UWorld Flashcards
0
Q
What is the long term therapy for patients with Crytococcus meningitis?
A
Fluconazole
1
Q
Treatment for cyrptococcus meningitis?
A
Amphotericin and Flyucytosine
2
Q
What are the causes of a pleural effusion?
A
- Infection
- Malignancy
- PE
- connective tissue disease
- iatrogenic
3
Q
Light’s criteria?
A
- Fluid to serum protein ration >0.5
- Fluid to serum LDH ratio >0.6
- Fluid LDH greater than >2/3 upper limit for serum LDH
4
Q
Enlarged central pulmonary arteries may be a sign of what?
A
Cor Pulmonale
5
Q
A holosystolic murmur at the L lower sternal border is what?
A
Tricuspid regurg,
May here in cor pulmonale because of pulmonary hypertension, so blood flows back into R ventricle from the pulmonary arteries, during systole (makes sense because this is when blood would enter the pulmonary arteries most forcefully which is what will cause the murmur)
6
Q
How does cor pulmonale affect P2 heart sound?
A
Louder
7
Q
What is Beck’s triad?
A
Tamponade: hypotension, elevated JVP, muffled heart sounds
8
Q
What are the 5 toxicities of amiodarone?
A
- pulmonary toxicity
- hepatotoxicity
- thyroid dysfunction (mostly hypothyroid) (amiodarone has a lot of iodine in it)
- corneal deposits
- skin changes
9
Q
How differentiate viral myocarditis from cardiac tamponade?
A
Both can have recent URI, fatigue, dyspnea and elevated JVP
Myocarditis: typically have pulmonary vascular congestion and audible S3
10
Q
Track marks, cavitary lesions on lung imaging and h/o IV drug use—Dx?
A
Septic emboli (most likely S. Aureus) from infective endocarditis
12
Q
Serum calcium correction formula?
A
= measured Ca + 0.8 (4-measured albumin)
13
Q
pt with HIV with an infection that sounds like UC?
A
CMV
14
Q
Cause of muscle weakness after and asthma attack?
A
B2 agonist drive K into cells
can cause clinically significant arrhythmias, muscle weakness and EKG changes
15
Q
ATII preferentially constricts AFF or EFF arteriole?
A
EFF
16
Q
How does hematuria at the beginning or end of urine stream clue you in to where in the anatomy you may find pathology?
A
Early in stream: urethra
Late: bladder or prostate
17
Q
Mgmt of pt with acute pancreatitis with a history of gallstones?
A
Cholecystectomy
18
Q
lethargy, hypogonadism, arthropathy and diabetes are suggestive of what dx?
A
hemochromatosis
19
Q
Sudden loss of vision and onset of floaters, dx? #1 cause?
A
vitreous hemorrhage #1 cause: diabetes
20
Q
What does factorial design involve?
A
randomization to different interventions with additional study of 2 or more variables
21
Q
What are the main components of Wegener’s
A
- systemic vasculitis
- upper and lower airway granulomatous inflammation
- glomerulonephritis
*destruction of nasal cartilage and ulcers are common manifestations
22
Q
Treatment of Wegener’s
A
cyclophosphamide
23
Q
Labs in Wegener’s
A
C-ANCA
- RBC casts, proteinuria and sterile pyuria
- elevated CRP
24
Q
Ring shaped scaly patches with central clearing and distinct borders - dx?
A
tinea corporis
25
Citrate in packed RBCs can have what effect on serum electrolytes?
can cause hypocalcemia because the citrate can cause the calcium to precipitate
26
POD 2: hypotension, extensive blood loss into tissues and massive blood replacement Dx?
postoperative cholestasis
27
Pathophys behind postoperative cholestasis?
jaundice due to:
- increased pigment load
- decreased liver functionality (due to hypotension)
- decreased renal bilirubin excretion (due to tubular necrosis)
28
Tx for sinus bradycardia?
Atropine
29
CLL involves what kind of cells?
B cells
30
What is a poor prognostic sign in CLL?
thrombocytopenia
31
kid bit by un-immunized dog, next step?
watch dog for 10 days
32
HTN, palpable bilateral abdominal masses and microhematuria = Dx?
ADPKD
33
common complication of ADPKD?
intracranial berry aneurysm, dangerous when coupled with HTN
Also: hepatic cysts, valvular heart disease, colonic diverticula, abdominal wall and inguinal hernia
34
indinavir side effect?
crystal induced nephropathy
35
didanosine side effect?
pancreatitis
36
Abacavir side effect?
hypersensitivity syndrome
37
NRTIs side effect
lactic acidosis
38
NNRTIs possible side effects?
Steven's Johnson
39
Nevirapine assoc side effect?
liver failure
40
amenorrhea, absence of vagina and uterus, normal pubic hair and breast development--dx?
