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STEP 2 > UW6 > Flashcards

UW6 Flashcards

1
Q

What is the acid base status of an aspirin overdose?

A

Mixed Respiratory alkalosis and metabolic acidosis

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1
Q

What medical problem may be diagnosed by sending vitreous humor for culture?

A

Endophthalmitis (postop endophthalmitis is MC in US, i.e. after cataract removal) tx involves intravitreal abx if severe

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2
Q

What gets torn in Mallory-Weiss tears?

A

Submucosal arteries at GE jxn

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3
Q

Why should HAART therapy be delayed for 2 weeks in a pt who was not in who is now dx’d with new cryptococcal meningitis being treated with antifungals?

A

To prevent immune reconstitution syndrome

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3
Q

Why would a person with systemic sclerosis have elevated BP? What antibody is elevated?

A

Renal involvement will cause increase BP; Anti-Topoisomerase I

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3
Q

Where are bronchogenic cysts found if mediastinal?

A

Middle mediastinum

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3
Q

What are two labs that are increased in pagets dz?

A

Increased alk phos (the main one); increased urine hydroxyproline (a marker of bone degradation)

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3
Q

What is the best way to confirm a diagnosis of acute HIV?

A

Viral load i.e. PCR since antibodies not made yet; same as if you want to exclude in a kid born to HIV mom since he will have her Abs and ELISA can be falsely positive

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3
Q

What is the feared complication of vertebral osteomyelitis? How do you follow response to therapy in osteomyelitis once fever and sx have gotten better?

A

Progression to epidural abscess with spinal compression; ESR (i.e. if asymptomatic but ESR is elevating, the meds arent doing their job)

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3
Q

If a person had a hemolytic crisis for which you suspected G6PD, when is the best time to test and why?

A

You should treat supportively and test G6PD activity 3 months later since G6PD is present in reticulocytes in high concentrations and in a pt who is acutely hemolyzing RBCs there will be a reticulocytosis so G6PD may be spuriously normal

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3
Q

Which DM pts should be on a statin

A

ALL PTS 45-75 regardless of baseline lipids should be on statin (target BP should be

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4
Q

T/F: the presence of deep tendon reflexes excludes brain death

A

False they are mediated by the spinal cord

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5
Q

How do you diagnose small bowel bacterial overgrowth?

A

EGD with a jejunal aspirate that shows greater than 10^5 organisms or positive hydrogen breath test

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6
Q

Which valvular disorder has a pulsus bisferiens?

A

AR (biphasic pulse) also has Austin-Flint murmur, Corrigan water hammer pulse, Duroziez’s sign, de Musset sign

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7
Q

Who gets antitopoisomerase I abs?

A

Systemic sclerosis (note, CREST is anti-centromere)

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7
Q

What are some good meds to increase appetite in pts with cancer related cachexia

A

Progesterone analogs apparently > marinol; i.e. medroxyprogesterone acetate and megestrol acetate

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9
Q

What is a very important to consider when differentiating normal changes of aging from dementia?

A

Dementia will impair daily functioning

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9
Q

Why is acetazolamide useful in pseudotumor cerebri?

A

Inhibits carbonic anhydrase in the choroid plexus

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10
Q

What should you think if a post op pt has dishwater discharge from the incision? Next step?

A

Necrotizing Surgical Site infection = get broad spec abx and surgical exploration

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11
Q

What kind of underlying disorders do pts with SIBO (Small Intestine Bacterial Overgrowth) usually have?

A

Some sort of motility disorder i.e. systemic fibrosis, DM, amyloidosis of gut

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12
Q

What are 4 risk factors for non-alcoholic steatohepatitis? What is the pathophys?

A

DM, HLD, obestiy and TPN; impaired response of fat cells to insulin with increased fat in the liver (i.e. increased peripheral lipolysis)

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13
Q

If you see elevated calcium what symptoms should you inquire your pt about having?

A

Ask if they have noticed constipation, polyuria, polydipsia

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13
Q

What kind of conjunctivitis can be txd with olapatadine?

A

Allergic, it is an antihistamine eyedrop

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14
Q

What are two ways in which TPN can cause cholecystitis?

A

It can cause gallbladder stasis since the GI tract is out of commision leading to gallstone formation and cholecystitis; it can also predispose a pt to acalculous cholecystitis

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15
Q

What is the best way to prevent aki from acyclovir?

A

Fluid hydration (aggressive) to prevent it from precipitating in the tubules

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16
Q

Why does pancreatitis cause ARDS?

