Review with Michelle Flashcards
1
Q
short term effects of lithium
A
LMN (loose stool, memory loss and nausea)
2
Q
the most common cause of acute kidney failure?
A
dehydration
3
Q
seizure med known for causing gingival hyperplasia?
A
Phenytoin (dilantin)
4
Q
antibiotic most likely to cause c.dif?
A
Clindamycin
5
Q
bug that causes whooping cough
A
bordatella
6
Q
bilateral peripheral vestibular dysfunction
A
oscillopsia (blurring with head movement
7
Q
two meds used to treat HTN with preclampsia
A
labetalol and methyldopa
8
Q
uterine procidentia
A
uterus descends beyond vulva
9
Q
Ethambutol an HIV drug can cause?
A
vision loss
10
Q
stroke + fever =
A
endocarditis
11
Q
how does the K+ level change in chronic renal failure?
A
increased serum potassium
12
Q
cardiac nuclear scan looks for?
A
vessel patency
13
Q
Romberg tests
A
proprioception of the posterior/dorsal column of the spinal cord
14
Q
if patient is ataxic but romberg is negative what part of the brain is likely affected?
A
Cerebellum=soberity and balance
15
Q
patient’s taking valproate (depakote) must have what labs drawn?
A
Liver enzymes
16
Q
spontaneous pneumo is caused by
A
sub pleural apical bleb due to high negative pressure
17
Q
test of choice for DVT
A
doppler and human’s sign….. it will be swollen
18
Q
test of choice for arterial claudiation
A
arterial duplex scan
19
Q
you say mesthelioma, I say…..
A
asbestos
20
Q
Kleb pneumonia = what type of antibiotic
A
IV-cefoxamine
21
Q
prognosis of lung CA with liver mets
A
horrible —-no resection
22
Q
dull aching, heaviness, in LE brought on by standing
A
Venous thrombosis
23
Q
pain in calf with ambulation
A
Claudication - Arterial
24
Q
OSA can cause what heart problem
A
right sided heart failure
25
S1 references what heart valve?
mitral
26
bones, stones, and groins =
hypercalcemia
27
vitamin deficiency = smooth red tongue
B12 (also think neuropathy of hands and feet)
28
hemarthrosis means?
bleeding into joint space
29
glucose 6 phosphate deficiency
x linked genetic deficiency
30
primaquine is a anti malaria drug, it may trigger
hemolysis
31
Philly chromosome
CML ( philly sandwich: Cheese, Meat, or Long bread)
32
Hyperthyroid med
propylthiouracil (PTU)
33
most common cause of hyperthyroidism
graves
34
gentamicin is toxic to....
fetus and ears
35
brown recluse bite description
ring of pallor/bleb in middle
36
erythema nodosum
unknown cause, may be post viral.. located on shins, red spots/inflammation. linked to HLA-B27. may also appear with sarcoidosis.
37
McMurray tests what in the knee?
positive McMurray = torn medial/lateral meniscus
38
bladder infection but allergic to sulfa, best alternative antibiotic?
Ampicillin
39
define pulse pressure
difference between systolic and diastolic BP
40
RA-hand deformities
swan neck, button hook, boutonniere and ulnar deviation
41
uterine leiomyomas
common, benign, represent localized proliferation of smooth muscle cells surrounded by compressed muscle fibers
42
During inhalation _______valve abnormalities are heard?
Right side-tricuspid
43
During exhalation________valve abnormalities are heard?
Left sided- mitral valve
44
double bubble sign---GI imagining
Pylori stenosis
45
Seidel's sign / Waterfall
Flurosein pouring out of ruptured globe
46
Cloudy cornea, mid-fixed pupil and firm
acute angle glaucoma
47
abnormal swing flashlight test
marcus-gunn
48
bloody diarrhea, occurs at night, and exacerbated at night
UC
49
how many fasting glucose tests to dx DM
2
50
Rheumatic fever causes what heart condition
mitral stenosis
51
type of murmur heard with cardiac rheumatic fever, mitral stenosis?
apical diastolic murmur
52
mono virus causes lymphadenopathy of what lymph chain
posterior chain
53
lab test to evaluate and dx hemochromatosis?
Ferritin and iron studies
54
I say Bence Jones, you say?
MM
55
Patient has known Aortic stenosis, can you do a treadmill stress echo?
