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48 Cards in this Set

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What is the biggest determinent if an parapneumonic effusion needs to be drained with a chest tube?
pH, <7.2 is empyema (glucose less than 60 also means it needs to drained).
Hypertrichosis of the face, painless blisters on dorsal hands (esp after sun exposure) and hyperpigmentation, familial, ass'd with HepC
Porphyria cutanea tarda, can be triggered by ethanol and estrogens, (d/c once suspected).
Rapid onset of pain and VISION LOSS, seeing HALOS around lights, injected/red eye, pupil is DIALATED AND UNRESPONSIVE to light, tearing may be present, n/v:
Acute Angle closure glaucoma. Precipitated by dim light, anticholinergic meds, or sympathomimetic med. If untx, can result in blindness w/in 2-5 hrs!
What is cosyntropin?
synthetic ACTH, used in stimulation tests
Adrenal calcification is characteristic of what disease?
Primary adrenal insufficiency due to TUBERCULOSIS!!!!! will require lifelong steroids replacement (mcc in immigrants/developing countries, but in USA its due to autoimmune adrenalitis-autoantibodies against adrenal steroid enzymes).
Radiopaque tablets seen on abd x-ray are likely to be what?
Fe tablets from prenatal vitamins (kids think they are candy, common in households with pregger women with little kids present)
Abd pain, hematemsis, hypovolemic shock, and METABOLIC ACIDOSIS, radiopaque tabs in abd xray (therefore leading to low bicarb, hypotension, and cool extremeties), lethargic indicate poisoning with what?
Fe tablets
Li overdose is tx with?
hemodialysis-most dialyzable drug
How do you tx iron poisoning?
With deferoxamine
Severe hyperglycemia(high urine glucose too), severe dehydration(the rule in this syndrome), lethargy, weakness, obtunded mental status, focal neurological defecits very common(ie arm weakness), eventual coma. Precipitated by a stressor like MI, infection, or recent operation (or stroke).
NonKetoicHyperosmolarSyndrome (NKHS). Occurs in Type 2 DM pt because insulin still sufficient to prevent ketones, but not absorb glucose properly. MISSED THIS TWICE NOW! CHECK BLOOD GLUCOSE WITH THIS Px.
What is use-dependence, and which antiarrythmics demonstrate this.
More effective at higher heart rates because there is LESS TIME FOR DRUG TO DISSOCIATE FROM RECEPTOR BETWEEN BEATS, SO IT STAYS ON LONGER! Class 1 and 4 antiarrthymics have this, but only class 1 prolongs the QRS complex(class 1C is the worst, Flecainide for example).
What is the DOC of tx aspiration pneumonia due to anerobes (a common complication of upper GI endoscopies, etc)?
Clindamycin
Improperly refrigerated rice eaten, and then n/v within three hrs on ingestion?
Bacillus cereus. Due to preformed toxin, Note the lack of fever or diarrhea.
Which type of hyptherthyroid disease would become permanently hypothyroid if tx with radioactive iodine ablation?
graves dz
Fever, weight loss, neurologic sx(embolization), mass in the atrium. Fatigued, and diastolic murmur heard.
Atrial Myxoma
Which enzyme maintains normal levels of activity DURING the hemolysis phase of G6PD def?
G6PD activity, ironically. Look for BITE CELLS, as well as a precipitating stressor, like sulfa drugs or fava beans
Post-ictal metabolic acidosis is due to lactic acid from tonic-clonic episode. How do you treat it?
Observe and repeat labs within two hours.
(giving HCO3- replacement is controversial, and if they do, its only up to pH=7.2)
hyperCa, hilar lung masses, in a smoker, due to what?
SqCC-->PTHrP (sCa++mous). Note: lung cancer is usually unilateral if located in hilar lymph nodes
Parkinsonism,widespread neurological signs(cerebllar, pyramidal, LMN), ortho hypo, and autonomic dysfunction(impotence, incontinence, etc.)
Shy-Drager syndrome (multiple system atrophy).
DONT CONFUSE WITH RILEY-DAY SYNDROME(gross autonomic dysfxn only w/ severe orthostatic hypotension, in kids of jewish ancestry, aka Familial Dysautonomia).
Most drug OD's cause slurred speech, unsteady gait and drowsiness. How can you distinguish benzo OD vs. Opioid (and from Phenytoin and EtOH)?
opioids lack of severe resp. depression and LACK OF PUPILLARY CONSTRICTION. Also, will lack nystagmus(vs. phenytoin/EtOH).
Exertional heat stroke is due to failure of:
thermoregulation, normally kept at 96.8 and 99.5, but in heat stroke, theres a failure to dissipate heat via sweat fast enough to cool the body down (typically >105).
Inadequate fluid and water replacement during physical activity can lead to heat:
exhaustion. -cool skin, low BP, confusion and muscle spasm. THERMOREGULATION STILL IN TACT, NO HYPERTHERMIA PX YET.
