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Uword Flashcards

1
Q

Mucormycosis - facial rhino-orbital - BUG?

A

Rhizopus

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2
Q

Fever, jaundice, RUQ pain (with poss hypotension and confusion) - Likely diagnosis? What seen on imagin?

A

Acute cholangitis

Common bile duct dilation on CT or US

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3
Q

Hypercalcemia presentation?

Treat with?

A

Volume depleted with weakness, GI distress, and neuro-psych sx
Saline fluids, calcitonin, and poss bisphosphonates

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4
Q

Flaccid bullae and mucosal erosions? Likely dx?
Caused by?
Biopsy shows?

A

Pemphigus vulgaris
Auto-Ab to desmogleins (adherence between epidermal keratinocytes)
Intracellular IgG deposits in epidermis

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5
Q

PCP in HIV. Bactrim AND steroids if what?

A

PaO2 <70 mmHg or A-a >35 mmHg on RA

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6
Q

Amiodarone side effects? Big 2 and 4 others

A

Thyroid (hypo or hyper), liver probs

plus bradycardia/heart block, pneumonitis, neuro, visual disturbances

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7
Q

Positional changes causing changes in O2 sat? Think?

A

V/Q mismatch caused by intrapulmonary shunt (2/2 PNA)

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8
Q

Key pathogenic factor in devleopment of T2DM and associated abnormalities (HTN, HLD)?

A

Insulin resistance with central-type obesity

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9
Q

First degree relative with colon cancer, start screening when?

A

40 instead of 50

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10
Q

Which requires workup in young aysmptomatic adults - diastolic or midsystolic murmurs?

A

diastolic

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11
Q

Immune thrombocytopenia - dx of exclusion - due to?

Treat with? And when?

A

IgG Ab to PLT glycoproteins

Treat with systemic glucocorticoids if count <30 or severe bleeding

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12
Q 
Hemodynamic shock - are these low, high, or nml:
CO?
SVR?
CVP?
PCWP?
Volume?
A 
CO: low
SVR: high
CVP: low
PCWP: low
Volume: low
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13
Q

Gradual loss of peripheral vision, esp in African Americans? Think?

A

Open angle glaucoma

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14
Q

Macular degeneration affects central or peripheral vision?

A

Central

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15
Q

Poor night vision, curtain falling with vitreous bleed, floaters on vitreous bleed resolution? Think?

A

Diabetic retinopathy

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16
Q

Test reliability means?

A

That the test gives the same result when repeated

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17
Q

Stuck with a Hep B needle? Action for immune vs nonimmune?

A

Immune: reassure
Nonimmune: HBIG and HBV vaccine

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18
Q

Pneumococcal vaccines: PPV13 vs PPV23 when to give?

A

PPV13 for all adults >65 then followed by PPV23 (and HIGH risk <65 sickle cell, asplenia, immunocomp, CKD, CSF leaks)
Just PPV23 for <65 if smoker, diabetic, lung, heart, or liver dz

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19
Q

Drug to prevent re-modeling after MI?

A

ACEi

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20
Q

First line for reactive arthritis?

A

NSAIDs! (NOT abx)

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21
Q

Drug for SVTs?

A

Adenosine

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22
Q

Causes of hyperkalemia?

A

AKI, CKD, meds, dz impairing RAAS

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23
Q

Meds causing hyperkalemia?

A

ACEi, ARBs, non-selective BB, NSAIDs, K-sparing diuretics (spiro, eplerenon, triamterene)

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24
Q

Hypercalcemia, hilar adenopathy, non-caseating granullooams that can satin for acid fast or fungal? Dx and rx?

A

Sarcoidosis, if symptoamtic then give steroids

sx: dyspnea, fatigue, nonproductive cough

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25
Q

Avoid AKI from acyclovir toxicity by doing what?

A

Aggressive IV hydration

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26
Q

Infective endocarditis - CXR findings and murmur?

A

Round alveolar lesions on CXR (septic pulmonary emboli)

Holosystolic murmur increases with inspiration (indicates tricuspid involvement)

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27
Q

Liver abscess with travel history? Think and treat?

A

Entameoba histolyca - treat with metronidazole

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28
Q

Diffuse pain, fatigue, mood/cognitive sx with normal infl/rheum workup - think?

A

Fibromyalgia

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29
Q

6 hours of pain after fatty meals then resolution, no fever, abd tenderness, TTP or WBC?

