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Questions--March 2017 Flashcards

1
Q

Disseminated gonococcal infection: Clinical presentation

A

Purulent monoarthritis and/or triad of (1) dermatitis, (2) assymetric migratory polyarthralgias, and (3) tenosynovitis

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2
Q

Disseminated gonococcal infection: diagnostic testing

A

Blood and pustule cultures may be negative.

NAAT of urethra, cervix, pharynx, or rectum usually will come back positive.

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3
Q

Two types of contact dermatitis

A

allergic vs irritant

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4
Q

Allergic contact dermatitis: pathophys, triggers, appearance

A

pathophys: type IV hypersensitivity
triggers: poison oak, poison ivy, nickel, rubber, meds
appearance: primarily on exposed skin and well demarcated, with erythema, papules/vesicles, and chronic lichenification

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5
Q

Irritant contact dermatitis: pathophys, triggers, appearance

A

pathophys: physical or chemical
triggers: soaps, detergents, chemicals
appearance: commonly on hands, with erythema and fissures

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6
Q

VIPoma: clinical presentation

A

watery diarrhea, hypo or achlorhydia due decreased gastric acid secretion, associated flushing, NN/V, muscle weakness, cranps

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7
Q

VIPoma: lab findings

A

hypokalemia, hyperclacemia, hyperglycemia, stool studies showing secretory diarrhea and increased sodium and osmolol gap less than 50

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8
Q

VIPoma: diagnostic criteria

A

watery diarrhea with VIP level greater than 75; abdominal CT or MRI to localize tumor in the pancreas (usually the pancreatc tail)

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9
Q

Acute interstitial nephritis: Clinical features and number of days until symptom onset

A

maculopapular rash, fever, new drug exposure (penicillins, TMP SMX, cephalosporins, NSAIDS), +/- arthralgias

NOTE: 5days to several weeks after use of offending agent

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10
Q

Acute interstitial nephritis: lab findings

A

AKI
Pyuria, hematuria, WBC casts
Eosinophilia, urinary eosinophils
Renal biopsy: inflammatory inflitrate, edema

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11
Q

stevens-johnson syndrome: triggers

A

Drugs: allopurinol, antibiotics, anticonvulsants, NSAIDs, sulfasalazine

Other: Mycoplasma pneumo, vaccination, graft-vs-host disease

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12
Q

steven-johnson syndrome: clinical features

A

4-28 days after exposure to trigger
Acute influenza-like prodrome
Rapid-onset erythematous macules, vesicles, bullae
Necrosis and sloughing of epidermis
Mucosal involvement (this is distinction with toxic epidermal necrolysis, which does not have mucosal involvement and involves >30% body surface area as opposed to <10%)

Systemic signs: AMS, fever, HDinstability

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13
Q

true positive vs flase positive rate

A 
true positive (sensitivity)
false positive (1-specificity) the higher the false positive rate the lower the specificity
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14
Q

Trichinellosis infection: clinical presentation

A

Intestinal stage (within one week of ingestion): asymptomatic or GI upset including abdominal pain, N/V/D

Muscle stage (up to 4 weeks after ingestion): myositis, fever, subungal splinter hemorrhages, periorbital edema, eosinophilia (usually >20%) with possible elevated CK and WBC

NOTE: severe disease can involve the heart, lungs, and CNS

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15
Q

Bacteria in viridans group streptococci

A

strept mutans/mitis/oralis/sanguinis

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16
Q

Major modified Duke criteria for infective endocarditis

A

Blood culture positive for typical organism (s. viridans, staph aureus, entercoccus), Echo showing valvular vegetation

NOTE: definite IE = 2 major OR1 major + 3 minor criteria

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17
Q

Minor modified Duke criteria for infective endocarditits

A

Predisposing cardiac lesion, IVDU, febrile, immunologic phenomena (glomerulonephritis), positive blood cx not meeting above criteria

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18
Q

6 clinical features of inectious mononucleosis

A 
fever
tonsillitis/pharyngitis +/- exudates
Posterior or diffuse cervical lymphadenopathy
Significant fatigue
\+/- hepatosplenomegaly
\+/- rash after amoxicillin
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19
Q

