MedStudy Board-style Q+A's Flashcards
Younger, intermittent dysphagia, solids not liquids, not progressive
Schatzki ring, do EGD
Rectal bleeding with cramps
Ischemic colitis, do flex-sig
Chronic diarrhea + GERD + Ulcers
Zollinger-Ellison syndrome, check gastrin level off PPI
Familial polyposis coli- what surveillance?
Scope any rectum remaining after surgery, also EGD for gastric or proximal small bowel malignancies
Common cause pill esophagitis
doxycycline. Rx supportive measures
Older with watery diarrhea, mild cramping, abdominal pain
Microscopic colitis, dx with colonoscopy with biopsy
Younger, recurrent severe GI bleeds, negative scopes
Meckel’s diverticulum; dx nuc med scan; rx surgery
Hospitalized pt with MSOF, on TPN, US shows thickened GB wall with surrounding fluid, no stones
Acalculous cholecystitis; place percutaneous cholecystostomy tube
Hep C with normal LFT’s- what rx?
No rx at this time
Gastric bleed with visible vessel- rx?
Endoscopic rx with heater probe to the vessel
Food poisoning: Chinese restaurant, fried rice; 4-6 hours after, diarrhea, vomiting
B. cereus
Food poisoning: food left out at a picnic, mayonnaise
Staph aureus
Food poisoning: fast food hamburgers
E. coli 0157:H7
Lung mass, draining cutaneous lesion, budding yeast
Ohio/Mississippi basins: Blastomycosis
Southwest: Coccidioidomycosis
Rx itraconazole, amphoB if severely ill
Treatment Pulmonary Arterial Hypertension
Warfarin, oxygen, calcium channel blockers, oral endothelin receptor antagonists, PDE inhibitors, prostacyclin analogues
Causes decreased DLCO
Emphysema, interstitial inflammation and fibrosis, edema, infections; also reduced capillary lung volumes as in pulmonary hypertension, pulmonary embolism; anemia (unless corrected for hgb count)
Drugs that interact with theophylline and can elevate levels causing toxicity
cipro, cimetidine, erythromycin, propranolol, tetracycline
Necrotizing pneumonia that is contagious (possible bioterrorism)
Yersinia pestis (plague pneumonia)
Cause of pleural effusion glucose < 30
Rheutoid arthritis pleural effusion
Best test if suspect tuberculous effusion
Pleural biopsy
Fever, malaise, headache, sore throat, nonproductive cough; sore throat seen 2-3 weeks prior to pneumonia
Chlamydophila pneumoniae (formerly Chlamydia) rx macrolide or doxycycline
Definition severe persistent asthma
continual symptoms, frequent exacerbations, nighttime symptoms, limited activity, FEV1 or PEF 30%
Calculate A-a gradient; normal A-a gradient
A-a gradient = 149 - (PaO2 + 1.25 x PaCO2);
Normal < 0.3 x age (years)
Neurofibromatosis-2 associated with what tumor?
vestibular schwannoma
Neurofibromatosis-1 associated with what tumor?
optic glioma
Tuberous sclerosis associated with what tumor?
Giant cell tumors
Turcot syndrome and nevoid basal cell carcinoma syndrome associated with what tumor?
medulloblastoma
von Hippel-Lindau syndrome associated with what tumor?
hemangioblastoma
Treatment of hypercalcemia of malignancy
IV hydration, bisphosphonate, diuresis
Cell types ovarian cancer old vs younger
Older- epithelial; Younger- germ cell, more treatable
Cell type testicular cancer
Germ cell > 95% of time; do not do transscrotal resection
Side effect alkylating agents
infertility
What chemorx cause capillary leak syndrome?
IL-2, GM-CSF
derived from bark of the western yew tree
Paclitaxel
Which causes more nausea and nephrotoxicity: carboplatin or cisplatin?
cisplatin
Stages CLL
0- lymphocytosis 1- + LAD 2- + HSM 3- anemia 4- thrombocytopenia
Side effects 5FU
GI toxicity and mucositis
Side effects methotrexate
mucositis and diarrhea
Side effects vincristine
neurotoxicity
Side effects vinblastine
myelotoxicity
Basal cell ca facts
Related to sun exposure
Can be inherited
Locally aggressive
Uncommonly seen black skin
Features Gorlin syndrome (nevoid basal cell carcinoma syndrome)
Autosomal dominant Numerous basal cell carcinomas Palmar and plantar pits Cysts of mandible Bifid ribs agenesis of the corpus callosum hypertelorism Generally good prognosis
Concussion recommendations
Grade I- no amnesia or LOC- ok return after 20 minutes
Grade II amnesia but no LOC out x 1 week
2nd concussion out one month
3rd concussion out for season
Coma with pinpoint pupils- dx?
