TEST 14-16 Flashcards
HIGH FEVER/ MALAISE/ THROAT PAIN + yellow-grayish white papulovesicles = ?
HERPANGINA - coxsackie virus
What is the Tx for COCAINE-INTOXICATION STEMI?
What medication is absolutely CONTRA-INDICATED in this pt (normally used for STEMI tx)?
IV BENZODIAZEPINE
CONTRA-INDICATED: BETA BLOCKER - unopposed alpha agonist activity of cocaine -> worsened vasoconstriction
What are the EKG changes of ACUTE PERICARDITIS?
PR INTERVAL DEPRESSION + DIFFUSE ST ELEVATIONS
ECHO FINDINGS OF STRESS-INDUCED CARDIOMYOPATHY (Older pts in response to physical/emotional stress or ACUTE medical illness)
TRANSIENT SYSTOLIC DYSFUNCTION of apical and/or mid-segments of LV + Hyperkinesis of basal segments =
BALLOON-LIKE APPEARANCE OF LV DURING SYSTOLE
After diagnosis of SOLID TESTICULAR MASS is made by ultrasound, what is the initial management?
RADICAL ORCHIECTOMY - removal of testis and cord
= HIGH INGUINAL ORCHIECTOMY
TOXICITY of what drug = SLURRED SPEECH + UNSTEADY GAIT + DROWSINESS + normal pupil size (2-5mm)
BENZODIAZEPINE
TOXICITY of what drug = HORIZONTAL NYSTAGMUS + CEREBELLAR ATAXIA + CONFUSION + MEGALOBLASTIC ANEMIA
PHENYTOIN
TOXICITY of what drug = TREMOR + HYPER-REFLEXIA + ATAXIA/SEIZURES + NEPHROGENIC DI
LITHIUM
What is the INITIAL TX MONOTHERAPY of HYPERTROPHIC CARDIOMYOPATHY?
NEGATIVE INOTROPES
**BETA BLOCKERS - Prolong diastole, decrease myocardial contractility -> Decreases LVOT obstruction -> Improves anginal sx
VERAPAMIL, DISOPYRAMIDE can also be used but beta blockers are first line
Tx for ORAL DEHYDRATION in ELDERLY pt
IV CRYSTALLOIDS (Na-containing solution) = 0.9% NaCl
What’s difference between IV CRYSTALLOID AND IV COLLOIDS?
IV COLLOIDS = ALBUMIN SOLUTIONS (used for burns and hypoproteinemia)
IV CRYSTALLOID = Na-containing solution used for rehydrating elderly
INTERMITTENT ELEVATIONS of ALT/AST + PORPHYRIA CUTANEA TARDA (Fragile skin, photosensitivity, vesicles, erosions of hands)
CHRONIC HEP C
What are the most appropriate tests to diagnose ACUTE HEPATITIS B INFECTION?
HBsAg + anti-HBc (IgM Ab)
**anti-HBc: tested bec it’s the only one elevated during window period (Between HBsAg and anti-HBs
GUIDELINES for pain management in metastatic cancer:
1) NON-narcotic (NSAIDS/OTC)
2) SHORT-acting narcotic (morphine) + adjuvant - Titrate subsequent doses
3) LONG-acting narcotics
In a pt who has HASHIMOTO THYROIDITIS (Rubbery enlarged goiter + anti-TPO Abs), there is increased risk for developing __.
THYROID LYMPHOMA
CT SCAN: doughnut sign - pseudocystic pattern
DRAMATIC LEUKOCYTOSIS + LAD + HSM + PANCYTOPENIA + infection = high clinical suspicion for ____
How does one make the diagnosis?
CHRONIC LYMPHOCYTIC LEUKEIMIA
DIAGNOSIS: Flow cytometry (clonality of mature B cells)
How do you distinguish between EBV IM and CLL?
Both can present with FEVER, MALAISE, LAD BUT
EBV = + PHARYNGITIS, MILD leukocytosis (12-18K), NO pancytopenia
CLL = MASSIVE leukocytosis (>40K) + PANCYTOPENIA
Following an MI, which drug is given to lessen VENTRICULAR REMODELING (LV dilation + thinning of ventricular walls -> CHF)?
ACE INHIBITORS
What is the mainstay Tx for DRESSLER SYNDROME (Acute pericarditis weeks after an MI)?
Why should ANTICOAGULANTS be avoided for this syndrome?
NSAIDs
If NSAIDs are contra-indicated or if it is refractory, use CORTICOSTEROIDS
AVOID anti-coagulants to prevent dvlm HEMORRHAGIC PERICARDIAL EFFUSION
What is ASPIRIN-EXACERBATED RESPIRATORY DISEASE?
What is the Tx?
Wheezing, cough, SOB, chest tightness (non-IgEmediated) reaction due to ASA-induced PG/leukotriene imbalance
LOW PG (pro/anti-inflammatory), ELEVATED LT (pro-inflammatory) in pt with history of ASTHMA, CHRONIC RHINOSINUSITIS/ NASAL POLYPS
Tx = AVOID NSAIDS, DESENSITIZE If NSAIDS are required, LEUKOTRIENE INHIBITORS (ZILEUTON) or LEUKOTRIENE-R ANTAGONISTS (MONTELUKAST)
How does one diagnosis AMYLOIDOSIS?
Tissue biopsy (abdominal fat pad mostly used) showing AMYLOID DEPOSITS
What is the difference between ACUTE INTERSTITIAL NEPHRITIS and CRYSTAL-INDUCED AKI?
