Medicine U World Flashcards
Where can the murmur for hypertrophic obstructive cardiomyopathy be heard best?
-lower left sternal border
Aortic stenosis in a young pt?
-usually due to congenital bicuspid valve
Chest pain and aortic stenosis?
- due to increased myocardial oxygen demand
- usually seen with LVH too!
2 diseases that spherocytes can be seen in?
- Hereditary spherocytosis
2. Autoimmune hemolytic anemia
Hereditary sphereocytosis v. Autoimmune hemolytic anemia: genetics & coomb’s test?
- spherocytosis: autosomal dominant + negative coomb’s
- AIHA: not hereditary + positive coomb’s test (usually)
Osteomyelitis: what is it? 2 categories?
- inflammatory destruction of bone due to infection
- categories:
1. Hematologic spread
2. Direct spread
Vertebral osteomyelitis: ssx?
- low grade fever (high grade fever and chills NOT common)
- Elevated ESR
- Local tenderness on percussion
- Paravertebral muscle spasms
Dx of vertebral osteomyelitis?
- MRI is the best!
- early diagnosis is important! Delay –> epidural abscess and spinal cord compression
Most effective and rapid abortive tx for cluster headaches?
-100% oxygen!
Dx of diverticulitis?
-CT scan of the abdomen is the best, especially is complications of abscess or perforation are suspected
Prefered tx for pts with hyoerthyroidism? 2 contraindications?
- radioactive ablative therapy
- contraindications:
1. Pregnancy
2. Severe opthalmopathy
Triad of sx in carcinoid syndrome?
- Flushing
- Valvular heart disease = murmur
- Diarrhea
What vitamin/mineral deficiency are pts w/ carcinoid syndrome at risk for? Why?
- 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!
What vitamin/mineral deficiency are pts w/ carcinoid syndrome at risk for? Why?
- 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!
3 ssx of niacin deficiency?
- Diarrhea
- Dermatitis
- Dementia
* * 3 Ds!
4 ssx of acute hemolytic transfusion reaction? When does it occur?
- Fever
- Chills
- Flank pain
- Hemoglobinuria
- occurs within an hour of the start of the transfusion
What is the most common rxn to transfused blood products? What is the cause?
- febrile nonhemolytic rxn
- due to a rxn to cytokines stored in the transfused blood products
- when blood is stored leukocytes release cytokines
3 Ssx of febrile nonhemolytic rxn to blood transfusion?
- Fever
- Chills
- Malaise
Acute hemolysis that develops after the use of primaquine or sulfa drugs?
-G6PD deficiency
G6PD levels during a hemolytic episode in a deficient ot?
-can be normal
Reason for the “shifting” of the abdominal pain with acute appendicitis?
- 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
Recurrent bacterial infections in an adult: what can be a cause? Dx?
- humoral immunity defect
- do a quantitative measurement of serum immunoglobulin levels
3 Common precipitants of pseudogout?
- Trauma
- Surgery
- Medical illness
* *can be idiopathic too!
3 Common precipitants of pseudogout?
- Trauma
- Surgery
- Medical illness
* *can be idiopathic too!
3 Common precipitants of pseudogout?
- Trauma
- Surgery
- Medical illness
* *can be idiopathic too!
2 ssx of aortic dissection?
- Severe chest pain that radiates to the back
2. Widened mediastinum on CXR
4 Ssx of cardiac tamponade?
- Hypotension
- Tachy
- Distended neck veins
- Pulsus paradoxis
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
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
Shoulder pain that doesnt decrease with lidocaine injection?
-rotator cuff TEAR
4 Causes of hypokalemia, alkalosis, + normotension?
- Surreptitious vomiting
- Diuretic abuse
- Bartter syndrome = defect in thick ascending limb of loop of henley
- Gitelman’s syndrome = milder version of bartter’s syndrome
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
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
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
Where is tropical sprue endemic to? Minimum amnt of time a pt has to live there to suspect it?
