UW4 Flashcards
What is DOC for ehrlichiosus? What is the vector?
Doxycycline; essentially if they’ve been bitten by a tick it is pretty safe to just go with doxy unless it is babesia; Lone star tick
What is the study of choice to follow a pt with AAA clinically?
US
How do you screen for pts whose FMHx suggests MEN2?
PCR for ret protoncogene
Which glomerulonephropathy is most likely to predispose to renal vein thrombosis? Associations?
Membranous glomerulopathy; HBV d/t deposition of HBeAg into the glomerulus
What are the clinical s/s of hypervitaminosis D?
The sx of hypercalcemia so polydipsia, polyuria, constipation and pre-renal azotemia (due to salt wasting)
How is the presentation in the extremities different in cardiogenic shock and neurogenic shock?
Cardiogenic shock will have cold and clammy skin due to hypersympathetic activity; Neurogenic shock will have warm skin due to dilation from loss of sympathetics
What are muddy brown casts on UA suggestive of?
ATN
What do you do if a person presents with an atrial myxoma? Why?
Surgical removal; prevents systemic embolization (stroke, limb occlusion, etc)
What is the most likely dx of a short systolic murmur that disappears with squatting? Next step in Dx?
MVP; Echo
What should you check in a hypertensive pt with unexplained hypokalemia?
Plasma aldosterone:renin ratio (if greater than 20 with aldo > 15, likely to be hyperaldosteronism)
After you have determined the SAAG is > 1.1, what does the total ascites protein tell you
SAAG >1.1 tells you that there is portal HTN; If the total protein is > 2.5 that is high protein ascites i.e. heart or TB; if
What is the primary nonpharmacologic intervention a person with HTN should follow?
DASH diet (i.e. dietary changes); but I’ve also seen that weight loss is the best so wtf
What are the only thing to decrease mortality in COPD?
Home O2 and smoking cessation
What 3 pieces of info are needed for dx of DKA?
Glucose > 250; pH
What are the best initial steps in mgmt of a pt with acute arterial occlusion who has recent anterior wall MI?
IV heparin; Consult vascular surgery; Check TEE to rule out murual thrombus
T/F: primary hyperparathyroidism can cause HTN?
True but through unknown mechanism
What test can detect cystine in the urine? i.e. cystinuria?
Urinary Sodium Nitroprusside test
Which infection may you see Kluver-Bucy syndrome?
HSV encephalitis
What is the most likely cause of acute knee pain in a pt with hyperparathyroidism?
Pseudogout
Why may multiple myeloma predispose to infection?
Due to hypogammaglobulinemia, all the effort is going into making the paraprotein by the plasma cell clone
What is diagnosed with the positive hydrogen breath test?
Lactose intolerance
What is the best screening in the acute setting for HBV?
BOTH HBsAg and IgM anti-HBcAg because of the window period where HBsAg may have disappeared and anti-HBsAg abs may not have been made yet
Cyclophosphamide increase the risk for what cancer?
Bladder CA
What are the steps to take in mgmt of normal pressure hydrocephalus?
Large volume CSF removal and if sx improve then refer to neurosurg for VP shunt
What would be a possible pulmonary finding in FSGS?
Transudative effusion
If you have an anion gap lactic acidosis after a seizure what is the most likely etiology?
Lactic acidosis from muscle contraction; note that a very common cause of acidosis after seizure is hypoventilation
How do you manage premature atrial beats?
Benign and require no tx
Plasmapheresis is a good adjunct to therapy in which pulmonary-renal syndrome?
Goodpasture’s dz
What is the cause of Meneire’s dz?
Increased production of endolymph
What are the 2 common hosts for Echinoccocus?
Dogs and Sheep
When a pt is on the ventilator what is the goal pO2? What do you want to keep the FiO2 at? What can you do if FiO2 is too high and pO2 is not at goal?
