Random mix Flashcards
Most common cause of death in dialysis patients
Cardiovascular disease
Eye dysfunction in NF T1
Optic giloma
Associated neoplasms of Lynch syndrome
Colorectal
Endometrial
Ovarian
MEN1 associated neoplasms
Parathyroid adenomas
pituitary adenomas
pancreatic adenomas
Initial symptomatic treatment for hyperthyroidism
Propranolol
When to use PTU?
Treat hyperthyroidism in cases when radio ablation is contraindicated (pregnancy)
Cause of pulmonary edema in the setting of aortic dissection
Aortic regurg
Chronic rhino sinusitis, asthma, aspirin or NSAID induced bronchospasm
Aspirin-Exacerbated respiratory disease.
Nasal polyps
Bilateral nasal obstruction, discharge and anosmia
Causes of renal transplant dysfunction early post-op
Ureteral obstruction, acute rejection, cyclosporine toxicity, vascular obstruction, acute tubular necrosis
What test to get if patient has hypertension and hypokalemia
plasma aldosterone/renin ratio
Suspicion of primary hyperaldosteronism
If PAC/PRA >20
Amiloride
potassium-sparing diuretic
Common causes of hyperkalemia
acute or chronic kidney disease
medications
Disorders impairing the renin-angiotensin axis
Aspirin intoxication acid-base disorder
mixed respiratory alkalosis and metabolic acidosis
Exertional heat stroke vs. heat exhaustion
Exertional heat stroke- thermoregulation failure
Heat exhaustion- inadequate fluid and salt replacement W/ NO CNS dysfunction
Pathophys of nephritic syndrome
primary damage to glomeruli
Causes of nephritic syndrome
Poststrep glomerulonephritis IgA nephropathy Lupus MPGN rapidly progressive glomerulonephritis
Anasarca, pulmonary and facial edema, hypertension, abnl UA with proteinuria and hematuria
Nephritic syndrome
Painful nodules in the armpit that progress to abscesses
Hidradenitis suppurativa
inflammatory occlusions of folliculopilosebaceous units
Treatment for uric acid kidney stones
alkalization of urine (potassium citrate)
Low-purine diet
Allopurinol
AKI acid/base disturbance
Non-anion gap metabolic acidosis (impaired acid excretion)
OR
Anion gap acidosis (retention of unmeasured uremic toxins)
Criteria for ATN
- BUN:Cr::20:1
- Urine osm 300-350
- Urine Na >20
- FENa >2%
- Muddy brown casts
Muddy brown casts
ATN
RBC casts
Glomerulonephritis
WBC casts
Interstitial nephritis and pyelo
Fatty casts
Nephrotic syndrome
Broad and waxy casts
Chronic renal failure
Drugs that cause acute interstitial nephritis
Penicillins
TMP-SMX
Cephalosporins
NSAIDs
Common complication of nephrotic syndrome
- Coagulopathy (renal vein thrombosis)
- Protein malnutrition
- iron-resistant microcytic hypo chromatic anemia
- Vit D deficiency
- decreased thyroxine levels
- Increased susceptibility to infection
Progression of DM kidney injury
- glomerular hyperfiltration
- Glomerular BM thickening
- Mesangial expansion
- nodular sclerosis
Treatment for kidney stones
hydration, analgesics and alpha blockers
relaxes ureteral muscle
URI 4 days ago, young male, gross hematuria
IgA nephropathy
normal serum complement
Timing of post infectious GN
10-21 days
-children
Post infectious GN labs
- Low C3
- Elevated anti-streptolysin O or anti-DNAse B
Most common cause of ascites
Cirrhosis
Hep C and Alcoholic liver dz
Level of G6PD activity during attack
may be normal
Most common cause of spontaneous deep intracerebral hemorrhage
Hypertensive vasculopathy
Most frequently effecting basal ganglia, cerebellar nuclei, thalamus and pons
Cause of subarachnoid hemorrhage
berry aneurysms
Treatment of metabolic alkalosis
Normal saline
determine if responsive or not
Causes of saline resistant metabolic alkalosis
- primary hyperaldo
- Cushing’s syndrome
- severe hypokalemia (
fever, chills and malaise w/in 1-6 hrs of transfusion
febrile non hemolytic transfusion.
can be avoided by leukoreduction.