A

Biliary colic 2/2 gallstones

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30
Q

Wernicke’s enceph vs Hepatic enceph - physical exam finding and tx?

A

HE has asterixis and Wernicke does not

Thiamine for Wernicke, lactulose for HE

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31
Q

Severe lymphocytosis with hepatosplenomegaly, LAD and anemia/thrombocytopenia (esp in elderly) - think? and daignose?

A

CLL

Diagnosed with flow cytometry

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32
Q

Catecholmaine surge induced by anesthesia or surgery - underlying problem?

A

Pheochromocytoma

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33
Q

kidney stone tx?

A

HYDRATION

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34
Q

AV block with infective endocarditis - think?

A

Perivalvular abscess

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35
Q

Case control study gives you?

A

Exposure odds ratio

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36
Q

Cohort studies give you?

A

Relative risk and relative rate

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37
Q

Median survival rates come from?

A

Cohort or RCT

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38
Q

Prevalence odds ratio comes from?

A

Cross sectional study

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39
Q

Proximal muscle weakness and elevated CK? Think?

First treatment?

A

Polymyositis

Steroids

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40
Q

Electrolyte disturbance form high dose B-agonists?

A

Hypokalemia

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41
Q

3 possible heart sound findings in cor pulmonale?

A

Loud P2 (pulmonic component of S2)
RV 3rd heart sound
Tricuspid regurg murmur (holosystolic, LLSB, increases with insp)

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42
Q

Schilling test is for?

A

B12 defic due to pernicious anemia or malabsorption

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43
Q

ITP (idiopathic low platelets) - test for what?

A

HCV and HIV

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44
Q

Most common vaccine preventable dz among travelers?

A

Hep A

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45
Q

Autoimmune disorder characterized by tense bullae and pruritus?
DIagnosed by?
Treated with?

A

Bullous pemphigoid
Skin biopsy showing IgG, C3 deposits at dermal/epidermal
High potency steroid topical (clobetasol)

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46
Q

Cause of Graves opthamology?

A

Orbital tissue expansion (following T-cell activation and stimulation of orbital fibroblasts and adipocytes by TRAB)

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47
Q

Initial frostbite tx?

A

Rapid heating with warm water

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48
Q

Flu antiviral window?

A

Within 48 hours of sx onset

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49
Q

Toxic megacolon can be initial presentation of what?
If suspected then first step?
And treat?

A

IBD
KUB
Steroids

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50
Q

HIV prophylaxis - needlestick/infected body fluids?

A

Draw serologies, 3 drug tx for 4 weeks

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51
Q

Lynch syndrome cancers? (3)

A

Colorectal and endometrial (and ovarian)

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52
Q 
Octreotide - class of drug?
MoA?
A

Somatostatin analog

Inhibit vasoldilation so induce splanchnic vasoconstriction and thus decrease portal flow

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53
Q

Clot in setting of increased homocysteine - along with AC give what?

A

B6 (pyridoxine) - cofactor for homocysteine to cystathionine

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54
Q

Acute massive increases in AST and ALT with mild increases in T-bili and Alk phos (in setting of hypotension)?

A

Ischemic hepatic injury

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55
Q

Why could you see celiac DZ without anti-transglutaminase Ab or IgA?

A

Could be concurrent selective IgA deficiency

Still suspect if malabsorption (foul smelling bukly floater stools) and Fe defic anemia

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56
Q

Palpable cervical lymph node in smoker with EtOH hx - suspect?
Best diagnostic test?

A

Squamous cell carcinoma of mucosa of head and neck

Panendoscopy

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57
Q

TB like signs, with brain abscess in immunocomrimpised - aid fast, but GRAM STAIN POSITIVE - think?
Treat?

A

Nocardia (TB no gram stain)

Tx with Bactrim

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58
Q

Mode of spread to osteomyelitis from diabetic foot ulcer?

Monomicrobial or poly?

A

Contiguous

Polymicrobial

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59
Q

How does NG relieve chest pain?

A

systemic vasodilation that decreases LV end diastolic voume and thus wall stress and thus myocardial O2 demand

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60
Q

How to tell lead toxicity from nutritional Fe defic?

Diagnx and treat?

A

Lead tox has hypertension and nephropathy alongside microcytic anemia and nonspecific sx
Diagnx with blood lead levels and treat with chelation

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61
Q

Meds that improve survival in pts with LV systolic dysfucntion?

