Medicine stuff 4 Flashcards
Meniere pathophys?
increased volume and pressure of endolymph
Active and former male smoker 65-75 get a US to screen for AAA, or just active?
Active and former
Young pt, mediastinal mass with elevated AFP and b-hCG?
germ cell tumor (nonseminomatous)
CPAP complications (3)?
alveolar damage, pneumothorax, hypotension
Valve problem that is complication of ascending aortic aneurysm - can present with SOB?
aortic regurg
Osteolytic lesions and recurrent infections - think?
MM
Dermatitis herpetiformis - treatment (med and lifestyle)?
Dapsone and gluten free
Anemia in ESRD due to?
Replacing it causes?
And when indicated?
Low EPO
Worse HTN, HA, flu-like sx
when Hgb <10
Leukocyte alk phos score in CML - high or low?
low
Hematuria with proteinuria and RBC casts (or dysmorphic RBCs)- problem likely to be in what part of kidney?
glomerulus
Pulm infx withverruocus nodules and plaques preogressing to micro abscesses - what fungus?
Blastomycosis
HIT increases or decreased clot risk?
way increases
First lien intervention for V-fib or pulseless VTach?
defibrillation
Cancer related anorexia - pharm tx?
progesterone analogues
Intra- and extrahepatic biliary tract dilation seen on imaging is suggestive of what?
pancreatic cancer causing obstruction
Zenker’s diverticulum is caused by what?
upper esophageal sphincter dysfunction and espophageal dysmotility
Tight glucose control in DM (goal of <6.5 A1C) decreases the risk of what?
microvascular complications (retinopathy, nephropathy etc.)
Toxin in reheated rice?
Bacillus cereus
How do nitrates relive chest pain?
systemic vasodilation lowers preload and thus LV end-dilatolic volume thus lowering wall stress and myocardial O2 demand
Postoperative patient with hypotension, JVD, new-onset right bundle branch blick (right heart strain) - think?
Massive PE
Best diagnostic imaging for suspected AAA?
Abd US (nearly 100% spec and sens)
Toxicity risk with prolonged infusion of nitroprusside (esp with CKD patients), presenting with HA, confusion, arrythmia, flushing and resp depression, AMS, seizures and coma?
Cyanide tox
BILATERAL progressive loss of CENTRAL vision - think?
Macular degen
Watery diarrhea in HIV - likley bug?
Bloody diarrhea, and CD4 <50?
So test for what?
cryptosporidium
CMV
retinitis
Heberden’s and Bouchard’s nodes are present in OA but which proximal and which distal?
Bouchard prox, Heberden distal
becasue H is distal to the beginning of the alphabet
Sever asthma attack - when pCO2 starts to normalize or get high - good or bad sign?
What do you do?
V bad
Intubate as sign of impending resp failure
Amiodarone can cause digoxin tox if used together - how does it present (acute and chronic)?
GI sx acutely, then neuro and visual sx chronically
Pancreatic cancer where is the mass if there’s jaundice, and no jaundice?
Jaundice - head of pancreas
No jaundice: body/tail
Diarrhea and abd pain, with arthralgias, weight loss, fever, sometimes hyperpigmentation, WITH PAS POSITIVE material in LAMINA PROPRIA - think?
Whipple’s dz
What can make Graves worse by increasing TRAB levels?
Do steroids help?
Radioactive iodine
They can
Essential hypertension in a young person (sloping ST depression, T wave inversion on EKG) - with EPISTAXIS or asymptomatic - think?
coarctation of aorta
Acute Liver Failure and dz is worsening or not improving - what do you do?
transplant
Hyponatremia with very concentrated urine while taking an SSRI - liekly to be?
SIADH
Strep mutans is what kind of strep found where?
Viridans, oral cavity
Post-vrial staph auresu PNA - possible characteristic lung CXR finding?
multilobar cavitary infiltrates
Common joint related complication of steroid use, foten presenting with progressive hip pain?
avascular necrosis
porcelain gallbladder (calcified on imaging) increases risk for? Tx?
gallbladder adenocarcinoma
cholecystectomy
3 causes of transudative effusion?
decreased intrapleural pressure
decreased plasma oncotic presure
increased hydrostatic pressure
2 causes of exudative effusion?
increased capillary/pleural membrane permeability
disruption to lymphtic outflow
A-fib in hemodyanmically unstable patient - next step?
