MKSAP/Uworld Flashcards
How does brown sequard px?
contralateral loss of pain/temp ~2 levels of below lesion
What happens w/ Primary Biliary cirrhosis?
Get loss of biliary ducts
What is risk of NE presser?
alpha agonist properties can cause vasoconstriction which can lead to ischemia of distal extremities
What is major adverse rxn w/ INH?
can cause isoniazid hepatitis, d/c drug if ALT/AST >100
What is HCAP?
pneumonia acquired w/in 72 hours of hospitalization. Most often 2/2 G - rods (E. coli, P.A., Staph aureus)
Sx of CAP?
fvr, chills, cough w/ thick sputum, pleuritic chest pain, dyspnea, tachy, tachypnea, late insp crackles, bronchial breath sounds, pleural frxn rub
Common bugs w/ atypical CAP?
mycoplasma pneumo, Chlamydophila pneumonia, C. psittaci, coxiella burnetti, viral (influ A, B, adeno, parainflu, RSV)
Si/sx of atypical CAP?
HA, sore throat, fatigue, myalgia, dry cough, fvr, wheezing, rhonchi, crackles, Pulse-temp dissoc, nl HR in setting of fvr
How w/u suspected CAP?
cxr (PA, lateral), CBC, BMP, O2 sat, need cx before ABX, w/ G stam/ cx of sputum.
Waht bug causes CAP in certain popualtions?
Alcoholics - klebs, Immigrants - TB, nursing home - nosocomial esp upper lobes and pseudomonas
Who likely to get legionella?
organ xplant recipients, renal failure patients, chronic lung disease pts
What determines whether pt is hospitalized for CAP?
depends on severity of illeness, may tx some w/ outpatient ABx
How tx uncomplicated CAP if no comorbidities?
if uncompl tx w/ azithro or clarithro. If comorbidities px, add quinolones. COnt for >5 days or until afebrile for 48 hrs
How tx HAP?
tailored towards G- rods = cephalosporins, imipinem, zosyn
What is complication of penumonia?
can get pleural effusion if significant that requires drainage. Can progress to empyema.
Where are aspiration infxns most likely to occur?
Posterior seg of upper lobes and superior seg of lower lobes of R lung.
Why ventilator incrsd risk of pneumonia?
loss of clearance mechanism, positive pressure inhibits clearence
How tx VAP?
ceftazidime or cefepime, or zosyn + aminoglycosides or quinolones + vanc or linezolid
Organisms assoc w/ aspiration pneumo?
peptostrep, fusobacterium, bacteroides (oral flora), also S. aureus, S. pneumo, G- Bacilli
When does TB because clinical? Si/sx?
w/ secondary TB (primary TB usually asx), px w/ fvr, night sweats, weight loss, malaise, cough (dry to puruelnt) hemoptysis
What type of virus is flu?
orthomyxovirus, types A and B cause flu
How do bugs causing meningitis typicalyl spread?
invasion of blood and hematog seeding, Also retrograde xport along CN ( esp olfactory), can be contig spread from sinusitis, otitis media, surgery
When use cardiac resynchronization therapy?
CHF w/ EF< .12, w/ LBBB.
Common side effects of bisphosphonates?
can cause pill esophagitis, incrsd risk of fx if used for >5 years
How determine COPD?
do PFTs, if FEV1/FVC < 70 = COPD. FEV1 grades severity of COPd
What is delayed sleep phase syndrome?
Circadian rhythm sleep dx affecting time of sleep, px w/ falling asleep very late and having difficulty waking.
What is most common cause of acute pericarditis?
viral infxn
What are indications of hemodialysis?
refractory hyperK, volume overload/ refract pulmo edema, refract metabolic acidosis (pH<7,2), uremic pericarditis, uremic enceph/neuropathy, coagulopathy
When likely to get invasive aspergillosis?
immunocompromised pts esp neutropenia or on steroids
How invasive aspergillosis px?
fvr cough dyspnea, hemoptysis, cxr shows rapidly progressing, dense opacitiy, CT shows halo sign
Best way to lower BP from best to least?
