UW1 Flashcards
How do you treat X-linked agammaglobulinemia? What is this called when it presents later in life?
IVIG ; Common variable immunodeficiency
Where do melanocytes come from? What neonatal marks around the sacrum involve melanocytes?
Neural crest (S100); Mongolian spots
What are 2 interventions in extreme leukocytosis to prevent leukostasis?
Plasmapheresis and hydroxyurea
What is a major AE of didanosine?
pancreatitis
What is the solid form of Waldenstroms macroglobulinemia called?
Lymphoplasmacytic lymphoma
Where do the following ulcers classically occur: Venous stasis? PAD? DM neuropathy?
Medial malleolus; MTP (dorsal); Sole of foot
What is the best way to dx chronic pancreatitis and why?
CT of abdomen usually shows calcifications; lipase and amylase may be normal/low because so much parenchyma has been destroyed
Which cause of microcytic anemia often has a normochromic and hypochromic population of cells?
Sideroblastic anemia
What is the tumor marker for dysgerminoma?
LDH
Why may post-op pts be hypocalcemic?
Secondary to hemodilution from fluids or chelation with EDTA from tranfusions
Differentiate type I and type II hepatorenal syndrome
Type I = a two fold increase in creatinine > 2.5 in less than 2 weeks; Type II is a less severe form and is due to diuretic resistant ascites
At what BUN level do you typically see pericarditis as a result of uremia?
60
What is the first line medication for DM neuropathy?
TCA’s followed by gabapentin
If a person overdosed on their diabetic neuropathy medications how would you treat them?
NaHCO3 since it is a TCA overdose
What is the MC cause of acute hemolytic transfusion rxn?
Clerical error (i.e. ABO incompatibility)
What is the MC cause of lacunar strokes?
HTN causing lipohyalinosis of small vessels (i.e. lenticulostriate)
Pt with Paroxysmal Nocturnal Hemoglobinuria gets spontaneous ascites
Budd-Chiari Syndrome due to venous thrombosis
Which cells harbor CMV?
Monocytes (use leukoreduced PRBC)
What should be calculated to determine type of aki in a pt on diuretics?
Feurea because FENA will be elevated due to natriuresis from the diuretic
What are 3 possible causes of asterixis?
Uremia, CO2 retention (COPD), and liver failure (hyperammonemia)
What is the tx for restrictive pericarditis?
Definitive tx with pericardiectomy
What symptoms do MOST ppl with histoplasmosis have?
Asymptomatic
What are 3 opiods you cannot give SSRI’s with?
Meperidine, tramodol, DXM
What is an absolute contraindication to epidural anesthesia for labor?
Refractory maternal hypotension
What information does a positive low dose dexamethasone suppression test give you?
Tells you that there is hypercortisolism does not necessarily tell why
What tumor marker would you look for to detect the ovarian tumor responsible for precocious puberty in girls?
Inhibin (granulosa cell tumor)
What is a major AE of AZT?
Anemia (Zidovudine)
How do you typically deal with ring-enhancing tumors in AIDS pts?
First give sulfadiazine-pyrimethamine assuming it is toxo; if not get better then consider bx for CNS lymphoma (DLBCL assoc EBV, enters via CD21)
What drugs are CI in hepatic encephalopathy for agitiation?
Benzodiazepines since potentiate GABA and the hyperammonemia is causing potentiation of GABA
What is oscillopsia?
The sensation of things moving around in the peripheral vision secondary to vestibular issue
Tubulointerstitial nephritis can be induced by chronic use of what type of meds?
Analgesics
What are the sx of acute digoxin toxicity? Chronic?
Acute = Anorexia, NV, abd pain; Less likely GI more likely neuro i.e. yellow vision or scotomas
What should ya think for a pig farmer with seizures? Pig farmer with bloody diarrhea?
Neuricysticercosis (T. solium); Balantidium coli (ciliated protozoan)
What are some provocative meds for pseudotumor cerebri?
Doxy and retinoids
Atypical causes of PNA are best tx with what drug class?