In stable?
cardioversion
rate or rhythm control (metop, dilt, vera or amiodarone etc.)
A-fib in hemodyanmically unstable patient - next step?
In stable?
cardioversion
rate or rhythm control (metop, dilt, vera or amiodarone etc.)
Free air under diaphragm (pneumoperitonitis) with epigastirc pain - think?
perfed ulcer (PUD)
Do you ever need to screen for bladder cancer?
NEVER!
Heart ausculatation finding that correlates with high BNP in HF?
S3
Diuretics associated with hyperglycemia and and hyperlipidemia, and hyperuricemia (and hypercalcemia)?
What happens to Na, K, and Mg?
thiazide
all low
Vasospastic angina (occuring in sleep, ST elevations but no CAD on angiograpy) - tx?
CCBs to prevent, NG to abort
Vasospastic angina (occuring in sleep) - tx?
CCBs to prevent, NG to abort
Knee pain with “soap bubble” on x-ray (eccentric lytic area) - think?
Giant cell tumor
Small tonsils and lymph nodes - what immune probelm?
Bruton
Treatment for myasthenic crisis (reps failure in myasthenia gravis)?
intubate, plasmapheresis or IVIG, then steroids
What heparin OK for ESRD?
unfractionated
Acromegaly - initial test?
IGF1
Top cause of SVC syndrome?
malignancy
Guillain Barre CSF finding?
Incr protein with normal everything esle
IIH/psuedotumor cerebri etc. tx?
acetazolamide
Cephalohematoma vs caput - whitch crosses suture lines?
Caput Crosses (hard C)
CNIII (down and out) palsy in diabetics due to what?
ischemic neuropathy
Left hemineglect - brain area?
right parietal
Tay Sachs vs Niemann Pick - both have red eyes spots but which one has hepatomegaly?
And reflex difference?
And enzymes?
NPD
NPD - hyper, TS - areflexia
NPD - sphingomyelinase, TS - hexosaminidase
Corneal abrasion on exam, but no pain or gritty sensation - which nerve?
opthalmic branch of trigeminal (V1)
Parkinson’s gait, festinating and hypokinetic but broad or narrow bsed?
narrow
BILATERAL trigeminal neuralgia - suspect what?
MS
Traumatic (hyperextension) nerve injury to suspect in an elderly patient with spondylosis?
Central cord syndrome
Areflexic weakness in UE and cape of sesnory loss - think?
Path?
syringomyelia
fluid filled cavity in center of spinal cord
Niklosky sign in scarlet fever (strep) vs staph scalded skin?
present in scalded, not in scarlet
CD19 marker for what?
CD3 marker for what?
B cell, T cell
SCID tx?
stem cell transplant
Sarcoidosis tx?
steroids
CLL diagnostic test?
peripheral blood flow cytometry for clonality of mature B cells (not lymphnode bx)
No fever suggests reactive arthritis vs gonococcal - pharm tx?
NSAIDs
Perciardial calcifications on chest radiograph - diagnx?
CONTRICTIVE pericarditis
Infective endocarditis - tx?
Get the heparin on early?
ABX
NO early heparin, increases head bleed risk
how to tell difference between intra/extra peritoneal bladder injury?
intra would have peritoneal signs
Atypical glandular cells on pap - next step?
endometiral biopsy
Cyanotic infant with left axis deviation of EKG (and decreased pulmonary markings) - diagnx?
tricupsid atresia
Prader Willi deletion?
Paternal deletion
Malrotation/volvulus best test?
Upper GI series
Probable toxic ingestion of acetaminophen - next step?
gastric decontamination (charcoal ) and measurement of aceta levels
Pain and stiffnes in neck, shoudler, hips, patient >50, elveated ESR - think?
treat?
polymylagia rheumatica
low dose steroids
Chest Xray in tamponade looks ….
NORMAL!
In Brown sequard where does the contralateral deficit start?
1-2 levels beneath
Abdominal ausculatation gives systolic-diastolic bruit (can be upper abd too) - think?
renal stenosis
Can Xrays be normal in osteonecrosis?
yup
Age of woman with struma ovarii thyrotoxicosis?
Tye of tumor?
> 40
teratoma
Boys 4-10 with limp (osteonecrosis of hip) - diagnx?
Legg Calves Perthes
TSH level in prolcatinoma?
PRL level?
Normal
>200