Upregulation of bodies thermoregulatory centers via cytokines to 104 or less is due to:
Fever
Molluscum contagious can be due to deficiency in:
cellular immunity (suspect HIV(18%) if severe or large number of lesions, esp in pubic region and abdominal region; skin-skin contact spreads it. Also seen in chemo and corticosteroid patients)
Recurrent resp infxns and chronic giardiasis/gastroenteritis
Selective IgA defiency
Complement deficiency: C1 esterase, C3, C5-9
C1 esterase: hereditary angioedema.
3: recurrent pyogenic bacterial respt tract and sinus infxns
5-9:Neisseria infections.
No increased risk of viral infections
Impaired phagocytosis:
recurrent pyogenic bacterial infections
What is a potential sequelae of treating hospitalized pt for DVT:
Tx with Heparin usually, so risk for HIT (decreased platelets via antibody mediated platelet activation, which leads to thrombosis, which can lead to a stroke ultimately). Ab activates "heparin platelet factor 4" on platelets and activates them.
Triad of asthma, chronic rhino sinusitis with nasal polyposis, and bronchospasm or nasal congestion following ingestion of aspirin or NSAIDs
Aspirin Exacerbated Resp disease. Will see bilateral grey, glistening mucoid masses. Polyps tend to recur despite surgery.
What protease inhibit is well known for its crystal-induced nephropathy?
Indinavir!!! Missed this twice!
HIV tx a/e:
didanosine
abacavir
NRTI
NNRTI
Nevirapine
Indinavir
didanosine=pancreatitis
abacavir-hypersensitivity
NRTI-lactic acidosis
NNRTI-SJS
Nevirapine-liver failure
Indinavir-crystal nephropathy
V. tach with stable blood pressure doesn't warrant cardioversion. Best treatment is:
IV amiodarone/lidocaine
Signs of ischemia, including cool limbs, and parasthesias in those limbs, are signs of Embolus to the limb's arterial bed. What is the best initial step of mgmt?
Immediate anticoagulation with heparin and surgical intervention(embolectomy/call vascular surgery for consult right away). Prevent tissue death and amputation.
What is the protocol for HIV exposure to healthcare works
Testing with serology and simultaneous administration of 3 Drug antiHIV regimen, typically two NTRI and one PI (post exposure prophylaxis)
Mayonnaise containing salads, like macaroni or potato salad, are common sources of what type of food poisoning? What are the main symptoms
Staph Aureus food poisoning: due to preformed exotoxin, induced gastroenteritis within six hours, and has freq. VOMITTING! as well as abdominal cramps and N. (other less common foods: poultry, egg, meat, cream filled pastries, dairy.) No diarrhea usually (same for B. cereus, which is found on reheated rice).
Watery diarrhea. After eating meats, poultry, and gravy; due to which organism?
C. preferingens

Hint: gravy looks like mud, and clostridia loves the dirt
Asplenic pt's are at risk for encapsulated bugs because of lack of what immune characteristic:
They have less germinal centers to process antigen and create antibodies, thus, they have a lack of ANTIBODY MEDIATED OPSINIZATION AND PHAGOCYTOSIS.
acute prostatitis>acute cystitis in men: true or false?
TRUE-->get a midstream urine culture to direct abx therapy
Matching groups in case control studies based on demographic traits(age, race, etc) reduces:
confounding.
Muscle weakness described after tx for rheum related disease is most likely to be
drug induced myopathy(usually LONG TERM corticosteroid WITH insidious onset, not seen in acute corticosteroid use).
Normal Ca, PO4, and PTH is seen in what two disease? What if there was an increased alk phos as well?
Osteoperosis and Pagets, pagers has increased alk phos as well.
Low Ca, Low PO4, and High PTH are classic for
Osteomalacia, will have low Vit D as well
Bronchiectasis(central bronchi thickening due to chronic infection or impaired airway clearing) can become so bad, it may lead to what complication?
Hemoptysis (may require bronchial artery embolization).
Two drugs causing priapism
trazadone and prazosin
Pt with significant smoking history, with chronic productive cough with new onset hemoptysis likely have:
chronic bronchitis (usually only has blood tinged sputum, not massive amounts of blood.)
Most important causes of low iodine uptake thyrotoxicosis:
1. subacute painless thyroiditis(most are post partum, but not necessarily related to preggers)
2. subacute granulomatous thyroiditis-painful (de Quervains)
3. iodine-induced thyroid toxicossi
4. leveothyroxine od
5. stuma ovarii
LOOK UP LIGHTS CRITERIA FOR PLEURAL EFFUSIONS NOW!
DO IT!
If you see signs of neuromuscular abnormality, and you know pt is IVDA, what can you suspect:
Epidural abscess causing spinal cord compression, EVEN IF NO FEVER IS PRESENT! Weakness, hyperreflexia, and extensor plantar response. Dx: MRI of spine