Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

medicine > uworld > Flashcards

uworld Flashcards

1
Q

treatment of esophageal varices

A
  • volume resuscitation
  • prophylactic ABx (ceftriaxone)
  • octreotide (somatostatin analogue) for splanchnic vasoconstriction
  • urgent endoscopy for band ligation/sclerotherapy followed by BB prophylaxis
  • balloon tamponade if bleeding uncontrollable
  • TIPS or shunt surgery definitive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when to do platelet transfusion?

A

active bleeding AND platelet count <50,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

effects of lifestyle change in HTN tx

A
  • weight loss most effective
  • then DASH diet
  • then exercise
  • decreased dietary sodium
  • alcohol intake <1-2 drinks/day (women/men)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

OA - radiographs

A
  • joint space narrowing
  • subchondral sclerosis
  • osteophytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

OA vs RA in hand

A
  • OA: DIP joints

- RA: PIP and MCP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hemochromatosis arthropathy - radiographs

A
  • squared off bone ends

- hook like osteophytes in 2nd and 3rd MCP jts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

untreated hyperthyroidism can cause?

A

bone loss

  • thyroid hormone –> osteoclastic bone resorption
  • increased serum calcium and hypercalciuria

cardiovascular: thyrotoxicosis –> tachycardia, systolic HTN, increased pulse pressure, AFib
- can unmask or worsen CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pathophys of proptosis in hyperthyroid

A
  • accumulation of GAGs in retro-orbital mm and tissues

- ONLY in Graves dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

tx shingles

A
  • valacyclovir is tx of choice, but acyclovir cheaper; can combine acyclovir with steroids if severe sx
  • early antiviral reduces duration of rash and pain
  • also reduces likelihood of postherpetic neuralgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

tx of frostbite

A
  • rapid rewarming with continuously circulating warm water

- debride only after rewarming complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

precipitating factors for hepatic encephalopathy

A
  • sedatives
  • hypovolemia
  • infection
  • excessive N load (e.g. GI bleed)
  • electrolyte disturbances (e.g. hypoK - maybe from diuretics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

tx of hepatic encephalopathy

A
  • supportive care: volume, electrolyte correction, restraints
  • nutrition w/o protein restriction
  • precipitating cause
  • lower serum ammonia: lactulose (oral/enema) –> rifaximin if no improvement in 48 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

clinical presentation of alcoholic hepatitis

A
  • jaundice, anorexia, fever
  • RUQ and/or epigastric pain
  • abdominal distention (ascites)
  • prox mm weakness
  • possible HE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

lab studies in alcoholic hepatitis

A
  • MODEST AST and ALT elevations ( 2 (usually ALT higher than AST in other liver dz)
  • GGT and ferritin elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T99 scan (sestamibi) used for what?

A

myocardial function and perfusion

  • normally done at rest and exercise
  • decreased at rest and at exercise = fixed defect = scar tissue
  • decreased at stress only = inducible ischemia, likely CAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

metformin given to pts with factors predisposing to hypoxia causes what?

A

lactic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

empyema

A
  • result from HEMOTHORAX, parapneumonic effusions, rupture of lung abscess, penetrating trauma, thoracotomy, ruptured viscus
  • dx: CT scan
  • tx: recent = streptokinase/urokinase (unless recent trauma), ABx; non-complex: chest tube drainage; complex (e.g. peel, loculated): SURGERY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

malignancy induced hypercalcemia

A
  • PTHrP production (80%)
  • 125OH2 VitD production
  • bone mets
  • ectopic PTH production (very rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PTHrP

A
  • squamous cell cancers, renal/bladder, ovarian/endometrial, breast
  • activation of PTH receptor –> excessive bone resorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

excess 1,25OH2 Vit D production

A
  • by lymphomas

- causes hypercalcemia via gut absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

bone mets and hypercalcemia

A
  • breast ca, MM, lymphomas most common

- cause release of cytokines that stimulate bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

folic acid repletion in B12 deficient pt

A
  • fixes Hgb (folate and B12 both cofactors for methionine synth)
  • does not fix neurologic sx; can actually precipitate/worsen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

