Medicine

Front 1

stable vs unstable angina -- oxygen demand and supply

Back 1

stable is due to increased oxygen demand. unstable is due to constant limited supply

Front 2

2 prognostic indicators of cad

Back 2

LV function, # of vessels involved

Front 3

metabolic syndrome x vs syndrome x

Back 3

metabolic syndrome = insulin resistance. syndrome x = exertional angina w/ normal angiogram

Front 4

mechanism of chemical stress test

Back 4

adenosine and dipyramidole cause vasodilation, due to steal, that causes decreased flow and st changes. dobutamine increases hr, bp, contractility, :. increase work

Front 5

bb and cad

Back 5

reduces freq of coronary events

Front 6

revascularization after cad and incidence of mi

Back 6

revasc doesn't affect MI incidence

Front 7

how to dx b/w unstable angina and nstemi

Back 7

cardiac enzymes elevated in nstemi

Front 8

how to manage pt with unstable angina

Back 8

need meds - aspirin, heparin, bb, nitrate. no difference b/w invasive or conservative mgmt. can perform stress test to assess

Front 9

what vitamin can be used to help tx cad

Back 9

folic acid

Front 10

mortality of MI

Back 10

30%, 1/2 of these prehospital

Front 11

pathophys of most mi

Back 11

plaque rupture forms thrombus

Front 12

results of care trial

Back 12

tx of pts w hx of mi result in decreased poor outcomes when tx w statin

Front 13

percutaneous transluminal coronary angioplasty vs thrombolysis

Back 13

ptca has more reduction in mortality

Front 14

CI to cardiac thrombolysis

Back 14

high htn, recent trauma, active pud, prev stroke, recent surgery, dissecting aortic aneurysm

Front 15

renal fail and cardiac enzymes

Back 15

elevated troponin in renal fail

Front 16

medical tx for mi

Back 16

mona, bb, acei, statin, heparin

Front 17

av block after mi

Back 17

caused by ischemic conduction tissue. if 2nd degree type ii or 3rd degree, then need emergent temporary pacemaker

Front 18

when do these occur after mi: free wall rupture, IV septum rupture

Back 18

<2w, <10d

Front 19

tx for pericarditis

Back 19

aspirin, but not another nsaid

Front 20

causes of systolic dysfunction

Back 20

post mi (most common), cardiomyopathy, myocarditis

Front 21

what is high output hf

Back 21

tissues have increased demand for CO -- due to increased o2 consumption, poor o2 capacity of blood, "short circuit of bloodstream" (av fistula)

Front 22

causes of diastolic dysfunction

Back 22

htn, valvular dz, restrictive cardiomyopathy

Front 23

nyha classification

Back 23

1 = sx with vigorous. 2 = sx with moderate. 3 = daily activities. 4 = rest

Front 24

initial tx of chf

Back 24

salt restriction <4g/day

Front 25

what imaging test can be used to diagnose EF when echo fails

Back 25

radionuclide ventriculography

Front 26

effect of diuretic on systolic dysfunction

Back 26

symptomatic, no effect on mortality or prognosis

Front 27

results of RALES trial

Back 27

spironolactone reduces morbidity and mortality in pts with class iii/iv hf

Front 28

effect of acei on systolic hf

Back 28

improves mortality and symtoms

Front 29

results of COMET trial

Back 29

carvedilol is better than metoprolol for chf

Front 30

dig tox

Back 30

nv, av block, afib, visual disturbances

Front 31

how to tx chf

Back 31

start w/ salt restriction/activity restriction,acei and diuretic if volume overload, then add bb, then finally my add dig and spirinolactone

Front 32

causes of PACs

Back 32

adrenergic excess, drugs, alcohol, tobacco, electrolyte imbalance, ischemia, infection

Front 33

prevalence of pacs and pvcs

Back 33

will find in 50% of normal people

Front 34

CAST trial results

Back 34

supression of PVCs after MI increases mortality

Front 35

causes of afib

Back 35

heart dz, pericardial issues, pulmonary dz, thyroid issues, systemic dz, stress, alcohol, sick sinus, pheo

Front 36

cardioversion vs defibrillation

Back 36

cardioversion delivers shock sync'd with qrs, terminates dysrhythmia. defib isn't sync'd, use only for vfib or vt w/o pulse

Front 37

tx of afib/aflutter

Back 37

if unstable, electric shock. control vent rate, restore sinus rhythm, possibly anticoagulate

Front 38

tx of choice for rate control for afib

Back 38

ccb, unless lv systolic dysfunction

Front 39

results of affirm trial

Back 39

rate control more important than rhythm control in afib

Front 40

risk of cva if afib

Back 40

if just afib, then 1%/yr. if heart dz, 4%/yr

Front 41

afib and cardioversion. tx options

Back 41

if afib >48h, then risk of embolization during cardioversion (incl spontaneous). therefore, need to anticoagulate. you could either anticoagulate for 3w then cardiovert, or get stat tee to look for thrombus, and if none, then can start heparin and cardiovert after 24h

Front 42

how to tx chronic afib

Back 42

rate control w/ bb or ccb

Front 43

causes of aflutter

Back 43

copd, heart dz, asd

Front 44

dz assoc w/ multifocal atrial tachycardia

Back 44

copd (hypoxia of conduction system)

Front 45

how to tx multifocal atrial tachy

Back 45

improve o2 and ventilation. if good lv function, then bb, flecainide, propafenone. if not, then diltiazem. can use amniodarone, dig for both.

Front 46

most common arrythmia from dig tox

Back 46

paroxysmal atach with 2:1 block

Front 47

difference between orthodromic av reentrant tachy vs av nodal reentrant tachy

Back 47

orthodromic is due to accessory tract b/w atria and ventricles whereas av nodal is in node. may see p waves in orthodromic

Front 48

does wpw always have delta wave

Back 48

not when there is an orthodromic reciprocating tachy (impulse traveling back from ventricles through accessory pathway to atria). other type of wpw is av node dysfunction in the context of afib/flutter (accessory tract permits conduction of impulse to ventricles)

Front 49

what drugs to avoid in wpw

Back 49

drugs that work on av node like digoxin

Front 50

how to prevent psvt

Back 50

dig

Front 51

mcc of vtach

Back 51

prior mi + cad

Front 52

what is sustained vt

Back 52

>30s, symptomatic

Front 53

significance of nonsustained vtach

Back 53

cad + lv dysfunction + nonsustained vt = independent risk factor for death

Front 54

jvp sx of vtach

Back 54

av disassociation causes cannon a waves

Front 55

how to tx vtach

Back 55

don't tx if nonsustained w/o heart dz or lv dysfunction. if stale, use iv amniodarone, procainamide or sotalol. if unstable then cardioversion (sync'd, dc)

Front 56

how to tx refractory vfib (shock and epi fail)

Back 56

amniodarone. could also try lido, bretylium, mag, procainamide

Front 57

wenckebach vs type ii

Back 57

1 = progressive prolonged pr until drop. 2 = sudden dropped beat. 2 needs tx

Front 58

what maneuvers hcom made worse by

Back 58

valsalva, standing = dec preload. hand grip = increased afterload

Front 59

what maneuvers hcom made better by

Back 59

increased preload = squat

Front 60

how to tx symptomatic hcom

Back 60

bb, then try ccb

Front 61

surgical options for hcom

Back 61

myomectomy

Front 62

tx for myocarditis

Back 62

supportive

Front 63

complications of acute pericarditis

Back 63

pericardial effusion, tamponade

Front 64

what maneuver relieves pain w/ pericarditis

Back 64

sitting up and leaing forward

Front 65

ekg changes in pericarditis

Back 65

diffuse st elevation, pr depression at first, then st normalization, then t wave inversion, then t wave normalization

Front 66

constrictive pericarditis vs tamponade

Back 66

tamponade is usually acute. lv filling is halted immediately after reaching point of noncompliance w/ constrictive. for tamponade, occurs throughout diastole

Front 67

ekg changes in constrictive pericarditis

Back 67

small qrs, t wave changes, left atrial abnormalities

Front 68

when does cxr show enlargement after pericardial effusion

Back 68

>250ml fluid

Front 69

what is most important parameter to assess for cardiac tamponade

Back 69

how fast fluid is accumulating

Front 70

causes of tamponade

Back 70

trauma, iatrogenic, pericarditis, post mi w rupture

Front 71

beck's triad

Back 71

hypotension, muffled heart sounds, jvd

Front 72

jvp findings for tamponade

Back 72

jvd + prominent x descent, no y descent

Front 73

ekg changes in tamopnade

Back 73

beat to beat variation in direction of ekg

Front 74

renal failure + tamponade, tx

Back 74

dialysis if stable

Front 75

mitral valve murmurs heard best in what position

Back 75

left lat decubitus

Front 76

s1 in mitral stenosis

Back 76

LOUD s1

Front 77

survival for symptomatic aortic stenosis w/o replacement

Back 77

25% 3-yr survival

Front 78

poor prognosis in aortic stenosis

Back 78

angina, syncope, hf

Front 79

tx for mitral stenosis

Back 79

1. tx afib 2. diuretics for pulmonary congestion & edema 3. prophylax ie 4. if symptomatic, then surgery

Front 80

surgical options for mitral stenosis

Back 80

percutaneous balloon valvuloplasty, open commisurrorotomy, mitral valve replacement

Front 81

behcet's syndrome

Back 81

vasculitis -- uveitis + apthous ulcers + genital ulcers

Front 82

corrigan's pulse

Back 82

water hammer pulse seen in aortic insufficiency

Front 83

muler's sign

Back 83

bobbing of uvula in aortic regurg

Front 84

duroziez sign

Back 84

pistol shot sound over femoral arteries in aortic regurg

Front 85

austin flint murmur

Back 85

aortic regurg causes mitral stenosis

Front 86

tx for aortic regurg

Back 86

if asymptomatic, can try salt restrict, diuretics, afterload reduction.

Front 87

cxr changes for aortic regurg

Back 87

lvh, dilated aorta

Front 88

causes of acute mitral regurg

Back 88

endocarditis, papillary rupture (mi, ischemia)

Front 89

radiation of murmur in mitral regurg

Back 89

back if posterior leaflet, or clavicular if anterior

Front 90

cxr in mitral regurg

Back 90

dilated lv

Front 91

tx for for mitral regurg

Back 91

1. tx afib 2. reduce afterload, salt, diuretics

Front 92

causes of tricuspid regurg

Back 92

1. any cause of rv dilation -- lv failure, rv infarction, inferior wall mi 2. tricuspid endocarditis 3. epstein 4. carcinoid

Front 93

pulsatile liver is sx of what valvular dz

Back 93

tricuspid insufficiency

Front 94

role of echo in aortic regurg

Back 94

perform serially in stable pt to assess need for surgery

Front 95

what maneuver increases and decreases mvp

Back 95

standing, valsalva -> less preload -> click occurs earlier cuz less filling.
handgrip -> afterload -> increases murmur

Front 96

major criteria for acute rheumatic fever

Back 96

JONES - joints (migratory polyarthritis), pancarditis (O), subcutaneous Nodules, erythema marginatum, syndenham

Front 97

tx for rheumatic fever

Back 97

nsaids, monitor response w/ crp. prophylaxis before procedures

Front 98

major duke's criteria

Back 98

sustained bacteremia from known endocarditis organism, endocardial involvement

Front 99

criteria for endocarditis

Back 99

2 major, 1 major+3minor, 5 minor

Front 100

minor criteria dukes

Back 100

VIP FEC - vascular abnormalities (like janeway), immune, predisposing condition (like abnormal valve), fever, echo, cultures

Front 101

test of choice for asd

Back 101

tee

Front 102

what kind of murmur seen in asd

Back 102

systolic ejection murmur at pulmonary area (increased pulmonary flow) + fixed split s2 + diastolic rumble across tricuspid

Front 103

when to tx asd

Back 103

when pulmonary:systemic flow > 1.5:1

Front 104

what kind of murmur in vsd

Back 104

harsh holosystolic murmur w/ thrill @ 4th ics

Front 105

what maneuvers can decrease vsd murmur

Back 105

valsalva and handgrip (less flow)

Front 106

what congenital defect is most likely to cause differential cyanosis

Back 106

pda

Front 107

tx pda

Back 107

if no pulmonary vascular dz, do ligation. if pulmonary htn or r-l shunt, then don't correct

Front 108

what is htn emergency

Back 108

sbp >220 / dbp . 120 + end organ dmg

Front 109

what to do for severe ha + high bp

Back 109

lower bp, then ct to r/o bleed, if neg then do lp

Front 110

how to lower bp in hypertensive emergency

Back 110

reduce map by 25% in 1-2h

Front 111

clinical features type a vs type b dissection

Back 111

typa a is anterior cp, type b is interscapular pain

Front 112

tx for dissection

Back 112

iv bb, iv nitroprusside

Front 113

most common site of AAA

Back 113

b/w renal a and iliac bifurcation

Front 114

grey turner's sign

Back 114

ecchymoses on back and flanks, sx of aaa, pancreatitis

Front 115

cullen's sx

Back 115

ecchymoses around umbilicus, sx of aaa, pancreatitis

Front 116

aaa triad rupture

Back 116

abdominal pain + hypotension + palpable pulsatile abdominal mass

Front 117

test of choice for aaaa

Back 117

ultrasound

Front 118

what is leriche's syndrome

Back 118

atheromatous occlusion of distal aorta above bifurcation --> bilateral claudication + impotence + absent femoral pulses

Front 119

what sites usually occluded in pvd

Back 119

superficial femoral artery, politeal artery, aortoiliac

Front 120

rest pain vs intermittent claudication in pvd

Back 120

rest pain is worse cuz sx ischemia may lead to gangrene.

Front 121

what is rest pain in pvd

Back 121

pain usually over distal mt relieved with hanging foot over side of bed (gravity-related perfusion)

Front 122

normal abi vs claudication abi vs rest pain abi

Back 122

>1 vs <.7 vs <.4

Front 123

what is leriche's syndrome

Back 123

atheromatous occlusion of distal aorta above bifurcation --> bilateral claudication + impotence + absent femoral pulses

Front 124

what sites usually occluded in pvd

Back 124

superficial femoral artery, politeal artery, aortoiliac

Front 125

rest pain vs intermittent claudication in pvd

Back 125

rest pain is worse cuz sx ischemia may lead to gangrene.

Front 126

what is rest pain in pvd

Back 126

pain usually over distal mt relieved with hanging foot over side of bed (gravity-related perfusion)

Front 127

normal abi vs claudication abi vs rest pain abi

Back 127

>1 vs <.7 vs <.4

Front 128

what is abi

Back 128

ankle-brachial index, ratio of sbps

Front 129

3 methods of dx'ing pvd

Back 129

1. abi 2. pulse volume recodrings 3. arteriography (only needed for surgery)

Front 130

conservative mgmt of pvd

Back 130

1. prevent progression - stop smoking, foot care, control astherosclerosis risk factors, aspirin 2. restore arteries - exercise 3. symptomatic control

Front 131

2 options for surgical tx of pvd

Back 131

1. surgical bypass grafting 2. angioplasty

Front 132

3 sources of emboli

Back 132

heart (afib, postmi, endocarditis), aneurysms, atheromatous plaque rupture

Front 133

6 p's of acute arterial occlusion

Back 133

pain, pallor, polar (cold), paralysis, paresthesias, pulselessness

Front 134

how long ischemia can skeletal mm tolerate before death

Back 134

6h

Front 135

what are sx that amputation might be necessary for ischemic injury to limb

Back 135

paralysis or paresthesias

Front 136

what is cholesterol embolization syndrome and how to tx

Back 136

shower of cholesterol crystals originating from plaque, often triggered by surgical or radiographic intervention. DO NOT ANTICOAGULATE, control bp

Front 137

doppler ultrasound for dvt vs location

Back 137

better at detecting proximal thrombi over distal

Front 138

most accurate test for dvt

Back 138

venography

Front 139

advantage of impedance plethysmography over doppler for dvt

Back 139

less operator dependent accuracy

Front 140

what is plegmasia cerulea dolens

Back 140

major dvt -- leg edema compromises arterial supply

Front 141

anticoagulation vs thrombolysis for dvt

Back 141

anticoagulation prevents propagation, thrombolysis speeds up clot breakdown

Front 142

goals of anticoagulation in dvt

Back 142

heparin bolus that causes 1.5-2x aPTT, start warfarin once aPTT is therapeutic

Front 143

when do you do thrombolysis for dvt

Back 143

1. unstable 2. massive PE 3. RHF 4. no CI for thrombolytics

Front 144

indications for ivc filter

Back 144

absolute ci to other prophylaxis

Front 145

how to prevent dvt after surgery

Back 145

1. mechanical (leg elevation, ambulation, compression stockings) 2. drugs (lmwh until ambulatory)

Front 146

3 compnents of LE venous system

Back 146

deep, superficial, perforating

Front 147

what causes discoloration of skin in chronic venous insufficiency

Back 147

extravasation of rbcs into subcutaneous tissues

Front 148

why do venous ulcers develop in chronic venous insufficiency

Back 148

reduced capillary flow -> hypoxia and decreased healing

Front 149

leg elevation producing relief vs aggravation of symptoms

Back 149

relief = venous insufficiency. aggravation = arterial insufficiency

Front 150

tx for venous insufficiency

Back 150

leg elevation, avoid long periods of sitting or standing, elastic stockings

Front 151

how to tx venous ulcers

Back 151

dressings, venous boot

Front 152

tx for superficial thrombophlebitis

Back 152

aspirin if mild. if severe (i.e. has cellulitis), do bed rest, elevation, and compresses, usually don't need antibiotics unless suppurative

Front 153

definition of cardiogenic shock

Back 153

sbp <90, urine output <20ml/hr + good lv filling pressure

Front 154

what is an intraaortic balloon pump

Back 154

put in descending aorta, deflates right before systole (decreases afterload), inflates right before diastole --> improved mvo2, better o2. good for cardiogenic shock

Front 155

causes of hypovolemic shock

Back 155

hemorrage, vomiting/diarrhea, dehydration, burns, third spacing

Front 156

best way to monitor response tx to shock

Back 156

monitor i/o's

Front 157

classes of shock

Back 157

I = 10-15% blood loss, slightly dec blood loss. ii = 20-30% loss, tachycardia, tachypnea, decreased cr, anxious. iii & iv = confusion/lethargy, <20mL/hr urine output.

Front 158

how to tx hypovolemic shock based on class

Back 158

ii benefits from fluid, iii/iv need fluids

Front 159

what is SIRS

Back 159

2+: temperature instability, rr>20|paco2<32, tachycardia, increased wbcs

Front 160

significance of SIRS

Back 160

prodrome of sepsis

Front 161

tx of neurogenic shock

Back 161

main thing is fluids, cautious use of vasoconstrictors, maintain temp

Front 162

what is an atrial myxoma an overgrowth of

Back 162

interatrial septum

Front 163

what kind of murmur w atrial myxoma

Back 163

diastolic murmr that changes with position

Front 164

centrilobular vs panlobular emphysema

Back 164

centrilobular = smokers, proximal acini, upper. panlobular = antitrypsin, both prox & distal, bases.

Front 165

dx of chronic bronchitis

Back 165

chronic cough for >3mo for at least 2y

Front 166

auscultation of copd findings

Back 166

end expiratory wheezes on forced expiration, decreased breath sounds, inspiratory crackles

Front 167

fev1 and age

Back 167

starts decreasing 25ml/yr after 35

Front 168

copd and ics

Back 168

no benefit, reserve for refractory

Front 169

when to start o2 in copd

Back 169

pao2<55 or o2 sat<88 at rest or exercise, pao2 55-59 +polycythemia/cor pulmonale

Front 170

sleep and copd

Back 170

hypoxia in sleep might need to be tx'd w cpap

Front 171

effect of o2 tx on copd

Back 171

mortality and quality of life

Front 172

3 characteristics of asthma

Back 172

airway inflammation + airway hyperresponsiveness + reversible airflow obstruction

Front 173

extrinsic vs intrinsic asthma

Back 173

intrinsic = not related to atopy or environmental triggers

Front 174

what is considered a bronchodilator response on pft for asthma

Back 174

12% improvement on fev1 or fvc

Front 175

what is methacholine challenge

Back 175

will bronchoconstriction, hyperresponsive airways will develop obstruction earlier

Front 176

when to get abg on asthma

Back 176

significant respiratory distress, increased paco2 is suspicious for respiratory failure

Front 177

how to decrease risk of oral infection w/ ics

Back 177

spacer, rinsing mouth after use

Front 178

mild persistent vs moderate persistent vs severe persistent asthma

Back 178

>2/wk | 3-4 PMs/mo, daily | >1night/wk, continuous

Front 179

how to dx bronchiectasis

Back 179

high res ct

Front 180

how to tx bronchiectasis

Back 180

1. ab for acute exacerbation 2. bronchial hygeine - hydration, mucus removal, bronchodilators

Front 181

what is a solitary pulmonary nodule

Back 181

single well circumscribed nodule on cxr w/o mediastinal or hilar involvement

Front 182

how to monitor solitary pulmonary lesion

Back 182

if suspect malignancy, do needle aspiration biopsy or fiberoptic bronchoscopy. otherwise regular image q3-4mo, then q6mo

Front 183

how to stage small cell lung carcinoma

Back 183

limited = confinted to chest + supraclavicular nodes

Front 184

where is scc usually located

Back 184

usually central

Front 185

what size of lung nodule is more suggestive of malignancy

Back 185

>3cm

Front 186

most common met sites of lung cancer

Back 186

brain, bone, adrenal glands, liver

Front 187

siadh and lung cancer

Back 187

usually small cell

Front 188

ectopic acth and lung cancer

Back 188

usuall small cell

Front 189

lung cancer and hypertrophic pulmonary osteoarthropathy

Back 189

adenocarcenoma and squamous

Front 190

eaton lambert and lung cancer

Back 190

small cell

Front 191

pleural effusion in lung cancer

Back 191

tap it to look for malignant cells

Front 192

tx for non small cell lung cancer

Back 192

surgery + radiation

Front 193

tx for small cell

Back 193

chemo

Front 194

sx of mediastinal mass

Back 194

compression -> cough, chest pain, dyspnea, postobstructive pneumonia

Front 195

how to evaluate solitary pulmonary nodule if new

Back 195

do ct with thin sections through nodule

Front 196

what type of pleural effusion does malignancy cause

Back 196

exudative

Front 197

what type of pleural effusion does PE cause

Back 197

can cause either transudative or exudative

Front 198

how to diff exudative vs transudative pleural effusion

Back 198

exudative: protein ratio >0.5, ldh ratio >0.6, ldh > 2/3 * upper limit of normal serum ldh

Front 199

how much effusion generated before seen on cxr

Back 199

250ml

Front 200

elevated pleural fluid amylase is sx of

Back 200

esophageal rupture, pancreatitis, malignancy

Front 201

frank purulent fluid in plureal effusion

Back 201

empyema

Front 202

what is pleural fluid that is pH <7.2

Back 202

parapneumonic effusion or empyema

Front 203

what is parapneumonic effusion

Back 203

plerual fluid effusion as a result of pneumonia, bronchiectasis, abscess

Front 204

ci for thoracentesis

Back 204

if effusion is <10mm thick on lateral decubitus cxr. risk of ptx outweights benefit of thoracentesis

Front 205

4's c's of fluid diagnostics (lp, pleural fluid, etc)

Back 205

chemistry (glucose, protein, ldh, protein, pH0
cytology
cell count
culture

Front 206

how to tx pleural effusion

Back 206

if transudative --- diuretics and sodium restriction. if exudative, tx dz.

Front 207

how to tx parapneumonic effusion if complicated or empyema

Back 207

chest tube, intrapleural thrombolysis (UNLESS MVA), possible surgical lysis of adhesion

Front 208

3 locations of MEN1

Back 208

pituitary, parathyroid, pancreas

Front 209

what is secondary spontaneous pneumothorax

Back 209

spontaneous pneumothorax that is due to complication to underlying disease. this is worse than primary cuz ppl usually don't have reserve pulmonary capacity

Front 210

3 locations of MEN2A

Back 210

parathyroid, pheochromocytoma, medullary thyroid

Front 211

causes of tension pneumothorax

Back 211

ventilation, cpr, trauma

Front 212

blood pressure & ptx

Back 212

decreased cuz of venous compression

Front 213

are all mesotheliomas malignant

Back 213

no, and benign ones have excellent prognosis

Front 214

4 granulomatous interstitial lung dz

Back 214

sarcoid, histiocytosis, wegeners, churg strauss

Front 215

3 locations of MEN2B

Back 215

pheochromocytoma, medullary thyroid, mucosal neuroma

Front 216

best dz for interstitial lung dz

Back 216

tissue biopsy

Front 217

skin finding in sarcoid

Back 217

erythema nodosum

Front 218

sarcoid: cxr, blood findings

Back 218

bil hilar adenopathy, elevated ace, hypercalcemia, hypercalciuria

Front 219

how to tx sarcoid

Back 219

most resolve w/in 2 yrs, but can use cs, mtx if refractory

Front 220

what type of ppl are histiocytosis x w/ interstitial lung dz

Back 220

smokers

Front 221

canca vs p anca

Back 221

canca = wegener, panca = churg strauss

Front 222

where is silicosis located

Back 222

upper lobes, localized and nodular

Front 223

where is asbestosis located

Back 223

lower lobes, diffuse

Front 224

pleural plaques on cxr

Back 224

asbestosis

Front 225

"egg shell" calcification on cxr

Back 225

silicosis

Front 226

blood test in hypersensitivity pneumonitis

Back 226

iga and igg to inhaled antigen

Front 227

what dz assoc w churg strauss

Back 227

asthma

Front 228

what 2 interstitial lung dz have eosinophils

Back 228

churg strauss, eosinophilic pneumonia

Front 229

what is pulmonary alveolar proteinosis

Back 229

accumulation of surfactant like proteins and phospholipids in alveoli

Front 230

cxr of pulmonary alveolar proteinosis

Back 230

ground glass w/ bilateral alveolar infiltrates

Front 231

how to tx plumonary alveolar proteinosis

Back 231

gcsf, lung lavage, NO STEROIDS

Front 232

how to tx goodpastures

Back 232

plasmapharesis, cyclophosphamide, cs

Front 233

what is cryptogenic organizing pneumoniitis, tx

Back 233

inflammatory lung dz that looks like pneumonia, spontaneous but try cs

Front 234

how to tx radiation pneumonitis

Back 234

cs

Front 235

when does radiation pneumonitis occur after radiation

Back 235

acute is 1-6mo, chronic is 1-2y

Front 236

how to dx radiation pneumonitis

Back 236

ct scan

Front 237

how to dx pulmonary alveolar proteinosis

Back 237

lung biosy

Front 238

what defines acute respiratory failure

Back 238

pao2 <60 or paco2>50

Front 239

paco2 and a-a gradient in v/q mismatch or shunting

Back 239

both are elevated, shunting has poor response to supplement o2

Front 240

hypoxemic respiratory failure vs hypercarbic

Back 240

hypoxemic -- low o2. hypercarbic -- high co2, due to decrease in ventilation rate or increased dead space

Front 241

co2 in v/q mismatch

Back 241

low to normal

Front 242

what is intrapulmonary shunting

Back 242

no ventilation to perfused areas -- atelectasis, fluid buildup in alveoli, right to left intracardiac shunt

Front 243

ventilation vs oxygenation

Back 243

oxygenation = o2 sat and pao2

Front 244

ventilation vs oxygenation

Back 244

ventilation is paco2. oxygenation is pao2 and o2 sat

Front 245

how to improvement tissue o2

Back 245

1. increase fio2 2. increase peep 3. extend inspiratory time 4. upright 5. increase CO or increase hemoglobin 6. decrease o2 requirements by decreasing work of breathing, fever, agitation 7. remove pulmonary vasodilators

Front 246

diffusion impairment and co2 levels

Back 246

normal

Front 247

advantage of venturi mask

Back 247

useful for co2 retainer, can deliver precise fio2

Front 248

how to tx hypoxemic respiratory failure

Back 248

use lowest concentration of o2 cuz of pottential free radical injury

Front 249

can you give nppv to unconcious pt

Back 249

no

Front 250

triad of ards

Back 250

hypoxemia refractory to o2 (pao2/fio2 <200) + bilateral diffuse pulmonary infiltrates + pcwp <18

Front 251

tx for ards

Back 251

oxygenation, peep, fluid management, tx underlying cause

Front 252

how can you assess resopnse to mechanical ventilation

Back 252

abg to get pao2 to 50-60, paco2 to 40-50, ph to 7.35-7.5

Front 253

mechanism of assisted controlled ventilation

Back 253

tidal volume delivered on inspiration, if no inspiration, tidal volume delivered at predetermined rate

Front 254

mechanism of synchronous intermittent mandatory ventilation

Back 254

like assisted controlled except if breathe on their own above mandatory rate, ventilator doesn't assist

Front 255

how to tell if et tube placed correctly on cxr

Back 255

et tip 3-5 cm above carina

Front 256

what is pressure support ventilation

Back 256

used when weaning... pressure delivered on inspiration

Front 257

how to determine success of extubation

Back 257

1. good respiratory drive and cough 2. pao2 >75, paco2 <45, o2sat >90 w/ peep < 5 & fio2 <40% 3. tidal volume >5ml/kg 4. rr<30 5. vital capacity > 10ml/kg

Front 258

what is the normal inspiratory to expiratory ratio

Back 258

1:2

Front 259

what is good initial tidal volume

Back 259

8-10ml/kg

Front 260

what is good initial peep

Back 260

2.5-10 cm h2o

Front 261

what is tracheomalacia a complication of

Back 261

softening of tracheal cartilage due to prolonged et tube

Front 262

what is pulm htn

Back 262

>25 mmhg at rest, >30 during exercise

Front 263

signs of pulmonary htn on pe

Back 263

rv heave and loud p2

Front 264

tx for 1* pulmonary htn

Back 264

pulmonary vasodilators (prostacyclins like epoprostenol, ccb0

Front 265

what is pulm htn

Back 265

>25 mmhg at rest, >30 during exercise

Front 266

what is cor pulmonale usually due to

Back 266

copd

Front 267

signs of pulmonary htn on pe

Back 267

rv heave and loud p2

Front 268

what study provides guidelines for v/q results? spiral ct?

