Set 2 Flashcards
What do you see on X-ray in multiple myeloma?
Lytic bone lesions
Perianal fistula – Ulcerative Colitis OR Crohn’s?
Crohns
Involves rectum – Ulcerative Colitis OR Crohn’s?
Ulcerative Colitis
How often is tetanus-diphtheria toxoid booster recommended?
At 10 year intervals
OR after 5 years in the even of a trauma
What is the treatment of hypercalcemia depending on the calcium level.
If < 14 and asymptomatic then no immediate treatment required
If > 14 or symptomatic then 2 treatments – short-term and long-term. Short-term = Saline, Calcinonin. Long-term = bisphosphonates (zoledronic acid)
Symptoms of infective endocarditis
Mn* FROM JANE
Fever
Roth Spots = white spots on retina due to hemorrhage
Osler Nodes = immune complex deposition on fingers/toes
Murmur
Janeway Lesions = hemorrhage on palms/soles
Anemia
Nail-bed hemorrhage
Emboli
Name 2 nonspecific symptoms of infective endocarditis.
Fever
Arthralgia
Name 2 cardiac symptoms of infective endocarditis
Dyspnea
Cough
Edema
Name 2 lab findings in infective endocarditis
Rheumatoid Factor
High ESR
Name 2 immunologic findings in infective endocarditis
Osler nodes = immune complex deposition on finger/toes
Glomerulonephritis = due to immune complex deposition, causing hematuria, proteinuria
Primary dysmenorrhea cause
Excessive endometrial prostaglandin release
Irregular menses in adolescents cause
Immature hypothalamic-pituitary-ovarian axis
High HgB, WBCs and PLTs. What is the diagnosis? Treatment?
Dx = Polycythemia vera Tx = Phlebotomy,
Why are patients with Crohn’s at increased risk for nephrolithiasis - mechanism?
Crohn’s -> Fat Malabsorption -> Calcium binds to fat instead of oxalate -> More free oxalate is absorbed into the bloodstream -> hyperoxaluria and oxalate stone formation
In pregnancy what happens to T3, T4, TSH? Mechanism?
T3 up
T4 up/same
TSH down
Mechanism:
Beta-HCG -> acts like TSH, b/c it has a similar structure, thus beta-HCG stimulates T3 and T4 production
Estrogen -> stimulates synthesis Thyroxine-binding globulin (TBG), which binds T3/T4, which decreases the pool of free T3/T4, and patient compensates by producing more T3/T4
Pt experiences bone pain and unilateral hearing loss. Dx? Mechanism of disease?
Dx = Paget disease of bone Mechanism = 1st osteoclast dysfunction; Later mixed ostoclast/osteoblast dysfunction
What are the cranial symptoms of Paget disease of bone?
Enlarging cranial bones can cause increased head size, headaches, hearing loss.
Eczematous patches over nipple and areolar skin. Dx? What type of cancer is this?
Paget Disease of Breast
Cancer type = adenocarcinoma
Indications for AAA repair
> 5.5 cm
or expansion rate of 1 cm per year
Highest risk factor for AAA expansion
smoking
Define Negative and Positive Predictive Value
Negative Predictive Value = The probability of being free of disease if the test result is negative
Positive Predictive Value = The probability of having the disease if test result is positive
Noncaseating granulomas. Crohn’s or Ulcerative Colitis?
Crohn’s
Virus that causes nasopharyngeal cancer
Epstein-Barr
A rash in a child or adolescent that goes along line of tension on the back. Dx?
Pityriasis rosea
Many target lesions. Dx? Cause?
Dx = Erythema multiforme cause = Infectious (Mycoplasma pneumoniae, HSV), Drugs (sulfa drugs beta-lactams, phenytoin).
Erythema marginatum is associated with _______
Acute Rheumatic Fever
Pt in third trimester with S3 heart sound. Dx?
Peripartum cardiomyopathy
What heart sound can be heard during acute phase of myocardial infarction?
S4
What is CREST Syndrome?
It is a subtype of what disease?
CREST = Calcinocis Cutis, anti-Centromere antibody, Reynaud Phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia.