No, do a drug stress echo
56
lung findings-Asbestosis
dyspnea, interstitial fibrosis of lower lobes, thickened pleura plaques
57
Asbestosis is a restrictive or congestive lung disease?
Restrictive
58
exposure to silica = lung findings
small rounded opacities throughout the lungs and calcified hilar lymph nodes
59
how do you dx nephrotic type of proteinuria
24 hour urine catch
60
I say polymyagia rheumatic, you say
giant cell arteritis
61
100% of dermatitis herpetiform have....
celiac dz
62
tx for chronic psoriasis
light treatment
63
dermatitis herpetiform is
papules on the extensor surface of elbow and knees
64
malignant otitis media
cellulitis with DM or other immunocompromised illnesses
65
most common genital tract malignancy in US
Endometrial carcinoma
66
most common cancer in the world
breast cancer
67
4 things to know w/ molar pregnancy
1. painless bleeding 2. uterine size and date discrepancy 3. passage of tissue 4. exaggerated AM sickness
68
molimina
mild form of PMS-3 or 4 symptoms = fluid retention, fluctuation of mood, headache and food craving
69
why not use antihistamines for sinus infection?
impairs drainage
70
what CN may be effected with septic cavernous sinus thrombophlebitis?
3 (oculomotor), 4(trochlear), and 6(abducens)
71
how do you dx purulent otitis media?
needle aspiration
72
quinsy throat aka....
peritonsillar abscess. complication of of strep A
73
antibiotics for peritonsillar abscess
pen G with clindamycin or metronidazole
74
antibiotic for pneumonia bug h.flu and m.cat
levofloxacin
75
antibiotic for s.pneumo
erythromycin
76
antibiotic for m.pneuno
doxycycine
77
neuroleptic malignant syndrome (NMS)
abrupt withdrawal of antiparkinson drugs, many dopamine receptors go unfilled = muscular rigidity
78
psych med that reduces seizure threshold?
wellbutrin
79
uncommon psych disorder in which agitation progresses to muscle rigidity and hyperthermia
lethal catatonia
80
cat scratch fever
bartonella henslae, playing with cats
81
trench fever
bartonella quintana, human lice
82
carrion's disease
bartonella bacilliformes , sand fly bites
83
symptoms of cat scratch fever
fever, lymph node enlargement, papule or pustule at inoculation site
84
beta lactam work by
inhibit transpeptidation of the cell wall
85
Macrolide (azithromycin) works by
50S ribosomal subunit
86
Sulfa drugs work by...
inhibit dihydropterate and folate reproduction
87
Tetracycline works by....
binds 30S ribosomal subunits
88
Quinolones work by....
inhibit DNA replication
89
"B" symptoms refer to what disease?
non-hodgkin lymphoma
90
Amiodarone side effect?
hypothyroidism
91
Tendons involved in DeQuervian's tenosynovitis?
Extensor Pollcis brevis and abductor pollis tendon
92
Test performed to confirm DeQuerivian's
Finkelstein
93
Test performed to confirm ruptured achilles tendon
Thompson, place pt is prone position legs off of table, squeeze calf and watch for planter flexion
94
Ligament involved in Game keepers thumb
ulnar collateral ligament
95
homen's sign
make sure patient's knee is flexed and then dorsiflex foot forcefully
96
1st line treatment for Abnormal uterine bleeding in a 40 year old?
Levonorgestrol IUD
97
Best imaging to dx a PE?
CT
98
What murmur can be heard best when pt is placed in left lateral decubitus position
mitral stenosis
99
isometric handgrip increases arterial & left ventricular pressure, this increases what type of murmur?
Aortic regurgitation
100
most common drug to cause pill induced esophagitis?
Ibuprofen
101
skin tags are associated with what syndrome?
metabolic syndrome
102
Lyme dz symptoms
fever, vomiting, meningeal sign, and photophobia
103
treatment for clostridium tetani?
Tetanus immuneglobin, tetanus toxoid, and metronidazole
104
Breathing pattern associated with DKA
Kussmaul
105
First line treatment for giant cell arteritis is high dose steroids, how many mg of prednisone? And what is the dx modality?
60mg, dx with biopsy
106
meconium ileus
cystic fibrous
107
when does pylori stenosis most often occur?
3 to 6 months old
108
most common cause of non traumatic subarachnoid hemorrhage
cerebral aneurysm
109
how long should a non-complicated shoulder dislocation be in a sling?
