MKSAP: Medicine Flashcards
0
Q
PIP and DIP: OA or RA?
A
- PIP = RA
- DIP = OA
1
Q
Leukocyte count in synovial fluid of: OA? Gout & pseudogout? Septic arthritis?
A
- OA = < 2,000
- Gout & pseudogout = 2,000 - 50,000
- Septic arthritis = > 50,000
2
Q
What are postmetopausal women who use diuretics at an increased risk for?
A
-tophaceous gout of the DIP joints
3
Q
Typical pt with patellofemoral pain syndrome?
A
-young active woman with anterior knee pain that is worsened by going down steps
4
Q
Best screening test for pts with suspected hemochromatosis?
A
-transferrin saturation measurement
5
Q
What 2 physical exam tests can be used to dx a meniscal tear?
A
- Pain along the joint line –> 76% sensitive
2. McMurray test –> 97% specific
6
Q
2 most common cause of nongonococcal septic arthritis in adukts?
A
- gram-positive bacteria:
1. Strep
2. Staph aureus –> most common
7
Q
Typical presentation of vasculitic neuropathies?
A
-acute onset of asymmetrical weakness and sensory loss with severe pain
8
Q
Typical age of onset of polymyalgia rheumatica?
A
> 50 yrs
9
Q
Aa
A
Aa
10
Q
3 Ssx of polymyalgia rheumatica?
A
- Pain and morning stiffness in axial joints and proximal muscles
- No evidence of joint inflammation or muscle weakness
- Elevated sed rate
11
Q
What is calcifications of cartilage pathognomonic for?
A
- pseudogout (AKA: calcium pyrophosphate deposition dz)
- esp in fibrocartilage of knee meniscus, symphysis of the pubis, glenoid and acetabular labra, and the triangular cartilage of wrist
12
Q
Tx for polymyalgia rheumatica?
A
-corticosteroids
13
Q
Aside from “bronze diabetes” what are 4 Ssx of hemachromatosis?
A
- Abnormal liver chemistries
- Arthropathy
- Fatigue
- Impotence
14
Q
Tx for patellofemoral pain syndrome?
A
- rest
- NSAIDs
15
Q
Ottawa Knee rules for obtaining an xray in a pt with acute knee pain (4)?
A
- Pt > 55 yrs old
- Tenderness in the head of the fibula or patella
- Inability to flex to 90*
- Cant bear weight immediately AND during the exam
16
Q
What is the most common cause of knee pain in pts < 45 yrs old?
A
-patellofemoral pain syndrome
17
Q
Tx for pts with infection of a closed space septic arthritis?
A
- IV antibiotics
2. Joint drainage
18
Q
Migratory arthralgias in a sexually active pt: most likely dx? Tx?
A
- dx: disseminated gonrrhea
- tx: ceftriaxone
19
Q
How does a pt typically describe the injury that caused their meniscal tear injury?
A
- twisting injury with the foot in a weight-bearing position
- popping or tearing sensation felt that is followed by severe pain
20
Q
DLCO in emphysema?
A
-reduced due to loss of parenchyma –> less surface area for diffusion
21
Q
Most common cause of hemothorax
A
-trauma –> blunt or penetrating (including iatrogenic)
22
Q
What contains isocyanates? What health consequence can they have?
A
- found in polyurethane paints
- can be potent sensitizers in some pts with asthma
23
Q
Tx for pt who is heterozygous for factor V Leiden mutation with recurrent thrombosis?
A
-long-term warfarin
24
DVT/PE prophylaxis in a pt who is at risk but heparin is contraindicated?
-intermittent pneumatic compression
25
Describe malignant pleural effusions?
1. Lymphocytic
| 2. Exudative
26
What characteristic means that a malignant pleural effusion has poor prognosis?
- pleural fluid glucose of < 60mg/dL
| - means less than 6 mnth survival!
27
Dx of exercise-induced asthma?
-confirmed with an exercise challenge test in which there is a post exercise > 20% fall in FeV1
28
Tx for secondary pneumothorax?
-tube thoracostomy
29
Malignant pleural effusions: usually transudative or exudative?
-exudative
30
Exercise induced asthma tx?
- SABA 5-10 min before exercise
| - works 80% of the time
31
Maintenance Tx for a pt with a malignancy and venous thromboembolism?
-low-molecular-weight heparin
32
What is more serious, primary or secondary pneumothorax?
-secondary, becuase it is due to an underlying lung disease, so the lung function is already compromised!
33
What position should a pt with suspected hemothorax be examined in? Why?
- upright
| - supine position will obscure the findings
34
PCO2 in asthma attacks?
- decrease in mild acute asthma exacerbations
- normal in moderate to severe exacerbations
- elevated in very severe exacerbations --> ominous sign, can be a sign of respiratory distress!
35
Preferred test for dx of PE?
-contrast-enhanced spiral CT
36
Lofgren's syndrome?
- triad of sx in the presentation of sarcoidosis:
1. Bilateral hilar lymphadenopathy
2. Polyarthraligias
3. Erythema nodosum
- triad of presenting sx is seen in 25-50% of pts with sarcoidosis, esp in females
37
Cough that occurs with sensitivity to cold is a clinical marker of? How can it be confirmed?
- clinical marker of airway hyperresponsiveness
| - can be confirmed via methacholine challenge test
38
Tx of acute severe asthma?
-bronchodilators after systemic corticosteroid tx
39
Dx of a cough-variant asthma?
-trail of albuterol inhaler that resolves sx
40
How many years does the pneumovax kast?
-about 5 yrs
41
What do you do next in a pt on low or moderate -dose inhaled corticosteroids that still has persistent asthma sx?
-add a LABA
42
Tx for a previously well controlled asthmatic following a respiratory tract infection?
-short course of oral steroids
43
3 Benefits of pulmonary rehab?
1. Improves sx
2. Improves exercise endurance
3. Improves quality of life
* * does NOT increase survival of pt though!