Equation for appropriate respiratory compensation for a metabolic acidosis

A

PaCo2 = 1.5 x bicarb + 8 +/- 2

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20
Q

Digoxin toxicity

A

N/V, decreased appetite, confusion, weakness, scotoma/blurry vision with changes in color/blindness

NOTE: Inciting events include anything that leads to volume depletion (viral illness or excessive diuretic use)

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21
Q

5 clinical features of primary hyperparathyroidism

A

nephrolithiasis, osteoporosis, nausea, constipation, and neuropsychiatric sxs (stones, bones, abdominal moans,and psychic groans)

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22
Q

Conditions associated with secondary amyloidosis

A 
inflammatory arthritis (RA)
Chronic infections (Tb)
IBD
Malignancy
Vasculitis
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23
Q

Clinical presentation and treatment of secondary amyloidosis

A

Clinical presentation: multi-organ dysfunction–asymptomatic proteinuria or nephrotic syndrome, cardiomyopathy with heart failure, hepatomegaly, mized sensory and motor peripheral neuropathy and/or autonomic neuropathy, visible organ enlargement (macroglossia), bleeding diathesis, waxy thickening/easy bruisability of skin

Treatment and ppx: colchine

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24
Q

Infective endocarditis: vascular phenomena

A

systemic emboli, mycotic aneurysm, janeway lesions (macular, erythematous, nontender lesions on the palms and soles)

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25
Q

Infective endocarditis: immunologic phenomena

A 
Osler nodes (painful, violacious nodules seen on the fingers and toes)
Roth spots (edematous and hemorrhagic lesions of the retina)
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26
Q

hepatitis A virus vaccine: indications

A

chronic liver disease (including HBV and HCV)

Risk factors for HIV (men who have sex with men, IVDU) or HIV itself

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27
Q

Chronic pancreatitis: clinical presentation

A

chronic epigastic pain with intermittent pain free periods, malabsorption (steatorrhea, weight loss), DM, partial relief when leaning forward

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28
Q

Chronic pancreatitis: appropriate labs and imaging

A

CT scan or MRCP (can show calcifications, dilated ducts, and an enlarged pancreas)

NOTE: Amylase/lipase in CPcan be nl or nondiagnostic, while they will be elevated 3xnl in AP

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29
Q

Adult Still Disease

A

An uncommon inflammatory d/o characterized by recurrent high fevers, arthritis/arthralgias, and a salmon-colored macular/maculopapular rash. ESR may be markedly elevated

NOTE: distinguished from infective endocarditis by absence of active urine sediment, painful fingertips, and pulmonary symptoms

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30
Q

MEN1

A

Primary hyperparathyroidism (hypercalcemia)

Pituitary tumors (prolactin, visual defects)

Pancreatic tumors (especially gastrinomas)

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31
Q

MEN2A

A

Medullary thyroid cancer (calcitonin)

pheo

parathyoid hyperplasia

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32
Q

MEN2B

A

Medullary thyroid cancer (calcitonin)

Pheo

Mucosal neuromas/marfanoid habitus

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33
Q

Porphyris cutanea Tarda: clinical features and associations

A

Clinical: blisters, bullae, scarring on sun-exposed skin
Scarring and calcification can look similar to scleroderma
Progressive buildup of porphorin lends itself to more severe presentations over time

Association: HCV, HIV, ecessive alcohol consumption, smoking, estrogen use

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34
Q

Scleroderma renal crisis

A

Occurs in 20% of those with systemic scleroderma (for most within first 5 years)

Presents with acute renal failure (w/ out previous kidney disease) and malignant HTN (HA, blurry vision, and nausea). UA may show mild proteinuria. PBScan show microangiopathic hemolytic anemia with schistocytes and thrombocytopenia

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35
Q

3 prokinetic agents used in diabetic gastroparesis

A

metoclopramide, erythromycin, and cisapride

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36
Q

Treatment of primary biliary cholangitis

A

ursodeoxycholic acid

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37
Q

relative risk vs exposure odds ratio

A

Relative risk: risk of one group having a certain outcome vs another group (cohort study where people tracked over time )

