Mixed Medicine Flashcards
1
Q
solitary liver mass , LOW Mcv and positive fecal occult blood screen
A
Colorectal cancer with mets to the liver
2
Q
what cancer spreads to the liver
A
lung breast skin cancers ( melanoma)
3
Q
hepatocellular cancer features
A
systemic symptoms
chronic hepatitis or cirrhosis
elevated alpha feta protein
4
Q
liver mets feature
A
single / multiple
Known extra hepatic malignancy
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
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
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
8
Q
treatment for aspiration pneumonia
A
ANEROBIC antibiotics
- metro , vlindamycin , amoxicillin calvulanic , carbapenem
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
10
Q
cause of trigeminal neuralgia
A
demyelination of the nerve nuclei
11
Q
duplex ultrasonography demonstrates incompressible popliteal and femoral veins
A
DVt
12
Q
patient with DVT or PE - without any provoking factors what do you think of?
A
malignancy
- perform age related cancer screening
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)
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)
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
16
Q
diagnosis of hep C
A
2 step process
- serological test HCV antibody
- molecular test RNA
17
Q
dysphagia initial diagnosis
A
- video fluoroscopic modified barrio swallow
18
Q
when do you do esophageal motility and upper Gi endoscopy test?
A
when sensation of food getting stuck in esophagus ( NOT THROAT)
19
Q
cystinuria
A
group of disorder characterized by IMPAIRED AA TRANSPORT
20
Q
urinaru cynaide nitroprusside test is positive
A
cystinuria
21
Q
treatment of hypercalcemia
A
Calcium > 14 - normal saline (short term) , long term (bisphosphonates)
22
Q
treatment of HOCM
A
beta blocker
23
Q
move cutoffpoint is moved from B to a what happens to sensitivity
A
INCREASE
24
Q
hidradenities suppurativa
A
chronic relapsing condition characterized by inflammatory skin areas and presents as painful nodules
Complications :; scarring, sinus tracks , comedones
25
what test works on Beta 1 adrenergic receipts
- affects on heart
Dobutamine - potent inotropic agent
- increase myocardial contractility leading to improved EF, reduced left ventricular end diastolic and symptomatic improvement of decompensated heart failure
26
```
proteinuria
hypoalbuminemia
edema
hyperlidemia and lipiduria
hypercoaguability
```
nephrotic syndrome
27
what meds interact with sidenafil
any meds that can cause hypotension - esp patients taking aha blockers or nitrates
28
diuretic abuse vs laxative abuse
both cause hypovolemia and hypotension
However , if stem mentions elevated urine sodium --> indicated that sodium is loss through the urinary tract ( diuretic use)
29
indication for low back pain and getting x-ray
osteoporosis / compression fracture
suspected malignancy
ank spon
30
indication for LBP and getting MRI
sensory / motor deficits
Cauda equina syndrome
Suspected epidural abscess / infection ( fever, intravenous drug abuse , concurrent infection , HD)
31
indication when LBP and getting radionuclide bone scan and CT scan
Same indications of MRI but not able to get MRI
32
AA amyloidosis ass/ conditions
chronic inflammatory conditions : RA , IBD
| Chronic infectious: osteomyelitis, TB
33
AL amyloidosis ass. conditions
multiple myeloma
| waldenstrom macroglobulinemia
34
Composition of amyloid AL amyloidosis
light chains ( usually lambda)
35
Composition of amyloid - AA amyloidosis
abnormally folded proteins, beta 2 microglobulin, apoplipoprotein or transthyretin
36
hypokalemia causes
- increase intracellular entry of potassium (with insulin, Beta adrenergic agents, heamtopoesis
- GI loses
- renal potassium wasting ( hyperaldosteronism , diuretics)
37
treatment of frostbite
rapid rewarming with warm water
analgesia and wound care
thrombolysis in severe , limb threatening conditions
38
clinical features of Magnesium toxicity
Mild: Nausea, flushing , headache, hypo reflex
Moderate: areflexia, hypocalemia
Severe: resp paralysis, cardiac arrest
39
Treatment of Magnesium toxicity
stop mg tx
| GIVE IV calcium gluconate bolus
40
cause of magnesium toxicity
1. Renal insufficiency
41
is MPGN nephrotic or nephritic?