A

BB, ACEi, ARBs, spiro/eplenerone

plus hydralazine and nitrates in black pts

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62
Q

Joint pain, INCLUDING DIPs, with “sausage digits,” morning stiffness, and nail involvement?
Treat with?

A 
Psoriatic arthritis (5-30% of psoriasis pts)
Tx: NSAIDs, methotrexate, anti-TNF meds
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63
Q

Boerhaave syndrome is?

A

Rupture of esophagus

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64
Q

Likely diagnx of Nephrotic syndrome in obese people, black people, HIV pos and IV drug users?

A

FSGS

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65
Q

Pseudogout crystals? Made of and shape?

Predisposing condition?

A

CPPD (calcium pyrophosphate), rhomboid

Hyperparathyroid (elev Ca)

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66
Q

Acetaminophen ingestion - tx?

Toxic level?

A

Charcaoal and get level. May not be symtomatic in first 24 hours
>7.5g

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67
Q

Young women with anterior knee pain, worse when climbing stair - think?
Diagnx?
Tx?

A

Patellofemoral syndrome
Pain on extension on knee
Tx by stretching thigh muscles and avoiding painful activity

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68
Q

Long term recurrent infx of lungs - leads to?

Diagnx with?

A

Bronchiectasis

Hi-res CT of chest

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69
Q

Hypotension, tachycardia, distended neck veins, pulsus parodoxus - complication of aortic dissection?

A

Tampenade 2/2 pericardial fluid accumulation

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70
Q

Presbyopia - age related near vision caused by?

A

Decrease in lens elasticity

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71
Q

> 70 yo pt, extreme fatigue, leukocytosis with mature lymphocytes and smudge cells - diagnx?

A

CLL

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72
Q

Most common adverse rxn, 1-6 hours after transfusion?

How to prevent?

A

Febrile non hemolytic transfusion (fever chills and malaise without hemolysis)
Prevent by leuko reduction of blood

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73
Q 
SEVERE hyperlgycemia (often >1000) in T2DM?
What happens to potassium?
A

HHS (hyperosmolar hyperglycemia)

Normal serum levels on BMP but total body depletion

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74
Q

Sudden loss of vision and onset of floaters?

Happens in patient with what?

A

Vitreous hemorrhage, in pts with diabetic retinopathy

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75
Q

HTN workup? (5 steps)

A 
5 steps
UA for hematuria and protein:Cr ration
CMP
Lipid panel
ECG
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76
Q

Isolated systolic HTN - often seen in what demographic?

HTN due to?

A

Seen in elderly

Due to arterial wall rigidity

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77
Q

Subacute onset of low grade fever, headache and increased ICP in HIV positive patients - suspect?
Diagnx with?

A

Crytococcal meningitis

Check the CSF for antigen or organism

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78
Q

Aspirin given to pts with history of asthma or chronic rhinosinusits with nasal polyps can cause?
Treat with?

A

AERD, asa exacrebated resp DZ (non IgE mediated, due to PG/LKT imbalance)
Avoid NSAIDs and use LKT recpetor antagonists

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79
Q

Before starting trastuzumab (herceptin) do what?

A

echo, as can be cardiotoxic, esp in low EF

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80
Q

Valve problem in HoCM?

A

Abnromal anterior leaflet motion of mitral valve - moves toward thickened septum during systole, creating LV outflow tract obstruction

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81
Q

Rapid resp distress and hypotension following transfusion (within minutes)?
Population at risk?

A 
Anaphylaxis
IgA defic (suscpetible to anti-IgA Ab)
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82
Q

Abx for human bite wounds (i.e to cover polymicrobial oral bacteria)”?

A

Amoxi-clav

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83
Q

Myalgias, proximal muscle weakness, elevated serum CK? Cosndier?

A

Hypothyroid myopathy

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84
Q

CURB-65

A 
Confusion
Urea>20
RR>30
BP<90 or DBP<60
Age >65
0=outpt, 1-2=likely inpt, 3-4=urgent admit, >4 ICU
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85
Q

CAP tx (outpt, floor, ICU)

A

Outpt: mac or doxy (healthy) or see floor if comorbidities
Floor: FQ or ceftri/azithro(IV)
ICU: Ceftriaxone with FQ or azithro (IV)

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86
Q

Most common cause of death in both renal transplant and dialysis patients?

