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A2 > Uworld reiview 3 > Flashcards

Uworld reiview 3 Flashcards

1
Q

What causes the increased incidence of serous otitis media in pts with AIDS?

A

LAD blocks drainage

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2
Q

Why does TB usually reactivate in the upper lung fields?

A

Lower amount of lymphatic drainage and higher oxygen tensions

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3
Q

How is acne caused by steroid use different than normal acne?

A

Monomorphic papules without associated comedones

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4
Q

What is the treatment for steroid induced acne?

A

D/c the steroid (usual acne treatment ineffective)

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5
Q

What is chloracne?

A

Severe skin disorder caused by exposure to halogenated hydrocarbons

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6
Q

How do you diagnose pneumocystis pneumonia?

A

Bronchoalveolar lavage–will NOT grow on culutre

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7
Q

What does a Beta-D glucan test assess for?

A

Fungal infections

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8
Q

What are the criteria for toxic megacolon?

A

Fever
Pulse over 120
Leukocytosis
Anemia

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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
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10
Q

What common diseases predispose pts to toxic megacolon?

A

IBDs

Diverticulitis

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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
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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+

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13
Q

What smoking status corresponds with low, intermediate, and high risk for pulmonary nodule malignancy?

A 
Low = never smoked
Intermediate = Current
High = current
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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
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15
Q

What nodule margin characteristics for low, intermediate, and high risk pulmonary nodules?

A 
Low = smooth
intermediate = scalloped
HIgh = corona radiata or spiculated
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16
Q

What is the treatment for a lung nodule in a pt with high risk for malignancy?

A

Surgery

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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

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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

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19
Q

What causes the hypercoagulable state with nephrotic syndrome?

A

Loss of antithrombin III

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20
Q

How does acute thrombosis of the renal vein present?

A

Sudden onset of flank/abdominal pain, hematuria, and fever

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21
Q

Renal vein thrombosis is most common with what type of nephrotic syndrome?

A

Membranous glomerulopathy

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22
Q

What are the indications for an MRI for radicular back pain?

A

Progressive sensory or motor deficits
cauda equina
Epidural abscess concern

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23
Q

What are the lab findings consistent with Paget’s disease of bone?

A

Increased alk-phos

Ca and phos normal

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24
Q

What is the pharmacotherapy for Paget’s disease? MOA?

A

Bisphosphonates

Inhibit osteoclasts and suppress bone turnover

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25
Q

What is the MOA and use of alendronate?

A

Bisphosphonates

Inhibits osteoclasts and suppress bone turnover

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26
Q

True or false: asymptomatic paget’s disease can be observed

A

True

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27
Q

What brain insult can untreated status epilepticus cause?

A

Cortical necrosis

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28
Q

Poor retention of subjects in a cohort study is characteristic of what type of bias?

A

Attrition bias

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29
Q

What is ascertainment (sampling) bias?

A

Study population differs from target population due to nonrandom selection methods

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30
Q

What is nonresponse bias?

A

High nonresponse rate to survey/questionnaires

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31
Q

What is Berkson bias?

A

Disease studied using only hospital-bed pts

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32
Q

What is prevalence (Neyman) bias?

A

Exposures that happen long before disease assessment can cause study to miss disease pts what die early or recover

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33
Q

What is reporting bias?

A

Subjects over or underreport exposure history d/t stigmatization

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34
Q

What is recall bias?

A

Subjects with negative outcomes more likely to report certain exposures

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35
Q

What is observer bias?

A

Observers misclassify data due to individual differences in interpretation or preconceived expectations

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36
Q

What is surveillance bias?

A

Risk factor itself cause increased monitoring in exposed group relative to unexposed

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37
Q

What timeframe distinguishes subate vs chronic cough?

A

3-8 weeks is subacute

8+ is chronic

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38
Q

What is the recommended PEP for HIV needle stick?

A

Draw pts blood for serology, and start HAART with 3 drugs for 4 weeks

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39
Q

What veins are the most common location for a clot to develop and cause a PE?

