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Miscellaneous Flashcards

1
Q

Specificity formula

A 
TN over (TN + FP)
*Proportion of patients who have a negative test result among all those who don't have the disease of interest
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2
Q

sensitivity formula

A
  • TP over (TP + FN)

* Proportion of true positives among all those who don’t have the disease of interest

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3
Q

HSV genital ulcers presentation

A

painful + tender LAD + pustules, vesicles, or small ulcers on an erythematous base

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4
Q

INitial workup of suspected bronchiectasis after hi res CT chest

A

Immunoglobulin quantitation, sputum culture and smear, CF testing (need to rule out reversible causes, including CVID and chronic infection)

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5
Q

return to play guidelines after concussion

A

graduated return to play protocol (athletes evaluated for recurrence of symptoms while performing stepwise increases in physical activity)

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6
Q

treatment of G6PD

A

avoid oxidative stressors (medications, fava beans, infection, metabolic abnormalities)

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7
Q

timing of G6PD presentation

A

typically 2-4 days after an oxidatively stressful event

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8
Q

C-peptide level in insulinoma

A

normal to high

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9
Q

Initial workup of dyslipidemia

A

TSH (hypothyroidism is a common cause of dyslipidemia)

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10
Q

Pericarditis clinical features

A
  • pleuritic chest pain (worse when leaning back and improved with leaning forward)
  • fever
  • pericardial friction rub
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11
Q

Mediastinitis clinical features

A
  • typically following open heart surgery

- fever + chest pain + signs of sternal wound infection (purulent drainage)

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12
Q

latent TB treatment options

A
  • INH + rifapentine weekly for 3 months
  • INH mono therapy for 6-9 months
  • Rifampin for 4 months
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13
Q

Silent brain infarcts are correlated with an increased risk of

A

dementia (vascular dementia)

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14
Q

Factitious disorder

A

falsifying symptoms for the purpose of assuming the sick role

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15
Q

silicosis clinical features

A
  • upper lung fields
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16
Q

silicosis sequela

A
  • increased risk of lung cancer and active TB
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17
Q

Other features of minimal change disease

A
  • can be explosive-onset with heavy proteinuria

- can be following a URI

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18
Q

Next step after suspected minimal change disease

A

biopsy

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19
Q

Erythema multiforme clinical feature

A
  • frequently after bacterial or viral infection
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20
Q

holter monitor vs. loop recorder

A
  • always loop recorder if very infrequent
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21
Q

Midbrain stroke (Weber syndrome) clinical features

A
  • ipsilateral cranial nerve III palsy

- contralateral lower facial weakness, hemiplegia

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22
Q

Lateral medulla stroke (Wallenberg syndrome) clinical features

A
  • ipsilateral horner syndrome
  • contralateral loss of body pain and temperature
  • hoarseness, dysphagia
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23
Q

Medial medulla stroke clinical features

A
  • ipsilateral tongue weakness

- contralateral hemiplegia

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24
Q

cerebellar stroke clinical features

A
  • nystagmus, ataxia, nausea, vomiting
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25
Q

localization of acute CN deficits in stroke

A

Brainstem (most cranial nerves originate in the brainstem + many motor and sensory fibers cross the midline in the brainstem)

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26
Q

TST interpretation in a patient with recent TB exposure

A

IF less than 5 mm, repeat TST in 8-12 weeks (may take a while to become positive because of immune response)

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27
Q

Management of flu outbreak in nursing homes

A
  • prophylactic antiviral therapy for all residents (even if previously vaccinated)
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28
Q

Antibiotics for skin abscesses

A
  • bactrim or doxy

* not keflex (no MRSA coverage?)

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29
Q

Indications for antibiotics with skin abscesses

A
  • greater than 2 cm
  • extensive surrounding cellulitis
  • systemic signs of infection
  • neutropenia
  • multiple abscesses
  • extremes of age
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30
Q

Relation of hyperthyroidism to hypercalcemia

A
  • thyrotoxicosis can cause parathyroid hormone-independent hypercalcemia (thyroid hormone acts on osteoclasts to increase bone turnover)
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31
Q

labs in hyperthyroid bone disease

A
  • hypercalciuria

- PTH is suppressed

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32
Q

Medications causing NAGMA

A
  • carbonic anhydrase inhibitors (topiramate, acetazolamide)
  • chemo (ifosfamide, cisplatin)
  • antibiotics (ahminoglycosides, bactrim)
  • amphotericin B
  • lithium
  • pentamidine
  • rifampin
  • inhaled toluene
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33
Q

mixed connective tissue disease clinical features

A

(overlap of systemic sclerosis, SLE, polymyositis)

- swollen hands, myositis, synovitis, Raynaud’s

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34
Q

Antibody associated with systemic sclerosis

A
  • RNA polymerase II and III

- Scl-80 and anti-topoisomerase I

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35
Q

Antibody associated with limited scleroderma

A

centromere

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36
Q

Antibody associated with poly and dermatomyositis (general name)

