Medicine U World Flashcards
0
Q
Where can the murmur for hypertrophic obstructive cardiomyopathy be heard best?
A
-lower left sternal border
1
Q
Aortic stenosis in a young pt?
A
-usually due to congenital bicuspid valve
2
Q
Chest pain and aortic stenosis?
A
- due to increased myocardial oxygen demand
- usually seen with LVH too!
3
Q
2 diseases that spherocytes can be seen in?
A
- Hereditary spherocytosis
2. Autoimmune hemolytic anemia
4
Q
Hereditary sphereocytosis v. Autoimmune hemolytic anemia: genetics & coomb’s test?
A
- spherocytosis: autosomal dominant + negative coomb’s
- AIHA: not hereditary + positive coomb’s test (usually)
5
Q
Osteomyelitis: what is it? 2 categories?
A
- inflammatory destruction of bone due to infection
- categories:
1. Hematologic spread
2. Direct spread
6
Q
Vertebral osteomyelitis: ssx?
A
- low grade fever (high grade fever and chills NOT common)
- Elevated ESR
- Local tenderness on percussion
- Paravertebral muscle spasms
7
Q
Dx of vertebral osteomyelitis?
A
- MRI is the best!
- early diagnosis is important! Delay –> epidural abscess and spinal cord compression
8
Q
Most effective and rapid abortive tx for cluster headaches?
A
-100% oxygen!
9
Q
Dx of diverticulitis?
A
-CT scan of the abdomen is the best, especially is complications of abscess or perforation are suspected
10
Q
Prefered tx for pts with hyoerthyroidism? 2 contraindications?
A
- radioactive ablative therapy
- contraindications:
1. Pregnancy
2. Severe opthalmopathy
11
Q
Triad of sx in carcinoid syndrome?
A
- Flushing
- Valvular heart disease = murmur
- Diarrhea
12
Q
What vitamin/mineral deficiency are pts w/ carcinoid syndrome at risk for? Why?
A
- Niacin
- serotonin is formed and released by the neuroendocrine tumor
- tryptophan is the precursor of serotonin –> tryptophan is also used in the formation of niacin!
12
Q
What vitamin/mineral deficiency are pts w/ carcinoid syndrome at risk for? Why?
A
- Niacin
- serotonin is formed and released by the neuroendocrine tumor
- tryptophan is the precursor of serotonin –> tryptophan is also used in the formation of niacin!
13
Q
3 ssx of niacin deficiency?
A
- Diarrhea
- Dermatitis
- Dementia
* * 3 Ds!
14
Q
4 ssx of acute hemolytic transfusion reaction? When does it occur?
A
- Fever
- Chills
- Flank pain
- Hemoglobinuria
- occurs within an hour of the start of the transfusion
15
Q
What is the most common rxn to transfused blood products? What is the cause?
A
- febrile nonhemolytic rxn
- due to a rxn to cytokines stored in the transfused blood products
- when blood is stored leukocytes release cytokines
16
Q
3 Ssx of febrile nonhemolytic rxn to blood transfusion?
A
- Fever
- Chills
- Malaise
17
Q
Acute hemolysis that develops after the use of primaquine or sulfa drugs?
A
-G6PD deficiency
18
Q
G6PD levels during a hemolytic episode in a deficient ot?
A
-can be normal
19
Q
Reason for the “shifting” of the abdominal pain with acute appendicitis?
A
- first the pain is visceral bc only the appendix is inflamed, the pain is dull, poorly localized, and constant
- afferent visceral pain fibers then carry the pain to the spinal cord –> periumbilical pain
- later peritonitis and inflammation of nearby skeletal muscles results in somatic pain –> pain is well localized to the right lower quadrant
20
Q
Recurrent bacterial infections in an adult: what can be a cause? Dx?
A
- humoral immunity defect
- do a quantitative measurement of serum immunoglobulin levels
21
Q
3 Common precipitants of pseudogout?
A
- Trauma
- Surgery
- Medical illness
* *can be idiopathic too!
21
Q
3 Common precipitants of pseudogout?
A
- Trauma
- Surgery
- Medical illness
* *can be idiopathic too!
21
3 Common precipitants of pseudogout?
1. Trauma
2. Surgery
3. Medical illness
* *can be idiopathic too!
22
2 ssx of aortic dissection?
1. Severe chest pain that radiates to the back
| 2. Widened mediastinum on CXR
23
4 Ssx of cardiac tamponade?
1. Hypotension
2. Tachy
3. Distended neck veins
4. Pulsus paradoxis
24
Familial hypocalciuric hypercalcemia: Pathophys? Genetics? Ssx?
- rare, autosomal dominant
- benign
- pathophys: abnormal calcium-sensing receptors on parathyroid cells and renal tubules --> hinders the normal calcium-induced PTH suppression that occurs with hypercalcemia
- ssx:
1. Asymptomatic hypercalcemia
2. High-normal to borderline-elevated PTH levels
3. Very low urine calcium levels (contrast to primary hyperPTH) --> bc defect causes excess calcium reabsorption
24
Familial hypocalciuric hypercalcemia: Pathophys? Genetics? Ssx?
- rare, autosomal dominant
- benign
- pathophys: abnormal calcium-sensing receptors on parathyroid cells and renal tubules --> hinders the normal calcium-induced PTH suppression that occurs with hypercalcemia
- ssx:
1. Asymptomatic hypercalcemia
2. High-normal to borderline-elevated PTH levels
3. Very low urine calcium levels (contrast to primary hyperPTH) --> bc defect causes excess calcium reabsorption
25
Shoulder pain that doesnt decrease with lidocaine injection?
-rotator cuff TEAR
26
4 Causes of hypokalemia, alkalosis, + normotension?
1. Surreptitious vomiting
2. Diuretic abuse
3. Bartter syndrome = defect in thick ascending limb of loop of henley
4. Gitelman's syndrome = milder version of bartter's syndrome
27
Urine chloride in surreptitious vomiting?
- can be low concentration
- due to hypovolemia and hypochloremia
* *can be used to determine that this is the cause of the hypokalemic alkalosis in a normotensive pt
28
Location of lesion in hemi-neglect syndrome?
-lesion in the right (non-dominant) parietal lobe --> causes the pt to ignore the left side of space
28
Location of lesion in hemi-neglect syndrome?
-lesion in the right (non-dominant) parietal lobe --> causes the pt to ignore the left side of space
29
Where is tropical sprue endemic to? Minimum amnt of time a pt has to live there to suspect it?
- Puerto Rico
| - >1 mnth
30
9 Ssx of tropical sprue?
1. Fatty diarrhea
2. Cramps
3. Gas
4. Fatigue
5. Progressive weight loss
6. Malabsorption of nutrients --> esp vit B12 and folate --> megaloblastic anemia
7. Hyperactive bowel sounds
8. Borboygmi
9. Flattening of intestinal villi seen on bx
31
Borborygmi?
-a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
31
Borborygmi?
-a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
32
Unique sfx of rifampin?
- red/orange urine
| - benign
33
Ssx of a intracardiac tumor?
1. Mid-diastolic murmur heard best at the apex
2. Mass
3. Low-grade fevers
4. Weight loss
5. Weakness due to embolization
34
What type of intracardiac tumor is most common? Where is it found?