A

Thigh veins (e.g. femoral, popliteal, iliac, etc)

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40
Q

When should dextrose be added to the IVFs in the treatment of DKA?

A

When serum glucose at or lower than 200 mg/dL

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41
Q

When should IV insulin be switched for SQ insulin in the treatment of DKA? (glucose, anion gap, HCO3)

A

Able to eat
GLucose less than 200 mg/dL
Anion gap less than 12
Serum HCO3 15 or greater

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42
Q

What is the correction for pseudohyponatremia 2/2 hyperglycemia?

A

Observed Na + 2 mEq/L for every 100 mg/dL glucose is over 100

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43
Q

How does amiodarone induced interstitial pneumonitis present? (4)

A

Progressive dyspnea
Nonproductive cough
Bilateral infiltrates with ground glass
Restrictive

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44
Q

What class of antiarrhythmics cause QRS prolongation with elevated heart rates? Why?

A
  • Class I

- Blocks Na channels but have slow binding and dissociation. When heart rate goes faster, this problem is exacerbated.

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45
Q

What type of diuretic enhances natriuresis, decreases serum ang II levels, and decreases aldosterone production?

A

Direct renin inhibitors

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46
Q

What inhalation injury is treated for without evidence of it? Why?

A

HCN poisoning

Blood levels cannot be measured rapidly to confirm diagnosis

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47
Q

What are the s/sx of HCN poisoning?

A

Neurological and cardiorespiratory stimulation
HA
Vertigo
Hyperventilation

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48
Q

What is the treatment for HCN poisoning? MOA?

A

Hydroxocobalamin or sodium thiosulfate which directly binds cyanide molecules

ALternatively, Nitrites can cause Fe2+ to Fe3+ which binds CN

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49
Q

What causes methemoglobinemia?

A

Oxidizing agents like dapsone

Topical/local anesthetics

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50
Q

What causes the lactic acidosis 2/2 to HCN toxicity?

A

Inability of tissues to utilize energy 2/2 binding cytochrome

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51
Q

What is the diagnostic test for esophageal rupture?

A

Water soluble contrast esophagram

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52
Q

What sort of dementia is characterized by rapid progression and myoclonus?

A

Prion disease

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53
Q

What is general paresis?

A

A dementing illness that is a form of late neurosyphilis Characterized by decreased concentration, memory loss, personality changes, dysarthria, irritability, and HAs

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54
Q

Which test for syphilis will be nonreactive in late neurosyphilis?

A

RPR

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55
Q

Describe the rash of scabies. (quality, location, symptoms)

A

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,

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56
Q

What is the treatment for scabies?

A

Topical Permethrin or oral ivermectin

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57
Q

Where are the plaques of eczema usually found?

A

Flexor surfaces

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58
Q

True or false: if there is a liver mass, but a colonoscopy shows cancer, there is no need to bx the liver mass

A

True

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59
Q

What are the exposures that increase the risk for hepatic angiosarcoma? (3)

A

Vinyl chloride
Inorganic arsenic compounds
Thorium dioxide

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60
Q

What type of liver mass can occur 2/2 OCP use?

A

Hepatic adenomas

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61
Q

Which type of macrocytic anemia causes hyper methylmalonic acidemia?

A

B12

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62
Q

Under what CD4 count is an indication for prophylaxis against PCP? What is the drug used?

A

200

TMP-SMX

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63
Q

Under what CD4 count is an indication for prophylaxis against toxoplasmosis? What is the drug used?

A

Less than 100

TMP-SMX

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64
Q

Under what CD4 count is an indication for prophylaxis against MAC? What is the drug used?

A

CD4 count less than 50

Azithromycin

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65
Q

Under what CD4 count is an indication for prophylaxis against histoplasmosis? What is the drug used?

A

Less than 50

Itraconazole

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66
Q

Under what CD4 count is an indication for prophylaxis against candidiasis? What is the drug used?