Exposure odds ratio: used in case-control (retrospective) studies where expousre of people already known to have the disease is compared to the exposure of those without the disease

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38
Q

ABG findings: COPD vs decompensated CHF

A

COPD: respiratory acidosis and hypoxia

CHF: respiratory alkalosis and hypocapnia as well as hypoxia

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39
Q

3 criteria in COPD exacerbation

A

Increased dyspnea
Increased cough (more frequent or severe)
Change in sputum production (color or volume)

Use antibiotics if fits 2 or more criteria, especially with increased sputum purulence

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40
Q

antibiotic tx of moderate-severe COPD exacerbation

A

macrolides (azithro)
fluoroquinolones (levofloxacin, moxifloxacin)
penicillin/beta-lactamase inhibitors (amoxicillin-clavulante)

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41
Q

Etiologies of interstitial lung disease

A

chronic inhalation of organic/inorganic dust (asbestos berylium, silicon dioxide)
Drug toxicity (amiodarone, bleomycin, nitrofurantoin)
radiation
systermic connective tissue disease (RA, scleroderma)

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42
Q

Adverse effects of ACE inhibbitors

A

Acquired angiodema
cough
hyperkalemia
acute renal failure in pts with bilateral renal artery stenosis

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43
Q

pulmonary capillary wedge pressure =

A

left atrial pressure and left-sided heart function

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44
Q

Pseudogout

A

An acute inflammatory arthritis caused by calcium pyrophosphate crystals

Occurs in the setting of recent surgery or medical illness

Diagnosed with synovial fluid showing rhomboid-shaped positively birefringent crystals and radiographic evidence of chondrocalcinosis ( caalcified articular cartilage)

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45
Q

Theophylline toxicity: 2 main manifestations

A

central nervous system stimulation (HA, insomnia, seuzures) and cardiac toxicity (arrythmia) in the setting of medication changes

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46
Q

Bronchiectasis

A

A disease of bronchial wall damage and airway dilation due to a recurrent cycle of infection, inflammation, and tissue damage in combinatio with impaired bacterial clearance (d/t impaired immmune defenses, structural airway defect, etc)

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47
Q

Modified Wells criteria for pretest probability of PE

A

+3 points–clinical signs of DVT, alternate diagnosis less likely

+1.5 points–previous PE or DVT, hr greater than 100, recent surgery or immobilization

+1 point–hemoptysis, cancer

Greater than 4 points = PElikely

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48
Q

DKA: Lab findings

A 
metabolic acidosis (shownn by low bicarb) with an elevated anion gap
Hyperkalemia (d/t extracellular shift and loss of insulin dependent cellular uptake. however, osmotic diuresis is actually promoting total body depletion of potassium)
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49
Q

Anion gap calculation

A

sodium - (chloride + bicarb)

nl is 10-14

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50
Q

Treatment of DKA: 3 must-haves +/- 2

A

IVfluids + potassium (when K<5.2 as nearly all pts K depleted even when hyperkalemic)
Insulin
Bicarb for pH < 6.9
Phosphate if cardiac dsyfunction

PIKIB

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51
Q

Polymyalgia rheumatica: symptoms and treatment

A

Age > 50
BL pain and morning stiffness > 1 month

Involvement of 2 of the following: Neck or torso, shoulders or proximal arms, proximal thigh or hip, constitutional

TX: glucocorticoids

52
Q

Time frame for reinfarction after acute MI

A

hours-2 days

53
Q

Time frame for ventricular septal rupture after acute MI

A

hours-1 week

54
Q

Time frame for free wall rupture after acute MI

A

hours-2 weeks

55
Q

Time frame for post-infarction angina after acute MI

A

hours-1 month

56
Q

Time frame for papillary muscle rupture after acute MI

A

2days-1week

57
Q

Time frame for pericarditis after acute MI

A

1day-3months

58
Q

Time frame for left ventricular aneursym after acute MI

A

5days-3months

NOTE: presents with ECGfindings of persistent ST-segment elevation after a recent MI and deep Q waves in the same leads

59
Q

Anti-pseudomonal agents

A

cefepime (4th) or ceftazidime (3rd)
piperacillin/ticarcillin-tazobactam

Aminoglycosides (amikacin, gentamicin)