- atrial myxomas
| - most commonly found in left atrium (80%)
35
What should you do next if the pt has a high pretest probability of having a DVT according to the Wells score?
-next do a compression ultrasonography
36
What should you do next if the pt has a low pretest probability of having a DVT according to the Wells score?
-D-dimer test
37
What should you do if a pt has an elevated D-dimer test result?
-get a compression ultrasonography for suspected DVT
37
What should you do if a pt has an elevated D-dimer test result?
-get a compression ultrasonography for suspected DVT
37
What should you do if a pt has an elevated D-dimer test result?
-get a compression ultrasonography for suspected DVT
38
What should be done if the D-dimer test result is low?
-nothing --> the patient is unlikely to have a DVT
39
What should be done if a compression ultrasonography is positive for a DVT?
-tx w/ heparin and warfarin!
40
What should be done if a pt with a suspected DVT has a negative compression ultrasonography test?
- nothing --> the pt is unlikely to have a DVT
| - if there is still suspicion --> do a contrast venography
41
2 Common presenting ssx of pancreatic cancer that is located in the body or the tail?
1. Upper abdominal pain that radiates to the back
| 2. Weight loss
41
2 Common presenting ssx of pancreatic cancer that is located in the body or the tail?
1. Upper abdominal pain that radiates to the back
| 2. Weight loss
42
3 Common ssx of pancreatic cancer in the head of the pancreas?
1. Steatorrhea
2. Weight loss
3. Jaundice
43
Labs in a pt with pancreatic cancer?
1. ^^ serum bilirubin
2. ^^ alk phos
3. Mild anemia
44
What is a useful lab test for the indication of dehydration?
-the BUN/creatinine ratio
45
What should be asked about in the hx of a pt with a mild asymptomatic elevation of his serum transaminases?
- screen for hepatitis risk factors:
1. Drug use
2. Alcohol use
3. Travel outside US
4. High-risk sexual practices
5. Medications on
46
3 symptoms of pulmonary congestion?
1. Exertional dyspnea
2. Nocturnal cough
3. Hemoptysis
47
What arrhythmia are pts with mitral stenosis at risk for developing? Why?
- a fib
| - bc the LA becomes dilated
48
Early presentation of herpes zoster?
- constant burning pain without any physical examination abnormalities
- pain can develop a few days before the rash
- pain is intense and deep/burning
48
Early presentation of herpes zoster?
- constant burning pain without any physical examination abnormalities
- pain can develop a few days before the rash
- pain is intense and deep/burning
49
6 sx of hypercalcemia of malignancy?
1. Confusion
2. Lethargy
3. Fatigue
4. Anorexia
5. Polyuria
6. Constipation
50
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
50
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
50
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
50
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
51
5 sfx of amioderone?
1. Pulmonary fibrosis
2. Thyroid dysfctn --> hyper or hypo
3. Hepatotox
4. Corneal deposits
5. Skin discoloration --> smurfs!!
51
5 sfx of amioderone?
1. Pulmonary fibrosis
2. Thyroid dysfctn --> hyper or hypo
3. Hepatotox
4. Corneal deposits
5. Skin discoloration --> smurfs!!
52
Tx for acute hepatic encephalopathy?
1. Lactulose --> lowers the blood ammonium level
| 2. Reduced-protein diet
53
Pathogenesis of hepatic encephalopathy?
- reversible decline in neurologic fctn that is precipitated by hepatic damage
- increased levels of ammonia in the circulation causes inhibitory NT via GABA receptors in the CNS
53
Pathogenesis of hepatic encephalopathy?
- reversible decline in neurologic fctn that is precipitated by hepatic damage
- increased levels of ammonia in the circulation causes inhibitory NT via GABA receptors in the CNS
54
What 4 effects does aldo have on the distal tubukes?
1. Reabsorption of sodium
2. Volume expansion
3. Secretion of K+
4. Secretion of H+
55
4 ssx of primary hyperaldo (Conn's syndrome)?
1. HTN
2. Mild hypernatremia
3. Hypokalemia
4. Metabolic alkalosis
55
4 ssx of primary hyperaldo (Conn's syndrome)?
1. HTN
2. Mild hypernatremia
3. Hypokalemia
4. Metabolic alkalosis
56
What should be given in the initial diagnosis/management of pts with narrow-QRS-complex tachy?
- adenosine!
| - slows the sinus rate at the AV node
57
What 4 things can be seen in an eye exam of a pt with diabetic background, or simple, retinopathy?
1. Microaneurysms
2. Hemorrhages
3. Exudates
4. Retinal edema
58
What is seen on an eye exam in a pt with diabetic pro-proliferative retinopathy?
1. Cotton wool spots
59
What can be seen on an eye exam in a pt with diabetic proliferative, or malignant, retinopathy?
1. Newly formed vessels
60
What js the tx of choice for diabetic retinopathy? What does it do?
- argon laser photocoagulation
| - prevents complications
61
6 ssx of theophylline toxicity?
1. Headache --> CNS stim
2. Insomnia --> CNS stim
3. Seizures --> CNS stim
4. Nausea --> GI disturbance
5. Vomiting --> GI disturbance
6. Arrhythmia --> cardiac tox
62
4 ssx of Fibromyalgia?
1. Wide spread musculoskeletal pain
2. Fatigue when awaking from sleep & in the mid-afternoon
3. Cognitive difficulties --> esp attention/tasks requiring rapid thought changes
4. Nonspecific GI sx
63
Describe the rash of rubella
- erythematous
- maculopapular
- starts on the face and progresses to the trunk and extremities
63
Describe the rash of rubella
- erythematous
- maculopapular
- starts on the face and progresses to the trunk and extremities
64
Typical lymphadenopathy in rubella?
-posterior cervical and occipital
65
5 Ssx of rubella?
1. Maculopapular erythematous rash that starts on the face and progresses down
2. Fever - prodromal
3. Lymphadenopathy --> posterior cervical and occipital - prodromal
4. Malaise - prodromal
5. Arthritis --> can be seen in adult women
66
Factorial study design?
- 2 or more experimental interventions
| - with 2 or more variables that are independently studied
67
P value with a 95% confidence interval?
- p value < .05
| - does not include the null value
68
3 Ssx of nephrotic syndrome?
1. High-range proteinuria
2. Hypoalbuminemia
3. Edema
69
What type of kidney dz is a common complication of hodgkin's lymphoma?
- nephrotic syndrome --> esp. Minimal change dz
| - focal glomerulosclerosis can also occur
70
What is the most common kidney dz seen with carcinomas? Name 1 exception.
- membranous nephropathy is the most common
| - exception = Hodgkin's lymphoma and minimal change dz
70
What is the most common kidney dz seen with carcinomas? Name 1 exception.
- membranous nephropathy is the most common
| - exception = Hodgkin's lymphoma and minimal change dz
70
What is the most common kidney dz seen with carcinomas? Name 1 exception.
- membranous nephropathy is the most common
| - exception = Hodgkin's lymphoma and minimal change dz
71
6 Ssx of acute prostatitis?
1. Urinary urgency
2. Dysuria
3. Positive leukocyte esterase
4. Pain of the perineal region
5. Tender prostate
6. Boggy prostate
72
What 2 medications are known to cause priapism as a sfx?
