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medicine Clerkship > UWorld > Flashcards

UWorld Flashcards

1
Q

What can you change on vent settings if in resp alkalosis?

A
  • decrease RR if TV is appropriate (6ml/kg of ideal body weight)
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2
Q

What is initial the treatment for PAD?

A

risk factor modiciation –> smoking cessation, statin, ASA, DM treatment, exercise therapyif claudication

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3
Q

When do you use cilostazol for PAD?

A

when persistent sx despite risk factor mod and exercise therapy

alternative = can do percutaneous or surgical revascularization

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4
Q

Which meds have mortality benefit in CHF?

A
  • ACE inhibitors
  • B Blockers
  • ARBs
  • spironolactone
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5
Q

What is next step if you suspect post-cholecystectomy syndrome (ab pain/dyspepsia post-op after cholecystectomy)?

A

do US followed by ERCP/MRCP to establish diagnosis and guide therapy

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6
Q

What is presentation of zinc deficiency? who is at risk?

A

alopecia, abnormal taste, bullous, pustulous lesions surrounding body orifices, impaired wound healing

at risk: TPN

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7
Q

What is presentation of vit A deficiency?

A

blindness, dry skin, impaired immunity

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8
Q

What is significance of S3? When is it normal? What pathological states associated?

A

2/2 rapid turbulent filling of ventricles w/ increased volume

normal in young adults, pregnant

associations: heart failure, restrictive cardiomyopathy, high output states

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9
Q

What is significance of S4? What pathological states associated?

A

hear after atrial contraction as blood forced into stiff ventricle

associations: ventricular hypertrophy, acute MI, hypertension, AS, hypertrophic cardiomyopathy

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10
Q

What happens to S2 in MI?

A

paradoxical splitting 2/2 delayed myocardial relaxation

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11
Q

What is next step after you confirm pancreatitis by CT/lipase?

A

do RUQ US to look for gallstones = more sensitive than CT, gallstones are major cause of pancreatitis

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12
Q

What is treatment of biliary pancreatitis?

A

do ERCP for extraction of visible common bile duct stone and laparoscopic cholecystectomy prior to discharge to prevent recurrent pancreatitis

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13
Q

What are clinical features of chronic hep C?

A
  • intermittent elevations of transaminases

- non-specific nausea, anorexia, myalgias/arthralgias

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14
Q

What are extra-hepatic manifestations of chronic hep C?

A
  • essential mixed cryoglobulinemia
  • membranous glomerulonephritis
  • porphyria cutanea tarda, lichen planus
  • increased risk of diabetes
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15
Q

What is presentation of porphyria cutanea tarda? associated with what underlying condition?

A

fragile skin, photosensitivity, vesicles and erosions on dorsum of hands

associated w/ HCV

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16
Q

What is essential mixed cryoglobulinemia? associated with what underlying condition?

A

circulating immune complexes deposit in small/medium vessls –> low serum complement, palpable purpura, arthralgias, renal complications (membranoproliferative glomerulonephritis)

associated w/ HCV

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17
Q

What is presentation of erythema nodosum? Associated w/ what underlying conditions?

A

painful nodules on anterior legs

associated w/ strep and TB infections, sarcoid

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18
Q

What is use of ACE inhibitors in MI?

A

start w/in 24 hrs of MI to prevent remodeling/dilation of ventricle

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19
Q

What are risk fractors for C Diff?

A
  • advanced age
  • recent abx (clinda, ceph, FQ)
  • hospitaliation
  • comorbidity (ESRD, dialyris)
  • PPI or H2 antagonist
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20
Q

How do you dx C diff?

A

stool assay for toxin A/BW

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21
Q

What are complications of long term PPI use?

A
  • cdiff
  • impaired Ca absorption –> osteoporosis
  • colonization pathogens of upper GI –> higher risk pna
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22
Q

When do you do empiric PPIs for GERD vs go straight to endoscopy?

A

endoscopy if:

  • men > 50 w/ sx 5 yrs
  • ca risk factors: tobacco
  • alarm sx: dysphagia, odynophagia, wt loss, anemia, GI bleed, recurent vomiting
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23
Q

What underlying condition should you think if you see jejunal ulcer?

A

ZE

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24
Q

What is pathogenesis of ZE?

A

gastrin producing tumor – causes parietal cell hyperplasia, stomach acid production is significantly increased.

steatorrhea 2/2 increased stomach acid production inactivates pancreatic enzymes

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25
Q

What are some lab changes in IBD?

A
  • anemia
  • elevated ESR
  • acute phase reactants
  • reactive thrombocytosis
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26
Q

What is the most common primary cardiac tumor? where are they usually located?

A

myxoma

in L atrium

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27
Q

What are clinical feat of cardiac myxomas?

A
  • constitutional: fever, wt loss, raynaud
  • dv: mitral disease, HF, myocardial invasion leading to arrhythmia, heart block
  • embolization
  • lung invasion cuaseing resp sx
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28
Q

What is acute liver failure (fulminant hepatitis)?

A

onset of severe liver injury with enecphalopathy and impaired synthetic function (INFR > 1.5) in pt w/o cirrhosis

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29
Q

What do you see in lab on acute liver failure?

A 
worsening PT/INR and bilirubin
elevated transaminases (declining AST/ALT can indicated decrease in fucntional liver tissue)

PT = single most important prognostic indicator in ALF

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30
Q

What is next step if you see organized rhythm on cardiac monitor w/o measurable BP or palpable pulse?

A

start CPR and vasopressor (epinephrine)

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31
Q

What are the reversible causes of asystole/pulseless electrical activity “5Hs and 5Ts”?

A
  • hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyperkalemia, hypothermia
  • tension pneumo, tamponade, toxins (narcotic, benzos), thrombosis (pulm, coronary), trauma
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32
Q

What is next step if suspect zencker diverticulum?

A

contrast esophagram

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33
Q

What are sx of zencker diverticulum?

A
  • elderly, particularly men
  • dysphagia, regurgitation
  • foul smelling breath
  • may have palpable diverticula in neck
  • at risk for aspiration pna
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34
Q

What is the usual presentation of mitral stenosis?

A

gradual and progressive worsening dyspnea on exertion, orthopnea, hemoptysis 2/2 pulm edema

eventual backflow of bblood int LA leads to elevated LA and pulm pressures, LA enlargement, leading to lcough/hoarse voice, and displaing L mainstem bronchus

can develop A fib

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35
Q

What should you change about vent if pH 7.42 pO2 105 pCO2 37 with:
FiO2 80%, RR 14 TV 380 PEEP 7?

A

decrease FiO2 –> goal

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36
Q

How can you distinguish CHF from COPD exacerbation?

A

BNP = elevated in CHF

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37
Q

What are indications for oxygen therapy in COPD?

A

PaO2 55

evidence of cor pulmonale

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38
Q

What is clinical presentation of esophagel perforation?

A

chest and abdominal pain, systemic sx
subcutaneus emphysema in neck
hamman sign = crunching on chest auscultation

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39
Q

How do you dx esophageal performation?

A

CXR/CT: wide mediastinum, pnuemomediastinum, pneumothorax, air around paraspinal muscle

CT: esophageal wall thickening, mediastinal air fluid level

water soluble contrast esophagogram: leave at perforation site

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40
Q

What do you see on pleural fluid analysis in boerhaave syndrome?

A

exudate, low pH, very high amylase (>2500)

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41
Q

What clinical feat/hx should make you think GI bleed is 2/2 angiodysplasia?

A
  • recurrent painless bleed in > 60yo

hx of aortic stenosis or ESRD

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42
Q

What are the 3 screening strategies for colon cancer?

A

routine for eeryone > 50

  • FOBT annually
  • flexible sigmoidoscopy q5 + FOBT q3
  • colonoscopy q10
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43
Q

What patients should begin screening for colon cancer earlier than 50?

A

if affected first degree relative, start screening at age 40 or 10 yrs before the age of the relatives diagnosis

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44
Q

What dx should you think if episodes of dysphagia, regurgitation +/- chest pain precipitated by emotional stress? next dx step?

A

diffuse esophageal spasm

next: do manometry –> repetitive non-peristaltic high amplitude contractions

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45
Q

What is next step in pt with upper GI bleed w/ depressed level of consciousness and ongoing hematemesis?

A
  • 2 large bore IVs
  • fluid resuscitation
  • type and screen
  • intubation if neeeded

do endoscopy w/ band ligation after pt is stabilizaed and intubated

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46
Q

When should you suspect 2ndary hypertension like renal artery stenosis?

A
  • systolic-diastolic abdominal bruit

- hx of atherosclerosis

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47
Q

What should you think if displaced apical impulse, holosystolic murmur, and 3rd heart sound? What is MC etiology?

A

chronic severe MR

MC = 2/2 MVP from myxomatous degeneration of mitral valve leaflets

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48
Q

When is carotid endarterecetomy recommended?

A
  • symptomatic w/ stenosis 70-99%

- asymptomatic 60-99

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49
Q

What is definition of pulmonary htn?

A

PA pressure > 25 or > 30 w/ exercise

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50
Q

What meds increase survival in CHF?

A

ACEi, ARBs, BBlockers, spironolactone

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51
Q

How do you define orthostatic hypotension?

A
  • postrual decrease in BP by 20 systolic or 10 diastolic
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52
Q

What should you do if pt with symptomatic 3rd degree (complete) AV block?

A

temporary pacemaker insertion while working up and correcting reversible causes

if no reversible cause, need permanent pacing

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53
Q

What are reversible causes of 3rd degree heart block?

A
  • myocardial ischemia
  • increased vagal tone
  • metabolic (hyper K)
  • ddrugs (Bblocker, CCB)
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54
Q

What signs in post-op patient should make you think massive PE?

