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UW Notes 4 Flashcards

1
Q

What is the shape of cystine renal stones?

How do you diagnose cystinuria?

A

hexagonal opaque

diagnose with urine cyanide nitroprusside test

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2
Q

what’s the difference between acute otitis media and otitis media with effusion?

A

AOM is acutely inflammed and can/likely have effusion

otitis media with effusion is not acutely inflammed

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3
Q

what is the time frame for PCI s/p MI?

A

12 hours since symptoms started
90 minutes door (aka medical contact) to balloon time.
or 120 minutes door to thrombolytic therapy

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4
Q

why is it that small for gestation babies can have hypoglycemia? AND hyperglycemia?

A

hypoglycemia because they’re small with little glycogen store.

hyperglycemia because they have insufficient insulin

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5
Q

If pt is brain dead. who do you need permission from before removing support?

A

no one

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6
Q

If you’re worried about pancreatic cancer how do you evaluate it?

A

CT scan. If there’s obstructive chole then you can do an US first

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7
Q

can LMWH cause HIT?

A

yes

Sx of thrombocytopenia + thrombosis of A &V

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8
Q

ADHD is associated with what other psych disorder?

A

oppositional defiant

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9
Q

ankylosing spondylitis. you do an xray to test for it even though it might not show anything at first… but why don’t you do a HLAB27 to start with?

A

only few people with HLA b27 have ankylosing spondylitis; but almost al AS patients have HLA b27

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10
Q

what med is used to treat pericaditis?

A

ibuprofen

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11
Q

what are the two options for bioplar longterm maintenance therapy? which is preferred when?

A

lithium is the standard. but Valproate is preferred when pt’s RENAL function is bad

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12
Q

is goodpastures nephrotic or nephritic?

A

nephritic

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13
Q

nitroprusside can precipitate what poisoning? what are the sx?

A

cyanide poisoning. it can precipitate seizure, AMS, coma, actic acidosis

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14
Q

what is spinal shock?

A

it is where spinal injury initially result in flaccid paralysis. This will change over the next days into UMN defect

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15
Q

what are the recommended vaccines for an older person with HIV?

A

influenza, hepB, varicella if CD4>200; Td q10y; and PCV13/PPSV23

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16
Q

There’s an increased incidence of what with erythromycin in infants?

A

pyloric stenosis

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17
Q

class IC, like flecainide, are “use dependent”. In faster heart rates they can’t dissociate as well from the Na channels… what change can be seen on ECG?

A

widenened QRS complex

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18
Q

Odds ratio is calculated for case control studies; Relative risk is calculated for cohort studies. Odds ratio is a a good approximation of relative risk when what is true?

A

when disease is rare the RR is a good approximation of OR

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19
Q

antithyroperoxidase antibodies are seen in what disease?

A

Hashimoto

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20
Q

orchipexy for cryptochidism removes chances of hernia and torsion but does not remove chances of waht?

A

lowered sperm count and cancer

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21
Q

what should you do if pt develops tardive dyskinesia while on antipsychs?

A

wean to a lower dose.

If you NEED it then you switch to CLOZAPINE

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22
Q

young person with kyphosis, high arch, hammer toe, ataxia. what is this?

A

Freidrich’s ataxia.

cardiac and resipiratory problems are most common.

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23
Q

what are the quad findings in Trisomy 21?

A

betahCG high, inhibin A high, estriol low, AFP low

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24
Q

What are the quad findings in Edward syndrome Trisomy 18

A

beta hcg low, inhibin A normal, estriol low, AFP low

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25
Q

what does high AFP in quad screen mean?

A

abd wall defect, neurotube defect, or multiple gestation

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26
Q

what is the Epo level like in Polycythemia vera?

A

Epo is low. Epo is upstream activator of JAK2… thus jak2 mutation will constitutively activation RBC synthesis… and Epo will be suppressed via neg feedback

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27
Q

what are three saline resistant metabolic alkalosis etiologies?

