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176 Cards in this Set
- Front
- Back
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What ion shifts does aldosterone cause in kidneys?
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acts on distal tubules to increase Na reabsorption, and secrete K and H ions
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What ECG findings are most specific for digitalis toxicity?
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Atrial tachycardia with AV block
dig can increase ectopy in atria or ventricles, can lead to atrial tachy dig can also increase vagal tone and decrease conduction thru AV node rare for these to occur together, so specific for digitalis |
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What medications should be withheld for 48 hours preceding cardiac stress testing?
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Antianginal agents
beta blockers, calcium channel blockers, nitrates these meds reduce the extend and severity of ischemia during exercise stress testing |
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What is the biggest risk factor for stroke (aside from prior stroke)?
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Hypertension - ~4x risk
greater risk than smoking or diabetes |
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What is the most common form of glomerulopathy associated with HIV?
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collapsing focal and segmental glomerulosclerosis
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What organism most likely causes cavitating lung nodules on radiography in an IV drug user?
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staph aureus - 2/2 tricuspid valve endocarditis w/septic embolism to lungs
HIV increases risk of staph aureus bacteremia |
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Young male with elevated beta-HCG and AFP?
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nonseminomatous germ cell tumor
seminoma will have elevated beta-HCG, but not AFP |
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What is the differential for an anterior mediastinal mass in young patient?
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"4 Ts"
thymoma, teratoma (& other germ cell tumors), thyroid neoplasm, and terrible lymphoma |
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What test can differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?
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Direct coombs
positive - AIHA negative - hereditary spherocytosis both conditions do have spherocytes w/o central pallor (confusing!) |
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Hepatocytes that stain with periodic acid-Schiff (PAST) rxn and resist digestion by diastase?
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Alpha-1 antitrypsin
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How is gout treated w/prophylaxis and acutely?
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Prophylaxis - allopurinol (xanthine oxidase inhibitor) and probenecid (uricosuric drug)
acutely - colchicine, NSAIDs, steroids |
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HIV patients with very low CD4 counts need abx prophylaxis against respiratory infection, what count, what drug, what infection is particularly likely?
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CD4 < 50
Azithromycin Mycobacterium avium complex |
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What cancer can be correlated with B12 deficiency?
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Gastric cancer
pernicious anemia, autimmune d/o w/anti-intrinsic factor atrophic gastritis increases risk of intestinal-type gastric cancer and gastric carcinoid tumors by 2-3x |
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What vitamin deficiency causes alopecia, abnormal taste, bullous pustulous lesions surrounding body orificies and/or extremities, and impaired wound healing?
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Zinc deficiency
found in animal prtn, whole grains, beans, nuts digested primarily in the jejunum |
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Bullous skin rash that began in mouth, middle aged otherwise no previous problems person?
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Pemphigus vulgaris
IgG deposits intracellularly in epidermis autoantibodies against desmoglein, an adhesion molecule tx w/steroids, may use azathiprine w/prednisone and methotrexate |
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How are foot ulcers classified? (Grade 0-5)
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Grade 0 - high risk, no ulcer
Grade 1 - superficial ulcer, full skin thickness, no underlying tissue Grade 2 - penetrating to ligament/muscle, no bone involved, no abscess Grade 3 - deep ulcer w/cellulitis, abscess, or osteomyelitis Grade 4 - localized gangrene Grade 5 - extensive gangrene of whole foot |
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In TCA overdose, what should be administered, and what complications does this prevent?
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Sodium bicarbonate
improves systolic BP (the major cause of mortality is hypotension) narrows QRS complex decreases incidence of ventricular arrhythmia |
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What is the formula used to assess for respiratory compensation in metabolic alkalosis? For metabolic acidosis?
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Alkalosis: PaCO2 expected = (0.9 x bicarbonates) + 16 +/- 2
Acidosis - Winter's Formula: PaCO2 expected = (1.5 x bicarbonates) + 8 +/- 2 |
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What pharmacotherapy is indicated for someone with hypterophic cardiomyopathy (dynamic outflow obstruction)?
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Beta blockers
this increases ventricular volumes and so decreases obstruction, by decreasing rate and thus allowing more diastolic filling |
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What renal disease is characterized by dense deposits w/in glomerular basement membrane w/immunofluorescence positive for C3, not immunoglobulins? What is mechanism?
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Membranoproliferative glomerulonephritis, type 2
persistent activation of alternative complement pathway caused by IgG antibodies (termed C3 nephritic factor) directed against C3 convertase of alternative complement pathway, leading to persistent complement activation & kidney damage |
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Which rash has tense bullae and urticarial plaques? Oral involvement? Immunofluorescence findings?
