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Success on Step 2 > Uworld (I missed this question 3x's in a row) > Flashcards

Uworld (I missed this question 3x's in a row) Flashcards

1
Q

What is the treatment for this pathology?

A

If the dissection is type A than surgery is the next best step. If the dissection is type B as long, as there are no perfusion issues these patients can be treated medically. In both patients it’s important to adminitster beta blockers (reduce shear stress). If the systolic blood pressure is > 120 than we can consider nitroprusside or nicardipine.

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2
Q

What murmurs are associated with crescendo- decrescendo murmur?

A

Pulmonic stenosis, aortic stenosis, and HOCM. Keep in mind that the age demographic will be younger.

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3
Q

How do you diagnose Acute limb ischemia?

A

Acute limb ischemia is a clinical diagnosis, if you have identified the 6 P’s that qualifies. As soon as you have confirmed you want to give a dose of unfractionated heparin.

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4
Q

When do we screen for AAA

A

In men age >60, that smoke or have a history of smoking.

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5
Q

When would we preform a TEE for a patient with blunt trauma ?

A

Patients with hemodynamic instability and recent history of blunt traumato make sure we rule out/in Aortic rupture

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6
Q

MAAM COCO

A

Mitral closes (tricuspid also), Aortic( pulmonic) opens and Mitral opens (tricuspid also) and Aortic (pulmonic) closes.

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7
Q

A 22 yo female patient that experiences pre-syncope during workouts, and had T wave inversions in lead V3-V6, what diagnosis would you most commonly consider?

A

HOCM, although you may check for other valvular abnormalities, or heart ischemia keep in mind that this patient is young and we wouldn’t expect a heart attack to be common.

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8
Q

Patients with malignant pericardial effusion may be considered for a __________ ____________, to prevent effusion reoccurrence.

A

Pericardial window

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9
Q

What is a pericardial window?

A

This is when a part of the pericardial lining is removed and thus the fluid of the heart drains into the peritoneal cavity.

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10
Q

What would be the treatment for this patient?

A

Pericardiocentesis

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11
Q

What are complications of cardiac catheterization just after PCI?

A

Arrhythmias are the most common after an MI, but stent thrombosis is also a potential complication that can occur. After revascularization the vessel becomes very thrombogenic which is why it’s important to administer aspirin and clopidogrel (dual anti-platelet ).

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12
Q

What are the things we need to know for cardiac risk assessment?

A
  1. Does the patient have any history of cardiac disease
  2. what’s the patients functional capacity (> 4mets, able to climb stairs)
  3. What’s the type of procedure with vascular and cardiac procedures being pretty high risk.
  4. Is the surgery emergent or urgent?
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13
Q

What are the RCI (revised cardiac index) criteria for assessing a patients risk for surgery.

A
  1. vascular or an intrathoracic surgery
  2. Previous history of myocardial ischemia
  3. History of stroke
  4. Hx of diabetes mellitus
  5. Creatinine >2
  6. CHF
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14
Q

Delayed and diminished carotid pulse (pulsus parvus et tardus) may indicate what valvular pathology?

A

Aortic stenosis,

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15
Q

Which cause of syncope has an aura prior to syncope?

A

Seizure

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16
Q

What may be some clues or indication of arrhythmia syncope?

A

Sudden onset with out any presentation of symptoms, hx of valvular, CHF or other cardiac diseases, ectopic beats, and

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17
Q

How would you go about treating this patient?

A

This patient would need immediate surgical treatment.

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18
Q

If a patient has sternal clicking and rocking what is the diagnosis and what is the best step in management?

A

The patient has dehiscence should be taken for surgical debridement and sternal fixation.

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19
Q

During laparoscopic procedures insufflation of the abdomen can cause what heart complication?

A

Can cause bradycardia, AV block. or asystole

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20
Q

What’s the difference between Dressler’s syndrome and peri-infarction pericarditis?

A

Peri-infarction pericarditis has an acute onset after a MI (2-4 days), whereas Dressler’s may occur weeks to a couple months after a myocardial infarction which triggers inflammation.

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21
Q

What reduces the chance of peri-infarction pericarditis from occuring?

A

Reperfusion

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22
Q

What are some of the characteristic features of Aortic regurgitation?

A
  1. water hammer pulse (rapid rise rapid fall)
  2. Widened pulse pressure
  3. abrupt carotid distension and collapse
  4. Decrescendo diastolic murmur
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23
Q

A 30 year old woman with no other history besides colonic polyps is admitted due to chest pain that occurs for 10 mins before it resolves. she says that this happens often especially during the nighttime. The pain is not associated with exertion. Emergent EKG is performed and shows ST elevations in three contiguous leads, why wouldn’t you want to cardiac catheterize this patient?

A

In a typical question usually we see MI’s happening in a much older demographic. This patient is young and has no history of cardiac disease. With her symptoms we see that she has had history of these episodes and they usually resolve relatively quickly. Notice that the pain is not a result of exertion. So we might want to be thinking of vasospastic angina. But the EKG it’s characteristic of an MI that’s true so the best next step in management is to confirm this with a CTA if there are no deficits then we know this is vasospastic angina.

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24
Q

How do we treat vasospastic angina?

A

Calcium channel blockers like Diltiazem or sublingual nitroglycerin

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25
Q

How do you differentiate a Supraventricular tachycardia from Ventricular tachycardias on EKG?

A

The QRS complex will be narrow < 0.12 (3 small boxes) or > 0.12 (3 boxes)

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26
Q

When should antibiotics pre- surgery be given to prevent infective endocarditis.

A

For high risk procedures like oral, respiratory, or undergoing procedures where the patient has active infections other wise low risk procedures like GI/GU don’t require antibiotics if there is no active infection present.

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27
Q

What are the characteristic findings of pericarditis?

A
  1. Friction rub
  2. JVD
  3. Pleuritic chest pain
  4. diffuse ST segment elevations or PR depressions
  5. Echo may show a pericardial effusion
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28
Q

What are the characteristic findings of tamponade?

A

Don’t Beck’s triad:
1. Hypotension
2. JVD
3. Distant heat sounds
Also low voltage QRS’s, pulsus alternans, and pulsus paradoxsus

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29
Q

When placing a central venous catheter what follow up imaging should always be done?

A

CXR (chest radiograph)

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30
Q

Before operating on a patient what information should you provide to the patient for their consideration (ethics question)?

A

The diagnoses, the procedure your recommending, alternate options, risks and benefits, and the possible risks associated with refusing treatment.

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31
Q

What are the hard signs of vascular injury?

A
  1. Pulsatile bleeding
  2. Expanding hematoma
  3. bruit or thrill
  4. ischemia
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32
Q

How do organize intervention in a patient with trauma to the extremities?

A
  1. Apply pressure to the bleed
  2. X-ray to determine if there are abnormalities in bone structure
  3. Check for neurovascular compromise
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33
Q

When is a loud S1 normally heard?

A

Mitral stenosis

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34
Q

S2 or S1 has a single sound?

A

S1 has a single sound because both the mitral and tricuspid valves close at the same time.

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35
Q

What would be the reason for a prolonged S2 split?

A
  1. Increased volume such as ASD
  2. Pulmonary stenosis
  3. RBBB
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36
Q

Why would a narrow S2 occur?

A

Due to pulmonary HTN, the increased levels of pressure on the right side of the heart causes the valve to close more quickly.

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37
Q

When does paradoxical splitting occur?

A
  1. Severe aortic stenosis
  2. LBBB
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38
Q

When would a singular S2 occur?

A
  1. Either in Aortic or pulmonic atresia
  2. Pulmonary HTN where the pressure is equal to the aortic valve pressure.
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39
Q

What is the protocol of managing a patient with recent blunt cardiac injury?

A

The patient should be monitored 24-48 hrs. The most common manifestation are arrythmias, myocardial dysfunction, ruptured valve septum or cardiac tamponade.