A

Cardiovascular DZ

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87
Q

Beta blocker overdose - symptoms and tx?

A

Bradycardia with AV block, hypotension, hypoglycemia, wheezing, delirium, seizures, cardiogenic shock
1st line: IVF and atropine, then glucagon if refractory hypotension

88
Q

Asian woman <40, weight loss and arthlragias, then aneurysm formation and hemodynamic sx?
Treat with?

A

Takayasu arteritis

Treat with systemic steroids

89
Q

Excercise induced ashtma tx?

A

albuterol 10 min before exercise, add anti-LKT or inhaled steroids in daily exercise

90
Q

Avascular necrosis of femur in sickle cell - Xrays normal or abnormal? How?
Deficiris in what movements?

A

Normal

Int rotation and abduction are limited

91
Q

Aortic stenosis heart findings on PE? (3)

A

Mid to late peaking systolic murmur
Pulsus parvus and tardus in carotids
Soft and single S2

92
Q

Why does low serum albumin mean low Ca?

Formula to correct Ca?

A

Because 40-45% of Ca binds albumin
Thus does snot effect ionized Ca
So have to correct Ca for low albumin:
Ca + 0.8 (4 - serum alb)

93
Q

Rhabdo signs and risks?

Causes?

A

Incr K and CPK (>20)
Immobility, cocaine use
Acute kidney failure (acute tubular necrosis due to myoglobinuria)

94
Q

Low K and HTN - Suspect what?

And first step in workup?

A 
Primary hyperaldosteronism (can be triggered by diuretics)
Check plasma renin activity and aldosterone levels
95
Q

TCA overdose - clues?

Give what IV?

A

QRS prolongation, seizures, possible arrythmias, hyptoension and anticholinergic sx.
Sodium bicarb

96
Q

HPV warts can be found which 3 places?

In which 2 demographics?

A

Genital, palmar, plantar

In young adults and immunocomprimised

97
Q

Giardia tx?

A

Metro

98
Q

If back pain radiates BEYOND the thigh/buttock to the calf/foot - think what?
And treat?

A

Lumbosacral radiculopathy 2/2 herniated disc

Trial NSAIDs, most recover spontaneously

99
Q

Housefire toxicities? Treat?

A

Cyanide and CO

For CO - O2, and for cyanide give hydroxocobalamin or sodium thiosuflate or nitrites to induce methemoglobinemia

100
Q

Cyanide tox causes acidosis how?

A

Reduced O2 tissue utilization - lactate buiildup

101
Q

Most common asbestos linked cancer - especially in smokers?

A

Bronchogenic carcinoma

Pleural plaques are sign of asbestos exposure

102
Q

What is hyposthenuria in sickle cell?

Does it occur in trait or just sickel cell DZ?

A

Inability to kideny to concentrate urine

In trait too

103
Q

sinus bradycardia in adults - first and second line?

A

IV atropine

Then pacing wire

104
Q

steatorrhea - think?
due to?
tx?

A

chronic pancreatitis
EtOH
stop boozing and supplement pancreatic enzyems

105
Q

3 most common causes of aortic stenosis?

A

Bicuspid aortic valve (majority of cases <70 yo)
Rheumatic heart dz
Calficified aorta

106
Q

Painful but benign tumor in young women on OCPs?

A

Hepatic adenoma

107
Q

ELevated alk phos and GGT suggest?

A

Biliary construction or obstruction

108
Q

Osteomyeleitis from a deep pucnture wound (esp on plantar foot) - bug?

A

Pseudomonas (even if a rusty nail)

109
Q

What happens if you give folic acid and its actually B12 defic?

A

Megaloblastosis resolves but neuro sx rapidly get worse

110
Q

Most common cause of rapid worsening in underlying lung DZ?

And most common cause of that

A

secodnary spontaneous pneumothorax

rupture of alveolar bleb

111
Q

Disseminated gonococcal infx triad?

A

polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions (2-10)
WITH venereal sx often absent

112
Q

Hypocalcemia - if normal serum albumin check these three before advancign to PTH?

A 
Low Mg (causes decr PTH release and resistance to PTH)
Drugs
Recent transfusion (incr citrate)
113
Q

Transaminitis, exposure to dirty water, fever and RUQ pain, and diarrhea: Imaging: single cystic lesion in RIGHT lobe - THINK?
Treat?

