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UW mix 1 Flashcards

1
Q

Pathobiology of Goodpasture’s dz

A

antibodies to alpha 3 chain of type IV collagen (glomerular and alveolar BM) - kidney bx see linear IgG deposition

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2
Q

Sx in Invasive Aspergillosis

A

hemoptysis, pleuritic chest pain, and fever

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3
Q

Imaging of invasive aspergillosis

A

nodules with halo sign surrounding ground glass opacities

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4
Q

Incidental finding of 1.5 cm lung nodule/opacity on CXR - what to do next?

A

Look up old films! Then get CT.
Low prob - serial CT
Intermed prob - PET
High prob - excise

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5
Q

Presentation of amniotic fluid embolism? Tx?

A

Cardiogenic shock, hypoxemic respiratory failure, DIC, coma or seizure. Tx: respiratory and hemodynamic support +/- transfusion.
Risks: advanced maternal age, G>5, C section, preeclampsia, placenta previa or abruption

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6
Q

Presentation and tx of eclamptic seizures

A

Seizures w/ hypertension. Give Magnesium sulfate.

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7
Q

Patient has weakness after asthma attack - why?

A

Treated with b2 agonists - drives K+ into cells, get hypokalemia - weakness, arrhythmia, and EKG changes. B2 agonists also get tremor, palpitations, headache.

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8
Q

What happens in asthma w/ GERD

A

Commonly comorbid. GERD causes microaspiration and can increase vagal tone and bronchial reactivity.

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9
Q

Tx of PE in patient with CKD? What can’t you use?

A

Unfractionated heparin - monitor with aPTT. Dont use enoxaparin, fondaparinux, or rivaroxaban (Xa levels would build up)

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10
Q

What is the step up tx pattern for asthma?

A

Rescue SABA, low dose ICS, low dose ICS + LABA, up doses of ICS + LABA, maybe adjuncts, last is oral corticosteroid

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11
Q

Do you use ipratropium in asthma?

A

Not typically; used in COPD

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12
Q

What is contraindicated as a monotherapy in asthma?

A

LABA. Only use in combination with an ICS.

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13
Q

How to treat anaphylaxis? Mode of delivery?

A

IM epinephrine (IV only if failed IM, has more SEs); adjuncts like antihistamines (help skin sx) and glucocorticoids (act slowly but can prevent relapse); airway support

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14
Q

pH of pleural effusion - transudative? exudative?

A

Trans - 7.44-7.55 (nml 7.6)

Exudate - 7.30-7.45

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15
Q

Causes of low pleural fluid glucose?

A

complicated parapneumonic effusion, malignancy, tb, RA

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16
Q

Main findings in granulomatosis with polyangiitis

A

Wegener’s - 30-50yo white
- upper and lower respiratory tract granulomatous inflammation (chronic sinusitis, otitis, lung nodules, tracheal narrowing with ulcers) and glomerulonephritis

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17
Q

what symptom might acetylcysteine treat?

A

it’s a mucolytic - but may increase risk bronchospasm in COPD exacerbation

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18
Q

When would you use inhaled corticosteroid (like fluticasone)?

A

long-term management of persistent asthma. don’t help in COPD exacerbation. Maybe helpful in reducing exacerbation frequency.

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19
Q

What inhaler to give in a COPD exacerbation?

A

inhaled bronchodilators - B2 agonist and anticholinergic

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20
Q

In malnutrition causing macrocytic anemia, which vitamin deficiency usually comes first? And why?

A

Folate deficiency - folate has much smaller stores. Lots of B12 stores - takes years to develop deficiency, usually.
- That’s why we give FOLATE to pregnant women, because the stores are that much smaller!

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21
Q

Cushing syndrome, way to remember, and causes

A

high urine cortisol 24hr. cushing like cushion (Face, central adiposity); adrenocortical adenoma, hyperplasia

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22
Q

Why are NSAIDs bad in kidney disease?

A

constrict afferent arteriole

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23
Q

What to do with patient with tachycardia to 240, young, BP 65/37?

A

Cardiovert! Any arrhythmia with hemodynamic instability.

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24
Q

signs someone is unstable during arrhythmia and needs cardioversion

A

hypotension, AMS, signs of shock, ischemic chest discomfort, acute heart failure

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25
Q

when would you defibrillate?