A

Cushing’s
primary hyperaldosterone
severe hypokalemia

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28
Q

what should you give to step pneumo meningitis pt other than abx

A

dexamethasone

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29
Q

empiric tx for meningitis

A

cefipime, vanco, +/- ampi

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30
Q

Secondary amyloidosis (AA)… what is the treatment?

A

colchicine

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31
Q

what are the sx of amyloidosis ?

A

hypertrophy of heart, 4th heart sound, palpable kidney, hepatomegaly

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32
Q

What are some complications from pos pressure mechanical ventilation?

A

ARDS, pneumonia, pneumothorax

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33
Q

kidney stone in a pregnant person. how to dx?

A

US

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34
Q

what organism is the most common in CF children for pneumonia? treatment?

A

staph aureus. vanco IV

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35
Q

what is the empric abx treatment for

A

floroquinolone (moxi); OR ceftriaxone + azithromycin

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36
Q

boy with gout

A

lysch nyhan

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37
Q

pt with Guillain barre… what test should you do to assess breathing?

A

Spirometry

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38
Q

what condition is most strongly associated with stroke

A

hypertension

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39
Q

how do you treat myesthenia crisis?

A

you do plasmaphoresis; also ABCs

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40
Q

what is the biggest cause for cerebral palsy?

A

prematurity (intrapartum hypoxia accounts for a small number)

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41
Q

abortive migraine treatments? name 2

A

prochlorperazine, tryptans

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42
Q

prophylactic migraine treatment?

A

propranolol

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43
Q

immunoCOMPETENT person with ring enhancing lesion. what is it?

A

brain abscess.

if associated with sinusitis–>think viridans strep

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44
Q

Rh incompatibility could be a huge deal. However, ABO isn’t. why?

A

ABO incompatibility usually only cause very mild disease in infants. They can develop some neonatal jaundice and can be treated with photothreapy

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45
Q

Simple cystitis UTI can be treated empirically and no cultures are needed. what are the drug choices

A

SMX-TMP for 5 days; nitrofurantoin for 3 days, or fosfomycin single dose

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46
Q

What is complicated UTI/cystitis? and how should you treat it?

A

pregnancy, immunocompromised, caused by procedure, hospital acquired, diabetes, chronic kidney disease
you need a culture before abx… which should be floroquinolones

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47
Q

what is the treatment of choice for SCFE?

A

surgical fixation

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48
Q

who should get meningococcal vaccination? age and population?

A

age: 12 and booster at 16
group: college dorm, military recruits, and subsaharan african

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49
Q

Light’s criteria is used to do what? what is it?

A

it’s used to determine exudate versus transudate. fluid/serum protein >0.5; and fluid/serum LDH >0.6 is exudate

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50
Q

what’s the acid base disturbance associated with Conn’s syndrome?

A

metabolic alkalosis

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51
Q

baby with mousy odor

A

PKU

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52
Q

what deficiency caues abnormal taste?

A

zinc. along with alopecia, poor wound healing

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53
Q

wallenberg syndrome is blockage of what vessels? x2

A

PICA or vertebral art

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54
Q

TB can cause adrenal insufficiency via infiltration. What pH problem can develop?

A

metabolic acidosis due to decreased aldosterone–> decreased rid of K and H

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55
Q

nephrotic syndrome in the presence of organ enlargement (liver/kidney)

A

amyloidosis

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56
Q

Hypothyroidism can cause what effects on lipids? sodium? creatinine and liver enzymes?

A

it can cause hyperlipidemia, hyponatremia, and asymptomatic elevation of creatinine and liver enzymes

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57
Q

schizophrenia CT head findings?

A

enlarged ventricles decreased cortical volume

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58
Q

define hypertensive urgency?
hypertensive emergency?
malignant hypertension?