1. Trazadone
| 2. Prazosin
73
5 Ssx of digoxin toxicity?
1. Nausea
2. Vomiting
3. Diarrhea
4. Vision changes --> blurry vision w/ changes in color
5. Arrhythmias
74
Describe tricuspid regurg murmur
-holosystolic murmur that increases with inspiration
74
Describe tricuspid regurg murmur
-holosystolic murmur that increases with inspiration
75
Palpable mass that forms in the epigatrium 4 weeks after the onset of acute pancreatitis?
-pancreatic pseudocyst
76
Pancreatic pseudocyst: tx? Complications?
- tx: drainage, only if it lasts for more than 6 wks, or is > 5 cm in diameter, or becomes infected --> otherwise it will resolve spontaneously
- complication: when the inflammatory process causes an erosion into a blood vessel, can cause hemorrhaging into the pseudocyst
77
Pancreatic pseudocyst: what is it? Dx?
- usually associated with chronic pancreatitis, but can be seen with acute too!
- not a true cyst bc lacks epithelial lining, walled by a thick fibrous capsule
- filled with inflammatory fluid (amylase, lipase,and enterokinase) and debris --> amylase can leak out and cause elevated serum amylase
- dx: ultrasound
77
Pancreatic pseudocyst: what is it? Dx?
- usually associated with chronic pancreatitis, but can be seen with acute too!
- not a true cyst bc lacks epithelial lining, walled by a thick fibrous capsule
- filled with inflammatory fluid (amylase, lipase,and enterokinase) and debris --> amylase can leak out and cause elevated serum amylase
- dx: ultrasound
78
What are 2 conditions that chronic GERD predisposes pts to?
1. Barrett's esophagus
2. Benign peptic esophageal strictures
* *both are a consequence of the body's reparative response
* *can occur simultaneously
78
What are 2 conditions that chronic GERD predisposes pts to?
1. Barrett's esophagus
2. Benign peptic esophageal strictures
* *both are a consequence of the body's reparative response
* *can occur simultaneously
79
Peptic strictures: what are they? What can they be caused by? Ssx? Clinical course?
- can be a result of chronic GERD, radiation exposure, or scleroderma
- causes slowly progressive dysphagia to solids --> without wt loss of anorexia!
- as they progress they can block reflux and improve heartburn sx
- seen as symmetric, circumferential narrowings on endoscopy
80
Effects of Proteus mirablis in UTIs on the urine pH? Consequence of that?
- causes alkalinization of the urine --> via the urease that it secretes, which hydrolyzes urea to ammonia and CO2
- ammonia combines with hydrogen to form ammonium --> vv free H+ concentration = alkalinzes urine --> promotes struvite stone formation!
80
Effects of Proteus mirablis in UTIs on the urine pH? Consequence of that?
- causes alkalinization of the urine --> via the urease that it secretes, which hydrolyzes urea to ammonia and CO2
- ammonia combines with hydrogen to form ammonium --> vv free H+ concentration = alkalinzes urine --> promotes struvite stone formation!
81
4 Clinical features of primary sclerosing cholangitis?
1. Fatigue
2. Pruritis
3. Most pts are asymptomatic at dx
4. 90% of pts have underlying inflammatory bowel dz (esp. UC)
81
4 Clinical features of primary sclerosing cholangitis?
1. Fatigue
2. Pruritis
3. Most pts are asymptomatic at dx
4. 90% of pts have underlying inflammatory bowel dz (esp. UC)
82
Primary sclerosing cholangitis: pathophysiology?
- unknown etiology
- chronic
- inflammation, fibrosis, and stricturing of medium-sized and lg intrahepatic and extrahepatic bile ducts
82
Primary sclerosing cholangitis: pathophysiology?
- unknown etiology
- chronic
- inflammation, fibrosis, and stricturing of medium-sized and lg intrahepatic and extrahepatic bile ducts
83
What type of anemia is lead poisoning?
-microcytic anemia
84
What is the most reliable index for monitoring the response of tx in DKA?
-serum anion gap
84
What is the most reliable index for monitoring the response of tx in DKA?
-serum anion gap
85
What type of diuretics can have ototoxic sfx?
-loop diuretics
86
Beat-to-beat variations in QRS axis and amplitude?
-due to the swinging motion of the heart in the pericardium with pericardial effusion
86
Beat-to-beat variations in QRS axis and amplitude?
-due to the swinging motion of the heart in the pericardium with pericardial effusion
87
What percentage in 1 SD?
-68%
87
What percentage in 1 SD?
-68%
88
What percentage in 2 SDs?
-95%
89
What percentage in 3 SDs?
-99.7%
89
What percentage in 3 SDs?
-99.7%
90
Most common cause of hypercalcemia of malignancy?
-parathyroid hormone-related peptide (PTHrP) production by the tumor
91
Tx of hepatotoxic effects of acetaminophen overdose?
- measure acetominophen levels of pt after 4 hrs of ingestion
- match up with the measurement on the Rumack-Matthew nomogram to determine if toxicity is present
- if toxicity is present, give N-acetylcysteine
- as long as N-acetylcysteine is administered within 8 hrs of ingestion the outcome will not be affected
92
What 2 things should pts with cirrhosis be screened for regularly?
1. Esophageal varices --> via endoscopy
| 2. Hepatocellular carcinoma --> via ultrasound
93
What effects does alcohol-related heart dz have on the structure of the heart?
-causes dilated cardiomyopathy
94
Cardiac effects of amyloidosis?
-can cause restrictive cardiomyopathy --> thickened ventricular walls + preserved ventricular dimensions
95
What deficiency can pre-dispose to anaphylactic rxns to blood transfusions?
-IgA deficiency
96
2 most common sx of PE?
1. Acute onset of shortness of breath
| 2. Pleuritic chest pain
97
How long should a pt be on warfarin for a DVT with a reversible cause? For an idiopathic cause?
- reversible = 3 mnths
| - idiopathic = 6-12 mnths
98
Presentation of renal vein thrombosis?
- sudden onset of:
1. Abdominal pain
2. Hematuria
3. Fever
99
What nephrotic syndrome is renal vein thrombosis most common in?
-membranous glomerulonephritis
99
What nephrotic syndrome is renal vein thrombosis most common in?
-membranous glomerulonephritis
100
What are 2 signs of poor prognosis in a PE?
1. Atrial fibrillation
| 2. Low oxygen saturation
100
What are 2 signs of poor prognosis in a PE?
1. Atrial fibrillation
| 2. Low oxygen saturation
100
What are 2 signs of poor prognosis in a PE?
1. Atrial fibrillation
| 2. Low oxygen saturation
100
What are 2 signs of poor prognosis in a PE?
1. Atrial fibrillation
| 2. Low oxygen saturation
101
3 typical features of Creutzfeldt-Jakob disease?
1. Rapidly progressive dementia
2. Myoclonus
3. Sharp, triphasic, synchronous discharges on EEG
101
3 typical features of Creutzfeldt-Jakob disease?
1. Rapidly progressive dementia
2. Myoclonus
3. Sharp, triphasic, synchronous discharges on EEG
101
3 typical features of Creutzfeldt-Jakob disease?
