Random Flashcards
1
Q
how much do I love Katie Jo
A
like crAzy forever and ever no matter what
2
Q
Docusate sodium
MOA
A
an emulsifier, like surfactant or bile, facilitates mixture of fat and water
3
Q
commercial name for docusate sodium
A
Colace
4
Q
generic name for Colace
A
Docusate sodium
5
Q
Senna MOA
A
mucosally stimulates enteric ns for peristalsis/motility
6
Q
presentation of multiple
A
we lost fatigue bone pain
7
Q
normal calcium range
A
8.4–10.2
8
Q
what is a protein gap
A
difference between total protein and albumin greater than four
9
Q
what oh FTE abnormality will be seeing in multiple myeloma what LFT abnormality
A
protein gap
Total protein minus album in greater than four, indicating increased non-album proteins
10
Q
how do you determine if serum protein is due to monoclonal or polyclonal source
A
SPEP
Serum protein electrophoresis
11
Q
what is the peripheral blood smear finding seen with elevated serum protein
A
what are our OU L EA X
Rollo formation
Our oh you LE a S
Letter ROULE a SROULletter ROULE a UX formation
12
Q
Rollo formation on peripheral smear indicates
ROUL EA ask
A
elevated serum protein
13
Q
diagnose multiple myeloma
A
serum protein electrophoresis shows monoclonal M spike
Diagnosis then confirmed by bone marrow biopsy showing greater than 10% clonal plasma cells
14
Q
what cell lines does a plastic anemia affect
A
also lines Results in pancytopenia Anemia is a misnomer Pancytopenia would be better a plastic pancytopenia
15
Q
megaloblastic erythroid hyperplasia is typically caused by
A
vitamin B 12 or folate deficiency
16
Q
mean corpuscular volume MCV, and megaloblastic anemia
A
greater than 100
17
Q
m-spike stands for
A
monoclonal protein elevation
18
Q
what standard lab findings are classic for multiple myeloma
A
Hypercalcemia
Anemia
Protein gap greater than 4
19
Q
if clot disorder treated with heparin develops H IT the most appropriate next step in management is
A
stop heparin Start our Gacha van ARGHEROBAN aRGaTROBaN or fondaparinux
20
Q
what signs raise suspicion of H IT
A
Drop and platelets greater than 50%
Or new thrombus within 5 to 10 days of initiating heparin
21
Q
our patients with H IT at greater risk of bleeding or thrombus
A
thrombus
Thrombotic risk is roughly 50% and untreated H IT
Antibody mediated thrombocytopenia is mild to moderate, rarely less than 20,000, with minimal bleeding risk
22
Q
T/F
The patient with H IT can we switch to low molecular weight heparin
A
false all heparin products including low molecular weight heparin should be avoided in patients with H IT
23
Q
when can a patient with an H IT be switched to warfarin
A
when platelets are greater than 150
E a RG a TROB AN or fondaparinux are used before that time
24
Q
why is initial treatment with warfarin contraindicated in patients with H IT
A
because it rapidly lowers protein C levels which may transiently increase the risk of thrombus
25
what is the pre-bolus prodrome that may precede bolus pemphigoid Bylas pen for Gordon BULL a S pemphigoid
urticaria or eczema
26
what is the first line treatment for bolus pemphigoid miss spelled BULL a S and annoyed
hey high potency glucocorticoid
I call betazole club bed is all call Verizon
CLOE
CLOBET a S OL
27
what is used to treat ball is pemphigoid one topical corticosteroids are not possible
oral steroids can be used but they are not preferredas they are associated with treatment complications
28
what is the rash seen with gluten allergy
dermatitis herpetiformis
pruritic vesicles buttocks and extensor limb surfaces
biopsy demonstrates dermal papillary necrosis and anti-tissue transglutaminase IGA antibodies (anti-TTG)
treatment is dapsone and gluten restriction
29
unasyn =
ampicillin/sulbactam
30
ampicillin/sulbactam comm name =
unasyn
31
tx hyper K
3 shift
3 remove
Ca gluconate
glucose + insulin
bicarb
k-exalate (binding resin GI)
lasix
dialysis
32
estimate normal weight
5 ft 100lb
+7/lb male
+5/lb female
33
how to spot rca infarct on ekg
get r sided ekg
| ste in V4R
34
rbbb on ekg
v1 rsr
| v6 qr slurred s
35
targey glucose inpt
140-170
36
define fever celcius
38. 3x1
| 38. 0x2 at least 1hr apart
37
uvea =
cilia + iris
so anterior uveiitis = iritis
posterior uveiitis = ciliitis
38
uvea =
cilia + iris
so anterior uveiitis = iritis
posterior uveiitis = ciliitis
39
3 clinical features of legionella pneumonia
high fever (>39 C; >102.2 Fw bradycardia
headache and confusion
watery diarrhea
40
high fever w bradycardia
headache and confusion
watery diarrhea
think this kind of pneumonia...
legionella
41
2 lab findings of legionella pneumonia
hyponatremia (watery diarrhea)
| sputum gram stain w neutrophils but no other organisms (intracellular poor staining GNR)
42
hyponatremia
sputum gram stain w neutrophils but no other organisms
think this kind of pneumonia
legionella
| diarrhea; does not gram stain well (intracellular poor staining GNR)
43
dx legionella
legionella urine antigen test
| +/- cx
44
tx legionella
```
newer macrolides
or fluoroquinolones (faveored when severe enough for hospitalization)
(both high intracellular concentration)
```
45
travel-associated lug infiltrates, confusion, diarrhea due to contaminated water supplies e.g. cruise ship or hotel think.... this bug
legionella pneumonia
| legionnaires' disease
46
what is a high grade fever
>39 C
| > 102.2 F
47
symptoms that help distinguish legnionella from other CAP
high grade fever (>39C or 102.2F)
GI (diarrhea)
neurologic (confusion, ataxia)
48
lung examination finding in legionella
rales (crackles)
49
legionella on gram stain of sputum cultures
many neutrophils but no organisms
| intracellular weak stain GNR
50
why are ___ and ___ antibiotics used to treat legionella
new macrolides
fluoroquinolones (pref if sev enough for hosp)
because achieve high intracellular conc
(legionella is intracellular weak stain GNR)
51
When is amoxicillin/clavalunate typically used
sinusitis, otitis media, some CAP
| active against beta-lactamase producing Haemophilus and Moraxella
52
what kind of pneumonia is ceftriaxone used to treat
pneumococcus (s pneumo)
haemophilus
moraxella
(CAP not Legionella or other atypicals)
53
what kind of pneumonia is clindamycin used to treat
aspiration pneumonia
| anaerobes above the diaphragm
54
what kind of pneumonia is vanc used to treat
nosocomial (HAP, HCAP)
| when MRSA probability higher
55
T/F
| Vanc has activity agains atypical pneumonias
F
| used in nosocomial HAP/HCAP when MRSA prob higher
56
cutaneous verrucae =
skin warts
57
T/F
| warts are most common cutaneous manifestation of HPV infection
T
58
where can HPV cause warts
various locations
| plantar, palmar, genital common
59
what demographic and what disease is associated with more plantar warts from HPV infection
young adults
| decreased cellular immunity (AIDS, transplant)
60
how are cutaneous verrucae (warts) caused by HPV transferred?
