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STEP2: Tidbits > TEST 14-16 > Flashcards

TEST 14-16 Flashcards

1
Q

HIGH FEVER/ MALAISE/ THROAT PAIN + yellow-grayish white papulovesicles = ?

A

HERPANGINA - coxsackie virus

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2
Q

What is the Tx for COCAINE-INTOXICATION STEMI?

What medication is absolutely CONTRA-INDICATED in this pt (normally used for STEMI tx)?

A

IV BENZODIAZEPINE

CONTRA-INDICATED: BETA BLOCKER - unopposed alpha agonist activity of cocaine -> worsened vasoconstriction

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3
Q

What are the EKG changes of ACUTE PERICARDITIS?

A

PR INTERVAL DEPRESSION + DIFFUSE ST ELEVATIONS

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4
Q

ECHO FINDINGS OF STRESS-INDUCED CARDIOMYOPATHY (Older pts in response to physical/emotional stress or ACUTE medical illness)

A

TRANSIENT SYSTOLIC DYSFUNCTION of apical and/or mid-segments of LV + Hyperkinesis of basal segments =
BALLOON-LIKE APPEARANCE OF LV DURING SYSTOLE

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5
Q

After diagnosis of SOLID TESTICULAR MASS is made by ultrasound, what is the initial management?

A

RADICAL ORCHIECTOMY - removal of testis and cord

= HIGH INGUINAL ORCHIECTOMY

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6
Q

TOXICITY of what drug = SLURRED SPEECH + UNSTEADY GAIT + DROWSINESS + normal pupil size (2-5mm)

A

BENZODIAZEPINE

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7
Q

TOXICITY of what drug = HORIZONTAL NYSTAGMUS + CEREBELLAR ATAXIA + CONFUSION + MEGALOBLASTIC ANEMIA

A

PHENYTOIN

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8
Q

TOXICITY of what drug = TREMOR + HYPER-REFLEXIA + ATAXIA/SEIZURES + NEPHROGENIC DI

A

LITHIUM

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9
Q

What is the INITIAL TX MONOTHERAPY of HYPERTROPHIC CARDIOMYOPATHY?

A

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

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10
Q

Tx for ORAL DEHYDRATION in ELDERLY pt

A

IV CRYSTALLOIDS (Na-containing solution) = 0.9% NaCl

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11
Q

What’s difference between IV CRYSTALLOID AND IV COLLOIDS?

A

IV COLLOIDS = ALBUMIN SOLUTIONS (used for burns and hypoproteinemia)

IV CRYSTALLOID = Na-containing solution used for rehydrating elderly

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12
Q

INTERMITTENT ELEVATIONS of ALT/AST + PORPHYRIA CUTANEA TARDA (Fragile skin, photosensitivity, vesicles, erosions of hands)

A

CHRONIC HEP C

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13
Q

What are the most appropriate tests to diagnose ACUTE HEPATITIS B INFECTION?

A

HBsAg + anti-HBc (IgM Ab)

**anti-HBc: tested bec it’s the only one elevated during window period (Between HBsAg and anti-HBs

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14
Q

GUIDELINES for pain management in metastatic cancer:

A

1) NON-narcotic (NSAIDS/OTC)
2) SHORT-acting narcotic (morphine) + adjuvant - Titrate subsequent doses
3) LONG-acting narcotics

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15
Q

In a pt who has HASHIMOTO THYROIDITIS (Rubbery enlarged goiter + anti-TPO Abs), there is increased risk for developing __.

A

THYROID LYMPHOMA

CT SCAN: doughnut sign - pseudocystic pattern

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16
Q

DRAMATIC LEUKOCYTOSIS + LAD + HSM + PANCYTOPENIA + infection = high clinical suspicion for ____

How does one make the diagnosis?

A

CHRONIC LYMPHOCYTIC LEUKEIMIA

DIAGNOSIS: Flow cytometry (clonality of mature B cells)

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17
Q

How do you distinguish between EBV IM and CLL?

A

Both can present with FEVER, MALAISE, LAD BUT

EBV = + PHARYNGITIS, MILD leukocytosis (12-18K), NO pancytopenia

CLL = MASSIVE leukocytosis (>40K) + PANCYTOPENIA

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18
Q

Following an MI, which drug is given to lessen VENTRICULAR REMODELING (LV dilation + thinning of ventricular walls -> CHF)?

A

ACE INHIBITORS

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19
Q

What is the mainstay Tx for DRESSLER SYNDROME (Acute pericarditis weeks after an MI)?

Why should ANTICOAGULANTS be avoided for this syndrome?

A

NSAIDs

If NSAIDs are contra-indicated or if it is refractory, use CORTICOSTEROIDS

AVOID anti-coagulants to prevent dvlm HEMORRHAGIC PERICARDIAL EFFUSION

20
Q

What is ASPIRIN-EXACERBATED RESPIRATORY DISEASE?

What is the Tx?

A

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)

21
Q

How does one diagnosis AMYLOIDOSIS?

A

Tissue biopsy (abdominal fat pad mostly used) showing AMYLOID DEPOSITS

22
Q

What is the difference between ACUTE INTERSTITIAL NEPHRITIS and CRYSTAL-INDUCED AKI?

A

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

23
Q

What are the possible drug causes of CRYSTAL-INDUCED AKI?