1. Rapidly progressive dementia
2. Myoclonus
3. Sharp, triphasic, synchronous discharges on EEG
101
3 typical features of Creutzfeldt-Jakob disease?
1. Rapidly progressive dementia
2. Myoclonus
3. Sharp, triphasic, synchronous discharges on EEG
102
Classic triad of ssx for reactive arthritis?
1. Nongonococcal urethritis
2. Asymmetric oligoarthritis
3. Conjunctivitis
103
First line tx for the acute phase of reactive arthritis?
-NSAIDS
104
What is the most common cause of painless hematuria in adults?
-bladder tumors
105
4 ssx of empyema?
1. Fever
2. Cough --> nonproductive or productive
3. SOB
4. Pleuritic chest pain
106
What does an S4 indicate?
- stiff ventricle
| - seen with restrictive cardiomyopathy or LVH from prolonged HTN
107
Nocardia microbio features?
- gram-positive
- weakly acid-fast
- filamentous
- branching rod
108
What medication is contraindicated in a STEMI? Why?
- nifedipine (and other dihydropyridines)
- causes vasodilation and reflex tachy --> worsens ischemia
- does not improve survival
108
What medication is contraindicated in a STEMI? Why?
- nifedipine (and other dihydropyridines)
- causes vasodilation and reflex tachy --> worsens ischemia
- does not improve survival
108
What medication is contraindicated in a STEMI? Why?
- nifedipine (and other dihydropyridines)
- causes vasodilation and reflex tachy --> worsens ischemia
- does not improve survival
109
Heparin and acute MIs?
-heparin is indicated in ALL acute MI pts!
109
Heparin and acute MIs?
-heparin is indicated in ALL acute MI pts!
109
Heparin and acute MIs?
-heparin is indicated in ALL acute MI pts!
110
3 ways to remove K+ from body in hyperkalemia?
1. Dialysis
2. Cation exchange resins --> ex. Kayexalate
3. Diuretics
111
Kayexalate: MOA?
- cation-exchange resin
| - acts in the GI tract by promoting exchange of Na+ for K+ = increases the excretion of K+
112
2 cause of hypovolemic hyponatremia?
1. GI losses --> ex. Vomiting, diarrhea
| 2. Renal losses --> ex. Diuretics
112
2 cause of hypovolemic hyponatremia?
1. GI losses --> ex. Vomiting, diarrhea
| 2. Renal losses --> ex. Diuretics
113
3 causes of euvolemic hyponatremia?
1. SIADH
2. Psychogenic polydipsia
3. HypoTH
114
3 causes of hypervolemic hyponatremia?
1. CHF
2. Cirrhosis
3. CKD
115
Most common cause of ascites?
-hepatic cirrhosis
115
Most common cause of ascites?
-hepatic cirrhosis
116
6 common ssx on presentation of idiopathic pulmonary fibrosis?
1. Chronic progressive dyspnea
2. Nonproductive cough
3. Digital clubbing
4. Dry, end-inspiratory crackles
5. Restrictive pattern on PFTs
6. Increased A-a gradient
117
Pathophysiology of lumbar spinal stenosis?
- usually a combination of:
1. Enlarging osteophytes at the facet joints of vertebrae
2. Hypertrophy of ligmentum flavum
118
3 Ssx of lumbar spinal stenosis? What aggravates and alleviates sx?
1. Back pain that radiates to buttock and thighs
2. Numbness
3. Paresthesias
- aggravating = walking and extension of lower back
- alleviating = flexion of lower back
118
3 Ssx of lumbar spinal stenosis? What aggravates and alleviates sx?
1. Back pain that radiates to buttock and thighs
2. Numbness
3. Paresthesias
- aggravating = walking and extension of lower back
- alleviating = flexion of lower back
119
Lumbar disk herniation: 3 ssx? Aggravating?
1. Lower back pain that might radiate down one leg
2. Numbness --> maybe
3. Paresthesias --> maybe
- aggravating = lumbar flexion and sitting
120
Formula for calculating serum osmolality?
- 2(serum Na) + blood glucose/18 + BUN/2.8
120
Formula for calculating serum osmolality?
- 2(serum Na) + blood glucose/18 + BUN/2.8
121
4 Lab characteristics of hyperglycemic, hyperosmolar non-ketotic coma? Pathogenesis?
1. Very high blood glucose levels
2. Plasma hyperosmolality
3. Normal anion gap
4. Negative serum ketones
- pathogenesis = pt has enough circulating endogenous insulin to prevent ketoacidosis, but not enough insulin to control and decrease the blood glucose level
122
Ichthyosis vulgaris
- normal skin at birth that progresses to dry, scaly skin
- hereditary or acquired
- dry rough skin with horny plates over the extensor surfaces of limbs
123
CSF of bacterial meningitis
1. Elevated WBC
2. Elevated proteins
3. Decreased glucose
124
4 ssx of perforated peptic ulcer disease?
1. Chronic epigastric pain that suddenly gets worse and becomes diffuse
2. Pneumoperitoneum on CXR = free air under the right diaphragm
3. Rebound tenderness
4. Guarding
125
Leukocyte alkaline phosphatase score in leukemoid rxns v. Chronic myeloid leukemia?
- leukemoid rxn = elevated
| - CML = low
125
Leukocyte alkaline phosphatase score in leukemoid rxns v. Chronic myeloid leukemia?
- leukemoid rxn = elevated
| - CML = low
126
Where does pain from acute cholecystitis radiate usually?
-to the right scapula
127
Where does pain from acute pancreatitis usually radiate to?
-the back, but usually not as high as the scapula
127
Where does pain from acute pancreatitis usually radiate to?
-the back, but usually not as high as the scapula
128
Tx of choice for PCP?
- trimethoprim-sulfamethoxazole
| - add steroids in severe cases --> shown to decrease mortality
142
6 Ssx of PCP in an HIV pt?
1. Non-productive cough
2. Exertional dyspnea
3. Fever
4. Severe hypoxia
5. Bilateral infiltrates in CXR
6. Normal white count
143
What is the best tx for uncomplicated diverticulosis?
-increasing intake if dietary fiber
144
Classic triad of ssx with granulomatosis with polyangitis?
- AKA: Wegener's
1. Systemic vasculitis
2. Upper and lower airway granulomatous inflammation
3. Glomerulonephritis
145
Tx for acute exacerbations of MS?
-high-dose IV glucocorticoids
146
Explain how warfarin can cause hypercoagulation?
- warfarin inhibits the formation of vitamin K dependent clotting factors + protein C & S
- clotting factors have a half-life of 60 hrs
- protein C has a half-life of 9 hrs
- when warfarin is first given it effects protein C production more bc of the shorter half-life, and that can make a pt protein C deficient --> hypercoagulable state --> at higher risk for thrombus formation and skin necrosis
* *especially common in a pt that has an underlying congenital protein C def!
* *why warfarin and heparin should both be given at first!
147
Acute tx of hypertensive pts with either type A or B aortic dissections? MOA?
- IV labetalol
- Bb simultaneously lower heart rt and BP --> decrease stress on aortic wall
- type B can usually be managed with meds alone
- type A usually needs surgery eventually
148
What type of lung cancer can be associated with hyperCa? Mnemonic?
