Uworld reiview 3 Flashcards
1
Q
What causes the increased incidence of serous otitis media in pts with AIDS?
A
LAD blocks drainage
2
Q
Why does TB usually reactivate in the upper lung fields?
A
Lower amount of lymphatic drainage and higher oxygen tensions
3
Q
How is acne caused by steroid use different than normal acne?
A
Monomorphic papules without associated comedones
4
Q
What is the treatment for steroid induced acne?
A
D/c the steroid (usual acne treatment ineffective)
5
Q
What is chloracne?
A
Severe skin disorder caused by exposure to halogenated hydrocarbons
6
Q
How do you diagnose pneumocystis pneumonia?
A
Bronchoalveolar lavage–will NOT grow on culutre
7
Q
What does a Beta-D glucan test assess for?
A
Fungal infections
8
Q
What are the criteria for toxic megacolon?
A
Fever
Pulse over 120
Leukocytosis
Anemia
9
Q
What will plain abdominal films show with toxic megacolon?
A
- Total or segmental nonobstructive colonic dilatation
- Possible multiple air-fluid levels
- Thick haustral markings that do not extend across lumen
10
Q
What common diseases predispose pts to toxic megacolon?
A
IBDs
Diverticulitis
11
Q
What size of a pulmonary nodules is a low, intermediate, and high risk for malignancy?
A
Low = Less than 0.8 cm Intermediate = 0.8-2 cm High = 2 cm or more
12
Q
What ages corresponds with low, intermediate, and high risk for pulmonary nodule malignancy?
A
Low = less than 40
Intermediate = 40-60
High 60+
13
Q
What smoking status corresponds with low, intermediate, and high risk for pulmonary nodule malignancy?
A
Low = never smoked Intermediate = Current High = current
14
Q
Smoking cessation lasting for how long corresponds with low, intermediate, and high risk for pulmonary nodule malignancy?
A
Low = Over 15 years Intermediate = 5-15 High = less than 5 years
15
Q
What nodule margin characteristics for low, intermediate, and high risk pulmonary nodules?
A
Low = smooth intermediate = scalloped HIgh = corona radiata or spiculated
16
Q
What is the treatment for a lung nodule in a pt with high risk for malignancy?
A
Surgery
17
Q
What size of lung nodule in a pt with low to intermediate risk of malignancy determine surgery vs serial CT scans?
A
8 or more mm then bx
5-7, serial CT scans
4 or less, no f/u needed
18
Q
What is the next diagnostic step needed for an intermediate-low risk pt with a new found lung nodule that is over 8 mm?
A
PET scan or bx
19
Q
What causes the hypercoagulable state with nephrotic syndrome?
A
Loss of antithrombin III
20
Q
How does acute thrombosis of the renal vein present?
A
Sudden onset of flank/abdominal pain, hematuria, and fever
21
Q
Renal vein thrombosis is most common with what type of nephrotic syndrome?
A
Membranous glomerulopathy
22
Q
What are the indications for an MRI for radicular back pain?
A
Progressive sensory or motor deficits
cauda equina
Epidural abscess concern
23
Q
What are the lab findings consistent with Paget’s disease of bone?
A
Increased alk-phos
Ca and phos normal
24
Q
What is the pharmacotherapy for Paget’s disease? MOA?
A
Bisphosphonates
Inhibit osteoclasts and suppress bone turnover
25
What is the MOA and use of alendronate?
Bisphosphonates
| Inhibits osteoclasts and suppress bone turnover
26
True or false: asymptomatic paget's disease can be observed
True
27
What brain insult can untreated status epilepticus cause?
Cortical necrosis
28
Poor retention of subjects in a cohort study is characteristic of what type of bias?
Attrition bias
29
What is ascertainment (sampling) bias?
Study population differs from target population due to nonrandom selection methods
30
What is nonresponse bias?
High nonresponse rate to survey/questionnaires
31
What is Berkson bias?
