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medicine Clerkship > UWorld2 > Flashcards

UWorld2 Flashcards

1
Q

What is presentation of open angle glaucoma?

A
  • insidious onset, gradual loss of peripheral vision and tunnel vision
    high IOP
    ophtho exam w/ cupping of optic disc
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2
Q

What is presentation of retinal detachment?

A

unilateral sudden curtain falling in front of eye

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3
Q

What are some complications of malaria?

A

jaundic, acute renal failure, pulmonar edema

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4
Q

What are potentially reversible causes of urinary incontinence?

A
  • delirium
  • infection
  • atrophic urethritis/vaginitis
  • pharmaceuticals
  • psychological
  • excess urine output
  • restricted mobility
  • stool impaction
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5
Q

What is next step if pt w/ squamous cell CA in cervical LN w/ negative CT chest?

A

panendoscopy = esophagus, bronch, laryngoscopy to look for primary tumor

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6
Q

What is ppx for HIV exposure?

A

initiate ARB uregntly in first few hours
3 or more drug regimen w/ 2 NRTIs (tenofovir, emtricitabine)
plus integrase inhibitor (raltegravir), protease inhibitor, or NNRTI

for 4 wks

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7
Q

What lifestyle meausres to prevent gout?

A

stop alchol
low purine diet
avoid diuretics, pyrazinamide

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8
Q

What is presentation of entamoeba histolytica?

A

primary infection: blood diarrhea

liver abscess: RUQ pain, single cyst in R lobe

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9
Q

What is tx for entamoeba histolytics?

A

metronidazole

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10
Q

What is tx for carbon monoxide poisoning?

A

100% O2 nonrebreather

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11
Q

What is presentaiton of CO poisoning?

A

confusion, agitation, somnolence, can have seizure

bright cherry red lips

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12
Q

What is level of BHCG and AFP in seminoma?

A

B-HCG elevated
AFP normal

vs non-seminomatous germ cell tumors have both

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13
Q

What is tx for goodpasture?

A

emergent plasmaphoresis

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14
Q

What is tx for wegeners (granulomatosis w/ polyangiitis)?

A

cyclophosphamide + steroids

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15
Q

What is pathophys of goodpasture?

A

anti glomerular basement membrane antibodies

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16
Q

What is MCC sudden cardiac arrest immately post-infarction?

A

reentrant ventricular arrhythmia {V fib]

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17
Q

What type of abx is used to treat serious gram negatives?

A

aminoglycosides

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18
Q

What are complications of ventilation w/ high PEEP?

A
  • alveolar damage
  • tension pneumo
  • hypotension
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19
Q

What is presenation of RCC?

A
  • flank pain, hematuria, palpable abdominal renal mass

L sided scrotal varicoceles –> fail to empty when recumbent 2/2 tumor obstrcution of gonadal vein

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20
Q

What is best test to dx RCC?

A

CT abdomen

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21
Q

What meds do you need to hold for 48 hrs prior to cardiac stress test?

A

BBlockers, CCBs, nitrates

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22
Q

What are the findings of simple, pre-proliferative, and proliferative diabetic retinopathy?

A

simple: microaneruysm, ehmorrhage, exudate, retinal edema
pre-proliferative: cotton woll spots
porlfieratvie: neovascularization

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23
Q

What is presentation of macular degeneration?

A

distorted visiona nd cetnral scotoma

icnraesed risk w/ cigarettes

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24
Q

What is tx for diabetic retinomthy?

A

argon laser photocoagulation

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25
Q

What is presentation of acute prostatitis?

A
  • fever, chills, malaise, myaglia
    pelvic pain, cloudy urine
    pyuria
    tender prostate
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26
Q

What is tx for acute prostatitis?

A

TMP-SMX or flouroquinolones

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27
Q

What plasma K, HCO3 and urine Cl in vomiting?

A
  • low K
  • high bicarb
  • low urine Cl [vs bartter/gitelman/diruetic = high urine Cl]
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28
Q

What things cause hypokalemic metabolic alkalosis w/ high urine Cl?

A

diuretic abuse
bartter
giltelman

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29
Q

What is likely etiology if urine initially w/ hematuria vs urine initially clear then turns red by end of stream vs red the whole time?

A

initial hematuria = urethral damage
terminal hematuria = bladder or prostate damage
total hematuria = damage in kidney or ureters

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30
Q

What is likely etiology of RUQ or epigastric pain w/ N/V/R shoulder pain after fatty meal?

A

biliary colic 2/2 gallstones

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31
Q

What are distinguishing features of fibromyalgia?

A
  • widespread MKS pain in both side
    fatigeu when arising from sleep
    no lab abnormalities (normal ESR/muscle enzymes)
    point tenderness
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32
Q

What are distinguishing features of polymyositis?

A
  • symmetric prox muscle weakness
  • difficulty climing stairs
    elevated muscle enzymes (AST, LDH, aldoalse, CK)
  • emg abnormal
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33
Q

What are distinguishing features of polymyalgia rheumatica?

A 
- age > 50
aching and morning stiffness ? pain
decreased ROM
no significant muscle tenderness
high ESR
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34
Q

What lab levels in DI?

A
  • decreased ADH
  • high serum Na
  • dilute urine
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35
Q

What lab levels in SIADH?

A
  • urine osm ? serum osm
    concentrated urine
    excess H2O reabsorption –> hyponatremia
    low serum uric acid
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36
Q

What vessel, EKG leads in anterior MI?

A

LAD

some or all of V1-V6

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37
Q

What vessel, EKG leads in inferior MI?

A

RCA or LCX

st elevation in II, III, aVF

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38
Q

What vesssel, EKG leads in posterior MI?

A

LCX or RCA
- st depression V1-V3
ST elevation in I, aVL (CX) OR ST depression in I and aVL (RCA)

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39
Q

What vessel, EKG leads in RV MI?

A

RCA

ST elevation in V$-V6R

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40
Q

How do you dx hisoplasmosis?

A
  • cytopenia
  • high LDG and ferritin
  • high LFTs
  • best DX = urine or serum antigen
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41
Q

What is tx for histo?

A

mild to moderate = itrazonazole

severe or disseminated = amphotericin B

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42
Q

What is likely dx if white patch/plaque on oral mucosa that cannot be scraped off?

A

leukoplakia

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43
Q

What is first dx step for back pain w/ some red flags but no sx of cord compression?

A

plain xray and ESR

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44
Q

What is tx for comedonal acne?

A

topical retinoids

salicylic, azelaic, or glycolic acid

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45
Q

What is tx for inflammatory acne?

A

mild: topical retinoid + benzoyl peroxide
mod: add topical abx (erythromcyin, clindamycin)
severe: add oral abx

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46
Q

What is tx for nodular (cystic) acne?

A

mod: topical retinoid + benzoyl peroxide, topical abx
severe: add oral abx
unresponsive severe: oral isotretinoid

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47
Q

What is presentation of whipples disease?

A

arthralgias, wt loss, fever, diarrhea, ab pain

PAS positive material in lamina proprio of small intestine

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48
Q

What can you use to diagnose hep B in the symptomatic phase?

A

HBsAg

IgM anti-HBc

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49
Q

What is classic triad of splenic abscess?

A

fever, leukocytosis, LUQ ab pain

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50
Q

What are risks for splenic abscess?

A 
infective endocarditis w/ hematogenous spread
hemoglobinopathy (sickle)
HIV
IVDU
trauma
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51
Q

In pulm edema what is the A-a gradient, PaCO2, does it correct w/ supplemental O2?

A

yes corrects
high A-a gradient
normal or high PaCO2

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52
Q

What is the tx for comedonal acne?

A

topical retinoids

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53
Q

How do you distinguish cellulitis from erysipelas?

A

cellulitis = erythema, edema of skin may have streaking, regional lymphadenopathy

erysipelas = limited to epidermis, raised sharp borders and intense erythema

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54
Q

What is tx for frostbite?

A

rewarming with wrm ater

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55
Q

What is tx for tinea corporis?

A

terbinafinecreamor oral griseofulvin for extensive disease

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56
Q

What is presentation of epidermal inclusion cyst?

A

discrete nodule, freely movable,central punctum

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57
Q

What is tx for dermatitis herpetiformis?

A

gluten free diet + dapsone

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58
Q

What diseases assocaited w/ seborrheic dermaittis?

A

HIV, parkinson

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59
Q

What is tx for seborrheic dermatitis?

A

topical intufungal –> ketoconazole selenium sulfide

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60
Q

What are senile purpura?

A

echymoses in older pts in areas exposed to repeat minor trauama
2/2 age related loss of elastic fibers in perivascular connective tissue

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61
Q

What is ichthyosis?

A

dry rough skin w/ horny plates over extensor surfaces of limbs

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62
Q

What should you think if hypopigmented lesions w/ fine scale and pruritis?

A

masassezia = tinea versicolor

tx = selenium sulfide or topical ketoconazole

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63
Q

What type of skin lesion presents as non-healing ulcer w/ polygonal cells w/ atypical nuceli at all levels of epidermis and zones of keratinizaiton?

A

squamous cell carcinoma

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64
Q

What should you suspect if pt develops nonhealing painless bleeding ulcer in a chronic scar?

A

squamous cell carcinoma!