Goal PO2 is greater than 60 mmHg; Goal FiO2 should be below 50-60% to prevent oxygen toxicity; you can increase the PEEP to improve oxygenation
What should you consider in a pt with difficulty following up with the warfarin clinic?
Rivaroxaban but there is not reverse anticoagulation
Which cause of kidney stones is assoc. with hexagonal crystals?
Cystinuria (d/t abnormality of transport of dibasic AA’s –COAL)
Why is it important to check the platelet count in CLL?
Because when you start seeing cytopenias, particularly thrombocytopenia it is a poor prognosis and indicates the need to tx (i.e. chlorambucil and prednisone)
When are ppx meds recommended in gout?
Only in pts with recurrent sx
What are two major predisposing conditions to secondary hyperparathyroidism?
Malabsorptive conditions and CKD (lack of vitamin D absorption or hydroxylation to active form)
What causes Cutaneous Larval Migrans? What are the risk factors and why?
Ancylostoma braziliense; Sandy beaches and sand boxes because dogs shit there
How do you initially manage a cerebral hemorrhage in a pt on warfarin?
FFP and Vitamin K
What is McConnell’s sign on echo?
dilated RV with hypokinesis of the free wall and sparing of apex; due to RV strain in pulmonary embolus
What is the amplitude of the resting tremor of PD?
Low amplitude tremor (i.e. 4-6 Hertz)
What are 5 associations of focal segmental glomerulosclerosis?
AIDS (collapsing variant), African American, Obesity, Heroin, and Hispanics
What are the next steps after having a positive PPD?
CXR to look for active vs. latent; if latent then give INH x 9 months; if active then RIPE therapy
Why do you vaccinate HCV pts for HAV and HBV?
Decreases risk of HCC; also, an acute hepatitis superimposed on chronic liver dz makes fulminant liver failure more likely
What is the test of choice to dx MS? How do you treat exacerbations? Which drug predisposes to PML?
MRI; IV corticosteroids and if not good enough then plasmapheresis; Natalizumab
Discuss the management of Stevens-Johnson and Toxic Epidermal Necrolysis?
AGGRESSIVE fluid replacement with antiseptic preparations on the areas of skin loss to prevent secondary infection
What is the use of acyclovir in VZV infxns?
It decreases duration of infection and post-herpetic neuralgia
How can you tell the diff between dementia and pseudodementia on an MMSE that is
Often times the pt with dementia will put forth poor effort whereas the one with real dementia will try hard
What is NAFLD probably due to?
Peripheral lipolysis (idk wtf this means exactly, just go with it)
What should you consider in a young female pt with carotid bruit and amaurosis fugax?
Fibromuscular dysplasia (does NOT just affect the renals)
What is the first step in a pt with excessive alcohol intake and HTN?
Quit alcohol if no response you can then give meds
What cause of PNA is assoc with relative bradycardia to the fever?
Legionella pneumophila
The hepatojugular reflux test is good to clinically differentiate what two things?
Cardiac and primary liver ascites
Which dz has sausage fingers and nail pitting? Tx?
Psoriatic arthritis; MTX and anti-TNF alpha drugs
What is the first line tx for reactive arthritis?
NSAIDs (conjunctivitis, arthritis, and urethritis)
What bug has intracytoplasmic morulae in monocytes?
Ehrilichia; can confirm dx with PCR
If a CTA and duplex US are inconclusive for fibromuscular dysplasia of renals, what can you do?
Catheter-based digital subtraction arteriography
What should you suspect in a pt with UC who develops fatigue and pruritis?
Primary Sclerosing Cholangitis
What is the vector for Babesia? What is the definitive way to Dx babesiosus; What is the tx?
Ixodes scapularis (coinfection of Lyme); Giemsa stain of thick and thin smears; Atovaquone-Azithromycin or Quinine-Clindamycin
Tension PTX is a common complication of which ventilator setting?
PEEP
What is the first step in treating suspected pyelonephritis?
IV Abx; no need to wait for imaging
What type of RTA does multiple myeloma supposedly predispose to?