decrescendo early diastolic murmur
aortic regurgitation
Most common causes of aortic regurg
Developed countries-biscupid valve
Developing countries- rheumatic heart disease
sensitive lab test for hypovolemia in pt on diuretics
BUN/Cr ratio
looking for (>20:1) pre renal azotemia
Young obese female with headache and normal neuroimaging and elevated CSF
Pseudotumor cerebri
Treatment for pseudo tumor cerebri
weight reduction and acetazolamide
Shunting or opt nerve sheath fenestration to prevent blindness
Diagnosis of myasthenia gravis
Bedside edrophonium test, ice pack test
- Ach receptor antibodies
- CT scan of chest for thymoma
physical exam findings in renovascular disease
resistant HTN
asymmetric renal size
abdominal bruit
Localized pain on anteromedial tibia after trauma with neg callous stress test
pes anserinus pain syndrome
Location of coccidioides
southwest
autoantibodies to RBCs + pallor, jaundice, splenomegaly
positive coombs test
Autoimmune hemolytic anemia
Peripheral vision loss, cupping of optic disc
open angle glaucoma
tx: timolol drops
Effects of IGF-1
excessive growth of bone and soft tissue
Leading cause of death in acromegaly
cardiovascular
Hypertension, palpable bilateral abdominal masses and microhematuria
AD polycystic Kidney disease
Common complication of ADPKD
- intracranial berry aneurysm
- hepatic cysts (most common!)
- valvular heart dz
- colonic civerticula
- abdominal wall inguinal hernia
rapid onset hirsutism
Androgen secreting neoplasm
test for testosterone and DHEAS
- elevated T w/ nl DHEAS (OVARIAN)
- elevated DHEAS (ADRENAL)
rapid onset hirsutism w/ elevated testosterone and nl DHEAS
OVARIAN TUMOR
Rapid onset hirsutism with elevated DHEAS
Adrenal tumor
what insulin for DKA?
regular insulin IV
Goals of treatment of DKA
- restore intravascular volume (NS)
- correction of hyperglycemia (regular insulin)
- correction of electrolytes (K+)
- treatment of precipitating factors like infection
Treatment for hypercalcemia
Severe (>14)- NS+calcitonin
Bisphosphonates for long term
Characteristics of HHS
Hyperglycemia
increased serum osm
little or no ketonemia or acidosis
gradual onset
cause of milk-alkali syndrome
excess intake of calcium and absorbable alkali.
Thiazide, ACE I, NSAIDs
Anti-TPO and anti-thyroglobulin antibodies
Hashimoto’s
positive urinary cyanide nitroprusside test
cystinuria
UA with hexagonal crystals
cystinuria
AL amyloidosis associated conditions
multiple myeloma
Waldenstrom macroglobulinemia
AA amyloidosis associated conditions
RA
IBD
chronic infection (osteomyelitis, TB)
Flank pain, low-volume voids +/- occasional high vol voids, renal dysfunction
Obstructive uropathy
Eye injury with contact lens
ulcers
Keratitis–Pseudomonas
Hip pain, limited internal rotation and abduction, normal XR and inflammatory markers.
Osteonecrosis (aseptic necrosis) of femoral head
Causes of hypercalciuria
idiopathic, hyperPTH, dehydration, prolonged immobilization
Cause of nephrolithiasis in pts with Crohn
Increased absorption of oxalate
NNT
1/ARR
Primary medication for COPD
anti-cholinergic (ipratropium and tiotropium)
Bright red, firm, friable, exophytic nodules in HIV pt
Bacillary angiomatosis
Signs of oropharyngeal dysphagia
difficulty initiating swallow, coughing, choking, nasal regurgitation
Diagnosis of oropharyngeal dysphagia
video fluoroscopic modifica barium swallow
Chalazion
painful swelling that progresses to nodular rubbery lesion on eyelid
beta-D-Glucan test
test for fungi
post-transplant pt with respiratory failure, dry cough, and fever
PCP
Indications for carotid endarterectomy
Men: 60-99% stenosis if asymp
Women: 70-99% stenosis
Cause of bullies pemphigoid
IgG autoantibodies against hemidesmosome and BM
First line treatment for Bullous pemphigoid
High-potency topical glucocorticoid (clobetasol)
Risk factors for idiopathic intracranial hypertension
Overweight women of childbearing age
medications (tetracyclines, hypervitaminosis A, isotretinoin)
Treatment for acute MS exacerbation
glucocorticoids (IV methylprednisolone)
Or plasmapheresis if steroids do not work
Treatment for metastatic bone cancer
Bisphosphonates (zoledronic acid)
Use dependence with antiarrhymitcs
enhanced pharmacologic effects of a drug during faster heart rates.
