Topics Flashcards
What is hyposthenuria and what disease is it associated with? Pts. have _____ urine frequency, ____ urine specific gravity, ______ serum sodium
inability for kidneys to concentrate urine, sickle cell disease/trait
-increased, dec, normal
In central insipidus diabetes, serum sodium is ______
elevated b/c not releasing ADH to take in water
In primary polydipsia, serum sodium is typically _____
low from excessive fluid intake
pts with persistent narrow complex tachycardia (also known as ______) should be tx with?
supra ventricular tachycardia, synchronized cardio version
work up of aortic stenosis
ECG, cardiac enzymes, echocardiogram, stress test (contraindicated in sever symptomatic AS)
treat AFib w/ WPW with that
procainamide
tilt table test is for what?
vasovagal syncope without structural heart disease
which three groups are more likely to have atypical sx with acute coronary syndrome and what are the sx?
women, elderly, people with diabetes
- from most com to least com
- chest pain, dyspnea, n/v, epigastric pain
isolated systolic HTN is caused by ______ stiffness or _____ elasticity of the arterial wall
increased, decreased
How should digoxin dose be changed when initiating amiodarone? How does acute digoxin toxicity look?
dose should be decreased by 25-50%
-n/v, anorexia, abdominal pain, vision changes
what is first line med for essential tremor
beta blockers (propanolol) -functional type tremor when doing tasks
baroreceptor sensitivity _____ with age
dec
initial tx for aortic dissection
beta blockers
sudden development of ischemic sx in one leg in a previously asymptomatic patient is most consistent with arterial ______
emboli,
long standing would be thrombus as PVD is gradual and both extremities would be affected
What are 3 causes of arterial emboli
AFib (left arterial thrombus), left ventricular thrombus following an anterior MI, septic emboli from infective endocarditis
_________ toxicity can happen when people get prolonged infusions of nitrates, esp with renal disease
cyanide
-AMS, seizures, coma, lactic acidosis
what is hypertensive encephalopathy characterized by?
marked INC in BP w/ signs of cerebral edema (HA, n/v, restlessness, confusion, agitation, seizures, coma)
How does aortic stenosis affect S2?
softer as that’s when the aortic valve closes
What arrhythmia is most specific for digoxin toxicity?
atrial tachycardia with AV block
what 2 classes of medications can help with inc appetite in cancer related anorexia/ cachexia syndrome?
progesterone analogues and corticosteroids
_________ can reduce the risk of febrile non hemolytic transfusion reaction
leukoreduction (dec the number of transfused leukocytes through filtering, saline washing, freezing
_______ presents with “soap bubble” appearance on X-ray (eccentric lytic lesions on epiphysis of distal femur)
giant cell tumor
treat epidural spinal cord compression with
IV glucocorticoids
What imaging to identify cause of SVC syndrome (face AND arm swelling). What’s most common cause of obstruction?
CXR, malignancy
-if was JUST ARM swelling, could consider DVT
Whats best initial test for head and neck tumor?
panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)
post op oliguria typically need
a catheter to restore normal urine output, if this doesn’t work-check other sources
Abnormal hemostasis can be common in chronic renal failure, why?
abnormal bleeding and bruising are characteristic of uremic coagulopathy
Seizures can lead to what acid base disorder
AG metabolic acidosis (lactic acidosis) because of skeletal muscle hypoxia
-this is transient and typically resolves w/in 90min
50 yr old pt presents with palpable purpura, proteinuria, hematuria, arthralgia, hepatosplenomegaly
mixed essential cryoglobunemia
Test for Cdiff with stool ___
TOXIN not culture
saline responsive metabolic alkalosis is commonly due to loss of _________. How is serum and urine Cl?
gastric secretions (vomiting, NG suction) -low serum Cl, high urine Cl
what typically triggers vasovagal syncope? How do you treat?
stress, emotional event, sight of blood etc
-counter pressure (lift legs, hand grip) to inc blood flow back to heart
what is the most effective intervention for dec BP
weight loss>DASH diet>exercise>dietary sodium>alcohol intake
COPD leads to ____ work of breathing and ____ inspiratory and expiratory flow rates
inc, dec
rapid treatment with _______ is needed in patients with severe hyperkalemia who develop significant ECG changes
calcium gluconate
moderate hypothermia is treated by ________
active rewarming and warmed IV fluids
What is trousseau’s syndrome?
hypercoagulabilty disorder that presents with migratory thrombophlebitis (blood clot in a vein leads to inflammation and pain) in weird spots like arm and chest, typically assoc with malignancy like pancreatic
what type of cancer is assoc with pernicious anemia
gastric cancer
when pts become pregnant what happens to TSH? How should someone who’s hypothyroid prior to pregnancy adjust their levothyroxine?
