UW3 Flashcards
Why are myeloproliferative disorders such as PV common causes of gout?
Because there is increased turnover and production of purines, esp. in PV because the RBC’s extrude the nucleus prior to maturation
What is the most common immunoglobulin produced by the plasma cell clone of multiple myeloma? Which bears a worse prognosis?
IgG; IgA
What is nonallergic rhinitis? What is the tx?
It is a vasomotor rhinitis like allergic rhinitis but does not have specific triggers; Tx = intranasal glucocorticoids and antihistamines
If a patient has respiratory acidosis secondary hydromorphone, what happens to the A-a gradient?
It is a normal A-a gradient acidosis (secondary to hypoventilation)
Which type of valve is most traumatic to RBC’s leading to macrovascular hemolytic anemia?
Mechanical i.e. as opposed to porcine
What is the most common etiologic agent in osteomyelitis in adults? What about assoc with history of nail puncture?
S. aureus; P. aeruginosa
How may factitious thyrotoxicosis initially present?
Atrial fibrillation
How do you manage acetaminophen ingestion?
If under 4 hours immediately give activated charcoal and check serum acetaminophen levels, look at the nomogram to decide if need NAC
What is something that should be considered in ALL pts with unexplained elevation of CK and myopathy?
Hypothyroidism
What is the most commonly used medication for aspiration PNA?
Clindamycin
What is the mgmt of acute angle closure glaucoma?
IV acetazolamide and laser peripheral iridotomy
What is trihexyphenidyl used for?
Anticholinergic agent used for PD if the primary Sx being tx’d is tremor
What is the best diagnostic test for spinal stenosis?
MRI of spine
Why can lamivudine be used to tx both HBV and HIV?
It is an NRTI and both viruses have reverse transcriptase
What should all pts with cirrhosis be immunized against?
HAV and HBV unless already immune
What is the treatment of anserine bursitis?
Corticosteroid injection, PO NSAID not absorb well into the anserine bursa
When can you give bicarb in DKA?
If pH less than 6.9
Explain why dehydration is a risk factor for PE
Hemoconcentration makes DVT more likely
What are the AEIOU for indications for HD?
Refractory acidosis
What should you think if pt has PMHx chronic pancreatitis and now has severe left sided abdominal pain gastric fundal varices
Splenic vein thrombosis
How much does each 1% HBA1C increase the plasma glucose?
35 mg/dl
What should you think if you have pancreatitis with serially decreasing H/H?
Hemorrhagic pancreatitis
Staging for Multiple Myeloma by the ISS staging is based on what?
Albumin and B2-microglobulin
What if you have a pt with acetaminophen ingestion and you plot the initial blood draw on the nomogram and it is not yet in toxic range?
Draw another sample in 2 hours
What skin lesion appears as ring-shaped scaly patches with central clearing and distinct borders?
Dermatophytes MC Tricophyton rubrum; the scaliness is big
What is the best tx for ITP? What is seen on bm bx
IVIG and steroids; megakaryocyte hyperplasia hypocellular bm
What effect would primary hyperaldosteronism have on renin levels?
Would be almost nondetectable
What is the leading cause of death in ADPKD?
Cardiovascular, same as any ESRD (don?t pick berry aneurysm)
How does acyclovir cause AKI?
Crystalline deposition
What is the mainstay of therapy for Dressler’s syndrome?
NSAIDs
How do you manage Budd-Chiari Syndrome?
tPA followed by anticoagulation (look for hx of malignancy or nephrotic syndrome with RUQ pain)
What is Post-Cholecystectomy syndrome? How do you manage?
Persistent Sx after cholecystecomy; Will see ductal dilation on US then do ERCP for stone removal (esp. if no intraoperative cholangiogram was done)
What are the genetics of Osler-Weber-Rendu?
AD
When should mono pts resume playing sports?
When all sx resolve
What is a common extraintestinal area that is affected in Whipple’s dz?
Heart can lead to valvular involvement with CHF
What are 3 major complications of Chagas dz? What is the bug? Tx?
Megacolon, megaesophagus, CHF; T. cruzi (protist); Nifurtimox
What is the most common manifestation of multiple myeloma?
