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116 Cards in this Set

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what is the MC type of pituitary tumor?

microadenoma
macroadenoma
macroadenoma-nonfunctioning
this is the passage of large volumes of inappropriately dilute urine in the presence of concentrated plasma.

DI
SIADH
MEN 1
DI
T/F

macradenoma is >1cm-can produce mass effects and hypopituitarism. Usually non-fcning, but can cause excessive hormonal secretion.
true
Primary polydipsia, is usually _ in origin.
psychogenic
in which of the following will you find low NA, low plasma osmolality, and the urine concentrates on water deprivation test?

cranial DI
Nephrogenic DI
primary polydipsia
primary polydipsia-which is usually psychogenic (excessive) water drinking.
t/f

the way to determine if you are dealing with cranial or nephrogenic DI is the bodies response to synthetic ADH.
true; in nephrogenic DI the body fails to concentrate when given synthetic ADH. but will concentrate the urine in cranial DI when given synthetic ADH.
what will you find in a pt with DI?

high sodium/high plasma osmo
low sodium/low plasma osmo
high sodium and high plasma osmolality. both with low urine osmo.
this disease is autosomal dominant inherited disease that results in an abnormal red cell membrane, typically presents in childhood with pallor and attacks of jaundice. Splenomegaly is very common. What is it?

pyruvate kinase deficiency
TTP
G6PD deficiency
hereditary spherocytosis
hereditary spherocytosis
people with hereditary spherocytosis are very susceptible to encapsulated bacteria and should receive all of the following vaccines before surgery except which one?

-HIB
-meningococcus
-influenza
-pneumovax
not influenza
this disease is X-linked, and results in a hemolytic anemia. is very common in the subtropics and tropics. more common in males. many are asymptomatic until an acute hemolytic attack happens. treatment is usually supportive. what is it?

TTP
ITP
G6PD deficiency
HUS
G6PD deficiency
TTP is an uncommon acquired disorder characterized by a pentad of hemolytic anemia with all of the following except?

rbc fragments
fever
thrombocytopenia
agranulocytosis
renal impairment
neurological abnormalities
not agranulocytosis.

the pentad includes:

rbc fragments
fever
thrombocytopenia
renal impairment
neuro abnormalities
what is the treatment of ttp?

infuse ffp
rbc transfusion
plasmaphoresis
plasmaphoresis is the mainstay of treatment.
this disease is characterized by a microangiopathic hemolytic anemia, thrombocytopenia and renal impairment. often associated with diarrhea, and E coli 0157 is sometimes responsible and may cause small epidemics. what am i?
HUS-looks alot like TTP but TTP is the one with neurological symptoms, HUS has no neuro symptoms.
deficiency of coagulation factors presents with hemarthroses and __ (in contrast to platelet disorders that principally present with skin bleeds).

gi bleeding
gu bleeding
intracranial bleeding
muscle hematomas
muscle hematomas
_ is caused by a deficiency of factor VIII.

von willebrands disease
hemophilia A
hemophilia B
DIC
hemophilia A, is an X-linked recessive disorder affecting 1 in 5000 males.
_ is the MC inherited bleeding disorder.

von willebrand's disease
G6PD deficiency
hemophilia A
hemophilia B
von willebrand's disease
_ is caused by a deficiency of factor IX.

von willebrands disease
hemophilia A
hemophilia B
DIC
hemophilia B
_ describes pathological activation of coagulation resulting in widespread microvascular thrombosis.

vit k deficiency
DIC
von willebrand's disease
hemophilia A
DIC
t/f

In DIC, often results in end organ damage from thrombosis, rather than the bleeding itself, that leads to the very high mortality.
true
what is the tx of DIC?
manage the underlying disease
all of the following except ? can trigger DIC?

septicemia
obstetrical emergencies
malignancy
A & C
all of the above
all of the above
vit k is required as a coenzyme for the carboxylation of which coagulation factors ? (4)
II, VII, IX, X
_ is a vitamin K antagonist inhibiting the carboxylation of clotting factors II, VII, IX, X.