Back 268

pioped study. christopher study

Front 269

tx for 1* pulmonary htn

Back 269

pulmonary vasodilators (prostacyclins like epoprostenol, ccb0

Front 270

what is cor pulmonale usually due to

Back 270

copd

Front 271

what study provides guidelines for v/q results? spiral ct?

Back 271

pioped study. christopher study

Front 272

what to do if low or intermediate probability v/q scan

Back 272

if high clinical suspicion, do lower extremity duplex ultrasound. if that is negative, then do pulmonary angiography

Front 273

what are the wells criteria

Back 273

sx/signs of dvt (3), alternative dx less likely than pe (3.0), tachycardia (1.5), hx of immobilization or surgery (1.5), previous dvt/pe (1.5), hemoptysis (1.0), malignancy (1.0). if >4.0, do spiral ct rather than d dimer

Front 274

treatment goals for pe

Back 274

o2, start heparin immediately getting aptt to 1.5-2.5x, then start heparin on day 1, continue for 3 months at least, longer if risk factors

Front 275

when to consider thrombolysis for pe

Back 275

massive pe w/ hemoinstability, rhf

Front 276

when to consider ivc filter

Back 276

ci to anticoagulation, low pulmonary reserve

Front 277

abs for aspiration pneumonia

Back 277

pen g or clinda

Front 278

5 top causes of hemoptysis

Back 278

bronchitis, lung cancer, TB, bronchiectasis, pneumonia

Front 279

DLco in asthma pt

Back 279

increased, cuz increased pulmonary capillary blood volume

Front 280

what can cause a high DLco

Back 280

obesity, asthma, intracardiac left-to-right shunt, exercise, pulmonary hemorrhage

Front 281

what can cause a low DLco

Back 281

emphysema, carcoid, interstitial fibrosis, pulmonary vascular dz, anemia

Front 282

what studies to order for hemoptysis

Back 282

cxr, fiberoptic bronchoscopy, chest ct

Front 283

ppv of fobt

Back 283

20%

Front 284

advantage and disadvantage of barium enema

Back 284

can see entire colon, but still need colonosocpy for abnormal findings

Front 285

dukes staging vs tnm

Back 285

d = metastasis. c = nodal involvement. b- t3-4. a = t1-2

Front 286

most common presenting sx of crc

Back 286

abdominal pain

Front 287

melena vs hematochezia, anatomy

Back 287

melena = rt sided, hematochezia = lt sided

Front 288

when is adjuvant therapy used for crc

Back 288

for duke's c colon cancer -- postop chemo, NO RADS
for duke's b2/c rectal cancer -- postop chemo + RADS

Front 289

what marker can be used to monitor response to crc remission

Back 289

cea

Front 290

prognosis - rectal vs colon cancer

Back 290

rectal is worse and more recurrence

Front 291

what % of crc recurrence occurs w/in 3 yrs of surgery

Back 291

90

Front 292

where are most polyps found

Back 292

rectosigmoidal

Front 293

malignancy: sessile vs pedunculated

Back 293

sessile is more likely

Front 294

dx test of choice for diverticulosis

Back 294

barium enema

Front 295

tx for diverticulosis

Back 295

need to stop constipation -- so high fiber foods or psyllium

Front 296

complications of diverticulosis vs diverticulitis

Back 296

painless rectal bleeding & diverticulitis. bowel obstruction, abscess, fistula.

Front 297

how to dx diverticulitis

Back 297

ct scan of abdomen and pelvis w/ contrast (both oral and IV). DO NOT DO BARIUM ENEMA CUZ OF PERF

Front 298

who is angiodysplasia symptomatic in, tx

Back 298

common cause of bleeding >60yo, bleeding stops spontaneously, butr can do coloscopyic coagulation

Front 299

common comorbidity assoc with angiodysplasia of colon

Back 299

aortic stenosis

Front 300

4 causes of acute mesenteric ischemia

Back 300

arterial embolism, arterial thrombosis, nonocclusive mesenteric ischemia (low CO), venous thrombosis

Front 301

sx of intestinal infarction

Back 301

hypotension, fever, lactic acidosis, tachypnea, altered mental status

Front 302

how to tx acute mesenteric ischemia

Back 302

iv fluids and antibiotics. if arterial, can insert vasodilator during angiography. if venous, do heparin.

Front 303

who is angiodysplasia symptomatic in, tx

Back 303

common cause of bleeding >60yo, bleeding stops spontaneously, butr can do coloscopyic coagulation

Front 304

common comorbidity assoc with angiodysplasia of colon

Back 304

aortic stenosis

Front 305

4 causes of acute mesenteric ischemia

Back 305

arterial embolism, arterial thrombosis, nonocclusive mesenteric ischemia (low CO), venous thrombosis

Front 306

sx of intestinal infarction

Back 306

hypotension, fever, lactic acidosis, tachypnea, altered mental status

Front 307

how to tx acute mesenteric ischemia

Back 307

iv fluids and antibiotics. if arterial, can insert vasodilator during angiography. if venous, do heparin.

Front 308

what exacerbates pain in chronic mesenteric ichemia

Back 308

postprandial pain (akin to angina)

Front 309

sx & symptoms of large bowel obstruction w/o mechanical obstruction

Back 309

ogilvie's syndrome

Front 310

cause of ogilvie's syndrome

Back 310

recent surgery trauma, medical illnesses, medications (narcotics, anticholinergic)

Front 311

what is risk of distention? what is threshold?

Back 311

rupture and peritonitis. decompress when diameter >10cm

Front 312

what is the min and max time after stopping antibiotics that can cause c diff

Back 312

first week - 6 week

Front 313

complications of c diff

Back 313

toxic megacolon, colonic perforation, anasarca

Front 314

what used to tx c diff if not metro

Back 314

vanc

Front 315

most common site of colonic volvulus

Back 315

sigmoid colon, and then cecal

Front 316

sx of colonic volvulus

Back 316

acute colicky abdominal pain, obstipation, distention, NV

Front 317

cxr sx of volvulus

Back 317

bent inner tube shape for sigmoid, distention of cecum and small bowel (coffee bean) for cecal

Front 318

how to tx colonic volvulus

Back 318

for sigmoid volvulus, do sigmoidoscopy (both dx and tx). for cecal, do emergent surgery

Front 319

what 5 things does child's classification measure? how many levels?

Back 319

ascites, bilirubin, encephalopathy, nutritional status, albumin. a,b,c

Front 320

how to tx esophageal/gastric varices after stabilization

Back 320

endoscopy (emergent). tx options include variceal ligation, sclerotherapy, vasopressin, octreotide

Front 321

causes of ascites

Back 321

chf, portal htn, renal dz, fluid overload (which can be caused by hyperaldosterone, which can be due to decreased deactivation by liver), tb, malignancy, hypoalbumin, sepsis,

Front 322

how to determine cause of ascites

Back 322

paracentesis -- cell count, albumin, gram stain, culture

Front 323

saag in portal HTN

Back 323

>1.1

Front 324

what precips hepatic encephalopathy

Back 324

alkalosis, hypokalemia, sedating agents, gi bleeding, sepsis, hypovolemia

Front 325

tx for hyperammonia

Back 325

lactulose, neomycin (kills bowel flora -- no more intestinal bacteria production of ammonia)

Front 326

why is kidney function important to assess liver dz

Back 326

hepatorenal syndrome

Front 327

what is hepatorenal syndrome

Back 327

renal failure due to hypoperfusion that occurs from vasoconstriction of renal vessels (3rd spacing?) in advanced liver dz

Front 328

complications of liver failure

Back 328

AC9H -- ascites, coagulopathy, hypoalbumin, portal htn, hyperammonia, hepatic encephalopathy, hepatorenal, hypoglycemia, hyperbilirubin, hyperestrinsim, hcc

Front 329

3 mcc of spontaneous bacterial peritonitis

Back 329

ecoli, klebs, pneumococcus

Front 330

how to tx coagulopathy from liver dz

Back 330

ffp (vit K ineffective)

Front 331

where does copper excretion normally occur

Back 331

liver

Front 332

renal manifestations of wilson's dz

Back 332

aminoaciduria, nephrocalcinosis

Front 333

tx options for wilson's

Back 333

chelating agents (penicillamine), zinc (prevents absorption), liver transplant

Front 334

why does fibrosis occur in hemochromatosis

Back 334

free radicals generated by excess iron

Front 335

what organs systems to look for dmg in hemochromatosis

Back 335

liver, pancreas, skin, (bronze diabetes) heart, joints, gonads, thyroid, hypothalamus

Front 336

how to dx hemochromatosis

Back 336

iron studies (elevated iron, ferritin, transferrin sat, decreased tbc), LIVER BIOPSY IS REQUIRED

Front 337

tx for hemochromatosis

Back 337

repeat phlebotomies, tx complications

Front 338

how to dx hepatocellular adenoma

Back 338

ct scan, U/S, hepatic arteriography

Front 339

when do you resect hepatocellular adenoma

Back 339

>5cm

Front 340

mc benign liver tumor

Back 340

cavernous hemangioma

Front 341

how to dx cavernous hemangioma

Back 341

u/s, ct scan w/ iv

Front 342

what is focal nodular hyperplasia

Back 342

benign liver tumor in women of reproductive age, but not assoc with contraceptive

Front 343

2 types of hcc

Back 343

nonfibrolamellar (most common, assoc w/ hep b/c and cirrhosis, usually unresectable), fibrolamellar (not assoc w hbv/hcv/cirrhosis, resectable)

Front 344

prognosis of resectable hcc vs unresectable hcc

Back 344

25% live to 5 yrs vs <1yr

Front 345

what is needed to definitively dx hcc

Back 345

liver biopsy

Front 346

associations with nash

Back 346

obesity, hyperlipid, dm

Front 347

causes of hemobilia

Back 347

trauma, papillary thyroid carcinomy, surgery, tumor, infection

Front 348

how to dx hemobilia

Back 348

arteriogram, upper gi endoscopy

Front 349

cause of pyogenic liver abscess

Back 349

biliary tract obstruction, gi infection, trauma

Front 350

mcc amebic liver abscess

Back 350

e histolytica

Front 351

tx of budd chiari

Back 351

medical therapy usually not good, do balloon angioplasty w/ stent

Front 352

dx of budd chiari

Back 352

hepatic venography, saag>1.1

Front 353

what bili level does jaundice show

Back 353

tb > 2mg/dl

Front 354

why is there dark urine with direct hyperbiliribunemia

Back 354

cuz conjugated bilirubin is water soluble and it will be secreted by kidney

Front 355

what is defect in dubin-johnson/rotor

Back 355

liver can't secrete into bile ducts

Front 356

lfts in dubin johnson/rotor

Back 356

normal

Front 357

which is more sensitive and specific for liver: alt, ast

Back 357

aLt

Front 358

mild elevation (low hundreds) in alt, ast

Back 358

chronic viral hep, acute alcoholic hep

Front 359

moderate elevation (high hundreds to thousands) in ast, alt

Back 359

acute viral hep

Front 360

alt, ast severely elevated (>10000)

Back 360

ischemia/shock, acetaminophen, several viral hep

Front 361

causes of transaminase elevation

Back 361

ABCDEFGHI - autoimmune, hbv, hcv, drugs, ethanol, fatty livery, growths, hemodynamic problems, iron/copper/antitrypsin

Front 362

10-fold increase in alp vs less intense increase

Back 362

10-fold = cholestasis. if just elevated, get a ggt. if ggt is normal consider pregnancy or bone dz

Front 363

boas sign

Back 363

referred right subscapular pain of biliary colic

Front 364

risk of developing acute cholecystitis after biliary colic

Back 364

1/3 develop after 2y

Front 365

complications of cholelithiasis

Back 365

cholecystitis, choledocholithiasis, gallstone ileus, malignancy

Front 366

dx of cholelithiasis

Back 366

ruq us

Front 367

complications of cholecystitis

Back 367

gangrenous cholecystitis, gb perf, emphysematous cholecystytis, cholecystenteric fistula w/ gallstone ileus, empyema of gallbladder

Front 368

bowel sounds in acute chole

Back 368

hypoactive

Front 369

findings in ruq us of acute chole

Back 369

1. thickened gb wall 2. pericholecystic fluid 3. distention 4. presence of stones

Front 370

what is most sensitive test to find complications of acute cholecystitis

Back 370

ct

Front 371

when to do a hida scan

Back 371

when us inconclusive

Front 372

what is + result on hida scan

Back 372

no gb visualized after 4 hours

Front 373

complications of choledocholithaisis

Back 373

cholangitis, obstructive jaundice, acute pancreatitis, billiary cirrhosis

Front 374

who is acalculous chole seen in

Back 374

usually idiopathic, usually severe underlying illness like dehydration, burns, trauma

Front 375

gold standard dx for choledocholithasis

Back 375

ercp

Front 376

primary vs secondary stones in choledocholithiasis

Back 376

primar stones originate in cbd usually pigmented

Front 377

charcot's triad.. what's it for

Back 377

ruq pain + jaundice + fever, cholangitis

Front 378

mcc of cholangitis

Back 378

choledocholithiasis

Front 379

what tests/interventions to run immediately in cholangitis

Back 379

1. cultures 2. iv fluids 3. iv antibiotics 4. decompress cbc after pt stable

Front 380

dx of cholangiitis

Back 380

ruq ultrasound + lbs (cbc, bilirubin, lft). don't do ptc/ercp in acute

Front 381

reynold's pentad

Back 381

charcot triad + sepsis + altered mental status

Front 382

prognosis of carcinoma of gb

Back 382

90% die of advanced dz w/in 1 yr of dx

Front 383

what is porcelain gb

Back 383

calcification of gb wall

Front 384

tx for porcelain gb

Back 384

cholecystectomy cuz it is risk factor for gb carcinoma

Front 385

associations with psc

Back 385

uc

Front 386

tx for psc

Back 386

liver transplant, if there is a identifiable stricture, can do ercp with stent

Front 387

who gets pbc

Back 387

middle aged women

Front 388

is psc intrahepatic or extrahepatic? pbc?

Back 388

both, intrahepatic

Front 389

what antibody is elevated in pbc

Back 389

ama

Front 390

associations with psc

Back 390

uc

Front 391

tx for psc

Back 391

liver transplant, if there is a identifiable stricture, can do ercp with stent

Front 392

who gets pbc

Back 392

middle aged women

Front 393

is psc intrahepatic or extrahepatic? pbc?

Back 393

both, intrahepatic

Front 394

what antibody is elevated in pbc

Back 394

ama

Front 395

associations with psc

Back 395

uc

Front 396

tx for psc

Back 396

liver transplant, if there is a identifiable stricture, can do ercp with stent

Front 397

who gets pbc

Back 397

middle aged women

Front 398

is psc intrahepatic or extrahepatic? pbc?

Back 398

both, intrahepatic

Front 399

what antibody is elevated in pbc

Back 399

ama

Front 400

what ig is elevated in pbc

Back 400

ig M

Front 401

causes of 2* biliary cirrhosis

Back 401

mechanical obstruction, sclerosing cholangitis, cystic fibrosis, biliary atresia

Front 402

bone consequences of pbc

Back 402

osteoporosis

Front 403

how to tx pbc

Back 403

symptomatic (cholestyramine for pruritus, and osteoporosis). ursodeoxycholic acid to slow progression of dz. liver transplant

Front 404

where does cholangiocarcinoma usually occur

Back 404

proximal 1/3 of cbd (klatskin tumor), distal extrapeatic (most favorable), intrahepatic

Front 405

what is choledochal cyst? complication? who does it occur in? dx? tx?

Back 405

cystic dilation of biliary tree, women, leads to cholangiocarcinoma, us & ercp, surgical resection

Front 406

mcc bile duct stricture

Back 406

iatrogenic

Front 407

tx of bile duct stricture

Back 407

endoscopic stenting, surgical bypass

Front 408

what is biliary dyskinesia, how to dx

Back 408

dysfunction of sphincter of oddi. hida -- low ejection fraction

Front 409

cause of acute appendicitis

Back 409

obstruction by lymphoid hyperplasia (usually), fecalith, foreign body, other cause. obstruction leads to stasis and infection and distention. distention can lead to infarction or necrosis.

Front 410

hunger and appendicitis

Back 410

hunger is almost never present

Front 411

psoas sx vs obturator sx

Back 411

pain on rt thigh extension when lying on left vs pain on rt thigh internal rotation

Front 412

causes of acute pancreatitis

Back 412

GET SMASHED -- gallstone, ethanol, trauma, scorpion bite, mumps/malignancy, autoimmune, steroid, hypercalcemia/hyperlipidemia, ercp, drugs

Front 413

3 sx of hemorrhagic pancreatitis

Back 413

grey turner's sx (flank), cullen's sx (periumbilical), fox's sx (inguinal)

Front 414

ranson's admission criteria

Back 414

GA LAW -- glucose > 200, age > 55, LDH > 350, AST > 250, WBC > 16000

Front 415

why does hypocalcemia result from acute pancreatitis

Back 415

fat saponification (fat necrosis binds calcium)

Front 416

how to predict mortality from ranson's criteria

Back 416

<3 = 1%. 3-4 = 15%. 5-6 = 40. 7+ = 100%

Front 417

48 hour ranson's critera

Back 417

C HOBBS - calcium < 8, hemotocrit decrease >10%, pa02 < 60, BUN increase >8, base deficit >4, fluid sequestration >6L

Front 418

dx of acute pancreatitis

Back 418

labs, ct abdomen

Front 419

possible signs of pancreatitis on axr

Back 419

sentinel loop (air filled bowel in LUQ), colon cut off sign (air filled segment of transverse colon around pancreas)

Front 420

complications of acute pancreatitis

Back 420

necrosis (which may be sterile or necrosis -- need to do ct guided aspiration), pancreatic pseudocyst, hemorrhagic pancreatitis, ards, ascites/pleural effusion, ascending cholangitis, abscess

Front 421

compliations of pancreatic pseudocyst

Back 421

rupture, infection, fistula, hemorrhage into cyst, pancreatic ascites

Front 422

how to tx pancreatic pseudocyst

Back 422

>5cm, drain. <5cm = observe

Front 423

tx for acute pancreatitis

Back 423

NPO (rest pancreas), IV fluids, pain control but no narcotics, ng tube if NV or ileus

Front 424

4 classic findings of chronic pancreatitis

Back 424

chronic epigastric pain + calcifications on axr/ct + dm + steatorrhea

Front 425

mcc of chronic pancreatitis

Back 425

chronic alcoholism

Front 426

medical tx for chronic pancreatitis

Back 426

narcotics, NPO, h2 blocks = pancreatic enzymes, insulin, small frequent meals

Front 427

surgical tx for chronic pancreatitis

Back 427

pancreaticojejunostomy, pancreatic resection

Front 428

mc locations for pancreatic cancer

Back 428

head > body > tail

Front 429

risk factors for pancreatic cancer

Back 429

cigarette, chronic pancreatitis, dm, heavy alcohol, benzidine/b-naphthylamine

Front 430

most sensitive test for pancreatic cancer

Back 430

ercp

Front 431

4 classic sx of pancreatic cancer

Back 431

jaundice (usually NOT painless) + weight loss + migratory thrombophebitis + courvoisier's sx (palpable gallbladder)

Front 432

tx for pancreatic cancer

Back 432

whipple's

Front 433

what is aortoenteric fistula

Back 433

fistula in someone with aortic graft surgery -- they have a small GI bleed involving duodenum before massive hemorrhage hours to weeks later

Front 434

causes of upper gi bleeding

Back 434

PUD, reflux esophagitis, esophageal & gastric varices, erosions, mallory-weiss, hemobilia, dieulafoy's vascular malformation (submucosal dilated arterial lesion), aortoenteric fistula

Front 435

causes of lower GI bleeding

Back 435

diverticulosis, angiodysplasia, IBD, CRC/polyps, ischemic colitis, anal fissures, hemorrhoids, small intestinal bleeding

Front 436

other causes of dark stools other than melena

Back 436

bismuth, iron, spinach, charcoal, licorice

Front 437

dx for gi bleeding

Back 437

vs (is pt stable?), labs (stool guiac, h&h, bun:cr ratio increased in upper gi bleed), upper endoscopy, ng tube, anoscopy, colonscopy, bleeding scan, arteriography

Front 438

how to evaluate ng aspirate -- bile w/ no blood vs bright red blood or coffee grounds vs nonbloody aspirate

Back 438

upper GI bleeding unlikely vs upper GI bleed vs unlikely, but cannot be ruled out

Front 439

how to tx upper GI bleed

Back 439

egd with coagulation

Front 440

how to tx lower gi bleed

Back 440

colonoscopy (polyp excision, cautery), arteriographic vasoconstriction, surgical resection

Front 441

indications for surgery for gi bleed

Back 441

hemodynamically unstable w/o response to fluids, recurrence of bleed after endoscopy, continued bleed for >24h, vessel at base of ulcer, ongoing transfusion requirement

Front 442

where is scc of esophagus located. where is adenocarcinoma of esophagus located

Back 442

upper to mid third. distal third

Front 443

risk factors for scc of esophagus

Back 443

alcohol, tabacco, diet (nitrosamine, betel nuts, chronic hot food ingestion), hpv, achalasia, plummer vinson

Front 444

risk factors for adenocarcinoma of esophagus

Back 444

gerd, barretts

Front 445

2 most common sx of esophageal cancer

Back 445

progressive dysphagia and weight loss

Front 446

how to dx esophageal cancer

Back 446

barium swallow, upper endoscopy, transesophageal u/s

Front 447

up to what stage is surgery curative for esophageal cancer

Back 447

2A (no node involvement)

Front 448

mcc of achalasia

Back 448

idiopathic in US, chagas worldwide

Front 449

sx of achalasia

Back 449

dysphagia, regurgitation, chest pain, weight loss, aspiration

Front 450

tx for achalasia

Back 450

no cure. can try antimuscarinic (dicyclomine), nitrates, and ccbs. botox injections into LES. forceful dilation. "heller myotomy"

Front 451

what is diffuse esophageal spasm

Back 451

nonperistaltic contraction of esophagus and prevent advancement of food. sphincter is normal

Front 452

sx of diffuse esophageal spasm

Back 452

CHEST PAIN

Front 453

dx of diffuse esophageal spasm

Back 453

esophageal manometry

Front 454

tx of DES

Back 454

no good therapy. nitrates and ccbs

Front 455

type 1 vs type 2 esophageal hernia. which one more common

Back 455

sliding vs paraesophgeal. type 1

Front 456

which type of esophageal hernia is riskier

Back 456

type 2 can strangulate

Front 457

sx of diffuse esophageal spasm

Back 457

CHEST PAIN

Front 458

dx of diffuse esophageal spasm

Back 458

esophageal manometry

Front 459

tx of DES

Back 459

no good therapy. nitrates and ccbs

Front 460

type 1 vs type 2 esophageal hernia. which one more common

Back 460

sliding vs paraesophgeal. type 1

Front 461

which type of esophageal hernia is riskier

Back 461

type 2 can strangulate

Front 462

tx of esophgeal hernia

Back 462

type 1: medicially (antacid, small meal, elevation). nissen fundoplication of unresponsive. type 2 = surgery

Front 463

complications of type 1 esophgeal hernia

Back 463

grd, reflus esophagitis, aspiration

Front 464

where is tear in mallory weiss

Back 464

at or just below gastroesophgeal jcn

Front 465

3 classic findings of plummer vinson

Back 465

UPPER esophageal webs + iron deficiency anemia + atrophic oral mucosa

Front 466

where are schatzki rings located

Back 466

lower esophagus

Front 467

what is schatzki's ring

Back 467

ring in lower esophagus + sliding hiatal hernia

Front 468

usual cause of schatzki ring

Back 468

ingestion of caustic agents (like alkali, acids, bleach)

Front 469

tx of schatzki ring

Back 469

esophagectomy if full thickness necrosis (more likely with alkali)

Front 470

3 types of esophgeal diverticula

Back 470

zenkers in type 1/3, traction in midpoint, epiphrenic in lower 1/3

Front 471

cause of zenkers

Back 471

failure of cripharyngeal mm to relax during swallowing

Front 472

cause of traction diverticula

Back 472

occurs near tracheal bifurcation. due to traction from mediastinal inflammation and adenopathy (eg TB)

Front 473

cause of epiphrenic diverticula

Back 473

achalasia, esophageal dysmotility

Front 474

hamman's sign

Back 474

mediastinal crunch produced by heart beating against air filled tissue.... seen in esophageal perf

Front 475

dx for esophageal perf

Back 475

contrast esophagram 9using soluble gastrografin)

Front 476

what is common b/w epiphrenic and zenkers

Back 476

due to underlying dysmotility of certain mucles

Front 477

most important prognostic factor in esophgeal perf

Back 477

time interval b/w esophgeal perf and surgery.

Front 478

tx for esophgeal perf

Back 478

if small perf -- iv vluids, npo, ab, h2 block. if large, surgery

Front 479

pathogenesis: duodenal vs gastric ulcers

Back 479

duodenal = increased acid. gastric = decreased defense (mucosa)

Front 480

which has higher malignant potential -- dudoenal or gastric

Back 480

gastric

Front 481

blood type association of pud

Back 481

duodenal = type O. gastric = type A

Front 482

eating relieves pain in PUD?