Fluoros (cipro, levofloxacin)
Monobactams (aztreonam)
carbapenems (imipenam, meropenam)

60
Q

Most commonly seen infections in MM (2)

A

respiratory (streptococcal pneumonia)and UTIs

61
Q

Mitral stenosis: PEfindings

A

mitral facies (pink/purple patches on cheeks)

Loud S1
Loud P2 if pulmonary HTN

diastolic sounds
Opening snap
mid-diastolic rumble

62
Q

Diabetic neuropathy affecting the large nerve fibers

A

negative sxs: numbness, loss of proprioception and vibration sense, diminished ankle reflexes

63
Q

Diabetic neuropathy affecting the small nerve fibers

A

positive sxs: pain, paresthesias, allodynia

64
Q

CD4 count where reactivation of toxo becomes high

A

<100

30% reactivation

65
Q

Cyanide toxicity

A

Presents with confusion, seizures

Often seen with prolonged nitroprusside drip (as you could see in treatment of HTNemergency), higher doses of nitrop, or baseline CKD

66
Q

Most sensitive indicator of hypovolemia in labwork

A

Decreased urine sodium (FeNa <1%)

67
Q

Acute urinary retention: 6 major risk factors

A 
Male sex
Advanced age 
BPH
Neurologi disease
Recent surgery
Anticholinergics
UTI

For diagnosis in someone unable to void, bladder US demonstrates >300mL urine

68
Q

Diagnosis of CAP

A

CXR showing a lobar, interstitial, or cavitary infiltrate

NOTE: clinical and physical findings have a <50% sensitivity at predicting presence of pna

69
Q

A person with a 44pack year smoking ho coming in with wt loss, constipation, increased thirst, fatigue, and a calcium level of 14.5 likelt has ________

A

humoral hypercalcemia of malignancy due to secretion of PTH related protein

volume depletion from hypercalcemia-induced nephrogenic DI and decreased PO

70
Q

Use ___ and ___ immediately and ____ long-term to treat severe hypercalcemia, defined as a calcium over ___

A

NS hydration, calcitonin, bisphosphonate, 14

71
Q

splenic abscess presents with triad of _____

A

fever, leukocytosis, and LUQpain

72
Q

_____ is most commonly associated with splenic asbcess

A

infective endocarditis

73
Q

5 features of pancoast tumors

A

pancoast tumors = superior sulcus tumor

Squamous cell lung carcinoma and adenocarcinoma most common types

(1) shoulder pain
(2) Horner syndrome (PMAVE)
(3) C8-T2 neurological involvement (weakness and paresthesias in hands)
(4) supraclavicular lymph node involvement
(5) weight loss

74
Q

otosclerosis VS presbycusis

A

otosclerosis = chronic conductive hearing loss associated with bony overgrowth of the stapes, often beginning in middle-age and affects low-frequencies

presbycusis = sensorineural hearing loss that occurs with aging, most commonly starting in the 6th decade. High-frequency hearing loss

75
Q

______ is the causative organism ofg bacillary angiomatosis

A

Bartonella (gram negative bacillus)

76
Q

____ is the antibiotic of choice for bacillary angiomatosis

A

oral erythromycin

77
Q

3 must-haves in acuteliver failure

A

markeeldly elevated transaminases (>1000)

hepatic encephalopathy

hepatic synthetic dysfxn (INR >1.5)

78
Q

3 cancers in Lynch syndrome

A

colorectal
endometrial
ovarian

79
Q

3 cancers in familial adenomatous polyposis

A

colorectal
desmoids/osteomas
brain

80
Q

3 most common causes of cough

A

Postnasal drip
GER
asthma

81
Q

Indications for an x-ray of back (3) =

A

osteoporotic fracture
ankylosing spondylitis
suspected malignancy

82
Q

Indications for an MRI of back =

A

epidural abscess/infection
sensory/motor deficits
cauda equina syndrome

83
Q

Causes of macrocytic anemia

A

meds (chemotherapy, DMARDs, hydroxyurea)

hypothyroidism
nutritional deficiencies (b12, folate)

liver disease
alcoholism

Myelodysplastic syndromes
acute leukoblastic leukemia

84
Q

People ages __ to ___ should receive statin regardless of baseline lipid panels

A

40-75

85
Q

Clinical manifestation of chromium deficiency

A

Impaired glucose control in diabetics

86
Q

Clinical manifestations of zinc deficiency

A

alopecia
perioral and extremity pustular skin rash

impaired taste, wound healing, and immune system

hypogonadism

87
Q

Clinical manifestations of selenium deficiency

A

thyroid dysfunction
cardiomegaly
immune dsfxn

88
Q

Clinical manifestations of copper deficiency

A

Ataxia (and peripheral neuropathy)

