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STEP 2 > UW3 > Flashcards

UW3 Flashcards

1
Q

Why are myeloproliferative disorders such as PV common causes of gout?

A

Because there is increased turnover and production of purines, esp. in PV because the RBC’s extrude the nucleus prior to maturation

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2
Q

What is the most common immunoglobulin produced by the plasma cell clone of multiple myeloma? Which bears a worse prognosis?

A

IgG; IgA

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2
Q

What is nonallergic rhinitis? What is the tx?

A

It is a vasomotor rhinitis like allergic rhinitis but does not have specific triggers; Tx = intranasal glucocorticoids and antihistamines

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3
Q

If a patient has respiratory acidosis secondary hydromorphone, what happens to the A-a gradient?

A

It is a normal A-a gradient acidosis (secondary to hypoventilation)

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4
Q

Which type of valve is most traumatic to RBC’s leading to macrovascular hemolytic anemia?

A

Mechanical i.e. as opposed to porcine

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4
Q

What is the most common etiologic agent in osteomyelitis in adults? What about assoc with history of nail puncture?

A

S. aureus; P. aeruginosa

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4
Q

How may factitious thyrotoxicosis initially present?

A

Atrial fibrillation

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5
Q

How do you manage acetaminophen ingestion?

A

If under 4 hours immediately give activated charcoal and check serum acetaminophen levels, look at the nomogram to decide if need NAC

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6
Q

What is something that should be considered in ALL pts with unexplained elevation of CK and myopathy?

A

Hypothyroidism

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7
Q

What is the most commonly used medication for aspiration PNA?

A

Clindamycin

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7
Q

What is the mgmt of acute angle closure glaucoma?

A

IV acetazolamide and laser peripheral iridotomy

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8
Q

What is trihexyphenidyl used for?

A

Anticholinergic agent used for PD if the primary Sx being tx’d is tremor

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8
Q

What is the best diagnostic test for spinal stenosis?

A

MRI of spine

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8
Q

Why can lamivudine be used to tx both HBV and HIV?

A

It is an NRTI and both viruses have reverse transcriptase

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8
Q

What should all pts with cirrhosis be immunized against?

A

HAV and HBV unless already immune

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9
Q

What is the treatment of anserine bursitis?

A

Corticosteroid injection, PO NSAID not absorb well into the anserine bursa

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9
Q

When can you give bicarb in DKA?

A

If pH less than 6.9

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9
Q

Explain why dehydration is a risk factor for PE

A

Hemoconcentration makes DVT more likely

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10
Q

What are the AEIOU for indications for HD?

A

Refractory acidosis

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11
Q

What should you think if pt has PMHx chronic pancreatitis and now has severe left sided abdominal pain gastric fundal varices

A

Splenic vein thrombosis

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12
Q

How much does each 1% HBA1C increase the plasma glucose?

A

35 mg/dl

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13
Q

What should you think if you have pancreatitis with serially decreasing H/H?

A

Hemorrhagic pancreatitis

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14
Q

Staging for Multiple Myeloma by the ISS staging is based on what?

A

Albumin and B2-microglobulin

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14
Q

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?

A

Draw another sample in 2 hours

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15
Q

What skin lesion appears as ring-shaped scaly patches with central clearing and distinct borders?

A

Dermatophytes MC Tricophyton rubrum; the scaliness is big

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16
Q

What is the best tx for ITP? What is seen on bm bx

A

IVIG and steroids; megakaryocyte hyperplasia hypocellular bm

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16
Q

What effect would primary hyperaldosteronism have on renin levels?

A

Would be almost nondetectable

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17
Q

What is the leading cause of death in ADPKD?

A

Cardiovascular, same as any ESRD (don?t pick berry aneurysm)

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17
Q

How does acyclovir cause AKI?

A

Crystalline deposition

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18
Q

What is the mainstay of therapy for Dressler’s syndrome?

A

NSAIDs

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19
Q

How do you manage Budd-Chiari Syndrome?

A

tPA followed by anticoagulation (look for hx of malignancy or nephrotic syndrome with RUQ pain)

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19
Q

What is Post-Cholecystectomy syndrome? How do you manage?

A

Persistent Sx after cholecystecomy; Will see ductal dilation on US then do ERCP for stone removal (esp. if no intraoperative cholangiogram was done)

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19
Q

What are the genetics of Osler-Weber-Rendu?

A

AD

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20
Q

When should mono pts resume playing sports?

A

When all sx resolve

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21
Q

What is a common extraintestinal area that is affected in Whipple’s dz?