Nephritic
42
what nephrotic syndrome has low serum C3 levels
PSGN
- seen 10-20 days after strep throat and skin infections
- presents with periorbital swelling, hematuria, oliguria
HTN , urinalysis - RBC cast and proteinuria
43
restrictive lung disease
decreased lung volume
decrease diffusion lung capacity
normal FEV1/FVC ratio
44
fundoscopy shows several yellow white exudates immediately adjacent to fovea and retinal vessels in HIV patient
- clinically FLOATERS and blurred vision in right eye
CMV retinitis
45
herpes simplex keratitis -
corneal lesions and results in ocular pain, tearing and discharge
dendritic
46
HIV retinopathy
cotton wool retinal lesions that are rarely heamorragic and tend to resolve in weeks to months
47
anemia in patient > 50 - what should you do
do endoscopic evaluation - think cancer
48
premature atrial beats - risk factors
1. tobacco
| 2. alcohol
49
treatment of premature atrial beats
b - blockers
50
uncomplicated pyelonephritis - when would you get a CT scan
after 72 hours if they don't improve with antibiotics
51
fundoscopy - venous dilatation and toruosity due to venous occlusion , diffuse hemorrhages , cotton wool spots , disk swelling , (blood and thunder appearance)
central retinal vein occlusion
52
severe eye pain, blurred vision, dilated pupil that is non reactive light
acute angle glaucoma
53
bone conduction > air conduction is suggestive of
conductive hearing loss
lateralizes to affected side
54
conductive hearing loss in patient 20-30
otosclerosis
55
sensorineural HL
air> bone
| lateralize to unaffected ear
56
what happens to the Aa gradient in IPF
impaired gas exchange resulting in
decrease diffusion capacity of Carbon monoxide
Increase Aa gradient
57
DDX high reticulocyte count
1. haemorrhage
2. hemolysis
- intrinsic: RBC membrane defect
- extrinsic:
Autoimmune , PNH
58
Ddx low reticulocyte count
leukemia
aplastic anemia
infection
medication s/e
59
if high suspicion of PE - treat or image first
early and effect anticoagulation decrease mortality risk of acute PE and should be initiated prior to confirmatory diagnosis
60
hemolytic anemia labs (MAHA)
- DECREASE serum haptoglobin
increase LDH
increase bill
61
what medication can cause acquired angiodema
ACE inhibitor
62
primary adrenal insufficiency vs. secondary adrenal insufficiency
```
- 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
63
examples of secondary adrenal insufficency
1. Sheehan syndrome
| 2. lymphocytic hypophysis ( lymphocytic infiltration)
64
what overdose: slurred speech, unsteady gait, drowsiness
benzo overdose
65
phenytoin toxicity
horizontal nystagmus, cerebellar ataxia, confusion
66
treatment of paget bone disease
bisphosphonates
67
elevated all phosphate , mixed osteolytic and sclerotic bone lesions and focal uptake of radiotacer on bone scan
paget disease of bone
68
how does TTP present and how do you treat
1. thrombocytopenia
2. MAHA
3. Renal insufficiency
4. neurological changes ( headache, confusion, coma , stroke)
5. fever
Tx ; plasma exchange, glucosteroids , rituximab
69
patient with RV MI may develop severe hypotension due to inadequate right ventricular preload ---> what do you do?