Macrolides
What is the first line therapy for Goodpasture’s dz? Why not the same as Wegener’s
Cyclophosphamide and Cortiosteroids with plasmapheresis; not the same as for Wegener’s because there are anti-GBM Abs to clear out with plasma exchange not present in Wegener’s
How can you abort a cluster headache? What alternative dx may be the case if this doesnt work and pt is a female?
100% O2 and triptan; paroxysmal hemicrania
What defense mechanism is common in alcoholics and substance abusers?
Denial
How do you treat suspected CO toxicity? What if carboxyhemoglobin levels come back > 20 and person is severely sx?
100% O2 via nonrebreather; hyperbaric O2 (i.e. HBO)
What do you do for ascites that is refractory to max doses of spironolactone and furosemide?
Large volume paracentesis
What is the major difference between a leukemoid rxn and CML?
LAP score is low in CML and high in leukemoid rxn
Which is worse Mobitz I or II?
II? I is a progressively prolonged PR with dropped QRS; II is randomly dropped P waves and can spontaneously degenerate into 3rd degree AV block and often needs pacing
What effect does pulmonary edema have on lung compliance? A-a gradient?
Increased; Increased
What is type I RTA assoc with?
Autoimmune dz (it is distal, due to decreased H secretion) often complicated by nephrolithiasis with calcim PHOSPHATE stones and nephrocalcinosis
What is the most important risk factor for developing breast CA? What is the most important prognosticator?
Age; Tumor burden (i.e. stage)
What effect does hypocalcemia have on QRS? Hypercalcemia?
Prolongs; shortens
In whom is succinylcholine C/I and why? (4) What drugs are better in these pts?
Hyperkalemia (any cause), Demyelinating dz (d/t hyperK), Crush/Burn victims (d/t hyperK), and Tumor Lysis Syndrome (hyperK); Vecuronium or rocuronium
What should you do for a person with hearing problems and caf? au lait spots?
MRI with gadolinium for acoustic neuromas
What are leukoreduced PRBC used for?
Hx of febrile nonhemolytic transfusion rxn or seronegativity for CMV
What is the gest diagnostic test for posterior urethral valves?
Voding cystourethrogram
What is the benzo of choice for status epilepticus? What do use for rapid sequence intubation in these pts?
Lorazepam, propofol
What joints are affected in ankylosing spondylitis?
Facet joints leading to bamboo spine; sacroiliac joint
What is the solid form of ALL L3?
Burkitt Lymphoma
What is multifocal atrial tachycardia assoc with? What are the dx criteria?
COPD and pulm dz; > 3 P wave morphologies with rate > 100 if not then it is wandering atrial pacemaker
What are your 2 options for initial screening test for Cushing’s dz
24 hour urinary free cortisol or low dose (1mg) dexamethasone suppression test
What is the immeidate mgmt of Kawasaki dz?
ASA and IVIG
What causes splanchnic vessel blood pooling in hepatorenal syndrome?
increased nitric oxide production in splanchnic vessels
What is the first line tx for essential tremor? In whom would the second line agent be contraindicated and why?
Propanolol; Porphyria since primidone is metabolized to phenobarbital and can precipitate acute intermittent porphyria
What supplement is often provided in hereditary spherocytosis?
Folate; in times of extreme anemia may need tranfusion
What disease has degeneration of the lenticular nucleus? Who needs screened?
Wilson’s dz (Hepatolenticular degeneration); relatives of 1st degree relatives
Name 3 paraneoplastic syndromes of small cell ca
ACTH secretion, LEMS, and SIADH
In the outpatient setting what do you do if a person has cellulitis and fever?
i.e. if pt is toxic that is indication for admission with IV abx (IV vanc or maybe clinda)
What bug is the #1 cause of brain abscess resulting from sinusitis?
Viridans group strep
How do you Tx Wenckebach?
Nothing to do unless symptomatic on AV nodal blocking drugs then you can hold em
How should you treat a perimenopausal woman with complex hyperplasia without atypia?
