Medicine stuff Flashcards
Fever, leukocytosis, LUQ pain - think?
Associated condition?
splenic abscess
Infective endocarditis
Drug Rx for Primary Biliary Cholangitis?
When to start?
Tx if advanced dz?
Assoc lab findings?
UDCA (ursodeoxycholic)
As soon as dz identified
Liver transplant
Positive AMA, elev Alk Phos
Positive GGT with elevated alk phos?
Biliary etiology rather than bone (if neg)
Diclofenac is what sort of drug?
NSAID
Pneumaturia or fecaluria with UTI like findings - think?
Confirm with what etst?
Colovesical fistula
CT with oral or rectal contrast (not IV contrast)
Best measure to reduce risk of CAUTI?
clean, intermittent catheterizationa
Minimal BRBPR - next best test and age cutoffs?
> 50 or suggesting malignancy - colonoscopy
<40 and no other risk factors anoscopy
Most common inherited hyercoagulable disorder for whites?
Pts unable to respond to what?
Factor V leiden
Activated protein C
Firm, freely moveable dome shaped nodule with small central punctum, can grow or produce cheesy white d/c - think?
Treat?
Epidermal (inclusion) cyst
Spontaneous resolution usually
Fibromylagia tx? 1st and 2nd and 3rd lines?
1st Sleep hygiene and aerobic exercise
2nd Amitriptyline (TCAs)
3rd Pregabalin, duloxetien, milnacipran if not responding to TCAs
Back pain with gradual onset, age <40, does not improve with rest but improves with activity - etiology think?
Inflammatory
wedge shaped lesion in lung on CT - think?
PE
Sudden or subacute painless monocular vision loss with “blood and thunder” on funduscopic exam - retinal hemmorhages, dilated veins, cotton wool spots, optic disk swelling - think?
central retinal vein occlusion
OD on TCAs - give what?
sodium bicarb
electrical alterans and sinus tach on ECG - think?
Treat?
pericardial effusion - poss tampenade
If tamponade and hemodynamic compromise - emergency pericardiocentesis
What do you need for solid testicular mass diagnosis?
Then do what?
painless hard testicular mass and suggestive ultrasound radical orchiectomy (testic and assoc cord)
Aminoglycosides are used to treat what bugs?
Potentially toxic to what organs?
Serious GN infections
Kidneys
Hydatid liver cysts come from what organism?
Transferred by?
Echinococcus granulosus, a dog tapeworm
Dog feces
pH and glucose cutoffs for pleural effusion that suggest bacteria in there?
pH 7.2 and glucose <60
Most common liver cancer?
Mets from somehwere else!
Epigastric pain, often worse on empty stomach, with intermittent melena - think?
Treat?
duodenal ulcer (gastric ulcer worse after eating) Triple tx: amoxi, clarithromycin and PPI
Prolactin level diagnostic of proloactinoma?
Effect on TSH level?
> 200
Normal or low depending on compression of thryrotophs
Virus common to kids that can cause an acute symmetric arthritis in adults?
Parvovirus B19
Multiple stomach ulcers and thickened gastric folds on endoscopy - suspect?
Confirm diagnosis with?
Gastrinoma (Zollinger-Ellision syndrome)
fasting serum gastrin of >1000
Right heart failure sx with a pericardial knock (mid-diastolic), pericardial calcifications on CXR - think?
Constrictive pericarditis
How to confirm tinea coporis (ringworm - ring-shaped scaly patches with central clearing and sitnic borders)?
potassium hydroxide prep of skin scrapings
Concurrent use of NSAIDs and aspirin can cuase what anemia?
Iron defic from occult bleedings
Glucocorticoid defic with hypogonadism and hypothyroidism - think?
Hypopoituitarism (so normal aldosterone)
Isolated septic arthritis (or with tenosynovitis and rash) in young sexually active patient, often migrating polyarthralgias leading to purulent monoarthritis - think?
Gonococcal infection
What does rheumatoid arthritis do to risk of osteopenia, osteoporosis and bone fracture?
risk goes up
Resp alkalosis in a patient on a vent - make what vent adjustment?
Decrease resp rate
When to begin colonoscopies with IBD?
Then how often?
8 years after diagnosis
Every 1-2 years
How long after injury do you see fat embolism?
12-24 hours (at LEAST)
What lipid levels indicate statin therapy in diabetics aged 40-75?
Any. They should all be on statins.