through tiny cuts on contact with infected person
61
describe lichen planus
purple
flat-topped papules or plaques
pruritic, planar, or polygonal
commonly on flexural surfaces (extremities, trunk, genitalia)
62
purple
flat-topped papules or plaques
pruritic, planar, or polygonal
commonly on flexural surfaces (extremities, trunk, genitalia)
=...
lichen planus
63
t/f
| lichen planus = white lesions on bottoms of feet
```
FALSE
PURPLE
flat-topped papules or plaques
pruritic, planar, or polygonal
commonly on FLEXURAL surfaces (extremities, trunk, genitalia)
```
64
molluscum contagiousum is caused by
poxvirus
65
describe molluscum contagiosum
single or multuple skin-colored papules w central punctum/umbilicus/put
66
t/f
| molluscum contagiousum is a common condition caused by poxvirus
T
67
molluscum contagiosum is caused by...
poxvirus
68
describe seborrheic keratosis
```
solitary or multiple
well-circumscribed
hyperpigmented lsions
can have "stuck-on" / warty appearance
usuallly on trunk, face, upper extremities
```
69
are subhorrheic keratoses solitary or multiple
either
70
are subhorrheic keratoses well or poorly circumscribed
well-circumscribed
71
what color are subhorreic keratoses
hyperpigmented
72
where do subhorreic keratoses typically occur
trunk, face, UE
73
erythematous skin lesion scaly, ulcerative, growing irregularly, slowly, non-resolving.... think...
squamous cell carcinoma
| espec in sun-exposed area but that would have given it away a bit to easily
74
```
low grade fever
acute watery diarrhea
abdominal pain
guaiac positive stool
in setting of prolongued omeprazole use
```
think...
C Diff colitis
75
which abx inc risk of c diff
clindamycin
penicillins
cephalosporins
fluoroquinolones
76
T/F
PPI or anti H2 antihistamine
inc risk of c diff
T
| prolongued gastrc acid suppresion
77
confirm dx of c diff
PCR for stool c diff toxins A and B
78
risks of prolongue PPI
c diff colitis (gastric acid suppression)
impaired Ca absorption (^ risk osteo porosis)
inc upper gi pathogen colonization --> inc risk PNA
79
dyspepsia =
epigastric pain
post prandial fullness
early satiety
80
T/F
| urea breath teast is noninvasive
T
81
urea breath test for...
h pylori in setting of dyspepsia
epigastric pain
post prandial fullness
early satiety
82
chronic diarrhea w foul-smelling/greasy stool and weight loss suggestive of...
steatorrhea and malabsorption
83
T/F
| fever and guaiac positive stool are characteristic of celiac disease
F
+aTTG ab
chronic diarrhea / malabsorbtion (weight loss, nutrient deficiencies)
84
when to measure serum gastrin level
suspected gastrinoma
(Zollinger-Ellison syndrome)
-recurrent duodenal peptic ulcers, GERD, diarrhea
85
when to eval stool for O&P
persistent diarrhea & risk exposures for protozoa
-exposed to infants in daycare
travel
drinking from mountain streams
86
T/F
dx of parasitic infection and O & P in stool is unlikely if not recently exposed to infants in daycare, travel, or drinking from mountain streams
T
| unlikely if not exposed to risks such as these
87
define pulsus paradoxus
drop in systemic (S or D?) BP > 10mmhg on inspiration
88
mechanism of pulsus paradoxus in severe asthma or copd
overexpansion of lungs can constrict space for heart
also intrathoracic pressure can drop 40mmhg with inspiration (normal 2-5mmhg) causing blood to pool in pulm vasculature
89
how does aortic regurge prevent pulsus paradoxus
inc end diastolic pressure of lv preventing shift of interventricular septum during inspiration
90
pyoderma gangrenosum
neutrophilic ulcerative skin disease
assoc w chronic inflam disease like ibd, ra (arthropathies), aml (heme conditions)
clinical dx, eclude others, comfirm w biopsy
tx w local or systemic corticosteroids
91
inflam nods w pur drainage w scar formation in chronic phase. in axilla, groin, scalp usually
hydradenitis suppurtiva
92
t/f
| hiv is a risk for vte
t
93
t/f
| hiv is a risk for vte
t
94
some clinical manifestations of sarcoid
```
multisystem noncaseating granulomas
hilar adenopathy
uveiitis
LAN, hepatosplenomeg
acute polyarthralgias (ankle esp)
hypercalcemia w bone resorb
central DI
e nodosum
lofgren (e nod, hilar ad, migratory polyarthralgias, fever)
```
95
sarcoid mos common in
young adult black women
96
presentation of sarcoid
incodental bilat hilar lan on cxr
cough dyspnea fever fatigue weight loss
97
dx sarcoid
biopsy noncaseating granulomas
98
tf
| nystagmus possible w etoh intox
t
99
```
tachycard
htn
dry mouth
conjunctival inj
inc appetite
impaired shirt term memory loss
```
what kind of intox
marijuana
100
```
tachycard
htn
mydriasis
self conf
good attention/vigilance
arousal
euphoria
```
what kind of intox
cocaine
withdrawal can inc appetite
101
mydriasis