A
  • hypotension
  • JVD
  • new onset R BBB (sx of acute R heat strain)
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55
Q

What is the etiology of isolated systolic hypertension in elderly? tx?

A

2/2 decreased elasticity of arterial wall

tx: monotherapy with low dose thiazie, ACEi, or long acting CCB

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56
Q

What are sx of chronic venous insufficiency?

A

B/L lower extremity pitting edema, varicose veins, venous ulcer

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57
Q

What is elevated JVD?

A

> 3

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58
Q

What are sx of chronic venous insufficiency?

A

leg discomfort, pain, swelling worse with prolonged standing, varicose veins, pitting edema, skin discoloration, ulcers

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59
Q

What is treatment for chronic venous insufficiency?

A

leg elevation, exercise, compression stockings

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60
Q

What should you think if palpable mass in epigastrum 4 wks after acute pancreatitis? Dx? Tx?

A

likely pancreatic pseudocyst

dx: US
tx: resolves spontaneoulsy, drainage if persists > 6 wks, >5cm diameter, or secondarily infected

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61
Q

What are the 3 categories of causes of hypertension and hypokalemia?

A
  • secondary hyperaldosteronism
  • primary hyperaldosteronism
  • non-aldosterone causes
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62
Q

What is the mech of action of aldosterone?

A
  • increases Na reabsorption, K secretion, H secretion
  • Na reabsorption leads to H2O reabsorption
  • hypokalemia increases renal HCo3 resorption –> metabolic alkalosis
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63
Q

What are sx of conn syndrome?

A

hypertension, mild hypernatremia, hypoK, metabolic alkalosis

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64
Q

What happens to plasma Ca when high pH (ex. resp alkalosis)?

A

H+ displaced from albumin so more Ca bound to albumin

  • higher Ca bound albumin
  • lower ionized free Ca
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65
Q

What happens to PaO2/PaCo2/pH in PE?

A

respiratory alkalosis –> low PaO2 and PaCO2, high pH, elevated A-a gradient

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66
Q

What is pathophys of diabetic nephropathy? best intervention to reduce progression?

A

hyperfiltration and microalbuminuria –> macroproteinuria and hypertension

intensive BP control = primary intervention to slow decline of GFR, goal BP 130/80 if DM w/ nephropathy

tx = ACEi and ARBs

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67
Q

How can you distinguish familial hypocalciuric hypercalcemia from primary hyperparathyroidism?

A

hypocalciuric hypercalcemia = low urine Ca

hyper PTH = high urine Ca

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68
Q

How do you dx primary hyperparathyroidism?

A
  • hypercalcemia w/ high or normal PTH
  • 24 hr urine Ca > 250
  • urine Ca/cr > 0.02
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69
Q

Which pts with primary hyperparathyroidism should get surgical removal?

A
  • serum ca > 1 mg/dl above ULN

- age

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70
Q

What is the effect of Mg on Ca?

A

low magnesium –> results in decrease PTH secretion –> low Ca

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71
Q

What are common causes of hypo-Ca with high PTH?

A

vit D deficiency

CKD

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72
Q

What is presentation of glucagonoma?

A 
necrolytic migratory erythema [erythmatous papules on face, perineum, extremities]
DM [mild, easily controlled]
GI sx [diarrhea, anorexia]
wt loss
associated w/ venous thrombosis
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73
Q

What is presentation of gastrinoma?

A

upper GI pain [ulcers], diarrhea, anemia, wt loss

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74
Q

What is presentation of carcinoid syndrome?

A

diarrhea, wt loss, episodic flushing w/ hypotension

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75
Q

When should you work up hypogonadotropic hypogonadism for secondary cause?

A
  • headaches

- testosterone

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76
Q

What type of CA most associated with ectopic ACTH? How are they different?

A

small cell lung cancer
= rapid high ACTH –> hypertension, hypokalemia, met alkalosis, hyperpigmentation

carcinoids (bronchial, pancreatic, thymus)
= slow growing –> more characteristic cushing syndrome

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77
Q

Why do ACTH secreting tumors cause effects of mineralcortioids?

A

in excess –> bypass enzyme 11 beta hydroxyl dehydrogenase and can have action on the minerlaocorticoid receptors

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78
Q

What are criteria for metabolic syndrome?

A
  1. ab obesity (M > 40in, W > 35 in)
  2. fasting gluc > 100-110
  3. BP > 130/80
  4. TG > 150
  5. HDL M
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79
Q

What are some complications of untreated hyperthyroid?

A 
rapid bone loss from increased osteoclast activity
cardiac arrhythmias (AFib)
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80
Q

What should you order next if hypercalcemia w/ hypoPTH?

A
  • measure PTHrP
  • measure 25OHD
  • SPEP/UPEP
  • 1,25 OHD
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81
Q

What should you think about if hypercalcemia > 13?

A

think malignancy

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82
Q

What metabolic abnormalities are associated w/ hypothyroid?

A

hyperlipidemia
hyponatremia
asx increase CK, AST/ALT

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83
Q

What is secondary hypothyroidism?

A

hypothyroidism 2/2 low TSH from pituitary

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84
Q

What should you think if sx of hypothyroid w/ high thyroid hromones and normal/elevated TSH?

A

generalized resistancen to thyroid hormones

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85
Q

How does thyrotoxic myopathy present?

A

proximal muscle atrophy/weakness, low amplitude tremor, normal/increased DTR

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86
Q

What should you think if patient’s urine turns dark and stains prussian blue after infection/med?

A

G6PD deficiency –> oxidative stress leading to hemolysis

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87
Q

What is the presentation of MEN1?

A
  • primary hyperparathyroidism
  • enteropancreatic tumor
  • pituitary tumor
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88
Q

What is the presentation of MEN2A?

A
  • medullary thryoid carcinoma
  • pheo
  • parathyroid hyperplasia
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89
Q

What is the presentation of MEN2B?

A
  • medullary thryoid cancer
  • pheo
  • mucosal/intestinal neuroms
    marfanoid habitus
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90
Q

Which MEN syndrome is associated w/ marfanoid habitus? which tumors?

A

MEN2B

  • MTC
  • pheo
  • mucosal/intestinal neuromas
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91
Q

What are the adverse effects of methimazole?

A

agranulocytosis
1st trimester teratogen
cholestasis

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92
Q

What are the adverse effects of propylthiouracil?

A

agranulocytosis
hepatic failure
ANCA associated vasculitis

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93
Q

What should you think if decrease T3 with normal T4/TSH?

A

euthyroid sick syndrome = ocurs in pts with severe illness

will recover with recovery of illness, do not need to treat

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94
Q

What lab values do you see in osteomalacia?

A
  • increased alk phos, PTH

- decreased serum Ca, phos, urine Ca, 25OHD

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95
Q

What do bilateral symmetric pseudofractures suggest?

A

osteomalacia

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96
Q

What antibodies associated w/ hashimoto?

A

anti-thyroid peroxidase and anti-thyroglobulin antibodies

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97
Q

What are the hemodynamic effects of thryotoxicosis leading to hypertension?

A
  • systolic hypertension and increased pulse pressure
  • increased contractility and cardiac output
  • decreased systemic vascular resistance
  • increased myocardial oxygen demand
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98
Q

What is the mech of thyrotoxicosis causing angina?

A

coronary vasospasm

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99
Q

What is the effect of diabetic autonomic neuropathy on GU?

A

decreased ability to sense full bladder –> incomplete emptying and decreased urination

eventually have recurrent UTI and overflow incontinence (dribbling, poor urinary stream)

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100
Q

What is the next best step if pt with asymptomatic hypercalcemia?

A

PTH level

– want to distinguish between PTH mediated vs non-PTH (malignancy, vit D, hyperthyroid)

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101
Q

What is likely etiology of thryotoxicosis w/ reduced thryoid uptake?

A

subactue lymphocytic (painless) thyroiditis

–> leakage of thryoid hormones into circulation 2/2 inflammatory damage of thyroid follicles

other causes:

  • subacute granulomatous thryoiditis
  • iodine-induced thryoid toxicosis
  • levothyroixine OD
  • struma ovarii
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102
Q

What is the etiology of ED 2/2 urethral injury?

A

nerve injury

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103
Q

What levels of prolactin, TSH, LH, FSH do you see in symptomatic prolactinoma?

A

prolactin > 200
normal TSH
low FSH/LH

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104
Q

What are effects of metformin? complicatoin?

A

weight netural, low risk hypoglycemia

lactic acidosis = complication

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105
Q

What are side effects of sulfonylureas?

A

weight gain and hypoglycemia

add when pts have failure w/ metformin

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106
Q

What are side effects of thiazolidinediones (pioglitazone)?

A

weight gain, edema, CHF, bone fracture, bladder cancer

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107
Q

Which DM meds can be used in renal insufficiency?

A

pioglitazone (thiazolidinediones)

sitagliptin (DPP-IV inhibitors)

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108
Q

Which DM meds good for wt loss?

A

GLP1 receptor agonists (exenatide, liraglutide)

add as 2nd agent for metformin failure

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109
Q

What are the first get H1 antihistamines? side effects?

A

diphenhydramine, chlorpheniramien, doxepin, hydroxyzine

lots of anticholinergic effects

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110
Q

What is the mech of diphenhydramine on bladder?

A

causes urinary retention and dysuria from detrusor inactivity

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111
Q

What is the presentation of menieres disease?

A

episodoes of vertigo lasting

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112
Q

What is therapy for menieres disease?

A

initially low salt diet, avoid triggers

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113
Q

What is the next step if have high T4, low TSH, no sx of graves (goiter, opthalmopathy) low iodine uptake?

