Uworld (I missed this question 3x's in a row) Flashcards
“What is the treatment for this pathology?
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.
What murmurs are associated with crescendo- decrescendo murmur?
Pulmonic stenosis, aortic stenosis, and HOCM. Keep in mind that the age demographic will be younger.
How do you diagnose Acute limb ischemia?
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.
When do we screen for AAA
In men age >60, that smoke or have a history of smoking.
When would we preform a TEE for a patient with blunt trauma ?
Patients with hemodynamic instability and recent history of blunt traumato make sure we rule out/in Aortic rupture
MAAM COCO
Mitral closes (tricuspid also), Aortic( pulmonic) opens and Mitral opens (tricuspid also) and Aortic (pulmonic) closes.
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?
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.
Patients with malignant pericardial effusion may be considered for a __________ ____________, to prevent effusion reoccurrence.
Pericardial window
What is a pericardial window?
This is when a part of the pericardial lining is removed and thus the fluid of the heart drains into the peritoneal cavity.
What would be the treatment for this patient?
Pericardiocentesis
What are complications of cardiac catheterization just after PCI?
Stent thrombosis isa 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 ).
What are the things we need to know for cardiac risk assessment?
- Does the patient have any history of cardiac disease
- what’s the patients functional capacity (> 4mets, able to climb stairs)
- What’s the type of procedure with vascular and cardiac procedures being pretty high risk.
- Is the surgery emergent or urgent?
What are the RCI (revised cardiac index) criteria for assessing a patients risk for surgery.
- vascular or an intrathoracic surgery
- Previous history of myocardial ischemia
- History of stroke
- Hx of diabetes mellitus
- Creatinine >2
- CHF
Delayed and diminished carotid pulse (pulsus parvus et tardus) may indicate what valvular pathology?
Aortic stenosis,
Which cause of syncope has an aura prior to syncope?
Seizure
What may be some clues or indication of arrhythmia syncope?
Sudden onset with out any presentation of symptoms, hx of valvular, CHF or other cardiac diseases, ectopic beats, and
How would you go about treating this patient?
This patient would need immediate surgical treatment.
If a patient has sternal clicking and rocking what is the diagnosis and what is the best step in management?
The patient has dehiscence should be taken for surgical debridement and sternal fixation.
During laparoscopic procedures insufflation of the abdomen can cause what heart complication?
Can cause bradycardia, AV block. or asystole
What’s the difference between Dressler’s syndrome and peri-infarction pericarditis?
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.
What reduces the chance of peri-infarction pericarditis from occuring?
Reperfusion
What are some of the characteristic features of Aortic regurgitation?
- water hammer pulse (rapid rise rapid fall)
- Widened pulse pressure
- abrupt carotid distension and collapse
- Decrescendo diastolic murmur
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?
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.
How do we treat vasospastic angina?
Calcium channel blockers like Diltiazem or sublingual nitroglycerin
How do you differentiate a Supraventricular tachycardia from Ventricular tachycardias on EKG?
The QRS complex will be narrow < 0.12 (3 small boxes) or > 0.12 (3 boxes)
When should antibiotics pre- surgery be given to prevent infective endocarditis.
For high risk procedures and for high risk patients. 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 pres
What are the characteristic findings of pericarditis?
- Friction rub
- JVD
- Pleuritic chest pain
- diffuse ST segment elevations or PR depressions
- Echo may show a pericardial effusion
What are the characteristic findings of tamponade?
Don’t Beck’s triad:
1. Hypotension
2. JVD
3. Distant heat sounds
Also low voltage QRS’s, pulsus alternans, and pulsus paradoxsus
When placing a central venous catheter what follow up imaging should always be done?
CXR (chest radiograph)
You are considering surgery as a potential treatment option for a patient with peripheral artery disease what information should you provide to the patient for their consideration (ethics question)?
The diagnoses, the procedure your recommending, alternate options, risks and benefits, and the possible risks associated with refusing treatment.
What are the hard signs of vascular injury?
- Pulsatile bleeding
- Expanding hematoma
- bruit or thrill
- ischemia
When is a loud S1 normally heard?