- weight loss, 2. dash diet, 3. exercise 4. dietary sodium 5. ETOH decrsd
What is idopathic pulmo fibrosis?
restrictive lung disease of unknown cause, 2/2 chronic inflamm of alveolar walls = widespread fibrosis
PFTs in restrictive diseae?
dcrsd TLC, FEV1, FVC, nl-incrsd FEV1/FVC, get incrsd A-a gradient deu to perfusion mismatch
What is seen on cxr w/ IPF?
honeycomb pattern, dcrsd lung volumes, pulmo vascular congestion
SIde effect of loop diuretics and result?
can get hypoK and hypoMg can lead to arrythmias like vtach.
How does nocardia appear on gram stain?
crooked branching, beaded G+ partially acid fast filaments
How tx nocardiosis?
bactrim is tx of choice
What is relative risk?
measure of associ in cohort study, IF >1 then positive correlation, if less than one then negative associate. Greater the value, stronger the assoc
When use in ACEI in diabetics?
BP > target value or signs of diabetic nephropathy
How define diabetic nephropathy
spot urine albumin/ creatine >30
WHat is gemfibrozil?
fibrate that incrs HDL and dcrs TG
Si/sx of ethylene glycol poisoning
metab acidosis w/ anion gap, rectangular enveloped shaped crystals, can lead to ARDS, HF, renal failure
Si/sx of adrenal tuberculosis?
weight loss, fvr, sputum prodxn, nausea, ab pain, orthostatic hypotension, calcification of adrenals on CT
Findigns w. ATN?
BUN/Cr20, FENA>2%, muddy brown granular casts
What causes RBC casts? What does it indicate?
glomerular disease or vasculitis
Braod casts indicated what?
chronic renal failure
What drugs commonly cause acute pancreatitis?
diuretics, lasix, thiazides, IBD drugs, immunosuppressants, valproic acid, flagyl, tetracycline
How manage PVCs?
if asx, just observe, if sx then give beta blockers
What is most common adverse rxn w/ infusion in 1st 1-6 hrs?
nonhemolytic transfusion rxn
What causes a nonhemolytic xfusion rxn?
leukocytes in PRBCs release cytokines that when xfused lead to xsient fvr, chills, malaise w/ no hemolysis
When use irradiated blood?
BMT recipietns, acquired congenital immunodeficiencies, blood by 1st or 2nd degree relatives
How does acute hemolytic rxn w/ blood px?
Fvr chills, flank pain, hemoglobinuria, prevent w/ careful crossmatching/.
When screen for DM and how?
Begin at 45 if no risk fx, any screening test is appropriate
When do pneumococcal vaccination?
all patients >=65 y/o w/ revaccination 5 years after first dose.
What are skin tags associated w/?
insulin resistance, pregnancy, crohns.
What skin fx associated w/ hep C?
porphyria cutanea tarda, cutaneous leukocytosis, vasculitis (palpable purpura)
Si/sx of esophageal scleroderma?
sticking sensation in throat, dysphagia w/ heartburn, absence of peristaltic waves in lower 2/3 of esoph, dcrs LES tone
How differentiate esophageal scleroderma and achalasia?
incrsd in LE ton in achalasia, not dcrs
How does interstitial nephritis px?
fvr, rash, acute renal dysfxn, eosinophiluria, w/ WBC casts
How does bacillary angiomatosis px in HIV?
fvr, weight loss, ab pain, exophytic purple skin lesions, can get intrahepatic lesions, lesions are prone to hemorrhage, due to bartonella species.
Px of thyroiditis?
painless thyroid mass w/ hyperthyroidism, could be painful if de quervans. Low radioactive iodine uptake
When use two sample z test?
When comparing means
How manage diabetic pt w/ pyelo?
