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48 Cards in this Set
- Front
- Back
What is the biggest determinent if an parapneumonic effusion needs to be drained with a chest tube?
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pH, <7.2 is empyema (glucose less than 60 also means it needs to drained).
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Hypertrichosis of the face, painless blisters on dorsal hands (esp after sun exposure) and hyperpigmentation, familial, ass'd with HepC
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Porphyria cutanea tarda, can be triggered by ethanol and estrogens, (d/c once suspected).
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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:
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Acute Angle closure glaucoma. Precipitated by dim light, anticholinergic meds, or sympathomimetic med. If untx, can result in blindness w/in 2-5 hrs!
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What is cosyntropin?
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synthetic ACTH, used in stimulation tests
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Adrenal calcification is characteristic of what disease?
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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).
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Radiopaque tablets seen on abd x-ray are likely to be what?
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Fe tablets from prenatal vitamins (kids think they are candy, common in households with pregger women with little kids present)
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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?
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Fe tablets
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Li overdose is tx with?
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hemodialysis-most dialyzable drug
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How do you tx iron poisoning?
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With deferoxamine
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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).
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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.
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What is use-dependence, and which antiarrythmics demonstrate this.
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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).
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What is the DOC of tx aspiration pneumonia due to anerobes (a common complication of upper GI endoscopies, etc)?
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Clindamycin
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Improperly refrigerated rice eaten, and then n/v within three hrs on ingestion?
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Bacillus cereus. Due to preformed toxin, Note the lack of fever or diarrhea.
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Which type of hyptherthyroid disease would become permanently hypothyroid if tx with radioactive iodine ablation?
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graves dz
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Fever, weight loss, neurologic sx(embolization), mass in the atrium. Fatigued, and diastolic murmur heard.
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Atrial Myxoma
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Which enzyme maintains normal levels of activity DURING the hemolysis phase of G6PD def?
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G6PD activity, ironically. Look for BITE CELLS, as well as a precipitating stressor, like sulfa drugs or fava beans
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Post-ictal metabolic acidosis is due to lactic acid from tonic-clonic episode. How do you treat it?
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Observe and repeat labs within two hours.
(giving HCO3- replacement is controversial, and if they do, its only up to pH=7.2) |
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hyperCa, hilar lung masses, in a smoker, due to what?
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SqCC-->PTHrP (sCa++mous). Note: lung cancer is usually unilateral if located in hilar lymph nodes
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Parkinsonism,widespread neurological signs(cerebllar, pyramidal, LMN), ortho hypo, and autonomic dysfunction(impotence, incontinence, etc.)
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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). |
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Most drug OD's cause slurred speech, unsteady gait and drowsiness. How can you distinguish benzo OD vs. Opioid (and from Phenytoin and EtOH)?
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opioids lack of severe resp. depression and LACK OF PUPILLARY CONSTRICTION. Also, will lack nystagmus(vs. phenytoin/EtOH).
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Exertional heat stroke is due to failure of:
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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).
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Inadequate fluid and water replacement during physical activity can lead to heat:
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exhaustion. -cool skin, low BP, confusion and muscle spasm. THERMOREGULATION STILL IN TACT, NO HYPERTHERMIA PX YET.
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Upregulation of bodies thermoregulatory centers via cytokines to 104 or less is due to:
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Fever
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Molluscum contagious can be due to deficiency in:
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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)
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Recurrent resp infxns and chronic giardiasis/gastroenteritis
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Selective IgA defiency
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Complement deficiency: C1 esterase, C3, C5-9
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C1 esterase: hereditary angioedema.
3: recurrent pyogenic bacterial respt tract and sinus infxns 5-9:Neisseria infections. No increased risk of viral infections |
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Impaired phagocytosis:
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recurrent pyogenic bacterial infections
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What is a potential sequelae of treating hospitalized pt for DVT:
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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.
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Triad of asthma, chronic rhino sinusitis with nasal polyposis, and bronchospasm or nasal congestion following ingestion of aspirin or NSAIDs
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Aspirin Exacerbated Resp disease. Will see bilateral grey, glistening mucoid masses. Polyps tend to recur despite surgery.
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What protease inhibit is well known for its crystal-induced nephropathy?
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Indinavir!!! Missed this twice!
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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 |
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V. tach with stable blood pressure doesn't warrant cardioversion. Best treatment is:
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IV amiodarone/lidocaine
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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?
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Immediate anticoagulation with heparin and surgical intervention(embolectomy/call vascular surgery for consult right away). Prevent tissue death and amputation.
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What is the protocol for HIV exposure to healthcare works
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Testing with serology and simultaneous administration of 3 Drug antiHIV regimen, typically two NTRI and one PI (post exposure prophylaxis)
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Mayonnaise containing salads, like macaroni or potato salad, are common sources of what type of food poisoning? What are the main symptoms
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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).
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Watery diarrhea. After eating meats, poultry, and gravy; due to which organism?
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C. preferingens
Hint: gravy looks like mud, and clostridia loves the dirt |
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Asplenic pt's are at risk for encapsulated bugs because of lack of what immune characteristic:
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They have less germinal centers to process antigen and create antibodies, thus, they have a lack of ANTIBODY MEDIATED OPSINIZATION AND PHAGOCYTOSIS.
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acute prostatitis>acute cystitis in men: true or false?
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TRUE-->get a midstream urine culture to direct abx therapy
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Matching groups in case control studies based on demographic traits(age, race, etc) reduces:
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confounding.
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Muscle weakness described after tx for rheum related disease is most likely to be
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drug induced myopathy(usually LONG TERM corticosteroid WITH insidious onset, not seen in acute corticosteroid use).
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Normal Ca, PO4, and PTH is seen in what two disease? What if there was an increased alk phos as well?
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Osteoperosis and Pagets, pagers has increased alk phos as well.
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Low Ca, Low PO4, and High PTH are classic for
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Osteomalacia, will have low Vit D as well
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Bronchiectasis(central bronchi thickening due to chronic infection or impaired airway clearing) can become so bad, it may lead to what complication?
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Hemoptysis (may require bronchial artery embolization).
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Two drugs causing priapism
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trazadone and prazosin
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Pt with significant smoking history, with chronic productive cough with new onset hemoptysis likely have:
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chronic bronchitis (usually only has blood tinged sputum, not massive amounts of blood.)
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Most important causes of low iodine uptake thyrotoxicosis:
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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 |
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LOOK UP LIGHTS CRITERIA FOR PLEURAL EFFUSIONS NOW!
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DO IT!
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If you see signs of neuromuscular abnormality, and you know pt is IVDA, what can you suspect:
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Epidural abscess causing spinal cord compression, EVEN IF NO FEVER IS PRESENT! Weakness, hyperreflexia, and extensor plantar response. Dx: MRI of spine
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