- squamous cell carcinoma
| - sCa++mous
149
Prophylaxis for PCP that should be given to all transplant pts?
-oral trimethoprim-sulfamethoxazole
150
What is an "eggshell" calcification of a hepatic cyst on CT scan highly suggestive of? How is it contracted?
- hydatid cyst
| - contract echinococcus granulosus infection from the close and intimate contact with dogs
150
What is an "eggshell" calcification of a hepatic cyst on CT scan highly suggestive of? How is it contracted?
- hydatid cyst
| - contract echinococcus granulosus infection from the close and intimate contact with dogs
151
What does the p value mean?
-the probability that the results occured by chance alone
152
Drug of choice for a pt with hyperTH-related tachy systolic a fib?
-a Beta blocker
153
4 Ssx of a tick-borne paralysis?
1. Rapidly progressive ascending paralysis
2. Absence of fever
3. Absence of sensory abnormalities
4. Normal CSF
154
Most common cause of thyroid nodules?
-colloid nodules
155
First step in tx of acute variceal bleeding?
-aggressive fluid resuscitation --> via establishing vascular access w/ 2 lg bore IV needles or a central line
156
When should a carotid endarterectomy be performed in a symptomatic pt? Asymptomatic?
- symptomatic = 70-99% blockage
| - asymptomatic = 60-99%
157
What fungal organism is endemic to the Mississippi and Ohio river valleys?
- histoplasmosis!
| - found in soil w/ high concentration of bird and bat droppings
157
What fungal organism is endemic to the Mississippi and Ohio river valleys?
- histoplasmosis!
| - found in soil w/ high concentration of bird and bat droppings
158
What hormone do leydig cell tumors typically cause an overproduction of?
-estrogen
159
Serum Sodium and specific gravity of urine in primary polpydipsia?
- AKA: psychogenic polydypsia
- hyponatremic
- maximally dilute urine = low specific gravity
160
What 3 meds can be given for an acute migraine attack?
1. Chlorpromazine
2. Prochlorperazine
3. Metoclopramide
161
Fungal organism that is endemic in Central and South US?
-coccidiomycosis!
162
4 Ssx of chronic mesenteric ischemia?
1. Chronic abdominal pain
2. Weight loss
3. Food aversion
4. Associated atherosclerosis dz (ex history if MI, etc.)
163
Relative risk and association?
- an RR > 1 = positive association
- an RR < 1 = negative association
- the higher the RR, the stronger the association
163
Relative risk and association?
- an RR > 1 = positive association
- an RR < 1 = negative association
- the higher the RR, the stronger the association
164
Pts with hemachromatosis and cirrhosis are at a higher risk for an infection with which organism?
-listeria monocytogenes
164
Pts with hemachromatosis and cirrhosis are at a higher risk for an infection with which organism?
-listeria monocytogenes
164
Pts with hemachromatosis and cirrhosis are at a higher risk for an infection with which organism?
-listeria monocytogenes
165
2 iron-loving bacteria?
1. Yersinia enterocolitica
| 2. Vibrio vulnificus
166
What 3 groups of pts are at a higher risk of osteomyelitis?
1. IV drug users
2. Sickle cell anemia pts
3. Immunosuppressed pts
166
What 3 groups of pts are at a higher risk of osteomyelitis?
1. IV drug users
2. Sickle cell anemia pts
3. Immunosuppressed pts
167
Describe the pain with vertebral osteomyelitis
- tenderness to gentle percussion over the spinous process involved
- pain is not relieved w/ rest
168
5 common manifestations of hypercalcemia?
1. Severe constipation
2. Anorexia
3. Weakness
4. Increased urination
5. Neurologic abnormalities (ex confusion, lethargy, etc)
169
What is the major electrolyte disturbance seen in multiple myeloma?
-hypercalcemia
170
CSF in Guillain-Barre Syndrome?
- high protein concentration
- normal cell count (both WBCs and RBCs)
- normal glucose
171
Fluphenazine, what is it? How can it cause hypothermia?
- "typical" antipsychotic drug that is more potent than haloperidol
- can cause hypothermia by disrupting thermoregulation and the body's shivering mechanism
172
6 Risk factors for developing pancreatic Ca?
1. Family hx
2. Chronic pancreatitis
3. Smoking
4. DM
5. Obesity
6. Diet high in fat
173
Ginseng and warfarin?
-known to decrease the serum concentration of warfarin
174
4 Drugs that can potentiate the anticoagulant effects of warfarin?
1. Acetaminophen
2. NSAIDs
3. Amioderone
4. Antibiotics
175
4 Steps to tx of ascities?
1. Na and H2O restriction
2. Spironolcatone
3. Loop diuretic
4. Frequent abdominal paracentesis
176
3 Causes for osmolar gap metabolic acidosis?
1. Acute methanol poisoning
2. Acute ethanol poisoning
3. Acute ethylene glycol poisoning
176
3 Causes for osmolar gap metabolic acidosis?
1. Acute methanol poisoning
2. Acute ethanol poisoning
3. Acute ethylene glycol poisoning
177
What are envelope-shaped crystals in the urine made of? When can they be seen?
- calcium oxalate crystals
| - seen in pts with ethylene glycol poisoning
178
5 Ssx of poor respiratory drive?
1. Decreased breath sounds
2. Absent wheezing
3. Decreased mental status
4. Marked hypoxia with cyanosis
5. Elevated or normal PaCO2
178
5 Ssx of poor respiratory drive?
1. Decreased breath sounds
2. Absent wheezing
3. Decreased mental status
4. Marked hypoxia with cyanosis
5. Elevated or normal PaCO2
178
5 Ssx of poor respiratory drive?
1. Decreased breath sounds
2. Absent wheezing
3. Decreased mental status
4. Marked hypoxia with cyanosis
5. Elevated or normal PaCO2
178
5 Ssx of poor respiratory drive?
1. Decreased breath sounds
2. Absent wheezing
3. Decreased mental status
4. Marked hypoxia with cyanosis
5. Elevated or normal PaCO2
179
Which hyperTH pts are most likely to develop hypoTH after radioactive iodine tx?
-grave's pts bc their whole gland is hyperactive
180
What is the most feared complication of a retropharyngeal abscess?
-spread of the infection to the mediastinum --> leads to acute necrotizing mediastinitis
181
Which neck space infection carries the highest risk of mediastinal involvement?
-retropharyngeal space
182
4 Main criteria for determining brain death?
1. Absent cranial nerve reflexes
2. Fixed and dilated pupils
3. No spontaneous breaths
4. Agreement of 2 physicians
183
Multiple system atrophy 5 Ssx?
1. Parkinonism
2. Orthostatic hypotension
3. Impotence
4. Incontinence
5. Other autonomic sx
183
Multiple system atrophy 5 Ssx?
1. Parkinonism
2. Orthostatic hypotension
3. Impotence
4. Incontinence
5. Other autonomic sx
184
AFP and B-HCG in seminomatous and non-seminatous germ cell tumors?
- seminomatous = elevated B-HCG only
| - nonseminomatous = elevated B-HCG and AFP
185
Most serious side effect of hydroxychloroquine? What does it tx?
