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STEP 2 > UW8 > Flashcards

UW8 Flashcards

1
Q

What is a common GI toxicity of valproate?

A

Pancreatitis

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1
Q

What are the effects of lidocaine on vfib and asystole?

A

Decreases rates of vfib in ACS, increases risks of asystole

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1
Q

What is the empiric mgmt of of meningitis from 2-50? Age > 50?

A

Vancomycin and Ceftriaxone, in kids younger you’d add ampicillin; Ampicillin, Vancomycin, and Ceftriaxone

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1
Q

What is the best tx for acute rejection?

A

IV Corticosteroids

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1
Q

T/F: Aspirin mediated respiratory dz is an allergic rxn

A

False it is NOT IgE mediated, it is related to increased leukotrienes and can be treated with montelukast

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1
Q

Whereas in asthma you add low dose glucocorticoids to SABA, in COPD you add _____

A

Ipratropium; also, staging in COPD is based on FEV1 not sx

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1
Q

What is the name of the scoring system that decides whether to tx CAP as an inpatient? Tx?

A

CURB-65; IV respiratory quinolone or beta lactam + macrolide

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2
Q

What is MC cause of slowly progressive vision loss in pt with axillary freckling and caf? au lait spots

A

Optic glioma

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2
Q

How do you treat metastatic esophageal ca

A

Chemotherapy; no role for surgery

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2
Q

What may precede a PNA with S. aureus?

A

Influenza

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2
Q

What stain will show Bartonella on a Bx of the bubo?

A

Warthin Starry stain; Tx is azithromycin

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3
Q

How would the presentation of an anaphylactic transfusion reaction differ from TRALI?

A

Anaphylactic transfusion rxn (often assoc. with IgA def) would present much sooner, TRALI tends to present 6 hrs after and looks like ARDS

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3
Q

What is the most serious AE of the thionoamides?

A

Agranulocytosis

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4
Q

What is the most likely cause of elevated Ca and PTH in a pt with CKD

A

PRIMARY hyperparathyroidism; in secondary the Ca is actually normal or even low

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5
Q

What is Riley-Day syndrome?

A

Familial dysautonomia; it is like Shy Drager but does not have parkonsonism, and occurs in Ashkenzi jews with AR genetics

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6
Q

What is the likely cause of torticollis in a pt being treated for gastroparesis?

A

Metoclopromide dystonic reaction

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8
Q

What is the next best step for fever in a pt with ascites? Empiric tx?

A

Diagnostic paracentesis; 3rd generation cephalosporin

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9
Q

What should you be thinking for a unilateral varicocele that fails to empy when pt is supine?

A

Obstruction i.e. RCC; CT scan is best test to dx RCC

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10
Q

What 2 tests can confirm the dx of myasthenia gravis?

A

EMG and Acetylcholine receptor Ab test

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11
Q

What antibodies are assoc with polymyositis? What else is elevated? What is the definitive way to dx?

A

Anti-Jo-1 ab also has elevated CK and aldolase; definitive dx by muscle bx

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12
Q

What are the 2 best ways to prevent contrast nephropathy?

A

NS or isotonic bicarbonate (apparently so can acetylcysteine)

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13
Q

T/F choriocarcinoma can only occur after a molar pregnancy

A

False it can occur after a normal pregnancy and can also occur from ovarian or testicular tumors

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14
Q

Why might the initial presentation of sarcoidosis be from shin pain?

A

Erythema nodosum

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16
Q

What is the effect of pleural effusion on tactile fremitus? Consolidation?

A

Decreased; increased? Sounds travel faster through solids than liquids

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17
Q

What are the mammogram guidelines from 40-50? 50-75?

A

Annualy; Biannualy

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19
Q

What maneuver diagnoses benign paroxysmal vertigo? Which treats it? What is the cause?

A

Dix-Hallpike maneuver, Epley maneuver, semicircular canal dysfunction

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21
Q

What should be suspected in any pt with history of malignancy presenting with new onset leg weakness?

