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138 Cards in this Set
- Front
- Back
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What is trihexphenidyl?
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anticholinergic agent used for Parkinson's
often used in younger patients in whom tremor is predominant symptom |
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What psychiatric disorder has the strongest genetic components of all?
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Bipolar
first degree relative - 5-10% risk of bipolar child of 2 parents w/bipolar - 60% risk monozygotic twin - 70% risk |
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curvilinear gas shadowing in the gallbladder on ultrasound?
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emphysematous cholecystitis
2/2 infection of gallbladder wall w/gas forming bacteria (clostridium, escherichia, staph, strept, pseudomonas, klebsiella) vascular compromise or immunosuppression, gallstones, and infection are predisposing |
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What is cutoff value of synovial WBC count to differentiate crystal vs septic arthritis?
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50,000
crystal 10,000 - 50,000 septic 50,000 - 150,000 |
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Formulas for:
Sensitivity Specificity Positive Predictive Value Negative Predictive Value |
Sensitivity = TP / (TP + FN, aka total dz)
Specificity = TN / (TN + FP, aka non-dz) PPV = TP / (TP + FP, aka tot pos) NPV = TN / (TN + FN, aka tot neg) |
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What test diagnoses primary syphilis?
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Dark field microscopy
(serum tests rely on antibodies, which in primary syphilus may not be positive yet) |
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Renal side effect of acyclovir mechanism?
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acyclovir poorly soluble in urine, precipitates easily
obstruction of rental tubules causing ARF administer with hydration |
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Acute lymphoblastic leukemia has what to positive staining tests?
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PAS (periodic acid schiff) - cytoplasmic aggregates
TdT - terminal deoxynucleotidyltransferase immunostaining (expressed only by pre B and pre T lymphoblasts) |
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What is the management of Goodpastures syndrome?
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Early / immediate plasmapheresis
pulmorenal dz caused by circulating anti-glomerular basement membrane antibodies, early removal of abs by emergency plasmapheresis minimizes extent of kidney injury, improves prognosis |
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What causes sideroblastic anemia, generally?
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inherited or acquired defects affecting biosynthesis of heme w/in red cell precursors
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What causes target cells, generally? What specific dz associations?
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excess membrane relative to amount of hemoglobin
low hgb - thalassemia, iron deficiency, hemoglobin C, other hemoglobinopathies excess membrane - liver disease other - asplenia |
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What gestational ages are amniocentesis and chorionic villus sampling performed at?
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Amniocentesis - 16-20 wks where MSAFP or triple/quad screen is abnl (after u/s to confirm dates)
Chorionic villus sampling - 10-12 weeks, early screening in women w/known genetic dz |
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What is used for prophylaxis of cluster headache?
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Verapamil
other options - prednisone, ergotamine, methysergide, cyproheptadine, indomethacin, lithium for chronic form |
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What is the MCC mechanism of death in patients w/acute MI?
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complex ventricular arrhythmias
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What is the most common extraarticular manifestation of Ankylosing Spondylitis?
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Anterior Uveitis, 25-40% of patients
monocular pain, bluring, and photophobia |
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What is anti-CCP associated with?
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Rheumatoid arthritis
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What is the treatment for fibromuscular dysplasia?
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percutaneous angioplasty w/stent placement
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How is arrest of descent defined?
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lack of change in descent in fetal presenting part
in 2h for primigravid 1h for multigravid extra hour for epidural is alotted |
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Pulmonary nodule with a halo sign in a sick patient?
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Aspergillus
occurs in immunocompromised patients (neutropenia, cytotoxic drugs, glucocorticoids) fever, cough, dyspnea, hemoptysis |
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How long can normal vaginal spotting, bleeding, or discharge be present in an infant 2/2 effects of maternal estrogen during pregnancy?
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Up to 3 months
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15 yo w/hematuria episodes over last 2 years, electrton microscopy shows alternating areas of thinned and thickened capillary loops w/splitting of glomerular basement membranes?