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Bullous pemphigoid
pruritis is common autoimmune in elderly person, often precipitating medication NO mucous membrane involvement caused by IgG autoantibodies against hemidesmosome and basement membrane zone, activates complement and inflamm mediators immunofluorescence shows IgG and C3 deposits linearly along basement membrane zone |
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What are the components of CREST syndrome?
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Calcinosis cutis
Raynauds Esophageal dysmotility Sclerodactyly Telangectasias |
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Wisconsin adult male w/fever, night sweats, productive cough, weight loss, skin lesions, and lytic bone lesions?
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Blastomycosis
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Where is the most common foci for ectopic origin of signals in atrial fibrillation?
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Pulmonary veins
tissue has diff electrical properties than surrounding atrial myocytes, prone to ectopic electrical foci |
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What is the prodrome for measles? What does the ensuing rash look like?
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3 C's: coryza, conjunctivitis, cough, ~10 days
rash is erythematous maculopapular, initially on face and spreads to trunk and extremities |
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What are treatment indications for carotid artery stenosis based on % stenosis?
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if < 50 % - ASA and observe
if symptomatic -70-99%: Carotid endarterectomy if good surgical candidate, if not then carotid angioplasty -CEA also considered for pts w/50-69% Asymptomatic -CEA beneficial if stenosis 60-99%, most benefit if > 80% -Carotid angioplasty is NOT beneficial in asymptomatic |
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What electrolyte and metabolic abnormalities are side effects of thiazide diuretics?
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Hyponatremia
Hypokalemia Hypercalcemia Hyperglycemia Unfavorable lipid metabolism effects Uric acid retention - gout |
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Proximal muscle weakness? (difficulty stairs, rising chair, combing hair)
how differentiate from other similar dz? what do mm biopsy show? |
Polymyositis
-inflammatory mm dz unknown etiology -dx w/mm biopsy spares mm of mastication, but dysphagia can develop differentiate from Dermatomyositis b/c no skin findings biopsy shows mononuclear infiltrate surrounding necrotic and regenerating mm fibers |
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Cupping of optic discs with loss of peripheral vision?
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Open angle glaucoma
african american, slow onset, high intraocular pressure tx w/beta-blockers (timolol) eye drops |
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Formula for corrected calcium based on albumin?
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Correced Calcium = measured calcium + [0.8 * (4.0 - measured albumin)]
or, ~ 0.8 mg calcium for ever 1 mg albumin |
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Ectopic ACTH production is most commonly associated with what 2 things?
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small cell lung cancer
carcinoid (bronchial, pancreatic, thymus) |
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How do ACE inhibitors and NSAIDs affect kidney blood flow specifically?
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Normally, angiotensin constricts glomerular efferent arterioles
prostaglandins dilate glomerular afferent arteriole this maintains GFR these meds blunt this |
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What characteristic deficits are present for:
Brainstem lesions? thalamus or cortex lesions? cortical lesions? |
Brainstem - CNs and sensory loss of 1/2 of the face, and contralateral half of body
Thalamus/cortex - sensory loss of one half of face, and SAME half of body cortical lesions - findings specific to cerebral cortex (aphasia, neglect, abnl graphesthesia, stereognosis) |
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What is the medial medullary syndrome? Caused by?
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caused by occlusion of vertebral arter, one or both branches
contralateral paralysis of arm and leg contralateral loss of tactile, vibrator, and position sense and tongue deviation to injured side so, limbs both sensory and motor are down on contralateral side, but tongue motor is down on ipsilateral side |
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What is lateral midpontine syndrome? Medial midpontine syndrome?
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lesion of lateral pons
impaired sensory and motor function of CN V, with accompanying limb ataxia lesion of medial pons ipsilateral limb ataxia, contralateral eye deviation, paralysis of face, arm, and leg impairment of touch and position sense is variable |
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What is Wallenberg syndrome?
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lesion of lateral medulla
ipsilateral Horner syndrome loss of pain and temp sensation of face weakness of palate, pharynx, and vocal cords cerebellar ataxia loss of pain and temp sensation of contralateral body |
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Which of the regional fungal infections is associated with skin lesions?
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Blastomycosis
endemic in south-central and north-central US affects lungs, skin, bones, joints, prostate cutaneous dz either verrucous or ulcerative - can become heaped up and warty Coccidioids can have erythema multiforme and erythema nodosum |
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What regions are what fungal microbes found?