- can cause retinopathy! --> send pt for eye exams every 6 mnths!
- can be used to tx isolated joint and skin involvement of SLE
186
What is an acid-fast stain that shows oocytes in stool suggestive of?
-cryptosporidium parvum
187
Cryptosporidium parvum: what does it cause?
-major cause of chronic diarrhea in HIV pts with CD4 counts <180
187
Cryptosporidium parvum: what does it cause?
-major cause of chronic diarrhea in HIV pts with CD4 counts <180
188
Effects if pregnancy on respiration?
-progesterone is present in high concentrations in the serum --> has direct stimulatory effect on the dorsal resp group of the medullary resp center
189
Where are bronchiogenic cysts usually found?
-middle mediastinum
189
Where are bronchiogenic cysts usually found?
-middle mediastinum
189
Where are bronchiogenic cysts usually found?
-middle mediastinum
190
Indinavir: what is it? Sfx?
- protease inhibitor for HIV
| - crystal-induced nephropathy can be a side effects
190
Indinavir: what is it? Sfx?
- protease inhibitor for HIV
| - crystal-induced nephropathy can be a side effects
191
5 features if Antiphospholipid antibody syndrome?
1. False + VDRL
2. Prolonged PTT
3. Thrombocytopenia
4. Tendency for spontaneous abortions
5. Arterial and venous thromboses are common
191
5 features if Antiphospholipid antibody syndrome?
1. False + VDRL
2. Prolonged PTT
3. Thrombocytopenia
4. Tendency for spontaneous abortions
5. Arterial and venous thromboses are common
192
Aspiration of a fibrocystic breast mass?
- fluid should be clear
| - removing the fluid should cause a disappearance of the mass
193
Fibrocystic breast disease?
- rubbery. Firm, mobile breast mass
- mass gets more tender during menses
- common in young females
194
What 3 cancers are more likely to cause solitary brain mets?
1. Breast
2. Colon
3. Renal cell carcinoma
195
What 2 types of cancer are more likely to cause multiple brain mets?
1. Lung cancer
| 2. Malignant melanoma
195
What 2 types of cancer are more likely to cause multiple brain mets?
1. Lung cancer
| 2. Malignant melanoma
196
Blastomycosis: where is it endemic to? 3 general characteristics of ssx?
- endemic to Great Lakes and Ohio and Mississippi River basins
1. Skin lesions
2. Lytic bone lesions
3. Pulmonary sx that can resemble TB on CXR
197
Tx for mucormycosis? Commonly infects?
- aggressive surgical debridement + amphotericin B
| - often seen in diabetics with DKA
198
What is bronchialveolar lavage most useful in detecting?
1. Pulmonary malignancy
| 2. Opportunistic infections
199
2 Ssx of agranulocytosis?
1. Fever
2. Sore throat
- w/in 90 days of starting a med that is known to cause agranulocytosis (ex. Antithyroid drugs)
200
What is a serious sfx of antithyroid drugs? 2 Ssx?
- agranulocytosis
1. Fever
2. Sore throat
201
When should you suspect GERD when an adult presents with asthma sx?
1. Worse after meals
2. Worse after exercise
3. Worse after lying down
202
Light's criteria for determining if a fluid is an exudate?
- fluid must have at least one of these:
1. Pleural fluid protein/serum protein ration > 0.5
2. Pleural fluid lactate dehydrogenase/ serum LDH > 0.6
3. Pleural fluid LDH > 2/3 of the upper limit of normal for serum LDH
203
Live vaccines and HIV pts?
- should be avoided
- EXCEPTION: MMR vaccine can be given if the pt has a CD4 count > 200/micro-L and no evidence or hx of an AIDS-defining illness
204
Chronic and barrett's esophagus are both a risk for what condition?
-adenocarcinoma of the esophagus
205
What arrhythmia can be specifically caused by digitalis toxicity?
-atrial tachy + AV block
206
Isoniazid and Liver?
- can cause hepatitis, a more sever hepatotoxicity, or minor subclinical hepatic injury
- 10-20% of pts develop mild aminotransferase elevation in the first few weeks of tx --> self-limited and resolves w/out tx
207
Presentation of ventricular free wall rupture?
- usually occurs 5-14 days after an acute MI
- acute onset of chest pain
- profound shock
- rapid progression to pulseless activity
- death
208
What to tell a ot who finds a tick on them?
-remove it with tweezers
209
Who is at the greatest risk of prerenal azotemia? Why?
- elderly pts, esp those who are bed ridden
| - due to decreased thirst response and decreased ability to self-administer fluids
210
Tx of premature atrial beats?
- nothing
| - they are completely benign.
211
3 Ssx of angioedema?
Rapid onset of:
1. Non-inflammatory edema of the face, limbs, and genitalia
2. Laryngeal edema
3. Edema of the bowels resulting in colicky abdominal pain
212
Pathophysology of angioedema?
- C1 inhibitor deficiency --> elevated levels C2b and bradykinin (edema-producing factors)
- can be inherited or acquired
- can be caused by ACEi
213
Best screening test for primary hyperaldo?
-early-morning plasma aldo concentration to plasma renin activity ratio
214
Definition of heat stroke?
- core temp > 40*C
| - altered mental status
214
Definition of heat stroke?
- core temp > 40*C
| - altered mental status
215
4 Complications of heat stroke?
1. Rhabdomyolysis
2. Renal failure
3. ARDS
4. Coagulopathic bleeding
216
What can be heard on the lung exam of a pt with idiopathic pulmonary fibrosis?
-"velcro-like" inspiratory crackles
217
CXR findings with sarcoidosis?
1. Bilateral hilar lymphadenopathy
| 2. Diffuse interstitial infiltrates
217
CXR findings with sarcoidosis?
1. Bilateral hilar lymphadenopathy
| 2. Diffuse interstitial infiltrates
218
Hemorrhages v. Infarcts on CT brain scans?
- hemorrhage = hyperdense
| - infarct = hypodense
219
Clinical association with enterococci and infective endocarditis?
-nosocomial UTI (usually via instrumentation or cath)
220
Clinical association with staph aureus and infective endocarditis?
1. Prosthetic valves
2. Intravascular catheters
3. Implanted devices
4. IV drug use
221
Clinical associations with viridans strep and infective endocarditis?
1. Dental procedures
| 2. Respiratory tract procedures that involve incision &/or bx
222
Clinical associations with strep bovis and infective endocarditis?
1. Colon carcinoma
| 2. Inflammatory bowel dz
222
Clinical associations with strep bovis and infective endocarditis?
1. Colon carcinoma
| 2. Inflammatory bowel dz
223
Clinical associations with fungi and infective endocarditis?
1. Immunocomp hosts
2. Chronic indwelling caths
3. Prolonged antibiotic tx
223
Clinical associations with fungi and infective endocarditis?
1. Immunocomp hosts
2. Chronic indwelling caths
3. Prolonged antibiotic tx
223
Clinical associations with fungi and infective endocarditis?
1. Immunocomp hosts
2. Chronic indwelling caths
3. Prolonged antibiotic tx
224
Antibodies in Eaton-Lambert syndrome?
-autoantibodies against voltage-gated calcium channels in the PREsynaptic motor nerve terminal
225
What is Eatin-Lambert syndrome associated with?