dilated pupil
102
dilated pupil
mydriasis
103
depressed mental status
depressed respiratory rate
meiosis
what kind of tox
opiod
104
```
tachycard
htn
impaired judgement
aggressiveness
ataxia
multidirectional nystagmus
```
what kind of tox
pcp
| phencyclidine
105
confusion
nystagmus
ataxia
opthalmoplegia
short term memory loss
confabulations
what kind of tox
not tox
thiamine deficiency
b1
```
wernicke encephalopathy
korsakoff syndrome (chronic)
```
106
vrdl test stands for
vinereal disease research lab test
| high sns for syphillis
but lower sp so confirm w fta-abs
fluorescent treponemal absorption
107
fta-abs test
| stands for
(fluorescent treponemal antibody absorption)
high sp for syphillis
use to confirm after positive vrdl (high sns, lower sp)
108
anti-phospholipid ab syndrome (APS)
| commonly causes false positive ____ test
vrdl
| venereal research disease lab test for syphillis
109
aps
antiphospholipid ab syndrome
summary
```
risk of a and v thromboses
prone to miscarriage
false pos vrdl
thrombocytopenia
long ptt
```
should get lmwh in subseq pregnancies to reduce risk to fetus
vit k antag warf if not preg (teratogen)
110
treat early or latent syphillis with
benzathine penicillin
| (benzylpenicillin
111
how to treat aps
antiphospholipid ab syndrome
not preg vs preg
not preg warfarin vit k antag
preg lmwh bc warf ci
112
bilateral trigeminal neuralgia suggestive of
ms
| teigeminal nerve nucleus demyelination
113
herpes zoster usually affects which trigeminal branch and what is the scary complication
v1
blindness
herpes zoster opthalmicus
114
clinical manifestations of cavernous sinus thrombosis after facial venous infection
```
fever
headache
proptisis
cn iii iv v vi deficits
(v1&v2 opth and max)
```
115
dihydropyridines preferentially dilate
precapillary arterioles
risk edema
116
how do acei's reduce the risk of ccb peripheral edema
cause post capillary venodilation to normalize pressure from ccb pre cap arteriolar dilatiom
117
why are acei's renoprotective
preferentially constrict efferent arteriole, preserving gfr
118
tf
| acei's cause peripheral edema
f
| angioedema
119
solitary pulm nodule size vs ct vs sc resection indications
resect any size if high malig risk (size age smoke stop border)
^8mm resect if high malig risk pet if low risk resect if pet+ serial ct if pet-
v8mm & low risk can serial ct if 5-7mm can stop workup if v4mm
120
lung nodule vs mass
3cm v^
121
5 ways to class solitary lung nod risk of malig
```
size age smoke stop marg
low mod high
v8mm .8-2mm ^2mm
v40yo 40-60 ^60
former current current
^15y 5-15y v5y
smooth scalloped spiculated corona
```
serial image growth, pet+, path
122
these 3 bugs causing infectious granulomas are responsible for majorityof benign pulm nodules
histoplasma
coccydioidomycosis
tb
123
#1 cause isolated aortic stenosis in elderly
age dependent idiopathic sclerocalcification
124
tf
| bacterial endocarditis can lead to aprtic stenosis
f
| aortic insufficiency
125
hyposthenuria
impairment in kidney ability to conc urine
sickle cell
and sickle cell trait
prob from ss occlusion of vasa rectae, impairing countercurrent multiplier system
126
acute gout pain reaches max intensity in what timeframe
12-24 hr
127
tf
| gout can be dxd by hyperuricemia
false
not correlated well, can be caused by acute delta urate up or down
need negative birefringent synovial urate crystals
can use urate levels to monitor, not dx
128
enthesetis
inflammation at tendon insertions
eg w spondyloarthropathies
129
tf
| neuropathic arthropathy can occur in longstanding dm
t
130
meralgia paresthetica
burning pain and paresthesias in lateral thigh unaffected by motion caused by compression of lat fem cutaneous nerve at waist
131
```
holocranial headache
vision changes (blurry, diplopia)
papilledema
cn vi palsy
pulsatile tinnitus whooshing
empty sella...
```
suggest
idiopath intracran hypertens
pseudotumor cerebri
young obese women
tetracyclines hypervitA
dx w high opening press LP
tx wt loss acetazolamide
132
tf
| papilledema ci lp
f
| not unless onstructive/noncommunicating hydroceph or slace occupying midline shifting lesion
133
tf
| lp is unsafe in pseudotumor cerebri
f
| communicating, cerebral press equiv to lumbar, safe, high opening press diagnostic
134
what is diagnostic opening pressure for pseudotumor cerebri/ iih
^250mmh2o
135
amaurosis
loss of vision
136
how does prolactinoma cause hypogonadism in men
prolactin inhibits gnrh release
| not by mass overgrowing gonadotrophs, at least early
137
tf
| tsh normal in symptomatic prolactinoma
tish
| normal early, can get low if big compressive effect later
138
what level of prolactin is virtually diagnostic of prolactinoma
^200 ng/ml
139
what does bivalirudin do?