CREST syndrome is a subtype of Scleroderma.
(Scleroderma = Systemic Sclerosis)
There are 2 subtypes of Scleroderma: Diffuse and Limited.
CREST syndrome is a subtype of Limited Scleroderma
How to tell apart limited and diffuse scleroderma.
Limited scleroderma has anti-centromere antibodies.
Diffuse scleroderma has ANA (anti-nuclear) antiboides, but NOT anti-centromere.
Right ventricular heave. Dx?
Pulmonary HTN
Lung biopsy demonstrates: alveolar spaces filled with fibroblasts.
Dx?
What is the expected FEV1 and FEV1/FVC ratio?
Dx = Idiopathic Pulmonary Fibrosis
(this is a restrictive lung disease)
FEV1 is low (<80% predicted)
FEV1/FVC is normal (>70%)
Lung biopsy demonstrates: arterial intimal hyperplasia.
Dx?
What is the FEV1 and FEV1/FVC ratio?
Dx = Pulmonary Hypertension
FEV1 is normal (>80% predicted)
FEV1/FVC is normal (>70%)
Lung biopsy demonstrates: Bronchial wall thickening and mucus plug.
Dx?
What is the FEV1 and FEV1/FVC ratio?
Dx = Bronchiectasis
(this is obstructive lung disease)
FEV1 is low (< 80% predicted)
FEV1/FVC is low (<70%)
Lung biopsy demonstrates: Chronic inflammation with noncaseating granulomas.
Dx?
What is the FEV1 and FEV1/FVC ratio?
Dx = Sarcoidosis
(this is a restrictive lung disease)
FEV1 is low (< 80% predicted)
FEV1/FVC is normal (>70%)
Lung biopsy demonstrates: Septal widening and hemosiderin-loaded macrophages.
Dx?
Dx = Congestive heart failure
What are the 2 categories of testicular neoplasms? What are their subcategories?
1) Germ cell tumor
a) Seminoma
b) Non-seminoma
2) Stromal
a) Leydig
b) Sertoli
How to tell apart between the 2 different types of germ cell tumors?
Non-seminoma: beta HCG and AFP usually positive
Seminoma: beta HCG and AFP negative
Examples of non-seminoma tumors
Yolk sac
Embryonal carcinoma
Teratoma
Choriocarcinoma
Ovarian tumor with high LDH. Dx?
Dysgerminoma
a type of ovarian germ cell tumor
ST elevation in lead II, III, aVF. Where is the occlusion?
This is an Inferior MI = Either RCA or LCX.
In RCA occlusion there will also be reciprocal ST depression in leads I and aVL.
Not so in LCX occlusion. LCX occlusion instead may have ST elevation in I and aVL.
Necrotic skin lesion in a patient that has chronic kidney disease. Dx? Mechanism of illness?
Dx = Calciphylaxis Mechanism = Hyperphosphatemia causes calcium and phosphate to precipitate, causing vascular calcifications
Mobile, nontender swelling at the dorsal surface of the wrist.
Ganglion cyst
What is trichotillomania?
Hair-pulling disorder
Mechanism of Hypertension in Hyperthyroidism vs. Hypothyroidism.
Hyperthyroidism causes increased BP due to increase in heart rate and increase in heart contractility, even though peripheral vascular resistance decreases in hyperthyroidism.
Hypothyroidism causes increased BP due to an increase in peripheral vascular resistance.
Pt is an elderly woman. Distended bowel loops with air-fluid levels. Tenderness in right groin. What is the most likely diagnosis?
Small bowel obstruction due to femoral hernia.
A defense mechanism where an individual transforms unacceptable feelings and impulses into their extreme opposites.
Reaction formation
Waddling gait. Dx?
Muscular dystrophy
Spastic gait.
Spastic gait = lesion to upper motor neuron
Spinal cord injury
Cerebral palsy
Small red papules on extremities. They are not painful or pruritic. What is the name of the skin condition? What STD is it associated with? What drug is it associated with?
Skin condition = Erythema multiforme
STD = Herpes
Drug = sulfonamide antibiotics
Newborn with swollen scrotum, which transilluminates with light. Dx?