A

v fib or pulseless v tach

- this is unsynchronized, high energy

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26
Q

arrhythmia seen in digitalis toxicity?

A

atrial tachycardia with AV block (one of the few times to see ectopy at same time as AV block)

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27
Q

megacolon (or megaesophagus) + heart disease is?

A

Chagas. Chronic protozoal disease caused by Trypanosoma cruzi. Common in Latin America.

Focal GI dilation from destruction of nerves

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28
Q

Most common cause of a liver mass?

A

Metastatic disease.

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29
Q

Common presentation of cholangiocarcinoma? And usually had this disease previously?

A

Sx of biliary obstruction - jaundice, pruritus, light stools, dark urine. Had primary sclerosing cholangitis.

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30
Q

What is PCWP a measure of?

A

LA pressure - and LV end diastolic pressure

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31
Q

In septic shock, what happens to cardiac index? SVR? MvO2?

A

Increase CI
Decreased SVR
INCREASED MvO2 due to hyperdynamic circulation (can’t use it fast enough!)

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32
Q

alcoholic cirrhosis - describe typical liver size and enzymes?

A

shrunken, not palpable. AST:ALT > 2:1

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33
Q

hemochromatosis - mild or significant transaminitis?

A

significant

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34
Q

Key to good outcomes in out of hospital sudden cardiac arrest?

A

Time to Effective CPR, and time to rhythm analysis and defibrillation. Usually from sustained v tach or v fib, probably from MI.

(Studies show better effectiveness of compression only CPR for bystanders)

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35
Q

When do you use epinephrine in ACLS?

A

Asystole, PEA (pulseless electrical activity), or refractory ventricular arrhythmias unresponsive to defibrillation

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36
Q

When do you see pulsus paradoxus and why?

A

Fall in SBP by more than 10 mmhg during inspiration. See in cardiac tamponade or restrictive pericarditis. Or asthma or COPD (drops in intrathoracic pressure a lot more, blood pools in pulmonary vasculature)

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37
Q

Sudden onset chest and neck pain in Marfan’s?

A

Aortic dissection - worry about regurgitation and associated murmur, too

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38
Q

Toxicity of high doses (or long tx with) nitroprusside?

A 
Cyanide toxicity (when high doses given for hypertensive emergency). Particularly in renal insufficiency. See AMS, lactic acidosis, seizure, and coma. 
- Nitroprusside as parenteral vasodilator, quick onset and offset. Metabolism releases NO and CN- ions. The NO causes arteriolar and venous dilation
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39
Q

Causes of unconjugated hyperbilirubinemia - including genetic

A

Hemolysis, overproduction, reduced uptake (TIPS), and Gilbert’s (low UDP glucuronyltransferase)

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40
Q

Causes of conjugated hyperbilirubinemia - including genetic

A

problems in liver (high AST and ALT - think hemochromatosis or hepatitis)

  • problems in biliary tract (high alk phos - think cholestasis, malignant biliary obstruction maybe from pancreas, cholangiocarcinoma) - primary biliary sclerosis, primary sclerosing cholangitis, or choledocholithiasis
  • Normal transaminases: Rotor’s (the motor rotor to push out the bili is broken) or Dubin Johnson
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41
Q

Physiology and symptoms of Wilson’s disease

A

Mutation in ATP7B - hepatic copper accumulation - leaks and goes to basal ganglia, cornea, etc
Get liver failure, neuro (parkinsonism, gait, dysarthria), and psych (depression, personality change)

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42
Q

Dx and tx for wilson’s disease

A

Dx: low ceruloplasmin, KF rings, more copper on liver biopsy
Tx: Chelators like d-penicillamine and trientine; or zinc (interfers w/ copper absorption)

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43
Q

transient monocular vision loss in 30yo?

A

Amaurosis fugax - disorders anterior to the optic chiasm

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44
Q

Fibromuscular dysplasia

A

Noninflammatory, nonatheroscloerotic - cause involvement in carotid artery, renal artery, and vertebrals.

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45
Q

Renin and aldosterone levels in primary hyperaldosteroneism

A

High aldosterone - this suppresses renin, so have aldosterone/renin ratio >20

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46
Q

What is dexamethasone suppression for?