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Alport syndrome
also has sensorineural deafness |
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What is treatment for prolactinoma?
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Dopaminergic agents
-cabergoline - new drug w/fewer side effects, more effective bromocriptine - old treatment |
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What is cabergoline?
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a new dopaminergic agent used in tx of prolactinomas
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What is the most important contributor to edema in CHF?
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Sodium retention 2/2 activation of RAAS system 2/2 renal hypoperfusion
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What pharmacologic treatment is approved for ALS?
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Riluzole
glutamate inhibitor may prolong survival and time to tracheostomy, tho cannot arrest underlying pathophys SE are dizziness, nausea, wt loss, elevated LFTs, skeletal weakness |
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What causes pulmonary cavitation in HIV patient?
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Myco tuberculosis, atypical mycobacteria, Nocardia, gram neg rods, anaerobes
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Which dementia is associated with prominent visual hallucinations, and can have Parkinson like findings?
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Dementia with Lewy Body
characterized by fluctuating cognitive impairment |
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Skin lesion w/invasive cords of squamous cells w/keratin pearls?
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Squamous cell carcinoma
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Skin lesion w/invasive clusters of spindle cells surrounded by palisaded basal cells?
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Basal cell carcinoma
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HbA1c, each 1% corresponds to what change in blood sugar concentration?
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1% ~ 35 mg/dL
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How does estrogen supplementation effect thyroid replacement?
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increased required drug levels
thought to induce metabolism by CYP3A4 of levothyroxine |
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What is cladribine?
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purine analog, toxic to bone marrow
used for treatment of Hairy Cell Leukemia SE - neurologic & kidney damage Cladribine = 2-chlorodeoxyadenosine (2-CdA) |
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What is CHOP regimen for?
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non-Hodgkin's lymphoma
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What are chlorambucil and prednisone for?
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chronic lymphocytic leukemia
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What is the difference between selection bias and confounding in case control?
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Selection bias refers to exposure status, is not addressed by case control
Confounding refers to matching other variables (age, race, etc), can be accounted for in case control |
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Screen for lead poisoning in children in housing built before what timeframe?
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pre-1950 housing
also parental occupational or other exposurs |
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Immunocompromised patient has an infection with characteristic cutaneous and visceral angioma-like blood vessel growths, what microbe?
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Bacillary angiomatosis, caused by Bartonella
constitutional symptoms, skin and viscera lesions extreme caution w/biopsy bc will hemorage |
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What are t-test, z-test, chi-squared test, and ANOVA designed to evaluate?
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t-test & z-test - compare two means (not proportions of dichotamous outcomes, z of limited use b/c need to know population variables)
chi-square - compare proportions (amount in each of two dichotomous outcomes), 2x2 table to compare observed w/expected values ANOVA - compare means of 3 or more variables |
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What are the 4 main side effects of erythropoietin?
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Worsening hypertension (~30%)
Headaches (~15%) Flu-like syndrome (~5%) Red cell aplasia - rare |
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How can peptic strictures be differentiated from esophageal adenocarcinoma in patient with Barett's esophagus?
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both may have resolution of heartburn symptoms (peptic stricture actually helps reduce GERD)
peptic stricture - tend to be symmetric, circumferential narrowings on endoscopy biopsy is req to r/o adenocarcinoma |
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What lab finding indicates a parapneumonic effusion requires chest tube?
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pH < 7.2 - needs to be drained
glucose < 60 also indication |
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What is the classic ECG finding in PE?
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S1 Q3 T3
(only a small fraction have) |
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What is the skin lesion associated w/celiac dz called? What is pharmacologic tx?
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Dermatitis herpetiformis
Dapsone |
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What symptoms of SLE is hydroxychloroquine best at treating? What is the most serious side effect?
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isolated skin and joint involvement
most serious side effect is retinopathy, eye exam q6mos |
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Muddy brown casts?
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Acute tubular necrosis
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RBC casts?