Mullerian agenesis
41
Vitamin D Deficiency: what pattern of PTH, ionized calcium and alk phos?
elevated iPTH, normal ionized calcium, and elevated alkaline phosphatase.
decreased vit D --> decreased Ca absorption, so increased PTH to maintain free Ca--> increased Alk Phos and bone resorption
42
Most commonly injured organ in stab wounds?
liver
43
What test is used to confirm a gastrinoma?
secretin stimulation test
In this test a fasting gastrin level is measured before administration of intravenous secretin and further samples of serum gastrin are obtained at 2, 5, 10, and 20 minutes after secretin administration. A rise in serum gastrin levels greater than 200 pg/mL above baseline after secretin administration is found in patients with ZES.
44
Severe pain and urinary retention s/p delivery = dx? mgmt?
vaginal hematoma
best treatment is incision and evacuation of the blood clots with ligation of the bleeding vessels if they can be identified
45
Structural heart defects are typical of what TORCHES infection?
Rubella
46
True or False:
Patients with hepatitis C genotype 2 or 3 are more likely to have a favorable response to treatment with interferon and ribavirin.
True
47
What is Universalization?
the awareness that the patient is not alone or unique in his or her suffering and that others share similar symptoms and difficulties, is a powerful healing factor in group therapy.
48
Ddx for splenomegaly?
```
Portal HTN (60%)
Myeloproliferative disorders
Leukemia
Lymphoma
Myelofibrosis **
ID
Infectious Mono
AIDS
```
49
What do infiltrates do to the liver?
Cause it to enlarge
50
Ddx pneumoperitoneum?
outside (trauma or s/p surgery)
inside (perforated DU or colon CA)
infection (emphysematous periotonitis)
51
Pelvic mass in a male, most likely diagnosis?
BPH
52
large pelvic tumors in women are most likely?
mucinous tumors of the ovary
53
2 major categories that cause dillatation of the stomach/GI tract?
1. mechanical obstruction
| 2. functional obstruction (adynamic ileus)
54
DDx long bowel strictures?
IBD
ischemia
radiation
55
Ahaustral colon DDX?
```
UC
chronic laxative abuse, usually R sided
Bowel proximal to a chronic bowel obstruction
ischemia
radiation
```
56
Thumbprinting cause?
focal infiltrations of bowel wall with edema, hemorrhage and/or inflammatory cells
57
Ddx of thumbprinting
```
ischemia
diverticulitis
IBD
infection (CMV in AIDS patients)
trauma
anticoagulant therapy
```
58
Rigler's sign?
see both sides of the bowel wall because of contrast against intra peritoneal air
59
Ddx portal venous gas
outside: umbilical vein cathterization
inside: bowel infarction
infection emphysematous cholecystitis
60
Ddx biliary tract air?
outside: ext biliary stent
inside: tubular GI tract and biliary fistula
-20 yo - Crohns
-40 yo - Diverticulitis
-60yo - Cancer
Infecction: Emphysematous cholecystitis
61
What is a varicocele and why do we care about it?
dilated extratesticular but intrascrotal vein plexus. Usually caused by defective venous valves. Increases temperature in the scrotum which decreases sperm production.
62
where should a subclavian line end?
tip should be in SVC proximal to atrium
63
What is the differential diagnosis for mediastinal shift?
- tension pneumothorax
- unilateral large pleural effusion
- lung collapse/atelectasis
- peumonectomy/lobectomy
- diaphragmatic hernia
64
What is the differential for mediastinal widening?
1. mediastinal masses (teratoma, lymphoma, metastases)
2. Hilar lymphadenopathy
3. Hiatal hernia and other esophageal pathologies (tumor, rupture, dilation)
4. Aortic pathology (dissection, aneurysm, rupture)
65
Differential diagnosis of pneumomediastinum?
air from outside (iatrogenic, surgery, intubation) (spontaneous trauma, knife or bullet wounds)
- air from inside: ruptured esophagus, ruptured trachea and/or bronchi, barotrauma, ex. asthma, emesis, parturition
- gas forming organisms: emphysematous mediastinitis
66
Treatment for achalasia
dilatation
67
Cause of secondary achalasia?
lesion of brain, vagus or esophageal wall that results in failure of relaxation of the LES
DDx: MS, cancer of lower esophagus or gastric fundus, Chagas
68
how distinguish renal infarcts vs. pyelo on CT?
Location of wedges
-in line with calyces: pyelo
=between calyces: infarcts
69
Extra-renal manifestations of ADPKD?
```
liver cysts
pancreatic cysts
cardiac valve disorders
hernias
berry aneurysms *HY*
```
70
What is the triad of gallstone ileus?
pneumobilia (air in the biliary tree), low small bowel obstruction with distended small bowel loops, and an impacted gallstone in the terminal ileum
71
Ddx for a solitary lung nodule?
```
Primary lung cancer
solitary mets
rounded pneumonia
pulmonary embolism
granuloma
```
72
Ddx for multiple lung nodules?
Metastases
Abscesses
Wegener's granulomatosssssis
Pneumoconioses
73
What is the differential diagnosis for diffuse osteopenia?
```
senile osteoporosis
systemic steroids
multiple myeloma
hyperparathyroidism
renal osteodystrophy
rickets
osteogenesis imperfecta
hypophosphatasia
cachexia /malnutrition
```
74
what is the difference between subluxation and dislocation?
