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uworld > Mixed Medicine > Flashcards

Mixed Medicine Flashcards

1
Q

solitary liver mass , LOW Mcv and positive fecal occult blood screen

A

Colorectal cancer with mets to the liver

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2
Q

what cancer spreads to the liver

A

lung breast skin cancers ( melanoma)

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3
Q

hepatocellular cancer features

A

systemic symptoms
chronic hepatitis or cirrhosis
elevated alpha feta protein

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4
Q

liver mets feature

A

single / multiple

Known extra hepatic malignancy

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5
Q

Carbon monoxide poisoning

A

Cause: smoking inhalation, defective heating system , poor ventilated area

Clinical :
Mild: headache, confusion, malaise , dizziness , nausea
Severe: Seizure , syncope , coma, Myocardial ischemia, arrythmia
polycytehmia ( elevate Hct)

Dx: ABG - caroxyhg , ecg, cardiac enzyme

Tx: high flow 100% oxygen , incubation / hyperbaric oxygen

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6
Q

why do you get polycythemia in caroxyheamoglobin toxicity

A

the dissociation curve to the left

impairing the ability of heme to load O2 at the tissue level – TISSUE HYPOXIA

Kidney - makes more EPO - stimulated BM to make more RBC –> secondary POLYCYTHEMIA

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7
Q

why do you have normal saturations in carboxyhemoglobin

A

b/c the oximetry cannot does not differentiate b/w carboxyhemoglobin and oxyhemoglobin

Therefore must do ABG for Dx

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8
Q

treatment for aspiration pneumonia

A

ANEROBIC antibiotics

- metro , vlindamycin , amoxicillin calvulanic , carbapenem

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9
Q

define positive predictive value

A

the probability that the patient who has the disease is given a positive result

Greater prevalence greater PPV

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10
Q

cause of trigeminal neuralgia

A

demyelination of the nerve nuclei

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11
Q

duplex ultrasonography demonstrates incompressible popliteal and femoral veins

A

DVt

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12
Q

patient with DVT or PE - without any provoking factors what do you think of?

A

malignancy

- perform age related cancer screening

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13
Q

when do you look at protein C and S and antithrombin 2 levels?

A

when the patients history is suggestive of

  • age < 45
  • recurrent DVT
  • multiple or unusual sites
  • family history (VTE)
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14
Q

acute gastropathy

A

severe hemorrhagic lesions after various agents or after a substantial reduction in blood flow - development of hemorrhagic lesions after schema or exposure of gastric mucosa to various agents ( alcohol, aspirin, cocaine)

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15
Q

hep B surface antibody positive and hepatitis C antibody positive - what is next step?

A

HEP C VIRUS RNA PCR testing

Once confirm with dual testing -> ledipasvir - sofosbuvir

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16
Q

diagnosis of hep C

A

2 step process

  1. serological test HCV antibody
  2. molecular test RNA
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17
Q

dysphagia initial diagnosis

A
  1. video fluoroscopic modified barrio swallow
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18
Q

when do you do esophageal motility and upper Gi endoscopy test?

A

when sensation of food getting stuck in esophagus ( NOT THROAT)

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19
Q

cystinuria

A

group of disorder characterized by IMPAIRED AA TRANSPORT

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20
Q

urinaru cynaide nitroprusside test is positive

A

cystinuria

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21
Q

treatment of hypercalcemia

A

Calcium > 14 - normal saline (short term) , long term (bisphosphonates)

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22
Q

treatment of HOCM

A

beta blocker

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23
Q

move cutoffpoint is moved from B to a what happens to sensitivity

A

INCREASE

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24
Q

hidradenities suppurativa

A

chronic relapsing condition characterized by inflammatory skin areas and presents as painful nodules

Complications :; scarring, sinus tracks , comedones

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25
Q

what test works on Beta 1 adrenergic receipts

  • affects on heart
A

Dobutamine - potent inotropic agent
- increase myocardial contractility leading to improved EF, reduced left ventricular end diastolic and symptomatic improvement of decompensated heart failure

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26
Q 
proteinuria 
hypoalbuminemia 
edema 
hyperlidemia and lipiduria 
hypercoaguability
A

nephrotic syndrome

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27
Q

what meds interact with sidenafil

A

any meds that can cause hypotension - esp patients taking aha blockers or nitrates

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28
Q

diuretic abuse vs laxative abuse

A

both cause hypovolemia and hypotension

However , if stem mentions elevated urine sodium –> indicated that sodium is loss through the urinary tract ( diuretic use)

