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random3 Flashcards

1
Q

recent URI followed by sudden onset of cardiac failure in an otherwise healthy pt – think?

A

Dilated cardiomyopathy (2dary to acute viral myocarditis)

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2
Q

most common virus to cause myocarditis?

A

Coxsackievirus B

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3
Q

Dilated ventricles w/ diffuse hypokinesia on echo - think?

A

Dilated cardiomyopathy

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4
Q

asymmetric septal hypertrophy can be found in what?

A

Hypertrophic cardiomyopathy

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5
Q

when is concentric hypertrophy of the heart seen?

A

Chronic pressure overload

  • AS
  • Untreated HTN
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6
Q

Eccentric hypertrophy of heart dev when?

A

Chronic volume overload

- valve regurg

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7
Q

mid-diastolic murmur w/ an opening snap?

A

Mitral Stenosis

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8
Q

what is Mitral Stenosis effect on the R side of the heart?

A
  • RVH

- RV heave 2dary to pulm HTN

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9
Q

In primary pulm HTN what will not be present?

A

b/l crackles

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10
Q

amiodarone side fx?

A
  • Cardiac: sinus brady, heart blok, risk of QT prolong, & torsades
  • Pulm: Chronic interstitial pneumonitis
  • HypO/ERthyroid
  • Elevated tansaminases, hepatitis
  • Optic neuropathy, corneal microdeposits
  • Blue-gray skin discoloration
  • Peripheral neuropathy
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11
Q

prior to starting Amiordarone be sure to get what tests?

A
  • PFTs
  • CXR
  • Thyroid
  • LFTs
  • ECG
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12
Q

childhood vax complete + minor scrape on fence + last booster

A

none

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13
Q

childhood vax complete + minor scrape on fence + last booster >=10 yrs ago - what tetanus prophylaxis required?

A

Tetanus toxoid containing vaccine (Td or Tdap)

NO immuneglobulin

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14
Q

complete childhood vaxs, deep dirty wound, booster >=5yrs ago - what tetanus prophylaxis required?

A

Tetanus toxoid vax (Td or Tdap)

NO immuneglobulin

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15
Q

When do you give tetanus immuneglobulin?

A

when pt is unimmunized or immunecompromised
AND
wound is severe/dirty

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16
Q

most severe mutation types/

A
  • Nonsense

- Frameshift

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17
Q

missense mutation is?

A

single nucleotide changed

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18
Q

nonsense mutation is?

A

codon changed to a chain terminating codon –> severe mutation

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19
Q

Hyper conjugated bilirubinemia w/ normal AST, ALT, and alk phos - think (2)?

A
  • Rotor syndrome
  • Dubin-Johnson syndrome

Defects in hepatic secretion of bili

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20
Q

positive urine bilirubin - think?

A

1) It’s conjugated bili

2) Due to: hepatic dysfunction, biliary obstruction, or defect in hepatic bili secretion (ie rotor or dubin johnson)

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21
Q

necrolytic migratory erythema – think?

A

Glucagonoma

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22
Q

necrolytic migratory erythema looks like?

A

erythematous papules or plaques that coalesce to form a large, painful, and inflammatory blister/crusting w/ central clearing. Found commonly on perineum, extremities, and face.

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23
Q

serum glucagon >500 – think?

A

glucagonoma

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24
Q

erythematous plaque w/ central clearing + mild DM + Diarrhea + weight loss + normocytic, normochromic anemia - think?

A

Glucagonoma

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25
Q

episodic flushing = think?

A

carcinoid syndrome

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26
Q

episodic flushing, diarrhea, weight loss - think

A

carcinoid syndrome

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27
Q

low leukocyte alkaline phosphatase + leukocytosis w basophilia - think?

A

CML

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28
Q

leukocytosis + high leukocyte alkaline phosphatase (LAP) + metamyelocytes > myelocytes – think?

A

Leukemoid rxn

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29
Q

metamyelocytes and bands are?

A

late/mature neutrophil precursors

- found more in leukemoid rxn (compared to CML)

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30
Q

myelocytes and promyelocytes are?

A

early neutrophil precursors

- found more in CML (compared to leukemoid rxn)

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31
Q

painless gross GI bleeding w/ cause missed on colonoscopy – think?

A

Angiodysplasia

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32
Q

maroon stools + painless + nothing seen on colonoscopy – think?

A

angiodysplasia (often missed on colonoscopy)

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33
Q

continuous abdominal bruit suggestive of?

A

renovascular disease

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34
Q

resistent HTN + diffuse atherosclerosis, asymmetric kidney size, recurrent flash pulm edema, or serum creatinine >30% from baseline post ACE/ARB therapy – think?

A

renovascular HTN

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35
Q

resistent HTN + abdominal bruit + recurrent flash pulm edema – think?

A

renovascular HTN

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36
Q

Crigler Najjar syndrome type 2 can be treated w/ what to help reduce serum bili?

A

IV phenobarbital or clofibrate

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37
Q

In which crigler najjar does phenobarbital not help?