A

measure serum thyroglobulin

low –> exogenous hormone
high –> thyroiditis, iodine exposure

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114
Q

What is the equation for number needed to treat?

A

1/Absolute risk reduction

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115
Q

What is the tx of primary raynaud phenomenon?

A

CCB (amlodipine) for persistent symptoms

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116
Q

What is the tx of secondary raynauds?

A

CCB for persistent sx, ASA for at risk for digital ulceration

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117
Q

What are features of primary raynaud?

A

F

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118
Q

How do you distinguish asthma vs copd?

A

positive bronchodilator response (>12% increase in FEV1) with normal DLco

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119
Q

What should you suspect if chronic scar develops into nonhealing painless bleeding ulcer?

A

squamous cell carcinoma

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120
Q

What are side effects of TMP-SMX?

A

rash, neutropenia, hyperkalemia, high transaminases

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121
Q

What are alternative regimens for PCP others than TMP-SMX?

A
  • pentamidine (IV)
  • atovaquone (PO)
  • trimethoprim + dapsone (PO)
  • clinda (IV/PO) + primaquind (PO)
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122
Q

What are side effects of primaquine?

A 
methemoglobinemia
hemolytic anemia (check for g6pd deficiency)
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123
Q

What are indications for adjunctive steroid use for PCP?

A
  • PaO2 35
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124
Q

What are guidelines for ventialtion in ARDS?

A
  • low TV [6-8 ml/kg]

- inspiratory plateau airway p

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125
Q

What is the pathophysiology of ARDS?

A
  • imparied gas exchange
  • decreased lung compliance
  • increased pulm artery pressure

PaO2/FiO2 indicates degree of severity,
usually

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126
Q

When does ventricular aneurysm occur after MI? presentation?

A

5 days to 3 mo after MI
presents with:
- persistent ST elevation after recent MI
- deep Q waves in sam leads
- progressive LV enlargement –> HF, mitral regurg

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127
Q

How/when does acute pericarditis present after MI?

A
  • acute pericarditis presents firs several days

- sx: pleuritic/positional CP, pericardial friciton rub, diffuse ST elevation

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128
Q

How/when does papillary muscle rupture present after MI?

A
  • 2-7 days after MI
  • life threatening, severe mitral regurg leading to hypotension and pulm edema, does not typically cause persistent ST elevation on EKG
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129
Q

What is presentation of pericardial effusion?

A

low voltage QRS and electircal alternanas on EKG

sx of tamponade (dyspnea, hypotension, pulsus paradoxus, elevated JP)

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130
Q

What are the recommended vaccines for chronic liver disease?

A
  • Tdap then Td every 10 yrs
  • influenza annualy
  • PPSV23 1x then at 65 yo revaccinate with PCV13 then PPSV23
  • hep A
  • hep B
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131
Q

What arrhythmia associated w/ digitalis tox?

A

atrial tachycardia w/ AV block

[increases ectopy in atria/ventricles leading to atrial tach]

  • HR 150-250
  • p present but different from normal
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132
Q

What is the treatment for fibromuscular dysplasia?

A

percutaneous angioplasty with stent placement

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133
Q

What is treatment of scabies?

A

topical permethrin 5% or oral ivermectin

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134
Q

What is next step if pt with hematochezia and no actie upper GI bleed, colonoscopy no source identified?

A

labeled erytherocyte scintigraphy (tagged RBC)

if pos –> do repeat colonoscopy or angiography
if negative –> do upper endoscopy with push enteroscopy to evaluate small bowel

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135
Q

What are the mos common causes of acute lower GI bleed > 50?

A

diverticulosis, angiodysplasia, ischemia, infectious, neoplasm

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136
Q

In order what should you give to a patient presenting wtih non-ketotic hyperglycemic coma?

A
  • NS, then replace w/ .45% saline
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137
Q

What are two major products of house fire? tx?

A
  • cyanide –> hydroxyocobalamin or Na thiosulfate

- CO

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138
Q

What is methemoglobinemia?

A

formed by exposure to dapsone/nitrates/anesthetics which xoide Fe2+ to Fe3_ in hgb, unable to bind O2

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139
Q

What happens in anaphylactic blood transfusion reaction?

A
  • rapid onset shock, angioedema/urticaria, resp distress/wheezing
  • w/in seconds to min of transfusion
  • due to recipient anti-IgA antibodies [in IgA deficient pt]
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140
Q

What happens in tranfusion related acute lung injury?

A
  • resp distress, signs of noncardiogenic pulm edema
  • w/in 6 hrs of transfusion
  • due to donor anti-leukocyte antibodies
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141
Q

What happens in primary hypotension reaction of transfusion?

A
  • transient hypotension in pts taking ACEis
  • occurs w/in minutes of transfusion
  • due to bradykinin in blood products (normally degraded by ACE)
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142
Q

What is etiology/presentation of cutaneous larva migrans?

A

due to infective stage larva of ancyclostoma braziliense

sx: initially multiple pruritic erythematous papules at site of larval entry, then severely pruritic, elevated, serpiginous red brown lesions on skin creeping up l=extremity

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143
Q

What should you do if dog/cat bite from animal with no rabies vaccine?

A

if available for quarantine: observe for 10 days and no PEP if animal healthy

if can’t quarantine: test animal if possible, start PEP and discontinue if rabies test negative

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144
Q

What is complication of temporal arteritis?

A

aortic aneurysm

pt should have serial CXR

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145
Q

What is presentation/ tx for hepatorenal syndrome?

A

hepatorenal: cirrhosis w/ renal failure that does not respond to volume resuscitation
tx: liver transplantation

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146
Q

What is presentation of peptic strictures? risk factors?

A

present: symmetric/circumferential narrowing of esophagus w/ dysphagia for solids but no wt loss
etiolgoy: chronic GERD, radiation, systemic sclerosis, caustic ingesionts

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147
Q

What is the etiology of parasthesia after getting blood transfusions?

A

citrate in stored blood chelastes Ca and Meg –> reduces their levels –> parasthesias

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148
Q

What bug is filamentous, aerobic, gram positive branching rod that is partially acid fast? tx?

A

nocardia

tx: TMP-SMX

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149
Q

What bug is filamentous, gram positive, non-aerobic, not acid fast? tx?

A

actinomyces

tx: penicillin G

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150
Q

Where does nocardia infect?

A

immunoompromised –> systemic sx, lung nodules, brain abscess causing seizures

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151
Q

What bug should you think if immune compromised pt presents with: cutaneous exophytic papules and visceral angioma-like blood vessel growths that are prone to hemorrhage?

A

bartonella

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152
Q

What are some forms of selection biases?

A
  • sampling bias (study pop different from target pop)
  • nonresponse bias (high nonresponse rate to survey)
  • berkson bias (disease studied using only hospital-based pts)
  • prevalence bias (exposure happens long before disease assessment, miss pts that die early or recover)
  • attrition bias
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153
Q

What are some forms of observation bias?

A
  • recall bias (subjects w/ neg outcome more likely to report certain exposures than control)
  • observer bias (misclassify data 2/2 differences in interpretation)
  • reporting bias (over/under report exposure hx due to perceived social stigma)
  • surveillance/detection bias (risk causes increased monitoring in exposed vs unexposed group, higher prob of identifying diease
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154
Q

Who is at risk for warfarin skin necrosis?

A

pts w/ underlying protein C deficiency

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155
Q

What type of BM cancer w WBCs w/ strong acid phosphatase rxn not inhibited by tartrate and CD11c?

A

hairy cell leukemia

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156
Q

What to cytochemical features of hairy cell leukemia?

A
  • tartrate-resistant acid phosphatase stain

- CD11c marker

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157
Q

What type of ulcer pain gets better w/ food?

A

duodenal ulcer –> better w/ food b/c buffered, worse 2-5 hrs after meals, on empty stomach, or at night

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158
Q

What should you do next if find a solitary pulm nodule (

A

if previous CXR shows stability ver 2-3 yrs –> no further testing necessary = likely benign hamartoma

if no previous CXR or CXR w/ no nodule –> do CT

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159
Q

What are characteristics of pulm nodule that make you think cancer?

A

larger size, low density, spiculated borders, eccentric calcification

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160
Q

What are some meds that can cause drug induced esophagitis?

A
  • tetracyclines
  • ASA/NSAIDs
  • alendronate
  • KCL
  • quinidine
  • Fe
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161
Q

What type of vasculitis presents with glomerulonephritis + upper and lower resp tract disease? How dx?

A

wegeners (granulomatosis w/ polyangiitis)

dx: c-ANCA + tissue bx
tx: high dose steroids

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162
Q

What should you think if pt has microcytic anemia not responsive to Fe supplmenetation?

A

thalassemia

- if mediteranea –> B thal minor

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163
Q

What are typical presentations of sarcoid?

A
  • pulm: dyspnea + dry cough
  • skin: erythema nodosum
  • eyes: uveitis
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164
Q

What are likely etiologies if syncope w/ exertion or during exercise?

A

aortic stenosis, hypertrophic cardiomyopathy, anomalous coronary arteries

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165
Q

What is likely etiology of syncope w/ hx of CAD/MI/cardiomyopathy or reduced EF?

A

ventricular arrhythmia

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166
Q

What is likely etiology of syncope w/ sinus pauses on monitor, prolonged PR or long WRS?

A

sick sinus syndrome, bradyarrhythmia, or AV block

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167
Q

What metabolic alteration typically w/ vomiting?

A

hypochloremic metabolic alkalosis w/ hypokalemia 2/2 GI loss of H/Cl/K

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168
Q

What is significance of ankle-brachial index?

