Second pass deck 01 Flashcards
erysipelas is most often caused by what organism?
group A strep (pyogenes)
how do you treat the severe tonsillar enlargement that could be a prelude to airway obstruction in infectious mononucleosis?
IV corticosteroids
- hypo / hyperpigmentation
- hyperkeratosis
- stocking glove neuropathy
what type of poisoning?
arsenic (chronic)
- vomiting
- watery diarrhea
- QTc prolongation
- profound pancytopenia and hepatitis
- garlic breath
what type of poisoning?
arsenic (acute)
what is the treatment for arsenic poisoning?
- dimercaprol (first line)
- DMSA, succimer
mees lines (horizontal striations of fingernails) is characteristic of:
arsenic poisoning
what is susceptibility bias? how do you prevent it?
- when the treatment regimen selected for a patient depends on the severity of the patient’s condition
- prevent by random assignment, intention-to-treat analysis to avoid counting crossover patients
what is the treatment for symptomatic neonatal thyrotoxicosis from maternal graves disease?
- methimazole
- beta blocker
what is the treatment for paroxysmal nocturnal hemoglobinuria?
eculizamab
what is the mechanism of trousseau syndrome in the context of latent visceral malignancy?
tumor release mucins that react with platelets to form platelet-rich microthrombi
elevation and equalization of intracardiac pressures is indicative of ________________
tamponade
which anti-seizure medication is associated with acute pancreatitis?
valproate
what is the a) initial and b) maintenance therapy for cryptococcal meningoencephalitis?
- initial: amphotericin B and flucytosine
- fluconazole
- fevers
- headaches
- increased intracranial pressure (papilledema)
- HIV patient
cryptococcal meningitis
which vaccinations should HIV patients receive?
- hep B
- PCV13 then PPSV23 eight weeks later then five years later and at age 65
- varicella if born after 1979 (CD4 must be over 200)
isoniazid causes what kind of liver damage?
hepatitis with panlobular mononuclear infiltration and hepatic cell necrosis
gonococcal conjunctivitis occurs within what time frame? chlamydial? what are the treatments?
- gonococcal: 2-5 days (single IM dose 3rd gen ceph)
- chlamydial: 5-14 days (PO macrolide)
what is a potential GI side effect of erythromycin and azithromycin in infants?
pyloric stenosis
which medication should be given in the weeks to months following an MI to prevent dilation and remodeling of the ventricles?
ACE inhibitors
which type of heparin is CONTRAindicated in end stage renal disease?
LMWH
what is the preferred long-term oral anticoagulant in end stage renal disease?
warfarin
the ice pack test is used for ____________
myasthenia gravis
what are treatment medications for restless leg syndrome?
- pramipexole
- ropinirole
- gabapentin if comorbid insomnia, chronic pain, or anxiety are present
how long may surgery be delayed to address an unstable comorbidity?
72 hours
what medication is used for mild tourettes? more severe cases?
- mild: a2 agonists (clonidine, guanfacine)
- severe: dopamine blocking antipsychotics (risperidone, haloperidol, pimozide)
*haloperidol and pimozide are FDA approved, but risperidone is the best studied of the second generation
osteitis fibrosa cystica is most often seen with what conditions?
- parathyroid carcinoma
- primary and secondary/tertiary (advanced renal disease) hyperparathyroidism
buproprion and selegeline can cause false positives for what drug on tox screen?
amphetamines
in patients with cirrhosis, both spider angiomas and palmar erythema arise due to __________ because ____________
- hyperestrinism
- impaired hepatic metabolism of circulating estrogens (which begins in the cyp450 system)
what is the treatment for patients with tinea capitis? what about for contacts?
- patients: oral griseofulvin or terbinafine
- contacts: selenium sulfide or ketoconazole shampoo
copper or rust colored nipple discharge?
intraductal papilloma
normal pleural fluid pH is:
7.6
transudative pleural fluid has a pH of:
7.4 - 7.55
exudative pleural fluid has a pH of:
7.3 - 7.45
patients at moderate to high risk of thromboembolic events due to systemic embolization should get what treatment?
non-vitamin K antagonist oral anticoagulation (apixaban, dabigatran, rivaroxaban, edoxaban)
- sclerotic, cortical lesion on imaging with a central nidus of lucency
- pain worse at night and unrelated to activity
- pain relieved by NSAIDs
osteoid osteoma
- pain, swelling, and decreased ROM at involved site
- osteolytic lesions with “soap bubble” appearance
- epiphyseal region of long bones
giant cell tumor
what is the cushing reflex with respect to intracranial HTN? what is it indicative of?
- HTN
- bradycardia
- respiratory depression
- indicative of brainstem compression
what are the CHADS-2-VASc criteria?
- C = CHF (1)
- H = HTN (1)
- A = Age over 75 (2)
- D = DM (1)
- S2 = Stroke / TIA / thromboembolism (2)
- V = Vascular disease (1)
- A = Age 65-74 (1)
- Sc = Sex category (female) (1)
Max score = 9
Score 2 or greater = anticoagulation
- a normal A-a gradient is under ____
- what is the equation for A-a gradient?
- under 15
- PAO2 - PaO2
a non-diagnostic gastrin level (between 110 and 1000) in the setting of suspected zollinger-ellison syndrome requires follow up with what test?
secretin stimulation test
why isnt PTU the preferred drug for hyperthyroidism?
black box warning for liver injury and acute liver failure
*however, it is preferred during the first trimester of pregnancy due to the teratogenicity of methimazole
what is the most common side effect of anti-thyroid drugs? what is the most serious?
- most common: allergic reaction
- most serious: agranulocytosis
a patient is on an anti-thyroid drug and develops sore throat and fever - what is happening?
agranulocytosis
when are antibiotics indicated for patients with COPD?
- MODERATE TO SEVERE (not mild) COPD exacerbation (two or more cardinal symptoms) especially with increased sputum purulence
- mechanical ventilation requirement
which empiric abx are used for COPD exacerbations?
- macrolides
- respiratory fluoroquinolones
- penicillin / beta lactamase inhibitors
how does hypokalemia exacerbate hepatic encephalopathy?
intracellular acidosis (excreted intracellular potassium replaced by hydrogen ions to maintain electroneutrality) causes increased NH3 production (glutamine conversion) in renal tubular cells
how does metabolic alkalosis exacerbate hepatic encephalopathy?
promotes conversion of ammonium (NH4), which cannot enter the CNS, to NH3, which can
how does succinylcholine cause cardiac arrhythmias?
- severe hyperkalemia
- triggers influx of sodium ions and efflux of potassium ions - depolarization ensues
patients with recurrent renal calculi should be advised to restrict ____________
sodium
what sail sign on pediatric CXR references the ____
thymus