Infective endocarditis - what step first, blood cultures or start ABX?
culture before starting ABX (serial cultures, at least 3)
C diff risk factors (4)?
Hospitalization
Recent ABX
PPI (gastric acid suppression)
Age >65
Notching of the ribs seen in what cardiovascular condition?
Coarctation of the aorta
Gram positive rod (beaded or branching), partially acid-fast, aerobic, immunocompromised pt - bug?
Treatment?
Nocardia
Bactrim
What happens to TBG levels after starting estrogen?
So effect on free T4?
And if on levothyroxine, requirement goes up or down?
They go up
FREE T4 goes down but total stays the same
Up
Side effect of hydroxychloroquine for lupus?
retinal toxicity
White paque on oral mucosa in smoker/drinker - think?
Leukoplakia
3 causes of hyperventilation –> resp alkalosis?
PNA, high altitude, salicylate intox
When is acalculous cholecystitis most commonly seen?
hospitalzied, criticalluy ill patients, post-surgery
Excessive IgM but also end-organ damage and >10% clonal lymphocytes on bone marrow biopsy- think?
Presenting with?
Neoplasm of which cell?
Differs form MGUS how?
Waldenstrom macroglobinemia
hyperviscosity, neruopathy, cryoglobulinemia
Plasma cell neoplasm
MGUS would have <10% clonal lymphocytes on biopsy
Indications for carotid endartectomy?
men and women if symptomatic 70-99%
also men if symptomatic 60-99%
Hemolytic anemia with thrombocytopenia, renal inuff, neuro sx and fever - think?
Due to?
Treat?
TTP (thrombotic thrombocytopenic purpura)
Auto-Ab to plasma protease
Emergent PLASMA EXCHANGE
Hereditary spherocytosis labs?
Anemia, high retics, low MCV, increased MCHgb concentration, high RDW
Varices - drugs for prophylactic vs active treatment?
Propanolol (or nadolol - non selective B-blockers) for prophylaxis, octreotide for active bleeding
2 meds that can trigger bronchoconstriction in patients with asthma?
B-lockers and aspirin
Frequent complication of IBD?
Effect of NSAIDs?
Spondylarthritis
Help joint pain but makes IBD worse
Unilateral varicoceles that fail to empty when recumbent - think?
Best diagnostic test?
Underlying pathology eg RCC
CT abd
Pain at tendon and ligament insertion sites (enthesitis), onset <40, for >30 months, better with use, worse with rest - think?
What HLA assoc?
Ankylosing spondylitis and other spondyloartropathies
HLA-B27
Anticardiolipin Ab assoc with?
Lupus anticoagulant is a pro-thrombotic that does what to partial thromboplastin time?
antiphospholipid syndrome prolongs it (PTT)
ABX class with photosesnitivity?
tetracyclines
What defines resistant HTN?
Most common cause (with a systolic-diastolic abd bruit)?
persists with 3 or more anti-hypertensives
renovascular HTN
Appearnce of nasal mucosa in allergic vs non-allergic rhinitis?
Tx for each?
pale/bluish in allergic, erythematous in non-allergic
Intranasal antihistamines glucocorticoids or both in non-allgx
Allgx: intrasnasal steroids, PO antihistamines
Loss to follow up means what kind of bias?
Selection (specifically attrition)
Chronic abd pain, weight loss, food aversion - think?
Mostly due to?
chronic mesenteric ischemia
atherosclerosis of celiac artery or SMA
First branch point in evaluation of hypercalcemia?
PTH level (low PTH likely malignancy, and elevated or inappropriately normal PTH likley primary hyperparathyroidism)
Imaging in back pain:
MRI (3)?
Xray (3)?
MRI: sensory deficits, cauda equina sx, suspected epidural abscess/infection
Xray: compression fracture/osteoporosis, malignancy, ank spondy
Infective endocarditis - most common valvular abnomralitty?
2nd most commoan valve?
Most common valve in IE with IVDU?
mitral prolapse with coexisting mitral REGURGITATION
aortic stenosis
tricupsid regurg
Common bugs for opportunistic infx post-transplant?
Systemic illness with multiple organ systems and without prophylaxis - suspect?
pneumocystis and CMV
CMV
Positive Prussin blue means presence of what? Which means what process?
Hemosiderin so hemolysis
Acute MI mech and artrery involved: RV failure? Papillary muscle rupture? Septal rupture? Free wall rupture?
RCA
RCA
LAD if apical, RCA if basal
LAD
HIV eye problems - most common serious prob but painless?