A

ratio of SBP at ankle to SBP at arm

normal = 0.9-1.3
ABI > 1.3 = noncompressible vessel = severe disease
ABI

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169
Q

What is biggest risk factor for peripheral vascular disease?

A

stop smoking

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170
Q

What does BUN/Cr ratio > 20 suggest?

A

prerenal cause of azotemia

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171
Q

When should you stop metformin in a diabetic?

A
  • stop in acutely ill pt w/ acute renal failure, liver failure, orsepsis –> increases risk of lactic acidosis
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172
Q

What is mech of HIT?

A

heparin-platelet-PF4 antibody complex removed by splenic mcrophages –> activated adjacent platelets to release procoagulants

= get thrombocytopenia but higher risk of thrombus

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173
Q

What is preferred anticoagulation for pt w/ DVT and severe renal insufficiency (GFR

A

unfractionated heparin preferred over LMWH (enoxaparin), direct factor X inhibitors (fondaparinux IM, rivaroxaban PO)

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174
Q

What should you think if adult presents w/ fever, conjuncitivitis, coryza, cervical lymphadenopathy, blanching erythematous maculopapular rash that spreads from head down body, polyarthralgias? dx? tx?

A

rubella = german measles

dx: PCR, acute/convalescent serology for anti-rubella IgM/IgG
tx: supportive

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175
Q

How does presentation of measles differ from rubella?

A

measles: fever higher (>40), more gradual spread of rash over days, no arthritis, less posterior cervical lymphadenopathy

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176
Q

What is porcelain gallbladder? Tx? associated risks?

A

calcium laden gallbladder 2/2 chronic cholecystitis

associated w/ increased risk gallbladder carcinoma

tx: requires surgical resection

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177
Q

What are signs of restrictive cardiomyopathy?

A
  • primarily diastolic dysfunction –> HF w/ only mild systolic dysfunction on echo
  • normal LV volume
  • normal or symmetrically thickened walls
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178
Q

What is likely dx if pt w/ decreased passive and active ROM of shoulder, more stiffness than pain?

A

adhesive capsulitis = frozen shoulder

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179
Q

What is likely dx if pt w/ anterior should pain, pain w/ lifting/carrying/overhead reach, less commonly weakness?

A

biceps tendinopathy/ rupture

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180
Q

What is likely dx if pain w/ abduction, external rotation, subacromial tenderness, normal ROM w/ positive impingement tests?

A

rotator cuff impingement or tendinopathy

if weakness w/ external rotation –> think rotator cuff tera

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181
Q

What should you do if pt on INH develops AST/ALT elevation w/o any sx of hepatitis?

A

nothing –> usualy yoccurs inf irst few weeks of treatment, self-limited and will resolved on its own

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182
Q

what antihypertensive is associated w/ peripheral edema side effect? how do you reduce the effect?

A

dihydropyridine CCBs [amlodipine/nifedipine]

reduces if add ACEI or ARB

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183
Q

What should you make sure to work up in young person w/ systemic hyeprtension?

A
  • coarctation of aorta
  • -> do B/L PBs to assess for differences in presure
  • -> check for brachial-femoral delay
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184
Q

What dx studies in aortic coarctation?

A

EKG w/ LV hypertrophy
CXR w/ notching 3rd-8th ribs, 3 sign from aortic indentation

echo = dx confirmation

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185
Q

How does aortic coarctation present?

A

asx htn = most common

also can have CP, claudication, HA, epistaxis, HF, aortic dissection

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186
Q

What is tx for aortic coarctation?

A

balloon angioplasty +/- stent

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187
Q

What does it mean if dark urine with high bilirubin but not urobilinogen?

A

conjugated hyperbilirubinemia

[unconjugated is insoluble, would have urobilinogen in urine]

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188
Q

What is the best test for polymyositis dx?

A

muscle biopsy

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189
Q

How does polymyositis present?

A
  • slowly progressive proximal weakness of lower extremities

- diffuclty going up/down stairs or rising from seated position

190
Q

When do you treat lyme disease w/ PO doxycycline vs IV ceftriaxone?

A

doxy: early localized [days - 1mo after bite]: erythema migrans, fatigue/malaise/mild HA/myalgias
ceftriaxone: eraly disseminated or late/chronic [wks - mos to yrs after bite] – carditis, neuro sx, migratory arthralgias, conjunctivitis

191
Q

What lab findings in antiphosphlipid syndrome?

A
  • long PTT
192
Q

What is medical tx for prolactinoma?

A

dopamine agonist [bromocriptine or cabergoline]

if does not respond –> consider surgery –> radiotherapy

193
Q

What is the effect of hyperinflation in COPD?

A

increases work of breathing b/c increases elastic recoil pressure

194
Q

What is next step if pt on cocaine presents w/ CP?

A

benzos for BP + anxiety, ASA, nitro/CCB for pain

195
Q

Why are Bblockers contrainidicated in cocaine induced MI?

A

can cause unopposed alpha stimulation and worsen coronary vasoconstriction

196
Q

What is interstitial cystitis?

A

painful bladder syndrome = chronic painful bladder/pelvic pain exacerbated by bladder filling and relieved by voiding

sx: iurinary urgency/frequency, chronic pelvic pain exacerbated by exercise, sex, alcohol

197
Q

How do you dx interstitial cystitis?

A

bladder pain w/ no other attributatble cause for > 6 wks w/ normal urinalysis

198
Q

What is likely underlying etiology if pt w/ nephrotic syndrome w/ palpable kidneys, hepatomegaly, ventricular hypertrophy in setting of chronic inflammation?

A

secondary amyloidosis

tx: treat underlying, also give colchicine

199
Q

What does S4 suggest?

A

ventricular hypertrophy

200
Q

What is presentation of central retinal artery occlusion?

A

painless loss of monocular vision w/ diffuse ischemic retinal whitening and cherry red spots

201
Q

What is tx for central retinal artery occlusion?

A

immediate: ocular massage to dislodge embolus plus high flow O2 or carbogen therapy

202
Q

What is the most common source of PE?

A

embolic in proximal deep veins [iliofemoral]

203
Q

What is presentation of ADPKD?

A

multiple renal cysts, intermittent flank pain, hematuria, UTIs, nephrolithiasis, hypertension –> renal failure

204
Q

What is meniere’s disease? presentation?

A

accumulation of endolymph in inner ear

sx: vertigo, ear fullness, hearing loss

205
Q

What is goal INR in anticoagulation w/ warfarin?

A

INR goal 2.5 w/ range 2.0-3.0 okay

206
Q

What is next step if suspect hepatic encephalopathy?

A

get serum NH3 –> nonspecific but helps support dx

207
Q

What are the 4 stages of hepatic encephalopathy?

A

stage 1: hypersomnia/insomnia, impaired cognition, confusion, tremor, asterixis

stage 2: lethargy, confusion, difficutly writing, slurred speech

stage 3: marked confusion, sleeping but arousable

stage 4: stupor or coma

208
Q

How do you distinguish insulinoma vs excess sulfonylurea or insulin use?

A

insulinoma: high insulin, high c peptide and proinsulin
sulfonylurea: high insulin ad C peptide but often prosinsulin

209
Q

What is tx of caustic ingestion?

A
  • secure airway, breathing, circulation
  • removed contaminated clothing and visible chemicals
  • CXR if resp sx
  • endoscopy w/in 24 hrs

do not use charcoal, steroids, emetics, or acid neutralization

210
Q

What can you do to prevent contrast induced nephropathy in pt w/ renal insufficiency?

A

use non-ionic contrast agen, IV hydration, acetylcysteine

211
Q

What is the treatment for febrile neutropenia?

A

start empiric broad spectrum abx as soon as blood culutres

empirically start monotherapy w/ anti-psueodmonal [cefepime, meropenem, piperacillin tazobactam]

212
Q

What is likely dx if pt w/ HIV presents with proteinuria, rapid renal failure, and normal size kidneys?

A

focal and segmental glomerulosclerosis = HIV related nephropathy

213
Q

What is the presentation of allergic conjunctivitis?

A

aucte hypersentivity rxn –> episodic itching, hyperemia, watery tearing, edema of conjunctiva and eyelids, gritty sensation

hx of atopic d/o, usually subsided in 24 hr

214
Q

What is presentation of anterior uveitis?

A

significant pain, miosis, photophobia, +/- visual loss, unlikely to have gritty sensation/itching

215
Q

What is presentation of endophthalmitis?

A

invasive infection of globe 2/2 disruption of external surface –> conjunctival irritation, purulent haziness of ocular contents, layerign-out of pus in anterior chamber

216
Q

What is presentation of orbital cellulitis?

A

erythema, edem,a tenderness of eyelids, w/ impaired EOM

217
Q

What do you see on kidney biopsy in hypertensive nephorpathy?

A

arteriosclerotic lesions of afferent/efferent renal arterioles and glomerular capillary tufts

218
Q

What do you see on kidney biopsy in DM nephropathy?

A

increased extracellular matrix, BM thickening, mesangial expansion, fibrosis

219
Q

What is presentation of malignant otitis externa?

A

ear discharge and severe ear pain, granulation tissue in ear canal, hx DM

220
Q

What types of Ca associated w/ PTHrP production?

A
  • squamous cell Ca of lung/ehad/neck/esophagus
  • renal/bladder
  • ovarian/endometrial
  • breast
221
Q

What is mech of bone metastasis causing hypercalcemia?

A

tumor cells induce cytokine release that activate osteoclasts

222
Q

What are the major side effects of cyclosporine?

A
  • nephrotoxicity –> high K
  • hypertension
  • neurotoxicity/tremor
  • glucose intolerance
  • gingival hypertrophy
  • hirsuitism
223
Q

What is mech of action cyclopsorine?