Type II; proximal; decreased HCO3 resorption with HYPOkalemia
What is the urinary sodium nitroprusside test used for?
Detecting cystine in urine for cystinuria
Where in the pancreas do neuroendocrine tumors most commonly reside?
Tail of pancreas
How is tick borne paralysis similar and different to Guillian Barre?
Both are ascending. Obviously tick borne has hx of tick but they might not remember; Also there is no autonomic dsyfxn in tick borne and the CSF is normal (no albuminocytologic dissociation)
What mnemonic can be used for the appearance of a joint affected by OA? First line Tx?
LOSS = Loss of joint space, Osteophytes, Subchondral sclerosis, and subchondral cysts; Acetaminophen and weight loss
Steppage gait is assoc with what radiculopathy and peripheral neuropathy?
L5 radiculopathy and common peroneal neuropathy
Why would fluphenazine cause hypothermia?
It can inhibit the shivering reflex as part of the EPS
What is the next best diagnostic step in a pt who has multiple liver masses?
Colonoscopy as they are likely mets since these are more common than HCC and they tend to have the cannonball effect
What are some common presenting sx of atrial myxomas?
Can p/w CONSTITUTIONAL SX and sometimes syncope and systemic embolization which is why you do surgery so that you can prevent embolization
What is the major concern when a pt combines heroin with cocaine (i.e. a speedball)?
Seizure; both drugs predispose to seizure
What insidious process often has cupping of the optic disc? Tx?
Open angle glaucoma; Timolol eye drops
Which cancer most commonly affects the lips?
SCC; usually lower lip? Note that basal cell rarely affects the lips but if it does it is usually upper
What murmurs may bicuspid aortic valves cause?
Either stenosis or regurgitation
What is the best predictor of development of foot ulcers in DM from peripheral neuropathy?
Monofilament testing
How should you manage a pt being tx’d for DVT with heparin who develops a massive diverticular bleed?
DC heparin, may need to give protamine; place IVC filter since bleeding on anticoagulation is CI to anticoagulation
How do you ppx for HSV and candida in HIV?
You fucking don?t
What are broad and waxy casts on UA suggestive of?
CKD
What is a kidney dz assoc with HIV that may present even with normal CD4 and viral loads?
Collapsing variant of Focal Segmental Glomerulosclerosis
What is external validity?
Generalizability? The ability to apply the results of a study to other populations
Why can diuretic resistant ascites lead to precipitation of hepatic encephalopathy?
The patient can become overdiuresed and it may lead to hypokalemia which can precipitate HE
What is often seen in the xray of a joint with pseudogout?
Chondrocalcinosis of the articular cartilage
What muscles are involved in DeQuervains tenosynovitis? Provocative test?
Abductor pollicus longus and abductor pollicus brevis; Finkelstein
What two worms can cause Fe Def anemia?
Ancylostoma duodenale and Necator americanus
What are the top 3 things that you should consider when a patient comes in with acute onset back pain and focal tenderness over the spinous process?
Osteoporosis, Osteomyelitis (look for fever, elevated ESR), and Multiple Myeloma (lytic lesion, plasmacytoma)
In a person intoxicated with PCP, what med can be given for sever psychomotor agitation?
Benzodiazepine
Describe atypical lymphoctes (i.e. Downey cells from EBV or CMV)
Large basophilic cells with a vacuolated appearance
How do you dx Legionella?
Urinary antigen
How is the history different for Echinococcal cysts, E. histolytica cysts (Amebic abscess), and Pyogenic liver abscesses?
Echinococcus is often assoc. with dogs and is often asymptomatic unless there are liver sx; E. histolytica is assoc with mexico and is often preceded by bloody diarrhea; Pyogenic liver abscesses are associated with recent hepatobiliary dz or peritonitis
What is the best test for HSV encephalitis?
MRI is better than CT though a CT is prob going to be ordered first
What is pagophagia?