A

urgency is BP >180/120
emergency is any sx + the BP
malignant HTN is BP + retinal exudates, hemorrhage, papilloedema

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59
Q

what are some long term sequelae of meningititis?

A 
hearing loss
cognition loss
seizures
mental retardation
spasticity/paresis
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60
Q

primary biliary cirrhosis. what is the treatment?

A

ursodeoxycholic acid

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61
Q

how do you diagnose avascular necrosis of the fem head?

A

MRI

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62
Q

3 features of wernicke’s encephalopathy?

A

confusion
nystagmus
ataxia

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63
Q

why can IV acyclovir be associated with renal failure? what should you do to prevent this?

A

it can cause crystal precipitation.

you should aggressively hydrate to prevent

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64
Q

immunecompromised people can get invasive aspergilosis of the lungs. Sx include fever, hemoptysis, chest pain. What does it look like on Xray?

A

nodule with surrounding ground glass opacity

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65
Q

What are the signs of felty syndrome? what is this associated with?

A

Felty is arthritis, spenomegaly, and neutropenia.

it’s associated with severe rheumatoid arthritis

66
Q

renal tubular acidosis type 1 is where and what’s the defect?

A

it’s distal tubule; decreased excretion of H

67
Q

renal tubular acidosis type 2. where is it and what’s the defect?

A

proximal tubule decreased reabsoprtion of bicarb

68
Q

what are some ototoxic drugs?

A

aminoglycoside
loop diuretics
asprin
chemo agents

69
Q

when should babies regain their birthweight?

A

by 2 weeks

70
Q

features of wiskot aldrich?

A

thrombocytopenia, eczema, and recurrent infections

71
Q

chronic granulomatous diseae is defect in NADPH oxidase enzyme leading to inability to kill catalase positive organisms. how to dx?

A

dx via dihydrorhodamine test or

nitroblue tetrazolium test

72
Q

what’s the most accurate method of estimating gestational age?

A

1st trimester US

73
Q

cutaneous larva migrans is caused by what?

A

hook worm

74
Q

hypercalcemia that’s NOT related to parathyroid is msot likely due to what

A

malignancy

75
Q

Immediate anticoagulation in a pt with renal disease…what med should you use?

A

heparin is preferred; NOT LMWH

76
Q

what do you use to encourage weight gain in cachexic patients?

A

progestrone analogs

77
Q

pulseless electrical activity should be treated how?

A

Chest compressions with vasopressors

78
Q

what are the 5Ts and 5Hs that can cause PEA?

A

hypovolemia, hypoxia, hyper/hypokalemia, hypothermia, hydrogen ions (acidosis)

Trauma, Thrombosis, Tension pneumo, Tamponade, toxins

79
Q

exertional heat stroke definition

A

Temp >104 and encephalopathy

80
Q

skin TB test. how big does the indurated area have to be to be psoitive if the pt is HIV+

A

5mm

81
Q

NAFLD is associated with what condition?

A

insulin resistance

82
Q

systemic sclerosis antibody?

A

anti topoisomerase I

83
Q

pt without vaccination for hep B is exposed, what should you do?

A

immunoglobulin AND vaccinaion immediately

84
Q

scabies treatment?

A

Ivermectin or permetherin cream

85
Q

allergic rhinitis treatment?

A

intranasal glucocorticoid spray

86
Q

what meds should you hold for a stress test?

A

for 48 hours: betablockers, calcium channel blockers, nitrates, vasodilators
for 12 hours: hold caffeine

87
Q

mechanism of diphenhydramine?

A

antihistamine and anticholinergic

88
Q

what are appropriate treatments for asymptomatic bacteriuria in pregnancy?

A

cephalexin, amoxicillin, nitrofurantoin

89
Q

type 4 renal tubular acidosis is characterized by what

A

hyperkalemia with non anion gap metabolic acidosis, and moderate renal insuff

90
Q

croup has cough bronchiolitis does not. how do you treat croup?