Progestins (to oppose the estrogen) with repeat bx in 3-6 months; if there was atypia then hysterectomy
What are 3 first line tx for acute mania?
Valproate, lithium, or atypical antipsychotics
What are the coagulation studies like for Hemophilias A and B?
increased aPTT with normal PT
What is the most specific arrhythmia for digoxin toxicity? What other commonly used heart med predisposes? What electrolyte abnormality?
2 degree AV block with atrial tachycardia; very unusual to have ectopy and AV block at same time!; Amiodarone, Hypokalemia
What is the first line therapy for Wegeners granulomatosis? Why no plasmapheresis?
Corticosteroids and cyclophosphamide; there is nothing to clear out
What test is best to check if vesicoureteral reflux is progressing to calyceal clubbing and scarring?
Renal scintigraphy with dimercaptosuccinic acid
What is typically the first line medication for pre-eclampsia and gestational HTN? Contraindications?
Labetolol; asthmatics (can give alpha-methyldopa or nifedipine)
MOA of bupropion? C/I in who (2)
inhibits DA and NE reuptake by unknown mechanism; epileptics and bulimics
How do you treat otitis externa? Malignant otitis externa?
Ciprofloxacin and dexamethosone topically; IV ciprofloxacin
How do you ppx against toxo/pcp in AIDS if there is a sulfa allergy? What if also G6PD?
Dapsone, atovaquone
What can be done if there is no access to a mediastinal lymph node via bronchoscopy (i.e. EBUS)?
Mediastinoscopy
Who should be screened for Wilson’s dz? Inheritance?
1st degree relatives of affected pts; AR
What is the first step to do if you suspect normal pressure hydrocephalus?
Do a large volume CSF removal and observe; if the sx improve then you can do a ventriculoperitoneal shunt
In the outpatient setting with high suspicion of MRSA but non-toxic what would outpatient tx for cellulitis be?
TMP-SMX, clindamycin, or doxycycline
T/F Polycythemia vera only has increased RBC’s?
ABSOLUTELY FALSE it is a clonal myeloproliferative disorder that also has an element of thrombocytosis and mild granulocytosis
What concentration of epinephrine is given in anaphylaxis?
IM 1:1000
What abx can cause serotonin syndrome when combined with SSRI’s?
Linezolid because has weak serotoninergic activity
What is the Hawthorne effect?
People modify behaviors after learning the purpose of a study
What condition precludes the existence of S4?
Afib; cant get atrial kick
Name some causes of spurious hyperkalemia
Fist clenching, leukocytosis (got pimped on heme onc), and thrombocytosis as well as delays in analyzing the sample
Henoch Schonlein purpura is due to deposition of what in the tissues?
IgA and C3
What medication can improve healing in venous stasis ulcers?
ASA
What is the greatest predictor of development of a coronary artery aneurysm in Kawasaki dz?
Fever length, if fever went on for 8 days that is high risk
How do you treat 3rd degree heart block?
Immediate trancutaneous pacer while awaiting transvenous pacer; ability to degenerate to asystole is a major concern;
How do you treat nonclassical CAH?
OCP’s to decrease CRH and ACTH
Which pulmonary infection is assoc. with antibodies against RBC’s?
M. pneumoniae
Methanol and ethylene glycol have similar presentations but methanol notably affects the ____ while ethylene glcyol notably affects the ______
Eyes (optic disk hyperemia); kidneys and can lead to ESRD if the kidneys don?t recover from the AKI
Which cells are not filtered out in leukoreduced blood products?
Lymphocytes (same size as RBC)
How do you dx DM gastroparesis? How do you manage it?
Gastric scintigraphy scan; increase fiber with smaller and more frequent meals and prokinetic agent (metoclopromide chronically assuming not Parkinsons; erythromycin acutely)
Which electrolyte abnormality is notorious for causng refractory hypokalemia?
Hypomagnesemia; Mg is important for K reuptake (MC in alcholics)
What other class of antidepressatn can you not give SSRI’s with?
MAOI’s
Why are CCB overdoses weird?