A

SPAME

S - SULFA, P - PROTEASE INHIBITORS, A- ACYCLOVIR, M- MTX, E - ETHYLENE GLYCOL

24
Q

What tests should be ordered if pt has IDIOPATHIC THROMBOCYTOPENIA?

A

HIV
HEPC

Tx of underlying infection can affect PLT ct

25
Q

What is the most sensitive test for detecting DIABETIC NEPHROPATHY?

Why not routine dipstick of urine for protein?

A

RANDOM URINE MICROALBUMIN/CREATININE RATIO - Se = 30-300mg/24hr
DIABETIC MICROALBUMINURIA

NOT routine dipstick because not sensitive enough - Se >300mg
MACROALBUMINURIA

26
Q

Vast majority of HEAD AND NECK CANCER is ___?

A

SQUAMOUS CELL CARCINOMA

27
Q

RADIOLUCENT KIDNEY STONES = ?

RADIOPAQUE KIDNEY STONES = ?

A

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

28
Q

How does SIBO, SURGICAL RESECTION, or CHRONIC DIARRHEA result in CALCIUM OXALATE CRYSTALS?

A

MALABSORPTION of free fatty acids -> Chelate calcium -> Increased absorption of oxalic acid -> Increased calcium oxalate stones

29
Q

3 most common causes of VIT K DEFICIENCY and thus THROMBOPHILIA (ELEVATED PT, PTT, BLEEDING EPISODES)

A
  1. INADEQUATE ORAL INTAKE
  2. UNDERLYING LIVER DISEASE (alcoholism, hepatocellular carcinoma)
  3. INTESTINAL MALABSORPTION
30
Q

How to distinguish between ASTHMA and COPD

Hint: PFT value DLCO, response to bronchodilator

A

ASTHMA:

  1. DLCO - NORMAL or INCREASED
  2. FEV1 YES, reversible with bronchodilator (>12% increase in FEV1)

COPD:

  1. DLCO - DECREASED or normal
  2. FEV1/FVC NOT reversible with bronchodilator
31
Q

ANTIBIOTIC for CLENCHED FIST INJURY (HUMAN BITE) or DOG BITE = ?

A

Covering for POLYMICROBIAL INFECTION - AMOXICILLIN/CLAVULANIC ACID

32
Q

Pathogenic mechanism for DIABETIC FOOT ULCER pt resulting in OSTEOMYELITIS?

A

DIRECT CONTIGUOUS SPREAD OF INFECTION

33
Q

YOUNG FEMALE ATHLETE: POPPING sensation of knee during injury + RAPID onset of HEMARTHROSIS

A

ACL tear

34
Q

DIABETIC ULCER risk assessment is tested by ___?

A

10G MONOFILAMENT TEST - Diabetic neuropathy is most common cause of DIABETIC ULCER

35
Q

What test is used to assess FIBROMYALGIA, OSTEOARTHRITIS (CHRONIC PAIN CONDITIONS)?

A

6-minute WALK TEST - How far pt can walk in standardized time

36
Q

What is the most PREFERRED Tx for GRAVE’S DISEASE in terms of best long-term outcome?

A

RADIOACTIVE IODINE THERAPY

Contra-indications: PREGNANCY + OPHTHALMOPATHY

37
Q

YOUNG OBESE WOMAN: Headache + blurry vision/diplopia + pulsatile tinnitus = ?
DIAGNOSIS made by?

A

IDIOPATHIC INTRACRANIAL HTN

Diagnosis: Ocular exam -> Neuroimaging -> LP with elevated opening pressure (>250mmH2O)

38
Q

What toxicities are related to CYCLOSPORINE and TACROLIMUS immunosuppressants?
Which AE are unique to CYCLOSPORINE?

A

Both are CALCINEURIN INHIBITORS - Inhibit IL-2 Tx and other cytokines (mainly Th cells)

NEPHROTOXICITY, HYPERKALEMIA, HTN, TREMOR
- Unique to CYCLOSPORINE: GUM HYPERTROPHY + HIRSUTISM

39
Q

What is the major toxicity of AZATHIOPRINE?

A

Dose-related DIARRHEA, HEPATOTOXICITY, LEUKOPENIA

40
Q

What is the major toxicity of MYCOPHENOLATE?

A

MYELOSUPPRESSION

41
Q

What is the critical distinction between CASE CONTROL STUDIES and RETROSPECTIVE COHORT STUDIES?

A

CASE CONTROL: First determine OUTCOME (diseased or not diseased) -> Then look for associated risk factors

RETROSPECTIVE COHORT: First ascertain RISK FACTORS -> Determine outcome

42
Q

What is the most common cause of MR in DEVELOPED countries?

A

MITRAL VALVE PROLAPSE

43
Q

SUDDEN ONSET odynophagia + retrosternal chest pain causing difficulty swallowing = ?
What are medications that cause this?

A

PILL ESOPHAGITIS

TAAP: 
Tetracyclines
ASA, NSAIDs
Alendronate, risedronate
Potassium chloride, Fe
44
Q

What is the purpose of OPTIMIZING GLYCEMIC control in DIABETES? (A1c)

A

Preventing MICROVASCULAR COMPLICATIONS (nephropathy, retinopathy)

UNCERTAIN effect on MACROVASCULAR complications (MI, stroke, all-cause mortality)

45
Q

What diagnostic test will CONFIRM diagnosis of ZENKER DIVERTICULUM

A

CONTRAST ESOPHAGRAM

STEP2: Tidbits (9 decks)

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