A

Entamoeba histolyic

Metro or intraluminal ABX (eg paromomycin)

114
Q

Drop in PLT post AC - which drug?

A

UF Hep (increases apTT)

115
Q

CHF that is unexplained, proteinuria, LV hypertrophy, but NO HTN?

A

amyloidosis

116
Q

parvvorisu causes 5th dz in kids but in adults manisfested as what?

A

acute viral arthritis

117
Q

paradoxical hyperkalemia in DKA is caused by ?

A

extracellular shift

118
Q

2nd agent to metformin esp if weight loss if desired?

A

GLP-1s

119
Q

Immunicompromisied with Fever, pleuritic chest pain, hemoptysis - halo sign (many nodules surrounding ground glass on imaging - think?
Treat?

A

Aspergillosis

treat with voriocnazole and caspofungin

120
Q

Cirrhosis - first screening when diagnsoed?

A

endoscopy for varcies

121
Q

Varices - medical accompaniment or alternative to banding? (ie prophylaxis for hemorrhage)

A

Nonselective BB - (nadolol or propanolol)

122
Q

Midwest fungus causing disseminated infx in HIV patients with CD4 <100?
How to test for it?
Treat?

A

Histoplasma - urine or serum

Amphotericin with antiretrovirals

123
Q

Exogenous insiulin - c peptide level?

A

low

124
Q

insulinoma - 3 signs?

A

elevated c-protein
proinsulin >5
hypoglycemia

125
Q

Cause of gallstones in TPN?

A

Galbaldder stasis

126
Q

What can happen to cartilage in psuedogout?

A

Calcification

127
Q

Beck’s triad - tamponade?

What happens to septum?

A

Muffled heart sounds, JVD, hypotension

Shifts toward LV cavity leading to LV preload reduction, decr SV and CO

128
Q

Most important factors for survival in out of hospital cardiac arrest?

A

Adequate bystander CPR

Prompt rhythm analysis and defibrillation

129
Q

Hard unilateral lymph nodes, esp if pt is smoker think?

A

squamous cell carcinoma if in neck, or metastatic cancer if elsewhere

130
Q

Metabolic acidiosis (low pH and low bicarb) - next ste p in diagnosis?

A

Calc anion gap

131
Q

Varicella vaccine in HIV?

A

Yes if CD4 >200, no if <200

132
Q

When to use D-dimer in PE assessment?

A

If PE unlikely (via Wells) - get a d-dimer and if it is >500 get a CTPE, if PE likely go straight to CTPE

133
Q

Who gets HIV screening?

What method?

A

Everyone 15-65 regardless of risk factors
plus pregnant women, MSM, IVDU, unprotected sex or other STDs
p24 Ag and Ab testing

134
Q

HTN and hypokalemia exposed by diuretics (also mild hypernatremia and low plasma renin activity) - think?

A

Primary hyperaldosteronism

135
Q

Vasovagal (neurocardiogenic) syncope - tx?

A

Reassurance and counterpressure maneuvers during prodrome

If exam and EKG suggest cardiac then investigate with Holter or TTE

136
Q 
Analgesic nephropathy (from eg combined NSAID and ASA) manifests as?
Sx as progresses?
A

Papillary necrosis
Tubulointerstitial nephritis
1. Polyuria and sterile pyuria (WBC casts)
2. microscopic hematuria
3. HTN, mild proteinuria, and impaired urine conc

137
Q

Nasal crease, cobblestone throat, nasal d/c?

Tx?

A

Allergic rhinitis

Glucocorticoid nasal spray

138
Q

Acute Liver Failure triad?

What setting should you suspect?

A

Elevated AST/ALT
Hepatic encephalopathy (asterixis, somnolence, confusion)
INR >1.5
SUSPECT in aceta use on top of EtOH

139
Q

B12 and folate cause macrocytic anemia with what kind of neutrophils?

A

HYPERsegmented

140
Q

What is elevated in BOTH B12 and folic acid defic?

And what ONLY in B12?

A

Homocysteine in both

MMA only in B12

141
Q

Odynophagia in HIV pts? Three causes and tx?

A

1) thrush, give fluconazole
If persists either:
2) HSV (ovoid ulcers and inclusions) - acyclovir
3) CMV (long ulcers on esophagus) - gancyclovir

142
Q

Refracteory duodenal ulcers and/or chronic diarrhea/steatorrhea - THINK? Dx?
Mech of malabsorption?

