)
643
paraneoplastic symptoms associated w/ RCC
anemia or erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia
644
amikacin
treats pyelo, aminoglycoside that can cause acute renal failure, used against mutli drug resistant bugs
645
what do you see in the urine of people with AIN?
eosinophils and WBC casts
646
HIV esophagigtis that's SUPER painful swallowing
viral esophagitis w/ CMV or HSV
HSV: circular vesicular lesions in esohagus
CMV: large linear distal ulcers distally
647
cryoglobulinemia features
hep C, low serum complement
| palpable purpura, arthralgia, membranoproliferative GN
648
polyarteritis nodosa
necrotizing vasculitis in small and medium vessles likely 2/2 deposition of circulating antigen/antibody immune comlexes in blood vessel walls, associated w hep B
649
what leukemia associated w/ tartrate resistant acid phosphatase TRAP)
hairy cell leukemia
650
angiodysplasia
cause of painless GI bleed; associated w/ advanced renal disease, vW disease, and aortic stenosis
651
warm agglutinin AIHA etiologies
CLL, viral infx (HIV), autoimmune conditions (SLE), and drugs (penicillin). Usually have normocytic anemia, jaundice, , splenomegaly.
test w/ Coombs, showing usually IgG bound to surface of RBC
652
tx for warm agglutinin
high dose prednisone
653
cold agglutinin AIHA
cold temperatures! ischemia and peripheral gangrene, direct coombs positive with IGM or anti C3, levido reticularis, gets better w/ warming. etiology is infx (like mycoplasma and EBV) and lymphoproliferative dz
654
hidradenitis suppurativa
acne inversa, chronic inflamm occlusion of skin follicles in the areas of the axilla, inguinal, genital perianla, perineum o rhair bearing skin. prurulent and gross, drainage.
655
furunculosis
abscess of hair follicle, usually 2/2 s aureus. not chronic
656
tx for pseudogout
intra-articular glucocorticoids, nsaids, colchicine.
associated w/ calcified cartilage on imagine.
657
features of reactive arthritis
oligoarthritis, nongonoccocal urethritis, and conjunctivitis. Usaully follows acute GU or GI infx (yersinia, salmonella, chlmaymdia)
658
neuroleptic malignant syndrome
usually haloperidol. sdiaphoresis, leevated CK, musle tone, AMS. tx with dantrolene (muscle relaxant) followed by bromocrptine and amantadine
659
pellagra
niacin deficiency, p/w photosensitive dermatitis, red tongue, diarrhea, vomiting, neuro sxs
660
acanthosis in older people
think GI malignancy
661
nocardia on pathology
partially acid fast, gram positive, filamentous branching rods
662
nocardiosis
affects immunocompromised hosts, can be confused w/ TB. sysxtemif findings weight loss, fever, night sweats, nodules, brain
663
tx for nocardia
trimethoprim sulfamethooxazole. + carbapenems when brain is involved
664
TB on pathology
rods, doesn't gram stain, acid fast
665
tx for actinomyces (filamentous gram positive bacteria)
penicillin G.
666
succinylcholine contraindicated for use when?
hyperkalemia or patients w/ high risk for it, like crush or burn injuries (risk of rhabdo), guillain barre
667
drug prevention of kidney stones
thiazide diuretics helps w/ calcium probs), potassium citrate/ bicarb salt (urine alkalinization) and allopurinol (for hyperuricosuria related stones)
668
common methotrexate adverse effect?
macrocytic anemia
can also develop pancytopenia. do peripheral blood counts for these pts every three months.
nausea, stomatitis, rash, hepato, ILD, alopecia, fever are other SE
it interferes w/ folate metab
669
SE of hydroxychloroquine
med for RA. GI distress, visual probs, and hemolysis in those with G6PD
670
cirrhosis sxs related to hyperestrinism
```
spider angiomata
gynecomastia
loss of pubic hair
testicular atrophy
palmar erythema
```
671
cirrhosis sxs related to portal htn
varices, splenomegaly, ascites, caput medusa, hemorrhoids
672
initial tx of toxic adenoma
beta blocker and thionamide, the second decreases thyroid hormone secretion.