- Puerto Rico
- >1 mnth
9 Ssx of tropical sprue?
- Fatty diarrhea
- Cramps
- Gas
- Fatigue
- Progressive weight loss
- Malabsorption of nutrients –> esp vit B12 and folate –> megaloblastic anemia
- Hyperactive bowel sounds
- Borboygmi
- Flattening of intestinal villi seen on bx
Borborygmi?
-a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
Borborygmi?
-a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
Unique sfx of rifampin?
- red/orange urine
- benign
Ssx of a intracardiac tumor?
- Mid-diastolic murmur heard best at the apex
- Mass
- Low-grade fevers
- Weight loss
- Weakness due to embolization
What type of intracardiac tumor is most common? Where is it found?
- atrial myxomas
- most commonly found in left atrium (80%)
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
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
What should you do if a pt has an elevated D-dimer test result?
-get a compression ultrasonography for suspected DVT
What should you do if a pt has an elevated D-dimer test result?
-get a compression ultrasonography for suspected DVT
What should you do if a pt has an elevated D-dimer test result?
-get a compression ultrasonography for suspected DVT
What should be done if the D-dimer test result is low?
-nothing –> the patient is unlikely to have a DVT
What should be done if a compression ultrasonography is positive for a DVT?
-tx w/ heparin and warfarin!
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
2 Common presenting ssx of pancreatic cancer that is located in the body or the tail?
- Upper abdominal pain that radiates to the back
2. Weight loss
2 Common presenting ssx of pancreatic cancer that is located in the body or the tail?
- Upper abdominal pain that radiates to the back
2. Weight loss
3 Common ssx of pancreatic cancer in the head of the pancreas?
- Steatorrhea
- Weight loss
- Jaundice
Labs in a pt with pancreatic cancer?
- ^^ serum bilirubin
- ^^ alk phos
- Mild anemia
What is a useful lab test for the indication of dehydration?
-the BUN/creatinine ratio
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
3 symptoms of pulmonary congestion?
- Exertional dyspnea
- Nocturnal cough
- Hemoptysis
What arrhythmia are pts with mitral stenosis at risk for developing? Why?
- a fib
- bc the LA becomes dilated
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
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
6 sx of hypercalcemia of malignancy?
- Confusion
- Lethargy
- Fatigue
- Anorexia
- Polyuria
- Constipation
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
Antiarrythmic that causes pulmonary fibrosis?
-amioderone
5 sfx of amioderone?
- Pulmonary fibrosis
- Thyroid dysfctn –> hyper or hypo
- Hepatotox
- Corneal deposits
- Skin discoloration –> smurfs!!
5 sfx of amioderone?
- Pulmonary fibrosis
- Thyroid dysfctn –> hyper or hypo
- Hepatotox
- Corneal deposits
- Skin discoloration –> smurfs!!
Tx for acute hepatic encephalopathy?
- Lactulose –> lowers the blood ammonium level
2. Reduced-protein diet
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
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
What 4 effects does aldo have on the distal tubukes?
- Reabsorption of sodium
- Volume expansion
- Secretion of K+
- Secretion of H+
4 ssx of primary hyperaldo (Conn’s syndrome)?
- HTN
- Mild hypernatremia
- Hypokalemia
- Metabolic alkalosis
4 ssx of primary hyperaldo (Conn’s syndrome)?
- HTN
- Mild hypernatremia
- Hypokalemia
- Metabolic alkalosis
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
What 4 things can be seen in an eye exam of a pt with diabetic background, or simple, retinopathy?
- Microaneurysms
- Hemorrhages
- Exudates
- Retinal edema
What is seen on an eye exam in a pt with diabetic pro-proliferative retinopathy?
- Cotton wool spots
What can be seen on an eye exam in a pt with diabetic proliferative, or malignant, retinopathy?