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29
Q

indication for low back pain and getting x-ray

A

osteoporosis / compression fracture
suspected malignancy
ank spon

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30
Q

indication for LBP and getting MRI

A

sensory / motor deficits
Cauda equina syndrome
Suspected epidural abscess / infection ( fever, intravenous drug abuse , concurrent infection , HD)

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31
Q

indication when LBP and getting radionuclide bone scan and CT scan

A

Same indications of MRI but not able to get MRI

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32
Q

AA amyloidosis ass/ conditions

A

chronic inflammatory conditions : RA , IBD

Chronic infectious: osteomyelitis, TB

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33
Q

AL amyloidosis ass. conditions

A

multiple myeloma

waldenstrom macroglobulinemia

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34
Q

Composition of amyloid AL amyloidosis

A

light chains ( usually lambda)

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35
Q

Composition of amyloid - AA amyloidosis

A

abnormally folded proteins, beta 2 microglobulin, apoplipoprotein or transthyretin

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36
Q

hypokalemia causes

A
  • increase intracellular entry of potassium (with insulin, Beta adrenergic agents, heamtopoesis
  • GI loses
  • renal potassium wasting ( hyperaldosteronism , diuretics)
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37
Q

treatment of frostbite

A

rapid rewarming with warm water
analgesia and wound care
thrombolysis in severe , limb threatening conditions

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38
Q

clinical features of Magnesium toxicity

A

Mild: Nausea, flushing , headache, hypo reflex
Moderate: areflexia, hypocalemia
Severe: resp paralysis, cardiac arrest

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39
Q

Treatment of Magnesium toxicity

A

stop mg tx

GIVE IV calcium gluconate bolus

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40
Q

cause of magnesium toxicity

A
  1. Renal insufficiency
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41
Q

is MPGN nephrotic or nephritic?

A

Nephritic

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42
Q

what nephrotic syndrome has low serum C3 levels

A

PSGN
- seen 10-20 days after strep throat and skin infections
- presents with periorbital swelling, hematuria, oliguria
HTN , urinalysis - RBC cast and proteinuria

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43
Q

restrictive lung disease

A

decreased lung volume
decrease diffusion lung capacity
normal FEV1/FVC ratio

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44
Q

fundoscopy shows several yellow white exudates immediately adjacent to fovea and retinal vessels in HIV patient
- clinically FLOATERS and blurred vision in right eye

A

CMV retinitis

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45
Q

herpes simplex keratitis -

A

corneal lesions and results in ocular pain, tearing and discharge

dendritic

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46
Q

HIV retinopathy

A

cotton wool retinal lesions that are rarely heamorragic and tend to resolve in weeks to months

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47
Q

anemia in patient > 50 - what should you do

A

do endoscopic evaluation - think cancer

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48
Q

premature atrial beats - risk factors

A
  1. tobacco

2. alcohol

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49
Q

treatment of premature atrial beats

A

b - blockers

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50
Q

uncomplicated pyelonephritis - when would you get a CT scan

A

after 72 hours if they don’t improve with antibiotics

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51
Q

fundoscopy - venous dilatation and toruosity due to venous occlusion , diffuse hemorrhages , cotton wool spots , disk swelling , (blood and thunder appearance)

A

central retinal vein occlusion

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52
Q

severe eye pain, blurred vision, dilated pupil that is non reactive light

A

acute angle glaucoma

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53
Q

bone conduction > air conduction is suggestive of

A

conductive hearing loss

lateralizes to affected side

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54
Q

conductive hearing loss in patient 20-30

A

otosclerosis

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55
Q

sensorineural HL

A

air> bone

lateralize to unaffected ear

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56
Q

what happens to the Aa gradient in IPF

A

impaired gas exchange resulting in
decrease diffusion capacity of Carbon monoxide
Increase Aa gradient

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57
Q

DDX high reticulocyte count

A
  1. haemorrhage
  2. hemolysis
    - intrinsic: RBC membrane defect
    - extrinsic:
    Autoimmune , PNH
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58
Q

Ddx low reticulocyte count

A

leukemia
aplastic anemia
infection
medication s/e

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59
Q

if high suspicion of PE - treat or image first

A

early and effect anticoagulation decrease mortality risk of acute PE and should be initiated prior to confirmatory diagnosis

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60
Q

hemolytic anemia labs (MAHA)