A

No prophylaxis

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67
Q

What are the HACEK organisms that cause endocarditis?

A
  • Haemophilus aphrophilus
  • Aggregatibacter actino…
  • Cardiobacterium hominis
  • Eikenella corrodens
  • Kingella Kingae
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68
Q

Where is Eikenella normal flora?

A

Mouth

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69
Q

What is the initial intervention in the treatment of claudication?

A

Graded exercise program

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70
Q

What meds are indicated if a pt has claudication? Why?

A

ASA and statin since evidence of CAD

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71
Q

Statins are indicated for people with atherosclerotic cardiovascular disease. What does this mean?

A

If h/o stroke, ACS, TIA, CAD, or PAD

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72
Q

When is surgery indicated for the treatment of claudication?

A

If limb threatened by complications

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73
Q

What is the best diagnostic test for chronic pancreatitis? What does this classically show?

A

CT scan showing calcifications

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74
Q

If a pt suspected of having B12 deficiency, but also has another autoimmune disorder present, what should be suspected as the etiology?

A

Pernicious anemia

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75
Q

If a DM pt is infected and has prerenal azotemia, what medication should be stopped, if they are taking it? Why?

A

Metformin

Hypotension may lead to acute tubular necrosis

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76
Q

What happens to ESR and CK with glucocorticoid induced myopathy?

A

Both normal

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77
Q

What happens to ESR and CK with polymyalgia rheumatica?

A

Increased ESR

Normal CK

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78
Q

What happens to ESR and CK with inflammatory myopathies

A

Both increased

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79
Q

What happens to ESR and CK with statin induced myopathy?

A

Normal ESR, but increased CK

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80
Q

What happens to ESR and CK with hypothyroid myopathy?

A

Normal ESR

Elevated CK

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81
Q

What are the s/sx of glucocorticoid induced myopathy?

A

Painless muscle weakness and atrophy

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82
Q

What are the s/sx of polymyalgia rheumatica?

A

Pain and stiffness in the shoulder and pelvic girdle

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83
Q

What are the s/sx of inflammatory myopathies?

A

Skin rash and inflammatory arthritis

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84
Q

What are the s/sx of hypothyroid myopathy?

A

Muscle pain, cramps, and weakness associated with Hypothyroid features

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85
Q

What other electrolyte abnormality makes hypokalemia difficult to treat? Why?

A
  • Hypomagnesemia

- Intracellular Mg is thought to inhibit K secretion by renal outer medullary potassium (ROMK) channels

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86
Q

What are light’s criteria for diagnosing an exudative parapneumonic effusion? (3)

A
  • 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
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87
Q

What level of pH, WBC, and glucose levels are characteristic of empyema as opposed to a sterile parapneumonic effusion?

A

pH less than 7.2
WBC over 50,000
Low Glucose

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88
Q

What is the treatment for mild and severe hyponatremia 2/2 SIADH?

A 
Mild = fluid restriction
Severe = hypertonic saline
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89
Q

Pts with SIADH and serum Na levels less than what level require active resuscitation of Na levels?

A

120 or less

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90
Q

How can you distinguish between s/sx of guillain-barre syndrome vs tick-borne paralysis?

A
  • There is no autonomic dysfunction with tick

- No albumin/cytologic dissociation with tick

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91
Q

How does optic neuritis present?

A

unilateral eye pain and vision loss, with optic disc edema

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92
Q

What happens to electrolyte levels with tumor lysis syndrome? Why?

A

Increased K
Increased PO3
Decreased Ca since PO3 binds it

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93
Q

What are the lab tests to order to diagnose acute Hep B infection? (2) Why?

A

HBsAg –first to appear

IgM anti-HBc –present during the window period

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94
Q

What overdose substance classically causes optic disk hyperemia, and can lead to blindness?

A

Methanol

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95
Q

What sort of medications classically set off acute angle closure glaucoma?

A

Anti-cholinergics

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96
Q

What is the MOA and use of Trihexyphenidyl?

A

Anticholinergic used to treat tremors in parkinson’s disease

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97
Q

What is the MOA and use of entacapone?

A

COMT inhibitor used to decrease peripheral conversion of dopamine

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98
Q

Is an essential tremor brought on or relieved by rest?

A

Relieved by rest–worsened with movement

99
Q

What is the MOA and use of selegiline?

A

MOA-B inhibitor used to treat PD

100
Q

Which has more of an effect in the treatment of CHF: ACE inhibitor, or alcohol cessation in a heavy drinker

A

EtOH cessation

101
Q

True or false: sensitivity and specificity are affected by pretest probability

A

False- NPV and PPV are

102
Q

What is sialadenosis, and in whom is it commonly seen?

A

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
Q

What is the typical lesion associated with actinic keratosis?

A

Scaly papules or plaques

104
Q

In panhypopituitarism, would you expect aldosterone to be low, normal, or high?

A

Normal since aldosterone secretion is regulated primarily by the RAAS and it NOT affected in hypopituitarism

105
Q

What are risk factors for the development of diverticulitis in a pt with diverticulosis?

A

Obesity / physical activity
Meat consumption
ASA/NSAID use

106
Q

What are the two major indications for abx treatment for a COPD exacerbation?

A
  • COPD exacerbation (two or more cardinal symptoms) with increased sputum production
  • Mechanical vent requirement (intubation or noninvasive)
107
Q

What is the role of inhaled glucocorticoids in acute COPD exacerbation?

A

None–good for asthma though

108
Q

When is IV Mg indicated for respiratory problems?

A

severe acute asthma attack

109
Q

When are sputum samples collected in the workup of COPD exacerbation? Why?

A

If suspecting pseudomonas

DIfficult to isolate a single pathogen from sputum sample

110
Q

What abx should be used for a severe COPD exacerbation?

A

Macrolide or fluoroquinolone

111
Q

What is the MOA, use, and major adverse effect of hydroxychloroquine?

A

TNF and IL-1 inhibition
SLE
Retinopathy

112
Q

What is the MOA, use, and major adverse effects of methotrexate?

A

Purine antimetabolite
RA
Hepatotoxic, stomatitis, cytopenias

113
Q

What is the MOA, use, and major adverse effects of leflunomide?

A

Pyrimidine synthesis inhibitor
Hepatotoxic
Cytopenias

114
Q

What is the MOA, use, and major adverse effects of sulfasalazine?

A

TNF and IL-1 suppressor
IBDs, RA
Hepatotoxic, stomatitis, hemolytic anemia

115
Q

What should SLE pts be screened for periodically?

A

CBCs
Inflammatory markers
ANA
Complement levels

116
Q

When is a detailed metabolic evaluation needed for kidney stones?

A

If recurrent renal stones.

117
Q

What is the use of PSA, besides following CA?

A

May be used in symptomatic individuals to assess CA. Note this is NOT a screen

118
Q

What are the four major laboratory clues in legionnaires disease?

A
  • Hyponatremia
  • Hepatic dysfunction
  • Hematuria/proteinuria
  • Sputum stain with many PMNs, but few or no organisms
119
Q

What are the four major clinical clues of legionnaires disease?

A
  • Fever of 102.2
  • Bradycardia despite febrile
  • GI s/sx
  • Neuro s/sx
120
Q

What is the treatment for Legionella?

A

Macrolide or fluoroquinolone

121
Q

What are the characteristics of legionella?

A

Intracellular Gram negative rod

122
Q

What culture is used for legionella?

A

Buffered Charcoal yeast extract

123
Q

How can you distinguish empyemas from pleural abscesses?

A

An abscess will be loculated with an air-fluid level, whereas an empyema is diffuse appearing

124
Q

What is the order to tests used to diagnose acromegaly?

A
  • IGF levels
  • Oral glucose GH suppression test
  • MRI of brain
125
Q

Why is IGF-1 the preferred initial test for GH excess?

A

GH levels can fluctuate widely throughout the day

126
Q

What are the three classic drugs that can set off a G6PD hemolytic rxn?

A
  • TMP-SMX
  • Dapsone
  • Primaquine
127
Q

What are the 3 first line agents used to treat stable angina?

A

ASA
Beta blockers or CCBs
NTG PRN

128
Q

What are the skin manifestations of blastomycosis?

A

Wart-like
Violaceous nodules
Skin ulcers

129
Q

What are the GU findings of blastomycosis?

A

Prostatitis

Epididymitis / orchitis

130
Q

What is the treatment for mild, moderate, and severe blastomycosis infx?

A

MIld or mod = itraconazole

Severe = AMP b

131
Q

Where is blastomycosis endemic to?

A

Mississippi river valley and midwest

132
Q

What are the skin manifestations of coccidioidomycosis?

A

Erythema nodosum

Erythema multiforme

133
Q

What is the first line agent to lower triglycerides in a patient with otherwise normal cholesterol levels?

A

Statin

134
Q

What is the imaging modality of choice for following a AAA?

A

US

135
Q

What must always be r/o in suspected cases of achalasia? How do you do this?

A

Esophageal malignancy

Endoscopy

136
Q

What characteristics/risk factors suggest a diagnosis of esophageal cancer over achalasia?

A

Fast onset
h/o smoking
Over 60 years
Weight loss

137
Q

What disease process should be suspected with bone pain, anemia, hypercalcemia, and AKI?

A

Multiple myeloma

138
Q

What hemoglobin level would indicate the need for a pRBC transfusion:

  • Generally
  • pts with cardiac surgery/HF/oncology
  • Symptomatic anemia/ongoing bleeding/ACS
A
  • Generally = less than 7
  • HF or oncology pts = 7-8
  • Symptomatic anemia/ACS = 8-10
139
Q

At what level of platelets is a platelet transfusion indicated for bleeding and nonbleeding pts respectively?

A 
Bleeding = under 50
Nonbleeding = under 10
140
Q

When is whole blood used for transfusions?

A

Severe hemorrhage pts

141
Q

When can live attenuated vaccines be given to HIV pts?

A

Over 200 CD4 counts

142
Q

What sort of anemia may occur with methotrexate use?

A

Macrocytic

143
Q

Which DMARD has alopecia as a side effect?

A

Methotrexate

144
Q

What syndrome causes knee pain when squatting or climbing stairs? What is the classic PE test for this?

A

Patellofemoral syndrome

Patellofemoral compression test

145
Q

Episodic pain and TTP at the inferior patella in an athlete suggest what syndrome?

A

Patellar tendonitis

146
Q

What is the classic presentation of internuclear ophthalmoplegia?

A

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
Q

Where is the lesion located with INO?

A

Ipsilateral medial longitudinal fasciculus

148
Q

What does the Edinger-westphal nucleus control?

A

Parasympathetic input of CN III, thus eye dilation and

149
Q

When is the meningococcal vaccine given (twice)?

A

Once at age 11-12

Again at 16-21

150
Q

What destinations warrant a meningococcal booster?

A

Central Africa
Mecca
Saudi Arabia

151
Q

What vaccines are contraindicated when pts are on TNF-alpha inhibitor/antagonists?

A

Live attenuated

152
Q

What are the three major contraindications to vaccination against yellow fever?

A

CD4 less than 200
Immunosuppressive therapy
Allergy to vaccine components

153
Q

What is the most common underlying valve condition that predisposes a pt to endocarditis (not in a drug user)?

A

Mitral regurg (mitral stenosis is less common)

154
Q

What sort of immune rxn occurs with ASA associated asthma? What is the pathophysiology?

A

Pseudoallergic drug rxn

NSAID use shunts arachidonic acid production away from prostaglandins to leukotrienes

155
Q

How long does asthma-exacerbated respiratory disease take to cause symptoms? What are the s/sx?

A

30 minutes to 3 hours

  • Periorbital edema
  • cough, wheezing
  • Rhinorrhea and nasal congestion
156
Q

What is the pathophysiology of lupus nephritis?

A

Immune complexes composed of anti-dsDNA deposits into mesangium and activates complement cascade, lower C3 and C4 levels

157
Q

What part of the brain is affected in a sudden onset contralateral sensory loss involving all sensory modalities?

A

Thalamus

158
Q

How do midbrain strokes present? (3)

A

Ipsilateral oculomotor nerve palsy
ataxia
contralateral hemiparesis

159
Q

What is thalamic pain syndrome?

A

s/p thalamic stroke causes allodynia in affected area

160
Q

What artery occlusion cause lateral medullary infarct? S/sx?

A
  • 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
Q

Stroke to the putamen leads to what symptoms?

A

the internal capsule that lies adjacent to the putamen is almost always involved, leading to contralateral hemiparesis, sensory loss, and conjugates gaze palsy

162
Q

What are the characteristics of dermatitis herpetiformis?

A

Intensely pruritic erythematous papules, vesicles, and bullae that occur symmetrically in grouped (“Herpetiform”) clusters on the extensor surfaces, back, and buttocks

163
Q

What are the characteristics of the rash of erythema multiforme?

A

Erythematous papules and plaques that evolve into target lesions

164
Q

What are the characteristics of psoriasis?

A

Erythematous, sharply demarcated, scaling papules that coalesce to form plaques on extensor surfaces

165
Q

How does carcinoid syndrome lead to niacin deficiency?

A

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
Q

What is vitamin deficiency causes pellagra? S/sx?

A 
Niacin
Dermatitis
Dementia
Diarrhea
Death
167
Q

What is the D-xylose test?

A

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
Q

What main effect does NTG have on hemodynamics of the heart?

A

Decreased left ventricular volume d/t systemic vasodilation (more of an effect than coronary vasodilation)

169
Q

What is the first abnormality that uncontrolled DM has on the kidneys? Following steps?

A
  1. Glomerular hyperfiltration
  2. GBM thickening
  3. Mesangial expansion
  4. Nodular sclerosis
170
Q

What are the lab abnormalities associated with Paget’s disease?

A

Elevated alk phos

Elevated urine hydroxyproline

171
Q

What are the effects on the skull of Paget’s disease?

A

Hearing loss

Headaches

172
Q

What are the effects of Paget’s disease on the spine?

A

Spinal stenosis

Radiculopathy

173
Q

What is the effect of Paget’s disease on bones?

A

Bowing
Fractures
Arthritis

174
Q

What are the classic x-ray findings for Paget’s disease?

A

Osteolytic or mixed lytic/sclerotic lesions with focal increase in uptake on bone scan

175
Q

What is the pharmacotherapy for Paget’s disease?

A

Bisphosphonates

176
Q

What is the underlying pathophysiology of Paget’s disease?

A

Abnormal osteolytic activity leading to increased bone turnover and disordered bone remodeling

177
Q

How does hearing loss occur with Paget’s disease?

A

Enlargement of the temporal bone and encroachment on the cochlea

178
Q

What will CXR show in cases of amiodarone induce lung disease?

A

Pulmonary fibrosis

179
Q

When is endoscopy indicated for the workup of suspected H.Pylori infection?

A

Age over 55, or with warning (B) symptoms

180
Q

What parasite causes Chagas disease?

A

Trypanosoma cruzi

181
Q

What are the two main symptoms of Chagas disease?

A

Megacolon and cardiac disease

182
Q

What is the formula to correct Ca levels for low albumin levels?

A

Measured Ca + 0.8*(4-albumin level)

183
Q

What are the three antibodies that may be present with antiphospholipid antibody syndrome?

A
  • Anticardiolipin
  • Anti-beta2-glycoprotein-I-ab
  • Lupus anticoagulant
184
Q

What is the treatment for antiphospholipid ab syndrome?

A

Life-long anticoagulation

185
Q

What is the treatment of choice for agitation in the elderly?

A

Haldol

186
Q

Why is angiodysplasia more common in pts with AS, vWF disease, and renal disease?

A

Acquired vWF factor deficiency from disruption of the vW multimers as the traverse the turbulent valve space/

187
Q

A subauricular bruit in a young female pt is suggestive of what disease?

A

Fibromuscular dysplasia

188
Q

What is the drug of choice for treating flash pulmonary edema 2/2 MI? What is not, and why?

A

Furosemide

Beta blockers are contraindicated since HF

189
Q

What are the s/sx of digoxin toxicity?

A

Anorexia
N/v
Abdominal pain
Color vision changes

190
Q

What is the most common type of arrhythmia that can occur with an MI?

A

Reentrant ventricular arrhythmias or v-fib

191
Q

What is the pathophysiology of peri-infarction arrhythmias? (2)

A
  • 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
Q

Inferior wall MI can lead to what sort of arrhythmia?

A

AV nodal block

193
Q

When is renal artery stenting indicated for renal artery stenosis?

A

If not manageable by ACEIs or ARBs

194
Q

What is the pathophysiology of esophageal dysmotility 2/2 systemic sclerosis?

A

Smooth muscle atrophy, and fibrosis

195
Q

What are the saline responsive causes of metabolic alkalosis? (5)

A
  • Vomiting
  • Gastric suctioning
  • Diuretics
  • Laxative abuse
  • Decreased oral fluid intake
196
Q

What are the saline unresponsive / resistant causes of metabolic alkalosis? (3)

A
  • Primary hyperaldosteronism
  • Cushing’s
  • Severe hypokalemia
197
Q

Describe the pathophysiology behind saline responsive metabolic alkalosis?

A

Loss of H+ and fluid causes kidney to sense volume loss, and increase aldosterone production. This lead to H+ loss (H+ follows K+)

198
Q

What is the definition of chronic bronchitis?

A

Cough lasting for more than 3 months, in 2 consecutive years

199
Q

How does the history of chronic bronchitis differ from bronchiectasis?

A

Bronchiectasis is more productive, and associated with recurrent infections

200
Q

What is advanced sleep phase syndrome?

A

Circadian rhythm disorder characterized by the inability to stay awake in the evening, and waking early

201
Q

What is delayed sleep phase disorder?

A

Inability to fall asleep at normal times, difficulty waking in the morning, and excessive early daytime sleepiness

202
Q

What is the treatment for diffuse esophageal spasms?

A

CCBs

203
Q

How do you diagnose diffuse esophageal spasm?

A

Manometry device for long period

204
Q

Corkscrew pattern on Ba swallow is characteristic of what disease?

A

Diffuse esophageal spasm

205
Q

Which type of drugs will increase warfarin’s effect: CYP450 inhibitors or inducers?

A

Inhibitors

206
Q

What is the effect of spinach, brussel sprouts, and ginseng on warfarin?

A

Decrease it 2/2 increased vitamin K

207
Q

What is the effect of acetaminophen on warfarin levels?

A

Increased 2/2 inhibition of CYP450 enzymes

208
Q

What are the s/sx of small bowel bacterial overgrowth?

A

Frequent episodes of watery diarrhea, flatulence, and abdominal pain
-Malabsorption/ weight loss

209
Q

What are the causes of small bowel bacterial overgrowth?

A

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
Q

How does cyclosporin cause hyperkalemia?

A

Blocks aldosterone activity

211
Q

How does trimethoprim cause hyperkalemia?

A

Blocking epithelial Na channels in the collecting tubules, similar to the diuretic amiloride

212
Q

What are the major adverse effects of azithromycin?

A

QT prolongation and cholestasis

213
Q

What is the major adverse effect of trastuzumab? HOw does this typically manifest?