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Blastomycosis - south central and north central US
Histoplasmosis - southeastern, mid-atlantic, and central US Coccidioides - southwestern US, Central and South America has cutaneous findings of erythema multiforme and erythema nodosum |
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Honeycomb pattern of lungs on CXR?
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Idiopathic pulmonary fibrosis
restrictive pattern with perfusion-ventilation mismatch |
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What diseases have low leukocyte alkaline phosphatase?
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Chronic myelogenous leukemia
Hypophosphatemia Paroxysmal nocturnal hemoglobinuria |
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What is the most common malignancy in asbestosis patients?
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bronchogenic carcinoma
also causes peritoneal as well as pleural mesothelioma, but bronchogenic carcinoma is more likely |
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What vitamin should be given in the setting of DVT with elevated homocysteine?
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Pyridoxine (Vitamin B6) and folate
-this is cofactor for cystathionine beta-synthase, which metabolizes homocysteine into cystathionine B12 if deficiency is documented |
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What is the treatment for iron overdose?
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Whole bowel irrigation (sometimes)
deferoxamine supportive care for circulation, airway & breathing |
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In acute coronary syndrome, what effect does lidocaine have?
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Effective to control complex forms of ventricular arrhythmia (v tach)
however, increases risk of asystole so not used prophylactically |
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In positive vs negative skewed distribution, what does curve look like and is mean greater or less than median and mode?
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Positive skew - tail on the right, mean greater than median and mode
Negative skew - tail on left, mean is less than median and mode |
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Characteristics of the MCC of lung cancer?
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Adenocarcinoma
usually located peripherally consisting of columnar cells growing along septa has the least association with smoking (as compared to squamous and small cell p- typically centrally located), but is still the most prevalent in smokers |
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What are anti-cyclic citrullinated peptides (CCP) associated with?
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Rheumatoid arthritis (in adition to rheumatoid factor)
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What is anti-mitochondrial antibody associated with?
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Primary Biliary cirrhosis
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What conditions are associated with primary biliar cirrhosis? What is treatment?
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PBC (anti-mitochondrial antibodies)
Sjogren's syndrome, Raynaud's syndrome, scleroderma, autoimmune thyroid disease, hypothyroidism, celiac disease, elevated risk of hepatobiliary malignancy ursodeoxycholic acid is drug of choice, slows dz progression and relieves sx methotrexate and colchicine have shown moderate benefit |
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What are symptoms of chronic Vitamin D overdose?
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can lead to hypercalcemia
constipation, abdominal pain, polyuria, polydipsia |
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How can you distinguish between Cushing disease and ectopic ACTH?
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high dose dexamethasone suppression test
Cushing dz should have urinary cortisol secretion decreased by ~50%, as pituitary adenomas are only partially resistant to regulation ectopic ACTH will not be suppressed |
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What is the location and presentation for the following 4 common lacunar syndromes?
-Pure motoer hemiparesis -Pure sensory stroke -Ataxic-hemiparesis -Dysarthria-clumsy hand syndrome |
Pure motor hemiparesis - lacunar infarction in posterior limb of internal capsule - unilateral motor deficit (face, arm, leg) mild dysarthria, no sensory visual or cortical dysfxn
Pure sensory stroke - stroke of ventroposterolateral nucleus of thalamus - unilateral numbness, paresthesias, and hemisensory deficit of face, arm, trunk and leg Ataxic-hemiparesis - lacunar infarction in anterior limb of internal capsule - weakness prominent in lower extremity, with ipsilateral arm and leg incoordination Dysarthria-clumsy hand syndrome - lacunar stroke at basis pontis - hand weakness, mild motor aphasia, no sensory abnlities |
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Does pulmonary embolism cause increased A-a gradient?
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yes
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In Inflammatory Bowel Disease, what rheumatologic marker is positive? What extra-colonic symptoms can manifest?
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p-ANCA and HLA-B27
skin findings (erythema nodosum and pyoderma gangrenosum) episcleritis arthritis cholangitis |
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What healthy individuals should not receive the intranasal influenza vaccine?
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those > 50 yo
those caring for severely immune compromised individuals |
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What individuals should receive the pneumococcal vaccine?
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all >= 65 yo
those < 65 w/chronic CV, pulm, hepatic, renal, metabolic dz, or immunosuppression |
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What is Bartter's and Gitelman's syndrome? What distinguishes them from other conditions with similar presentation?
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Defective sodium and chloride reabsorption in thick ascending limb (Bartter) or distal convoluted tubule (Gitelman)
presents as polyuria, polydipsia, growth & mental retardation similar to diuretic use and surreptitious vomiting, all have elevated plasma and renin levels, hypokalemia, and metabolic alkalosis Bartter and Gitelman syndrome have elevated URINE CHLORIDE, where the others do not |
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What is the prophylactic and acute treatment for cluster headache?