673
untreated thyroid adenoma causes what?
bone loss and osteoporsosis
| also tachyarrhythmias
674
which has a greater risk of malignancy, hot or cold thyroid nodules?
cold
675
aortic dissection on chest radiograph
mediastinal widening
676
type A aortic dissection
involving ascending, can rapidly progress to cardiac tamponade and cardiogenic shock
dx: TEE
677
when is pericardiocentesis indicated
patients w/ pericardial effusion and tamponade w/ hemodyamic instability or cardiogenic schocke
678
leprosy
chronic granulomatous disease,
peripheral nerves and skin
acid fast mycobacterium leprae
679
pathology on diabetic nephropathy
increased EC matrix, BM thickening, mesangial expansion, fibrosis
680
four common drugs w/ photosensitivy rxn
tetracyclines (doxy)
antipscyhotics (chlorpromazin)
diuretics (furosemide, HCTZ)
amiodarone, promethazine
681
diphenhydramine
antihistamine w/ anticholinergic properties (benadryl).
682
anticholinergic effects
```
dry mouth "dry as a bone"
blurry vision "blind as a bat"
Hyperthermia "hot as a hare"
Urinary retension "full as a flask)
decreased bowel sounds
```
683
salicylate intox
tinnitus, N/V, fever, acid base abnormalities (met acid resp alk combo)
684
serotonin syndrome
overdose of MAOIS mixed w/ other drugs like SSRI
- autonomic hyperactivity (tachy, hyperthermia, bowel sonds, HTN), AMS, dilated pupils, neuromuscular findings like clonus
685
theophylline tox
seizures, hyperthermia, cardiac tachy ypotension
686
physostigmine
cholinesterase inhibitor
687
clinical features of cholesterol crystal embolism
livedo reticularis, bluee toes, acute or subacute kidney injury, CNS (stroke/amarusosi), eye involvement, GI (intestinal ischemia, pancreatitis)
risks includ erecent cardiac cath and hyperpcholesterolemia
688
lab findings of cholesteral crystal embolism
creatinine, eosinophilia, low complement, eosinopihliuria
689
urinalysis in contrast induced kidney injury
muddy brown granular and epithelial casts. usually resolves in 3-5 days
690
hyperoxaluria RF
ppl w/ crohns or small intestine disorder leading to fat malabs
691
clinical signs of multiple myeloma
hypercalcemia, normocytic anemia, renal insufficiency, protein ga >4.
692
rouleaux formation (stacking of RBCs) indicates:
elevated serum protein
693
urins osmolality in polydipsia?
low
694
two causes of euvolemic hyponatremia
SIADH, polydipsia
695
three causes of hypervolemic hyponatremia
CHF, hepatic failure, nephrotic syndrome
696
diagnostic criteria for SIADH
```
serum osms S osms
UNa >20
absence of hypovolemia
normal renal/adrenal and thyroid fnx
absence of other causes of hyponatremia
```
697
Tx for MALT lymphoma
omeprazole, clarithromycin, amoxicillin
| if ieradicating h pylori fails to regress the lymphoma, then chemo like CHOP can be involved
698
CHOP?
cyclophosamide, adriamycin, vincristine, prednisone
699
nonseminomatous germ cell tumor secretion
AFP and HCG
700
choriocarcinoma secretes
beta-HCG, usually in s/o molar pregnancy
701
black liver on pathology, elevated direct bilirubin
Dubin Johnson
benign condition
confirm w/ coproporphyrin levels
702
sxs of CO poisoning
bright cherry lips
elevated carboxyhemoglobin
headache, Nausea, dyspnea, malaise, AMS, dizzy, coma
703
aspirin exacerbated respiratory disease (AERD0
associated w/ nasal polyps, asthma, chronic rhionosinustis, and bronchospasm after NSAID use
704
when do you give vaccines for splenectomy person
either fourteen days before or after surgery
705
TIPS procedure
treatmet for those w/ cirrhosis who have failed thoracentesis, salt restricted diet and diuretics; this if for patients who have hepatic hydrothorax, transudative pleural effusions.
706
sxs of primary biliary cholangitis (PBC)
signs of cholestasis! itching, fatigue, elevated alk phos, hyperlipidemia. Often associated w/ autoimmune diseases like hypothyroidism.