44
Methacholine test: describe
- give a pt suspected to have asthma increasing doses of methacholine until they have a fall in FEV1 of > 20%
- calculate the provocative concentration (PC20) using a dose response curve
- a PC20 of < 4 mg/mL = asthma
- PC20 of 4-16 = hyperreactivity
- PC20 > 16 = normal
45
What 3 characteristics mean chest tube drainage should be used for a parapneumonic effusion?
1. Pus detected
2. Gram-positive pleural fluid
3. pH < 7.0
46
What 3 things can a erythrocyte count in pleural fluid of >100,000 mean?
1. Trauma
2. Pulmonary infarction
3. Pleural malignancy
47
Pts with Hoddkin's lymphoma who received extended-field radiation tx are at risk for?
-developing solid tumors
48
What is the best tx for a pt with cancer of the head of pancreas?
- Whipple procedure = pancreaticoduodenectomh
| - best chance of cure
49
Tx for pt with metastatic small-cell lung cancer?
-combo of chemo and whole brain radiation
50
What should be given to a cancer pt with pain that ceases to respond to short-term pain management?
- long-acting narcotics
| - morphine is better than oxycodone bc oxy is more expensive
51
What should you do for a women with an abnormal pap smear that shows atypical squamous cells?
-HPV testing
52
Tx for widely metastatic non-small cell lung cancer?
-hospice
53
What what type of pancreatic cancer causes pain and weight loss?
-pancreatic body or tail
54
What should be done next for a pt with a PSA > 4 ?
-transrectal ultrasound-guided prostate biopsy
55
Women on combination hormone replacement tx are at risk for which cancer?
-breast cancer
56
What are the 2 most common causes of malignant pericardial dz?
1. Breast cancer
| 2. Lung cancer
57
Next step for an asymptomatic pt positive for fecal occult blood?
-colonoscopy
58
What can be done to reduce risk for squamous cell carcinoma and melanoma?
-avoiding direct sunlight during peak hours and other sun avoiding stratagies
59
What medication can help reduce the risk of prostate cancer?
-finesteride
60
Malignant v. Benign lung nodules: margins?
- malignant: spiculated
| - benign: smooth
61
What medication can be used to reduce the risk of breast cancer in pts who have elevated risk for breast cancer?
-tamoxifen
62
Malignant v. Benign lung nodules: calcification?
- malignant: little or no
| - benign: central, diffuse, or laminated
63
Which cancer causes obstructive jaundice and weight loss?
-cancers of the pancreatic head
64
Malignant v. Benign lung nodules: growth?
- malignant: intermediate doubling
| - benign: no or slow growth
65
Tx for hepatic encephalopathy?
-acyclovir
66
When should thrombolytic tx be started?
-must be started within 3 hrs of the onset of sx (or last time the pt was known to be well)
67
3 features of Lewy Body dementia?
1. Fluctuating cognition
2. Parkinsonism
3. Visual hallucinations
68
5 Characteristics of toxic encephalopathy?
1. Cognitive impairment
2. Fluctuating lethargy
3. Inattention
4. Hallucinations
5. Asterixis
69
7 Ssx of vertebral artery stroke?
1. Horner's syndrome
2. Dysarthria
3. Dysphagia
4. Decreased pain & temp
5. Dysmetria
6. Ataxia
7. Vertigo
70
5 Ssx of Demyelinating polyneuropathy?
1. Symmetrical proximal muscle weakness
2. Symmetrical distal muscle weakness
3. Decreased deep tendon reflexes
4. Distal loss of vibration senses
5. Distal loss of position senses
71
When can do chronic daily headaches occur?
- they can occur when a pt with migranes or tension headaches take analgesics too frequently
- these migranes and tension headaches "transform"
72
What is the most common cause of fatal sporadic encephalitis in the US?
-herpes encephalitis
73
Tx for cluster headache?
- prednisone
| - oxygen
74
What tx can help improve sx in a pt w/ mild/moderate Alzheimer's?
-cholinesterase inhibitors can have a modest effect on cognition
75
What 2 meds should be given to cover s. Pneumo and n. Meninigitis in empiric menigitis tx?
1. Ceftriaxone
| 2. Vancomycin
76
What is alteplase?
- thrombolytic agent that is a recombinant tissue-type plasminogen activator
- must be given within 3 hrs of the onset of sx
77
4 Characteristics of vascular dementia?
1. History of vascular risk factors
2. Abrupt onset with subsequent improvement
3. Periventricular white matter ischemia on imaging
4. Focal neurological findings on exam
78
What is "locked in" syndrome due to?
-lesion in the base of the pons usually from a pontine infarction due to a basilar artery occlusion
79
What should be done in a pt with suspected subarachnoid hemorrhage but normal CT scan?
-do an LP to check for blood or xanthochromia
80
5 Ssx of herpes encephalitis?
- rapid development of:
1. Fever
2. Headache
3. Seizures
4. Focal neurologic signs
5. Impaired conciousness
81
What should you think of as a cause of meningitis in a transplant pt? Tx?
- listeria
| - penicillin
82
What are monomorphic or intact erythrocytes characteristic of when found in urine sediments?
-nonglomerular hematuria
83
What electrolyte imbalance can occur in a pt taking hydrochlorothiazide
-hyponatremia
84
Common cause of nephrotic syndrome in children and adults?
-minimal change disease
85
What electrolyte imbalance does sarcoidosis cause? Why?
- hypercalciuria and hypercalcemia
- the granulomatous tissue can produce 1-alpha-hydroxylase --> converts 25-hydroxyvitamin D to the active form, 1-25-dihydroxyvitamin D3 --> more absorption of calcium via vit D toxicity
86
Abdominal pain and an increasing creatinine level in an elderly man?
-consider acute renal failure caused by urinary tract obstruction
87
5 Characteristics of acute glomerulonephritis?
1. HTN
2. Edema
3. Proteinuria
4. Glomerular hematuria
5. Erythrocyte casts in urine
88
Which comes first diabetic retinopathy or nephropathy?
-retinopathy!