Highly use dependent antiarrhythmic
Class 1 (flecanide) and class 4 (CCB)
leads to widened QRS
pain in groin that radiates to thigh. Worse with activity. decreased internal and external rotation of hip. No redness or warmth or tenderness to joint.
Osteoarthritis
Osteonecrosis pain
Constant
Cutaneous larva migrans source
walking barefoot on beach
Hookworm larvae
Diseases associated with vitiligo
autoimmune disorders (SLE, thyroid, pernicious anemia, addison disease)
Clinical features of glucocorticoid-induced myopathy
progressive proximal msk weakness and atrophy w/o pain
Nl ESR and CK
Most common pulmonary complication of scleroderma
interstitial fibrosis
trihexylphenidyl
anticholinergic med for parkinsons and drug induced EPS
Pt with NSTEMI with pulmonary edema needs
IV furosemide
Pt with NSTEMI with unstable sinus bradycardia
IV atropine
Pt with NSTEMI with persistent severe pain
IV morphine
Pt with NSTEMI w/ pain, hypertension, or HF
IV nitro
Tx for SVT
adenosine or vagal maneuvers
Fourth heart sound causes
Ventricular hypertrophy
Acute MI
Association with cryoglobulinemia
hep C
IgM against anti-hepatitis C virus IgG
ADAMTS13
Thrombi thrombocytopenic purpura
urine positive for prussian blue stain
hemosiderin
diagnosis of obstructive ureterolithiasis
US or spiral CT
Test for EBV
heterophiles antibody test
most common thrombophilia
Factor V Leiden
Activated protein C resistance
RBC casts, proteinuria and low serum C3
post-strep GN
inflammatory arthritis, splenomegaly, ulcerating skin lesions and neutropenia
Felty syndrome
common in pts w/ RA
isolated elevated alk phos
Paget’s disease of the bone
Normal Ca and phos
elevated bone turnover markers: procollagent type 1 N propertied, urine hydroxyproline
travel diarrhea >2wks
Cryptosporidium, cystoisosporia, cyclospora, giardia
clinical manifestations of waldenstrom macroglobulinemia
Hyperviscosity syndrome (diplopia, tinnitus, HA), Neuropathy and hepatosplenomegaly, anemia, thrombocytopenia
elevated IgM with hepatosplenomegaly
Waldenstrom macroglobulinemia
elevated IgG, IgA and hypercalcemia
Multiple myeloma
elevated IgM with no end organ effects
MGUS
Are deep diabetic wounds mono microbial or polymicrobial
Poly
Treatment for symptomatic SIADH
Hypertonic saline
Vaptains
Middle aged woman with widespread pain, fatigue and cognitive/mood disturbances
Fibromyalgia
Treatment for Fibromyalgia
Exercise w/ aerobic conditioning
Fever, severe focal spinal pain, neurologic deficits
spinal abscess
Causes of hypokalemia
- increased entry into cells
- renal potassium wasting
- GI loss
Effect of beta-adrenergic agonists on potassium
Shift potassium into cells
Hypokalemia
Fixed, dilated pupil that is “down and out” with no accommodation
compression of CNIII
Ptosis and down and out gaze with normal light and accommodation reflexes
diabetic CN III neuropathy
Test with high sensitivity for CHF
BNP
Dipyridamole and adenosine use in diagnosis of CAD
Coronary vasodilators
lead to coronary steal
unexplained elevation of serum CK and myopathy
Hypothyroid
polymyositis
cause of secondary bacterial pneumonia
S. aureus
Tx for TTP
plasma exchange
Thrombocytopenia Hemolytic anemia Renal insufficiency Neurologic changes Fever
Thrombotic thrombocytopenic purpura
Normal PT
Drop in plts >50% or new thrombus w/in 5-10 days of heparin initiation
HIT
Recurrent infection, osteolytic bone lesions, weight loss, fatigue
Multiple myeloma
Multiple myeloma labs
normocytic anemia
renal insufficiency
-hypercalcemia
Indications for HAV vaccine
Chronic liver dz
Men who have sex with men
IV drug users
Indication for HPV vaccine
all pts age 11-26
Complications of mono
autoimmune hemolytic anemia (IgM cold agglutinin ab) and thrombocytopenia
Treatment for HBV
Entecavir and tenofovir
Groin pain on weight bearing, pain on hip abduction and internal rotation.
