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Step 2 CK > Woo studying > Flashcards

Woo studying Flashcards

1
Q

Light criteria defining exudative pleural effusion

A

At least 1 of the following:
[Pleural fluid protein]/[Serum protein] > 0.5
[Pleural fluid LDH]/[Serum LDH] > 0.6
Pleural fluid LDH > 2/3 upper limit of nml serum LDH

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2
Q

Anti-AChR

A

Myasthenia gravis

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3
Q

Anti-basement membrane

A

Goodpasture syndrome

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4
Q

Anti-cardiolipin

A

SLE,

Antiphospholipid syndrome

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5
Q

Anti-centromere

A

Limited scleroderma (CREST syndrome = Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasias)

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6
Q

Anti-desmosome

A 
Pemphigus vulgaris (Includes oral mucosa, +Nikolsky's, Intraepidermal IC deposits)
PemphiguS = Superficial
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7
Q

Anti-hemidesmosome

A 
Bullous pemphigoid (Spares oral mucosa, -Nikolsky's, Epidermal-dermal jxn IC deposits)
PemphigoiD = Deep
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8
Q

Anti-dsDNA, Anti-Smith

A

SLE

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9
Q

Anti-glutamic acid decarboxylase

A

T1DM

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10
Q

Anti-histone

A

Drug-induced SLE

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11
Q

Anti-Jo-1, Anti-SRP, Anti-Mi-2

A

Polymyositis, Dermatomyositis

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12
Q

Anti-microsomal

A

Hashimoto thyroiditis (also anti-TG)

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13
Q

Anti-mitochondrial

A

Primary biliary cirrhosis

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14
Q

ANA

A

Nonspecific (SLE usually)

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15
Q

Anti-parietal cell

A

Pernicious anemia

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16
Q

Anti-Scl-70

A

(AKA anti-DNA topoisomerase I)

Diffuse scleroderma

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17
Q

Anti-smooth muscle

A

Autoimmune hepatitis

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18
Q

Anti-SSA/-SSB

A

Sjogren’s syndrome

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19
Q

Anti-TSHR

A

Graves’ disease

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20
Q

Anti-U1 RNP

A

Mixed CT disease

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21
Q

IgA anti-endomysial/-tissue transglutaminase

A

Celiac disease

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22
Q

p-ANCA

A

(AKA MPO-ANCA)

Micro-PAN, eosinophilic granulomatosis w/ polyangiitis (Churg-Strauss syndrome)

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23
Q

c-ANCA

A

(AKA PR3-ANKA)

Wegener’s granulomatosis w/ polyangiitis

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24
Q

IgM targeting IgG Fc region

A

(AKA RF)
RA
(RF is not as specific for RA as anti-CCP)

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25
Q

Febrile nonhemolytic transfusion rxn

A

1-6h post-transfusion
Fever/chills
Due to cytokine accumulation during storage

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26
Q

Acute hemolytic transfusion rxn

A

Within 1h post-transfusion
Fever, flank pain, hemoglobinuria, AKI, DIC
Due to ABO incompatibility
Positive direct Coombs

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27
Q

Delayed hemolytic transfusion rxn

A

2-10d post-transfusion
Mild fever, hemolytic anemia
Due to anamnestic Ab response
Positive direct Coombs, Positive new Ab response

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28
Q

Anaphylactic transfusion rxn

A 
Rapid onset (sec-mins) shock, angioedema/urticaria, respiratory distress
Due to recipient anti-IgA Abs
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29
Q

Urticarial/allergic transfusion rxn

A

2-3h post-transfusion
Urticaria, flushing, angioedema, pruritus
Due to recipient IgE Abs, mast cell activation

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30
Q

Transfusion-related acute lung injury

A

Within 6h post-transfusion
Respiratory distress, noncardiogenic pulm edema
Due to donor anti-leukocyte Abs

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31
Q

Pleural fluid pH

A

Normal ~7.60
Transudative 7.4-7.55
Exudative below 7.45

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32
Q

TTP cause, symptoms, treatment

A

(Thrombotic thrombocytopenic purpura)
Due to acquired autoAb against ADAMTS13 (would cleave vWF from endothelium; plts get caught near endothelium and form microthrombi)
Fever, Neurologic changes, AKI, MAHA, Thrombocytopenia
Treat w/ plasma exchange; 9/10 die w/o treatment

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33
Q

HIT cause, symptoms, risk

A

Due to Abs against PF4-Hep complex which activates plts to cause thrombus formation and plt consumption –> thrombocytopenia, venous/arterial thrombi, necrosis at heparin sc injection site, anaphylaxis to injections
Highest risk w/ unfractionated heparin

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34
Q

Metabolic alkalosis ddx

A

Low (vomiting, prior diuretics) vs High urine Cl
If high urine Cl, hypervolemic (excess mineralocorticoid activity: hyperaldosteronism, Cushing’s, ectopic ACTH) vs hypo-/euvolemic (Current diuretics vs Bartter, Gitelman)
Vomiting, diuretics are saline-responsive
Mineralocorticoid or renal syndromes are saline-unresponsive

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35
Q

SIADH labs

A 
Serum diluted: Hyponatremia
Hypotonic serum (under 275mOsm)

Urine concentrated: Urine osmolarity over 100
Urine Na over 40

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36
Q

Dermatomyositis symptoms, disease associations

A

Proximal symmetric extremity weakness
Heliotrope rash, Gottron’s papules (scales over joints), CPK over 10x ULN

Assoc w/ internal malignancies - do age appropriate screenings

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37
Q

Lactose intolerance test

A

Lactose hydrogen breath test

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38
Q

Leukomoid rxn vs CML

A

Leukomoid rxn:
WBC over 50, High LAP, Mature PMN precursors, No basophilia

CML:
WBC over 100, Low LAP, Immature PMN precursors, Basophilia

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39
Q

Trihexyphenidyl

A

Anticholinergic Rx for symptomatic Parkinson’s

May cause acute angle closure glaucoma

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40
Q

AIHA vs Hereditary spherocytosis

A

AIHA has a negative FHx and positive Coombs’ test

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41
Q

Difference between case-control and retrospective cohort studies

A

Case-control: Determine outcome first, then look for associated risks

Retrospective cohort: First ascertain risk exposure, then determine outcome

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42
Q

Expected FEV1 change with bronchodilators in asthma

A

At least 12%

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43
Q

Acid-base compensations

A

MetAc: Winter’s formula (Exp paCO2 = 1.5 * [HCO3=] + 8 +/-2)

MetAlk: Exp PaCO2 +0.7 for every +1 HCO3-

Acute RespAc: Serum HCO3- +1 for every +10 PaCO2

Acute RespAlk: Serum HCO3- -2 for every -10 PaCO2

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44
Q

D-xylose test

A

Monosaccharide absorbed in proximal small bowel without degradation by pancreatic or brush border enzymes before urinary excretion
Low abs = proximal small bowel disease (Celiac’s)

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45
Q

Cross-sectional study

A

Collects data from a group of people to assess disease frequency at a particular point in time
May show risk association, but not causality
“What’s happening?”
Measures prevalence

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46
Q

Case-control study

A

Compares group with disease to a group without disease
Looks for prior exposure/risk
Retrospective
“What happened?”
Measures odds ratio: OR = [(a/c)/(b/d)] = (ad)/(bc)

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47
Q

Cohort study

A

Compares initially disease-free people in two groups to see who develops disease: one with exposure/risk, and one without exposure/risk
Can show if exposure/risk increases disease likelihood
Retrospective OR prospective
“Who will develop/developed disease?”
Measures relative risk: RR = [a/(a+b)]/[c/(c+d)]

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48
Q

Twin concordance, adoption studies

A

Measure heritability and environmental influence
Mono- vs dizygotic twins
Siblings with biological vs adoptive parents

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49
Q

Clinical trial phase goals

A

I: Is it safe?
II: Does it work?
III: Is it as good or better than current treatments?
IV: Can it stay?

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50
Q

Odds ratio

A

Odds that a group with disease was exposed to a risk divided by the odds that the group without the disease was exposed
OR = (a/c)/(b/d) = (ad)/(bc)
Typically used for case-control studies

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51
Q

Relative risk

A

Risk of developing disease in the exposed group divided by risk in the unexposed group
RR = [a/(a+b)]/[c/(c+d)]
Typically used in cohort studies
If prevalence is low, OR ~ RR

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52
Q

Attributable risk

A

Difference in risk between exposed and unexposed groups, i.e. proportion of disease occurrences attributable to an exposure
AR = a/(a+b) - c/(c+d)

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53
Q

Relative risk reduction

A

Proportion of risk reduction attributable to an intervention as compared to a control
RRR = 1 - RR = 1 - [a/(a+b)]/[c/(c+d)]

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54
Q

Absolute risk reduction

A

Difference in risk attributable to the intervention as compared to the control
ARR = c/(c+d) - a/(a+b) = -AR

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55
Q

Number needed to treat

A

NNT = 1/ARR (treat has more letters than harm)

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56
Q

Number needed to harm

A

NNH = 1/AR

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57
Q

Recruiting biases, examples, fix

A

Selection, sampling, referral, allocation bias
E.g. Berkson bias - study population is from a hospital and less healthy than the general population
Healthy worker effect - (opposite of Berkson)
Non-response/differential f/u - nonrespondents may differ from participants meaningfully
Randomize to reduce

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58
Q

Procedure bias, example, fix

A

Subjects in different groups are not treated the same
Includes detection bias: Those with a risk factor undergo greater diagnostic scrutiny than those without the risk
Use blinding and placebos to reduce

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59
Q

Recall bias, fix

A

Awareness of disorder alters recall by subjects
Common in retrospective studies
Decrease time from exposure to follow-up to reduce

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60
Q

Observer-expectancy bias, example, fix

A

Researcher’s belief in a treatment’s efficacy changes outcomes
AKA Pygmalion effect or self-fulfilling prophecy
Use blinding and placebos to reduce