89
4 Characteristics of nephrotic syndrome?
1. Urine protein excretion > 3.5 g/day
2. Hyperlipidemia
3. Hypoalbuminemia
4. Edema
90
Electrolytes in primary hyperparathyroidism?
- elevated serum calcium
- low phosphorus
- elevated hypercalcemia
91
Tx and prognosis of atheroembolic acute renal failure?
-no tx and the renal function does not usually return
92
What acid/base disturbance often develops in a pt with ESLD? Why?
- respiratory alkalosis
- the liver normally metabolizes steroid hormones, the elevated prostaglandin levels in ESLD cause a stimulation of the respiratory drive --> primary resp alkalosis
93
Formula to calculate osmolality?
2*[Na]+[glucose]/18+[BUN]/2.8
| -normal gap < 10
94
What electrolyte abnormality can be caused by ACEi? What drug should be used instead in these pts?
- hyperkalemia
| - instead use: hydralazine/nitrate combo to control the BP
95
What can hypomagnesium in pts with alcoholism mimic? Why?
- can mimic hypoparathyroidism with hypocalcemia
- hypomagnesium can cause suppression of parathyroid hormone secretion and resistance to PTH action
- so magnesium needs to be corrected in order to correct the calcium
96
4 Characteristics of hypertensive nephrosclerosis?
1. HTN
2. Non-nephrotic proteinuria
3. Bland urine sediments
4. Slowly progressive loss of kidney function
97
Which pathogen is associated with HUS?
-E. Coli O157:H7 shiga toxin
98
What rash is characteristic of atheroembolic acute renal failure?
- fine reticular rash, livedo reticularis
| - red, lacy rash
99
Why does hypomagensium occur in alcoholics?
-acute alcohol ingestion induces magnesium loss via urine
100
Acetazolamide: what is it? What acid/base disturbance can it cause? Why?
- carbonic anhydrase inhibitor
| - can cause a non-ion gap metabolic acidosis --> prevents the reabsorption of bicarb in the proximal tubule
101
Classic triad of sx for acute interstitial nephritis?
1. Fever
2. Rash
3. Arthralgias
102
What classifies as ACEi-induced prerenal acute renal failure? Tx?
- increase of creatinine >30% after the initiation of an ACEi or ARB (less than 30% is tolerable, an increase in creatinine is expected with these drugs)
- tx: stop the ACEi or ARB
103
Low anion gap? Common cause?
- less than 6
| - hypoalbuminemia
104
Muddy brown casts?
-acute tubular necrosis
105
Anion Gap formula?
= [Na+] - ([Cl-] + [HCO3-])
106
How long after an arterial catheter can atheroembolic acute renal failure occur?
-1-4 weeks afterwards
107
4 Characteristics of multiple myelomma?
1. Calcium is elevated
2. Anemia
3. Renal failure
4. Bone lesions
* *"CRAB"
108
General characteristic of SIADH?
-patient is unable to make dilute urine
109
3 features of ethylene glycol poisoning?
1. Elevated Anion gap metabolic acidosis
2. Elevated osmolar gap
3. Calcium oxalate crystals in urine
110
Decreased pH and bicarb?
-metabolic acidosis!
111
Osmolar gap?
- difference btwn the calculated and measured osmolality
| - normal < 10
112
What are dysmorphic erythrocytes associated with when they are found in urine sediments?
-glomerular hematuria
113
Mechanism for how NSAIDs can cause prerenal acute renal failure?
-inhibition of prostaglandin synthesis causes vasoconstriction --> decreased glomerular capillary pressure --> acute renal failure
114
Normal anion gap
- = 6-11
115
Common cause of mixed anion gap metabolic acidosis and respiratory alkalosis?
-salicylate toxicity
116
Oval fat bodies in urine?
-hallmark of proteinuria
117
C3 and C4 levels in SLE nephritis?
-C3 and C4 will be really low!
118
5 Characteristics of minimal change disease?
1. Edema
2. Hypoalbuminemia
3. Hyoercholesterolemia
4. Urine protein excretion of >3.5 g/24hrs
5. Numerous oval fat bodies in urine --> " maltese cross"
119
In what kidney disease are ACEi contraindicated? Why?
- bilateral renal artery stenosis bc in these pts the GFR is maintained by an angII-induced vasoconstriction at the efferent arterioles
* *switching to an ARB will NOT solve this problem!
120
Best screening test for diabetic nephropathy?
-measurement of microalbumin
121
Dipstick-positive hematuria, but no intact eyrthrocytes on microscopic analysis of urine sediments?
-think: rhabdomyolysis-associated acute renal failure
122
C3 and C4 levels in postinfectious glomerulonephritis?
- low C3
| - normal C4
123
What is the normal response to a fluid deprivation test?
-increasing urine osmolarity
124
What does an elevated osmolar gal mean? Common causes?
- means there is a presence of an unmeasured osmole
| - causes: ethylene glycol or methanol
125
What type of casts are seen in acute interstitial nephritis?
-leukocyte casts
126
Winter's formula?
-Expected PCO2 = 1.5*[HCO3-]+ 8
| +/-2
127
Primary metabolic acidosis plus a PCO2 higher than expected?
-mixed metabolic and respiratory acidosis
128
4 Characteristics if Wegener's granulomatosis?
1. Upper respiratory dz
2. Lower respiratory dz
3. Glomerulonephritis
4. C-ANCA
129
Glomerular nephritis + alveolar hemorrhage?
-Goodpasture's syndrome
130
Three most common causes of vaginal discharge?
1. Candidal infection
2. Trichomonias
3. Bacterial vaginosis
131
Definition of sepsis?
-SIRS in response to confirmed infectious process
132
What tx has shown to have the most impact on survival in a pt with severe sepsis?
-aggressive fluid resuscitation within 6 hrs!
133
What post surgery sx means the pt is more likely to have a periprosthetic infection?
- periosthetic pain
| - those who are pain-free aftery surgery are less likely to become infected
134
What imaging is preferred for the dx of osteomyelitis?
