Uworld Flashcards
Osteomalacia causes?
malabsorption, intestinal bypass surgery, celiac sprue, chronic liver or kidney disease
bone resorption markers?
c-telopeptide & n-telopeptide
bone formation markers?
alkaline phosphatase & osteocalcin
osteomalacia?
def: defective bone mineralization due to vitamin D deficiency
px: hypophosphatemia + hypoCa + elevated alk phos
metabolic compensation for respiratory alkalosis =
2 mEq/L of HCO3 for every 10 mmHg change in PaCO2
Winter’s formula?
Arterial PaCO2 = 1.5(HCO3) + 8 +/- 2
-estimates respiratory compensation in primary metabolic acidosis
ASA intoxication –>
mixed respiratory alkalosis & metabolic acidosis
resp alk: increase respiratory drive from medullary respiratory center
metabolic acidosis: increased production/ decreased renal elimination of lactic/ ketoacids
multiple myeloma
CRAB
hyperCa + renal impairment + anemia + bone pain (lytic lesions, fractures)
- inc risk for infection
- leukopenia
- inc total protein from paraproteins
infectious mononucleosis
fever + lymphadenopathy + pharygitis
cause: EBV
dx: heterophile Ab (monospot test) –> EBV-specific Ab (if heterophile test neg)
mucormycosis
fungal infection
agent: Rhizopus species
cause: poorly controlled DB
actinomyces
- anaerobic, gram+, filamentous branching bacteria
- oral cavity
- sulfur granules –> yellow granular pus
-tx: high dose penicillin for prolonged period (12 weeks)
what treatment limits ventricular remodeling after a MI?
ACEI
diabetic neuropathy tx?
TCAs (amytriptyline, desipramine, nortriptyline)
Gabapentin
NSAIDs
HITT
- heparin-induced thrombocytopenia & thrombosis
- paradoxical pro-thrombotic state
- autoimmune –> skin necrosis & hemorrhage
vitamin K paradoxical pro-coagulant effects?
occur in first few days of treatment due to inhibition of protein c (which has a shorter half life than factors 2, 7, 9, 10)
extrapulmonary sites for TB
liver, spleen, kidney, bone, adrenal gland
signs of adrenal insufficiency
hyperkalemia, hypoglycemia, eosiniphilia
causes: histoplasmosis, coccidiodomycosis, cryptococcosis, sarcoidosis
Indications for aortic valve replacement?
1) symptomatic pts with AS
2) pts with severe AS undergoing CABG or other valvular surgery
3) asymptomatic pts with severe AS & either poor LV systolic functions, LV hypertrophy >15mm, valve area <0.6cm2, or abnormal response to exercise
primary biliary cirrhosis marker and tx?
marker: anti-mitochondiral antibodies
tx: ursodeoxycholic acid
- methotrexate & colchicine have moderate benefit
- liver transplantation for advanced disease
giant cell arteritis symptoms?
px: headache, jaw claudication, muscle fatigue, visual disturbance
complications: aortic aneurysm
causes of pancreatitis?
- cholelithiasis (stones)
- hyperTG
- ethanol use
- medication (thiazides)
Haldane effect
DeO2-blood has an increased ability to carry CO2
O2-blood has a decreased ability to carry CO2
side effects of beta-2 agonists
hypoK, tremor, palpitation, headache
hyperthyroid px
anxiety, insomnia, palpitations, heat intolerance, perspiration, weight loss without dec appetite
goiter, HTN, tremors, hyperreflexia, proximal muscle weakness, lid lag, a. fib
chronic HCV
-waxing & waning elevations of ALT & AST
- mixed cryoglobulinemia
- porphyria cutanea tarda
- membranoproliferative glomerulonephritis
what is the mechanism of kidney damage in SLE patients?
- immune complex mediated
- low C3 from complement activation
drugs that cause idiosyncratic reactions?
isoniazid, chlorpromazine, halothane, antiretroviral therapy
-NO rash, arthralgias, fever, leukocytosis, or eosinophilia
causes of ARDS?
- impaired gas exchange
- dec lung compliance
- pulmonary hypertension
side effects of isoniazid
peripheral neuropathy, hepatitis
-give pyridoxine (vit B6) supplement for neuropathy tx
cause of isolated systolic HTN?
decreased elasticity of the arterial wall
- inc risk of CVD event
- tx: low dose thiazide, ACEI, or long-acting CCB
Factor V Leiden?
Factor V becomes resistant to inactivation by protein C –> hypercoaguable state –> DVT
-commonly inherited disorder
PCP (pneumocystis PNA) prophylaxis?
TMP-SMX (trimethoprim-sulfamethoxazole)
tx for pericarditis
ibuprofen
what is the use-dependance phenomenon in anti arrhythmic medications?