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40
Q

What is used to diagnose BTAI (blunt thoracic aortic injury)

A

Ideally a CTA and possibly a TEE

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41
Q

This cardiomyopathy is the most inherited cardiomyopathy.

A

HOCM

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42
Q

What are the hemodynamic changes of chronic progressive mitral regurgitation?

A

In chronic progressive MR, ventricular remodeling occurs, allowing maintenance of cardiac output, and an initial increase in EF is usually observed. However, the effective EF can be considerably lower depending on the regurgitant fraction. Over time, there is a positive feedback loop by which volume overload from MR causes dilation of the ventricle, widening of the mitral annulus, and diminishing coaptation of leaflets, leading to progressive worsening of the MR. Becomes so severe that excitation-contraction coupling of the muscle membrane becomes impaired, and wall stress-related afterload on the left ventricle leads to dilation with decreased contractility, resulting in a reduction of EF.n addition, the regurgitant blood from the left ventricle during systole can eventually cause left atrial enlargement, impairment of left atrial contraction, and subsequent atrial fibrillation, leading to a thrombus in the left atrial appendage

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43
Q

What is Duke’s criteria?

A

Assess for possible endocarditis

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44
Q

What are the hemodynamic changes of compensated chronic MR?

A

Were gonna assume that everything stays the same because the slow progression of the regurgitant flow the heart is able to compensate.

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45
Q

What are the hemodynamic changes of decompensated regurgitation.

A
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46
Q

What’s the difference in the physiology of patient with HOCM versus a patient with an athlete or a pregnant mothers heart?

A

An athlete and the pregnant woman will both have larger ventricle (eccentric) allowing for more preload, their ventricular function is not comprimised, there is no increase in left atrial pressure and usually there is no septal defect? As opposed to HOCM all the latter findings would be positive.

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47
Q

In patients with A fib with a CHAD VASC score greater than >2 what should be treatment?

A

Oral anticoagulation via warafin or apixaban etc.

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48
Q

What is pulseless electrical activity?

A

The heart is still pumping and circulating blood but an arrythimia, hypovolemia, PE or other cardiac dysfunction keeps CI well below and adequate perfusion capacity. This commonly results in an absent pulse and eventually can lead to asystole where the heart is no longer contracting

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49
Q

peripheral edema can occur as a side affect to what drug?

A

Calcium channel blockers

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50
Q

What is Non-sustained ventricular tachycardia?

A

Three consecutive beats greater than >100 bpm

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51
Q

What’s the treatment for acute pericarditis?

A

NSAID’s and colchicine

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52
Q

What are possible EKG findings you may see for a patient with pericarditis?

A

The patient may show concave ST elevations, waves in acute pericarditis and electrical alternans, low voltage QRS

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53
Q

A 32 yo M with history of polysubstance abuse is admitted to the ED due to septic shock. On physical exam patient has a new murmur located at the right sternum. The patient is being administered fluids. Pt. is started on a broad spectrum antibiotic. The patients blood cultures come back positive for alpha hemolytic Strep. The patient states that he last injected himself with heroin 3 days ago. What could possibly be this patients source of infection?

A

An infection could be from anywhere, but the fact that you have a history of poly substance abuse a new onset murmur and strep (viridans) infection may indicate endocarditis and possible infection from the valves.

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54
Q

For patients being treated for endocarditis when do we get blood cultures relative to antibiotic treatment.

A

Always get cultures before starting antibiotics

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55
Q

What are the indications for surgical repair in aortic stenosis.

A

Aortic jet velocity greater than 4.0 m/sec>40 mmhg (transvalvular pressure)

And meet at least one of these criteria.
> onset of cardiac symptoms
> Left ventricular ejection fraction < 50%
> undergoing another cardiac surgery

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56
Q

What is the most important risk factor for stroke?

A

HTN

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57
Q

What’s the work up for HTN?

A

An initial work up should included urinalysis, creatinine, electrolytes, TSH. This basic work up rules out common secondary causes of HTN.

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58
Q

What lifestyle intervention can most effectively reduce HTN.

A

Losing weight

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59
Q

What’s are the most common causes of SVC syndrome?

A

Cancer: Small cell or non- Hodgkin lymphoma

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60
Q

What is the diagnostic modality for identifying SVC?

A

Chest X-ray

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61
Q

In the absence of any clear provoking factors for DVT and VTE, what is the next thing we need to consider?

A

Age appropriate cancer screening

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62
Q

what is the role of protein C and S?

A

A deficiency of protein C and protein S results in the loss breaking down clots (anti-coagulate), resulting in unchecked thrombin generation and thromboembolism.

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63
Q

What does LAP stand for?

A

Stands for leukocyte alkaline phosphatase

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64
Q

What is the difference between a leukomoid reaction and CML?

A
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65
Q

Shiny tongue and palmar creases may be incognito to suggest?

A

A vitamin B12 deficiency

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66
Q

Sideroblastic anemia has a ____ ferritin level and a ____ TIBC

A

Elevated to normal iron and ferritin; and decreases TIBC.

(it’s also a microcytic hypochromic anemia)

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67
Q

How do we classify anemias?

A

1.Decreased RBC production (bone marrow infiltration)
2. Blood loss
3. Increased RBC destruction

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68
Q

Basophilic stipling can present in what other blood pathologies?

A

Thalasemia, alcohol use disorder, vitamin deficiencies and lead poisoning.

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69
Q

A 31 yo F patient is scheduled for an emergency surgery for appendectomy. Prior to the surgery her platelet count was normal, but her PT and PTT are elevated. A 1:1 inhibitor mixing study is done (pts plasma is mixed with normal plasma), but her PT and PTT haven’t corrected what could be the possible cause?

A

lupus anti-coagulant a form of anti-phospholipid antibody. It’s the most common form of coagulant inhibition.

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70
Q

A 5yo child presents with acute onset of fatigue. The patient has a previous history of sickle cell. The patients hemoglobin is 6. The patient is slightly dyspenic, but responsive to simple commands. The patients spleen is palpable. Reticulocyte count is elevated, what is the cause of her reduced hemoglobin levels?

A

The patient has splenic sequestration which is a complication of an occlusion of an exit route from the spleen thus causing RBC’s to become trapped in the spleen. The next step would be to give this patient a transfusion.

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71
Q

RBC’s, plasma, platelets should be administered at what ratio?

A

1:1:1

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72
Q

What’s the treatment for a patient with TTP?

A

Plasma transfusion

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73
Q

Would this lab suggest ITP or Von Willebrand’s dz

A

Remember that while Von Willebrand will increase PTT and BT, it usually doesn’t affect the platelet levels. So this lab suggests more ITP.

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74
Q

A patient of good stature, erratic behavior present with these labs. Would this lab be more suggestive of EPO abuse or steroid abuse?

A

This lab would be more suggestive of steroid abuse, steroids can cause erythocytosis. In addition, if the stem suggests increased aggression and gynecomastia consider steroids.

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75
Q

A pt. with a hx of Sjogren’s autoimmune, shiny tongue, and IBS

A

Megaloblastic anemia due to pernicious anemia.

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76
Q

If a patient is in an emergent situation and you don’ t have the time to crossmatch blood, what blood should you give?

A

Blood group O, Rh (-)

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77
Q

A pt. after blood transfusion is has a b/p 80/50, HR 120, the patient has labored breathing on physical examination. What kind of transfusion reaction is she having?

A

Anaphylatic

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78
Q

A pt after blood transfusion is short of breath, CXR show pulmoary infiltrates and edema, what transfusion reaction is she having?

A

TRALI (fn related acute lung injury)

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79
Q

What kind of reaction is graft versus host disease

A

This is a cytotoxic (CD8) reaction that typically develops by day 100. Donor CD8 cells respond to recipient antigens. Typical patient presentation is GI symptoms like diarrhea or maculopapular rash. The diagnosis is made by biopsy and treatment is usually steroids.

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80
Q

What’s the management for splenic sequestration.