A

steroids and racemic epi

91
Q

asplenia predisposes to what kind of organisms?

A

encapsulated. strep pneumo, hemophilus, neisseria

92
Q

hyperpigmentation occurs with what kind of adrenal disease?

A

primary adrenal insufficiency ONLY. not secondary. pigment is due to over production of ACTH

93
Q

lung nodules of what size are worrisome for malig?

A

> 2cm

94
Q

parvo 19 in adults involve 1 or many joints

A

many

95
Q

how should ticks be removed?

A

with tweezers

96
Q

what diseases are carried by ixodes?

A

lyme, babesiosis, anaplasmosis

97
Q

criteria for prophylaxis in lyme disease

A

attached tick, >36 hours or engorged, endemic area, prophylaxis started within 72 hours of tick removal, no doxy contraindication (<8, preg, or lactating)

98
Q

sensory defects followed by allodynia…where is the stroke?

A

thalamus

99
Q

what allows the confidence interval to narrow?

A

increased sample size

100
Q

how does HIT present in pts s/p subQ LMWH?

A

necrotic patches of purple and red on abd

101
Q

what meds other than isotretinoin can cause pseudotumor cerebri?

A

tetracyclins

growth hormone

102
Q

what’s the mutation in CML?

A

BCR-ABL 9:22

103
Q

what class of drugs can you use to treat CML

A

imatinib; tyrosine kinase inhibitors

104
Q

HIV linear esophageal ulcers (AKA YOU HAVE TO DO endoscopy to see it)

A

CMV esophagitis

105
Q

what are the 4 emergency contraception methods?

A

Copper IUD
Ulipristal
Levoprogestrel
Oral contraceptive pill

106
Q

B6 (pyridoxine) deficiency can cause sideroblastic anemia. Why?

A

because it inhibits protoporphyrin synthesis.

you can see “dimorphic RBC population’ of normochromic and hypochromic

107
Q

microcytic anemia. how can you tell if it’s thalassemia versus iron deficiency?

A

iron deficiency will have increased RDW >20;

thalassemia will have normal RDW

108
Q

what’s the treatment for atropic vaginitis? what’s the treatment for lichen sclerosis?

A

atrophic is low dose topical steroids;

lichen is high dose topical steroids

109
Q

Dopamine inhibits prolactin. What two things stimulate prolactin?

A

serotonin and TRH

110
Q

painless bloody stools in infants

A

milk protein colitis; or it could be meckles

111
Q

mets to the brain… what’s the most likely source?

A

lung…then melanoma, colon, breast

112
Q

pt in stable vtach. tx?

A

amiodarone

113
Q

torsade de ponte tx?

A

magnesium sulfate/ defibrillation

114
Q

sinus bradycardia. tx?

A

atropine

115
Q

torsade depointe due to quinidine?

A

sodium bicarb

116
Q

sx of babesiosis

A

fatigue, malaise, fever, hemolytic anemia and jaundice.
treat with atovaquon + azithromycin or quinine
do blood smear to visualize maltese cross

117
Q

pregnant person got rubella vaccination on accident. how do you treat

A

expectant management

118
Q

methemaglobinemia tx

A

methylene blue

119
Q

cyanide poisoning treatment?

A

sodium thiosulfate

120
Q

ethylene glycol treamtnt?

A

fomepizole

121
Q

the triad findings of hereditary spherocytosis

A

splene enlargement, jaundice, negative coombsn, also elevated mchc

122
Q

what blood abnomrlaities are associated with mono?

A

autoimmune hemolytic anemia and thrombocytopenia

123
Q

major side effects of cyclosporin?

A

nephrotoxicity, hyperkalemia, hypertension, gum hypertrophy, hirsutism, tremor

124
Q

major toxicity of azathioprine

A

diarrhea, leukopenia, hepatotoxicty

125
Q

mycophenolate toxcity

A

marrow suppression

126
Q

heat can damage what vitamin?