A

Due to release of phospholipase A2 into circulation (more generally, proteolytic enzymes are released and damage alveoli)

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18
Q

How do you treat pulmonary nocardiosis? What if it is disseminated to brain?

A

TMP-SMX; add carbapenems

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19
Q

What is the likely cause of a bright red, friable, exophytic nodule in an AIDS pt? Tx?

A

Bacillary angiomatosis (often look like pyogenic granuloma) caused by Bartonella henselae/quintana; Azithromycin

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20
Q

How is symptomatic sarcoidosis treated?

A

Steroids

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21
Q

How do you treat polymyalgia rheumatica? Giant cell arteritis?

A

Low dose glucocorticoids; high dose glucocorticoids (you do not need to have one to have the other)

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23
Q

What type of blood products could have prevented the sx of a BMT pt who gets colitis and pneumonitis?

A

Leukoreduced blood products to get rid of CMV containing monocytes

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24
Q

When can you treat pts with the flu with neuraminidase inhibitors (name 2)? How much do they help?

A

If the pt is presenting within 48 H of sx onset; Oseltamavir and zanamavir and they cut it down by 2-3 days duration

25
Q

What are the preferred 2 drugs to use for HBV now?

A

Entacavir and tenofovir; they are able to be used in decompensated cirrhosis; if these are the options pick these over IFN alpha and ribavirn

26
Q

In any woman with rapidly developing virilization what two hormones should you check?

A

Testosterone and DHEAS; if DHEAS elevated likely adrenocortical; if testosterone likely ovarian sertoli-leydig tumor; ALWAYS DO BIOCHEMICAL STUDIES BEFORE IMAGING

27
Q

What is the likely cause of adrenal insufficiency in a pt with calcified adrenal glands?

A

TB; tx involves lifelong mineralocorticoid and glucocorticoid replacement

29
Q

What does smoking in a pt with Grave’s increase the risk of?

A

Ophthalmopathy

29
Q

What are the genetics of familial hypocalciuric hypercalcemia?

A

AD

29
Q

What is the maximum rate at which hypnatremia should be corrected? Why

A

No more than 0.5 mEq/hr; prevent CPM

30
Q

Tx of Cryptosporidium parvum

A

Nitazoxinide

31
Q

What causes loss of pain and temp on the ipsilateral face and contralateral body with nystagmus and vertigo?

A

PICA STROKE i.e. lateral medullary syndrome (Wallenburg syndrome)

33
Q

CPK levels greater than what are assoc with AKI

A

> 20,000

35
Q

Name 3 inherited diseases that decrease the conjugation rate of bilirubin

A

Gilbert’s, Criggler-Najjar 1; Criggler Najjar II

36
Q

Discuss the basic drugs given in the stages of asthma? What is an option if the parent doesnt want the kid to have steroids?

A

1) Mild intermittent gets SABA 2) Mild persistent gets SABA + low dose glucocorticoid (or montelukast) 3) Moderate persistent gets SABA low dose gluc and now add LABA 4) Severe persistent gets SABA, LABA and now high dose glucocorticoid

37
Q

How do you prevent pregnancy loss in pts with antiphospholipid ab syndrome? What are the coagulation studies in these pts?

A

Get ASA and LMWH (enoxaparin); falsely elevated aPTT when they are actually hypercoagulable (where the name lupus anticoagulant originally came from)

39
Q

What is the next best step in a pt with known SLE and a positive RPR?

A

FTA-ABS (confirmatory test for syphilis); just because it is known that there tend to be false positives you still get the more specific test don?t want to miss lupus

40
Q

What are the 4 indications for home O2 in COPD

A

SaO2 55% (secondary polycythemia); or evidence of cor pulmonale

41
Q

What is the normal JVP

A
42
Q

How do you treat bleeding in a pt with cirrhosis (i.e. due to elevated PT)

A

FFP; you don?t give vitamin K because the liver is so shot it cant use it anyway

44
Q

Why is that in Cushing’s syndrome there is hypernatremia and hypokalemia?

A

Because corticosteroids (which are in excess) have some mineralocorticoid activity due to structural similarity and bind to aldosterone receptors in DCT

45
Q

What are 3 criteria to treat chonic HCV with ifn alpha and ribavirin

A

If a viral load is detectable; If INR

46
Q

What is the most beneficial treatment to prevent progression of DM nephropathy?

A

BP control with ACEI to goal of 140/90 if no nephropathy or under 130/80 if nephropathy present

47
Q

What is the utility of the urinary calcium:creatinine clearance when comparing familial hypocalciuric hypercalcemia to primary hyperparathyroidism?