Hydrocele
Small painless smooth firm nodules with central dimpling. Dx?
Molluscum contagiosum
caused by poxvirus
Vulva has pruritic purple lesions with white lines. Dx?
Vulval lichen planus
The white lines are called Wickham striae
Nontender verrucous growths of vulva. Dx?
Verrucpous = wart like
Dx = Condyloma acuminata
(Caused by HPV 6 and 11)
What do condyloma lata lesions look like? What are they caused by?
Condyloma lata is a sign of secondary syphillis.
They are raised gray-white lesions on mucosal surfaces
What is the indication to perform surgery for mitral regurgitation? (at what EF)
For surgery ejection fraction must be less than 60%.
However if patient is symptomatic and ejection fraction is less than 30% then pt will not benefit from surgery.
The 3 manifestation of von Hippel-Lindau disease
Hemangioblastomas of CNS and retina
Renal cell carcinoma
Pheochromocytoma
Which diuretics can cause metabolic alkalosis?
Thiazides
Loops
Fleshy papules on vulva and anus. Dx?
Condyloma acuminata (anogenital warts) HPV 6 and 11
Both consolidation (due to pneumonia) and pleural effusion can cause dullness to percussion. On physical exam how do you differentiate consolidation and pleural effusion.
Consolidation will have increased breath sounds.
Pleural effusion will have decreased breath sounds.
Consolidation will demonstrate increased tactile fremitus and egophany (E to A).
Pleural effusion will demonstrate decreased tactile fromitus and NO egophany.
Which 2 lung conditions will have hyperresonant lungs on percussion?
Pneumothorax
and
Emphysema
In which lung condition will there be mediastinal shift toward the pathology?
Atelectasis (e.g. mucus plugging), there is mediastinal shift toward the atelectasis.
In what direction is the mediastinal shift in pneumothorax?
Away from the pneumothorax
Geriatric patient with flat, dark purple ecchymotic areas over the dorsum of the forearms. Dx? Mechanism?
Dx = senile purpura Mechanism = Perivascular connective tissue atrophy
Patient with a history of tuberculosis that develops a new cavitary lesion and hemoptysis. Dx? Test for diagnosis? Tx?
Dx = Aspergillosis Test = Aspergillus IgG serology Tx = Itraconazole, Voriconazole
Treatment for Torsades de Pointes
For stable patient Tx = IV magnesiums (cardiac stabalization)
For hemodynamicaly unstable pt, Tx = Immediate defibrilation
At what PPD induration size to treat PPD?
> 15 mm = treat everybody
10 mm = treat high risk individuals (e.g. healthcare employees, prisoners, diabetics)
5 mm = treat only if pt is immunocompromized (e.g. HIV, organ transplant), or if there is a known recent contact with TB.
Treatment of tuberculosis: latent vs active
Latent TB Tx = Isoniazid + Pyridoxine (B6)
Active TB Tx = R.I.P.E
(Rifampin, Isoniazid, Pyrazinamide, Ethambutol)
Rapid acting insulin. Name 3.
Mn* LAG
Lispro
Aspart
Glulisine
Long acting insulin. Name 2
Determir
Glargine
Recurrent chest discomfort at night lasting less than 15 minutes with spontaneous resolution. Dx? Mechanism? Tx?
Dx = Vasospastic angina Mechanism = Hyperactivity of coronary smooth muscle Tx = Calcium channel blocker (preventative) and sublingual nitroglycerin (abortive)
Fingers and toes change color to blue in cold. Dx? Mechanism? Tx?
Dx = Raynaud phenomenon Mechanism = cold-induced hyperactivity of the digital arterial smooth muscle leading to episodic vasospasm in fingers and toes Tx = Calcium channel blockers
What size ureter stone can pass spontaneously and what size requires urology consult?
< 10 mm pass spontaneously
> 10 mm urology consult
Acamprosate. What is the use of this drug?
Acamprosate is used for alcohol cessation
Timetable of postpartum blues vs postpartum depression.
Postpartum blues is up to 2 weeks.
Postpartum depression after 2 weeks.
What is Mittelshmerz? Timetable?