A

calcineurin inhibitor = inhibits transcription of IL-2

224
Q

Which immunosuppressive causes hirsuitism and gum hypertrophy?

A

cyclosporine

225
Q

What are the main side effects of tacrolimus?

A

nephrotoxicity, hyperkalemia

226
Q

What is mech of action azathrioprine?

A

purine analog, converted to 6-mercaptopurine

227
Q

What are toxicities of azathioprine?

A

dose related diarrhea, leukopenia, hepatotoxicity

228
Q

What is major side effect of mycophenolate?

A

BM suppression

229
Q

What is presentation of BBlocker overdose?

A 
bradycardia
AV block
hypotension
diffuse wheezing
hypoglycemia
delirium
seizures
leading to cardiogenic shock
230
Q

What is treatment for B Blocker overdose?

A
  • 1st give IVF, atropine

- if refractory, give glucagon

231
Q

What should you suspect if pt w/ nephropathy presents w/ sudden onset flank pain and gross hematuria?

A

renal vein thrombosis = higher risk of thrombosis 2/2 loss of antithrombin III

232
Q

Which type of nephropathy is most associated w/ renal vein thrombosis?

A

membranous glomerulopathy

233
Q

What are CSF characteristics of cryptococcal meningitis?

A
  • elevated opening pressure

- low WBC (

234
Q

What CD4 count puts you at risk for cryptococcal meningitis?

A

CD4

235
Q

What is tx for cryptococcal meningitis?

A

amphotericine B and flucytosine VI for 2 wks then fluconazole x 8 wks

+/- serial lumbar punctures to reduce ICP

hold ARVs for 2 wks after start antifungal

236
Q

What should you think if pt presents w/ polyarthralgia, tenosynovitis (pain along tendon sheeth w/ movement), and painful vesiculopustular skin lesions?

A

disseminated gonococcal infection

237
Q

What is next step if pt presents w/ back pain + positive straight-leg raise w/o neurological deficit?

A

likely disk herniation –> next step = early mobilization + NSAIDs

if pain persists 4-6 wks or progressive neuro deficit –> do MRI or CT /- contrast myelography

238
Q

What should you suspect if pt presents w/ hypercalcemia, anemia, bone pain/lytic leiosn, and high Cr? Why would they be at increased risk of infection?

A

suspet multiple myeloma

at increased risk infection b/c total decrease in functional abs and leukopenia as BM filled w/ malignant plasma cells

239
Q

What should you think if more than 3-4 g/dl difference between total protein and albumin conc?

A

paraprotein gap = suggestive of MM

240
Q

What should you think if young healthy man w/ chronic low back pain, worse at night, improved w/ activity and high ESR?

A

ankylosing spondylitis = progressive stiffness of spine, sacroiliitis, HLA-B27+

241
Q

What are extra-articular causes of ankylosing spondylitis?

A
  • anterior uveitis
  • IBD
  • aortic regurg
  • restrictive lung dz 2/2 diminished chest wall expansion
242
Q

What PFT findings in ankylosing spondylitis?

A
  • decreased VC
  • decreased TLC
  • normal FEV1/FVC
243
Q

What is tx for giant cell arteritis?

A

high dose IV steroids

reduces progression of visual complications in affected and unaffected eye, start while awating confirmation of dx

244
Q

What two pathologies commonly seen w/ analgesic nephropathy?

A
  • papillary necrosis

- chronic tubulointerstitial nephritis

245
Q

What are UA findings of glomerular damage?

A

blood + portine

RBC casts, dysmorphic RBC

246
Q

What is likely dx if proteinuria and hematuria a few days after pharyngitis?

A

IgA nephropathy

247
Q

What type of testicular tumor presents w/ hyperestrogenism?

A

leydig cell tumors –> produce testosterone –>have increased estrogen from aromatase

248
Q

What is definition of orthostatic hypertension?

A

drop in SBP > 20 when standW

249
Q

What is definition of fulminant hepatic failure? tx?

A

hepatic encephalopathy w/in 8 wks of onset of acute liver failure

tx = only treatment is orthotopic liver transplant

250
Q

What are etiologies of fulminant hepatic failure?

A
  • acetaminophen
  • alcohol
  • methamphetamines
  • coinfection hep B/D
251
Q

What should you think if pt w/ hx of smoking presents w/ clubbing and sudden onset join arthropathy?
next step?

A

hypetrophic osteoarthropathy
often associated w/ lung CA

next: do CXR to r/o malignancy

252
Q

What is next step of pt w/ sx of polymyalgia rheumatica?

A

low dose steroids –> do temporal artery biopsy if symptoms – HA, jaw claudication, vision loss

253
Q

What percent of values w/in 1 SD from mean? 2 SD? 3 SD?

A

1 SD = 68%
2 SD = 95%
3 SD = 99.7%

254
Q

What things increase and decrease the murmur of HOCM?

A

increase: w/ decreased preload –> valsalva, absrupt standing, nictroglycerin
decrease: w/ increase afterload/preload: sustained hand grip, squatting, passive leg raise

255
Q

What is the murmur of HOCM?

A

harsh crescendo-descrescendo systolic murmur heard best at apex and L lower sternal border

256
Q

What is MCC death in pts w/ acromegaly?

A

cardiovascular –> corohnary heart disease, MI, etc

257
Q

What is emphysematous cholecystitis?

A

common form of cholecystitis in elderly DM males

2/2 infection of gallblader wall w/ gas-forming bacteria

258
Q

What should you think if air fluid levels in gallbladder on XR or US w/ curvilinear gas shadowing in gallbladder?

A

emphysematous cholecystitis

259
Q

What is tx for staph abscess of eyelid (stye)?

A

apply warm compresses

incision and drainage if not resolved in 48 hrs

260
Q

What should you think if pt w/ AV block and infectious endocarditis?

A

perivalvular abscess extending into cardiac conduction tissue

261
Q

What are risk factors for periannular extension of endocarditis?

A
  • IVDU

- aortic valve endocarditis

262
Q

What are auscultation, tactile fremitus, and percussion findings in consolidation?

A
  • crackles/bronchial breath sounds
  • increased tactile fremitus
  • dull to percussion
263
Q

What are auscultation, tactile fremitus, and percussion findings in pleural effusion?

A
  • decreased breath sounds
  • decreased tactile fremitus
  • dull to percussion
264
Q

What are acuscultation, tactile fremitus, and percussion findings in COPD?

A
  • decreased breath sounds
  • decreased fremitus
  • hyperresonant to percussion
265
Q

What are auscultation, tactile fremitus, and percussion findings in pneumothorax?

A
  • decreased breath sounds
  • decreased fremitus
  • hyperresonant to percussion
266
Q

What meds have mortality benefit as secondary prevention in MI?

A
  • ASA
  • B blocker
  • ACEi
  • statin
267
Q

When do you give clopidogrel in pt w/ MI?

A

give for 12 mo to all pts w/ unstable angina/NSTEMI

or for 1 mo post-PCI w/ bare metal, 1 yr w/ drug eluding

268
Q

What is the nature of appendicitis peri-umbilical vs RLQ pain?

A 
peri-umbilical = referred, visceral
RLQ = somatic
269
Q

What is tx if pt w/ acute hep B?

A
  • if unvaccinated: give vaccine and IG
270
Q

What are AST/ALT changes in acute alcoholic hepatitis?

A

AST > ALT, usually in 2-300s, rarely exceed 500

271
Q

What are 3 MCC acute liver failure?

A

acute viral hepatitis (acetaminophen), acetaminophen tox, ischemic hepatopathy

272
Q

What is presentation of acute liver failure?

A
  • RUQ pain, pruritis, jaundice, hepatic encephalopathy

high PT, INR > 1.5, AST/ALT > 10x normal, worsening PT/INR

273
Q

What is pathophysiology of SLE nephritis?

A

immune complex mediated (thats why you get decreased C3)

274
Q

Can alpha blocker (doxazosin) and phosphodiesterase inhibitor (sildenafil) be given together?

A

yes but w/ 4 hours interval to reduce risk of hypotension

275
Q

When is sildenafil CI?

A

pts w/ nitrates

276
Q

What are clinical markers of severe pancreatitis?

A 
age > 75
alcoholism
obesity
CRP > 150 at 48 hrs
increased BUN/cr in first 48 hrs
277
Q

What is cullen sign?

A

periumbilical bluish coloration indicating hemoperitoneum in pancreatitis

278
Q

What is grey-turner sign?

A

reddish brown coloration around flanks indicating retroperitoneal bleed in pancreatitis

279
Q

What are wells criteria for pretest probability of PE?

A

score +3:

  • clinical sx DVT
  • alternative dx less likely

score + 1.5:

  • previous PE/DVT
  • HR > 100
  • recent surgery or immobilization

score +1:

  • hemoptysis
  • cancer

do d-dimer
>4 = likely –> do CTA

280
Q

What are sx of TCA overdose?

A

CNS depression
hypotension
anticholinergic –> dilated pupils, hyperthermia, intestinal ileus, QRS prolongation

281
Q

What is tx for TCA overdose?

A

ABCs and Na bicarb to improve BP, shorten QRS, and prevent arrhythmia

282
Q

What are manifestations of carcinoid sx?

A
  • flushing, tenalngiectasia
    diarrhea, cramping
  • valve lesions (R>L)
  • bronchospasm
283
Q

How do you dx carcinoid syndrome?

A

elevated 24hr urine 5HIAA

CT/MRI of abdomen/pelvis to localize

284
Q

What is tx for carcinoid?

A

octreotide for sx prior to surgery if liver met

285
Q

What vitamin needs to be supplemented in carcinoid?