directly reversibly inhibits thrombon
bival (reversible)
rudin ~ "thrombin"
140
STEMI mgmt
- o2 for sat v90%
- nitrates (caution r infarct, hypot, aortic stenosis)
- asa & p2y12 inhib (grel)
- cath lab reperfuse v90min capable v120min if transfer needed v12 h sympx onset pci>fibrinolysis unless outside window
- bb but not if hf, risk shock
- ufh lmwh bivalirudin
- statin
141
acute pericarditis on ekg
diffuse ste w std in limb and left precordial leads
142
tf
| it is within ethical guidelines to practice procedures on deceased pt
```
t
if pt (prior to death) or family consents
```
143
prevent mi in cad
asa
bb
behavior mod
144
why appetite suppressants ci in cad
because sympathomimetic and can elevate hr and bp
145
why avoid metformin in cad
can exacerbate lactic acidosis
146
tf
| ankylosing spondylitis risks vertebral fracture with minimal trauma
t
chronic inflammation, osteoclast activation, bone loss
also spinal rigidity makes prone
147
describe ankylosing spondylitis pain
insidious, unilateral, intermittent, may eventually become bilateral and persistent
not usually acute onset
148
```
presentation
exam
compx
lab
imaging
```
ankylosing spondylitis
- inflam back pain, insidious age v40, relieved w ex, nocturnal
- enthesitis, arthritis, dactylitis, uveitis, kyphosis, diastolic murm
- osteopor vert fractures, cauda equina, aortic regurge
- esr crp hla-b27
- xr sacriloiliac, mri sacroiliac
149
dementia
gait disturbance
bladder incontinence
triad for
nph
| normal pressure hydrocephalus
150
how to diff normal pressure hydrocephalus from brain atrophy on mri
both have enlarged ventricles, atrophy has enlarged sulci
151
typical mmse score in alzheimers
v24
| amnesia first, confusion only late advanced
152
tf
| cml has high LAP leukocyte alk phos
false
| cml immature pmn precursors (promy metamyelocytes), LAP comes from mature leukocytes
153
what blood stain for malaria
girmsa stain
154
tf
| auer rods in cml
f
| Auer rods in Aml
155
which is more mature, myelocyte or metamyelocyte
meta
blast pro my meta band pmn
myeloast promyelocyte myelocyte metamyelocyte band neutrophil
156
how will mys and metamys compare cml vs leukemoid rxn
metas more mature
more metas in leukemoid
more mys in cml
157
on urine dipstick,
esterase signifies
nitrites signify
leukocytes (pyuria)
| enterobacter e.g e.coli (converts urine nitrates to nitrites)
158
tf
| atheroembolism is a complication of vasc procedures such as cardiac cath
t
159
tf
| cholesterol embolism is synonymous with atheroembolism
t
160
tf
| hashimoto pts are hypothyroid
f
eu or hypo
ai thyroid destruction
161
another name for hashimotos
chronic lymphocytic thyroiditis
162
graves disease hyper or hypo thyroid
hyper
| ai activation of thyroid
163
another name for grave's
diffuse toxic goiter
164
dreaded complication of status
cortical laminar necrosis from excitatory toxicity
165
new soft cresc decresc systolic murm in setting of fever suggests
flow murmur
from hyperdynamic state induced by fever and hypoxia
(vs harsh murmer w fever in endocarditis)
166
a a gradient refers to
A-a
| Alveolar-arterial
167
alveolar hypoventilatiom signifies
uniform fall in inspired o2 in All regions of the lungs
168
new harsh murmur w ^ pulm cap wedge pressure in setting of fever suggests
infective endocarditis with mitral valve involvement
169
ara-c...
cytirabine
arabinofuranosyl cytidine
pyrimidine (cytosine) analogue
blocks dna/rna synth
eg used to treat ALL
170
tf
| poor urine output with intermittent high output can be consistent with obstructive uropathy
t
| this is called post obstructive diuresis which occurs when obstruction overcome by high retained volume
171
quantify microscopic hematuria
^ 3 rbcs/hpf
172
tf
| renal artery stenosis often presents with flank pain
f
| htn w/o flank pain or urinary sympx usually
173
tf
| there is an HAV vaccine
```
t
for pts w
chronic hepatitis (HBV,HCV)
MSM
IVDU
travel to hav endemic area
```
174
HPV vaccine recommended for
all pts age 11-26 ish
11-12 yo m&f
11-26 f
11-21 m, -26 if hiv+
175
meningococcus acwy vaccine for
all pts 11-18
large groups in small quarters
asplenia or complement deficiency
176
how often to repeat TDaP vaccine
every pregnancy for women
| TD q10yrs everyone else
177
pneumococcal vacc sched for hiv pts
pcv13
| ppsv23 8 wks later, 5 yrs later, and age 65
178
hav vaccine for
```
for pts w
chronic hepatitis (HBV,HCV)
MSM
IVDU
travel to hav endemic area
```
179
tf
| mmr requires a redo later in life
f
| not even in hiv pts
180
red firm friable exophytic nodules in hiv pt
bacillary angiomatosis
gnr bartonella henslae
po erythromycin
181
extrapulmonary pneumocystis
nodular and papular cutaneous lesions of external auditory meatus
(tx pneumocystis w tmp-smx)
182
molluscum contagiousum
dome shaped umbilicated non-pruritic papules
| poxvirus
183
mama cyst w multiple daughter cysts (anywhere but usually liver or lung) in a sheel farmer caused by
echinococcus tapeworm
dogs definitive host
sheep intermediate host
humans collateral damage
tx azoles or surgical cyst removal
184
parasites
sheep farmers get
pig farmers get
sheep echinococcus
| pigs neurocystercercosis
185
neurocystercercosis often in __ farmers
pig farmers
186
treat isoniazid induced peripheral neuropathy
give pyridoxine B6 100mg qd
187
which tb antibiotic cam cause peripheral neuropathy and how do you treat it
INH isoniazid
give pyridoxine b6 100mg qd
RIPE P after I, Periph neurop, Pyridox
188
2 known side effects of inh isoniazid
peripheral neuropathy (so always give w 10mg qd pyridoxine b6, tx w 100mg)
hepatitis
189
key vitamin to always give with RIPE therapy
pyridoxine b6 10mg qd to prevent inh induced peripheral neuropathy
190
hemobilia
blood in biliary tree
rare
from surgery or trauma
191
typical setting of gi stress ulcers
prolongued physiologic stress eg icu or burn unit
192
fever night sweats weight loss
cough ab pain diarrhea
splenegaly ^alk phos
hiv cd4 v50
MAC
disseminated mycobact avium or intracellulare
should have prevented w azithromycin ppx
ddx tb or cmv
so check ppd cxr cmv-IgG
193
positive ppd criteria
>15mm no risks
>10mm from endemic area, health care workers or high risk setting, ivdu
>5mm hiv, transplants, known recent exposure, suspicious cxr nodules or fibrotic
194
negative ppd criteria
v5mm
v15mm no risk factors
v10mm from endemic area, health care workers or high risk setting, ivdu
v5mm hiv, transplants, known recent exposure, suspicious cxr nodules or fibrotic
195
alternative pneumocystis ppx
dapsone
competes w paba to inhib folate synth
alternative to preferred tmpsmx
196
signs of liver cirrhosis
jaundice, edema (low prot), ecchymoses (low clot factors)
portal htn, ascites, esoph and anorectal varices, splenomeg, caput medusae
hyperestrinism, gynecomast, testicular atrophy, loss of sex hair, spider angiomata (subtype of telangiectasia -- swollen bv's beneath skin), palmar erythema
197
why hyperestrinism in cirrhosis
impaired cyt p450 metabolism of circulatimg estrogens
198
what are spider angiomas and why do they occur from cirrhosis
central dilated arteriole with radiating distal vessels
cirrhosis, impaired p450 metab of circulating estrogens, vessel wall dilation
199
why does palmar erythema occur from cirrhosis
hyperestrinism (impaired p450 metab of circulating e), vessel wall dilation, increases normal speckling of palm from vasculature
200
dupytren contracture
thickening of palmar aponeurosis contracts fingers, 4th and 5th digits first usually
etiology not specific... possible ox stress and free rads for some reason...