A

Aminoacyl-tRNA syntheses

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37
Q

Antibody associated with MPA

A

Myeloperoxidase

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38
Q

Antibody associated with GPA

A

proteinase-3

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39
Q

rhino-orbital-cerebral mucormycosis clinical features

A
  • can also be in maxillary or orbital area

- uncontrolled diabetic with frequent DKA

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40
Q

primary ovarian insufficiency presentation

A
  • amenorrhea + menopausal symptoms (hot flashes, dyspareunia)
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41
Q

primary ovarian insufficiency lab features

A

elevated FSH + low estradiol

42
Q

Functional hypothalamic amenorrhea clinical featrues

A

relative caloric deficiency (endurance athlete, etc)

43
Q

Functional hypothalamic amenorrhea lab features

A
  • low GnRH, FSH, estrogen
44
Q

treatment of ascites in decompensated cirrhosis

A 
high-dose spironolactone
low dose furosemide
(Oral lasix 40, aldactone 100)
*therapeutic para if refractory
*don't use IV lasix (increased risk of acute prerenal azotemia)
45
Q

additional treatment of NSTEMI

A
  • beta blockers
46
Q

Treatment of parkinson’s disease in relatively young and old people

A

IF severe disease OR older 65 – levodopa, carbidopa
IF younger than 65 or mild to moderate disease – dopamine agonists (pramipexole) (fewer motor fluctuations)
*anticholinergics if under 70 and just have a tremor

47
Q

Other features of Cushing’s syndrome

A
  • DM2 with no FH
  • proximal muscle weakness
  • fungal skin infections
  • amenorrhea
  • hypokalemia
48
Q

COPD step up therapy

A

SABA
THEN – add LAMA (tiotropium) or LABA
THEN – LABA + ICS
THEN - LAMA + LABA + ICS (triple therapy

49
Q

Management of patient with high pretest for PAD but normal ABI

A

exercise testing with repeat ABI

50
Q

ABI cutoff for PAD

A

less than 0.9

51
Q

Cause of postoperative hyponatremia

A
  • infusion of fluids or surgical stress-related vasopressin release
52
Q

Treatment of sigmoid volvulus

A
  • sigmoidoscopy
53
Q

sigmoid volvulus radiographic features

A
  • elderly patient + unstructured + X-ray showing large air-filled sigmoid colon with *absence of air in the rectum (due to twisted colon)
  • CT with dilated sigmoid colon creating a bird beak appearance
54
Q

How to monitor respiratory status of patients with myasthenic crisis

A
  • serial measurements of vital capacity + maximal inspiratory (FIC)
  • Intubate when VC below 20 ml per kg
55
Q

Treatment of myasthenic crisis

A

plasma exchange or IVIG + high-dose steroids

56
Q

Low fat compared to low carbohydrate diets in terms of weight loss and CV mortality

A
  • similar long term weight loss and improvement in BP.
  • low-carb diets can produce rapid weight loss and may decrease CV and all cause mortality but are associated with increased incidence of GI side effects
57
Q

Management of bilateral renal artery stenosis

A

1) diuretic
2) ACE or ARB (bilateral renal ischemia induces RAAS activation)
* If failed medical therapy or recurrent flash pulmonary edema or heart failure – renal angioplasty with stenting

58
Q

Indication for mammography after Chest radiaion

A
  • any patient who has chest radiation needs mammogram annually starting 8 years after radiation therapy
  • annual TSH also recommended
59
Q

Mean length of time between exposure to radiation therapy and presentation of breast cancer

A

15 years

60
Q

Frequent complications of gastric bypass surgery

A
  • stomal stenosis
  • cholelithiasis
  • dumping syndrome
61
Q

Treatment of ovulatory dysfunction in subclinical hypothyroidism

A
  • synthroid

* ovulatory dysfunction is common in both overt and subclinical hypothyroidism

62
Q

Treatment of ovulatory dysfunction in PCOS

A
  • initial is weight loss

- then clomiphene citrate (verify)

63
Q

Presentation of migraine with brainstem aura

A

woman with history of migraine having migraine + brainstem symptoms (vertigo, dysarthria, ataxia, diplopia)

64
Q

Initial step in management of migraine with brainstem aura

A

MRI and MR angiography (rule out posterior cerebral circulation lesions like basilar aneurysm and TIA, which can mimic symptoms)

65
Q

Typical migraine aura symptoms

A
  • visual – flickering light, diagonal lines
  • sensory (numbness)
  • aphasia
66
Q

Abx for suspected MRSA secondary PNA

A
  • vanc or linezolid (preferred in hospitals where a major portion of MRSA isolates have a vanc mimimum inhibitory concentration of greater than 2)
67
Q

Management of zoster involving face (zoster ophthalmic)

A
  • IV acyclovir + urgent ophtho evaluation
68
Q

Why do patients with DM2 gradually require more treatment?

