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step II > medicine uworld > Flashcards

medicine uworld Flashcards

1
Q

prolonged activated PTT in a female

A

could be von willebrand factor

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2
Q

what is the presentation of DIC

A

marked by abnormal activation o the coagulation cascade and fibrinolysis. thrombocytopenia and elevated PT and PTT

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3
Q

vitamin K deficiency

A

prolonged PT and INR

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4
Q

hypercalcemia can cause joint accumulation, what is the shape of calcium crystals in a joint

A

rhomboid

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5
Q

what are needle shaped crystals in a joint space

A

usually have negative birefringence and this is gout. uric acid crystals

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6
Q

common causes of uveitis

A

herpes infections, toxoplasmosis, syphillis, sarcoidosis, spondylarthritis, inflammatory bowel disease

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7
Q

redness of the sclera, most prominent at the junction o the cornea and the sclera. pupillary constriction and photophobia

A

specific presentation of anterior Uveitis

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8
Q

treatment of uveitis

A

dilated eye drops (cyclpentolate), topical glucocorticoids

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9
Q

pyoderma gangrensum is what

A

neutrophilic dermatosis often seen in inflammatory bowel disease and arthropathies. lesions develop rapidly and begin as cutaneous papule or nodule that quickly matures into a painful, purulent ulcer with violaceous borders. fever is uncommon

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10
Q

what is the presentation of pseudomonas bacteremia

A

immunocompromised individual with gangerous skin lesions

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11
Q

what is ecthyma gangrenosum

A

punched out gangrenous ulcers caused by pseudomonas

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12
Q

skin rash with segmented hyphae

A

tinea corporis

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13
Q

how should skin fungal infections be managed

A

oral fluconazole, test for HIV, diabetes and watch for systemic glucocorticoid therapy

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14
Q

what is the presentation of lupus nephritis

A

50% of lupus patients. range of presentations from asymptomatic to rapidly progressive glomerulonephritis and end stage renal disease. low C3 and C4 levels. immune complexes of ANA and anti-DsDNA deposit in the mesangium and or the sub endothelial space triggering immune response and activating complement. the subendothelial deposits cause nephrotic syndrome

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15
Q

chemotherapy induced diarrhea treatment

A

loperamide

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16
Q

who should be given statin

A

patients with an estimated 10 risk of athersclerotic heart disease >7.5-10%; LDL≥190 and those age ≥40 with DM regardless

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17
Q

what is the treatment for uremic encephalopathy

A

urgent hemodialysis

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18
Q

what is a cause of false positive VDLR

A

antiphopholipid syndrome

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19
Q

treatment of antiphospholipid syndrome

A

LMWH

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20
Q

what is the treatment for giardiasis

A

metronidazole

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21
Q

what is the presentation of pagets

A

HEARING LOSS and bone pain. this is osteoclast dysfunction with increased bony turnover

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22
Q

what is the cause of osteomalacia

A

malabsorption of calcium

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23
Q

what is the cause of anemia of chronic disease

A

increased inflammatory cytokines

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24
Q

presentation of hypopituitarism

A

low T4, low cortisol and NORMAL aldosterone.
person would have low energy, cold intolerance, low libido, weight gain/loss, fatigue, dry skin, bradycardia, hypoglycemia

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25
Q

what is the treatment for MAC in AIDS

A

macrolide based combination therapy.

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26
Q

what are the CD4 counts for mAC

A

<50

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27
Q

what are the manifestations of MAC in AIDS

A

fever, weight loss, abdominal pain and diarrhea, ALD and hepatosplenomagaly. increase alk phophs

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28
Q

what is the treatment for toxoplasmosis

A

pyrimethamine based combination therapy

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29
Q

what drug has been shown to reduce cravings in patients with alcoholic liver disease and help with cessation

A

baclophen

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30
Q

why do kleinfelter patients have reduced testicular volume and infertility

A

semiferous tubule dysgenesis

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31
Q

what is the presentation of pemphigus vulgaris

A

blisters int eh mouth and on the trunk placid bullae and ulcers, nikloski signs positive, netlike IgG. tombstone cells at the basal layer

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32
Q

what is the treatment for pemphigus vulgaris

A

agggresive wound therapy, corticosteroids

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33
Q

what are the antibodies directed at for pemphigus

A

desmosomes desmogleins 1 and 3

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34
Q

what is bullous pemphigoid

A

autoimmune blistering disease that causes pruritic, tense bullae in the flexural surfaces of the groin, and axilla.

