WE4 mock SB (-4) Flashcards
WE4 blocks (70-74, F1-4) Missing blocks 70-74, F1(half)
why does met acidosis occur in the setting of sepsis?
decr O2 to tissues –> incr anaerobic metab –> incr LA –> met acidosis
RTA type leads to what type of met acidosis?
non-anion gap met acidosis
what s/s of lactic acidosis 2/2 sepsis will you not see in RTA type 2?
- fever
- low BP
- incr HR
- crackles
new onset CHF (DOE + paroxysmal nocturnal dysp + pulm edema + LE edema) after URI. what is the likely dx = ?
dilated cardiomyopathy 2/2 myocarditis
young age + acute HF + CP + arrhythmia. dx = ?
HF 2/2 myocarditis
what virus commonly causes myocarditis in developed nations?
coxsackie B
which is more common pancreatic or GB ca?
pancreatic Ca
which is more likely to present w/ jaundice, pancreatic ca or GB ca?
pancreatic Ca
pt presents w/ jaundice + wt loss + vague abd discomfort + incr ALP. suspected dx = ?
pancreatic Ca
what labs suggest cholestatic cause of jaundice?
incr ALP + incr bili
how does Fe OD present?
- abd pain
- dark green diarrhea
- hematemesis
- shock
- liver necrosis
what diagnostic findings are expected w/ Fe OD?
- anion gap met acidosis
- incr s Fe
- radiopaque pills on xray
why are stools/emesis green/black in Fe OD?
Fe tablet disintegration
what sequela may be seen several weeks after Fe OD?
SBO 2/2 GI scarring
how does acetominophen OD present?
- n/v
- hepatotoxicity
what GI s/s are uncommon in acetominophen OD?
GI bleeding
what GI s/s is expected w/ TCA OD?
GI dysmotility
pt presents w/ back pain + subacute illness w/ intermittent F + xray showing pulm (cavitary lesion) and bone (vertebral collapse) involvement. dx = ?
systemic TB
what immunosuppressed states incr the risk for latent TB reactivation?
- CKD
- DM
- HIV
- hematologic malig
- chronic immunosuppression med use
how does skeletal TB present?
- spondylitis (back pain +/-vertebral collapse on xray)
- arthritis
- osteomyelitis
how do you distinguish mult myeloma from subacute disseminated TB infx?
mult myeloma won’t have subacute F or pulm infiltrates
what types of injury generally cause medial menisal tear vs MCL tear?
- medial meniscal tear 2/2 twisting during strenuous activity or on uneven ground
- MCL tear 2/2 blow to the lateral knee
how does meniscal tear present?
- joint line tenderness
- slow onset effusion
- sensation of instability
- locking/catching w/ rot and ext while under load
how do ACL tears typically present?
rapid onset hemarthrosis w/in min –> hrs of injury
how do you distinguish CML from CLL using labs?
CML = incr WBC w/ incr PMNs CLL = incr WBC w/ incr lymphocytes
what is the 1st line CML tx targeted @?
BCR-ABL tyrosine kinase (imatinib)
what is the 1st line CLL tx targeted @?
CD20 antigen (rituximab)
what kind of hyponatremia does SIADH cause?
euvolemic
what are the causes of hypovolemic hypoNa?
- extrarenal = v/d, burns, pancreatitis
- renal = diuretics, mineralocorticoid def
- decr circ vol = CHF, cirrhosis
what are the MCCs of sepsis in sickle cell pts?
- s pneumo
2. H influ type B
what is the MCC of PNA in sickle cell pts?
s pneumo
what are the MCCs of osteomyelitis in sickle cell pts?
- s aureus
- salmonella
what is the MCC of meningitis in sickle cell pts?
s pneumo
what conditions require infective endocarditis ppx?
high risk conditions =
- prosthetic heart valves
- prev infective endocarditis
- structural abn in heart transplant
- congenital cyanotic heart defect (unrepaired + residual defect)
what procedures warrant infective endocarditis ppx in high risk pts?
- gingival manipulation
- resp tract incision
- GI/GU procedure (active infx only)
- sx of infected skin/muscle
- placement of prosthetic cardiac material
infective endocarditis ppx is not recommended for pts w/ what conditions?