Brittle hair

Sideroblastic anemia

Depigmentation (skin)

Osteoporosis

(ABCD-O)

89
Q

Risk factors for trace mineral deficiency

A

iron, copper, selenium, zinc, chromium

TPN
poor nutritional intake
malabsorption
bowel resection

90
Q

Supravalvular aortic stenosis

A

Second most common cause of AS

Can present with CP 2/2 LVH

Can lead to coronary aortery stenosis

Signs: suprasternal thrill
midsystolic murmur at right second intercostal space

91
Q

Kussmaul sign

A

Increase or lack of decrease of JVP on deep inspiration in constrictive pericarditis

92
Q

Normal JVP

A

8

93
Q

2 agents used for lowering serum ammonia

A

in hepatic encephalopathy

lactulose and lactilol (nonabsorbable dissaccharides)

94
Q

Transudative causes of pleural effusions

A

CHF (most commonly bl)
liver cirrhosis
peritoneal dialysis
nephrotic syndrome

ph > 7.4

95
Q

Exudative causes of pleural effusion

A 
malignancy
infection
Connective tissue disorders
inflammatory disorders
PE

fluid LDH/serum LDH > .5
Fluid protein/serum protein >.6
LDH fluid is 2/3 uln of serum LDH

96
Q

AL amyloidisis

A

Associated with MM and waldenstrom macroglobulinemia (IgM)

Light chains (usually lambda)

97
Q

AA amyloidosis

A

Associated with inflammatory conditions (RA, IBD) and chronic infections (osteomyelitis, tb)

abnormally folded proteins (beta 2 microglobulin, apolipoprotein, or transthyretin)

98
Q

initial tx for renovascular stenosis or HTN

A

ACE-is/ARBs

NOTE: renal artery stenting of surgical revascularization reserved for pts with resistant hypertension or ruecurrent flask pulmonary edema

99
Q

3 causes of vitamin K deficiency

A

inadequate dietary intake
intestinal malabsorption
hepatocellular disease

100
Q

Indications for acute hemo dialysis

A 
Acidosis
Elecrolytes (K or Ca)
Intoxication 
Overload
Uremia (encephalopathy, pericarditis)
101
Q

Casts seen in different intrarenal conditions

A

golmerulonephritis–RBCcasts (nephrotic syndromes)
AIN–WBCcasts (infection or antibx)
ATN–muddy casts (ischemia or contrast)

102
Q

Treatment of mild, mod, severe hypernatremia

A

mild: PO h20
mod: NS (N/V, headaches)
severe: d5w or 1/2NS (seizures, coma)

103
Q

Treatment of mild, mod, severe hyponatremia

A

mild: disease-specific
mod: NS
severe: 3% NS

104
Q

serum osmoles =

A

2 x Na + glucose/18+ BUN/2.8

NLis 280

105
Q

Hypertonic hyponatremia

A

low Na, but high serum osmoles

Happens in DM, with high glucose and or BUN

Remember: serum osm = 2 x NA + glucose/18 + BUN/2.8

106
Q

Sodium correction with hyperglycemia

A

(glucose-100) x 4 +Na

107
Q

Categories of hypotonic hyponatremia

A

hypervolemic (ESRD, CHF)
euvolemic
hypovolemia (V,D, decreased PO, sepsis, burns)

108
Q

Euvolemic hyponatremia

A

Rta
Addisons
Thyroid
SIADH (tx with volume restriction, diuresis, demecycline)