B6 deficiency

A
  • peripheral neuropathy
  • pts on INH
  • rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

adverse effects of inhaled corticosteroids

A
  • most common = THRUSH

- adrenal suppression, cataract formation, decreased growth, purpura, bone metabolism issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

cutaneous larva migrans

A
  • “creeping eruption”
  • helminth A braziliense (dog/cat hookworm)
  • sandboxes/beaches, esp in tropics/subtropics
  • serpiginous lesions on skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

sporotrichosis

A
  • fungal infx from sporothrix schnckii
  • papule at inoculation –> ulceration/LAN
  • GARDENERS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

dx of DKA

A
  • blood glucose >250
  • blood pH < 7.3 or bicarb < 15-20
  • plasma ketones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

tx of DKA

A
  • rapid IV admin of NS and regular insulin
  • correction of electrolyte abnormalities (esp K)
  • treatment of precipitating factors
  • bicarb can cause cerebral edema; use only if pH < 7.1 or bicarb < 5 or severe hyperK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

organophosphate poisoning

A
  • blocks AChEsterase –> cholinergic toxidrome

- give ATROPINE and remove clothes/sources of OP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

complications of chronic GERD

A
  • Barrett’s –> adenocarcinoma

- esophageal strictures: 5-15% of patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

esophageal strictures

A
  • causes: GERD, radiation, systemic sclerosis, caustic ingestions
  • cause progressive dysphagia to solid foods; can eventually block reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T gondii

A
  • HIV+ with ring enhancing lesions
  • H/A, confusion, ataxia
  • usually CD4 <100
  • give trimethoprim/sulfamethoxazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

M avium prophylaxis

A
  • M avium complex

- HIV+, CD4 < 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acute acalculous cholecystitis

A
  • most common in hosp pts with burns/trauma/TPN/fasting/ventilation
  • RUQ pain, fever, leukocytosis, abnl liver panel
  • complications: gangrene, perf, emphysematous cholecystitis
  • dx: US; CT/HIDA more sensitive/specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Wegener’s

A
  • systemic vasculitis
  • airway granulomas
  • glomerulonephritis
  • onset ~40yo
  • cutaneous: nodules, palpable purpura, pyoderma gangrenosum
  • dx: C-ANCA to proteinase-3 and elevated CRP
  • tx cyclophosphamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

classification of pulm HTN

A
  • assoc with resp system d/os
  • due to pulm venous HTN (LV heart dz, mitral valve dz, pulm veno occlusive dz)
  • from chronic thromboembolic dz
  • pulm artery HTN
  • d/os of pulm vasculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

clinical features of pulm HTN

A
  • dyspnea, weakness, fatigue
  • chest pain, hemoptysis, syncope, hoarseness
  • RV failure late in dz
  • CXR: enlgmt of pulm aa with pruning and enlged RV
  • EKG: R axis deviation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

DHEA vs DHEAS

A

DHEA: from ovaries and adrenal glands
DHEAS: adrenals only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

serum albumin ascites gradient

A
  • ascites albumin - serum albumin
  • if SAAG > 1.1 = transudative
  • SAAG > 1.3 = portal HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Winter’s formula

A

arterial pCO2 = 1.5[HCO3] + 8 +- 2

for appropriate resp compensation of metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

MEN 1

A
  • primary hyperpara
  • enteropancreatic tumors
  • pituitary tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

MEN 2A

A

AD

  • medullary thyroid carcinoma
  • pheochromocytoma
  • parathyroid hyperplasia
    dx: genetic test for ret proto-oncogene germline mutation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MEN 2B

A

AD

  • medullary thyroid carcinoma
  • pheochromocytoma
  • marfanoid habitus, mucosal/intestinal neuromas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

vaccines for chronic liver dz pts

A
  • HAV
  • HBV
  • pneumococcal
  • flu
  • Td/TdaP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

dacryocystitis

A
  • infection of lacrimal sac
  • sudden onset of pain, redness in medial canthal region
  • staph aureus, GABHS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

mild glomerulonephritis

A
  • nephritic urine sediment alone

- causes: IgA nephropathy, lupus nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

mod to severe glomerulonephritis

A
  • nephritic urine sediment, decreased GFR, variable proteinuria
  • causes: postinfectious, lupus nephritis, MPGN, vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

nephrotic syndrome

A
  • bland urinary sediment, proteinuria > 3.5g/day, microscopic hematuria possible
  • causes: MCD, FSGS, diabetes, lyps, membranous nephropathy, IgA nephropathy, primary amyloidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

mixed cryoglobulinemia

A
  • usually due to Hep C
  • immune complex (IgM + IgG-anti-HCV + HCV RNA + complement) deposition in small blood vessels
  • skin, kidney, NS, MSK involvement possible
  • dx: serology, kidney/skin biopsy
  • tx: treat HCV, plasmapheresis, immunosuppressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