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61
Q

Confounding bias, fixes

A

Factor is related to both exposure and outcome, but not the causal pathway
Reduce with multiple/repeat studies, matching of patients with similar characteristics in both control and treatment groups, crossover studies where subjects act as their own controls

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62
Q

Lead-time bias, fix

A

Early detection is confused with increased survival
Especially important for studies of long-term chronic disease
Reduce by measuring back-end survival by controlling for disease severity at time of diagnosis

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63
Q

Hawthorne effect

A

AKA observer effect

Subjects tend to change their behavior when they know they’re being observed

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64
Q

alpha definition

A

Probability of making a type I error (finding a difference between control and experimental groups when one does not exist)

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65
Q

beta definition

A

Probability of making a type II error (stating there is no difference between control and experimental groups when one does exist)
beta increases as alpha decreases

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66
Q

Power

A

1 - b

Increases as beta decreases: Increased precision, increased effect, or INCREASED SAMPLE SIZE

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67
Q

t-test

A

Checks differences between the MEANS OF 2 GROUPS

E.g. BP between males/females

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68
Q

ANOVA

A

Checks differences between the MEANS OF AT LEAST 3 GROUPS

E.g. BP between members of 3 ethnic groups

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69
Q

Chi-square test

A

Checks differences between 2 or more PERCENTAGES OR PROPORTIONS OF CATEGORICAL OUTCOMES
E.g. Percentage of members of 3 ethnic groups with HTN

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70
Q

Ordinal data

A

Data ordered by a position on a scale
Usually categorical - cannot perform arithmetic with these
E.g. Runners finishing in 1st, 3rd, 5th places
Qualitative - Non-parametric

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71
Q

Interval data

A

Data measured along a scale in which each position is equidistant
Quantitative - Parametric
Allows for distances between data points to be equivalent in a way
E.g. Happiness scale from 1-10 or Runners finishing a 5k between 18:00-18:59, 19:00-19:59, 20:00-20:59, etc.

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72
Q

Nominal data

A

Data differentiated by a simple naming system
Usually categorical - E.g. “employee”
May have a number assigned, but is not ordinal (E.g. Runner’s ID number or an athlete’s jersey number)
Qualitative - Non-parametric

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73
Q

Ratio data

A

Data in which numbers are multiples of each other and can be mathematically compared. Zero has a meaning on the scale used for this data
E.g. Runner’s finishing time for a race
Quantitative - Parametric

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74
Q

Continuous data

A

Measured along a continuous scale allowing for infinitely fine subdivision
Vs. discrete where data falls into bins like with interval data

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75
Q

Parametric data

A

Quantitative, forms predictable distributions (e.g. normal)

Can use arithmetic to gain insight into the datasets

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76
Q

Non-parametric data

A

Qualitative, does not assume any distribution

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77
Q

Likelihood ratio for a positive test

A

Sensitivity/(1-Specificity)

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78
Q

Likelihood ratio for a negative test

A

(1-Sensitivity)/Specificity

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79
Q

Sensitivity

A

Chance a test detects disease when it is present
(True-positive rate)
a/(a+c)
TP/(TP+FN)

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80
Q

Specificity

A

Chance a test indicates no disease when none is present
(True-negative rate)
d/(b+d)
TN/(TN+FP)

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81
Q

Positive predictive value

A

Proportion of positive test results that are true positives
a/(a+b)
TP/(TP+FP)

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82
Q

Negative predictive value

A

Proportion of negative test results that are true negatives
d/(c+d)
TN/(TN+FN)

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83
Q

Incidence

A

New cases occuring during a particular time period

N(new cases)/N(at risk)

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84
Q

Prevalence

A

Number of people affected by a disease at a given point in time
N(w/disease)/N(population)
Increases w/ incidence
Decreases w/ death of affecteds and recovery

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85
Q

Standard error of the mean

A

Used for samples of a population

SEM = s/sqrt(n), where s = stddev of sample

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86
Q

Correlation coefficient

A

r
Always between -1 and 1
More negative = stronger negative correlation, etc.

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87
Q

Coefficient of determination

A

r^2
Always between 0 and 1
Represents the amount of variance in the dependent variable (y) due to the independent variable (x):
y = a + bx

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88
Q

Psych Rx SEs

A

1st gen: Extrapyramidal symptoms, hyperprolactinemia (also risperidone)

2nd gen: Metabolic syndrome (weight gain, dyslipidemia, new T2DM) - esp. olanzapine, clozapine

Ziprasidone - Long QT

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89
Q

Clozapine indications, SE

A

Treatment-resistant or suicidal schizophrenia

SE: Agranulocytosis, SZ, myocarditis, metabolic syndrome

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90
Q

DSM-5 psychosis disorders

A

Brief psychotic - less than 1m w/ full return of fxn

Delusional - delusions over 1m w/o other psychotic symptoms and w/ nml fxn

Schizophreniform - less than 6m of schizophrenic sx

Schizophrenia - at least 6m w/ 1m active sx and functional decline

Schizoaffective - Schizophrenia + concurrent mood episode + at least 2w psychosis w/o mood sx

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91
Q

Major depression signs and symptoms

A 
SIGECAPS
Sleep changes
Interest deficit (anhedonia)
Guilt
Energy deficit
Concentration deficit
Appetite changes
Psychomotor changes
Suicidality
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92
Q

Depressed mood ddx

A

Major depressive disorder - at least 2w, 5 of SIGECPAS, fxn impairment, no mania/drug/medical hx

Adjustment disorder w/ depressed mood - Within 3m of identifiable stressor

Normal stress response - Not excessive, no fxn impairment

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93
Q

Bipolar 1 vs Bipolar 2

A

Bipolar 1 - Manic episodes: Severe sx, over 1w, marked fxn impairment, psychotic features

Bipolar 2 - Hypomanic episodes: Less severe sx, over 4d, impairment not severe enough to be hospitalized, no psychotic features

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94
Q

Differentiating bipolar disorder and major depressive disorder w/ psychotic features vs schizophrenia vs schizoaffective disorder

A

Bipolar and MDD w/ psychotic features have psychosis only during mood disturbances
Schizophrenia has psychosis w/o mood disturbances
Schizoaffective has major depressive episode concurrent w/ schizophrenia sx

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95
Q

NMS management

A

Discontinue offending antipsychotic, supportive care

Add dopaminergic Rx (bromocriptine, amantadine) to reverse blockade if necessary

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96
Q

Nightmare disorder vs non-REM sleep terrors

A

Nightmares: Full awakening from REM w/ alertness and dream recall
Non-REM: Partial arousal, unresponsiveness, no recall of dream content

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97
Q

Postinfectious glomerulonephritis vs IgA nephropathy

A

PIGN: 1.5-3w post-infxn, more common in kids, gross hematuria
Low C3, elevated anti-streptolysin O/anti-DNAse B, subepithelial humps of C3 deposits

IgA nephropathy: within 5d of infxn, young adult males, recurrent gross hematuria
Nml complement, mesangial IgA deposits

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98
Q

First test w/ suspected acromegaly?

A

IGF-1 - Responsible for most of GH effects

GH is too variable to make decisions

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99
Q

Primary manifestations of Chagas’ disease

A

Megacolon/megaesophagus

Cardiac disease 2/2 prolonged protozoal myocarditis

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100
Q

Winter’s formula

A

For determining appropriate respiratory compensation for metabolic acidosis:
Expected paCO2 = 1.5 * [HCO3-] + 8 +/- 2

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101
Q

Weber test

A

Tuning fork on midline skull
Conductive hearing loss: Lateralizes to affected ear
Sensorineural hearing loss: Lateralizes to unaffected ear

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102
Q

Rinne test

A

Normally, tuning fork over mastoid, then in outside EAM until no longer heard
Abnormal if can’t hear outside EAM = Conductive hearing loss

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103
Q

Paranoid

A

Suspicious, distrustful, hypervigilant

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104
Q

Schizoid

A

Prefer loner, detached, unemotional

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105
Q

Schizotypal

A

Eccentric, odd thoughts/perceptions/behaviors

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106
Q

Antisocial

A

Disregards/violates others’ rights

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107
Q

Borderline

A

Chaotic relationships, sensitive to abandonment, labile mood, impulsive, inner emptiness, self-harm

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108
Q

Histrionic

A

Dramatic, superficial, attention-seeking

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109
Q

Narcissistic

A

Grandiose, lacks empathy

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110
Q

Avoidant

A

Avoids interaction due to fear of criticism/rejection

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111
Q

Dependent

A

Submissive, clingy, needs to be taken care of

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112
Q

Obsessive-compulsive personality disorder

A

Rigid, controlling, perfectionistic (ego-syntonic)

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113
Q

Acute dystonia, treatment

A

(EPS from blocking D2Rs)
Sudden sustained cntrxn of neck, mouth, tongue, eye mm
Treat w/ benztropine, diphenhydramine

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114
Q

Akathisia, treatment

A

(EPS from blocking D2Rs)
Subjective restlessness, inability to sit still
Treat w/ b-blocker (propranolol) or BZD (lorazepam)

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115
Q

Drug-induced Parkinsonism, treatment

A

(EPS from blocking D2Rs)
Gradual-onset tremor, rigidity, bradykinesia
Treat w/ benztropine, amantadine

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116
Q

Tardive dyskinesia, treatment

A

(EPS from blocking D2Rs)
Gradual onset mouth/face/trunk/extremity dyskinesia after 6m Rx
Remove offending agent, Clozapine least likely to cause issues

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117
Q

Somatic symptom disorder

A

Excessive anxiety/preoccupation w/ unexplained sx

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118
Q

Illness anxiety disorder

A

Fear of having serious dx despite few sx, neg evals

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119
Q

Conversion disorder

A

Neuro sx incompatible w/ known dx

Often acute onset assoc w/ stress

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120
Q

Factitious disorder

A

Intentional falsification or inducement of sx to assume sick role

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121
Q

Malingering

A

Falsification or exaggeration of sx to obtain external incentives

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122
Q

SSRIs, SE

A

Fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluvoxamine
Sexual SEs, SIADH

