Set 6 Flashcards
MC breast tumor in pre-, peri- and post-menopausal women?
pre = fibroadenoma (benign) peri = intraductal papilloma (benign, unilateral bloody discharge) pst = DCIS (+/- discharge)
HIV drug causing pancreatitis
didanosine (NRTI)
2 diseases associated with angiodysplasia in elderly?
Aortic stenosis (called Heyde's Syndrome) ESRD
obese diabetic with hepatomegaly and transaminitis? a/w? mechanism?
NASH, 2/2 insulin resistance causing increased rate of lipolysis and circulating insulin
a/w obesity, DM2, HLD and TPN
Immunocompromised pt with FOCAL neurologic deficits? Findings?
PML –> MRI w/ multiple demyelinating NON-enhancing lesions, no masses effect
Anserine Bursitis
anteromedial tibeal swelling/pain, normal xray, negative valgus stress test (vs. MCL injury)
HIV drug CLASS causing SJS
NNRTI
Dx and 2nd line Tx for lyme disease
Dx = ELISA/WB Tx = doxcycline 1st, amoxicillin 2nd
HIV drug causing liver failure
Nevirapine (NNRTI)
Hemorrhage vs. infarct on CT
hemorrhage = HYPERdense infarct = hypodense
Worst type of mutation in NF2, inheritance?
Nonsense mutation (severe variant) all are AD
photophobia, painful red eye, non-reactive mid-dilated pupil? dx, tx?
acute closed-angle glaucoma
dx = tonometry
tx = acetazolamide (decrease pressure) then pilocarpine (relieve obstruction)
deformed feet, joint effusions, osteophytes and bone fragments?
Charcot’s joint = neurogenic arthropathy 2/2 neuropathy and repeated wt-bearing trauma
What happens to levels of ACTH, aldosterone, cortisol and ADH if chronic steroid patient abruptly stops?
central, tertiary adrenal insufficiency
decreased ACTH, cortisol
increased ADH (normally suppressed by cortisol)
normal aldosterone
2 risks of tamoxifen use?
VTE cancer (endometrial CA, uterine sarcoma)
Acid-base disturbance in ASA overdose?
mixed respiratory alkalosis and AG metabolic acidosis (NOT a compensatory respiratory alkalosis though!)
conjunctivitis in neonate, 3 ddx and how to differentiate
chemical = 1st 24hrs, no pus gonococcal = 2-5 days with purulence chlamydia = 5-15 days, less pus
When to do EGD in GERD
fail empiric tx OR
**complicated GERD = dysphagia, odynophagia, wt loss, bleeding or iron deficiency
3 MCC bacterial rhinosinusitis? tx?
S pneumo, H flu, M catarrhalis
Tx: augmentin
6 causes of drug-induced esophagitis
Tetracyclines, ASA/NSAIDs, Alendronate, KCl, Quinidine, Iron
urine/serum osmolality in osmotid diuresis
both elevated but urine > serum
3 dx features of Wilson’s Disease
Increased urinary copper
Decreased ceruloplasmin
Kayser-Fleischer rings on slit lamp eye exam
most and least malignant potential regarding colon polyps
Most = sessile, villous adenoma >2.5cm Least = hamartomatous and hyperplastic (~benign)
Iron, TIBC, ferritin, transferrin sat% in anemia of chronic disease
Decreased = iron, TIBC, transferrin, ~transferrin sat%
Increased ferritin
OI pathogenesis, PE findings (4)
type 1 collagen disorder
PE = blue sclera, hearing loss, hypermobile joints, dentinogenesis imperfecta
Fall on oustretched hand resulting in Positive drop-arm test (can’t hold it up)
rotator cuff tear = supraspinatus injury which controls first 15 degrees of abduction
Migratory thrombophlebitis indicates? W/u?
aka Trousseau’s Syndrome –> indicates likely underlying malignancy MCC adenocarcinoma (pancreas > lung > prostate > gastric)
Dx = CT abdomen
Hemolytic anemia + hepatic vein thrombosis, think…pathogenesis?
Paroxysmal nocturnal hemoglobinuria –> ACQUIRED defect in GP1 anchor responsible for CD55/59 anchoring to RBCs to keep from being targeted by complement
acute* symmetric, polyarticular arthritis
viral! MCC parvo B19
location of axial skeletal involvement in RA
C1-C2 causing isntability +/- subaxial subluxation
retinal hemorrhages vs. pale retina, which viruses?