Disease studied using only hospital-bed pts
32
What is prevalence (Neyman) bias?
Exposures that happen long before disease assessment can cause study to miss disease pts what die early or recover
33
What is reporting bias?
Subjects over or underreport exposure history d/t stigmatization
34
What is recall bias?
Subjects with negative outcomes more likely to report certain exposures
35
What is observer bias?
Observers misclassify data due to individual differences in interpretation or preconceived expectations
36
What is surveillance bias?
Risk factor itself cause increased monitoring in exposed group relative to unexposed
37
What timeframe distinguishes subate vs chronic cough?
3-8 weeks is subacute
| 8+ is chronic
38
What is the recommended PEP for HIV needle stick?
Draw pts blood for serology, and start HAART with 3 drugs for 4 weeks
39
What veins are the most common location for a clot to develop and cause a PE?
Thigh veins (e.g. femoral, popliteal, iliac, etc)
40
When should dextrose be added to the IVFs in the treatment of DKA?
When serum glucose at or lower than 200 mg/dL
41
When should IV insulin be switched for SQ insulin in the treatment of DKA? (glucose, anion gap, HCO3)
Able to eat
GLucose less than 200 mg/dL
Anion gap less than 12
Serum HCO3 15 or greater
42
What is the correction for pseudohyponatremia 2/2 hyperglycemia?
Observed Na + 2 mEq/L for every 100 mg/dL glucose is over 100
43
How does amiodarone induced interstitial pneumonitis present? (4)
Progressive dyspnea
Nonproductive cough
Bilateral infiltrates with ground glass
Restrictive
44
What class of antiarrhythmics cause QRS prolongation with elevated heart rates? Why?
- Class I
| - Blocks Na channels but have slow binding and dissociation. When heart rate goes faster, this problem is exacerbated.
45
What type of diuretic enhances natriuresis, decreases serum ang II levels, and decreases aldosterone production?
Direct renin inhibitors
46
What inhalation injury is treated for without evidence of it? Why?
HCN poisoning
| Blood levels cannot be measured rapidly to confirm diagnosis
47
What are the s/sx of HCN poisoning?
Neurological and cardiorespiratory stimulation
HA
Vertigo
Hyperventilation
48
What is the treatment for HCN poisoning? MOA?
Hydroxocobalamin or sodium thiosulfate which directly binds cyanide molecules
ALternatively, Nitrites can cause Fe2+ to Fe3+ which binds CN
49
What causes methemoglobinemia?
Oxidizing agents like dapsone
| Topical/local anesthetics
50
What causes the lactic acidosis 2/2 to HCN toxicity?
Inability of tissues to utilize energy 2/2 binding cytochrome
51
What is the diagnostic test for esophageal rupture?
Water soluble contrast esophagram
52
What sort of dementia is characterized by rapid progression and myoclonus?
Prion disease
53
What is general paresis?
A dementing illness that is a form of late neurosyphilis Characterized by decreased concentration, memory loss, personality changes, dysarthria, irritability, and HAs
54
Which test for syphilis will be nonreactive in late neurosyphilis?
RPR
55
Describe the rash of scabies. (quality, location, symptoms)
Intensely pruritic rash with small, crusted rep papules and linear burrows. Vesicles and pustules can also develop.
Usually found on extensor surfaces of the wrist, lateral surfaces of the fingers,
56
What is the treatment for scabies?
Topical Permethrin or oral ivermectin
57
Where are the plaques of eczema usually found?
Flexor surfaces
58
True or false: if there is a liver mass, but a colonoscopy shows cancer, there is no need to bx the liver mass
True
59
What are the exposures that increase the risk for hepatic angiosarcoma? (3)
Vinyl chloride
Inorganic arsenic compounds
Thorium dioxide
60
What type of liver mass can occur 2/2 OCP use?
Hepatic adenomas
61
Which type of macrocytic anemia causes hyper methylmalonic acidemia?
