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Medicine stuff 3 Flashcards

1
Q

Malignant hypertension is sever hypertension asscoiated with what findings?

A

retinal hemorrahges, exudates and/or papilledema

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2
Q

Worst polyps to find on colonscopy?

A

Large (>1 cm), adenomatous, villous, sessile (nonpedunculated)

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3
Q

Alcoholic with macrocytic anemia - likely to be B12 or folate defic?

A

Folate

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4
Q

What does pharm stress test do to heart vessels (difference between obstructed and non-obstructed)?

A

Big increase in flow through non obstructed and v small increases in obstructed

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5
Q

Spider angiomas in cirrhosis are caused by excess estrogen - which other cirrhosis sx is also caused by excess estrogen?

A

Palmar erythema

also decreased body hair, smalltesticles and gynecomastia but those are obvious

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6
Q

ROULEAUX stacking of RBCs on smear, with hypercalcmia, normocytic anemia, protein gap of >4, and renal insuff - THINK?

A

multiple myeloma

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7
Q

Incidence vs prevalence?

A 
Incidence = new cases in set time
Prevalence = incidence x time
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8
Q

A-fib with hx of Wolf Parkinson White - tx?

A

Cardioversion or antiarryhtmics (procainamide)

NOT AV nodal blocks like B-blockers, vera/dilt, digoxin or adenosine

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9
Q

Lidocaine for what arrythmias?

A

ventricular

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10
Q

ADPKD - presenting as HTN and bilateral flank masses - most likely complication?

A

Interncranial bleed due to berry aneurysm

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11
Q

Asymptomatic rise in alk phos in elderly pt - most likely cause?

A

Paget dz of bone

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12
Q

Bruising in old people is due to senile purpura which is a defect in what?

A

elastic fibers in perivascular CT

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13
Q

Tests for acute Hep B infex?

A

HBsAg and anti-HBc

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14
Q

Acute decompensated HF - tx?

A

O2, aggressive diuresis, possible vasodilators

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15
Q

In tachycardia, vagal maneuvers (PSNS, eg cold water) slow down heart rate by slowing what?

A

AV conduction

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16
Q

Upper AND lower resp granulomatous infl with glomerulorephritis …. think?

A

Wegener’s aka GPA (granulomatosis with polyangitis)

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17
Q

Pleural effusion pH:
Normal:
Transudative:
Exudative:

A
  1. 6
  2. 4-7.55
  3. 3-7.45
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18
Q

Acute MI heart sound?

A

S4 (atrial gallop)

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19
Q

Flulike state, POLYARTHRALGIAS, rash with low WBC and low PLT - after travel to Latin America, Africa, South Asia - think?

A

Chikungunya fever

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20
Q

Secretory diarrhea with melanosis coli (dark pigmentation in proximal colon), woman, health care field - think?

A

Laxative abuse

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21
Q

Test to compare two means?
Three means?
Proportions?

A

t-test or z-test
ANOVA
chi-square

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22
Q

Young patient (<45) with COPD like sx and basilar predominant dz - think?

A

Atlpha-1 antitrypsin defic

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23
Q

Chest xray with hilar LAD and non caseating-granulomas and yeast - and the patient likes CAVING, erythema nodosum too, think of what bug?
Transmitted by?

A

histoplasma

Soil with bird or bat droppings

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24
Q

DM nephropathy four stages in order?

A
  1. Glomerular hyperfiltration
  2. Thickening of GBM
  3. Mesangial expansion
  4. Nodular sclerosis
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25
Q

AMS with Metabolic acidosis with hypocalcemia and calcium oxalate crystals (rectangular, envelope shaped) in urine - what toxicity?
Treat?

A

ethylene glycol

fomepizole or ethanol, sodium bicarb for acidosis and dialysis if severe

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26
Q

Hyperthyroid with painful neck, fever, after URI - think?

A

Subacute (de Quervain) thyroiditis

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27
Q

Hep B vacciantion and previous cleared infection both are +ve for HBsAb but which one also has anti-HBc +ve?

A

Previous infx NOT vaccination

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28
Q

When is HBeAg +ve?

A

during acute infx

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29
Q

Nephrotic syndrome in patient with RA - likely to be due to what co-morbidity?

A 
AA amyloidosis
(AL version due to multiple myeloma)
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30
Q

mL cutoff for oliguria?

A

<250mL / hr

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31
Q

Pathophysioloyg of Rotor’s syndrome?

A

defect in hepatic secretion of bilirubin

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32
Q

Plethora and swelling of upper extremities and face - suspect?
Associated with?

A

SVC syndrome

Malignancy

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33
Q

Bright red, firm, friable, exophytic nodules in HIV pt - AND CAN PROGRESS TO SYSTEMIC DZ - diagnx?
Bug?
Tx?