- Newly formed vessels
What js the tx of choice for diabetic retinopathy? What does it do?
- argon laser photocoagulation
- prevents complications
6 ssx of theophylline toxicity?
- Headache –> CNS stim
- Insomnia –> CNS stim
- Seizures –> CNS stim
- Nausea –> GI disturbance
- Vomiting –> GI disturbance
- Arrhythmia –> cardiac tox
4 ssx of Fibromyalgia?
- Wide spread musculoskeletal pain
- Fatigue when awaking from sleep & in the mid-afternoon
- Cognitive difficulties –> esp attention/tasks requiring rapid thought changes
- Nonspecific GI sx
Describe the rash of rubella
- erythematous
- maculopapular
- starts on the face and progresses to the trunk and extremities
Describe the rash of rubella
- erythematous
- maculopapular
- starts on the face and progresses to the trunk and extremities
Typical lymphadenopathy in rubella?
-posterior cervical and occipital
5 Ssx of rubella?
- Maculopapular erythematous rash that starts on the face and progresses down
- Fever - prodromal
- Lymphadenopathy –> posterior cervical and occipital - prodromal
- Malaise - prodromal
- Arthritis –> can be seen in adult women
Factorial study design?
- 2 or more experimental interventions
- with 2 or more variables that are independently studied
P value with a 95% confidence interval?
- p value < .05
- does not include the null value
3 Ssx of nephrotic syndrome?
- High-range proteinuria
- Hypoalbuminemia
- Edema
What type of kidney dz is a common complication of hodgkin’s lymphoma?
- nephrotic syndrome –> esp. Minimal change dz
- focal glomerulosclerosis can also occur
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
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
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
6 Ssx of acute prostatitis?
- Urinary urgency
- Dysuria
- Positive leukocyte esterase
- Pain of the perineal region
- Tender prostate
- Boggy prostate
What 2 medications are known to cause priapism as a sfx?
- Trazadone
2. Prazosin
5 Ssx of digoxin toxicity?
- Nausea
- Vomiting
- Diarrhea
- Vision changes –> blurry vision w/ changes in color
- Arrhythmias
Describe tricuspid regurg murmur
-holosystolic murmur that increases with inspiration
Describe tricuspid regurg murmur
-holosystolic murmur that increases with inspiration
Palpable mass that forms in the epigatrium 4 weeks after the onset of acute pancreatitis?
-pancreatic pseudocyst
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
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
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
What are 2 conditions that chronic GERD predisposes pts to?
- Barrett’s esophagus
- Benign peptic esophageal strictures
* *both are a consequence of the body’s reparative response
* *can occur simultaneously
What are 2 conditions that chronic GERD predisposes pts to?
- Barrett’s esophagus
- Benign peptic esophageal strictures
* *both are a consequence of the body’s reparative response
* *can occur simultaneously
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
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!
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!
4 Clinical features of primary sclerosing cholangitis?
- Fatigue
- Pruritis
- Most pts are asymptomatic at dx
- 90% of pts have underlying inflammatory bowel dz (esp. UC)
4 Clinical features of primary sclerosing cholangitis?
- Fatigue
- Pruritis
- Most pts are asymptomatic at dx
- 90% of pts have underlying inflammatory bowel dz (esp. UC)
Primary sclerosing cholangitis: pathophysiology?
- unknown etiology
- chronic
- inflammation, fibrosis, and stricturing of medium-sized and lg intrahepatic and extrahepatic bile ducts
Primary sclerosing cholangitis: pathophysiology?
- unknown etiology
- chronic
- inflammation, fibrosis, and stricturing of medium-sized and lg intrahepatic and extrahepatic bile ducts
What type of anemia is lead poisoning?
-microcytic anemia
What is the most reliable index for monitoring the response of tx in DKA?
-serum anion gap
What is the most reliable index for monitoring the response of tx in DKA?
-serum anion gap
What type of diuretics can have ototoxic sfx?