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65
Q

What is most likely etiology of asymptomatic non-healing ulcer in lower lip?

A

squamous cell carcinoma

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66
Q

What is tx for non pregnant person w/ syphilis and penicillin allergy?

A

oral doxycyline

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67
Q

What is tx for PVCs?

A

if asx: nothing

if sx: BBlockers

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68
Q

What is presentaiton of cryoglobulinemia?

A 
palpable purpura
glomerulonephritis
arthralgias
HSM
peripheral neuropathy
hypocompletmentemia
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69
Q

When do you give live vaccines (MMR, varicella, zoster, live flu) in HIV?

A

as soon as posisble w/ CD4 >200

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70
Q

What are recommendations for Tdap in HIV?

A

Tdap once
repeat for women during each pregnancy
Td every 10 yrs

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71
Q

What are recomendations for pneumococal vaccination in HIV?

A

PCV13 once

PPSV23 8 wks later then eery 5 yrs

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72
Q

What are findings in central retinal vein occlusion?

A

painless loss of vision
- venous dilation and tortuosity 2/2 venous occlusion
- scattered and diffuse hemorrhages 2/2/ backpup blood and increased resistace
blood and thunder appearance
cotton wool spots
disk swelling

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73
Q

What is bakers cyst?

A

2/2 excess fluid production by inflamed synovium

occurs in RA, OA

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74
Q

What are sx of ADPKD?

A
  • hematuria
  • flank pain
  • htn
  • palpable BL ab masses
  • proteinuria
  • CKD
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75
Q

How do you dx ADPKD?

A

US (or CT, MRI) of abdomen showing multiple renal cysts

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76
Q

What are the main side effects of amiodarone?

A
  • heart block, QT prolongation
  • chronic interstitial pneumonitis
  • thyroid changes
  • high LFTs, hepatitis
  • blue gray skin
  • peripheral neuropathy
  • optic neuropathy
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77
Q

What is postop endopthalmitis?

A

occurs w/in 6 wks of surgery
presnet w/ pain, decreased visual acuity, swollen eyelids and conjunctiva, corneal edema, infection

tx = intravitreal abx injection or vitrectomy

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78
Q

What is usualy mech of osteomyelitits in DM?

A

2/2 contiguous spread from foot ulcer

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79
Q

What are best markers for DKA resolution?

A

serum anion gap

beta hydroxybutyrate

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80
Q

What lab findings in hereditary spherocytosis?

A
  • increased mean corpuscular hemoglobin conc
  • negative coombs
  • osmotic fragility on acidified glycerol lysis test
  • abnormal eosin-5-maleimide binding test
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81
Q

What is the pathophysiology of hereditary spherocytosis?

A

AD mutation in ankyrin gene = abnormal plasma membrane scaffold protieins

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82
Q

What disease is 2/2 absent CD55 on RBCs?

A

paroxysmal nocturnal hemoglobinuria = complement attacks RBCs

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83
Q

What is likely dx if pt w/ gnawing epigastric pain at night relieved w/ water and bread?

A

likely duodenal ucler

–> over 90% are 2/2/ h pylori

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84
Q

What is tx of diabetic gastroparesis?

A

metoclopramide
erythromycin
cisapirde

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85
Q

WHat does high leukocyte alk phos tell you?

A

leukemoid reaction 2/2 severe infection or inflammation

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86
Q

How do you distinguish leukemoid reaction from CML?

A

leukemoid reaction has high leukocyte alk phos

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87
Q

What is ramsay hunt?

A
  • herpes zoster infection of ear 2/ facial nerve palsy and vesicles in audity canal
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88
Q

What should you think if pt w/ DM2 presenting with facial droop, ear drainage, and granulation tissue in ear canal?

A

malignant otitis externa 2/2 pseudomonas

complicated by osteomyelitis of skull base

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89
Q

What is tx for malignant otitis externa?

A

cipro or other systemic abx that are effective against pseudomonas

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90
Q

When do you use IV colloids vs crystalloids?

A
  • crystalloids for dehydration

- colloids (albumin) for burns or conditions w/ hypoproteinemia

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91
Q

What are findings on physical exam w/ lung consolidation?

A
  • bronchial breath sounds = have full expiratory phase
  • dullness to percussion
  • increased fremitus
  • bronchophony
  • egophony
  • whispered pectoriloquy
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92
Q

What is next step in dx BPH after do a rectal exam?

A

UA = assess for urinary infection and hematuria

if life expectancy > 10 yrs –> also do PSA

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93
Q

What should you think if elderly pt w/ bone pain, renal failure, and hypercalcemia?

A

MM until proven otherwise

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94
Q

What is tx for DKA (including what type of insulin)?

A
  • normal saline
  • regular insulin
  • K correction
  • abx if infected
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95
Q

What are side effects of androgen abuse?

A

men: decreased sperm, gynecomastia
women: acne, hirsutism, voice deepening, menstrual irregularities

CV: LVH, decrease HDL, increased LDL

psych: aggressive
heme: polycythemia

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96
Q

How do you distinguish emphysema from chronic bronchitis on PFTs?

A

emphysema = low DLCO

chronic bronchitis = normal DLCO

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97
Q

What are lab findings in PBC?

A

elevated IgM

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98
Q

What is tx for PBC?

A

ursodeoxycholic acid

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99
Q

What is tx for acute aoritc dissection?

A

beta blocker = IV labetolol

type A = ascending –> do medical and srugical
type B = descending only –> do medical therapy alone

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100
Q

What is tx for endocarditis w/ strep viridans?

A

IV penicillin G or IV ceftriaxone for 4 weeks

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101
Q

What is tx for aspiration pna?

A

clindamycin or amp-sulbactam for anaerobes

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102
Q

What is likely dx if pt syncopizes when emotionally stressed, preceded by lightheadedness, weakness, blurred vision?

A

vasovagal syncope

establish dz w/ upright tilt table test

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103
Q

What is the abdominal succussion splash?

A 
dx gastric outlet obstruction = place stethoscope over upper abdomen and rock patient back and forth at the hips
retained gastric material > 3 hrs after meal will generate slash sound
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104
Q

What are characteristics of low risk vs high risk pulm nodule?

A

low = 15 yrs smoking cessation, smooth

high risk = > 2cm, > 60yo, current smoker, quit

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105
Q

What happens to CO, PCWP, SVR, BP in hypovolemic shock?

A
  • decreased CO
  • decreased PCWP/RAP (preload)
  • increased SVR
  • decreased BP
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106
Q

What happens to CO, PCWP, SVR, BP in cardiogenic shock?

A
  • decreased CO
  • increased PCWP
  • increased SVR
  • decreased BP
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107
Q

What happens to CO, PCWP, SVR, BP in septic shock

A
  • increased CO
  • normal/decreased PCWP
  • decreased SVR
  • decreased BP
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108
Q

What should you think if pt w/ liver cyst filled with daughter cysts?

A

hydatid cyst = sign of echinococcus granulosus infection

2/2 infection from sheep / dog

usually liver and lung involved

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109
Q

What is presentation, timing, sx of echo, and artery usually involved in RV failure 2/2 MI?

A

present: hypotension w/ clear lungs, kussmaul sign
echo: hypokinetic RV
timing: acute

RCA

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110
Q

What is presentation, timing, sx on echo, and artery usually involved in papillary rupture 2/2 MI?

A

present: acute, severe pulm edema, new holosystolic murmur
echo: severe MR w/ flail leaflet
timing: acute + w/in 3-5 days

RCA

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111
Q

What is presentation, timing, sx on echo, and artery usually involved in IV septum rupture 2/2 MI?

A

present: shock and CP, new holosystolic murmur, biventricular failure
echo: L to R shunt at ventricle, step up O2 level between RA and RV

acute and w/in 3-5 d

LAD = apical, RCA = basal

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112
Q

What is presentation, timing, sx on echo, and artery usually involved in free wall rupture 2/2 MI?

A

present: shock and CP, JVD, distant heart sounds
echo: pericardial effusion w/ tamponade –> progresses rapidly to PEA

w/in first 5dys - 2 wks

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113
Q

What is pathophysiology of paget?

A

increased bone turnover = increased osteoclast –> bone breakdown and compensatory increased bone formation = mosaic pattern of lamellar bone

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114
Q

What is presentation clostridium perfringens diarrhea?

A
  • brief illnes w/ watery diarrhea, cramps, fever

- associated w/ undercooked or unrefrigerated food

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115
Q

What is presentation of salmonella diarrhea?

A

watery diarrhea w/ fever, ab pain, vomiting

undercooked eggs + poultry

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116
Q

What is presentation of vibrio vulnificus diarrhea?

A

vomiting, diarrhea, ab pain
w/ hx raw or undercooked shellfish
may have invasive life threatening if liver dz

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117
Q

What is presentation of e coli diarrhea?

A

watery diarrhea, may be bloody if EHEC

undercooked beef

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118
Q

What is atributable risk percent equation?

A

(RR-1)/RR

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119
Q

What are complications of high PEEP in ARDS?

A

barotrauma, tension pneumo

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120
Q

What side effects of thiazide use?

A
  • hyperglycemia, increased LDL/TG, hyperuricemia (gout), hyperCa
  • hypoNa, hypoK,
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121
Q

What electrolyte changes in ASA tox?