Subluxation: some of the joint is touching
Dislocation: no part of joint is congruous
75
What are the most common causes of sclerotic bone mets?
males - prostate cancer
females - breast cancer
Hodgkin's lymphoma
76
Bone pain at night alleviated with aspirin = what dz?
osteoid osteoma
77
psammomatous calcifications are associated with what kinds of cancers?
mucinous cystadenocarcinoma of colon and serous? of ovaries
78
When does the odds ratio approximate the relative risk?
when the disease is rare
79
most common dx in patient with hypercalcemia and elevated PTH?
primary hyperparathyroidism
80
What is the most common source of PE emboli?
Deep veins of proximal leg: iliac, femoral and popliteal
81
afebrile patient with new-onset blood tinged sputum without signs of a more serious disease: treatment?
close follow up
82
branching, filamentous, partially acid fast bacteria?
nocardia
83
tx for nocardia?
TMP-SMX
84
First steps in patient with decreased renal output after surgery?
bladder scan or catheterization if the bladder scan is inconclusive (giving fluids could exacerbate overload on kidney)
*post op urinary retention (PUR) is a common complication of surgery and anesthesia
85
arthritis is characteristic of measles or rubella?
rubella (just think rub joints together)
86
What are the key features of multiple myeloma?
C: hyperCalcemia
R: renal failure
A: Anemia
B: lytic bone lesion
MC pres is back pain
Dx: serum electrophoresis
87
Tx for multiple myeloma
Gleevec
| hematopoietic cell transplantation
88
how does lidocaine affect a patient with ST segment elevation in anterior leads and premature beats?
increases the risk of asystole, so you do not give prophylactically to prevent V tach
89
Mgmt of a patient with a large STEMI?
```
high risk of LV thrombus
increased risk of systemic embolization
-immediate anticoagulation
-vascular surgery eval
-TTE with echo contrast to screen for LV thrombus
```
90
How treat diabetic nephropathy?
ACEi/ARB and strict glycemic control
91
what are the main types of diabetic nephropathy?
nodular glomerular sclerosis (Kimmelstiel-Wilson syndrome) where there is focal hyaline deposition
diffuse glomerular sclerosis: diffuse hyaline deposition
92
how treat basal cell carcinoma?
Electrodissication and curettage
| 3-5mm margins
93
How is DKA managed?
restore IV volume with 0.9% saline (normal saline)
correct hyperglycemia with IV Regular insulin
correct electrolyte abnormalities esp. Potassium
Tx precipitating factors like infections with abx
94
what are symptoms of DKA?
```
Kussmaul hyperpnea (deep and labored breathing)
abd pain
dehydration
anion gap
low bicarb
```
95
What 3 things do you need to dx DKA?
- DM
- Ketosis (blood and urine ketones)
- AGMA
96
What is another name for nitrofurantoin?
macrobid
97
What is the MCC of angioedema?
ACE inhibitors
98
Which blistering skin disorder affects the oral mucosa?
pemphigous vulgaris
| think pemphigoiD, D for deep
99
nephrotic syndrome can increase patient's risk of what?
atherosclerosis
100
what type of anemia is pica associated with?
iron deficient, NOT b12
101
young athlete with episodes of syncope while playing sports, dx?
hypertrophic cardiomyopathy
AD
increased muscle and pressure leads to diastolic failure
102
tx for hypertrophic cardiomyopathy?
Beta blockers
103
What tx in diabetics to decrease end organ damage?
ACEi
104
Tx for SVT with hemodynamic instability
Immediate cardioversion
105
Dx patient with back pain, anemia, renal dysfunction and elevated ESR
multiple myeloma
106
Abx regimen for immunocompromised patients with meningitis?
Amp + Vanc + Cefepime
107
Why DON'T you treat pheochromocytomas with B-blockers?
because you can get reflex hypertension
treat with alpha blockers first
108
what is the first sign of diabetic neuropathy?
microalbuminuria
109
eosinophils in UA indicate what?
acute interstitial nephritis
110
RBC casts are an indicator of what?
glomerulonephritis, ischemia or malignant HTN
111
what do WBC casts indicated?
pyelonephritis, tubulointerstitial dz or malignant HTN
112
What do granular casts indicate?
ATN
113
what do broad waxy casts indicated
chronic renal failure with dilated ducts
114
what do fatty casts indicate
nephrotic syndrome
115
what do hyaline casts indicate?
nonspecific
116
How treat PCN allergic syphylis?
Doxy or Ceph in non-pregnant pts
PCN desensitization and PCN in pregnant patients
117
What type of drug abuse leads to gynecomastia and erythrocytosis?
steroid drug abuse (includes androgens)
118
appropriate initial therapy/mgmt for patient with concern for MI?
- ASA
- EKG
- Troponins
119
What do you do if CKMB and trops are negative in a pt with a high suspicion of MI?
repeat at 6 and 12 hours
120
How treat patient with acute chest pain ongoing unstable angina?