TSH dec, inc levo at detection of pregnancy
______ is a first line tx for major depression with psychotic features and is appropriate for elderly patients who are refusing to eat or drink and need immediate therapy
ECT electroconvulsive therapy (30-60 sec tonic-clonic seizures)
spinal central cord syndrome typically affects the ______ extremities
upper
spinal anterior cord syndrome typ affects the _______ extremities
lower
hemolytic anemia, hepatic vein thrombosis, and high bilirubin, and abdominal pain think
paroxysmal nocturnal hemoglobinuria
what prophylaxis for suspected bacterial meningitis 2-50yrs and >50yrs
2-50: vanco and 3rd gen cephalosporin
50+: vanco and 3rd gen cephalosporin and ampicillin
the degree of dec of what electrolyte can let you know how severe the heart failure is
hyponatremia
______ nerve fiber injury is associated with positive sx (pain, paresthesias, allodynia-inc pain response)
small
______ nerve fiber injury is associated with negative sx (numbness, loss of proprioception and vibration sense, diminished ankle reflexes)
large
dry, flat, scaly papulues on skin in sun exposed areas
actinic keratosis
_______ presents as macule or raised wart like lesions, pink brown or black “stuck on”
seborrheic keratosis
______ can be described as a state of mutism, stupor, posturing and is treated with _______. ______ drugs worsen this state
catatonia, benzos (lorazepam), antipsychotics
_______ is an acute arthritis caused by release of Ca rhomboid crystals. See lots WBCs but no bacteria. See what on radiology
pseudo gout, meniscal calcification
in polycythemia vera, EPO tends to be_____
decreased b/c overproduction of RBCs is from JAK2 kinase mutation
ruptured berry aneurysm is associated with a _______ hemorrhage
subarachnoid
_______ is recommended for pts with gross hematuria or w/ microscopic hematuria and other risk factors for bladder cancer
cystoscopy
with pyelonephritis, see urine ph>8 think ______ producing organisms like?
urease, proteus and klebsiella
_________ is characterized by pain and stiffness in neck, shoulders, pelvic girdle, inc ESR, >50yrs. Tx with?
polymyalgia reumatica, low dose prednisone
attributable risk percentage formula
ARP=(RR-1)/RR
whats first line tx for idiopathic intracranial HTN
acetazolemide (inhibits choroid plexus carbonic anhydrase)—>dec CSF prod and intracranial HTN
dec renal perfusion leads to ____ renal tubular sodium delivery, which stimulates the _______ system and how does this affect renin, aldo, ADH levels
dec, RAAS, inc renin, inc aldo, inc ADH
exertional dyspnea, pounding heart sensation, and widened pulse pressure think
aortic regurgitation
What type of gallop is heard in acute coronary syndrome?
S4: heard immediately after atrial contraction and blood is forced into a stiff ventricle
s3 gallop
heard during rapid filling of ventricles in diastole, turbulent blood flow to the ventricles due to inc volume
_____ is the most common cause of MR in the developed world. How does this occur?
MVP, myxotamtous degeneration of mitral valve leaflet
use _____ in VFib or pulseless ventricular tachycardia
defibrillation (provides a high energy shock at random point in the cardiac cycle)
in _______ energy delivery is synchronized to the QRS complex to minimize the likelihood of shock occurring during repolarization which can predispose to _____
cardio version, VFib
What does the ristocetin cofactor assay test for and what disease can it help dx?
platelet aggregation, vWdisease
If someone comes in with a severe headache what do you get, and if that’s negative how do you follow up?
CT scan look for hemorrhage, and then Lumbar puncture looking for inc opening pressure and RBCs
with COPD when does oxygen therapy decrease mortality?
When O2 sat is <88%
when have elderly patient with pathologic fracture, renal failure, anemia, and hypercalcemia, think? Test with what?
MULTIPLE MYELOMA, SPEP( serum protein electrophoresis)
symptomatic super bradycardia: what is best acute tx, long term?
acute: atropine, long term: ICD
what four things have been shown to dec mortality in systolic HF
ACEi, Beta blockers, spironolactone, ICD
what is the only population you tx asymptomatic bacteriuria?
pregnant women
what is acute tx for suspected adrenal insufficiency
IV hydrocortisone?