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123
Q

SNRIs, major SE

A

Venlafaxine, desvenlafaxine, duloxetine

Discontinuation/withdrawal syndrome

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124
Q

NDRI, CIs, benefits

A

Bupropion
CI - SZ disorder (Lowers seizure threshold), Bulimia (Worsens electrolyte abnmlities)
No sexual SEs

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125
Q

TCAs

A

Amitriptyline, nortriptyline

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126
Q

MAOIs

A

Phenelzine, tranylcypromine

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127
Q

Social anxiety disorder

A

Anxiety restricted to social/performance situations, fear of scrutiny/embarrassment

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128
Q

Panic disorder

A

Recurrent, unexpected panic attacks

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129
Q

Specific phobia

A

Excessive anxiety about specific object/situation

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130
Q

Generalized anxiety disorder

A

Chronic multiple worries

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131
Q

Wallenberg syndrome

A

Lateral medullary infarction from blocked vertebral a:
Vestibulocerebellar sx (vertigo, nystagmus, IL limb ataxia)
IL loss of face + CL loss of limbs P/T/CT
Dysarthria, dysphagia
IL Horner’s, loss of automatic respiration

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132
Q

Medial medullary syndrome

A

ASA or vertebral a occlusion

CL limb paralysis + IL CN XII (lick your wounds)

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133
Q

Medial mid-pontine infarction

A

CL ataxia, hemiparesis of face+trunk+limbs, variable loss of CL tactile+position

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134
Q

Gonococcal urethritis vs chlamydial urethritis, testing, pregnancy

A

Gonorrhea will gram stain w/ G- cocci in vast majority of cases
Chlamydia cannot be visualized or cultured - requires DNA amplification testing
Chlamydia is in std initial prenatal screening
Gonorrhea is only indicated for high risk preg women (under 25y, multiple partners, STI hx)

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135
Q

Auer rods are specific for?

A

AML

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136
Q

When to start COPD patients on home oxygen?

A

Uncomplicated: Resting PaO2 under 55 or O2sat under 88%

Complicated by cor pulmonale or Hct over 55%: Resting PaO2 under 59 or O2sat under 89%

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137
Q

How to assess ARDS severity

A

PaO2/FiO2 ratio
Under 300: ARDS
Under ~50: Severe ARDS

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138
Q

Syphilis treatment in those w/ penicillin allergies

A

If neurosyphilis, pregnant, or other treatment failures: Desensitize and use Pen G
If primary: Doxycycline x14d

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139
Q

Heart block and diastolic murmur in an IVDU?

A

Perivalvular abscess involving conducting tissues

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140
Q

Fluoxetine name, common SE

A

Prozac

Weight gain, birth defects (cardiac)

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141
Q

Paroxetine name, benefit

A

Paxil

Long half-life of 1-3d better for those who may have poor adherance

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142
Q

Buspirone mech

A

5-HT and D2R agonist

Anxiolytic

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143
Q

Felty syndrome

A

Triad of inflammatory arthritis, splenomegaly, and neutropenia
Most common in those with long-standing severe RA

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144
Q

Anemia of prematurity, cause, labs

A

Most common anemia in preterm infants
D/t low Epo, short RBC lifespan, and blood loss
Labs: low Hb, Hct, retics

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145
Q

Beckwith-Wiedemann syndrome cause, pres, complications, monitoring

A

D/t gene on c11
Hemihyperplasia, macrosomia, rapid growth, macroglossia, omphalocele/umbilical hernia
Increased risk of Wilms tumor, hepatoblastoma - monitor w/ AFP, US

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146
Q

McCune-Albright syndrome

A

5% of female precocious puberty, assoc w/ other endocrine abnmlities
3Ps: Precocious puberty, Pigmentation (cafe-au-lait spots), Polyostotic fibrous dysplasia (bone defects)

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147
Q

ALL

A

Lymphoblasts on smear lack peroxidase (myeloblasts) but do stain PAS+ and contain TdT
May also have pancytopenia, LAD, splenomegaly

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148
Q

HUS

A

Hemolytic anemia + thrombocytopenia + AKI

Most common in toddlers after diarrheal illness caused by Shiga-toxin producing bacteria

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149
Q

Legg-Calve-Perthes disease

A

Osteonecrosis of femoral head usually in boys 4-10yo

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150
Q

Slipped capital femoral epiphysis

A

Displaced femoral neck from femoral head

Most often in obese adolescents (12-14yo)

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151
Q

Transient synovitis

A

Mild chronic hip/knee pain of insidious onset (usually post-viral illness and max 4wk) w/ uneven gait W/O PATH ON X-RAY
(Dx of exclusion)

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152
Q

Kawasaki disease sx, treatment

A

5d of fever
B/l nonexudative conjunctivitis
Mucositis (strawberry tongue, no exudates)
Cervical LAD (often u/l)
Rash (generalized, erythematous, polymorphous)
Extremity changes (edema)

Treat w/ ASA and IVIG to reduce coronary artery aneurysm risk

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153
Q

Scarlet fever sx

A 
Complication of untreated Strep pharyngitis:
Fever
Tonsillar exudates
Cervical LAD
Rash ("sandpaper" sparing palms/soles)
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154
Q

Niemann-Pick disease sx, cause

A 
Sphingomyelinase deficiency
2-6m
Areflexia
HSM
Cherry-red macula
Hypotonia
Dev regression
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155
Q

Tay-Sachs sx, cause

A 
b-hexosaminidase A deficiency
2-6m
Cherry-red macula
Hypotonia
Dev regression
Hyperreflexia

NO HSM or areflexia

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156
Q

RTA 1 defect, cause, labs

A

Non-anion gap MetAcid
Poor H+ secretion into urine (distal RTA)
D/t genetic disorders, med tox, or autoimmune
Low-nml serum K
Urine pH over 5.5

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157
Q

RTA 2 defect, cause, labs

A

Non-anion gap MetAcid
Poor HCO3- resorption from urine (proximal RTA)
D/t Fanconi syndrome (glucosuria, phosphaturia, aminoaciduria)
Low-nml serum K
Urine pH under 5.5

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158
Q

RTA 4 defect, cause, labs

A 
Non-anion gap MetAcid
Aldosterone resistance
D/t obstructive uropathy, congenital adrenal hyperplasia
High serum K
Urine pH under 5.5
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159
Q

Endometriosis

A

Pain 1-2wk prior to menses peaking before menstruation

Triad of dysmenorrhea, dyspareunia, infertility

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160
Q

REM sleep disorder sx, assoc

A

Complex motor behaviors during REM due to absent muscle atonia
Usually latter part of the night (non-REM is earlier)
Assoc w/ neuro degen in PD, Lewy body dementia

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161
Q

Bereavement major depressive episode treatment

A

Psychotherapy + SSRI

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162
Q

First trimester screen

A

Screens for trisomies 18, 21 risk (not diagnostic)

F/u w/ amniocentesis (15-20w) or CVS (10-13w) if abnml

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163
Q

Goal of HCV treatment

A

Limit risk for future liver damage - avoid IVDU, EtOH; HepA + B vac if not given

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164
Q

Causes of increased maternal serum AFP

A

Open neural tube defects
Ventral wall defects (omphalocele, gastroschisis)
Multiple gestation

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165
Q

Causes of decreased maternal serum AFP

A

Aneuploidy (esp. trisomies 21, 18)

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166
Q

Severe features of preeclampsia, tests

A 
SBP over 160, DBP over 110
Thrombocytopenia
High Cr
High LFTs
PULM EDEMA
Visual/cerebral sx

Confirm proteinuria by urine protein/Cr ratio or 24h collection

167
Q

Anemia in pregnancy, complications

A

Nml for dilution of Hb, but anemic if under 11 in 1/3 and 3/3, 10.5 in 2/3
Anemia can cause poor perfusion and subsequent lactic acidosis (anion gap)

168
Q

Oxytocin SE

A

Hyponatremia (similar structure to ADH, can cause SZ)
Hypotension
Tachysystole

169
Q

Signs of anterior shoulder dislocation

A

D/t direct blow or FOOSH

Arm slightly abducted, externally rotated

170
Q

Signs of posterior shoulder dislocation

A

D/t violent muscle contractions

Arm adducted, internally rotated, flattened anterior shoulder aspect

171
Q

Ovarian masses increase risk of?

A

Ovarian torsion

172
Q

Missed abortion

A

No bleeding
Closed os
No fetal cardiac activity or empty sac

173
Q

Threatened abortion

A

Vaginal bleeding
Closed os
Fetal cardiac activity

174
Q

Inevitable abortion

A

Vaginal bleeding
Dilated os
Products of conception may be seen/felt at/above os

175
Q

Incomplete abortion

A

Vaginal bleeding
Dilated os
Some products of conception expelled, some remain

176
Q

Complete abortion

A

May or may not have vaginal bleeding
Closed os
Products of conception completely expelled

177
Q

Protracted labor, treatment

A

Slower than expected cervical change w/ or w/o contractions

Give oxytocin

178
Q

Arrested labor, treatment

A

No cervical change for 4h w/ adequate ctrxns (over 200 MVUs) OR for 6h w/ inadequate ctrxns
C-section

179
Q

Causes of asymmetric fetal growth restriction

A

Placental insufficiency in 2/3 or 3/3, e.g. HTN, pregestational DM
These cause hypoxemia and head-sparing growth pattern

180
Q

Causes of symmetric fetal growth restriction

A

Congenital disorders (aneuploidy, 1/3 infxns)

181
Q

Fetal hydantoin syndrome, cause

A 
Small body size
Microcephaly, midfacial hypoplasia
Digital/nail hypoplasia
Hirsutism
Cleft palate
Rib anomalies
D/t anticonvulsants (e.g. phenytoin)
182
Q

Congenital syphilis sx

A

Rhinitis
HSM
Skin lesions
Later Hutchinson teeth, saddle nose, saber shins, deafness, CNS sx

183
Q

Cocaine in pregnancy

A

Placental abruption

Can lead to fetal loss, CNS dysfxn due to hypoperfusion

184
Q

Tamoxifen risks

A

Hot flashes
DVT
Endometrial hyperplasia/carcinoma (only SERM w/ this risk)