B12
62
Under what CD4 count is an indication for prophylaxis against PCP? What is the drug used?
200
| TMP-SMX
63
Under what CD4 count is an indication for prophylaxis against toxoplasmosis? What is the drug used?
Less than 100
| TMP-SMX
64
Under what CD4 count is an indication for prophylaxis against MAC? What is the drug used?
CD4 count less than 50
| Azithromycin
65
Under what CD4 count is an indication for prophylaxis against histoplasmosis? What is the drug used?
Less than 50
| Itraconazole
66
Under what CD4 count is an indication for prophylaxis against candidiasis? What is the drug used?
No prophylaxis
67
What are the HACEK organisms that cause endocarditis?
- Haemophilus aphrophilus
- Aggregatibacter actino...
- Cardiobacterium hominis
- Eikenella corrodens
- Kingella Kingae
68
Where is Eikenella normal flora?
Mouth
69
What is the initial intervention in the treatment of claudication?
Graded exercise program
70
What meds are indicated if a pt has claudication? Why?
ASA and statin since evidence of CAD
71
Statins are indicated for people with atherosclerotic cardiovascular disease. What does this mean?
If h/o stroke, ACS, TIA, CAD, or PAD
72
When is surgery indicated for the treatment of claudication?
If limb threatened by complications
73
What is the best diagnostic test for chronic pancreatitis? What does this classically show?
CT scan showing calcifications
74
If a pt suspected of having B12 deficiency, but also has another autoimmune disorder present, what should be suspected as the etiology?
Pernicious anemia
75
If a DM pt is infected and has prerenal azotemia, what medication should be stopped, if they are taking it? Why?
Metformin
| Hypotension may lead to acute tubular necrosis
76
What happens to ESR and CK with glucocorticoid induced myopathy?
Both normal
77
What happens to ESR and CK with polymyalgia rheumatica?
Increased ESR
| Normal CK
78
What happens to ESR and CK with inflammatory myopathies
Both increased
79
What happens to ESR and CK with statin induced myopathy?
Normal ESR, but increased CK
80
What happens to ESR and CK with hypothyroid myopathy?
Normal ESR
| Elevated CK
81
What are the s/sx of glucocorticoid induced myopathy?
Painless muscle weakness and atrophy
82
What are the s/sx of polymyalgia rheumatica?
Pain and stiffness in the shoulder and pelvic girdle
83
What are the s/sx of inflammatory myopathies?
Skin rash and inflammatory arthritis
84
What are the s/sx of hypothyroid myopathy?
Muscle pain, cramps, and weakness associated with Hypothyroid features
85
What other electrolyte abnormality makes hypokalemia difficult to treat? Why?
- Hypomagnesemia
| - Intracellular Mg is thought to inhibit K secretion by renal outer medullary potassium (ROMK) channels
86
What are light's criteria for diagnosing an exudative parapneumonic effusion? (3)
- Pleural fluid protein/serum protein over 0.5
- Pleural fluid LDH/Serum LDH over 0.6
- Pleural fluid LDH over 2/3 ULN for serum LDH
87
What level of pH, WBC, and glucose levels are characteristic of empyema as opposed to a sterile parapneumonic effusion?
pH less than 7.2
WBC over 50,000
Low Glucose
88
What is the treatment for mild and severe hyponatremia 2/2 SIADH?
```
Mild = fluid restriction
Severe = hypertonic saline
```
89
Pts with SIADH and serum Na levels less than what level require active resuscitation of Na levels?
120 or less
90
How can you distinguish between s/sx of guillain-barre syndrome vs tick-borne paralysis?
- There is no autonomic dysfunction with tick
| - No albumin/cytologic dissociation with tick
91
How does optic neuritis present?
unilateral eye pain and vision loss, with optic disc edema
92
What happens to electrolyte levels with tumor lysis syndrome? Why?
Increased K
Increased PO3
Decreased Ca since PO3 binds it
93
What are the lab tests to order to diagnose acute Hep B infection? (2) Why?