aspirin
heparin
coumadin
plavix
coumadin
_ is a powerful naturally occurring anticoagulant, which potentiates the action of anti-thrombin, with an immediate onset of action.

aspirin
heparin
coumadin
plavix
heparin
_ is MC in men in there 50's, it is a clonal stem cell disorder, red cell mass is high and 50% of pt's have high plt's and wbc's, complications are vascular in nature. the pt will c/o aquagenic pruritis. what am I?

thalassemia
sickle cell disease
polycythemia rubra vera
myeloma
polycythemia rubra vera
_ is MC in men in there 50's, it is a clonal stem cell disorder, red cell mass is high and 50% of pt's have high plt's and wbc's, complications are vascular in nature. the pt will c/o aquagenic pruritis. what am I?

thalassemia
sickle cell disease
polycythemia rubra vera
myeloma
polycythemia rubra vera
if you have a pt with Bence-Jones proteins in the urine what do you have?

PCV
myeloma
CML
thalassemia
myeloma
if you have a pt with Bence-Jones proteins in the urine what do you have?

PCV
myeloma
CML
thalassemia
myeloma
_ disease has a bimodal distribution with a peak in young adults and another peak in elderly people. Hint: reed sternberg cells

CML
hodgkin's lymphoma
myeloma
non-hodgkin's lymphoma
hodgkin's lymphoma
_ disease has a bimodal distribution with a peak in young adults and another peak in elderly people. Hint: reed sternberg cells

CML
hodgkin's lymphoma
myeloma
non-hodgkin's lymphoma
hodgkin's lymphoma
t/f

non-hodgkin's lymphoma: 80% are of B cell origin with the remainder derived from T cells. The incidence is increasing, some but not all of this increase is due to AIDs.
true
t/f

non-hodgkin's lymphoma: 80% are of B cell origin with the remainder derived from T cells. The incidence is increasing, some but not all of this increase is due to AIDs.
true
you will find Philadelphia Chromosomes in which of the following?

ALL
AML
CML
CLL
CML-come my love to philadelphia
you will find Philadelphia Chromosomes in which of the following?

ALL
AML
CML
CLL
CML-come my love to philadelphia
if you find a pt to have neutrophil leukocytosis, this MC occurs with a _.

bacterial infection
viral infection
bacterial infection

lymphocytosis occurs in pt's with a viral infection
all of the following except what could cause a neutrophil leukocytosis?

tissue necrosis
bone necrosis
MI or pulmonary infarction
mild fever
noninfectious inflammatory disorder
connective tissue disease
corticosteroid usage
dka
not bone necrosis
t/f

if pt's have an excess of eosinophils, they usually are asymptomatic
true, with very high eosinophils it may be r/t tropical infections causing MI and endocardial damage such as restrictive cardiomyopathy.
t/f

blood pressure in the long term should be low, but should not be decreased acutely because this may provoke watershed infarcts.
true
Aspirin and other antiplatelet agents are used to decrease the incidence of further strokes. Thombolytics continue to undergo evaluation. Current evidence suggest that disability is reduced if given <_hours from symptom onset.

1
2
3
6
3 hours
A subdural hemorrhage is a _ bleed.

venous
arterial
venous
a subarachnoid bleed is an _ bleed.

venous
arterial
arterial
venous sinus thrombosis is MC found in what patient demographic?

female
male
young or old
young females
All pt's presenting with dementia complaints should be evaluated for _.
psudo-dementia, should check for depression and hypothyroidism
_ is the global impairment of cognition with normal levels of consciousness.

confusion
delerium
dementia
dementia
_ is the recurrent tendency to spontaneous disordered electrical discharge in the brain manifesting as alteration in motor, sensory or psychological function.

confusion
delerium
dementia
seizures
seizures
t/f

generalized seizures arise in the brain of anyone subjected to appropriate stimuli so a single seizure does not make the diagnosis of epilepsy.
true
What is the simplest way to divide seizures as focal or general?