185
Q

Age to begin Pap smears

A

21y

186
Q

HPV vax schedule

A

Beginning at 11-12y, but can be received until 26y

187
Q

Stress incontinence cause, sx

A

D/t decreased sphincter tone

Leakage w/ straining

188
Q

Urge incontinence cause, sx

A

D/t detrusor overactivity

Sudden overwhelming urge to urinate

189
Q

Overflow incontinence cause, sx

A

D/t impaired detrusor contractility or bladder outlet obstruction
Incomplete emptying w/ persistent involuntary dribbling

190
Q

Congenital rubella syndrome

A 
Deafness
Cardiac defects
HSM
Microcephaly
Cataracts
191
Q

Mg SE

A 
Hyporeflexia
Lethargy
Headaches
Resp failure
Cardiac arrest
Sx start above 8
192
Q

Quad screen tests and timing, f/u

A

Performed in 2/3 (15-20w)
Maternal serum AFP, b-hCG, estriol, inhibin A are tested
F/u w/ cell-free fetal DNA testing (higher sens, spec)

193
Q

Trisomy 18 quad screen results

A

Low MSAFP, b-hCG, estriol

Nml inhibin A

194
Q

Trisomy 21 quad screen results

A

Low MSAFP and estriol

High b-hCG and inhibin

195
Q

Neural tube/abd wall defect quad screen

A

High MSAFP

Nml b-hCG, estriol, and inhibin A

196
Q

Placenta previa management

A 
Pelvic rest (no intercourse, digital exam) to decrease risk of disruption, painless bleeding
Schedule C-section for 36-37w unless resolution shown on u/s prior
197
Q

Combined OCP risks and benefits

A

Benefits: Contraception, endometrial and ovarian CA risk reduction, menstrual regulation, benign breast disease risk reduction

Risks: DVT, HTN, hepatic adenoma, (CVA, MI - slight)

198
Q

Hydatidiform mole pres, tests

A

Preeclampsia sx before 20w, enlarged uterus

Elevated b-hCG

199
Q

Complete mole cause, risk

A

D/t 1 or 2 sperm fertilizing an egg that has no DNA (46chr)

Choriocarcinoma risk

200
Q

Incomplete mole cause

A

D/t haploid egg being fertilized by a sperm that duplicates it’s DNA (69chr)
Minimal choriocarcinoma risk

201
Q

Fitz-Hugh Curtis syndrome

A

Perihepatitis as a sequela of PID

202
Q

Secondary amenorrhea def, eval

A 
Absence of menses for 3cyc/6m in those w/ prior periods
Exclude pregnancy (b-hCG), then serum prolactin (brain MRI), TSH (hypothyroid), FSH (premature ovarian failure)
203
Q

Ovarian torsion ddx

A

Appendicitis, pelvic abscess, ectopic preg

Torsion may not have fever or leukocytosis, risk w/ ovarian mass hx, no b-hCG elevation

204
Q

LBBB ECG

A

Widened QRS (over 120ms) w/ 2+ deflects to L leads (V6) and +/- deflects to R leads (V1)

205
Q

RBBB ECG

A

Widened QRS (over 120ms) w/ 2+ deflects to R leads (V1) and +/- deflects to L leads (V6)

206
Q

Kussmaul sign

A

Increased JVP w/ inspiration

Seen in cardiac tamponade, constrictive pericarditis

207
Q

S3 indicates? Assoc?

A

Fluid overload (as in CHF, MV disease) causing rapid ventricular filling
Nml in younger patients, high output states (preg)
Dilated cardiomyopathy association

208
Q

S4 indicates? Assoc?

A

Decreased compliance causes sound of atrial kick
Nml in younger patients, athletes
Hypertrophic cardiomyopathy association

209
Q

Bounding peripheral pulses may indicate?

A

AR, Aortic coarc, PDA,

210
Q

Cardiac tamponade signs

A 
Kussmaul sign (up JVP w/ inspiration)
Pulsus paradoxus (down sysBP w/ inspiration)
Pulsus alternans (alternating weak/strong pulse d/t impaired LV systolic fxn)
211
Q

Pulsus parvus et tardus indicates?

A

AS

212
Q

CHADS-VASC score

A

(CHA2DS2-VASc)
Estimate CVA risk in AFib - give anticoagulation for score over 2:

CHF - 1
HTN - 1
(Age over 75y) - 2
DM - 1
(Stroke) CVA/TIA hx - 2
Vasc disease hx - 1
Age 65-74y - 1
Sex (female) - 1
213
Q

AFib management

A 
ABCD
Anticoagulate
b-blockers (rate control)
Cardiovert/CCBs
Digoxin (in refractory cases)
214
Q

2nd deg AV block types, signs, treatments

A

Mobitz I/Wenckebach - Progressive PR lengthening until dropped QRS, d/t drugs (digoxin, b-block, CCBs), increased vagal tone, or R coronary a ischemia - stop drug, periodic atropine

Mobitz II/non-Wenckebach - Random dropping of QRS, d/t fibrosis of conduction system from prior MI - Needs pacemaker d/t frequent progression to 3rd deg block

215
Q

Sick sinus syndrome pres, treatment

A

Tachy-/bradycardias may induce intermittent supraventricular tachyarrhythmias or bradyarrhythmias

May present w/ syncope, palpitations, dyspnea, angina, TIA, CVA - Most common reason for pacemaker

216
Q

Causes of acute AFib

A 
PIRATES
Pulm dx
Ischemia
Rheumatic heart dx
Anemia/Atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis
217
Q

Chronic and acute AFib treatment

A

Rate control - b-blockers, CCBs, or digoxin
Anticoagulate w/ warfarin for those w/ CHA2DS2-VASc over 2

Unstable or new-onset (under 2d) - cardiovert
(Over 2d or unclear) - get TEE to rule out atrial clot

218
Q

Multifocal atrial tachycardia cause, signs/sx, ECG, treatment

A

Multiple atrial pacemakers/reentrant pathways. Often d/t COPD, hypoxemia
At least 3 different P-wave morphologies, rate over 100bpm
Treat underlying disorder
Verapamil/b-blockers for rate control and suppression of atrial pacemakers (limited effectiveness)

219
Q

AV node reentrant tachycardia (AVNRT) cause, signs/sx, ECG, treatment

A

D/t reentry circuit in AV node depolarizes atrium + ventricle simultaneously
Pres w/ palpitations, SOB, angina, syncope, lightheadedness
Rate 150-250bpm, BURIED P-waves
Cardiovert if unstable; Carotid massage, valsalva, or adenosine can stop arrhythmia

220
Q

AV reentrant tachycardia (AVRT) cause, signs/sx, ECG, treatment

A

D/t ectopic connection between atrium + ventricle causing reentry circuit (seen in WPW)
Pres w/ palpitations, SOB, angina, syncope, lightheadedness
Retrograde P-wave seen after nml QRS (Pre-QRS delta wave in WPW)
Cardiovert if unstable
Carotid massage, valsalva, or AV nodal blockers (adenosine, b-blockers, CCBs) can stop arrhythmia
If in AFib, use procainamide/ibutilide

221
Q

Paroxysmal atrial tachycardia cause, signs/sx, ECG, treatment

A

Rapid ectopic pacemaker in the atrium (not sinus node)
Pres w/ palpitations, SOB, angina, syncope, lightheadedness
Rate over 100bpm, P-wave w/ unusual axis BEFORE QRS
Adenosine to unmask underlying atrial activity by slowing rate

222
Q

PVC causes

A

From ventricular foci d/t hypoxia, abnml electrolytes, hyperthyroidism

223
Q

Acute CHF management

A 
LMNOP
Lasix (furosemide)
Morphine
Nitrates
Oxygen
Position (upright)
224
Q

Loop diuretics, mech, SE

A

Furosemide, ethacrynic acid (non-sulfa), torsemide
Block Na/K/2Cl transporter in ascending loop
Hypokalemia, hypocalcemia (Loops Lose Ca), gout flares, ototoxicity, dehydration

225
Q

Thiazide diuretics, mech, SE

A

Hydrochlorothiazide, chlorothalidone
Block Na/Cl transporter in DCT -
Hypokalemic metabolic alkalosis, hyponatremia, hyperGLUC (hyperGlycemia, -Lipidemia, -Uricemia, -Calcemia)

226
Q

K+ sparing diuretics, mechs, SE

A

Spironolactone, amiloride, triamterene
Block aldosterone receptor (spironolactone) or Na channels (amiloride, triamterene) in collecting tubule
Hyperkalemia, sexual dysfxn, gynecomastia

227
Q

Carbonic anhydrase inhibitors, SE

A

Acetazolamide

Hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy

228
Q

Osmotic diuretic, SE

A

Mannitol

Pulm edema, dehydration

229
Q

Angina treatment

A

ASA, b-blockers (shown to improve mortality)

Nitrates

230
Q

ACS treatment

A

MONA - morphine, O2, nitrates, ASA

b-blockers as hemodynamics allow (avoid in R-sided MI)

231
Q

Statin SE, indications

A

Those w/ CV hx, DM + 10y risk over 7.5%, or LDL over 190: high-intensity statin

Those w/ DM + 10y risk under 7.5%: mod-intensity statin

Those w/o DM or hx:
Over 7.5% 10y CV risk - high-intensity statin
5-7.5% 10 CV risk - mod-intensity statin

Increased LFTs, myositis, warfarin potentiation

232
Q

HTN treatments

A 
ABCD
ACEIs/ARBs
b-blockers
CCBs
Diuretics (usually thiazide)
233
Q

Secondary HTN causes

A 
CHAPS
Cushing syndrome
Hyperaldosteronism (Conn syndrome)
Aortic coarctation
Pheochromocytoma
Stenosis of renal aa
234
Q

ST-elevations in pericarditis vs MI

A

MI - localized to ischemic area

Pericarditis - global

235
Q

AR exam, treatment

A

Blowing diastolic murmur, mid-diastolic rumble (Austin Flint murmur), WIDENED PULSE PRESSURE, water-hammer pulse
CCBs (DHPs) or ACEIs until severe enough to warrant valve replacement

236
Q

Virchow Triad

A

DVT risk up d/t: Hemostasis, Endothelial damage, Hypercoagulability

237
Q

Acute ischemia sx

A

6Ps:

Pain, Pallor, Paralysis, Pulselessness, Paresthesias, Poikilothermia

238
Q

How to determine severity of PVD?