TTP

A
  • decreased ADAMTS13

- fever, microangiopathic hemolytic anemia, renal failure, neurologic findings possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

APLA

A
  • anti cardiolipin antibodies

- recurrent thrombosis, pregnancy loss, neurologic findings, microangiopathic hemolytic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

comm acquired PNA - tx

A
  • CURB65: confusion, uremia, tachypnea (RR>30), hypotension (BP65yo
  • CURB65 > 2 –> hosp; >=4 –> ICU
  • levoflox/moxiflox OR betalactam plus macrolide (e.g. amp/sulbactam)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

causes of avascular necrosis of femoral head

A
  • chronic corticosteroids
  • alcoholism
  • hemoglobinopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

best test for diabetic nephropathy?

A

random urine microalbumin to creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

diabetic nephropathy and Cr clearance

A

initially: hyperfiltration –> increased Cr clearance
- then decline in Cr
- Cr can be relatively normal for a while; low Cr clearance usually with advanced renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

excess oxygen in COPD

A
  • baseline: hypoxic drive (instead of hypercapnic drive)
  • get vasodilation –> increased perfusion of poorly ventilated areas
  • worsened VQ mismatch
  • decreased CO2 excretion –> hypercapnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

squamous cell carcinoma of lung

A
  • PTHrP –> hypercalcemia (sCa++mous) –> anorexia, constipation, thirst, fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

CMV retinitis

A
  • yellow-white retinal opacification
  • retinal hemorrhages
  • HIV+, CD4 <50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

ocular toxo

A
  • severe necrotizing retinochoroiditis
  • white fluffy retinal lesions surrounded by edema and vitritis
  • usually accomp by encephalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

HIV retinopathy

A
  • benign cotton wool spots

- remit spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

chronic pancreatitis

A
  • causes: alcohol, CF, autoimmune
  • epigastric abd pain, malabsorption, weight loss, T2DM
  • amylase/lipase often NORMAL
  • AXR or CT: pancreatic calcifications; if neg do MRCP/ERCP
  • tx: pain, alcohol/smoking cessation, frequent small meals, enzyme supplementation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Ca 19-9

A

pancreatic cancer!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

pregnant with HCV

A
  • get HBV and HAV vaccines
  • can breastfeed, have SVD, have unprotected sex
  • can’t have ribavirin or IFNa (teratogens!)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

FSGS: common pt groups

A
  • AfAm, Hispanic
  • obesity
  • HIV
  • heroin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

membranous nephropathy: common pt groups

A
  • adenocarcinoma (breast, lung): most common form assoc with malignancies
  • NSAIDs
  • HBV
  • SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

membranoproliferative glomerulonephritis: common pt groups

A
  • HBV
  • HCV
  • lipodystrophy
  • chronic bacterial infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

minimal change disease: common pt groups

A
  • NSAIDs

- lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

IgA nephropathy is associated with?

A

URI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

crescentic glomerulonephritis

A
  • AKI, hematuria, HTN

- assoc with AI disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

opioid withdrawal

A
  • sx w/in 6-12 hrs of last dose; peak at 24-48 hrs
  • sx: N/V, cramps, diarrhea, dysphoria, restlessness, rhinorrhea, lacrimation, myalgias, arthralgias
  • PE: mydriasis, piloerection, hyperactive bowel sounds
  • tx: methadone replacement (NEVER IV MORPHINE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

cirrhotic stigmata

A

loss of liver function:

1) synthetic: clotting factors, cholesterol, proteins –> edema, hypocoagulability
2) metabolic: drugs, steroids –> hyperestrogenism: gynecomastia, palmar erythema, spider angiomas, testicular atrophy, decreased body hair in males
3) excretory: bile and ammonia secretion –> asterixis

also ascites, portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

most common causes of chronic cough

A

1) post nasal drip
2) asthma
3) GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

chlorpheniramine

A

H1 antihistamine

  • blocks histamine release from mast cells, limits response to inflammatory cytokines
  • decreased nasal discharge and cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

acute mesenteric ischemia: presentation

A
  • rapid onset periumbilical pain
  • pain out of proportion to exam
  • hematochezia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

acute mesenteric ischemia: risk factors

A
  • age
  • atherosclerosis, Afib, CHF, peripheral artery dz
  • hypercoagulable disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

acute mesenteric ischemia: lab findings

A
  • leukocytosis
  • elevated lactate
  • elevated amylase and phosphate levels
  • metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

acute mesenteric ischemia: diagnosis

A
  • early mesenteric angiography

- — multidetector-row CT angiography if not avail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

acute mesenteric ischemia: tx

A
  • resuscitative
  • broad-spectrum ABx
  • NG tube for decompression
  • surgery for infarction/perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

therapies proven to prolong survival in COPD

A
  • smoking cessation
  • supplemental O2
  • lung reduction surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

mainstays of sx reduction in COPD

A

aims: decreasing resp sx, improving QOL, decreasing hospitalizations
- inhaled anti-cholinergics
- can add short acting beta-ag, inhaled steroids, long acting beta ag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

should you give beta blockers to pts with reactive airway disease?