IV abx for 48-72 hrs, then switch to sensitive ABX PO for 10-14 days
What is abnormal PNH?
GP1 anchor protein which blocks CD55 & CD59 from binding - > leads to complement attachment and destrxn of RBC
WHat are signs of intravascular hemolysis?
low hgb & low haptoglobin w/ incrsd bili and LDH
RIsk w/ PNH?
predisposed to venous thrombi
Most common causes of inflamm monoarthritis?
Septic arthritis & crystal induced arthritis. Incrs risk of septic arthritis if have RA.
What is abnormal in parkinsons disease?
dopaminergic pathway damaged, unlimited activation of cholinergic pathway. Also loss of dopaminergic neurons in substantia nigra and locus cereleus
Clinical fx of parkinsons?
pill-rolling tremor @ rest that is worse w/ emotional stress, bradykinesia, rigidity, poor postural reflexes, masked facies, micrographia, dementia in advanced disease.
Cause of huntington’s chorea?
chr 4 mutation, AD, CAG repeats leads to loss of GABA producing neuron in striatum - > atrophy of head of caudate.
How does cerebellar dysfxn present?
can occur w/ alcohol abuse, - > gait probs, truncal ataxia, nystagmus, intention tremor, dysmetria (tremor when trying to write), impaired rapid alternating movements.
What is clasp knife spasticity?
represents clonus, suggests pyramidal tract disease
Types of NF2 mutations?
Wishart - more severe, nonsense/frameshift mutation, no prodxn of tumor suppressor gene.
Gardner- milder missense mutat.
Si/sx of beta thalassemia?
Meditern adult w/ microcytifc anemia, disproport RBC count, hypochromic & target cells. If Beta thal minor - > 1 abnml gene and 1 nml B gene
What is purpose of hydroxyurea in sickle cell?
dcrs freq and severity of pain crises in pts w/ sickle cell
Opthalmoscopic signs of amaurosis fugax?
retinal emobli lead to zones of whitened, swollen retina following distribution of renal arteries
How does central retinal artery occluison appear?
Pallor of optic disc, cherry red fovea, boxcar segmentation of blood
Most common cause of spontaneous bacterial peritonitis?
E. coli & kelbs - > tx w/ 3rd gen cephalo
When does PCP occur in HIV? How dx?
CD4 counts <200, diagnose w/ BAL, sputum cx 50% sensitive
Si/sx of TTP?
hemolytic anemia, renal failure, AMS, thrombocytopenia, low grd fvr, schistocytes on periph smear
Si/sx of optic neuritis?
vision changes, color perception chng, pain in one eye, assoc w/ MS
Cuase of infective endocarditis following dental caries?
Viridians group strep - > strep sanguins, s. mitis, s. oralis, s. mutans
How dx parkinsonism?
dx w/ physical exam - > no lab/imaging
How manage HIT?
- stop heparin 2. obtain serotonin release assay 3. Begin altern anticoag as high risk of thrombosis.
What is manifestations of polyarteritis nodosa?
fvr, MS sx, vasculitis of nerves, GI tract probs, heart involvement, nonglomerular renal vessles. Get htn, kidney insuff, proteinuria, hematuria
How dx PAN?
sural nerve biopsy + kidney angiography
How tx giant cell arteritis?
Immediate high dose methylprednisolone.
How tx Paget’s disease?
FIrst line is bisphosphonates, usually only tx symptomatic patients.
What is screening and confirmatory test for HIV?
screening is ELISA, confirmatory is western blot
How manage HIV pt w/ positive PPD?
even if cxr neg, need ppx tx w/ isoniazid x 9 mo. ALso tx w/ pyridoxine to prevent periph neuropathy.
WHat is pathophys assoc w/ ARDS?
impaired gas exchange, dcrsd lung compliance, pulmonary htn. 2/2 lung injury 2/2 release of inflamm cytokines and neutrophils — leukage of fluid into alveolar space
What is torticollis?
focal dystonia (involuntary cntrx) of SCM, can be twisting, reptitive movement, or sustained
What is chalazion?