A

Ankle-brachial index (ABI): Pleg/Parm

Nml 1.0-1.2, Severe (rest pain) under 0.4

239
Q

SCC vs BCC

A

SCC - erythematous hyperkeratotic ULCERATED papule/nodule arising from precursor AK (also: Marjolin’s ulcer, As poisoning causing palmoplantar distribution) w/ faster growth, rare metastasis. More common on lower lip

BCC - most common, pearly nodule w/ umbilicated center + telangectasias, may be ulcerated/open, virtually no metastatic potential

240
Q

DVT risk calculation, Rx

A

Wells score:
-2-0: Low risk, 1-2: Mod risk, 3-8: High risk

1 - Paralysis, recent LE casting
1 - Bedridden over 3d or major surgery last 4w
1 - Local tenderness
1 - Swelling of entire leg
1 - Calf swelling 3cm more than other leg 10cm below tib tuberosity
1 - Pit edema greater in symptomatic leg
1 - Collateral nonvaricose superficial vv
1 - Cancer active or within last 6m
-2 - Alt dx more likely (Baker’s cyst, cellulitis, other vv stuff, etc)

If at least 2, U/S to confirm before anticoag

241
Q

Primary hyperparathyroidism cause, labs

A

High PTH secreted by single adenoma (80%), diffuse hyperplasia (over 15%), or carcinoma (under 5%)

High PTH and Ca
Low PO4

242
Q

Secondary hyperparathyroidism cause, labs

A

Renal insufficiency causes low production of 1-25(OH)2 vit D. Also can happen w/ vit D or Ca deficiency

High PTH
Low/nml Ca
High PO4 in setting of CKD

243
Q

Tertiary hyperparathyroidism cause, labs

A

Hyperplasia of PT gland/s in dialysis patients w/ long-standing secondary hyperparathyroidism leads to autonomous PTH secretion

High PTH, Ca, PO4

244
Q

Pseudohyperparathyroidism cause, labs

A

Target organs are resistant to PTH (genetic disorders)

High PTH
Low Ca
High PO4

245
Q

Hypercalcemia sx, Rx

A

“Stones, bones, groans, psychiatric overtones”
IV fluids, then loop diuretics
Add bisphosphonates in malignancy +/- calcitonin

246
Q

Hyperkalemia treatment

A 
C BIG K
1st - Calcium gluconate
Bicarbonate, b-2 agonists
Insulin + Glucose
Last - Kayexalate (Na polystyrene sulfonate)
247
Q

What to monitor w/ digitalis?

A

K+

Hypokalemia can sensitize heart to digitalis toxicity (K+ and digitalis compete for same site on Na/K pump)

248
Q

Factors causing K+ shift out of cells

A

Acidosis (exercise - lactic)
Cell lysis
Hyperosmolarity

249
Q

If hypokalemia doesn’t respond to K+ repletion, check what?

A

Mg levels may be low

250
Q

Hypercalcemia causes

A

CHIMPANZEES

Calcium supplements
Hyperparathyroidism/Hyperthyroidism
Iatrogenic/Immobile
Milk-alkali syndrome
Paget disease
Adrenal insufficiency/Acromegaly
Neoplasm
Zollinger-Ellison syndrome (MEN 1)
Excess vitA
Excess vitD
Sarcoidosis/granulomatous dx
251
Q

Anion-gap metabolic acidosis dx + Rx

A

MUDPILES

Methanol (vision loss, optic disc hyperemia) - Fomepizole (block liver conversion to toxic metabolite)
Uremia - Dialysis (aeioUy)
DKA - Insulin, IVF, K+
Paraldehyde
Iron, Isoniazid - GI lavage, charcoal (INH)
Lactic acidosis - IVF
Ethylene glycol (urine CaOx stones) - Fomepizole
Salicylates - Alkalinize urine

Use NaHCO3 in severe acidosis (under 7.2)

252
Q

Hypomagnesemia causes, signs, Rx

A

Low intake - malnutrition, malabsorption, short bowel syndrome, TPN, PPIs
High loss - diuretics, diarrhea, vomiting, hypercalcemia, alcoholism (most common)
Misc - DKA, pancreatitis, ECF volume expansion

Concurrent hypocalcemia and hypokalemia
ECG - long PR + QT
IV/po supplements

Must correct low Mg to correct low K and low Ca

253
Q

Urgent dialysis indications

A

AEIOU, sometimes Y

Acidosis
Electrolytes (high K+)
Intoxication (ASA, methanol, ethylene glycol, etc.)
Overload (fluid)
Uremia
Y not, nothing else is working
254
Q

Determining acid-base status

A

Art pH first for acidosis/alkalosis

Acidotic + pCO2 over 40 = RespAc (hypoventilation)
Acidotic + pCO2 under 40 = MetAcid w/ compensation –> Check anion gap

Alkalotic + pCO2 over 40 = MetAlk w/ compensation –> Check urine Cl for NS responsiveness (low = yes, high = no)
Alkalotic + pCO2 under 40 = RespAlk (hyperventilation, early ASA ingestion)

255
Q

PTH effects

A

PT response to low Ca
Renal: Up Ca reabs from urine, Down PO4 reabs from urine, Up vitD activation
Bones: Up Ca + PO4 reabs

256
Q

VitD effects

A

GI: Up Ca + PO4 reabs

257
Q

Calcitonin effects

A

Mildly lower Ca by causing deposit in bones

258
Q

Nephritic/nephrotic syndrome w/ low C3 ddx

A

Postinfectious glomerulonephritis
Membranoproliferative glomerulonephritis (including mixed cryoglobulinemia)
SLE nephritis

259
Q

Mixed cryoglobulinemia presentation

A 
Palpable purpura
Arthralgias
Nephritic/nephrotic syndrome
Low C3
HCV+
260
Q

Nephritic syndromes

A

Immune complexes:
Postinfectious glomerulonephritis
IgA nephropathy (Berger dx)
HSP

Pauci-immune (No IF):
Wegener’s granulomatosis w/ PolyAngiitis
Micro-PAn
(Churg-Strauss) Eosinophilic granulomatosis w/ PAn

Anti-GBM dx:
Goodpasture syndrome
Alport syndrome

261
Q

Postinfectious glomerulonephritis hx, labs, treat

A

Seen w/ 2-6w after any infxn, but usually GABHS
Tea-/Cola-colored urine, HTN, oliguria, edema
Low C3 nmlizes after 6-8w
High anti-Streptolysin O (ASO) + anti-DNase
“Lumpy-bumpy” IF
Diuretics + supportive

262
Q

IgA nephropathy (Berger) hx, labs, treat

A 
Most common nephritic syndrome
Within 5d of GI/URI, young adult males, recurrent gross hematuria - assoc w/ HSP
Nml C3, mesangial IgA deposits
Steroids
ACEIs in patients w/ proteinuria
20% progress to ESRD
263
Q

HSP hx, labs, treat

A

Small vessel vasculitis often in childhood
Triad of: Palpable purpura, arthralgias, abdominal pain
Nml C3, mesangial IgA deposits (same as IgA nephropathy)
Steroids + supportive

264
Q

Wegener’s granulomatosis w/ poly-angiitis hx, labs, treat

A

Granulomatous inflammation of respiratory tract (including nasopharynx, eg septum) + kidney w/ necrotizing vasculitis
Resp + sinus sx - cavitary pulm lesions bleed and cause hemoptysis
+c-ANCA
Segmental necrotizing glomerulonephritis
High-dose steroids, cytotoxins, or rituximab - frequent relapses

265
Q

Micro-PAN hx, labs, treat

A 
Small vessel vasculitis W/O GRANULOMAS
Resp sx w/ hemoptysis, but NO SINUS SX
\+p-ANCA
Necrotizing glomerulonephritis
Glucocorticoids, cyclophosphamide, or rituximab
266
Q

Eosinophilic granulomatosis w/ PAN hx, labs, treat

A 
AKA Churg-Strauss
Granulomatous small vessel vasculitis
ASTHMA, sinusitis, purpura/skin nodules, peripheral neuropathy
\+p-ANCA, HIGH IgE
Steroids
267
Q

Goodpasture syndrome hx, labs, treat

A

Rapidly progressive glomerulonephritis w/ pulm hemorrhage classically in young men
Hemoptysis, dyspnea, resp failure - NO UR involvement
Linear anti-GBM deposits on IF, Fe-deficiency anemia
Plasma exchange, pulsed steroids, may progress to ESRD

268
Q

Alport syndrome hx, labs, treat

A

Hereditary glomerulonephritis presenting in boys 5-20y
Hematuria, sensorineural deafness, eye disorders
GBM splitting on EM
Progresses to ESRD, may recur after transplant

269
Q

Nephrotic syndromes,

complication

A 
Minimal change disease
FSGS
Membranous nephropathy
DM nephropathy
SLE nephritis
Renal amyloidosis
Membranoproliferative nephropathy (types I, II, III)
RV thrombosis (esp. MN)
270
Q

Minimal change disease hx, labs, treat

A

Most common nephrosis cause in children
Idiopathic or 2/2 NSAIDs, hematologic malignancies
Tendency to infxns, thrombosis; sudden onset edema
Nml light microscopy, podocyte foot effacement on EM
Steroids, good prognosis

271
Q

FSGS hx, labs, treat

A

Most common nephrosis in adults
Assoc w/ black/Hispanic ethnicity, hx of IVDU (heroin), HIV, obesity
HTN, micro hematuria
Sclerosis in capillary tufts
Prednisone, cytotoxins; ACEIs/ARBs to reduce proteinuria