A
  • probably not!

- may exacerbate pulmonary sx if dz is severe

82
Q

dermatitis herpetiformis

A
  • papules/vesicles/bullae
  • B/L, symmetric, grouped
  • EXTENSOR surfaces, upper back, buttocks
  • IgA deposits, circulating anti-endomysial Abs
  • commonly assoc with CELIAC DZ
  • tx: dapsone + gluten free diet
83
Q

common causes of priapism

A
  • sickle cell dz
  • leukemia
  • perineal/genital trauma: laceration of cavernous artery
  • neurogenic lesions: spinal cord injury, cauda equina
  • medications: trazodone, prazosin
84
Q

middle mediastinal masses

A
  • bronchogenic cyst
  • tracheal tumor
  • pericardial cyst
  • lymphoma
  • LAN
  • aortic aneurysms of arch
85
Q

anterior mediastinal masses

A
  • thymoma
  • retrosternal thyroid
  • teratoma
  • lymphoma
86
Q

posterior mediastinal masses

A
  • meningocele
  • enteric cysts
  • lymphomas
  • diaphragmatic hernias
  • esophageal tumors
  • aortic aneurysms
87
Q

CEA in pancreatic cancer

A
  • can be useful as marker for response to therapy

- not useful as screening test

88
Q

isoniazid and liver injury

A
  • idiosyncratic injury: not dose-dependent, variable latency periods
  • causes hepatitis morphology on biopsy
89
Q

medications causing liver cholestatic picture

A
  • chlorpromazine
  • nitrofurantoin
  • erythromycin
  • anabolic steroids
90
Q

mx causing fatty liver morphology

A
  • tetracycline
  • valproate
  • anti-retrovirals
91
Q

mx causing hepatitis picture

A
  • halothane
  • phenytoin
  • isoniazid
  • alpha-methyldopa
92
Q

mx causing toxic/fulminant liver failure

A
  • carbon tetrachloride

- acetaminophen

93
Q

mx causing granulomatous liver picture

A
  • allopurinol

- phenylbutazone

94
Q

lateral epicondylitis

A
  • repeated forceful wrist extension and supination
  • pain near lateral epicondyle, worsened by use
  • degeneration of ECRB tendon
95
Q

posterior interosseus nerve entrapment

A

weakness of extrinsic extensors of hand and fingers

96
Q

management of hypercalcemia

A
  • asyx/mild: avoid thiazides, Li, volume depletion
  • moderate (12-14): no tx unless sx
  • severe (>14): short term: NS + calcitonin, avoid loop diuretics; long term: bisphosphonate
97
Q

sx of hypercalcemia

A
  • anorexia
  • nausea
  • constipation
  • polyuria/polydipsia
  • dehydration
  • if severe: neurologic - lethargy, weakness, confusion, stupor, coma
98
Q

how to treat hypercalcemia in chronic granulomatous disorders

A
  • corticosteroids!
  • reduce calcitriol production by mononuclear cells
  • not useful in acute management
99
Q

causes of normal anion gap met acidosis

A
  • diarrhea
  • fistulas
  • carbonic anhydrase inhibitors
  • RTA
  • ureteral diversion
  • iatrogrenic
100
Q

hyperkalemic RTA

A
  • type 4 RTA (non-anion gap met acidosis)
  • elderly pts with poorly controlled diabetes
  • damage to juxtaglomerular apparatus
  • mild to mod renal insufficiency
101
Q