- beta blocker to decreased O2 demand
- ASA
- heparin
- angiography
- Statin
- sublingual nitro
121
HOw distinguish aortic dissection vs. cardiac tamponade
cardiac tamponade will have elevated JVP and pulsus paradoxus (variation in systolic BP related to breathing)
122
What is Beck's traid for Cardiac tamponade?
hypotension JVD and muffled heart sounds
123
what is dx gold standard for cardiac tamponade?
echo
124
what is more important in tamponade: rate or amt?
rate. bc pericardium can stretch
125
mainstay of tx for kidney stones?
rehydration
126
Dx test when suspicious of choriocarcinoma?
quantitative b-hcg
127
CHADS2 risk score what counts for each thing?
```
CHF
Hypertension
Age > 75
DM
Prior Stroke or TIA
```
128
Tx for CHADS 0, 1 or >2
0: nothing or ASA
1: Anticoag or ASA
2: anticoag
129
what is triad asthma?
- asthma
- aspiring sensitivity
- nasal polyps
130
what is the treatment for histo/blasto/coccidio
itraconazole
131
tx for uric acid kidney stones?
ppx allopurinol
| tx potassium citrate
132
stone tx for stones up to 0.5cm-2cm or greater than 2cm?
0.5 to 2: shockwave lithotripsy
| >2: percutaneous nephrostomy
133
MCC chronic bronchitis
smoking
134
tx for hepatic encephalopathy
lactulose (decreases urea absorption)
| neomycin (kills GI flora that make urea)
135
MCC secondary clubbing?
- lung cancer
- CF
- R to L cardiac shunts
136
tx for postnasal drip?
anti-histamine +/- pseudoephedrine
137
tx for actinomycosis israeli?
high dose PCN
138
tx for nocardia
TMP-SMX
139
how does compliance change in ARDS?
decreases (stiff lungs)
140
tx cat-scratch dz
azithromycin
141
tx for pt with heavy alcohol use, MCV 101 and CHF that will REVERSE dz process?
stop using alcohol
142
MGMT pt with FAP
total proctocolectomy
143
tx paroxysmal SVT
vagal maneuvers or IV adenosine
144
tx a fib
control rate with beta-blocker, DV cardioversion, anticoagulation
145
tx v tach
IV amiodarone if stable, if not, DC cardioversion
146
tx v fib
immediate defibrillation and CPR
147
What is the CSF picture like for herpes encephalitis?
elevatd WBC, lymphs, normal glucose, elevated protein concentration
148
elevatd WBC, lymphs, normal glucose, elevated protein concentration
Herpes encephalitis
149
ringed sideroblasts, severe anemia in elderly dx?
myelodysplastic syndrome
150
Treatment for chronic Hep B?
Tenofovir
151
Sx similar to CHF with rapid onset and s3 dx?
viral myocarditis
| typically due to coxsackie b
152
Young pt with decreased K, HTN refractory to meds, dx?
primary hyperaldosteronism
| dx: abd CT scan
153
threshold for resecting adrenal incidentaloma?
>5cm
154
Ectopic cushing syndrome can be due to what underlying illness?
SCLC
155
5 P's of pheochromocytoma?
pressure, pain (HA), prespiration, palpitations, pallor
156
what type of drug is fludrocortisone?
mineral corticoid
157
Tx Addison's
mineralcorticoid: fludrocortisone and glucocorticoid: prednisone
158
MCC 2o adrenal insufficiency
abrupt cessation of steroids
159
what labs are suggestive of primary hyperaldosteronism
plasma aldosterone: renin >20, aldo >15
160
tx for DKA?
insulin, potassium, IVF (NS)
161
cryoglobulinemia assoc w/?
Hep C
162
Dacrolytis
inflammation of lacrimal sac
163
tx for constrictive pericarditis
pericardiectomy
164
increase in systemic venous pressure, edema, ascites, hepatic congestion, JVD, pericardial knock, Kussmaul sign--Dx?
constrictive pericarditis
165
Bug that can cause osteomyelitis in a puncture wound?
pseudomonas
166
prevention of meniere's disease
low salt diet, low alcohol, caffeine and nicotine
167
what glomerular dz is associated with hodgkin's lymphoma?
minimal change dz
168
how to decrease risk of contrast induced kidney injury in a patient with decreased renal function?
non ionic contrast
169
pt's with PAD and intermittent claudication are at risk of what?
MI 20% over 5 years
| ~20% risk of death due to CVD over 5 years
170
decrescendo early diastolic murmur
AR
171
2 common causes of pulsus paradoxus
cardiac tamponade, COPD
172
common side effects of niacin
flushing and itching
173
what are the 5 Hs and 5 Ts of PEA?
```
hypovolemia
hypo/per kalemia
hypoxia
H ions
hypothermia
```
```
Tension PTX
tamponade
toxins
thrombosis
trauma
```
174
what effect does dipyrimadole have in pharmacologic stress testing?
increases cardiac steal so can highlight areas of ischemia on exertion
175
what is a PVC? tx?
wide QRS without a preceding p wave
| -reassurance unless recurrent with underlying heart dz--> implantable defib
176
aliskiren is what kind of drug?
direct renin inhibitor
177
high-pitched systolic murmur at second R intercostal space--> what could cause chest pain
AS in young person due to bicuspid valves--> increased O2 demand because of hypertrophy 2/2 bicuspid valve
178
1st line tx for stable, chronic angina
metoprolol, beta blocekr
179
what non-pharmacologic intervention will have the biggest impact on decreasing BP
1. weight loss
| 2. DASH diet
180
what is associated with an increased rate of AAA expansion and rupture
ciagarette smoking
181
assoc/RFs for
- ascending aortic aneurysms
- descending aortic aneurysms
ascending: cystic medial necrosis or connective tissue disorder
descending: atherosclerosis
182
Do premature atrial beats require treatment?