Back 482

for duodenal ulcer, not for gastric

Front 483

dx of pud

Back 483

endoscopy, needed esp for gastric ulcer cuz need biopsy to r/o malignancy. lab test for pylori. can measure serum gastrin for ze syndrome

Front 484

advantage of quadruple therapy vs triple therapy for pylori

Back 484

quad takes 1 week, triple is 2 weeks

Front 485

what is regimen of quadruple therapy vs triple

Back 485

ppi + bismuth + 2 ab's vs PPI + 2 ab's

Front 486

relationship between eating and pain in acute gastritis

Back 486

no relationship

Front 487

complications of pud

Back 487

perforation, gastric outlet obstruction, gi bleed

Front 488

how to dx perf from pud

Back 488

upright cxr

Front 489

how to dx gastric outlet obstruction

Back 489

barium swallow and upper endoscopy, saline load

Front 490

what is saline load test

Back 490

(empty stomach with ng, add 750 ml saline, if there is >400 mL of saline after 30 min then positive). used to dx gastric outlet obstruction

Front 491

causes of chronic gastritis

Back 491

h pylori, autoimmune

Front 492

best dx for chronic gastritis

Back 492

endoscopy

Front 493

what is most common type of gastric cancer

Back 493

adenocarcinoma

Front 494

4 types of gastric cancer

Back 494

ulcerative, polypoid, superficial spreading (most favorable), linitis plastica

Front 495

risk factors for gastric cancer

Back 495

chronic atrophic gastritis, h pylori, postanrectomy, pernicious anemia, menetrier dz, high intake of preserved foods, blood type A

Front 496

dx gastric cancer

Back 496

endoscopy

Front 497

tx for gastric cancer

Back 497

surgical resection with wide (>5cm) margins with lymph node dissection

Front 498

what is krukenberg tumor

Back 498

gastric cancer met to ovary

Front 499

what is blumer's shelf

Back 499

gastric cancer met to rectum that is palpable on rectal exam

Front 500

what is sister mary josephs node

Back 500

gastric cancer met to periumbilical lymph node

Front 501

hat is virchow node

Back 501

met of gastric cancer to supraclavicular fossa

Front 502

what is irish's node

Back 502

gastric cancer met to left axilla

Front 503

3 classification of sbo

Back 503

1. partial vs complete -- i.e. obstipation = complete. 2. closed loop vs open loop -- closed means lumen occluded at 2 points which can compromise blood supply 3. proximal vs distal -- distal obstruction causes distention of proximal segments, which eases dx. proximal obstruction also means frequent vomiting

Front 504

why does dehydration occur in sbo

Back 504

intestinal distention causes reflex vomiting

Front 505

causes of sbo

Back 505

adhesions from surgery, incarcerated hernias, malignancy, intussusception, crohns, superior mesenteric artery syndrome

Front 506

how is pain from strangulated bowel different

Back 506

it is continuous pain (vs colicky)

Front 507

causes of large bowel obstruction

Back 507

volvulus, adhesions, hernia, colon cancer

Front 508

how to dx sbo

Back 508

axr,barium enema, upper gi series

Front 509

when is surgery needed for sbo

Back 509

complete obstruction, persistent or constantly painful partial obstruction, strangulation

Front 510

causes of paralytic ileus

Back 510

drugs (narcotics, anticholinergic), postop, spinal cord injury, shock, metabolic dz (HYPOKALEMIA), peritonitis

Front 511

axr finding of paralytic ileus

Back 511

uniform distribution of gas in small bowel

Front 512

what electrolyte disturbance can cause paralytic ileus

Back 512

hypokalemia

Front 513

ibd: erythema nodosum vs pyoderma gangrenosum

Back 513

nodosum in crohn's, pyoderma in UC. erythema parallels ibd activity, pyoderma doesn't

Front 514

ibd: episcleritis vs anterior uveitis

Back 514

episcleritis follows ibd activity

Front 515

ibd: arthritis vs sacroilitis

Back 515

arthritis is migratory monoarticular and parallels ibd activity

Front 516

what is sbo due to in ibd

Back 516

at first edema and spasm of bowel. then scarring and thickening

Front 517

mc location of crohn's dz

Back 517

terminal ileum

Front 518

ibd: erythema nodosum vs pyoderma gangrenosum

Back 518

nodosum in crohn's, pyoderma in UC. erythema parallels ibd activity, pyoderma doesn't

Front 519

ibd: episcleritis vs anterior uveitis

Back 519

episcleritis follows ibd activity

Front 520

ibd: arthritis vs sacroilitis

Back 520

arthritis is migratory monoarticular and parallels ibd activity

Front 521

what is sbo due to in ibd

Back 521

at first edema and spasm of bowel. then scarring and thickening

Front 522

why is risk of kidney stone higher in ibd

Back 522

increased colonic absorption of dietary oxalate

Front 523

when is sulfasalazine most useful

Back 523

if colon involved

Front 524

antidiarrheal agents and ibd

Back 524

can cause ileus

Front 525

surgery uc vs crohns

Back 525

surgical resection often curative for uc

Front 526

uc and rectum

Back 526

always involves rectum

Front 527

diarrhea in uc vs crohns. implications for dx?

Back 527

uc is bloody, crohns is not. therefore need to workup infectious diarrhea (c diff, ova, paracytes, fecal leukocytes)

Front 528

ibd: which one more assoc with anorectal complications

Back 528

crohns

Front 529

ibd: which one is transmural?

Back 529

crohns

Front 530

ibd: which one more likely lead to bleeding

Back 530

uc

Front 531

ibd: which one can lead to sclerosing cholangitis and cholangiocarcinoma

Back 531

uc

Front 532

what are "red flags" for abd pain that warrant surgical consult

Back 532

peritoneal sx -- rigidity, guarding, rebound

Front 533

respiratory causes of abd pain

Back 533

upper quadrant pain -- pneumonia, pe

Front 534

radioiodide scan and graves dz

Back 534

diffuse uptake

Front 535

what is plummer's dz

Back 535

multinodular toxic goiter

Front 536

bumpy irregular assymetric thyroid gland

Back 536

plummer's dz, hashimoto

Front 537

tender, diffusely enlarged thyroid

Back 537

subacute thyroiditis

Front 538

thyroid bruit is specific for

Back 538

graves dz

Front 539

what things can increase thryoid binding globulin

Back 539

pregnancy, ocp, liver dz, aspirin

Front 540

utility of radioactive t3 uptake

Back 540

resin and radioactive t3 is given, so gives information on how much tbg is there.

Front 541

ptu vs methimazole

Back 541

both inhibit thyroid synthesis, but ptu also block conversion of t4 to t3

Front 542

what is sodium ipodate or iopanoic acid do

Back 542

lowers serum t3 and t4, tx acute mgmt of severe hyperthyroid

Front 543

complications of subtotal thyroidectomy

Back 543

permanent hypothyroidism, recurrence of hyperthyroid, recurrent laryngeal nerve palsy, hypoparathyroidism

Front 544

tx for graves (nonpregnant)

Back 544

start methimazle + bb, taper bb after 4 w, monitor thyroid igg, if absent d/c therapy

Front 545

indications for radioactive iodine ablation

Back 545

elderly pts with graves, solitary toxic nodule, failure with antithyroid drugs

Front 546

mortality from thyroid storm

Back 546

20%

Front 547

tx for thyroid storm

Back 547

iv fluids, cooling blankets, glucose, ptu q2h, bb, dexamethasone

Front 548

why is dexamethasone given for thyroid storm

Back 548

impair peripheral conversion of t3 to t4

Front 549

what is myxedema coma

Back 549

depressed consciousness, hypothermia, respiratory depression that occurs after several yrs of severe untreated hypothyroid

Front 550

what antibodies assoc w hashimoto

Back 550

antimicrosomal antibodies

Front 551

lab findings of hypothyroid

Back 551

high tsh (unless 2*), elevated ldl, anemia

Front 552

what is subclinical hypothyroid

Back 552

inadequate thyroid function, but increased tsh keeps t4 normal. tx if goiter, hypercholesterol, sx of hypothyroidism, or tsh >20

Front 553

radioiodine uptake in subacute thyroiditis

Back 553

decreased (damaged follciular cells)

Front 554

what is subacute lymphocytic thyroidtitis

Back 554

painless thyroiditis 2-5mo long

Front 555

what is thyroid associated ophthalmopathy

Back 555

autoimmune attack on periorbital connective tissue. may be hypothyroid, graves, or euthyroid. tx is not useful.

Front 556

sx of malignant thyroid nodule

Back 556

fast onset, no movement on swallowing, fixed, unusually firm or irregular, solitary, hx of radiation, cervical adenopathy, elevated serum calcitonin

Front 557

dx of thyroid nodule

Back 557

FNA biopsy, thyroid scan (iodine), thyroid u/s

Front 558

what type of finding on thyroid u/s indicates benign

Back 558

cystic masses >4cm

Front 559

what type of thyroid cancer is fna poor at detecting

Back 559

follicular

Front 560

what % of cold nodules are malignant

Back 560

20

Front 561

most common type of thyroid cancer

Back 561

papillary

Front 562

how does papillary carcinoma of thyroid spread

Back 562

lymphatics

Front 563

how does follicular carcinoma spread

Back 563

hematogenous

Front 564

what is hurthle cell tumor

Back 564

variant of follicular cancer but more aggressive, spreads by lymphatics

Front 565

tx for thyroid cancer

Back 565

papillary - lobectomy unless >3cm. follicular - total thyroidectomy + iodine. medullar - total. anaplastic - poor prognosis

Front 566

size cutoff of microadenoma of pituitary

Back 566

<10mm diameter

Front 567

what is best tx for pituitary adenoma

Back 567

transsphenoidal surgery

Front 568

causes of hyperprolactinemia

Back 568

prolactinoma, medications (psych, h2, estrogen), pregnancy, renal failure, suprasellar mass lesions, hypothyroidism, idiopathic

Front 569

how to tx prolactinoma

Back 569

bromocriptine, cabergoline (better tolerated)

Front 570

mc cause of death in pts with acromegaly

Back 570

cardiovascular dz

Front 571

heart complication of acromegaly

Back 571

hcom

Front 572

parasellar manifestations of putuitary growth

Back 572

superior growth -optic chiasm compression
lateral - cavernous sinus compression
inferior - sphenoid sinus invasion

Front 573

glucose in acromeglay

Back 573

glucose intolerance

Front 574

tx for acromegaly

Back 574

surgery, radiation if elevated igf-1 postop, octreotide

Front 575

urine findings in DI

Back 575

low specific gravity + low osmolality

Front 576

how to dx DI

Back 576

water deprivation (urine osmolality will stay normal), urine and plastma osmolality

Front 577

how to tx central DI? how to nephrogenic DI?

Back 577

ddavp, chlorpropamide vs thaizide

Front 578

how does thiazide diuretics work in nephrogenic DI

Back 578

increased reabsorption of sodium in pct works out in this disorder end up decreasing urine volume

Front 579

why does edema not occur in siadh

Back 579

sodium is excreted despite hyponatremia

Front 580

why does natriuresis occur in siadh

Back 580

1. volume expansion leads to ANP 2. volume expansion leads to decreasd sodium absorption 3. inhibition of raas

Front 581

sx of acute hyponatremia

Back 581

lethargy, somnolence, weakness, seizures

Front 582

tx of siadh

Back 582

water restriction, saline + loop diuretic if faster results, lithium/demeclocycline.

Front 583

fastest rate of sodium replacement

Back 583

0.5 meq/L/hr

Front 584

what is chvostek's sx

Back 584

tappng facial nerve elicits contraction, sign of hypocalcemia

Front 585

calcium levels in hypoparathyroidism

Back 585

low

Front 586

ekg changes with hypopth

Back 586

prolonged qt

Front 587

urine findings of hypopth

Back 587

low urine camp

Front 588

uses of calcium gluconate

Back 588

1. hypocalcemia 2. antidote to mgso4 3. cardioprotective in hyperkalemia

Front 589

mcc hypercalcemia

Back 589

primary hyperpth

Front 590

mc causes of primary hyperpth

Back 590

adenoma > hyperplasia >> carcinoma

Front 591

normal pth levels + hypercalcemia indicate what

Back 591

hyperpth

Front 592

how can electrolytes be used to help dx hyperpth

Back 592

1. high ca 2. low phophate 3. chloride/phosphorus ratio > 33

Front 593

indications for surgery in primary hyperpth

Back 593

age>50, bone decrease, ckd/nephrolithiasis, severe hypercalcemia, urine calcium >400 in 24h

Front 594

one classic lab sx of iatrogenic cushing's

Back 594

no androgen excess

Front 595

dx for cushings

Back 595

1.low dose dexamethasone suppression (1mg at night, measure in AM, <5 = r/o cushings). 2. 24 urine cortisol 3. acth level (if low then probably adrenal origin) 4. crh stimulation test

Front 596

tx for cushings

Back 596

surgery

Front 597

where are pheochromocytomas located

Back 597

90% in adrenal medulla, 10% extra-adrenal

Front 598

what is the organ of zuckerkandl

Back 598

chromaffin body near bifurcation of aorta which can be the cause of pheo

Front 599

what radioactive test can be used to localize pheo

Back 599

I-metaiodobenzlguanidine scan (norepi analog)

Front 600

tx of pheo

Back 600

bb, surgical resection w/ ligation of venous drainage

Front 601

men 1 vs 2a vs 2b

Back 601

wermer = pt+pancreas+pituitary. sipple = medullary thyroid + pheo+ hyperpt. mucosal neuroma + medullary thyroid + pheo + marfanoid

Front 602

2 electrolyte abnormalities in hyperaldosterone

Back 602

hypokalemia, metabolic alkalosis

Front 603

what is conn's syndrome

Back 603

adrenal adenoma producing purely aldosterone

Front 604

tx of primary hyperaldosteronism

Back 604

if adenoma, resection. if hyperplasia, use spironolactone

Front 605

dx of hyperaldosteroneism

Back 605

aldosterone to renin ratio >30, saline infusion test (saline infusion should decrease aldosterone below 8.5 normally)

Front 606

mcc addison's? adrenal insufficiency in general

Back 606

autoimmune in west, TB worldwide. chronic steroids.

Front 607

aldosterone levels in primary vs secondary adrenal insufficiency

Back 607

low in primary, normal in secondary

Front 608

how to dx adrenal insufficiency

Back 608

ACTH stimulation test

Front 609

what is good drug for mineralocorticoid replacement

Back 609

fludrocortisone

Front 610

how to dx 21-hydroxylase cah

Back 610

high levels of 17 hydroxyprogesterone

Front 611

tx of cah

Back 611

cortisol + mineralcorticoid, correct genitalia early

Front 612

annual risk of developing type ii diabetes if impaired glucose tolerance

Back 612

1-5% annual increase in risk

Front 613

mechanism of obesity and insulin resistance

Back 613

increased FFAs make muscles more insulin resistant, FFAs increase production of glucose, FFAs fail to stimulate pancreatic insulin secretion

Front 614

dawn phenomenon vs somogyi effect

Back 614

dawn phenomenon is noctural secretion of gh, somogyi is counterregulatory hormones activated in response to hypoglycemia. check glucose at 3AM, if elevated, then has dawn phenomenon and need more basal control. if low, then somogyi, and need less PM insulin to avoid hypoglycemia

Front 615

typical insulin dosage for dm1 qday

Back 615

0.5-1.0units/kg

Front 616

general insulin dosage scheme

Back 616

2/3 in morning (2/3 of this is nph), 1/3 in PM (1/2-2/3 is nph)

Front 617

how often is glucose monitored for slidacting scale

Back 617

4 times -- qhs and before meals

Front 618

how does physical activity impact insulin dosage

Back 618

lower by 1-2 units q20-30 min of activity

Front 619

why is there accelerated atherosclerosis in diabetes

Back 619

glycation of lipoproteins, incrased plt aggregation

Front 620

typical scheme for sliding scale insulin dosage

Back 620

start at blood glucose of 150-200 corresponding to 2 units of insulin. for every 50 increase in glucose, increase insulin by 2 units.

Front 621

definition of microalbuminuria

Back 621

1. 30-300 mg/day 2. 20-200g/min 3. albumin-cr ratio of 0.02-0.2

Front 622

prognosis of diabetic nephropathy once proteinuria (not microalbuminuria) is reached

Back 622

unaffected by glycemic control, at this point need to really start ACEi and restrict protein

Front 623

2 types of retinopathy in dm. which one leads to blindness

Back 623

proliferative and nonproliferative. both can lead to blindness -- nonproliferative can cause macular edema which leads to blindness.

Front 624

most common cranial nerve affected in dm

Back 624

cn3

Front 625

respiratory & gi findings of dka.

Back 625

kussmaul's breathing. N/V, abdominal pain

Front 626

why do you see hyponatremia in dka? how much should sodium decrease for every 100 increase in blood sugar

Back 626

fluid moves from ICF to ECF. sodium decreases by 1.6

Front 627

potassium levels in dka

Back 627

hyperkalemia (acidosis and low insulin cause k+ to come out of icf)

Front 628

dosage of insulin for dka

Back 628

0.1mg/kg bolus + 0.1 mg/kg/hr until anion gap closes and metabolic acidosis corrected

Front 629

when do you start adding d5 to ivf for dka

Back 629

once serum glucose is 250

Front 630

what electrolyte needs to be replenished with dka. when do you start?

Back 630

k+, start 1-2 hr after insulin

Front 631

complications of dka tx

Back 631

1. cerebral edema 2. hyperchloremic nongap metabolic acidosis

Front 632

dx of dka

Back 632

hyperglycemia, acidosis, ketonemia

Front 633

dx of hyperosmolar syndrome

Back 633

hyperglycemia, hperosmolarity, dehydration

Front 634

what labs to order for hypoglycemia

Back 634

insulin level, c peptide, anti-insulin antibodies, plasma and urine sulfonylurea level

Front 635

what are neuroglycopenic symptoms

Back 635

irritability, behavioral changes, drowsiness/lethargy, confusion

Front 636

what do you need to assess before giving glucose to ANYONE (diabetic or not)

Back 636

alcoholic? give thiamine

Front 637

whipple's triad

Back 637

for hypoglycemia. hypoglycemia brought on by fasting, glucose <50 during symptomatic attack, glucose administration brings relief

Front 638

what is the gastrinoma triangle

Back 638

cystic duct, junction of 2nd and 3rd parts of duodenum, neck of pancreas. location of 90% of tumors located here

Front 639

how to dx ze syndrome

Back 639

inject secretin (secretin inhibits gasrin)

Front 640

is ze syndrome malignant

Back 640

60%, that's why everyone with it should undergo exploratory surgery with attempted resection

Front 641

what is necrotizing migratory erythema below the waist assoc with

Back 641

glucagonoma

Front 642

triad of somatostatinoma

Back 642

gallstones + dm + steatorrhea

Front 643

what is verner morrison syndrome

Back 643

vipoma

Front 644

4 classic sx of vipoma

Back 644

watery diarrhea + achlorydia (vip inhibits gastric acid secretion) + hyperglycemia + hypercalcemia

Front 645

risk of stroke after tia

Back 645

30% 5-yr risk

Front 646

carotid vs vertebrobasilar tia

Back 646

dysphasia, contra weakness/numbness, amaurosis fugax (ipsi curtain-like vision loss to retinal ischemia) VS dizziness/ataxia, double vision, ipsi face/contra body numbness, dysphagia/dysarthria

Front 647

most common sources of emboli for stroke

Back 647

heart>ICA>aorta>paradoxical emboli

Front 648

what causes lacunar stroke

Back 648

thickening of small vessels narrows lumen and thus causes ischemia

Front 649

which vessels affected in lacunar stroke

Back 649

branches of MCA, vertebrobasilar arteries, circle of willis arteries

Front 650

what is subclavian steal syndrome

Back 650

stenosis of subclavian a proximal to origin of vertebral, therefore there is reversal of flow down the vertebral artery -- causes vertebrobasilar insufficiency and UE claudication

Front 651

4 major syndromes seen in lacunar strokes

Back 651

1. pure motor (involving internal capsule) 2. pure sensory (involving thalamus) 3. ataxic hemiparesis (incoordination ipsi) 4. clumsy hand

Front 652

6 classic sx of vertebrobasilar stroke/insufficiency

Back 652

ipsi: 1. ataxia 2. diplopia 3. dysphagia 4. dysarthria 5. vertigo; 6. CONTRA homo hemianopsia

Front 653

why should you not use contrast ct for dx of new stroke

Back 653

cuz hemorrhagic stroke hasn't been excluded

Front 654

workup for acute stroke

Back 654

1. noncontrast ct 2. ekg 3. cxr 4. cbc, plt, pt, ptt, electrolytes, glucose 5. echo 6. carotid doppler

Front 655

3 orders to give after giving tpa

Back 655

1. no aspirin 2. neuro check qh 3. bp < 185/110

Front 656

bp control and strokes

Back 656

unnecessary unless 1. sbp>220|dbp>120|map>130 2. pt has big need for antihypertensive 3. getting tpa

Front 657

how to prevent strokes

Back 657

1. atherosclerosis -- control risk factors, aspirin, carotid endarterectomy if symptomatic 2. embolic -- aspirin, reduce atherosclerotic risk factors 3. prevent lacunar -- control htn

Front 658

what types of stroke does cocaine increase risk for

Back 658

intracranial hemorrhagic stroke, ischemic stroke, AND subarachnoid hemorrhage

Front 659

mc location of intracranial hemorrhage

Back 659

basal ganglia >> pons = cerebellum

Front 660

pinpoint pupils vs poorly ractive pupils vs dilated pupils in intracranial hemorrhage

Back 660

involvement: pons, thalamus, putamen

Front 661

tx for hemorrhagic stroke

Back 661

abcs, GRADUAL bp reduction (only if sbp >160, dbp>105), mannitol/diuretics to reduce ICP

Front 662

in which type of intracranial hemorrhage is surgical evacuation good

Back 662

cerebellar hemmorhage

Front 663

most common locations of subarachnoid hemorrhage

Back 663

junction of anterior communicating with ACA, jcn of posterior communicating with ICA, bifurcation of MCA

Front 664

what physical sx is a CI for LP

Back 664

papilledema -- risk of herniation

Front 665

what study to order once subarachnoid hemorrhage has been dx'd

Back 665

angiogram

Front 666

complications of subarachnoid hemorrhage

Back 666

rerupture, vasospasm leading to infarction, hydrocephalus, seizures

Front 667

tx for subarachnoid hemorrhage

Back 667

surgery (clip aneurysm), stool softeners (avoids straining which raises ICP), CCB (to prevent vasospasm)

Front 668

what is shy drager syndrome

Back 668

parkinson + autonomic insufficiency

Front 669

what type of parkinsons has better prognosis than others

Back 669

tremor is better prognosis than bradykinesia

Front 670

anticholinergic drugs are better for controlling what sx in parkinson

Back 670

tremor

Front 671

what is progressive supranuclear palsy

Back 671

degeneration of BS, cerebellum, and basal ganglia. like parkinson's dz except NO TREMOR OR OPHTHALMOPLEGIA

Front 672

what is trinucleotide repeat in huntington

Back 672

CAG

Front 673

how to dx huntington

Back 673

MRI shows caudate atrophy

Front 674

what type of tremor seen in essential benign tremor

Back 674

intentional tremor

Front 675

sensory deficits in friedreich's ataxia

Back 675

vibratory sense and propioception

Front 676

what is binswanger's dz

Back 676

type of vascular dementia, slow insidious (rather than stepwise) diffuse subcortical white matter degeneration, in ppl with htn and atherosclerosis

Front 677

what drug is associated with lower risk of developing alzheimers

Back 677

hrt

Front 678

how is dementia with lewy bodies different from parkinson's or alzheimer's

Back 678

features of both, but often psychotic features while being extra sensitive to adverse effects of neuroleptics

Front 679

causes of delirium

Back 679

P DIMM WIT - postop, dehydration, infection, medications, metals, withdrawal, inflammation, trauma,

Front 680

2 components of conciousness

Back 680

arousal (brainstem) and cognition (cerebrum)

Front 681

what is sundowning and what is it assoc with

Back 681

worsening at night of symptoms, seen with dementia

Front 682

ddx of coma

Back 682

SMASHED - structural, meningitis/mental illness, alcohol/acidosis, seizures, hypercapnia/hyper|hypoglycemia/hyper|hypothermia,hyponatremia,hypoxia,hypotension, endocrine, drugs

Front 683

describe the gcs in detail

Back 683

E4V5M6. eyes: opens to pain (2), opens to command (3). voice: incomprehensible (2), inappropriate, confused (4). motor: decerebrate, decorticate, pain withdrawal, localizes pain

Front 684

what is decorticate positioning

Back 684

arms AND HANDS flexed, legs extended

Front 685

what is decerebrate positioning

Back 685

everything extended (back arched, elbows hyperextended, etc)

Front 686

what is higher on gcs, decorticate or decerebrate

Back 686

decorticate>decerebrate

Front 687

ddx of abnormal pupilary light refle

Back 687

structural intracranial lesions, drugs, anoxic encephalopahty, eye drops

Front 688

what does bilateral fixed dilated pupils mean

Back 688

severe anoxia

Front 689

coma with bilateral fixed dilated pupils

Back 689

severe anoxia

Front 690

coma with unilateral fixed dilated pupil

Back 690

herniation w/ cn3 compression

Front 691

coma with pinpoint pupils

Back 691

narcotics, intracranial hemorrhage

Front 692

2 ways to check brainstem reflexes on coma pt

Back 692

pupillary light reflex, oculocephalic test (head turning to once side should move the eyes conjugately to opposite side)

Front 693

what is locked in syndrome

Back 693

hemorrhage/infarction of ventral pons -- complete paralysis with sparing of respiration, blinking, vertical eye movement

Front 694

motor findings of uncal herniation

Back 694

contra hemiparesis

Front 695

sx of central herniation

Back 695

hypertonicity, bilateral babinski (i.e. UMN sx)

Front 696

brain death vs persistent vegetatitve state

Back 696

irreversible, apnea despite ventilation, no BS reflexes, no other explanation, not hypothermic, evidence for brain death, electrical silence on EEG vs unresponsive but eyes open, random movements

Front 697

classic location of ms plaques

Back 697

angles of lateral ventricles

Front 698

geographical association with MS

Back 698

lower incidence near equator, moving there before age 15 reduces risk of MS

Front 699

what is internuclear ophthalmoplgia

Back 699

ipsi MR palsy

Front 700

how can optic neuritis present as clinically

Back 700

vision loss/central scotomy, decreased pupillary light reflex, pain on mvmt of eye

Front 701

how to tx acute attacks of ms

Back 701

high dose IV CS (oral doesn't work)

Front 702

what long term therapy can be used in MS for prophylaxis

Back 702

interferon beta, glatiramer

Front 703

what is most important prognostic factor for guiillain barre

Back 703

recovery w/in 1-3 wks after onset. if >6w, chronic relapsing course more likely

Front 704

sphincter control and guillain barre

Back 704

preserved

Front 705

dx of guillaine barre

Back 705

elevated csf protein, decreased motor nerve conduction

Front 706

tx of guillain barre

Back 706

iv ig, plasmapheresis if severe. DO NOT GIVE STEROIDS

Front 707

what are 2 indications for mri to r/o intracranial mass

Back 707

new onset seizure, new + persistent/progressive HA

Front 708

dx of cns newplasm

Back 708

mri +/- gadolinium

Front 709

6 ways to control increased icp

Back 709

steroids, mannitol, hyperventilation/decrease co2, reverse trendelenberg position (elevate head of bed), lower body temperature

Front 710

what is meningeal carcinomatosis. sx?

Back 710

cancer that mets to meninges. focal neurological deficits or hydrocephalus

Front 711

what is cerebral perfusion pressure, what is it normally

Back 711

MAP - ICP. >50mmHg.

Front 712

what is mechanism of death with increased ICP

Back 712

decreases cerebral perfusion pressure, which results in loss of autoregulation, which leads to cerebral vasodilation, and thus vasogenic edema, further increasing ICP. ALSO, SBP IS THE ONLY DETERMINENT OF CEREBRAL BLOOD FLOW

Front 713

6 secondary insults that need to be potentially reversed in head trauma

Back 713

1. hypotension (decreased cerebral perfusion) 2. hypoxia (chest wall or respiratory injury, brainstem injury) 3. hypercapnia (causes vasodilation) 4. increased ICP 5. mass effect (hematoma) 6. anemia

Front 714

4 sx of basilar skull fx

Back 714

raccoon eyes, battle's sx (postauricular ecchymoses), hemotympanum, csf rhinorrhea/otorrhea

Front 715

what is diffuse axonal injury

Back 715

global dmg to brain during impact, elevated ICP not seen, but small hemorrhages in many tracts, 1/3 mortality

Front 716

what is cushing's triad

Back 716

HTN + bradycardia + respiratory irregularity

Front 717

eye finding on epidural hematoma

Back 717

ipsi blown pupil (i.e. fixed and dilated)

Front 718

acute vs chronic subdural hematoma

Back 718

chronic = sx at least 1 week after injury, better prognosis

Front 719

what sx after concussion suggest elevated icp? what needs to be done?

