World9 Flashcards
Bypass surgery can cause symptomatic gallstones, but what causes the gallstones
rapid weight loss promotes gallstone formation
patient with hypocalcemia and hyperphosphatemia in the setting of CKD has what
secondary hyperparathyroidism
- causes parathyroid hyperplasia
- causes renal osteodystrophy on bone
when do you perform large-volume abdominal paracentesis
if patient is symptomatic
- SOB
- abdominal pain
first step in spontaneous bacterial peritonitis
abs not abdominal paracentesis
type II renal tubular acidosis
impaired renal bicarbonate
hypokalemia
non-anion gap metabolic acidosis
what causes constrictive pericarditis
result of acute pericarditis
Jaundice, decreased appetite with weight loss, abdominal discomfort, fullness in right upper quadrant … has?
pancreatic cancer
- Elevation of bilirubin and alkaline phosphatase implies a cholestatic cause of jaundice, which can be caused by blockage of the common bile duct by a pancreatic mass.
- gallbladder neoplasms –> less likely jaundice b/c bile can pass through the common bile duct.
What type of knee injury causes impairment of extension of the knee, instability, and exacerbation of pain with squatting
meniscal tears
valgus instability indicates
medial collateral ligament
Interleukin-1 receptor antagonists are useful in the treatment of
rheumatoid arthritis
pulsatile abdominal mass
abdominal aortic aneurysm
when do you repair an abdominal aortic aneurysm
size greater than equal to 5.5 cm
What is the only thing increased in hypovolemic shock
systemic vascular resistance
which type of shock only has elevated cardiac index
septic shock
hemodynamically stable patient with widened mediastinum
transesophaglea echo or
CT scanning
unstable patient with widened mediastinum
ex. thoracotomy
clinical feature of lymphatic obstruction
marked thickening and rigidity of skin
- uncommon cause of edema
hypovolemic hyponatremia triggers what
ADH secretion
- decreased serum osmolality
- decreased urine sodium (less 20)
Common cause of osteomyelitis/ septic arthritis in sickle cell
Staph aureus
salmonella
When is abs prophylaxis not recommended for dental procedure
mitral valve prolapse
rheumatic fever
ASD
bicuspid aortic valve
treatment for extrapyramidal symptoms from antipsychotic medications
anticholinergic
diphenhydramine
Dilated bowel can mean
small bowel obstruction
what statin medication adverse effect give you leukocytosis
no
the most effective treatment for benign paroxysmal positional vertigo
Epley maneuver
humeral midshaft fracture most like to damage what
radial nerve
treatment for advanced pancreatic cancer
endoscopic common bile duct stent
Large unilateral pleural effusion without evidence of infection
malignancy should be suspected
low acetylcholine activity–> neuro
alzheimer
Eosinophlic inclusions in neurons of the substantial nigra
Lewy body dementia
Loss of dopamine-producing cells
parkinsons
when does dementia occur in Parkinson’s
later in disease course
patient with a combination of renal failure, hypercalcemia,and anemia should be evaluated for?
multiple myeloma
ER, physical violent person, next step
physical restraints and emergency haloperidol or Benz
Cardiac tamponade causes equilibration of what pressures
diastolic pressures
pathology in Meckel diverticulum
ectopic gastric mucosa
difference between autoimmune hemolysis and DIC
DIC will have elevated fibrinogen and increase INR.
DIC = microangiopathic hemolytic anemia
how often do you get a lipid profile
every 5 years
potential compilation of thoracentesis
hemothorax
- decreases left ventricular preload
clinical findings for testicular torsion
acute scrotal pain
tenderness
bell-clapper deformity
loss of the cremasteric reflex
transient inguinal bulge on Valsalva maneuver
hernia
most common cause of nephrotic syndrome in adults, particularly African Americans
focal segmental glomerulosclerosis
When do seizures typically occur in juvenile myoclonic epilepsy
occur upon awakening
lab values for complicated effusions
low glucose
low pH
high protein
2 most common organism for brain abscess are
viridian’s streptococci
Staphylococcus aureus
renal vein thrombosis is most commonly associated with what nephrotic syndrome?
membranous glomerulopathy
define oliguria
<250 mL urine in 12 hours
what should be performed in all patients with oliguria and acute renal failure due to suspected bladder outlet obstruction
urgent bladder scan and catheterization
what causes heat exhaustion
inadequate fluid and salt replacement
what causes extensional heat stroke
thermoregulation failure
what is the difference between heat exhaustion and exertional heat stork
Exertional heat stroke has CNS dysfunction (altered mental status)
What is the most common cause of abnormal hemostasis in patients with chronic renal failure? treatment?
platelet dysfunction
DDAVP
clinical features of minimal change disease
NSAIDs
lymphoma
elevated endolymphatic pressure
Meniere disease
bitter almond breath
cyanide poisoning
bony pain mets from cancer. treatment?
radiation therapy is faster
bisphonates (Etidronate disodium) has a slower onset
can you get a macular skin rash with mycoplasma pneumonia
yes
first line treatment for beta blocker overdose
IV fluids and atropine
IV glucagon if refractory hypotension
what are the 3 categories of lead toxicity
nonspecific (fatigue, irritability, insomnia)
neuropsychiatric (peripheral neuropathy, neurocognitivie deficits)
GI manifestations
Damage of one eye (the sympathetic eye) after a penetrating injury to the other eye? pathophysiology of this?