HBsAg --first to appear
| IgM anti-HBc --present during the window period
94
What overdose substance classically causes optic disk hyperemia, and can lead to blindness?
Methanol
95
What sort of medications classically set off acute angle closure glaucoma?
Anti-cholinergics
96
What is the MOA and use of Trihexyphenidyl?
Anticholinergic used to treat tremors in parkinson's disease
97
What is the MOA and use of entacapone?
COMT inhibitor used to decrease peripheral conversion of dopamine
98
Is an essential tremor brought on or relieved by rest?
Relieved by rest--worsened with movement
99
What is the MOA and use of selegiline?
MOA-B inhibitor used to treat PD
100
Which has more of an effect in the treatment of CHF: ACE inhibitor, or alcohol cessation in a heavy drinker
EtOH cessation
101
True or false: sensitivity and specificity are affected by pretest probability
False- NPV and PPV are
102
What is sialadenosis, and in whom is it commonly seen?
Nontender, noninflammatory swelling of salivary glands, commonly found in alcoholics. It is associated with abnormal autonomic innervation of the glands with accumulation of secretory material
103
What is the typical lesion associated with actinic keratosis?
Scaly papules or plaques
104
In panhypopituitarism, would you expect aldosterone to be low, normal, or high?
Normal since aldosterone secretion is regulated primarily by the RAAS and it NOT affected in hypopituitarism
105
What are risk factors for the development of diverticulitis in a pt with diverticulosis?
Obesity / physical activity
Meat consumption
ASA/NSAID use
106
What are the two major indications for abx treatment for a COPD exacerbation?
- COPD exacerbation (two or more cardinal symptoms) with increased sputum production
- Mechanical vent requirement (intubation or noninvasive)
107
What is the role of inhaled glucocorticoids in acute COPD exacerbation?
None--good for asthma though
108
When is IV Mg indicated for respiratory problems?
severe acute asthma attack
109
When are sputum samples collected in the workup of COPD exacerbation? Why?
If suspecting pseudomonas
DIfficult to isolate a single pathogen from sputum sample
110
What abx should be used for a severe COPD exacerbation?
Macrolide or fluoroquinolone
111
What is the MOA, use, and major adverse effect of hydroxychloroquine?
TNF and IL-1 inhibition
SLE
Retinopathy
112
What is the MOA, use, and major adverse effects of methotrexate?
Purine antimetabolite
RA
Hepatotoxic, stomatitis, cytopenias
113
What is the MOA, use, and major adverse effects of leflunomide?
Pyrimidine synthesis inhibitor
Hepatotoxic
Cytopenias
114
What is the MOA, use, and major adverse effects of sulfasalazine?
TNF and IL-1 suppressor
IBDs, RA
Hepatotoxic, stomatitis, hemolytic anemia
115
What should SLE pts be screened for periodically?
CBCs
Inflammatory markers
ANA
Complement levels
116
When is a detailed metabolic evaluation needed for kidney stones?
If recurrent renal stones.
117
What is the use of PSA, besides following CA?
May be used in *symptomatic* individuals to assess CA. Note this is NOT a screen
118
What are the four major laboratory clues in legionnaires disease?
- Hyponatremia
- Hepatic dysfunction
- Hematuria/proteinuria
- Sputum stain with many PMNs, but few or no organisms
119
What are the four major clinical clues of legionnaires disease?
- Fever of 102.2
- Bradycardia despite febrile
- GI s/sx
- Neuro s/sx
120
What is the treatment for Legionella?
Macrolide or fluoroquinolone
121
What are the characteristics of legionella?
Intracellular Gram negative rod
122
What culture is used for legionella?
Buffered Charcoal yeast extract
123
How can you distinguish empyemas from pleural abscesses?
An abscess will be loculated with an air-fluid level, whereas an empyema is diffuse appearing
124
What is the order to tests used to diagnose acromegaly?