Avascular necrosis
Treatment for urge incontinence
- bladder training
- kegels
- antimuscarinic drugs (oxybutynin)
Treatment for SVT causing hemodynamic instability
Synchronized cardioversion
Middle 28 yo woman with difficulty swallowing, weakness worse in evenings, and severe dyspnea
Myasthenia crisis
Precipitating factors for myasthenic crisis
Infection or surgery, Pregnancy, tapering immunosuppressive drugs, Medications (ahminoglycosides, BB)
Signs and symptoms of myasthenic crisis
ptosis, diplopia
fatiguable chewing, dysphagia, nasal speech
proximal limb weakness
respiratory muscle weakness
Effect modification
external variable positively or negatively impacts effect of a risk factor on the disease of interest
Treatment for Guillain-Barre
IV immunoglobulin OR plasmapheresis
Diagnosis of Guillain-Barre
LP w/ elevated protein and nl WBC
elderly pt with dramatic leukocytosis (primarily lymphocytes), hepatosplenomegaly, lymphadenopathy and anemia/thrombocytopenia
CLL
Diagnosis of CLL
Flow cytometry
Best initial treatment for migraine
Prochlorperazine (IV antiemetic) PLUS NSAIDs
Papule with indented center everywhere but palms and soles
Molluscum contagiosum (Poxvirus)
consider testing for HIV
Salvage therapy
treatment for a disease when standard therapy fails
Neoadjuvant
treatment given before standard therapy
Timing of gait impairment in NPH
early
Episodic vertigo, sensorineural hearing loss, tinnitus
Meniere disease
Initial test for lupus
ANA
Most common cause of lower Gi bleed
Diverticulosis (bleeding most commonly from right colon)
painless
OSA effect on kidneys and electrolytes
kidneys increase bicarb reabsorption and decrease Cl reabsorption to compensate for metabolic alk
what part of spine effected by RA
Cervical
Young pt with chronic back pain that improves with NSAIDS
inflammatory process
Consider AS
Most common extraarticular manifestation of ankylosing spondylitis
Anterior uveitis (iritis)
also look for dactylitis
treatment for febrile neutropenia
anti-pseudomonad agent (cefepime, meropenem, pip/tazo)
Which test to use to test for syphilis
Nontreponemal (VDRL) (more false neg rates)
FTA-ABS (highest sensitivity)
Asymmetric resting tremor 4-6 Hz associated with rigidity
first presentation of Parkinson’s dz.
Treatment for younger pts with parkinson’s and mainly a tremor
Trihexyphenidyl
Causes of chronic cough
- upper-airway cough syndrome (postnasal drip)
- asthma
- GERD
treatment of upper-airway cough syndrome
Chlorpheniramine
blocks H1 receptors, histamine release from mast cells, limits secretory response to inflammatory cytokines
Vaccines for pts post splenectomy and timing
PCV13, meningococcal, H influenza type B
14 days before or after splenectomy
Treatment for aspiration pneumonia
Clindamycin
Metronidazole + amox
Amox/clavu
Carbapenem
Brain death characteristic findings
absent cortical and brain stem functions
Does brain death eliminate DTR?
NO spinal cord might still work
when to get booster meningococcal vaccination
age 16-21 if vaccinated pre 16th b-day
Live attenuated vaccines
- polio (PO)
- measles/mumps/rubella
- rotavirus
- nasal influenza
- yellow fever
- varicella
hypertension, bradycardia, respiratory depression
Cushing reflex
brainstem compression
Brown-Sequard syndrome effect on pain
contralateral loss of pain and temp
first line for chemo induced n/v
ondansetron
Treatment for botulism
equine serum heptavalent botulinum antitoxin
Cause of osteomyelitis by puncture wound
Pseudomonas aeruginosa
5-HIAA tests for…
carcinoid
treatment for carcinoid
octreotide
episodic flushing and wheezing, diarrhea, valvular heart disease with tricuspid regurg
Carcinoid syndrome
treatment for chronic low back pain
exercise therapy
intermittent NSAIDs
maybe TCAs or duloxetine
Diagnosis of pancreatic cancer
US
then CT
Treatment for hairy cell leukemia
Cladribine
Antibiotic treatment for human bites
Amox/clauv
Treatment for ALS
Riluzole (glutamate inhibitor)
Treatment of graves dz
thyroidectomy
radioactive iodine W/ steroids if eye issues
Treatment for acute glaucoma
mannitol, acetazolamide, timolol, pilocarpine
Medications to avoid with acute glaucoma
atropine
how to diagnose parkinson’s
Physical exam
Tremor, rigidity, bradykinesia, postural instability