A

Neoplastic epidural spinal cord compression

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21
Q

What may you see in the lungs in a pt with endocarditis? What if you started antibiotics and 2 days later they had acute arterial occlusion of the leg?

A

Nodular lung infiltrates (septic emboli; i.e. the pt is still embolizing after abx is an indication for surgery

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22
Q

On colonoscopy what should you think if you see brown discoloration with lymph follicles shining through?

A

Melanosis coli from laxative abuse

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24
Q

How do you treat cocaine associated chest pain?

A

Benzodiazepines; BB’s are actually CI because it could lead to unopposed alpha stimulation and hypertensive emergency

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25
Q

Why would a person with intolerance to ASA complain of bland tasting foods?

A

They often have nasal polyps that occlude the nares

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25
Q

What lab should you check in a pt with RLS? Tx?

A

Ferritin (

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26
Q

What is seen on KOH prep of tinea versicolor? Tx?

A

Spaghetti and meatballs; Selenium sulfide or ketoconazole

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27
Q

If you give EPO and precipitate an Fe def anemia what is the best tx?

A

IV iron dextran

28
Q

How do you manage spontaneous conjunctival hemorrhage?

A

Just observe, no further workup needed

29
Q

Explain why statins cause myositis

A

Although they inhibit production of cholesterol, they also inhibit production of Coenzyme Q10 which is important for production of energy in muscles, leads to myositis

29
Q

What should you suspect in a pt who was in the OR and got a rash and became hypotensive?

A

Latex allergy (would give IM epinephrine 1:1000)

31
Q

How is essential tremor inherited?

A

AD

32
Q

What is the best screening test if suspect hemochromatosis? Confirmatory?

A

Serum iron studies; PCR for HFE gene

33
Q

What should you suspect in a pt with hx of RA who develops nephrotic syndrome?

A

AA amyloidosis

34
Q

If a pt swallowed a buncha pills and has tinnitus, fever, and tachypnea what did the probs take?

A

Aspirin

36
Q

Where is the HMG CoA reductase enzyme located?

A

Intracellularly. Converts HMG CoA to mevalonate

38
Q

Why would a patient with PE have paresthesias and carpopedal spasm?

A

Because the pt has a respiratory alkalosis and alkalotic states cause calcium to bind more avidly to albumin

39
Q

How do you manage a pt who has needle stick from HIV positive host?

A

Post exposure ppx is immediate 3 drug regimen for 4 weeks (i.e. emtracitabine, tenofovir, and raltegravir)

42
Q

What effect may hypothyroidism have on muscle reflexes

A

Delayed relaxation of muscle reflexes

43
Q

What are 2 drugs that often trigger asthma that are used in AMI?

A

BB and ASA

44
Q

How can you assess the extent of dz in Paget’s?

A

Bone scan

45
Q

How do you tx warfarin associated intracranial hemorrhage?

A

Prothrombin Complex Concentrate and vitamin K; if unavailable then FFP and vitamin K

46
Q

Which type of dementia presents with a stepwise decline in executive functioning with mild memory loss early in the dz

A

Vascular dementia

47
Q

What is Shy-Drager syndrome? Tx?

A

Multi-system atrophy; parkonsonism with autonomic dysfunction; Tx is aimed at increasing the intravascular volume and giving fludricortisone and alpha agonists

48
Q

What effect may broad spectrum abx have on coagulation panel?

A

Increased PT from decreased vitamin K absorption

49
Q

What is the MC cause of AL amyloidosis? AA?

A

Multiple Myeloma; RA

50
Q

How do you tx sustained monomorphic ventricular tachycardia in unstable pt? Stable?

A

Cardioversion; Amiodarone

51
Q

What is the CURB-65 for admission to hospital in pt with CAP

A

Confusion, Uremia (BUN > 20), Tachypnea (> 30), Hypotension (

52
Q

What are “Protean Manifestations” of sarcoidosis

A

Things like erythema nodosum

53
Q

How do you treat hepatorenal syndrome

A

Liver transplant but in the meantime can try octreotide, midodrine, or norepinephrine; hepatorenal syndrome is prerenal but does NOT respond to fluids

55
Q

What screening test should be done after confirmation of myasthenia gravis?

