UW6 Flashcards
What is the acid base status of an aspirin overdose?
Mixed Respiratory alkalosis and metabolic acidosis
What medical problem may be diagnosed by sending vitreous humor for culture?
Endophthalmitis (postop endophthalmitis is MC in US, i.e. after cataract removal) tx involves intravitreal abx if severe
What gets torn in Mallory-Weiss tears?
Submucosal arteries at GE jxn
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?
To prevent immune reconstitution syndrome
Why would a person with systemic sclerosis have elevated BP? What antibody is elevated?
Renal involvement will cause increase BP; Anti-Topoisomerase I
Where are bronchogenic cysts found if mediastinal?
Middle mediastinum
What are two labs that are increased in pagets dz?
Increased alk phos (the main one); increased urine hydroxyproline (a marker of bone degradation)
What is the best way to confirm a diagnosis of acute HIV?
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
What is the feared complication of vertebral osteomyelitis? How do you follow response to therapy in osteomyelitis once fever and sx have gotten better?
Progression to epidural abscess with spinal compression; ESR (i.e. if asymptomatic but ESR is elevating, the meds arent doing their job)
If a person had a hemolytic crisis for which you suspected G6PD, when is the best time to test and why?
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
Which DM pts should be on a statin
ALL PTS 45-75 regardless of baseline lipids should be on statin (target BP should be
T/F: the presence of deep tendon reflexes excludes brain death
False they are mediated by the spinal cord
How do you diagnose small bowel bacterial overgrowth?
EGD with a jejunal aspirate that shows greater than 10^5 organisms or positive hydrogen breath test
Which valvular disorder has a pulsus bisferiens?
AR (biphasic pulse) also has Austin-Flint murmur, Corrigan water hammer pulse, Duroziez’s sign, de Musset sign
Who gets antitopoisomerase I abs?
Systemic sclerosis (note, CREST is anti-centromere)
What are some good meds to increase appetite in pts with cancer related cachexia
Progesterone analogs apparently > marinol; i.e. medroxyprogesterone acetate and megestrol acetate
What is a very important to consider when differentiating normal changes of aging from dementia?
Dementia will impair daily functioning
Why is acetazolamide useful in pseudotumor cerebri?
Inhibits carbonic anhydrase in the choroid plexus
What should you think if a post op pt has dishwater discharge from the incision? Next step?
Necrotizing Surgical Site infection = get broad spec abx and surgical exploration
What kind of underlying disorders do pts with SIBO (Small Intestine Bacterial Overgrowth) usually have?
Some sort of motility disorder i.e. systemic fibrosis, DM, amyloidosis of gut
What are 4 risk factors for non-alcoholic steatohepatitis? What is the pathophys?
DM, HLD, obestiy and TPN; impaired response of fat cells to insulin with increased fat in the liver (i.e. increased peripheral lipolysis)
If you see elevated calcium what symptoms should you inquire your pt about having?
Ask if they have noticed constipation, polyuria, polydipsia
What kind of conjunctivitis can be txd with olapatadine?
Allergic, it is an antihistamine eyedrop
What are two ways in which TPN can cause cholecystitis?
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
What is the best way to prevent aki from acyclovir?
Fluid hydration (aggressive) to prevent it from precipitating in the tubules
Why does pancreatitis cause ARDS?
Due to release of phospholipase A2 into circulation (more generally, proteolytic enzymes are released and damage alveoli)
How do you treat pulmonary nocardiosis? What if it is disseminated to brain?
TMP-SMX; add carbapenems
What is the likely cause of a bright red, friable, exophytic nodule in an AIDS pt? Tx?
Bacillary angiomatosis (often look like pyogenic granuloma) caused by Bartonella henselae/quintana; Azithromycin
How is symptomatic sarcoidosis treated?
Steroids
How do you treat polymyalgia rheumatica? Giant cell arteritis?
Low dose glucocorticoids; high dose glucocorticoids (you do not need to have one to have the other)
What type of blood products could have prevented the sx of a BMT pt who gets colitis and pneumonitis?
Leukoreduced blood products to get rid of CMV containing monocytes
When can you treat pts with the flu with neuraminidase inhibitors (name 2)? How much do they help?
If the pt is presenting within 48 H of sx onset; Oseltamavir and zanamavir and they cut it down by 2-3 days duration
What are the preferred 2 drugs to use for HBV now?
Entacavir and tenofovir; they are able to be used in decompensated cirrhosis; if these are the options pick these over IFN alpha and ribavirn
In any woman with rapidly developing virilization what two hormones should you check?
Testosterone and DHEAS; if DHEAS elevated likely adrenocortical; if testosterone likely ovarian sertoli-leydig tumor; ALWAYS DO BIOCHEMICAL STUDIES BEFORE IMAGING
What is the likely cause of adrenal insufficiency in a pt with calcified adrenal glands?
TB; tx involves lifelong mineralocorticoid and glucocorticoid replacement
What does smoking in a pt with Grave’s increase the risk of?
Ophthalmopathy
What are the genetics of familial hypocalciuric hypercalcemia?
AD
What is the maximum rate at which hypnatremia should be corrected? Why
No more than 0.5 mEq/hr; prevent CPM
Tx of Cryptosporidium parvum
Nitazoxinide
What causes loss of pain and temp on the ipsilateral face and contralateral body with nystagmus and vertigo?