Test: Anti-mitochondrial antibody titers
707
autoimmune hepatitis associated with
ANA and anti-smooth. fluctuating hepatocellular injury
| give stoeroids
708
sxs of hereditary spherocytosis
increased MCV, hemolytic anemia, coombs negative, jaundice, splenomegaly, pigment gallstones
many pts require splenectomy
709
tx for torsades de points
iv mag for conscious/stable
| immediate defibb for pts who are stable
710
use of adenosine?
paroxysmal SVT
711
sxs of toxic megacolon
AMS, peritonitis, electrolyte abnormalities, fever, abd distension, leukocytosis
712
sxs of ureteral stones
can't sit still, writhing, referred pain to lower abdomen
713
follicular carcinoma thyroid
invades tumor capsule and blood vessels, has early hematological spread to lung, brain bone
LN involvement rare
714
which kind of thyroid cancer secretes calcitonin
medullary thyroid cancer
715
whare are hurthle cells?
seen in both follicular and papillary cancers (thyroid)
716
most common thyroid malignancy
papillary thyroid cancer, slow spread to regional LN. large cells w/ ground glass cytoplasm ad pale nuclei
no capsule
717
signs of alcoholic dilated cardiomyopathy
heart failure w/ elevated LFT, high platelets, macrocytosis
718
most common cause of death in acromegaly
CHF
| - also stroke is increased,
719
charcot joint associated conditions
B12 deficiency, DM, peripheral nerve damage, spine cord injury, tabes dorasalis, syringlmyelia
720
what is a charcot joint
neurogenic arthropathy 2/2 underlyin condtion : deformed, loss of neurlolgic input, mild pain, degenerative joint disease. Patients unknowingly traumatize their joint as they lose sensation
tx underlying condition, B12, DM, syphilis.
721
lab findings in hemophilia A/B
prolonged PTT
| normal platelets, bleding time, prothrombin time
722
`post influenza bacteria to cause pneumonia
usually staph aureus
723
tx for klebsiella pneumonia
aminoglycosides (gentamicin, tobramycin, amikacin) and cephalosporins
theyre resistant to ampicillin, has a beta lactamase
724
pneumocystis jiroveci
pneumo in HIV patients
725
lung abscess cause in patients who aspirate/poor dentition?
anaerobes
726
valgus stress test
for MCL injury
727
Varus stress test
for LCL injury
728
apley test
meniscal tear
729
boerhaave syndrome
transmural esophageal tear, caused by forceful retching. esophageal air/fluid leakage into nearby area like pleura
cxr can show pleural effusion, widened mediastinum
dx w/ gastrografin
pleural effusion shows high amylase exudate
730
pneumonoconioses
occupational lung diseases 2/2 inhalation of things like asbestosis and silicosis.
731
trypanosoma cruzi
chagas, south america
| megacolon, megaesophagus, cardiac disease / systolic and diastolic heart failure
732
mutation associated w/ polycythemia vera
JAK2 V617F
EPO is low
733
chronic myeloid leukemia fusion protein?
BRC-ABL
734
tx for mild persistent asthma
albuterol and inhaled corticosteroids
735
tx for moderate persistent asthma
albuterol, inhaled corticosteroids, LAA
736
cause of bleeding in ppl w/ kidney disease
uremic coagulopathy causes platelets that don't really work.
737
tx for uremic coagulopathy
DDAVP, cryo
738
polymyositis
proximal weakness, raynaud's, interstitial lung disease
739
causes of high protein ascites
CHF, constrictive pericarditis, carcinomatosis of peritoneum, TB, budd chiari, fungal
740
causes of low protein ascites
cirrhosis, nephrotic syndrome
741
serum to ascites albumin gradient
≥1.1 = portal htn 2/2 cardiac ascites, cirrhosis, budd chiari syndrome
742
cause of anemia in alcoholics
folate deficiency
743
hepatolenticular degeneration
aka wilson's disease
"lenticular = basal ganglia"
low ceruloplasmin w/ increased urinary copper
744
two copper chelators
penicillamine and trientine
| also take oral zinc because it prevents copper abs
745
hemochromatosis
high iron, liver disease, hyperpigmentation, DM (bronze diabetes) impotence, arthropathy, cardiac enlargement
746
AST:ALT > 2:1
alcoholic hepatitis
747
meralgia paresthetica
lateral femoral cutaneous nerve compression, causes paresthesias in lateral thigh
748
osteonecrosis type of pain?