Sympathetic ophthalmia
immunologic mechanism involving the recognition of ‘hidden’ antigens
Reagin-mediated disease
IgE-mediated
circulated immune complexes can affect the eye in what disease
SLE
Elbow held in extension, passive flexion of the wrist reproduces the patient’s pain?
lateral epicondylitis (tennis elbow)
when you see first degree AV block, what should you do?
CHECK QRS duration
normal = observation
prolonged = electrophysiology testing
how do you treat bradycardia with hypothermia
hypothermia correction should correct heart
most common cause of bloody diarrhea in absence of fever is?
E. coli
targeted INR value for Warfarin
between 2-3
is Sporothrix Schenichkii purulent?
nope
Post-op patient with unexplained fever, diffuse RUQ abdominal pain, leukocytosis, normal liver/alk phos levels
Acalculous cholecystitis
What is contraindicated in lye (sodium hydroxide) ingestion
activated charcoal
What has low Leukocyte alkaline phosphatase levels
CML
First line pharmacotherapy options for alcohol use disorder
acamprosate and naltrexone
acamprsate is better if the patient has liver disease
Treatment for body dysmorphic disorder
SSRI
CBT
old lady on Benzo for sleep, next step
stop Benz then reassess, no need to start another drug just yet
Patient’s psychiatric symptoms (anxiety, psychosis, insomnia), autonomic instability (hyperthermia, hypertension, tachycardia), short-term memory impairment, rigidity, dystonia, and focal seizure following a flu-like prodrome
autoimmune encephalitits
difference between meningitis and encephalitis
encephalitis has cognitive dysfunction
alcohol withdrawal, what type of benzodiazepines
short acting ATOM
Someone who presents with PCOS type symptoms with myopathy and bruising has what
Cushing syndrome
Upper GI series shows a crockscrew-shaped and rightward displaced deodenum
midgut volvulus (intestinal malrotatio)
first-line interventions for initial gout attack
alcohol cessation and weight loss
What is the strongest risk factor for superior pulmonary sulcus
smoking (not family history)
What murmur is best heard with the patient sitting up, leaning forward, and holding the breath in full expiration
aortic regurgitation
most likely diagnosis? child with cough, runny nose, and oral vesicles
viral pharyngitits
reassurance and observation
which type of shock has mixed venous oxygen saturation
septic shock
Patient has a impaired wound healing and kidney failure?
Granulomatosis with polyangiitis (necrotizing vasculitis)
Peripheral blood smear shows signs of dysplasia, including oval macrocyte and hypo segmented/hypogranulated neutrophils? how to make diagnosis
myelodysplastic syndrome
bone marrow biopsy is required for diagnosis
fevers, chronic diarrhea, abdominal pain, weight loss, been passing gas, and malordorerous discharge from vagina?
Crohn’s with fistula formation
Tumor lysis syndrome
hypocalcemia
hyperphosphatemia
hyperkalemia
elevated uric acid levels
bad side effect of chemotherapy
neutropenia
signs of sepsis is much more subtle
pathophys for diabetic ketoacidosis
fatty acids breaks down to ketones in the liver
Are focal neurologic deficits common in subarachnoid hemorrhage
nope
Thunderclap headache
When do you use Pentamide with steroids for PCP
allergies to TMP-SMX
What complication occurs 5days to 2weeks after acute MI
rupture of ventricular free wall
- profound shock
- rapid progression to pulseless electrical activity and death
clinical feature of theophylline toxicity
central nervous system (headache, insomnia, seizure)
GI (nausea, vomiting)
cardiac toxicity (arrhythmia)
what type of gait is found in Parkinson’s
Hypokinetic gait
suffering gait
pharmacotherapy for patients who have recurrent stroke already on aspirin therapy
aspirin plus dipyridamole OR clopidogrel
conductive hearing loss
Rhine: bone conduction is greater than air conduction
Weber: lateralizes to affected ear
Sensorineural hearing loss
Rhine: air conduction is greater than bone (normal)
Weber: lateralizes to unaffected ear
2 things to thing about in a house fire
hydrogen cyanide toxicity (more worried about, more fatal)
carbon monoxide
Treatment for cyanide toxicity
hydroxocobalamin or sodium thiosulfate
What causes methemoglobinemia?
exposure to oxidizing agents (dapsone, topical/local anesthetics)