A

Heart can lead to valvular involvement with CHF

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22
Q

What are 3 major complications of Chagas dz? What is the bug? Tx?

A

Megacolon, megaesophagus, CHF; T. cruzi (protist); Nifurtimox

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23
Q

What is the most common manifestation of multiple myeloma?

A

Back pain (watch for pathologic fx can be due to lytic lesions or solitary plasmacytoma of bone)

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23
Q

How do you screen for acromegaly? How do you confirm Dx? What malignancy are they at increased risk for?

A

IGF-1 levels; oral glucose tolerance test with failure to supress GH; colon CA (most die from cardiac dz though)

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23
Q

What is the best way to differentiate asthma from COPD?

A

Spirometry before and after administration of a bronchodilator where asthma has > 12% increase in FEV1 and COPD does not

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24
Q

“Slow finger tapping” is describing what event?

A

Bradykinesia (if due to antipsychotic, tx is benztropine)

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24
Q

How does PCP PNA usually appear on CXR what lab value is often elevated?

A

Diffuse interstitial infiltrates that begin in the perihilar area; LDH (Recall Dr. Fazal)

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25
Q

Salmonella typhi carraige is a risk factor for which CA?

A

Cholangiocarcinoma; Cholecystectomy is sufficient tx for CA localized to GB mucosa

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26
Q

Severe symptomatic hypercalcemia is often assoc with calcium values greater than ___

A

14

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28
Q

What is the cause of the increased blood pressure in hyperthyroidism?

A

Increased contractility due to increased B1 receptors on the myocardium

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30
Q

What is the tx for Mollscum Contagiosum? What else should you do?

A

Mild curretage; Screen for HIV

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32
Q

How do you tx pyoderma gangrenosum? Histology?

A

Steroids and tx underlying IBD; often need skin bx to confirm dx and it is a neutrophilic ulcerative lesion

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33
Q

What is the tx of seasonal affective disorder?

A

SSRI it is a type of MDD

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34
Q

What is the highest that the AST usually goes in alcoholic hepatitis?

A

Usually no higher than 500

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35
Q

What is the mainstay of tx of pseudotumor cerebri

A

Weight loss and if no improvement then acetazolamide

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36
Q

What is the mgmt of Wegeners granulomatosis?

A

Corticosteroids and Cyclophosphamide

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38
Q

Which types of familial HLD can cause pancreatitis?

A

Type I, IV, and V

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38
Q

What should be suspected in any pt with ascites and a fever?

A

Spontaneous Bacterial Peritonitis

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39
Q

What are the two most common causes of dacryocystitis (inflammation of lacrimal sac)

A

S. aureus and S. pyogenes and tx involves systemic abx

41
Q

What is the difference between secondary and tertiary hyperparathyroidism?

A

Both assoc with CKD from decreased hydroxylation of vitamin D in peritubular cells but tertiary is when one of the glands becomes autonomous

42
Q

Why does hypocalcemia predispose to arrhythmias?

A

Causes QT prolongation

43
Q

When is aggressive diuresis NOT recommended in the setting of ascites?

A

If there is hepatorenal syndrome

44
Q

What is the step by step mgmt of ascites?

A

First fluid and Na restriction; Then spironolactone then furosemide then large volume paracentesis

45
Q

Thumb-printing on AXR indicates what

A

Ischemic colitis

46
Q

What is the radioactive iodine uptake like in factitious thyrotoxicosis?

A

Low

47
Q

Why don?t you use intravenous tPA for acute arterial thrombosis?

A

Because it should be intra-arterial

49
Q

What are the CPK levels in polymyalgia rheumatica? Glucocorticoid myopathy?

A

NORMAL IN BOTH (note in statin myopathy the CPK is elevated, can lead to rhabdo)

50
Q

What is the cause of AV block in the setting of endocarditis?

A

Perivalvular abscess (i.e. periannular extension)

51
Q

How do you manage narrow complex tachycardia with hemodynamic instability?

A

Immediate DC cardioversion (sedation first)

53
Q

What are the 2 drugs for HOCM?

A

BB and then second line is CCB to increase diastolic filling time (note that in systolic CHF you would NOT give CCB)

55
Q

How do you manage a stroke due to sickle cell?

A

Plasma exchange as tPA is not useful here

56
Q

What imaging study should be done whenever a dx of myasthenia gravis is made?

A

CT chest to rule out thymoma

57
Q

What are 3 things to GET RID OF potassium?

A

Kayexelate (poop it out), loop diuretics (piss it out), and dialysis

58
Q

When treating hyperosmolar coma what should you do when the glucose gets down to 250 (i.e. was 870 and now is 250)

A

Start dextrose to prevent cerebral edema

59
Q

What is a good approach to treating drug rashes?