A
  • progressive insulin deficiency (patients are generally insulin resistant initially, this causes pancreatic beta cells to overproduce insulin to compensate, but beta cells eventually decline and produce less insulin)
  • this is why patients gradually typically require more therapy over time to maintain glycemic control
69
Q

Medication for antithrombotic therapy of mechanical valves

A

Aspirin + warfarin

70
Q

Target INR in mechanical valves

A

IF no RFs – 2-3

IF high risk RF’s – 2.5-3.5

71
Q

High risk features indicating higher INR in mechanical valve antithrombosis

A
  • AF, EF less than 30%, prior thromboembolism, *mechanical mitral valve
72
Q

Leptomeningeal carcinomatosis is

A
  • neoplasm or metastatic disease involving brain and spinal cord
73
Q

Cancer types in which leptomeningeal carcinomatosis occurs

A
  • breast, lung, melanoma

* same cancer types associated with brain mets

74
Q

m avium treatment

A
  • macrolides, ethambutol, rifamycins
75
Q

Typical setting + presentation + cause of refeeding syndrome

A
  • refeeding or giving D5-containing fluids to nutritionally depleted individuals
  • new onset weakness
  • severe hypophosphatemia
76
Q

Work up of gastroparesis

A
  • first step always EGD to rule out mechanical or mucosal causes
  • definition of gastroparesis requires proving delayed gastric emptying in the absence of obstruction
77
Q

Chronic Subdural hematoma clinical features

A
  • elderly patient –> (history of falls and alcohol abuse) –> new confusion + headache + focal weakness + lethargy
78
Q

Indications for aldosterone antagonists

A

1) Post STEMI with LVEF less than 40% + symptomatic or DM2

2) NYHA class II to IV heart failure with EF less than 35%

79
Q

When to avoid aldosterone antagonists in heart failure patients

A
  • creatinine clearance less than 30

- K greater than 5

80
Q

Initial step in management of insomnia

A

2 week sleep diary

81
Q

Pathogens necessitating catheter removal in CLABSI

A
  • pseudomonas
  • staph aureus
  • fungi
82
Q

Cancer which Klinefelter’s syndrome patients are at risk for

A
  • breast cancer
83
Q

Treatment of hypothyroidism in celiac disease

A
  • increasingly high synthroid requirements (malabsorption of levothyroxine)
84
Q

Management of thyroid strom

A

Initial treatment: beta-blocker + PTU

Subsequently: steroids (given afterward to inhibit peripheral T4 to T3 conversion)

85
Q

Management of patient with new diagnosis of AF and RVR following cardioversion

A
  • still need anti arrhythmic therapy
86
Q

Preferred antiarrhythmic drugs in patients with AF

A

IF no CAD or structural heart disease – flecainide or propafenone
IF LVH – amiodarone
IF CAD without heart failure – sotalol or dronedarone
IF heart failure – amio

87
Q

Gilbert’s syndrome presentation

A
  • asymptomatic + isolated unconjugated hyperbilirubinemia typically after hemolysis or infection or medication use
88
Q

Clinical + pathologic features of weakness from colchicine

A
  • symmetry myopathy

- cytoplasmic vacuolization

89
Q

papillary muscle rupture presentation with acute MR

A
  • sudden onset hypotension + pulmonary edema

- systolic murmur

90
Q

LV free wall rupture presentation

A
  • tamponade + chest pain + PROFOUND shock + rapid progression to PEA and death
91
Q

Ventricular septal rupture vs. acute MR after STEMI

A
  • based on murmur
  • septal rupture = loud holosystolic murmur at left lower sternal border
  • MR = systolic murmur at apex
  • (both can present with hypotension and CHF)
92
Q

Presentation of phenytoin toxicity

A
  • nystagmus, ataxia, slurred speech, mental status changes
93
Q

Unique SE of omeprazole as opposed to other PPIs

A
  • inhibits P450, leading to increased serum phenytoin levels
94
Q

medical term for charcot joint

A

diabetic neuropathic arthropathy

95
Q

charcot joint presentation

A

diabetic patient + foot or ankle erythema, warmth, swelling + often looks septic but is not
(its progressive bony and soft tissue destruction that leads to joint dislocation and deformities)

96
Q

treatment of charcot joint

A
  • casting, avoid weight bearing
97
Q

Retroperitoneal fibrosis clinical features

A
  • low back, flank pain
  • CKD due to perioartic fibrosis
  • ureteral obstruction without ureteral dilation
98
Q

Malaria clinical features

A
  • acute febrile illness + anemia + splenomegaly + jaundice
99
Q

tertiary syphilis features

A
  • sensory ataxia
  • lancinating pains
  • argyll robertson pupil
  • cardiovascular syphilis
100
Q

physiology of pseudothrombocytopenia

A

EDTA-induced platelet clumping

101
Q

Management of nocturnal angina

A
  • work up for OSA

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