2 to 4 weeks
110
fall onto outstretched abducted arm =
shoulder dislocation, majority are anterior
111
Cullen's sign
sign of retroperitoneal hemorrhage such as periumbicilical (Cullen's sign)
112
Grey-Turner's sign
flank ecchymosis, a sign of retroperitoneal hemorrhage
113
AAA larger than ____cm are at higher risk of rupturing
5cm
114
How is a AAA diagnosed?
US is unstable or CT is the gold standard if patient is stable.
115
Risk factors AAA?
Hypertension, congenital heart disease, pregnancy, Marfans or iatrogenic from cardiac cath
116
how dissections occur
Intima is damaged allowing blood to enter the media and dissect between the initial and adventitial layers, developing a false lumen.
117
Common sites of AAA?
ascending aorta and the region of the ligamentum arteriosum
118
Gold standard to dx AAA?
Angiography
119
ER care of AAA-control hypertension with...
B-Blockers
120
where are most of DVTs located?
80% are located in or proximal to the popliteal vein.
121
negative ELISA D-dimer tell you that....
97% sure there is no clot
122
Treatment for DVT?
low molecular weight heparins (LMWH)
123
Common low molecular weight heparins?
dalteparin, enoxaparin, and tinzaparin
124
what is phlegmasia cerulean dolens
is an uncommon severe form of dvt which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb.
125
common location for acute arterial occlusion?
femoropopliteal, tibial, aortoiliac, and brachiocephalic
126
treat acute arterial occlusion with?
unfractionated heparin, catheter embolectomy using Fogarty ballon. All patient's should be admitted and placed on telemetry.
127
dilated myopathy causes what type of heart failure?
Systolic, due to dilatation of the ventricle
128
Aortic regurgitation causes what type of heart failure?
Systolic
129
Beriberi, anemia, thyrotoxicosis, and pheochromocytoma all cause what type of heart failure?
High output failure --high metabolic output
130
Where is BUN produced? When is it increased?
Produced in the liver as a byproduct of protein metabolism and secreted by kidneys. Increased in dehydration, GI bleeding, and if renal excretion of urea is decreased (renal failure)
131
BNP stands for? Level that suggests cardiac cause of dyspnea?
Brain natriuretic peptide >200 =coronary cause of dyspnea
132
BNP <100 and dyspnea = what type of etiology?
pulmonary
133
patient is 65 years old, anemic, has bone pain, proteinuria and renal failure, this is.....
Multiple myeloma
134
cushing's syndrome is a disorder of ?
cortisol
135
true or false cushing's syndrome can cause osteopenia?
true
136
needle shaped crystals?
gout
137
Aspiration of joint shows >50,000 cell count?
septic joint
138
you think a patient has a lower leg DVT, how is this dx?
LE Doppler US
139
what is more specific and sensitive a myocardial perfusion scan (MPI) or an exercise stress test?
myocardial perfusion scan, is a nuclear medicine procedure that illustrates the function of the heart muscle
140
Glucose level, CSF mononuclear, and total protein level in Viral meningitis will be increased or decreased?
Viral meningitis: Increase in mononuclear cells and total protein. Glucose may be normal
141
Is C-reactive protein elevated in viral or bacterial meningitis?
Bacterial, glucose will be low
142
patient is female with a hx of iritis and erythema nodosum, fever, malaise, and dyspnea. Think?
Sarcoidosis
143
Iritis is a hint for?
autoimmune disorders
144
most common congenital viral infection in US?
CMV
145
babies infected with CMV prior to birth will have:
hearing loss, visual impairment, mental retardation and enlargement of liver / spleen.
146
What is sarcoidosis
idiopathic disease, noncaseating granulomatous inflammation in affected organs. 90% have lung involvement.
147
Physiological changes during severe hypothermia
fixed pupils, ventricular fibrillation
148
palmar cord causing palmar flexion of 4th and 5th fingers
Dupuytren's
149
Red reflex tests?
corneal clarity and retinal mass
150
test done for strabismus?
corneal light reflex and uncover/cover test
151
Corneal light reflex is used on PE to evaluate?
Strabismus
152
Patient has AIDS and interstitial infiltrates, what is the most common opportunistic infection in HIV?
Pneumocystis jiroveci (PCP pneumonia)
153
what can be used as prophylaxis for pneumocystis jiroveci in HIV patient when CD4 count is below 200?
