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116 Cards in this Set
- Front
- Back
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what is the MC type of pituitary tumor?
microadenoma macroadenoma |
macroadenoma-nonfunctioning
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this is the passage of large volumes of inappropriately dilute urine in the presence of concentrated plasma.
DI SIADH MEN 1 |
DI
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T/F
macradenoma is >1cm-can produce mass effects and hypopituitarism. Usually non-fcning, but can cause excessive hormonal secretion. |
true
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Primary polydipsia, is usually _ in origin.
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psychogenic
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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.
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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.
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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.
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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
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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
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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
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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 |
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what is the treatment of ttp?
infuse ffp rbc transfusion plasmaphoresis |
plasmaphoresis is the mainstay of treatment.
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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?
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HUS-looks alot like TTP but TTP is the one with neurological symptoms, HUS has no neuro symptoms.
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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
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_ 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.
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_ is the MC inherited bleeding disorder.
von willebrand's disease G6PD deficiency hemophilia A hemophilia B |
von willebrand's disease
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_ is caused by a deficiency of factor IX.
von willebrands disease hemophilia A hemophilia B DIC |
hemophilia B
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_ describes pathological activation of coagulation resulting in widespread microvascular thrombosis.
vit k deficiency DIC von willebrand's disease hemophilia A |
DIC
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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
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what is the tx of DIC?
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manage the underlying disease
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all of the following except ? can trigger DIC?
septicemia obstetrical emergencies malignancy A & C all of the above |
all of the above
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vit k is required as a coenzyme for the carboxylation of which coagulation factors ? (4)
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II, VII, IX, X
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_ is a vitamin K antagonist inhibiting the carboxylation of clotting factors II, VII, IX, X.
aspirin heparin coumadin plavix |
coumadin
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_ is a powerful naturally occurring anticoagulant, which potentiates the action of anti-thrombin, with an immediate onset of action.
aspirin heparin coumadin plavix |
heparin
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_ 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
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_ 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
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if you have a pt with Bence-Jones proteins in the urine what do you have?
PCV myeloma CML thalassemia |
myeloma
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if you have a pt with Bence-Jones proteins in the urine what do you have?
PCV myeloma CML thalassemia |
myeloma
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_ 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
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_ 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
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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
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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
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you will find Philadelphia Chromosomes in which of the following?
ALL AML CML CLL |
CML-come my love to philadelphia
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you will find Philadelphia Chromosomes in which of the following?
ALL AML CML CLL |
CML-come my love to philadelphia
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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 |
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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
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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.
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t/f
blood pressure in the long term should be low, but should not be decreased acutely because this may provoke watershed infarcts. |
true
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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
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A subdural hemorrhage is a _ bleed.
venous arterial |
venous
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a subarachnoid bleed is an _ bleed.
venous arterial |
arterial
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venous sinus thrombosis is MC found in what patient demographic?
female male young or old |
young females
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All pt's presenting with dementia complaints should be evaluated for _.
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psudo-dementia, should check for depression and hypothyroidism
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_ is the global impairment of cognition with normal levels of consciousness.
confusion delerium dementia |
dementia
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_ 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
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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
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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
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SAH is an arterial bleed from a _.
clot from right ventricle ruptured berry aneurysm venous rupture |
ruptured berry aneurysm-arterial bleed
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subdural hemorrhage is a venous bleed, often occurring in the context of brain _. from age, dementia, chronic alcoholism.
enlargement shrinkage thrombosis |
shrinkage
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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
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optic neuritis is seen in pt's with _.
myasthenia gravis multiple sclerosis cerebral vasculitis SLe |
multiple sclerosis
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_ 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
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_ are used for acute attacks of gout.
nsaids aspirin allopurinal colchicine |
nsaids
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t/f
measurement of serum uric acid is diagnostic for gout attacks |
false; it is helpful but not diagnostic. diagnosis is by joint aspiration
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_ osteoporosis occurs in people with endocrine diseases such as: thyrotoxicosis, cushing's disease, hypogonadism, hyperparathyroidism.
primary secondary tertiary |
secondary
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foot puncture wounds can cause calcaneal osteomyelitis, which is d/t _ in 90% of cases.
strep staph ecoli pseudomonas |
pseumdomonas
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_ is infection of the bone arising either from direct innoculation with infecting organisms or from hematogenous spread.