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35
Q

what is hepatic hydrothorax

A

this is when ascitic fluid passes through the defects in the diaphragm

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36
Q

what is the treatment for hepatic hydrothorax

A

salt restriction and diuretics; chest tubes are generally avoided. definitive treatment is liver transplant

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37
Q

what is HIV retinopathy

A

no floaters or blurred vision. causes cotton wool sets and are rarely hemorrhagic. they usually resolve within weeks to months

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38
Q

what is the presentation of CMV retinitis

A

most common end organ manifestation of CMV in patients with advanced AIDS. primarily when CD4 < 100. blurred vision and floaters, sensation of flashing lights. yellow white fluffy hemorrhagic lesions adjacent to the fovea and retinal vessels.

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39
Q

treatmetn for CMV retinitis

A

valgancyclovir then start antiretrovirals 2 weeks after infection

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40
Q

what is a cause of vitamin B12 deficiency

A

PPI use due to achlorhydria and inactivated pepsin from elevated stomach pH

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41
Q

what are the causes of gout

A

myeloproliferative disorder/lymphoproliferative, tumor lysis syndrome, hypoxanthine guanine phosphoribosyl transferase deficiency, CKD, thiazide/loop diuretic

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42
Q

subclavian steal sydnrome

A

refers to the subclavian artery stealing the blow from from the vertebral because of stenotic lesion proximal

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43
Q

what is wernickes encephalopathy

A

thiamine deficiency.

encephalopathy, oculomotor dysfunction (bilateral gaze abducens palsy, horizontal nystagmus), postural and gait ataxia.

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44
Q

what are the causes of wernickes

A

alcoholism, malnutrition, hyperemesis gravidarum

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45
Q

treatment for wernickes

A

thiamine and glucose

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46
Q

how to treat addissons disease with hypoaldosteronism

A

fludricortisone

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47
Q

treatment for addisons

A

hydrocortisone for cortisol replacement and mineralocorticoid replacement for aldosterone (fludricortisone)

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48
Q

what type of adenoma is the worst

A

villous adenoma.
adenomatous polyps carry increased malignant potential and warrant enhanced colonic surveillance large polyps >1 cm and adenomas with high grade dysplasia or villous features have greater malignant potential

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49
Q

what type of arrhythmia does mitral stenosis put you at risk for and what type of risk does that carry

A

a fib

stroke risk

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50
Q

what is the management of hypercalcemia

A

IVF, calcitonin, bisphosphonates

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51
Q

how to calculate the number needed to treat

A

1/ARR.

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52
Q

bronchietasis

A

linear ateleachtasis at the base of the lungs, hemoptysis, copious sputum production with recurrent infections

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53
Q

how do you diagnose bronchiectasis s

A

high resolution CT

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54
Q

what is the presentation of histoplamsa capsulatumn

A

most common endemic mycoses in US. exposure in the midwest (ohio and Mississippi River valley) and in the northeast. granuloma and narrow based budding yeast forms.

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55
Q

presentation of cocidioimycoses

A

Arizona and chest pain, cough, fever, fatigue. CXR normal or with unilateral infiltrate with ipsilateral hilarious LAD, spherules and endospores

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56
Q

what is the presnetation of blastomycosis

A

fungal infection caused by inhaling Blastomyces dermatitidis spores. fever, cough, night sweats, muscle pains, weight loss, chest pain, and feeling tired.

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57
Q

what is isoniazid peripheral neuropathy caused by

A

pyridoxine deficiency

will have sensory and proprioceptive changes as well as stocking glove

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58
Q

what causes mucosa and submucosal inflammation and crypt abscesses

A

ulcerative colitis

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59
Q

what blood disorders have RBCs without central pallor and how can you tell them apart

A

hereditary spherocytosis and autoimmune hemolytic anemia.

positive Coombs test

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60
Q

What is the presentation of rheumatoid and what are the treatmetn strategies

A

morning stiffness lasting more than hour, pain and swelling with redness. there will be joint erosions as opposed to narrowing DMARD ASAP.

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61
Q

what does urobilinogen indicate

A

acute intermittent porphyria.
abdominal pain, hyponatremia, loss of pain and DTRs, restlessness, hallucinations, autonomic dysfunction. elevated urinary porphrin levels confirm diagnosis

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62
Q

when is acute rejection and what mediates it

treatment

A

T cell, within the first 6 months
usually asymptomatic.
high dose glucocorticoids

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63
Q

osteomalacia is what

A

impaired osteoid mineralization.