201
senile purpura vs solar purpura/ actinic purpura
superficial bleeds from loss of perivascular elastic tissue in elderly vs middle aged w lots of sun exposure
202
which tb drug has urinary se's
rifampin turns urine red
203
diff hematuria from glomerulonephritis from bladder cancer
glomneph has rbc casts
204
most common cause of gross hematuria in smoker age ^35
bladder cancer
205
gross hematuria more common w bph or prostate ca?
bph
206
hematuria from bladder ca painful or painless?
painless
207
presentation and dx of glucagonoma
- necrolytic migratory erythema - papules into patches blister crust scale w central clearing perineum perioral extrem
- diabetes mild controllable
- gi sympx d/c pain anorex wloss
- neuropsych, venous thrombosis
hypergly w glucagon ^500
normocytoc anemia of chronic disease/epo suppression from glucagon
tumor vs mets on imaging
208
- necrolytic migratory erythema - papules into patches blister crust scale w central clearing perineum perioral extrem
- diabetes mild controllable
- gi sympx d/c pain anorex wloss
- neuropsych, venous thrombosis
what is dx and how make it
glucagonoma
hypergly w glucagon ^500
normocytoc anemia of chronic disease/epo suppression from glucagon
tumor vs mets on imaging
209
anti-glutamic acid antibidies and low insulin levels amd ralid progression to insulin dependence
indolent late onset type 1 DM
210
induration
firmness
211
dx workup of bph
1 dre for smooth enlarge (bph) vs nodules (prost ca)
2 UA for hematuria (bladder ca, stone) or infection to rule these out
3 psa for prost ca for men w le >10yrs
212
tf
| Cr is a good lab to trend in bph
f
| no different risk for renal dysfunction than gen pop
213
when is transrectal us of prostate indicated
for biopsy when nodules on dre or persistent psa ^4
214
1st step in mgmt of svt
adenosine or vagal maneuver, will slow an help determine type of svt
215
tx panic attack
alprazolam (BZD)
216
amiodarone and lidocaine treat
vtach
| ami also tx afib
217
how does adenosine affect heart
slows sinus node rate
slows av node conduction
tx/dx of svt
218
acute pericarditis post mi
usually within days
sharp, pleuritic, better sitting up leaning forward
diffuse ste espec w pr dep
friction rub
219
how long to interventricilular free wall or papillary muscle rupture after mi
physical exam finding
3-7 days
new systolic murmur
220
free wall rupture after mi
3-7 days
| rapid deterioration to pericardial tamponade and pulseless electrical activity
221
what renal labs are affected by upper gi bleed
bun/cr ratio ^
hb breakdown and absorb by gut
inc urea retention 2/2 hypovolemia
222
inc alk phos w what kind of disease
biliary obs
osteoblastic bone d (paget's)
mild in ibd and gi infection
223
tf
| apthous ulcers can be seen in crohns celiac or folate deficiency
t
| apthous ulcers = small shallow ulcers in mouth
224
hairy cell leukemia
pancytopenia, splenomeg sometimes leukocytosis
rare b cell lymphocytic leukemia
fine hair-like irregular cytoplasmic projectioms
fibrotic bone marrow dry taps
TRAP tartrate resistant acid phosphatase stain
CD11+
225
paresthesias a sign of hyper or hypocalcemia
hypocalcemia
226
why might pt get tingling in toes and fingers after large transfusion
paresthesias from hypocalcemia
while blood donations stored w citrate anticoagulant, chelates calcium, makes hypocalcemic. packed rbcs derived from those donations, can also be hypocalcemic. usually only affects pts of large transfusions
227
what electrolyte leaks out of stored rbc's and can cause hyper__ in transfused pt
k+ leaks out
| can get hyperkalemic when transfused
228
how do glucocorticoids affect wbc's
inc pmns by demarg slight inc production and inhib apop
dec lympho eo by extrav dec production inc apop
overall leukocytosis
229
describe heat stroke and compx
temp ^40C (104F) + AMS
hot no water or shade
elderly can't move non-exertional
young exertional
compx coagulopathy (epistaxis) ARDS ARF rhabdo
230
tf
| heat stroke can present w epistaxis
t
coagulopathic bleeding is a complication
also rhabdo ARDS ARF
231
typical upper limit of infection induced fever
40.5C
| 105F
232
tf
| infections rarely cause fever ^105F 40.5C
t
233
tf
| latex allergy can cause anaphylactic shock
t
234
what endocrine abnorm should be suspected in pt suddenly hypotensive in stressful sitch such as surgery
adrenal insufficiency
| primary called addison's
235
riluzole
glutamate inhib
tx ALS
prolong time to tracheostomy, not reverse or halt
se's dizzy nausea weight loss skeletal weakness elevated liver enzymes
236
tf
| ALS tx involves steroids, ivig, cyclophosphamide
f
als neurodgen, not immunologic like
MS (steroids for acute exacerbations)
or GBS (ivig ~ plasmapheresis)
237
dx pancreatitis
2/3
epigast pain rad to back
amylase or lipase ^3x uln
imaging findings
238
causes of pancreatitis
```
alc 40%
gallstones 40%
#3 Hyper TAG ^1000
drugs azt vpa thiazide diurs
azathioprine valproic acid
inection cmv
ercp
trauma
```
239
yellow red papules on extensor surfaces
| + elugastric tenderness
xanthomas and pancreatitis caused by hylertriglyceridemia
240
what key lab suggests biliary pancreatitis
ast ^150
241
4 uses if tmpsmx
gnrs (uncomplicated uti)
pcp pneumonia ppx
mrsa skin infections
nocardia
242
8 drugs that cause hyperkalemia
```
bb's (cell k uptake b2)
acei arbs k+ sparing diurs
cyclosporine blocks aldo
heparin blocks aldo synth
nsaids dec renal perfusion
succinylcholine k leak from cells
tmpsmx blocks enac like amiloride
```
243
how dors tmp smx work
sequential block of bacterial thf
244
what electrolyte to monitor in high dose tmpsmx tx
k
blocks enac, hyperkalemia