109
Q

treatment of symptomatic hypercalcemia

A

ALWAYS DILUTE Ca (IVF)
Immediate phase and super symptomatic: calcitonin
ALWAYStreat with long term: bisphosponate

Consider diuretics

110
Q

Assessment of hyperparathyroidism

A

high Ca
high PTH
low phosphorous

sestamibi scan:
multiple areas of uptake (tertiary) or one area (primary –> resection

NOTE: secondary hyperPTH is from CKD

111
Q

Hyperparathyroidism from cancer (2 types of findings)

A

Metastatic cancer affecting bone: high Ca, high phosphorous, LOWPTH

Cancer that secretes PTH-rp: high ca, low phosphrous, low PTH, PTH-rp (PTH-rp acts on kidneys just like PTH)

112
Q

2 types of granulomatous diseases causing increased vit D

A

TB and sarcoid

Secrete 1-25 vit D

high calcium, high phosphorous, low PTH (gut affected to absorb ca and P)

113
Q

3 signs of severe aortic stenosis

A

pulsus pardus and tardus
soft or absent S2
late peaking SEM in 2nd right ics

114
Q

CHADSVASC score for risk of thromboembolic event in a person with nonvalvular AF

A 
Congstive heart failure
Hypertension
Age > 75 (2)
DM
Stroke/TIA/thromboembolism (2) 
Vascular disease (prior MI, PAD, or aortic plaque)
Age between 65-74
Sex (F-->1)

Max score is 9

115
Q

Proximal vs distal SBO presentations

A

Proximal: early vomiting, abdominal discomfort, and abnl contrast filling on XR

Mid/Distal: colicky abdominal pain, delayed vomiting, prominent abdominal distension, constipation/obstipation, hyperactive bowel sounds, and dilated loops of bowel on XR

Note: both of these can have the complication hypokalemia (from K loss in emesis and through contraction alkylosis) and of strangulation, which would additionally present with peritoneal signs and shock with feverm tachycardiam and leukocytosis being late findings.

116
Q

Rotator cuff impingement/tendinopathy vs rotator cuff tear

A

impingement /tendinopathy–pain with abduction, external rotation but normal range of motion

tear–weakness with abduction and external rotation; age >40

MRI scan will confirm diagnosis

117
Q

Differential diagnosis of anterior medistinal mass

A

The 4 Ts!

Thymoma
Teratoma
Thyroid neoplasm
Terrible lymphoma

118
Q

Concerned for ____ in a pt s/p cardiac cath who is hypotensive and complaining of flank/back pain

A

retroperitoneal hematoma

119
Q

Scaphoid fxs diagnosis options

A

Xray at time of injury not sensitive for fx –> either get CT or MRI ORimmobilize in thumb sicca splint and repeat XR i 7-10 days

120
Q

Presentation of acute mediastinitus

A

Complication of cardiothoracic surgery, often within 14 days post-op

fever, tachycardia, CP, leukocytosis

XR showing mediatinal widening

sternal wound cloudy/prurulent drainage

121
Q

2 most common peripheral artery aneurysms associated with AAAs

A

popliteal and femoral artery aneurysms

122
Q

Lab values seen in alcoholic hepatitis

A

AST/ALT > 2
AST and ALT under 500
elevated ggt
elevated ferritin

123
Q

Invasive aspergillosis: risk factor, clinical findings, and management

A

RF: immunocompromise

Clinical: Triad of fever, CP, and hemoptysis
pulmonary nodules with halo sign

Tx: voriconazole +/- caspofungin

124
Q

Chronic pulmonary aspergillosis: risk factors, clinical findings, and Tx

A

RF: lung disease/damage (cavitary tb)

Clinical: >3 months wt loss (seen in 90% of pts), cough, hemoptysis, fatigue, cavitary lesion +/- fungus ball, positive aspergillus IgG

Tx: resect aspergilloma, voriconazole, embolization(if severe hemoptysis)

125
Q

3 most common malignancies responsible for pleural effusion

A

lung, breastm lymphoma

126
Q

Acute post-streptococcal glomerulonephritis

A

occurs 10-20days after streptococcal throat or skin infections

Presents with hematuria, HTN, RBCcasts, and mild proteinuria –> periorbital edema

Step 2 (14 decks)

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