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64
Q

what is the cause of osteomalacia

A

impaired vitamin D absorption, low calcium intake

elevated alphos, elevated PTH, decreased serum calcium and phosophorus can be seen, decreased urinary calcium

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65
Q

what is complex regional pain sydnrome

A

swelling, erythema, excruciating pain with skin changes, bone changes after an accident or break

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66
Q

what is a sign of intracranial hypertensino

A

blurry vision when you lean forward

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67
Q

what is the presentation of infective endocarditis

A

oslers nodes, janeway lesions, (painful finger pads), positive rheumatoid factor, passive joint pain, low grade fever, weight loss, fatigue, dyspnea, cough, valvular insufficiency, immune-complex mediated glomerular nephritis

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68
Q

what is a cure for tinea versicolor

A

selenium sulfide lotio

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69
Q

what are the ECG findings for long-standing hypertension

A

high voltage QRS, T wave inversions

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70
Q

what is the treatment for small intestine bacterial overgrowth sydnrome

A

rifaximin.

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71
Q

what is the most common complication of influenza infection

A

secondary bacterial infection/pneumonia

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72
Q

what are the risk factors for male breast cancer

A

family history BRCA, Klinefelter, obesity, cirrhosis, marijuana use

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73
Q

what is 95% of the population with respect to standard deviation

A

2 standard deviations from the mean

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74
Q

what is the treatment for sporitrichoiss

A

3-6 months of oral itraconazole

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75
Q

what is a sexual SE of opioids

A

decreased testosterone, suppresses GnRH and LH secretion and thus causes a secondary hypogonadism

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76
Q

pes anserinus pain syndrome (anserine bursitis)

A

localizes to the medial knee and is not associated valgus stress posivity. there is usually some pain on palpation.

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77
Q

what is the managment for pes anserinus

A

NSAIDs and quadriceps strengthening

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78
Q

dermatofibroma

A

nontender, discrete, firm, hyper pigmented, usually <1 cm dimpling in the center when the area is pinched

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79
Q

Hawthorne effect

A

when people change their behavior because they know they are being watched

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80
Q

what is a common cause or association with carpel tunnel

A

diabetes

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81
Q

supra scapular nerve injury

A

common in backpackers due to compression. causes rotator cuff weakness.

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82
Q

what is first line therapy for bleeding ulcers

A

PPIs have been shown to reduce bleeding and requirements for transfusion. However, histamine blockers like famotidine have not shown the same efficacy

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83
Q

aplastic anemia is caused by what

A

acquired deficiency of pleuripotent cells

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84
Q

what is familial dysautonomia (Rylie-day syndrome)

A

autosomal recessive found predominantly in askanazi Jews, and presents at birth with feeding problems and low muscle tone. characterized by gross dysfunction of the autonomic nervous system. no tears, orthostatic hypotension.

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85
Q

what is the presentation of multi system atrophy

A

Parkinsonism, autonomic dysfunction (postural hypotension, abnormal sweating, disturbances in bowel or bladder function, impotence, gastroparesis), widespread neurological symptoms (cerebellar, pyramidal, lower motor neuron)

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86
Q

diagnostic requirements for acute liver failure

A

severe liver injury AST/ALT > 1000, hepatic encephalopathy, synthetic dysfunction INR > 1.5

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87
Q

best way to diagnose chronic pancreatitis

A

CT scan abdomen

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88
Q

cauda equina

A

lower motor neuron findings, hyporeflexia, decrease sensation, saddle anesthesia, patchy sensory loss, rectal sphincter bladder hesitancy

more gradual with more mild back pain.
does not usually cause impotence.
usually bladder retention

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89
Q

conus medularis

A

hypertonia, spasticity, hyperreflexia, positive babinski
upper motor neuron findings
sudden onset with high level of back pain
impotence is frequent
usually urinary and fecal incontinence

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90
Q

what’s the management for erythema nodosum

A

inflammatory disorders. is associated with sarcoidosis, bacets, endemic fungus, TB
the initial workup should consist of CBC, liver function, renal function, antistreptolysin O, TB skin testing, chest CXR

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91
Q

what is the treatment for aspiration pneumonia

A

clindamycin and amoxicillin

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92
Q

what is the presentation of idiopathic intracranial hypertension

A

pseudotumor cerebra maybe a history of glucocorticoid use or exposure to vitamin A. OCPs are assocaited with IIH. it is caused by impaired absorption of CSF from arachnoid villi. blindness can occur if left untreated.