A

The first goal is packed RBC transfusion. If the patient were to have greater than one incidence of splenic sequestration than we might consider splenectomy.

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81
Q

What are some signs of splenic sequestration?

A

Hypotension, splenomegaly, hepatomegaly, low hemoglobin, thrombocytopenia, reticulocytosis

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82
Q

Are these labs more suggestive of ITP or Von Willebrand’s dz?

A

The platelet count is low remember that low platelet is more suggestive of ITP.

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83
Q

A 64 yo woman presents bitemporal headache, flushing, itching, blurry vision, tingling, and numbness in her feet. Total protein is 10.5 and albumin is 3.7. PE shows tortuous and dilated retinal vasculature. What are some possible differentials your considering?

A

Giant cell arteritis, Carcinoid syndrome, Waldenstrom macroglobulinemia.

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84
Q

What’s the difference between WM and MM?

A
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85
Q

A patient who has nosebleeds for an hour gets a plasma replacement and still continues to bleed. Why would this not be VW disease?

A

Von Wille would correct with administration of plasma thus this may be due to the common anti-coagulant factor anti-phospholipid.

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86
Q

Are these labs more indicative of Aplastic crisis or splenic sequestration?

A

Aplastic crisis, splenic sequestration will have a high reticulocyte count.

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87
Q

A patient presents to your clinic with pain along the bottom of their foot, it is exacerbated when the patient dorsiflexes and flexes the toes. X-ray findings are unremarkable. What’s the diagnosis and what can we r/o based on the history?

A

Plantar fasciitis, based on the fact that the X-ray is unremarkable we can rule out bone spur, which are typically found in the proximal fascia.

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88
Q

A patient that is 40 yo with chronic bilateral MCP joint pain and stiffness presents to your office in search of possible treatment. Patient has had X-rays in the past showing calcifications within the joint space. Patient had recent lab work that showed AST 100 and ALT 105? What is a possible diagnosis?

A

Hereditary hemochromatosis

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89
Q

What’s the treatment for hereditary hemochromatosis?

A

NSAIDS, but also sometimes phlebotomy

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90
Q

What are some risk factors of tendonopathy?

A

athletic activity, an increase in activity, psoriasis, ankylosing spondylitis, glucocorticoids and floroquinoloes.

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91
Q

What’s the difference between tendonopathy and calcaneal apophysitis?

A

Calcaneal apophysitis is usually found in children and adolescents that are active. Although tendonopathy does also occur in active patient usuaully you can illlicit a burn like sensation or pain 2-6 cm from the insertion of the tendon.

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92
Q

What is patellofemoral syndrome

A

Diagnosis of exclusion, we don’t really know what the etiology is but some risk factors include trauma, muscle imbalance, and mal-alignment. Pt induce pain on a loaded and flexed knee (running, stairs, etc)

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93
Q

Pt presents to the office with knee pain worsened by squatting, running, prolonged sitting, or using stairs. The patient explains that sometimes when she is walking she feels like her knee is giving out. What is the most likely diagnosis?

A

Patellofemoral syndrome

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94
Q

What are some red flags to consider when considering a patient with acute back pain.

A
  1. Symptoms of cauda equina
  2. Fever
  3. IV drug use
  4. current or recent malignancy
  5. weight loss
  6. Bilateral progressive weakness
  7. Nocturnal pain
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95
Q

Gout presentation on joint aspiration?

A

Negatively birefrengent uric acid stone build up.

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96
Q

Pseudo-gout is a combination of what minerals?

A

calcium pyrophosphate dihyrdate

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97
Q

Gout can commonly be associated with what blood disorder?

A

Myeloproliferative disorder

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98
Q

What is is the treatment for this patient?

A

This is ankylosing spondylitis, treatment is usually NSAIDS. This imaging is showing widening of the joint space and sclerosing of the bone.

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99
Q

What are common NSAIDS

A
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100
Q

When are X-rays indicated in an ankle injury?

A
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101
Q

What are the risk factors for femoral fractures?

A

age >65, osteoporosis

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102
Q

How would we treat a femoral neck fracture?

A

Because the femoral head doesn’t have a very strong vascular supply lack of blood supply can lead to avascular necrosis, maluninion, femoral degeneration. With this being such a delicate fracture open reduction, internal fixation (pins), and hemiarthroplasty (prosthetic hip joint)

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103
Q

What is the pathology behind Pagets’s disease

A

Osteoclasts are dysfucntional and overstimulated, thus breaking down a lot of bone, there is mild osteoblastic function as well.

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104
Q

What are typical lab values for Paget’s disease?

A

Elevated ALK phos, PINP, and hydoxyproline. Normal levels of calcium and phosphorous.

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105
Q

What is the treatment for symptomatic Paget’s disease?

A

Biphosphonate

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106
Q

_____ gout presents in the setting of hyperuricemia

A

tophaceous

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107
Q

Red tender spots on the anterior legs, elevated 1- alpha hydroxylase =

A

Sarcoidosis

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108
Q

What are the antibodies we look for for rheumatoid arthritis?

A

RF is sensitive and anti- citrullinated peptide (anti-ccp) is specific.

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109
Q

What are the antibodies we look for SLE?

A

ANA is sensitive, Anti-ds and ant- smith

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110
Q

Positive ANA and positive anti-histone is specific for what disease?

A

Drug induced lupus

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111
Q

Positive ANA and positive scl 70 is specific for what disease?

A

Diffuse systemic sclerosis

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112
Q

Positive ANA and positive anti-centromere is specific for what disease?

A

Limited sclerosis

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113
Q

ANA positive and Anti-Jo1 is specific for what disease?

A

polymyositis and demratoyositis

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114
Q

Anti-topisomerase, is the same as what antibody?

A

Anti-scl 70

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115
Q

Anti- Ro and anti-ssa are specific for what disease?

A

Sjoren

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116
Q

positive ANCA

A

granulomatous polyangitis, and other vasculitides

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117
Q

What are the risk factors for OA (osteoarthritis)

A

age >40, DM, excessive alcohol intake and joint stress

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118
Q

Herbden bouchard node is a specific finding of ?

A

OA

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119
Q

How do you differentiate herbden bouchard nodes from tophaceous gout?

A
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120
Q

A patient with chronic cough, use of a proton pump inhibitor for severe GERD, and sensitive to temperature. What is a possible pathology you are considering?

A

Scleroderma

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121
Q

What is the difference between shin splints (medial tibial stress syndrome) and stress fractures

A

Usually shin splints are associated with novice athletes and there is diffuse tenderness. The patient who has stress fractures will have point tenderness

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122
Q

A hip dislocation should be reduced in less than ____ hours otherwise we are concerned of osteonecrosis of the femoral head.

A

6 hrs

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123
Q

What is the next step in management of this patient?

A

This is osteochondroma they are benign osteophytes that typically grow at the metaphysis. The occur in skeletally immature kids. The osteophytes stop growing when bone growth has haulted. Treatment for this patient would be observation.

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124
Q

Straight leg test, tests for what?

A

Radicular pain, The pain should be a shooting electrical shock down the leg. If the pain is dull and achy then it’s not a positive sign.

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125
Q

What is the diagnostic work up for stress incontinence?

A

Provocation test (e.g., coughing while standing with legs apart)

Cystomanometry.

Sonography (possible relaxation of the urethra during stress).

Urethra pressure profile (to identify the etiology): decreased urethral closed pressure.

Gynecological workup of other various causes.

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125
Q

When should we consider transurethral ureteral splinting ?

A

In patients with urinary retention.

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125
Q

When is Percutaneous nephrolithotomy indicated?

A

When stones are greater than 2cm

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125
Q

When is Extracorporeal shock wave lithotripsy (ESWL) indicated?

A

stones <2cm

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126
Q

Bone pain that is worse at night, relieved with NSAIDs, and not related to increased activity.