NO, they are completely benign
183
What type of glomerular dz is associated with HIV?
FSGS
184
One test for histoplasmosis?
urine antigen testing
185
leading cause of death in acromegaly?
congestive cardiac failure
186
jewish woman with a black liver and increased conjugated bilirubin = ?
dubin-johnson
187
When is MMR vaccine contraindicated in HIV patients?
if CD4 <200
188
hexagonal renal stones = ?
cystine stones
dx urinary sodium nitroprusside test
tx acetazolamide
189
Dx imaging test for kidney stones
non con CT
190
severe abdominal pain with syncope followed by abdominal discomfort dx
ruptured AAA
191
diarrhea and tenesmus s/p radiation: next step mgmt
likely radiation proctitis
| Flex Sig is next test, looking for mucosal telangiectasia
192
workup HUS
peripheral blood smear, looking for schistocytes
193
IBS like sx with mostly diarrhea--dx?
IBS!
194
Tx for salmonella gastroenteritis
no Abx
195
increased AST, ALT, slightly elevated alk phos, increased direct bilirubin --what pattern of injury?
hepatocellular
196
adult with elevated indirect bilirubin and no symptoms, dx?
Gilbert syndrome
197
if US doesn't show a gallstone in the CBD does that mean one isn't there?
NO!!
can still have them. If you suspect it's there and see dilatation of the CBD, then even if you don't see it on US you manage pt as if it's there
198
MGMT of edematous, severe pancreatitis
enteral nutrition via NJ tube
199
Tx for IBS diarrhea?
loperamide
200
how should patients with Hep B be screened for HCC?
US
201
treatment for esophageal varices in cirrhotics?
prophylactic beta blocker
202
What liver/GI lab elevations can OCPs cause
direct bilirubin, alk phos
203
new cirrhotic, next step intervention?
esophageal scope to look for varices
204
Zenker's workup
contrast esophogram
205
suspect achalasia, after barium swallow next step?
endoscopy to r/o cancer
206
esophageal perf workup?
gastrograffin contrast esophagraphy
207
cause of gallstones in pts on TPN?
gallbladder stasis
208
67 yo pt with nausea vomiting, diffuse abdominal pain, decreased bowel sounds, elevated amylase
Dx?
acute mesenteric ischemia
| amylase can be elevated
209
pt with 5 month history of episodic retrosternal pain, radiates to intrascapular area, precipitated by hot/cold food and emotional stress, regurgitates food intermittently, cardiac testing negative, CXR normal, normal EGD, next step and dx?
next step: motility studies (manometry)
| dx: diffuse esophageal spasm
210
brown discoloration of colon with white lymph follicles in a patient with profuse watery diarrhea
laxative abuse aka factitious diarrhea
211
45yo man with h/o PUD, 3 duodenal ulcers, upper jejunal ulceration and prominent gastric folds on EGD, nex step?
serum gastrin concentration to r/o Zollinger Ellison
212
if IgA testing for celiac is negative can a patient still have the disease?
yes because many people with celiac have an IgA deficiency and in that case will test negative
213
Diarrhea in an AIDS patient?
cryptosporidium (acid fast staining)
214
what are the 2 watershed areas of the colon
splenic flexure and recto-sigmoid junction
215
traveler with malabsorptive sx, dx? tx?
Giardia
pathophys: forms adhesive discs
Tx: Flagyl
216
best long-term symptom relief tx in patients with PUD?
Abx and PPIs since H Pylori is the #1 cause (not vagotomy)
217
lactose intolerance test
hydrogen breath test, indicates bacterial carbohydrate metabolism
218
what dx should you consider in patients with regional pain and no evidence of dz of internal organs?
zoster
219
what phases of alcoholic hepatitis can be reversed if the patient stops drinking?
ALL OF THEM
220
AIDS pt with malaise, B sx, elevated alk phos, splenomegaly: Dx? Tx?
disseminated mycobacterium avium complex
dx w/blood cultures
tx: clarithromycin or azithromycin
*pts with CD4<50 should be on Azithro prophylaxis
221
Pt with symptoms suspicious for MEN2A, next test?
dx pheo
plasma free metanephrines or 24 hr urine metanephrines
Definitive test : ret proto-oncogene
222
Pt with a thyroid mass, first step in workup?