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93
Q

what are the complications of IIH

A

blindness is the most severe

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94
Q

what is the complication of sjrogens

A

corneal ulceration

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95
Q

what are the urinary symptoms of NPH

A

urgency/incontinence

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96
Q

what is the measure of sensitivity

A

the number of cases tested positive out of the real number of positive cases.
measure of picking up the cases that are positive.

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97
Q

what endocrinological disease is associated with primary biliary cholangitis

A

osteomalacia due to malabsorption of fat soluble vitamins

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98
Q

what is antimitochondrial antibodies associated with

A

primary biliary cholagnitis

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99
Q

what are the autoimmune liver disease antibodies

A

anti smooth muscle and antiLMK

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100
Q

what is the characteristic finding for drug0-indiuced liver injury

A

eosinophilia

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101
Q

what is the presentation of isoniazid induced liver injury

A

characteristically lacking eosinophils. panlobar mononuclear infiltrate and hepatic cell necrosis.

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102
Q

what is the presentation of anabolic steroid induced liver injury

A

cholestasis

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103
Q

what is the presentation of valproate liver injury

A

fatty liver

104
Q

what is the presentation of acetominophen induced liver injruy

A

toxic or fulminant liver injruy

105
Q

what is the presnetaion of allopurinol liver injury

A

granulomatous

106
Q

somatic symptom disorder

A

have prominent somatic symptoms such as abdominal pain, GI distress and sexual dysfunction).

107
Q

illness anxiety disorder

A

have little to no symptoms and are preoccupied with the idea that they may be sick. despite few or no symptoms at all and negative tests.

108
Q

what is conversion disorder

A

neurological symptoms incompatible with known disease

109
Q

what auscultation findings are associated with acute coronary syndrome

A

atrial gallop or S4.

110
Q

what is the S4 characteristic of

A

younger adults and children, acute coronary syndrome and ventricular hypertrophy
normal in healthy older adults

111
Q

what is the S3 associated with

A

fluid overload/heart failure. restrictive cardiomyopathy high output states

112
Q

when you decrease the sensitivity but increase the specificity what happens

A

the true positives decrease and the false negatives increase.

113
Q

what is the presentation of legionaries

A

GI symptoms, atypical pneumonia, central nervous system findings such as confusion. there will be no findings on gram stain as it is an intracellular gram negative rod.

114
Q

what is the treatmetn for legionaires

A

fluoroquinolone or macrolide.

115
Q

what is the booster for tetanus

A

tetanus and diphtheria Td

116
Q

what is the PEP for a puncture wound

A

depends on what their vaccination status is
if no vaccine in 5 years, then Td booster. If no Tdap in adulthood, then Tdap. If symptomatic or severe and dirty wound then TIG and tetanus toxoid.

117
Q

what is the schedule for tetanus vaccine

A

2,4,6, 15-18 months and 4-6 years. One adult Tdap and then Td every 10 years.

118
Q

what is the presentation of idiopathic pulmonary fibrosis

A

slowly progressive dyspnea, dry cough, and fine crackles usually with a smoking history, but not necessary. usually 50-70. restrictive pattern with decreased lung capacity and normal FEV/FVC. there will be reduced diffusion capacity

119
Q

what is the presentation of B12 def and what causes the symptoms

A

megaloblastic anemia, increased cell turnover due to immature megaloblasts. can present with a shiny tongue, anemia, dyspnea, fatigue.
this is caused by failure of DNA synthesis because B12 is a cofactor

120
Q

what are the features and presentation of chronic lymphocytic leukemia

A

lymphadenopathy, hepatosplenomegaly, mild thrombocytopenia and anemia, often asymptomatic. there will be severe lymphocytosis and smudge cells.
night sweats, fever, infections or weight loss also possible.

121
Q

what do you do if a solitary lung nodule is found on CXR

A

if less than 8cm with smooth margins most likely not malignant
however, if not on previous imaging, then do CT. if less likely on CT then follow up CT for 2-3 years to monitor growth. if suspicious biopsy.

122
Q

are the lungs effected in cardiac tamponade

A

not usually. as the right side is predominantly effected in tamponade there is a decrease propensity for the lungs to become affected by back up

123
Q

what is the diagnosis of bibasilar crackles in aortic dissection.