A

niacin –> get pellagra w/ dermatitis, diarrhea, dementia b/c uses up tryptophan that is required for niacin synthesis

286
Q

By how much should FEV1 improve after bronchodilator in pt w/ asthma?

A

by > 12%

287
Q

How does injection of joint w/ lidocaine differentiate rotator cutt tendonitis from tear/frozen shoulder?

A

tendonitis – pain/ROM resolved w/ injection

vs others do not

288
Q

What are the 3 cardinal symptoms of COPD exacerbation?

A
  • increased dyspnea
  • increased cough
  • increased sputum production
289
Q

What is the tx for acute COPD exacerbation?

A

supplemental O2
bronchodilators (albuterol, ipratropium)
systemic steroids
abx IF 2 of 3 cardinal sx [cough, dyspnea, sputum] OR severe exacerbation OR ventilation required

290
Q

What type of abx for acute COPD exacerbation?

A

macrolide, FQ, or penicillin/beta lactamase inhibitor

for 3-7 days

291
Q

What are the 3 tumors associated w/ type 1 MEN?

A
  • parathryoid adenoma
  • enteropancreatic tumor
  • pituitary tumor
292
Q

What are the 3 tumors of type 2A MEN?

A
  • meduallry thryoid cancer
  • pheo
  • parathyroid hyperplasia
293
Q

What is the mech of nitrates having an anti-angina effect?

A

systemic vasodilation –> lowers preload and LVEDV –> less wall stress and oxygen demand

294
Q

What is the pathology in DM nephropathy?

A

nodular glomerulosclerosis (kimmelstiel wilson nodules)

295
Q

What genetic condition is associated w/ hyposthenuria?

A

hyposthenuria = impaired ability to concentrate urine –> have nocturia

seen in sickle cell disease and trait –> 2/2 RBC sickling in vasa rectae of inner medulla

296
Q

What does S4 suggest?

A

stiff LV 2/2 restrictive cardiomyopathy or LV hypertrophy from prolonged hypertension

297
Q

What is likely dx if pt presents w/ muffled voice, deviation of uvula, and unilateral lymphadenopathy in setting of fever/sore throat? tx?

A

likely peritonsillar abscess complicating tonsillitis

tx: aspiration of abscess and IV abx

298
Q

How can you distinguish epiglottitis from peritonsillar abscess?

A

epiglottitis = more distal in airway, would require emergency lrayngoscopy

both present w/ muffed voice and difficulty swalloing

absecess = w/ uniltareal lymphadenopathy and deviation of uvula

299
Q

What is presentation of behcet’s syndrome?

A

recurrent oral and genital ulcers, anterior uveitis, skin lesions (erythema nodosum = painful and nodules 2/ areas of hyperpigmentation)

300
Q

What is the most frequent location of the ectopic foci that cause atrial fibrillation?

A

pulmonary veins

301
Q

What is usually the source of foci in atrial flutter?

A

reentrant circuit around the tricuspid annulus

302
Q

What is the source of foci in AVNRT?

A

reentrant circuit formed by 2 separate conducting paths within the AV node,

303
Q

What is the source of foci in AVRT?

A

reentrant circuit involing accessory AV bypass tract

304
Q

What clinical associations w/ FSGS nephrotic syndrome?

A
  • AA, hispanic
  • obesity
  • HIV
  • heroin use
305
Q

What clinical assocaitions w/ membranous nephropathy?

A
  • adenoCA (breast/lung)
  • NSAIDs
  • hep B
  • SLE
306
Q

What clinical associations w/ membranoproliferative glomerulonephritis?

A
  • hep B/C

- lipodystrophy

307
Q

What clinical associations w/ minimal change disease?

A
  • NSAIDs

- lymphoma

308
Q

What are the 4 main substrates of gluconeogenesis?

A

alanine
glutamine
lactate
glycerol 3-phosphate

lactate/alanine get turned into pyruvate

309
Q

What is MCC AR in young adult?

A

congenital bicuspid aortic valve in developed country

rheumatic heart disease of aortic valve in developing

310
Q

What is the murmur of HOCM?

A

harsh crescendo-decrescendo systolic murmur best at apex and LLSB

increases w/ valsalva, standing

311
Q

When is AR murmur heard loudest?

A

apply firm pressure w/ diaphragm of stethoscope, pt sit up, lean forward, hold breath in full expiration

312
Q

What are clinical feat of nocardia infection? tx?

A
  • gram positive partially acid fast, aerobic, filamentous
  • present: PNA [similar to TB], CNS, or cutaneous
  • tx: TMP-SMX
313
Q

What is recommended colon cancer screening in UC patients?

A

yearly colonoscopy beginning 8-10 yrs after dx

314
Q

How do you distinguish MGUS from MM?

A

MGUS: absence of anemia, hypercalcemia, lytic lesions, arenal insufficiency

serum monocloncal protein

315
Q

When do you do abdominal fat bad biopsy?

A

if concern for amyloidosis

316
Q

What type of angioma is small, red, cutaneous, common in aging adult?

A

cherry angioma

317
Q

What medication for AFib should be avoided in pt w/ underlying restrictive lung disease?

A

amiodarone –> can cause lung fibrosis

318
Q

What is tx of SIADH?

A

fluid restriction

if sx or resistant hyponatremia –> hypertonic saline

319
Q

What underlying dz associated w/ acanthosis nigricans?

A
  • insulin resistance [DM, PCOS]

- GI malignancy

320
Q

What underlying dz associated w/ multiple skin tags?

A
  • insulin resistance,
  • pregnancy
  • crohn [perianal]
321
Q

What underlying dz associated w/ dermatitis herpetiformis?

A

celiac

322
Q

What underlying dz associated w/ severe seborrheic dermatitis?

A
  • HIV

- parkinson

323
Q

What dz asscoaited w/ prophyria cutanea tarda?

A

hepatitis C

324
Q

What is benefit of Na bicarb in TCA toxicity?

A

use in pts w/ QRS >100msec
increases serum pH –> decreases drug avididity for Na channels
alleviates effect on myocardial Na channels

325
Q

What is presentation of TCA overdose?

A 
- mental status change
seizure resp depression
- sinus tach, long PR/QRS/QT
arrhythmia
anticholinergic
326
Q

What are presenting sx of addisons dz?

A

anorexia, fatigue, GI sx, wt loss, hyperpigmentation, decreased BP, vitiligo

hyponatremia 22 volume contraction, hyperkalemia

327
Q

What are two most common electrolyte abnormalities in primary adrenal insufficiency?

A
  • hyponatremia

- hyperkalemia

328
Q

What is tx for NMS [fever, muscle rigidity, ANS instability]?

A
  • dantrolene [muscle relaxant]
  • bromocriptine [dopamine agonist]
  • amantadine [antirial]
329
Q

What are sx of worsening prognsos in CLL?

A 
- lymphocytosis only = good
\+ adenopathy = fair
\+ splenomegaly = fair
\+ anemia = intermediate
\+ thrombocytopenia = poor
330
Q

What lab findings in alcoholic hepatitis?

A
  • AST/ALT 2
  • high GGT, bilirubin, or INR
  • leukocytosis, PMNs
  • decreased albumin
  • elevated ferritin
331
Q

What defines obesity hypoventilation syndrome?

A

BMI > 30
daytime hypercapnia (PaCO2 > 45)
- alveolar hypoventilation –> hypoxemia

will have resp acidosis

332
Q

What is tx for obesity hypoventilation syndrome?

A
  • wt loss

- noninvasive Positive pressure ventilation

333
Q

What is pathophys of giardia?

A

adhesive disks and malabsorption

334
Q

What levels of Ca, phos, Alk phos, urinary hydroxyproline in paget

A
  • normal Ca, phos
  • high alk phos
  • high urine hydroxyproline and other markers of bone degradation
335
Q

What bone disease w/ recent hearing loss, bone resorption and sclerosis?

A

paget disease

336
Q

What is tx for HIV infected pt w/ positive PPD (>5mm) and negative CXR?

A
  • ppx w/ INH and pyridoxine for 9 months
337
Q

What is reason for adding pyridoxine to INH treatment/ what should you still monitor?

A

decrease neuropathy

still monitor LFTs for inh induced hepatitis

338
Q

What should you think if pt on high dose albuterol develops muscle weakness?

A

hypokalemia –> check serum electrolytes and do EKG

339
Q

What are indications for urgen dialysis?

A

Acidosis: pH 6.5 refractory to medical therapy

Ingestion:

  • toxic alcohols
  • salicylate
  • lithium
  • valproate/carbamazepine

Overload:
- volume overload refractory to diuretics

Uremia
- symptomatic encephalopathy, pericarditis, bleeding

340
Q

What is likely bug if pt w/ secondary bacterial PNA complicating viral infection w/ blood spreaked sputum and midfield lung cavities on CXR?

A

staph aureus = suggests necrotizing PNA w/ secondary pneumatoceles

341
Q

What is the pathogenesis of ASA-exacerbated respiratory disease?

A

pseudoallergic rxn to NSAIds

broncospasm or nasal congestion following ASA ingestion, usually in pts w/ asthma w/ nasal polyps

342
Q

What is presentation of acute angle closure glaucoma?

A

acute onset severe eye pain and blurred vision w/ N/V, red eye w/ steamy cornea and moderatley dilated pupil that is non-reactive to light

343
Q

What is next step if pt w/ fever, back pain, focal spinal tenderness?

A
  • blood culture
  • ESR/CRP
  • spinal xray

if high ESR/CRP but normal CRAY –> do MRI, then CT guided bone bx

344
Q

What is presentation of dig toxicity?