272
Q

Membranous nephropathy hx, labs, treat

A

Assoc w/ solid-tumor malignancies, HBV, SLE, NSAIDs
Can cause RV thrombosis from AT3 loss
“Spike-and-dome” granular IgG and C3 deposits at GBM
Prednisone, cytotoxins for severe dx

273
Q

DM nephropathy hx, labs, treat

A

Diffuse hyalinization + nodular glomerulosclerosis (Kimmelstiel-Wilson lesions)
Long-standing poorly controlled DM w/ neuropathy/retinopathy
Thickened GBM + increased mesangial matrix
Blood glucose control + ACEIs/ARBs

274
Q

SLE nephritis

A

Nephrotic + Nephritic
Proteinuria or RBCs on UA during eval of SLE patients
Mesangial proliferation; subendothelial/subepithelial IC deposits
Prednisone, cytotoxins may slow

275
Q

Renal amyloidosis

A

Primary (plasma cell dyscrasia - AL [Ab light chain] amyloid) or secondary (infectious/inflammatory - AA [serum amyloid A] amyloid) - may also deposit in HEART, LIVER
Hx of multiple myeloma or chronic inflammatory dx (RA, TB)
Nodular glomerulosclerosis, apple-green birefringence w/ Congo red
Prednison + melphalan; Bone marrow transplant in MM

276
Q

Membranoproliferative nephropathy type I hx, labs, treat

A

Nephritic/nephrotic
Assoc w/ HBV, HCV, SLE, cryoglobulinemia, subacute bacterial endocarditis
“Tram-track” split GBM from subendothelial and mesangial deposits; Low C3
Steroids + cytotoxins

277
Q

Membranoproliferative nephropathy type II/III hx, labs, treat

A

Nephritic/nephrotic
Idiopathic, d/t C3 nephritic factor (autoAb that stabilizes C3 convertase - LOW C3)
Intramembranous dense deposits
Steroids + cytotoxins

278
Q

Dialysis-related amyloidosis cause

A

Deposition of b2-microglobulin

279
Q

Viral exanthems

A

Erythema infectiosum (5th dx), Measles, Rubella, Roseola, Varicella, Hand-foot-and-mouth

280
Q

Rubella cause, sx, complications

A

“3d measles”
Rubella virus
Prodrome - LAD, esp. post auricular; polyarthritis in adolescents
Rash - tender erythematous maculopapular spreading head to toe
Low-grade fever and do not appear as ill as measles
Encephalitis, neonatal triad (PDA, cataracts, deafness, +/- “Blueberry muffin” rash)

281
Q

Roseola cause, sx, complications

A

HHV6, HHV7
Prodrome - 3-4d high fever (over 40C)
Rash - As fever breaks, maculopapular rash starts on trunk to face, limbs; resolves in 24h
Febrile SZ

282
Q

Varicella cause, sx, complications

A

VZV
Prodrome - Mild fever, anorexia, malaise precede rash by 24h
Rash - Generalized pruritic vesicles on red base at different stages of healing. Usually start on face, spread to body, spare palms/soles
Meningoencephalitis, PNA, hepatitis if IC’d
Reactivation for shingles in dermatomal pattern w/ pain before rash
Bacterial skin infxn 2/2 lesions
Reye syndrome w/ ASA

283
Q

Hand-foot-and-mouth dx cause, sx, complications

A

Coxsackie A virus
Prodrome - Fever, anorexia, oral pain
Rash - oral ulcers; maculopapular vesicular rash on hands, feet, sometimes butt
No complications (Coxsackie B may cause myocarditis)

284
Q

Herpes transmission, maternal sx, neonate sx

A

Skin/mucus membrane contact
Vesicular lesions, usually asymptomatic
Vesicular lesions, encephalitis

285
Q

Syphilis transmission, maternal sx, neonate sx

A

Sexual contact
Primary chancre or secondary disseminated rash (no transmission at tertiary stage)
Stillbirth, hydrops fetalis
Abnml facies (notched teeth, saddle nose, short maxilla), saber shins, CN8 deafness if neonate survives

286
Q

Rubella transmission, maternal sx, neonate sx

A

Resp droplets
Rash, LAD, arthritis
Triad: PDA, cataracts, deafness, +/- “Blueberry muffin” rash

287
Q

Erythema infectiosum cause, sx, complications

A

Parvovirus B19
Prodrome - none
Rash - “Slapped-cheek” pruritic, maculopapular, erythematous rash starts on arms and spreads to trunk, legs
Arthropathy, aplastic crisis (SCD, hereditary spherocytosis, Fe deficiency anemia), hydrops + death if congenital

288
Q

Measles cause, sx, complications

A

Paramyxovirus
Prodrome - Low-grade fever + 3Cs (Cough, Coryza, Conjunctivits), Koplik spots on buccal mucosa after 1-2d
Rash - Erythematous maculopapular rash spreads head to toe
Common - OM, PNA, laryngotracheitis
Rare - Subacute sclerosing panencephalitis

289
Q

Bruton agammaglobulinemia cause, infxns, dx/Rx

A

XR B-cell deficiency
Sx begin after 6m d/t no longer active maternal IgG
Encapsulateds - Pseudomonas, S pneumo, H flu
Quantify Ig lvls, confirm w/ B- (absent) + T-cell (high) subtypes
Absent tonsils, lymph tissue
Prophylactic abx, IVIG

290
Q

CVID cause, infxns, dx/Rx

A

Combined B- and T-cell defect presenting 15-35y
Low lvls of all Ig, Nml B-cell count, Low plasma cell count
Pyogenic URIs + LRIs; Increased risk of lymphoma, autoimmune dx
Quantitative Ig lvls, confirm w/ B- + T-cell subsets
IVIG

291
Q

IgA deficiency cause, infxns, dx/Rx

A

Mild, most common immunodeficiency
Low IgA only
Usually asymptomatic, but some develop recurrent respiratory or GI (Giardia) infections
Anaphylactic transfusion rxn d/t anti-IgA Abs - CAREFUL GIVING IVIG (give w/o IgA)
Quantitative IgA lvl, treat infxns

292
Q

Thymic aplasia cause, infxns, dx/Rx

A

AKA DiGeorge syndrome
AD chr22 defect causing tetany 2/2 hypocalcemia in neonatal period
Variable infxn risk d/t T-cell deficiency - viral, fungal, PCP pneumonia infxns
Absent thymic shadow on CXR
Low abs T-cell count, delayed hypersensitivity skin testing
Bone marrow transplantation w/ IVIG for Ab deficiency, PCP prophylaxis, (alt - thymus transplant)

293
Q

Ataxia-telangiectasia cause, infxns, dx/Rx

A

AR mutation prevents repair of dsDNA breaks
Progressive cerebellar ataxia and oculocutaneous telangiectasias, increased malignancy risk (NHL, leukemia, gastric CA)
IVIG depending on Ig deficiency

294
Q

SCID cause, infxns, dx/Rx

A

Commonly XR defect in stem cell maturation and decreased adenosine deaminase causes severe lack of B- and T-cells
Severe frequent bacterial, opportunistic, Candida infxns
Bone marrow/stem cell transplant; IVIG for Ab deficiency, PCP prophylaxis

295
Q

Wiskott-Aldrich syndrome cause, infxns, dx/Rx

A

XR disorder
Great risk of atopic dx, lymphoma/leukemia, encapsulated infxns d/t low IgM
WIPE: Wiskott-aldrich Infections, Purpura, Eczema
Bleeding/purpura, eczema, recurrent OM from birth
High IgE, IgA; LOW IgM, plt
IVIG + Abx (most don’t reach adulthood)

296
Q

Chronic granulomatous disease cause, infxns, dx/Rx

A

XR/AR deficient superoxide production in PMNs, M0s
Anemia, LAD, Hypergammaglobulinemia
Chronic skin, LN, pulm, GI, UTInfxns by CATALASE+ organisms
Abs PMN count w/ assays
Dihydrorhodamine (DHR) or nitroblue tetrazolium test (no blue = pos)
Daily TMP-SMX; IFN-g to reduce infxn severity

297
Q

Leukocyte adhesion deficiency cause, infxns, dx/Rx

A 
Defect in chemotaxis, phagocytosis
Recurrent skin, mucosal, pulm infxns
Omphalitis in newborn w/ delayed cord separation
NO PUS and minimal inflammation
High WBC count
Bone marrow transplant (BMT)
298
Q

Chediak-Higashi syndrome cause, infxns, dx/Rx

A

AR defect in chemotaxis, microtubule polymerization
Syndrome of partial oculocutaneous albinism, peripheral neuropathy, neutropenia
High incidence of pyogenic infxns w/ Staph, Strep pyogenes, Pseudomonas
Giant granules in PMNs
BMT

299
Q

Job syndrome cause, infxns, dx/Rx

A 
AKA Hyper-IgE syndrome
Defect in PMN chemotaxis
FATED: coarse Facies, Abscesses (Staph), retained primary Teeth, hyper IgE (Eosinophilia), Dermatologic (eczema)
Staph infxns, abscesses
Penicillinase-resistant abx + IVIG
300
Q

C1 esterase inhibitor deficiency cause, risk, dx/Rx

A

AKA hereditary angioedema
AD episodes of angioedema 2/2 stress/trauma
Risk of airway obstruction
CH50 to assess quantity, fxn of complement
Purified C1 esterase + FFP prior to surgeries

301
Q

Terminal complement deficiency cause, infxns, dx/Rx

A

C5-C9 deficiency
Can’t form MAC against encapsulated organisms
Recurrent Neisseria infxn (meningo- or gonococcal)
Meningococcal vaccine + appropriate abx

302
Q

PNA hospitalization criteria

A 
CURB-65:
Confusion
Uremia (BUN over 19)
RR over 30
BP under 90/ or /60
Over 65yo

Consider at 2-3, admit over 4

303
Q

PNA pathogen tests

A

Legionella - Urine Ag
Chlamydophila - PCR, serologic testing
Strep pneumo - Urine Ag

304
Q

Neonatal PNA causes

A

Group B Strep, E coli, Listeria (same as meningitis)

305
Q

COPD PNA causes

A

H flu, Moraxella, Strep pneumo

306
Q

OP CAPna w/o abx in last 3m - causes, Rx

A

Strep pneumo, Mycoplasma, Chlamydophila pneumo, H flu, viral

Macrolide (Erythro-, clarithro-, azithromycin) OR doxycycline

307
Q

OP CAPna w/ comorbidity or recent abx - causes, Rx

A

Strep pneumo, H flu, aerobic GNRs (E coli, Enterobacter, Klebsiella), Staph, Legionella, viral
Fluoroquinolone OR b-lactam+marcolide

308
Q

IP CAPna - causes, Rx

A

Strep pneumo, H flu, anaerobes, aerobic GNRs, Mycoplasma, Pseudomonas
Fluoroquinolone OR Antipneumococcal b-lactam+macrolide

309
Q

ICU CAPna - causes, Rx

A

Strep pneumo, Legionella, H flu, anaerobes, aerobic GNRs, Mycoplasma, Pseudomonas
Antipneumococcal b-lactam + azithromycin/fluoroquinolone

310
Q

Ventilator-/HAPna - causes, Rx

A 
GNRs (including Pseudomonas), Staph, Legionella, mixed flora
Extended-spectrum cephalosporin/anti-Pseudomonal carbapenem
Add aminoglycoside (gentamicin, tobramycin, streptomycin, amikacin) OR fluoroquinolone to cover resistant Pseudomonas until culture sensitivities found
311
Q

Critical or worsening PNA on 1-2d of abx - cause, Rx

A

MRSA

Vancomycin OR linezolid

312
Q

Active TB Rx, SE

A

Active TB patients are RIPE for treatment:
Rifampin - orange body fluids
Isoniazid - peripheral neuropathy (give B6), hepatitis
Pyrazinamide
Ethambutol - optic neuritis

313
Q

+PPD criteria

A

Over 5mm - HIV+, close TB contacts, or +CXR
Over 10mm - Homeless, residents of dev nations, IVDU, healthcare workers/residents
Over 15mm - Everyone else

314
Q

GAS criteria, risk

A 
1- Fever
1- Tonsillar exudate
1- Tender ant cervical LAD
1- Lack of cough
1- 3-14yo
0- 15-45yo
-1- Over 45yo

4-5: Treat empirically
2-3: Perform rapid Strep Ag test, culture if -test
0-1: Sx Rx only

315
Q

Neonatal (under 1m) bacterial meningitis causes, Rx

A

GBS, E coli/GNRs, Listeria

Ampicillin + cefotaxime/gentamicin

316
Q

1-3m bacterial meningitis causes, Rx

A

Strep pneumo, meningococcus, H flu

IV vancomycin + ceftriaxone/cefotaxime

317
Q

3m-adult bacterial meningitis causes, Rx

A

Strep pneumo, meningococcus

IV vancomycin + ceftriaxone/cefotaxime

318
Q

Over 60y/alcoholic/chronic illness bacterial meningitis causes, Rx

A

Pneumococci, G- bacilli, Listeria, meningococci

Ampicillin + vancomycin + cefotaxime/ceftriaxone

319
Q

Prophylaxis for meningococci contacts

A

Rifampin or ciprofloxacin

320
Q

Meningitis vs brain abscess vs encephalitis sx

A

Meningitis - photophobia, nuchal rigidity
Brain abscess - focal neuro defects + headache, fever
Encephalitis - AMS/confusion

321
Q

HSV encephalitis lab, Rx

A

CSF nml labs + PCR

IV acyclovir

322
Q

CMV encephalitis lab, Rx

A

CSF nml labs + PCR

IV ganciclovir +/- foscarnet

323
Q

Lyme encephalitis Rx

A

Ceftriaxone

324
Q

HIV testing

A

ELISA screening + Western blot confirmatory

325
Q

HIV ART principles

A

2 nucleoside/nucleotide RTIs + non-nucleoside RT/protease/integrase inhibitor

326
Q

HIV - PCP detection, prophylaxis indication, Rx

A

PCP found on silver sputum stain, interstitial infiltrate on CXR
CD4 under 200 or prior infxn
1x str TMP-SMX

327
Q

HIV - MAC prophylaxis indication, Rx

A

CD4 under 100

Weekly azithromycin

328
Q

HIV - Toxoplasmosis prophylaxis indication, Rx

A

CD4 under 100 + anti-Toxo IgG

2x str TMP-SMX

329
Q

HIV - TB prophylaxis indication, Rx

A

PPD over 5mm

INH x 9m + vitB6 OR rifampin 4m

330
Q

HIV - Candida prophylaxis indication, Rx

A

Multiple recurrences
Esophagitis - fluconazole
Oral - fluconazole/nystatin swish/swallow

331
Q

HIV - HSV prophylaxis indication, Rx

A

Multiple recurrences

Daily a-/fam-/valacyclovir

332
Q

HIV - Strep pneumo prophylaxis indication, Rx

A

All HIV+ patients

Pneumovax every 5y if CD4 over 200

333
Q

HIV - Flu prophylaxis indication, Rx

A

All HIV+ patients

Annual flu vaccine

334
Q

Klebsiella granulomatis vs Haemophilus ducreyi pres, Rx

A

KG - Beefy-red painless ulcer w/ rolled granulation tissue edge; doxycycline/azithromycin
HD - Necrotic, irregular, painful, demarcated papules/pustules w/ inguinal LAD; azithromycin/ceftriaxone

335
Q

Lymphogranuloma venereum cause

A

Chlamydia trachomatis

336
Q

Chlamydia dx tests, Rx

A

Culture - gold standard
Urine DNA amplification test for rapid detection
Gram stain - PMNs w/ no bacteria (intracellular)

Doxycyline x7d or Azithromycin 1x
Azithromycin or amoxicillin in pregnant women
Treat sexual partners

337
Q

Chlamydia complications

A

PID, ectopic preg, epididymitis
Reiter syndrome (reactive triad of urethritis, conjunctivitis, arthritis)
Fitz-Hugh-Curtis syndrome (perihepatic inflam/fibrosis)

338
Q

Gonorrhea dx tests, sx

A

Purulent discharge, pelvic pain, swollen Bartholin glands
Disseminated - monoarticular septic arthritis, rash, tenosynovitis
Local: IM ceftriaxone + azithromycin po regardless of chlamydia status, (no fluoroquinolones d/t resistance) treat partners
Disseminated: IV ceftriaxone

339
Q

Uncomplicated UTI Rx

A

po TMP-SMX/fluroquinolone (avoid d/t resistance) x3d OR nitrofurantoin x5d

340
Q

Complicated UTI Rx

A

Same abx as for uncomplicated, but for x14d

341
Q

Pregnant UTI Rx

A

Treat asymptomatic bacteriuria or symptomatic UTI w/ nitrofurantoin, po cephalosporin, or amoxicillin x3-7d
F/u w/ post-Rx urine culture

342
Q

Urosepsis Rx

A

Hospitalize + broad IV abx

343
Q

Pyelonephritis Rx

A

Mild cases - Fluoroquinolones x7-14d + po fluids

Serious cases - admit + fluoroquinolones, 3rd/4th gen cephalosporin, b-lactam w/ b-lactamase inhibitor, or carbapenem

344
Q

SIRS criteria

A

Temp over 38C or under 36C
Tachypnea over 20
Tachycardia over 90
Leukocytosis/leukopenia - Over 12k or under 4k

345
Q

Sepsis criteria, treatment

A

SIRS + documented infxn

Empiric abx + IVF + vasopressors to maintain BP and organ perfusion

346
Q

Malaria tests, Rx

A

Prophylaxis - Chloroquine std, Atovaquone-proguanil/mefloquine for resistant areas
Rx - Add primaquine for P ovale/vivax cases to kill liver hypnozoites
Giemsa-/Wright-stained thick + thin blood films
Rule out hypoglycemia w/ fingerstick if AMS+malaria

347
Q

Complication of EBV + penicillin?

A

Prolonged pruritic maculopapular rash

348
Q

Neutropenic fever Rx

A

Empiric abx w/ anti-pseudomonal (cefepime, piperacillin-tazobactam)
Start antifungal Rx if fever persists after 3d
Colony stimulating factors not indicated generally

349
Q

Ehrlichiosis sx, labs, Rx

A

Tick exposure in SC/SE US
Headache, fever, AMS, myalgias – rash uncommon
Leukopenia, thrombocytopenia, high LFTs
Doxycycline

350
Q

Lyme disease treatment

A

Doxycycline in adults, amoxicillin in children under 8y/pregnancy; Ceftriaxone for advanced dx
Prophylaxis w/ one dose doxy on initial exposure if no CI

351
Q

RMSF cause, sx, labs, Rx

A

Rickettsial small vessel vasculitis
Fever, headache, rash starting at wrists/ankles that spreads to trunk, AMS, DIC
Biopsy of skin lesion w/ indirect IF
Doxycycline or chloramphenicol (pregnancy)

352
Q

Orbital cellulits sx, Rx

A

General infxn sx + Restricted eye mvt, decreased visual acuity, diplopia, proptosis
Admit + IV abx + consult
IC’d/DM may need amphotericin B + surgery for Mucor/Rhizopus

353
Q

N gonorrhoeae conjunctivitis signs, Rx

A

G- intracellular diplococci

IV/IM ceftriaxone

354
Q

Chlamydia trachomatis conjunctivitis signs, Rx

A

1-2w neonatal mucopurulent conjunctivitis OR trachoma (recurrent epithelial keratitis causing blindness)
Azithromycin, tetracycline, or erythromycin 3-4w in neonates
Single po dose for trachoma

355
Q

Infective endocarditis sx, dx

A

Constitutional sx (fever/FUO, weight loss, fatigue), new heart murmur (esp. MV), Osler nodes, Janeway lesions, Roth spots, embolic phenomena