- IGF levels
- Oral glucose GH suppression test
- MRI of brain
125
Why is IGF-1 the preferred initial test for GH excess?
GH levels can fluctuate widely throughout the day
126
What are the three classic drugs that can set off a G6PD hemolytic rxn?
- TMP-SMX
- Dapsone
- Primaquine
127
What are the 3 first line agents used to treat stable angina?
ASA
Beta blockers or CCBs
NTG PRN
128
What are the skin manifestations of blastomycosis?
Wart-like
Violaceous nodules
Skin ulcers
129
What are the GU findings of blastomycosis?
Prostatitis
| Epididymitis / orchitis
130
What is the treatment for mild, moderate, and severe blastomycosis infx?
MIld or mod = itraconazole
| Severe = AMP b
131
Where is blastomycosis endemic to?
Mississippi river valley and midwest
132
What are the skin manifestations of coccidioidomycosis?
Erythema nodosum
| Erythema multiforme
133
What is the first line agent to lower triglycerides in a patient with otherwise normal cholesterol levels?
Statin
134
What is the imaging modality of choice for following a AAA?
US
135
What must always be r/o in suspected cases of achalasia? How do you do this?
Esophageal malignancy
| Endoscopy
136
What characteristics/risk factors suggest a diagnosis of esophageal cancer over achalasia?
Fast onset
h/o smoking
Over 60 years
Weight loss
137
What disease process should be suspected with bone pain, anemia, hypercalcemia, and AKI?
Multiple myeloma
138
What hemoglobin level would indicate the need for a pRBC transfusion:
- Generally
- pts with cardiac surgery/HF/oncology
- Symptomatic anemia/ongoing bleeding/ACS
- Generally = less than 7
- HF or oncology pts = 7-8
- Symptomatic anemia/ACS = 8-10
139
At what level of platelets is a platelet transfusion indicated for bleeding and nonbleeding pts respectively?
```
Bleeding = under 50
Nonbleeding = under 10
```
140
When is whole blood used for transfusions?
Severe hemorrhage pts
141
When can live attenuated vaccines be given to HIV pts?
Over 200 CD4 counts
142
What sort of anemia may occur with methotrexate use?
Macrocytic
143
Which DMARD has alopecia as a side effect?
Methotrexate
144
What syndrome causes knee pain when squatting or climbing stairs? What is the classic PE test for this?
Patellofemoral syndrome
| Patellofemoral compression test
145
Episodic pain and TTP at the inferior patella in an athlete suggest what syndrome?
Patellar tendonitis
146
What is the classic presentation of internuclear ophthalmoplegia?
A disorder of conjugate horizontal gaze, in which the affected eye (ipsilateral to the lesion) is unable to adduct, and the contralateral eye abducts with nystagmus
147
Where is the lesion located with INO?
Ipsilateral medial longitudinal fasciculus
148
What does the Edinger-westphal nucleus control?
Parasympathetic input of CN III, thus eye dilation and
149
When is the meningococcal vaccine given (twice)?
Once at age 11-12
| Again at 16-21
150
What destinations warrant a meningococcal booster?
Central Africa
Mecca
Saudi Arabia
151
What vaccines are contraindicated when pts are on TNF-alpha inhibitor/antagonists?
Live attenuated
152
What are the three major contraindications to vaccination against yellow fever?
CD4 less than 200
Immunosuppressive therapy
Allergy to vaccine components
153
What is the most common underlying valve condition that predisposes a pt to endocarditis (not in a drug user)?
Mitral regurg (mitral stenosis is less common)
154
What sort of immune rxn occurs with ASA associated asthma? What is the pathophysiology?
Pseudoallergic drug rxn
| NSAID use shunts arachidonic acid production away from prostaglandins to leukotrienes
155
How long does asthma-exacerbated respiratory disease take to cause symptoms? What are the s/sx?