A

mixed respiratory alkalosis and anion gap met acidosis w/ normal pH

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122
Q

What etiology should you think if pt post-BMT w/ resp distress and GI sx and multifocal diffuse patchy infiltrates?

A

CMV pneumonitis

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123
Q

What are side effects of EPO therapy?

A

worsening of HTN
HA
flu like sx
red cell aplasia

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124
Q

What is mech of decreased O2 sat when pt lies on side of lung w/ PNA?

A

PNA = acts a physiolgoic shunt
V and P are greatest at lung bases
if turn on side with PNA down then V is greatest in area of lung where shunt is = increased shunt

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125
Q

What are complications of mono?

A

autoimmune hemolytic anemia and thrombocytopenia

splenic rupture

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126
Q

What kind of drug causes tendinopathy and tendon rupture?

A

fluoroquinolones

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127
Q

What should you think if pt w/ pain on overhead motion of arm esp internal rotation and forward flexion and no pain at rest?

A

subacromial bursitis

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128
Q

What are rules for colonoscopy in pts w/ UC?

A

begin colonoscopy 8 yrs after dx, repeat every 1-2 yrs

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129
Q

What is presentation of lead poisoning in adult?

A

GI (ab pain, constipation ,anorexia)
neuro (cog, peripheral neuropathy)
hematologic (anemia)

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130
Q

What lab findings suggest lead poison?

A
  • anemia (microcytic)
  • elevated serum zinc protoporphyrin
  • high cr
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131
Q

What is likely etiology of substernal chest pain that radiates to arm/shoulder/jaw, precipitated by exertion?

A

coronary artery disease = angina

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132
Q

What is likely etiology of sharp stabbing chest pain worse w/ inspiration worse when lying flat?

A

pericarditis

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133
Q

What is likely etiology of pleuritic CP w/ resp distress and hypoxia?

A

PE or pneumothorax

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134
Q

What is likely etiology of nocturnal non-exertional substernal CP?

A

GI/esophagela

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135
Q

What is likely etiology of CP that follows repetitive activity?

A

chest wall or MSK pain

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136
Q

What are criteria for HNPCC?

A
  • 3 relateives w/ colon cancer, 1 must be first degree
  • 2 or more generationss
  • at least 1
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137
Q

What statistical test to compare 2x2 table of observed and expected values?

A

chi square test

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138
Q

What statistical test to compare two means?

A

z test or t test

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139
Q

What is contraindication to succinylcholine use?

A

pts at risk for hyperkalemia (b/c can cause it)

  • burn or crush injury > 8 hrs (risk rhabdo)
  • demyelinating (guillan barre)
  • tumor lysis
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140
Q

How can you differentiate from a and B thalassemia?

A

both with low MCV and target cells
alpha = normal Hgb eletrophoresis
Beta = increased hgb A2

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141
Q

What is likely cause of UTI in pt w/ urine pH 8.5?

A

proteus = secretes urease to alkalinize urine –> form struvite stones

other urease: klebisella, pseudomonas, staph, ureaplasma

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142
Q

What is next step for pt w/ subacute cough and postnasal drip after acute illness?

A

try 1st gen antihistamine for UACS (chlorpheniramine)

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143
Q

What is tx for cocaine induced stemi causing STEMI? what should you avoid?

A

give ASA, nitrates, PTCA or thrombolysis
avoid B blockers (can cause unopposed alpha)
can use CCB and alpha blockers

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144
Q

What is pathophys and presentation of pellagra?

A 
niacin defiiciency (B3)
- diarrhea, dermatitis, dementia
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145
Q

What should you think if pt prsents w/ malar rash that increases w/ sunlight, ab tenderness, and watery diarrhea, depression, and difficulty remembering?

A

pellagra = 3 Ds

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146
Q

What is presentation of acute intermittent porphyria?

A

episodic ab pain, N, V, diarrhea, sweating, agitation/anxiety, confusion
no photosensitivity

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147
Q

What is next step if pt w/ suspected avascular necrosis of hip w/ normal radiograph?

A

do MRI to dx

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148
Q

at what levels of sx should you add daily ICS for asthma control?

A
  • sx > 2x wk
  • 3-4 nighttime awakenings/mo
  • use beta agonist > 2 x wk
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149
Q

What should you think if pt w/ flattened top and bottom of flow volume loop?

A

fixed upper airway obstruction like larygneal edema 2/2/ food allergy

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150
Q

What are findings in anabolic steroid abuse?

A
  • low LH/FSH
  • normal T
  • acne, gynecomastia, decreased testicle size, aggressive, psychotic
  • erythrocytosis, cholestasis, hepatic failure, dyslipidemia, slightly elevated creatinine
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151
Q

What are clinical sx of arteriovenous fistula?

A
  • decreased SVR
  • increased preload
  • increased CO
  • widened pulse P, strong peripheral arterial pulse (brisk carotid upstroke), systolic flow murmur, flushed extremities
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152
Q

What is post void residual volume in BPH?

A

> 50mL

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153
Q

What is likely cause of older man w/ significant lower GI hemorrhage?

A

diverticulosis = painless

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154
Q

What is equation for calcium correction?

A

corrected Ca = measured + 0.8 (4 - albumin)

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155
Q

What should you think if pt presents w/ fever, HA, myaglias, neuro sx, leukopenia, and thrombocytopenia after tick bite?

A

human monocytic ehrlichiosis

tx = doxy while waiting confirmation test

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156
Q

What is presenation of ehrlichiosis

A 
tick borne (lone star) in SE and central US
flu like illness w/ confusion, luekopenia, thrombocytopenia, elevated LFTs, LDH

dx: intracytoplasmic morulae in monocytes, PCR for ehrlichiosis
tx = doxy

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157
Q

What is tx for uremic pericarditis?

A

hemodyalisis

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158
Q

How do you distinguish gonococcal from reactive arthritis?

A

reactive: urethritis, conjunctivitis, mucocutaneous lesions, asymmetric
gonococcal: fever, gram stain/culture

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159
Q

What should you think if pt w/ chondorcalcinosis?

A

hemachromatosis

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160
Q

What are earliest changes in diabetic nephropathy?

A

glomerular hyperfiltration = first change
ACEi decreased intraglomerular hypertension

thickening of BM is first change that can be quantified

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161
Q

What should you think if pt w/ dully tympanic membrance that is hypomobile?

A

serous otitis media = middle ear effusion, have conductive hearing losss

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162
Q

What is mech of presbyopia w/ age?

A

decreased lens elasticity leads to difficulty w/ near vision

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163
Q

What are major causes of morbidity and mortality in pts w/ PAD?

A

MI /CVA

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164
Q

What should you think if immune compromised pt presents w/ pulmonary nodules w/ halo sign?

A

invasive aspergillosis

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165
Q

What shoudl you think if pt w/ contact lens + painful R eye and opacification and ulceration of cornea?

A

contact lens asscoaited infectious keratisis = medical emergency

usually 2/2 gram negative

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166
Q

What type of heart med has use dependence w/ increased QRS with higher HR?

A

class 1C antiarrhythmics = flecainide and propafenone

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167
Q

What two types of cardiac drugs have use dependence?

A 
CCBs (increased PR w/ high HR)
Class 1C (flecainide) (increased QRS w/ increased HR)
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168
Q

What happens to RAAS in CHF?

A

activation of RAAS and increased ADH

  • vasoconstriction of afferent and efferent glomerular arterioles –> inceased vascular resistance and net decrease in RBF
  • peripheral vasoconstriction of efferent renal arterioles –> increased intraglomerular pressure
  • decreased Na delivery to distal tubule
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169
Q

What is 1st line therapy for stable chronic angina?

A

beta blocker –> improves exercise tolerance, improves survival in those w/ MI

add CCB if angina persists

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170
Q

How do you dx SBP?

A
  • temp > 100
  • Asictes w/ PMN > 250 + positive culture
  • SAAG (serum albumin - ascites albumin) > =1.1 = portal htn as the cause
  • ascites protein 50
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171
Q

What is tx for SBP?

A

3rd gen ceph

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172
Q

What should you do if pt presents w/ sudden eye pain, HA, nausea, conjunctival erythema, mid dilated pupil?

A

do gonioscopy or ocular tonometry = concern for acute angle glaucoma

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173
Q

What is acalculous cholecysitis?

A

acute inflammation of gallbladder in absence of gallstones

- occurs in hospitalized pts w/ etxtensive burns, trauma, TPN, prolonged fasting, mechanical ventilation

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174
Q

What are indications for long term O2 in COPD?

A

PaO2 55% if PaO2

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175
Q

What types of polyps are most likely to be malignant?

A

villous adenoma, sessile adenoma, and size > 2.5cm

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176
Q

What is likely location of hemorrhage if pt w/ contralaterla hemiparesis and hemisensory loss, homonymous hemianopsia, and gaze palsy?

A

basal ganglia

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177
Q

What is likely location of hemorrhage if pts w/ no hemiparesis but w/ facial weakness, ataxia, nystagmus, occiptal HA, neck stiff?

A

cerebellum

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178
Q

What is likely location of hemorrhage if pt w/ contralateral hemiparesis and hemisensory loss, nonreactive miotic pupils, upgaze palsy, eyes deviate toward hemiparesis?

A

thalamus

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179
Q

What is likely location of hemorrhage if pt w/ contralateral hemiparesis, contralateral hemisensory loss, homonymous hemianopsia, eyes away from hemiparesis?

A

cerebral lobe
hemiparesis = frontal
hemisensory = parietal
homonymous hemianopsia = occipital

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180
Q

What is likely location of hemorrhage if pt w/ deep coma, total paralysis w/in minutes, pinpoint reactive pupils?

A

pons

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181
Q

What is common location of intracranial hemorrhage in hypertension?

A

basal ganglia, cerebellum, tahlamus, pons

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182
Q

What are complications of SAH? which occur within 24 hrs vs a few days later?

A
  • rebleed in first 24 hrs
  • vasospasm after 3 days
  • seziure, hydrocephalus, hyponatremia
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183
Q

What is tx to prevent vasospasm in CAH?

A

nimodipine

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184
Q

What is tx for myasthenia gravis crisis?

A

plasmapharesis or IVIG

PLUS steroids

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185
Q

What is presentation of central cord syndrome?

A

occurs in hyperesxtension in juries

weakness more pronounced in UE than LE may be accompanied by localized deficit in pain and temp sensation

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186
Q

What is presenation of neurofibromatosis type 2?

A

subcuteanous fibromas
hyperpigmented cafe au lait spots
deafness 2/2/ acoustic B/L neuromas

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187
Q

What are characteristics of thrombotic stroke?

A

hx of atherosclerotic risk factors
local in situ artery obstruction
sx fluctuate = stuttering progression w/ periods of impovements

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188
Q

What are characteristics of embolic stroke?

A

hx of cardiac dz

onset of sx is abrupt and maximal at the start

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189
Q

What are characteristics of intracerebral hemorrhage?

A

uncontrolled htn, coagulopathy, illicit drug use

sx progress over min to hr

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190
Q

What cadn primidone precipitate?

A

can precipiate aucte intermitten porphyria = ab pain, neur and psych sx

191
Q

what should oyu think if pt w/ unilateral HA w/ N/V, eye pain w/ conjunctival injection and dilated pupil w/ poor response to light?

A

acute angle clousre glaucoma

192
Q

What is location and presentation of broca aphasia?

A
  • sparse nonfluent speech
  • preserved comprehension
  • impaired repetition
  • R heiparesis
  • dominant frontal lobe
193
Q

What is location and presentation of wernick aphasia?

A
  • fluent and volumincous lacks meaning
  • diminished comprehension
  • impaired repetition
  • R superior visual field defect
  • dominant temporal lobe
194
Q

What is location and presentation of conduction aphasia?

A
  • fluent w/ phonemic errors
  • relatively preserved comprehension
  • very poor repetition
195
Q

What is the etiology of a pt w/ staggering, wide based gait, w/ dysdiachokinesia, + romberg?

A

cerebellar

  • degen
  • stroke
  • drug/alc
  • B12 eficiency
196
Q

What is etiology of gait w/ start and turn hesitation?

A

gait apraxia = frontal gait

can be 2/2/ frontal lobe degen or NPH

197
Q

What is etiology of gait w/ foot drop, excess hip and knee flexion, slapping quality?

A

2/2 distal sensory loss and wekaness from common peroneal motor neuropathy
L5 radiculopathy = common

198
Q

What are criteria for TPA in stroke?

A 
- sx onset w/in 3-4.5 hrs
contraindications:
- hemorrhage r multilobar infarct of > 33% of cerebral hemisphere
- trauam in past 3 mo
- hx of hemorrhage or neoplasm
- recent incracranial or psinal surgery
- acitve bleed in past 7 days
BP > 185/110
- plt  1.7, PT > 15 or high aPTT
199
Q

What are complications of pseudotumor cerebri?

A

blindness

should do shunting or optic nerve sheath fenestration to rprevent blindness

200
Q

What blood vessel and location involved in wallenberg syndrome?

A

lateral medulla

incracranial vertebral artery

201
Q

What are sx of wallenberg (lateral medullary)?

A

vestibulocerebellar: vertigo, falls to side of lesion, diplopia and nysgagmus
- loss of pain and temp ipsi face and contra body
- dysphagi, dysarthria, hoarseness
- ipsilateral horners

202
Q

What is presentation of medial medullary syndrome? what blood vessel

A

contralateral hemiparesis
contralateral loss of vibration/position
ipsilateral tongue paralysis w/ deviation to side of lesion

due to occlusion of vertebral or anterior spinal artery

203
Q

What is presentation of medial mid pons infarct?

A

contralateral ataxia and hemiparesis of face, trunk, limbs (ataxic hemiparesis)
loss of contralateral tactile and position sense

204
Q

What is presentation of lateral pons lesions?

A

weak muscles of mastication, diminished jaw jerk, imparied tactile and psotion sese over face

205
Q

What is first line tx for idiopathic intracranial hypertension?

A

acetazoloamide (inhibits carbonic anhydrase –> decrease csh production)
add furosemide if continued sx

206
Q

What is tx for pt w/ stroke on no tx?

A

give asa

207
Q

What is tx for pt on stroke already on ASA?

A

ASA + dipyridamole or clopidogrl

208
Q

What is tx for pt on stroke on asa if pt also w/ intracranial large artery atherosclerosis?

A

ASA + clopidogrel

209
Q

How do you dx parkinson?

A

2 of 3 cardinal signs: rest tremor, rigidity, bradykinesia

210
Q

What is presentation of corneal abrasion?

A

severe eye pain 2/2 trigeminal nerve sensory innervatio (unless trigeminal nerve dysfunction then have anesthesia)
photohobia w/ reluctance to open eye

flouorescein eam shows corneal staining deficit

211
Q

What is tx for acute dystonic reaction?

A

benztropine or diphenhydramine

212
Q

What is tx for akathisia 2/2 antipsychotic?

A

benzo (lorazepam)

213
Q

What location of stroke causes severe dysethesia and sensory loss?

A

thalamic stroke

214
Q

What is tx for solitary brain met? vs multiple mets?

A

surgical resection of mass if good performance status and stable extracranial disease

for multiple = do whole brain radiation

215
Q

What location of brain responsible for hemi-neglect syndrome?

A

non-dominant parietal lobe

216
Q

What is likely dx if pt is awoken from sleep w/ acute severe retroorbital pain and ptosis and miosis w/o blurry vision?

A

cluster HA
ppx = verapamil, lithiu, ergotamine
tx for acute = 100% O2 and subq sumatriptan

217
Q

What is presentation of posterior lim of internal capsule lesion (lacunar infarct)?

A

U/L motor impairment

no visual field deformities or sensory/cortical deficits

218
Q

What is presentation of anterior cerebral artery occlusion?

A

contralateral somatosensory and motor deficit, predominantly lower extremity
abulia (lack of will)
dyspraxia, emotional disturbance, urinary incontinence

219
Q

What is presentation of MCA occlusion?

A

contra somatosensory and motor deficit (face, arm, leg)
conjugate eye deviation toward side of infarct
homonymous hemianopia
aphasia (dominant)
hemineglect (nondominant)

220
Q

What is presentation, tx for carbon monoxide poisoning?

A

present: smoke inhalation, HA, N, pink red skin
dx by high carboxyhemoglobin level
tx: hyperbaric O2

221
Q

When is carotid sinus massage useful?

A

in paroxysmal SVT = regular narrow complex tachycardia

222
Q

What is dacrocystitis?

A

infection of lacrimal sac
occurs in infants and adults > 40
sudden pain and redness in medial canthal region, purulent discharge

use systemic abx for staph aureus or B hemolytic strep

223
Q

What is episcleritis?

A

infection of tissue between conjunctiva and sclera
acute onset midld to mod discomfort, photophobia, watery discharge
diffuse or localized bulbar cojunctival injetion

224
Q

What is chalazion?

A

chronic granulomatous inflammation of gland above eyelid = hard painless lid nodule

225
Q

What is presentation of orbital cellulitis?

A

infeciton posterior to orbital septum = abrupt fever, proptosis, restriction EOM, swollen red eyelids

226
Q

What is next step if pt presents w/ concern for foreign body in eye?

A

pen light exam, if no abrasian –> do fluorescein exam

227
Q

How can you tell difference between neurogenic and vascular claudication?

A

neurogenic = posture dependent, worse w/ lumbar extension (walking down), better w/ flexion (walking while bent fwd), low back pain, normal pulses

vascular: externioally dependent, decreased pulses, cool extremities, dx by ABI

228
Q

What is likely dx if pt w/ cystic hepatic lesion w/ eggshell calcification?

A

echinococcus = hydatid cyst

229
Q

What is tx for pt w/ SIADH and confusion/lethargy?

A

hypertonic saline in first 3-4 hrs to increase Na > 120

then gluid restriction

230
Q

What should you think if diabetic pt presents w/ necrotic nasal turbinate w/ fever, face pain, and hyphae? tx?

A

mucormycosis 2/2/ rhizopus

aggressive surical debridement + IV emphotericin B

231
Q

What is best test to dx and evaluate pt w/ acute diverticulitis?

A

CT scan

232
Q

How can you differentiate between waldenstrom macroglobulinemia and MM?

A

waldenstrom: IgM, hyperviscosity (ex. retinal vein engorgement), pain and numbness in extremities, bruise/bleed easily, splenomegaly

MM: IGG or IgA, hyperCa, high creatinine, anemia, bone pain

233
Q

What is tennis elbow?

A

lateral epicondylitis = pain w/ supination or extension of wrist and point tenderness distal to lat epicondyle

234
Q

What is presentation of inferior MI? what extra tx?

A

hypotension, JVD, clear lung fields

give IVF to increase preload, avoid nitrates and diuretics

235
Q

What is tx for stable torsades? unstable?

A 
stable = iv mag
unstable = immediate defibrillation
236
Q

What are the two types of HIT?

A

type 1 = nonimmune mediated

  • more common, 1-4 days after heparin, plt > 100K
  • tx = continue heparin

type 2 = immune mediated

  • less common, 5-10 days after hep, plt > 20K, increased risk of thrombosis
  • tx = stop heparin, use alternate anticoagulan
237
Q

What is nonallergic rhinitis?

A
  • nasal congestion w/ rhinorrea, sneezing, postnasal drainage, no obvious allergi trigger, erythematous nasal mucosa
  • tx for mild = intranasal antihistamine or glucocorticoids
  • for mod to severe = combo therapy
238
Q

What type of nephrotic syndrome assocaited w/ heroin and HIV?

A

FSGS

239
Q

What findings in cholesterol crystal embolism 2/2 angiography/catheterization?

A
  • livedo reticularis, blue toe syndrome
  • kidney injury
  • hollenhorst palques
  • eosinophilia, high cr, low complement
  • eos in urine
240
Q

What kind of hearing loss 2/2 aminoglycosides?

A

sensorineural = air conduction > bone in both ears, weber lateralizes to unaffected ear

241
Q

What are weber and rinne findings in pt w/ otosclerosis?

A

conductive hearing loss

  • bone > air in affected, air > bone in unaffected
  • lateralized to affected ear
242
Q

What should you do to prevent complications of diverticulosis?

A

increase intake fruit and fiber, decrease ASA, smoking NSAID use

chronic constipation is responsible for diverticulosis

243
Q

What type of stone is cystine stone?

A

hard
radioopaque
hexagonal

244
Q

What test for cystinuria?

A

urinary cyanide nitroprusside

245
Q

What is presentation of vit D excess?

A

ab pain, constipation , polydipsia 2/2 hypercalcemia

246
Q

How can you differentiate between herpest opthalmicus vs herpes keratitis?

A

herpes opthalmicus = 2/2 zoster, in elderly, w/ fever malaise and burning/itching in periorbital region, vesicular rash in V1 division

herpes keratitis = corneal vesicles and dendritic ulcers

247
Q

What are clinical sx of polycythemia vera?

A 
hypertension 2/2/ increased volume
peptic ulcers 2/2 histamine release from basophils
gout 2/2 increased cell turnover
plethoric face
splenomegaly
248
Q

What is most common preventable risk factor for kidney stones?

A

hydration

249
Q

What types of kidney stones are radio-opaque (visible on ab radiograph)?

A

calcium stones

struvite stones

250
Q

What are examples of some meds that cause hyperkalemia?

A
  • B blockers
  • ACEi
  • ARBs
  • K sparing diuretics (spironolactone, amiloride)
  • digozin
  • NSAIDs
251
Q

What is pathophysiology of mallory weiss tera?

A

increased intragastric pressure during vomiting causes tears in mucosa of distal esophagus and proximal stomach

252
Q

What is most likely dx in pt w/ adrenal insufficiency and calcifications in the adrenal glands B/L?

A

adrenal TB = prominent cause of adrenal insufficiency in developing countries

253
Q

What is presentation of scleroderma renal crisis?

A 
acute renal failure
malignant htn (HA, vision, nausea)
urinalysis w/ proteinuria
MAHA w/ schistocytes
thrombocytopenia
254
Q

When do you see burr cells (echinocytes) on smear?

A

spiculated RBCs

in liver dz and ESRD

255
Q

When do you see howell jolly bodies on smear?

A

basophilic dark bellets in RBCs

in pts w/ splenectomy or functional asplenia

256
Q

When do you see spur cells (acanthocytes) on smear?

A

liver disease

257
Q

When do you see target RBCs?

A

thalassemia or chronic liver (espectially obstructive) dz

258
Q

What characteristics suggest ascites is 2/2 portal hypertension?

A

SAAG >1.1 = serum albumin - ascites albumin

total protein

259
Q

What is presentation of patellofemoral syndrome?

A

young female athlete
subacute to chronic pain worse w/ squatting, running, prolonged sitting
test = patellofemoral compression test = extend knee while compressing patella

260
Q

What is presentation of patellar tendonitis?

A

athletes

episodic pain and tenderness at inferior patella

261
Q

What is presentation of osgood schlatter?

A

pre-adolescent athlete w/ recent growth spurt
increased pain w/ sports, relieved by rest
tender and swelling at tibial tubercle

262
Q

What do testosterone and DHEAS tell you about excess androgen production?

A

high T w/ normal DHEAS = ovarian source

high DHEAS w/ normalish T = adrenal source

263
Q

What is immediate tx for hyperthryoidism until underlying cause is identified?

A

propanolol

264
Q

What should you think if pt w/ resistant htn?

A

secondary cause:

  • renovascular dz
  • renal parenchymal dz
  • aldosteronism
  • pheo
  • cushing
265
Q

What should you look for in renovascular hypertension?

A
  • cr elevated > 30% from baseline after ACE/ARB
  • recurrent flash pulm edema
  • diffuse atherosclerosis
  • htn onset after 55yo
  • asymmteric kidney size
  • abdominal bruit
266
Q

What is mech and side effects of selegiline?

A

MAO B inhibitor

- insomnia, confusion

267
Q

What is mech and side effects of entacapone/ tolcapone?

A

COMT inhibitor

- dyskinesia, hallucinations, confusion, nausea, orthostasis

268
Q

What is mech and side effects of bromocription, pramipexole, ropinirole?

A

dopamine agonist

  • somnolence, hypotension, confusion
  • hallucinations
269
Q

What are side effects of amantadine?

A

ankle edema

livedo reticcularis

270
Q

What does pronator drift suggest?

A

sensitive/specific for UMN lesion

271
Q

How can you differentiate cauda equina syndrome from conus medullaris syndrome?

A

cauda equina = b/l, severe radicular pain, saddle hypo/anesthesia, asymmetric motor weakness, hyporeflexia/arreflexia, late onset bowel and bladder

conus medullaris: sudden onset severe back pain, perianal hypo/anesthesia, symmetric motor weakness, hyperreflexia, early onset bowl and bladder

272
Q

What is most common site of ulnar nerve compraession?

A

at elbow medial epicondyle groove

273
Q

What is best test to dx acoustin neuromas?

A

gadolinium enhanced MRI

274
Q

What is the location and presentation of pure motor hemiparesis?

A

posterior internal capsule

u/l motor face, arm, lesser extent leg, mild dysarthria, no sensory visual or higher cortical function

275
Q

What is location and presentation of pure sensory stroke

A

thalamus

unilateral numb, parastehsia, hemisensory deficit of face, arm, trunk, leg

276
Q

What is location and presentation of ataxic hemiparesis

A

anterior internal capsule

weakness in lower extremity and ipsilateral arm and leg incoordination

277
Q

What is location and presentation of dysarthria-clumsy hand syndrome?

A

lacunar - basis pontis

head weak, mild motor aphasia, no sensory changes

278
Q

What is presentation of diabetic CN III neuropathy

A

ischemic nerve damage
only somatic nerve affected
parasympathetic reatins fnction
ptosis + down and out gaze w/ normal light and accomodation

279
Q

What is the path of pain/temp tracts?

A

lateral spinothalamic

have loss of pain and temp beginning contralateral two levels below level of lesion

280
Q

What is major side effect of metoclopramide?

A

EPS = tardive dyskinesia, dystonic reactions, parkinsonism

281
Q

What is pathophys of NPH?

A

decreased CSF absorption

282
Q

Which type of abx causes ototoxicity?

A

aminoglycosides (esp gentamicin)

283
Q

What is tx for restless leg syndrome?

A

mild/intermittent: supplement Fe if

284
Q

What is the biggest risk factor for stroke?

A

hypertension

285
Q

What is major complication of status epilepticus?

A

permanent injury 2/2/ excitatory cy

286
Q

What is presentation of glucocorticoid induced myopathy

A

proximal muscle weakness and atrophy w/o pain
LE >UE
normal ESR, normal CK

287
Q

What is presentation of polymyalgia rheumatica? ESR and CK?

A

muscle pain and stiffness in shoulder and pelvic girdle
decreased ROM shoulder/neck/hip
respond to steroid
high ESR, normal CK

288
Q

What is presentation of inflammatory myopathy? ESR and CK?

A

muscle pain, tener, prox muscle weakness
+/- skin rash and inflammatory arthrtis
high ESR, high CK

289
Q

What is presentation of statin induced myopathy? ESR and CK?

A

prominent muscle pain/tenderness +/- weakness
rare rhabdo
normal ESR, high CK

290
Q

What is presentation of hypothyroid myopathy? ESR and CK?