A

DC drug and give antihistamine

60
Q

Which Streptococcal infection involves the superficial dermis and is raised with well-demarcated areas?

A

Erysipelas (legs are most frequently involved area)

61
Q

What are the two best markers of resolution of DKA?

A

Closure of anion gap or decrease in beta-hydroxybutyrate levels; both tell you that the ketoacids are going away

62
Q

What is it called when a pt overuses pseudoephedrine and the nasal passage becomes erythematous? What is the next best step?

A

Rhinitis medicamentosa; add intranasal glucocorticoids

63
Q

What is the best diagnostic test to confirm ADPKD

A

Renal US

64
Q

In which position does spinal stenosis improve?

A

Flexion since it widens the spinal canal

65
Q

Define Post-Partum Thyroiditis; Tx?

A

Diffusely enlarged thyroid with sx of hyperthyroidism within 6 months of delivery; tx is propanolol

66
Q

What may be the cause of a pt with many GI ulcers and renal stones?

A

MEN 1 i.e. ulcers from gastrinoma and stones from hyperparathyroidism

67
Q

What are the most important ramifications of being dx’d with Behcet’s dz? What is the use of corticosteroids in this dz for?

A

It leads to blindness and dementia; steroids for the ulcers but do not decrease progression to blindness (anterior uveitis) and dementia

69
Q

What is the most important step in the mgmt of nonketotic hyperosmolar coma?

A

Volume repletion (NS)

70
Q

What kind of medications should be given to kids with vesicoureteral reflux?

A

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

71
Q

What are the causes of acanthosis nigricans in younger pts and older pts?

A

Younger = often insulin resistance i.e. DM II or PCOS; Older = GI malignancy

72
Q

What effect do PPI’s have on PEFR in a pt with GERD induced asthma?

A

They actually do increase the PEFR

74
Q

CHOP is a regimen used for what?

A

NHL esp. DLBCL (add rituximab to make RCHOP if CD20 positive)

74
Q

What should you consider if a pt with long-standing RA has really bad pain but a normal ESR?

A

i.e. the RA is in “remission” but there is a mechanical element to the pain now, may need ortho referral

75
Q

What is the MC manifestation of rheumatic heart disease long term?

A

Mitral stenosis and the second most common valve is aortic

77
Q

Why would a patient with sarcoidosis need an ophthalmology referral?

A

Anterior uveitis can lead to blindness

78
Q

What does a normal PCO2 level in an asthma attack indicate?

A

The patient is getting worse, they should be hyperventilating and blowing off CO2

79
Q

At what valvular area does AS often become symptomatic?

A
80
Q

Any young patient with chronic (>3 months) LBP and spinal stiffness should be worked up for what?

A

Ankylosing spondylitis

81
Q

How do you ppx against SBP in a pt with cirrhosis? How do you treat SBP?

A

TMP-SMX; 3rd generation cephalosporin like cefotaxime, ceftriaxone

83
Q

How do you treat ASX HYPOvolemic hyponatremia? SX?

A

5% dextrose; NS

84
Q

What should you be thinking for leukocytes in the anterior chamber? If histoplasam affected the eye, where would it go?

A

Anterior uveitis (i.e. sarcoidosis, JRA, ankylosing spondylitis); Retina

85
Q

What is the most important medication to give a patient in thyroid storm? Why?

A

Propanolol to tx the high output CHF or Afib with RVR

86
Q

What potential screening should be considered in ITP?

A

HIV and HCV as these can precipitate ITP

87
Q

What is the most likely malignancy to develop from asbestosis?

A

Bronchogenic CA (not mesothelioma)

88
Q

What is the standard of care for follicular lymphoma?

A

Watch and wait regardless of stage i.e. even if BM involvement need signs of cytopenias etc.

89
Q

How do you manage a stable pt with Torsades? Unstable?

A

If stable give Magnesium sulfate (even if pt is not hypomagnesemic); if unstable immediate defibrillation

90
Q

What is the definition of Fulminant Hepatic Failure; Tx?

A

Encephalopathy wihtin 8 days of acute liver failure; orthotopic liver transplant is the only cure

92
Q

What is the most important prognosticator for breast CA? Most important risk factor?

A

Stage (tumor burden); age

93
Q

Define Severe Acute Pancreatitis how to tx?

A

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!

94
Q

What is the characteristic finding on EEG for Creutzfeld-Jakob? What lab assay is elevated?

A

Periodic sharp wave complexes; 14-3-3 assay

95
Q

What OTC pain reliever must be used carefully with warfarin as it can potentiate warfarin levels?