- they are more effective at higher HRs
- bc there’s not as much time b/t heartbeats for the medication to dissociate from its receptor
- class IC (Na) and IV (Ca) medications
acute-onset dyspnea + wheezing + prolonged expiration =
bronchoconstriction
psoriatic arthritis px?
-distal interphalangeal joints
- morning stiffness
- deformity
- dactylitis (“saugsage digit”)
- nail involvement
-tx: NSAIDs, methotrexate
(RA is usually DIP joints)
what is ARDS?
acute respiratory distress syndrome
- non-cardiogenic pulmonary edema
- caused by leaky alveolar capillaries
-mechanical ventilation: PEEP and low tidal volumes
what are the causes of ARDS?
sepsis, severe infection, severe bleeding, toxins, burns
aliskiren
= renin inhibitor
3 common causes of cough
- postnasal drip (upper airway cough syndrome)
- asthma
- GERD
ACEI-induced cough mechanism
increased [bradykinin] due to dec degradation of bradykinin–>substance P
late px of aortic coarctation
- asymptomatic HTN
- epistaxis
- upper extremity HTN, lower extremity hypotension
- brachial-femoral delay
- left ventricle hypertrophy (EKG)
- intercostal artery notching (CXR)
side effects of thiazide diuretics
Hyper GLUC:
- hyperGlycemia
- hyperLipidemia
- hyperUricemia
- hyperCalcemia
-hypoNa, hypoK
medications that cause hyperK
- nonselective beta blockers
- ACEI
- ARB
- NSAIDs
- K-sparing diuretics
- cardiac glycosides (digoxin)
causes of hyperK
- medications
- AKI or CKD
- acidemia
- hyperglycemia
- tumor lysis syndrome
-acute tx: calcium gluconate
EKG changes from hyperK
- peaked T waves
- shorted QT interval
- QRS widening
flail chest
- due to crush injury
- > 3 adjacent rib fractures that break in 2 places
- respiratory distress
- tachypnea with shallow breaths
pulsus paradoxus
fall in systolic pressure >10 mmHg during inspiration
-causes: cardiac tamponade, asthma, COPD
signs of PE
SOB tachypnea hypoxemia tachycardia pleuritic CP hemoptysis low grade fever hemoptysis
Behecet’s syndrome
multi-systemic inflammatory condition
recurrent oral ulcers + genital ulcers + skin lesions (erythema nodosum) + uveitis
- positive pathergy test
- Asian, Turkish, Middle East populations
Reactive arthritis
urethritis + conjunctivitis + arthritis
=Reiter’s syndrome
endocardial fibroelastosis
occurs in first 2 years of life
restrictive cardiomyopathy
hereditary hemochromatosis
abnormal Fe deposition in various organs –> end-organ damage/failure
increased intestinal Fe absorption
- cirrhosis + DB + skin pigmentation
- “bronze DB”
- elevated liver enzymes
- hypogonadism (dec libido, testicular atrophy)
- conduction abnormalities in heart
- restrictive or dilated cardiomyopathy
neuroleptic malignant syndrome px?
mental status change fever muscle rigidity diaphoresis CK = 50,000
tx:
dantrolene (muscle relaxant)
bromocriptine (dopamine agonist)
amantadine (antiviral with dopaminergic properties)
cause: antipsychotic drugs (dopamine antagonists)
common causes of digital clubbing
- lung malignancy
- cystic fibrosis
- R–>L cardiac shunts
-NOT from hypoxemia/COPD
“fight bite” tx
amoxicilling-clavulanate (Augmentin)
=human bite –> polymicrobial coverage needed (gram+, gram-, and anaerobes)
SE of floroquinolone
tendinopathy or tendon rupture (Achilles most commonly)
- rotator cugg, hand, biceps, thumb, etc
- stop drug, avoid exercise
renal cell carcinoma
flank pain + hematuria + palpable abdominal mass LEFT scrotal varicocele paraneoplastic symptoms (anemia, erythrocytosis, thrombocytosis, fever, hyperCa, cachexia)
hyperCa induces?
urinary salt wasting
–>volume depletion
tx: saline hydration + bisphosphonates (long term tx)
congenital long QT syndrome
FH of sudden death
prolonged QT interval
syncope with triggers (exercise, swimming, sudden noise, during sleep)
torsades de pointes
= acquired long QT syndrome
cause: hypoK, hypoMg
methotrexate
dihydrofolate reductase inhibitor
DMARD = disease-modifying anti-rheumatic drug
SE: macrocytic anemia, nauseas, stomatitis, rash, hepatotoxicity, interstitial lung disease, alopecia
common causes of avascular necrosis of bone (osteonecrosis)?