-MRI (best) or CT
135
Oral antiviral agent used to tx uncomplicated genital herpes simplex virus?
-oral valacyclovir
136
Prophylaxtic tx for an immunocomp, nonvaccinated pt exposed to the flu?
1. Zanamivir or oseltamivir
| 2. Inactivated flu vaccine
137
What is the best solution to use to clean a catheter insertion site?
-chlorhexidine
138
What PPD cutt-off range are adolescents who are exposed to adults in high-risk category in?
-> 10
139
Which heart valve is the most susceptible to an abscess formation?
-the aortic valve and its adjacent ring
140
Tx for orthopedic implant-associated osteomyelitis?
- surgical debridement and removal of infected implant
| - plus IV antibiotic
141
Tx of acute pyelonephritis in a pt who is: compliant, can eat and drink, and not pregnant?
-oral levofloxacin
142
Definition of severe sepsis?
-sepsis with organ dysfunction, hypoperfusion, or hypotension
143
What contact precautions should a suspected or confirmed TB patient be tx with?
-airborne isolation + personal respirators for the hospital staff
144
What extrapulmonary manifestations are common with legionella pneumonia?
1. Hyponatremia
2. Azotemia
3. Elevated live enzymes
4. Elevated creatine kinase
145
What is the best way to decrease the risk of UTIs from catheters?
- remove the catheter
| - no other method (prophylactic antibiotics, disinfecting wash, etc) has been useful
146
Latent TB tx?
-isoniazid for 9 mnths
147
5 Ssx of bacterial vaginosis?
1. Homogenous white discharge
2. Absence of vaginal erythema
3. Presence of clue cells
4. Vaginal pH > 4.5
5. Vaginal discharge with malodorous "fishy" odor
148
What kind of drugs are oseltamivir and zanamivir? What are they used for?
- neuraminidase inhibitors
- both active against influenza A and B
- zanamivir can cause bronchospasm --> CONTRAINDICATED IN ASTHMA!!
149
Pt with recurrent GI and resp infections, what disease should you think about? Dx?
- think: common variable immunodeficiency (AKA acquired hypogammaglobulinemia)
- dx: measure serum IgG levels
* *recurrent GI infections especially with giardiasis!
150
Septic shock definition?
- sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation
- this dx cannot be made until fluid resuscitation has been administered and the response has been evaluated!!
151
What helps prevent ventilator-associated pneumonia?
-keeping mechanically ventilated pts at 45* angle
152
How does a prior vaccination with bCG affect the interpretation of a PPD?
- it does NOT change it!
| - test is read as if the person does not have the vaccine!
153
What IV catheter site is associated with a lower risk of infection?
-subclavian
154
Name 2 neuraminidase inhibitors that can be used for influenza?
1. Oseltamivir
| 2. Zanamivir
155
What should be done first in a pt with a contiguous foot ulcer and possible bone involvement?
-bone bx with cultures before starting antibiotics!
156
What is drug fever and which commonly cause it?
- a prolonged fever caused by a medication, with no other obvious signs of inflammation
- antibiotics can cause this, esp beta-lactams
157
What influenza medication is contraindicated in asthmatic pts? Why?
- zanamivir
| - may induce bronchospasm!
158
What is the most sensitive test to do in an HIV infection during the acute (early) stage?
-HIV viral load
159
3 Cut-offs for induration from TB test? Who is in each group?
1. >5 mm --> highest risk, immunosuppresed, TB contacts, chest xray shows TB
2. >10 mm --> mid risk, immigrants, IV drug users, prisoners, health care workers, pts with chronic disease/malignancy
3. > 15 mm --> lowest risk, "normal" people
160
What could happen if an infected orthopedic implant is not removed?
-a biofilm can form & the bug will escape the hosts defenses!
161
Best way to stop the spread of c. Diff from an infected pt?
- put the pt in contact isolation
| - ALCOHOL RUBS are NOT effective for killing c. Diff!
162
Tx for acute bacterial rhinosinusitis?
- 3 - 10 day course of narrow-spectrum antibiotics, such as:
1) amoxicillin
2) TMP-SMZ
3) doxycycline
163
Which two common infections cause cervicitis rather than vaginitis?
1. Chlaymidia
| 2. Gonorrhea
164
What is the Tx for an uncomplicated UTI in a compliant, young, healthy, nonpregnant female?
-TMP-SMZ
165
4 Ssx of bacterial rhinosinusitis?
1. Duration of the sx --> greater than 1 week + worsening sx after an initial improvement
2. Maxillary tenderness
3. Purulent drainage
4. Poor response to decongestants
166
What bug is likely to be the cause if there are extrapulmonary manifestations too?
-legionella
167
A
A
168
Progressive multifocal leukoencephalopathy: what is it? What is it caused by? What dies it lead to? Tx?
- opportunistic infection
- caused by polyomavirus JC
- leads to demyelination of the CNS --> causes progressive neurologic deficits
- tx: HAART tx
169
What is the best antibiotic tx for aspirate pneumonia? What are the common bugs involved?
- use: clindamycin
| - bugs: anaerobes
170
How does prednisone effect a PPD test?
- can cause a false-negative result!
| - so test pt with PPD BEFORE starting prednisone!
171
Rhinitis medicamentosa? Tx?
- persistent rhinitis sx in a pt with chronic nasal decongestant spray use
- due to the rebound phenomenon
- tx: withdraw the decongestant and give nasal corticosteroid spray
172
Reccomended tx for a pt with CAP who is being hospitalized?
Either:
1) IV beta-lactam plus IV or oral macrolide or doxy
2) IV fluoroquinolones
173
What is the initial antiTB tx regime?
- 4 antiTB drugs (Rifampin, Isoniazide, Pyraznamide, Ethambutol)
- the fourth drug may be stopped when the sensitivity results are back
174
Definition of systemic inflammatory response syndrome (SIRS)?