A

muscle pain, cramps, weakness of prox muscles
delayed tendon reflex
normal ESR, high CK

291
Q

What vaccines should a patient receive who just had splenectomy? and when?

A

either 14 days before or after splenectomy should get:

  • PCV13 [then will get PPSV23 wks later]
  • meningococcus
  • HIB
292
Q

What are clinical criteria to dx toxic megacolon?

A

radiographic evidence of colonic distension PLUS at least 3 of:
- fever > 38, HR > 120, PMNs > 10,5000, anemia
plus one of:
- volume depletion
- electrolyte changes
- hypotension
- altered sensorium

293
Q

What are side effects of hydroxychloroquine?

A

retinopathy –> do eye exam every 6 mo

294
Q

What type of liver nodule will have hx w/ sinusoids and kupffer cells?

A

fibral nodular hyperplasia

295
Q

What type of liver nodule will have atypical hepatocytes w/ glycogen and lipids?

A

hepatic adenoma

296
Q

What is presentation / risk factors for hepatic adenoma?

A

usually R hepatic lobe
in younger women w/ hx OCPs

complications = intra-tumor hemorrhage and malignant transformation

297
Q

What is the effect of estrogen on levothyroxine?

A

increases TBG concentration –> has no effect in pt w/ normal thyroid but for pt w/ hypothyroid will increase drug dose requirement

298
Q

What is a varicocele? presentation?

A

dilation of pampiniform plexus
- bag of worms, smaller in supine, bigger w/ standing/valsalva

US: retrograde venous flow

299
Q

What is tx for varicocele?

A

gonadal vein ligation in boy/young men w/ testicular atrophy

scrotal support and NSAIDs in older men who do not desire more children

300
Q

What is the pathophys/presentation of small intenstine bacterial overgrowth?

A

2/2/ anatomical abnormalities, motility d/o (DM, scleroderma), other causes

sx: ab pain, diarrhea, bloating, excess flatulence, malabsorption, wt loss, anemia
dx: endoscopy, hydrogen breath test

301
Q

What is tx for small intestine bacterial overgrowth?

A

7-10 d abx (rifaximin, amox-clavulanate)
avid anti-motility drugs
diet changes
trial pro-motility agents

302
Q

What is tx for asperiglloma? invasive aspergillosis?

A 
aspergilloma = surgical resect
invasive = voriconazole or capsofungin
303
Q

What is tx for pagets?

A

bisphosphonates

304
Q

What are clinical features of VIPoma?

A 
watery diahreah
- low Cl 
flushing, lethargy, N/V, muscle weak
hypokalemia
hypercalcemia
hyperglycemia
305
Q

What is tx for cardiogenic shock 2/2 RV MI?

A

daul antiplatelet, statins, anticoagulation , uregent revascularization

+ high flow IVF b/c very preload dependent

avoid nitrates, diuretics, opioids

306
Q

What should you think if pt w/ MI, hypotension, distended jugular veins and clear lung fields?

A

RVMI

307
Q

What should you think if pt w/ central scotoma, afferent pupil defect, change in color perception, decreased visual acuity?

A

optic neuritis

308
Q

What underlying conditions associated w/ erythema nodosum (painful subQ pretibial nodules)?

A

sarcoid, TB, histo, recent strep, IBD

309
Q

What is likely dx if electrical alternanas and sinus tach?

A

pericardial effusion
if hemodynamically unstable –> do emergency pericardiocentesis
if stable –> do echo to confirm

310
Q

What is tx for acute angle closure glaucoma? what should you avoid?

A

tx = mannitol, acetazolamide, pilocarpine, or timilol to decrease IOP

avoid atropine = dilated pupil and worsens

311
Q

What is tx for cholelithiasis 2/2 4Fs?

A

surgery = cholecystectomy

if poor surgical candidate or refuse –> ursodeoxycholic acid + avoid fatty foods

312
Q

What are recommendations for meningococcal vaccine and booster?

A
  • primary age 11-12 (or 13-18 if not previosuly vaccinated)
  • if havent received can get it at 19-21 if high risk, in college

if received before 16 yo, get booster between 16-21

313
Q

WHat other findings associated w/ dermatomyositis?

A

associated w/ internal malignancy –> ovarian, lung, pancreatic, stomac, CLC, lymphoma

314
Q

What imaging test to dx rotator cuff tear?

A

MRI

315
Q

What is tx if pt w/ MI has pulm edema?

A

IV furosemide (as long as not hypotensive or hypovolemic)

316
Q

What is tx if pt w/ MI has persistent pain, hypertension, or HF?

A

IV nitroglycerin (unless hypotensive, RV infarct, or severe AS)

317
Q

What is tx if pt w/ MI has persistent severe pain?

A

IV morphine

318
Q

What is tx if pt w/ MI has unstable sinus bradycardia?

A

IV atropine

319
Q

WHat is tx for pt w/ high homocysteine?

A

give B6 (pyridoxine) –> acts as cofactor for cystathionine B synthase to metabolize homocysteine into cystathionine

320
Q

What is pathophysiology of neurocysticercosis?

A

consumption of T solium eggs from human feces (not from eating pork)

321
Q

What are features of constrictive pericarditis?

A

fatigue/DOE, peripheral edema and ascites, high JVP, pericardial knowck, pulsus paradoxus, kussmaul sign

ekg low voltage or w/ AFib
pericardial thickening or calcification
prominent x and y descents on JVP

322
Q

What are common etiologies of constrictive pericarditis?

A

in africa/india/china MCC = TB

in US mcc = idiopathic or viral > radiation > heart surgery

323
Q

How can you distinguish viral URI from influenza?

A

viral URI: slow stepwise migratory or evolving sx, rhinorrhea, coryza, sneeze, pharyngitis, mild systemic sx, nasal edema w/ normal or erythematous pharynx

flu: abrupt and dramatic, mild UR sx, prominent systemic sx, variable exam

324
Q

What are recommendations for palying sports in pt w/ mono?

A

refrain from sports for at least 3 wks until sx resolve

325
Q

What eye finding likely in pt w/ axillary freckling and cafe au lait spots?

A

NF type 1

can have optic glioma = progressive U/L vision loss and exopthalmos

326
Q

What is likely dx if diarrhea w/ p-ANCA?

A

ulcerative colitis

327
Q

What is next step if pt w/ DVT and bleeding on enoxaparin?

A

stop enoxaparin, do IVC failure

328
Q

What are indications for IVC failure in DVT?

A

failure of anticoagulation or recurrence of DVT/PE

329
Q

What should you think if pt w/ syncope and crescendo-decrescendo systolic murmur along LSB w/o carotid radiation?

A

HOCM

330
Q

What is tx for legionella?

A

macrolide or FQ

331
Q

What are likely aldo, cortisol, ACTH levels in pt w/ adrenal insufficiency 2/2 chronic glucocorticoid therapy?

A

decrease ACTH, cortisol

normal aldo

332
Q

What is presentation of MAC?

A

nonspecific (fever, cough, diarrhea, wt loss)
splenomegaly
high alk phos

333
Q

Who is at risk for mac? what is ppx?

A

CD4

334
Q

What is mech of nitroglycerin decreasing pain in cardiovascular dz?

A

dilated veins = capacitance vessels –> get venous pooling and decreased preload and those decreased work of heart

335
Q

What are possible clinical presentations of amyloidosis?

A 
- proteinuria or nephrotic syndrome
restrictive cardiomyopathy
hepatomegaly
peripheral neuropathy
visible organ enlargement
bleeding diasthesis
336
Q

How do you dx amyloidosis?

A

abdominal fat bad biopsy

337
Q

What are other findings in aortic regurg besides early diastolic murmur?

A

hyperdynamic pulse = bounding

338
Q

What valve defect is associated w/ pulsus parvus and tardus?

A

aortic stenosis

339
Q

What are findings of analgesic nephropathy?

A

2/2 long term use of ASA or ibuprofen

high cr w/ hematuria or sterile pyruia
mild proteinuria

340
Q

What disease is characterized by bile duct loss?

A

primary biliary cirrhosis

341
Q

What can you do to prevent uric acid stones?

A

hydrate
alkalinize urine –> give K citrate
low purine diet

342
Q

What is pathophys of CML?

A

fusion 9;22 –> BCR-ABL = philadelphia chrmosomes so have high tyrosine kinase activity

343
Q

How can you tell difference between leukemia and leukemoid reaction?

A

low leukocyte alk phos in leukemia vs normal or high in leukemoid reaction

344
Q

How can you tell difference between polycythemia vera and CML?

A

polycythemia vera has high leuk alkaline phosphatase

345
Q

What is presentation of osler weber rendu syndrome?

A

hereditary telangiectasias = AVMs in mucous membranes, skin, GI tract,

—> diffuse telangiectasia, recurrent epistaxis, widespread AV malformations

346
Q

What should you think if patient w/ decreased peripheral vision and cupping of optic disc?

A

primary open angle glaucoma

347
Q

What is tx for small nonbleeding varices?

A

prophylaxtic BB (propanolol, nadolol) to reduce progression to large varices

348
Q

When is staph aureus likely cause of endocarditis?

