UW5 Flashcards
What acid base disorder would a pt with cyanide toxicity have? Why?
Lactic acidosis (metabolic acidosis) because the cyanide inhibits the electron transport chain so everything goes into lactic acid fermentation
What is the most important prognosticator of TCA overdose?
Length of the QRS
What is the general mgmt of myasthenia crisis?
ABC’s then (plasmapheresis OR IVIG) + Steroids; HOLD anticholinesterases in this setting to prevent resp. secretions and worsening resp. status
Which renal syndrome is assoc with Hodgkin lymphoma? Which is assoc with solid organ tumors (carcinomas)?
Minimal change dz; membranous nephropathy
What is the treatment for cyanide toxicity?
Sodium thiosulfate and HYDROXYcobalamin (why give cyanocobalamin! It has cyanide!)
What is Charcot’s triad? Reynold’s pentad?
RUQ pain, Fever, jaundice; same + MS changes and shock
What if a person with AIDS has ring enhancing lesion with EBV in the CSF?
Primary CNS lymphoma (DLBCL) tx is CHOP or RCHOP (or in theory, EPOCH)
Allopurinol can be used prophylactically for urate nephropathy but what kidney issue can it cause?
Interstitial nephritis
When do pts with masked primary hyperaldosteronism often first develop hypokalemia?
When placed on diuretics
An abnormal D-xylose test (i.e. low serum and urine concentrations after ingestion) indicates what?
Malabsorption (small bowel) since it is absorbed in proximal small bowel via passive diffusion
What 2 antibodies are present in most pts with Hashimoto’s?
Anti-thyroid peroxidase and Anti-thryoglobulin
What is a major distinguishing factor between osteoporosis and osteomalacia in terms of symptoms?
Osteomalacia usually has bone pain whereas osteoporosis does not; osteomalacia also has pseudofractures (looser zones)
What is the number 1 form of drug induced CKD?
Analgesic nephropathy (tubulointersitial nephritis)
Aside from porphyria cutanea tarda, what other skin disorder is HCV assoc with?
Lichen planus
Why may dermatomyositis be “associated with malignancy”?
Because it can be a paraneoplastic syndrome
What is more common to see on renal bx of DM nephropathy, diffuse glomerular sclerosis or nodular glomerulosclerosis?
Diffuse is more common but nodular (Kimmelstiel Wilson nodules) are pathognomonic
For every 1 point drop in albumin how much does the serum calcium drop?
0.8 but recall that you need to correct the calcium
What is a reentrant ventricular arrhythmia?
Essentially ventricular fibrillation!
Why should you look for sx of fatigue, dry skin, and constipation in a pt just started on amiodarone?
It can cause hypothyroidism (note it can also cause hyperthryoidism)
Which valvular disease commonly has hemoptysis?
MS
How is Trichinella spiralis often transmitted?
From pork or bear meat; encysts in muscle causes myalgias with peripheral eosinophilia often preceded by intestinal sx; can have splinter hemorrhages
What is required in all pts with newly dx’d lupus nephritis and why?
Renal biopsy because the treatment is different by stage (Class I = minimal mesangial; Class IV = advanced sclerosis i.e. wire-looping)
If a person is on PDE-5 inhibitor and alpha blockers how would you advise the pt to take them?
Have at least a 4 HOUR INTERVAL to decrease the risk of hypotension; PDE5 inh are CI with nitrates though!
What pulmonary-renal syndrome may be associated with pyoderma gangrenosum?
Wegeners
What TB drug can cause interstitial nephritis? Describe the casts?
Rifampin; WBC casts with eosinophils
What is often the clinical scenario in which ascending cholangitis develops? Potential complication?
Choledocolithiasis since there is no where to go but up; Pyogenic liver abscess
How do you treat exercise induced asthma?
B2 agonists 30 min prior to exercise NOT ipratropium
Describe necrolytic migratory erythema and what else you’d expect them to present with
Erythematous papules and plaques often assoc with mild hyperglycemia (“DM II”) due to increased hepatic production from the glucagon stimulation; weight loss and diarrhea too
Lynch Syndrome II increases the risk of which cancers?