A

Osteoid osteoma

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127
Q

Bone pain that is worse with activity, is not relieved by NSAIDS, presents in long bone diaphysis in children

A

Ewing Sarcoma

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128
Q

What’s the age presentation for Ewing sarcoma?

A

14-15

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129
Q

Bone pain with imaging showing sunburst and codman’s triangle?

A

Osteosarcoma

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130
Q

Anticentromere: _________ anti-neurtophilic cytoplasmic antibody: _________

A

scleroderma

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131
Q

Does a knee need to be tapped if it’s swollen but not red or warm?

A

Nope it has to show some inflammatory process to be tapped

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132
Q

A person with diabetes wants to do a triathlon. What is your advice for his insulin taking regimen?

A

Because the muscle readily takes up glucose during exercise less insulin is required. So I would tell this patient to lower there long acting and short acting dose.

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133
Q

In primary hyperthyroidism what are the TSH, T3, T4 levels like?

A

TSH is low, T3 high and T4 high

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134
Q

Normal TSH value?

A

0.4 - 4.0

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135
Q

T4

A

5-12

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136
Q

Free T4

A

0.9 - 1.7

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137
Q

What bone pathology is associated with malabsorbative disorders?

A

Osteomalacia; this disease usually occurs due to the lack of reabsorption of Vitamin .

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138
Q

What does calcium, PTH, phosphorus, and Vitmain D look like in a patient with osteomalcia?

A

Ca (low to normal)
PTH (High)
PO34 (extremely low)
Vitamin D (Low)

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139
Q

What is the treatment for this patient?

A

may also see cortical thinning, pseudo-fractures, and concave vertebral bodies

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140
Q

Primary adrenal insufficiency is targeted specifically to what organ?

A

the adrenal glands

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141
Q

cosyntropin is an analouge like?

A

ACTH

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142
Q

What are tell tell signs that you are dealing with primary adrenal insufficiency?

A

darkening in the color of the skin, salt cravings.

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143
Q

What is the difference between cushings disease and cushings syndrome?

A

Cushing syndrome is hypersecretion of cortisol from the adrenal glands, whereas cushing disease is overproduction of cortisol due to increased ACTH production but the pituitary gland.

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144
Q

How often do we check a persons A1C with diabetes?

A

every 3-6 months

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145
Q

What are the screening tests that need to be done every year for a diabetic patient?

A

albumin; creatinine, eye examination, foot examination,

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146
Q

What are risk factors that contribute to osteoporosis?

A

DXA < -2.5, smoking hx, alcohol history, age >65

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147
Q

Episodic headaches with diaphoresis, heightened emotions, and palpitations are common findings of what form of secondary HTN?

A

Pheochromocytoma

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148
Q

If a patient is taking 2> anti-hypertensive medications with no resolve than

A
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149
Q

Hypertensive emergency vitals

A

> 180/120, with evidence of end organ damage

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150
Q

After confirmed diagnosis of pheochromocytoma what are other important pathologies to look for?

A

MEN 2, NF-1, VHL-1

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151
Q

Men 1

A

Pituitary tumors, parathyroid tumors, pancreatic tumors

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152
Q

Men 2A

A

Pheochromocytoma, parathyroid tumors, and medullary thryroid cancer

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153
Q

Men2B

A

Medullary thyroid cancer, pheochromocytoma, marfanoid habitus, oral and intestinal ganglioneuramtosis.

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154
Q

What is adrenal insufficency?

A

Its an autoimmune disease that results in reduced production of hormone from the adrenal medulla.

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155
Q

At what age do we primarily see intususception?

A

6 months to 3 years of age

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156
Q

What are alarm gastrointestinal symptoms?

A

Age >50
Nocturnal diarrhea
Bleeding
History of IBD or cancer
Worsening abdominal pain

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157
Q

In order to diagnose someone with IBS what criteria have to be met?

A

The patient must have abdominal pain >1 day of the week for three months. And have (2 or more) the following symptoms. Pain relief with defecation, changes in bowel consistency, frequency, and lack of alarm symptoms.

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158
Q

What is the treatment for patients with IBS type C?

A

lifestyle modifications ie psyllium soluble fiber, diet exercise, and drinking water

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159
Q

What’s the first step in treatment for a patient with blunt injury and multiple traumatic injuries?

A

Do a Fast exam.

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160
Q

A patient with burning tounge pain, loss of vibration sensation to the toes and hands, and microcytic anemia. Has what diagnosis

A

Celiac dz

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161
Q

Dermatitis, Dementia/ Depression, and Diarrhea is used to define what vitamin excess?

A

Niacin

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162
Q

Do vaccines contain the core and surface antibodies?

A

Hepatitis vaccines only cover the surface and not the core.

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163
Q

How does one diagnosis chlamydia?

A

Nucleic Acid Amplification test

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164
Q

What is the treatment for chlamydia?

A

Azithromyocin or doxycycline for 7 days

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165
Q

What antibiotic covers pasturella multicocida?

A

Amoxicillin

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166
Q

Patients with cat bites should always be treated with?

A

Amoxicillin clauvlante, keep in mind that the cat bite is a mix of the skin flora of the patient but also anaerobes and pasturella from the cats mouth

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167
Q

Patients that have chronic catheters should have their catheters changed how frequently?

A

every 4-6 hrs

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168
Q

A patient who is in college has an insidious onset of headaches since this morning. The patient has become obtunded and has nuchal rigidity on passive neck flexion. The patients roommate noticed rash appearing on her earlier this morning. What bug do you think is causing the patients symptoms?

A

Nisseria Meningits; keep in mind that there are other bugs that can cause meningitis don’t have an acute course of presentation

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169
Q

What is the treatment for a patient with Nisseria Meningitis?

A

Ceftriaxone, ciprofloxacin, or Rifampin

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170
Q

How is Nisseria M spread

A

droplets, respiratory

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171
Q

What labs would help differentiate a bacterial versus a viral infection in the brain?

A
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172
Q

What vaccinations are adults with HIV able to get?

A

Hep A, Hep B, HPV, influenza (nasal is live and contranidicated), Nisseria Meningicocus (booster every 5 years), Tdap, strep. pneumo, Varicella can only be given if the CD count is greater than 500 otherwise a recombinant vaccine is required.

173
Q

Lymphogranuloma venerum is the same as..

A

Chlamydia trachomatis

174
Q

The primary bug that causes Erysipelas?

A

Strep pyogenes

175
Q

Group A contains what strep ?

A

Strep pyogenes: remember group A&B are under beta hemolytic strep

176
Q

What is Erysipelas?

A

It’s an infection of the dermis and lymphatics

177
Q

How does one get Erysipelas?

A

Usually some small trauma to the skin or an opening in the skin.

178
Q

What is the main organism that causes cellulitis?

A

If the cellulitis is purulent staph areus, if non- purulent than Strep. pyogenes

179
Q

Strep pneumonia is the primary bacterial culprit in what pathologies?

A

MOPS, Meningitis, otitis media, pneumonia, and sinusitis

180
Q

Strep Pyogenes is the primary bacterial culprit in what diseases?

A

LINES, lymphangitis, impetigo necrotizing fascitis, erysipelas (celluitus), Scarlett fever

181
Q

What organism is normally present in furuncle, carbuncle, or and abcess?

A

Staph. A predominantly

182
Q

What are the stages of lyme disease

A
183
Q

What is organism that cause lyme disease?

A

Boriella B

184
Q

In what areas in the US could you get Lyme disease.

A

North of PA and wisconson and Minnesota

185
Q

What is the first line treatment for lyme disease?

A

Doxycycline, and for pregnant woman amoxicillin

186
Q
A
187
Q

A patient presents after a weekend at Yosemite national park with acute presentation of fatigue, muscle pain, fever. The. patient has red rash around the ankles. Labs show thrombocytopenia, and elevated AST and ALT what is the diagnosis.

A

Rickettsia R. In general RR progresses faster than lyme disease.