CML: stages

A
  • chronic
  • accelerated
  • blast crisis
102
Q

CML peripheral smear

A
  • increased immature myelocytes
  • basophilia and eosinophilia
  • platelet count normal/elevated
  • patients commonly anemic

bone marrow: hypercellularity with prominent granulocytic hyperplasia

103
Q

auer rods

A
  • seen in M3 subtype of APL
104
Q

AML vs CML

A
  • no fever in AML unless infx
  • splenomegaly uncommon in AML
  • peripheral blood smears: myeloblasts
105
Q

vaccines for pts with HIV

A
  • HiB (anatomic/functional asplenia)
  • HAV, HBC
  • HPV
  • flu
  • meningococcus
  • pneumococcal conjugate (1x)
  • pneumococcal polysaccharide (Q5)
  • Tdap, Td
106
Q

live vaccines in HIV pts

A
  • MMR, varicella, zoster

- CONTRAINDICATED if CD4<200

107
Q

risk factors for NASH

A

TOP 3

  • obesity
  • DM
  • hyper TGs

others: steroids, amiodarone, dilt, tamoxifen, HAART, TPN, endocrinopathies

108
Q

NASH

A
  • impaired responsiveness of fat cells to insulin –> accum of fat in liver
  • steatosis can progress to steatohepatitis and fibrosis
  • hepatomegaly WITHOUT stigmata of chronic liver dz
  • mild ALT and AST elevation
  • dx: percutaneous liver biopsy
  • tx: ursodeoxycholic acid
109
Q

PBC

A
  • jaundice, pruritus
  • positive AMAbs
  • portal tracts infiltrated by lymphocytes, macrophages, plasma cells, eos
  • can eventually cause portal tract scarring and bridging fibrosis –> cirrhosis
110
Q

test of choice for dx rotator cuff tear

A

MRI!

111
Q

test of choice for shoulder fx/disloc/calcific tendonitis

A

XR!

112
Q

what do you use bone scans for?

A

dx of: osteomyelitis, fx, metastatic dz

113
Q

pemphigus vulgaris

A
  • blistering of skin and mucous membranes
  • FLACCID BLISTERS
  • unknown etiology
  • positive Nikolsky sign
  • IgG deposits in epidermis
  • tx: steroids, azathioprine, methotrexate
114
Q

bullous pemphigoid

A
  • benign pruritic disease
  • TENSE BLISTERS
  • IgG and C3 deposits at dermal/epidermal jct
115
Q

bullous impetigo

A
  • caused by Staph
  • honey color!
  • red denuded areas when removed
116
Q

common causes of steatorrhea

A
  • panc insufficiency
  • bile salt-related
  • impaired intestinal surface epithelium
  • rare: Whipple dz, Zollinger-Ellison, medication-induced
117
Q

Nocardia

A
  • gram pos, PARTIALLY acid fast, filamentous branching rods
  • immunocompromise; systemic sx, lung nodules, brain abscess
  • tx for pulm nocardia: BACTRIM
  • if brain involved: ADD CARBAPENEM
  • long tx
118
Q

Waldenstroms macroglobulinemia

A
  • rare chronic plasma cell neoplasm
  • abnl plasma cells invade BM, LNs, spleen
  • excessive IgM production –> hyperviscosity (e.g. retinal v engorgement)
119
Q

tx of acute exacerbation of COPD

A
  • O2: target sat 88-92
  • inhaled bronchodilators and anticholiergics
  • systemic glucocorticoids
  • ABx IF: 2/3 cardinal sx, mod-to-severe exacerbation, mechanical ventilation
  • non-invasive pos pressure ventilation/intubation
120
Q

acetylcysteine

A
  • mucolytic

- useful in CF

121
Q

Wilson’s dz

A
  • AR
  • copper in liver, basal ganglia, cornea
  • liver disease in children/adols
  • neuropsych dz in young adults
  • low ceruloplasmin + high copper; increased urinary Cu excretion, KF rings
122
Q

Mallory hyaline on biopsy

A
  • alcoholic liver injury

- wilson dz also

123
Q

Osler Weber Rendu syndrome

A
  • hereditary telangiectasia
  • AD
  • diffuse telangiectasia, recurrent epistaxis, widespread AVMs (mucus membranes, skin, GI, liver, brain, lungs)
124
Q

lung AVM

A
  • shunt blood from R to L heart
  • chronic hypoxemia and reactive polycythemia
  • massive hemoptysis
125
Q

most common locations of ischemic colitis

A
  • splenic flexure
  • recto-sigmoid junction
    (both watershed areas)
126
Q

mechanical ventilation in ARDS

A
  • improves O2 and prevents alveolar collapse (via PEEP)
  • arterial pO2 = measure of oxygenation
  • pCO2: affected by RR and TV
  • goal: decrease FiO2 to under 60, make sure PaO2>60
127
Q

can pancreatitis cause ARDS?