30 minutes to 3 hours
- Periorbital edema
- cough, wheezing
- Rhinorrhea and nasal congestion
156
What is the pathophysiology of lupus nephritis?
Immune complexes composed of anti-dsDNA deposits into mesangium and activates complement cascade, lower C3 and C4 levels
157
What part of the brain is affected in a sudden onset contralateral sensory loss involving all sensory modalities?
Thalamus
158
How do midbrain strokes present? (3)
Ipsilateral oculomotor nerve palsy
ataxia
contralateral hemiparesis
159
What is thalamic pain syndrome?
s/p thalamic stroke causes allodynia in affected area
160
What artery occlusion cause lateral medullary infarct? S/sx?
- Posterior inferior cerebellar artery
- Loss of pain/temp sensation over the ipsilateral face and contralateral body (due to spinal trigeminal and spinothalamic tract)
- Ipsilateral bulbar muscles
161
Stroke to the putamen leads to what symptoms?
the internal capsule that lies adjacent to the putamen is almost always involved, leading to contralateral hemiparesis, sensory loss, and conjugates gaze palsy
162
What are the characteristics of dermatitis herpetiformis?
Intensely pruritic erythematous papules, vesicles, and bullae that occur symmetrically in grouped ("Herpetiform") clusters on the extensor surfaces, back, and buttocks
163
What are the characteristics of the rash of erythema multiforme?
Erythematous papules and plaques that evolve into target lesions
164
What are the characteristics of psoriasis?
Erythematous, sharply demarcated, scaling papules that coalesce to form plaques on extensor surfaces
165
How does carcinoid syndrome lead to niacin deficiency?
Serotonin is synthesized in carcinoid cells from Y, which is alo used in the production of niacin or nicotinic acid. Advanced disease results in increased Y conversion to 5HT,
166
What is vitamin deficiency causes pellagra? S/sx?
```
Niacin
Dermatitis
Dementia
Diarrhea
Death
```
167
What is the D-xylose test?
D-xylose in a monosaccharide that can be absorbed in the proximal small intestine without degradation by pancreatic or brush border enzymes. It is subsequently excreted in the urine. In the test, the patient is given an oral dose, with subsequent assay of urine and venous blood. Pts with proximal small intestinal mucosal disease cannot absorb the d-xylose, and urinary/blood levels will be low.
By contrast, pts with malabsorption due to enzyme deficiencies will have normal absorption of D-xylose.
This test can be false positive if renal function is down or delayed gastric empyting
168
What main effect does NTG have on hemodynamics of the heart?
Decreased left ventricular volume d/t systemic vasodilation (more of an effect than coronary vasodilation)
169
What is the first abnormality that uncontrolled DM has on the kidneys? Following steps?
1. Glomerular hyperfiltration
2. GBM thickening
3. Mesangial expansion
4. Nodular sclerosis
170
What are the lab abnormalities associated with Paget's disease?
Elevated alk phos
| Elevated urine hydroxyproline
171
What are the effects on the skull of Paget's disease?
Hearing loss
| Headaches
172
What are the effects of Paget's disease on the spine?
Spinal stenosis
| Radiculopathy
173
What is the effect of Paget's disease on bones?
Bowing
Fractures
Arthritis
174
What are the classic x-ray findings for Paget's disease?
Osteolytic or mixed lytic/sclerotic lesions with focal increase in uptake on bone scan
175
What is the pharmacotherapy for Paget's disease?
Bisphosphonates
176
What is the underlying pathophysiology of Paget's disease?
Abnormal osteolytic activity leading to increased bone turnover and disordered bone remodeling
177
How does hearing loss occur with Paget's disease?
Enlargement of the temporal bone and encroachment on the cochlea
178
What will CXR show in cases of amiodarone induce lung disease?
Pulmonary fibrosis
179
When is endoscopy indicated for the workup of suspected H.Pylori infection?
Age over 55, or with warning (B) symptoms
180
What parasite causes Chagas disease?