chronic corticosteroid use
chronic excessive alcohol ingestion
hereditary spherocytosis
- autosomal dominant
- lack of spectrin causes RBCs to become spheres –> unable to pass through splenic red pulp –> hemolysis
- tx: supportive or splenectomy
- risk of sepsis from encapsulated organisms (Strep pneumo, H flu) >10 yrs
- vaccinate against pneumococcus, H flu, meningococcus
mild asymptomatic hyperCa + inappropriately high-to-normal PTH
familial hypocalciuric hypercalcemia
- low urinary Ca
- Ca/cr 0.02
pericarditis px
worsening CP with inspiration, improved leaning forward
diffuse ST elevation
reciprocal depression in avR
tx: NSAIDs; corticosteroids in refractory cases
Dressler’s syndrome
=pericarditis 1 week after an MI
- immunologic phenomena
- tx: NSAIDs
- avoid anticoagulants to prevent hemorrhagic pericardial effusion
symptoms of alcohol withdrawal
reflex hyperactivity:
- anxiety
- insomnia
- tremors
- diaphoresis
- hallucinations
- withdrawal seizure
- delirium tremens
what is delirium tremens
-result of alcohol withdrawal
HTN + agitation + tachycardia + hallucinations + fever
- mortality rate up to 5%
- tx: benzodiazepines (chlordiazepoxide) bc of similar cross-tolerance with alcohol
opiod withdrawal px?
dilated pupils + piloerection + dysphoria + myalgias + abdominal pain
-tx: methadone (long acting opiod –also for heroin addiction management)
lupus arthritis
- MCP & PIP joints
- non deforming (which is how it is differentiated from RA)
arthritis in DIP
OA (non-inflammatory) & psoriatic arthritis (dactylitis)
opiod intoxication
respiratory depression
miosis
sedation
lithium toxicity
tremor
hyperreflexia
ataxia
seizures
phenytoin toxicity
horizontal nystagmus
cerebellar ataxia
confusion
CHADS2
CHF HTN Age >75 DB Stroke hx (2 points, all others 1)
- measures risk for stroke
- low (0) – no anticoag or ASA
- med (1) – anticoag or ASA
- high (2-6) –anticoag
zinc deficiency
- alopecia
- abnormal taste
- bullous, pustulous lesions around perioral and periorbital areas
-normally absorbed in jejunum
vitamin A deficiency
blindness
dry skin
impaired immunity
B12 deficiency
macrocytic anemia
neurologic symptoms
selium deficiency
cardiomyopathy
trastuzumab
- tx for HER2 breast cancer
- HER2 gene detected by FISH or immunohistochemical staining
=herceptin
DIC
thrombocytopenia + thrombosis + bleeding
hereditary telangiectasia
diffuse telangiectasias + recurrent epistaxis + widespread AV malformations
- autosomal dominant
- AVM in mucous membranes, skin, GI, liver, brain lung (–> chronic hypoxemia)
chronic bronchitis
chronic productive cough for 3 months in 2 successive years
anti-pseudomonal agents
cefepime
meropenem
piperacillin-tazobactam
hypoCa from transfused blood via..
- chelation by citrate anticoagulant
- chelates Mg, as well
- ->paresthesias
-stored RBCs can also release K –> hyperK
type 4 RTA
- non-anion gap metabolic acidosis
- aldosterone deficiency/ resistance
- hyperK & acidosis
-elderly pts with poorly controlled DB
loop diuretics cause metabolic______ & hyp___K
metabolic alkalosis
hypoK
venous thrombosis in what type of nephrotic syndrome?
membranous glomerulonephritis
3 types of DB retinopathy
- background/simple = microanneurysm, hemorrhage, exudates
- pre-proliferative = cotton wool spots
- proliferative/malignant = neovascularization
elevated AFP & beta-HCG + mediastinal mass
nonseminomatous germ cell tumor
-seminomas only have elevated beta-HCG
choriocarcinoma
- elevated beta-HCG
- associated with molar pregnancy
- elevated beta-HCG also in seminoma
alcoholic hepatitis
AST:ALT >2
absolute values of AST & ALT always 25x upper limit = toxin-induced (acetaminophen), ischemic, viral hepatitis
hemolysis labs
inc reticulocyte count inc serum LDH dec haptoglobin fragmented RBC on peripheral smear anemia
causes of anion gap metabolic acidosis
- lactic acidosis
- ketoacidosis
- methanol/ formaldehyde
- ethylene glycol ingestion
- salicylate poisoning
- uremia (ESRD)
-inc anion gap bc of inc non-chlorinated acids in serum
HCV tx
peginterferon + ribavirin
+/- telaprevir or boceprevir (protease inhibitors)
contraindications: ongoing alcohol or drug abuse; major uncontrolled depression
signs of laxative abuse
watery diarrhea
inc frequency and volume of stool
dark brown discoloration of colon with lymph follicles shining through on biopsy