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Glomerulonephritis
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WBC casts?
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Interstitial nephritis and pyelonephritis
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Fatty casts?
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Nephrotic syndrome
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Broad and waxy casts?
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chronic renal failure
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Pregnancy HTN before 20 weeks represents what 2 possibilities?
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Chronic hypertension
Hydatidiform mole (snow storm appearance) |
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IBD - crypt abscesses and non-caseating granulomas, which is more characteristic of which?
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non-caseating granulomas - Crohn's
crypt abscesses - Ulcerative colitis |
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What lab measurement can be used to indicate exogenous thyroid hormone abuse?
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low thyroglobulin indicates exogenous thyroid hormone ingestion, when combined with low radioactive iodide uptake
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What does alkaline blood pH do to calcium and albumin?
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increases calcium's affinity to albumin, thereby increasing levels of albumin-bound calcium
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What two conditions account for majority of avascular necrosis of bone in adults?
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chronic corticosteroids + excessive alcohol = >90%
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What should be considered when patient with Parkinson like symptoms develops orthostatic hypotension, impotence, incontinence, or other autonomic symptoms?
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Multiple system atrophy (Shy-Drager syndrome)
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What is best treatment for disseminated histoplasmosis?
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Itraconazole
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what is TRAP stain?
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Tartrate-RESISTENT acid phosphatase
Hairy Cell Leukemia CD11c marker |
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What electrolyte abnormality is commonly seen in subarrachnoid hemmorhage? What is pathophys?
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Hyponatremia - "cerebral salt wasting syndrome"
-inappropriate secretion of vasopressin -increased secretion of atrial/bran natriuretic peptide (causing cerebral salt-wasting) hyponatremia usually resolves w/in 1-2 weeks |
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What should be tried prior to intubation in children with croup refractory to initial treatment?
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trial of racemic epinephrine, shown to decrease need for intubation
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What women with DUB require endometrial biopsy?
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> 35 yo, obese, chronic HTN, diabetic
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What pharmacologic therapy for DUB?
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cyclic progestins
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What is MCC of nephrotic syndrome in patients with hepatitis B?
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Membranous glomerulonephritis
also associated w/membranoproliferative glomerulonephritis |
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What patients typically have Focal segmental glomerulosclerosis?
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African americans
HIV infection |
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What ovarian tumor presents with precocious puberty w/o signs of androgen excess?
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Granulosa cell tumor
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what ovarian tumor presents with signs of androgen excess?
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Sertoli-Leydig cell
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What metabolite is diagnostic of congenital adrenal hyperplasia?
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17-hydroxyprogesterone
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What are maternal contraindications to breast feeding?
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Infections: HIV, Tuberculosis, active HSV on breast
Drugs of abuse Rx - chemo, radioactive isotopes, anti metabolites |
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What fungal lung infection shows mass in lung which moves with change in position?
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Aspergillus
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What is anti-topoisomerase-1 antibody associated with?
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Systemic sclerosis
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What condition causes hypocalcemia, hyperphosphatemia, and increased PTH?
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2ndary hyperPTH in chronic renal failure
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What prophylaxis is required in HIV patients with CD4 ct < 50?
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Azithromycin for MAC (or clarithromycin)
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What bacteria are patients with hemochromatosis at increased risk for?
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Listeria monocytogenes
Yersinia enterocolitica Vibrio vulnificus |
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How does sodium bicarb treat TCA overdose?
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increases Na concentration extracellularly, alleviating the depressant action on Na channels
HCO3 alkalinity also decreases affinity of TCA for Na channels combined helps relieve the QRS widening |
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Where do spinalthalamic tracts decussate?
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at the level they enter the spinal cord
pain and temperature lesion of this tract in spinal cord results in contralateral sensory loss 2 segments below |
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What is the genetic abnormality in cri-du-chat?
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5p deletion
microcephaly, hypotonia, short stature, cat-like cry |
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What measurement should be used to evaluate respiratory failure in Guillain-Barre? What value is cutoff?