A

CT chest to rule out thymoma

56
Q

What is the screening test for gastrinoma? Confirmatory test?

A

Fasting gastrin > 1000; Secretin stimulation test

58
Q

What is an important cause of refractory hypocalcemia?

A

Hypomagnesemia also causes refractory hypokalemia! Hypmagnesemia causes PTH resistance and decreased PTH levels

59
Q

What are the most important first steps when suspect spinal compression?

A

IV glucocorticoids and MRI of spine while awaiting neurosurgery consult

60
Q

What is the connection with hemochromatosis and joint pain?

A

Tends to be associated with pseudogout and chondrocalcinosis

61
Q

What would you expect to happen to total T3 and T4 in pregnancy? Cirrhosis?

A

Increase due to increased TBG; Decrease due to decreased TBG; note that the free T4 may be unchanged

63
Q

What is the most common cause of splenic abscess? Tx

A

Hematogenous spread from another source such as infective endocarditis; IV abx and splenectomy as IV abx are not enough

64
Q

How is CO2 narcosis often caused in the inpatient setting?

A

in COPD pts whose O2 sats are too high i.e. more than 88-92 because will decrease their respiratory drive and will further trap CO2

65
Q

What should you suspect in a pt with chronic pancreatitis who gets abdominal pain and weight loss? Dx test?

A

pancreatic cancer; CT scan

66
Q

Why do alkalotic states cause hypocalcemia?

A

They cause Ca to bind more avidly to albumin

67
Q

What is the next best step in PEA or Asystole

A

Start chest compressions! Then give pressors to maintain coronary and cerebral perfusion

68
Q

How can you you confirm a diagnosis of amyloidosis?

A

Abdominal fat pad aspiration

69
Q

What do positive predictive value and negative predictive value depend on?

A

The prevalance! PPV increases with increased prevalance

70
Q

T/F oligoclonal bands are diagnostic for MS

A

False they only support the dx; MRI confirms it

71
Q

What kind of bias is introduced into a study when subjects are lost to follow up

A

Attrition bias a form of selection bias

72
Q

How do you tx ethylene glycol ingestion? What if there is severe organ damage?

A

Fomepizole to inhibit alcohol dehydrogenase and NaHCO3 to alleviate acidosis; HD i.e. if refractory to meds and getting worse

73
Q

What is seen on EEG of CJD

A

Sharp, triphasic, and synchronous discharges

74
Q

What is the only live vaccine that is ok to give in AIDS?

A

MMR but only if CD4 > 200

75
Q

What should you consider in a pt with severe orthostasis and parkinsonian traits? Tx?

A

Shy Drager syndrome; Fluid replacement with fludricortisone and alpha agonists

76
Q

What are the diagnostic tests for cryptococcal meningitis? Tx?

A

India ink stain of CSF, cryptococcal antigen testing (latex agglutination); Amphotericin B IV with flucytosine followed by consolidation with fluconazole; if fail then salvage tx is intrathecal amphotericin B

77
Q

Which type of diuretic has unfavorable metabolic AE?

A

Thiazides

78
Q

What is the best test to technically confirm sideroblastic anemia?

A

Bone marrow bx showing ringed sideroblasts

79
Q

If a pt with aspirin induced respiratory disease had ACS what would you give?

A

Clopidogrel

80
Q

How do you work up acute urinary incontinence in the elderly?

A

UA and UC first since acutely may be secondary to UTI; if tx underlying infxn it often gets better

81
Q

What is the hemoglobin threshold for transfusion in a pt with active ischemia?

A

9

82
Q

What is the most likely cause of hypokalemia in cirrhosis?

A

The fact that the person is on diuretics for their ascites

83
Q

What is the DOC for restless leg syndrome? MOA?

A

Pramipexole; DA agonist

STEP 2 (13 decks)

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