A

Zollinger Ellison S (gastrin producing tumor)
Dx with gastrin >1000 and gastric pH <4
Malabsorption due to inactivation of pancreatic enzymes by stomach acid

143
Q

Prevention of PE in pts contraindicated (eg bleeding) or failed ant-coag?

A

Place retrievable IVC filter

144
Q

Causes of hypokalemia? (3)

A

1) Increased intracellular entry
(eg insulin, B-agonists, hematopoesis)
2) GI losses
3) renal wasting (hyperaldosteronism or diuretics)

145
Q

Hemolytic anemia after sulfa drugs or primiquine - think?

Why can the lab test be normal?

A

G6PD defic

Reticulocytes are abnormally high

146
Q

BPH - first line? Then?

A

a-blockers

5-a-reductase inhibs as alternative or additional but slower onset

147
Q

Ventilator - goal for PaO2 is?
Start FiO2 high and try to reduce to what if blood gases OK?
To maintain adequate oxygenation do what to PEEP?

A

55-80
<60%
Increase PEEP

148
Q

Anemia of chronic dz/inflammation - what labs would you see?

And tx by?

A

Normocytic with decr serum iron, decr TIBC, decr Fe sat and normal to elev ferritin
Treat the underlying condition

149
Q

In true iron def anemia - labs/studies would show?

And thalassemia?

A

Microcytic with low iron, low ferritin, low Fe Sat but HIGH TIBC
VERY microcytic, HIGH iron and ferritin and low TIBC

150
Q

Facial plethora, vision disturbances, pruritus, thormobosis, splenomegaly with eryhtocytosis - think?
Tx?

A

Polycyhtemia vera

Phlebotomy and add hydorxyurea (or other bone marrow suppressant) if high risk of thrombosis

151
Q

Fever, hemolysis, DIC, within an hour of transfusion. Oh shit .. . it’s?
If it were just fever and chills, 1-6 hours, it would be?

A

Acute hemolytic transfusion mismatch (eg ABO mismatch)

Febrile nonhemolytic reaction due to cytokines in blood product

152
Q

Odd thromboses presenting in arms or chest and other places - think?
Likely accompanied by?

A

Trousseau’s
Cancer somewhere, most likely pancreatic
Also stomach, lung or prostate

153
Q

Ascending aortic aneurysms due to (2)?

Descending due to?

A

Connective tissue dz or cystic medial necrosis

Athersclerosis

154
Q

Graft vs Host is due to T-cells from donor or recipient?

Organs often effected?

A 
Donor
Skin (macukpapular rash), intestine (bloody diarrhea), liver (LFTs and jaudice)
155
Q

Euvolemic hypERnatremia - diagnx is? What psych med causes it?

A

DI

Lithium

156
Q

3 meds that decrease response to anti-hypertensives?

A

Steroids, NSAIDs, decongestants

157
Q

Drooling, dysphagia, mouth pain, with edema in the mouth and possibly neck, poss airway compromise - think?
Tx?

A

Ludwig angina (a cellulitis from teeth infection)
Give IV abx - amp/sulbactam or clinda and pull teeth
(deal with airways too!)

158
Q

Bilateral nasal obstruction, anosmia (can’t taste), plus nasal discharge - esp in setting of chronic rhinosisuitis, asthma or ASA or NSAID induced bronchospasm (AERD) - THINK?

A

Nasal polyp

159
Q

Home O2 indications for chronic COPD?

In setting of RHF or hematocrti >55?

A

PaO2 <55 or SaO2 <88

PaO2 <59 or SaO2 <89

160
Q

Advantage of DOACs over warfarin?

A

Fast onset, no monitoring needed

161
Q

Indications thrombolytics in PE.DVT?

A

HD unstable PE (massive), massive proximal DVT with significant symptomatic swelling (not just pretibial edema) or ischemia

162
Q

Hemolytic anemia, cytopenia, hypercoagulable state (thrombosis seen), presenting with abd pain and dark urine? THINK?
If WITHOUT the hematologoic abnormlaities and thromboses?

A

Paroxysmal nocturnal hemoglobiuria

Acute intermittent porphyria

163
Q

Recurrent kidney stones from childhood, fam hx
Hard, radioopaque stones and hexagonal crystals on UA
Diagnx?
Dz process?
What test is positive?