-loop diuretics
Beat-to-beat variations in QRS axis and amplitude?
-due to the swinging motion of the heart in the pericardium with pericardial effusion
Beat-to-beat variations in QRS axis and amplitude?
-due to the swinging motion of the heart in the pericardium with pericardial effusion
What percentage in 1 SD?
-68%
What percentage in 1 SD?
-68%
What percentage in 2 SDs?
-95%
What percentage in 3 SDs?
-99.7%
What percentage in 3 SDs?
-99.7%
Most common cause of hypercalcemia of malignancy?
-parathyroid hormone-related peptide (PTHrP) production by the tumor
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
What 2 things should pts with cirrhosis be screened for regularly?
- Esophageal varices –> via endoscopy
2. Hepatocellular carcinoma –> via ultrasound
What effects does alcohol-related heart dz have on the structure of the heart?
-causes dilated cardiomyopathy
Cardiac effects of amyloidosis?
-can cause restrictive cardiomyopathy –> thickened ventricular walls + preserved ventricular dimensions
What deficiency can pre-dispose to anaphylactic rxns to blood transfusions?
-IgA deficiency
2 most common sx of PE?
- Acute onset of shortness of breath
2. Pleuritic chest pain
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
Presentation of renal vein thrombosis?
- sudden onset of:
1. Abdominal pain
2. Hematuria
3. Fever
What nephrotic syndrome is renal vein thrombosis most common in?
-membranous glomerulonephritis
What nephrotic syndrome is renal vein thrombosis most common in?
-membranous glomerulonephritis
What are 2 signs of poor prognosis in a PE?
- Atrial fibrillation
2. Low oxygen saturation
What are 2 signs of poor prognosis in a PE?
- Atrial fibrillation
2. Low oxygen saturation
What are 2 signs of poor prognosis in a PE?
- Atrial fibrillation
2. Low oxygen saturation
What are 2 signs of poor prognosis in a PE?
- Atrial fibrillation
2. Low oxygen saturation
3 typical features of Creutzfeldt-Jakob disease?
- Rapidly progressive dementia
- Myoclonus
- Sharp, triphasic, synchronous discharges on EEG
3 typical features of Creutzfeldt-Jakob disease?
- Rapidly progressive dementia
- Myoclonus
- Sharp, triphasic, synchronous discharges on EEG
3 typical features of Creutzfeldt-Jakob disease?
- Rapidly progressive dementia
- Myoclonus
- Sharp, triphasic, synchronous discharges on EEG
3 typical features of Creutzfeldt-Jakob disease?
- Rapidly progressive dementia
- Myoclonus
- Sharp, triphasic, synchronous discharges on EEG
Classic triad of ssx for reactive arthritis?
- Nongonococcal urethritis
- Asymmetric oligoarthritis
- Conjunctivitis
First line tx for the acute phase of reactive arthritis?
-NSAIDS
What is the most common cause of painless hematuria in adults?
-bladder tumors
4 ssx of empyema?
- Fever
- Cough –> nonproductive or productive
- SOB
- Pleuritic chest pain
What does an S4 indicate?
- stiff ventricle
- seen with restrictive cardiomyopathy or LVH from prolonged HTN
Nocardia microbio features?
- gram-positive
- weakly acid-fast
- filamentous
- branching rod
What medication is contraindicated in a STEMI? Why?
- nifedipine (and other dihydropyridines)
- causes vasodilation and reflex tachy –> worsens ischemia
- does not improve survival
What medication is contraindicated in a STEMI? Why?
- nifedipine (and other dihydropyridines)
- causes vasodilation and reflex tachy –> worsens ischemia
- does not improve survival
What medication is contraindicated in a STEMI? Why?
- nifedipine (and other dihydropyridines)
- causes vasodilation and reflex tachy –> worsens ischemia
- does not improve survival
Heparin and acute MIs?
-heparin is indicated in ALL acute MI pts!