A

Cushing’s (central obesity and moon facies like a cushion, purple striae, proximal mm wasting, glucose intolerance and hypertension

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47
Q

drugs to hold before a cardiac stress test

A

b blocker, CCB, nitrate; day of don’t use caffeine

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48
Q

Name an ultra short acting b blocker

A

esmolol

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49
Q

Classic triad in renal cell carcinoma

A

hematuria, abdominal mass, flank pain (contrast enhancing lesion on CT)

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50
Q

How to diagnose Boerhaave’s

A

Transmural esophageal rupture - get CT or contrast esophagography with gastrographin. CXR may show wide mediastinum with pleural effusion (L) - effusion with low pH and high amylase

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51
Q

Most common cause of sudden cardiac arrest post acute MI?

A

Reentrant ventricular arrhythmia! ( v fib) - also common are PVCs and sustained or nonsustained v tach. And re-entry is the most common mechanism for these arrhythmias.

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52
Q

What is orthodeoxia

A

decreased o2 sats while upright- often seen with platyptnea - increased dyspnea while upright. See in setting of hepatopulmonary syndrome - intrapulmonary vascular dilations in setting of chronic liver dz. Essentially shunts through areas with poor oxygen perfusion.

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53
Q

Extrahepatic issues in chronic hepatitic C?

A

derm: porphyria cutanea tarda (fragile, photosensitive skin that develops vesicles and bullae with trauma or sun - eg dorsum of hand).
Renal: membranoproliferative glomerulonephropathies
Heme: mixed cryoglobulinemia syndrome (palpable purpura, arthralgias, glomerulonephritis, low complement)
Systemic: fatigue, arthralgia

54
Q

Sx in a1 antitrypsin:

A

emphysema, chronic hepatitis, cirrhosis, panniculitis (painful pannus w/ erythematous nodules, plaques on thighs or buttocks)

55
Q

Heart failure in otherwise healthy young(ish) person

A

Dilated cardiomyopathy from viral myocarditis - parvovirus B19, coxsackievirus, adenovirus, influenza and HIV.
May also see chest pain mimicking MI
Usually have viral prodrome

56
Q

Coccidiodomycosis typical presentation

A

Looks like community acquired PNA - see in Southwestern USA

57
Q

Main treatment of chronic Hep C

A

Strategies to prevent further liver damage. Quit drinking, vaccinage Hep A and B. Evaluate for cirrhosis / varices.

58
Q

Treatment for severe alcoholic hepatitis

A

Prednisolone

-see fever, abd pain, jaundice, nausea, vomiting

59
Q

Leriche syndrome (triad of sx with aortoiliac artery occlusion)

A

bilateral hip/buttock/thigh claudication, impotence, and symmetric atrophy of bilateral lower extremities. Chronic ischemia.

60
Q

List 4 causes of ankle swelling

A

Venous insufficiency, renal insufficiency, right heart failiure, or liver disease

61
Q

how long after MI would you expect papillary MM rupture? free wall or septal wall rupture? reinfarct? pericarditis or LV aneurysm?

A 
papillary mm rupture - 2-7 days
wall rupture - hours - 2 weeks
pericarditis - 1 day - 3 months
LV aneurysm - 5 days - 3 months
reinfarct - hours - 2 days
62
Q

1 month after MI, still have ST elevations and deep q waves, what is this?

A

ventricular aneurysms

63
Q

EKG findings for acute inferior MI - and what artery? what ventricle?

A

RCA - see STEMI in II, III, avF. (Right ventricle)

Can happen after aortic dissection!

64
Q

Symptoms of right ventricular MI - and what artery?

A

hypotension, JVD, and clear lung fields - RCA

65
Q

Symptoms of digoxin toxicity

A

anorexia, n/v, fatigue; abd pain, confusion, color vision alteration

66
Q

What is the risk of gadolinium? why is it used?

A

It’s used for MRI contrast

Risk: nephrogenic systemic fibrosis - long term complication, not good for kidney problem pts

67
Q

Chest pain in CKD patient, relieved by sitting forward?

A

Uremic pericarditis. Particularly when BUN >60. Needs dialysis.

68
Q

Name 2 cardioselective beta blockers

A

carvedilol and metoprolol ER (don’t use in acute CHF!)