A

Cystinuria
Process: imparied amino acid transfer
Urine cyanide nitroprusside in positive

164
Q

Inferior MI think what chamber of heart and vessel?
Sx?
Preload or afterload dependent?

A

RV, proximal RCA
Hypotension, clear lungs, JVD, chest pain and vomiting
Preload so give fluids not nitrates or diuretics

165
Q

PE ECH findings? (4)

A

sinus tachy
non-specifc St or T wave changes
new RBBB
S1Q3T3

166
Q

Women 15-50 with HTN (nonathlerosclerotic and nonflammatory), poss nonspecific sx or poss TIA/brian sx - think?
And it effects what?

A

Fibromuscular dysplasia

Renal arteries

167
Q

LIfestyles mods that reduce PACs?

When would you use BBs in PACs?

A

Stop smoking and drinking

BBs only if symptomatic

168
Q

IBD: noncaseating granulomas on biopsy? Which dz?
Pseudopolyps?
Perianal dz?

A

Crohn’s
UC
Crohn’s

169
Q

Woman with prolonged PTT and low PLT, and possible false positive VDRL - think?
Treat with? To avoid?

A

APS (anti phospholipid Ab syndrome)

Give ASA and LMWH for prophylaxis of miscarriage

170
Q

1st degree heart block - when to observe and when to get EP study?

A

ONly get EP study if QRS is widened (>120) - likely to have conduction delay below the AV node (rather than at the Av node with normal QRS)

171
Q

Cancer with hypERcalcemia?

A

Squamous cell (SCa++umous cell) (PTHrP assoc)

172
Q

Syndromes assoc with small cell lung cancer?

A

SIADH, ACTH production

173
Q

Adenocarcinoma, squamous cell - lung locations?

A

Adeno - outer, squamous - central

174
Q

Epipdidymitis - unilateral scrotal pain, TTP, erythema - bugs for <35 and >35?

A

> 35 e coli (from bladder obstruction or infx)

<35 chlamydia or gonorrhea (from STD)

175
Q

Acromegaly - for diagnosis check what?

A

IGF1, less likely to fluctuate than GH

176
Q

“Oh shit” in acute asthma exacerbation?

A

Normal or elevated PaCO2 and normal pH

You would expect to see lower PaCO2 due to hyperventilation, if not then impending respiratory failure

177
Q

Fever, maculopapular rash, renal failure post ABX (bactrim, PCNs, rifampin, cephs) - think?
What do you see on UA?

A

(acute) interstitial nephritis

on UA: WBC casts and sometimes eosinophils

178
Q

Type 1 vs Type2 HIT?

A

Type 1 is nonimmune PLT aggregation , usually mild so <100, usually withn 2 days
Type 2 is Ab mediated and usually halves PLTs, 5-10 dyas or earlier

179
Q

MALT without mets - tx?

A

Treat the H. pylori with PPI, clarithro and amoxi

180
Q

Aspiration presenting hours vs days after event?

A

Hours: pneumonitis (gastric acid)
Days: pneumonia (upper ariway or stomach mircobes)

181
Q

GI sx that resolve spontaneously then progress to myositis, eosinophila and periorbital edema (can also have splinter hems) - dx?

A

Trichinellosis

round worm from undercooked meat

182
Q

Stable angina - first line meds?

A

Beta blocker

Alternaitves would be CCBs or long acting nitrates, or in addition

183
Q

Acute limb ischemic (6 Ps)

If sudden most likley due to ?

A

Pain, Pallor, Paresthesias
Pulselessness, Poikilothermia, Paralysis
Arterinal emoblic occlusion

184
Q

Dietary recs for people who get kidney stones? (3)

A

Increased fluids
Low sodium
Normal calcium

185
Q

Autoimmune hemolytic anemia vs hereditary spherocytosis as a cause of hemolytic anemia (FamHx and Coombs test)?
What is common to both?

A

AIHA - neg FamHx, pos Coombs
HS - pos FamHx, neg Coombs
Common: spherocytes without central pallor

186
Q

Bright flashes of light, floaters, “curtain coming down over eye” - dx?

A

Retinal detachment

187
Q

What on the BMP increases with GI bleed?

Why?

A

BUN and so BUN/Cr ratio
Increased urea production from breakdown of HgB
and increase urea absorption due to hypovolemia

188
Q

Hep B serology: vaccinated vs resolved infx?