also blocks renal tubular creatinine secretion so gets high but glomerular function normal
245
se's of macrolides
long qt
| cholestasis
246
ceftriaxone se
cholestasis
247
how does prednisone affect k+
some k+ wasting
| because glucocorticoid with some mineralcorticoid activity
248
tick borne paralysis
- tick must feed 4-7 days to release neurotoxin
- ascending motor paralysis arms or legs, can affect one side more than another (unlike gbs)
- develops over hours (vs days to weeks gbs)
- no fever or prodromal illness (unlike gbs)
- does not affect ANS, (unlike gbs)
- normal csf (unlike gbs)
tx meticulous search and removal of tick makes better
249
guillan barre
- ascending paralysis
- days to weeks gradual onset
- often affects ANS (tachycardia, arrhythmias, urinary dysf)
- often csf albuminocytologic dissoc (high alb few cells)
tx ivig plasmapheresis
250
botulism
descending paralysis with early cn involvement (eg pupil)
251
tf
| fever with tick borne paralysis
f
| no prodrome
252
tf
| removal of the tick usually results in spontaneous improvement of tick borne paralysis
t
253
hyponatremia with normal serum osmolarity caused by
hyperproteinemia
| hyperlipidemia
254
hyponatremia with high osmolality caused by
etiology
```
hyperglycemia
exogenous solutes (mannitol, radiocontrast)
```
255
hypoosmotic hypovolemic hyponatremia with urine sodium v10
etiology
dehydration
vomiting
diarrhea
256
hypoosmotic hypovolemic hyponatremia with urine sodium ^20
etiology
renal salt loss
- acei
- diuretics
- mineralcorticoid deficiency
257
why treat siadh with demeclocycline
it is an antibiotic known to cause reversible nephrogenic diabetes insipidus
258
how much can kidneys dilute urine sodium
Una v 10meq/__
259
tf
| gonoccocal arthritis may present with migratory polyarthralgias
t
| or mono or oligoarthritis
260
what % gonococcal arthritis is "silent" without noticed preceeding gu or pharyngeal infection
75%
261
tf
| purulent arthritis in a sexually active individual is gonoccocal until proven otherwise
t
confirm w
synovial gram stain and cultures (each only 25% positive)
and pharyngeal or gu mucosal nucleic amplification (90% positive)
262
sympx of acute hiv
```
non specific
2-4 weeks after exposure
fever
arthralgias
sore throat
LAN
mucocutaneous lesions
diarrhea
weight loss
```
263
what kind of glomerulonephritis do you get with lupus
focal proliferative gn
264
define malignamt hypertension
```
extreme htn (urgent emergent range) w
retinal hemorrhages, exudates, or papilledema
```
arf from nephrosclerosis also possible but not required to dx
265
mechanism of hypertensive encephalopathy
breakthru vasodilation from failure of autoreg
266
common organ damage in hypertensive emergency
malignant htn
- retinal hemorrhage, exudate, papilledema
- nephrosclerosis and arf
hypertensive encephalopathy
subarachnoid hemorrhage
intracerebral hemorrhage
267
tf
cerebral salt wasting (hypovolemic hyponatremic w high Una ^20)
is always due to surgery or trauma
t
268
what electrolyte abnorms does vomiting cause
hypovolemia
hypokalemia
hyponatremia
269
most common cause of isolated aortic regurge in developed countries
bicuspid aortic valve
270
most common cause of airtic regurge in developing countries
rheumatic heart disease
271
how to hear aortic regurge better
firm pressure w steth at lsb let 3rd or 4th interspace
| patient sot up lean forward hold breath at full expiration
272
uses of carbamazepine
atypical bipolar depression
trigeminal neuralgia
reduces post tetanic potential... certain seizures too...
273
treatment for trigeminal neuralgia
carbamazepine
if that fails
surgical gangliolysis
or suboccipital craniectomy to decompress trigeminal are options
274
key followup in pt treated w carbamazepine chronically
routine cbc's
carbamazepine se aplastic anemia
275
primary therapeutic agent for manic depression
lithium
276
another name for manic depression
bipolar disorder
277
moa sumatriptan
ssra
selective serotonin agonist
ag 5HT1a, vasoconstriction
278
tx upper airway cough syndrome (post nasal drip)
1st gen antiH1
eg chloropheniramine
or combined antih1-decongestant
eg brompheniramine-pseudoephedrine
279
another name for upper airway cough syndrome
postnasal drip
280
another name for postnasal drip
upper airway cough syndrome
281
moa psudoephedrine
stim a1
vasoconstrict
reduce nasal congestion
282
some manifestations of renal cell carcinoma
```
flank/abdominal pain/mass
left sided scrotal varicocele
anemia or erythrocytosis
thrombocytosis
fever
hypercalcemia
c
```
283
left varicocele fails to empty when recumbent
think obstruction of gonadal vein into renal vein
284
left varicocele
hematuria
polycythemia (or anemia)
thrombocytosis
renal cell carcinoma
invasion of collecting system hematuria
obstruction of gonadal vein varicocele
epi polycy thrombocy vs anemia
285
sports advice for mono pts
avoid contact sports (also strenuous sports that inc ab pressure) for three weeks or more, splenic rupture risk
286
what muscles does lambert eaton affect
proximal limb muscles
also autonomics.. dry mouth, erectile dysfunction
287
another name for guillan barre
acute inflammatory demyelinating polyneuropathy
288
define chronic bronchitis
productive cough
greater than 3 mos
over more than 2 consecutive yrs
289
chrin bronchitis vs emphysema
which has prominent bronchovascular markings which has decreased vascular markings
chron bronch prom vasc marks
290
meticlopramide moa and uses and ses
D antag
tx nausea vomiting gastroparesis
agitation
loose stools
extrapyrimidal sympx - tardiv dyskinesia, dystonia, parkinsonism
neuroleptic malignamt syndrome
291
tf
| neck tenderness assoc w meningitis
f
neck stiffness, not neck pain