188
Q

A patient with fever and myalgias presents to the office after going hiking in Alabama. The patients labs show elevated liver enzymes, leukopenia, and thrombocytopenia. But she hasn’t noticed any spots, what is the diagnosis and treatment?

A

Erlichiosis and the treatment is doxycycline. Presents like Ricketssia without a rash. The patients usually acquire diseases in the SouthEastern states.

189
Q

What is the treatment for RR

A

doxycycline

190
Q

Describe the presentation of bordatella pertusis in one sentence.

A

Patient with mild cough that progresses to severe bought of coughing, waining immunity and not being vaccinated are risk factors

191
Q

During application of local anesthetic to a patient a colleague gets stuck with a needle from a patient known to have HIV. Blood is drawn for testing what should the patient do in the meantime?

A

The patient should start PEP (post -exposure prophylaxis) which is three anti-retrovirals for 4 weeks.

192
Q

A patient presents to the office with complaints of cracked and peeling skin in between the toes the patient is constantly on his feet and wears sneakers throughout the day, what may be the cause of the cracking and peeling.

A

Dermatophytes like trichophyton ruburum. They can cause an opening point for other bacteria to enter into the feet.

193
Q

To prevent a patient from acquiring toxoplasmosis when should we give prophylactic treatment

A

<100 /mm3

194
Q

What is the CD4 count number we need to prophylax for histoplasma?

A

< 150

195
Q

When is prophylaxis indicated for CMV?

A

Only in patients with recent transplants.

196
Q

A patient recently returning from Ecuador has RUQ. On physical exam she has hepatomegaly. Labs show elevated eosinophils and imaging shows cysts. What is the treatment for this patient?

A

Albendazole; this patient has Echinococus granulosus which is a dog tapeworm that usually reside in it’s host sheep.

197
Q

Descibe babeosis in one sentence?

A

It’s North Eastern protozoa that comes from a tick (same tick as lyme dz) bite it prefers summer early fall months

198
Q

How do you treat someone with babeosis?

A

Atovaquone, azithromycin
Quinine or clindamycin (QAAC)

199
Q

How do you diagnose Hep C?

A

Serology Hep C IgG antibody
HCV RNA via molecular test

200
Q

What is the most common cause for viral gastroenteritis?

A

Norovirus, unless they are younger than the age of two and have not been vaccinated.

201
Q

A patient recently diagnosed with gastroenteritis is is tachycardic, has poor skin turgor and increased capillary refilling time, what is the next step in management.

A

IV fluid repletion. Patients who are asymptomatic have good bp, heart rate and normal capillary refill time can be discharged home on an oral rehydration therapy

202
Q

What is gastroenteritis?

A

Acute diarrheal illness, usually lasting less than 1-3 days ( a week). The patient can experience other GI symptoms including vomiting, fevers <39). It’s a clinical diagnosis.

203
Q

What is the key difference in distinguishing Disseminated Intravascular coagulation with parvovirus B19?

A

Although both present with fatigue, myalgias, and joint pain. Parvo presents with a malar rash and lacey trunk rash whereas DIC presents as a pustular (maculopapularish)

204
Q

Screening test should typically have a high?

A

Sensitivity, the idea is to identify the earliest cases of disease. We want a screening test to have the lowest amount of possible false negatives.

205
Q

Why are false positives not as scary as false negatives when it comes to screening?

A

Because false positives can be ruled out with a specific test.

206
Q

This bias prolongs the survivor rate because disease detection is determined earlier?

A

Lead time bias

207
Q

Confounding variables

A

Both the independent variable and other external factors can influence the dependent variable (outcome)

208
Q

What prevents cofounding varibales?

A

Matching

209
Q

What is an odd ratio

A

Are the odds that an outcome was due to some previous risk factor.

210
Q

What is a cohort study?

A

looks prospectively to figure out the risk associtated with a certain outcome, which is the relative risk.

211
Q

What is a case control study?

A

Looks on the events that could have had influence on acquiring a disease process.

212
Q

What is prevalence?

A

The amount of people in the population who have the disease

213
Q

What is a confidence interval?

A

How willing are you to be wrong

214
Q

What percentage is one standard deviation?

A

65%

215
Q

What is the percentage of three standard deviations?

A

99.7%

216
Q

What is the percentage of two standard deviations ?

A

95%

217
Q

What is the incidence?

A

The new cases of disease

218
Q

What is case fatality?

A

The number of persons with the disease over the number of people that die from the disease.

219
Q

What is number needed to treat?

A

It signifies how many patients would need to be treated to get one additional patient better who
would not have gotten better without this particular treatment.

220
Q

How do you calculate numbers needed to treat?

A
221
Q

What is number needed to harm?

A

The amount of patients treated before someone is harmed?

222
Q

Experimental event rate

A

The number of exposed person with a positive disease.

223
Q

Control event rate

A

The number of control group with disease.

224
Q

Absolute risk reduction

A
225
Q

Attributable risk

A

is the incidence of disease in the exposed group that can be attributed to the exposure. IE if you have an attributable risk of 18% of patients developing lung cancer in smoking. That value is confirmatory that smoking caused the disease.

226
Q

A cough that lasts for greater than 3 months for greater than two consecutive years is what diagnosis?

A

Chronic bronchitis

226
Q

Digital clubbing is a sign of?

A

Chronic hypoxia

227
Q

What is the greatest risk factor for COPD?

A

Smoking

228
Q

What are some of the pathological changes we see in chronic bronchitis?

A

Increased presence of macrophages and neutrophils.

Goblet cell metaplasia → replacement of surfactant-producing club cells with mucus-secreting cells.

Smooth muscle hypertrophy.
Fibrosis.
Increased mucus.
Wall edema.

229
Q

What is the treatment for chronic bronchitis?

A

Macrolide for anti-inflammation, bronchodilators, and glucocorticoids

230
Q

Air embolisms can intiate from

A

decompression sickness and catheter placement

231
Q

For patients with an ABG that shows hypoxemia what can we do to the ventilator settings to maintain Po2 >60

A

Increase the PEEP or FIO2

232
Q

In patient with an ABG showing hypercapnia what can we do to maintain the PCO2 <40?

A

We can increase the RR or increase the tidal volume

233
Q

Pulmonary hypertension is considered when the pulmonary artery pressure is greater than?

A

20

234
Q

Hypersensitivity pneumonitis

A

Results from exposure to a causative agent, such as bird feathers or mold. Presentation is variable, ranging from acute (i.e., 4–6 hours after exposure and self-limited with exposure removal) to chronic (insidious onset of cough with constitutional symptoms and fibrosis). For chronic HP, HRCT demonstrates small centrilobular nodules, ground-glass attenuation, and lobular areas of decreased attenuation and vascularity; rarely HRCT shows UIP but with air trapping, which is suggestive of HP. Tx: Detailed history and removal of all potential exposures. Partial lung function may return.

235
Q

What is Virchows triad?

A

Venous stasis, hypercoagulation, endothelial damage

235
Q

What is the best treatment for hospitalized pneumonia?

A

beta lactam, macrrolide and floroquinolone

236
Q

What is the triad for fat embolism?

A

dyspnea, petechial hemorrhages (notably on the neck and axillary regions), and confusion. Usually presents at 72 hours post trauma

237
Q

Acute eosinophilic pneumonia (AEP):

A

Rare, cause unknown. Age varies, most commonly 20–40 yr. M:F = 2:1. Nonproductive cough, dyspnea, and fever are present in nearly all patients. Usually symptoms for less than 1 week, occasionally as long as 1 month. Leukocytosis initially neutrophilic, but may become eosinophilic. ESR/CRP, IgE elevated. Imaging: CXR: Subtle reticular or GGO, later diffuse GGO. HRCT not necessary, but helpful to select an area for BAL (BAL cell count shows eos >25%). Tx: Steroids.

238
Q

How we diagnose fat embolism?

A

bronchiolar lavage

239
Q

Causes of acute bronchitis primarily consist of?