A

Vaccinated: just anti-HBs

Resolved infx: anti-HBs and anti-HBc

189
Q

Infective endocarditis from Eikenella - source?

Gram status?

A

Poor dentition, oral

Gram negative anaerobe

190
Q

Uric acid stones (needle shaped crystals) - next step?

A

Abd CT

191
Q

Suspicion for foreign body in eye. Penlight exam shows nothing, next step?

A

Fluoroscein examination

192
Q

Plasma aldosterone/renin activity ration in primary hyperaldosteronism?

A

> 20

193
Q

White tongue, salivations, dysphagia - GI pain - after ingestion. Suggests?

A

Caustic poisoning

194
Q

post-transfusion electrolyte abnormality?

A

hypocalcemia

195
Q

Mitral stenosis presentation?
Common arrythmia?
Underlying dz?

A

Progressive dyspnea and orthopnea
A-fib
Rheumatic fever

196
Q

Drugs causing acute pancreatitis (6 classes)

A 
AEDs (depakote)
Diuretics (lasix, thiazides)
IBD drugs (5-ASA, sulfasalazine)
Immunosuppressives (azathioprine)
HIV meds
ABX (metro, TCNs)
197
Q

3 causes that account for 90% of chronic cough in nonsmokers w/o chronic lung dz

A

PND (tx empiric with oral antihistamine, first gen)
GERD
asthma

198
Q

Why do empyemas (exudative effusions) have low glucose?

A

Metabolic activity of leukocytes and bacteria in the pleural fluid

199
Q

Raynaud’s medical tx?

A

CCBs

200
Q

Acute pancreatitis etioligies (6)

A

Gallstones, EtOH, TGs
Drugs, infx (legionella, CMV, aspergillus), iatrogenic (post-ECRP)
and SCORPION BITES!

201
Q

Mixed resp alklosis and metabolic acidosis - think?

A

ASA intox

202
Q

In addition to hypokalemia, 2 other side effects of loop diuretics in the kidney?

A

metabolic alkalosis and prerenal kidney injury

203
Q

Metaoblic alkalosis - saline responsive vs saline unresponsive?

A 
Saline responsive (low urine Cl and volume contraction)
Saline unresponsive (urine Cl >20)
204
Q

Corneal vesicles and dendritic ulcers in the eye?

A

HSV keratitis

205
Q

WBC upper limit for osteoarthtitis on joint tap?

A

2000

206
Q

Lactose intolerance dx?

A 
Positive hydrogen breath test
Increased stool osmotic gap
Positive stool for reducing substances
Low stool pH
NO steatorrhea
207
Q

Wide complex tachy - shock if AMS, unstbale etc. but if stable give what?

A

Anti-arrythmics, i.e. amiodarone, lidocaine, procainamade, sotalol)

208
Q

Effect of squatting on preload/afterload?

And effect on mitral prolapse/regurg murmurs systolic murmurs?

A

Increases preload and thus LV volume

Decreases them

209
Q

Hypocalcemia, hyperphosphatemia, with an increased PTH is likley due to ?

A

Renal failure (secondary hyperparatyroidism)

210
Q

Can diabetic neuropathy affect bladder and cause incontinence?

A

YES

211
Q

Hyperinflation in COPD causes flattening if diaphragm which causes?
Hyperinflation itself is caused by?

A

Increased work of breathing

Decreased alveolar elasticity

212
Q

Cause of pancytopenia in lupus?

A

Peripheral immune destruction of blood cells

213
Q

Thyroid storm sx?

A

Fever, HD instability, CHF, arrhythmais, triggered by specific event (trauma, childbrith, surgery, iodine contract etc.)

214
Q

Fatigue, fever, weight loss, cough, in setting of incarceration or IVDU?

A

TB, miliary or otherwise

215
Q

Pericarditis weeks after MI - dx?

Tx?

A

Dressler’s
NSAIDs, then steroids if refractory
(No AC)

216
Q 
Hookworm larvae (cutaneous larva migrans) , very itchy- how do you get it'?
Treat?
A

Walking on sand or soil barefoot

Treat with ivermectin

217
Q

Abd pain, fever, gross hematuria in setting of neprhotic syndrome?
Dz most assoc with?

A

Renal vein thrombosis, due to losing antithrombn III in urine
Most assoc with membranous glomerulopathy

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