Pica specifically for ice
What is the major way to differentiate cauda equina syndrome from conus medullaris syndrome?
Conus medullaris syndrome has UMN signs i.e. hyperreflexia whereas cauda equina syndrome does not MGMT IS THE SAME (i.e. MRI with steroids and neurosurg cs)
Why would a pt with ADPKD have an enlarged liver? What is the MC cause of death in this dz?
Due to the liver cyts; Cardiovascular since it is basically ESRD (don?t pick ruptured berry aneurysm)
What would the electrolyte panel of a patient with adrenal crisis secondary to glucocorticoids look like?
Normal because RAAS is intact, only in autoimmune adrenalitis where there is a primary issue with the adrenals is this a problem with hyponatremia and hyperkalemia
What liver dz is assoc with xanthelasmas? What is the tx?
PBC (anti-AMA Ab); Ursodeoxycholic acid increases transplant free survival
Which drug improves time to tracheostomy and survival in a pt with amyotrophic lateral sclerosis? MOA?
Riluzole (glutamate inhibitor)
What are the two MC causes of epiglottitis?
S. pyogenes and H. influenzae
What is often the cause of ascending aortic aneurysms? Descending?
Cystic medial necrosis and connective tissue dz; Descending is more likely to be from atherosclerosis
What is the most likely cause of a holosystolic murmur at the apex of the heart in a pt with long standing CHF?
Stretching of the mitral annulus leading to MR
What is the best diagnostic step in gonococcal arthritis? TX?
PCR, Ceftriaxone
What cause of vision loss has boxcar segmentation of retinal veins on fundoscopy?
CRAO (Amaurosis Fugax)
What is the MC cause of pneumonia in AIDS?
Pneumococcus; esp. if CD4 count is normal
T/F: you should protein restrict patients with hepatic encephalopathy
False this increases mortality
Discuss the incidence of vertical transmission of HCV?
Very low, it is much higher with HBV
How is the presentation of central retinal vein occulsion different from central retinal artery occlusion?
CRVO is a subacute vision loss whereas CRAO (Amaurosis Fugax) is a very rapid and often transient loss of vision
How do you manage a pt with isoniazid induced hepatic injury?
If there is just a transaminitis then you can observe if the pt presents with overt hepatitis then you should DC the INH
What is the initial tx for DKA?
IV NS, REGULAR insulin and K
What is the best way to dx disseminated histoplasmosis? Tx
Serum or Urine antigen (NOT fungal blood cx); Itraconazole; Note if severe you do liposomal amphotericin B x 2 weeks and then itraconazole for a year
What is DOC for pregnant and lactating women with Lyme Dz in the rash stage? What about beyond that?
Amoxicillin; Ceftriaxone
What is the MC cause of vanishing bile duct syndrome? What is another cause
PBC as PSC causes fibrosis of the ducts not just ductopenia; GVHD S/P BMT can also cause vanishing duct syndrome
What are the common presenting signs of hepatitis?
Fatigue, malaise and nausea sometimes with hepatomegaly and RUQ tenderness or pain
Which membranoproliferative glomerulonephritis is assoc with C3 nephritic factor? What is this?
Type II; it is IgG against the C3 convertase of the alternate pathway of complement so there is constant activation of the complement pathway
What is a normal FiO2?
21% i.e. atmospheric O2 content
How do the adrenal suppression tests for hyperaldosteronism work?
There is a salt loading phase that shows inability to suppress aldosterone
What test can you do for an adult with recurrent infections whom you suspect a B cell problem?
Quantitative measurement of immunoglobulins
What can have momentary vision loss depending on positional changes?
Papilledema (check CT or MRI)
What other more common dz has spherocytes vs. hereditary spherocytosis? What test could differentiate?
Autoimmune Hemolytic anemia; Direct Coombs
What are fatty casts on UA suggestive of?
Nephrotic syndrome (i.e. it causes hyperlipidemia to bulk up the blood)