A

adenovirus, coronavirus

240
Q

What is the single most important risk factor when considering chronic bronchitis?

A

Smoking

241
Q

What are the most common causes of CAP bacterial pneumonia?

A

Strep Pneumonia, HI, mycoplasma, and legionella.

242
Q

What ph finding would a patient with COPD have?

A

respiratory acidosis, due to CO2 retention

243
Q

rheumatic heart disease causes what valvular disease?

A

Mitral stenosis

244
Q

Patients with acute COPD exacerbation should be treated with inhaled or IV steroids?

A

IV

245
Q

What group of individuals require a CT scan for screening of lung cancer?

A

patients with a smoking history of greater than 20 years. Every year starting at age 50-80

246
Q

What do decreased breath sounds indicate?

A

that there is fluid or air surrounding the lung (in the pleural layer)

247
Q

What are the main organisms that cause rhinnitis (common cold)?

A

Rhinovirus, coronavirus, influenza, adenovirus

248
Q

What are the main organisms that cause sinusitis?

A

Strep. peumoniae, haemophilus influenza, moraxella

249
Q

What are the main organisms that cause (herpangina)gingivitis and stomatitis?

A

Cocksackie and herpes

250
Q

What is the most common bacterial infection associated with an acute on chronic COPD exacerbation?

A

Strep. Pneumonia

251
Q

What are the most common bacterial agents causing CAP?

A

Strep Pneumo, Hin, Mycoplasma

252
Q

What’s the common treatment for CAP?

A

Amoxicllin, azithromycin and doxycycline ( and sometimes floroquinolones)

253
Q

What are the most common microbial agents of HAP?

A

Enterobacteracciae, Pseudomonas, Staphylococcus A

254
Q

Vaccines that HIV patients should have?

A

HAV, HBV, HPV, influenza, N.M every 5 years requires a booster, strep pneumo, Tdap

255
Q

When are live vaccines contraindicated by in HIV patients?

A

A CD4 <200

256
Q

Partially acid fast, gram Positive, branching rods is what organism?

A

Nocardia

257
Q

What is the treatment for nocardia?

A

Trimethoprim sulfamethzole

258
Q

What is the presentation of candidal esophagitis?

A

oral thrush(whit plaques)

259
Q

What is the presentation for herpes esophagitis?

A

round ulcers well circumcised crater like lesions

260
Q

What is the presentation of CMV esophagitis?

A

large linear ulcerations in the distal esophagus.

261
Q

Immunity for pertussis whether it’s via previous infection or previous vaccination wanes after how many years?

A

5-10 years

262
Q

What is the most common cause of meningitis in infants < 1 month old?

A

Group B strep , Listeria, Uropathogenic E.coli

263
Q

What is the most common culprit for menigitis in children >1 month

A

Strep pneumonia

264
Q

> 2 weeks of blood diarrhea tells that the organism is most likerly (parasite, fungal, viral, or bacterial)

A

parasite

265
Q

What is the difference between primary and secondary polycythemia?

A

Primary polycythemia will have low EPO levels whereas secondary polycythemia will have high EPO levels.

266
Q

What are the most likely bacterial infections that occur after a post-viral infection?

A

Staph A, strep pneumonia, pyogenes, and haemophilus influenza

267
Q

What is the treatment of a patient with history of tuberculosis that has been reinfected with TB?

A

We give them empiric treatment to prevent resistance to treatment. This includes the whole RIPE therapy

268
Q

Bactrim is a what combination of antibiotics?

A

Trimethoprim sulfethmazole

269
Q

enveloped stones are most likely composed of?

A

calcium oxalate

270
Q

Coffin stones are most likely composed of?And cause primarily by what organism?

A

Mg, NH, and PO

271
Q

Radiolucent stones are composed of?

A

uric acid

272
Q

hexagonal stones are composed of?

A

cystiene

273
Q

Mitral stenosis is heard where?

A

At the 4th intercostal space at the midclavicular line

274
Q

Pemphigoid is autoantibodies to what?

A

hemi-desmosomes (subepidermal)

275
Q

Pemphigus vulagris has auto-antibodies to?

A

desmosomes

276
Q

Direct anti-body immunofloursecene is a diagnostic tool for what diseases?

A

pemphigus and pemphigoid

277
Q

For GI infections what are usually the most common forms of treatment?

A

Metronidazole, Amoxicillin, and Gentamicin (stomach lining is MAGENta)

278
Q

Does primary or secondary adrenal insufficency have hyperpigmentation?

A

Primary, because low negative feedback will increase the release of CRH and thus ACTH and POMC

279
Q

Fludricortisone is most like what hormone?

A

Aldosterone

280
Q

What happens to the level of aldosterone in secondary adrenal insufficency?

A

It;s unchanged because ACTH doesn’t stimulate the production of aldosterone.

281
Q

Do you need to give fludricortisone in secondary adrenal insufficency?

A

No

282
Q

What is the Na level in adrenal insufficency patients?

A

low, because aldosterone typically reabsorbs Na

283
Q

What’s normally the treatment for neonatal meningitis?

A

Ampicillin and gentamicin

284
Q

How do we diagnose septic arthritis?

A

An athrocentesis
a WBC > 50,000 and neutrophil predominance and a confirmed organism. Also in a prosthetic limb a WBC of greater than >1100 with a neutrophil differeiental of 64 %

285
Q

How does salmonella gastroenteritis present differently than shigella or E.coli?

A

Salmonella typically has onset of fever for about of week and followed by abdominal pain. And the patients will sometimes present with rose spots on the trunk.

286
Q

What is CENTAR’s (centor’s) criteria

A

Is used if we suspect that infection could be caused by Step. PAyogenes (group A)

287
Q

What are the common co-infections we check for in patients that have HIV

A

Hepatitis A, B, and C and TB,

288
Q

What are the physical exam findings for a tension pnumothorax?

A

reveals decreased to absent respiratory excursions, decreased breath sounds, a hypertympany to percussion, and absent tactile fremitus on the affected side

289
Q

What is the diagnosis?

A

tension pneumothorax

290
Q

A patient of a roommate that you recently saw in the ER was diagnosed with Nisseria M. The roomate of the patient states that she is up to date on vaccination, but wonders if she needs to take any medication to prevent the spread?

A

Yes the patient should be on prophylactic ceftriaxone

291
Q

What are the most common causes of atypical pneumonia

A

Mycoplasma, chlamydia, and legionella

292
Q

Perivnetircular calcifications?

A

CMV

293
Q

Owls eye inclusions

A

CMV

294
Q

intracalcifications on head MRI ?

A

Toxoplasma

294
Q

Most lobar pneumonias tend to be caused by what organisms?

A

community acquired organisms like strep Pneumo, HiN, and Moraxella

295
Q

What is the antibiotic given for aspiration pneumonia?

A

Clindamycin covers anaerobes

296
Q

What is CURB-65?

A

Its an assessment to determine whether a patient needs to be admitted to the hospital for pneumonia

296
Q

What are some of the test that we can use to diagnose the organisms of pneumonia

A
296
Q

Invasive aspergillosis should be treated with?

A

voriconazole and amphotericin B

297
Q

Most interstitial pneumonias tend to be caused by?

A

Atypical organisms like mycoplasma, chlamydia, legionella

298
Q

How is Aspergillus acquired

A

inhalation of spores that are found in the environment

299
Q

How do we diagnose allergic bronchopulmonary aspergillosis?

A

Asthmatic symptoms.
Blood count: eosinophilia and increased IgE.
X-ray of chest: recurrent pulmonary infiltrates.
CT of thorax: central bronchiectasis.

300
Q

How do you diagnose nosocomial pneumonia?