-small cell carcinoma of the lung
256
5 Ssx of Lewy body dementia?
1. Alterations in consciousness
2. Disorganized speech
3. Visual hallucinations
4. Extrapyramidal symptoms
5. Relatively early compromise of executive functions
257
What can hemothorax lead to? Tx?
- can lead to empyema --> blood is an excellent growth medium for the growth of bacteria
- tx: surgery, thick pleural peel and pus need to be removed and the chest needs to be drained
258
Cause of pneumonia that occurs in a pt with a recent influenza infection?
-staph aureus
259
First thing to do in a pt with suspected infective endocarditis?
- obtain blood cultures from separate venipuncture sites over a specified period of time
- do BEFORE tx with antibiotics!
264
The main essential ssx of alveolar hypoventillation?
-elevated PaCO2 of 50-80 mmHg
265
Equation to determine A-a gradient? Normal?
(PAO2-PaO2)
| -normal < 15 --> but value will increase with age, so anything > 30 = abnormal
266
4 Causes of alveolar hypoventilation?
1. Pulmonary/thoracic disease = COPD, obstructive sleep apnea, obesity, scoliosis
2. Neuromuscular dz = MG, Lambert-Eaton syndrome, Guillain-Barre syndrome
3. Drug-induced = anesthetics, narcotics,sedatives
4. Primary central nervous system dysfunction = brainstem lesion, infection, stroke
267
Bladder cancer screening recommendations?
-recommended against bc of low incidence and low predictive value of screening tests --> even in pts with risk factors!
267
Bladder cancer screening recommendations?
-recommended against bc of low incidence and low predictive value of screening tests --> even in pts with risk factors!
268
Renal compensation for respiratory alkalosis?
-kidney tries to hold onto more H+ & excrete more bicarb --> urine will be alkalinized
269
Most common form of kidney damage seen in HIV pts?
- collapsing focal and segmental glomerulosclerosis
- AKA HIV-related nephropathy
- typical presentation:
1. Heavy proteinuria
2. Rapid development of renal failure
3. Can occur even with normal CD4 and viral load
270
Associated condition with acanthosis?
1. Insulin resistance
| 2. gI malignancy
271
Associated conditions with multiple skin tags?
1. Insulin resistance
2. Pregnancy
3. Crohn's disease (perianal)
272
2 Skin conditions associated with HIV infection?
1. Severe seborreic dermatitis
| 2. Sudden-onset severe psoriasis
273
What is the associated condition with an explosive onset of multiple itchy seborrheic keratoses?
1. GI malignancy
274
What are 2 skin conditions associated with GI malignancy?
1. Acanthosis nigricans
| 2. Explosive onset of multiple itchy seborrheic keratoses
275
Presentation of oral leukoplakia?
-white patches or plaques over the oral mucosa that cannot be scraped off
276
Risk factors for oral leukoplasia? What can it progress to?
- risk factors:
1. Smokeless tobacco
2. Alcohol use
- can progress to squamous carcinoma
277
How to calculate number needed to treat?
-inverse of absolute risk reduction = risk without drug/exposure - risk without drug/exposure
278
What is sympathetic opthamlmia? Pathophysiology?
- AKA: "spared eye injury"
- damage of one eye (the sympathetic eye) after a penetrating injury to the other eye via immune mediated inflammation
- caused by an immunologic mechanism that involves the recognition of "hidden" antigens
278
What is sympathetic opthamlmia? Pathophysiology?
- AKA: "spared eye injury"
- damage of one eye (the sympathetic eye) after a penetrating injury to the other eye via immune mediated inflammation
- caused by an immunologic mechanism that involves the recognition of "hidden" antigens
279
3 Ssx of diabetes insipidus?
1. Polyuria
2. Polydipsia
3. Excretion of dilute urine in the presence of elevated serum osmolality
280
2 Ssx of primary polydipsia?
1. Dilute plasma
| 2. Dilute urine
281
3 Ssx of SIADH?
1. Hyponatremia
2. Low serum osmolality
3. Inappropriately high urine osmolality = highly concentrated urine
282
Formula for anion gap calculation? Normal?
- AG = measured cations - measured anions
- AG = Na+ - (HCO3- + Cl-)
- normal = 6-12
283
What drugs can be used to tx/prevent chemo-induced nausea and vomiting?
- serotonin antagonists that block 5HT3 receptors
| - ex. Odansetron
284
Which skin cancer tends to be found above the upper lip on the face? Which is found on the lower lip and below on the face?
- upper = basal cell
| - lower = squamous cell
285
Typical presentation of a vitamin K deficient pt?
- pt who has been NPO for a prolonged period of time and receiving broad-spectrum antibiotics
- prolonged PT and PTT, but PT is more elevated
286
Myasthenia crisis: what is it? Tx?
- weakness of respiratory and pharyngeal muscles
| - tx: endotracheal intubation and withdrawal of anticholinesterases for several days
287
3 Possible Reasons for an elevated hematocrit in a competitive athlete?
1. Exogenous androgens
2. Autologous blood transfusions
3. EPO abuse
288
What are autologous blood transfusions?
- removal of multiple units of blood several weeks before a competitive event and then transfusing them back into the athlete a few days before the event
- net effect: increased hematocrit, oxygen-carrying capacity, and performance
- can be seen in competitive athletes
289
Where do Mallory-Weiss tears occur?
-submucosal arteries of the distal esophagus and proximal stomach
290
4 Characteristics/ssx of Creutzfeldt-Jakob dz?
1. Older pt (50-70 yrs)
2. Rapidly progressing dementia
3. Myoclonus
4. Periodic synchronous bi or triphasic sharp wave complexes on EEG
291
What should all sickle cell pts be supplemented with daily? Why?
- folic acid --> prevent macrocytic anemia
| - folate deficiency can occur bc of increased RBC turnover and increased consumption of folate in bone marrow
315
2 Herpes simplex keratitis signs on exam?
1. Corneal vesicles
| 2. Dendritic ulcers
316
5 Sx of herpes simplex keratitis?
1. Pain
2. Photophobia
3. Blurred vision
4. Tearing
5. Redness
317
What 4 things can precipitate a reoccurrence of herpes simplex keratitis?
1. Sun exposure
2. Outdoor occupation
3. Fever
4. Immunodeficiency
318
What is seen on epithelial scrapings in a pt with herpes simplex keratitis?
-multi-nucleated giant cells
319
What electrolyte disturbance is seen with DKA? Why?
- hyperkalemia
- paradoxical though, bc the body potassium reserves are depleted
- potassium moves out of the cell when H+ moves in --> so intracellular K+ is low, esp since insulin is needed to push K+ back into the cells
320
What is choriocarcinoma! When can it be seen?
- a form of gestational trophoblastic disease
- can occur after:
1. Normal gestation
2. Molar pregnancy --> most common
3. Abortion
321
Triad of ssx in all types of gestational trophoblastic disease?
1. Irregular vaginal bleeding
2. Enlarged uterus
3. Pelvic pain
322
How long is normal to have irregular vaginal bleeding post partum for? What should you be concerned about if it is longer?
- < 8 weeks is normal
| - if longer, be concerned about gestational trophoblastic disease
323
What are the 2 malignant forms of gestational trophoblastic disease? Are they local or metastatic?