Painful with keratitis?
CMV
HSV or VZV
RUQ pain, mild elevation in liver enzymes, firm hepatomegaly - think?
Confirm with?
Liver mets!
Abd CT
4 point differential for hypokalemia, alkalosis and normotension?
Surreptitious vomiting
Diuretic abuse
Bartter syndrome
Gitelman’s syndrome
3 hemolytic anemia labs?
low haptoglobin, high LDH and bilirubin
Acute or subacute renal failure, skin probelms (eg mottling/livedo reticularis) AFTER RECENT CATH - suspect?
Cholesterol emboli
Medication to help passage of ureteral stones?
Tamsulosin and other alpha agonists that let the ureter smooth muscle relax
Temporal headaches, jaw claudication and vision loss - think?
Treat?
Giant cell artertitis
High does systemic glucocorticoids
Bug responsible for tinea versicolor?
Appearance?
Diagnosis and tx?
Malassezia
Hypo- hyper- or salmon colored lesions
KOH prep and tx with topical antifungals
Pulsus paradoxus is a drop in BP during inspiration associated with (the big one?) but also?
tamponade/pericardial effusion
but also severe asthma and COPD
Rash, joint pains, kidney problems, low complement AND PATIENTS USUALLY HAVE Hep C?
cryoglobulinemia
ARDS results in these 3 big things?
Impaired gas exchange, decreased lung compliance, pHTN
Common cause of esphagitis in HIV (CD4 <100)?
candida
Fluids to give in HypOvolemic HYPERnatremia (if mild? or severe?)
Mild: D5 in 0.45 NS
Severe: NS (0.9)
Why does niacin for lipid abnormalities cause itching and flushing?
And to reduce it?
PG induced peripheral vasodilation
Low dose aspirin
How to diagnose PCP (pneumocystis PNA)?
NO CULTURE! so sputum stain, and if cannto get sputum, bronchoscopy with bronchoalveolar lavage
Breath sounds in lung consolidation - increased or decreased?
Increased
3rd heart sounds associated with what?
LV failure
2 nasty Cyclophosphamide side effects?
acute hemorrhagic cystitis, bladder carcinoma
Hx of gastrectomy and glossitis with anemia think??
b12 defic
Blisters and skin fragility assoc with Hep C?
Porphyria cutanea tarda
Heart finding in Lyme?
Bacterial morphology of borellia (eg. cocci, bacilli, spirochete?)
AV block
Spirochete
Spondylitis increases risk for …?
Vertebral fractures
Marfans: complication of aortic dissection that present with early diastolic murmur?
aortic regurg
Cushings workup (two steps)?
1) cortisol test (late night saliva, 24 hr urine free cortisol or low-dose DEXAmethasone suppression test
2) If high cortisol then check ACTH levels
Dry cough, fever, high LDH, even in a non-HIV patient (but immunosuppressed eg steroids)?
PCPna
HFpEF is aka …
Diastolic dysfunction
Vasospastic angina shows ST elevations during chest pain episodes AT REST OR DURING SLEEP, smoking risk factor - same pathopshysiology as what?
Raynaud’s (hyperactvie smooth muscle)
Case control vs Retrospective cohort?
Case control knows outcome then looks at risk factors, retrospective knows risk factors then looks at outcome
Steroid therapy in SLE increases risk of what (presenting eg. as hip pain)?
Best test?
ostenecrosis
MRI
Infective endocarditis - ABX?
Start with vanc then narrow - if PCN sesntive then use IV pen G or ceftriaxone (4 weeks)
Another name for the heterophile antibody test?
monospot
Microcytic anemia with hemolysis in patients with artificial heart valves think?
Macrovascular hemolysis
Both have red cell casts m but IgA nephropahty arises when compared to post-infectious glomerulonephritis?
Complement levels differentiation?
Within 5 days compared to 10-21 days
Normal complement levels in IgA neph (Low C3 in postinfectious)
Fungal meningoencephalitis in HIV bug?
CD4 count?
Start antiviral tx?
Cryptococcus
<100
2 weeks after antifungal and possible serial LP to reduce pressure
Fungal CAP, Arizona, with erythema nodosum/erythema multiform, arthralgias - bug?
Tx?
Coccidioides
Healthy don’t need rx, but immunocomp get ketoconazole or fluconazole
Spike in WBC to >50K with severe infx, high alk phos, high bands, no basophilia - think?
Leukemoid rxn, not leukemia