292
palpable bilateral abdominal masses
probs adpkd
293
common early finding in adpkd and how to manage
htn
| acei
294
tf
| palpable upper abdominal masses and htn think pheochromocytoma
f
pheos too small to palpate
think adpkd
295
adpkd presentation
```
htn
hematuria
proteinuria
palpable masses bilat
renal insufficiency
```
pain from cyst rupture hemorrhage calculi uti
296
tx nafld nash
diet
exercise
consider bariatric sx if bmi ^35
297
ast/alt in nafld
v1
298
tf
| it is safe to give statins in nafld
t
299
define light-moderate etoh unlikely to cause alc liver disease
v15 drinks/wk men
| v10 drinks/wk women
300
young obese female w headache suggestive of tumor but no imaging abnorms and csf elevated
pseudotumor cerebri
| benign intracranial htn
301
physical findings in pseudotumor ceribri benign intracranial htn
papilledema
visual field defects
cnVI palsy
302
tx pseudotumor cerebri
| benign intracranial htn
```
weight loss
acetazolamide
shunting
optic nerve sheath fenestration
to prevent blindness
```
303
large globular cardiac solhouette with clear lung fields
pericardial effusion / tamponade
304
hypotension
elevated jvp
muffled heart sounds
beck's triad for cardiac tamponade
305
malignant necrotizing otitis externa
demographs
bug
tx
elderly, poorly controlled diabetic, immune suppressed
pseudomonas usually
cipro #1, other antipseudomonals
306
antipseudomonals
ticarcillin pileracillin
ceftazidime cefipime
amikacin gentamycin tobramycin
cipro levo
aztreonam
307
OE vs MOE
otitis externa
vs
malignant (necrotizing) otitis externa
pain severity
granulation tissue
elevated esr in moe
antipseudomonal moe
tooical abx or steroid oe
308
test to diagnose lactose intolerance
hydrogen breath test
rise in breath hydrogen after lactose ingestion indicates bacterial carbohydrate metabolism (because human lactase not doing it)
309
stool osmotic gap
290 - 2 stool Na - stool K+
high in all osmotic diarrheas... due to other osmotic substances...
310
stool ph in lactase deficiency
acidic
| due to fermentation products
311
initial stabilizationof acute mi -- 3 steps
o2 asa p2y12i statin slnitrate anticoag bb (not brady hypot heart block hf)
chf loop
pain morphine
unstable brady atropine
htn hf nitro (not hypot rvmi as)
cath v90min, thrombolysis if no cath v120min
312
stool ph in lactase deficiency
acidic
| due to fermentation products
313
stool ph in lactase deficiency
acidic
| due to fermentation products
314
initial stabilizationof acute mi -- 3 steps
o2 asa p2y12i statin slnitrate anticoag bb (not brady hypot heart block hf)
chf loop
pain morphine
unstable brady atropine
htn hf nitro (not hypot rvmi as)
cath v90min, thrombolysis if no cath v120min
315
pronator drift indicates
umn
or
pyramidal or cst disease
(cortex-antlat pons-antlat medulla-...)
316
pyramidal signs
```
pronator drift
weakness
spasticity
hyperreflexia
babinski
```
317
this drug causes hyperammonemia
vpa
valproic acid
encephalopathy
neuromuscular bradykinesia asterixis
318
tf
| pronator drift indicates impaired proprioceotion
f
umn pyramidal disease
proprioceotion rhomberg and moving fingers w pt eyes closed
319
sympx if PBC
| primary biliary cirrhosis
ruq pain
jaundice
pruritus
fatigue
320
tf
| pnc usually shows a dilated duct on imaging
f
321
uses for urso
| ursodeoxycholic acid
mild cholesterol gallstones in pt not cholecystectomy candidate
pnc, psc... questionable...
322
all new onset afib should be screened for this endocrine abnorm
hyperthyroid
| tsh free t4
323
tf
| afib is a common finding in cushing syndrome
f
| hyperthyroid, diabetes, not cushing
324
kussmaul sign
paradoxical inc jvp w inspiration
325
3 categories of pericarditis etiology
idiopathic or viral
sx / radiation
tuberculous pericarditis
326
why do cardiac complications occur in Hodgkin lymphoma
10-20 yrs post mediastinal radiation of lymph nodes
327
tx pericarditis
diuretics
| pericardiectomy if refractory
328
2 top predisposers to portal htn
decompensated cirrhosis
| hypercoagulable state
329
tf
| elevated jvp in portal vein thrombosis
f
330
lab to diff hirsutism from adrenal vs ovarian
both high T
adrenal high dhea
ovary high dheas
331
how does testosterone affect epo
t inc epo by inhib hepcidin
332
where does pain from perforated peptic ulcer localize
maybe eoigastric injtially but spreads over entire abdomen, chemical peritonitis
333
gram positive
partially acid fast
filamentous branching rods
bug and tx
nocardia - can clinically resemble tb
tmpsmx respiratory
add carbapenem brain
long course 6-12 mos
sx drain abscesses
334
aztreonam coverage
gram negative
| pseudomonas coverage
335
tf
| clindamycin covers nocardial lung abscesses
f
tmpsmx for nocardia lung
carbapenem for nocardia brain
clinda for anaerobe oral flora aspiration lung abscesses, not good against nocardia
336
tf
| tb is afb weakly gram pos
f
tb doesn't gram stain
nocardia af branching filamentous rods weakly gram pos
337
actinomyces
pres
dx
tx
can present like nocardia or tb (lung, brain, cavities/abscesses, fev ns wl... etc)
anaerobic filamentous gram pos rod, sulfur granules, not afb
penicillin G
338
nocardia
| aerob or anaerob
aerob
| afb branching filamentous rods weakly gram pos
339
tx lung aspergillosis
voriconazole
340
how can otc cold meds potentiate warfarin assoc intracerebral hemorrhage
acrtaminophen tylenol potentiates warf anticoag
decongestants phenylephrine can inc bp
341
tx warf assoc intracerebral hemorrhage
prothrombin complex concentrate pcc (has pt vit k dep coag factors) or ffp if pcc not available (longer to prep and give and larger vol infusion)
vit k (12-24 hr onset to get coag factors produced)
342
tf