PICA STROKE i.e. lateral medullary syndrome (Wallenburg syndrome)
CPK levels greater than what are assoc with AKI
> 20,000
Name 3 inherited diseases that decrease the conjugation rate of bilirubin
Gilbert’s, Criggler-Najjar 1; Criggler Najjar II
Discuss the basic drugs given in the stages of asthma? What is an option if the parent doesnt want the kid to have steroids?
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
How do you prevent pregnancy loss in pts with antiphospholipid ab syndrome? What are the coagulation studies in these pts?
Get ASA and LMWH (enoxaparin); falsely elevated aPTT when they are actually hypercoagulable (where the name lupus anticoagulant originally came from)
What is the next best step in a pt with known SLE and a positive RPR?
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
What are the 4 indications for home O2 in COPD
SaO2 55% (secondary polycythemia); or evidence of cor pulmonale
What is the normal JVP
How do you treat bleeding in a pt with cirrhosis (i.e. due to elevated PT)
FFP; you don?t give vitamin K because the liver is so shot it cant use it anyway
Why is that in Cushing’s syndrome there is hypernatremia and hypokalemia?
Because corticosteroids (which are in excess) have some mineralocorticoid activity due to structural similarity and bind to aldosterone receptors in DCT
What are 3 criteria to treat chonic HCV with ifn alpha and ribavirin
If a viral load is detectable; If INR
What is the most beneficial treatment to prevent progression of DM nephropathy?
BP control with ACEI to goal of 140/90 if no nephropathy or under 130/80 if nephropathy present
What is the utility of the urinary calcium:creatinine clearance when comparing familial hypocalciuric hypercalcemia to primary hyperparathyroidism?
0.02 in hyperparathyroidism
How is hereditary spherocytosis inherited?
AD
What psychotropic medication can be used to improve appetite in CA pts? AE?
Mirtazepine; agranulocytosis (also clozapine, carbemazepine, thionoamides)
How do you treat dermatitis herpetiformis?
Adherence to gluten free diet and dapsone
What is induction therapy for cryptococcal meningitis? What if the pt fails that?
Amphotericin B and Flucytosine; Salvage therapy with intrathecal amphotericin B
Explain the dosage considerations of a woman starting OCP’s who also has pmhx of Hashimotos
May need increased dose of levothyroxine as estrogen increases TBG just like in pregnancy
What is the next step diagnostically in a pt presenting with SVC syndrome? What are some infectious causes?
CXR to see what’s going on; TB and Hisoplasmosis can cause fibrosing mediastinitis; most common cause is neoplasm
Why should you get an echocardiogram in suspected ARDS?
Need to rule out a cardiogenic cause since it looks a lot like decompensated CHF on CXR
When does gait impairment occur in normal pressure hydrocephalus vs. Alzheimers
Early in NPH and late in Alzheimers
When does vitiligo tend to present? What antibodies are present?
20s and 30s; anti-melanocyte ab
Where are all neurogenic tumors of the mediastinum located?
Posterior mediastinum
What is a good drug to give in a suicide attempt with bradycardia, AV block, hypotension, and diffuse wheezing?
Glucagon as it may be a BB overdose (Note that first line for symptomatic bradycardia is still going to be Atropine and IVF)
What is the treatment for cryptococcal meningitis?
Induction tx = Amphotericin B and Flucytosine; Consolidation Tx = Fluconazole
Why may pts with advanced dementia get recurrent aspiration PNA?
They tend to have epiglottic dysfunction
When do primary relatives of a pt with colon CA get screened?
At 40 or 10 years prior to the age of the person dx with colon CA whichever comes first
What should you think if a pt had AMI and now is s/p PCI and develops levido reticularis?
Likely from atheroembolism, can see blue toe syndrome as well
Discuss imaging in pyelonephritis?
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
How is alanine used in gluconeogenesis?
Gets converted to pyruvate
What is the number one form of endophthalmitis in the US? Tx?
Postoperative Endophthalmitis i.e. s/p cataract removal; if severe then you can give intravitreal Abx
How many blood cultures should be positive to dx endocarditis? When do you start abx?
3 from different sites; AFTER the blood cx
What are two causes of hypercoagulability in nephrotic syndrome?
Loss of antithrombin III in the kidneys and hepatic overproduction of fibrinogen
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)
IgA anti-endomysial; IgA anti-tissue transglutaminase; if negative but suspicion is high check total serum IgA to rule out IgA def
What is the MC cause of nursing home pneumonia?
Streptococcus pneumoniae; however, this is still HCAP and should be treated as such
T/F: corticosteroids and serial LP are used for maintenance tx in Idiopathic Intracranial HTN
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
Explain the mixed venous O2 levels in septic shock
They are elevated because of cytopathic hypoxia; the cells are unable to use O2 because there is mitochondrial damage
When do you consider surgery in endocarditis? (3)
If valvular dysfunction present; difficult to tx with Abx (medically refractory); or if there are recurrent septic emboli as Abx should decrease embolization
What is the best way to dx leprosy?
Skin bx showing acid fast bacilli
Improvement of lesions after starting dapsone is a diagnostic criterion for what autoimmune phenomenon?
Dermatitis herpetiformis (IgA deposits at dermal papillae)