A
  • DECREASE serum haptoglobin
    increase LDH
    increase bill
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61
Q

what medication can cause acquired angiodema

A

ACE inhibitor

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62
Q

primary adrenal insufficiency vs. secondary adrenal insufficiency

A 
- autoimmune 
HIGH ACTH, low cortisol, low aldosterone 
- hyper pigmentation 
- hyperkalemia 
- hyponatremia 
- hypotension

Secondary
- chronic glucocorticoid treatment
LOW ACTH< LOW cortisol, normal aldosterone
no hyper pigmentation, no high K+, some hyponatremia

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63
Q

examples of secondary adrenal insufficency

A
  1. Sheehan syndrome

2. lymphocytic hypophysis ( lymphocytic infiltration)

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64
Q

what overdose: slurred speech, unsteady gait, drowsiness

A

benzo overdose

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65
Q

phenytoin toxicity

A

horizontal nystagmus, cerebellar ataxia, confusion

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66
Q

treatment of paget bone disease

A

bisphosphonates

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67
Q

elevated all phosphate , mixed osteolytic and sclerotic bone lesions and focal uptake of radiotacer on bone scan

A

paget disease of bone

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68
Q

how does TTP present and how do you treat

A
  1. thrombocytopenia
  2. MAHA
  3. Renal insufficiency
  4. neurological changes ( headache, confusion, coma , stroke)
  5. fever

Tx ; plasma exchange, glucosteroids , rituximab

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69
Q

patient with RV MI may develop severe hypotension due to inadequate right ventricular preload —> what do you do?

A
  1. give saline bolus

2. if failed give - inotropic agents ( dopamine, dobutamine )

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70
Q

cause of abnormal hemostasis if patient has chronic renal failure but normal PT and PTT , platelet count

how do you treat condition?

A

platelet dysfunction

Tx:
- DDAVP - increase factor 8: vWF from endothelial stage sites

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71
Q

friable mucosa extending from rectum to sigmoid colon - with shallow ulcers seen on colonoscopy what is DX

A

UC

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72
Q

common causes of decrease platelet count

A
  1. viral infections (EBV, hepatitis)
  2. chemotherapy
  3. MDS
  4. Alcohol use
  5. congenital ( fanconi syndrome)
  6. Vitamin B12 or folate deficiency
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73
Q

increase platelet list

A
  1. SLE
  2. MEDS ( heparin)
  3. ITP, DIC ,TTP , HUS
  4. APS
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74
Q

what is untreated hyperthyroid patients at risk for

A

risk of rapid bone loss from increase osteoclastic actin in bone cell

risk of cardiac tacyarrythmias
(a. fib)

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75
Q

what kind of kidney stones are patients with chrons more likely to get?

A

OXOLATE ABSORPTION IS INCREASE

therefore oxalate stones

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76
Q

HA, jaundice and splenomefly - what lab value is elevated

A

think Hereditary spheropcystosis

  • ELEVATION in MCHC
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77
Q

recommended vaccines for adults > 65

A

Tdap once as substitute for Td booster
Td every 10 years
Influenza annually
Sequential PCV 13 Plus PPSV23 - one dose of PCV 12 followed by PPSV23 at a later time

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78
Q

Age 19-64 vaccine recommendation

A

Tdap once as substitute for Td booster, then Td every 10 years
Anual influenza
PPSV23 - alone (Chronic heart, lung liver disease , diabetics , current smokers, alcoholics)

Add in PCV12 - sickle cell disease , immunocompromised, CKD

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79
Q

leads V1 - v6

A

anterior MI

blocked LAD

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80
Q

inferior MI

A

ST elevation in 2,3, avF

RCA or LCX artery blocked

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81
Q

V1 - V3 ST depression
ST elevation 1,avL
St depression 1 and aVL

A

Posterior MI
LCX - ST elevation in leafs I and aVL
RCA - ST depression in 1 and avL

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82
Q

lateral MI

A

st elevation in 1, avL, V5,6

ST depression in leads 2,3,avf

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83
Q

best treatment for fibromyalgia

A

AMYTRIPTYLINE

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84
Q

Symp, PE and Tx of allergic rhinitis

A

Symptoms:

  • rhinorrhea, nasal congestion, sneezing and nasal itching
  • cough secondary to postnasal drop
  • ocular itching and tearing

Exam:
- allergic shiners ( infrraorbiral edema and darkening
- allergic salute ( transverse nasal crease )
- pale bluish enlarged turbinates
Pharyngeal cobblestoning
Allergic facies ( high arched palate , open mouth breathing

Tx:

  • avoid allergy
  • intranasal corticosteroid
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85
Q

what type of cardiac condition odes patients with acromegaly get?