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Acute - 100% oxygen, subQ sumatriptan
Prophylactic - verapamil, lithium, ergotamine |
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What findings on paracentesis are indicative of spontaneous bacterial peritonitis?
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PMN > 250
positive ascities culture SAAG (serum-ascites albumin gradient) > 1.1 indicates portal hypertension as etiology of ascities |
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What finding on paracentesis would indicate ascites is due to portal hypertension?
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SAAG (Serum-ascites albumin gap) > 1.1 mg / dL
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How do you calculate the serum osmolar gap?
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Osmolar gap = measured osmolarity - calculated osmolarity
calculated osmolarity = [2Na + Glu/18 + BUN/2.8] normal is < 10 osmolar gap metabolic acidosis indicates acute methanol, ethanol, or ethylene glycol poisoning |
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What is primary medical therapy for patients with aortic regurg?
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Vasodilators to reduce afterload
nifedipine or ACE inhibitors |
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What organism most commonly causes epididymitis?
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In sexually active: chlamydia and gonococcus
Not sexually active, older men: E. Coli, and less commonly Pseudomonas |
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What microbe is most likely to cause a skin infection looking as an erythematous rash with a well demarcated border?
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Group A Strept
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What microbe most commonly causes UTI in patients with indwelling cathethers AND alkaline urine?
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Proteus species
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What is the ScVO2 in septic shock?
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increased, due to hyperdynamic circulation, improper distribution of CO, inability of tissue to extract oxygen
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Where is chloroquine resistant plasmodium falciparum most common? What is preferred prophylaxis in these areas?
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sub-saharan Africa and the Indian subcontinent (India, Pakistan, Bangladesh)
Mefloquine is drug of choice |
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Is cigarette smoking or alcohol a risk factor for pancreatic cancer?
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Cigarette smoking
Alcohol is NOT a RF (tho chronic pancreatitis is) |
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How do you treat neuroleptic malignant syndrome acutely? What do you follow this with?
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A muscle relaxant first (dantrolene)
follow with bromocriptine (dopamine agonist) and amantadine (antiviral drug w/dopaminergic properties) |
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What lab changes are expected in tumor lysis syndrome for potassium, uric acid, phosphate, and calcium?
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increased K+
increased phosphate (intracellular ion) increased uric acid (prtn breakdown) decreased calcium (bound up by phosphate) |
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What is the major cause of mortality in subarrachnoid hemmorhage?
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vasospasm (~30% of patients, ~7 days after event), give Nimodipine to prevent
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Criteria for ARDS?
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acute dyspnea
inciting condition b/l infiltrates on CXR PCWP < 18 PaO2/FiO2 < 200 |
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Back pain in young-middle aged person that is worse in morning and improves gradually throughout day?
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Seronegative spondyloarthropathy (ie ankylosing spondylitis)
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What are the MEN syndromes?
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MEN I - PTH, pituitary tumor, tneropancreatic tumor
MEN 2A - PTH hyperplasia, medullary thyroid cancer, pheo MEN 2B - medullary thyroid, pheo, & other (mucosal & intestinal neuromas / marfanoid habitus) |
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What is amiloride?
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A potassium sparing diuretic
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What can cause chest pain following MI with ST elevation and deep Qs in the same leads as with presentation, 5 days to 3 months following MI?
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Ventricular aneurysm
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What are pharmacologic treatments for Graves disease? What are the side effects of each?
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Both - agranulocytosis, rash, arthralgias, hepatitis
Methimazole - teratogen in 1st trimester, cholestatic jaundice Propylthiouracil - vasculitis |
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What kind of renal disease is associated with Hepatitis C?
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Membranoproliferative glomerulonephritis
less freq membranous nephropathy |
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How do you managed SVT in setting of Wolf Parkinson White?
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cardioversion, either electrical or with antiarrhythmics (procainamide in this question)
do NOT use beta-blockers, adenosine, etc, as anything that decreases AV node conduction will increase bypass and lead to v fib |
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In treating acne, what is the order treatments should be used in increasing severity of condition?
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First line - topical retinoids
Moderate to severe - oral antibiotics Severe acne w/atrophic scarring or resistant cases - oral isoretinoin |
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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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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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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 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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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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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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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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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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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 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 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 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 metabolite is diagnostic of congenital adrenal hyperplasia?
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17-hydroxyprogesterone
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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 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 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 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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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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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 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 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 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 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 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 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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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) |