TSH and thyroid US
223
Pt with hypothyroid sx, nml TSH and elevated T3 and T4, dx?
resistance to thyroid hormones, receptor deficits on peripheral tissues
224
Pt with decreased TSH, increased T3/T4 and diffusely decreased radioisotope--dx?
factitious thyrotoxicosis
225
MC side effect of radioactive iodine tx?
hypothyroidism
226
DDx of a patient who presents with hypokalemia, alkalosis and normotension?
diuretics
surrupticious vomiting
Barrter's
Gitelman's
227
constipation, ab pain, polyuria and polydipsia
dx?
hypercalcemia
228
1st step in management of DI in a symptomatic patient?
normal saline to fluid resuscitate
| THEN hypotonic D5W
229
In a patient on levothyroxine, how will taking estrogen affect their thyroid therapy?
estrogen will lead to an increase in TBG, so the patient will have to increase their dose of L-thyroxine
230
what is the MC type of thyroid cancer?
papillary
231
what is the best way to screen of MEN2?
DNA testing since it's associated with a GERMLINE mutation in the ret oncogene
patients who test positive should have a prophylactic thyroidectomy
232
pts with untreated hyperthyroidism are at risk for what?
rapid bone loss
233
What are some common and endocrine causes of SIADH?
NSAIDs
| hypothyroidism and adrenal insufficiency
234
pt with increased Ca, decreased Phos and increased PTH, high urine ca, and high Ca/Cr clearance---best next step?
refer for surgery
235
pt presents with rapid onset hirsuitism and virilization
| --next best step?
measure serum testosterone and DHEAS
236
pt with throat pain and fever s/p PTU---dx?
agranulocytosis, stop PTU
237
marfanoid habitus assoc with which MEN type?
2B
238
mexican pt with sx of adrenal insufficiency, bilateral adrenal calcs--dx?
TB
239
1st line test for suspected adrenal insufficiency
250ug cosyntropin stimulation test with cortisol and ACTH levels
240
best 1st test for ED
nocturnal penile tumescence
241
tx pagets
bisphosphonates
242
35 yo man with bilateral gynecomastia, decreased LH and FSH, increased estrogen and testosterone, negative hcg and AFP--- Dx?
Leydig cell tumor
243
best first test dx acromegaly
```
IGF levels (elevated whole day, growth hormone levels fluctuate)
if high, do OGTT
```
244
pt with HTN and undetectable renin, dx?
primary hyperaldosteronemia
245
should risperdol affect pituitary thyroid axis?
No
246
what is the cause of 80% of malignancy induced hypercalcemia?
PTHrP
247
avoid loop diuretics in calcium overload status unless ______________
volume overload present
248
treatment for androgen excess in PCOS
combined hormonal pills
249
what is the cause of a hydatid cyst?
echinococcus granulosus
250
what is the mainstay of treatment in primary biliary cirrhosis?
ursodeoxycholic acid
251
pt on diuretics who develops hepatic encephalopathy, found to have hypokalemia, next step in mgmt?
give K
252
pt with hep c, being considered for treatment, next step?
biopsy
253
alcoholic hepatitis: lab pattern?
2:1 ratio of AST to ALT
| elevated Ferritin and GGT
254
test of choice for achalasia
manometry
255
est of choice for GERD
24hr pH monitoring
256
esophageal DDx for an HIV pt with CD <100
candida
CMV
HSV
esophagitis
257
```
MCC iron deficiency in
kids
women
men
elderly
```
kids: meckel diverticulum
women: menorrhagia
men: peptic ulcers
elderly: colon cancer
258
goal INR prosthetic valve
2.5 to 3.5
259
what marker of Hep B infection is present during the window period?
IgM anti-HBc
260
how does cirrhosis effect total T3 and T4 levels?
decreases total T3 and T4 levels because of decreased liver synthesis of serum binding proteins for T3 and T4, however, the free concentration of T3 and T4 is unchanged
261
best lab test to use for follow up of chronic Hep B infection?
serial ALT and HBeAg
262
MCC macrocytic anemia in pt with sickle cell
folate deficiency
263
SIADH is most commonly associated with what cancer?
small cell lung cancer
264
mainstay of treatment of MALT lymphoma
antibiotics
| most associated with h pylori
265
treatment of a solid testicular mass
orchiectomy: removal fo testis and cord
266
paget's disease of the breast associated with what type of cancer?
adeno
267
chondrocalcinosis associated with what conditions
pseudogout
hemochromatosis
hyperparathyroidism
hypomagnesemia
268
MCC iron deficiency anemia worldwide
hookworms
269
treatment for aplastic anemia
antithymocyte globulin, cyclosporine, marrow transplant if refractory
270
tx TTP
plasma exchange
271
tx HUS
dialysis
272
tx ITP
steroids, IVIG, splenectomy, rituximab for refractory dz
273
patients who have HIT-2 are at risk of developing what?
thrombus
274
tx for spinal cord compression (decreased sphincter tone and DTRs)
steroids! can see in prostate cancer, etc.
275
treatment for cancer associated cachexia?
progesterone analogs or glucocorticoids
276
elevated WBCs and thrombocytosis, ddx
myeloproliferative neoplasm
277
rash and new-onset diabetes that doesn't require tx
glucagonoma
278
peripheral lung lesion with gynecomastia and galactorrhea dx?
large cell lung cancer
279
what is the initial drug of choice for hypercalcemia of malignancy?
bisphosphonates aka zolendronic acid
280
Hypercalcemia, epigastric abdominal pain with occult bleed
| dx?