AIN - Presents 7-10d after drug exposure (6P’s)
Crystal-induced AKI - Presents 24-48hrs after drug exposure -> Precipitates in renal tubules -> INTRA-TUBULAR OBSTRUCTION -> Direct renal toxicity
What are the possible drug causes of CRYSTAL-INDUCED AKI?
SPAME
S - SULFA, P - PROTEASE INHIBITORS, A- ACYCLOVIR, M- MTX, E - ETHYLENE GLYCOL
What tests should be ordered if pt has IDIOPATHIC THROMBOCYTOPENIA?
HIV
HEPC
Tx of underlying infection can affect PLT ct
What is the most sensitive test for detecting DIABETIC NEPHROPATHY?
Why not routine dipstick of urine for protein?
RANDOM URINE MICROALBUMIN/CREATININE RATIO - Se = 30-300mg/24hr
DIABETIC MICROALBUMINURIA
NOT routine dipstick because not sensitive enough - Se >300mg
MACROALBUMINURIA
Vast majority of HEAD AND NECK CANCER is ___?
SQUAMOUS CELL CARCINOMA
RADIOLUCENT KIDNEY STONES = ?
RADIOPAQUE KIDNEY STONES = ?
RADIOLUCENT (not visible on X-ray) = URIC ACID CRYSTALS = acidic pH
RADIOPAQUE (visible on X-ray) - calcium oxalate, ammonium mg phosphate, cystine crystals = basic pH
How does SIBO, SURGICAL RESECTION, or CHRONIC DIARRHEA result in CALCIUM OXALATE CRYSTALS?
MALABSORPTION of free fatty acids -> Chelate calcium -> Increased absorption of oxalic acid -> Increased calcium oxalate stones
3 most common causes of VIT K DEFICIENCY and thus THROMBOPHILIA (ELEVATED PT, PTT, BLEEDING EPISODES)
- INADEQUATE ORAL INTAKE
- UNDERLYING LIVER DISEASE (alcoholism, hepatocellular carcinoma)
- INTESTINAL MALABSORPTION
How to distinguish between ASTHMA and COPD
Hint: PFT value DLCO, response to bronchodilator
ASTHMA:
- DLCO - NORMAL or INCREASED
- FEV1 YES, reversible with bronchodilator (>12% increase in FEV1)
COPD:
- DLCO - DECREASED or normal
- FEV1/FVC NOT reversible with bronchodilator
ANTIBIOTIC for CLENCHED FIST INJURY (HUMAN BITE) or DOG BITE = ?
Covering for POLYMICROBIAL INFECTION - AMOXICILLIN/CLAVULANIC ACID
Pathogenic mechanism for DIABETIC FOOT ULCER pt resulting in OSTEOMYELITIS?
DIRECT CONTIGUOUS SPREAD OF INFECTION
YOUNG FEMALE ATHLETE: POPPING sensation of knee during injury + RAPID onset of HEMARTHROSIS
ACL tear
DIABETIC ULCER risk assessment is tested by ___?
10G MONOFILAMENT TEST - Diabetic neuropathy is most common cause of DIABETIC ULCER
What test is used to assess FIBROMYALGIA, OSTEOARTHRITIS (CHRONIC PAIN CONDITIONS)?
6-minute WALK TEST - How far pt can walk in standardized time
What is the most PREFERRED Tx for GRAVE’S DISEASE in terms of best long-term outcome?
RADIOACTIVE IODINE THERAPY
Contra-indications: PREGNANCY + OPHTHALMOPATHY
YOUNG OBESE WOMAN: Headache + blurry vision/diplopia + pulsatile tinnitus = ?
DIAGNOSIS made by?
IDIOPATHIC INTRACRANIAL HTN
Diagnosis: Ocular exam -> Neuroimaging -> LP with elevated opening pressure (>250mmH2O)
What toxicities are related to CYCLOSPORINE and TACROLIMUS immunosuppressants?
Which AE are unique to CYCLOSPORINE?
Both are CALCINEURIN INHIBITORS - Inhibit IL-2 Tx and other cytokines (mainly Th cells)
NEPHROTOXICITY, HYPERKALEMIA, HTN, TREMOR
- Unique to CYCLOSPORINE: GUM HYPERTROPHY + HIRSUTISM
What is the major toxicity of AZATHIOPRINE?
Dose-related DIARRHEA, HEPATOTOXICITY, LEUKOPENIA
What is the major toxicity of MYCOPHENOLATE?
MYELOSUPPRESSION
What is the critical distinction between CASE CONTROL STUDIES and RETROSPECTIVE COHORT STUDIES?
CASE CONTROL: First determine OUTCOME (diseased or not diseased) -> Then look for associated risk factors
RETROSPECTIVE COHORT: First ascertain RISK FACTORS -> Determine outcome
What is the most common cause of MR in DEVELOPED countries?
MITRAL VALVE PROLAPSE
SUDDEN ONSET odynophagia + retrosternal chest pain causing difficulty swallowing = ?
What are medications that cause this?
PILL ESOPHAGITIS
TAAP: Tetracyclines ASA, NSAIDs Alendronate, risedronate Potassium chloride, Fe
What is the purpose of OPTIMIZING GLYCEMIC control in DIABETES? (A1c)
Preventing MICROVASCULAR COMPLICATIONS (nephropathy, retinopathy)
UNCERTAIN effect on MACROVASCULAR complications (MI, stroke, all-cause mortality)
What diagnostic test will CONFIRM diagnosis of ZENKER DIVERTICULUM
CONTRAST ESOPHAGRAM