COPD bleb rupture can lead to a ______. Tx by?
symptomatic pneumothorax, chest tube insertion
METFORMIN is contraindicated in what disease?
CKD
what is de quervain’s tenosynovitis? How do you tx?
swelling of the thumb tendons caused by repetitive motion, hurts to make a fist,
tx: thumb spica splint=immobilization
What are some assoc. conditions with pseudo gout and what labs would you get for these?
hemochromatosis, hypothyroidism, and hyperparathyroidism
so ferritin/transferrin/TIBC, TSH, Ca
in a patient with achalasia, who has a hx os osteoporosis, what’s best med?
zolendronic acid is a PO bisphosphonate, alendronate is PO so contraindicated given risk of pill esophagitis
when have a healthy patient that has back pain that improves with rest and dec with exercise, think of ________ and tx with?
ankylosing spondylitis, tx: NSAIDs
-RF is negative and have HLA B 27 genotype, and can have uveitis
management of acute asthma exacerbation is
oxygen with nebulizer albuterol
most common recurrence after acute pericarditis
recurrent pericarditis
if have someone with pyelonephritis who does not get better after susceptible abx tx, think?
renal or perinephric abscess
- observe w/ CT
- if abscess is <5cm: observe w/ abx
- if abscess > 5c: give abx and drainage
why is a normal PaCO2 a bad sign in acute respiratory exacerbation
pts. should be hyperventilating–> dec in CO2 and a respiratory alkalosis, if it’s normal: pt is getting tired of compensating
what is acute retroviral syndrome
acute HIV presentation can be: fever, chills, sore throat, mucocutaneous lesions, maculopapular rash
TAILS mnemonic for microcytic anemia
thalassemias, anemia of chronic disease, iron deficiency, lead poisoning, sideroblastic anemia
when someone comes in with suspected meningitis and they’re stable what do you do
CT scan, LP, empiric abx or antivirals
difference and cut off for hypertensive emergency and urgency?
BP> 180/120
urgency: no signs of organ damage, gradually lower BP over a few days
emergency: end organ damage, rapidly lower BP over minutes to hrs (nitroglycerin, nitroprusside, labetolol, captopril, hydralazine)
Best way to tx migraines acutely? Two medications for migraine prophylaxis?
sumatriptan (oral) or chlorpromazine (IV so better if pt presents with vomiting)
-propanolol, amitryptiline
Low FeNa signals ______ AKI and high FeNa signals _____ AKI
prerenal (holding on to Na to inc volume), intrinsic (not filtering properly so inc Na in urine)
distinguish between gout and septic arthritis via
joint aspiration w/ synovial fluid analysis
-gout will ahh elevated uric acid levels but this isn’t sensitive or specific
if a person gets stuck by a needle by someone with Hep B and has unknown vaccination status how do you tx? What if you know their vaccinated?
- both HBIG (passive immunity) and hep B vaccine (active immunity)
- reassurance
Difference between sepsis, sever sepsis, septic shock
consider SIRS criteria: temp >38C or <36, HR >90, RR>20 or PaCO2 <30, leukocyte > 12 or <4 w/ >10% bands
- sepsis is when theres a source of infxn
- severe sepsis adds in SIRS criteria
- septic shock is severe sepsis that doesn’t respond to adequate fluid resuscitation
How is a pleural effusion BEST diagnosed
thoracentesis
What is the best diagnostic test for bronchiectasis?
CT
3 methods to test for suspected Cushing’s syndrome
urine 24 hr free cortisol, dexamethasone suppression test, late night salivary cortisol
how does chronic glucocorticoid use affect ACTH, cortisol, aldosterone
dec ACTH, dec cortisol, normal aldo(dec in primary autoimmune adrenal insufficiency w/ severe hyperkalemia)
thyroid cancer that invades blood vessels
follicular
thyroid cancer with psammoma bodies
papillary
thyroid cancer with inc calcitonin
medullary
When do you I’ve fresh frozen plasma
with severe coagulopathy (DIC, liver disease) w/ active bleeding
When do you give packed red blood cells
when Hgb <7 and pt is stable
hub <9 for acute coronary syndrome
When do you give platelets?
when platelets <10,000
What is ABO incompatibility in pregnancy and how does it affect the baby?