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Vital Capacity
if belo 15 mL/kg then high risk of resp failure |
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What is the pathophys of a Baker's cyst?
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excessive fluid production by an inflamed synovium, accumulates in popliteal bursa expanding to create a tender mass
occurs w/RA, OA, and cartilage teras |
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What is the name for measels?
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Rubeola
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Palpable purpura, glomerulonephritis, arthralgias, hepatosplenomegaly, peripheral neuropathy, and decreased complement levels?
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Cryoglobulinemia
most pts also have Hep C |
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Difference between severe rhizopus and pseudomonas infections in diabetics?
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Rhizopus - begin in paranasal sinus and extend into orbit and brain
Pseudomonas - ear pain and drainage, granulation tissue, osteomyelitis of skull base and destruction of facial nerve (MOE) |
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Blood transfusions before what year put people at risk for what infections?
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before 1992 - hep C
before 1986 - hep B |
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What are Lights criteria for exudative pleural effusion?
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Protein in pleural fluid : serum ratio > 0.5
pleural fluid LDH : serum LDH ratio > 0.6 pleural fluid LDH > 2/3 ULN for serum LDH |
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What is A-a gradient formula? Normal values?
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A-a = PAO2 - PaO2
PAO2 = (FiO2 - [Patm - PH20]) - (PaCO2 / R) =150 - PaCO2 / 0.8 nl is < 15 (or up to 30 in elderly) >30 is always abnl |
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Do you use corticosteroids or IVIG for Guillan Barre tx?
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IVIG (+ plasmaphoresis)
corticosteroids was once mainstay, but has not showed any benefits and are no longer used |
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What is the treatment for solitary brain metastasis w/stable extracranial disease?
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Surgical resection followed by whole brain radidation
if multiple metastases then just palliative whole brain radiation |
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What is characteristic of waldenostrom's macroglobinemia? How can it be differentiated from MGUS?
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Hyperviscosity of blood from overproduction of IgM
-IgM spike -Hyperviscosity -tiredness, increased spleen/liver/lymph node size, easy bleeding & bruising/night sweats, HA/dizziness, visual problems, pain and numbness in extremities patients with MGUS are largely asymptomatic |
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Hemolytic anemia with venous thrombosis? Which vein in particular?
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Paroxysmal nocturnal hemoglobinuria
(cell membrane anchor prtn GP1 abnl, CD55 and CD59 not bound, which nl help inhibit destruction) PNH has tendency towards hepatic venous thrombosis |
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Risk of diethylstilbestrol?
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Clear cell adenocarcinoma of vagina and cervix in offspring
ADENOcarcinoma |
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What portion of the spine does Rheumatoid arthritis most commonly affect?
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Cervical spine joints in axial skeleton
spinal subluxation and spinal cord compression can occur |
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What is the most common nephropathy associated with carcinomas? What is a cancer that is an exception to this?
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Membranous glomerulonephritis
Hodgkin's lymphoma has association with minimal change dz |
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Up to what age do all children with first febrile UTI receive renal & bladder ultrasound?
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Up to 24 months
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What organisms cause endometritis? What is treatment?
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Polymicrobial
IV clindamycin and gentamycin |
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What is a serious side effect of propylthiouracil?
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Agranulocytosis
fever and sore throat in patient taking anti-thyroid drugs suggests agranulocytosis |
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What drug can be given to counteract the anti-cholinergic effects of diphenhydramine overdose?
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Physostigmine (cholinesterase inhibitor)
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What is tx for platelet dysfxn in renal failure?
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DDAVP if needed
increases release of factor VIII:von Willebrand factor multimers from endothelial storage sites |
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What is MOA and SE of cyclosporine and tacrolimus?
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Calcineurin-inhibitor
SE - nephrotoxic, hyperkalemia, HTN, tremor (Cyclosporine also has gum hypertrophy and hirsutism) |
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What is the MOA and SE of azathioprine?
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purine analog converted to 6-mercaptopurine, inhibiting purine synthesis
SE - diarrhea, leukopenia, hepatotoxicity |
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What is MOA and SE of Mycophenolate?
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reversible inhibitor of inosine monophosphate dehydrogenase, rate-limiting enzyme in de novo purine synthesis
SE - bone marrow suppression |
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What effect does hyperthyroidism have on bones?
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if left untreated hyperthyroid patients are at risk for rapid bone loss due to direct effects of thyroid hormones on bone cells
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Eggshell calcification of hepatic cyst on CT?
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Hydatid cyst (echinococcus)
intimate contact with dogs |
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What is a radiolucent kidney stone made of? What is treatment?
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Uric acid stones (10-15% of total cases)
seen in low urine pH levels and hyperuricosuria tx - alkalinize urine, hydration, low-purine diet alkalinize urine to pH > 6.5 w/oral KHCO3 or K-citrate |
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What are CSF findings in Guillain-Barre syndrome?
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High protein
Normal - WBC, glucose, RBC |
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What is presentation and timeline of Heparin Induced Thrombocytopenia? What is pathophys? What is a diagnostic lab test?
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Platelets drop by > 50% baseline in 5-14 days after starting heparin
2/2 antibodies against heparin-platelet factor 4 complexes, activating platelets serotonin release assay can confirm diagnosis |
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What is a particular use for procainamide?
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Wolff-Parkinson-White ventricular arrhythmias
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What is the ideal range for maternal fasting glucose?
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75 - 90 mg/dL
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What is the difference between Steven's Johnson syndrome and Toxic Epidermal Necrolysis?
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SJ up to 10% skin involved
TEN > 30% body surface involved |
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What obstetric condition presents similarly to hyperemesis gravidarum but has severe consequences?
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Gestational trophoblastic disease (hydatiform mole and choriocarcinoma)
Hydatiform mole - triad: enlarged uterus, hyperemesis, elevated HCG (> 100,000) |
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What should you think of in HIV patient with bloody diarrhea and negative stool exam?
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CMV, warrants colonoscopy biopsy
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How is CIN II/III managed?
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Either
-Pap smear with or w/o colposcopy and endocervical curettage q6mos x3 negative samples OR HPV testing or combo of HPV and cytology |
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What is the mechanism of Eaton-Lamber syndrome?
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antibodies against voltage-gated calcium channels in PREsynaptic nerve terminal
associated w/small cell carcinoma tx w/plamapheresis and immunosuppressive drug therapy |
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How is Riboflavin (B2) deficiency different than Niacin (B3 deficiency)?
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Riboflavin does not have the diarrhea nor the dementia (neurologic) components (except for some photophobia)
they both can have dermatitis, oropharyngeal changes |
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What causes bacillary angiomatosis? How does it present? How is it treated?
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caused by Bartonella, gram-negative bacillus
bright red, firm, friable, exophytic nodules in an HIV infected patient tx - oral erythromycin |
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What kind of lesion are patient's with Hashimoto's thyroiditis at increased risk for developing?
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Thyroid lymphoma (~60x increased risk)
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What lab findings confirm premature ovarian failure?
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Markedly elevated FSH in woman under 40 yo w/3+ mos amenorrhea
FSH and LH are both elevated FSH:LH ratio > 1.0 b/c FSH cleared more slowly |
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What causes an Erlenmeyer flask deformity of distal femur? Associated findings?
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type 1 Gaucher's dz (MC lysosomal storage dz)
deficient beta-glucosidase wrinkled paper appearance of cells on bone marrow biopsy |
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What is associated w/wrinked paper appearance of cells on bone marrow biopsy?
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type 1 Gaucher's dz (MC lysosomal storage dz)
deficient beta-glucosidase erlenmeyer flask deformity of distal femur |
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What is the main gluconeogenic amino acid? What intermediate metabolite is it converted to?