lyte check
ct scan of brain
mri of brain
eeg of brain
eeg
SAH is an arterial bleed from a _.

clot from right ventricle
ruptured berry aneurysm
venous rupture
ruptured berry aneurysm-arterial bleed
subdural hemorrhage is a venous bleed, often occurring in the context of brain _. from age, dementia, chronic alcoholism.

enlargement
shrinkage
thrombosis
shrinkage
all of the following are a decent first choice in the treatment of primary generalized epilepsy except?

phenytoin
lamotrigine
sodium valproate
carbamazepine
not carbamazepine, it may worsen the problem
optic neuritis is seen in pt's with _.

myasthenia gravis
multiple sclerosis
cerebral vasculitis
SLe
multiple sclerosis
_ is the MC of a group of inflammatory conditions in which the basic pathological process is one of loss of myelin in the brain and spinal cord. This leads initially to a relapsing and remitting neurological disturbance, in the end, in all but a few pt's, to permanent and progressive disability as a result of loss of axons.

MS
MG
cerebral vasculitis
huntington's chorea
MS
_ are used for acute attacks of gout.

nsaids
aspirin
allopurinal
colchicine
nsaids
t/f

measurement of serum uric acid is diagnostic for gout attacks
false; it is helpful but not diagnostic. diagnosis is by joint aspiration
_ osteoporosis occurs in people with endocrine diseases such as: thyrotoxicosis, cushing's disease, hypogonadism, hyperparathyroidism.

primary
secondary
tertiary
secondary
foot puncture wounds can cause calcaneal osteomyelitis, which is d/t _ in 90% of cases.

strep
staph
ecoli
pseudomonas
pseumdomonas
_ is infection of the bone arising either from direct innoculation with infecting organisms or from hematogenous spread.
osteomyelitis
t/f

in the diagnosis of osteomyelitis, standard x-rays do not show changes within 10 days. MRI is therefore the investigation of choice.
true
extensor tenosynovitis, prominent ulnar styloid and wrist tenderness are early symptoms of _.

osteoarthritis
rheumatoid arthritis
MS
rheumatoid arthritis
ulnar deviation and swan neck deformity are late signs of _.

osteoarthritis
rheumatoid arthritis
MS
rheumatoid arthritis
all of the following except what are extra-articular manifestations of RA.

splinter hemorrhages
elbow nodules
splenomegaly
median nerve entrapment
lymphadneopathy
cirrhosis
pericarditis
ischemic ulcerations
neuropathy
eye disease
not cirrhosis
a 47 y.o. woman presents with a month long history of morning stiffness in hands, feet and knees that takes "half the morning to work its way out" the patient has hard nodules on the extensors of her elbows. what is it?
RA
_ happens in pregnancy, steroid therapy, folowing radio/chemo therapy, sickle cell dx, and decompression sickness. The cause is often idiopathic and often affects the femoral head or the scaphoid. what am I?

secondary osteoporosis
AVN
osteomyelitis
RA
AVN
All of the following except _ can occur in pt's with RA.

episcleritis
scleritis
keratoconjunctivitis
conjunctivitis
not conjunctivitis
t/f

biological agents can cause reactivation of TB
true
t/f

there remains a long term risk of future myocardial ischemia in pt's with a history of kawasaki arteritis
true; this disease occurs in childhood but could be responsible for an MI in adulthood
All of the following are true of kawaski arteritis except ???

-75% of cases are <5 y.o.
-F>M
-rash of hands/feet progressing to peeling a few days later
-conjunctivitis
-coronary dilatation can occur with aneurysm development
M > F
Giant cell arteritis is aka ?
temporal arteritis
what is the tx of temporal arteritis?

high dose steroids
low dose steroids
IVIG
antibiotics
high dose steroids (40mg/day)
which of the following labs are found to be high in temporal arteritis?

esr
crp
wbc
hgb
CRP
all of the following except ? are potential complications of temporal arteritis.

retinal artery inflammation leading to sudden blindness
aortitis
temporal anopsia
CVA
aortic dissection
not temporal anopsia
_ is a multi-system disease characterized by inflammation involving many systems, exhibits a relapsing/remitting course. Strongly associated with autoantibodies to components of the cell nucleus. (ANA).