A

concentric left ventricular hypertrophy

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86
Q

most appropriate response when dealing with angry patient is

A

May I ask what is upsetting you so that I can help you as best as I can?

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87
Q

what timor do you get visual disturbances, headache, and symptoms pituitary hormones

A

Craniopharyngiomas ( supresellar tumours)

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88
Q

types of CPA tumours

A

headache, HL, balance problems

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89
Q

what happens to calcium when you have an increase in extracellular pH

A

dissociation of hydrogen ions from albumin - allowing increase binding of calcium and a drop of unbound ionized calcium

Clinical - symptoms of hypocalcemia

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90
Q

vasospastic angina

A

hyperactivity of coronary artery muscles

  • young < 50 years old
  • smoking
  • recurrent chest discomfort - AT NIGHT , resolves < 15 minutes
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91
Q

Chest pain at night , resolves in 15 minutes - how do you treat

A 
CCB (preventative) 
Subinguinal nitroglycerin ( abortive)

patient has vasospastic angina

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92
Q

what process is similar to vasospastic angina

A

raynaud’s phenomenon

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93
Q

telangiectasis, recurrent epistles and widespread AV malformation ass/ w/ heampotysis from R-L shut

A

Osler Weber Rendu syndrome - hereditary telangiectasia

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94
Q

abrupt onset of regular tachycardia that resolves in cold water immersion - what is DX and why does that happen

A

that patient has Paroxysmal SVT

With cold water immersion - patient gets activation AV node conductivity

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95
Q

clinical ass. of MCD

A
  • NSAIDS

- Lymphoma

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96
Q

Clinical ass. with FSGN

A 
African americans 
Hispanic 
obesity 
HIV 
heroin use
97
Q

membranous nephropathy - clinical association

A

Adenocarcinoma ( breast, lung)
NSAID
hepatitis B
SLE

98
Q

MPGN clinical associations

A

hep C and C

lipodystrophy

99
Q

iga nephropathy

A

URTI

100
Q

young adult asian women with blood pressure discrepancies

A

think takyasu arteritis - large vessel vasculitis

  • initial: fever, arthralgia, WL
    Later: blood pressure discrepancies and pulse deficits

Ct and MRI - aneurysm formation or lumens narrowing

Tx: systemic glucocsteroids

101
Q

Small vessel lipohyalinosis

A

lacunar stroke

- HTN is risk factor

102
Q

most common cause of secondary bacterial pneumonia

A

Streptococcus pneumonia and S. aureus

103
Q

pain and stiffness in neck, shoulder and pelvic grille, along with elevated ESR

Dx and Treatment

A

polymyalgia rheumatica

  • tx low dose prednisone
104
Q

megaloblastic anemia, glossitis ( shinny tonge), vertigo, thyroid disease and neurologic abnormalities - dx?

A

pernicious anemia

105
Q

how will patients with CML present

A 
anemia
 thrombocytopenia 
leukocytosis 
SPLENOMEGLY 
WBC > 100 000
106
Q

labs seen in patients with osteomalacia

A 
recall due to vit D deficiency
low/ normal serum calcium 
increase PTH 
low phosphate
low plasma 25 OH vit D levels 
elevated all phosphate
107
Q

c-ray with decrease bone density with thinning of cortex and pseudo fractures

A

osteomalacia

108
Q

causes of osteomalacia

A 
recall due to vit D deficiency 
- malabsorption 
intestinal bypass surgery 
celiac sprue 
chronic liver disease 
chronic kidney disease
109
Q

DDX widened mediastinum

A 
traumatic aortic injury 
( thoracic aortic aneurysm)  
Atelectasia 
Mediastinal LAD 
thymus
110
Q

what type of renal failure associated with analgesics

A

analgesic nephropathy - most common form of drug induced chronic renal failure

CHRONIC TUBULOINTERSTITAL NEPHRITIS ( b/c patients with chronic analgesic abuse - develop premature aging, atherosclerotic vascular disease and urinary tract cancer

111
Q

serious infection of ear seen in elderly patients with poorly controlled diabetes

A

Malignant otitis externa

112
Q

most common cause of Malignant otitis external

A

Pseudomonas aeruginosa

113
Q

clinical for malignant otitis externa

A
  • ear pain
  • ear discharge
  • GRADULATION tissue
114
Q

Complication of malignant otitis external

A

osteomyelitis of skull bone

115
Q

graduation tissue in ear canal

A

Malignant otitis extern

116
Q

patient on warfarin and delves intracerebral hemorrhage what do you do

A

GIVE THEM PROTHROMBIN COMPLEX CONCENTRATE to reduce the risk of death and permanent disability