A

bacillary agiomatosis
bartonella
erythromycin (or doxy)

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34
Q

Warfarin necrosis due to rapid drop off of what?

A

protein C

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35
Q

Autiimmune adreanlitis vs Sheehan as cause of adrenal insuff?

A

Hyperpigmentation and mineralocorticoid defic suggest automimmune

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36
Q

First-line med tx for stable patient with recurrent TORSADES?

A

Mg

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37
Q

Acute aortic dissection - initial meds?

A

IV B-blokcer (like labetalol)

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38
Q

Recent URI followed but sudden onset CHF sx in otherwise healthy patient - think?
Bug?

A

dilated cardiomyopathy 2/2 acute viral myocarditis

Coxsackie B

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39
Q

Syphilis - what if SEVERE PCN allergy?

A

don’t desensitize give doxy

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40
Q

Wafarin like necrosis but at Heparin injection sites think?

Pathophys?

A

HIT

Ab against PLT component

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41
Q

Back pain with spinal cord compression sx - med tx?

A

IV steroids

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42
Q

Hypoxia in PNA is casued by alveloar hypoventialtion or V/Q mismatch?

A

V/Q mismatch (alveolar hypo refers to unifrom chage across whole lung)

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43
Q

Classic side effect of metformin?

SO do not give in what 3 coditions?

A

Lactic acidosis

Acute renal failure, liver failure, sepsis

44
Q

Recurrent oral and genital ulcers, uveitis, thrombosis, Turkish, Middle Eastern and Asian young people, amybe they ulcerate with a needle - dz?

A

Bechets

45
Q

When do you intervene emergently in hypercalcemia (level)?

What intervention?

A

> 14
NS, then start bisphosphonates
(Only HD if renally impaired)

46
Q

Common complication of Paget’s dz of bone casues by involvement of cranial bones?

A

hearing loss

47
Q

Uric acid kidney stones: prevention?

A

Alkalinize urine to pH6-6.5 with oral potassium citrate

48
Q

Vitiligo due to what pathophys?

Tx?

A

Destruction of melanocytes

Topical or systemic steroids

49
Q

Low T3 but normal T4 and TSH levels - esp in a acutely and severely sick patient?

A

Euthyroid sick syndrome

50
Q

HIV, infx prophylactic drugs, cutoffs for CD4?

A

<200 bactrim

<50 azithro or clarithro

51
Q

If you suspect melanoma then what kind of biopsy?

A

Excisional with 1-3mm margins

52
Q

Common B-1 agonist?

A

Dobutamine

53
Q

Cause recurrent painless GI bleeds that is FREQUENTLY MISSED on colonoscopy?

A

Angiodysplasia

54
Q

PE (and the resulitng resp alkalosis) does what to Ca levels?

A

Hypocalcemia

More bound to albumin as H has dissociated

55
Q 
Neprotic sydnrome, most common:
Kids, lympphoma, NSAIDs?
HIV, obese, balck or hispanic, heroin?
Hep B, carcinoma, lupus (and NSAIDs)?
URI?
A

minimal change
FSGS
Membranous nephropathy
IgA

56
Q

Slow growing notender mass in the mouth after dental trauma, draining yellow granules - bug?
Drug?

A

Actinomyces

PCN

57
Q

Digoxin (digitalis) toxicity - heart arrythmia?

A

Atrial tachycardia with AV block

58
Q

Most beneficial tx to reduce progression of diabetic nephropathy?
Goal?

A

Strict blood pressure control, goal of 130/80

59
Q

Risk factors for AAA rupture (3)?

A

large diameter, rapid rate of expansion, current smoking

60
Q

Adrenal insuff - tests?

When to do a dexa suppression test?

A

8AM cortisol and plasma ACTH PLUS ACTH stim test (cosyntropin)
Dexa suppresion in HYPERcortisolism

61
Q

Acute limb ischemia post-I - check what? Why?

A

Echo, possible LV thrombus

62
Q

Get PFTs before you start what anti-arryhtmic?

Why?

A

Amiodarone

So you have baseline expecting lung injury

63
Q

ROME criteria for IBS (so fucntional prob) - 3?

A

sx improve after BM
Change in stool frequency and form
(without worrying sx)

64
Q

Intermittent claudication in limbs - tx?

A

exercise/PT! pharm and surg only for persistent sx if exercise fails

65
Q

Hypovolemic hypERnatremia - intial tx?

A

NS

66
Q

Cavitary lung lesion containing fluid/debris with cancer like sx - think?
Confirm diagnx with?

A

aspergillosis

IgG serology

67
Q

Rash on body starting from trunk, grey mucus patches in mouth - and sexual partners?

A

Secondary syphilis

68
Q

What else dose MEN2B have as well as the cancers?