CMV = retinal hemorrhages (painless) HSV/VSV = pale retina (+/- necrosis, painful)
AMS and abnormal MRI in HIV patient, DDx and differentiation?
Toxo = multiple ring-enhancing round lesions, MC basal ganglia
PML = non-enhancing lesions
Primary CNS lymphoma = solitary, weakly ring-enhancing PERIVENTRICULAR mass (2/2 EBV)
SE / complication of radioidone therapy, early vs. delayed?
early = transient thyrotoxicosis/hyperthyroidism MC in elderly 2/2 excess thyroid hormone released from dying cells --> prevent with methimazole later = hypothyroidism possible in all patients
Major criteria for rheumatic fever (5)
JONES: Joints (migratory polyarthritis) Heart (carditis) Nodules (subcuticular) Erythema marginatum Sydenham chorea
Minor criteria for rheumatic fever (5)
PEACE: Previous rheumatic fever ECG w/ prolonged PR (ie 1st degree block) Arthralgias CRP/ESR elevation, Elevated temp (fever)
major and minor combos for dx rheumatic fever
2 major or 1 major + 2 minor
Fever, tonsillar exudates, sore throat and erythema? Dx, Tx?
GAS pharyngitis
Dx = rapid strep test
Tx = oral PCN or amoxicillin (macrolide for penicillin allergy)
Sore throat, conjunctivitis, rash, rhinorrhea
viral pharyngitis
Early tx of strep throat prevents what?
rheumatic fever but NOT PSGN
Peaked T waves
HYPERkalemia
EKG findings in HYPOkalemia
U waves, flat and broad T waves, PVCs
daily multiple seizures in kid <7yo, often at night? associated with? EKG findings?
Lennox-Gastaut Syndrome, associated with mental retardation, psychological and psychomotor delay.
EKG = interictal slow spike-and-wave complexes
Suspected pancreatitis, what imaging to get?
if no h/o alcoholism, get RUQ US 1st to look for gallstones.
THEN get abdominal CT to confirm
Female with pruritis, hypercholesterolemia, hyper alk phos, + IgM antibodies? Tx?
PBC
Tx = ursodeoxycholic acid ? MTX/colchicine
W/u algorithm for erythema nodosum
1st = anti-streptolysin-O titer (strep infxn MCC) 2nd = CXR (histo/sarcodiosis) 3rd = PPD 4th = h/o diarrhea/GI complaints (IBD)
low leukocyte alkaline phosphatase seen in…(5)
CML, PNH, AML, aplastic anemia, pernicious anemia (its found in WBCs, indicates hematologic malignancy)
high leukocyte alkaline phosphatase seen in…(4)
LEUKEMOID RXN! and Pvera, ET, myelofibrosis
Tx MG crisis
intubate and D/C acetylcholinesterase inhibitors (possibly for days) +/- plasmapheresis or IVIG
MG associated with (2)
thyrotoxicosis and thymomas
Dx ZE syndrome
serum gastrin >1000
if non-dx, then secretin-stim test (if causes a rise in gastrin, then abnormal)
70 yo with shoulder and hip pain with elevated ESR? Tx?
Polymyalgia Rheumatica
Tx LOW-dose steroids unless associated with giant-cell arteritis (then high dose)
2 MCC AVN of femoral head? 2 dx tests?
Chronic steroids and alcohol abuse
Dx = MRI and scintography (detects earlier than MRI)
anterior hip pain worse with activity and limited ROM +/- pain at rest
AVN of femoral head
Ensthesitis associated with?
HLA-B27 Arthrophathies (AS, psoriatic and reactive arthritis)
MC achilles, tibal tuberosities, iliac crests
Dx criteria for Lewy Body Dementia?
2+ of the following needed:
fluctuating cognition, recurrent visual hallucinations, parkinson-like motor features
Rinne test is abnormal (BC>AC) on the Right, weber test lateralizes to the Left
Mixed hearing loss in the right ear (conductive and sensorineural)
Tx seizure in the ER
Benzodiazepine (lorazepam), if fails then phenytoin
Dx lactose intolerance
Hydrogen breath test
3 Tx fibromyalgia
TCA (amitriptyline), exercise +/- muscle relaxant (cyclobenzaprine)
HIV drug class causing lactic acidosis
NRTIs