A

YES! up to 15% of patients

128
Q

three major mechanical complications of MI

A
  • MR due to papillary mm rupture
  • LV free wall rupture
  • interventricular septum rupture
129
Q

malaria

A

CYCLICAL FEVER - correlates with RBC lyses

  • cold phase –> hot phase –> sweating stage
  • anemia and splenomegaly
130
Q

when to get EGD in GERD

A
  • alarm sx (dysphagia, odynophagia, weight loss, anemia, bleeding, vomiting)
  • or age > 50 with >5 yrs sx and cancer risk factors
131
Q

when to get H pylori testing

A
  • active or past PUD

- pts with dyspepsia but NOT GERD

132
Q

cat scratch disease

A
  • localized cutaneous and LN disorder
  • rare involvement of liver/spleen/eye/CNS
  • tx: azithromycin
133
Q

cholestasis: lab findings

A

elevated direct bili + elevated alk phos

134
Q

amebic liver abscess

A
  • hx of travel to endemic area
  • dysentery and RUQ pain
  • single cyst in R lobe of liver
  • E histolytica!
135
Q

hydatid cyst

A
  • E granulosus infection

- from intimate contact with dogs

136
Q

common causes of hematuria

A
  • neoplasm
  • infection
  • trauma
  • nephrolithiasis
  • glomerulonephritis
  • prostatic dz
137
Q

risk factors for urinary tract malignancy

A
  • age >35
  • smoking
  • occupational hx
  • drug exposure (cyclophosphamide)

bladder cancer most common

138
Q

medications that cause ototoxicity

A
  • aminoglycosides
  • chemo drugs
  • aspirin
  • loop diuretics
139
Q

aspirin SEs

A
  • tinnitus

- hearing loss at higher doses

140
Q

EPO therapy SEs

A
  • worsening of HTN: more common in IV vs subQ
  • headaches
  • flu-like syndrome
  • red cell aplasia
141
Q

smudge cells on smear

A

CLL!

- get flow cytometry to confirm

142
Q

JAK2 mutation

A
  • myeloproliferative dz

- esp POLYCYTHEMIA VERA

143
Q

what does a positive hepatojugular reflux test mean?

A
  • reflection of failing RV

- cannot accommodate increased venous return

144
Q

most common causes of hepatojugular reflux

A
  • constrictive pericarditis
  • RV infarction
  • restrictive cardiomyopathy
145
Q

TMJ

A
  • pain often reported as from ear
  • pain worsened with chewing
  • audible clicks/crepitus possible
  • radiology studies limited use
  • tx: conservative –> surgical
146
Q

comedonal acne

A
  • closed or open comedones on forehead, nose, chin
  • may progress to inflammatory pustules or nodules
  • TX: topical retinoids, salicylic/glycolic acid
147
Q

inflammatory acne

A
  • inflamed papules and pustules
  • erythematous
  • TX: inflammatory: topical retinoids + benzoyl peroxide (+ topical/oral ABx if mod/severe)
148
Q

nodular (cystic) acne

A
  • large nodules, can appear cystic
  • nodules may merge to form sinus tracts
  • possible scarring
  • TX: mod: topical retinoid + benzoyl + topical ABx; severe - add oral ABx;
  • unresponsive severe cases: add oral isotretinoin
149
Q

indomethacin contraindicated in?

A
  • renal failure

- hx of GI bleeding

150
Q

Beck’s triad?

A

assoc with cardiac tamponade

  • hypoT
  • distended neck vv
  • muffled heart sounds
151
Q

cardiac tamponade pathophys

A
  • increased pericardial P > diastolic ventricular P
  • -> decreased venous return –> decreased preload
  • -> decreased SV and CO
  • worsened by inspiration: increased R venous return –> septum shifted to left –> LV filling further decreased –> PULSUS PARADOXUS
152
Q

HSV keratitis

A
  • freq cause of corneal blindness
  • pain, photophobia, blurred viison, tearing, redness
  • recurrences precip by sun exposure, outdoor work, fever, immundef

DENDRITIC ULCERS and CORNEAL VESICLES

  • clinical dx
  • epithelial scrapings –> multi-nuc giant cells
  • tx: oral/topical antiviral
153
Q

Well’s criteria

A

3 pts: clinical signs of DVT, alternate dx less likely
1.5 pts: previous PE/DVT, HR >100, recent surg or immobilization
1 pt: hemoptysis, cancer

score > 4: PE likely

154
Q

nafcillin and renal failure

A
  • causes acute interstitial nephritis (eos and WBC casts in urine)
155
Q

aminoglycosides: uses and SEs

A
  • usually for serious G-neg infections

- nephrotoxic!