Midcycle unilateral pain due to follicular rupture. Occurs 2 wks into menstrual cycle.
Wide-based gait. Dx?
Cerebellar dysfunction
The 2 types of parasites that can cause liver cysts. How to differentiate? What is the treatment?
Entamoeba histolytica (protozoan). Tx = Metronidazole.
Echinococcus granulosus (Cestode i.e. tapeworm). Tx = Albendazole
Entamoeba infection is associated with diarrhea, Echinococcus is not.
Guideline for pneumococcal vaccine depending on patient age and smoking status.
< 65 - give pneumococcal conjugate vaccine (PCV13) if patient is a current smoker or has chronic medical conditions
> 65 y.o - give sequential pneumococcal conjugate vaccine (PCV13) and pnemococcal polysaccharid vaccine (PPSV23).
Timetable for Tetanus-diphtheria toxoid booster vaccine.
Every 10 yrs for adults >18
What is the hallmark of asbestosis on imaging?
Pleural plaques
What lab values tell you that a jaundice person has Dubin-Johnson syndrome?
Dubin-Johnson is a defect in liver excretion of bilirubin. Therefore it has: HIGH conjugated (direct) bilirubin Normal AST, ALT, Alk Phos
If someone is jaundiced then what lab values help you suggest that it is primarily a liver and not gallbladder disease?
High AST, ALT
Normal Alk Phos
Chest pain 2 weeks after MI. Dx? Tx?
Dx = Dressler's syndrome (autoimmune pericarditis) Tx = NSAIDs
Th 3 adverse effects of TCAs.
Treatment?
3 Cs = Convulsions, Coma, Cardiotoxicity
Tx = IV sodium bicarbonate (alleviates the inhibitory effect of TCAs of fast acting sodium channels in the heart)
When are antibiotics indicated for COPD exacerbation.
Antibiotics are indicated if 2 or more cardinal symptoms are present. Cardinal symptoms = - dyspnea - cough - sputum production
Muscle weakness and decreased deep tendon reflexes. Dx?
Hypothyroidism
Auto-Antibodies in polymyositis and dermatomyositis.
Anti-synthetase (anti-Jo-1)
Anti-helicase (anti-Mi-2)
anti-SRP
Patients deficiency of what vitamin are at an increased risk for multiple sclerosis?
Vit D
Treatment for scabies
Topical 5% permethrin
OR
Oral ivermectin
Treatment of ventricular tachycardia.
Stable = IV amiodarone Unstable = Synchronized cardioversion
What are the 2 phases of the menstrual cycle.
1) Follicular phase = Proliferative phase
2) Luteal phase = Secretory phase
In what phase of the menstrual cycle does menses occur?
Follicular phase (proliferative phase)
In what phase of the menstrual cycle does premenstrual syndrome (PMS) occur?
Luteal phase (secretory phase) 1-2 wks before menses.
What contraceptives are contraindicated in patients with migranes?
Estrogen-containing contraceptives are contraindicated in patients with migranes
What is the treatment for premenstrual syndrome (PMS)
SSRI
What is the treatment of pituitary adinoma depending on the size and symptoms?
< 10 mm and asymptomatic = no treatment
< 10 mm and symptomatic = Dopamine agonists (Cabergoline and Bromocriptine)
> 10 mm and asymptomatic = Dopamine agonists
> 3 cm = surgery
Nightmare disorder vs Sleep terror disorder vs REM sleep behavior disorder
Nightmare disorder = pt can remember the dream. Occurs during REM sleep.
Sleep terror disorder = pt cannot remember the dream. Occurs during non-REM.
REM sleep behavior disorder = complex motor behavior or vocalization during REM sleep
Panic disorder treatment: acute vs chronic
acute Tx = benzodiazepines
chronic Tx = SSRI and CBT
How is lung distensibility (compliance) affected by COPD vs Pulmonary Fibrosis
COPD = increased distensibility (compliance)
Pulmonary fibrosis = decreased distensibility (compliance)
Value of urine protein/CR ratio that indicates preeclampsia.
> 0.3
Value of 24 hr urine collection that indicates preeclampsia.
> 300 mg