117
Q

what type of anemia is alcohol abusers more likely to develop

A

folate deficiency

118
Q

effects on heart with nitrate use

A

decrease LV volume

b/c vasodilators - dilates veins, arterioles, coronary arteries by relaxing smooth muscle walls

ventilation - lowers preload and LV EDV, reduced myocardial O2 demands by reducing wall stress

nitrates will also decrease systemic vascular resistance

119
Q

what rash worsens with alcohol intake

A

rosacea

- facial flossing, telangiectasis and roughness or scaling and burning discomfort

120
Q

clinical features of Antiphospholipid antibody syndrome

A

Venous and arterial thrombosis
- DVT , PE, TIA

Adverse pregnancy outcomes
- detal loss , preterm birth

121
Q

malassezia globosa infection

A

same as tine versicolor

122
Q

HIV patient with severe acute retinal necrosis - what is cause

A

HSV or VZV

123
Q

HIV patient with fully or granular retinal lesions

A

CMV

124
Q

management of causative injection

A

Secure airway ABC
CXR
endoscopy within 24 hours

125
Q

when treatment regimen selected for a patient depends on the severity of patients condition - what is the bias

A

selection bias

126
Q

mid 30 year old female presents with severe respiratory muscle weakness leading to rest failure, bulbar muscle weakness - after on antibiotics - what is it

A

myasthenia crisis

Triggers:

  • infection or surgery
  • pregnancy or childbirth
  • tapering immunosuppressive drugs
  • meds ( ahminoglycosides, BB)
127
Q

sudden loss of vision and onset of floaters

A

vitrous haemorrhage \

128
Q

treatment choice of lYME DISEASE IN pregnant and children

A

Amoxicillin

b/c they can’t take doxycillin due to teeth discolouration and retardation in skeletal development

129
Q

first line treatment to stabilize patient with tordes de point

A

magnesium sulphate

130
Q

what can happen as a delay responds in SAH

A

vasospasm

- which canc cause cerebral infarction

131
Q

number one treatment for legionella pneumonia

A

FLOROQUINOLONES

or newer macrolide

132
Q

multiple liver mets - where can primary be?

A
  • GI , lung , breast
133
Q

back pain that has a gradual onset, age < 40 , pain at night that does not improve with rest and improvement of back pain with activity or exercise

A

THINK inflammatory back pain

134
Q

numerous minute punctuate hemorrhages and loss of the grey white interface

A

diffuse axonal injury

135
Q

CT findings in MS

A

will not show anything - need MRI which will show lesions in white matter in periventricularr areas

136
Q

hepatorenal syndrome treatment

A
  1. address precipitating factors
  2. Splanchnic vasoconstrictors ( midodrine, octreotide, norepinephrine)
  3. Liver transplantation
137
Q

Precipitating factors for HRS

A
  1. Reduced renal perfusion
  2. GI bleed, vomitting, sepsis, excessive diuretic use, SBP
  3. Reduce glomerular pressure and GFR (NSAIDS use )
138
Q

liver ultrasound shows 10cm smooth round cyst with daughter cyst inside

A

Echinocactus granulosus
- close contact with dogs

Tx: albendazole

139
Q

complication of ank spondolysis

A

Osteoporosis/ vertebral fractures

Aortic regurg

Cauda equina

140
Q

milk alkali syndrome

A
  • excessive consumption of calcium bicarbonate ( taken ofr osteoporosis )

Clinical: N, V, constipation, Polyuria, polydipsia, neuropsychiatric symptoms

141
Q

TCA over toxicity

A

sodium bicarb - cardiac toxicity

142
Q

pemiphigus vulgaris

A

flaccid bullae and ulcers
mucosal erosions
separation of epidermis by light friction ( niklosky sign)

143
Q

pemphigus vulgaris immunofluorescence

A

netlike intercellular IgG

144
Q

bilateral cranial neuropathies followed by symmetric descending muscle weakness

A

botulism toxin

145
Q

PBC - what complications can they get

A

malabsorption , fat soluble vitamin deficiency
metabolic bone disease ( osteoporosis , osteomalacia)
HCC