worse w/ activity but remains w/ rest and night pain, decreased ROM
usually have some disorder that disrupts microciruclation
749
vW disease causes which clotting numbers to be abnormal?
increased bleeding time and PTT
| normal PT
750
most common cause of acute epiditymitis (non STD)
e coli
also pseudomonas
in young people it's usually chlamydia/gonnorrhea
751
mitral stenosis can increase risk for
a fib 2/2 L atrial dilattion
752
feared side effect of propylthiouruacil (used in graves)
agranulocytosis, immune destruction of granulocytes.
stop once they get feversore throat, measure WBC. unless it's more than 1500
especially tx for pseudomonas
753
indications for urgent dialysis
AEIOU:
Acidosis
Electrolte (symptomatic hyperK)
Ingestion (methanol, ethylene glycol, ASA, lithium, valproate carbamedzpime)
Overload
Uremia (symptomatic, pericarditis, encephalopathy, bleeding)
754
hydatin cyst
in liver, 2/2 echinococcus granulosus. Get it from dogs tapeworm. Usually unilocular, can occur in any organ. smaller daughter cysts may be present.
eggshell calcification of the cyst
755
signs of av block
aka wenckebach
| prolonged QRS, prolonged PR. can be intermittent and cause syncope
756
Mobitz type I (2nd degree heart block)
AV node, prolonged PR leads to noncunductive P wave "group beating"
narrow QRS, exercise improves, vagal maneuvers worsen
low risk of complete heart block
757
Mobitz type II (2nd degree heart bock)
blocked in bundle of His (below AV), PR intervals consistent w/ intermittent nonconducted P waves
narrow or wide, exercise worsens, vagal improves, indication for pacemaker
758
first degree heart block
delayed transmission so long PR but no dropped beats
759
third degree heart block
complete failure of impulse conduction. p waves entirely disconnected from qrs
760
Behcet disease
young adults, recurrent painful oral aphthous ulcers, genital ulcers, eye lesions (uveitis), skin lesions (erythema nodosum), thrombosis
biopsy shows nonspecific high risk of vasculities. vasculitis of different sized vessels
761
pathergy
exaggerated ulcerating skin response following minor injuries, seen in Behcet disease
762
oral estrogen does what to thyroid
decreased clearance of thyroid binding globulin, leading to elevated TBG and need for more thyroid hormone
763
tx of pulmonary htn
loop diuretics and ACE I, often w/ beta blockers and sometimes aldo antagonists
764
when to leukoreduce blood
chronically transfused
CMV negative
potential transplant recips
previous febrile nonhemolytic transfusion rxn
765
febrile nonhemolytic transfusion rxn timeline
1-6 hours; small amounts of plasma/leukocyte debris that let out cytokines that can caause fevers/chills/malaise but no hemolysis
766
what to do when transfusing patients w/ IgA deficiency?
wash RBC to get rid of as much plasma as possible - we worry about antibodies to IgA
767
indications for washing RBC before transfusion
IgA deficiency, complement dependent autoimune hemolytic anemi
768
when to irradiate RBC before transfusion
BMT recips
acquired or congenital cellular immunodeficiency
blood commponents donated by first or second degree relatives
769
what do you give to prevent severe hypocalcemia following blood transfusion
calcium gluconate infusion
770
pleural fluid w/ low glucose
empyema and complicated pleural effusion
| they will need ddrainage and antibiotics
771
in what kind of arrhythmias can you use lidocaine
ventricular
772
tx for a fib with RVR
beta blockers or calcium channel blockers
cardioversion if HD unstable
773
crypt abscesses in the colon
UC
774
intestinal villous atrophy
celiac disease
775
hepatorenal syndrome
decreased GFR in absence of shock, proteinuria, or other clear cause of renal dysfunction, failure to resond to 1.5 NS bolus.
2/2 renal vasoconstriction in resonse to decreased total renal blood flow and vasodilatory substances
776
type one and two hepatorenal syndrome
1. rapidly progressive, die in 10 weeks w/out tx
| 2. progresses more slowly, avg survival of 306 months
777
Tx of as cites fluid
1. Na and h2o restriction
2. Spirinolactone
3. Furosemide
4 tap that
778
Organophosphate poisoning
Remove clothing
Give atropine
NOT physostigmine, which would make it worse (ach Esterase inhibitor)