opiate overdose or pontine infarct
Sx Creutzfeldt-Jacob disease
Rapidly progressive dementia
myoclonus (precipitated by sudden noises or startle)
Pyramidal, extrapyramidal, cerebellar signs
Anticonvulsant that is only could for absence seizures
Ethosuximide
Encephalitis with personality changes/encephalopathy dx
viral meningitis- HSV (usually 1 except in neonates) or WNV
Rx active TB
4-drug therapy x 2 months then INH+RIF x 4 months
INH, RIF, Pyrazinamide, and either ethambutol or streptomycin
Upper lobe predominant lung diseases
Silicosis
Ankylosing spondylitis
Eosinophilic granuloma
What agent will effectively bronchodilate and not be blunted by beta-blockade?
Ipratropium
Lower lobe predominant lung diseases
Rheumatoid fibrosis
Asbestosis
Connective tissue diseases e.g. SLE
Sarcoidosis and berylliosis both cause non-caseating granulomas. How to differentiate?
Lymphocyte transformation test on BAL lymphocytes or blood;
positive = berylliosis
Clinical features silicosis
Mining, stone cutting, quarrying, construction, glass manufacturing, sand-blasting Restrictive lung function "Eggshell calcification" of hilar nodes Increased risk TB, lung cancer Associated with scleroderma, RA
Clinical features coal worker’s pneumoconiosis
Similar PFT findings to silicosis
No eggshell calcifications or increased TB or lung cancer risks
Clinical features berylliosis
Exposure to electronics, nuclear material, ceramics
Bilateral hilar LAD similar to sarcoid
Byssinosis
Related to exposure to impurities in cotton, flax, and hemp dusts
after > 10 years exposure, often “first day of work week”
associated with gm neg exotoxin
What is CD4 cutoff in HIV pt at which you are concerned for MAI/MAC?
CD4 < 50
Treatment latent TB?
INH 9 months
Appropriate ventilator settings for asthma
You want prolonged expiratory phase, therefore:
low rate, low tidal volume, high flows
Clinical features of Hand-Schuller-Christian syndrome?
Lytic bone lesions
DI
exophthalmus
On lung bx look for eosinophilic granulomatosis
Clinical features Loeffler’s syndrome
Pulmonary infiltrates
Peripheral eosinophilia
Due to Ascaris or other worm migrating through the lung
Light’s criteria
Exudate if:
pleural:serum protein > 0.5
pleural:serum LDH > 0.6
pleural LDH > 2/3 upper limit of normal for serum LDH
Adenosine deaminase in pleural fluid
TB related effusion
Elevated triglycerides in pleural effusion
Chylous effusion from disruption of thoracic duct
Rx mild RA
ASA or other NSAID
Crystals gout
strongly negatively birefringent needle-like
Crystals pseudogout
weakly positive birefringent rhomboid; precipitated by infection, trauma, surgery
Clinical features drug-induced lupus
Procainamide can cause
+ anti-histone antibodies
Serositis, fever are common
Rash, CNS, renal involvement are rare
Eosinophilic fasciitis
scleroderma-like condition with eosinophilia and skin thickening (sparing the hands) that frequently starts after vigorous exercise
Unlike scleroderma, which always involves hands, causes Raynauds, + ANA, synovitis
In dermatomyositis, what autoantibody indicates possible pulmonary fibrosis?
Anti-Jo-1
Rx Behcets with retinal vasculitis
Thalidomide
Methotrexate
Colchicine
c-ANCA associated with
Wegeners; think if sinusitis and vasculitis
p-ANCA associated with
microscopic polyangiitis
anti-GBM associated with
Goodpastures
Rx sicca symptoms of sjogren’s
Artificial tears and saliva and secretagogues such as pilocarpine or cevimeline
SLE: what antibodies associated with increased disease activity and nephritis?
anti-dsDNA and low complement levels
SLE: 17-30% positive what antibody?
anti-Sm
SLE: what antibody 100% for drug-induced but 25% of not drug-induced?
anti-histone
SLE: what antibody suggests better prognosis?
anti-U1 RNP
SLE: what antibody associated with complete heart block and neonatal lupus?
anti-Ro/SS-A
PPD: Positive at 5mm
Immunosuppressed such as HIV or organ transplant
Close contact with documented case
Fibrotic changes on CXR consistent with prior TB
PPD Positive at 10mm
High risk with normal immunity: Health care workers, IV drug users, prisoners, homeless
PPD Positive at 15
People with no risk factors
How to calculate pressure gradient across a valve?
modified Bernoulli equation
4 v squared
v = velocity of flow