A

0.02 in hyperparathyroidism

48
Q

How is hereditary spherocytosis inherited?

A

AD

49
Q

What psychotropic medication can be used to improve appetite in CA pts? AE?

A

Mirtazepine; agranulocytosis (also clozapine, carbemazepine, thionoamides)

50
Q

How do you treat dermatitis herpetiformis?

A

Adherence to gluten free diet and dapsone

52
Q

What is induction therapy for cryptococcal meningitis? What if the pt fails that?

A

Amphotericin B and Flucytosine; Salvage therapy with intrathecal amphotericin B

53
Q

Explain the dosage considerations of a woman starting OCP’s who also has pmhx of Hashimotos

A

May need increased dose of levothyroxine as estrogen increases TBG just like in pregnancy

54
Q

What is the next step diagnostically in a pt presenting with SVC syndrome? What are some infectious causes?

A

CXR to see what’s going on; TB and Hisoplasmosis can cause fibrosing mediastinitis; most common cause is neoplasm

56
Q

Why should you get an echocardiogram in suspected ARDS?

A

Need to rule out a cardiogenic cause since it looks a lot like decompensated CHF on CXR

57
Q

When does gait impairment occur in normal pressure hydrocephalus vs. Alzheimers

A

Early in NPH and late in Alzheimers

58
Q

When does vitiligo tend to present? What antibodies are present?

A

20s and 30s; anti-melanocyte ab

60
Q

Where are all neurogenic tumors of the mediastinum located?

A

Posterior mediastinum

61
Q

What is a good drug to give in a suicide attempt with bradycardia, AV block, hypotension, and diffuse wheezing?

A

Glucagon as it may be a BB overdose (Note that first line for symptomatic bradycardia is still going to be Atropine and IVF)

62
Q

What is the treatment for cryptococcal meningitis?

A

Induction tx = Amphotericin B and Flucytosine; Consolidation Tx = Fluconazole

63
Q

Why may pts with advanced dementia get recurrent aspiration PNA?

A

They tend to have epiglottic dysfunction

65
Q

When do primary relatives of a pt with colon CA get screened?

A

At 40 or 10 years prior to the age of the person dx with colon CA whichever comes first

66
Q

What should you think if a pt had AMI and now is s/p PCI and develops levido reticularis?

A

Likely from atheroembolism, can see blue toe syndrome as well

67
Q

Discuss imaging in pyelonephritis?

A

Because it can lead to perinephric abscess you start with IV broad spectrum abx and often don?t need to image; if clinical status doenst improve in 48-72 hours could be a perinephric abscess so get CT

68
Q

How is alanine used in gluconeogenesis?

A

Gets converted to pyruvate

70
Q

What is the number one form of endophthalmitis in the US? Tx?

A

Postoperative Endophthalmitis i.e. s/p cataract removal; if severe then you can give intravitreal Abx

71
Q

How many blood cultures should be positive to dx endocarditis? When do you start abx?

A

3 from different sites; AFTER the blood cx

72
Q

What are two causes of hypercoagulability in nephrotic syndrome?

A

Loss of antithrombin III in the kidneys and hepatic overproduction of fibrinogen

73
Q

What are the usual antibodies to be seen in Celiac Dz (2)? What if these are negative but clinical suspicion is high (and there is villous atrophy)

A

IgA anti-endomysial; IgA anti-tissue transglutaminase; if negative but suspicion is high check total serum IgA to rule out IgA def

74
Q

What is the MC cause of nursing home pneumonia?

A

Streptococcus pneumoniae; however, this is still HCAP and should be treated as such

75
Q

T/F: corticosteroids and serial LP are used for maintenance tx in Idiopathic Intracranial HTN

A

False they may be used as bridging mechanisms but really you tx with avoidance of provocative meds, weight loss and acetazolamide with or without furosemide

76
Q

Explain the mixed venous O2 levels in septic shock

A

They are elevated because of cytopathic hypoxia; the cells are unable to use O2 because there is mitochondrial damage

77
Q

When do you consider surgery in endocarditis? (3)

A

If valvular dysfunction present; difficult to tx with Abx (medically refractory); or if there are recurrent septic emboli as Abx should decrease embolization

78
Q

What is the best way to dx leprosy?

A

Skin bx showing acid fast bacilli

79
Q

Improvement of lesions after starting dapsone is a diagnostic criterion for what autoimmune phenomenon?

A

Dermatitis herpetiformis (IgA deposits at dermal papillae)

STEP 2 (13 decks)

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