- MVP
- acquired valvular defects (RHDz)
- low risk cong heart dz (bicuspid aortic valve, ASD)
is infective endocarditis ppx recommended for dental procedures in MVP pts?
no
increasing the cutoff value for a dx test will do what to sensitivity and specificity?
decr sensitivity (incr FN incr specificity (decr FP)
how does acute dystonia present?
sudden sustained contraction of the neck, mouth, tongue, and eyes
how does akathisia present?
- restlessness
- inability to sit still
how does parkinsonism present?
-gradual onset resting tremor, rigidity, and bradykinesia (gait, speech, slow start)
how does tardive dyskinesia present?
- gradual onset (after > 6mos use)
- dyskinesia of mouth, face, trunk and extremities
how do you tx tardive dyskinesia?
- valbenazine
- deutetrabenazine
how would valvular regurg be depicted on doppler flow tracings?
pressure tracing on opp side of line as nL (b/c flow is retrograde)
how would vavular stenosis be depicted on doppler flow tracing?
pressure tracing would look exaggerated (b/c flow is nL direction but more forceful)
how might atyp acute cholecystitis pain present?
mid-epigastric w/ radiation to the back
F and WBC are not commonly seen in peptic ulcer dz unless what?
perforation has occured
how does peptic ulcer perforation present?
- decr BP + peritoneal signs
- F + incr WBC
- dyspepsia
what is a common comp of humeral midshaft frx?
radial n. injury
how would radial n. injury 2/2 humeral frx present?
- weak wrist and finger extension
- dorsum of hand decreased sensation
what type of humeral frx can lead to medial n. injury?
suprachondylar frx
what tx can be done to relieve s/s of CBD obstruction 2/2 advanced pancreatic adenoCa?
endoscopic CBD stent placement
pruritis 2/2 ___ can be improved w/ ursodeoxycholic acid?
intrahepatic cholestasis
which 2 types of meds can be used to control HR in afib?
- BB
- nondihydrapyrimadine CCB (diltiazem and verapamil)
which 2 components are needed to form clots?
- fibrin
- platelets
which is the more important component of venous clot formation?
fibrin
which is the more important component of arterial clot formation?
platelets
when do you choose antiplatelet over anticoag therapy?
to prevent clots 2/2 endothelial damage (e.g. MI)
when do you choose anticoag over antiplatelet therapy?
to prevent clots 2/2 statis (DVT)
what are the 2 types of anti-thrombotic?
- antiplatelets
- anticoagulants
what drugs are anti-platelets?
- ASA
2. P2Y12 inhib (clopidogrel, prasugrel, ticagrelor)
what drugs are considered anti-coagulants?
- heparin/LMWH
- warfarin
- factor 10a inhib
when do you give antiplatelet vs anticoag for afib?
CHADS2VASC 0 = ASA
CHADS2VASC 1 = ASA or anticoag
CHADS2VASC 2+ = anticoag
renal insuf 2/2 glomerular injury will likely present w. what?
protenuria and/or hematuria
how does mult. myeloma lead to decr renal f(x)?
causes renal tubular damage
unstable trinucleotide (CGG) rept on FMR1 gene (x chromosome) is diagnostic for what?
fragile x synd
how does fragile x synd present?
- delayed milestones
- features of autism
- intellectual disability
- long face
- big testes
when hould sodt restraints be used?
as a last resort for delirious pts whose safety is in jeapordy
what do decr CO + incr RA pressure + incr RV pressure + incr pulm artery pressure + nL PCWP suggest?
PE (incr resistance before lungs but what makes it back to heart is nL)
what is a comp of thoracentesis that manifests as rapid re-accumulation of effusion + SOB + hemodynamic instability?
hemothorax
w/ hemothorax what change will be seen @ the heart?
decr LV preload
how does hypothyroid myopathy typically present?
= painful
how does cushing synd present?
- central obesity
- proximal m. weakness
- HTN
- abn bleeding
- purple striae
- glucose intolerance
- depression/anxiety
what is the 1* mechanism by which nitrates relieve ischemic chest pain?
venodilation
what is the classic triad for spinal epidural abscess?
- F
- back pain
- neuro s/s
what will glucocorticoids do if given to pt w/ spinal epidural abscess?
worsen the infx
what are the MCC pharyngitis in kids?
viruses
child presents w/ pharyngitis + vesicles on uvula/soft palate/tonsillar pillars (i.e. vesicular pharyngitis). dx = ?
herpangina
what causes herpangina?
coxsackie A = MC
how do you tx herpangina?
- reassurance + supportive care
- will resolve w/in 1 week
if decr BP leads to decr SVR, will cardiac index be incr/decr/nL?
incr (to compensate)
in septic shock, will PCWP be incr/decr/nL?
decr/nL depending on the extent of preload reduction (2/2 low BP)
incr cardiac index + decr SVR + incr PCWP + decr mixed v O2. likely dx = ?
high output heart failure
what 2 findings can be seen on p/e of high output HF?
- bounding pulses
- systolic bruit
granulomatosis w/ polyangiitis (wegners) presents w/ rapidly progressive GN + lung nodules/cavitation + what URI and what skin manifestations?
- URI = sinusitis/otitis, saddle-nose
- skin = livedo reticularis, non-healing ulcers
pts w/ new onset psychosis and depression should have what lab checked especially if physical s/s are also present?
TSH level
what is the pathophysiologic process that leads to DKA?
decr insulin –> incr catacholamines–> incr lipolysis of peripheral fat stores –> fatty acid break down to ketones in the liver
when/why do you see incr real excretion of ketoacids in DKA pt?
during tx (this is the result of IVF admin)
when do you transition from insulin gtt + K to subQ insulin during treatment of a DKA pt?
when the anion gap closes and metabolic acidosis resolves
pregnant pt presents highly susp for PE but V/Q perfusion scan result = low probability PE. what do you do?
extra testing = CTA +/- LE dopplers
what is the only V/Q scan result that can r/o PE if there is high clinical suspicion?
nL V/Q scan
what is efavirenz?
non-nucleoside RT inhibitor
what are some early s/e of efavirenz therapy?
neuropsych s/s (insomnia w/ vivid dreams, depression, and anxiety)
what are the tx for urge incontinence?
- lifestyle mods
- bladder training
- antimuscarinics (oxybutinin)
what are alpha-adrenergic antag used to tx?
bladder outlet obstruction 2/2 BPH
what is the 1st line tx for urge incontinence?
hint: think non-pharm tx
bladder training
what is fetal fibronectin used to detect?
incr risk of pre-term delivery (if incr @ 24-34 wks)
what is the kleihauer-betke test used for?
- tests for fetomaternal hemorrhage 2/2 placental abruption or abd trauma
- used to determine Rhogam dosing
what is the w/u for painless vaginal bleeding during pregnancy?
- FHT (r/o vasa previa)
2. transABD U/S (locate placenta)
pt presents w/ recent h/o blunt chest trauma + tachy + hemodynamic STABILITY. CXR shows mediastinal widening. what do you do?
chest CTA (to help w/ surgical planning)
resp depression 2/2 opiod OD involves decr RR and what change in tidal volume?
decr
coadmin of triptan w/ erot derivative or 2nd dose triptan can lead to what complication and why?
prolongued vasospasm –> high serotonin receptor activation –> severe HTN –> MI or stroke
how do cataracts present?
- painless blurring vision
- glare
- halos around lights
- decr distance vision (myopic shift)
- opacification
how do cataracts look on physical exam?
- decr red reflex
- decr retinal detail
what is reactive (2*) thrombocytosis?
incr plts 2/2 incr cytokines 2/2 inflamm state (infx, sx, malig)
how does essential (1*) thrombocytosis typically present?
persistent incr plt
>600k + thombosis + hemorrhage
pt presents w/ mild thrombocytopenia w/ h/o abd sx 2/2 blunt abd trauma. dx = ?
2* (reactive) thrombocytosis likely 2/2 splenectomy
striate palmar xanthomas (yellow streaks on palms) are a classic finding in what dz?
severely high TG 2/2 familial dysbetalipoproteinemia
ETOH use + incr TG leads to incr risk of what?
pancreatitis
milky opalescent blood samples are/suggest what?