Colon and Endometrial
How is the treatment of stomach CA guided?
By stage; limited stage gets surgical resection and more widespread gets chemo and palliative surgery; so after dx get a CT
What is the difference between interstitial nephritis and chronic tubulointerstitial nephritis?
Interstitial nephritis is essentially an allergic rxn; chronic tubulointerstitial is a form of CKD due to analgesics both have WBC casts (not to confuse with pyelonephritis)
What are the PTH levels in hypercalcemia of malignancy?
Suppressed (unless of course, the cause was parathyroid carcinoma)
What is DOC for cat bites? Human bites? Dog bites?
AMOXICILLIN-CLAVULANATE
What are the contraindications for radioactive iodine ablative tx?
Pregnancy is the main one (severe ophthalmopathy but don?t read too much into this)
What kind of study is best for studying the incidence of a disease?
Cohort study
What is removed in radical orchiectomy?
Testis and spermatic cord not just testis; via high-inguinal incision
What is the study of choice for Zenker’s
Barium esophagogram
What are 3 interventions that can help with uremic bleeding?
DDAVP, Cryoprecipitate, and CONJUGATED ESTROGENS
HCV is classically assoc with blood products from before what year?
1992
What is the MC cause of mitral regurgitation in developed countries?
MVP
How do you treat central retinal artery occlusion in first 4-6 hours? After?
tPa; Ocular massage (dislodge the thrombus) and High flow O2
In a pt with pleural plaques from asbestosis what would be the cause of breathing problems?
Interstitial lung disease, the plaques are just there not the cause of the dyspnea
What should be suspected in a pt with post-cholecystectomy syndrome in which no stones are found on ERCP? Tx?
Sphincter of Oddi dysfunction; tx is sphincterotomy during the ERCP
What is the most likely group to develop emphysematous cholecystitis?
Elderly diabetics; often the bugs are clostridial
Name 2 common causes of drug induced esophagitis
Potassium chloride (PO) and Bisphosphonates, I believe Iron tablets can do it too
What is porphyria cutanea tarda assoc with? What does it present like?
HCV; Vesicles and photosensitivity
A young woman with anterior knee pain when climbing stairs probs has what? Tx?
Patellofemoral syndrome; Exercises to strengthen thigh muscles
What is the tx of PML?
None the pts die in about 6 months
Why would a pt with ankylosing spondylitis for several years possibly develop restrictive lung dz?
Diminished chest wall and spinal mobility
What is the corrected calcium equation?
(Measured total calcium + 0.8(4 - serum albumin)
What is a big thing to consider when the ddx includes RA and paravoviral arthritis?
TIME; RA needs to be present for 6 weeks whereas parvovirus is more acute
When someone is diagnosed with hereditary hemochromatosis? What is an important clinical question to ask?
IS THERE END ORGAN DAMAGE?? i.e. cardiomyopathy, diabetes, etc.
What do progressive multifocal leukencephalopay lesions look like on MRI or CT?
THEY ARE NON CONTRAST ENHANCING
Why does alcohol precipitate gout?
Metabolized to lactate and competes with urate in kidney (pct)
Why does AS cause exertional syncope?
Because you cannot increase your cardiac output to meet the demands of exercise
What electrolyte abnormality should you watch out for in a pt being treated for severe asthma attack?
Hypokalemia (B2 agonists pull K into the cell)
What is the mechanism by which bence jones proteins cause CKD
Tubular obstruction of distal tubules
What ist he pathophys of presbyopia?
decreased elasticity of the lens
Describe the vision loss in age related macular degeneration
Central vision loss mostly
What may be seen on CXR for LA enlargement?
Elevation of L mainstem bronchus
What is the eponym for multiple myeloma?
Kahlers dz
What causes NPH?
Decreased CSF absorption by arachnoid granulations; do CT first then LP
What is the temporizing treatment of constrictive pericarditis? Permanent?
Diuretics; Pericardiectomy
What is the worst prognosticator in HAV infection
Increasing PT – this can be an indicator of fulminant hepatic failure (development of encephalopathy within 8 d of acute liver injury)