A

N/V, decreased appetite, confusion, weakness
visial sx
renal injury
precipitated by loop diuretic use causing hypokalemia

345
Q

What is tx of chocie for human bite?

A

amoxicillin clavulanate –> covers gram positive, negatives, and anaerobes

346
Q

What is tx for nephrogenic DI 2/2 lithium?

A

salt restriction and discontinue lithium

347
Q

What is mech of edema on glomerulonephritis?

A

decreased GFR and retention of Na and H2O by kidneys

348
Q

What is the prognosis of alcoholic liver disease if stop drinking?

A

reversible unless have true cirrhosis w/ regenerative nodules

349
Q

What does it suggest if pt has mallory bodies in liver?

A

alcoholic hepatitis

350
Q

What is MC malignancy in asbestos?

A

bronchogenic carcinoma

351
Q

What is presentation of alcoholic ketoacidosis? lab reults?

A
  • slurred speech, unsteady gait, eltered mentation

- high osmolar gap, increased anion gap

352
Q

What is presentation of methanol ingestion? labs?

A

visual blurring, central scotomata, afferent pupillary defect
- high osmolar gap, increased AG met acidosis

353
Q

What is presentation of ehtylene glycol? labs?

A

flank pain, hematuria, oliguria, CN palsies, tetany

- high osmolar gap, increased AG met acidosis, Ca oxalate crystals in urine

354
Q

What is presentaiton of isopropyl alcohol ingestion? labs?

A

CNS depression, disconjugate gaze, absent ciliar reflex

- high osmolar gap, no increased AG, no met acidosis

355
Q

What is tx for ethylene glycol tox?

A

fomepizole or ethanol to inhibit alcohol dehydrogenase

356
Q

What should you think if hemolytic anemia and thrombocytopenia in pt w/ renal failure and neuro sx?

A

TTP-HUS

tx = plasma exhange

357
Q

What are clinical sx of atheroembolism (cholesterol embolism) 2/2 cardiac catheterization?

A
  • cutaneous: livdeo reticularis
  • cerebral or intestinal ischemia
  • AKI
  • hollenhorst plaques
358
Q

What is the pathophysiology of cardiac tamponade?

A

exagerrated shift of IV septum toward LV –> reduced LV preload, stroke volume, and cardiac output

359
Q

What are some medications that cause hyperkalemia?

A 
non-selective B blockers
ACEi/ARB/k sparing diuretics
digitalis
cyclosporine
heparin
NSAID
succinylcholine
360
Q

What is next step if pt on methotrexate for RA has persistent sx for > 6 mo?

A
  • add another nonbiologic [sulfasalazine, hydroxychloroquine]
    OR
  • add biologic [TNF inhibitor]
361
Q

What is best tx for prinzmetal angina?

A

eliminate risk factors {smoking]

- CCBs or nitrates

362
Q

What do you see on CSF w/ HSV encephalitits?

A
  • high WBC (lymphocytes)
  • normal glucose
  • high protein
363
Q

What is next best test if suspect diverticulitis?

A

abdominal CT

364
Q

What should you think if pt w/ LLQ pain, nausea, vomiting, constipation?

A

diverticulitis

365
Q

What should you think if HIV pt w/ severe odynophagia w/o dysphagia and no thrush?

A

viral esophagitis

  • HSV = round ovoid ulcers
  • CMV = deep linera ulcers
366
Q

What is MCC PNA in nursing home pt?

A

strep pneumo

unless advanced dementia –> worry about aspiration by anaerobes

367
Q

When is primary percutanesou coronary intervention recommendied in STEMi?

A

if w/in 12 hrs x onset AND 90 min from first medcal contact to device time
OR 120 min from first medical contact at non-PCI facilitiy (allows transprot time)

368
Q

When is fibrinolysis used in STEMI?

A

if w/in 12 hrs of STEMI sx onset and can’t do PCI

369
Q

What stabilization measures do you do immediately in pt w/ STEMI?

A
  • O2
  • full dose ASA
  • platelet P2Y12 receptor blocker
  • nitroglycerin for pain (don’t use if hypotension, RV infarct)
  • BB (CI in HF, bradycardia)
  • anticoagulation (heparin)
370
Q

What is tx of choice to assess glucose tolerance/DM in pt w/ PCOS?

A

2 hr oral glucose tolerance test

371
Q

What are 4 dx tests for DM2?

A

fasting BG >=126
A1C >= 6.5
1 hr OGTT >=200
random plasma gluc >=200 + sx

372
Q

What are 3 dx tests of prediabetes?

A

fasting BG 100-125
2 hr OGTT 140-199
A1C 5.7-6.4

373
Q

What is dx test of choice for pt w/o jaundice to assess if pancreatic Ca? what if they are jaundiced?

A

contrast enhanced CT of abdomen

ab US = preferred 1st test if jaundice to assess for obstruction

374
Q

What does S3 suggest?

A

increased cardiac filling pressure –> seen in CHF

375
Q

What does high BNP mean?

A

secreted in response to ventricular stretch and wall tension when cardiac filling pressures are high

376
Q

What is tx for symptomatic AS?

A

aortic valve replacement

377
Q

What are indications for aortic valve replacement?

A
  • symptomatic AS
  • severe AS undergoing CABG or other valve surgery
  • asx w/ severe AS and either poor LV systolic function, LV hypertrophy > 15, valve area
378
Q

What is the screening test for syphilis?diagnostic?

A

screening = VDRL and FTA-ABS = test ofr syphilis exposure

- dx = darkfield microscopy, visualize of spiorchtes

379
Q

What physical exam findings of lymph node make it more likely to be benign?

A

less than 1cm, small, ruberry

vs Ca = firm and immobie, >2cm

380
Q

What medical conditions associated w/ AL amyloidosis?

A
  • multiple myeloma

- waldenstrom macroglobulinemia

381
Q

What medical conditions associated w/ AA amyloidosis?

A

chronic inflammatory: RA, IBD

chronic infections: osteomyelitis, TB

382
Q

What is composition of AL amyloid?

A

light chains (usually lambda)

383
Q

What is composition of AA amyloid?

A

abnormally folded proteins

beta 2 microglobulin, apolipoprotein, or transthyretin

384
Q

What should you think if pt w/ suddent onset CHF after URI?

A

likely dilated cardiomyopathy 2/2 vial myocarditis

mC = coxsackie B virus

385
Q

What screening tests shouly ou do in pt w/ PID?

A

screen for HIV, syphilis, hep B, cervical Ca, and hep C if hx of IVDU

386
Q

What neuro sx w/ B12 deficiecny?

A

loss of proprioception and virbaton sense mostly in lower extremities

387
Q

What is tx for fibromyalgia?

A

regular areobic exercise, good sleep hygiene

if need drugs: TCAs (amitriptyline)

388
Q

What is MC valvular abnormality detected in infective endocarditis?

A

mitral valve disease (usually MVP w/ coexisting MR)

389
Q

What is management of compensated cirrhosis? [those who are asx or w/ vague complaints]

A
  • US surveilance for HCC +/- AFP q6mo

- EGD varicies surveilance

390
Q

What are indications for statin?

A
  • clinically significnat atherosclerotic dz (ACS, MI, angina, etc)
  • LDL > 190
  • age 40-75 w/ DM
  • estimated 10 yr ASCVD risk > 7.5%
391
Q

What type of statin should you give w/ pt w/ clinically significant atherosclerotic dz?

A

if 75 - moderate

392
Q

What type of statin should you give pt w/ LDL > 190?

A

high intensity statin

393
Q

What type of statin should you give pt w/ DM age 40-75?

A

10 yr risk > 7.5 = high

10 yr risk

394
Q

What markers of para-pneumonic pleural fluid tell you it needs to be drained?

A

if pH

395
Q

What can you do in pt w/ neurogenic bladder to reduce risk of recurrent UTI?

A

intermittent catheterization {vs indwelling = greater risk infection]

396
Q

What is tx for pt w/ coagulopathy in liver fialure?

A

FFP [b/c missing all vit K dependent factors]

397
Q

What is the mech of albuterol?

A

beta 2 agonist

398
Q

What sx distinguish between primary HIV and mono?

A

rash and diarrhea suggest HIV

tonsillar exudate suggests mono

399
Q

What are side effects of TMP-SMX?

A

rash, neutropenia, hyperkalemia, elevated LFTs

400
Q

What is presentation of acute hypersensitivity pneumonitis?

A

cough, breathelessness, fever, malaise 2/in 4-6 hrs of antigenic exposure

chronically –> wt loss, clubbing, honeycombing

401
Q

What does urine chloride tell you in metabolic alkalosis?

A

UCl 20 = volume non-responsive

402
Q

What is presentation of thyroid storm?

A
  • fever up to 104-106
  • tachycardia, hypertension, CHF, cardiac arrhythmia
    agistation, delirium, sezirue coma
    goiter, lid lag, trmemor
    N/V, diarrhea, jaundice
403
Q

What is tx for thyroid storm?

A
  • Bblocker (propanolol) for drenergic manifestioant
  • PTU then iodine solution
  • glucocorticoirds to decreased peripheral conversion T4 –> T
404
Q

What characteristics of low back pain suggest disk dz?

A
  • postive straight leg
  • radiculopathy
  • neuro deficits
405
Q

What characterisitcs of low pain pain suggest spinal stenosis?

A
  • pseudoclaudication
  • better w/ spine flexion
  • worse w/ extension
  • older age
406
Q

What characteristics of low back pain suggest compression fracture?

A
  • older age
  • more common in F
  • trauma/fall
407
Q

What charactersitics of low back pain suggest inflammatory?

A

better w/ activity or exercise

- HLA B27

408
Q

What characteristics of low back pain suggest met?