They cause profound hypotension, bradycardia, with PRESERVED MENTATION
Eggshell calcifications in the upper lobes usually from what? Predisposes to what?
Silicosis; predisposes to TB (cant form a phagolysosome)
The presence of palatal ulcers may tip you off to infxn with which dimorphic fungus?
Hisoplasma capsulatum
What kind of stones form in type I RTA?
Calcium phosphate
What cell is affected in LEMS?
Presynaptic calcium channels
What is required for definitive dx of pseudotumor cerebri after normal neuroimaging is shown?
Normal CSF analysis with elevated opening pressure ( > 200)
In the outpatient setting how would you treat cellulitis if there was low suspicion for MRSA?
Cephalexin
What is unique about Todd paralysis?
MOTOR ONLY
What is the next best step in asymptomatic hyperkalemia?
Draw another sample
What is an important complication of meningitis in peds? What is the ppx in exposed children? Adults?
Deafness; Rifampin; Cipro or rifampin bc cant give cipro to kid
What is Berkson’s bias?
Bias introduced when experiments are done on hospitalized pts
What part of the brain is MC affected by medulloblastomas?
Cerebellar vermis
What is the Pygmalian effect?
ppl more likely to perform better with greater expectations placed on them
What is the tetrad of CADASIL?
Psychiatric disturbance, dementia, multiple white matter strokes, and migraine with aura
What is the cause of nonclassical CAH?
MILD deficiency of 21-hydroxylase
Why is obesity a risk factor for endometrial hyperplasia?
The aromatase in adipose leads to increased estrogen levels
How can the LAP score be misleading when differentiating CML from leukemoid rxn?
In CML with secondary infection it will be elevated so when in doubt do a flow cytometry (i.e. looking for that BCR ABL)
What is the most important aspect of therapy in fat embolus syndrome?
Respiratory support
What disease can predispose to septic arthritis, AA amyloidosis, and anemia of chronic dz?
RA
Why is there hypochloremia in obesity hypoventilation syndrome and OSA?
Because the chronic acidosis leads to increased HCO3 absorption by kidneys with exchange for Cl to maintain electrical neutrality
What is the arthritis in hemophilia pts referred to as?
Hemophilic arthritis secondary to recurrent hemarthroses with hemosiderin deposition
What is photopsia?
Flashing lights seen in retinal detachment
Why does histoplasma sometimes cause LAD, pancytopenia, and hepatosplenomegaly?
Targets MO in the reticuloendothelial system
How do you tx Philadelphia positive ALL
Imatinib, dasatinib (non receptor tyrosine kinase inhibitors)
Irradiated blood products are used in who and for what?
BMT pts to prevent transfusion-related GVHD
What should you always do next whenever confronted with metabolic acidosis on labs?
CALCULATE A FUCKING ANION GAP
What are scintillating scotomas suggestive of?
Aura of migraine with aura
What can be seen on the physical exam of a pt with 3rd degree heart block and why?
Canon A waves due to atrioventricular dissociation
How is the presentation of reactivated TB different from CAP?
TB often has pretty nonspecific sx not the picture of fulminant CAP
How does Huntington’s chorea typically show up on neuroimaging? How do you treat the associated psychosis? The chorea?
Enlarged lateral ventricles (because caudate makes up the wall of the lateral ventricles); haloperidol; tetrabenazine
When do you use milrinone in CHF?
For refractory CHF to the typical meds this is inotropic support (recall that in EF
What is the likely cause of basophilic stippling with low MCV? Basophilic stippling with high MCV?
Sideroblastic anemia (lead poisoning); Alcoholism
What ist he most common sex cord stromal tumor
Leydig
Dull achy headaches, refractory to OTC pain meds raise suspicion for what?
Brain tumor
Presence of a fever for more than 5 days is an important consideration for what pediatric illness?
Kawasaki dz
What kind of metabolic disturbance does diarrhea cause?
Non-Gap metabolic acidosis
When may angioedema occur when being treated with ACE-I
ANYTIME IN THE COURSE OF THERAPY