- presence of 2 or more of (in absence of a known cause):
a) temp > 100*F or < 96.8*F
b) heart rate > 90/min
c) resp rate > 20/min, or PCO2 < 32
d) leukocyte count > 12,000 or < 4,000 or > 10% bands
175
2 Tx options for candida vaginitis?
1. Intravaginal clotrimazole cream
| 2. Single oral dose of fluconazole
176
5 Ssx of TTP?
1. Fever
2. Neurologic abnormalities
3. Thrombocytopenia
4. Microangiopathic hemolytic anemia --> see: anemia, schistocytes, and elevated lactate dehydrogenase concentration
5. Renal insufficiency
177
What is the most common cause of thrombocytopenia during pregnancy? Tx?
- incidental thrombocytopenia of pregnancy
| - tx: none, its a benign condition, just monitor the pt and platelet levels
178
What is required for the dx of myelodysplastic syndrome?
-cytopenia of at least one of the cell lines
179
What is seen on the peripheral blood smear in a pt with alpha-thal trait?
-target cells
180
In what 2 situations are protein C & S concentrations decreased in patients?
1. Pregnancy
| 2. When they are on oral anti-coagulants
181
Tx for Philadelphia chromosome positive CML?
-imantinib mesylate --> targets BCR-ABL
182
Tx of HIT?
- stop heparin immediately
| - use an alternative anticoagulation tx = direct thrombin inhibitor
183
4 Common ssx of multiple myleoma?
1. Hypercalcemia
2. Bone pain
3. Anemia
4. Clusters of Large plasma cells on bone marrow aspirate
184
What happens to iron levels during an infection? Why?
- the iron levels decrease during an infection bc there is an increase in hepcidin and bacterial lactoferrin binds to the iron (bacteria use iron to support their growth)
- cytokine levels also increase, which affects transferrin and ferritin expression = low total iron binding capacity & low transferrin levels & high ferritin levels
185
2 Most common mutations that predispose to venous thrombosis? What ethnicities are they most common in?
1. Factor V Leiden
2. Prothrombin G20210A
- most common in whites, rare in Asian and black populations
186
What is the leading cause of death in a pt with sickle cell anemia?
-acute chest syndrome
187
What drug should be used to prevent renal dz in sickle cell pts that show signs of developing kidney dysfunction?
-ACEi
188
What does HELLP stand for?
- Hemolysis with microangiopathic blood smear
- Elevated Liver enzymes
- Low Platelets
189
Dx for an acquired factor VIII inhibitor coagulopathy?
- mixing study
- patient's plasma and normal plasma are mixed in 1:1 ratio & the abnormal test is repeated --> if the abnormality is due to a factor VIII deficiency, the abnormality will correct with mixing, but if the abnormality is due to an inhibition, the abnormality will not correct with mixing!
190
2 Micro bio signs of Chronic myeloid leukemia?
1. Elevated leukocyte count
| 2. Increased numbers of granulocytic cells in all phases of development on peripheral blood smear
191
3 Major criteria for dx of polycythemia vera?
1. Elevated RBC mass
2. Normal arterial oxygen saturation
3. Splenomegaly
192
What 2 proteins are decreased during pregnancy? When else are they decreased?
-protein C and protein S are decreased during pregnancy and when using oral anticoagulants
193
3 Features of Autoimmune hemolytic anemia?
1. Anemia
2. Elevated reticulocyte count
3. Microspherocytes on peripheral blood smear
194
5 Ssx of acute chest syndrome?
1. Fever
2. Chest pain
3. Shortness of breath
4. Hypoxia
5. Radiographically detected pulmonary infiltrate
* * in a pt with a sickling disorder (SS)
195
What is seen in the CBC and bone marrow in aplastic anemia?
- CBC = pancytopenia
| - bone marrow = hypocellular hone marrow
196
Tx for TTP
-plasma exchange ASAP
197
2 Most common infectious causes of acute chest syndrome?
1. Chlamydia
| 2. Mycoplasma
198
2 Microbio signs of Acute Myeloid Leukemia?
1. Pancytopenia
| 2. Increased myeloid blasts
199
Initial tx in pts with warm-antibody autoimmune hemolytic anemia?
-corticosteroid tx
200
What is the mean corpuscular hemoglobin concentration in hereditary sphereocytosis?
-elevated
201
Serum methylmalonic acid and homocysteine concentrations in vitamin B12 deficiency v. Folate deficiency?
- B12: both methylmalonic acid and homocysteine concentrations are elevated
- Folate: only homocysteine concentrations are elevated, not methylmalonic acid
202
4 Signs of DIC?
1. Elevated prothrombin time
2. Elevated activated partial thromboplastin time
3. Low fibrinogen levels
4. Thrombocytopenia
203
In what 3 settings can an acquired factor VIII inhibitor coagulopathy occur?
1. Some malignancies --> ex lymphomas
2. Some autoimmune diseases
3. Postpartum
204
3 Ssx of HUS?
1. Thrombocytopenia
2. Microangiopathic hemolytic anemia
3. Renal disease
205
3 Hematologic findings in iron deficiency anemia on the peripheral blood smear?
1. Hypochromatic RBCs
2. Abnormalities in the size and shape of RBCs
3. Occasional bizarre shaped (ex cigar) RBCs
206
What are patients with refractory anemia and an excessive amount of blasts at risk for?
-transforming into an acute leukemia during their lifetime
207
Ssx of ITP?
1. Severe thrombocytopenia
2. Normal hemoglobin
3. Normal leukocytes
4. Absence of other sx, such as fever, headache, other constitutional manifestations
208
Tx of choice for heroes zoster?
-famciclovir (replaced acyclovir as the top choice)
209
Tx of scabies?
-topical permethrin
210
What 2 drugs are the tx of choice for HtN in chronic kidney dz?
1. ACEi
| 2. ARBs
211
Phenoxybenzamine: what is it?
-alpha blocker
212
Initial tx for common warts?
-topical tx containing salicylic acid
213
What does tinea versicolor look like on KOH prep? Tx?