156
Q

loop diuretics: effects

A
  • increased Na, H, K secretion in urine

- volume contraction, increased aldosterone

157
Q

drugs that cause folic acid deficiency

A
  • phenytoin, primidone, phenobarbital
  • trimethoprim
  • methotrexate

–> megaloblastic anemia

158
Q

MC site of mets for CRC

A

liver!

159
Q

treatment for torsades?

A

MG! (if conscious, stable)
if unstable, defibrillate

  • if TdP due to quinidine use: give sodium bicarb
160
Q

treatment for PSVT?

A

adenosine

161
Q

tx of hyperkalemia

A
  • if EKG changes: calcium gluconate
  • rapid intracellular shifts: beta2 agonists, insulin with glucose, sodium bicarb
  • removal of K: diuretics, cation exchange resins, hemodialysis
162
Q

XR findings in gouty arthritis

A

punched out erosions with rim of cortical bone

163
Q

XR findings in RA

A

periarticular osteopneia

joint margin erosions

164
Q

common causes of megaloblastic anemia

A
  • folate deficiency
  • B12 deficiency
  • myelodysplastic syndrome
  • AML
  • drugs: hydroxyurea, zidovudine, chemo
  • liver dz
  • alcohol abuse
  • hypothyroidism
165
Q

pernicious anemia

A
  • MCC of B12 defic in white people
  • assoc autoimmune dz common (thyroid, vitiligo)
  • shiny tongue, ataxia, loss of position/vibration
166
Q

common arrythmias in post MI period

A
  • ventricular premature beats
  • VT
  • Vfib: most freq cause of sudden cardiac arrest in setting of acute MI

w/in 10 minutes: immediate arrythmia, ischemia –> reentrant arrhythmia
delayed (10-60 min): from abnormal automaticity

167
Q

giant cell tumor of bone

A

benign and locally aggressive neoplasm in young adults

  • pathologic fx common
  • XR: epiphyses of long bones - soap bubble appearance
  • patho: sheets of giant cells
  • tx: surgery!
168
Q

glucocorticoids and immune effects

A
  • diminish circulating eos
  • lymphopenia
  • increase BM release of neutrophils –> neutrophilia
169
Q

MCC of epiglottitis

A
  • HiB

- Strep pyogenes

170
Q

post cholecystectomy syndrome

A
  • persistent abd pain or dyspepsia following chole (can be years after)
  • biliary or extra biliary causes
  • lab: high alk phos, abnl AST/ALT, dilated common bile duct on abd US
171
Q

PPD: treat or not?

A
  • if PPD > 5mm: treat HIV+, recent contacts of TB+, XR changes consistent with previous TB, immdef
  • PPD > 10mm: recent immigrants, IVDU, high-risk setting employees/residents, higher risk for TB reactivation, children 15 mm: treat EVERYONE
172
Q

treatment for latent TB

A
  • INH + rifapentine weekly for 3 mos (not for HIV)
  • INH monotherapy for 6-9 months
  • rifampin for 4 months
  • INH + rifampin for 4 months
  • add pyridoxine to prevent neuropathies if taking INH
173
Q

tx for active TB

A
  • INH, rifampin, ethambutol, pyrazinamide for 8 weeks

- INH + rifampin for another 4 months

174
Q

tx of open angle glaucoma

A
  • BB eye drops (e.g. timolol)
  • laser trabeculoplasty as adjunct
  • if continues to increase, surgical trabeculectomy
175
Q

CREST

A
  • calcinosis cutis
  • Raynaud
  • esophageal dysmotility
  • sclerodactyly
  • teleangiectasias
176
Q

ideal tidal volume

A

6 ml/kg

177
Q

SEs of beta2 agonist tx

A
  • hypokalemia –> mm weakness, arrhythmia, EKG chg
  • tremor
  • HA
  • palpitations
178
Q

lab findings suggestive of alcoholism

A
  • TCP
  • macrocytosis
  • elevated transaminases
179
Q

indications for O2 therapy in COPD

A

PaO255

evidence of cor pulmonale

180
Q

bruit in renal artery stenosis

A
  • 85% of pts with RAS have bruit

- systolic-diastolic common

181
Q

mx that cause hyperkalemia

A
  • BBs
  • ACEi, ARB, K-sparing diuretics
  • digitalis
  • cyclosporine (blocks aldosterone production)
  • heparin (blocks aldosterone production)
  • NSAIDs
  • succinylcholine
  • trimethoprim (block ENaC)
182
Q