Trypanosoma cruzi
181
What are the two main symptoms of Chagas disease?
Megacolon and cardiac disease
182
What is the formula to correct Ca levels for low albumin levels?
Measured Ca + 0.8*(4-albumin level)
183
What are the three antibodies that may be present with antiphospholipid antibody syndrome?
- Anticardiolipin
- Anti-beta2-glycoprotein-I-ab
- Lupus anticoagulant
184
What is the treatment for antiphospholipid ab syndrome?
Life-long anticoagulation
185
What is the treatment of choice for agitation in the elderly?
Haldol
186
Why is angiodysplasia more common in pts with AS, vWF disease, and renal disease?
Acquired vWF factor deficiency from disruption of the vW multimers as the traverse the turbulent valve space/
187
A subauricular bruit in a young female pt is suggestive of what disease?
Fibromuscular dysplasia
188
What is the drug of choice for treating flash pulmonary edema 2/2 MI? What is not, and why?
Furosemide
| Beta blockers are contraindicated since HF
189
What are the s/sx of digoxin toxicity?
Anorexia
N/v
Abdominal pain
Color vision changes
190
What is the most common type of arrhythmia that can occur with an MI?
Reentrant ventricular arrhythmias or v-fib
191
What is the pathophysiology of peri-infarction arrhythmias? (2)
- Immediate arrhythmias are within 10 minutes of onset, and are due to ischemic areas causing a reentrant circuit
- Delayed is over 10 mins, and are caused by abnormal automaticity
192
Inferior wall MI can lead to what sort of arrhythmia?
AV nodal block
193
When is renal artery stenting indicated for renal artery stenosis?
If not manageable by ACEIs or ARBs
194
What is the pathophysiology of esophageal dysmotility 2/2 systemic sclerosis?
Smooth muscle atrophy, and fibrosis
195
What are the saline responsive causes of metabolic alkalosis? (5)
- Vomiting
- Gastric suctioning
- Diuretics
- Laxative abuse
- Decreased oral fluid intake
196
What are the saline unresponsive / resistant causes of metabolic alkalosis? (3)
- Primary hyperaldosteronism
- Cushing's
- Severe hypokalemia
197
Describe the pathophysiology behind saline responsive metabolic alkalosis?
Loss of H+ and fluid causes kidney to sense volume loss, and increase aldosterone production. This lead to H+ loss (H+ follows K+)
198
What is the definition of chronic bronchitis?
Cough lasting for more than 3 months, in 2 consecutive years
199
How does the history of chronic bronchitis differ from bronchiectasis?
Bronchiectasis is more productive, and associated with recurrent infections
200
What is advanced sleep phase syndrome?
Circadian rhythm disorder characterized by the inability to stay awake in the evening, and waking early
201
What is delayed sleep phase disorder?
Inability to fall asleep at normal times, difficulty waking in the morning, and excessive early daytime sleepiness
202
What is the treatment for diffuse esophageal spasms?
CCBs
203
How do you diagnose diffuse esophageal spasm?
Manometry device for long period
204
Corkscrew pattern on Ba swallow is characteristic of what disease?
Diffuse esophageal spasm
205
Which type of drugs will increase warfarin's effect: CYP450 inhibitors or inducers?
Inhibitors
206
What is the effect of spinach, brussel sprouts, and ginseng on warfarin?
Decrease it 2/2 increased vitamin K
207
What is the effect of acetaminophen on warfarin levels?
Increased 2/2 inhibition of CYP450 enzymes
208
What are the s/sx of small bowel bacterial overgrowth?
Frequent episodes of watery diarrhea, flatulence, and abdominal pain
-Malabsorption/ weight loss
209
What are the causes of small bowel bacterial overgrowth?
Stricture, surgeries, motility disorders, anything that allows bacteria to grow in places that they should not be, like in the duodenum where the acidity of gastric contents normally kills bacteria
210
How does cyclosporin cause hyperkalemia?