A

prosthetic valve
IV catheter
implanted device
IVDU

349
Q

When is strep viridans likely cause of endocarditis?

A
  • dental procedure
350
Q

When is coag neg staph likely cause of endocarditis?

A

IV cath
prosthetic valve
pacemaker

351
Q

When is enterococcus likely cause of endocarditis?

A

nosocomial UTI

352
Q

What is next step if pt presents w/ minimal BRBPR

- if 50 or red flags?

A

anoscopy
40-49 –> sigmoid or colonoscopy
> 50 or red flags –> colonoscopy

353
Q

What is tx for raynauds?

A

CCBs

354
Q

How can you differentiate primary from secondary ryanaud?

A 
primary = younger, F, symmetric
secondary = > 40, can be M, asymmetric, feat of tissue ischemia (ulcers) , sys dz
355
Q

What is workup for pt w/ suspected secondary raynaud?

A

CBC and CMP
urinalysis
ANA and RF
ESR and complement levels

356
Q

What is tx for HBV?

A

tenofovir = drug of choice

interferon = for younger w/ compensated liver disease

lamivudine = in HIV +

entecavir = in decompensated cirrhosis

357
Q

Who should you treat in EBV?

A

pts w/:

  • acute liver failure
  • clinical complications of cirrhosis
  • advanced cirrhosis w/ high HBV DNA
  • w/o cirrhosis but pos HBeAg, HBV DNA > 20K
358
Q

What is tx for cellulitis w/ sys signs? w/o sys?

A

IV nafcillin or cefazolin

w/o sys: oral dicloxacillin

359
Q

What shoul you think if pt w/ recurrent PNA in same location of lung?

A

local anatomic obstruction from bronchiectasis, neoplasm, etc

or recurrent aspiration

360
Q

What is a potential long term complications of B12 deficiency?

A

gastric cancer risk increased in pernicious anemia

361
Q

What is presentations of chronic pancreatitis?

A

chronic epigastric pain w/ intermittent pain free intervals
malabsorption (steatorrhea, wt loss)
DM

dx by calcifications of CT

362
Q

What is tx for lyme in pregnancy?

A

amoxicillin

363
Q

What is tx for acute kidney transplant rejection?

A

IV steroids

364
Q

What is presentation of chikungunya?

A

aedes mosquito
3-7 day incubation
high fever, polyarthralgias, HA, myalgias, conjunctivitis, maculopapular rash, lymphopenia, thrombocytopenia, elevated LFTs

365
Q

When do you use cyclophosphamide in SLE? what are side effects?

A

only if pt w/ significant renal or CNS problems

side effects: acute hemorrhagic cystitis, bladder CA, sterility, myelosepression

prevent by giving MESNA

366
Q

What is most common cause of epididymitis?

A

in younger pt = G/C

in older = gram neg rods

367
Q

What should you think if pt w/ low D-xylose absorption? what should cahnge after rifamixin?

A

if no change w/ rifamixin = celiac = absorption problem

if improves w/ rifamixin = SIBO

368
Q

What is reason for refractory hypo-K in pt w/ chronic alcoholism?

A

hypomagnesemia

need to correct Mg to correct K

369
Q

What is tx for HOCM?

A

B Blocker or cardiac acting CCB (diltiazem)

370
Q

What does pressure at held inspiration measure?

A

plateau pressure = when pulm airflow and resistance = 0

so plateau P = elastic P + PEEP = compliance

371
Q

What happens to cardiac index, SVR, and LVEDV in CHF 2/2 LV systolic dysfucntion?

A
  • decreased CI/CO
  • increased SVR
  • increased LVEDV
372
Q

What are common manifestations of paroxysmal noctural hemoglobinuria?

A

in 40s present w/

  • hemolysis
  • cytopenias
  • hypercoaglable
373
Q

What should you think if pt w/ macular rash, vomiting, mucous membrane hyperemia, low platelets

A

toxic shock syndrome

374
Q

What is first line tx for PCOS?

A

wt loss and combing E/P contraceptives

375
Q

What is febrile nonhemolytic tranfusion reaction?

A

MC adverse rxn w/in 1-6 hrs of transfusion
pt w/ fever, chills, malaise, w/o hemolysis

prevent w/ leukoreduction of donor RBCs

376
Q

What lab values can you see in cryoglobulinemia?

A

low complement
high RF
increasesed LFTs
serum cryoglobulins

377
Q

What drugs are knwon to have ototoxicity?

A

aminoglycosides
chemo drugs
Asa
loop diuretics

378
Q

What is felty syndrome?

A

severe long standing RA . 10 yrs + neutropenia + splenomegaly

379
Q

What should you think if pt w/ RA develops painful mouth ulcers?

A

likely 2/2 methotrexate side effect

380
Q

What is mech, adverse effects of mtx?

A

mech: purine antimetabolite
SE: hepatotoxicity, stomatitis, cytopenias

381
Q

What is mech, adverse effects of leflunomide?

A

mech: pyrimidine synthesis inhibitor
SE: hepatotoxitiy, cytopenias

382
Q

What is mech, adverse effects of hydroxychloroquine?

A

mech: TNF + IL1 suppressor
SE: retinopathy

383
Q

What is mech, adverse effects of sulfasalazine?

A

mech: TNF + IL1 suppressor
SE: hepatotoxicity, stomatitis, hemolytic anemia

384
Q

What are names of TNF inhibitors? side effects?

A

ex: adalimumab, etanercept, infliximab

SE: infection, demyelination, CHF, malignancy

385
Q

What is tx for acute limb ischemia?

A

start IV heparin

tx = surgical embolectomy or intra-arterial fibrinolysis

386
Q

What are common side effects of dihydropyridine CCBs (ex. amlodipine)?

A

peripheral edema

387
Q

How do you dz toxic megacolon?

A

ab xry and

3 of: fever > 100.4, HR > 120, WBC > 10.5, aenmia

388
Q

What is tx for toxic megacolon?

A

IV steroid, nasogastric decompression, abx, fluid managment

if doesnt resolve –> emergency surgery

389
Q

What are sx of dig toxicity?

A

anorexia, nausea, vomiting, ab pain

color vision alterations, fatigue/confusion/weakness

390
Q

What precipitates dig toxicity?

A

amiodarone/verpamil/quinidine/propafenone increase levels of dig –> should decrease dose by 25-50% when start one of them

391
Q

What is presentation of mesenteric ischemia?

A

severe perimbilical ab pain out of proportion of findings on ab exam

392
Q

How can you differentiate between BPH and prostate CA?

A

BPH: central portion (transitional zone) hypertrophied, symmetrically enlarged, smooth

prostate ca: lateral lobes, asymmetric enlargement, nodules, firm

393
Q

What is tx for BPH?

A

alpha 1 blockers (tamsulosin, doxazosin )
or
5 alpha reductase inhibitors (finasteride)
or both

394
Q

What do you see on bx w/ PSC?

A

fibrous obliteration of small bile ducts intra and extrahepatic
concentric replacement by connective tissue in onion skin pattern

395
Q

How do you dz PSC?

A

cholangiogram (ERCP/MRCP)

396
Q

What is next step if pt presents w/ sx of adrenal insufficiency?

A

do cosyntropin stim test

397
Q

What should you think if pt w/ vomiting during intubation that requires suctioning and a few hours later w/ hypoxemiaa nd B/L infiltrates on CXR?

A

aspiration pneumonitis 2/2 gastric acid damage

398
Q

What is tx for immune compromised person w/ bacterial meningitis?

A

vanc + amp + cefepime

399
Q

What are side effects of antithryoid drugs?

A

agranulocytosis
methimazole = 1st tri teratogen, cholestasis
propylthiouracil: hepatic failure, anca associated vasculitis

400
Q

What is presentation of MEN1?

A
  • pituitary adenoma
  • primary hyperparathyroidism
  • pancreas/GI tumor
401
Q

What is presentation of VIPoma?

A

secretory diarrhea
hypokalemia
hypochlorhydria

402
Q

What is presentation of glucagonoma?

A

wt loss
necrolytic migratory erythema
hyperglycemia

403
Q

What is tx for hairy cell leukemia?

A

cladribine

404
Q

What are characteristics of hairy cell leukemia?

A 
TRAP stain (tartrate resistant acid phosphotase)
dry bone marrow tap
405
Q

What is presentation of hepatorenal syndrome?

A

pt w/ cirrhosis, portal htn/edema and reduced renal perfusion 2/2/ GI bleed, vomit, sepsis, excess diruetic, SBP, anemia, or NSAID use

have FeNa

406
Q

What HIV med associated w/ pancreatitis?

A

didanosine (NRTI)

407
Q

What HIV med associated w/ hypersensitivity syndrome?

A

abacavir (NRTI)

408
Q

What HIV med(s) associated w/ lactic acidosis?

A

NRTIs

409
Q

What HIV med(s) associated w/ steven johnson?

A

NNRTIs

410
Q

What HIV med associated w/ liver failure

A

nevirapine (NNRTI)

411
Q

What HIV med associated w/ crystal induced nephropathy?

A

indinavir = protease inhibitor

412
Q

What is anserine bursitis?

A

sharp localized pain over anteromedial part of tibia

413
Q

What is mech of immunity in polysacchardie vaccine vs conjugate vaccine?