Mitral stenosis
S2 or S1 has a single sound?
S1 has a single sound because both the mitral and tricuspid valves close at the same time.
What would be the reason for a prolonged S2 split?
- Increased volume such as ASD
- Pulmonary stenosis
- RBBB
Why would a narrow S2 occur?
Due to pulmonary HTN, the increased levels of pressure on the right side of the heart causes the valve to close more quickly.
When does paradoxical splitting occur?
- Severe aortic stenosis
- LBBB
When would a singular S2 occur?
- Either in Aortic or pulmonic atresia
- Pulmonary HTN where the pressure is equal to the aortic valve pressure.
What is the protocol of managing a patient with recent blunt cardiac injury?
The patient should be monitored 24-48 hrs. The most common manifestation are arrythmias, myocardial dysfunction, ruptured valve septum or cardiac tamponade.
What is used to diagnose BTAI (blunt thoracic aortic injury)
Ideally a CTA and possibly a TEE
This cardiomyopathy is the most inherited cardiomyopathy.
HOCM
What is Duke’s criteria?
Assess for possible endocarditis
What are the hemodynamic changes of compensated chronic MR?
Were gonna assume that everything stays the same because the slow progression of the regurgitant flow the heart is able to compensate.
What’s the difference in the physiology of patient with HOCM versus a patient with an athlete or a pregnant mothers heart?
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.
In patients with A fib with a CHAD VASC score greater than >2 what should be treatment?
Oral anticoagulation via warafin or apixaban etc.
What is pulseless electrical activity?
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
peripheral edema can occur as a side affect to what drug?
Calcium channel blockers
What’s the treatment for acute pericarditis?
NSAID’s and colchicine
What are possible EKG findings you may see for a patient with pericarditis?
The patient may show concave ST elevations, waves in acute pericarditis and electrical alternans, low voltage QRS
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?
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.
For patients being treated for endocarditis when do we get blood cultures relative to antibiotic treatment.
Always get cultures before starting antibiotics
What are the indications for surgical repair in aortic stenosis.
> onset of cardiac symptoms
Left ventricular ejection fraction < 50%
undergoing another cardiac surgery
What’s the work up for HTN?
An initial work up should included urinalysis, creatinine, electrolytes, TSH. This basic work up rules out common secondary causes of HTN.
What are common NSAIDS
Hypertensive emergency vitals
> 180/120, with evidence of end organ damage
What is Virchows triad?
Venous stasis, hypercoagulation, endothelial damage
What is the triad for fat embolism?
dyspnea, petechial hemorrhages (notably on the neck and axillary regions), and confusion. Usually presents at 72 hours post trauma
How we diagnose fat embolism?
bronchiolar lavage
Causes of acute bronchitis primarily consist of?
adenovirus, coronavirus
What is the single most important risk factor when considering chronic bronchitis?
Smoking
What are the most common causes of CAP bacterial pneumonia?
Strep Pneumonia, HI, mycoplasma, and legionella.
What ph finding would a patient with COPD have?
respiratory acidosis, due to CO2 retention
rheumatic heart disease causes what valvular disease?
Mitral stenosis
Patients with acute COPD exacerbation should be treated with inhaled or IV steroids?
IV
What group of individuals require a CT scan for screening of lung cancer?
patients with a smoking history of greater than 20 years. Every year starting at age 50-80
What do decreased breath sounds indicate?
that there is fluid or air surrounding the lung (in the pleural layer)
What are the main organisms that cause rhinnitis (common cold)?
Rhinovirus, coronavirus, influenza, adenovirus
What are the main organisms that cause sinusitis?
Strep. peumoniae, haemophilus influenza, moraxella
What are the main organisms that cause (herpangina)gingivitis and stomatitis?
Cocksackie and herpes
What is the most common bacterial infection associated with an acute on chronic COPD exacerbation?
Strep. Pneumonia
What are the most common bacterial agents causing CAP?
Strep Pneumo, Hin, Mycoplasma
What’s the common treatment for CAP?
Amoxicllin, azithromycin and doxycycline ( and sometimes floroquinolones)
What are the most common microbial agents of HAP?