A

New CXR findings after a 48 hr period in the hospital. In addition the patient must have leuckocyte count >12,000 or <3000. And a fever of 38.3 > or <36

301
Q

How do you treat PHTN

A

endothelin antagonist,

302
Q

Often occurs in male young adults; leading symptom is dysphagia.
Reflux symptoms despite PPI administration, annular strictures, and whitish coatings in endoscopy (with biopsy), as well as massive infiltration with eosinophils in the histological findings are indicative or diagnostic. What’s the diagnosis?

A

Eosinophilic esophagitis

303
Q

What other drugs can cause esophagitis?

A

tetracyclines, NSAIDs, bisphosphonates, and K chloride

304
Q

how often should you recieve the tetanus booster?

A

10 years

305
Q

What is the most common bug to acquire after a transplant?

A

CMV,

306
Q

What is the treatment for mycoplasma pneumonia?

A

macrolide or a floroquinolone

307
Q

What is the most common cause of conjunctivitis in adults ?

A

Staph A

308
Q

What is the most common cause of conjunctivitis in children?

A

Strep P and Haemophilius In

309
Q

What is the course for treating tuberculosis?

A

RIPE for 2 months and rifampin and isoniazid for an additional 4 months

310
Q

Pyelonephritis can be typically caused by any of the enterobacteracciae family, but how do you determine if the cause of pyelonephritis is due E.coli or proteus infection?

A

Proteus infections will increase the urine ph to >8 because urease alkalinizes the urine

311
Q

What are the possible treatments for acute cystitis?

A

Nitrofurantoin, Bactrim, fosfomycin and floroquinolones?

312
Q

This disease starts with presentation of fever, coryza and then presents with a diffuse maculopapular rash?

A

Measles

313
Q

Infectious mononucleosis will have abnormal what blood cell type?

A

lymphocytes

314
Q

How does a Strep meningitis spread

A

Hematogenous

315
Q

What’s the most common cause of osteomyelitis?

A

Staph A

316
Q

How does staph A cause osteomyelitis

A

hematogenous spread

317
Q

Blastomyces is found where

A
318
Q

Ring enhancing lesion at grey white matter junctions is indicative of what infection?

A

Toxoplasma encephalitis

319
Q

What is the treatment for toxoplasma (not the prophylatic therapy)?

A

sulfadiazine pyrimethamine (leucovorin)

320
Q

Blastomyces differentiates itself from other demographic fungal infections because?

A

It causes lytic lesions of the bone and verrucous skin lesions

321
Q

All of the pulmonary fungal infections present like?

A

Fever, night sweats, weight loss, and productive cough

322
Q

When should live vaccines be avoided in HIV patients?

A

When the WBC is < 200

323
Q

What organism is most likely to acquire in the 4 and 5th metatarsals?

A

Pseudomonas

324
Q

Which organism can cause meningitis and associated seizure?

A

herpes simplex

325
Q

What valvular disease is most common in patients with infective endocarditis?

A

Mitral regurgitation

326
Q

A patient with Nisseria Meningitis may present with no specific symptoms, but what symptoms should clue you in?

A

arthralgia and skin mottling (aka poor perfusion)

327
Q

Coccidiodies is found in what location?

A
328
Q

What are other associations with coccidiodies?

A

Erythema nodosum, arthralgias and erythema multiforme

328
Q

tuberculin skin test is the same as

A

mantoux test

329
Q

Coccidiodies cause what disease?

A

CAP

330
Q

What regions do people acquire histoplasmosis?

A

American Midwest, Central America

331
Q

interferon gamma release assay is the same as

A

Quantiferon its specific and sensitive

332
Q

If a patient has eyelid swelling and opthalmoplegia what diagnosis do you need to make sure to rule out?

A

orbital cellulitis, mcc of progression is recurrent infections of sinusitis, dental abscess, or pre-septal cellulitis

333
Q

What are the hallmarks for infection with Ebstein barr virus?

A

Lymphosytosis (atypical lymphocytes), splenomegaly, and cervical lymphadenopathy

334
Q

Nisseria M vaccination should be administered?

A

At ages 11-12 and the booster at age 16. Nisseria M serotype should be considered in 16-18 yo. (N the letter has to ones)

335
Q

up-regulating metaloproteases, retinal detachment, aortic aneurysm, upregulation of MP (metaloprotease) are complications associated with what drug?

A

Floroquinolones

336
Q

When is the HPV vaccine normally given?

A

11-12 thorugh 26. Patients can get he vaccine up to age 46 (the letter H has an 11 in it)

337
Q

If a patient gets into a fight and gets bitten by a human what treatment do we give and why?

A

Amoxicillin and clavulanate, because you need to protect for Strep and Staph, but also Eikinella which has beta lactamases so that is why we add clavulanate

338
Q

What are the common triggers for acute gastritis?

A

TRy PMS; toxins, radiation, pathogens medications, stress

339
Q

What medications can comonly cause gastritis?

A

NSAIDs, bisphosphonates, alcohol,

340
Q

What is the quadruple therapy for H. pylori

A

Bismuth, tetracycline, metronidazole, and PPI

341
Q

What are the risk factors associated with gastric carcinoma?

A

Chronica gastitis (H.pylori), Nitrate rich foods, smoking, and alcohol

342
Q

What are the tumor markers for gastric carcinoma?

A

CEA and CA 19-9

343
Q

The TNM classification is used for grading or staging?

A

staging

344
Q

What is the most common type of gastric cancer?

A

Adenocarcinoma

345
Q

Where does gastric cancer typically spread?

A

lymphatics and the liver

346
Q

What is the most common cause of liver cancer?

A

Metastasis most commonly from the GI tract (colon)

347
Q

Smooth red tounge, burning pain and loss of pinprick in the hands, fatty stools, and iron deficency sound like what diagnosis?

A

Celiac disease

348
Q

What are the classic signs of cancer at the head of the pancreas?

A

painless jaundice, and a non-tender distended gall bladder. (Aka courvosier)

349
Q

antibodies for PBC?

A

anti-mitochondrial

350
Q

What is PBC?

A

It’s a chronic liver disease where an autoimmune process attack the intrahepatic duct causing jaundice, itching, hepatomegaly.

351
Q

What is a type 1 error?

A

your data rejects the null hypothesis when in fact the null hypothesis is true in reality

352
Q

What is a type two error?

A

You don’t reject the null hypothesis

353
Q

HAWKthorne effect

A

When research participants change their behavior based on being watched.

354
Q

Berkson Bias

A

bias that assumes hospital patients are less healthy than the general population. e

355
Q

What is the clinical triad for toxoplamsa in children

A

CHI, Chorioretinitis, intracranial calcifications and hydrocephalus

356
Q

When should you start screening for osteoporosis in females

A

age 65

357
Q

Good coverage for MRSA

A

vancomycin, clindamycin, linezolid

358
Q

If albumin goes down what happens to the total calcium and what happens to the ionized calcium?

A

The total calcium goes down the ionozed calcium is normal

359
Q

what is more sensitive lipase or amaylase?

A

Lipase

360
Q

Collins sign

A

ecchymoses around the navel area

361
Q

Great Turner sign

A

ecchymoses on the flank

362
Q

Acid fast bugs

A

TB, cryptosporidium parvum, MAC and Nocardia (partial acid fast)

363
Q

What HLA is found in rheumatoid (roomatoid)

A

There are 4 walls in a room

364
Q

What is the drug treatment for rheumatoid?

A

1st methotrexate and TNF id it doesn’t improve on methotrexate

365
Q

Where is lymphadenopathy in patients with Strep?

A

anterior cervical lymph nodes

366
Q

Where is lymphadenopathy in patients with mono?

A

Posterior cervical lymph nodes

367
Q

SLE causes what type of heart complications?

A

Libman sac endocarditis, which are vegitations on the mitral valve in a patient with SLE

368
Q

What is the treatment for UC?

A

5-ASA (mesalamine sulfasalzine)

369
Q

When should colonscopy screeing start in an average risk individual?

A
370
Q

What are common physcial exam findings for patients with anorexia nervosa?