1. give saline bolus
| 2. if failed give - inotropic agents ( dopamine, dobutamine )
70
cause of abnormal hemostasis if patient has chronic renal failure but normal PT and PTT , platelet count
how do you treat condition?
platelet dysfunction
Tx:
- DDAVP - increase factor 8: vWF from endothelial stage sites
71
friable mucosa extending from rectum to sigmoid colon - with shallow ulcers seen on colonoscopy what is DX
UC
72
common causes of decrease platelet count
1. viral infections (EBV, hepatitis)
2. chemotherapy
3. MDS
4. Alcohol use
5. congenital ( fanconi syndrome)
6. Vitamin B12 or folate deficiency
73
increase platelet list
1. SLE
2. MEDS ( heparin)
3. ITP, DIC ,TTP , HUS
4. APS
74
what is untreated hyperthyroid patients at risk for
risk of rapid bone loss from increase osteoclastic actin in bone cell
risk of cardiac tacyarrythmias
(a. fib)
75
what kind of kidney stones are patients with chrons more likely to get?
OXOLATE ABSORPTION IS INCREASE
| therefore oxalate stones
76
HA, jaundice and splenomefly - what lab value is elevated
think Hereditary spheropcystosis
- ELEVATION in MCHC
77
recommended vaccines for adults > 65
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
78
Age 19-64 vaccine recommendation
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
79
leads V1 - v6
anterior MI
| blocked LAD
80
inferior MI
ST elevation in 2,3, avF
| RCA or LCX artery blocked
81
V1 - V3 ST depression
ST elevation 1,avL
St depression 1 and aVL
Posterior MI
LCX - ST elevation in leafs I and aVL
RCA - ST depression in 1 and avL
82
lateral MI
st elevation in 1, avL, V5,6
| ST depression in leads 2,3,avf
83
best treatment for fibromyalgia
AMYTRIPTYLINE
84
Symp, PE and Tx of allergic rhinitis
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
85
what type of cardiac condition odes patients with acromegaly get?
concentric left ventricular hypertrophy
86
most appropriate response when dealing with angry patient is
May I ask what is upsetting you so that I can help you as best as I can?
87
what timor do you get visual disturbances, headache, and symptoms pituitary hormones
Craniopharyngiomas ( supresellar tumours)
88
types of CPA tumours
headache, HL, balance problems
89
what happens to calcium when you have an increase in extracellular pH
dissociation of hydrogen ions from albumin - allowing increase binding of calcium and a drop of unbound ionized calcium
Clinical - symptoms of hypocalcemia
90
vasospastic angina
hyperactivity of coronary artery muscles
- young < 50 years old
- smoking
- recurrent chest discomfort - AT NIGHT , resolves < 15 minutes
91
Chest pain at night , resolves in 15 minutes - how do you treat
```
CCB (preventative)
Subinguinal nitroglycerin ( abortive)
```
patient has vasospastic angina
92
what process is similar to vasospastic angina
raynaud's phenomenon
93
telangiectasis, recurrent epistles and widespread AV malformation ass/ w/ heampotysis from R-L shut
Osler Weber Rendu syndrome - hereditary telangiectasia
94
abrupt onset of regular tachycardia that resolves in cold water immersion - what is DX and why does that happen
that patient has Paroxysmal SVT
With cold water immersion - patient gets activation AV node conductivity
95
clinical ass. of MCD
- NSAIDS
| - Lymphoma
96
Clinical ass. with FSGN
```
African americans
Hispanic
obesity
HIV
heroin use
```
97
membranous nephropathy - clinical association
Adenocarcinoma ( breast, lung)
NSAID
hepatitis B
SLE
98
MPGN clinical associations
hep C and C
| lipodystrophy
99
iga nephropathy
URTI
100
young adult asian women with blood pressure discrepancies
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
Small vessel lipohyalinosis
lacunar stroke
| - HTN is risk factor
102
most common cause of secondary bacterial pneumonia
Streptococcus pneumonia and S. aureus
103
pain and stiffness in neck, shoulder and pelvic grille, along with elevated ESR
Dx and Treatment
polymyalgia rheumatica
- tx low dose prednisone
104
megaloblastic anemia, glossitis ( shinny tonge), vertigo, thyroid disease and neurologic abnormalities - dx?