Enterobacteracciae, Pseudomonas, Staphylococcus A
Vaccines that HIV patients should have?
HAV, HBV, HPV, influenza, N.M every 5 years requires a booster, strep pneumo, Tdap
When are live vaccines contraindicated by in HIV patients?
A CD4 <200
Partially acid fast, gram Positive, branching rods is what organism?
Nocardia
What is the treatment for nocardia?
Trimethoprim sulfamethzole
What is the presentation of candidal esophagitis?
oral thrush(whit plaques)
What is the presentation for herpes esophagitis?
round ulcers well circumcised crater like lesions
What is the presentation of CMV esophagitis?
large linear ulcerations in the distal esophagus.
Immunity for pertussis whether it’s via previous infection or previous vaccination wanes after how many years?
5-10 years
What is the most common cause of meningitis in infants < 1 month old?
Group B strep , Listeria, Uropathogenic E.coli
What is the most common culprit for menigitis in children >1 month
Strep pneumonia
> 2 weeks of blood diarrhea tells that the organism is most likerly (parasite, fungal, viral, or bacterial)
parasite
What is the difference between primary and secondary polycythemia?
Primary polycythemia will have low EPO levels whereas secondary polycythemia will have high EPO levels.
What are the most likely bacterial infections that occur after a post-viral infection?
Staph A, strep pneumonia, pyogenes, and haemophilus influenza
What is the treatment of a patient with history of tuberculosis that has been reinfected with TB?
We give them empiric treatment to prevent resistance to treatment. This includes the whole RIPE therapy
Bactrim is a what combination of antibiotics?
Trimethoprim sulfethmazole
enveloped stones are most likely composed of?
calcium oxalate
Coffin stones are most likely composed of?And cause primarily by what organism?
Mg, NH, and PO
Radiolucent stones are composed of?
uric acid
hexagonal stones are composed of?
cystiene
Mitral stenosis is heard where?
At the 5th intercostal space at the midclavicular line
Pemphigoid is autoantibodies to what?
hemi-desmosomes (subepidermal)
Pemphigus vulagris has auto-antibodies to?
desmosomes
Direct anti-body immunofloursecene is a diagnostic tool for what diseases?
pemphigus and pemphigoid
For GI infections what are usually the most common forms of treatment?
Metronidazole, Amoxicillin, and Gentamicin (stomach lining is MAGENta)
Does primary or secondary adrenal insufficency have hyperpigmentation?
Primary, because low negative feedback will increase the release of CRH and thus ACTH and POMC
Fludricortisone is most like what hormone?
Aldosterone
What happens to the level of aldosterone in secondary adrenal insufficency?
It;s unchanged because ACTH doesn’t stimulate the production of aldosterone.
Do you need to give fludricortisone in secondary adrenal insufficency?
No
What is the Na level in adrenal insufficency patients?
low, because aldosterone typically reabsorbs Na
What’s normally the treatment for neonatal meningitis?
Ampicillin and gentamicin
How do we diagnose septic arthritis?
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 %
How does salmonella gastroenteritis present differently than shigella or E.coli?
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.
What is CENTAR’s (centor’s) criteria
Is used if we suspect that infection could be caused by Step. PAyogenes (group A)
What are the common co-infections we check for in patients that have HIV
Hepatitis A, B, and C and TB,
What are the physical exam findings for a tension pnumothorax?
reveals decreased to absent respiratory excursions, decreased breath sounds, a hypertympany to percussion, and absent tactile fremitus on the affected side
What is the diagnosis?
tension pneumothorax
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?
Yes the patient should be on prophylactic ceftriaxone
What are the most common causes of atypical pneumonia
Mycoplasma, chlamydia, and legionella
Perivnetircular calcifications?
CMV
Owls eye inclusions
CMV
intracalcifications on head MRI ?
Toxoplasma
Most lobar pneumonias tend to be caused by what organisms?
community acquired organisms like strep Pneumo, HiN, and Moraxella
What is the antibiotic given for aspiration pneumonia?
Clindamycin covers anaerobes
What is CURB-65?