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Alanine
pyruvate |
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Infection causing erythematous, maculopapular rash, starting on face and progressing to trunk and extremities? How differentiate from other causes?
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Rubella or Rubeola
Measles (Rubeola?) prodrome will include additional items of fever, cough, coryza, and conjunctivitis (may also have Koplik spots) Rubella has arthritis, which Rubeola does not |
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Important disease association with Dermatomyositis?
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Internal malignancies (>10% of DM patients)
Ovarian MC also breast, lung, other female urogenital |
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What lab findings are present in adrenal insufficiency 2/2 chronic exogenous steroids?
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Central adrenal insufficiency
decreased ACTH, decreased cortisol (CRH is also suppressed) |
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Is ursodeoxycholic acid indicated for asymptomatic gallstones?
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nope
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How is sarcoidosis treated?
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Asymptomatic - followed w/o tx due to high rate of spontaneous remission
Symptomatic - systemic glucocorticoids If w/renal involvement - cyclophosphamide |
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When and why is ampicillin used in meningitis tx?
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In adults > 55 yo
covers listeria monocytogenes |
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What is treatment for toxoplasmosis?
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Treatment - sulfadiazine and pyrimethamine
(prophylaxis - trimethoprim-sulfamethoxazole) |
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Infant born w/infection from mother, has cutaneous lesions on palms and soles, hepatosplenomegaly, jaundice, anemia, and rhinorrhea?
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Congenital syphilis
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7 yo w/bleeding, poor growth, morphologic abnormalities, thrombocytopenia, leukopenia, and macrocytic anemia - MCC? Underlying defect?
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Fanconi's Anemia (an aplastic anemia)
autosomal recessive - chromosomal breaks |
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What is the inability to release the hand after a handshake called? Associated with?
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Myotonia
muscular dystrophy |
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What is the 2nd MCC of muscular dystrophy? How does it present? What is unique about it?
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Myotonic Muscular Dystrophy
(aka Steinert dz, Autosomal Dominant) presents w/nl at birth, then slowly develop mm weakness & progressive mm wasting -distal mm hands, forearm, anterior compartment legs facial wasting atrophy of thenar and hypothenar eminences unique in that all types of mm (smooth, striated, cardiac) are involved also have endocrine, immunologic, and CNS abnormalities |
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What is the difference between bronchiectasis and bronchitis?
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Bronchiectasis - recurrent purulent expectoration
Bronchitis - recurrent NONpurulent expectoration |
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Which fungal infection causes palatal ulcers, hepatosplenomegaly, and pancytopenia?
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Disseminated histoplasmosis
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What bursa is located anteromedially over the tibial plateau?
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Anserine bursitis
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What peripheral blood smear findings are characteristic of G6PD deficiency?
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Heinz bodies
bite cells |
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What is the organism and treatment for cat-scratch dz?
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Bartonella henselae
azithromycin x5 days |
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What are the associated HIV therapy reactions?
Didanosine - Abacavir - NRTIs- NNRTIs - Nevirapine Indinavir - |
Didanosine - induced pancreatitis
Abacavir - hypersensitivity NRTIs - lactic acidosis NNRTIs - Steven Johnson Nevirapine - liver failure Indinavir - crystal induced nephropathy |
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What is going on in HIV patient receiving tx that develops heamturia and needle-shaped crystal sediment?
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Crystal induced nephropathy
2/2 Indinavir (protease inhibitor) |
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Hepatolenticular degeneration?
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Wilson's dz
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What kind of bias does loss to follow-up create?
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Selection bias (b/c the ones remaining to be studied are no longer properly "selected")
ascertainment and observer bias relate to misclassification of the OUTCOME |
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What is the MCC of nephrotic syndrome in adults? What is a vascular complication?
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Membranous glomerulonephritis
loss of Antithrombin III increases risk of venous and arterial thrombosis, including Renval vein thrombosis (abdominal pain, fever, hematuria) |