pernicious anemia
105
how will patients with CML present
```
anemia
thrombocytopenia
leukocytosis
SPLENOMEGLY
WBC > 100 000
```
106
labs seen in patients with osteomalacia
```
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
c-ray with decrease bone density with thinning of cortex and pseudo fractures
osteomalacia
108
causes of osteomalacia
```
recall due to vit D deficiency
- malabsorption
intestinal bypass surgery
celiac sprue
chronic liver disease
chronic kidney disease
```
109
DDX widened mediastinum
```
traumatic aortic injury
( thoracic aortic aneurysm)
Atelectasia
Mediastinal LAD
thymus
```
110
what type of renal failure associated with analgesics
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
serious infection of ear seen in elderly patients with poorly controlled diabetes
Malignant otitis externa
112
most common cause of Malignant otitis external
Pseudomonas aeruginosa
113
clinical for malignant otitis externa
- ear pain
- ear discharge
- GRADULATION tissue
114
Complication of malignant otitis external
osteomyelitis of skull bone
115
graduation tissue in ear canal
Malignant otitis extern
116
patient on warfarin and delves intracerebral hemorrhage what do you do
GIVE THEM PROTHROMBIN COMPLEX CONCENTRATE to reduce the risk of death and permanent disability
117
what type of anemia is alcohol abusers more likely to develop
folate deficiency
118
effects on heart with nitrate use
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
what rash worsens with alcohol intake
rosacea
| - facial flossing, telangiectasis and roughness or scaling and burning discomfort
120
clinical features of Antiphospholipid antibody syndrome
Venous and arterial thrombosis
- DVT , PE, TIA
Adverse pregnancy outcomes
- detal loss , preterm birth
121
malassezia globosa infection
same as tine versicolor
122
HIV patient with severe acute retinal necrosis - what is cause
HSV or VZV
123
HIV patient with fully or granular retinal lesions
CMV
124
management of causative injection
Secure airway ABC
CXR
endoscopy within 24 hours
125
when treatment regimen selected for a patient depends on the severity of patients condition - what is the bias
selection bias
126
mid 30 year old female presents with severe respiratory muscle weakness leading to rest failure, bulbar muscle weakness - after on antibiotics - what is it
myasthenia crisis
Triggers:
- infection or surgery
- pregnancy or childbirth
- tapering immunosuppressive drugs
- meds ( ahminoglycosides, BB)
127
sudden loss of vision and onset of floaters
vitrous haemorrhage \
128
treatment choice of lYME DISEASE IN pregnant and children
Amoxicillin
b/c they can't take doxycillin due to teeth discolouration and retardation in skeletal development
129
first line treatment to stabilize patient with tordes de point
magnesium sulphate
130
what can happen as a delay responds in SAH
vasospasm
| - which canc cause cerebral infarction
131
number one treatment for legionella pneumonia
FLOROQUINOLONES
| or newer macrolide
132
multiple liver mets - where can primary be?