MEN1
primary hyperPTH
gastrin-producing tumor
281
Tamoxifen use can cause an increased risk of what cancer?
endometrial
282
what drugs can cause mild megaloblastic anemia?
phenytoin
primidone
phenobarbital
--> impaired absorption of folic acid
283
pt with sx of microcytic anemia, decreased concentration, insomnia and muscle pain
lead poisoning
284
what is a diagnostic hallmark of lupus anticoagulant?
elevated PTT
285
before treat with trastuzumab and chemo, what test?
EKG
| combined can cause cardiac toxicity
286
what cancer can pernicious anemia cause?
gastric
287
treatment of hyperkalemia in a patient with renal failure?
furosemide with saline infusion
288
an infection in what neck space can spread to the mediastinum?
retropharyngeal
289
white granular patch or plaque over the buccal mucosa in patients with a history of alcohol and tobacco
leukoplakia
can progress to squamous cell carcinoma
290
what drugs can cause ototoxicity
loop diuretics
aminoglycosides
salicylates
cisplatin
291
what is a contraindication to succinylcholine administration?
hyperkalemia
292
treatment for pt with 4 weeks of foul smelling stools s/p trip?
Giardia so give FLAGYL
293
low urinary Cl in a patient with metabolic alkalosis is suggestive of what?
vomiting or prior diuretic use as cause of metabolic alkalosis
294
mgmt of post-ictal lactic acidosis?
observe and repeat labs in 2 hours
295
pt with cocaine use and chest pain, mgmt of chest pain
diazepam
296
common complication of GCA?
aortic aneurysm
297
bone pain, renal failure and hypercalcemia = Dx?
multiple myeloma
298
immediate tx of central retinal artery occlusion?
ocular massage and high flow O2
299
eye dz that causes straight lines to appear bent and wavy?
macular degeneration
300
cause of presbyopia
decreased lens elasticity
301
what is a stye? tx?
staph abscess of lid
| responds to warm compress of eyelid
302
tx for a patient with wolff parkinson white?
procainamide
303
first line tx HOCM
Beta blockers
304
Niacin side effects due to what
prostaglandin mediated vasodilation
305
tx Prinzmetals
nitrates or CCBs to block vasoconstriction
306
fatigue, constipation, weight gain, dry skin, forgetfulness or other neuro signs are side effects of what drug
Amiodarone
Used for ventricular arrhythmias and rhythm control in pts with AFib and underlying LV systolic dysfunction
307
risk of untreated hyperthyroidism
rapid bone loss
308
MCC HTN with low renin
hyperaldosteronism
309
how dx factitious thyrotoxicosis
low serum thyroglobulin levels
310
renal vein thrombosis is most commonly associated with what glomerulonephritis
membranous
311
aside from increasing fluid intake, what medication is recommended to patients who have recurring kidney stones
thiazides
312
why might someone have difficulty urinating after taking diphenhydramine?
detrusor inactivity
313
is normal saline a crystalloid or colloid?
crystalloid
314
patients with Afib and what comorbidity are started on digoxin?
CHF
315
how treat TB meningitis
RIPE and steroids
316
Dx meningitis
gram stain > 1000 WBCs
317
common extra-pulm manifestation of mycoplasma pneumonia
rash
318
tx for tularemia pneumonia
streptamycin or gent
319
tx for lung abscess?
amp-sulbactam
320
when give oseltamivir
only if within 48 hours of symptom onset
321
next step, pt with + PPD and CXR
acid fast stain of sputum
322
TB drug side effects
| RIPE?
oRifampin→ turns everything RED, CYP450 inducer
oINH→ B6 vitamin deficiency, sideroblastic anemia, peripheral neuropathy
oPyrazinamide→benign hyperuricemia
oEthambutol→ optic neuritis or color vision abnormalities
323
MCC meningitis in HIV patients
s pneumo
324
MCC pneumonia in HIV patients
S. pneumo
325
treatment for Bartonella
oral azithro
326
patient with recent nasal packing, presents with confusion, nausea, hypotension and febrile, dx?
TSS
327
halo or air crescent sign on chest imaging is associated with what bug?
aspergillus
328
subacute meningitis in HIV pt?
cryptococcus
329
HIV patient with clear oropharynx and odynophagia, dx?
viral: CMV or HSV
330
best first screening test for HIV
p24 antigen and antibody testing
331
how dx histo?
| tx?
urine antigen
tx itraconazole
332
tx of symptomatic sinus bradycardia
atropine
| then pacing
333
when use digitalis?
Diastolic CHF, pts with Afib with RVR
334
mixed venous O2 sat is elevated in what type of shock
septic
hyperdynamic circulation, improper distribution of cardiac output and inability of the tissues to adequately extract oxygen
335
hemochromatosis causes what cardiac effects?
cardiac conduction abnormalities
336
how does cold water therapy treat SVT?
affects AV node conductivity and re-entry
337
two common causes of hemorrhagic pleural effusion?