A

aortic valve insufficiency

if the valve is affected the patient will have severe orthopnea, lung involvement and hypotension

124
Q

what is some neurological signs of subarachnoid hemorrhage

A

severe, sudden onset headache. oculomotor nerve III palsy, CN II involvement can cause unilateral vision los cranial nerve IV can also be affected

125
Q

cavernous sinus thrombosis presents how

A

typically with fever, headache, periorbital swelling, there is usually CN III, IV and VI resulting in ophthalmoplegia

126
Q

what is the treatment for CNS toxoplasmosis

A

sulfadiazine and pyrimethamine with leucovorin

127
Q

presentation of CNS toxoplasmosis

A

multiple ring enhancing lesions, seizures, fever, jerky movements of the extremities

128
Q

what is villous atrophy

A

celiac

129
Q

what is villous atrophy

A

celiac

130
Q

what is initiated in atherosclosis patients

A

aspirin and statin

131
Q

what is beta blocker toxicity

A

hypoglycemia, hypotension, bradycardia, seizures, altered mental status

132
Q

why do beta blockers decreased glucose

A

prevents catecholamines from inducing glycogen breakdown

133
Q

treatment of beta blocker toxicity

A

airway support, gastric decontamination, IVF, atropine and glucagon

134
Q

labs for osteomalacia

A

increased PTH, decreased calcium and phoshorus

135
Q

what are some causes of osteomalacia

A

malabsorption, celiac sprue, intestinal bypass, CKD, chronic liver disease

136
Q

a fib with RVR in a hemodynamically UNSTABLE person

A

direct current cardio version

137
Q

subacute thyroiditis

A

usually secondary to a viral infection. diffuse tender thyroid with goiter. there will be elevated ESR, T4, low TSH,

138
Q

suppurative thyroiditis

A

rare. usually focal and euthyroid. tender thyroid

139
Q

when is the odds ratio a good predictor of relative risk

A

when the incidence of a disease is low; also good when the cases and controls are good predictors or representative of the individuals in the overall population

140
Q

what is a good preventative for migraine

A

topiramate, tricyclics, beta blockers, divalproex sodium

141
Q

what are abortives for migraines

A

triptans, NSAIDs, acetaminophen, antiemetics (metoclopramide prochlorperazine) and ergotamine

142
Q

what is associated with temporal arteritis giant cell arteritis

A

aortic aneurysm

Polymyalgia Rheumatica

143
Q

who gets treated for TB based on skin testing ≥5mm

A

HIV postive, recent contacts with known TB, nodular or fibrotic changes on CXR consistent with previous TB, organ transplant recipients.

144
Q

who gets treated for TB based on skin testing ≥10mm

A

recent imigrant, injection drug users, resident and employee of high risk setting, micro bacteriology lab personnel, higher risk for TB reactivation (DM, leukemia, ESRD, malabsorption syndromes) children under the age of 4 exposed to adults

145
Q

who gets treated for TB based on skin testing ≥15mm

A

everyone

146
Q

what is the cause finger clubbing

A 
occult malignancy (lung), cystic fibrosis, and left to right pulmonary shunts. 
connective tissue proliferation at the nail bed.
147
Q

why does niacin cause flushing and pruritus

A

due to vasodilation and the release of histamine and prostaglandin

148
Q

what is the course of leukoplakia

A

usually progresses to squamous cell within in ten years

149
Q

how do you diagnose avascular necrosis of the hip

A

MRI

150
Q

what is the best medication for cancer induced loss of appetite

A 
magestrol acetate (progesterone analog) 
medoxyprogesterone acetate
DO NOT USE CANNABIS analogues. not as effective.
151
Q

what is the treatment for hiv cachexia

A

cannaboids can be used

152
Q

who is contraindicated for sildenafil

A

people taking nitrates or alpha blockers

153
Q

what is the treatment of choice for erectile dysfunction in someone with acute coronary syndrome/cardiovascular disease

A

sildenafil -safe and effective. first like therapy

second line alprostadil

154
Q

what is the cause of anemia in someone with chronic lymphocytic leukemia, high reticulocyte count

A

immune mediated hemolysis

this is warm agglutination disease more common in SLE and CLL

155
Q

the positive predictive value is calculated how

A

number really positive/number positive from the test (this includes false positive)

156
Q

what is responsible for the highest proportion of medical errors

A

communication failure between providers

157
Q

what is the physiological defense from hypoglycemia as blood sugar decreases

A

decreases in insulin, increases in glucagon, increase in epinephrine, increased cortisol and growth hormone.