- GI , lung , breast
133
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
THINK inflammatory back pain
134
numerous minute punctuate hemorrhages and loss of the grey white interface
diffuse axonal injury
135
CT findings in MS
will not show anything - need MRI which will show lesions in white matter in periventricularr areas
136
hepatorenal syndrome treatment
1. address precipitating factors
2. Splanchnic vasoconstrictors ( midodrine, octreotide, norepinephrine)
3. Liver transplantation
137
Precipitating factors for HRS
1. Reduced renal perfusion
2. GI bleed, vomitting, sepsis, excessive diuretic use, SBP
3. Reduce glomerular pressure and GFR (NSAIDS use )
138
liver ultrasound shows 10cm smooth round cyst with daughter cyst inside
Echinocactus granulosus
- close contact with dogs
Tx: albendazole
139
complication of ank spondolysis
Osteoporosis/ vertebral fractures
Aortic regurg
Cauda equina
140
milk alkali syndrome
- excessive consumption of calcium bicarbonate ( taken ofr osteoporosis )
Clinical: N, V, constipation, Polyuria, polydipsia, neuropsychiatric symptoms
141
TCA over toxicity
sodium bicarb - cardiac toxicity
142
pemiphigus vulgaris
flaccid bullae and ulcers
mucosal erosions
separation of epidermis by light friction ( niklosky sign)
143
pemphigus vulgaris immunofluorescence
netlike intercellular IgG
144
bilateral cranial neuropathies followed by symmetric descending muscle weakness
botulism toxin
145
PBC - what complications can they get
malabsorption , fat soluble vitamin deficiency
metabolic bone disease ( osteoporosis , osteomalacia)
HCC
146
who gets bile acid diarrhea
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
what is the BUN : Cr ratio for prperenal injury
> 20:1
148
fontotemporal dementia vs. dementia with Lew bodies
Frontotemporal
- early personality changes
- apathy, disinhibition and compulsive behaviour
Atrophy in frontotempral area
Dementia with Lewy bodies
- visual hallucination
spontaneous parkinsonism
fluctuating cognition
149
beta 2 agonist can cause what
muscle weakness
150
non opiod analgesic is not controlling cancer pains what would you use next?
short acting opioids
151
HIGH ALP
high PTH
Low vit D levels
Low Ca and phosphorus
osteomalacia
| - impaired osteoid metric mineralization
152
what cancers do lunch syndrome increase risk for
Colon cancer
Endometrial cancer
ovarian syndrome
153
what cancer does von Hippel lindau syndrome increase risk of
Hemangioblastomas
Clear cell renal cell cancer
Pheochromocytoma
154
Causes of myopathy
1. CTD
- polymyositis / dermatomyositis
2. Endocrine/ metabolic
- hypo/ hyper throidism
- cushing syndrome
- electrolytes - Low K+ , Ca+ , Phosphorus
3. Drugs - corticosteroids , statin, alcohol, colchicine
155
what does milk alkaline syndrome cause
HIGH calcium
Renal failure
Metabolic alkalosis
156
type 1 MEN
pituitary adenoma
Parathyroid ademoa / hyperplasia - high calcium
gastrointesintal / pancreatic endocrine tumour ( gastromas) - ZES - refractory PUD
157
theophyillin toxicity
CNS stimulation - headache, insomnia, seizure
GI disturbances - N and V
Cardiac toxicity - arrythmias
History: ciprofloxacin - decrease clearance of theophyillin - therefore increase toxicity
158
Risk factor for porphyria cutanea trade
```
Hepatitis C
HiV
Excessive alcohol consumption
estrogen use
smoking
```
159
complication of early CABAG
cardiac tamponade
| - get an ECHO
160
aortic dissection can increase risk of what
can propagate proximally from the site of intimal tear to involve the aortic valve and aortic regurg - patient presents in pulm edema
161
dementia with generalized cortical atrophy
think Alzhiemers
162
patient with metastatic cancer , elated Pulmonary artery and right arterial pressure - has what?
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
increase Right arterial pressure > 10mmhg and increase pulmary artery pressure > 40mmg - suggestive of what?
MASSIVE PULMONARY ARTERY
164
winters formula
Arterial pCO2 = 1.5 bicarb + 8 +/-2
165
patient gets confused with t2DM , ketones , high glucose - what is the cause of his confusion?