Painful swelling that progresses to rubbery nodular lesion on eyelid — chronic granulomatous condition — if persistent may be sebaceous carcinoma so should be biopsied.
How does pericardial effusion appear on CXR?
heat enlarged w/ globular appearing shadow, “water bottle heart”
How would cxr appear if audible 4th heart sound?
would get LV hypertrophy, (left lung space involved by heart)
What is pulsus bisferrens?
biphasic systolic pulse felt w/ HOCM and AR
WHat is AST:ALT ratio in ETOH liver disease?
AST:ALT > 2
How does ETOH hepatitis px?
fvr, anorexia, hepatomegaly, jaundice, anorexia, incrsd LFTs, ggt, alk phos
How can pericardial effusion initially px?
If slowly develop, minimum sx w/ enlrg cardiac silhouette, nml lung sounds, low volt ECG, no JVD
Which gender more susceptible to ETOH hepatitis?
Females more susceptible
Biopsy findings with ETOH liver damage?
Ballooning degen, Pmn infiltration, fibrosis, necrosis. May see Mallory bodies but these are non specific
How does splenic abscess px?
Triad of fvr, Leukocytosis, LUQ pain, left side pleuritic chest pain and pleural effusion. May have splenomegaly.
What bugs most often cause splenic abscess
Staph strep salmonella
How splenic abscess likely to occur?
Can happen after infective endocarditis, sickle cell disease, HIV, IV drug use, or trauma
How manage splenic abscess?
ABX, splenectomy, can do percutaneous drainage if not a surgery candidate
How does cavernous sinus thrombosis px?
Inflamm at cs leads to thrombosis and intracranial htn, px w. Low grade fever, HA, periorbital edema, vomiting, papilledema. Bilateral CN deficits.
How tx cavernous sinus thrombosis
Tx w. Broad spectrum ABX
What type of cancer is Paget’s disease of the breast?
It is an adenocarcinoma
How does Paget’s disease of breast appear on biopsy?
Large cells w. Halos due to cancer cells becoming retracted from adjacent keratinocytes
Cortisol effects on BP?
Vasoconstrixn, insulin resistance leads to incrsd glucose, also mineralocorticoid activity
Other findings in cushions disease
Proximal muscle weakness, central adiposity, thinning of skin, weight gain, psych problems
Sx of pheochromocytoma
Weight loss, tachy, htn, diaphoresis, anxiety
Organism causing infxn due to use of shared needles?
MRSA, staph, strept, also nml skin and oral flora
Cause of infective endocarditis assoc w. UTI?
Most often due to enterococcus
Anemia and lymphadenopathy think what?
Likely autoimmune hemolytic anemia 2/2 underlying malignancy — warm agglutination Ab, tx w/ prednisone
How confirm multiple myeloma?
1st do serum electrophoresis looking for monoclonal m spike. Then do BM biopsy.
How does cml px?
Fatigue, malaise, low grade fever, anorexia, weight loss, bone pain, fvr, night sweats, almost always over 50
Complications of multiple myeloma?
HyperCa, hyperviscosity, renal failure
Lab findings w/ CML?
Leukocytosis, anemia, incrsd number of mature granulocytes (segs and bands), bcr-abl, low leuk alk phosphatase
How diff CML and leukemoid rxn?
W/ nml leukemoid rxn, leuk alk Phos is high
How does cmv retinitis px? How tx?
Yellow white spots w/ retinal hemorrhages. Tx w/ ganciclovir and foscarnet
How differentiate seminoma w/ nonseminoma germ cell tumor?
Seminoma only produces beta hcg and only 1/3 of time. Non seminoma produces beta hcg and AFP
Possible tumors w/ nonseminoma gct?
Yolk sac carcinoma, choriocarcinoma, embryonal carcinoma mixed cell type
How osteoclastic activity occur w/ diff tumors?