Back 719

vomiting, delirium, focal deficit. r/o hematoma.

Front 720

what is emergency in myasthenic crisis

Back 720

respiratory arrest

Front 721

dx for myasthenia

Back 721

achr antibody test, emg shows stepwise decrease in responsiveness, ct scan of thorax to r/o THYMOMA, edrophonium test has high fp

Front 722

when should a thymectomy be done in myasthenia pt

Back 722

always should be offered cuz even in absence of thymoma OFTEN get benefit and remission. obviously, if have thymoma then do it

Front 723

what medicines can exacerbate sx of myasthenia

Back 723

antibiotics, bb, antiarrythmics

Front 724

options if achei fails for myasthenia

Back 724

immunosuppression (corticosteroids), plasmapharesis, ivig.

Front 725

what is lambert eaton assoc with. how different from myasthenia

Back 725

small cell. sx improve with use

Front 726

dx of duchenne's

Back 726

DNA testing, elevated CPK

Front 727

bone findings in nf1

Back 727

bone erosion, scolioisis, congential tibial dysplasia

Front 728

eye findings of nf1 vs nf2

Back 728

lisch nodules (iris hamartoma) vs cataracts

Front 729

what type of CNS neoplasm assoc with von hippel lindau

Back 729

cavernous hemangioma

Front 730

sx of syringomyelia

Back 730

bilateral loss of p&t over shoulders (capelike)

Front 731

how to tx syringomyelia

Back 731

syringosubarachnoid shunt

Front 732

sx of brown sequard

Back 732

contra loss of p&t, ipsi hemiparesis, ipsi dorsal column

Front 733

what is transverse myelitis

Back 733

rare condition which horizontally affects spine and presents with LE weakness, back pain, sensory deficits, incontinence

Front 734

how to dx transverse myelitis

Back 734

mri with contrast

Front 735

3 sx of horners

Back 735

ptosis , miosis, anhidriosis

Front 736

sx of polio

Back 736

asymmetric muscle weakness, no reflexes, but normal sensation

Front 737

danger of polio

Back 737

bulbar involvement sometimes (cn 9-10) -- respiratory/cv problems

Front 738

what test to order for dizziness + vestibular sx

Back 738

audiogram

Front 739

3 causes of central vertigo

Back 739

MS, vertebrobasilar insufficiency, migraine associated vertigo

Front 740

5 causes of peripheral vertigo

Back 740

bpv, menieres, acute labyrinthitis, ototoxic drugs, acoustic neuroma

Front 741

5 causes of syncope

Back 741

seizure, cardiac, vasovagal, orthostatic, severe cerebrovascular dz, others

Front 742

what is vasovagal syncope

Back 742

some kind of trigger causes vagal response (bradycardia and vasodilation)

Front 743

tx for vasovagal syncope

Back 743

avoid circumstances, tx with bb and disopyramide

Front 744

main priority in dx of syncope

Back 744

differentiate b/w cardiac and noncardiac causes

Front 745

8 causes of seizures

Back 745

4M4I - metabolic (hyponatremia, glycemia, thermic, uremia), mass lesion, missing drugs, misc (pseudoseizure, eclampsia, hypertension), intoxication, infection, ischemia, ICP

Front 746

2 main types of seizure

Back 746

partial (one part of brain) vs generalized (spread to many parts of brain)

Front 747

2 types of partial seizures

Back 747

simple (no loss of consciousness) vs complex (impaired consciousness)

Front 748

tonic vs clonic phase in grand mal

Back 748

tonic = muscle rigidity, clonic = repetitive muscle jerking

Front 749

workup for new onset seizures

Back 749

cbc, electrolytes, glucose, lfts, renal, calcium, UA, eeg, ct, lp

Front 750

how long to keep on seizure medicine for

Back 750

2 yrs

Front 751

sx of als

Back 751

UMN and LMN lesions, SYMMETRIC

Front 752

what does an EMG test

Back 752

neuropathy (LMN), myopathy, nmj dz

Front 753

how are the following affected in als: bowel/bladder, cognition, extraocular mm

Back 753

none of these affected

Front 754

how to dx als

Back 754

2 regions on emg and nerve conduction affected = probable, 3+ = definite

Front 755

how does conduction aphasia present as. what is it physiologically

Back 755

disturbance in repitition. disturbance in connection b/w wernicke and broca

Front 756

how to tx bells palsy

Back 756

usually no tx, resolve w/in 1 mo. consider emg if not resolved by 2w. wear eye patch. NO STEROIDS IF LYME SUSPECTED

Front 757

what needs to be r/o for trigeminal neuralgia

Back 757

CPA tumor

Front 758

aphasia vs visuospatial defects in terms of cortex deficits

Back 758

left = aphasia. right = visuospatial

Front 759

race predilection for sle

Back 759

african american

Front 760

what antibodies assoc with drug induced lupus

Back 760

antihistone

Front 761

most specific ab's for sle

Back 761

anti dsdna, anti smith

Front 762

tx for apls

Back 762

anticoagulation to inr 2.5-3.5

Front 763

what type of renal glomerulonephritis is associated with renal failure in lupus

Back 763

type iv -- diffuse proliferative

Front 764

what hla type is sle, sjogren and ra assoc with

Back 764

dr2/dr3, dr3, dr4

Front 765

mcc death from scleroderma

Back 765

pulmonary fibrosis

Front 766

2 antibodies for scleroderma

Back 766

ANAs are nonspecific, but anticentromere for limited, anti-topoisomerase for diffuse

Front 767

2 main sx of sjogrens

Back 767

dry eyes, dry mouth

Front 768

sx of CREST syndrome

Back 768

calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasias

Front 769

who is more likely to have a child with neonatal SLE/congenital heart block

Back 769

someone with Ro (SSA)

Front 770

what is mixed connective tissue disease

Back 770

has features of many connective tissue dz. presence of anti U1 RNP ab

Front 771

what spinal problem assoc with RA

Back 771

cervical spine instability -- GET CERVICAL XR BEFORE SURGERY

Front 772

characteristics of pleural fluid effusion in RA

Back 772

low glucose and low completement

Front 773

what is feltys syndrome

Back 773

RA, neutropenia, splenomegaly

Front 774

4 indicators of poor prognsois in RA

Back 774

high RF titers, subcutaneous nodules, erosive arthritis, autoantibodies to RF

Front 775

what is Still's Dz

Back 775

JRA

Front 776

first line dma's for tx of ra

Back 776

mtx, hydroxychloroquine, sulfasalazine

Front 777

what is risk of tx with hydroxychloroquine

Back 777

retinopathy, so do eye exams q6mo

Front 778

surgical options for ra

Back 778

synovectomy (does not improve rom), joint replacement

Front 779

relationship of gender to gout

Back 779

women notaffected till after menopause

Front 780

what can cause decreased excretion of uric acid

Back 780

renal dz, nsaid/diuretics, acidosis

Front 781

what things can precipitate an acute gout attack

Back 781

decrease in temperature, dehydration, stress, alcohol, starvation

Front 782

likelihood of gout attack w/in first 2 yrs of acute gouty attack

Back 782

75%

Front 783

how is chronic tophaceous gout different from acute gouty attack

Back 783

in ppl with poorly controlled gout for long time, tophi are aggregates of urate crystals

Front 784

joint aspiration results of gout

Back 784

needle shaped negatively birefringent

Front 785

what medicines can increase uric acid levels

Back 785

thiazide/loops

Front 786

side effects of colchicine

Back 786

n/v/cramps, diarrhea

Front 787

when is colchicine CI

Back 787

renal insufficiency, cytopenia

Front 788

when to start prophylactic therapy for gout

Back 788

2+ attacks/yr

Front 789

should you use uricosuric drug or allopurinol for gout prophylaxis

Back 789

if 24-hr urine uric acid <800, then give uricosuric if no renal insufficiency

Front 790

joint aspirate of pseudogout

Back 790

weakly positively birefringent, rod/rhomboid shaped

Front 791

xr findings of pseudogout

Back 791

cartilage calcification

Front 792

5 causes of acute polyarticular arthritis

Back 792

septic joint, viral, lyme, reiters,rheumatic FEVER

Front 793

what is special about inclusion body myositis

Back 793

men>women, no autoantibodies, DISTAL muscle involvement, low CPK,poor prognosis

Front 794

pathogenesis: dermatomyositis vs polymyositis

Back 794

humoral immune activation vs cell mediated immunity

Front 795

4 main features of dermatomyositis

Back 795

1. symmetric proximal muscle weakness 2. elevated cpk 3. EMG 4.biospy

Front 796

what are gottron's papules

Back 796

papular, erythematous, scaly lesions over knuckles

Front 797

is there any increased neoplasia risk in polymyositis? dermatomyositis?

Back 797

only dermatomyositis

Front 798

what antibodies associated with myositis

Back 798

anti-jo

Front 799

what factor may lead to better prognosis in myositis? worse prognosis

Back 799

anti-mi-2 = good. anti-signal recognition = worst. anti-synthetase = abrupt onset.

Front 800

muscle biopsy results in dermatomyositis vs polymyositis

Back 800

dermato = perimysial. poly = endomysial.

Front 801

relationship b/w temporal arteritis and polymyalgia rheumatica

Back 801

40-50% of temporal arteritis may have PMR

Front 802

sx of polymyalgia rheumatica

Back 802

hip and shoulder pain + flu-like + joint swelling

Front 803

tx of PMR

Back 803

cs 4-6w,but may need for up to 2 yrs

Front 804

special consideration in someone with ankylosing spondylitis and trauma

Back 804

if even minor trauma + neck/back pain, strictly immobilize to prevent injury until proper imaging (high risk of fx)

Front 805

complications of anklyosing spondylitis

Back 805

restrictive lung,cauda equina, osteoporosis -> spine fx, spondylodiscitis

Front 806

what is enthesitis

Back 806

inflammation at tendinous insertions into bone

Front 807

where does reactive arthritis usually occur

Back 807

LE

Front 808

tx for reactive arthritis

Back 808

NSAID

Front 809

what type of arthritis is psoriatic arthritis

Back 809

asymmetric polyarthritis

Front 810

what is undifferentiated spondyloarthropathy

Back 810

features of reactive arthritis but no past infection

Front 811

tx for temporal arteritis

Back 811

oral steroids based on suspicion for at least 4 weeks, iv if visual loss present

Front 812

constitutional sx + absent pulses/bruits

Back 812

takayasu

Front 813

labwork for churg strauss

Back 813

panca, eosinophilia

Front 814

3 major sx areas for churg strauss

Back 814

constitutional + respiratory + skin lesions

Front 815

mc death from wegeners

Back 815

renal

Front 816

what body parts does wegeners involve

Back 816

kidneys, upper & lower respiratory tract

Front 817

what organ systems does PAN involve

Back 817

medium sized vessels in nervous system and GI

Front 818

dz associatiosn of PAN

Back 818

hbv, hiv

Front 819

dx of PAN

Back 819

biopsy, esr, panca, fobt

Front 820

triad of behcet

Back 820

aphthous ulcers, uveitis, genital ulcers

Front 821

what is affected mostly in hypersensitivity vasculitis

Back 821

small vessel, mostly skin -- palpable murmura, etc

Front 822

what is azotemia

Back 822

elevated bun and cr

Front 823

urine osmolarity, urine na, fena in prerenal failure

Back 823

>500, <20, <1%

Front 824

urine osmolarity, fena in atn

Back 824

>350, >1%

Front 825

bun/cr ratio in prerenal failure

Back 825

>20:1 (kidney can ramp up BUN absorption)

Front 826

phases of ATN

Back 826

oliguric phase, diuretic phase, recovery phase

Front 827

bun/cr in atn

Back 827

<20:1

Front 828

3 tests to perform for postrenal failure

Back 828

palpate bladder, u/s, catheter to look for urine

Front 829

ARF + rbc casts

Back 829

glomerular dz

Front 830

ARF + protein dipstick

Back 830

intrinsic renal failure

Front 831

ARF + WBC cast

Back 831

renal parenchyal inflammation

Front 832

what is renal failure index

Back 832

Una/Ucr/Pcr. <1% = prerenal, >1% = ATN

Front 833

early causes of death from ARF

Back 833

hyperkalemic cardiac arrest, pulmonary edema

Front 834

metabolic consequences of arf

Back 834

hyperkalemia, metabolic acidosis, hypocalcemia, hyperphosphatemia, uremia

Front 835

medications and ARF

Back 835

must be adjusted for lvl of renal fcn

Front 836

3 prognostic factors for arf

Back 836

severity of renal failure, overall health of pt, clinical course

Front 837

what is chronic renal insufficiency

Back 837

no renal failure but elevated cr

Front 838

why might a person with ckd be at increased risk for bleeding

Back 838

platelet dysfunction due to uremia

Front 839

what is calciphylaxis

Back 839

vascular calcifications result in necrotic skin lesions

Front 840

what is tachyphylaxis

Back 840

desensitization to drug

Front 841

why might you see hypercalcemia in ckd pt

Back 841

long term hyperpth and use of calcium based phosphate binders

Front 842

tx for ckd

Back 842

1. low protein (0.7g/kg), low salt if volume issues or oliguria, restrict potassium, phosphate, mg 2. acei (monitor k+) 3. bp control 4. glycemic control 5. correct hyperphosphatemia, hypocalcemia 6. epo 7. capsaicin/uv/cholestyramine for pruritus

Front 843

why is there increased risk of infection in ckd

Back 843

uremia

Front 844

absolute indications for dialysis

Back 844

AEIOU -- acidosis, electrolytes (hyperkalemia), intoxications (methanol, ethylene glycol, lithium, aspirin), overload (hypervolemia), uremia (eg uremic pericarditis)

Front 845

what is continuous AV hemodialysis and continuous venovenous hemodialysis used in

Back 845

hemodynamically unstable pts, minimizes rapid shifts in volume and osmolality

Front 846

advantage/disadvantage of hemodialysis

Back 846

more efficient, less time needed, but less similar to kidney physiology, which can lead to hypotension and hypoosmolality

Front 847

advantage/disadvantage of PD

Back 847

natural kidney physiology, but high glucose load, peritonitis

Front 848

types of proteinuria

Back 848

glomerular, tubular, overflow (eg bence jones)

Front 849

what is definition of proteinuria

Back 849

>150mg/day

Front 850

level of proteinuria in nephrotic syndrome

Back 850

>3.5g /day

Front 851

why is there hyperlipidemia in nephrotic syndrome

Back 851

generalized increased hepatic synthesis

Front 852

what is urine dipstick able to detect in level of protein

Back 852

1+ = 15-30

Front 853

is urine dipstick able to detect all types of urine protein equally

Back 853

no. more sensitive to albumins

Front 854

best test to detect chronic pyelo

Back 854

ivp

Front 855

what health maintenance item required for chronic proteinuria

Back 855

vaccination (pneumo, flu)

Front 856

definition of hematuria

Back 856

>3 rbcs/hpf

Front 857

what type of hematuria most associated with glomerular dz

Back 857

microscopic, usually not gross

Front 858

workup hematuria

Back 858

urine dipstick & UA (look for sediment/casts), cytology, blood tests, ivp/ct/us

Front 859

classic sx of nephritis syndrome

Back 859

hematuria, htn, azotemia

Front 860

associations with minimal change dz

Back 860

hodgekins and nonhodgekins

Front 861

mcc of glomerular hematuria

Back 861

berger's dz, aka iga nephropathy

Front 862

what proteins are deposited in berger's dz

Back 862

iga, c3. rmr berger's dz is iga nephropathy

Front 863

mcc of membranoproliferative glomerulonephritis

Back 863

hcv>hbv, syphilis, lupus

Front 864

association with membranoproliferative

Back 864

cryoglobulinemia

Front 865

how long does glomerulonephritis take to develop after infection with gas

Back 865

2w

Front 866

lung dz vs kidney dz time course in goodpasture

Back 866

lung dz occurs earlier

Front 867

what type of histopathology in hiv nephropathy. tx?

Back 867

like fsgs. prednisone, acei, arv

Front 868

3 causes of acute interstitial nephritis

Back 868

drug allergy (penicillin, diuretic, nsaid, anticoagulation, pheyny, sulfa), infection, collagen vascular dz

Front 869

dx of acute interstitial nephritis

Back 869

eosinophils in urine

Front 870

acute vs chronic intersitital nephritis

Back 870

acute has rapid decline in renal fcn. chronic has an indolent course with slow fibrosis and atrophy

Front 871

causes of chronic interstitial nephritis

Back 871

chronic obstruction, chronic analgesic, arteriolar nephrosclerosis (htn), heavy metal exposure

Front 872

do you see eosinophils in chronic interstitial nephritis

Back 872

no

Front 873

causes of renal papillary necrosis

Back 873

analgesic, dm, sickle cell, transplant rejection, obstruction

Front 874

what type of metabolic d/o with rta

Back 874

nonanion gap hyperchloremic metabolic acidosis

Front 875

what is type 1 rta, causes, effects on electrolytes. tx

Back 875

can't secrete h+ at distal tubule, due to kidney dmg or systemic dz. all ions secreted (na, ca, k, po4)... so can get hypokalemia and renal stones. tx = bicarb, which also helps stones

Front 876

what is type 2 rta. causes. electrolyte effects. tx

Back 876

can't absorb bicarb at pct. fanconi, kidney dmg. hypokalemia. sodium restriction (will cause increased bicarb reabsorption)

Front 877

what is type 4 rta. cause. electrolyte effects.

Back 877

hypoaldosteroneism .. so increased acid and k+. cause is interstitial dz and dm.

Front 878

what is hartnup dz, sx?

Back 878

can't absorb neutral amino acids ... so similar sx to pellagra (dermatitis, diarrhea, dementia)

Front 879

associated findings with adpkd

Back 879

berry aneurysm, valvular dz, abdominal hernias, cysts in other organs

Front 880

what antihypertensive to avoid in renovascular htn

Back 880

acei

Front 881

is magnetic dye in mra nephrotoxic

Back 881

no

Front 882

what test can be used to dx renal artery stenosis if renal fcn is good? if not?

Back 882

renal arteriogram, captopril renal scintigram (not invasive). mra

Front 883

dx test for renal vein thrombosis

Back 883

selective renal venography, ivp

Front 884

what is nephrosclerosis

Back 884

thickening of glomerual afferent arterioles due to htn

Front 885

can nephrosclerosis be acute problem

Back 885

can cause malignant dz

Front 886

tx for nephrosclerosis

Back 886

control bp

Front 887

how to tx sickle cell nephropathy

Back 887

control sickle cell, acei

Front 888

most common locations of nephrolithaisis

Back 888

ureterovesicular jcn, calyx, ureteropelvic jcn, pelvic brim

Front 889

what types of stones are radiolucent

Back 889

uric acid stones

Front 890

what size kidney stones can pass sponteeously

Back 890

<.5cm

Front 891

what are causes of hyperoxaluria

Back 891

severe steatorrhea, small bowel dz, pyridoxine deficiency

Front 892

hematuria + pyuria with kidney stone

Back 892

comorbid infection

Front 893

workup for kidney stone

Back 893

UA (look for coexisting infection and low pH maybe uric acid stone, high pH maybe struvite), 24-hr urine (what type of stone), serum chemistry (electrolytes can hint at what type of stone), KUB, ct

Front 894

when would you need to admit pt for nephrolithiasis

Back 894

intractable pain, anuria, renal colic + UTI/fever, large stone

Front 895

surgical options for kidney stone

Back 895

extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy

Front 896

lower vs upper urinary tract obstruction

Back 896

lower affects urination, upper causes renal colic

Front 897

causes of lower urinary tract obstruction

Back 897

BPH, stricture, neurogenic bladder, bladder cancer

Front 898

causes of upper urinary tract obstruction

Back 898

intrinsic causes like stones, clots, crystal deposits, strictures, or extrinsic like pregnancy, AAA, endometriosis, IBD, etc

Front 899

workup for urinary obstruction

Back 899

us, ua/labs, kub, ivp, voiding cysurethrography, cystoscopy, ct

Front 900

risk factors for prostate cancer

Back 900

age, bllack, fatty diet, famhx, chemical exposure

Front 901

indications for prostate biopsy

Back 901

psa >10, psa velocity >.75, dre

Front 902

tx for prostate cancer

Back 902

if localized -- radical prostatectomy. if locally invasive, radiation + androgen deprivation. metastasis -- severe androgen reduction (orchiectomy, antiandrogen, leuprolide)

Front 903

prognosis of bladder cancer

Back 903

high recurrence

Front 904

how does bladder cancer spread

Back 904

local extension

Front 905

initial presenting sx of bladder cancer

Back 905

painless hematuria

Front 906

dx for bladder cancer

Back 906

ua/uc (r/o infection), urine cytology, ivp, CYSTOSCOPY, cxr/ct (tumor hunting)

Front 907

tx for bladder cancer

Back 907

if CIS, intravescle chemo. if involves lamina propria, TUR. if muscle invasion, radical cystectomy+lymph nodes+removal of surrounding. if met -- cystectomy + chemo

Front 908

why is it important to be careful with pe for scrotal mass

Back 908

testicular cancers are almost always maligant, extratesticular scrotal cancers almost always benign

Front 909

afp and what type of testicular tumor

Back 909

embryonal tumors

Front 910

staging of testicular tumor

Back 910

a = confined. b = lymph nodes below diaphragm. c = met

Front 911

by when does infarction occur in testicular torsion

Back 911

6h

Front 912

tx for testicular torsion

Back 912

urgent bilateral orchiopexy

Front 913

cause of epidydimits

Back 913

ecoli in age extremes, stds in young males.

Front 914

what are the sizes of the fluid compartments

Back 914

60-40-20. 1/4 of ECF is plasma.

Front 915

normal i/o's

Back 915

input: 1500 fluids, 500 solids/metabolism
output: minimum 500 urine, 250 stool, 600 minimum insensible

Front 916

what is normal hourly urine output

Back 916

>1mL/kg/hr

Front 917

is D5W good at maintaining intravascular volume? LR?

Back 917

no (11/12 diffuses into TBW). yes

Front 918

can you use LR in pt with potential hyperkalemia

Back 918

no

Front 919

how does hct change with hypovolemia

Back 919

3% increase for every liter of deficit

Front 920

how to use crystalloid solution to replace fluids

Back 920

3 times as much blood lost to replace intravascular compartment

Front 921

why is dextrose added to maintenance fluids

Back 921

to inhibit muscle breadown

Front 922

tx for hypervolemia

Back 922

fluid restriction, diuretics

Front 923

2 homeostatic mechanisms to regulate water

Back 923

osmoreceptors in hypothalamus cause thirst when >295mosm. posterior pituitary gland secretes adh.

Front 924

what is hyponatremia (definition)

Back 924

<135

Front 925

hypotonic vs isotonic vs hypertonic hyponatremia

Back 925

hypotonic = "true hyponatremia". isotonic = pseudohyponatremia (lab error caused by lipids/protein/etc). hypertonic = osmoactive substances causes dilution.

Front 926

causes of hypotonic hyponatremia

Back 926

can be hypovolemic (if low urine sodium, kidneys trying to conserve sodium for extrarenal losses. if high, then renal loss), euvolemic, hypervolemic (water retaining states).

Front 927

causes of euvolemic hypotonic hyponatremia

Back 927

siadh, psychogenic polydipsia, postop, hypothyroid, haldol/cyclophosphamide/antineoplastics

Front 928

how does hyponatremia cause neurologic sx

Back 928

causes increased icf volume --> icp

Front 929

3 dx for hyponatremia

Back 929

plasma osmolality, urine osmolality, urine sodium

Front 930

how to tx hyponatremia

Back 930

if isotonic or hypertonic, tx the underlying d/o. if hypotonic, then if mild -- withhold free water. if moderate, give looops. if severe, give hypertonic soln to increase serum sodium by 1-2meq/L/hr

Front 931

causes of hypernatremia

Back 931

hypovolemic = extrarenal loss of water, renal loss of water > sodium. isovolemic = di/insensible. hypervolemic = iatrogenic, cushing, hyperaldosterone

Front 932

max rate of correction for hypernatremia

Back 932

12meq/L/day

Front 933

how to workup hypernatremia

Back 933

check kidneys (low urine volume and urine osmol > 800), try desmopressin challenge to see if DI suspected

Front 934

how to tx hypernatremia

Back 934

for hypovolemic -- give nacl. if isovolemic -- give fluids, adh if di. hypervolemic -- give diuretics.

Front 935

how can you calculate the water deficit

Back 935

tbw * (1 - actual na/desired na)

Front 936

how can you estimate ionized calcium

Back 936

total calcium - .8 * albumin

Front 937

why can hypomagnesium result in hypocalcemia

Back 937

cuz decreased mg causes less pth

Front 938

ekg changes of hyper vs hypocalcemia

Back 938

qt shorten vs qt prolonged

Front 939

how to tx hypercalcemia

Back 939

increase urine (fluids and diuretics), inhibit bone resorption (bisphosophates, calcitonin)

Front 940

what is effective for tx of hypercalcemia from vitamin D related issues

Back 940

glucocorticoids

Front 941

what is the only cause of hypokalemia that also causes htn

Back 941

hypoaldosterone

Front 942

sx of hypokalemia

Back 942

arrythmia w/ twave inversion, muscle weakness, decreased dtrs, decreased gi motility, nv

Front 943

how to replace k+

Back 943

oral is safest -- 10meq increases by .1meq/L. if potassium <2.5, can do IV (mas 10meq/hr peripheral, 20meq/hr in central)

Front 944

watch out for what drug when potassium is low

Back 944

dig

Front 945

sx of hyperkalemia

Back 945

arrythmia (peaked t wave, prolonged pr, wide qrs), muscle weakness, decreased dtr, respiratory failure

Front 946

why might k+ be falsely elevated

Back 946

venipucture injury releases k+ from cells (ie prolonged use of torniquet)

Front 947

tx for hyperkalemia

Back 947

give IV calcium (to stabilize mycardial excitability), glucose, insulin and bicarb (all move k+ into cells), kayexalate (k+ binder), dialysis

Front 948

causes of hypomagnesium

Back 948

gi problems, alcohol, renal

Front 949

ekg changes of hypomagnesium

Back 949

prolonged qt, t wave flattening, torsades

Front 950

causes of hypermag

Back 950

renal fail,

Front 951

what can be given for mg tox

Back 951

calcium gluconate

Front 952

ekg changes of hypermag

Back 952

similar to hyperkalemia (wide qrs, elevated t, increased pr)

Front 953

causes of hypophosphatemia

Back 953

GI (absorption, malnutrition), increased renal excretion (incl hyperglycemia)

Front 954

causes of hyperphosphatemia

Back 954

renal failure (decreased excretion), bisphosphanates, rhabdo

Front 955

how to tx hyperphosphate

Back 955

phosphate binding antacid (aloh)

Front 956

bicarb in serum chemistry vs abg

Back 956

bicarb in abg is calculated so less reliable

Front 957

why is respiratory + metabolic acidosis bad

Back 957

sx of impending respiratory failure

Front 958

ecf contraction vs expansion in metabolic alkalosis

Back 958

ecf contraction is sensitive to saline, urine cl <10. ecf expansion has htn, urine cl >20.