69
Q

Labs to get after initial dx of HTN

A

UA for occult hematuria, UPC ratio, BMP, lipids, baseline ECG

70
Q

Biggest risk factors for AAA expansion and rupture

A 
1 - pre-existing large diameter
2 - rate of expansion
3 - current cigarette smoking
(uncontrolled HTN is small risk factor!)
-- repair if >5.5cm or >1 cm/yr, or symptomatic
71
Q

Side effects of amiodarone: cardiac, GI, endocrine, pulm, derm

A

cardiac: QT prolong / torsades, sinus brady/heartblock
GI: transaminases,
Endo: hypo/hyperthyroid
Pulm: chronic interstitial pneumonitis **
Derm: blue gray skin
Ocular: corneal microdeposit, optic neuropathy

72
Q

How might a pt abort a vasovagal episode?

A

Stop neurocardiogenic syncope by counterpressure measures. Cross legs tensely, handgrip - to improve venous return and cardiac output.

73
Q

symptoms of CHF in otherwise healthy, younger patient?

A

Think viral myocarditis - like coxsackie virus

74
Q

Concentric vs eccentric ventricular hypertrophy?

A

Concentric: from chronic pressure overload
Eccentric: from chronic volume overload, like in valvular regurgitation

75
Q

Nondihydropyridines: name two - name primary mechanism

A

verapamil, diltiazem - reduce rate (AV nodal slowing - ‘north of the av node) and contractility - potent vasodilator to increase

76
Q

Dihydropyridines:

A

amlodipine, nifedpine - coronary artery vasodilation (increase myocardial supply) and systemic arterial vasodilation to reduce afterload
- can cause reflex tachycardia 2/2 decreased afterload - good to use with BB in angina

77
Q

Other name for ventricular preexcitation?

A

Wolff Parksinson White - short PR with wide QRS and delta

78
Q

What do you need to have after a drug-eluting stent (for CAD) is placed?

A

dual anti platelet therapy - aspirin + P2y12 inhibitor (clopidogrel etc). Watch for subacute thrombosis - particularly med noncompliance as risk predictor in first 12 months

79
Q

Signs of most common cardiac tumor

A

Myxoma - usually left atrium - mimicks atrial valve disease, early diastolic rumble/plop

80
Q

Indications for Statins:

A

1 - clinically significant atherosclerotic disease (CAD, PVD, Carotid stenosis)
2 - LDL >190
3- age 40-75 w/ diabetes
4- ascvd >7.5

81
Q

What does electrical alternans signify?

A

Pericardial effusion - often 2/2 viral URI

- QRS amplitude varying beat to beat

82
Q

Name one thing that RBBB may signify if new onset?

A

pulmonary embolism

83
Q

bradycardia, AV block, hypotension and diffuse wheezing suggests? tx?

A

beta blocker overdose. Causes cardiogenic shock, hypoglycemia, bronchospasm from beta 2 blockade, and neurologic dysfunction
-give glucagon. increases intracellular cAMP. Good for BB and CCB toxicity. Can also give IV calcium, vasopressors, insulin and glucose, and IV lipids

84
Q

Digoxin toxicity and treatment?

A

Tox: fatigue, anorexia, nausea, blurred vision, changed color perception, and arrhythmia
Tx: dig specific antibody

85
Q

Cocaine intoxication toxicity tx if you think they also have myocardial ischemia?

A

Chest pain - give benzo. beta blocker is contraindicated

Also aspirin because predisposes to thrombus formation. And nitroglycerin and CCB if needed

86
Q

common heart sound during acute MI?

A

S4

87
Q

two main causes of galactorrhea outside of pregnancy?

A

pituitary adenoma, dopamine antagonists like antipsychotics - which causes hyperprolactinemia

88
Q

Visual cortex damage (occluded posterior cerebral artery) vs optic tract or optic radiation damage?

A

Optic tract: contralateral hemianopia (left side of world is blind)
Cortex / PCA: contralateral hemianopia BUT macular sparing due to collateral flow from MCA

89
Q

acute painful vision loss with abnormal pupillary response to light?

A

optic neuritis - think about MS

90
Q

what is pseudotumor cerebri? age/sex most common?

A

idiopathic intracranial hypertension.
MC in obese women >45
Presents with headache, transient visual sx, and pulsatile tinnitis.
Exam: papilledema, 6th nerve palsy, visual field loss

91
Q

Cause of episode of painless hematuria in 17yo AA boy?