Bactrim
154
Patient presents complaining of 12 plus weeks of laryngitis and a slight cough. She has a h/o mitral regurg. Indirect laryngoscopy performed in the office reveals vocal cords that do not move with phonation. what is the next step in her evaluation?
If the vocal cords do not move it is no longer an ENT problem, but a chest or left recurrent laryngeal nerve problem. It is possible that mitral regurg has caused increase of her marked enlargement of her atrium, putting tension on the nerve
155
What is the most common anomaly associated with coarctation?
Bicuspid aortic valve (congenital)
156
reduced HCO3 bicarbonate concentration on the ABG may be due to....
anytime there is a significant change in the HC03 you are looking at a metabolic problem. Loss of bicarb means a loss of a base, and would therefore cause a metabolic acidosis.
157
do changes in CO2 affect the metabolic or respiratory side of the equation?
respiratory
158
highest populations affected by sarcoidosis
north american blacks and northern europeans
159
Organs affected in sarcoidosis?
Lungs, lymph nodes, eyes, skin, liver, spleen, parotid glands, heart and nervous system
160
Symptoms of sarcoidosis?
fever, cough, chest discomfort, erythema nodosum, malasie
161
How do you dx sarcoidosis?
Transbronchial biopsy of the lung or fine needle node biopsy. It will show noncaseating granulomas
162
treatment for sarcoidosis?
steroids
163
What labs are elevated in sarcoidosis?
Eosinophilia, erythrocyte sedimentation rate, angiotensin-converting enzyme.
164
Frost bite 1st degree
freeze no blister
165
Frost bite 2nd degree
freeze + blister
166
3rd stage frost bite
freeze = dead skin
167
4th stage frost bite
full thickness including bone
168
treatment for high altitude sickness
descent, oxygen, dexamethasome, acetazolamide
169
antidote for acetaminophen
acetylcysteine
170
antidote for organophosphate
atropine
171
antidote for benzos
flumazenil
172
antidote for b-blockers
glucagon
173
antidote for CCB
calcium
174
Antidote for digoxin
digibind
175
antidote for heparin
protamine
176
antidote for narcotics
naloxone (narcan)
177
antidote for tricyclic antidepressants?
sodium bicaronate
178
antidote for warfarin?
vitamin K
179
what electrolyte abnormality causes paralytic ileus
hypokalemia
180
sudden painless complete vision loss eye with cherry red fovea. treatment?
this is central retinal artery occlusion
| tx with ocular massage and acetazolamide ( same drug used for altitude sickness
181
what electrolyte abnormality goes with DKA
hyperkalemia and low bicarb
182
Type II DM, with infection, weakness, polydipsia, glucose >600 most likely has?
hyperosmolar hyperglycemic state
183
Hypoglycemia is BG <50, what is the treatment
IV glucose or IM glucagon, thiamine to alcoholics
184
Thyroid storm treatment
volume replacement. b-bloker, PTU, methimazole and steroids
185
EKG changes that occur with thyroid storm?
tachycardia, a fib or flutter and prolonged QRS
186
absent cremasteric reflex =
testicular torsion (this is a surgical fix)
187
what cardiac med is responsible for angioedema
ACE
188
do steroids help with steven johnson syndrome?
no, just stop the offending agent
189
treatment for staph scalded skin syndrome
tx nafacillin or oxacillin
190
pemphigus vulgaris
loss of cohesion between keratinocytes in the epidermis, classified as a type II hypersensitivity reaction (in which antibodies bind to antigens on the body's own tissues). It is characterized by extensive flaccid blisters and mucocutaneous erosions. Tx is fluids and steroids
191
#1 cause of hypercalcemia?
primary hyperparathyroidism
192
#2 cause of hypercalcemia?
malignancies
193
cardiac symptoms of hypercalcemia
short QT, bradycardia, hypertension
194
band keratopathy in the eye are associated with what electrolyte abnormality?
hypercalcemia
195
a patient with vomiting, lower chest pain and subcutaneous emphysema most likely has?
Esophageal rupture (boerhaaves syndrome)
196
tx for esophageal rupture?
NPO, IV antibiotics and surgery
197
What drug do you give for any pulseless rhythm?
Epi 1mg
198
what drug do you give for SVT?
Adenosine 6-6-12mg
199
What drug do you give for bradycardia?
Atropine 0.5-1mg
200
what node does atropine excite?