146
Q

who gets bile acid diarrhea

A

in patients with terminal ill disease

  • ill resection
  • crohn ileitis

b/c they get impaired bile absorption in the ileum leads to increase bile salts in the colon, resulting in diarrhea ( choleric diarrhea)

147
Q

what is the BUN : Cr ratio for prperenal injury

A

> 20:1

148
Q

fontotemporal dementia vs. dementia with Lew bodies

A

Frontotemporal
- early personality changes
- apathy, disinhibition and compulsive behaviour
Atrophy in frontotempral area

Dementia with Lewy bodies
- visual hallucination
spontaneous parkinsonism
fluctuating cognition

149
Q

beta 2 agonist can cause what

A

muscle weakness

150
Q

non opiod analgesic is not controlling cancer pains what would you use next?

A

short acting opioids

151
Q

HIGH ALP
high PTH
Low vit D levels
Low Ca and phosphorus

A

osteomalacia

- impaired osteoid metric mineralization

152
Q

what cancers do lunch syndrome increase risk for

A

Colon cancer
Endometrial cancer
ovarian syndrome

153
Q

what cancer does von Hippel lindau syndrome increase risk of

A

Hemangioblastomas
Clear cell renal cell cancer
Pheochromocytoma

154
Q

Causes of myopathy

A
  1. CTD
    - polymyositis / dermatomyositis
  2. Endocrine/ metabolic
    - hypo/ hyper throidism
    - cushing syndrome
    - electrolytes - Low K+ , Ca+ , Phosphorus
  3. Drugs - corticosteroids , statin, alcohol, colchicine
155
Q

what does milk alkaline syndrome cause

A

HIGH calcium
Renal failure
Metabolic alkalosis

156
Q

type 1 MEN

A

pituitary adenoma
Parathyroid ademoa / hyperplasia - high calcium
gastrointesintal / pancreatic endocrine tumour ( gastromas) - ZES - refractory PUD

157
Q

theophyillin toxicity

A

CNS stimulation - headache, insomnia, seizure

GI disturbances - N and V

Cardiac toxicity - arrythmias

History: ciprofloxacin - decrease clearance of theophyillin - therefore increase toxicity

158
Q

Risk factor for porphyria cutanea trade

A 
Hepatitis C 
HiV  
Excessive alcohol consumption 
estrogen use 
smoking
159
Q

complication of early CABAG

A

cardiac tamponade

- get an ECHO

160
Q

aortic dissection can increase risk of what

A

can propagate proximally from the site of intimal tear to involve the aortic valve and aortic regurg - patient presents in pulm edema

161
Q

dementia with generalized cortical atrophy

A

think Alzhiemers

162
Q

patient with metastatic cancer , elated Pulmonary artery and right arterial pressure - has what?

A

consistent with pulmonary hypertension

if PCWP is high - due to right heart

if PCWP - normal - pulmonary cause

  • history of metastatic cancer - increase likelihood of PE
163
Q

increase Right arterial pressure > 10mmhg and increase pulmary artery pressure > 40mmg - suggestive of what?

A

MASSIVE PULMONARY ARTERY

164
Q

winters formula

A

Arterial pCO2 = 1.5 bicarb + 8 +/-2

165
Q

patient gets confused with t2DM , ketones , high glucose - what is the cause of his confusion?

A

type 2 DM - think hyperosmolar hyperglycaemia - therefore confusion is due to hyperosmolarity

166
Q

treatment of patients with non bleeding varies

A

non selective beta blockers - propranolol, nadol

167
Q

management of CLD

A

involves both treatment of underlying cause and strategies to prevent further liver damage (alcohol avoidance, hepatitis A and hepatitis B vaccine)

168
Q

Acute liver failure causes

A

Viral hepatitis - HSV, CMV, hep ABDE

Drug toxicity - acetaminophen ,
Ischemia ( budd chiari ) 
Autoimmune hepatits 
Wilson disease 
malignant infiltration
169
Q

Dx criteria for Acute liver disease

A
  • ALT and ASt > 1000
    SEVERE hepatic encephalopathy ( confusion, asterixis)
    Synthetic liver dysfunction ( INR >1.5)
170
Q

hallmark of secretory diarrhea includes

A

larger daily stool volumes - >1L/ day
Diarrhea - during fasting or sleep
Reduced stool osmotic gap < 50

171
Q

young individuals with rapid onset of fever, myalgia, nuchal rigidity, petechial rash and shock

A

MENINGOGOCCAL MENINGITIS

172
Q

why do you get hyperkalemia in DM

A

deu to extracellular shift of potassium

173
Q

chronic weakness, WL, hyponatremia, hyperkalemia ass. w/ low normal cortisol level