A
  • Cardiotoxicity

- Asymptomatic decline in left ventricular ejection fraction

214
Q

What are the major adverse effects of platinum based chemotherapy agents?

A

Ototoxic

215
Q

What is the major adverse effect of aromatase inhibitors in postmenopausal women?

A

Osteoporosis

216
Q

For what chemotherapy drug is a bone marrow bx indicated prior to starting treatment?

A

5FU

217
Q

Which chemotherapy drug classically causes pulmonary fibrosis?

A

Bleomycin

218
Q

What are the recommendations regarding AAA screening?

A

Once for men aged 65-75 who have smoked more than 100 cigarettes in their lifetime

219
Q

When is metronidazole alone indicated for the treatment of c.diff?

A
  • WBC less than 15

- Cr less than 1.5x baseline

220
Q

When is the addition of metronidazole to vanco indicated in the treatment of C.diff?

A

If ileus is present

221
Q

What are the indications for a subtotal colectomy for the treatment of C.diff?

A

WBC over 20
Lactate over 2.2
Toxic megacolon
Severe ileus

222
Q

When is fidaxomicin indicated in the treatment of C.diff?

A

Reserved for recurrent colitis or if cannot tolerate vanco

223
Q

What are the head CT findings of diffuse axonal injury?

A

Punctate hemorrhages and blurring of the gray-white matter interface

224
Q

What is the treatment for prostate CA mets to the spine?

A

RXT

225
Q

What is the role of etidronate in the treatment of bony mets from prostate cancer?

A

Reduces bone resorption, so reduces pain, but is slow in onset

226
Q

What is the MOA and use of flutamide?

A

Anti-androgen used to prolong survival of prostate CA pts

227
Q

What is the common side effect that occurs early with levodopa/carbidopa therapy?

A

Hallucinations

228
Q

When do involuntary movements associated with levodopa/carbidopa therapy occur?

A

5-10 years of treatment

229
Q

What are the major side effects of amantadine use?

A

Ankle edema and livedo reticularis

230
Q

Are cholinergics or anticholinergics used to treat parkinson’s?

A

Anticholinergics like benztropine

231
Q

What is acute erosive gastropathy, and what is the pathophysiology?

A

Hemorrhagic lesions in the stomach after the exposure of gastric mucosa to various injurious agents, or after a substantial reduction in blood flow

232
Q

What is the role of the following in acute erosive gastropathy:

  • ASA
  • Cocaine
  • EtOH
A
  • ASA = decreases protective prostaglandins
  • Cocaine = vasoconstriction of gastric vessels
  • EtOH = direct mucosal injury
233
Q

How does an aortoenteric fistula present?

A

Massive hematemesis

234
Q

What cause of abdominal pain is classically associated with cocaine use?

A

Mesenteric ischemia

235
Q

When is US vs CT scan indicated for suspected pancreatic cancer?

A

US if in the head

CT if in the tail

236
Q

When is SCC of the skin suspected?

A

Patients with rough, scaly nodule or nonhealing, painless ulcer the develops in the setting of a scar or chronic inflammatory lesion

237
Q

What is the treatment for keloids?

A

Intralesional glucocorticoids

238
Q

What is used to treat actinic keratosis?

A

5FU

239
Q

What is the natural h/o leukoplakia?

A
  • 1-20% go on to develop into SCC

- Most stop after cessation of irritant

240
Q

What are the two common irritants that cause leukoplakia?

A

EtOH

Tobacco

241
Q

How does toxic megacolon present?

A

h/o IBD,
Fever
Hypotension
Abdominal distention and absent bowel sounds

242
Q

What is the treatment for toxic megacolon?

A
  • Bowel rest, NG suction, abx (steroids if 2/2 IBD)

- Surgery if unresponsive

243
Q

What is the classic abdominal x-ray finding for toxic megacolon?

A

More than 6 cm of colonic distention

244
Q

Why are Ba enema and colonoscopy contraindicated in the work up of toxic megacolon?

A

Risk of perforation

A2 (26 decks)

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