- grossly lipemic serum samples
- suggest severe hyperTG
child age < 2 yo presents w/ 3-5d high fever followed by a blanching pink/red maculopapular rash. dx = ?
roseola infantum
what causes roseola infantum?
HHV-6
what does coxsackie A normally cause?
- hand foot and mouth dz
- herpangina
when doe the fever occur that’s related to coxsackie A infx?
w/ the rash
OCPs decrease the risk of what 2 Ca?
- endometrial
- ovarian
long term OCP use has been shown to slightly incr the risk for what 2 Ca?
- cervical
- breast
pt presents w/ h/o afib + sotalol use. what arrhythmia is likely causing the pt to experience sudden syncopal events?
torsades de pointes (i.e. polymorphic ventricular tachycardia)
pts w/ multiple sclerosis freq develop what eye condition?
optic neuritis
what is the uhthoff phenom?
exacerbation of MS (or other demylinating neuro cond.) s/s 2/2 heat exposure
when is cholestasis expected in a pt on TPN?
w/ TPN use > 2wks
what serious comp of TPN use is seen early on (1st week)?
bloodstream infx
immunocomp pt presents w/ F + rapidly progressive skin lesion that develops into nontender nodule w/ necrotic center. dx = ?
ecthyma gangrenosum
what is ecthyma gangrenosum assoc w/?
pseudomonas bacteremia
pt presents w/ thready pulses that disappear w/ deep inspiration. what is this called?
pulsus paradoxus
pt presents w/ chest discomfort + weakness and dizziness (low CO) + pulsus paradoxus + h/o recent viral illness. Ddx = ?
- cardiac tamponade
- large pericardial effusion
how does CMV encephalitis present clinically?
- F + HA + seizures + AMS + stupor
- imaging shows frontotemporal abn
what PFT results suggest restrictive lung dz?
- decr TLC + decr FVC + decr FEV1
- nL FEV1 / FVC ratio
what PFT results suggest obstructive lung dz?
- incr TLC + nL FVC + decr FEV1
- decr FEV1 / FVC ratio
PFT alue < X% = decr. what is x?
80%
bibasillar, fine, “velcro-like” crackles +/- digital clubbing suggest what dx?
pulm fibrosis
pt presents w/ cushings s/s + lung mass. what is the likely cause?
paraneoplastic synd (incr ACTH) assoc w/ small cell lung Ca
ACTH is what kind of molecule?
polypeptide hormone
if cortisol is being overproduced by the adrenal glands in 1* cushing, what symp won’t you see and why?
- hyperpigmentation
- high cortisol feeds back to inhib ACTH release
what rate of cervical change is expected during active labor (>= 6-10 cm dilation)?
> = 1 cm/ 2hrs
how do you manage protracted active labor (< 1 cm/2 hr cervical change) if CTX are weak?
admin oxytocin
what meds should afib pt w/ CHADS2VASC >= 2 receive?
anti-coag
what does CHADS2-VASC stand for?
CHADS2-VASC CHF +1 HTN +1 Age >=75 +2 DM +1 Stroke/TIA +2 Vasc dz +1 Age 65-74 +1 Sc sex = F +1
how does pleural fluid look in TB infx?
- exudative (pH < 7.45, meets lights criteria)
- protein > 4 g/dL
- WBC incr lymphocyte predom
- glucose < 60 mg/dL
superior vena cava synd is a potential complication of what malignancy?
lung Ca and lymphoma
how does superior vena cava synd present?
- HA
- facial edema
- incr JVP w/o peripheral edema
what is the 1st line tx for superior vena cava synd?
radiation
how do you prevent asp pneumonia?
- diet mod if pt has dysphagia
- raise the head of the bed to 30-45*
do NG tubes incr/decr risk of asp PNA?
incr risk
how do brain mets lesions look on imaging?
well circumscribed enhancing lesions surrounded by vasogenic edema @ white-grey matter junctions
how do gliomas present on MRI?
enhancing solitary lesions w/ irreg borders
what are gliomas?
tumors arising from glial cell proliferation
what is the MC 1* CNS tumor in adults?
glioma