Its an assessment to determine whether a patient needs to be admitted to the hospital for pneumonia
What are some of the test that we can use to diagnose the organisms of pneumonia
Invasive aspergillosis should be treated with?
voriconazole and amphotericin B
Most interstitial pneumonias tend to be caused by?
Atypical organisms like mycoplasma, chlamydia, legionella
How is Aspergillus acquired
inhalation of spores that are found in the environment
How do we diagnose allergic bronchopulmonary aspergillosis?
Asthmatic symptoms.
Blood count: eosinophilia and increased IgE.
X-ray of chest: recurrent pulmonary infiltrates.
CT of thorax: central bronchiectasis.
How do you diagnose nosocomial pneumonia?
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
How do you treat PHTN
endothelin antagonist,
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?
Eosinophilic esophagitis
What other drugs can cause esophagitis?
tetracyclines, NSAIDs, bisphosphonates, and K chloride
how often should you recieve the tetanus booster?
10 years
What is the most common bug to acquire after a transplant?
CMV,
What is the treatment for mycoplasma pneumonia?
macrolide or a floroquinolone
What is the most common cause of conjunctivitis in adults ?
Staph A
What is the most common cause of conjunctivitis in children?
Strep P and Haemophilius In
What is the course for treating tuberculosis?
RIPE for 2 months and rifampin and isoniazid for an additional 4 months
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?
Proteus infections will increase the urine ph to >8 because urease alkalinizes the urine
What are the possible treatments for acute cystitis?
Nitrofurantoin, Bactrim, fosfomycin and floroquinolones?
This disease starts with presentation of fever, coryza and then presents with a diffuse maculopapular rash?
Measles
Infectious mononucleosis will have abnormal what blood cell type?
lymphocytes
How does a Strep meningitis spread
Hematogenous
What’s the most common cause of osteomyelitis?
Staph A
How does staph A cause osteomyelitis
hematogenous spread
Blastomyces is found where
Ring enhancing lesion at grey white matter junctions is indicative of what infection?
Toxoplasma encephalitis
What is the treatment for toxoplasma (not the prophylatic therapy)?
sulfadiazine pyrimethamine (leucovorin)
Blastomyces differentiates itself from other demographic fungal infections because?
It causes lytic lesions of the bone and verrucous skin lesions
All of the pulmonary fungal infections present like?
Fever, night sweats, weight loss, and productive cough
When should live vaccines be avoided in HIV patients?
When the WBC is < 200
What organism is most likely to acquire in the 4 and 5th metatarsals?
Pseudomonas
Which organism can cause meningitis and associated seizure?
herpes simplex
What valvular disease is most common in patients with infective endocarditis?
Mitral regurgitation
A patient with Nisseria Meningitis may present with no specific symptoms, but what symptoms should clue you in?
arthralgia and skin mottling (aka poor perfusion)
Coccidiodies is found in what location?
What are other associations with coccidiodies?
Erythema nodosum, arthralgias and erythema multiforme
tuberculin skin test is the same as
mantoux test
Coccidiodies cause what disease?
CAP
What regions do people acquire histoplasmosis?
American Midwest, Central America
interferon gamma release assay is the same as
Quantiferon its specific and sensitive
If a patient has eyelid swelling and opthalmoplegia what diagnosis do you need to make sure to rule out?
orbital cellulitis, mcc of progression is recurrent infections of sinusitis, dental abscess, or pre-septal cellulitis
What are the hallmarks for infection with Ebstein barr virus?
Lymphosytosis (atypical lymphocytes), splenomegaly, and cervical lymphadenopathy
Nisseria M vaccination should be administered?
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)
up-regulating metaloproteases, retinal detachment, aortic aneurysm, upregulation of MP (metaloprotease) are complications associated with what drug?
Floroquinolones
When is the HPV vaccine normally given?
11-12 thorugh 26. Patients can get he vaccine up to age 46 (the letter H has an 11 in it)
If a patient gets into a fight and gets bitten by a human what treatment do we give and why?
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
What are the common triggers for acute gastritis?
TRy PMS; toxins, radiation, pathogens medications, stress
What medications can comonly cause gastritis?
NSAIDs, bisphosphonates, alcohol,
What is the quadruple therapy for H. pylori
Bismuth, tetracycline, metronidazole, and PPI
What are the risk factors associated with gastric carcinoma?