Front 959

2 main determinents of paco2

Back 959

respiratory rate, tidal volume

Front 960

how does 1 unit of packed rbcs affect hgb

Back 960

raises by 1, raises hct by 3

Front 961

when might a hgb of 7 or 8 not be well tolerated

Back 961

impaired cardiac fcn

Front 962

what is cryoprecipitate

Back 962

contains factor 8 and fibrinogen (for hemophilia & vwd)

Front 963

effect of 1 unit of plts

Back 963

raises plt by 10000

Front 964

what 3 groups of ppl have increased iron requirements

Back 964

infants, adolescents, pregnants

Front 965

how to dx beta thalassemia

Back 965

elevated hbf on electrophoresis, microcytic hypochemoia on pbs

Front 966

what is hbh dz

Back 966

mutation/deletion of 3 alpha loci

Front 967

causes of sideroblastic anemia

Back 967

drugs (chloarmphenicol, inh, alcohol), lead, collagen vascular dz, neoplasm

Front 968

how to do shillings test

Back 968

give unlabeled b12 IM to saturate. then give labeled b12 PO, then measure in urine. then give intrinsic factor andsee if that changes anything

Front 969

extravascular vs intravascular hemolysis: haptoglobin

Back 969

lower in intravascular

Front 970

most common clinical manifestation of sickle cell

Back 970

painful crisis of bone (bone infarct)

Front 971

what is splenic sequestration crisis

Back 971

seen in sickle cell with sudden pooling of blood into spleen resulting in hypovolemia and splenomegaly

Front 972

prophylaxis for sickle cell

Back 972

AVOID high altitude, dehydration, TREAT infections aggressively, do penicillin prophylaxis for children until 6yo, folic acid supplements, hydroxurea

Front 973

tx for hereditary spherocytosis

Back 973

splenectomy

Front 974

what dz has bite cells and heinz bodies

Back 974

g6pd. heinz bodies are hgb precip and bite cells result after removal

Front 975

ab in warm vs cold autoimmune hemolytic anemia

Back 975

igg vs igm

Front 976

type of hemolysis in warm vs cold autoimmune

Back 976

extravascular (digested by splenic macrophages) vs intravascular (complement mediated destruction)

Front 977

causes of warm autoimmune hemolysis

Back 977

lymphoma/leukemia(cll), collagen vascular dz, drugs (methyldopa)

Front 978

ab in warm vs cold autoimmune hemolytic anemia

Back 978

igg vs igm

Front 979

how to dx autoimmune hemolysis

Back 979

direct coombs --- if igg then warm, if complement then cold.

Front 980

type of hemolysis in warm vs cold autoimmune

Back 980

extravascular (digested by splenic macrophages) vs intravascular (complement mediated destruction)

Front 981

tx for warm hemolysis

Back 981

glucocorticoids, other imunosppression

Front 982

causes of warm autoimmune hemolysis

Back 982

lymphoma/leukemia(cll), collagen vascular dz, drugs (methyldopa)

Front 983

how to dx autoimmune hemolysis

Back 983

direct coombs --- if igg then warm, if complement then cold.

Front 984

tx for warm hemolysis

Back 984

glucocorticoids, other imunosppression

Front 985

mutated proteins in pnh

Back 985

cd55,59

Front 986

dx for pnh

Back 986

ham's test (put into acid which causes lysis), sugar water test, flow cytometry

Front 987

what type of hemolysis in pnh

Back 987

intravascular

Front 988

definition of thrombocytopenia

Back 988

<150k

Front 989

HIT type 1 vs type 2

Back 989

aggretation <48h after initiation vs 3-12 days. type 1 don't do anything, type 2 stop heparin

Front 990

when do you run risk of bleeding during surgery/ trauma? minor spontaneous? major spontaneous?

Back 990

<50000. <20000. <5000

Front 991

cause of ttp

Back 991

unknown but platelet thrombi occlude small vessels and cause dmg to rbcs

Front 992

5 sx of ttp

Back 992

hemolytic anemia + thrombocytopenia + renal failure + fever + fluctuating neurologic sx

Front 993

how is ttp different from hus

Back 993

ttp tends to have fever and altered mental status

Front 994

tx for ttp

Back 994

plasmapharesis, cs. DONT DO PLT TRANFUSION

Front 995

what proteins affected in bernard soulier vs glanzmann

Back 995

gp1b, gp2b

Front 996

bleeding study results of bernard soulier vs glanzmann

Back 996

bernard has low but large platelets. glanzmann has high bleeding time, but normal plt

Front 997

what is factor VIII antigenic protein

Back 997

vWF

Front 998

how to dx vWF deficiency

Back 998

prolonged bleeding time, decreased plasma vWF, reduced ristocetin induced platelet aggregation

Front 999

what metabolic condition can cause impaired platelet fcn

Back 999

uremia

Front 1000

tx for vWD deficiency

Back 1000

DDAVP, factor VIII concentrate, don't give cryoprecipitate (viral risk)

Front 1001

joint problems in hemophiliacs

Back 1001

joint destruction

Front 1002

how severe is hemophilia A usually

Back 1002

usually severe (<1% of normal levels of 8)

Front 1003

can you use DDAVP for hemophilia

Back 1003

mildly useful in hemophilia A only

Front 1004

PT, PTT, PLT, fibrinogen levels in vitamin k deficiency

Back 1004

only PT prolonged

Front 1005

what can be done as supportive tx for dic

Back 1005

use FFP/cryoprecipitate to replace clotting factors, PLT transfusion. o2, ivf to maintain bp and renal perfusion. may use heparin if lots of thrombosis

Front 1006

which clotting factor has the shortest half life

Back 1006

VII

Front 1007

which clotting factor is not produced by liver

Back 1007

vWF

Front 1008

why does coagulopathy develop in liver failure

Back 1008

decreased synthesis of clotting factors, cholestasis prevents vitamin K absorption, hypersplenism causes thrombocytopenia

Front 1009

is antiphospholipid syndrome arterial or venous thromobisis

Back 1009

both

Front 1010

what does protein S bind to

Back 1010

protein C

Front 1011

how is standard heparin given

Back 1011

therapy: bolus of 80 U/kg then 15 U/kg/hr infusion
prophylaxis: 5000 U subcut q12h

Front 1012

when is the only situation heparin is given as prophylaxis

Back 1012

for DVT

Front 1013

what anticoagulation drug has risk of alopecia and rebound hypercoagulability

Back 1013

heparin

Front 1014

mechanism of LMWH

Back 1014

mostly inhibition of Xa

Front 1015

what to do if severe bleeding with heparin or warfarin

Back 1015

FFP

Front 1016

how long does warfarin take to reach therapeutic levels

Back 1016

4 days

Front 1017

hematological abnormalities in MM

Back 1017

pancytopenia

Front 1018

electrolyte abnormalities in MM, why

Back 1018

hypercalcemia, bone destruction

Front 1019

how many plasma cells must be abnormal to dx MM

Back 1019

10%

Front 1020

how long does it take to correct warfarin OD with vit K

Back 1020

4-10h

Front 1021

are there bone lesions in waldenstrom

Back 1021

no

Front 1022

cutoff of immunoglobulins to call it MGUS

Back 1022

IgG spike < 3.5g, <10% abnormal plasma cells in BM; bence jones proteinuria <1g/day

Front 1023

ann arbor staging of hodgekins

Back 1023

stage 1 = 1 lymph node. 2 = same side diaphragm. 3 == boxth sides of diaphragm.
B = constitutional sx

Front 1024

other than rs cells, what histological characteristic of hodgekins that sets it appart from nhl

Back 1024

inflammatory cells reacting to rs cells

Front 1025

what types of hodgekins require chemo

Back 1025

3b,4

Front 1026

staging system of nhl vs hodgekins

Back 1026

same

Front 1027

what types of autoimmune dz may increase risk of nhl

Back 1027

hashimoto, sjogren

Front 1028

most common type of nhl

Back 1028

follicular

Front 1029

grade of small lymphocytic lymphoma vs follicular vs diffuse large cell vs lymphoblastic vs burkitt

Back 1029

2x indolent, intermediate, high grade

Front 1030

what type of cells are involved in lymphoblastic lymphoma

Back 1030

t cells

Front 1031

which type of lymphoma usually presents as large extranodal mass

Back 1031

diffuse large b cell

Front 1032

what test may help to gauge tumor burden for lymphoma

Back 1032

ldh, b2 microglobulin

Front 1033

low grade vs high grade lymphoma: cure vs survival

Back 1033

high grade have higher rates of cure but less survival w/o tx

Front 1034

what is CHOP therapy

Back 1034

cyclophosphamide, hydroxydaunomycin (doxorubicin), oncovin (vincristine), prednisone

Front 1035

most common malignancy in children under 15

Back 1035

ALL

Front 1036

poor prognostic indicators for ALL

Back 1036

age <2 or >9, wbc >100000, cns involvement (b cell phenotype, lots of LDH, rapid proliferation)

Front 1037

which type of leukemia tends to have testicular involvement

Back 1037

ALL

Front 1038

which type of leukemia tends to have skin nodules

Back 1038

AML

Front 1039

prognosis of ALL

Back 1039

75% children get complete remission.

Front 1040

what leukemia has smudge cells

Back 1040

cLL

Front 1041

which leukemia is most at risk of blast crisis

Back 1041

CML

Front 1042

leukemoid rxn vs CML

Back 1042

leukemoid rxn: no splenomeglay, increased LAP, hx of precipitating event like infection

Front 1043

tx for CML

Back 1043

chemo to control sx before blast crisis. hard to prevent it

Front 1044

tx for CLL

Back 1044

symptomatic tx with chemo

Front 1045

dx for polycythemia vera

Back 1045

major (need all, or 2 with 2 minor) elevated RBC (>36 in men, >32 in women), o2 sat >92, splenomegaly.
minor: thrombocytosis, leukocytosis, LAP>100, B12 >900

Front 1046

2 main life threatening features of polycythemia vera

Back 1046

thrombotic phenomena, bleeding

Front 1047

peripheral blood smear of myelodysplastic syndrome

Back 1047

low reticulocyte, howell-jolly/basophilic stippling

Front 1048

what is erythromelalgia

Back 1048

burning pain and erythema of extremties due to occlusions

Front 1049

whats anagrelide

Back 1049

antiplatelet agent

Front 1050

prognosis of myelodysplastic

Back 1050

oft progress to acute leukemia

Front 1051

prognosis of agnogenic myeloid metaplasia

Back 1051

AML, death from bleeding/infection

Front 1052

mc organisms cap

Back 1052

s pneumo, hi, aerobic gnrs (klebs, enterobacteria

Front 1053

how do you differentiate b/w pneumonia and acute bronchitis

Back 1053

clinical features (cough, sputum, fever, dyspnea) not great. do CXR

Front 1054

what is pulse temperature disassociation commonly seen in

Back 1054

atypical cAP

Front 1055

likelihood of pneumonia in outpt with normal vs

Back 1055

<1%

Front 1056

how do you know if a sputum sample collection is good

Back 1056

>25 pmns, <10 epithelial cells per low power field

Front 1057

what to order on sputum taken for pneumonia

Back 1057

gram stain in all pts, culture in all pts needing hospital, if suspect hiv, then do silver stain. if suspect tb, then do acid fast

Front 1058

why is sputum studies helpful in pneumonia

Back 1058

cuz may identify resistance

Front 1059

first line tx for cap <60yo? older?

Back 1059

macrolide, doxy. 2nd/3rd gen ceph, fluoroquinolone.

Front 1060

when do you tx parapneumonic effusion? how do you analyze fluid?

Back 1060

>1cm effusion on lateral decubitus film. gram stain, culture, ph, cell count, determine glucose, protein, ldh

Front 1061

what is main risk factor for lung abscess

Back 1061

predisposition to aspiration, poor dental hygeine

Front 1062

what bacteria must be covered for in lung abscess

Back 1062

gpc (penicillin, or vanc if mrsa), anaerobes (clinda/metro). if you think gnr, then add quinolone

Front 1063

primary vs secondary tb

Back 1063

secondary = reactivation

Front 1064

what is progressive primary TB

Back 1064

incomplete immune response leads to symptoms of TB during primary phase

Front 1065

ghon's complex vs ranke's complex. what do both indicate

Back 1065

calcified primary focus vs calcified primary focus + calcified hilar lymph node. healed primary tb

Front 1066

how long does culture of tb take

Back 1066

4-8w

Front 1067

what induration of ppd is positive

Back 1067

>15mm, >5 if hiv or if close contact with active tb pt

Front 1068

first line tx for active tb

Back 1068

inh + rifampin + pyranzimide + ethambutol/streptomycin x2 months, then inh+rifampin x4months

Front 1069

prophylaxis for latent tb

Back 1069

9 mo inh

Front 1070

what URI sx does flu present with

Back 1070

fever, nonproductive cough, sore throat

Front 1071

brudzinski's sx vs kerning

Back 1071

flexing neck causes reflex flexion of legs. vs inability to extend knees when supine and hips flexed.

Front 1072

what to do if suspected meningitis and focal neurological deficits, why?

Back 1072

ct cuz there might be a space occupying lesion

Front 1073

nl csf findings: wbc coung, glucose, protein

Back 1073

<5, 50-75, <60

Front 1074

empiric tx for acute bacterial meningitis, what organisms?

Back 1074

infant = gbc/ecoli/listeria = cefotaxime+ampicillin
<50yr=neisseria/pneumo/hi=ceftriaxone+vanc
>50yr=pneumo/neisseria/listeria=ceftriaxone+amp+vanc
if IC, then do 4g ceph instead to cover pseudomonas

Front 1075

workup for encephalitis

Back 1075

1. r/o nonviral causes -- cxr, urine/blood cultures, UDS, chemistries, LP w/ PCR, MRI

Front 1076

organisms that cause brain abscess

Back 1076

strep (sinusitus), saureus (trauma, postop), anaerobes (OM, COPD)

Front 1077

what infectious dz is polyarteritis nodosa assoc w

Back 1077

hbv

Front 1078

utility of hbv viral load

Back 1078

if persists for >6w, likely to develop chronic dz

Front 1079

if someone has hepatitis sx, and hbv is positive and then sx resolves, is repeat testing necessary

Back 1079

yes hdv may be missing in acute illness

Front 1080

progression to chronic state in hbv vs hcv

Back 1080

10% vs 90%

Front 1081

risk of developing cirrhosis/hcc in chronic hbv vs hcv

Back 1081

30% vs 15%

Front 1082

tx of chronic hbv vs hcv

Back 1082

ifn-alpha or 3tc vs ifn-alpha+ribavirin

Front 1083

how does botulism start

Back 1083

dry mouth, diplopia, dysarthria

Front 1084

how to dx botulinum

Back 1084

toxin in serum or stool

Front 1085

causes of intraabdominal abscess

Back 1085

spontaneous bacterial peritonitis, pelvic infection, pancreatitis, GI perforation, osteomyelitis of vertebral bodies

Front 1086

when might you suspect midstream clean catch might be contaminated

Back 1086

epithelial cells

Front 1087

what tests to get for UTI

Back 1087

dipstick, UA, urine gram stain, urine culture

Front 1088

what is phenazopyridine

Back 1088

urinary analgesic

Front 1089

tx options for UTI

Back 1089

bactrim, cipro, metro

Front 1090

how to tx pregnant lady with uti

Back 1090

amp/amox/ceph x7-10d

Front 1091

what is recurrent infection uti? how to prophylax

Back 1091

>2uti/yr. single dose tmp/smx after intercourse or after sx, or do 6mo prophylax

Front 1092

how to tx pyelo

Back 1092

if uncomplicated, tx based on gram stain. bactrim/cipro for gnrs. amox for gpc.

Front 1093

what is complicated pyelo

Back 1093

pyelo due to functional or structural problems of tract. these groups assumed to have complicated: men, elderly, renal dz, dm, ic

Front 1094

what do you do if no response to uncomplicated pyelo

Back 1094

perform urologic investigation for functional/structural causes

Front 1095

how long do you tx pyelo in hospital

Back 1095

broad spec (amp+gent/cipro) until pt is afebrile, then oral ab until 14-21day course

Front 1096

organisms behind acute prostatitis

Back 1096

gn

Front 1097

when should you dre for suspected prostatitis

Back 1097

avoid in straightforward cases of acute bacterial prostatitis cuz of risk for bacteremia

Front 1098

tx for prostatitis

Back 1098

if mild can use bactrim + fluoro/doxy

Front 1099

mcc reiters

Back 1099

chlamydia

Front 1100

men or women more likely to have sx with chlamydia? gc?

Back 1100

men > women both

Front 1101

what is seen on gram stain with gc

Back 1101

urethral dc shows organisms within leukocytes

Front 1102

how long doxy given for std

Back 1102

7d

Front 1103

monitoring for hiv

Back 1103

cd4 count, viral load (rna) q3-4mo. if viral load >50 after 4mo therapy, reconsider modification of tx

Front 1104

what cd4 count with aids? is this only way to dx

Back 1104

<200. but dx can also dx with aids defining infection

Front 1105

when do you start arv for hiv

Back 1105

if symptomatic or if cd4<500

Front 1106

what is haart

Back 1106

2 nrti's + nnrti/pi

Front 1107

leading cause of death in aids pts

Back 1107

pcp

Front 1108

what cd4 count do you see cmv? mac?

Back 1108

<50

Front 1109

what cd4 is candida seen

Back 1109

<100

Front 1110

what is hiv wasting syndrome

Back 1110

loss of >10% tbw + chronic diarrhea/fever&weakness

Front 1111

hiv prophylaxis -- organism, cd4, and tx

Back 1111

pcp, <200, bactrim. tb, yrly ppd, inh+pyridoxine. mac, <100, azithromycin. toxo, <100, bactrim.

Front 1112

how often to do pneumovax in ic

Back 1112

q5-6y

Front 1113

complications of neonatal hsv

Back 1113

congenital malformation, iugr, chorio, death

Front 1114

what is herpetic whitlow

Back 1114

painful vesicular hsv infection of finger

Front 1115

what is paronychia

Back 1115

infection of skin around cuticle

Front 1116

how long after exposure does syphilitic chancre take

Back 1116

3-4w

Front 1117

mc presentation of 2* syphilis

Back 1117

maculopapular rash

Front 1118

appearance of ulcer in chancroid vs chancre vs granuloma inguinale

Back 1118

chancre is clean raised ulcer. chancroid is shaggy and purulent. GI is coalescing ulcers and nodules

Front 1119

what stds may produce painful inguinal lymphadenoapthy

Back 1119

herpes, chancroid, LV

Front 1120

what is definitive test for syphilis

Back 1120

darkfield microscopy

Front 1121

how to dx syphilis

Back 1121

vdrl/rpr then confirm with fta abs

Front 1122

how to dx chancroid

Back 1122

clinically. r/o syphilis, hsv

Front 1123

is the ulcer produced by LV painful or painless

Back 1123

painless

Front 1124

tx for chancroid

Back 1124

azithromycin, ceftriaxone, or azithromycin

Front 1125

tx for LV

Back 1125

doxy x 21d

Front 1126

mcc cellulitis

Back 1126

saureus, gas

Front 1127

cellulitis: mc bacteria ssociated with -- local trauma, wound/abscess, immersion in water, acute sinusitis

Back 1127

gas, saureus, pseudo/aeromonas/vibrio, hi

Front 1128

when do you get cultures for cellulitis

Back 1128

blood culture if fever, tissue culture if wound

Front 1129

when is cellulitis emergent

Back 1129

orbital involvement

Front 1130

tx for cellulitis

Back 1130

based on hx. can use antistaph pen, or cephalosporin

Front 1131

what is erysipelas

Back 1131

cellulitis confined to dermis and lymphatics caused by gas.

Front 1132

mcc nectrotizing fasciitis

Back 1132

gas, c perfringens

Front 1133

what is lymphadenitis

Back 1133

inflammation of lymph node caused by skin or soft tissue bacterial infection

Front 1134

what is trismus

Back 1134

lockjaw, oft seen in tetanus

Front 1135

how long after infection does tetanus take to occur

Back 1135

1-7d

Front 1136

when do intervene with antitetanus for clean minor wounds? other wounds?

Back 1136

clean: use Td only if <4 doses of Td in past. other: use both Td and TIG if not had >3 doses of Td in past

Front 1137

what types of wounds are at risk for tetanus

Back 1137

if not clean (contamination w dirt/feces/saliva)
if major (deep puncture)

Front 1138

mc type of osteomyleitis in prosthetic joint

Back 1138

coag neg staph

Front 1139

mc type osteomyelitis in diabetic foot

Back 1139

polymicrobial

Front 1140

what is risus sardonicus

Back 1140

grin due to forced contraction of facial mm (tetanus)

Front 1141

what is opisthotonus

Back 1141

arched back (tetanus)

Front 1142

mc osteomyelitis

Back 1142

saeurs, coag neg staph

Front 1143

mc finding in osteomyletis

Back 1143

tenderness over bone

Front 1144

use of esr/crp in osteomyeltis

Back 1144

monitor response to therapy

Front 1145

how long to see xr changes in osteomyelitis? what are they?

Back 1145

periosteal reaction takes 10d

Front 1146

gold std dx for osteomyelitis

Back 1146

needle aspiration of infected bone

Front 1147

empiric tx for osteomylitis

Back 1147

antistaph pen, 1g ceph. add aminoglycoside for gnr

Front 1148

causes of infectious arthritis

Back 1148

hematogenous spread is mc, local extension, trauma, iatrogenic after procedure

Front 1149

mc organisms of acute bacterial artheritis

Back 1149

saureus, then strep.

Front 1150

what organisms seen in arthritis in pt with sickle cell? IC? iv drugs?

Back 1150

pseud, salmonella

Front 1151

what studies should be run on aspirated joint fluid for suspected septic joint

Back 1151

cytology w differential, gm stain, culture, PCR, crystal studies if possible

Front 1152

how is septic arthropathy tx'd

Back 1152

if healthy adult -- antistaph pen or 1g ceph x4w. if sexually active young adult, 3g ceph until clinical improve, then switch to gnr coverage cipro x10d. if IC, use broad spec (glycoside/3g ceph) x3-4w

Front 1153

3 areas of lyme dz in u s

Back 1153

NE, north central, west coast

Front 1154

most common sx of stage 2 lyme

Back 1154

flu/mono prodrome,

Front 1155

dx for lyme dz

Back 1155

ELISA then western blot. unless you see erythema migrans in endemic area

Front 1156

complications of stage 3 lyme

Back 1156

arthritis, chronic cns dz, acrodermatitis chronica (red plaques and nodules on extensor leg)

Front 1157

tx for lyme

Back 1157

if stage 1 and localized to skin only, 10d doxy. if spread beyond, 20-30d. can use macrolide and amox.

Front 1158

tx for rmsf

Back 1158

7d doxy, or chloarmphenicol if CNS sx or pregnant

Front 1159

dx of malaria

Back 1159

blood smear w/ giemsa stain

Front 1160

sx of rabies

Back 1160

bite pain -> prodrome -> encephalitis -> hydrophobia -> paralysis

Front 1161

tx for rabies

Back 1161

wound cleaning, capture animal and send brain for analysis or if animal is not suspicious then observe it for 10d, give both ig (in butt and wound) and vaccine (in arm or thigh)

Front 1162

organs affected in severe leptospirosis

Back 1162

renal/liver fail

Front 1163

what things carry leptospirosis

Back 1163

rodents, farm animals

Front 1164

tx for oral candida

Back 1164

clotrimazole troche 5x/d, nystatin swish and swallow

Front 1165

tx for vaginal candida

Back 1165

miconazole/clotrimazole

Front 1166

what is invasive aspergillosis. who at risk

Back 1166

when fungus invade lung vasculature and cause thrombosis. IC

Front 1167

3 types of aspergillus. dx of aspergillus

Back 1167

allergic, aspergilloma, invasive. cxr (pulmonary consoidation), sputum.

Front 1168

tx of aspergillus

Back 1168

if allergic, avoid exposure. if aspergilloma, and if having hemoptysis may need lobectomy. invasive, need amphotericin

Front 1169

presentation of cryptococcus

Back 1169

cns dz, maybe pulmonary

Front 1170

dx of cryptococcus

Back 1170

latex agglutination and india ink on csf

Front 1171

sx of histo, how u get?

Back 1171

flu like sx, erythema nodosum, hsm, bat/bird drop in ohio/mississippi river

Front 1172

how is crytosporidiosis usually spread

Back 1172

feco oral

Front 1173

what parasite may cause bloody diarrhea, tenesmus, abdominal pain, liver

Back 1173

entamoeba

Front 1174

classic definition of fever of unknown origin

Back 1174

fever >101f, >3w, no dx with 1 week of intensive workup

Front 1175

hyperthermia vs fever

Back 1175

hyperthermia is elevation in temp not caused by hypothalamus, usually due to inability to dissipate heat. therefore antipyretics does not work

Front 1176

when is it important to tx fever

Back 1176

temp >105, pregnancy, cardiopulmonary dz

Front 1177

definition of toxic shock syndrome

Back 1177

needs involvement of 3 organ systems

Front 1178

risk factors for catheter related sepsis

Back 1178

emergent placement, femoral line, prolonged indwelling

Front 1179

do people with catheter sepsis have evidence at site of insertion

Back 1179

only 50%

Front 1180

what is definition of neutropenia

Back 1180

anc <1500, with <500 leading to severely high risk of infection

Front 1181

what to order for neutropenic pt with fever

Back 1181

cxr, culture of everything, cbc, cmp

Front 1182

most common physical sx in ebv

Back 1182

lymphadenopathy, esp of tonsillar and post cervical

Front 1183

whiteheads vs blackheads

Back 1183

closed vs open

Front 1184

mechanism of benzoyl peroxide

Back 1184

drys skin (prevents pore clogging), kills bacteria

Front 1185

mechanism of topical retinoids

Back 1185

cause peeling of skin (prevents pore clogging)

Front 1186

tx for mild to moderate acne vs severe

Back 1186

for severe, do systemic ab and if no response do oral retinoids

Front 1187

difference b/w acne vulgaris and rosacea

Back 1187

1. older population (30-50yo) 2. no comedones 3. can cause rhinophyma (thickened greasy nose)

Front 1188

tx for rocacea

Back 1188

1. avoid alcoholic, hot beverages, reduce stress, avoid extreme temp 2. topical metronidazole

Front 1189

sx of seborrheic dermatotis

Back 1189

scaly pathes with erythema in scalp, hairline, skin folds

Front 1190

tx for seborrheic dermatitis

Back 1190

sunlight, dandruff shampoo, topical ketoconazole, cs if severe

Front 1191

2 types of contact dermatitis, which one more common

Back 1191

irritant >> allergic

Front 1192

pathophys of allergic contact dermatitis

Back 1192

hs4 with sensitization having occurred 1-2w before, dermatitis occurs several hours after reexposure

Front 1193

appearance of contact dermatitis

Back 1193

erythema + papules/vesicles that progresses to crusting/thickening/scaling

Front 1194

tx for pityriasis

Back 1194

antihistamine for pruritus, remits on own

Front 1195

sx of erythema nodosum

Back 1195

painful red subcut nodules on tibia (usually)

Front 1196

causes of erythema multiforme

Back 1196

hsv, drugs, idiopathic

Front 1197

drugs that can cause erythema nodosum

Back 1197

sulfa, penicillin, pheny, allopurinol, barb

Front 1198

4 p's of linchen planus

Back 1198

pruritic, polygonal, purple, papules

Front 1199

age group of pemphigoid

Back 1199

elderly

Front 1200

are warts ever erythematous

Back 1200

no

Front 1201

are warts always hyperkeratotic

Back 1201

usually, but flat wart (verrucua plana) isnt

Front 1202

tx for warts

Back 1202

cryotherapy, salicylic acid, 5-fu cream, excision

Front 1203

how to tx genital warts

Back 1203

podophyllin

Front 1204

3 main organisms causing tinia

Back 1204

trichophyton, microsporum, epidermophyton

Front 1205

type of rxn in scables

Back 1205

hs4

Front 1206

tx for scabies

Back 1206

permethrin applied to all areas of body, lindane (if age >2)

Front 1207

3 p's of bcc

Back 1207

pearly, pink (telangiectasia), papule

Front 1208

what is marjolin's ulcer

Back 1208

scc arising from chronic wound

Front 1209

who is predisposed to melanoma

Back 1209

fair complexion esp if easily sunburned, reckles, red hair, or with numermous moles

Front 1210

what is dysplastic nevus sndrome

Back 1210

large nevi with indistinct borders and varied color. if fam hx, then 100% of getting melanoma

Front 1211

what are spitz nevi

Back 1211

well circumscribed raised lesion confused with melanoma... but still excise

Front 1212

4 most common site of met for melanoma

Back 1212

lymph, lung, liver, brain

Front 1213

most important prognostic factor for melanoma

Back 1213

depth of invasion

Front 1214

4 stages of decubitus ulcers

Back 1214

1 = intact skin w/ erythema. 3-4 = full thickness skin loss. 4=extension past subcut tissue