type 2 DM - think hyperosmolar hyperglycaemia - therefore confusion is due to hyperosmolarity
166
treatment of patients with non bleeding varies
non selective beta blockers - propranolol, nadol
167
management of CLD
involves both treatment of underlying cause and strategies to prevent further liver damage (alcohol avoidance, hepatitis A and hepatitis B vaccine)
168
Acute liver failure causes
Viral hepatitis - HSV, CMV, hep ABDE
```
Drug toxicity - acetaminophen ,
Ischemia ( budd chiari )
Autoimmune hepatits
Wilson disease
malignant infiltration
```
169
Dx criteria for Acute liver disease
- ALT and ASt > 1000
SEVERE hepatic encephalopathy ( confusion, asterixis)
Synthetic liver dysfunction ( INR >1.5)
170
hallmark of secretory diarrhea includes
larger daily stool volumes - >1L/ day
Diarrhea - during fasting or sleep
Reduced stool osmotic gap < 50
171
young individuals with rapid onset of fever, myalgia, nuchal rigidity, petechial rash and shock
MENINGOGOCCAL MENINGITIS
172
why do you get hyperkalemia in DM
deu to extracellular shift of potassium
173
chronic weakness, WL, hyponatremia, hyperkalemia ass. w/ low normal cortisol level
most likely has primary adrenal insufficiency - ADDISON DISASE
174
basal cortisol low, ACTH high , min response to cosyntropin
primary adrenal insufficiency
175
basal cortisol low
ACTH low
Minimal or subcortisol response to cosyntropin
secondary or tertiary adrenal insufficiency
176
How long does it take for Hep A to recover
recover 2-6 weeks
177
best test pancreatic cancer
abdo CT
178
initial test for pancreatic cancer
abode ultrasound- usually non diagnostic and then you do an abode CT scan
179
when do you check the Ca19-9
it is helpful in evaluating the tumor response to chemotherapy
180
sudden onset of redness , watery discharge and itching of both eyes , excessive tearing but not blurred
allergic conjunctivitis
181
difference b/w allergic conjunctivitis and viral
viral- more likely to be unilateral , not itchy
ALLERGIC 0 bilateral , itchy
182
history of MS - patient gets sudden arrest of speech and right arm weakness resolves in 30 minutes - what do you think is going on?
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
idiopathic intracranial hypertension cause
HYPERVITAMINOSIS A
Tetracycline
Overweight
Child bearing age
184
difference in treatment for E. histolytic vs echinococcus
echinnococus - drain liver abscess ( no fever, animal and dogs have to be in stem )
E. histolytic - metronidazole
185
most appropriate test to diagnose hep B infection
HBsAg and ism AntiHBc
186
zinc deficiency risk factors
malabsorption
bowl resection
poor nutritional intake
PTN
187
clinical manesfication of Zn deficiency
```
hypogonadism
impaired tate
healing
alopecia
skin rash
```
188
Selenium deficiency
can lead to thyroid dysfunction as well as cardiomegaly
189
what does it mean if there is a linear relationship b/w 2 variables
means that increase in one variable there was a decrease the other variable
190
what is the study of choice for abdominal ultrasound
abdominal aortic aneurysms
191
flank pain, low volume voids with or without occasional high volume voids, renal dysfunction
think obstructive uropathy
192
lung nodule on X-ray what is the next step
CT chest
193
characteristic of E.coli infection
watery diarrhea
may be bloody - only if enterohemorrhagic (shiga toxin strain)
accompanied with undercooked beef or foods contaminated with bovine faces
194
fever, altered mental status with confusion and agitation, risk of seizures and coma
viral herepes simplex virus
| - they will have UMN signs
195
how does polysaccharide vaccine work
relatively T cell independent B cell response
196
if melanoma is suspect what do you do?
1-3mm margin excision biopsy
197
linear IgG and C3 deposition in the dermal epidermal junction
topical clobestasol ( high potency glucorticoid )
198
treatment of dermatitis herpetiformis
dispose and elimination of dietary gluten
( grouped pruritic vesicles on buttock and extensor surfaces of the limbs
199
BCC on the face - what is the treatment we use?
MOHS surgery
200
difference b/w SJS and TEN
SJS - <10% of body surgery
TEN > 50% of body survive
Both get sloughing of epidermis and mucosal involvement
201
epidermal inclusion cyst
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
HPV on feet
WARTS
203
pain at elbow with resisted wrist extension or supination or with passive wrist flexion
lateral epicondylitis
204
what value is affected in IVDU if they have IE
- right sided heart valves - TR usually holosystolic murmur, increase intensity with inspiration
205
someone on Prednisone an having difficulty WB and pain in hip -- they have a normal hip x-ray what do you do?