AV node
201
Patient presents with torsades de points
give Mg 1-2grams
202
For VF and pulseless VT give?
vasopressin
203
Hypertensive emergency give?
IV labetalol and IV Nitroprusside
204
What type of aortic dissection is fixed surgically?
Type A (ascending aorta)
205
most likely cause of metabolic alkalosis
vomiting-volume depletion
206
what is the pH and bicarb level in metabolic alkalosis
pH is >7.45 and bicarb is >26
207
Treatment for metabolic alkalosis?
acetazolamide ( this is also given for altitude sickness and central retinal artery occlusion
208
Name two conditions that cause Carpopedal spasm (painful contractions with adduction of the thumb, flexion of MCP joint, extension of the IP joints and flexion of the wrist)
Hypocalcemia and Respiratory acidosis
209
what are level of Ca+ that are considered hypo and hyper?
hypo <11
210
most common cause of hypocalcemia?
Chronic kidney disease, others include: hypoalbuminemia, hypoparathyroidism, vitamin d deficiency and low Mg
211
Signs and symptoms of hypocalcemia?
Tetany, tingling paresthesias and carpopedal spasm
212
A patient with MM is found to have hypercalcemia, what is the first line treatment?
Glucocorticoid steroids
213
Name 3 treatments for hypercalcemia
1. Hydration to diruesis 2. IV biphosphonates to inhibit osteoclasts 3. Calcitonin
214
asthmatic attack will show what on ABGs?
respiratory acidosis
215
how does BiPAP help asthmatics
lowers the CO2 level
216
treatment for hypocalcemia
calcium chord of calcium gluconate
217
chvostek's sign, what electrolyte imbalance is it testing?
tap the cheek causes contraction, hypocalcemia
218
Trousseau's sign
hypocalcemia, use BP cuff to induce carpel spasm
219
EKG findings with hypocalcemia?
QT is prolonged (quite tense and longing for ca+)
220
Respiratory acidosis pH level and CO2 level
pH 45
221
guillian barre and myasthenia gravis will have what type of acid/base disorder?
respiratory acidosis
222
pH >7.45 and pCO2 <35
respiratory alkalosis
223
A patient presents with symptoms of pituitary tumor, what is the next step in evaluating whether or not this tumor is causing bitemporal hemianopsia?
since the question is asking about vision the next step is to formally evaluate peripheral field testing. Adenomas that affect the optic chiasm may cause irreversible vision changes.
224
Peripheral blood cell count in AIDS are best characterized as?
Decreased helper T cells and Lymphopenia
225
name the splint for the scaphoid fracture
thumb spica splint, refer to ortho
226
kiddo swallows battery- next step?
esophagogastroduodenoscopy b/c battery can cause a caustic erosion of the esophagus
227
Explain S4?
S4 is the sound of blood ejected during atrial contraction and striking the stiff ventricular wall of hypertrophy or stunned myocardium
228
If S4 is the sound of blood hitting the stiff enlarged ventricle or stunned myocardium. What heart conditions will you hear S4
Left or right Ventricle hypertrophy (heart failure), post MI, and cor pulmonale
229
If thyroid gland and parathyroid is removed, why may a patient have a positive chvostek sign?
Likely to have hypocalcemia, b/c parathyroid is responsible for calcium regulation
230
what does the Glasgow coma scale measure
Best eye movement, verbal response, and motor response
231
One category of the GCS is eye response, name the 4 levels of eye movement
1pt. no eye opening
2pt. eyes open to pain
3pt. eyes open to verbal response
4pt. eyes open spontaneously
232
Name the 5 levels of motor response according to the GCS
1pt. no response
2pt. extension to pain
3pt. flexion to pain
4pt. withdrawal to pain
5pt. localizes to pain
6pt. obeys commend
233
Name the 5 levels of verbal response according to the GCS
```
1pt no verbal
2pt incomprehensible sounds
3pt inappropriate sound
4pt confused
5pt orientated
```
234
What class of drug is Verapamil
CCB
235
what are CCB avoided in CHF
significant negative inotropic effect and reduces the EF and CO
236
What CCB is sometimes used in CHF due to it's semi positive effects on contractility?
Amlodipine
237
what tests are the most S&S for RA?
CCP (cyclic citrullinated peptide) is 96%
238
Cholesteatoma
destructive/expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Can still cause problems because of their erosive and expansile properties resulting in the destruction of the ossicles and spread through the base of the skull into the brain.