Back pain (watch for pathologic fx can be due to lytic lesions or solitary plasmacytoma of bone)
How do you screen for acromegaly? How do you confirm Dx? What malignancy are they at increased risk for?
IGF-1 levels; oral glucose tolerance test with failure to supress GH; colon CA (most die from cardiac dz though)
What is the best way to differentiate asthma from COPD?
Spirometry before and after administration of a bronchodilator where asthma has > 12% increase in FEV1 and COPD does not
“Slow finger tapping” is describing what event?
Bradykinesia (if due to antipsychotic, tx is benztropine)
How does PCP PNA usually appear on CXR what lab value is often elevated?
Diffuse interstitial infiltrates that begin in the perihilar area; LDH (Recall Dr. Fazal)
Salmonella typhi carraige is a risk factor for which CA?
Cholangiocarcinoma; Cholecystectomy is sufficient tx for CA localized to GB mucosa
Severe symptomatic hypercalcemia is often assoc with calcium values greater than ___
14
What is the cause of the increased blood pressure in hyperthyroidism?
Increased contractility due to increased B1 receptors on the myocardium
What is the tx for Mollscum Contagiosum? What else should you do?
Mild curretage; Screen for HIV
How do you tx pyoderma gangrenosum? Histology?
Steroids and tx underlying IBD; often need skin bx to confirm dx and it is a neutrophilic ulcerative lesion
What is the tx of seasonal affective disorder?
SSRI it is a type of MDD
What is the highest that the AST usually goes in alcoholic hepatitis?
Usually no higher than 500
What is the mainstay of tx of pseudotumor cerebri
Weight loss and if no improvement then acetazolamide
What is the mgmt of Wegeners granulomatosis?
Corticosteroids and Cyclophosphamide
Which types of familial HLD can cause pancreatitis?
Type I, IV, and V
What should be suspected in any pt with ascites and a fever?
Spontaneous Bacterial Peritonitis
What are the two most common causes of dacryocystitis (inflammation of lacrimal sac)
S. aureus and S. pyogenes and tx involves systemic abx
What is the difference between secondary and tertiary hyperparathyroidism?
Both assoc with CKD from decreased hydroxylation of vitamin D in peritubular cells but tertiary is when one of the glands becomes autonomous
Why does hypocalcemia predispose to arrhythmias?
Causes QT prolongation
When is aggressive diuresis NOT recommended in the setting of ascites?
If there is hepatorenal syndrome
What is the step by step mgmt of ascites?
First fluid and Na restriction; Then spironolactone then furosemide then large volume paracentesis
Thumb-printing on AXR indicates what
Ischemic colitis
What is the radioactive iodine uptake like in factitious thyrotoxicosis?
Low
Why don?t you use intravenous tPA for acute arterial thrombosis?
Because it should be intra-arterial
What are the CPK levels in polymyalgia rheumatica? Glucocorticoid myopathy?
NORMAL IN BOTH (note in statin myopathy the CPK is elevated, can lead to rhabdo)
What is the cause of AV block in the setting of endocarditis?
Perivalvular abscess (i.e. periannular extension)
How do you manage narrow complex tachycardia with hemodynamic instability?
Immediate DC cardioversion (sedation first)
What are the 2 drugs for HOCM?
BB and then second line is CCB to increase diastolic filling time (note that in systolic CHF you would NOT give CCB)
How do you manage a stroke due to sickle cell?
Plasma exchange as tPA is not useful here
What imaging study should be done whenever a dx of myasthenia gravis is made?
CT chest to rule out thymoma
What are 3 things to GET RID OF potassium?
Kayexelate (poop it out), loop diuretics (piss it out), and dialysis
When treating hyperosmolar coma what should you do when the glucose gets down to 250 (i.e. was 870 and now is 250)
Start dextrose to prevent cerebral edema
What is a good approach to treating drug rashes?
DC drug and give antihistamine
Which Streptococcal infection involves the superficial dermis and is raised with well-demarcated areas?
Erysipelas (legs are most frequently involved area)
What are the two best markers of resolution of DKA?