Diagnosed by Duke criteria: 2maj, 1maj+3min, 5min
Maj: 2+ blood cx, persistent bacteremia, +C burnetii cx OR TEE shows endocard involvement/new murmur
Min: Predisposing risks; Fever over 101F; Vasc- Septic emboli/infarcts, Janeway lesions, mycotic aneurysm; Imm- Glomerulonephritis, Osler nodes, Roth spots

356
Q

IE Rx

A

Early empiric IV abx - Vancomycin + gentamicin
Tailor to cx
May need valve replacement

Pre-procedure prophylaxis in those w/ risks - amoxicillin

357
Q

Anthrax sx, dx, Rx

A

Cutaneous: 1-7d post-exposure pruritic papule w/ LAD that becomes black eschar in 7-10d
Pulm: Fever, dyspnea, hypoxia, hypotension, PNA sx 1-3d post-exposure d/t HEMORRHAGIC MEDIASTINITIS w/o infiltrates
GI: dysphagia, N/V, dysentery, abd pain

Dx by culture + PCR/ELISA/Immunohistochem; CXR for pulm dx

Ciprofloxacin (also 60d ppx)/doxycycline 14d

358
Q

Osteomyelitis sx, labs

A

Localized bone pain, warmth, edema, erythema, limitation of adjacent joint, fever, pus
Leukocytosis, high ESR/CRP, +blood cx
Periosteal deviation in 10-14d on XR – prefer MRI
Bone aspiration + gram stain + cx

359
Q

Osteomyelitis Rx

A 
Surgical debridement + 4-6w IV abx
Clindamycin + cipro
Ampicillin/sulbactam
Oxacillin/nafcillin (MSSA)
Vancoymycin (MRSA)
Ceftriaxone/ciprofloxacin (G-)
360
Q

Osteomyelitis causes

A 
No risks - Staph
IVDU - Staph/Pseudomonas
SCD - Salmonella
Foot puncture - Pseudomonas
DM - Polymicrobial (Pseudomonas)
361
Q

Obstructive pulm dx PFTs

A

FEV1 under 75% of FVC

RV nml-high

362
Q

Restrictive pulm dx PFTs

A

FEV1 over 75% of FVC (nml)
FVC low
RV low in severe dx

363
Q

Small cell CA location, histo, sx, Rx

A

Small = Sentral
Neuroendocrine (chromogranin A+) cells
Aggressive, pos paraneoplastic syndromes from ACTH, SIADH, Lambert-Eaton
CTX only

364
Q

Lung adeno CA location, histo, sx, Rx

A 
Peripheral
Most common in nonsmokers, overall
Glandular histo, mucin+
Clubbing, CXR shows PNA-like infiltrates
Bronchioalveolar subtype = apparent thickening of alveolar walls
365
Q

Pulm squamous cell CA location, histo, sx, Rx

A

Squamous = Sentral
Hilar mass w/ Keratin pearls, intercellular bridges
Cigarette-assoc, Cavitation, PTHrP = hyperCa

366
Q

Pulm large cell CA location, histo, sx, Rx

A

Peripheral

Anaplastic giant cells, poor prog, surgery

367
Q

SLE criteria

A

DOPAMINE RASH

Discoid rash
Oral ulcers
Photosensitivity
Arthritis (non-deform)
Malar rash
Immune - dsDNA, anti-phospholipid autoAbs
Neuro - SZ, cerebritis
Elevated ESR
Renal dx
ANA+
Serositis - pleural, pericardial
Hem abnmlities
368
Q

Behcet syndrome sx

A

Triad: Oral aphthous ulcers, Genital ulcers, Uveitis

Also visceral organ small vessel vasculitis involvement

369
Q

Avoid UTIs in AZD incontinence by?

A

Use Depends instead of catheter, change regularly

370
Q

Appropriate patient management of PICC to prevent infxn?

A

Good hand hygiene before contact

371
Q

Tinea versicolor pres, lab, Rx

A

Discrete hypopigmented patches that may become hyperpigmented on sun exposure
“Spaghetti and meatballs” on KOH prep
Selenium sulfide/Ketoconazole

372
Q

What to do with any vaginal bleeding in a post-menopausal female?

A

Endometrial biopsy

373
Q

Anticholinergic toxicity signs

A

Blind as a bat (miosis)
Red as a beet (flushing)
Hot as a hare (hyperthermia)
Dry as a bone (skin)
Mad as a hatter (agitation/hallucination)
Bloated as a toad (ileus/urine retention)
Heart runs alone (tachy)

374
Q

Reporting bias

A

Subjects under-/over-report exposure due to perceived stigmatization

375
Q

Detection bias

A

Risk factor itself causes increased monitoring in exposed group relative to unexposed, increasing likelihood of finding disease

376
Q

b-blocker OD sx, Rx

A

Bradycardia, hypotension, shock, wheezing, hypoglycemia, AMS, SZ
Treat w/ IVF + atropine, followed by glucagon (up intracellular cAMP) for refractory hypotension

377
Q

Cat-scratch disease cause, sx, Rx

A

Bartonella henselae
Papule at bite/scratch site 1-2w later, fever, regional LAD
Azithromycin

378
Q

Pasteurella sx

A

Animal bite w/ local cellulitis, fever 1-2d later

379
Q

Isolated systolic HTN def, cause

A

SBP over 140 w/ DBP under 90 - no diastolic murmur like AR

Seen in elderly d/t rigid arterial walls

380
Q

Follicular thyroid carcinoma characteristics

A

Can’t diagnose on FNA - must see invasion of LNs, vessels through tumor capsule on biopsy
Heme spread
Hurthle cells may be present, but nonspecific

381
Q

Papillary thyroid cancer

A

Slow LN spread

Psammoma bodies

382
Q

Factor V Leiden mech

A

Activated protein C resistance

383
Q

Cyclosporine mech, SE

A

Calcineurin inhibitor

Nephrotoxicity, hyperkalemia, HTN, gum hypertrophy, hirsutism, tremor

384
Q

Tacrolimus mech, SE

A

Tacrolimus inhibitor

Nephrotoxicity, hyperkalemia, HTN, tremor

385
Q

Azathioprine mech, SE

A

Purine analog converted to 6-MP to inhibit purine synthesis

Dose-related diarrhea, leukopenia, hepatotoxicity

386
Q

Mycophenolate mech, SE

A

Reversible inhibitor of IMPDH - blocks de novo purine synth

Bone Marrow suppression

387
Q

Aortic dissection dx

A

TEE preferred (esp CKD or unstable)
CT w/ IVC if no CKD
MRI is too slow

388
Q

Chorioamnionitis treat

A

Broad abx, delivery

C/s reserved for std indications (distress, breech, multiple), not nec infxn

389
Q

ESRD Epo indication, SE

A

When Hb under 10

HTN, Headache, flu-like sx

390
Q

Gallstone ileus sx

A

N/V, pneumobilia, hyperactive BS, dilated loops of bowel

Intermittent tumbling obstruction sx, lodges in ileum

391
Q

Toxoplasmosis sx

A

Congenital - macrocephaly, hydrocephalus, intracranial calc

Chorioretinitis d/t reactivation as adults

392
Q

BMT is used in which dx? (+Inheritance)

A

WAS, SCID (both XR)

393
Q

Acute bronchitis dx, Rx

A

Clinical dx w/ sx Rx - no abx

394
Q

Blastomycosis sx

A

Mild pulm dx

If disseminated, may cause cutaneous verrucous nodules/plaques/microabscesses even in non-IC’d

395
Q

Aspergillosis sx

A

Invasive pulm dx in IC’d

Rare dissemination

396
Q

Histoplasmosis sx

A

Asx/mild pulm dx

Dissemination w/ IC’d - papular crusting skin lesions

397
Q

Central vs primary adrenal insufficiency

A

Primary: autoimmune, high ACTH, low cort/aldo – pigmentation, hyperkalemia
Central: d/t chronic steroids, low ACTH, low cortisol, nml aldo – less severe sx

398
Q

Acalculous cholecystitis sx

A

Acute GB inflam w/o stones in hospitalized patients

399
Q

SC compression vs lumbar OA

A

Sub-/acute pain + neuro sx (incl. incontinence/retention)

Pain d/t nerve root compression, nml neuro exam

400
Q

Abx for anaerobes

A

Clindamycin OR metronidazole + (amoxicillin/amox-clav/carbapenem)

401
Q

Ampicillin+gentamicin target

A

G- aerobes

Not for anaerobes w/o b-lactamase inhibitor

402
Q

Fluoroquinolones target

A

G-

403
Q

TMP-SMX targets

A

Many G- and G+

No anaerobes

404
Q

Lyme disease sx

A 
Erythema migrans
Malaise, fatigue, arthralgia
Regional LAD
Meningitis, CN palsy
AV block
405
Q

Malrotation sx, dx

A

Neonate w/ bilious vomiting, hematochezia, peritonitis
XR to rule out free air, duodenal atresia; then upper GI series
Ligament of Treitz on R

406
Q

Painless thyroiditis sx

A

Acute thyrotoxicosis, mild enlargement w/o pain, low TSH, low I uptake

407
Q

Subacute thyroiditis sx

A

Hyperthyroidism, low TSH, low I uptake

Pain

408
Q

Tetrology of Fallot PE, CXR

A

Harsh PV stenosis murmur, VSD murmur, RVH

409
Q

GV transposition PE, CXR

A

Single S2 +/- VSD murmur

Narrow mediastinum

410
Q

21-OHase def pres

A

Most common CAH cause

Hyperandrogenism (acne) + high 17-OHprog in young women

411
Q

Secretory diarrhea

hx, labs

A

Large stool volumes, D during sleep/fast

Low stool osmotic gap (under 50)

412
Q

Cauda equina syndrome sx

A 
Radicular pain
Saddle anesthesia
Asymmetric motor weakness
Hyporeflexia
Late-onset GI/GU dysfxn
413
Q

Conus medullaris syndrome sx

A 
Sudden-onset severe back pain
Perianal anesthesia
Symmetric motor weakness
Hyperreflexia
Early-onset GI/GU dysfxn

Step 2 CK (1 decks)

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