A

Acetaminophen

96
Q

What situations are colloid solutions often used?

A

Burns and hypoalbuminemia (i.e. cirrhosis)

97
Q

What are 2 assays that you can order when you suspect HIT?

A

PF-4 assay; serotonin release assay

98
Q

What kind of drug is bortezomib (used for multiple myeloma, what is the regimen?)

A

Proteasome inhibitor; VCD (Velcade = bortezomib, Cyclophosphamide, and dexamethasone)

99
Q

Why might cirrhosis lead to pancytopenia?

A

Splenomegaly with hypersplenism can cause pancytopenia

101
Q

What skin lesion results from P. aeruginosa bacteremia?

A

Ecthyma gangrenosum

103
Q

What is the strongest overall risk factor for aortic dissection? Stroke?

A

HTN for both? Don?t be a jackass

103
Q

What should you think of when there is a liver mass in association with dogs?

A

Echinococcus granulosus (if multiple then echinococcus multilocularis)

105
Q

What should you think if a person on thionoamides has fever and sore throat?

A

Possible agranulocytosis

106
Q

What condition may result from taking too much pseudoephedrine intranasally? Tx?

A

Rhinitis medicamentosa; add intranasal glucocorticoids

108
Q

What is the first line tx for post-nasal drip?

A

antihistamines; post-nasal drip often causes nagging dry cough

109
Q

What are the genetics of Charcot-Marie-Tooth? What direction does it progress?

A

AD; distal to proximal (it is a motor and sensory polyneuropathy)

110
Q

What is the first thing to do when get poison in the eye?

A

Wash for 15 min under sink with water

111
Q

What are the 4 steps of caustic ingestion?

A

1) ABC 2) remove clothing 3) CXR and 4) EGD within 24 hours; NO ROLE FOR ACTIVATED CHARCOAL

113
Q

Why might a pt with Osler-Weber-Rendu have elevated Hct?

A

Secondary polycythemia from the AVM shunting blood R to L (if in lung) causing chronic hypoxemia and reactive polycythemia

114
Q

Why are obesity hypoventilation pts hypoxic? Tx?

A

Because chronic hypercapnia leads to decreased inspiratory drive during day; weight loss and positive pressure ventilation

115
Q

If a patient is on ASA and Clopidogrel and comes in with stroke for past 2 hours and negative CT what is next step?

A

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

116
Q

Chlorambucil and prednisone is a regimen for which leukemia?

A

CLL (watch and wait until cytopenias, bulky LAD, painful splenomegaly, etc)

117
Q

When should you suspect HIT?

A

If platelet count drops > 50 % about 5-10 days after starting heparin (this is type II HIT the immune mediated one)

118
Q

What do you need to watch for in kids being Tx’d for ADHD

A

Growth retardation secondary to decreased appetite

119
Q

How does mixed essential cryoglobulinemia present?

A

Palpable purpura, proteinuria, hematuria (confirm dx with circulating cryoglobulins)

120
Q

How do you diagnose mesenteric ischemia? What will be seen on ABG?

A

Mesenteric Angiography; Lactic acidosis

122
Q

What is the most important thing to give in a person with symptomatic hypercalcemia? What are 2 other meds you can add?

A

NS to prevent the prerenal azotemia; bisphosphonates and calcitonin

123
Q

Name 4 provocative medications for pseudotumor cerebri

A

OCP’s, steroids, retinoids (vitamin A, poss ATRA for AML M3!), and doxycycline

124
Q

When adding trastuzumab to a Her2neu positive breast CA they tend to get better response to what class of chemotherapeutic?

A

Anthracyclines

125
Q

Why is octreotide used in hepatorenal syndrome?

A

Constriction of the splanchnic vessels makes more available for the kidneys!

127
Q

How do you treat CoNS endocarditis?

A

VANCOMYCIN IF IT IS STAPH ENDOCARDITIS IT IS ALWAYS ALWAYS IV VANCO

128
Q

What is mixed essential cryoglobulinemia assoc with?

A

HCV

129
Q

What is the most common predisposing scenario to retropharyngeal abscess?

A

Local trauma such as something scratching the back of the throat

130
Q

Why shouldn?t you use typical antipsychotics in Lewy Body dementia?

A

They have neuroleptic hypersensitivity and get severe parkinsonism and impaired consciousness with administration

131
Q

Which diuretic is most infamous for precipitating gout?

A

Thiazides

132
Q

What is the major concern with not treating pseudotumor cerebri?

A

Can progress to blindness

STEP 2 (13 decks)

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