Closure of anion gap or decrease in beta-hydroxybutyrate levels; both tell you that the ketoacids are going away
What is it called when a pt overuses pseudoephedrine and the nasal passage becomes erythematous? What is the next best step?
Rhinitis medicamentosa; add intranasal glucocorticoids
What is the best diagnostic test to confirm ADPKD
Renal US
In which position does spinal stenosis improve?
Flexion since it widens the spinal canal
Define Post-Partum Thyroiditis; Tx?
Diffusely enlarged thyroid with sx of hyperthyroidism within 6 months of delivery; tx is propanolol
What may be the cause of a pt with many GI ulcers and renal stones?
MEN 1 i.e. ulcers from gastrinoma and stones from hyperparathyroidism
What are the most important ramifications of being dx’d with Behcet’s dz? What is the use of corticosteroids in this dz for?
It leads to blindness and dementia; steroids for the ulcers but do not decrease progression to blindness (anterior uveitis) and dementia
What is the most important step in the mgmt of nonketotic hyperosmolar coma?
Volume repletion (NS)
What kind of medications should be given to kids with vesicoureteral reflux?
Abx for ppx they will usually outgrow it, it can progress to ESRD and if concerned about scarring can evaluate with renal scintigraphy scan with dimercaptosuccinic acid
What are the causes of acanthosis nigricans in younger pts and older pts?
Younger = often insulin resistance i.e. DM II or PCOS; Older = GI malignancy
What effect do PPI’s have on PEFR in a pt with GERD induced asthma?
They actually do increase the PEFR
CHOP is a regimen used for what?
NHL esp. DLBCL (add rituximab to make RCHOP if CD20 positive)
What should you consider if a pt with long-standing RA has really bad pain but a normal ESR?
i.e. the RA is in “remission” but there is a mechanical element to the pain now, may need ortho referral
What is the MC manifestation of rheumatic heart disease long term?
Mitral stenosis and the second most common valve is aortic
Why would a patient with sarcoidosis need an ophthalmology referral?
Anterior uveitis can lead to blindness
What does a normal PCO2 level in an asthma attack indicate?
The patient is getting worse, they should be hyperventilating and blowing off CO2
At what valvular area does AS often become symptomatic?
Any young patient with chronic (>3 months) LBP and spinal stiffness should be worked up for what?
Ankylosing spondylitis
How do you ppx against SBP in a pt with cirrhosis? How do you treat SBP?
TMP-SMX; 3rd generation cephalosporin like cefotaxime, ceftriaxone
How do you treat ASX HYPOvolemic hyponatremia? SX?
5% dextrose; NS
What should you be thinking for leukocytes in the anterior chamber? If histoplasam affected the eye, where would it go?
Anterior uveitis (i.e. sarcoidosis, JRA, ankylosing spondylitis); Retina
What is the most important medication to give a patient in thyroid storm? Why?
Propanolol to tx the high output CHF or Afib with RVR
What potential screening should be considered in ITP?
HIV and HCV as these can precipitate ITP
What is the most likely malignancy to develop from asbestosis?
Bronchogenic CA (not mesothelioma)
What is the standard of care for follicular lymphoma?
Watch and wait regardless of stage i.e. even if BM involvement need signs of cytopenias etc.
How do you manage a stable pt with Torsades? Unstable?
If stable give Magnesium sulfate (even if pt is not hypomagnesemic); if unstable immediate defibrillation
What is the definition of Fulminant Hepatic Failure; Tx?
Encephalopathy wihtin 8 days of acute liver failure; orthotopic liver transplant is the only cure
What is the most important prognosticator for breast CA? Most important risk factor?
Stage (tumor burden); age
Define Severe Acute Pancreatitis how to tx?
Acute pancreatitis with failure of at least 1 other organ often due to hypoperfusion of other organs from massive fluid extravasation into retroperitoneum; involves giving IVF and several liters of it!
What is the characteristic finding on EEG for Creutzfeld-Jakob? What lab assay is elevated?
Periodic sharp wave complexes; 14-3-3 assay
What OTC pain reliever must be used carefully with warfarin as it can potentiate warfarin levels?