A

folate

127
Q

what’s mech of flutamide?

A

androgen receptor blocker

128
Q

social anxiety treatment if it’s performance related? if it’s not performance related?

A

performance related–>propranolol

performance unrelated–>behaviroal therapy; SSRI

129
Q

galactose 1 phosphate uridyl transferase deficiecy sx?

A

hypoglycemia, cataracts, jaundice, failure to thrive

130
Q

galactokinase deficiency sx

A

only cataracts

131
Q

tca antidote?

A

sodium bicarb

132
Q

cluster HAprevention and tx?

A

prevent with lithium, verapamil, ergotamine

133
Q

tx of bartholin cyst w/o infection?

A

observe

134
Q

euthyroid sick syndrome is characterized by what?

A

low T3 level normal T4 and TSH

135
Q

subclinical hypothyroidism is characterized by what?

A

low T4 level, normal TSH

136
Q

how to diagnose lactose intolerance?

A

breath hydrogen test, increased stool reducing agents, and increased stool osmotic gap

137
Q

factor V leiden mechanism?

A

increased resistance to fantithrombin C

138
Q

criteria for long term O2 therapy

A

Hct >55%, Sat O2 <89%, PaO2 <59

139
Q

measles…what kind of precaution is needed?

A

airborne (neg air pressure)…not droplet

140
Q

what marker in Hep b remains present during the window period? what are the two ebst tests for new hep B diagnosis?

A

HBc antibody IgM will be positive in the window period there fore Core IgM and surface antigen is the best.

141
Q

how do you treat botulinum poisoning?

A

horse derived antitoxin antibody for passive immunity

142
Q

how many percent is in 1 SD, 2SD, and 3SD?

A

68%, 95%, 99.7%

143
Q

criteria for actue liver failure?

A

marked elevated ast/alt; encephalopathy; synthetic dysfunction

144
Q

you suspect spinal cord compression. what should you do first? what should you do to image?

A

Give steroids; THEN do MRI

145
Q

hyponatremic patient…what’s the highest rate you can go up by?

A

0.5 meq/L/hour

146
Q

myastheniua gravis can be brought on by infections and what drug?

A

floroquinolones

147
Q

renal cyst filled with fluid…what do you do?

A

observe.

148
Q

most common congenital cyanotic disease… egg on string? Single S2

A

transposition of great vessel.

149
Q

acute bronchitis treatment?

A

symptomatic only.

typically Abronchitis is >5 days of coughing that easily mobilizes sputum

150
Q

Lyme treatment in preg or lactating?

A

amoxicillin

151
Q

patient presenting with pyelo…what’s first, second? when do you image?

A

first collect urine, second give abx empirically. Image if they don’t improve in 2-3 days

152
Q

what does CMV viremia look like?

A

pneumonitis, gastritis, hepatitis

153
Q

most common opportunistic organisms associated with transplants

A

CMV, PCP

154
Q

splenomegaly and elevated alk phos with nonspecific symptoms in CD4<50? prophylaxis drug?

A

MAC infection; prophylax with Azithromycin

155
Q

patient with PCP should be started on TMP-SMX at CD4 <200 and steroid should be added when?

A

if PaO2 is lower than 70

156
Q

name the live vaccines?

A

MMR, varicella, rotavirus, nasal influenza

157
Q

name the toxoid vaccines?

A

tetanus, diphtheria

158
Q

name the killed vaccines?

A

hep A, polio

159
Q

kids should be vaccinated according to their what age?

A

chronological

160
Q

back pain in third trimester is because of?

A

increased lordosis and increased laxity of pelvic joints

161
Q

if there’s one brain metastasis, but the patient is functioning well what should you do?

A

resect it?

162
Q

what should you do after a kid was exposed to varicella but currently has no sx?

A

vaccinate as prophylaxis

Step 2 CK (5 decks)

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