- KOH: spaghetti and meatballs
| - tx: topical ketoconazole cream
214
What ankle-brachial index indicates leg ischemia?
- <0.9 & decreases 20% or greater with exercise
215
Corticosteroids and acne?
-nit used for tx and can even cause acne!
216
What 3 cardiovascular findings are normal in pregnancy?
1. Systolic murmur
2. S3 gallop
3. Mild peripheral edema
217
When can a multidrug antihypertensive regimen be considered ineffective?
-only if it contains a diuretic
218
What can significantly increase the accuracy of a breast exam?
- the duration
| - the examiner should spend 3 minutes per breast
219
What medication should be added for a pt with uncontrolled HTN who is already on an ACEi and beta-blocker?
-thiazide diuretic
220
What are the colon cancer screening recommendations for a person with a familial hx of colon cancer? What does it mean by familial risk?
- familial risk = multiple first degree relatives or a first degree relative < 60 yrs old
- screening: every 5 yrs starting at age 40, or 10 yrs before the youngest diagnosis!
221
Orlistat: MOA? Results? Sfx?
- MOA: lipase inhibitor, increases fecal fat loss
- results: average of 6.3 lbs lost in 12 mnths
- sfx: related to malabsorption of fat
222
How long does it typically take for a girl's menses to regulate? What does it mean if it doesnt?
- usually takes a year
| - can suggest PCOS if it doesnt regulate
223
Tx of what is the best way to preserve renal fctn in a pt with diabetic nephropathy?
-HTN
224
What has been shown to prevent pelvic inflammatory disease?
-annual chlamydial screening of sexually active women < 24 yrs old and other women who are at increased risk
225
What BMI indicates obesity tx with medications? Surgical tx?
- medications: > 27 with comorbidities or > 30
| - surgery: > 35 with comorbidities or > 40
226
What imbalance can thiazide diuretics cause? How? Tx?
- thiazide diuretics can cause hypercalcemia bc they stimulate renal tubular calcium reabsorption
- tx: stop the diuretic & it should self correct
227
What common medication can cause HTN that is resistant to tx? Why?
- NSAIDs, esp in elderly
| - bc they effect sodium excretion
228
What is the tx of choice for scleroderma renal crisis?
-shirt acting ACEi
229
What is considered hazardous drinking in young men (< 65 yrs)? In older men ( > 65 yrs)?
- young = more than 4 drinks on a given day, or more than 14 drinks per week
- old = more than 3 on a given day, or more than 7 drinks per week
230
Tx for comedonal-only acne?
-topical retinoids
231
What is an aphthous ulcer?
- one of the most common oral ulcers in north america
- painful lesions that are localized, shallow, round, can be whitish in appearance
- can begin to occur in teenagers and recur often
- cause unknown
232
What are the recommendations for abdominal aortic aneurysm screening?
-men ages 65-70 yrs who are, or have ever been smokers should be screened via an abdominal ultrasound once
233
What can unprovoked hypokalemia suggest?
-hypoaldosteronism
234
Sibutramine: MOA? Results? Sfx?
- MOA: appetite suppressant that works through combine NE and serotonin reuptake inhibition
- results: 9.8 lbs at 12 mnths
- sfx: increase in HR, BP, nervousness, dry mouth, headache, insomnia
235
What cardio med is contraindicated with cocaine use? Why?
-Beta-blockers --> bc cocaine causes both alpha and beta stimulation, so using a beta blocker would cause unopposed stimulation of alpha receptors!
236
Tx for poison ivy?
-oral prednisone
237
ACEi and ARBs in pregnancy?
-contraindicated, can cause adverse effects on fetal renal function esp in 2nd and 3rd trimesters
238
When should oral antibiotics be used for acne treatment? How long does it take to determine efficacy? Which are the best to use?
- used: when the combination of a topical comedolytic agent (ex retinoid) plus a topical antibiotic have not worked
- duration: takes 6-8 wks to determine efficacy
- which: use an oral tetracycline + an additional topical antibiotic
239
What 2 dugs are preferred for tx of chronic HTN in pregnant pts?
1. Labetalol
| 2. Methyldopa
240
What is the most common cause of acute mesenteric artery ischemia?
-arterial embolism originating from the heart, most often due to afib
241
4 Ssx of primary biliary cirrhosis?
1. Puritis
2. Hypercholesterolemia
3. Cholestatic liver dz
4. Positive antimicrobial antibody titer
242
What liver dz are pts with inflammatory bowel dz at higher risk for developing?
-primary sclerosing cholangitis
243
Tx for acetaminophen toxicity?
-N-acetylcysteine
244
How do pts with severe cholangitis usually present (4)?
1. Fever
2. Jaundice
3. Altered mental status
4. Abdominal pain
245
3 Most common causes of aminotransferase values of > 5000 U/L?
1. Acetaminophen hepatotox
2. Hepatic ischemia
3. Viral hepatitis (ex. Herpes simplex)
246
6 "Alarm sx" of abdominal pts?
1. Hematochezia
2. Weight loss
3. Family Hx of colon cancer
4. Fever
5. Anemia
6. Chronic severe diarrhea
* *require careful evaluation
247
Pseudoachalasia: what is it?
- sx of achalasia caused by a tumor
| - usually seen in pts >60 yrs --> do an endoscopy on elderly pts that present with sx of achalasia!
248
Tx for HELLP syndrome?
- delivery of fetus
| - usually resolves within 48 hrs of delivery
249
When should repeat endoscopies be done for pts with barrett's esopagitis?
-endoscope with bx every 3 yrs
250
What 3 situations would make you suspicious of a gastrinoma in a pt?
1. Multiple ulcers
2. Ulcers in unusual locations
3. Ulcers that recur frequently, esp in absence of NSAID use!
**zollinger-ellison syndrome
251
What is a common cause of self-limited, mild pain, hematochezia in eldery pts?