Chronica gastitis (H.pylori), Nitrate rich foods, smoking, and alcohol
What are the tumor markers for gastric carcinoma?
CEA and CA 19-9
The TNM classification is used for grading or staging?
staging
What is the most common type of gastric cancer?
Adenocarcinoma
Where does gastric cancer typically spread?
lymphatics and the liver
What is the most common cause of liver cancer?
Metastasis most commonly from the GI tract (colon)
Smooth red tounge, burning pain and loss of pinprick in the hands, fatty stools, and iron deficency sound like what diagnosis?
Celiac disease
What are the classic signs of cancer at the head of the pancreas?
painless jaundice, and a non-tender distended gall bladder. (Aka courvosier)
antibodies for PBC?
anti-mitochondrial
What is PBC?
It’s a chronic liver disease where an autoimmune process attack the intrahepatic duct causing jaundice, itching, hepatomegaly.
What is a type 1 error?
your data rejects the null hypothesis when in fact the null hypothesis is true in reality
What is a type two error?
You don’t reject the null hypothesis
HAWKthorne effect
When research participants change their behavior based on being watched.
Berkson Bias
bias that assumes hospital patients are less healthy than the general population. e
What is the clinical triad for toxoplamsa in children
CHI, Chorioretinitis, intracranial calcifications and hydrocephalus
When should you start screening for osteoporosis in females
age 65
Good coverage for MRSA
vancomycin, clindamycin, linezolid
If albumin goes down what happens to the total calcium and what happens to the ionized calcium?
The total calcium goes down the ionozed calcium is normal
what is more sensitive lipase or amaylase?
Lipase
Collins sign
ecchymoses around the navel area
Great Turner sign
ecchymoses on the flank
Acid fast bugs
TB, cryptosporidium parvum, MAC and Nocardia (partial acid fast)
What HLA is found in rheumatoid (roomatoid)
There are 4 walls in a room
What is the drug treatment for rheumatoid?
1st methotrexate and TNF id it doesn’t improve on methotrexate
Where is lymphadenopathy in patients with Strep?
anterior cervical lymph nodes
Where is lymphadenopathy in patients with mono?
Posterior cervical lymph nodes
SLE causes what type of heart complications?
Libman sac endocarditis, which are vegitations on the mitral valve in a patient with SLE
What is the treatment for UC?
5-ASA (mesalamine sulfasalzine)
When should colonscopy screeing start in an average risk individual?
What are common physcial exam findings for patients with anorexia nervosa?
osteoporosis, amenorrhea, lanugo, gastroparesis, enlarged parotid gland, hypothermia BMI <18.5
A patient with retorcardiac air fluid levels, feeling of food getting caught in the throat and dysphagia may suggest?
Hiatal hernia
A patient presenting with RUQ pain, fevers, crepitus, and air fluid level around the gallbladder what is the best step in managment?
Take them to surgery for cholecystectomy and IV pipercillan-tazobatam should be administerd
What organisms can cause emphysematous cholecystitis?
Clostridiodies and E Coli
What are common risk factors for acute gastritis?
stress
What are common risk factors for chronic gastritis?
H. pylori, chronic NSAID use, smoking, alcohol,
What would the stool osmotic gap be in a patient with osmotic diarrhea?
> 125 (high)
What would be the stool osmotic gap in a patient secretory diarrhea
<50 (low)
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?
bacteria with toxins (vibrio C, HEC)
Vipomas etc. these patients will have diarrhea even when fasting
What are treatments for Achlasia
ballon palsty, myotomy, calcium channel blockers,
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?
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
What are common infections associated with cholangitis
E.coli, klebsiella and other enterbacteraciae
Charcot’s triad is used to identify what pathology?
Jaundice, fevers, and RUQ ; is used to describe cholangitis
What’s the difference between absolute risk reduction and relative risk reduction?
Relative risk reduction is the proportion where as the absolute risk reduction is the difference between the control rate and the experimental rate.r
How do you calculate the relative risk?