PE and malignancy
338
if you suspect ankylosing spondylitis, best first test?
x ray of lumbar spine
339
SLE with renal sx, best first test
renal bx
340
treatment for fibromyalgia
amytriptyline
341
tx for dermatitis herpetiformis
dapsone
342
Pt with positive PPD, negative chest xray, next step?
INH for 9 months
343
acute migriane tx
prochlorperazine
344
guillain barre tx?
IVIG or plasmapheresis
345
dx carcinoid syndrome?
urine 5-HIAA
346
how dx gallbladder cancer?
abdominal CT
347
how dx cholangiocarcinoma
ERCP since it's a tumor of the bile ducts
348
tx liver failure patients with a bleed
FFP because they cannot synthesize clotting factors
349
first step in unstable upper GI bleed
intubate
350
mgmt if suspect variceal hemorrhage
volume resuscitation, IV octreotide, abx
351
watery diarrhea, muscle weakness and hypo/achlorhydria, also have facial flushing/lethargy/N/V are all signs of what dx?
VIPoma
can have co-existing hyperPTH as part of MEN
Dx: VIP level >75, often mets to liver
352
all patients with hep c should have what immunization?
Hep A
353
preferred tx for chronic Hep B?
TEnofavir and Entecavir
| less drug resistance, can be used in decompensated cirrhosis
354
MCV 60 and target cells, dx
thalassemia
355
superficial thrombophlebitis, palpable venous cord, next step
CT abdomen
| assoc with pancreatic cancer
356
what type of drug is zofran?
serotonin antagonist
357
increased leukocyte alk phos score suggests what
leukemoid reaction, 2/2 severe inflammation or infection
358
altered mental status + fever + MAHA dx
TTP
359
treatment for TTP or HUS
plasmapheresis emergently
360
SIADH is associated with what lung cancer?
small cell
361
spherocytes without central pallor are seen in what illnesses?
spherocytosis and AIHA
362
tx warm agglutinins
steroids, splenectomy if refractory
363
tx cold agglutinins
avoid cold weather, rituximab
364
DM, necrolytic migratory erythema, weight loss, diarrhea and anemia dx?
glucagonoma
365
older pt with difficulty hearing in noisy environments, dx
presbycusis
366
mgmt of a patient with a single brain met
surgical removal
367
mgmt acute acetaminophen tox
charcoal if
368
MC electrolyte abnormality in patients with Cushing's
hypokalemia
369
Gi sx in patients with A Fib dx?
Digoxin toxicity
370
hypertensive pt on meds who drinks a lot, next step in HTN mgmt?
counsel on drinking less
371
how does valsalva impact LV preload
decreases it
372
how treat beta blocker overdose?
glucagon
373
how treat beta blocker overdose?
glucagon
374
what types of arrhythmias are common in the first 10 mins s/p MI and in the first 10-60 mins?
0-10 min: reentrant
| 10-60 mins: impaired automaticity
375
what types of arrhythmias are common in the first 10 mins s/p MI and in the first 10-60 mins?
0-10 min: reentrant
| 10-60 mins: impaired automaticity
376
atrial tachycardia with AV block is specific for what?
digoxin toxicity
377
inheritance pattern of HOCM?
AD
378
Foci of Atrial fibrillation?
pulmonary veins
379
Foci of Atrial fibrillation?
pulmonary veins
380
how treat PVCs?
no sx: no tx
| sx: BB
381
pregnant woman at 25 weeks with history of hep C, next step
immunize against Hep A and B
382
who needs menigococcal vaccine booster
16-21yo who had shot before age 16
383
what vaccines are contraindicated in pts with CD4 count
VZV, MMR, live flu
384
what HIV med turns urine red
indinavir bc causes crystal nephropathy
385
sounds like RA but started 10 days ago, dx?
Parvo B19
386
side effect of hydroxychloroquine
retinopathy
387
crampy pain, parasthesieas and carpopedal spasm are signs of what electrolyte abnormality
hypocalcemia
388
what acid base disorder causes hypocalcemia
alkalosis, ex. resp 2/2 hyperventilation
increased pH--> increased affinity of Ca for albumin, leads to a decrease in ionized calcium
389
pt with BPH symptoms and AKI, next step?
renal US
390
persistent ST elevation 1-2 months s/p MI with Q waves in same leads dx?
ventricular aneurysm
391
hypogonadism, arthropathy, diabetes and hepatomegaly
hemochromatosis
cardiac conduction abnormalities
392
recurrent chalazion mgmt
histopath eval to r/o cancer
393
how dx Wernicke's vs. B12 deficiency
Wernickes: gait instability, AMS and nystagmus and conjugate gaze palsy, which you do not see in B12 deficiency
394
hashimoto's causes an increased risk of what thryoid cancer?
lymphoma
395
young Asian woman with absent pulses and asymmetrical BP dx? tx?
Takayasu's
Dx: ateriogram
Tx: steroids, angioplasty for stenosed vx
396
Dx and Tx for PAN
dx: tissue bx, increase P anca
tx: steroids
397
asthma, eosinophilia and granulomatous vasculitis
| dx? tx?
dx: churgg strauss, p-anca
tx: steroids