158
Q

people with cystic fibrosis also have decreased what in their blood making them susceptible top hypoglycemia

A

glucagon

159
Q

what is the best treatment for rosacea

A

avoidance of sun exposure, hot spicy foods, alcohol. topical metronidazole. second line oral tetracyclines

160
Q

when does a ventricular wall rupture usually happen

A

5days -2weeks

161
Q

when does a papillary muscle rupture occur

A

3-5 days after an MI

162
Q

what are the labs for pagets

A

normal calcium and phosphate high alkphos and urine hydroxyproline

163
Q

treatment for pagets

A

bisphosphonate

164
Q

what can stop the formation of uric acid stones

A

potassium citrate

165
Q

what is the mechanism of high altitude sickness

A

headache, nausea, fatigue, lightheadedness, and dyspnea due to hypoxemia that results from the low partial pressure of O2 at high altitude. hyperventilation is the most immediate and important response to high altitude. hyperventilation causes respiratory alkalosis. the kidneys respond by trying to excrete bicarb, but this take 72 hours to compensate. azetozolamide does this quicker by inhibiting carbonic anhydrase

166
Q

what is associated with pernicious anemia overtime

A

gastric cancer

167
Q

chronic hyperthyroid can result in what muscular tissue disorder

A

hyperthyroid myopathy. muscle weakness , especially in the proximal muscles

168
Q

what is the difference between case control and retrospective cohort

A

case control compares risk factor frequency between cases and controls.
retrospective cohort reviews past medical records and assesses risk factors and disease incidence

169
Q

where is the likely location of pure sensory stroke

A

thalamus. usually lacunar strokes and posterior cerebral artery branches

170
Q

who gets Hodgkin’s lymphoma

A

15-35 and >60

171
Q

what are the manifestations of hodgkins

A

painless lymphadenopathy, mediastinal mass, B symptoms and pruritus

172
Q

what is the treatment for legionella

A

fluoroquinolone levofloxacin

173
Q

what is the most common cause of constrictive pericarditis in developing countries or endemic areas like china, Africa, and India

A

TB.

174
Q

what is the most common cause of pericarditis in the US

A

viral and radiation therapy and cardiac surgery

175
Q

what are the risk factors for high output cardiac failure

A

morbid obesity, arteriovenous fistula, hyperthyroidism, pagets disease

176
Q

what are the clinical findings of high output cardiac failure

A

hyperedynamic circulation, bounding pulses and increased pulse pressure, peripheral and pulmonary edema, laterally displaced PMI.

177
Q

what is the cause of high output cardiac failure

A

reduced systemic vascular resistance. this causes increased preload. eccentric hypertrophy of the left ventricle will laterally displace the PMI. there is usually a systolic murmur due to high flow.

178
Q

will vasovagal syncope have a slow pulse

A

yes neurocardiogenic syncope will have a weak pulse

179
Q

who is at risk for anaphylaxis

A

people with asthma and aczema

180
Q

what are the most likely causes of brain abscess

A

staph aureus, strep viridens, anaerobes.

usually caused by direct spread from otitis media, mastoiditis, sinusitis

181
Q

treatment of Polymyalgia Rheumatica

A

low dose steroids; rapid and thorough relief is expected.

182
Q

what is the presentation of polymyalgia

A

stiffness of the major joint girdles in the morning. elevated ESR, age of onset usually >50.
watch for giant cell arteritis

183
Q

what is the characteristic digoxin arrhythmia

A

atrial tachycardia and AV block

184
Q

what are the antivirals for Hep C infection

A

sofosbuvir-velpatasvir

185
Q

what are the symptoms of chronic hep C

A

usually asymptomatic

186
Q

what do pleural plaques suggestr

A

asbestosis

187
Q

what is clorthalidone and what is the most likely SE

A

thiazide diuretic

hyperglycemia, hypomagnesemia, gout

188
Q

what does pronator drift indicate (when pronation > supination)

A

upper motor neuron or pyramidal tract lesions

189
Q

what is eplerenone

A

potassium sparing diuretic usd for excessive aldosterone

better used in men, less SE than spironolactone which can cause gyncomastia

190
Q

what would you expect renin activity to be in someone with primary hyperaldosteronism

A

LOW…. thats the difference between between secondary and primary.

191
Q

what is the cause of erysipelas

A

group A strep pyogenes

192
Q

what is the presentation of polyarteritis nodosa

A

casuses lesions similar to erythema nodusum but is assoicated with fever, arthalgias, weight loss. renal insufficiency, abdominal pain and mononeuritis multiplex. aneurysms that look like beads on a string

193
Q

what is the treatment for acute pericarditis

A

ibprophen and colchicine

194
Q

what will the labs be for exogenous steroid use

A

low LH and normal testosterone because the exogenous will reduce the normal testosterone and thus the level looks normal.

195
Q

what are the FSH and LH levels in klinefelters

A

high

196
Q

what is tricuspid valve murmur for drug users

A

holosystolic murmur that increases with inspiration. this is tricuspid valve involvement
this is tricuspid regurg which increases with inspiration

197
Q

what is the difference in esophageal findings between achalasia and systemic sclerosis

A

achalasia is increased LES pressure and incomplete LES relaxation. systemic sclerosis is fibrosis of the lower esophagus with aperistalsis

198
Q

what is the cause of sick sinus syndrome

A

cardiac conduction degeneration

199
Q

what is milk-alkali syndrome

A

essentially hypercalcemia symptoms. risk factors are thiazide diuretics. caused by excessive calcium and absorbable alkali (calcium carbonate solutions for osteoporosis).
results in hypomagnesemia, metabolic alkalosis, acute kidney injury

200
Q

what is the next step if perforated viscous is suspected

A

upright chest and abdominal x ray which show pneumoperitoneum

201
Q

disruption of lymphatics results in what clinical finding

A

inability to pinch the skin.

this is lymhpoedema

202
Q

what is the management for syphillis in someone with penicillin allergy

A

doxycycline

desensitization is performed in pregnancy.

203
Q

what is the source of calcium oxalate stones in a homeless person

A

ethylene glycol

204
Q

what is the medication that treats ethylene glycol poisoning

A

fomepizole

205
Q

what is the medication that treats ethylene glycol poisoning

A

fomepizole

206
Q

primary hyperparathyroidism

A

mildly elevated calcium, normal to low phosphorus, significantly elevated PTH, kidney stones, osteoporosis, nausea, constipation and neuropsychiatric symptoms

207
Q

secondary hyperparathyroidism

A

increased secretion of PTH due to hypocalcemia, common in chronic kidney disease, due to inadequate phosphate excretion and low vt D levels. serum phosphorus will be high and calcium will low normal

208
Q

presentation of wilsons

A

hepatic failure, Parkinsonism, gait disturbance, dysarthria, depression, personality changes, psychosis, decreased ceruloplasmin,

209
Q

treatmetn for Wilsons

A

d-penicillamine or Tridentine

zinc can be used to decreased copper absorption

210
Q

what are the most likely causes of watery diarrhea (travelers diarrhea)

A

bacterial and viral are most common. cryptosporidium parvum and giardiasis are the most common for prolonged watery diarrhea

211
Q

what is the cause of purulent conjunctivitis that reaccumulates after wiping

A

staph aureus. usually bacterial. especially if the purulence reaccumulates after wiping

212
Q

what are the criteria for extubation

A

pH > 7.25, adequate oxygenation with minimal support. intact inspiratory effort and sufficiency mental status to protect airway

213
Q

can bronchitis cause hemoptysis

A

yees.

214
Q

what is the presnetation of thyroid storm

A

high fever, tachycardia, hypertension, CHF, agitation, delirium, seizure, coma, lid lag, tremor

215
Q

what can precipitate thyroid storm

A

iodine load from contrast

216
Q

what is the cause of membranoproliferative glomerulonephritis

A

C3 nephritic factor perpetually activates complement and causes the deposition of C3 into the membrane causing nephrotic sydnrome

217
Q

what is diagnosis if someone has marfanoid habitus with neurocutaneous nodules

A

MEN2B

218
Q

what is the treatment for strep viridans infective endocarditis

A

usually susceptible to penicillin. can treat with IV pen G or ceftriaxone which has easier dosing

219
Q

what is the presentation of an inferior infarct involving the rt ventricle

A

hypotension, increased right ventricular preload.

DO NOT GIVE NITRATES

220
Q

what is the presentation of inferior lead infarct involving the left ventricle/septum and papillary muscle rupture

A

murmur, BP okay, mitral regurg with increase LEDV and pulmonary symptoms due to blood backup

221
Q

what is the def of prerenal

A

> 20

222
Q

what is the post renal def

A

<15

223
Q

what is the cause of sudden high frequency hearing loss

A

cochlear hair cell loss/damage. this is sensorineural

224
Q

what do beta adrenergic agonists do to potassium

A

they cause a potassium shift into the intracellular space.

225
Q

what is the treatmetn for seborrheic dermatitis

A

topical antifugals ketoconazole or selenium sulfide

226
Q

reactive arthritis

A

urethritis, conjunctivitis, mouth ulcers, joint pain.

treat with NSAIDs

227
Q

how long does it take to get lab changes from iron therapy of microcytic anemia

A

2-4 weeks

228
Q

if someone has microcytic anemia that is not responsive to iron therapy what should you look for

A

thalassemia

229
Q

what is the presentation of severe acute pancreatitis

A

can cause severe hypfotension due to intravascular permeability.

230
Q

when do women get mammography

A

50-74 every 2 years

231
Q

when do women get paps

A

21-65 every 3

232
Q

when do you get colonscopy

A

50-75 every 10

233
Q

when should you get a lipid if healthy

A

every 5 years. men starting 35 and women starting 45

234
Q

what is the presentation of masked hypertensino

A

arteriovenous nicking in the retina, left ventricular hypertrophy. normal in office blood pressures.

235
Q

what is the presntation and cause of sarcoidosis

A

hypercalcemia, cough with reticualr opacities in the lungs. systemic graulomatous inflammation

236
Q

when do you give potassium in HHS

A

when the potassium is less than 5.3

237
Q

blastomycoses

A

rib notching, cough, verucous skin lesions, cough, fever, weight loss. upper lobe lung lesions and general presentation will be reminiscent of TB and histoplasmosis

238
Q

why do we give sodium bicarb to TCA OD

A

to alleviate depressant action on myocardial sodium channels

239
Q

what is the indication for sodium bicarb treatment in TCA OD

A

QRS interval > 100

240
Q

what is the most likely cause of death in TCA OD

A

cardiac toxicity

241
Q

what are the SE of amitriptyline

A

dry mouth, constipation, urinary retention (anticholinergic), lethargy, orthostatic hypotension

242
Q

If you have a patient taking amiodarone and digoxin what must be done

A

reduce digoxin by 25-50% or toxicity

243
Q

after the clinical suspicion of acromegaly what is the next stewp

A

IGF levels

244
Q

how to diagnose acromegaly

A

has to have elevated IGF, oral glucose suppression has to inadequately suppress GH and then MRI for pituitary

245
Q

what are the early signs of meningitis

A

nonspecific fever, myalgia, muscle aches. similar to flu

246
Q

what are the features of hemochromatosis

A

cardiomyopathy, diabetes, joint pain, hypopituitarism and secondary hypogonadism.

247
Q

what is lateral medullary syndrome

A

vestibular nucleus vertigo, diplopia nystagmus, vomiting, ipsilateral loss of facial pain and temperature diminished gag reflex and dysphagia with dysphonia. contralateral loss of trunk and extremity pain and temperature.

248
Q

what to treat Lyme disease in pregnancy

A

amoxicillin

249
Q

what are the guidelines for FAP screening

A

10-12 years old begin screening with colonoscopy followed by annual once polyps are discovered.

250
Q

what is the presentation of CMV colitis in HIV

A

frequent small volume diarrhea, hematochezia, abdominal pain, low-grade fever, weight loss

251
Q

what is essential tremor

A

progressively worsening tremor of the upper extremities that becomes more pronounced with extension of the arms. worsens more at the end of an intended action.
no further neurological deficits and positive family history

252
Q

what is intention tremor

A

Coarse hand tremor with a frequency of < 5 Hz
Worse with goal-directed movements
Other cerebellar signs
Dysmetria (abnormal heel-to-shin and finger-to-nose testing)
Dysdiadochokinesia(inability to perform rapid alternating hand movements)
Dysarthria, nystagmus and abnormal gait
Diagnosis
CT/MRI: cerebellar lesions
IgG in CSF if multiple sclerosis is suspected
Screen for alcohol abuse or toxic lithium blood levels

253
Q

treatment for intention tremor

A

propanolol

254
Q

what improves essential tremor.

A

alcohol

255
Q

what are the differences between tremors

parkinson (resting), essential, intention

A

Parkinson’s or resting occurs at rest and has features such as rigidity and bradykinesia. this improves with movement.

essential will have a normal neurological exam except for head tremor that mild. also highly hereditary. improves with alcohol, beta blockers and primidone.

intention tremor will have other findings as well on exam. Ataxia, hypotonia, gait instability, difficulties with rapid movements, dysarthria, nystagmus

step II (22 decks)

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