-ischemic colitis
252
5 Ssx of achalasia?
1. Dysphagia
2. Regurgitation
3. Weight loss
4. Chest discomfort
5. "Bird beak" sign on barium swallow = dilated esophageal lumen and smooth muscle narrowing at esophageal outlet
253
Serologic testing for H. Pylori
- can be done if the pt doesnt have any alarm sx (if they do, they need an endoscopy!)
- test blood, serum, &/or saliva for IgG antibody to H. Pylori --> will remain positive for months
254
Aminotransferase values in a pt with hepatic ischemia?
-will be high (>5000), but then will rapidly improve over a few days
255
Why are alcoholics at a higher risk of developing acetaminophen hepatotoxicity?
-chronic alcohol use causes a depletion in the stores of glutathione (used for metabolism of alcohol) --> also needed for the metabolism of acetaminophen --> so they can develop toxicity at lower doses
256
How does uncomplicated diverticulitis present?
-left lower quadrant abdominal pain and fever
257
Grey-Turner's sign?
- ecchymosis of the flanks
- suggests pancreatitc hemorrhage due to pancreatic necrosis
- very rare presentation of acute pancreatitis
258
What is the best initial imaging study for a pt with possible pancreatic adenocarcinoma?
-helical CT scan of abdomen
259
5 alarm features for gastric malignancy with dyspepsia?
1. Weight loss
2. Bleeding
3. Early satiety
4. Vomiting
5. Anemia
260
What is elevated in Gilbert's syndrome?
-indirect (unconjugated) bilirubin
261
Dx of diverticulitis?
- abdominal CT
- colonoscopy should be done several weeks after resolution --> do not do colonoscopy during acute flare up bc complications such as: can occur
1. Abscess
2. Fistula
3. Obstruction
262
What is the most common cause of occult gastrointestinal bleeding in pts > 60yrs?
-angiodysplasia = vascular malformations
263
Tx for diarrhea predominant IBS?
-loperamide
264
How often should a lt with pan-colitis (for more than 10 yrs) undergo a colonoscopy with bx?
-every 1-2yrs for cancer surveillance
265
What 2 groups of pts is herpes hepatitis seen most often in?
1. Pregnant pts
| 2. Immunocomp pts
266
Relationship of nausea and vomiting in relationship to the pain of acute appendicitis?
-n/v follow the onset of pain
267
Ssx of acute cholecystitis (4)?
1. Prolonged right upper quadrant abdominal pain
2. Fever
3. Leukocytosis
4. Hyperbilirubinemia
268
What is fulminant hepatic failure? What is the first thing that should be done?
- clinical syndrome of severe acute liver failure and encephalopathy in a pt w/out a hx of liver dz
- immediate evaluation for liver transplant should be done!
269
What prophylaxtic tx should pts with large esophageal varicies undergo?
-nonselective beta-blocker --> decrease splanchnic blood flow
270
What does the acronym HELLP syndrome stand for?
- Hemolysis
- Elevated Liver enzymes
- Low Platelets
271
How does acute mesenteric artery ischemia usually present?
-sudden, severe, generalized abdominal pain
272
What creatinine levels should metformin not be used in?
- men > 1.5
| - women > 1.4
273
4 features of myxedema coma? What is it typically preceded by?
1. Progressive obtundation
2. Hypothermia
3. Hypotension
4. Bradycardia
274
Definition of subclinical hyperTH?
-low or undetectable TSH level with free T4 and free T3 are within reference range
275
4 Recommendations to prevent cortico-steroid induced osteoporosis?
1. Calcium supplementation
2. Vit D supplememntation
3. DEXA scan before tx
4. Bisphosphanates if tx will be >3 mnths
276
Name 6 coronary artery dz equivalents? What should they be treated for?
1. Clinical coronary artery dz
2. Symptomatic carotid artery dz
3. Peripheral artery dz
4. Abdominal aortic aneurysm
5. Diabetes mellitus
6. Framingham risk score of > 20%
- should be tx with lipid-lowering therapy
277
2 criteria for predibetic glycemic states?
1. 2-hour glucose tolerance test of 140-199 = impaired fasting glucose
2. Fasting glucose of 100-125 = impaired fasting glucose
278
What is the main tx for symptomatic thyroiditis?
-beta blocker --> for tachy or palpitations that may occur during the thyrotoxic phase
279
What bone mineral density is diagnostic for osteoporosis?
- <-2.5 SD below the young adult mean
280
What is usually the level of prolactin in a nonpregnant female with a prolactinoma?
> 200 ng/mL
281
Which pts are thiazolidinediones contraindicated in? Why?
- type II DM pts with heart failure
| - thiazolidinediones increase fluid retention and can cause decompensated heart failure
282
What happens to the thyroid hormone requirement during pregnancy?
-increases by 30-40%
283
What are women with subclinical hyperthyroidism at an increased risk for?
-atrial fibrillation (3-fold increased risk!)
284
What is the recommended 2-hour postprandial glucose for diabetics?
- < 180
285
Hyperfunctioning adenomatous thyroid nodule: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?
- PE: palpable nodule
- increased iodine uptake
- "hot" nodule on tracer uptake
286
Grave's dz: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?
- PE: diffusely enlarged thyroid gland
- elevated iodine uptake
- homogenous uptake of tracer
287
5 Major risk factors for osteoporosis?
1. Personal hx of a fracture as an adult
2. History if fragility fracture in a first-degree relative
3. Low body weight (<127 lbs)
4. Current smoker
5. Oral corticosteroid use for > 3 mnths
288
What should the dose of metformin be held on the day that a pt has radiographic procedure that will be using contrast? When should it be restarted?
- bc metformin will accumulate in a pt that has renal insufficiency and cause lactic acidosis
- radiocontrast can be nephrotoxic and cause renal insufficiency
- resume once renal fctn normalizes
289
3 Criteria for dx Diabetes?
1. Fasting glucose on 2 occasions > 126
2. Glucose tolerance test of > 200
3. Random glucose of > 200 + symptoms
290
Alcoholic ketoacidosis v. DKA?
- have similar sx and can mimic DKA
| - blood glucose conc is the key difference --> it will be normal or low in setting of ketoacidosis
291
Toxic multinodular goiter: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?
