UW8 Flashcards by Joe Cioccio

What is a common GI toxicity of valproate?

Pancreatitis

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What are the effects of lidocaine on vfib and asystole?

Decreases rates of vfib in ACS, increases risks of asystole

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

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

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What is the best tx for acute rejection?

IV Corticosteroids

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

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

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

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

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

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

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

Optic glioma

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How do you treat metastatic esophageal ca

Chemotherapy; no role for surgery

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What may precede a PNA with S. aureus?

Influenza

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

Warthin Starry stain; Tx is azithromycin

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

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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What is the most serious AE of the thionoamides?

Agranulocytosis

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

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

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What is Riley-Day syndrome?

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

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

Metoclopromide dystonic reaction

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

Diagnostic paracentesis; 3rd generation cephalosporin

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

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

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What 2 tests can confirm the dx of myasthenia gravis?

EMG and Acetylcholine receptor Ab test

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

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

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What are the 2 best ways to prevent contrast nephropathy?

NS or isotonic bicarbonate (apparently so can acetylcysteine)

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T/F choriocarcinoma can only occur after a molar pregnancy

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

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

Erythema nodosum

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

Decreased; increased? Sounds travel faster through solids than liquids

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

Annualy; Biannualy

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

Dix-Hallpike maneuver, Epley maneuver, semicircular canal dysfunction

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

Neoplastic epidural spinal cord compression

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?

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

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

Melanosis coli from laxative abuse

How do you treat cocaine associated chest pain?

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

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

They often have nasal polyps that occlude the nares

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

Ferritin (

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

Spaghetti and meatballs; Selenium sulfide or ketoconazole

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

IV iron dextran

How do you manage spontaneous conjunctival hemorrhage?

Just observe, no further workup needed

Explain why statins cause myositis

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

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

Latex allergy (would give IM epinephrine 1:1000)

How is essential tremor inherited?

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

Serum iron studies; PCR for HFE gene

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

AA amyloidosis

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

Aspirin

Where is the HMG CoA reductase enzyme located?

Intracellularly. Converts HMG CoA to mevalonate

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

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

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

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

What effect may hypothyroidism have on muscle reflexes

Delayed relaxation of muscle reflexes

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

BB and ASA

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

Bone scan

How do you tx warfarin associated intracranial hemorrhage?

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

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

Vascular dementia

What is Shy-Drager syndrome? Tx?

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

What effect may broad spectrum abx have on coagulation panel?

Increased PT from decreased vitamin K absorption

What is the MC cause of AL amyloidosis? AA?

Multiple Myeloma; RA

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

Cardioversion; Amiodarone

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

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

What are "Protean Manifestations" of sarcoidosis

Things like erythema nodosum

How do you treat hepatorenal syndrome

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

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

CT chest to rule out thymoma

What is the screening test for gastrinoma? Confirmatory test?

Fasting gastrin \> 1000; Secretin stimulation test

What is an important cause of refractory hypocalcemia?

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

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

IV glucocorticoids and MRI of spine while awaiting neurosurgery consult

What is the connection with hemochromatosis and joint pain?

Tends to be associated with pseudogout and chondrocalcinosis

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

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

What is the most common cause of splenic abscess? Tx

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

How is CO2 narcosis often caused in the inpatient setting?

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

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

pancreatic cancer; CT scan

Why do alkalotic states cause hypocalcemia?

They cause Ca to bind more avidly to albumin

What is the next best step in PEA or Asystole

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

How can you you confirm a diagnosis of amyloidosis?

Abdominal fat pad aspiration

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

The prevalance! PPV increases with increased prevalance

T/F oligoclonal bands are diagnostic for MS

False they only support the dx; MRI confirms it

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

Attrition bias a form of selection bias

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

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

What is seen on EEG of CJD

Sharp, triphasic, and synchronous discharges

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

MMR but only if CD4 \> 200

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

Shy Drager syndrome; Fluid replacement with fludricortisone and alpha agonists

What are the diagnostic tests for cryptococcal meningitis? Tx?

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

Which type of diuretic has unfavorable metabolic AE?

Thiazides

What is the best test to technically confirm sideroblastic anemia?

Bone marrow bx showing ringed sideroblasts

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

Clopidogrel

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

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

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

What is the most likely cause of hypokalemia in cirrhosis?

The fact that the person is on diuretics for their ascites

What is the DOC for restless leg syndrome? MOA?

Pramipexole; DA agonist