Front 1215

how to prevent decubitus ulcers

Back 1215

turning and repositioning q2h

Front 1216

pathophys of psoriasis

Back 1216

abnormal proliferation of skin cells causing defective keratinization

Front 1217

what is auspitz sx

Back 1217

bleeding when scales of psoriasis removed

Front 1218

tx for psoriasis

Back 1218

cs, calcipotriene (works very well, vit D derivative), tazarotene (vit a derivative)

Front 1219

what is vitiligo assoc with

Back 1219

dm, hypot, pernicious anemia, addisons

Front 1220

progression of urticaria

Back 1220

wheals that disappear within hours and then return in another place

Front 1221

what is missing in hereditary angioedema

Back 1221

c1 esterase inhibitor deficiency

Front 1222

life threatening consequence of angioedema

Back 1222

airway obstruction

Front 1223

4 most common medicines associated with drug allergy

Back 1223

beta lactams, aspirin, nsaid, sulfa

Front 1224

what timeframe do drug allergies usually appear

Back 1224

within 1 mo, but usually more than 1 week

Front 1225

2 types of skin rxns to insect sting

Back 1225

1. nonallergic - localized swelling, erythema, pain that subsides in hours 2. allergic - large area of swelling and erythema that can last for several days and can sometimes have systemic sx

Front 1226

mcc 2* htn

Back 1226

renal artery stenosis

Front 1227

alcohol and htn

Back 1227

>2 drinks a day assoc w htn

Front 1228

goals for tx of htn (3)

Back 1228

1. look for 2* cause 2. assess dmg to target organs 3. assessing cv risk

Front 1229

htn tx goals for htn

Back 1229

130/80

Front 1230

what lipoprotein is affected in each of the following familial dyslipidemias: 1, 2a, 2b, 3, 4, 5

Back 1230

cm, ldl, ldl+vldl, idl, vldl, vldl+cm

Front 1231

effect of alchol on cholesterol

Back 1231

increase tg and hdl

Front 1232

effects of propranolol on cholesterol

Back 1232

increase tg (vldl) and lower hdl

Front 1233

effects of thiazide on cholsterol

Back 1233

increase ldl, tg

Front 1234

risk of cad vs hdl level

Back 1234

every 10 hdl = decrease in cad risk by 50%

Front 1235

average TC-to-hdl ratio

Back 1235

5 = average

Front 1236

why would you want to check renal function for dyslipidemia

Back 1236

nephrotic syndrome

Front 1237

when to tx hypertg

Back 1237

>500

Front 1238

tx for tension ha

Back 1238

stress reduction, nsaids,

Front 1239

prophylaxis for cluster

Back 1239

verapamil

Front 1240

which foods associated with migraine trigger

Back 1240

chocolate, cheese, alcohol, tobacco,

Front 1241

CI for ergotamines

Back 1241

CAD, pregnancy, TIA, PVD, sepsis

Front 1242

CI for triptans

Back 1242

uncontrolled htn, basilar or hemiplegic migraines, use of MAOI or SSRI or Li

Front 1243

first line prophylaxis for migraine

Back 1243

tca, bb

Front 1244

what is chronic cough

Back 1244

>3w

Front 1245

likelihood of bacterial URI: rhinorrhea, myalgia, HA, sputum

Back 1245

rhinorrhea, myalgias, HA are more likely with viral

Front 1246

likelihood of fever with cold

Back 1246

uncommon in adults, commin in children

Front 1247

tx for cold

Back 1247

hydration (inhale steam, drink water) loosens secretions and prevents airway obstruction, cough suppressant, nasal decongestent

Front 1248

usual causes of acute bacterial sinusitis

Back 1248

pneumo, hi, anaerobes

Front 1249

pain of sinus may mimic

Back 1249

dental caries (toothache)

Front 1250

pain of sinus worsens with

Back 1250

percussion, bending head down

Front 1251

complications of sinusitis

Back 1251

orbital cellulitis, osteomyelitis, cavernous sinus thrombosis

Front 1252

tx for sinusitis

Back 1252

acute: nsal irrigation, decongestant, antibiotics, avoid antihistamine
chronic: broad spec penicillinase-resistant ab

Front 1253

why are antihistamines avoided in sinusitis

Back 1253

can dry out secretions and worsen congestion

Front 1254

tx for laryngitis

Back 1254

rest voice cuz don't want to form vocal nodules

Front 1255

what is dyspepsia

Back 1255

spectrum of epigastric sx (hearburn, bloating, indigestion)

Front 1256

when should you perform endoscopy for dyspepsia

Back 1256

new onset in >45yo, alarming sx, no resopnse to empiric, recurrence, systemic sx

Front 1257

conservative measures for dyspepsia

Back 1257

avoid alcohol, caffeine, tobacco. rest head of bed, avoid eating before meals. small frequent meals.

Front 1258

sx of gerd

Back 1258

heartburn after meals, exacerbated by lying down

Front 1259

surveillance for berrett's

Back 1259

q3y to look for dysplasia

Front 1260

bronchospopic finding of recurrnet aspiration

Back 1260

lipid laden macrophages

Front 1261

6 stages of tx for gerd

Back 1261

antacid+behavior. h2. ppi. promobility (metaclopramide). combinations. surgery (eg nissen)

Front 1262

causes of acute diarrhea

Back 1262

infection, medications, malabsorption, ischemic bowel, tumor

Front 1263

causes of chronic diarrhea

Back 1263

ibs, ibd, medications, infection, cancer, diverticulitis, malabsorption, postsurgical, endocrine, fecal impaction

Front 1264

4 main flag symptoms for acute diarrhea

Back 1264

1 blood stool 2. systemic sx or fever 3. dehydration 4. NV, pain

Front 1265

things that can be tested from stool

Back 1265

stool wbc, ova&parasides, culture, c diff, giardia

Front 1266

what drugs may cause constipation

Back 1266

anticholinergic, narcotic, CCB!, antacid, laxative

Front 1267

transmission of shigela

Back 1267

feco oral

Front 1268

tx for salmonella

Back 1268

cipro

Front 1269

tx for shigella

Back 1269

bactrim

Front 1270

tx for c jejuni

Back 1270

erythromycin

Front 1271

tx for chonric constipation

Back 1271

find 2* cause, physical activity, high fiber food, fluids

Front 1272

diarrhea from c perfringes -- main sx

Back 1272

crampy abdominal pain within 24 hours of ingestion

Front 1273

what is tegaserod

Back 1273

serotonin agonist for ibs

Front 1274

mc electrolyte abnormality after severe vomit

Back 1274

hypokalemia + metabolic alkalosis

Front 1275

risk factors for hemorrhoids

Back 1275

constipation, preganancy, portal htn, obesity, inactivity

Front 1276

mc location of lumbar disk herniation

Back 1276

l5-s1 or l4-l5

Front 1277

tx options for vetebral compression fx

Back 1277

kyphoplasty

Front 1278

complications of vertebral osteomyelitis

Back 1278

epidural abscess with compromise of blood supply, compression fx

Front 1279

what is scotty dog sign

Back 1279

normal appearance of vertebrae in oblique position. defect in pars interarticularis

Front 1280

spondylosis vs spondylolysis vs sponddylolisthesis

Back 1280

spondylosis = osteoarthritis of vertebrae. spondylolysis = defect in pars interarticularis (oft caused by spondylolisthesis). spondylolisthesis = ant or post slippage of vertebrae.

Front 1281

what nerve largely responsible for hip flexion

Back 1281

l2

Front 1282

what nerve largeley responslile for knee extension

Back 1282

l3

Front 1283

what nerve largely responsible for ankle dorsiflexion

Back 1283

l4/5

Front 1284

what nerve largely responsible for great toe dorsiflexion

Back 1284

l5

Front 1285

what nerve largely responsible for ankle plantar flexion

Back 1285

s1

Front 1286

aggrevating/alleviating of patellofemoral. tx?

Back 1286

climbing/descending stairs. strengthen quads, hamstrings

Front 1287

when is surgery good for meniscus problem

Back 1287

when no arthritic changes associated

Front 1288

what is osteochondritis dissecans

Back 1288

area of necrotic bone + degenerative changes in cartilage

Front 1289

where is pain in patellar tendinitis

Back 1289

anterior knee at inferior pole of patella

Front 1290

ligaments in medial ankle? lateral ankle

Back 1290

deltoid. anterior talofibular (mc injured), calcaneofibular, posterior talofibular

Front 1291

where is pain in patellar tendinitis

Back 1291

anterior knee at inferior pole of patella

Front 1292

ottowa rules for ankle

Back 1292

don't need xr if: pt is able walk steps at injury and at time of injury, no bony tenderness over distal 6 cm of either malleolus

Front 1293

ligaments in medial ankle? lateral ankle

Back 1293

deltoid. anterior talofibular (mc injured), calcaneofibular, posterior talofibular

Front 1294

where is tenderness with supraspinatus tendonitis

Back 1294

subacromial and lateral aspect of shoulder if arm abducted

Front 1295

ottowa rules for ankle

Back 1295

don't need xr if: pt is able walk steps at injury and at time of injury, no bony tenderness over distal 6 cm of either malleolus

Front 1296

tx for lateral epicondylitis

Back 1296

splinting with couterforce

Front 1297

where is tenderness with supraspinatus tendonitis

Back 1297

subacromial and lateral aspect of shoulder if arm abducted

Front 1298

tx for lateral epicondylitis

Back 1298

splinting with couterforce

Front 1299

which mucle group assoc with lateral vs medial epicondylitis

Back 1299

extensor vs flexor

Front 1300

risk factors for carpal tunnel

Back 1300

hypothyroid, dm, repetitive use, pregnancy, trauma/fx wrist

Front 1301

ddx of hand numbness

Back 1301

carpal tunnel, cervical radiculopathy, peripheral neuropathy, median nerve compression

Front 1302

first line tx for carpal tunnel

Back 1302

nsaid + wrist splint

Front 1303

bouchard vs heberden node

Back 1303

bouchard = pip. heberden = dip

Front 1304

where should cane be held for leg pain

Back 1304

opposite hand

Front 1305

type 1 vs type 2 primary osteoporosis

Back 1305

type 1 = postmenopausal, excess loss of trabecular bone, vertebral. type 2 = elderly, equal cortical and trabecular, femoral.

Front 1306

mechanism of bisphosophnates

Back 1306

decrease osteoclastic activity by binding to hydroxyapatite

Front 1307

PROOF trial

Back 1307

calcitonin decreases vertebral fx by 40%, but no effect at hip

Front 1308

what type of age related macular degen most common? most severe? what does ranibizumab do

Back 1308

dry. wet. reduces rate of vision loss due to wet armd

Front 1309

risk factors for glaucoma

Back 1309

age>50, afam, asian/eskimo, famhx, eye trauma, steroids

Front 1310

physical sx of closed angle glaucoma

Back 1310

NV, HA, dilated fixed pupil

Front 1311

dx of glaucoma

Back 1311

tonometry, fundoscopic exam, gonioscopy, visual field testing

Front 1312

what medicines good for glaucoma

Back 1312

bb, alpha agonist, carbonic anhydrase inhibitor, prostaglandin

Front 1313

risk factors for cataract

Back 1313

old age, smoking, steroid, UV, dm, trauma, metabolic dz

Front 1314

sx of scleritis

Back 1314

pain with palpation, deep pain

Front 1315

classic finding of herpes simplex keratitis

Back 1315

dendrite on cornea with fluorescein staining

Front 1316

sx of anterior uveitis

Back 1316

injection around cornea, blurry vision, pain, photophobia, constricted pupil

Front 1317

mc of bacterial conjunctivitis

Back 1317

pneumococcus, then gn

Front 1318

trachoma vs inclusion conjunctivitis of chlam

Back 1318

trachoma can cause blindness, caused by different subtypes

Front 1319

what is chemosis

Back 1319

buildup of fluid under bulbar conjunctiva

Front 1320

tx for bacterial conjunctivitis

Back 1320

broad spec + culture, if hyperacute rmr to think of gonoccocus

Front 1321

what is def of mild to mod OSA? tx?

Back 1321

<20 apnea episodes, tx conservatively w/ weight loss, avoid things that will reduce airway tone eg alcohol, sedatives

Front 1322

why does systemic htn occur in OSA

Back 1322

increase in sympathetic tone

Front 1323

what is exostoses

Back 1323

bony outgrowth of external auditory canal due to repititve exposure to cold water

Front 1324

how long does perf'd TM take to heal on its own

Back 1324

6w

Front 1325

what is presbycusis

Back 1325

degeneration of sensory cells in cochlea in elderly

Front 1326

decreased perception of sound with response to increasing voluem vs difficulty with high frequency and word deciphering with no response to increasing volume

Back 1326

conductive vs sensineural

Front 1327

what medicines can favor urinary incontinence

Back 1327

diuretics, anticholergics/adrenergics cause urinary retention, bb diminish sphincter tone, ccb/narcotics decrease detrusor contraction

Front 1328

what is reflex incontinence

Back 1328

inability to sense need to urinate due to spinal cord injury

Front 1329

what is normal postvoid residual volume

Back 1329

<50ml

Front 1330

what is chronic fatigue syndrome

Back 1330

fatigue >6mo w/o medical/psychiatric d/o

Front 1331

what tests are available for evaluation of ED

Back 1331

lipid panel, testosterone lvl, prolactin lvl, thyroid, vascular testing (u/s, arteriography)

Front 1332

what vaccine to avoid if egg allergy

Back 1332

flu

Front 1333

how do you assess quality of cxr

Back 1333

1. assess penetration (visible intervertebral spaces and outline of vertebrae should be seen through heart) 2. assess inspiratory effort (should see 9 post ribs above diaphragm) 3. assess rotation (sternum should bisect clavicles)

Front 1334

when you place ET tube, how do you know it's right spot in xr

Back 1334

4-6 cm above tracheal carina

Front 1335

how do you assess central line placement by xr

Back 1335

tip should be above RA

Front 1336

how do you know which ribs are which on pa xr

Back 1336

on pa cxr, ant ribs are angle downward

Front 1337

what type of xr needs to be ordered to evaluate abd perf

Back 1337

either upright (free air under diaphragm), or if too sick than lat decubitus

Front 1338

mobitz 1 vs 2

Back 1338

1 -- progressive lengthing until drop. 2 = nonconduction of p waves in some ratio

Front 1339

what is central line good for

Back 1339

placement of catheters into heart, transvenous pacing, emergency dialysis, emergency iv meds or meds that cause problems if given peripherally, high volumes

Front 1340

3 sites for central line

Back 1340

IJ, subclavian, femoral

Front 1341

what are arterial lines used for

Back 1341

bp monitoring, frequent abg

Front 1342

when doing tube feeding, how often should they be checked? when to hold them?

Back 1342

q4h. if residual > 150ml

Front 1343

how is peg tube inserted

Back 1343

1. with endoscope through mouth 2. open abdominal incision

Front 1344

are cyclines static or cidal? macrolides

Back 1344

both static

Front 1345

what condition may pyrazinamide precip

Back 1345

hyperuricemia -> gout

Front 1346

spectrum of tmp/smx

Back 1346

uti, pcp, shigella/salmonella

Front 1347

4 types of breath sounds

Back 1347

1. vesicular (soft and low pitch, in most lung fields, during inspiration and some of expiration) 2. bronchial (loud, high pitch, in central areas, mostly in expiration, suggest consolidation if heard peripherally) 3. bronchovesicular sounds 4. adventitious breath sounds (crackles, wheezes, rhonchi)

Front 1348

how to grade muscle strength

Back 1348

0 = no contraction. 4 = weak against some resistance. 3 = weak against ANY resistance. 2 = weak against gravity. 1 = ANY evidence of contraction

Front 1349

definition of oliguria

Back 1349

<400mL/day, <15mL/hr

Front 1350

forward vs backward heart failure

Back 1350

forward is sx due to not having enough CO (fatigue, lethargy, hypotension), backward failure is sx due to congestion due to inability to pump out

Front 1351

what drug can be used to lower mortality in chf if cannot use acei/arb

Back 1351

hydralzine+nitrate (bidil), bb

Front 1352

mc aortic stenosis in pts <30 vs >30

Back 1352

congenital bicuspid valve vs degenerative calcific stenosis

Front 1353

valve replacement vs balloon valvuloplasty for as

Back 1353

valvuloplasty is only temporary

Front 1354

causes of AFib

Back 1354

I SMART CHAP - inflammatory, surgery, medications, atherosclerosis, rheumatic, thyrotoxis, CHD, HTN, alcohol, pulmonary dz

Front 1355

causes of AFib

Back 1355

I SMART CHAP - inflammatory, surgery, medications, atherosclerosis, rheumatic, thyrotoxis, CHD, HTN, alcohol, pulmonary dz

Front 1356

4 major goals of AFib

Back 1356

stabilization, rate control, rhythm conversion, anticoagulation

Front 1357

4 major goals of AFib

Back 1357

stabilization, rate control, rhythm conversion, anticoagulation

Front 1358

how to tx hemodynamically unstable AFib

Back 1358

DC cardioversion

Front 1359

how to tx hemodynamically unstable AFib

Back 1359

DC cardioversion

Front 1360

what do you have to check before cardioverting AFib

Back 1360

is there a clot in atrium? if less than 48h of AFib, then don't need to worry

Front 1361

what do you have to check before cardioverting AFib

Back 1361

is there a clot in atrium? if less than 48h of AFib, then don't need to worry

Front 1362

prognostic factors for refractoriness of AFib

Back 1362

left atrial dilitation (>4.5cm), duration of AFib

Front 1363

prognostic factors for refractoriness of AFib

Back 1363

left atrial dilitation (>4.5cm), duration of AFib

Front 1364

risk reduction of stroke with warfarin

Back 1364

2/3

Front 1365

when should an echocardiogram be ordered based on auscultation of a murmur

Back 1365

if cardiac sx, if continuous systolic or if > 3/6, or if diastolic

Front 1366

what are benign murmurs

Back 1366

midsystolic <3/6

Front 1367

what sx are assoc w neurogenic syncope

Back 1367

lightheadedness, nausea, diaphoresis, blurred vision

Front 1368

synonym for neurocardiogenic syncope

Back 1368

vasovagal

Front 1369

what common drug used to tx acs is ci in cocaine induced mi

Back 1369

bb

Front 1370

what is pseudoclaudication

Back 1370

spinal stenosis - pain on standing that also occurs with walking, and relieved by sitting

Front 1371

when to do bariatric surgery

Back 1371

>40 bmi, cannot maintain weight loss and have comorbidity

Front 1372

how to distinguish bw vtach and wpw + af conducting to ventricles

Back 1372

wpw+af will have irregular

Front 1373

why is dig, bb, cardiosuppressive ccb a good tx for wpw

Back 1373

trick q! not good. cuz they block av node, which gives more leeway to the accessory node. use procainamde or ibulitide instead

Front 1374

when do you do endoscopy for new onset dyspepsia

Back 1374

>45yo, or if alarm sx, failure to respond to empirics

Front 1375

2 complications of pud

Back 1375

perforation/hemorrhage, gastric outlet obstruction (vomit+weight loss w/o distention)

Front 1376

why does increased or decreased sodium cause neurologic sx

Back 1376

cerebral edema or cerebral shrinkage

Front 1377

3 categories of hyponatremia

Back 1377

hypertonic, normotonic, hypotonic

Front 1378

how to measure tonicity of blood

Back 1378

osmolality is a very good predictor of tonicity

Front 1379

mechanism of hypertonic hyponatremia

Back 1379

some osmotically active agent is added to ECF that draws water out and dilutes sodium.Usually GLUCOSE (1.6 change in sodium for every 100 glucose), or MANNITOL (often seen post-TURP)

Front 1380

mechanism of hypotonic hyponatremia. how much free water can kidney usually clear per day. therefore what can cause it?

Back 1380

ALWAYS occurs when free water is added -- so either impaired free water excretion or free water addition. 18L/day. 1. Primary sodium loss leading to secondary water gain (from ICF) -- sweating, renal losses, GI loss. 2. Primary water gain -- polydipsia, renal insufficiency, adh. 3. Primary sodium gain but with greater water gain (HF, cirrhosis, nephrotic)

Front 1381

how to workup hypotonic hyponatremia

Back 1381

divide by volume status. if hypovolemic, is kidney working correctly (get urine sodium). if hypervolemic, is kidney working correctly, what's the 2* cause (eg chf, etc). if euvolemic, get a urine osmolarity cuz kidneys should be trying to make dilute urine, to correct hyponatremia. if kidneys not making dilute urine, check for hypoT and adrenal insufficiency cuz that can cuase water retention. once these ruled out, suspect siadh

Front 1382

how fast can u correct chronic hyponatremia

Back 1382

0.5-1 mEq/h

Front 1383

why can hyponatremia occur postop or while in pain

Back 1383

SIADH

Front 1384

definition of hyponatremia

Back 1384

<135

Front 1385

complications of aortic dissection

Back 1385

intimal flap that occludes branching vessels, rupture into pericardial sac or pleural space, severe aortic regurg

Front 1386

mechanism of thrombolytics/anticoagulation in aortic dissection

Back 1386

WTF DO NOT DO

Front 1387

does nitrate relieve pain of aortic dissection

Back 1387

no

Front 1388

where are most aortic dissections located

Back 1388

ascending aorta

Front 1389

next step in mgmt for aortic dissection

Back 1389

bb to lower pulse pressure, then imaging to see if it's type a or b. A needs surgery

Front 1390

when do surgery for aaa

Back 1390

>5.5cm or if >.5cm/yr expansion

Front 1391

if an aids pt has thrush with unknown cd4, what is likely cd4

Back 1391

<250

Front 1392

tx for pcp

Back 1392

tmp/smx + steroids when pao2 < 70 or aa gradient > 35

Front 1393

opportunistic pneumonia with increased ldh is

Back 1393

pcp. <220 ldh r/o pcp

Front 1394

diffuse vs patchy infiltrates in aids

Back 1394

diffuse - tb, pcp, histo. patchy - tb, cryptococcus

Front 1395

when to prophylax pcp? toxo? mac?

Back 1395

cd4<200, tmpsmx. <100, tmpsmx. <50 azithromycin

Front 1396

claudication abi vs critical limb ischemia

Back 1396

.4-.9

Front 1397

what is pentoxifylline

Back 1397

increases erythrocyte elasticity, supposedly helps in pad

Front 1398

what is cilostazol

Back 1398

pde inhibitor, vasodilatory and antiplatelet that helps with pad

Front 1399

6 p's of acute limb arterial occlusion

Back 1399

pain, pallor, pulselessness, paresthesias, poikilothermia, paralysis

Front 1400

5 things that thiazides can increase/decrease

Back 1400

hypokalemia, hyponatremia, hyperuricemia, hyperlipidemia, hypercalcemia

Front 1401

hypertensive emergency vs hypertensive urgency vs crisis

Back 1401

emergency has complications, urgency doesn't. both are crises

Front 1402

bp reduction goal in htn emergency

Back 1402

reduce map by 25% or less, or to diastolic of 100-110 over few hrs

Front 1403

ast:alt in alcohol

Back 1403

ast>alt

Front 1404

what drug can tx chronic hep b

Back 1404

lamivudine

Front 1405

toxic dose of acetaminophen

Back 1405

10g

Front 1406

when should n acetylcysteine be started for how long for tylenol od

Back 1406

within 10 hours, continued for 3d

Front 1407

effect of TRH on prolactin

Back 1407

stimulates prolactin

Front 1408

what is brugada syndrome

Back 1408

ion channel dysfunction, common cause of sudden death, ekg changes

Front 1409

how long does TSH take to respond to thyroid hormoen replacement

Back 1409

8w

Front 1410

tx for hep c

Back 1410

alpha interferon and ribavirin

Front 1411

utility of saag gradient

Back 1411

if >1.1, then portal htn. if <1.1, then not.

Front 1412

dx of spontaneous bacterial peritonitis

Back 1412

>250 pmns on paracentesis or if + culture

Front 1413

what relieves pain of pancreatitis

Back 1413

sitting up and bending forward

Front 1414

tx for pancreatitis

Back 1414

npo, narcotics, ivf +/- suction

Front 1415

what is a phlegmon

Back 1415

solid mass of inflamed pancreas with patchy necrosis, complication of pancreatitis

Front 1416

mcc early death in pancreatitis

Back 1416

hypovolemic shock from third spacing

Front 1417

how to dx choledocholithiasis

Back 1417

u/s

Front 1418

abd pain + abd mass + high amylase in pt w prev pancreatitis

Back 1418

pseudocyst

Front 1419

mechanism of syncope

Back 1419

GLOBAL cerebral hypoperfusion

Front 1420

what types of neurologic dz are most assoc w syncope

Back 1420

dysautonomia -- parkinsonism, diabetes

Front 1421

major risk factors, complication and finding of aortoenteric fistula

Back 1421

surgery/gi bleed. hemorrhage, hypotension

Front 1422

mcc high blood pressure in left arm vs right

Back 1422

subclavian atherosclerosis. NOT COARC CUZ THAT WOULD INCREASE R>L

Front 1423

4 categories of asthma

Back 1423

intermittent, persistent: mild, mod, severe

Front 1424

intermittent vs mild persistent asthma

Back 1424

sx or need rescue <2/wk, wake up <2/mo = intermittent. both have normal pfts

Front 1425

mild vs mod persistent asthma

Back 1425

mod: daily sx, weekly wake up. mild has normal pfts.

Front 1426

risky sex + fever + negative cultures + pustules + tampon usage

Back 1426

disseminated gonococcus! NOT TSS CUZ TSS DUN HAVE PUSTULES

Front 1427

why do you get hypotension with severe acidosis

Back 1427

tachycardia can result in inefficient pumping with reduces CO (inefficient because poor response to epi and arrythmias)

Front 1428

how do you dx cll/sll

Back 1428

flow cytometry

Front 1429

CV, eye, mental, lung, GI findings of opioid intoxication

Back 1429

bradycardia+hypotension (due to histamine). mioisis. lethargy. bradypnea. hypoactive BS.

Front 1430

bradypnea vs hypopnea.

Back 1430

brady = slow rate. hypo = low amplitude of breathing, shawllow

Front 1431

what type of lung cancer is siadh assos cw

Back 1431

small cell

Front 1432

risk factors for hepatic angiosarcoma

Back 1432

VAT - vinyl chloride, arsenic, thorotrast

Front 1433

goals for treating benign intracranial htn

Back 1433

1. prevent vision loss 2. reduce pressure 3. symptomatic

Front 1434

how to tx pseudotumor cerebri

Back 1434

acetazolemide, lp if infrequent. surgery is final option.cs if acute loss of vision.

Front 1435

mechanism of acetazolemide in intracranial htn

Back 1435

inhibits carbonic anhydrase which reduces csf production

Front 1436

would you see pleural plaques in bronchogenic carcinoma

Back 1436

yes you could

Front 1437

ddx for colitis

Back 1437

ischemia, infectious (c diff, e coli, sal/shig, campy), radiation, ibd

Front 1438

age group of ibd

Back 1438

young (15-25) nand old (60-70)

Front 1439

wall involved uc vs crohns

Back 1439

mucosa vs transmural

Front 1440

surgery for crohn vs uc

Back 1440

curative for uc, but only symptomatic for crohns

Front 1441

what is infleximab

Back 1441

anti tnf ab

Front 1442

screning for uc pts

Back 1442

annual or q2y colonscopy

Front 1443

which ibd is associated more with arthritis

Back 1443

crohn

Front 1444

why are gallstones more common in crohns

Back 1444

kills the ileum and prevents bile absorption

Front 1445

how can a hypervolemic pt get prerenal failure

Back 1445

third spacing, congestion, etc

Front 1446

how is postrenal failure usually dx'd

Back 1446

hydronephrosis on renal us

Front 1447

how can fena be obscured in chf pt with prerenal failure

Back 1447

diuretic use can increase sodium excretion

Front 1448

what are the indications for dialysis in akd

Back 1448

fluid overload (eg pulmonary edema), metabolic acidosis, hyperkalemia, uremia (pericarditis), severe hyperphosphatemia

Front 1449

how do you tx severe hyperkalemia

Back 1449

give calcium, then give d50 + 10u insulin or beta agonist or bicarb. long term can do furosemide, kayexalate, or dialysis.