A

Marfanoid habitus

69
Q

Electrolyte sign of hyPOvolemia?

A

decreased URINE sodium

70
Q

Not treating hypERthyroid puts you at risk for what (2)?

A

A fib and bone loss

71
Q

Effect of increased prevalance on PPV and NPV?

A

PPV goes up, NPV goes down

72
Q

Lupus like facial rash but also affected by EtOH, flushing, and does not spare nasolabial folds?

A

Rosacea

73
Q

Glaucoma emergency meds (M.A.P.T.) and avoid what?

A

mannitol, acetazolamide, pilocarpine or timolol

Avoid mydriatics like atropine

74
Q

Likely pathology of vitiligo?

So linked to what other kinds of diseases?

A

Autoimmune destruction of melanocytes

Autoimmunes pathology

75
Q

Best study for determinng incidence of dz?

Comparing incidence is 2 populations with or without a particular risk factor gives you what?

A

Cohort

RR

76
Q

dysphagia evaluative study?

A

barium swallow (videofluroscopic)

77
Q

Hyponatremia: when hypertonic saline not 0.9%?

A

If <120 with severe sx

78
Q

Can’t fall asleep at normal times becasue of a disrupted circadian rhythm - diagnx?

A

Delayed sleep phase syndrome

79
Q

Secretory diarrhea and flushing but with a mass int he PACNREAS too?

A

VIPoma, carcinoid probably wouldn’t have mass in pancreas

80
Q

Giant cell/temproal arteritis complication?

A

Aortic aneurysm

81
Q

UTI - urine pH >8 which bug?

A

Proteus

82
Q

Macrocytic anemia, shiny tongue, vitiligo, thryoid dz and neuro probs in a Northern European white - what kind of anemia?

A

Pernicious anemia causing B12 defic

83
Q

Electrolytes in tumor lysis:

Phos, K, Uric acid, Ca - up or down?

A

Ca down rest up

84
Q

Erysipelas bug (well demarcated edges)?

A

Strep pyogenes

85
Q

Aortic dissection - imaging test to confirm diagnosis?
When to get it?
If not what test?

A

TEE (trans-esophageal echo)
If HD unstable or renal insuff
CT angio

86
Q

What happens to Na and K in adrenal insuff?

A

Hyponatremia due to increased ADH

Hyperkalemia due to decreased Aldosterone

87
Q

Location of ectopic foci …
A fib?
A flutter?

A

pulmonary veins

around tricuspid annulus

88
Q

R sided HF after pacemaker placement - suspect what valvular problem?

A

triscuspid regurg

89
Q

AKI on acyclovir - think?

A

RENAL TUBULAR OBSTRUCTION (with crystals)

90
Q

Nephrotoxicity, hyperkalemia, hypertension, tremor WITH gum hypertropthy and hirsutism - which immunosuppresant toxicity?

A

Cyclosporine

91
Q

Nephrotoxicity, hyperkalemia, hypertension, tremor WITHOUT gum hypertrophy and hirsutism - which immunosuppresant toxicicty?

A

Tacrolimus

92
Q

Dose-related diarrhea, leukopenia, hepatotoxicity - which immunosuppressant toxicity?

A

Azathioprine

93
Q

Bone marrow suppression - which immunosuppressant toxicity?

A

mycophenolate

94
Q

Caustic ingestion - alkali. First step within 12-24 hours?

A

Endoscopy to assess damage

95
Q

S gallolyticus (S bovis) is assocated with what neoplams?

A

Colonic

96
Q

In Crohn’s increased absoroption of what increases kidney stones?

A

oxalate

97
Q

Anaerobic coverage options (3)?

A

Clinda, metro with amoxicillin, amoxi-clav

98
Q

Moderate to high probability of DVT, don’t start anti-coag yet - confirm with this test (equivalent of CTPE for PE)?

A

Compression US

99
Q

Empiric abx in meningitis age 2-50, >50, and immunocomprimized?

A

3rd gen ceph + vanc, then add ampicillin to cover listeria if >50, if immunocomprimized then swtich 3rd gen ceph to cefepime for pseuodmonas coverage

100
Q

Panacinar vs centriacinar emphysema - which with smoking and which with a-1 antitrypsin defic?

A

Panacinar a-1, centracinar smoking

101
Q

PCT (porphyria cutanea tards) presents with photosensitve skin rash - associated with what dz?

A

Hep C

102
Q

Phenytoin assoc with what anemia?

A

Folate defic macrocytic

103
Q

Low vit D can lead to what changes to Ca, Phos, PTH?

A

low Ca, low Ph, high PTH

104
Q

Straight lines appear wavy - problem?

A

macular degeneration

105
Q

What 10 year ASCVD risk do you get a statin?

A

> 7.5%

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