1. Gestational trophoblastic neoplasm --> locally invasive
| 2. Choriocarcinoma --> highly metastatic --> esp to lungs (presents w/ pulmonary sx & hemoptysis)
324
What is the best way to confirm the dx of a choriocarcinoma?
-quantitative Beta HCG level
325
FEV1/FVC ratio in obstructive v restrictive lung dz?
- obstructive < 80%
| - restrictive > 80%
326
What is the first thing you do when managing a pt with suspected temporal arteritis?
- HIGH DOSE STEROIDS!!!!
| - do not wait to tx!!
327
Tx for a fib in an unstable pt?
-immediate cardioversion with DC
328
Bug responsible for osteomyelitis in pts with nail puncture wound?
-pseudomonas aeruginosa
329
Most common cause of osteomyelitis in adults and children?
-staph aureus
330
Gentamicin: what type of drug is it? What 2 sfx does that class have? What can gentamicin cause?
- aminoglycoside
- can cause:
1. Ototoxicity
2. Nephrotoxicity
- gentamicin can cause severe vestibulotoxicity that can result in potentially permanent vertigo and ataxia
331
Triad of ssx in post-streptococcal glomerulonephritis? When can it occur?
1. Periorbital swelling
2. Hematuria
3. Oliguria
- can be seen 10-20 days after strep throat or skin infections
332
What drug can be used tk limit ventricular remodeling following an MI?
-an ACEi
333
Dacryocystitis: what is it? Who is it usually seen in? 6 Ssx?
-infection of lacrimal sac
-usually seen in infants and adults > 40 yrs
-ssx:
1. Sudden onset of pain
2. Redness in medial canthal region of eye
3. Purulent discharge from punctum
Less common:
4. Fever
5. Prostration
6. Elevated WBCs
334
2 Common organisms that cause dacryocystitis?
1. Staph aureus
| 2. Beta-hemolytic strep
335
Tx for symptomatic sarcoidosis?
-glucocorticoids
336
Hepatitis A and B vaccinations during pregnancy?
- both are safe during pregnancy!
| - should both be given if someone has hep C
337
Rubella vaccination and conception?
-previously women were advised not to get pregnant within 3 mnths of vaccination, but there is no proof for that, so no recommendations now
338
Septic embolic and infectious endocarditis?
- in right sided endocarditis (IV drug users) can send emboli to lungs
- in left sided endocarditis can send emboli to blood rich organs (ex brain, kidneys, liver, & spleen)
- septic emboli predispose to abscess formation
339
Tx for TTP-HUS?
- plasmapheresis = plasma exchange
| - do ASAP!
340
TTP-HUS: what is it? Pathophysiology?
- thrombotic thrombocytopenic purpura-hemolytic uremic syndrome
- thought to be due to a deficiency or autoantibodies against a specific von Willebrand factor-cleaving protease --> causes an accumulation of lg vWf multimers + platele aggregation
341
Pneumonitis and colitis in a post-bone marrow transplant pt?
-Cytomegalo virus!
342
How is chloride-sensitive metabolic alkalosis classified? What is the most common pathophysiology?
- urinary chloride < 20 mEq/day
- common pathophys = usually due to an ECF volume contraction --> causes an increase in mineralocorticoid action --> bicarb retention, H+ and K+ loss --> urinary chloride level remains low bc the kidneys are retaining NaCl and water
- can be seen with thiazide or loop diuretics, or loss of gastric secretions (ex surreptitious vomiting - bulemia)
343
What drug should be avoided in acute glaucoma? Why?
- atropine
| - it can dilate the pupil and make the glaucoma worse!
344
4 Drugs that can be used to tx acute glaucoma?
1. Mannitol
2. Acetazolamide
3. Pilocarpine
4. Timolol
345
Question
20
345
What type of dz is chagas dz? What organism is it caused by?
- chronic protozoal dz
| - caused by Trypanosoma cruzi
346
What causes isolated systolic HTN?
-decreased elasticity in the arterial wall
347
What is Waldenstrom's Macroglobulinemia?
- rare
- chronic
- plasma cell neoplasm
- abnormal plasma cells multiply out-of-control and invade the bone marrow, lymph nodes, and spleen
- excess IgM in blood --> causes hyperviscosity of blood
348
7 Major Ssx of Waldenstrom's Macroglobulinemia?
1. Increased size of spleen, liver, and some lymph nodes
2. Tiredness, due to anemia
3. Tendency to bleed and bruise easily
4. Night sweats
5. Headache and dizziness
6. Various visual problems
7. Pain and numbness in extremities due to predominantly demyelinating sensorimotor neuropathy
349
Immunoglobulins seen increased in multiple myeloma?
-IgG or IgA
350
Formula for attributable risk percent (ARP)?
ARP = (RR-1)/RR
351
What is a t-test used for?
-compares the means of 2 groups
352
What test is used to compare the means of 2 groups?
-T-test
353
What is the ANOVA test used for?
-comparing 3 or more means
354
What test can be used to compare 3+ means?
-ANOVA
356
What is the best way to dx polymyositis?
-muscle bx
357
What is polymyositis? How does it typically present? Which 2 groups of muscles are usually spared?
- inflammatory muscle dz
- presents with slowly progressive proximal wkness of lower extremities
- soares:
1. Muscles of mastication
2. Facial expression muscles
358
6 Indications for hemodialysis?
1. Refractory hyperkalemia
2. Volume overload or pulmonary edema not responding to diuretics
3. Refractory metabolic acidosis (pH <7.2)
4. Uremic pericarditis
5. Uremic encephalopathy or neuropathy
6. Coagulation due to renal failure
359
Most important initial step in tx a pt w/ DKA?
-give normal saline and regular insulin
360
Mucopurulent urethral discharge in a pt with multiple partners?
-Chlamydia
361
What is the most common site of colon cancer mets?
-the liver
362
Why can alcoholics have hypocalcemia?
-excessive alcohol consumption --> predisposes to chronic pancreatitis --> malabsorption of vit D
363
Pathophysiology of Lithium-induced DI? Tx?
- lithium accumulation in the kidneys directly damages the renal tubules
- tx:
1. Amiloride --> prevents further lithium accumulation in the renal tubules
2. IV Normal saline --> for severe dehydration and hypotension
364
Organism that most commonly causes pneumonia in nursing homes?
-strep pneumo
365
2 Tx for cellulitis with systemic ssx?
1. Nafcillin
| 2. Cefazolin
366
What is the basic problem in nephrotic syndromes, and what 3 things can that lead to?
- problem: massive loss of protein in the urine that the liver can't keep up with by making more albumin
- consequences:
1. Edema
2. Hyperlipidemia
3. Hypercoagulability w/ thrombosis (esp in renal vein)
367
Tx for MS exacerbation?
-corticosteroids
368
2 best first line long term tx for MS?
1. Glatiramer
| 2. Beta-interferon
369
Pt on chronic suppressive MS tx who develops worsening neurological deficits and new white-matter hypodense lesions on MRI?
-most likely cause by chronic med Natalizumab
370
What is Natalizumab sometimes associated with causing in MS pts?
-PML = progressive multipack leukoencephalopathy