A

most likely has primary adrenal insufficiency - ADDISON DISASE

174
Q

basal cortisol low, ACTH high , min response to cosyntropin

A

primary adrenal insufficiency

175
Q

basal cortisol low
ACTH low
Minimal or subcortisol response to cosyntropin

A

secondary or tertiary adrenal insufficiency

176
Q

How long does it take for Hep A to recover

A

recover 2-6 weeks

177
Q

best test pancreatic cancer

A

abdo CT

178
Q

initial test for pancreatic cancer

A

abode ultrasound- usually non diagnostic and then you do an abode CT scan

179
Q

when do you check the Ca19-9

A

it is helpful in evaluating the tumor response to chemotherapy

180
Q

sudden onset of redness , watery discharge and itching of both eyes , excessive tearing but not blurred

A

allergic conjunctivitis

181
Q

difference b/w allergic conjunctivitis and viral

A

viral- more likely to be unilateral , not itchy

ALLERGIC 0 bilateral , itchy

182
Q

history of MS - patient gets sudden arrest of speech and right arm weakness resolves in 30 minutes - what do you think is going on?

A

this is a TIA

Not MS - b/c if MS - would be days to weak attack , if < 2 4hours and patient has multiple risk factors cardiovascularly - think TIA - start statin and aspirin

183
Q

idiopathic intracranial hypertension cause

A

HYPERVITAMINOSIS A
Tetracycline
Overweight
Child bearing age

184
Q

difference in treatment for E. histolytic vs echinococcus

A

echinnococus - drain liver abscess ( no fever, animal and dogs have to be in stem )

E. histolytic - metronidazole

185
Q

most appropriate test to diagnose hep B infection

A

HBsAg and ism AntiHBc

186
Q

zinc deficiency risk factors

A

malabsorption
bowl resection
poor nutritional intake
PTN

187
Q

clinical manesfication of Zn deficiency

A 
hypogonadism 
impaired tate 
healing 
alopecia 
skin rash
188
Q

Selenium deficiency

A

can lead to thyroid dysfunction as well as cardiomegaly

189
Q

what does it mean if there is a linear relationship b/w 2 variables

A

means that increase in one variable there was a decrease the other variable

190
Q

what is the study of choice for abdominal ultrasound

A

abdominal aortic aneurysms

191
Q

flank pain, low volume voids with or without occasional high volume voids, renal dysfunction

A

think obstructive uropathy

192
Q

lung nodule on X-ray what is the next step

A

CT chest

193
Q

characteristic of E.coli infection

A

watery diarrhea
may be bloody - only if enterohemorrhagic (shiga toxin strain)

accompanied with undercooked beef or foods contaminated with bovine faces

194
Q

fever, altered mental status with confusion and agitation, risk of seizures and coma

A

viral herepes simplex virus

- they will have UMN signs

195
Q

how does polysaccharide vaccine work

A

relatively T cell independent B cell response

196
Q

if melanoma is suspect what do you do?

A

1-3mm margin excision biopsy

197
Q

linear IgG and C3 deposition in the dermal epidermal junction

A

topical clobestasol ( high potency glucorticoid )

198
Q

treatment of dermatitis herpetiformis

A

dispose and elimination of dietary gluten

( grouped pruritic vesicles on buttock and extensor surfaces of the limbs

199
Q

BCC on the face - what is the treatment we use?

A

MOHS surgery

200
Q

difference b/w SJS and TEN

A

SJS - <10% of body surgery

TEN > 50% of body survive

Both get sloughing of epidermis and mucosal involvement

201
Q

epidermal inclusion cyst

A

epidermal cyst - benign nodule with squamous epithelium contains a semisolid core of keratin and lipid

  • common spots: face , scalp and truck

LOOK FOR SMALL CENTRAL PUNCTUN - pore like opening

Tx: drainage

202
Q

HPV on feet

A

WARTS

203
Q

pain at elbow with resisted wrist extension or supination or with passive wrist flexion

A

lateral epicondylitis

204
Q

what value is affected in IVDU if they have IE

A
  • right sided heart valves - TR usually holosystolic murmur, increase intensity with inspiration
205
Q

someone on Prednisone an having difficulty WB and pain in hip – they have a normal hip x-ray what do you do?