A

Possibly renal papillary necrosis 2/2 sickle cell trait. Also can have UTIs, painless hematuria, renal medullary cancer. Inability to concentrate urine.

92
Q

Name several categories of syncope

A 
Vasovagal / neurocardiogenic - prodrome
Situational (cough, micturition, BM)
Orthostatic
LVOT obstruction (AS, HCM)
Ventricular arrhythmia
Sick sinus, bradyarrhythmia, AV block
Long QT - Congenital or Torsades (hypokalemia, hypomag, long QT)
93
Q

isolated systolic hypertension

A

2/2 increased arteriolar wall stiffness and decreased elasticity

94
Q

McCune Albright sx

A

ovarian cyst (may cause precocious puberty), polyostotic fibrous dysplasia of bone, and café au lait spots

95
Q

DiGeorge syndrome

A

absent thymus, congenital absence of parathyroid glands = hypoparathyroid = cause hypocalcemia (tetany, long QT), tetany in first 48 hrs of life, immunodeficiency, cardiac anomalies, and midline facial defects

96
Q

Hypertension, hypokalemia, hypernatremia, and edema

A

Hyperaldosteronism! See weakness and edema

Low renin if primary dz (uncommon)

97
Q

Causes of central DI? Nephrogenic DI?

Main sx and cause of DI?

A

Sx: tons of dilute urine 2/2 no ADH effect
Central DI: lack of ADH from posterior pituitary - idiopathic, trauma, neoplasm, sarcoid, granuloma
Nephrogenic: meds (lithium, demeclocycline)

98
Q

Name a bunch of causes of SIADH:

A

stroke, hemorrhage, infection, trauma. Oxytocin (in pregnant patients), narcotics, PAIN, PNA, small cell cancer

99
Q

Weakness, dizziness, sweating, n/v after eating -

hint - especially after some sort of surgery

A

Dumping syndrome. Anything with small stomach or missing pylorus.

100
Q

Symptoms of pernicious anemia…. other than just vitamin B12 deficiency anemia

A

Achlorhydria! Destroyed acid secreting parietal cells.

101
Q

Causes of secretory diarrhea

A

bacterial toxin (e coli, cholera), VIPoma (pancreatic islet cell tumor), or bile acids after ileal resection

102
Q

Is toxic megacolon more likely with UC or Crohns?

A

UC

103
Q

TTP pentad

A

thrombocytopenia, microangiopathic hemolytic anemia, renal insufficiency, neurologic changes (AMS), fever.
- Live threatening small vessel thrombotic dz! Normal coags!

104
Q

hot thyroid nodule is high or low risk for canceR?

A

LOW. if low TSH with hot nodule, just tx for hyperthyroid without FNA>

105
Q

Name an antibiotic used to treat MSSA, but can cause AIN version of AKI

A

nafcillin

106
Q

Name a drug/class commonly used for serious gram negative infections, but can be nephrotoxic

A

aminoglycosides - like amikacin

107
Q

Sudden and severe headache, brief LOC, n/v, and meningismus?

A

subarachnoid hemorrhage

108
Q

Suspected acute stroke first step?

A

CT head w/o contrast

109
Q

acute focal neurologic deficits gradually worsening over minutes to hours - first concern?

A

stroke! probable intracerebral hemorrhage

110
Q

vincristine and vinca alkaloids / platinum based chemo neuropathy sx

A

symmetrical paresthesias, stocking-glove pattern. early loss of ankle jerk reflexes, and loss of pain and temperature sensation.

111
Q

Does ILD have impaired gas exchange? High or low FEV1/FVC? Normal or high A-a gradient?

A

Impaired gas exchange / DLCO
NML or even elevated FEV1/FVC ratio (both both are low)
Big A-a gradient

112
Q

New DM2 diagnosis - what do start with for glucose control? What not to use for lipid help in this patient?

A

Always lifestyle modification, but probably add on metformin right away. Goal <7.5 A1c.

Don’t use niacin in diabetes - can worsen BS control

113
Q

Tx for recent lyme disease? What if severe/meningitis with lyme? What about <8yo or pregnant?

A

Doxycycline for most. IV ceftriaxone for severe. Amoxicillin for kids b/c doxy stains teeth.