Breast cancer — metastases locally produce PTHrP
MM, leukemia — produce interleukins IL-6, RANKL that induce osteoclast activity
Stand does a 4th heart sound indicate?
Cntrxn against stiff or hypertrophic ventricle. Occurs just before S1.
What is Osler-weber-rendau syndrome?
Disease w/ hereditary telangiectasias, AD, px w/ recurrent epistaxis, widespread AV malformations
In OWR. Where most likely to get AVM?
Mucous membranes, skin, GI tract, can have intrapulm shunt leading to hypoxia and polycythemia
Most common cause of pneumonia in nursing homes?
Strept pneumo
Px of CJD
Rapid progression of dementia, nystagmus, periodic high volt complexes on EEG
What is seen on brain biopsy w/ CJD?
Cortical spongiform changes
Lab findings w. Exogenous thyrotoxicosis?
Low tsh and hiigh free t4’ do thyroglobulin levels to confirm dx of exog thyroid hormone use
What is thyroglobulin?
Precursor protein in thyroid follicle
Major side effect of isoniazid?
Periph neuropathy due to B6 deficit. Prevent by supplementing with pyridoxine
What is Jalisch herxheimer rxn?
Occurs w/ syphillis after tx. Due to spirochete dying and release of Ag, Ag-Ab complex form leading to immune rxn resembling acute syphillis
Px of upper airway cough syndrome?
Cough following URI, mainly cough at night, no sputum prodxn
How manage UACS?
Empirically tx w/ first gen oral antihistamine or decongestant+antihist combo
What are possible products of homocysteine
Can become cysteine or methionine
Stand cofactors needed to breakdown homocysteine
B6, folate, b12, most likely to be b6
How does temporal arteritis px?
Elderly w/ new onset HA, jaw claudication, scalp pain, vision loss. On fundo see swollen pale disc w/ blurred margins
How tx temporal arteritis?
High dose steroids
MSG common cause of nephrotic syndrome in Hodgkin’s lymphoma
Minimal change most common but can also be FSGS
What renal pathology assoc w/ visceral carcinomas
Membranous glomeruli nephritis
Stand drugs improve mortality with MI?
Aspirin, beta blockers, ace inhibitors, heparin
What drugs contraindicated in MI?
CCB (nifedipine)
How tx pemphigous vulgarus?
Tx with prednisone 1st line, can also use azathiprine + metho with steroids
How bullous phemphigous differ from PV?
Tense blisters in BP whereas flaccid in PV. BP rarely has oral lesions
Px of erythema multiforme
Macular, popular, bullous, purpurin lesions w/ target lesions possible. Can form on extensor surfaces, palms, soles, mucous membranes
If pt presents w. Limited history and diffuse depression of CNS how manage
Give thiamine, dextrose, o2, naloxone
Signs of benzo OD?
Hypotension and drowsiness
What vaccines contraindicated in HIV pt?
Bcg, anthrax, oral typhoid, intranasl flu, oral polio
What live vaccines ok in HIV?
If >200 cd4, can give zoster, mmr, varicella
Other notable vaccines needed in HIV.
Need Td every 10 yrs, pneumovax every 5 years
What is greatest risk fx for variant angina?
Smoking
What is riluzole?
Glutamate inhibitor used in ALS
How does bronchiectasis px?
Cough w/ sputum prodxn most days, rhinosinusitis, dyspnea, hemoptysis, pleurisy, wheezing. Crackles clubbing
Best test to dx bronchiectasis?
Do CT of chest
CT findings with bronchiectasis
Bronchial dilation, lack of airway tapering, bronchial wall thickening
How differentiate chronic bronchitis and bronchiectasis
Bronchiectasis px w/ lrg volhme of sputum prodxn (>100ml/day) also recurrent fvr, hemoptysis, P.A. Infxn
How tx bronchiectasis?
Chest PT, ABX specific to CX