A

Crigler Najjar type 1 (severe)

    • phototherapy, plasmapheresis short term
    • long term needs liver transplant

type 2 is helped by phenobarbital

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38
Q

smudge cells - think?

A

CLL

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39
Q

lymphocytosis w/ small mature lymphocytes - think?

A

CLL

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40
Q

elderly pt + lymphadenopathy + hepatosplenomegaly + lymphocytosis w/ smudge cells - think

A

CLL

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41
Q

Hairy cell leukemia findings?

A
  • pancytopenia

- splenomegaly

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42
Q

painless lymphadenopathy + night sweats + fevers + nL CBC and blood smear - -think?

A

Hodgkin lymphoma

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43
Q

dead space means?

A

ventilation fine, but perfusion dec (ie PE)

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44
Q

physiological shunting in lung means?

A

perfusion fine, but ventilation dec –> shunting of deoxygenated bld to L heart

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45
Q

Pneumonia –> what type of v/q mismatch?

A

physiological shunting (vent dec, perfusion fine)

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46
Q

serum progesterone measurement for infertility should be done when?

A

mid-luteal phase

(b/t ovulation –> menses)

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47
Q

conductive hearing loss ?

A

obstruction of external sound to inner ear

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48
Q

sensorineural hearing loss involves?

A

involves inner ear, chochlea, auditory nerve

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49
Q

rinne test?

A

tuning fork on mastoid bone –> abnl suggests CONDUCTIVE hearing loss

air conducting should be heard longer than bone (so nL AC>BC, abnl BC>AC)

50
Q

abnl rinne test indicates?

A

CONDUCTIVE hearing loss

51
Q

weber test?

A

tuning fork middle of forehead

  • nL - same in both
  • conductive - lateralize to obstructed/effected ear
  • sensiorineural - lateralize to unaffected ear
52
Q

abnl rinne test w/ weber laterilzes to same ear?

A

conductive hearing loss

53
Q

shoulder pain radiating in an ulnar distribution where is leision?

A

pulm apex at thoracic inlet (superior sulcusl invade C8, T1 n.)– > compress inf portion of brachial plexus –> Pancoast syndrome

54
Q

normal rinne test b/l, weber lateralizes – think?

A

sensorineural hearing loss

55
Q

abl rinne in 1 ear, weber lateralizes to opposite ear - think?

A

mixed hearing loss

56
Q

serous otitis media symp?

A
  • middle ear effusion w/o evidence of acute infx
  • conductive hearing loss
  • hypomobile dull tympanic membrane
57
Q

serous otitis media seen in what population?

58
Q

Pt w/ HIV w/ hypomobile, dull typmanic membrane and conductive hearing loss – think?

A

serous otitis media (non-infx effusion)

59
Q

expansile, eccentric lytic lesion on epiphysis - think?

A

Giant cell tumor of bone

“soap-bubble appearance”

60
Q

soap bubble appearance on XR of femur – think?

A

giant cell tumor

61
Q

popliteal synovial cyst is?

A

baker’s cyst

- enlarged gastrocnemius-semimembranous bursa in medial side of popliteal fossa

62
Q

osgood schlatter disease is?

A

overuse injury caused by repetitive strain

- typically young kids and adolescents who have recently undergone a rapid growth spurt

63
Q

xray apperance of osgood schlatter disease?

A

avulsion of the apophysis of tibial tubercle

64
Q

osteitis fibrosa cystica aka?

A

von recklinghausen disease of bone

65
Q

osteitis fibrosa cystica commonly due to ?

A

hypERparathyroidism from parathyroid CA

66
Q

osteitis fibrosa cystica (von recklinghausen) is?

A

osteoclastic resorption of bone –> replacement w/ fibrous tissue (brown tumors) –> bone pain

67
Q

salt and pepper appearance of skull think?

A

osteitis fibrosa cystica

68
Q

distal clavicular tapering + bone cysts + brown tumors - think?

A

osteitis fibrosa cystica

69
Q

brown tumors in bone think?

A

osteitis fibrosa cystica

70
Q

findings of OA (4)?

A
  • joint space narrowing
  • osteophyte formation
  • subchondral sclerosis
  • subchondral cysts
71
Q

osteoid osteoma on xray?

A

sclerotic, cortical lesion w/ central nidus of lucency

72
Q

giant cell tumor of bone most commonly effects?

A

epiphyseal regions of distal femur and proximal tibia

73
Q

memory issues w/ weight gain, fatigue, constipation, and hoarseness - think?

A

hypOthyroidism

74
Q

walking in normal pressure hydrocephalus?

A

broad-based, shuffling gait

75
Q

wernicke korsakoff syndrome findings:?

A

Wernicke - ataxia, ophthalmoplegia, confusion

Korsakoff - confabulation and amnesia

76
Q

vesicular rash on forehead on eye w/ dendriform ulcers on cornea and conjunctivitis + fever, malaise – think?

A

Herpes zoster opthalmicus

77
Q

treatment of herpes zoster opthalmicus?

A

w/in 72hrs –> high dose acyclovir

78
Q

eye pain, photophobia, dec vision w/ clear vesicles on corneal epi and dendritic ulcers – think?