Front 1450

how to distinguish rub of pericarditis from murmur

Back 1450

sometimes hard, need ekg

Front 1451

ekg in pericarditis

Back 1451

diffuse st elevation, sinus tachy, pr segment depression

Front 1452

what are the 11 criteria for SLE

Back 1452

IM DAMN SHARP - immunologic, mucositis, discoid, ana, malar rash, neurologic, serositis (incl pericarditis), arthritis, renal, photosensitivity

Front 1453

what study to do for probable nephritic syndrome as evidenced by h&p, ua

Back 1453

urine microscopy for sediment examination

Front 1454

how can you tell from urine microscopy whether hematuria is glomerular in origin

Back 1454

dysmorphic/fragmented rbcs, or rbc casts

Front 1455

what nephritic dz is low complement

Back 1455

SLE, MPGN, poststreptococcal, postinfectious, cryoglobulin

Front 1456

triad of churg strauss

Back 1456

granuloma, asthma, eosinophilia

Front 1457

which dz have + panca

Back 1457

churg strauss, pan

Front 1458

nephritic dz -- what two categories of dz have immune complex deposition without anti-gbm or anca

Back 1458

complement mediated and antibody mediated

Front 1459

when is topical cs not first line for dermatitis

Back 1459

if on face, neck, or intertriginous areas (suscep to cs atrophy)

Front 1460

acute erythema nodosum + arthritis. what if + fever + hilar LAD

Back 1460

acute sarcoid. lofgrens syndrome (variant of sarcoid)

Front 1461

ddx of thickened and dystrophic nails

Back 1461

psoriasis, pad, lichen planus, atopic dermatitis, onychomycosis

Front 1462

seasonal variation of seborrheic dermatitis

Back 1462

improves in summer, worse in winter/fall

Front 1463

which fungus has spaghetti and meatballs

Back 1463

tinea versicolor

Front 1464

tx options for warts

Back 1464

salicylic acid, cryotherapy (care when near sensitive areas incl nail bed). topical imiquimod (not approved), candida ag injection (not approved)

Front 1465

activities of daily living vs instrumental activities of daily living

Back 1465

adl = basic things like toileting, eating, dressing. can't live alone. iadl = shopping, finances, etc. may live alone but need some mgmt

Front 1466

nsaids and hypertension

Back 1466

decrease sodium excretion and contribute to htn

Front 1467

when is stage 1 htn goals changed

Back 1467

dm2, renal failure

Front 1468

what is scleroderma renal crisis, how to tx

Back 1468

sudden increase in renin, tx with short acting acei, like captopril

Front 1469

what are 2 categories of thrombocytopenia. what is the ddx for both

Back 1469

BM vs non-BM. BM will have depression of other cell lines. DDx for non-bm = itp/hit/ttp/hus, sepsis, ***hiv, sle***, dic, hypersplenism

Front 1470

pentad for ttp

Back 1470

fever, thrombocytopenia, hemolytic anemia, neurologic sx, renal sx

Front 1471

what grade does hsil correspond to. what is mgmt?

Back 1471

cin2/3. either 1) pap + endocervical curettage q6mo x3 (all have to be -) 2) pap + hpv testing q6mo x3

Front 1472

why can't you use ampicillin for cap? cipro?

Back 1472

pneomococcus resist + no atypical coverage. no atypical or strep coverage.

Front 1473

what type of pneumonia clinda good for

Back 1473

aspiration

Front 1474

another name for detrusor instability

Back 1474

urge incontinence

Front 1475

how can pain cause urinary retention

Back 1475

in pt with bph, bladder can't generate enough force to pass urine, so need valsalva. if pain with valsalva, then this is impaired

Front 1476

what is necrolytic migratory syndrome

Back 1476

erythematous blisters often on butt that is assoc w glucagonoma

Front 1477

bronchovascular markings: emphysema vs chronic bronchitis

Back 1477

emphysema has decreased marks whereas brochitis has increased markings

Front 1478

panacinar vs centriacinar emphysema

Back 1478

panacinar = antitrypsin. centriacinar = copd

Front 1479

dlco: emphysema vs chronic bronchitis

Back 1479

emphysema is decreased, whereas chronic bronchitis is nl

Front 1480

how much bronchodilator response needed to dx asthma

Back 1480

>12% and >200cc

Front 1481

dlco in asthma

Back 1481

can be nl or increased

Front 1482

+ HBsAg and + HBV DNA means

Back 1482

chronic infection

Front 1483

how to tx chronic hbv

Back 1483

3tc or interferon IF PERSISTENTLY ELEVATED ALT

Front 1484

proximal muscle weakness + tremor + anxiety + weight loss

Back 1484

hyperthyroidism

Front 1485

how to tx solitary brain met w/ controlled extracranial dz

Back 1485

surgical resection followed by whole brain radiation

Front 1486

how to tx multiple brain met

Back 1486

palliative whole brain radiation

Front 1487

causes of early renal transplant dysfunction

Back 1487

ureteral obstruction, acute rejection, cyclosporine toxicity, vascular obstruction, ATN

Front 1488

when is the odds ratio equal to the risk in a study

Back 1488

when the dz is rare and it's a case control study

Front 1489

best test to dx pancreatic exocrine insufficiency

Back 1489

fecal elastase

Front 1490

what % of ppl presenting w nephrotic syndrome have systemic dz

Back 1490

1/3

Front 1491

how to manage edema of nephrotic syndrome

Back 1491

salt restrict + diuretics (oft large doses cuz they are protein bound) + protein restrict (causes greater proteinuria) + acei

Front 1492

life expectancy for dm + esrd

Back 1492

<2y

Front 1493

albumin/cr ratio

Back 1493

>100 = microalbuminuria

Front 1494

migratory arthralgia + tenosynovitis (usually wrist and hands) + pustular skin lesions that progresses to mono/oligoarthritis

Back 1494

gonococcal arthritis

Front 1495

how to distinguish arthritis from inflammatory conditions near joint

Back 1495

painful limitation of motion in all planes during active and passive movement

Front 1496

wbc count in septic arthritis

Back 1496

>100000

Front 1497

birefringence of gout

Back 1497

negative

Front 1498

why do false negatives occur when trying to dx septic arthritis

Back 1498

oft fastidious organisms, so can do blood cultures or skin cultures of lesions.

Front 1499

what is chondrocalcinosis, what arthritis is it asoc with

Back 1499

linear calcium deposits in joint cartilage. pseudogout

Front 1500

mcc nongonoccocal septic arthritis

Back 1500

gp organisms, oft saureus

Front 1501

tx for acutely swollen and red joint with numerous PMNs and leukocytes + few negatively birefringent crystals

Back 1501

abx (still suspicious for infection)

Front 1502

suspect what if peripheral ischemia after any invasive procedure involving artery? what lab findings

Back 1502

cholesterol emboli, urinary eosinophilia

Front 1503

how to tell between mobitz 2 and 3rd degree av block on ekg

Back 1503

mobitz 2 will have a regular interval b/w p wave and qrs, just some will be dropped

Front 1504

ekg findings of lbbb vs rbbb

Back 1504

lbbb=large R in 1,vL,v6
rbbb = small Q, tall R in 1. small R, small S in v6

Front 1505

abi >1.3 indicates

Back 1505

calcification

Front 1506

ekg change in hypokalemia

Back 1506

inverted t, large u wave,

Front 1507

ekg finding in dig tox

Back 1507

atrial tach w variable block

Front 1508

sx of thoracic duct obstruction

Back 1508

lymphedema

Front 1509

htn and OCP mechanism

Back 1509

OCP can cause HTN by increased angiotensinogen or RAAS involvement

Front 1510

ddx of decreased leukocyte alkaline phosphatase

Back 1510

CML, hypophosphatemia, PNH

Front 1511

what is spikes method for bad news

Back 1511

set up, patient's perception, invitation (how much they want to know), give KNOWLEDGE, emotions, summary/strategy

Front 1512

does sunscreen protect against melanoma

Back 1512

no evidence to suggest, but protects against scc

Front 1513

3 types of parapneumonic effusions, how to dx, how to tx each type

Back 1513

uncomplicated, complicated (pus, gpc's, or pleural fluid pH <7), empyema. abx, abx + tube, abx+complete drainage+reexpansion

Front 1514

mechanisms of metoclopramide

Back 1514

d2 antagonist, muscarinic agonist

Front 1515

indications for tube thoracostomy for parapneumonic effusion

Back 1515

<7.0 ph, gluc < 60, ldh >1000.... correlate highly with either complicated or empyema. also tx if loculations or empyema seen

Front 1516

what to give babies born to mothers with active hbv

Back 1516

hbig and vaccine

Front 1517

how to differentiate overflow incontence vs urge incontinence via labs

Back 1517

overflow will have high postresiduals

Front 1518

ekg changes in PE

Back 1518

classically s1q3t3, which indicates acute cor pulmonale with RAD

Front 1519

mnemonic to remember lbbb vs rbbb

Back 1519

WiLLiaM MaRRoW
LBBB - W in V1, M in V6
RBBB - M in V1, W in V1

Front 1520

active vs passive mvmt and arthritis

Back 1520

will have pain with both in arthritis, only active pain with parajoint things

Front 1521

mcc viral arthritis

Back 1521

hbv**, hcv, rubella, parvovirus

Front 1522

arthritis + sausage digits

Back 1522

psoriatic arthritis or reactive arthritis

Front 1523

how many joints have to be affected in RA

Back 1523

at least 3

Front 1524

bannworth syndrome

Back 1524

lyme dz with radicular pain, csf pleocytosis

Front 1525

how do you tx 2* or 3* lyme dz

Back 1525

iv abx like ceftriaxone

Front 1526

when does bell's palsy occur in lyme dz

Back 1526

2* dz

Front 1527

how to see posterior wall infarct on ekg

Back 1527

v1-v2 st depression

Front 1528

for a stemi, fibrinolytics vs pct

Back 1528

prefer pct. do either if <12h. but goal is <90min. if don't have facility to do pct, and can't transfer w/in 2 h, do fibrinolytics unless CI, >12h with residual st elevation or complication, s/p CABG, cardiogenic shock (sbp <100 + pulmonary edema)

Front 1529

can you use fibrinolytics in nstemi

Back 1529

no

Front 1530

name a type of AV reentrant tachycardia

Back 1530

wpw

Front 1531

how to distinguish AVNRT and AVRT on ekg

Back 1531

AVRT has a short RP segment cuz the retrograde pathway is fast, and you see atrial activity in ST segment. AVNRT either has no p waves, or small deflection. BOTH ARE REGULAR UNLIKE AFIB

Front 1532

mcc multifocal atrial tachycardia

Back 1532

illness

Front 1533

what dose of bb to use in heart failure

Back 1533

raise dose until bp "appropriately low"

Front 1534

can you have as and physiologically split s2

Back 1534

unlikely cuz as aortic valve stiffens you get loss of aortic component of s2

Front 1535

significance of ejection click and as

Back 1535

stenosis is at valvular level and there is mobility to valve

Front 1536

thyroid hormone requirements during pregnancy

Back 1536

goes up by 30%

Front 1537

iodine uptake in thyroiditis

Back 1537

decreased

Front 1538

lab abnormal in paget dz

Back 1538

alp

Front 1539

cutoff for osteoporosis

Back 1539

2.5

Front 1540

when do you start bisphosphonate for chronic cs therapy

Back 1540

if prednisone >5 qd or equivalent used >3 mo or if t score < -1

Front 1541

when to do dexa, 5 major risk factors for osteoporosis (that u use)

Back 1541

65 or <55 if 1+ risk fx. fx as adult, fragility fx in 1st deg relative, smoking, low body weight, cs > 3mo

Front 1542

name some associations (dz) with chronic hcv

Back 1542

cryoglobulinemia (that can lead to glomerulonephritis), PCT, ITP, autoimmune dz, lichen planus

Front 1543

trigeminal neuralgia is assoc w what dz

Back 1543

ms

Front 1544

tx for febrile neutropenia

Back 1544

admit, cultures, BS abx

Front 1545

tx for hairy cell

Back 1545

purine analogs (cladribine, pentostatin)

Front 1546

sudden loss of vision + hard to visualize fundus using ophthalmoscope + floating debris

Back 1546

vitreous hemorrhage

Front 1547

sudden painless loss of vision + htn + disk swelling + venous dilation

Back 1547

central retinal vein occlusion

Front 1548

by when should common lower back pain resolve

Back 1548

4-6w

Front 1549

normal daily intake of iron, how much absorbed

Back 1549

15, 1mg

Front 1550

iron studies in sideroblastic anemia

Back 1550

increased iron and ferritin and percent sat

Front 1551

how to tx ida, how long to take. adverse effect of iv form

Back 1551

po iron 325mg bid, 6 weeks. anaphylaxis risk w iv

Front 1552

what are diverticula histologically

Back 1552

pseudodiverticula through weakness in muscle lining

Front 1553

llq pain + peritoneal sx + abd pain

Back 1553

acute diverticulitis

Front 1554

how to xr help in pt with diverticulitis

Back 1554

help to identify pts with pneumoperitoneum

Front 1555

how to dx diverticulitis, what are findings

Back 1555

ct. pericolic fat stranding, bowel wall thickening, peridiverticular abscess

Front 1556

what type of abx coverage needed for diverticulosis

Back 1556

abdominal gnrs + anaerobes (tmpsmx or cipro+metro or clinda+gent)

Front 1557

when should pt be considered for elective surgery to prevent complications of diverticulitis

Back 1557

2+ episodes of diverticulitis

Front 1558

do you need to have fever in neutropenic pt to suspect sepsis

Back 1558

ANY CLINICAL DETERORIATION

Front 1559

what to cover for neutropenic fever

Back 1559

gnr incl pseudomonas, gp (esp if catheter)

Front 1560

when can you leave a line in during suspected sepsis

Back 1560

alwyas remove if nontunneled or implanted. if permanent, then what is condition of pt? if erythema on subcut,then remove. if not, then put abx into catheter.

Front 1561

what to suspect when >7d of fever despite bs abx in neutropenic fever

Back 1561

fungus

Front 1562

what is acute chest dyndrome

Back 1562

vasoocclusive crisis in lungs usually caused by infection

Front 1563

tx for vasoocclusive crisis in sickle cell

Back 1563

hydration, o2, pain control. if chest syndrome, then use empiric abx as well. transfusion can be used.

Front 1564

what agents can increase hemoglobin f

Back 1564

hydroxyurea, decitabine

Front 1565

brudzinski vs kernig

Back 1565

leg flexion on passive neck flexion vs pain on passive knee flexion

Front 1566

when can you do lp w/o ct beforehand

Back 1566

if no papilledema, focal neurologic sx, ams

Front 1567

general empiric therapy of meningitis

Back 1567

3g ceph + vanc

Front 1568

is any prophylaxis needed for neisseria meningitis in regular person

Back 1568

if they have it then give rifampin bid x2d for close contacts

Front 1569

hallmark csf finding in tb meningitis

Back 1569

fall of csf glucose at 48h

Front 1570

osler nodes vs janeway lesions vs roth spots, what are the seen in

Back 1570

ie. tender nodules on fingers or toes. painless macules on palms and soles. hemorrhagic retinal lesions with WHITE CENTERS

Front 1571

what to do for suspected endocarditis

Back 1571

serial blood cx (3x over 2-3h acutely, 3x over 24h if subacute)

Front 1572

how long to tx endocarditis

Back 1572

4-6w

Front 1573

how to tx hacek endocarditis

Back 1573

ceftriaxone

Front 1574

when should you do surgery for endocarditis

Back 1574

intractable chf, embolic episode, or >10mm vegetation indicating high risk of embolism, uncontrolled infection, no effective antimicrobial tx (fungal), prosthetic endocarditis

Front 1575

how, when? to prophylax endocarditis

Back 1575

amox. prosthetic valve, previous ie, chd, cardiac transplant w/ valve regurg

Front 1576

what area of lung does primary tb affect? reactivation?

Back 1576

middle & lower. upper.

Front 1577

what is a rasmussen aneurysm

Back 1577

rupture of dilated vessel in tb

Front 1578

mc sites of extrapulmonary tb

Back 1578

lymph > pleura > GU > bone/joints > meninges > peritoneum

Front 1579

cutoff's for ppd test

Back 1579

5 mm if HIV, close contact of TB, cxr findings of TB. 10 if IC or other risk factors. 15 otherwise

Front 1580

tx for active TB

Back 1580

2 month INH + rifampin + pyrazinamide

Front 1581

how much fluid in pericardium does it take to produce tamponade

Back 1581

if acute, then 200ml. if chronic then 2000ml

Front 1582

ekg finding of cardiac tamponade

Back 1582

low voltage, electrical alternans

Front 1583

do you see pulsus paradoxicus in constrictive pericarditis

Back 1583

no

Front 1584

how do you distinguish bw restrictive cardiomyopathy and constrictive pericarditis

Back 1584

mri, endomyocardial biopsy

Front 1585

what is kussmaul sx? what is it seen in

Back 1585

fail to DECREASE JVD on inspiration. constrictive pericarditis

Front 1586

what imemdiate supportive care is available for tamponade right before pericardiocentesis

Back 1586

fluids

Front 1587

neurological findings of neurosyphilis

Back 1587

tabes dorsalis, argyll robertson or other crania nerve, vasculitis leading to ischemia, dementia

Front 1588

tx for syphilis

Back 1588

if 1* or 2*, then single dose of IM penicillin. if latent, then 3x IM penicillin qweek. if 3*, IV penicillin for 10-14d

Front 1589

how to monitor response to tx for syphilis

Back 1589

4-fold drop in titers within 3 mo, and negative titer after 1 yr

Front 1590

indications for lp to r/o neurosyphilis

Back 1590

if symptomatic, or if hiv+ and cd4 <350 or rpr > 1:32

Front 1591

when to start o2 in copd

Back 1591

pao2<55

Front 1592

expiratory vs inspiratory wheezing

Back 1592

inspiratory wheezes usually associated with upper airway (negative airway compression occurs during inspiration). expiratory wheezes usually associated with lower airways (negative airway compression occurs during expiration)

Front 1593

is barium study diagnostic for achalasia

Back 1593

pseudoachalasia can occur with malignancy

Front 1594

best dx test for ibd

Back 1594

colonoscopy/endoscopy

Front 1595

how to tx acute diverticulitis

Back 1595

empiric abx that covers anaerobes

Front 1596

what drug is useful for diarrhea predominant ibs

Back 1596

loperamide

Front 1597

no gb wall thicken + no pericholecystic fluid + dilated bile duct... is this cholangitis or cholecystitis

Back 1597

cholangitis

Front 1598

what supportive measure is critical for acute pancratitis

Back 1598

fluids

Front 1599

how to tx gallstone pancreatitis

Back 1599

urgent ercp

Front 1600

most common reason for decreasing h&h in stable pt after ugib

Back 1600

redistribution of fluid into vascular space

Front 1601

what do you suspect when decompensation in context of cirrhosis

Back 1601

sbp

Front 1602

how to prophylax bleeding from esophageal varices if cirrhosis

Back 1602

bb

Front 1603

how to distinguish appropriate vs inappropriate erythrocytosis

Back 1603

look at o2 sat

Front 1604

what is seen on blood smear of autoimmune hemolytic anemia

Back 1604

microspherocytes

Front 1605

how to tx autoimmune hemolytic anemia

Back 1605

cs

Front 1606

what is mgus

Back 1606

ig spike w/o mm sx, <10% plasma cells in bm

Front 1607

mgmt for drug fever

Back 1607

if on tail end of drug, stop it, should go away by 3d. if not, then sub with another drug class

Front 1608

hwo is septic shock diff fromsevere sepsis

Back 1608

refractory to fluids

Front 1609

how to prophylax flu in IC

Back 1609

deactivated viral vaccine + ostelvamir

Front 1610

what drugs fight both flu a & b? which one ci in asthma

Back 1610

ostelmivir and zanamivir. zanamivir is ci

Front 1611

effect of pt positioning and ventilator assoc pna

Back 1611

45 degreee angle is best

Front 1612

which organisms need special coverage in hospital assoc pneumonia

Back 1612

mrsa, x2 coverage of pseudomanos

Front 1613

does bcg vaccine change interpretation of ppd

Back 1613

no

Front 1614

empiric tx for hospitalized cap pt on general floor

Back 1614

iv quinolone or iv blactam+po macrolide/doxy

Front 1615

empiric tx for hospitalized cap pt on icu

Back 1615

iv blactam + iv macro/quinolone

Front 1616

sx of legionellosis, how to tx

Back 1616

pneumonia, hyponatremia, azotemia, elevated lfts/ck. macro + bb if high risk

Front 1617

do you need predental abx prophylaxis if have mild regurg

Back 1617

no

Front 1618

red flags for HA

Back 1618

rapidly increasing freq, dizziness or incoordination, focal neurologic sx, wake from sleep

Front 1619

sx of west nile

Back 1619

like polio-- muscle weakness and flaccid paralysis

Front 1620

empiric meningitis tx

Back 1620

vanc, amp, ceftriaxone

Front 1621

eye findings of locked in syndrome

Back 1621

vertical movement or blinking are only possible things

Front 1622

hallmark of ruptured av malformation in brain

Back 1622

intracranial hemorrhage + sah

Front 1623

how to r/o sah

Back 1623

lp for xanthochromic bloo

Front 1624

what areas affected by lynch syndrome

Back 1624

colon, endometrium, ovary, stomach, small intestine, hepatobiliary

Front 1625

what is isolated systolic htn, pathophys

Back 1625

sbp>140, dbp<90 usually in elderly. calcified vessels.

Front 1626

is alcohol a risk factor for htn

Back 1626

yes

Front 1627

best tx for frostbit

Back 1627

rapid rewarming with warm water. do not debride right away

Front 1628

how to work up conjugated bilirubinemia

Back 1628

is it intra or extra hepatic? (look at liver enzymes -- if aminotransferase elevation then hepatocellular. if alp, then is it intrahepatic obstruction or extrahepatic (do u/s or ct)

Front 1629

2 types of metabolic alkalosis

Back 1629

saline responsive (urine cl < 20) and saline resistent. saline responsive is due to gi loss, vomiting, or diuretics. can tx by giving ns fluids

Front 1630

does acute intermittent porphoria have photo

Back 1630

no

Front 1631

traid of niacin deficiency

Back 1631

dermatitis, dementia, diarrhea

Front 1632

dx of gc vs chlam urethritis

Back 1632

gc is usually on gram stain and is PURULENT. chlam is not on gram stain (cytoplasmic inclusion), has MUCOPURULENT

Front 1633

first line for cocaine mi

Back 1633

benzo, aspirin, nitrate

Front 1634

skin lesions with blasto

Back 1634

either ulcerations or verracuous (warty, violaceous, or papulopustular)

Front 1635

which systemic fungi can have skin findings

Back 1635

blasto, coccidiodes, aspergillosis

Front 1636

skin lesion of coccidioides

Back 1636

erythema multiforme/nodosum

Front 1637

how to tx acute hypercalcemia

Back 1637

hydration + loops

Front 1638

virchow's triad

Back 1638

endothelial injury, hypercoagulability, stasis

Front 1639

cause of death in PE

Back 1639

progressive RHF

Front 1640

heart sounds in PE

Back 1640

loud s2

Front 1641

westermark sign

Back 1641

congested central pulmonary artery with decreased pulmonary vascularity seen in cxr of pe

Front 1642

what is aggressive tx for pe? who gets it?

Back 1642

thromboylysis/surgerical embolectomy if RHF or hypotension. otherwise anticoagulation -- goal is to prevent thrombus extension or recurrence

Front 1643

how long to anticoagulate pe

Back 1643

depends on risk of recurrence. if provoked (i.e. trauma/surgery) of calf/UE, then 3 mo. if provoked LE , 6 mo. if unprovoked, then controversial

Front 1644

mc hereditary thrombophilia

Back 1644

factor v leidin

Front 1645

how to tx dvt if anticoagulation is ci

Back 1645

ivc filter

Front 1646

blood streaked purulent sputum vs chronic copious sputum vs hemoptysis + acute pleuritic chest paina nd dyspnea

Back 1646

bronchitis, bronchiectasis, pe

Front 1647

what is massive hemoptysis? tx>

Back 1647

>100mL. need to maintain airway, keep affected side in dependent position, suppress cough

Front 1648

which lung cancers are central? peripheral?

Back 1648

small cell, scc. adeno, large cell.

Front 1649

which lung cancer most likely to cavitate

Back 1649

scc

Front 1650

which lung cancer mets early

Back 1650

adenocarcinoma

Front 1651

which lung cancer mets to cns/bones/adrenal? cns/mediastinum?

Back 1651

adenocarcinoma. large cell (look for svc syndrome/hoarseness)

Front 1652

limited stage vs extensive stage lung cancer

Back 1652

ways to describe sclc. if one hemithorax vs distant met/contra lung.

Front 1653

tx modalities for lung cancer

Back 1653

sclc is usually radio/chemo. nsclc is usually resection/radio

Front 1654

workup for solitary pulmonary nodule

Back 1654

"popcorn"/"bullseye" = benign. if young age and nonsmoker, do serial chest ct, is benign if no growth after 2y (risk of malig <2%). lesions > 2.5 cm are risky

Front 1655

how you know when sputum is good quality

Back 1655

>25 pmns, <10 epithelial cells

Front 1656

aspiration pneumonitis vs aspiration pneumonia

Back 1656

pneumonitis also produces infiltrate, but resolves within 2d.

Front 1657

how to tell b/w adrenal crisis vs septic shock

Back 1657

hypoglycemia in adrenal crisis, hypotension refractory to pressors

Front 1658

definition of adrenal insufficiency in acutely ill pt

Back 1658

AM cortisol <5

Front 1659

in chronic steroid use, how to prophylax adrenal crisis before surgery

Back 1659

stress dose before surgery

Front 1660

location of dz: primary sclerosing cholangitis vs primary biliary cirrhosis

Back 1660

larger intra/extrahepatic ducts vs smaller intrahepatic bile ducts

Front 1661

work if abd u/s shows extrahepatic bile duct dilation w/o stones

Back 1661

do ct/ercp to detect occult stones/strictrictures & exclude malignancy

Front 1662

first step in evaluation of microscopic hematuria

Back 1662

is it glomerular or nonglomerular (glomerular = dysmorphic erythrocytes)

Front 1663

what is max tolerable increase in cr afte radding acei

Back 1663

30%

Front 1664

hallmark sign of atheroembolic acute renal failure

Back 1664

reticular rash

Front 1665

how to differentiate causes of renal failure in cirrhotic

Back 1665

give them volume to exlude prerenal. then what's left is hepatorenal, ischemic tubular injury, sepsis-induced AKD

Front 1666

name some sx of tumor lysis syndrome

Back 1666

cell breakdown -> hyperkalemia, hyperphosphatemia, hyperuricemia leading to akd

Front 1667

which fungi cause lung dz

Back 1667

PNA: histo, blasto, coccidio
cavity: aspergillus

Front 1668

progression of iron tox

Back 1668

gi sx within 30min-6h, then hepatotox

Front 1669

how does amyloid affect: kidney, GI tract, heart, msk, nervous sx

Back 1669

nephrotic syndrome, hepatomeglay, cardiomyopathy, pseudohypertrophy, peripheral neuropathy

Front 1670

htn in child + bruit at cva + string of beads angiogram

Back 1670

fibromuscular dysplasia

Front 1671

how to give tetanus shot as adult

Back 1671

Td q10 y. TdaP once under age 65 as booster.