114
Q

severe hypercalcemia with pancytopenia suggests? how to treat first? then diagnose what second?

A

First IV fluids for hypercalcemia. Then bone marrow biopsy to look for suspected multiple myeloma!

115
Q

what causes warfarin-induced skin necrosis? what factors does warfarin inhibit?

A

necrosis: protein C deficiency - usually early in therapy. C gets blocked first - turns into transient hypercoagulability.
inhibits: II, VII, IX, X, C and S

116
Q

subdural hematoma vs epidural. Which is biconvex? which crosses suture lines?

A

subdural: rupture of bridging veins, concave; 1-2 days after injury. Crosses suture lines.
epidural: miningeal arteries, bigger trauma; convex

117
Q

what commonly causes lacunar strokes?

A

HTN causing hyalinosis of penetrating branches of major cerebral arteries. Lacunes are small, often missed on early CT; deep = BG, thal, internal capsule

118
Q

sudden clap of headache, brief LOC, then meningismus - what happened?

A

subarachnoid hemorrhage

119
Q

risks of being small for gestational age?

A

Long term hypoxia can lead to polycythemia, hypocalcemia, hypoglycemia, hypothermia 2/2 low SC fat, meconium aspiration

120
Q

Suspect pyoderma gangrenosum in patient with a large painful ulcer and what underlying health condition?

A

Violaceous border to the ulcer

Hx of a systemic disease, like IBD, UC, arthropathies, RA, or heme stuff (AML)

121
Q

Risk factors for RCC?

A

smoking, HTN, diabetes= the basics

122
Q

Patient has ischemic stroke. also hemineglect - where was stroke?

A

Most likely R (or non-dominant) parietal lobe. MCA or PCA. May also have anosognosia - inability to learn self-awareness.

123
Q

anion gap metabolic acidosis, abdominal pain, n/v, hematemesis. Radioopaque pills on CXR. Hypotensive shock.

A

Iron poisoning! Can have acute onset, 30 min to 4 days. Give: whole bowel irrigation, deferroxamine.

It’s corrosive to the GI mucosa! Also potent vasodilator, cellular toxin

124
Q

dry eyes, dry mouth, dysphagia to solids - likely diagnosis? first test?

A

Sjogren syndrom - most common in middle age women. Text with anti Ro and anti-La (SSA and SSB, respectively) antibodies first.

Dry mouth causes caries.
Can biopsy salivary (submandibular glands) if others are nondiagnostic

125
Q

Suspecting acromegaly - first test? Main sx?

A

Get IGF-1 level. Always elevated in acromegaly. Then oral glucose suppression test, doesn’t suppress growth hormone in acromegaly!
Sx: coarse facial features, arthralgias, HTN, enlarging digits, carpal tunnel.

126
Q

Acid base disturbance in DKA? Expected Na? Glucose? K?

A

low nml Na (also low phos)
Glucose HIGH
K high due to intracellular shifts 2/2 plasma hypertonicity and loss of insulin dependent shifts (but total body K is down due to loss in urine!)
Metabolic acidosis, low bicarb

127
Q

workup of male hypogonadism -

A 
testosterone, LH, FSH. Primary hypogonadism = low T, high FSH/LH. Fine, can give T?
Secondary = low or nml FSH/LH also. Check for prolactin level. If high, check other pituitary hormones. If more problems, consider imaging. 
Pituitary adenoma (tx with dopamine agonists!) mass effects, visual field defect
128
Q

Diabetic nephropathy - what level becomes macroproteinopathy?

A

> 300 mg/24hrs

129
Q

What causes Graves ophthalmopathy? What is it?

A

Cause: T cell activation and stimulation by orbital fibroblasts by TSH receptor autoantibodies, leading to expansion of orbital tissues
Sx: ocular irritation, impaired extraocular movtion, and proptosis

130
Q

Relevance of urine staining positive with prussian blue?

A

Stains hemosiderin. Found in urine during hemolytic episodes (e.g. in G6PD flare after sulfa drug, infection, antimalarial drug, or nitrofurantoin)

131
Q

Patient on antithyroid drugs (like propylthiouracil) + new sore throat and fever - indicates?

A

Concern for agranulocytosis. Check WBC count (for ANC <1000 is concerning)

Step 2 CK z (5 decks)

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