A

hx malignancy, > 50

  • worse at night
  • wt losss
  • cauda equina
409
Q

What is tx for basal cell carcinoma?

A
  • low risk on trunk or extremities = do electrodessiation and curretage (ED&C)
  • higher risk or on face –> do mohs micrographic surgery
410
Q

What is tx for rosacea?

A

topical abx such as metronidazole

411
Q

What are ferritin, TIBC, transferrin sat findings in iron deficiency anemia?

A
  • low ferritin
  • high TIBC
  • low transferrin sat
412
Q

What are ferritin, TIBC

A
  • normal/high ferritin
  • low TIBC
  • normal/low transferrin sat
413
Q

What is tx for cat scrtch disease?

A

azithromycin

414
Q

What does it suggest if pts SBP falls > 10 during inspiration?

A

pulsus paradoxus = seen in pts w/ cardiac tamponade, asthma, COPD

415
Q

What is tx for tinea versicolor?

A

topical ketoconazole, terbinafine, or selenium sulfide

416
Q

What should you suspect if pt w/ idiopathic thrombocytopenia purpura?

A

test for hep C and HIV

417
Q

What tests for dx lactose intolerance?

A
  • positive hydrogen breath test,
  • positive stool test for reducing substance
  • low stool pH
  • increased stool ostmotic gap
418
Q

What is the common mech of thrombocytopenia in SLE?

A

immune mediated destruction

419
Q

What are rome diagnostic criteria for IBS?

A
  • recurrent ab pain/discomfort > 3day/mo for last 3 mo w/ at east 2 of:
  • sx improves w/ BM
  • change in stool frequency
  • change in stool form
420
Q

What are sx of theophyllnine tox?

A

CNS stimulation (HA, insomnia, seizrue), GI (N/V), cardiac (arrhythmia)

421
Q

Which murmurs get softer w/ squatting?

A

HOCM

MVP

422
Q

Which murmurs get softer w/ handgrip?

A

HOCM

AS

423
Q

How can you use maneuvers to distinguish AS vs HOCM vs MVP?

A

AS = softer w/ handgrip, valsalva, standing

HOCM = louder w/ valsalva, standing, softer w/ squatting, handgrip

MVP = louder w/ valsalva, standing, not softer w/ handgrip

424
Q

What are guidelines for hypoNa correction to prevent osmotic demyelination?

A

increase in Na conc w/ 3% or hypertonic Na at rate no more than 0.5 mEq/L/hr

425
Q

What shold you suspect in pt w/ hx of mediastinal irradiaton and edema, JVP, hepatomegay?

A

HF 2/2 constrictive pericarditis

426
Q

What are 3 clinical findings in constrictive pericarditis?

A
  • hepatojugular reflux
  • kussmaul [lack of decrease or increase in JVP on inspiratoin]
  • pericardial knowck [mid-diastolic sound]
427
Q

What do ca oxalate stones look like on radiograph?

A

envelope shaped

radio-opaque

428
Q

What is MC type of renal stone? what are some risk factors?

A

ca oxalate

risks: small bowel dz, surgical reection, chronic diarrhea

429
Q

Who should get just PPSV23 (not PPSV13) before 65 yo?

A

chronic heart, lung, liver disease

DM, current smoker, alcoholic

430
Q

Who should get both PCV13 and PPSV23 before 65?

A

pt w/ csf leak, sickle cell, asplenia
HIV, malignancy
SKD

431
Q

What are lab findings in SIADH?

A
  • hypotonic hyponatremia w/ euvolemia
  • low plasma osmo (100-150)
  • low uric acid
432
Q

What are lab findings in mineralocorticoid deficiency?

A
  • hypotonic hyponatremia
  • hypovolemia
  • high K
433
Q

What is tx for pt w/ AFib who is hemodynamically unstable? stable?

A

unstable: do immediate cardioversion
stable: rate control – B Blocker

434
Q

What is tx for pt w/ suspected variceal hemorrhage?

A
  • vol resusctiation
  • IV octreotide
  • abx
  • then urgent endo tehrapy [sclerotherapy or band ligation]

if no further bleeding –> do B Blocker + endoscopic band ligation 1-2 wks later
- if continued bleed –> balloon tamponade –> then TIPS or shunt

435
Q

What kind of back pain is worse w/ lumbar extension, relieved by flexion?

A

spinal stenosis

436
Q

What are some revesrible risk factors for premature atrial contraction?

A
  • tobaca, alcohol, caffiene, stress
437
Q

What is tx for PAC?

A

bblocker if sx

if asx dont treat

438
Q

What is dx test for aotic dissection?

A

TEE

439
Q

What heme cancer associated w/ abnormal ch 22? tx?

A

CML = t(9;22) = BCR-ABL = philadeplphia chromosome

tx = tyrosine kinase inhibitors [imatinib]

440
Q

What type of nephritic syndrome presents w/ intramembranous deposits of C3 w/o immunoglobulins?

A

membranoproliferative glomerulonephritis

mech: iGG antibodies (C3 nephritic factor) against C3 convertase of alternative complement path, leads to persistnet complement activation and kidney damage

441
Q

What do needle shaped crystals on urinalysis indicate? what is next dx step?

A

uric acid stones. do CT abdomen or IV pyelography or US b/c radiolucent

442
Q

What is likely dx if bright red firm friable exophytic nodules in HIV pt? tx?

A

bacillary angiomatosis 2/2 bartonella

tx = oral erythromycin

443
Q

What is next step if pt presents 7.5 g acetaminophen?

A

administer activated charcoal
check acetaminophen levels

if timing of ingestion unclear, > 10ug/ml, any evidence of liver injury –> administer NAC and monitor for liver injury

444
Q

What are clinical feat of trichinellosis?

A 
2/2 undercooked meet
w/in 1 wk ingestion:
- asx or ab pain, N, V , diarrhea
p to 4 wks later
- myositis, fever, subungual splinter hemorrhage, periorbital edema, eosinophilia, high CK + leukocytosis
445
Q

What should you suspect if pt w/ periorbital edema, myositis, and eosinophlia?

A

trichinellosis

446
Q

What is presentation of dengue fever?

A

HA, retro-orbital pain, rash, significant myalgia, arthralgia

can also have hemorrhage in skin/nose

447
Q

What is tx for antiphosphoipid syndrome?

A

prophylax w/ ASA and LMWH in pregnancy to avoid loss

448
Q

What is next step if pt w/ persistent tachycardia causing hypotension, AMS

A

synchronized cardiovert and sedation

449
Q

What is tx for pt hemodynaically stable but w/ persistent tachycardia?

A

if narrow (GRS

450
Q

What disease is characterized by autoimmune destruction of intrahepatic bile ducts and cholestasis? tx?

A

primary biliary cirrhosis

tx = ursodeoxycholic acid

451
Q

What are lab findings in PBC?

A
  • high alk phos, cholesterol, IgM

- anti-mitochondrial antibodies

452
Q

What happens if you give BBlocker to pt w/ pheochromocytoma?

A

will cuase unopposed alpha stimulation –> rapid increased in BP

*you should always give alpha blocker first before B blocker

453
Q

What blood d/o presents w/ bite cells and heinz bodies on peripheral smear?

A

G6PD deficifiency

454
Q

What is likely dx if pt ? 40 presents w/ knee pain worse w/ activity, relieved w/ rest, and crepitus?

A

OA

drug of choice = acetaminophen

455
Q

What should you think if pt w/ CHF, thrombocytopenia, macrocytosis, and elevated LFTs?

A

alcohol induced dilated cardiomyopathy

456
Q

What are findings of ATN?

A

BUN:cr 20

FeNa > 2%

457
Q

What do WBC casts suggest?

A

interstitial nephritis and pyelonephritis

458
Q

What do broad and waxy casts suggest?

A

chronic renal failue

459
Q

What is pt lackign post-splenectomy?

A

risk of encapsulated organisims 2/2 impaired antibody-ediated opsonization in phagocytosis

460
Q

What electrolyte abnormlaities in recurrent vomiting?

A

hypoK, hypoCL, met alklaosis

461
Q

What are best meds for increasing appetite in cachexia?

A

progesterone analgos (megestrole, medroxyprogesterone) > steroids

462
Q

What is difference bewtween steven johnson and toxic epidermal necrloysis?

A

TEN = > 30% body surface

SJS =

463
Q

What is next step after dx adenocarcinoma of stomach?

A

CT ab/pelvis to look for mets, stage

depending on findings may do laparoscopy, US, CT, PET etc

464
Q

What type of lung cancer is peripheral and presents w/ clubbing, hypertrophic osteoarthropathy?

A

adenocarcinoma

465
Q

xanthelasma is associated w/ what GI condition?

A

PBC

466
Q

What shoul you think if pt w/ popping sensation in knee injury w/ significnat sweeling and hemarthrosis and joint intstabliity?

A

ACL tear

467
Q

What is the stepwise approach for ascites?

A
  1. Na and H2O restric
  2. spironolacton
  3. loop diuretic (no more than 1L/day diuresis)
  4. frequent abdominal paracentesis
468
Q

What is drug of choice for chemo induced N/V?

A

5HT3 receptor antagonists

469
Q

What antibodies in sjgoren?

A

SSA (Ro) or SSB (La)

470
Q

What is etiology of zenker diverticulum?

A

upper esophageal sphincter dysfunction and esophageal dysmotitligy

471
Q

What is presentation of cyanide yox in nitroprusside?

A

AMS, lactic acidosis, seizure, coma

472
Q

What is next step if suspcet lupus nephritis?

A

do renal biospy to classify degree of nephritis –> start immunosuppresive therapy after it is classified

medicine Clerkship (4 decks)

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