A

Herpes simplex keratitis

locally limited w/o rash – distinguish from herpes zoster opthalmicus

79
Q

dacrocystitis is?

A

infx of lacrimal sac due to obstruction of nasolacrimal duct

80
Q

bacterial keratitis seen w/?

A

contact lens wearers following corneal trauma

81
Q

hypopyon is?

A

inflammatory cells in ant chamber of eye –> leukocytic exudate

82
Q

eye appearance in bacterial keratitis?

A

cornea appears hazy w/ central ulcer and adjacent stromal abscess
- hypopyon may also be seen

83
Q

complication of giant cell arteritis?

A

aortic aneurysm

–> pts should have serial CXR

84
Q

headache, jaw claudication, muscle fatigue, visual distrubances, ESR >50, tender cord at temporal area – think?

A

giant cell arteritis

85
Q

confusion, wheezing, and aseizure post smoke inhalation – think?

A

carbon monoxide poisoning

86
Q

treatment of CO poisioning?

A

100% oxygen via nonrebreather facemask

  • hyperbaric O2 if unresponsive to facemask
87
Q

cardioversion and defibrillation have no role w/ which pts?

A
  • Pulseless electrical activity

- Asystole

88
Q

reversible causes of pulseless electrical activity/asystole?

A 
5H's and 5 T's
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
HypO/ERKalemia
HypOthermia

Tension pneumo
Tamponade
Toxins
Thrombosis
Trauma
89
Q

pulselss VT or ventricular fibrillation - treat?

A

Defibrillation

90
Q

pulseless electrical activity or asystole should be managed w/

A

uninterrupted CPR w/ vasopressor therapy

91
Q

most common nephrotic syndrome in adults in US?

A

focal segmental glomerular sclerosis

92
Q

FSGS associated w/?

A

HIV, heroin use, morbid obesity

*african american and hispanic

93
Q

Membranous nephropathy associated w?

A
  • Hep B
  • adeocarcinoma (breast, lung)
  • NSAIDs
  • Lupus
94
Q

Membranoproliferative GN - associated w/?

A

Hep C»Hep B

lipodystrophy

95
Q

minimal change disease associated w/?

A

Kids
NSAIDs
lymphoma (often Hodgkin)

96
Q

Amyloidosis in kidney associated w.?

A
  • Multiple myeloma

- chronic inflam disease (ie RA, bronchiectasis)

97
Q

crystal induced nephropathy side effect of?

A

Indinavir (protease inhibitor; HIV treatment)

98
Q

indinavir is ?

A

protease inhibitor

- HIV treatment

99
Q

indinavir side effect?

A

Crystal-induced nephropathy

–> hematuria w/ needle-shaped crystals in sediment

100
Q

main organ of concern w/ indinavir (protease inhibitor)?

A

Nephrotoxicity

- due to crystal induced nephropathy

101
Q

major rxns w/ HIV therapy? (6)

A
  • Didanosine –> pancreatitis
  • Abacavir –> hypersensitivity syndrome
  • NRTIs –> lactic acidosis
  • NNRTIs –> Steven-Johnson’s syndrome
  • Nevirapine –> Liver failure
  • Indinavir - nephrotoxicity (crystals)
102
Q

Main concern w/ didanosine?

A

pancreatitis

103
Q

Main concern w/ Abacavir?

A

hypersensitivity syndrome

104
Q

Main concern w/ NRTIs?

A

lactic acidosis

105
Q

Main concern w/ NNRTIs?

A

Steven Johnson

106
Q

Main concern w/ Nevirapine?

A

Liver failure

107
Q

Most common causes of osteomyelitis in sickle cell disease? (2)

A

1) Salmonella

2) Staph

108
Q

Empiric treatment of osteomyelitis for children w/ sickle cell disease?

A
  • 3rd gen Cephalosporin (ie ceftriaxone, cover salmonella)
    AND
  • Anti-staph med (ie vanco, oxacillin, etc)
109
Q

most common causes of osteomyelitis in children

A
  • GBS

- E.coli

110
Q

most common cause of osteomyelitis in children 2mo-4yrs?

A

Kingella kingae (gram- bacillus)

111
Q

most common cause of osteomyelitis >4yrs?

A

Staph aureus

112
Q

bilateral trigeminal neuralgia - what is one of the main causes?

A

Multiple sclerosis

113
Q

bilateral trigeminal neuralgia + eye issues + arm weakness – think?

A

multiple sclerosis

114
Q

Pill rolling tremor + bradykinesia + rigidity + mask-like face – think?

115
Q

caudate atrophy found w/?

A

Huntington’s

116
Q

depression + choreiform movements + subcortical dementia - think?

A

Huntington’s

117
Q

aseptic meningitis usually happens when?

118
Q

aseptic meningitis often caused by?

119
Q

young female bilateral trigeminal neuralgia – concern for?

120
Q

pleural plaques - think

A

asbestosis

121
Q

asbestos risk in what jobs?

A
  • pipe work (plumbing)
  • mining
  • shipbuilding
  • insulation

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