A

polysaccharide: T cell independent B cell response
- decrease incidence of replacement strains

conjugate:
- increased efficacy in elderly and kids

414
Q

What are extraarticular associated w/ ankylosing spondylitis?

A

acute uveitis = MC

415
Q

Anti cyclic citrullinated peptide antibodies are assocaited w/ what condition?

A

RA

416
Q

anti dsDNA is assocaited w/ what condition?

A

SLE

417
Q

glutamic acid decarboxylase ab is assocaited w/ what condition?

A

DM1

418
Q

What is charcot joint?

A

neurogenic arthropathy
2/2 B12 deficiency, DM, peripheral nerve damage

have deformed join w/ decreased sensation and loss of neurologic input, mild pain, fractures, degeneraive joint disease

419
Q

What kind of shock presents w/ high mixed venous O2 sat?

A

septic shock

420
Q

What should you think if pt presents w/ dark brown discoloration of colon and lymph follicles shining through as pale patches?

A

= melanosis coli

sign of laxative abuse

421
Q

What diet recs for pt w/ renal calculi?

A
  • decreased protein and oxalate
  • decrease Na
  • increased fluid
  • increased dietary Ca
422
Q

What is tx for hepatic encephalopathy?

A
  • volume repletion, orrect electrolytes
  • nutrition w/o protein resestriction
  • oral lactulose
  • rifamixin if no improvement in 48 hrs
423
Q

What are alk phos, pth, ca, phos, vit D levels in osteomalacia?

A

high alk phos, pth
low ca, phos, 25OHD

associated w/ celiac = defective mineralization of bone matrix

424
Q

What is tx for malignant otitis externa?

A

IV cirprofloxacin

425
Q

What are causes of hypovolemic hyponatremia?

A
  • vol depletion
426
Q

What is a complication of hashimoto thyroiditis?

A

lymphoma of thyroid

427
Q

What is next step to dx kidney stone?

A

US or non-contrast spiral CT of abdomen/pelvis

428
Q

Where in mediastinum ar eneurogenic tumors located?

A

posterior mediastinum

429
Q

What are the middle mediastinal masses?

A

tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, aortic aneurysm

430
Q

What differentiates gilbert from crigler najjar 1 and 2?

A

gilbert = scleral icterus w/ unconjugated hyper bili usually

431
Q

What is tx for hepatic hydrothorax?

A

initial = salt restriction and diuretics

TIPS placement if refractory

432
Q

What is tx for entamoeba histolytica liver abscess?

A

empiric tz w/ metronidazole

433
Q

What parts of presentation make you think pt w/ pancreatitis is 2/2 gallstones?

A
  • no hx of alcoholic, meds, normal lipids

- ALT > 150

434
Q

What cardiac manifestations of hemochromatosis?

A

restrictive or dilated cardiomyopathy and conduction abnormalities

435
Q

What electrolyte changes w/ loop diuretics?

A
  • hypoK
  • met alkalosis
  • pre-renal AKI
436
Q

What happens to thyroid in cirrhosis?

A

decrease synthesis of binding proteins

lowers total T3 and T4

437
Q

What is most effective intervention to treat htn?

A

wt loss –> down by 5-20 SBP for every 10kg wt loss

438
Q

What is malaria ppx for subsaharan africa and SE asia? what about if south america, mexico?

A

SE asia + subsaharan africa: atovaquone proguanil, doxy, or mefloquine (DOC for pregnancy)

if S america, mexico, korea: primaquine

in areis w/ chloroquine susceptible P falciparium: chloroquine or hydroxychloroquine

439
Q

What is de quevain tenosynoivits?

A

classically affects new moms holding infant w/ outstretched thumb

affects abductor pollicis longus and extensor pollicis brevis

440
Q

What should you think if pt w/alkalosis and Urine Cl

A

saline responsive alkalemia
2/2 to prior diuretic use, vomiting, nasogastric aspiration

have met alkalosis, lower urine Cl, low K

441
Q

What is mech of angina in severe aortic stenosis?

A

CP 2/2 myocardial O2 demand

442
Q

What should you think if pt w/ BL severe hypothyroidism?

A

hypothyroidism

443
Q

What does expansile eccentric lytic “soap bubble” area of bone suggest?

A

giant cell tumor of bone

444
Q

What is presentation of giant cell bone tumor?

A
  • distal femur or proximal tibia
  • tumor w/ cystic and hemorrhage regions
  • eccentric lytic area
  • sheets of interspersed large osteoclast giant cells that appear round
445
Q

What is presentation of baker’s cyst?

A

popliteal synovial cyst = swelling on medial side of popliteal fossa 2/2 enlarged gastrocneumius-semimebranous bursa
often 2/2 degenerative joint disease or injury

446
Q

What is presentation of osteitis fibrosa cystica?

A 
= von recklinghausen disese of bone = 2/2 hyperPTH from parathyroid CA
brown tumors (fibrous tissue) and bone pain
salt and pepper appearance
447
Q

What is presentation of osteoid osteoma?

A

slcerotic cortical lesion w/ central nidus of lucency
causes pain worse at night and unrelated to activity
relieved by NSAIDs

448
Q

What can you give pt w/ distal stone to help passage?

A

tamsulosin = alpha 1 antagonist –> relaxes ureteral muscle and decreases intrea-ureteteral pressure

449
Q

What are screening recs for AAA?

A

male active or former smokers 65-75 one time AAA

450
Q

What type of thyroid CA associated w/ hx of radiation?

A

papillary carcinoma

451
Q

What type of thyroid CA associated w/ MEN?

A

medullary thyroid ca = clacitonin producing

452
Q

What is salvage vs adjuvant vs neoadjuvant therapy?

A 
salvage = tx when standard therapy fails
adjuvant = in addition o standard
neoadjuvant = tx before stanardar therapy
453
Q

What serum level should you check in pt w/ androgen producing adrenal tumor?

A

DHEA-s (dehydroepiandrosterone sulfate)

454
Q

Where are androstenedione (AS), DHEA (dehydroepiandrosterone), testosterone, and DHEA-S produced in woman?

A

AS/DHEA/T by ovaries and adrenal

DHEA-S by adrenals only

455
Q

What should you think if sudden onset sharply demarcated erythematous edematous tender skin lesion w/ rised borders in febrile pt?

A

erysipelas, MCC = group A B hemolytic strep

456
Q

What is mech of kidney stones in crohns?

A

increased oxalate absorption

2/2 Ca being bound by fat and leainv oxalate unbound

457
Q

What is presentation of cyanide tox?

A 
flushing cherry red skin
cyanosis
HA, AMS, seizure, coma
arrhythmias
met acidosis, renal failure
GI sx
tachypnea thne resp depression, pulm edema
458
Q

What is trousseau’s syndrome? what undelryign dz associated?

A

hypercoagulability d/o w/ recurent and migratory superficial thrombophlebitis at unusual sites (arm, chest)
associate dw/ occult visceral malignancy (pancreas MC)

459
Q

What is likely cause of excess bleeding in pt w/ chronic renal failure? tx?

A

platelet dysfunction –> normal PC, PT, PTT, BT is prolonged

tx = DDAVP

460
Q

What is hypertensive emergency? malignant htn? hypertensive encephalopathy?

A

hypertensive emergecy = htn w/ acute life threatening end organ complications
two subtypes:
- malignant htn = retinal hemorrhages, exudates, papilledema (can also have renal findings)
- hypertensive encephalopathy =

461
Q

How can you differentiate chlamydia vs gonorrhea as cause of urethritis?

A

urethritis = dysuria, pyuria, urinary freq, discharge

culture negative = chlamydia
- dx w/ nucleic acid amp testing

gonococcal: gram stain w/ gram neg cocci

462
Q

What are strongest predictors of AAA expansion and rupture?

A

large aneurysm diameter
rapid rate of expansion
current cigarette smoking

463
Q

What are indications for endovascular repair of AAA?

A
  • size > 5.5cm
  • rapid rate of expanison > 0.5cm in 6 mo or 1cm in 1 yr
  • sx
464
Q

What is tx for Afib in WPW?

A

cardioversion or procainamide

avoid BB, CCB, dig, adenosine in WPW

465
Q

What is next step if HIV pt w/ oral thrush and sx of esophagitis?

A

empiric tx w/ fluconazole since most likely candida

if no thrush or fail empiric tx –> do esophagoscopy

466
Q

What is tx for symptomatic bradycardia? what is next step if no response?

A

IV atropine

if no response pacing

467
Q

What is tx for actinomyces?

A

penicillin

468
Q

What is tx for nocardia?

A

sulfonamides

469
Q

What type of thyroid CA w/ psammoma bodies?

A

papillary

470
Q

How do you dx follicular thyroid CA?

A

invasion of capsule and blood vessels required to differentiate from follicular adenoma

471
Q

What is tx for legionairs?

A

macrolide or FQ

472
Q

What does low glucose in pleural effusion suggest?

A

empyema –> 2/2 high metabolic activity of WBCs or bacteria in fluid

473
Q

What electrolyte abnormality after surgery can cause hyperactive deep tendon reflexes?

A

hypocalcemia 2/2 getting transfusions w/ citrate

medicine Clerkship (4 decks)

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