SLE
RA
OA
vasculitis
SLE
arthritis as a significant clinical feature of systemic infection, such as all of the following except?

parvovirus B19
Lyme disease
rubella
CHF
not CHF
Disseminated _ infection may feature urogenital symptoms and a pustular rash.

chlamydia
gonococcal
parvovirus B19
pseudomonas
gonococcal
_ is the most frequent joint pathogen in adults.

staph aureaus
strep pneumo
pseudomonas
klebsiella
staph
_ is a common organism found in septic arthritis of IV drug users.

staph a.
strep p.
klebsiella
pseudomonas
pseudomonas
What but is MC isolated in septic arthritis of patients < 2 y.o. ?

staph
strep
h. flu
pseudomonas
h. flu
over zealous correction of hyponatremia can cause a syndrome of encephalopathy, cranial nerve palsies, and quadriplegia known as ???
central pontine myelinolysis
what is the MC malignant cause of SIADH??

prostate CA
GI CA
lung CA
ovarian CA
hematologic CA
lung CA is the MC, can also occur with GI, prostate and hematologic CA's as well.
_ is characterized by polyuria and polydipsia and is the result of defects in ADH action.

SIADH
DI
DM type I
central pontine myelinolysis
DI. can produce hypernatremia
AOTF are included in the calculation of plasma osmolality except ??

Na
K
urea
creatinine
glucose
not creatinine
central pontine myelinolysis occurs d/t too rapid correction of hyponatremia and causes all of the following except ??

encephalopathy
cranial nerve palsies
cva
quadriplegia
not cva
which of the following drugs can cause SIADH?

aspirin
vasopressin
carbamazepine
cyclophosphamide
A & C
all of the above
B & D
all of the above
a pt. presents with fevers, tachycardia, splinter hemorrhages, osler's nodes, new heart murmur, and splenomegaly. What are you thinking about?

myocarditis
infective endocarditis
pericarditis
acute rheumatic fever
infective endocarditis-the presentation is typically nonspecific. The most important diagnostic test is blood cultures x3.
_ is an infection of the lining of the heart, usually heart valves which are commonly diseased or prosthetic.

myocarditis
pericarditis
infective endocarditis
acute rheumatic fever
infective endocarditis
_ is inflammation of the heart muscle.
myocarditis
AOTF are common complaints with infective endocarditis except?

fever
wt. loss
anemia
fatigue
murmur
not murmur
the normal _ node acts as a 'turnstile' because it conducts depolarizations slowly and is refractory for a relatively long period after each depolarization.

AV node
SA node
bundle of HIS
AV node
What are the first line treatments of SVT? (2)

beta blockers
adenosine
vagal manuvers
radiofrequency ablation
vagal manuvers
adenosine
a prolonger P-R interval is a _ degree heart block. What is the treatment.
1st degree, and the treatment is observation only
an ekg shows a progressively elongating P-R interval that eventually drops every 5th QRS. what is it and what is the treatment?
2nd degree block, type I. May be benign but often the pt. requires a pacemaker.
an ekg shows no association between p waves and qrs waves. the pt is bradycardic. relates to structural disease of the AV and or conduction system. what is it and what is the treatment?
3rd degree or CHB, requires immediate pacemaker.
AOTF except ? are common causes of LGI bleeding.

ischemia
colitis
angiodysplasia
diverticular disease
hemorrhoids
not colitis
which of the following is a uncommon cause of LGI bleeding, which one is rarely a cause?

colitis
polyps
meckel's diverticulum
neoplasm
meckel's diverticulum
which of the following are true regarding achalasia?