Acetaminophen
What situations are colloid solutions often used?
Burns and hypoalbuminemia (i.e. cirrhosis)
What are 2 assays that you can order when you suspect HIT?
PF-4 assay; serotonin release assay
What kind of drug is bortezomib (used for multiple myeloma, what is the regimen?)
Proteasome inhibitor; VCD (Velcade = bortezomib, Cyclophosphamide, and dexamethasone)
Why might cirrhosis lead to pancytopenia?
Splenomegaly with hypersplenism can cause pancytopenia
What skin lesion results from P. aeruginosa bacteremia?
Ecthyma gangrenosum
What is the strongest overall risk factor for aortic dissection? Stroke?
HTN for both? Don?t be a jackass
What should you think of when there is a liver mass in association with dogs?
Echinococcus granulosus (if multiple then echinococcus multilocularis)
What should you think if a person on thionoamides has fever and sore throat?
Possible agranulocytosis
What condition may result from taking too much pseudoephedrine intranasally? Tx?
Rhinitis medicamentosa; add intranasal glucocorticoids
What is the first line tx for post-nasal drip?
antihistamines; post-nasal drip often causes nagging dry cough
What are the genetics of Charcot-Marie-Tooth? What direction does it progress?
AD; distal to proximal (it is a motor and sensory polyneuropathy)
What is the first thing to do when get poison in the eye?
Wash for 15 min under sink with water
What are the 4 steps of caustic ingestion?
1) ABC 2) remove clothing 3) CXR and 4) EGD within 24 hours; NO ROLE FOR ACTIVATED CHARCOAL
Why might a pt with Osler-Weber-Rendu have elevated Hct?
Secondary polycythemia from the AVM shunting blood R to L (if in lung) causing chronic hypoxemia and reactive polycythemia
Why are obesity hypoventilation pts hypoxic? Tx?
Because chronic hypercapnia leads to decreased inspiratory drive during day; weight loss and positive pressure ventilation
If a patient is on ASA and Clopidogrel and comes in with stroke for past 2 hours and negative CT what is next step?
tPA; antiplatelet therapy, even dual, is not a CI to thrombolytic therapy; however, antiplatelet agents should be held for 24 hours after tPA is used
Chlorambucil and prednisone is a regimen for which leukemia?
CLL (watch and wait until cytopenias, bulky LAD, painful splenomegaly, etc)
When should you suspect HIT?
If platelet count drops > 50 % about 5-10 days after starting heparin (this is type II HIT the immune mediated one)
What do you need to watch for in kids being Tx’d for ADHD
Growth retardation secondary to decreased appetite
How does mixed essential cryoglobulinemia present?
Palpable purpura, proteinuria, hematuria (confirm dx with circulating cryoglobulins)
How do you diagnose mesenteric ischemia? What will be seen on ABG?
Mesenteric Angiography; Lactic acidosis
What is the most important thing to give in a person with symptomatic hypercalcemia? What are 2 other meds you can add?
NS to prevent the prerenal azotemia; bisphosphonates and calcitonin
Name 4 provocative medications for pseudotumor cerebri
OCP’s, steroids, retinoids (vitamin A, poss ATRA for AML M3!), and doxycycline
When adding trastuzumab to a Her2neu positive breast CA they tend to get better response to what class of chemotherapeutic?
Anthracyclines
Why is octreotide used in hepatorenal syndrome?
Constriction of the splanchnic vessels makes more available for the kidneys!
How do you treat CoNS endocarditis?
VANCOMYCIN IF IT IS STAPH ENDOCARDITIS IT IS ALWAYS ALWAYS IV VANCO
What is mixed essential cryoglobulinemia assoc with?
HCV
What is the most common predisposing scenario to retropharyngeal abscess?
Local trauma such as something scratching the back of the throat
Why shouldn?t you use typical antipsychotics in Lewy Body dementia?
They have neuroleptic hypersensitivity and get severe parkinsonism and impaired consciousness with administration
Which diuretic is most infamous for precipitating gout?
Thiazides
What is the major concern with not treating pseudotumor cerebri?
Can progress to blindness