A

osteoporosis, amenorrhea, lanugo, gastroparesis, enlarged parotid gland, hypothermia BMI <18.5

371
Q

A patient with retorcardiac air fluid levels, feeling of food getting caught in the throat and dysphagia may suggest?

A

Hiatal hernia

372
Q

A patient presenting with RUQ pain, fevers, crepitus, and air fluid level around the gallbladder what is the best step in managment?

A

Take them to surgery for cholecystectomy and IV pipercillan-tazobatam should be administerd

373
Q

What organisms can cause emphysematous cholecystitis?

A

Clostridiodies and E Coli

374
Q

What are common risk factors for acute gastritis?

A

stress

375
Q

What are common risk factors for chronic gastritis?

A

H. pylori, chronic NSAID use, smoking, alcohol,

376
Q

What would the stool osmotic gap be in a patient with osmotic diarrhea?

A

> 125 (high)

377
Q

What would be the stool osmotic gap in a patient secretory diarrhea

A

<50 (low)

378
Q

Think of secretory diarrhea as secreting more water into the lumen on the bowel reducing the osmotic gap? What are some common agents that cause secretory diarrhea?

A

bacteria with toxins (vibrio C, HEC)
Vipomas etc. these patients will have diarrhea even when fasting

379
Q

What are treatments for Achlasia

A

ballon palsty, myotomy, calcium channel blockers,

380
Q

A patient presents to your clinic with difficulty swallowing liquids and solids for the past several months, barium swallow shows a bird beak what is the next step in managment?

A

Although this likely seems like achlasia you have to rule out cancer with endoscopy so you can jump to treatment after you’ve confirmed its not cancer

381
Q

What are common infections associated with cholangitis

A

E.coli, klebsiella and other enterbacteraciae

382
Q

Charcot’s triad is used to identify what pathology?

A

Jaundice, fevers, and RUQ ; is used to describe cholangitis

383
Q

What’s the difference between absolute risk reduction and relative risk reduction?

A

Relative risk reduction is the proportion where as the absolute risk reduction is the difference between the control rate and the experimental rate.r

384
Q

How do you calculate the relative risk?

A

It’s the absolute risk reduction dived by the CER

385
Q

____ alkalinizes the urine making it easier for stones to pass

A

Potassium
citrate

386
Q

What is winter’s formula?

A

[1.5 x Hco-3 ]+ 8 +/- 2 , this formula helps us determine if there has been proper compensation or if there is another acid base disorder if the pco2 we calculate is greater than the patients pco2 then that would suggest a respiratory alkalosis. If the calculated pCO2 is less than the patients CO2 then there is an underlying respiratory alkalosis

387
Q

In order to acquire HAP how long must one be in the hospital?

A

> 48 hrs

388
Q

Courvoisier’s sign

A

jaundice with asymptomatic enlarged gallbladder

389
Q

What are some important pancreatic cancer markers?

A

elevated amylase and lipase, CEA CA 19-9 for cancer progression, and KRAS

390
Q

What is the primary risk factor for pancreatic cancer?

A

smoking

391
Q

What are the indications for dialysis?

A

Metabolic acidosis, especially with large anion gap.

Anuria for >12 h.

Hyperkalemia (K+ >6.5 mmol/L).

Intoxication with dialyzable toxin.

Hyperhydration or refractory pulmonary edema.

Uremic symptoms

392
Q

What is the most common risk factor for CKD?

A

diabetes

393
Q

What is azotemia?

A

a biochemical abnormality, defined as elevation, or buildup of, nitrogenous products (BUN-usually ranging 7 to 21 mg/dL), creatinine in the blood, and other secondary waste products within the body.

394
Q

What is the most common site of metastasis of pancreatic cancer.

A

liver

395
Q

What image findings might you see for bronchiectasis?

A

Tram lines or rails signs

396
Q

In a patient with chronic COPD and history of bronchiectasis what immunization should you insure they have?

A

Strep pneumonia and influenza

397
Q

What is the definition of AKI?

A

serum creatinine increases by ≥0.3 mg/dL (in 48 h) or increases by 1.5 times the baseline value within the last 7 days or when urine volume is <0.5 mL/kg/h for ≥6 h

398
Q

How do NSAIDs affect the physiology of the kidney?

A

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. The lack of prostaglandin leads to contraction of the afferent arteriole of the glomerulus, reducing blood flow to the kidney.

399
Q

What are potential treatments for urge inctinence?

A

Anticholinergics and antispasmodics: e.g., oxybutinin, darifenacin, tolterodine, trospium chloride (oxybutinin should be used with caution in elderly patients).

β3-adrenoceptor agonists: mirabegron.

Tricyclic antidepressants: e.g., imipramine.

399
Q

What is the diagnostic work up for urge incontinence?

A

Urinalysis and culture to identify any potential infections or abnormalities.

Urethral swab to assess estrogen levels.

Urethrocystoscopy with biopsy to exclude inflammatory or malignant diseases of the urinary bladder and exclusion of bladder stones.

400
Q

What is the treatment for overflow incontience?

A

Medication therapy includes parasympathomimetics (e.g., betanechol, carbachol) and α-sympatholytics (e.g., tamsulosin).

400
Q

_____ is an alpha 1 blocker that relaxes the smooth muscle of the prostate?

A

tamsulosin, prazosin, terzosin

401
Q

What is the most common cause of orchitis? in young children

A

mumps and measles

402
Q

How does bladder cancer present?

A

For many patients this could be asymptomatic hematuria

402
Q

What is the most common cause of epididymitis?

A

E.coli. chlamydia and Nisseria

402
Q

Insulin is secreted by what cel type?

A

beta cells

403
Q

______ is 5 alpha reductase that helps prevnet hyperplasia of the prostate

A

finasteride

404
Q

What are some common risk factors of bladder cancer?

A

smoking, napthylamine (paint, plastics, and rubber industries), patients with infections of schistasomiasis

405
Q

What drugs can cause raynauds

A

β-blockers, ergotamine, phenylephrine, chemotherapy

406
Q

What do we use to treat raynauds

A

Calcium channel blockers

407
Q

What study should follow after a patient demonstrates positive tinsel sign and palen?

A

Nerve conduction studies

408
Q

What‘s the treatment for rheumatoid arthritis

A

The treatment is DMARD methotrexate, and in severe cases entanercept

409
Q

Where are the most common areas to obtain bursitis?

A

The electron faucet and prepatellar treatment includes rest and NSAIDS

410
Q

What is the acute treatment for gout?

A

Colchicine

411
Q

What is the chronic treatment for gout?

A

Allopurinol

412
Q

Anticoagulation for Patients with renal failure

A

Heparin unfractioned, low molecular weight, heparin, and 10 a inhibitors are contraindicated in patients with kidney disease

413
Q

To prevent cardiac remodeling after a myocardial infarction what drug do we give?

A

Ace inhibitor

414
Q

Drugs that decrease mortality in MI?

A

Aspirin ACE inhibitors and beta blockers 

415
Q

What drugs, decrease mortality, in chronic heart failure

A

Beta blockers spironolactone, and Ace, inhibitors

416
Q

What’s the treatment for ventricular tachycardia?

A

Adenosine if the patient is stable, if the patient is not stable, then we will use synchronized cardioversion

417
Q

What’s the treatment for ventricular tachycardia?

A

Amiodarone if the patient is stable, it’s a patient is unstable, then will do synchronized cardioversion

418
Q

How do you treat someone with pulseless Vtach

A

Defibrillation

419
Q

How do you treat somebody with ventricular fibrillation?

A

Defibrillation

420
Q

PEA

A

Push epinephrine compressions then adenosine

421
Q

If a patient has a medial malleolus ulcer what is usually the cause?

A

Venous insufficiency

422
Q

How do you diagnose spontaneous bacterial peritonitis?

A

First, you have to get a paracentesis fluids, showing neutrophilia and white blood cell count greater than 250 is diagnostic

423
Q
A

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