hypertonic sphincter
progressive dilatation above the LES
can cause local nerve death
long history of intermittent dysphagia
A & C
A & C & D
all of the above
all of the above
t/f

bilirubin from destruction of red cells circulates bound to albumin
true
t/f

bilirubin is excreted into stool
false; bile
AOTF are causes of biliary obstruction except ??

gallstone disease
intrahepatic ducts, viral/drugs
pancreatic head neoplasm
gastric cancer
not gastric cancer
t/f

urobilinogen is excreted in urine
true
AOTF are causes of transudative ascites except ?

portal hypertension
IBD
altered renal sodium clearance
nephrotic syndrome
pericardial constriction
not IBD, inflammatory/infective or malignant processes cause exudative ascites

transudative=protein <25, and serum ascites protein gradient >11

exudative=protein >30, and serum ascites protein gradient <11
if a urine sample shows mild to moderate proteinuria, wbc's and white cell casts, eosinophils and eosinophil casts as well as red cells, what do you have?

acute glomerulonephritis
renal azotemia
acute interstitial nephritis
tubular injury ischemia
acute interstitial nephritis

acute glomerulonephritis will show moderate to severe proteinuria, hgb, rbc's, red-cell casts (dysmorphic)
AOTF are causes of polyuria except ??

Cranial DI, d/t dec. ADH 2' head injury or tumors
excess IV fluids
excess oral intake (psychogenic)
osmotic diuresis-uncontrolled DM
renal causes-failure, nephrogenic DI 2' Ca++, Li+ toxicity
A,B,C,
all of the above
all of the above
fluid depletion can be accompanied by elevations in all except?

albuminuria
creatinine
hct
BUN (disproportionately)
hgb
not hgb
in a pt with recurrent uti's you should consider AOTF except?

calculi
TB
abn. urinary tract
prostatitis
pyelonephritis
not pyelo
AOTF are components of glomerulonephritis except ?

dysmorphic red cells
wbc's
red cell casts
abn. renal function
heavy proteinuria
not wbc's
AOTF are indicative of essential tremors except ?

barely present at rest, most pronounced with movement
symmetrical distribution
relieved by small amounts of etoh
assoc with family hx
all of the above
all of the above
an asymmetrical tremor that is worse at rest, decreased or abolished with movement is ?

essential tremor
cerebellar tremor
parkinsonian tremor
parkinsonian tremor
the characteristic feature of _ tremor is that it is brought out a the end of movement.

essential tremor
cerebellar tremor
parkinsonian tremor
cerebellar tremor
a headache that progresses over weeks to months, has a tender scalp, with an ESR >100 and is typically found in pt's >50. what is it?

temporal arteritis
migraine
subarachnoid hemorrhage
meningitis
temporal arteritis
the _ test is used to dx neurocardiogenic syncope. Dark, quiet room. isoprenaline is given. this test is useful if symptoms are atypical, or injury occurs.

tilt table testing (TTT)
ventricular stimulation study
tilt table testing-problems with it are high false positive, false negative rates and has poor reproducibility
what is the name of the test used if you believe there is a cardiac cause to a patient's syncope?

TTT-tilt table testing
VSTIM-ventricular stimulation study
VSTIM
Q-wave MI means what?
full thickness MI.
a pt presents with c.p., their ekg shows ST elevation in II, III, and aVF, what type of MI is this?

anterior
inferior
septal
posterior
inferior and the RCA is usually occluded
a pt with presents with c.p. and there is ST elevation in leads V2-V5, what type of MI is it and what artery is occluded?

anterior
inferior
septal
lateral
posterior
anterior
AOTF are causes of aortic stenosis except?

bicuspid aortic valve
endocarditis
rheumatic aortic stenosis
calcification in tricuspid valve
endocarditis causes aortic regurg
effort dyspnea, effort angina, effort dizziness/syncope are a result of ??

aortic regurg
aortic stenosis
aortic stenosis-this is the classic triad