When a mother who is type O has a baby with type A or B blood
-Affected infants are usually asymptomatic at birth or have mild anemia that lasts a few days and jaundice (which responds to phototherapy)
tx papillary thyroid cancer with
surgical resection followed by radiation if there is inc risk of tumor recurrence
in DKA what fluids do you give?
normal saline and normal insulin, add D5W when glucose <200
if someone has a PE, how is Ca affected
PE=respiratory alkalosis and this means that more H+ is dissociated from albumin which means more Ca can bind albumin and this leads to dec ionized free Ca(which is the active form) so you see muscle spams
fever w/ sore throat in anyone who recently started antithyroid drugs suggests and what do you do?
agranulocytosis, STOP PTU or the drug
Hflu B vaccine is not administered after what age
5
What can be a side effect of metoclopromide because of what if blocks
it is a D2 blocker so can lead to dystonia, restlessness, and parkinsonism
asymptomatic hematuria on UA follow up
get another UA in a month, if still there get a urine culture
_________ as a single dose has been shown to lessen hospitalization for croup when they are not in respiratory distress
dexamethasone
nasal crease is a sign of and is associated with
chronic nasal itching, allergic rhinitis
what imaging in acute setting of diverticulitis
CT scan, colonoscopy and barium enema can inc risk of perforation
Long standing mitral stenosis can lead to _____ enlargement which leads to what with the esophagus
LA, esophageal compression
knee injury is a strong predisposing factor for ______ cyst
popliteal (trauma stimulates the production of synovial fluid)
hepatic adenoma tx?
stop OCP, and reimage in 6 months if <5cm, if greater than consider surgical resection
presentation of thromboangiitis obliterans, Best thing to stop doing to improve prognosis
intermittent claudication, Raynaud’s phenomenon, migratory thrombophlebitis
STOP SMOKING
diastolic murmur with opening snap in apex
mitral stenosis
holosystolic murmur at apex
mitral regurgitation
in psoriasis _______ hyperproliferate
keratinocytes
when have someone with fatty diarrhea, anemia, and skin problems think
celiac
a positive d xylose test (less than normal) indicates
malabsorption
tx pregnant women with antiphoslipid syndrome with
low dose aspirin(low dose makes effects negligible) and heparin (doesn’t cross placenta)
milk alkali syndrome sx
nausea, vomiting, constipation, polyuria, polydipsia, neuropsych sx,
-lab: hyperCa, metabolic alkalosis, AKI, suppressed pTH
oral estrogen levels _____ TBG. This leads to an ______ number of TBG binding sites. This leads to a ______ free thyroxine and ___ TSH in hypothyroid patients
inc TBG by dec it’s clearance, inc TBG sites, dec free thyroxine to bind up all the TBG, increase TSH
what is the best test to evaluate improvement in DKA
anion gap and beta hydroxybutyrate
In Graves disease their are antibodies to _____ receptor
TSH
In Hashimotos there are antibodies to ____
TPO
How do glucocorticoids affect muscle mass
they lead to muscle atrophy
What ate five risk factors for osteomalacia
malabsorption, Celiacs, intestinal bypass surgery (think Crohn’s), CKD< chronic liver disease
chronic bladder condition characterized by bladder pain that is worst with filling and relieved by voiding, can also see dyspareunia, inc urinary frequency & urgency
interstitial cystitis (painful bladder syndrome)
what are amiloride and triemterene
potassium sparing diuretics
What is Bechet syndrome
painful pathos oral and genital ulcers along with uveitis and erythema nodosum
what are symptoms of relative arthritis and what is first line tx
afebrile, urethritis, conjunctiviits, mucocutaneous lesions, knee pain
patient with symmetrical proximal muscle weakness and an erythematous rash, dx with
dermatomyositis
-dx muscle biopsy
______ can occur in Paget’s disease of bone due to overgrowth of temporal bones on cochlea
Hearing loss
how to tx patellofemoral syndrome and what are sx
strengthening exercises, compression of the patella tends to reproduce the pain
pernicious anemia need to be monitored for dvpt of ______ cancer
gastric
thrombotic thrombocytopenic purpura is which 5 sx. Tx w/
thrombocytopenia, MAHA, renal insufficiency, neuro changes, fever
-plasma exchange (gets rids of pts autoantibodies)
Use cryoprecipitate in _____
DIC b/c it contains clotting factors, fibrinogen, vWF