| treat warf assoc intracerebral hemorrhage w protamine sulfate
f
| protamine sulfate reverses heparin not warfarin
343
tranexamic acid
moa
uses
antifibrinolytic
reduce menstrual bleed
reduce surgical bleed
344
tf
| use inhaled corticosteroid like fluticasone to tx copd exacerbation
f
systemic corticosteroids oral pred or iv methyl prednisolone for exacerbation
inhaled fluticasone for persistent asthma... maybe some advanced copd but not exacerbations
345
when to use methylxanthine pdei's theophylline aminophylline in asthma and copd
rarely, bad se profile
346
tf
| laba like salmeterol used in copd exacerbation
f
laba for maintanence
saba, po or iv steroid ~5days for exacerbation
abx, o2, ventilatory support when indicated
347
spikes
step by step for fam meetings or breaking news
```
set up (environment)
perception (pt fam starting point)
invitation (from pt fam to give info)
knowledge (give info)
empathy
strategy/plan
```
348
presentation of acute hiv
```
mono-like
-fever LAN sore throat arthralgias
macular rash
gi sympx
mucocutaneous ulcer
```
349
tf
| hiv ab testing may be neg in acute hiv
t
presents 2-4 wks post inf usually
(but acute hiv = sympx in first 6 mos)
may not have seroconverted yet
but high viral load
cd4 may be normal
350
tx of choice in elderly with agitation
low dose haloperidol
(1st gen antipsychotic)
(D2 antag)
acute only, not in lewy bod dem
2nd line 2nd gen risperidone quietapine
D2 5ht antag.. tx bipolar more commonly
351
tf
| tx agitation in elderly w amitriptyline
f
tca inhib ne and serot reuptake to tx depression, sleep disorders, neuropathic pain
but has anticholinergic effects
potentiates delirium AVOID IN ELDERLY
352
hypothyroid sympx w elevated free t3 t4 and normal tsh
dx
thyroid hormone resistance
can present young w growth and mental retardation
can present a little older if milder form
353
se's of mtx methotrexate
stomatitis (oral ulcers)
hepatotox
cytopenias
354
tx RA
mtx (folate purine antimetab) #1
leflunomide (pyrimidine inhib)
hydroxychloroquine (anti il1 tnf)
sulfasazine (anti il1 tnf)
biologics for severe - anti tnf infliximab rituximab etanercept (vacc tb fungus screens first)
prednisone for flare
355
hepatotox and stomatitis in RA pt a result if
mtx methotrexate treatment se's
356
felty syndrome
neutropenia and splenomegy in pt treated for RA for long time
357
neutropenia and splenomegy in pt treated for RA for long time
felty syndrome
358
normal hpa axis function canntake how long to recover after stopping chronic steroid
6-12 mos
359
5 clinical features of toxic shock syndrome
- fever usually ^38.9C 102F
- hypot sbp v90
- diffuse macular erythroderma
- skin desq incl palm sole 1-2 wks post onset
- ^3 multisystem involv
360
4 etiologies of (staph a) toxic shock syndrome
```
50% tampon use
also
sx wound infection
urti (sinusitis, nasal packing)
septorhinoplasty
```
361
tf
| confluent erythematus macules on trunk and extremities in setting of urti can be consistent with toxic shock syndrome
- fever usually ^38.9C 102F
- hypot sbp v90
- diffuse macular erythroderma
- skin desq incl palm sole 1-2 wks post onset
- ^3 multisystem involv
362
usual interval from onset of menstruation or infection (eg sx urti septorhinoplasty) to TSS toxic shock syndrome
2-3 days
363
diffuse macular erythroderma in tss toxic shock syndrome is similar to what more typical more benign rash
sunburn
364
tf
TSS toxic shock syndrome
always gets leukocytosis
f
not always leukocytosis
but bands immature pmns elevated (3-5% is wnl)
365
wnl for pmn bands
3-5%
366
cbc in tss toxic shock syndrome
wbc can be normal
but bands elevated
thrombocytopenia
367
skin findings in acute meningococcemia
petechial rash progressing to exchymoses, bullae, vesicles, and into gangrenous necrosis
368
describe rocky mountain spotted fever rash in 2 adjectives
petechial
| starts in extremities
369
scarlet fever
presentation
s&s
peds
prior GAS pharyngitis/tonsilitis
prodrome of fever ha vom sorethroat
12-48 hrs later, fine pink blanching sand paper texture rash neck and upper trunk quickly generalizes
370
generic for Lyrica
pregabalin
-| VCaCs
antinociceptive anticonvulsant
371
what is enteroclysis
xray of contrast through small bowel
372
solid organ transplant imunnosuppression greatest risk of which two bugs and how to ppx
pcp tmpsmx bactrim
covers listeria, toxoplasma, many other urtis giis utis
cmv valcyclovir or valgancyclovir
depending on serostatus of donor and recipient
373
whipple disease
infection by tropheryma whipplei (intracellular gram +, PAS + foamy macrophages)
damage to small intestinal villi causes inflammation, weight loss, diarrhea, joint pain, arthritis most commonly, but presentation variable (Whip cream in a CAN cardiac arthralgias, neurologic symptoms)
374
presentation of normal pressure hydrocephalus
ataxia
then dementia
and urinary incontinence
not fnd's
375
cushing reflex
htn
bradycardia
resp dep
caused by brainstem compression
376
how to separate acute angle closure glaucoma from intracranial htn using eye exam in ddx of headache and blurry vision
acute angle glaucoma often has conjunctival erythema amd mildly dilated pupil poorly reactive to light
ichtn eye exam normal but for papilledema
377
s&s of intracranial htn
```
headache worse at night
n/v
mental status changes
papilledema
"fnd's" -- vision change, unsteady date
cushing reflex -- htn, bradyc, respdep from brainstem compression
```
378
is ataxia caused by cerebellar lesion ipsi or contralat?
ipsilat
| corticopontocerebellar tracts decussate twice
379
lesions of what areas of the cerebellum cause truncal vs limb ataxia
trunk ataxia -- vermis
| limb ataxia -- cerebellar hemispheres