SO YOU THINK AVASCULAR NECROSIS
| - that means you want to do a MRI of hip to Dx it
206
difference b/w Waldenstrom macroglobulinemia and multiple myeloma
MM
- CRAB
- high Ca, renal insufficiency, anemia, bone lesions
- elevated igG , IgA, light chains
```
Waldenstrom
- hyper viscosity
neuropathy
bleeding
HSM
LAD
- elevated IgM
```
207
difference b/w MGUS and walderstrom macroglobulinemia
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
patient reports that straight grid appears curved
macular degeneration
209
enlarged blindspot
seen in ppl with raised ICp - papilledema
210
treatment of acute angle glaucoma
TONOMETRY
| consult opthamology
211
what happens to Chloride in patients with Obesity hypoventilation syndrome and OSA
decrease chloride due to bicarbonate retention
212
loss of follow up contributes to what type of bias
selection bias
213
elderly man that develops urinary retention - what is Dx
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
treatment of Nocardia
TMP SMX
215
high leukocytes , low Hg - what do you think of?
CML - BCR_ABL - chromosome 22
216
A. fib for 6 hours in patient with hyperthyroidism what do you give
give propranolol
- b/c patients with hyperthyroidism - won't respond to electrical or chemical cardioversion
217
why are patients with spenomegly at increase risk of infections with encapsulated bacteria
antibody mediate phagocytosis / complement activation
218
when is lipid lower agent medications recommend for primary prevention
in patients age 40-75 with a 10 year risk of atherosclerotic cardiovascular disease > 7.5%
219
best treatment for hepatic encephalopathy
LACTULOSE
220
case controls studies - calculate OR which is a close approximation of RR - what does this mean
OR - looks at rare disease assumption
221
treatment of hyponaatremic encephalopathy
hypertonic 3% saline and monitor electrolytes
222
how to test for HIV
HIV p24 antigen and antibody testing
223
spontansous retrosternal pain , ass/ w/ hot and cold food - what do you do next ?
esophageal motility studies ( manometric recording) - b/c this patient most likely has diffuse esophageal spasm
224
3 most common causes of cough
upper airway cough syndrome ( postnasal drip)
Asthma
GERD
225
deep linear ulcers on distal esophagus known HIV
think CMV
226
herpetic vesicles and round ulcers on esophagus
HSV
227
diabetic ophthalmoplegia
eye down and out position
normal sized reactive pupil
ptosis
DUE to CN3 ischemia
228
problem with Pagets disease
osteoblast dysfunction
229
what do you do to Levothyroxine level if patient is on oral estrogen
Want to make sure that you increase dose of Levothyroxine
b/c estrogen is known to increase level of thyroxine binding global
230
antibody for scleroderma
antinuclear antibodies
anti-topoisomerase 1 ( anti Scl70(
anti RNA polymerase III
231
parapneumonia effusions - uncomplicated parapneumonic effusions
ph > 7.2
Glucose > 60
WBC < 50 000
232
Complicated parapneumonia effusion
ph < 7.2
Glucose < 60
WBC > 50 000
233
treatment of uncomplicated vs. complicated Parapneumonic effusion
uncomplicated - antibiotics
complication - antibiotic and draining
234
treatment of right sided endocarditis with hx IVDU
vs.
Naive valve IE
IVDU - vancomycin
Naive valve - Pen G and gentamicin
235
what antibody ass/ w/ hashimoto thyroiditis
anti TPO ( anti-thyroidperoxidase )
236
treatment of polycytemia vera
Phlebotomy
| Hydroxyurea
237
8 years post UC Dx
colonoscopy now then every 1-2 year therefor
238
pressor effects on skin
pressers can cause schema of the distal fingers and toes secondary to vasospasm