A

SO YOU THINK AVASCULAR NECROSIS

- that means you want to do a MRI of hip to Dx it

206
Q

difference b/w Waldenstrom macroglobulinemia and multiple myeloma

A

MM

  • CRAB
  • high Ca, renal insufficiency, anemia, bone lesions
  • elevated igG , IgA, light chains
Waldenstrom
-  hyper viscosity 
neuropathy 
bleeding 
HSM 
LAD 
- elevated IgM
207
Q

difference b/w MGUS and walderstrom macroglobulinemia

A

both patients will have M spikes

MGUS - illl have either ida, gig, IgD ( rare IgM - only 15%)
- they will also only have <10% monoclonal plasma cells

Waldernstrom

  • igM , > 10 % clonal B cells
  • they also get HSM, LAD, neuropathy, hyper viscosity
208
Q

patient reports that straight grid appears curved

A

macular degeneration

209
Q

enlarged blindspot

A

seen in ppl with raised ICp - papilledema

210
Q

treatment of acute angle glaucoma

A

TONOMETRY

consult opthamology

211
Q

what happens to Chloride in patients with Obesity hypoventilation syndrome and OSA

A

decrease chloride due to bicarbonate retention

212
Q

loss of follow up contributes to what type of bias

A

selection bias

213
Q

elderly man that develops urinary retention - what is Dx

A

think obstruction - bladder outlet obstruction - due to benign prostate hyperplasia or carcinoma of the prostate

  • achilles reflex may be decreased or absent in elderly
214
Q

treatment of Nocardia

A

TMP SMX

215
Q

high leukocytes , low Hg - what do you think of?

A

CML - BCR_ABL - chromosome 22

216
Q

A. fib for 6 hours in patient with hyperthyroidism what do you give

A

give propranolol

  • b/c patients with hyperthyroidism - won’t respond to electrical or chemical cardioversion
217
Q

why are patients with spenomegly at increase risk of infections with encapsulated bacteria

A

antibody mediate phagocytosis / complement activation

218
Q

when is lipid lower agent medications recommend for primary prevention

A

in patients age 40-75 with a 10 year risk of atherosclerotic cardiovascular disease > 7.5%

219
Q

best treatment for hepatic encephalopathy

A

LACTULOSE

220
Q

case controls studies - calculate OR which is a close approximation of RR - what does this mean

A

OR - looks at rare disease assumption

221
Q

treatment of hyponaatremic encephalopathy

A

hypertonic 3% saline and monitor electrolytes

222
Q

how to test for HIV

A

HIV p24 antigen and antibody testing

223
Q

spontansous retrosternal pain , ass/ w/ hot and cold food - what do you do next ?

A

esophageal motility studies ( manometric recording) - b/c this patient most likely has diffuse esophageal spasm

224
Q

3 most common causes of cough

A

upper airway cough syndrome ( postnasal drip)
Asthma
GERD

225
Q

deep linear ulcers on distal esophagus known HIV

A

think CMV

226
Q

herpetic vesicles and round ulcers on esophagus

A

HSV

227
Q

diabetic ophthalmoplegia

A

eye down and out position
normal sized reactive pupil
ptosis

DUE to CN3 ischemia

228
Q

problem with Pagets disease

A

osteoblast dysfunction

229
Q

what do you do to Levothyroxine level if patient is on oral estrogen

A

Want to make sure that you increase dose of Levothyroxine

b/c estrogen is known to increase level of thyroxine binding global

230
Q

antibody for scleroderma

A

antinuclear antibodies
anti-topoisomerase 1 ( anti Scl70(
anti RNA polymerase III

231
Q

parapneumonia effusions - uncomplicated parapneumonic effusions

A

ph > 7.2
Glucose > 60
WBC < 50 000

232
Q

Complicated parapneumonia effusion

A

ph < 7.2
Glucose < 60
WBC > 50 000

233
Q

treatment of uncomplicated vs. complicated Parapneumonic effusion

A

uncomplicated - antibiotics

complication - antibiotic and draining

234
Q

treatment of right sided endocarditis with hx IVDU

vs.

Naive valve IE

A

IVDU - vancomycin

Naive valve - Pen G and gentamicin

235
Q

what antibody ass/ w/ hashimoto thyroiditis

A

anti TPO ( anti-thyroidperoxidase )

236
Q

treatment of polycytemia vera

A

Phlebotomy

Hydroxyurea

237
Q

8 years post UC Dx

A

colonoscopy now then every 1-2 year therefor

238
Q

pressor effects on skin

A

pressers can cause schema of the distal fingers and toes secondary to vasospasm

uworld (11 decks)

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