Front 1672

tx for 2* spontaneous ptx

Back 1672

immediate thoracostomy cuz 2* dz is more serious cuz of underlying lung compromise

Front 1673

how does crest syndrome affect lungs

Back 1673

pulm htn

Front 1674

how do you know when pleural fluid is malignant

Back 1674

hx, rbc >100k, no trauma or infarction, lymphocytic exudate

Front 1675

lights criteria

Back 1675

effusion = exudative. plerual protein:serum >.5|ldh ratio >.6|LDH > 2/3 serum

Front 1676

what is poor prognosis for malignant pleural fluid

Back 1676

ph < 7.3|glucose<60 means <6mo survival

Front 1677

when do you tx acute bronchitis with abx

Back 1677

copd

Front 1678

ci for lung volume reduction

Back 1678

fev pred <20, homogenous emphysema, dlco <20, non upper lobe emphysema or high exercise capacity

Front 1679

bibasilar end inspiratory dry crackles like velcro + clubbing

Back 1679

idiopathic pulmonary fibrosis

Front 1680

how to prophylax dvt in cancer pt

Back 1680

use lmwh rather than warfarin

Front 1681

mc cancer after tx'ing hodgkins w radiatio

Back 1681

breast

Front 1682

management of supraclavicular lad

Back 1682

if <2cm, monitor 3mo. if >2cm, excision (rather than needle biopsy cuz will get preserved architecture)

Front 1683

do ppl with cholangiocarcinoma have dilation of cbd?

Back 1683

no intrahepatic ducts only

Front 1684

masectomy vs breast conserving surgery with radiation and lumpectomy in early stage breast cancer

Back 1684

equal outcome

Front 1685

sclc: rad vs chemo vs surg

Back 1685

surg is best, but only for stage 1 local. rad is also very local and offers limited benefit.

Front 1686

xr appearance of malig solitary pulm nodules

Back 1686

spiculated margins, >2.5, little-no calcification

Front 1687

dysplasia seen on colonoscopy in uc

Back 1687

do colectomy cuz 25% risk of progression

Front 1688

tx widespread sclc vs squamous nsclc

Back 1688

chemo+brain radiation vs hospice

Front 1689

4 mc locations pseudogout

Back 1689

knee meniscus, symphisis pubis, glenoid/acetabulum, triangular cartilage of wrist

Front 1690

impotence + fatigue + abnormal lfts + arthropathy, what test to order

Back 1690

iron studies

Front 1691

cpk: polymyositis vs pmr

Back 1691

elevated in polymyositis

Front 1692

sulfonylurea and renal function

Back 1692

can accumulate in renal insuffiency

Front 1693

quartad of thyroid storm

Back 1693

tachycardia, fever, agitation/delirium/psychosis, vomiting/diarrhea

Front 1694

indications for subtotal thyroidectomy

Back 1694

large goiters with obstructive symptoms

Front 1695

what to suspect if not recovering after pneumonia

Back 1695

parapneumonic effusion

Front 1696

what type of pleural effusion does tb cause

Back 1696

exudative

Front 1697

what type of pleural effusion does connective tissue dz occur

Back 1697

exudative

Front 1698

what type of pleural effusion does pancreatitis cause

Back 1698

exudative

Front 1699

mc hemorrhagic pleural effusion

Back 1699

malginancy, pe, tb

Front 1700

3 mcc tia/stroke. what things are life threatening and need to be checked for

Back 1700

carotid atherosclerosis, cardioemboism, lipohyalonisis. hemorrhage

Front 1701

rickets w normal serum calcium, normal serum alp, normal vit D

Back 1701

hypophosphatemic rickets

Front 1702

how is erysipelas diff from ordinary cellulitis

Back 1702

erysipelas caused by gas. erysipelas has sharp borders (cellulitis is poorly defined), and is on face or legs

Front 1703

what is bullous myringitis

Back 1703

blistering of TM due to otitis media

Front 1704

when are diuretics necessary to tx MI

Back 1704

flash pulmonary edema caused by MI

Front 1705

which nephrotic syndrome is assoc with hodgkins

Back 1705

minimal change

Front 1706

skin findings: tss vs meningococcemia vs scarlet fever

Back 1706

diffuse confluent erythematous vs stellate purpura w central gray vs rough sandpaper

Front 1707

what do you do for stable pt recovering from pancreatitis

Back 1707

cholecystectomy

Front 1708

how to tx long qt syndrome

Back 1708

bb

Front 1709

how to tx long qt syndrome

Back 1709

bb

Front 1710

mtx effect on heme

Back 1710

macrocytic anemia

Front 1711

how to tell b/w hemorrhagic shock and neurogenic shock

Back 1711

neurogenic has high vagal tone so bradycardia

Front 1712

if central skeleton is affected by RA, which area would be most likely to be affected

Back 1712

cervical spine, esp c1-2

Front 1713

bacterial vs viral gastroenteritis: vomiting

Back 1713

vomiting usually more assoc with viral ge

Front 1714

4 types of shock, how to differentiate

Back 1714

1. septic 2. neurogenic 3. hypovolemic 4. cardiogenic.

cardiogenic and hypovolemic will have low co (cold & clammy), but cardiogenic will have high pwcp and hypovolemic oft has low pwcp. septic will have have high co (hot), oft low pcwp due to low preload from dilation and normal-high mvo2.

Front 1715

esr in polycythemia vera

Back 1715

decreased

Front 1716

what is primidone used to tx? what can it precipitate?

Back 1716

essential tremor. aip

Front 1717

do cat bites need to be ppx'd?

Back 1717

x5d of augmentin to cover pasturella

Front 1718

when do the following post-mi complications occur: free wall rupture, papillary mm rupture, septal rupture, ventricular aneurysm

Back 1718

5-10d, 5-10d, 5-10d, 7weeks

Front 1719

what type of fungal infection assoc w palatal ulcers? mucosal ulcers?

Back 1719

histo. blasto

Front 1720

what type of lung findings in histo

Back 1720

hilar lad +/- pneumonitis

Front 1721

fungal infection -- palatal ulcers, hsm, pancytopenai

Back 1721

histo

Front 1722

hemodynamics in HIT

Back 1722

thrombocytopenia but also platelet activation (PF4) that causes hypercoagulability

Front 1723

mc site of compression for ulnar nerve

Back 1723

cubital tunnel at elbow

Front 1724

aspirin vs heparin for ami

Back 1724

aspirin actually decreases mortality. but use both

Front 1725

causes of 2* livedo reticularis

Back 1725

vasculitis, pancreatitis, tb, lymphoma, capillary obstruction

Front 1726

what chemical is notorius for causing pancytopenia

Back 1726

benzene

Front 1727

what to suspect in someone with chronic inflammatory dz + hip pain

Back 1727

consider avascular necrosis 2/2 cs

Front 1728

skin findings in fanconi

Back 1728

vitiligo, cafe au lait, freckles

Front 1729

how to distinguish bacterial atypical pneumonia vs influenza pneumonia

Back 1729

both can have leukopenia, bilateral infiltrates. influenza is 1. sudden 2. often in winter 3. fever is more common

Front 1730

kaposi vs ba based on hx

Back 1730

ba is more likely to have 1. exposure to some animal (cats, lice) 2. systemic effects esp liver issues

Front 1731

how to distinguish lmwh vs hep usage on labs

Back 1731

hep will elevate ptt

Front 1732

associations with pseudogout

Back 1732

hyperpth, hypoT, hemochromatosis,

Front 1733

herxheimer rxn

Back 1733

after using abx, develop sepsis like rxn incl fever and hypotension, due to widespread release of toxin from bacteria

Front 1734

stool osmotic gap is used to...

Back 1734

low = secretory diarrhea, high = osmotic diarrhea

Front 1735

how to dx lactose intolerance

Back 1735

hydrogen breath test in adults , stool ph in infants (bacteria make acid)

Front 1736

tx for cholesteatoma

Back 1736

surgery

Front 1737

sx of cholestatoma

Back 1737

painless otorrhea + hearing loss

Front 1738

why might you have decreased brath sounds in pe

Back 1738

pulmonary edema

Front 1739

what type of bias does loss to follow up cause

Back 1739

selection bias

Front 1740

mechanism of postictal metabolic acidosis

Back 1740

increased lactic acid from muscle activity during seizure

Front 1741

mobile cavitary mass in lung + intermittent hemoptysis

Back 1741

aspergilloma

Front 1742

choleastoma vs malignant otitis externa

Back 1742

choleasteoma = painless otorrhea + hearing loss + granulation tissue in middle ear
moe = painful ear canal esp on movement of ear + dc

Front 1743

what is trihexyphenidyl, what is it used for

Back 1743

m1 antagonist used for symptomatic tx in parkinson

Front 1744

vitamin a effect on brain

Back 1744

pseudotumor cerebri

Front 1745

cardiac manifestation of hemochromatosis

Back 1745

dilated cardiomyopathy, conduction problems, chf

Front 1746

central retinal vein occlusion vs central retinal a occlusion

Back 1746

both are permanent. artery is more acute, and see pallor and cherry red fovea in funduscopic. crvo is more subacute and optic disk swelling, retinal hemorrhage, vein dilation

Front 1747

appearance of porcelain gallbladder on ct

Back 1747

calcified rim with dark bile in center.

Front 1748

what is aspirin sensitivity syndrome

Back 1748

shutdown of cycloxygenase pathyway shunts to lipooxygenase and causes bronchoconstriction, polyp formation

Front 1749

vestibular neuritis vs labyrinthitis

Back 1749

labyrinthitis usually has hearing loss, vn doesn't

Front 1750

muscle strength in polymyalgia rheumatica? polymyositis?

Back 1750

normal, decreased

Front 1751

lifestyle tx for menieres

Back 1751

salt restricted diet

Front 1752

which nephritic syndrome needs emergent plasmaphoresis

Back 1752

goodpasture

Front 1753

what arv can cause crystal nephropathy

Back 1753

pi (indinivir)

Front 1754

which arv most likely to cause pancreatitis

Back 1754

didanosine

Front 1755

which arv most likely to cause hypersensitivity

Back 1755

abacavir

Front 1756

which arv most likely to cause sjs

Back 1756

nnrti

Front 1757

which arv most likely to cuase lactic acidosis

Back 1757

nrti

Front 1758

which arv most likely to cause liver failure

Back 1758

nevirapine

Front 1759

why do you get hypocalcemia in tumor lysis syndrome

Back 1759

released phosphate binds up the calcium

Front 1760

tx for mild acne

Back 1760

topical retinoids, benzoyl peroxide, azeleic acid

Front 1761

sspe vs pml

Back 1761

pml: more assoc with IC, jc, like ms except quick progression, dx by dna or by mri w multifocal non enhancing w/o mass effect
sspe: personality changes first, white matter affected

Front 1762

most serious complications of tx w hydroxychloroquine

Back 1762

macular toxicity (do eye exams)

Front 1763

expectoration: chronic bronchitis vs bronchiectasis

Back 1763

bronchietctasis is purulent, chronic bronchitis is not.

Front 1764

mc isolated & asymptomatic elevated alp in elderly

Back 1764

paget's dz

Front 1765

what types of seizure most likely to have aura

Back 1765

partial seizures

Front 1766

complex partial seizure vs partial seizure with secondary generalization

Back 1766

complex partial usually have automatiusms during loc, but partial seizure with generalization tends to have tonic clonic movements

Front 1767

tx for sickle cell stroke

Back 1767

exchange transfusion

Front 1768

pruritic eruption that occurs in person in contact with a bunch of stuff and grows coag neg staph

Back 1768

contact dermatitis (the s epidermis is just contaminant)

Front 1769

how to tx siadh

Back 1769

jif symptomatic (lethargy, coma etc) do hypertonic saline. fluid restriction, demeclocycline (can cause nephrotox, nephrogenic DI), vaptans, urea

Front 1770

physiologic acid base in pregnancy

Back 1770

respiratory alkalosis

Front 1771

mechanism of spironolactone in cirrhosis

Back 1771

fights 2* aldosteronism

Front 1772

memory impairment + personality changes + visuospatial intact

Back 1772

frontotemporal

Front 1773

disadvantage of tx'ing heat stroke with immersion in cold water

Back 1773

causes immediate vasoconstriction which limits heat dispersion

Front 1774

what causes zenker's

Back 1774

motor dysfunction and incoordination causing herniation b/w UES and cricopharyngeal mm

Front 1775

nasal obstruction + epistaxis + visible nasal mass in adolescent

Back 1775

angiofibroma

Front 1776

mechanism of analgesic nephropathy

Back 1776

papillary necrosis and chronic tubulointerstitial nephritis

Front 1777

4 criteria of brain death

Back 1777

1. absent CN reflexes 2. fixed & dilated pupils 3. no spontaneous breaths 4. agreement of 2 physicians

Front 1778

why would lying on your affected side in a PNA cause decreased o2 sat

Back 1778

v/q mismatch (bad lung will get dependent increase in ventilation and perfusion)

Front 1779

5 dietary recommendations for nephrolithiasis

Back 1779

1. decrease protein 2. decrease oxalate 3. decrease sodium 4. increase calcium 5. increase fluids

Front 1780

can NASH have macrovesicular steatosis, PMNs, and necrosis

Back 1780

yes

Front 1781

most common complication of pud

Back 1781

hemorhage

Front 1782

pickwickian and abg

Back 1782

increased pco2

Front 1783

why doesn't lp in bih cause herniation

Back 1783

pressure is evenly distributed in bih. not so with mass lesion

Front 1784

IM injection to which mm group has highest bioavailability

Back 1784

anterolateral thigh

Front 1785

sjs vs ten

Back 1785

>30% = ten

Front 1786

what pharmacologic tx other than epi can you use for anaphylaxis

Back 1786

diphenhydramine, ranitidine, albuterol, glucagon (if pt on bb), steroids (to prevent delayed rxns)

Front 1787

mechanism of radiocontrast "allergy", how to prevent

Back 1787

hyperosmolar dye causing degranulation of mast/basophil. pre-tx w diphenhydramine, h2 block, cs

Front 1788

fever, lad, maculopapular rash, arthralgia in response to drug

Back 1788

dilantin

Front 1789

what are reversible causes of dementia?

Back 1789

thyroid, syphilis, hiv, b12/folate, depression, CNS diseases (incl nph, use MRI),

Front 1790

what part of prostate does bph affect? cancer?

Back 1790

center? peripheral

Front 1791

tx for gastric outlet syndrome

Back 1791

vomiting -> hypokalemic hypochloremic metabolic alkalosis. :. NG, IVF, potassium

Front 1792

mc brain abscess

Back 1792

strep (anaerobic and aerobic) + anaerobes

Front 1793

what to suspect in young pt w htn, muscle weakness, numbness

Back 1793

1* aldosteronism

Front 1794

orbital cellulitis vs preseptal cellulitis

Back 1794

orbial involves fat and mm within orbit. preseptal = superficial only. orbital cellulitis has pain w eye mvmt, proptosis, and decresaed vision

Front 1795

mc mets to brain. what if hemorrhage? what if single vs multiple?

Back 1795

lots of bad stuff kills glia: lung, breast, skin, kidney, GU/GI. hemorrhage = melanoma. multiple = melanoma & lung, single = breast, colon, renal

Front 1796

what nerves does cauda equina contain

Back 1796

starts l1.

Front 1797

damage to what nerve in cauda equina syndrome causes urinary sx? what is the urinary sx?

Back 1797

urinary retention due to loss of pelvic nerve

Front 1798

definition of microscopic hematuria

Back 1798

>2 rbc/hpf

Front 1799

what is bartter's syndrome

Back 1799

defect in TAL. behaves exactly like thiazide diuretics

Front 1800

how is saline sensitive metabolic alkalosis diff from saline resistant. how to tx?

Back 1800

saline-sensitive involves volume contraction, saline-resistant involves expansion. tx: fix underlying cause (esp for saline resistant). if volume depleted, then give normal saline + potassium. if volume expanded, then just give potassium cl. if you need diuresis, use acetazolemide

Front 1801

what type of study seeks to measure odds ratio? how about relative risk?

Back 1801

case control. cohort

Front 1802

10 causes of pulseless arrest

Back 1802

H: hypovolemia, hypothermia, hypo/hyperkalemia, hypothermia, hydrogen
T: toxin, tamponade, tension ptx, thrombosis, trauma

Front 1803

does scc skin met to brain? how about esophageal carcinoma? oropharyngeal? prostate?

Back 1803

none of these do

Front 1804

tx for recurrent chalazion

Back 1804

biopsy to r/o carcinoma

Front 1805

how to workup syncope

Back 1805

if h&p (incl carotid sinus pressure to r/o sinus hypersensitivity), routine labs, and ekg reveal cause, then good. if unexplained, then if cardiac etiology then do cardio workup, if not then do tilt table & psych.

Front 1806

blood tests in cholesterol embolization

Back 1806

low c3, high eosinophils

Front 1807

what do you get echinococcus from? what imaging finding

Back 1807

close contacts w dogs, eggshell calcifications on ct

Front 1808

how does theophylline cause toxicity

Back 1808

phosphodiesterase inhibition, adenosine antagonism, stimulation of epinephrine release

Front 1809

what is susceptibility bias

Back 1809

a tx regimen is selected based on the severity of their condition

Front 1810

ekg finding with hypercalcemia

Back 1810

shortened qt

Front 1811

how do you get attributable risk %

Back 1811

(rr-1)/rr

Front 1812

how to culture for suspected acute prostatits

Back 1812

cx urine, DO NOT DO PROSTATE MASSAGE CUZ YOU WILL SEPSIS

Front 1813

histopathology of reye's

Back 1813

fatty vacuolization of hepatic cells (remember that salicylates are a mitochondrial poison and fats need energy to be broken down)

Front 1814

top causes of bacterial sinusitis

Back 1814

pneumo > hi > moraxella

Front 1815

liver histopathology: rotor vs dubin johnson

Back 1815

rotor doesn't have black pigment

Front 1816

csf WBC and RBC in g-b

Back 1816

normal

Front 1817

best tx for cancer-related cachexia

Back 1817

progestin

Front 1818

prognosis in cll: splenomeglay, anemia, tcp

Back 1818

spleen better than anemia better than tcp (worst)

Front 1819

mc organism septic joint in artificial joint

Back 1819

saureus

Front 1820

what's hepatolenticular degeneration

Back 1820

wilson's dz

Front 1821

infection of what spaces can lead to infection of: mediastinum, ludwig's angina, carotid sheath

Back 1821

retropharyngeal, submandibular, parapharyngeal

Front 1822

mcc spinal stenosis

Back 1822

osteoarthritis

Front 1823

herniated disk vs spinal stenosis

Back 1823

spinal steosis doesn't have any neurologic sx and pain is better with sitting/lying. herniated is worse with sitting, +dslr

Front 1824

mc thyroid malignancy

Back 1824

papillary

Front 1825

ocular trauma -> central scotoma, retinal edema, hemorrhagic detachment of macula, subretinal hemorrhage, crescent shaped streak concentric to optic nerve w/ blurred vision

Back 1825

choroidal rupture

Front 1826

sudden painless loss of vision w/ pallor of optic disk, cherry red fovea, boxcar segmentation of blood in retinal veins

Back 1826

central retinal artery occlusion

Front 1827

who is bronchoalveolar lavage mostly useful for

Back 1827

evaluation of malignancy or opportunistic infection *esp pcp)

Front 1828

most effective lifestyle intervention for reducing bp

Back 1828

if obese, then weight loss. if nonobese, dash diet

Front 1829

necrosis of nasal turbinate in diabetic is highly suggestive of

Back 1829

mucormycosis

Front 1830

bb and potassium

Back 1830

bb causes hyperkalemia

Front 1831

mgmt for suspected testicular tumor

Back 1831

do u/s -> if +, then radical orchiectomy -> ct for staging

Front 1832

WTF IS GUTTATE PSORIASIS

Back 1832

infection -> psoriasis with multiple salmon color papules

Front 1833

which thyroid cancer causes following: secretes calcitonin, has psomomma bodies, invades hematogenously

Back 1833

medullary, papillary, follicular

Front 1834

what does lambert eaton antibody bind

Back 1834

calcium channel on PRESYNAPTIC neuron

Front 1835

causes of secondary pellegra

Back 1835

hartnup disease (decreased absoprtion) carcinoid (shunting to serotonin), inh

Front 1836

what test to do after dx'ing myasthenia

Back 1836

ct for thymoma

Front 1837

what to do for acute UMN lesion + sensory deficit

Back 1837

MRI

Front 1838

anemia, mouth ulcers, lft abnormalities after tx for RA

Back 1838

mtx side effects

Front 1839

ddx for anterior mediastinal mass

Back 1839

thymoma, teratoma, thyroid neoplasm, and terrible lymphoma

Front 1840

prisoner with fluid collection in spleen, fever, leukocytosi, abd pain

Back 1840

ie to spleen

Front 1841

histology of ALL lymphoblasts

Back 1841

PAS+

Front 1842

acid fast oocysts in IC pt

Back 1842

cryptosporidium > isosporodium

Front 1843

mcc bloody emesis in pt abusing alcohol and aspirin

Back 1843

acute gastritis.

Front 1844

most sensitive test for disseminated histo infection

Back 1844

urine antigen

Front 1845

tx for histo in ic

Back 1845

itraconazole

Front 1846

most common organism in pneumonia after flu

Back 1846

saureas

Front 1847

dendriform corneal ulcers + vesicular rash in trigeminal distribution vs pain, photophobia, decreased vision, dendritic ulcer, vesicles in epithelium

Back 1847

herpes zoster ophthalmmicus vs herpes simplex keratitis

Front 1848

hazy cornea with central ulcer and ajacent stromal ulcer

Back 1848

bacterial keratitis

Front 1849

invasion of the tumor capsule and blood vessels in thyroid cancer

Back 1849

follicular cancer

Front 1850

cbc abnormality in ashtmatic tx'd with ics

Back 1850

neutrophilia

Front 1851

pyelo unresponsive to abx for 72h

Back 1851

look for obstructions or complications - renal u/s

Front 1852

change in gross appearance of eye in glaucoma

Back 1852

red eye

Front 1853

bone cancer pain

Back 1853

unrelenting pain not responsive to rest

Front 1854

tx for acute hypercalcemia

Back 1854

iv saline -> loop

Front 1855

usptsf osteoporosis

Back 1855

65+ do screening, or younger if risk factors

Front 1856

def of osteoporosis on bone mineral density

Back 1856

-2.5sd

Front 1857

pecularities in legionaries dz

Back 1857

fever with bradycardia (temperature disassociation), hyponatremia

Front 1858

wernicke vs korsokoff

Back 1858

mamillary body
confusion + ophthalmoplegia + ataxia
amnesia + confabulation + personality change

Front 1859

peculiarity in histo lesions radiographically

Back 1859

tend to calcify

Front 1860

which fungus can have lytic bone lesions

Back 1860

blasto

Front 1861

physiology of histamine

Back 1861

h1: nasal and bronchial mucus secretions, bronchiolar constriction, pruritus, pain, increased capillary permeability leads to wheals
h2: gi acid secretion

Front 1862

what is polyarteritis nodosa assoc w. what does it affect

Back 1862

hepatitis b. renal and visceral

Front 1863

what is microscopic polyangiitis

Back 1863

like wegener's except no granulomas that is panca +

Front 1864

microscopic polyangiitis vs pan

Back 1864

pan = different aged lesions. microscopic poly = same aged

Front 1865

osler weber randu

Back 1865

abnormal vessel proliferation that can lead to bleeding AD

Front 1866

what drug can u use to tx wpw with afib

Back 1866

amniodarone, procainamide, dc. don't use avn blockers

Front 1867

pulmonary causes of pulsus paradoxicus

Back 1867

asthma, copd, tension ptx

Front 1868

gold std test for acromegaly

Back 1868

measure gh after oral glucose

Front 1869

what secondary pneumonia can cause a necrotizing bronchopneumonia resulting in pneumatoceles

Back 1869

saureus

Front 1870

endocarditis following GU procedure usually caused by

Back 1870

enterococci

Front 1871

palpable purpura + glomerulonephritis w/ proteinuria + hematuria + hep C

Back 1871

mixed cryoglobulinemia

Front 1872

metabolic abnormality assoc w ischemic bowel

Back 1872

lactic acidosis

Front 1873

workup for new onset lupus nephritis

Back 1873

kidney biopsy cuz diverse effect on kidney with diverse management

Front 1874

tx for polymyalgia rheumatica

Back 1874

low dose steroids

Front 1875

how to tx peritonsillar abscess

Back 1875

if airway compromise, then surgery. if abscess, then drain + abx. if cellulitis, then abx.

Front 1876

workup for cholangitis

Back 1876

abd us then ercp

Front 1877

sx of mac in hiv

Back 1877

tb-like (fever, night sweat, weight loss) + if bm involved then anemia + if gi involved, abd pain & diarrhea

Front 1878

travel to weird area + skin lesion + numbness & weakness, how to dx

Back 1878

leprosy, do biopsy

Front 1879

what to check in pt who you are deciding po vs iv drug (assume efficacy, etc all the same)

Back 1879

if nausea/vomiting/gi problem, don't give po

Front 1880

tx for restless leg

Back 1880

trial of iron -> ropinarole/premipaxole (da agonist) -> levodopa

Front 1881

3 broad categories of delirium etiologies

Back 1881

1. cns lesion (trauma, infection, etc) 2. metabolic abnormality 3. toxic abnormality

Front 1882

what kinds of things must you exclude before diagnosing dt

Back 1882

infection (blood culture), pna, hypoxia

Front 1883

4 types of alcohol withdrawal

Back 1883

1. tremulousness (within 6h) 2. withdrawal seizures (6-48h) 3. alcoholic hallucinations (12-48h) BUT SENSORIUM INTACT 4. dt's (48-72h)

Front 1884

what type of vaccine is shingles shot

Back 1884

live attenuated

Front 1885

conjugated molecules have what type of molecule attached? what type of immunity do they invoke

Back 1885

polysaccharide, t-cell independent

Front 1886

causes of hiv esophagitis ranked by organism

Back 1886

candida > cmv ~ herpes

Front 1887

herpes esophagitis vs cmv esophagitis

Back 1887

hsv - multiple, small, deep ulcers. cmv - large, superficial

Front 1888

how is hypercalcemia of malignancy caused

Back 1888

bone mets cause osteolysis by production of cytokines. some release PTHrP. some make PTH. Hodgekin's produces calcitriol.

Front 1889

young black male with painless hematuria

Back 1889

sickle cell trait (caused by paipllary ischemia)

Front 1890

emergent tx for central retinal artery occlusion

Back 1890

high o2 and ocular massage (to dislodge the embolus to a more peripheral location)

Front 1891

what is shy dragar syndrome

Back 1891

aka multiple system atrophy. parkinsonism + autonomic dysfunction (incl postural hypotension) + widespread neurological sx

Front 1892

pt overdosed on something ... see radioopaque tablets on xr

Back 1892

iron tablets

Front 1893

what is a hordeolum

Back 1893

infection of meibomian gland or gland of zeis

Front 1894

bone complication of RA

Back 1894

osteoporosis

Front 1895

what clotting factors do cf pts lack

Back 1895

2,7,9,10. cuz of vit k def

Front 1896

when is essential tremor

Back 1896

it is a kinetic tremor that is seen only on usage of affected muscle, but can worsen with stress, temperature, emotions, etc

Front 1897

mechanism of pancytopenia in sle

Back 1897

peripheral destruction

Front 1898

mechanism of sequestration in pancratitis

Back 1898

release of pancreatic enzymes nad cytokines escaping local area and causing damage to endothelial tissue

Front 1899

clubbing of digits + periostitis of long bones + arthritis + pachydermia

Back 1899

hypertrophic osteoarthropathy. rmr to r/o lung cancer

Front 1900

drug interactions with sildenafil

Back 1900

1. don't use with nitrates 2. using with PI can cause decreased metabolism 3. watch out with hypotension w alpha block (give 4h apart)

Front 1901

drug interactions with sildenafil

Back 1901

1. don't use with nitrates 2. using with PI can cause decreased metabolism 3. watch out with hypotension w alpha block (give 4h apart)

Front 1902

increased urine/serum hydroxyproline

Back 1902

pagets

Front 1903

normal pcwp

Back 1903

2-15

Front 1904

right atrial pressure vs pcwp

Back 1904

pcwp = lap = pulmonary venous pressure
rap = central venous pessure

Front 1905

granulomas in crohns vs sarcoidosis

Back 1905

both are noncaseating

Front 1906

what dose of bb should chf pt be on

Back 1906

titrate up until hr drops