It’s the absolute risk reduction dived by the CER
____ alkalinizes the urine making it easier for stones to pass
Potassium
citrate
What is winter’s formula?
[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
In order to acquire HAP how long must one be in the hospital?
> 48 hrs
Courvoisier’s sign
jaundice with asymptomatic enlarged gallbladder
What are some important pancreatic cancer markers?
elevated amylase and lipase, CEA CA 19-9 for cancer progression, and KRAS
What is the primary risk factor for pancreatic cancer?
smoking
What are the indications for dialysis?
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
What is the most common risk factor for CKD?
diabetes
What is azotemia?
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.
What is the most common site of metastasis of pancreatic cancer.
liver
What image findings might you see for bronchiectasis?
Tram lines or rails signs
In a patient with chronic COPD and history of bronchiectasis what immunization should you insure they have?
Strep pneumonia and influenza
What is the definition of AKI?
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
How do NSAIDs affect the physiology of the kidney?
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.
What are potential treatments for urge inctinence?
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.
What is the diagnostic work up for urge incontinence?
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.
What is the treatment for overflow incontience?
Medication therapy includes parasympathomimetics (e.g., betanechol, carbachol) and α-sympatholytics (e.g., tamsulosin).
_____ is an alpha 1 blocker that relaxes the smooth muscle of the prostate?
tamsulosin, prazosin, terzosin
What is the most common cause of orchitis? in young children
mumps and measles
How does bladder cancer present?
For many patients this could be asymptomatic hematuria
What is the most common cause of epididymitis?
E.coli. chlamydia and Nisseria
Insulin is secreted by what cel type?
beta cells
What are some common risk factors of bladder cancer?
smoking, napthylamine (paint, plastics, and rubber industries), patients with infections of schistasomiasis
What drugs can cause raynauds
β-blockers, ergotamine, phenylephrine, chemotherapy
What do we use to treat raynauds
Calcium channel blockers
What study should follow after a patient demonstrates positive tinsel sign and palen?
Nerve conduction studies
What‘s the treatment for rheumatoid arthritis
The treatment is DMARD methotrexate, and in severe cases entanercept
Where are the most common areas to obtain bursitis?
The electron faucet and prepatellar treatment includes rest and NSAIDS
What is the acute treatment for gout?
Colchicine
What is the chronic treatment for gout?
Allopurinol
Anticoagulation for Patients with renal failure
Heparin unfractioned, low molecular weight, heparin, and 10 a inhibitors are contraindicated in patients with kidney disease
To prevent cardiac remodeling after a myocardial infarction what drug do we give?
Ace inhibitor
Drugs that decrease mortality in MI?
Aspirin ACE inhibitors and beta blockers 
What drugs, decrease mortality, in chronic heart failure
Beta blockers spironolactone, and Ace, inhibitors
What’s the treatment for SVT tachycardia?
If stable carotid massage and adenosine if the patient is not stable, then we will use synchronized cardioversion
What’s the treatment for ventricular tachycardia?
Amiodarone if the patient is stable, it’s a patient is unstable, then will do synchronized cardioversion
How do you treat someone with pulseless Vtach
Defibrillation
How do you treat somebody with ventricular fibrillation?
Defibrillation
PEA
Push epinephrine compressions then adenosine (this and asystole are unshockable rhythms)
Patients with pronlonged QT are susceptible to this ventricular tachyvardia?
Torsades
What is the single largest risk factor for the advancement of atherosclerosis?
Smoking
If a patient has a medial malleolus ulcer what is usually the cause?
Venous insufficiency
How do you diagnose spontaneous bacterial peritonitis?
First, you have to get a paracentesis fluids, showing neutrophilia and white blood cell count greater than 250 is diagnostic
Asthma, Rhino-sinusitis, Eosinophilia is specific to what vasculidity?
Churgg strauss
What is the first step in work up for giant cell arteritis?
First obtain CRP and ESR levels.
ESR should be greater than 40
What is the most common complication of Giant cell arteritis?
Aneurysm
_____ vasculitis cause ANCA-positive necrotizing vasculitis, predominantly affecting vessels in lung (modular cavities), kidney, and ear-nose-throat.
Granulomatous with polyangitis