- PE: nodular to palpation
- elevated iodine uptake
- heterogenous uptake of tracer
292
What is the recommended prepradial glucose for diabetics?
-glucose 90-130
293
What 3 leads are inferior?
1. Lead II
2. Lead III
3. Lead aVF
294
What hypertensive medication should be avoided in pregnancy? Why?
-ACEi --> can cause fetal renal agenesis
295
Initial tx of acute viral pericarditis?
-high-dose NSAID, such as indomethacin or ibuprofen
296
Peripheral ischemia after an arterial catheterization?
-think: cholesterol embolism syndrome
297
Which heart condition can go undiagnosed until pregnancy and why?
- mitral stenosis
| - can be asymptomatic until the body is hemodynamically stressed, as in pregnancy
298
Most common artery to be involved with ascending aortic dissection?
-right coronary artery
299
What are the 4 main benefits of using a Beta-blocker post MI?
1. Reduces size of infarct
2. Reduces frequency of recurrent MI
3. Improves short-term survival
4. Improves long-term survival
300
What is the one drug that is indicated for all pts with systolic heart failure, regaurdless of ejection feaction?
-ACEi
301
Tx for tachycardic pts who are unstable?
-immediate direct-current cardioversion
302
What is one physical exam finding that can help exclude the dx of severe aortic stenosis? Why?
- a physiologically split S2
| - with severe stenosis the valve leaflets do not "snap" shut, so the aortic component will be absent
303
For an acute MI, if fibrinolytics are indicated, when should they be given?
- within 30min of arrival to hospital
| - not after 12 hrs of sx!
304
What is the most important determinant of survival in cardiac arrests? Why?
- time to defibrillation
| - most adults go into cardiac arrest bc of a ventricular arrhythmia
305
What 3 things are seen on EKG for a Wolff-Parkinson-White syndrome pt?
1. Short PR segment
2. Delta wave
3. Tachycardia
306
Inferior leads
Leads II, III, and aVF
307
Tx for life threatening Dig toxicity?
-digitoxin-specific antibody fragments
308
What is pathognomonic for acute pericarditis on EKG?
-PR-segment depression
309
How to dx diastolic heart failure?
-made when the ssx of systolic heart failure are present, but there is normal left ventricular ejection fraction and an absence of significant valvular abnormalities
310
Lack of pericardial effusion on echo?
- does not exclude pericarditis
| - 40% of pts w/ pericarditis lack effusion
311
What 2 medications are indicated in all pts with systolic heart failure?
1. ACEi
| 2. Beta-blocker
312
Which pts does CABG improve the survival in?
- w/ obstructive left main and/or 3-vessel CAD
| - reduced EF
313
Lateral and apical leads?
-V4-6
314
What is pathognomonic for acute pericarditis on EKG?
-PR-segment depression
315
What increases the murmur of hypertrophic cardiomyopathy? What decreases it?
- increases w/ valsalva maneuver
| - decreases w/ squatting from standing
316
Atrial tachycardia with variable block?
-think: digitalis toxicity
317
Tx for ventricular fibrillation or sustained ventricular tachy?
-implantable cardioverter-defibrillator
318
Ankle-brachial index for pts with peripheral vascular dz? For severe cases? For vascular calcification?
- ABI < 0.9 = peripheral vascular dz
- severe < 0.4
- calcification > 1.3
319
What 2 things can an ascending aortic dissection lead to?
1. Aortic regurg
| 2. Obstruction of right coronary a.
320
Pt with prosthetic heart valve and unexplained fever?
-think: bacterial endocarditis
321
What 3 cardiac problems can give you an ST elevation?
1. MI
2. Variant angina
3. Acute pericarditis
322
Pulmonary capillary wedge pressure and CO in cardiogenic shock?
- PCWP = elevated
| - CO = low
323
EKG finding of digitalis toxicity?
-atrial tachy with variable block
324
Tx of monophasic ventricular tachy in a hemodynamically stable pt? Unstable pt?
- stable: IV
1. Lidocaine
2. Procainamide
3. Amioderone
- unstable: direct-current cardioversion
325
Anteroseptal leads?
-leads V1-3
326
Dosage of beta-blockers in pt with systolic HF?
-should be titrated to pts heart rate
327
Short term and long term tx of coronary artery vasospasm?
- short term = nitrates
| - long term = CCBs
328
List 4 physical findings of severe aortic stenosis?
1. Small and late carotid pulses
2. Late peaking systolic murmur
3. Absence of splitting of S2
4. Sustained apical pulse
329
Alcoholic cardiomyopathy: describe changes in heart? Tx?
- both ventricles are dilated and globally hypokinetic
| - tx: abstaining from alcohol may reverse the cardiomyopathy in pts with less advanced dz + tx for heart failure
330
Cardiac amyloidosis: describe changes in heart? How dies it typically present?
- changes: left ventricular wall thickness increased --> due to amyloid deposition
- presentation: restrictive cardiomyopathy w/ diastolic dysfunction (rather than systolic dysfunction)
331
How to determine which pts with afib should be on warfarin v aspirin?
- determine the CHADS2 score:
1. CHF --> 1 pt
2. HTN --> 1 pt
3. Age >/= 75 --> 1 pt
4. Diabetes --> 1 pt
5. Stroke or TIA hx --> 2 pts
- score of >/= 3 --> give warfarin
- score of 1 or 2 --> give aspirin
332
What is meconium ileus almost always associated with?
-CF
333
Meconium illeus: what is it? What is it thought to be caused by?
- congealed meconium that obstructs the distal ileum
- thought to be caused by a deficiency of proteolytic enzymes
- obstruction begins in utero --> results in under development of distal lumina
334
Meconium ileus: tx? 2 Possible complications?
1. Volvulus
| 2. Perforation peritonitis
335
What can cause the bulging fontanelle in an infant as the presenting sign of CF?
-inability of vitamin A metabolism --> vitamin A excess