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osteomyelitis
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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
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extensor tenosynovitis, prominent ulnar styloid and wrist tenderness are early symptoms of _.
osteoarthritis rheumatoid arthritis MS |
rheumatoid arthritis
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ulnar deviation and swan neck deformity are late signs of _.
osteoarthritis rheumatoid arthritis MS |
rheumatoid arthritis
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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
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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?
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RA
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_ 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
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All of the following except _ can occur in pt's with RA.
episcleritis scleritis keratoconjunctivitis conjunctivitis |
not conjunctivitis
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t/f
biological agents can cause reactivation of TB |
true
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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
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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
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Giant cell arteritis is aka ?
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temporal arteritis
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what is the tx of temporal arteritis?
high dose steroids low dose steroids IVIG antibiotics |
high dose steroids (40mg/day)
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which of the following labs are found to be high in temporal arteritis?
esr crp wbc hgb |
CRP
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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
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_ 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
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arthritis as a significant clinical feature of systemic infection, such as all of the following except?
parvovirus B19 Lyme disease rubella CHF |
not CHF
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Disseminated _ infection may feature urogenital symptoms and a pustular rash.
chlamydia gonococcal parvovirus B19 pseudomonas |
gonococcal
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_ is the most frequent joint pathogen in adults.
staph aureaus strep pneumo pseudomonas klebsiella |
staph
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_ is a common organism found in septic arthritis of IV drug users.
staph a. strep p. klebsiella pseudomonas |
pseudomonas
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What but is MC isolated in septic arthritis of patients < 2 y.o. ?
staph strep h. flu pseudomonas |
h. flu
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over zealous correction of hyponatremia can cause a syndrome of encephalopathy, cranial nerve palsies, and quadriplegia known as ???
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central pontine myelinolysis
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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.
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_ 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
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AOTF are included in the calculation of plasma osmolality except ??
Na K urea creatinine glucose |
not creatinine
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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
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which of the following drugs can cause SIADH?
aspirin vasopressin carbamazepine cyclophosphamide A & C all of the above B & D |
all of the above
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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.
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_ 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
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_ is inflammation of the heart muscle.
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myocarditis
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AOTF are common complaints with infective endocarditis except?
fever wt. loss anemia fatigue murmur |
not murmur
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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
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What are the first line treatments of SVT? (2)
beta blockers adenosine vagal manuvers radiofrequency ablation |
vagal manuvers
adenosine |
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a prolonger P-R interval is a _ degree heart block. What is the treatment.
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1st degree, and the treatment is observation only
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an ekg shows a progressively elongating P-R interval that eventually drops every 5th QRS. what is it and what is the treatment?
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2nd degree block, type I. May be benign but often the pt. requires a pacemaker.
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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?
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3rd degree or CHB, requires immediate pacemaker.
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AOTF except ? are common causes of LGI bleeding.
ischemia colitis angiodysplasia diverticular disease hemorrhoids |
not colitis
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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
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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
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t/f
bilirubin from destruction of red cells circulates bound to albumin |
true
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t/f
bilirubin is excreted into stool |
false; bile
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AOTF are causes of biliary obstruction except ??
gallstone disease intrahepatic ducts, viral/drugs pancreatic head neoplasm gastric cancer |
not gastric cancer
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t/f
urobilinogen is excreted in urine |
true
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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 |
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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) |
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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
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fluid depletion can be accompanied by elevations in all except?
albuminuria creatinine hct BUN (disproportionately) hgb |
not hgb
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in a pt with recurrent uti's you should consider AOTF except?
calculi TB abn. urinary tract prostatitis pyelonephritis |
not pyelo
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AOTF are components of glomerulonephritis except ?
dysmorphic red cells wbc's red cell casts abn. renal function heavy proteinuria |
not wbc's
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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
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an asymmetrical tremor that is worse at rest, decreased or abolished with movement is ?
essential tremor cerebellar tremor parkinsonian tremor |
parkinsonian tremor
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the characteristic feature of _ tremor is that it is brought out a the end of movement.
essential tremor cerebellar tremor parkinsonian tremor |
cerebellar tremor
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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
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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
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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
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Q-wave MI means what?
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full thickness MI.
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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
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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
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AOTF are causes of aortic stenosis except?
bicuspid aortic valve endocarditis rheumatic aortic stenosis calcification in tricuspid valve |
endocarditis causes aortic regurg
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effort dyspnea, effort angina, effort dizziness/syncope are a result of ??
aortic regurg aortic stenosis |
aortic stenosis-this is the classic triad
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