Blocks aldosterone activity
211
How does trimethoprim cause hyperkalemia?
Blocking epithelial Na channels in the collecting tubules, similar to the diuretic amiloride
212
What are the major adverse effects of azithromycin?
QT prolongation and cholestasis
213
What is the major adverse effect of trastuzumab? HOw does this typically manifest?
- Cardiotoxicity
| - Asymptomatic decline in left ventricular ejection fraction
214
What are the major adverse effects of platinum based chemotherapy agents?
Ototoxic
215
What is the major adverse effect of aromatase inhibitors in postmenopausal women?
Osteoporosis
216
For what chemotherapy drug is a bone marrow bx indicated prior to starting treatment?
5FU
217
Which chemotherapy drug classically causes pulmonary fibrosis?
Bleomycin
218
What are the recommendations regarding AAA screening?
Once for men aged 65-75 who have smoked more than 100 cigarettes in their lifetime
219
When is metronidazole alone indicated for the treatment of c.diff?
- WBC less than 15
| - Cr less than 1.5x baseline
220
When is the addition of metronidazole to vanco indicated in the treatment of C.diff?
If ileus is present
221
What are the indications for a subtotal colectomy for the treatment of C.diff?
WBC over 20
Lactate over 2.2
Toxic megacolon
Severe ileus
222
When is fidaxomicin indicated in the treatment of C.diff?
Reserved for recurrent colitis or if cannot tolerate vanco
223
What are the head CT findings of diffuse axonal injury?
Punctate hemorrhages and blurring of the gray-white matter interface
224
What is the treatment for prostate CA mets to the spine?
RXT
225
What is the role of etidronate in the treatment of bony mets from prostate cancer?
Reduces bone resorption, so reduces pain, but is slow in onset
226
What is the MOA and use of flutamide?
Anti-androgen used to prolong survival of prostate CA pts
227
What is the common side effect that occurs early with levodopa/carbidopa therapy?
Hallucinations
228
When do involuntary movements associated with levodopa/carbidopa therapy occur?
5-10 years of treatment
229
What are the major side effects of amantadine use?
Ankle edema and livedo reticularis
230
Are cholinergics or anticholinergics used to treat parkinson's?
Anticholinergics like benztropine
231
What is acute erosive gastropathy, and what is the pathophysiology?
Hemorrhagic lesions in the stomach after the exposure of gastric mucosa to various injurious agents, or after a substantial reduction in blood flow
232
What is the role of the following in acute erosive gastropathy:
- ASA
- Cocaine
- EtOH
- ASA = decreases protective prostaglandins
- Cocaine = vasoconstriction of gastric vessels
- EtOH = direct mucosal injury
233
How does an aortoenteric fistula present?
Massive hematemesis
234
What cause of abdominal pain is classically associated with cocaine use?
Mesenteric ischemia
235
When is US vs CT scan indicated for suspected pancreatic cancer?
US if in the head
| CT if in the tail
236
When is SCC of the skin suspected?
Patients with rough, scaly nodule or nonhealing, painless ulcer the develops in the setting of a scar or chronic inflammatory lesion
237
What is the treatment for keloids?
Intralesional glucocorticoids
238
What is used to treat actinic keratosis?
5FU
239
What is the natural h/o leukoplakia?
- 1-20% go on to develop into SCC
| - Most stop after cessation of irritant
240
What are the two common irritants that cause leukoplakia?
EtOH
| Tobacco
241
How does toxic megacolon present?
h/o IBD,
Fever
Hypotension
Abdominal distention and absent bowel sounds
242
What is the treatment for toxic megacolon?
- Bowel rest, NG suction, abx (steroids if 2/2 IBD)
| - Surgery if unresponsive
243
What is the classic abdominal x-ray finding for toxic megacolon?
More than 6 cm of colonic distention
244
Why are Ba enema and colonoscopy contraindicated in the work up of toxic megacolon?
Risk of perforation