A1AT

A
  • bullous changes of lungs
  • emphysematous chg in lower lobes
  • can also cause liver dz: neonatal hepatitis, cirrhosis, liver failure
183
Q

PSVT

A
  • re-entry in AV node is most common mechanism
  • abrupt attacks, HR 160-220
  • vagal maneuvers increase vagal tone and decrease AV conduction
  • can also use adenosine
184
Q

Wegener’s

A
  • granulomatosis with polyangiitis
  • upper airway: nasal discharge, oral ulcers, sinusitis
  • lower airway: dyspnea, cough, hemoptysis
  • renal: insufficiency, micro hematuria, RBC casts
  • systemic: fever, weight loss, fatigue
  • CXR: nodular densities, alveolar/pleural opacities
  • test for ANCA
185
Q

aortic dissection

A
  • risks: HTN, Marfan, cocaine
  • > 20 mmHg BP variation bw arms
  • complications: stroke, AR, Horner’s, MI, pericardial effusion/tamponade, hemothorax, lower-extremity weakness, abdominal pain
  • dx: CXR - mediastinal widening; best test is chest CT or TEE
  • tx: labetalol (if HTN)
  • ascending aorta: need surg; descending aorta: medical management only
186
Q

flash pulm edema

A
  • usually 2ary to acute MI

- give furosemide: decrease preload and increase venodilation

187
Q

common causes of aortic regurg

A
  • Marfan, syphilis –> aortic root dilation
  • post-inflammatory: rheumatic heart dz, endocarditis
  • congenital bicuspid valve
188
Q

clinical features of aortic regurg

A
  • diastolic decrescendo murmur
  • widened pulse pressure
  • collapsing/water hammer pulse
  • heart failure signs/sx
  • increased LV size –> apex close to chest wall –> uncomfortable awareness of heartbeat
189
Q

amiodarone and lungs

A
  • pulmonary toxicity!
  • chornic interstitial pneumonitis, organizing PNA, ARGDS
  • related to cumulative dose
190
Q

CHADS2 score

A

for anticoag in Afib

  • CHF, HTN, Age>75, DM, stroke/TIA (2 pts)
  • score 0: no anticoag or aspirin
  • score 1: anticoag or aspirin
  • score 2+: anticoag
191
Q

AAA risk factors

A
  • age, smoking, family hx, white, atherosclerosis

- risk factors for expansion/rupture: large diameter, rate of expansion, current cig smoking (biggest

192
Q

massive PE

A
  • PE complicated by hypoT and/or acute RH strain
  • syncope possible
  • JVD and RBBB possible
  • causes cardiogenic shock and CNS effects
  • can confirm with CT pulm angio if time allows
  • give resp, hemodynamic support; fibrinolysis
193
Q

tx for stable angina

A
  • BB
  • CCB (addl to BB or alternative)
  • nitrates (acute or long-acting)

preventive: aspirin, statin, smoking cessation, exercise/wt loss, BP and DM control

194
Q

lidocaine

A
  • 1B anti-arrhythmic drug, good for variety of ventricular arrhythmias
  • DON’T use as prophylaxis for Vfib in MI pts – increases risk of asystole!
  • decreases freq of ventricular premature beats and risk of Afib
195
Q

complications of PEEP

A
  • alveolar damage
  • tension PTX
  • hypoT (if high P)
196
Q

PEEP in ARDS

A
  • mainstay of therapy

- levels up to 15 may be needed

197
Q

pulsus parvus et tardus

A

assoc with aortic stenosis

198
Q

Light criteria for pleural effusion

A

exudative pleural effusion IF 1+ of:

  • p/s protein ratio >0.5
  • p/s LDH ratio >0.6
  • pleural LDH >2/3 ULN for serum LDH
199
Q

causes of primary adrenal insuff

A
  • autoimmune
  • infections (TB, HIV, fungal)
  • hemorrhagic infarction
  • metastatic ca
200
Q

dx of primary adrenal insuff

A
  • ACTH and cortisol with high dose ACTH stim test
  • primary: low cortisol, high ACTH
  • 2ary/3ary: low cortisol, low ACTH
201
Q

MC 2ary tumors in HL patients

A
  1. 5x risk of 2ary malignancy
    - lung, breat, thyroid, bone, GI
    - if got radiation/chemo tx: increased risk of leukemia or non-HL

medicine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions