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362 Cards in this Set
- Front
- Back
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3 causes of aminotransferase values > 5000
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Acetaminophen toxicity
Hepatic ischemia Unusual viruses (e.g. HSV) |
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Distinguishing pseudoachalasia from achalasia
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In adenocarcinoma, there is resistance to the scope passing thru the GEJ
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Asymptomatic indirect hyperbilirubinemia with normal Hb and otherwise normal LFTs
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Gilbert's
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3 cirrhosis-like changes that are normal in pregnancy
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Increased alk phos
Spider angiomata Palmar erythema |
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Pain with internal rotation of the hip
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Obturator sign
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The obturator sign is associated with ?
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Pelvic appendix
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Pain in the right lower quadrant with extension of the right hip
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Iliopsoas sign
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The iliopsoas sign is associated with?
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Retrocecal appendix
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Red flags for alternative to IBS diagnosis
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Weight loss
Nocturnal awakening Fever, onset >50yo, recent antibiotic use, FH of colon cancer or IBD |
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Rx for IBS
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Loperamide
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Abdominal pain with leukocytosis, hyperkalemia, and metabolic acidosis
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Acute mesenteric artery ischemia
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3 most common causes of acute mesenteric artery ischemia
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Mesenteric arterial embolism originating from the heart (often due to atrial fibrillation)
Mesenteric arterial thrombosis (due to atherosclerotic lesions) Mesenteric venous thrombosis (usually in SMV) |
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Best diagnostic test for potential pancreatic carcinoma
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Helical CT of the abdomen
(then an ERCP afterward) |
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Calcium supplementation may cause this GI problem
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Constipation
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Two treatments for cholangitis
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Empiric antibiotics
ERCP (must do as well, b/c of high mortality; may need to do ductal decompression) |
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Gall bladder wall thickening indicates
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Acute cholecystitis
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Total bilirubin >4.0 mg/dL, elevated aminotransferase levels, diminished consciousness or shock
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Suspect acute cholangitis
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Gallbladder disease associated with ulcerative colitis
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Sclerosing cholangitis
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Test for diagnosis and treatment of sclerosing cholangitis
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ERCP
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Rx for gallstone pancreatitis
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IVF, pain management, and laparoscopic cholecystectomy (due to high relapse rate)
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Pretest odds (formula)
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Pretest probability / 1- pretest prob
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Post-test probability (formula)
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Post-test odds/ Post-test odds + 1
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A screening abdominal ultrasound is recommended to evaluate for ___ in men 65-79yo who are current or former smokers?
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AAA
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Best prophylactic measure against influenza for immunosuppresed pts?
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Oseltamivir (pts can't respond to live or inactivated vaccine) + vaccination of all family members
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Who should use the inactivated influenza vaccine vs. the live intranasal vaccine?
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Elderly (>50yo), anyone with a chronic medical condition, pt on chronic corticosteroids, or pregnant
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Systolic murmurs necessitate a TTE only when they are
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Grade III or higher
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How to differentiate vertebrobasilar TIA from carotid TIA?
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Both have focal neurologic deficits, but vertegrobasilar usually has LOC, whereas carotid does not
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Presyncopal symptoms of warmth, diaphoresis, and lightheadedness are consistent with
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Neurocardiogenic syncope
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Drug class contraindicated in cocaine-induced MI
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Beta blockers
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Should be used in place of beta blockers in cocaine-induced MI
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Labetalol (both alpha and beta blocker)
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Imaging modality of choice for potential spinal cord compression?
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MRI (of the entire spine, not just suspect region)
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Leg ischemia is likely if pt has ____ with exertion and an ankle:brachial index of ____ that ____ with exercise
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Pain
<.9 Decreases (by at least 20%) |
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Best intervention in pts with peripheral artery disease
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Smoking cessation
(Best medical intervention for symptoms: cilostazol) |
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Phosphodiesterase inhibitors are contraindicated in pts with
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Heart disease
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Gastric bypass surgery is recommended as an option for which pts?
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patients with class III obesity, defined as those who have a Those with Class III obesity:
BMI of ≥40 who have been unable to maintain weight loss with exercise and diet with or without drug therapy, and have obesity-related comorbid conditions |
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Mechanism of orlistat
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Lipase inhibitor
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Mechanism of sibutramine
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Appetite suppressant
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Which is contraindicated in pts with HTN, orlistat or sibutramine?
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Sibutramine
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Positive depression screening with what score on the Geriatric Depression Scale?
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At least 2 out of 5
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How to differentiate B12 and folate deficiency on lab testing
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Folate: only homocysteine is elevated
B12: both homocysteine and methylmalonic acid are elevated |
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Other than hereditary spherocytosis, spherocytes are seen in this disease
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Warm antibody autoimmune hemolytic anemia
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Low/normal iron, low TIBC, and increased ferritin indicate
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Anemia of chronic disease (i.e. inflammation)
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Rx for TTP
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Plasmapheresis
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Prolonged PTT time after previously normal tests indicates
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Acquired Factor VIII inhibitor
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3 associations with Factor VIII inhibitor development
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Malignancies (esp lymphomas)
Autoimmune disorders Postpartum setting. |
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How does a mixing study (aka inhibitor screen) differentiate between deficiency and inhibitor?
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Deficiency: coagulopathy fixed when pt's serum mixed with normal serum
Inhibitor: coagulopathy not corrected |
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In pts with recurrent giardiasis and respiratory infections, suspect ____ and test ____
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Common variable immunodeficiency
IgG levels |
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Malodorous vaginal discharge without irritation, pain, or itching
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Bacterial vaginosis
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Rx for bacterial vaginosis
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Metronidazole or clindamycin
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Frothy yellow green pruritic discharge
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Trichomonas vaginalis
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Cottage cheese discharge with inflammation, irritation, and no smell
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Candida
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Two symptoms that may accompany a drug fever
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Eosinophilia
Rash |
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Noninfectious causes of SIRS
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Trauma, pancreatitis, and severe burn
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Which should be avoided in asthmatics, oseltamivir or zanamivir?
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Zanamivir (can induce bronchospasm)
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Rx for acute sinusitis
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3- to 10-day course of a narrow-spectrum antibiotic (amox, Bactrim, doxy)
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Pentad of TTP
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Fever
Microangiopathic hemolytic anemia Renal failure Neurologic findings Thrombocytopenia |
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What is the anion gap in multiple myeloma?
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Low (e.g. around 3)
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Maltese cross fat droplets of urine sediment under polarized light
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Minimal change disease
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C3 and C4 levels in SLE
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Both low
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Edema, hypoalbuminemia, hypercholesterolemia
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Minimal change diseaes
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Rx of hyperuricemia
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Rasburicase
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Increased serum uric acid, potassium, and phosphorus concentrations
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Tumor lysis syndrome
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Obesity hypoventilation syndrome causes a? (respiratory or metabolic, acidosis or alkalosis)
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Respiratory acidosis
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4 diagnostic features of delirium
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1) acute onset or fluctuations in mental status over24hrs
2) inattention 3) disorganization of thinking 4) altered LOC |
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What causes migraine or tension headaches to transform into chronic daily headache?
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Excessive analgesic use
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Rx for cluster headaches
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Prednisone
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5 diagnostic criteria for migraine headaches
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POUND: pulsatile, one-day duration, unilateral, nausea or vomiting, and disabling
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3 headache red flags
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Age >50
Acute onset Hx of malignancy |
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Fluctuating lethargy and inattention, hallucinations, and asterixis
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Toxic encephalopathy (causing a dementia/ delirium picture)
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Abrupt onset of dementia with subsequent improvement
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Vascular dementia
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Periventricular white matter ischemia on CT or MRI of the brain
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Vascular dementia
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Memantine is not useful in patients with this level of Alzheimer's dementia
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Mild
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Three cholinesterase inhibitors with efficacy in dementia
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Rivastigmine, donezepil, galantamine
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Rx for HSV encephalitis
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Acyclovir
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Poor prognostic sign for neurologic recovery in herpes encephalitis
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Abnormality in the temporal lobe (e.g., a hemorrhagic lesion) on imaging
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Rx for restless leg syndrome
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Dopamine agonist
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Check this serum measurement before beginning pharma treatment for restless leg syndrome
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Serum ferritin: correcting iron deficiency can alleviate symptoms
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Hodgkin's lymphoma survivors who receive extended-field radiation therapy have a greatly increased risk for developing
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Solid tumors (e.g. breast cancer in young women treated)
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Alkylating-agent chemotherapy treatment increases the risk of
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AML
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Best chance of cure for pts with cancer of head of pancreas?
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Whipple procedure (pancreaticoduodenectomy)
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Most common causes of malignant pericardial disease
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Breast and lung cancers
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Trastuzumab
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Ab to HER2/Neu receptor
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Rx for metastatic small cell lung cancer
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Chemotherapy only (usually a platinum agent (cisplatin or carboplatin) and etoposide or irinotecan)
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Are malignant pulmonary nodules generally spiculated or not, and calcified or not?
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Spiculated, minimally calcified
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Women at increased risk for breast cancer (>1.6% over next 5 years) can receive this therapy to decrease their risk
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Tamoxifen
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Rx for ulcerative colitis pt with low-grade dysplasia
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Colectomy
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Pain only on full elbow flexion
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Olecranon bursitis
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Extreme pain on passive joint motion
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Acute crystalline or infectious synovitis
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Pain and tenderness over the anteromedial aspect of the lower leg below the joint line of the knee
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Anserine bursitis
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Pain exacerbated by going down steps and by extended flexion at rest
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Patellofemoral pain syndrome
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Rx for patellofemoral pain syndrome
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NSAIDs
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Difference in swelling patterns for ligamentous vs. meniscal injuries
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Ligamentous: immediate swelling
Meniscal: swelling occurs over several hours |
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Twisting injury w/ popping or tearing sensation often felt, followed by severe pain, esp on walking (commonly up and down stairs)
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Meniscal injury
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Rx for knee sprain
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RICE: rest, ice, compression, elevation
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Knee radiograph indicated if pt has any of these features
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1) >55yo
2) tenderness at head of fibula or patella 3) inability to flex to 90 or bear weight |
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Subacromial tenderness and impingement; pain when reading overhead and when lying on the shoulder
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Rotator cuff tendonitis
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Decreased ROM of shoulder from stiffness rather than pain or weakness
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Adhesive capsulitis (aka frozen shoulder)
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Postmenopausal women who use diuretics have an increased risk for
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Tophaceous gout of the DIPs
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Two drugs for long-term gout management and their mechanisms
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Probenecid: uricosuric
Allopurinol: xanthine oxidase inhibitor |
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Two drugs for acute gout treatment
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NSAIDs (preferred)
Colchicine (high toxicity; binds and stabilizes tubulin to prevent polymerization) |
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Target uric acid level for pts with recurrent gout
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<6
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Abnormal LFTs, arthropathy, fatigue, impotence
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Hereditary hemochromatosis
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Morning joint pain lasting 15 minutes
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Osteoarthritis! Only think RA if >30 minutes
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Heberden's and Bouchard's nodes are on which joints and indicate?
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DIP and PIP, respectively
Osteoarthritis |
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Rx for osteoarthritis
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Acetaminophen (NSAIDs have equal/ marginally better efficacy but more adverse effects)
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Rx for refractory knee osteoarthritis
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Intra-articular corticosteroid injections
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Dermatomyositis, polymyositis, and inclusion-body myositis have an increased risk for
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Malignancy
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Ausculatory findings of COPD
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Hyperresonance
Decreased breath sounds Prolonged expiration |
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Chylothorax (drainage of lymphatic fluid into pleural space due to disruption/blockage of thoracic duct) is associated with
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Malignancy (non-Hodgkin's lymphoma) or cardiothoracic procedures
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Most common cause of hemothorax
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Trauma (either blunt or penetrating, incl. iatrogenic)
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Radiation-induced heart diseases
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Myocardial fibrosis, constrictive pericarditis, early CAD, valve dysfunction
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Increased JVP, fatigue, dyspnea, peripheral edema, ascites in a pt without CHF
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Constrictive pericarditis
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Which is more dangerous, primary or secondary pnuemothorax?
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Secondary (there is already underlying lung disease)
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Rx for secondary pneumothorax
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Tube thoracostomy (chest tube placement)
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Paradoxical abdominal motion on breathing, excessive decrease in FVC while supine, and poor inspiratory force
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Neuromuscular respiratory failure
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When is tube thoracostomy (chest tube drainage) indicated for a parapneumonic effusion, and why?
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If pus or G+ pleural fluid is detected or if pleural pH is <7.0
They are complicated parapneumonic effusions, at risk for loculation |
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Size cutoff for a pleural effusion that requires thoracentesis?
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>10 mm in height (on lateral decubitus CXR)
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Pleural fluid erythrocyte count >100,000/uL indicates
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Pleural malignancy (if not in the setting of trauma or pulmonary infarction)
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These non-selective meds can cause asthma exacerbations
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Beta blockers
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Rx for beta-blocker induced bronchocontstriction
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Ipratropium bromide (or atropine, glucagon, corticosteroids, etc.)
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3 most common causes of chronic cough
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GERD
Cough-variant asthma Postnasal drip syndrome |
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Diagnosis of exercise-induced asthma?
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Exercise challenge test; post-exercise spirometry showing >20% fall in FEV1
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Rx for acute severe asthma
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1) Systemic corticosteroids
2) Inhaled bronchodilators (anticholinergic and short-acting beta-agonist) 3) Magnesium sulfate (IV or inhaled) --> bronchodilation 4) Intubation |
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Rx for home treatment of asthma
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1) short-acting beta agonist
2) inhaled corticosteroid 3) long-acting beta agonist 4) theophylline or leukotriene receptor antagonist 5) IgE Abs (if have elevated Ab levels) |
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Episodic flushing, decreased BP, increased HR
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Carcinoid syndrome
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Pheochromocytomas are improved with these drugs and worsened by these drugs
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Alpha-blockers
Beta-blockers (unless after adequate alpha blockade) |
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In ____, hyperreninemia can cause recurrent episodes of flash pulmonary edema
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Renovascular HTN
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Scleroderma pt w/ new onset HTN, increased Cr, decreased platelets, anemia, LE edema
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Scleroderma renal crisis
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Rx for scleroderma renal crisis?
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Short-acting ACEIs, e.g. captopril (to counteract increased renin)
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Alteplase is contraindicated in pts with what BP?
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>185/ 110 (or an MAP >135)
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What types and when should anticoagulation be used in ischemic stroke?
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LMWH and antiplatelet agents, 24-48 hrs after alteplase
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Test used for suspected subarachnoid hemorrhage in pt with normal head CT?
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Lumbar puncture to look for xanthrochromia
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3 types of events that can precede Guillain-Barre syndrome?
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Infection, immunization, surgery
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Rx of Guillain-Barre
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IV Ig or plasmapheresis
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Symmetric proximal and distal muscle weakness, decreased DTRs, and distal loss of vibration and position senses
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Chronic inflammatory demyelinating polyneuropathy
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Rx for chronic inflammatory demyelinating polyneuropathy
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Immunosuppressants (steroids, IV Ig, plasmapheresis)
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Preventive therapy for prostate cancer
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Finasteride (5-alpha reductase inhibitor)
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Lateral compression of this lesion will produce a depression, or dimple, that helps distinguish it
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Dermatofibroma
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This skin lesion develops quickly and spontaneously resolves over 4-6mo
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Keratoacanthoma
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Migratory arthralgia in one inflamed joint and tenosynovitis (wrist or ankle) and/or tender necrotic pustules on an erythematous base, especially on the distal extremities
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Gonococcal arthritis
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Rx for septic arthritis
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IV antibiotics (not oral b/c is a closed space, need penetration)
Daily drainage |
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How to differentiate diffuse and limited systemic sclerosis?
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Location of skin thickening
Limited: distal to elbows & knees Diffuse: proximal to elbows & knees |
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Positive findings on pathergy test (development of an erythematous papular or pustular lesion >5 mm 24 to 48 hours after skin prick by a needle)
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Behçet's disease
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Recurrent aphthous oral ulcers +/- recurrent genital ulcers, inflammatory eye disease, cutaneous lesions
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Behçet's disease
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Scalp tenderness, carotidynia, and jaw claudication
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Giant cell arteritis
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Acute onset of asymmetrical weakness and sensory loss associated with severe pain
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Vasculitic neuropathy
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Thyrotoxicosis, a nontender thyroid gland, absent radioiodine uptake, and no visualization of tracer on the thyroid scan
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Thryoiditis
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Rx for thyroiditis
|
Beta-blockers
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Which hyperthyroid states cause increased radioiodine uptake vs. decreased?
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Increased: Graves', toxic multinodular goiter, autonomous thyroid nodules
Suppressed: Sporadic, postpartum, or subacute thyroiditis |
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Differentiate bone mineral density in osteoporosis vs. osteopenia
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<-2.5 in osteoporosis
Between -1 and -2.5 SD below the mean is osteopenia |
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Which calcium channel blocker can be used in heart failure?
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Amlodipine (2nd generation): more vasoselective, less cardiodepressant
CanNOT use nifedipine, diltiazem, or verapamil (1st generation): cause a reactive increase in sympathetic vasodilation due to peripheral vasodilation and negative ionotropic effects |
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Tuberculin skin testing cut-offs
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>15mm of induration
> 5mm if immunosuppressed, close contacts, or + CXR > 10mm for immigrants, IVDU, HCWs, prisoners |
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Rx for outpatient CAP?
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Macrolide or doxycycline
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Rx for hospitalized CAP?
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IV fluoroquinolone or
IV Beta-lactam + macrolide or doxy |
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Rx for ICU CAP?
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IV Beta-lactam + macrolide or fluoroquinolone
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Bronchiectasis is a risk factor for the development of what pneumonia?
|
Pseudomonas aeruginosa
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IV drug use, soft S1, muffled S2, heart block
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Aortic valve perforation and paravalvular abscess
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Best drug for antibiotic prophylaxis before dental procedures?
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Amoxicilllin 1 hr beforehand
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Osteomyelitis in sickle cell disease: 3 causative agents and appropriate antibiotics
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Staph, strep, salmonella
Vanc + ceftriaxone |
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Anti-TNF-alpha therapy (e.g. infliximab) increases the risk for what infection?
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Reactivation TB
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Bone xray showing marginal erosions and juxta-articular osteopenia
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Rheumatoid arthritis
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Rx for gonococcal arthritis
|
Ceftriaxone
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Empiric meningitis Rx, and the bugs they cover
|
Ceftrixone and vancomycin (for S. pneumoniae and N. meningitides)
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Risk factors for Listeria meningitis
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Immunosuppression, extreme ages, alcoholism, malignancy, DM, hepatic failure, renal failure, iron overload, collagen vascular disorders, HIV
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Intracerebral hemorrhage w/ subarachnoid hemorrhage is the hallmark of a
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Ruptured arteriovenous malformation
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Contralateral visual field deficit is due to a stroke in which artery?
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Posterior cerebral artery
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Contralateral leg weakness is due to a stroke in which artery?
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Anterior cerebral artery
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Contralateral arm>leg weakness, sensory loss, visual field deficit and aphasia or hemi-neglect is due to a stroke in which artery?
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Middle cerebral artery
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Left MCA stroke causes ___ vs. right MCA stroke, which causes ____?
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Aphasia from left, hemi-neglect from right
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Horner's syndrome, dysarthria, dysphagia, and alternating signs (contralateral body, ipsilateral face) is due to a stroke in which artery?
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Vertebral artery (brainstem lesion)
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Rx for ischemic stroke pts outside of the tPA window?
|
Aspirin
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Major contributor to progression to ESRD
|
Uncontrolled HTN
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Elevated leukocyte count and increased numbers of granulocytic cells in all phases of development
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CML
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Increased leukocyte count and increased numbers of mature lymphocytes and “smudge” cells (lymphocytes that appear flattened or distorted)
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CLL
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Elevated leukocyte count, anemia, thrombocytopenia, and blasts
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AML
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CAD equivalents for lipid goals
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CAD, PAD, AAA, DM, Framingham score >20%
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Mechanism of hypercalcemia in sarcoidosis
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PTH-independent extrarenal production of 1,25-dihydroxyvitamin D3 by activated macrophages in the lungs and lymph nodes, which results in excess calcium absorption from the gut leading to hypercalciuria, hypercalcemia and hyperphosphatemia
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Rx for ITP
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Prednisone, followed by splenectomy if refractory
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Achalasia is a risk factor for this type of esophageal cancer (vs. Barrett's, which is a risk for this type)
|
Squamous cell and adenocarcinoma, respectively
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2 CXR findings in aortic coarctation
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Rib notching (from erosion by collateral arteries formed in response to flow resistance) and a figure 3 sign (dilation before and after coarctation)
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Alternative to an ACEI in pts with heart failure who develop hyperkalemia
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Hydralazine and a nitrate
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EF, K+, and Cr criteria for using spironolactone
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EF < 35%, K+ <5, Cr < 2.5
|
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Rx for hemoynamically unstable V-tach
|
Direct-current cardioversion
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Rx for hemodynamically stable but symptomatic V-tach
|
IV lidocaine, procainamide, or amiodarone
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Murmors of pulmonary stenosis and regurg ___ and ___ w/ inspiration
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Increase for both
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Rx for herpes zoster
|
Famciclovir or valacyclovir, ideally w/in 72hrs
|
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Rx for onychomycosis
|
Terbinafine, griseofulvin, or itraconazole
|
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Where are the lesions in inverse psoriasis?
|
Flexural sites, e.g. azillae and antecubital fossa
|
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Guttate psoriasis often occurs after?
|
Beta-hemolytic strep infection
|
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Which form of psoriasis can affect up to 100% of the skin?
|
Erythrodermic psoriasis
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Erythematous lesions w/ central clearing and peripheral scale
|
Dermatophyte infection
|
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Effect of sun on psoriasis?
|
Improves it
|
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|
Ringworm like patch on trunk 1-2wks after viral infection
|
Pityriasis rosea (herald patch, followed by other scaly lesions)
|
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Rx for pityriasis rosea
|
Topical cortisones and antihistamines
|
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Papules that are sharply demarcated on yellowish-red skin and may be greasy or dry
|
Seborrheic dermatitis
|
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Rx for tinea versicolor
|
Topical ketoconazole
|
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Rx for common wart
|
Topical salicylic acid for 6-12wks (cryotherapy if persistant)
|
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Multifocal atrial tachycardia is often associated w/ this lung disease
|
Hypoxic COPD
|
|
|
Risk factors for osteoporosis
|
Personal fracture Hx, Hx in family member, smoking, oral corticosteroids in last 3mo, weight <127lbs
|
|
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When should screening for osteoporosis start?
|
DEXA scan at 65yo, or younger in women with risk factors
|
|
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Possible underlying endocrine cause of hyperlipidemia
|
Hypothyroidism
|
|
|
Subclinical hyperthyroidism increases the risk for this cardiac condition
|
Atrial fibrillation
|
|
|
Rx for hyperglycemic hyperosmolar syndrome
|
Normal saline first, then insulin (maintaining volume is most imp)
|
|
|
Sodium correction for hyperglycemia
|
Increase by 1.6 for every 100 of glucose over normal (100)
|
|
|
Most sensitive physical exam finding to exclude aortic stenosis
|
Physiologically split S2
|
|
|
HCOM murmur ___ with Valsalva and ___ with stand-to-squat maneuver, passive leg raises, and handgrib
|
Increases (decreased preload --> smaller chamber size --> more obstruction)
Decreases (increased preload --> opposite) |
|
|
Ecchymosis of the flanks indicates?
|
Pancreatic hemorrhage due to pancreatic necrosis (rare presentation of acute pancreatitis)
|
|
|
Cigarette smoking is a risk factor for this pancreatic condition
|
Cancer (NOT pancreatitis)
|
|
|
4 signs of glucagonomas
|
4 Ds
DM, dermatitis (necrolytic migratory erythema), depression, DVT |
|
|
Rx for H. pylori
|
Triple therapy for 10-14 days:
- Acid suppression (PPI or bismuth subsalicylate) - Clarithromycin - Amox or metronidazole |
|
|
Med to give for acute esophageal variceal bleeding
|
Octreotide
|
|
|
Sign of fulminant acute hepatitis that is an indication for liver transplantation?
|
Encephalopathy/ declining mental status
|
|
|
Incubation period for HBC
|
1-4mo
|
|
|
When should you biopsy patients with NAFLD?
|
When you suspect fibrosis (and therefore want to know if need to screen for cirrhosis): >45, obese, DM, AST/ALT >1, low albumin
|
|
|
Rx for primary biliary cirrhosis
|
Ursodeoxycholic acid (improves pruritis, liver chemistries, decreases progression to cirrhosis)
|
|
|
Pts with this underlying disease are the only ones who should be given antibiotics for acute bronchitis
|
COPD
|
|
|
A type of sarcoidosis with bilateral hilar lymphadenopathy, polyarthralgias, and erythema nodosum
|
Lofgren's Syndrome
|
|
|
Which pts need LMWH instead of warfarin for long-term anticoagulation?
|
Pts w/ acute venous thromboembolism in association w/ metastatic cancer
|
|
|
Acidosis with increased osmolar gap and calcium oxalate crystals in the urine?
|
Ethylene glycol poisoning
|
|
|
Common cause of mixed anion gap metabolic acidosis and respiratory alkalosis
|
Salicylate toxicity
|
|
|
Things to rule out before diagnosing SIADH
|
Volume depletion, adrenal insufficiency, congestive heart failure, hypothyroidism, cirrhosis, and/or renal impairment
|
|
|
2 causes of pseudohyponatremia (normal serum osmolality)
|
Marked elevation of plasma lipids, proteins, or both
Hyperglycemia (or high concentration of another solute) |
|
|
Hypercalcemia with hypophosphatemia
|
Primary hyperparathyroidism
|
|
|
Hyperphosphatemia is most commonly caused by
|
Chronic kidney disease
|
|
|
Hypomagnesemia in an alcoholic can mimic ____, causing ____ and ____
|
Hypoparathyroidism (b/c is suppresses PTH), causing hypocalcemia and hyperphospatemia
|
|
|
Fever, chest pain, shortness of breath, hypoxia, and a pulmonary infiltrate in a patient with a sickling disorder
|
Acute chest syndrome
|
|
|
Leading cause of death in pts with sickle cell anemia?
|
Acute chest syndrome
|
|
|
Rx for acute chest syndrome?
|
Blood transfusion
|
|
|
When is daily hydroxyurea indicated?
|
SCA pts with 3+ hospitalizations requiring opioids
|
|
|
This lab value is elevated in TTP
|
LDH
|
|
|
Rx for TTP
|
Plasma exchange
|
|
|
Best OCP for a woman with an inherited thrombotic disorder?
|
Progestin-only
|
|
|
Factor V Leiden and prothrombin gene mutations are common in this population and very rare in these populations
|
White
Black and Asian |
|
|
2 agents for AML induction chemo
|
Cytarabine and an anthracycline
|
|
|
Where does recurrent HSV1 usually present?
|
Lips (vermillion border), as opposed to in the mouth
|
|
|
When do recurrent aphthous ulcers usually begin to occur, and what is their cause?
|
Teenage years
Unknown |
|
|
Rx for poison ivy (or other contact dermatides)
|
Topical corticosteroids
|
|
|
Rx for severe poison ivy, esp if involves face, neck, or intertriginous areas, or if has edema/blisters (and why)?
|
Oral corticosteroids (these areas are more prone to corticosteroid-induced atrophy w/ topicals)
|
|
|
How fast should you taper oral corticosteroids for contact dermatitis?
|
Slowly (2-3wks) b/c of risk of rebound dermatitis
|
|
|
Hypokalemia, HTN, and metabolic acidosis
|
Hyperaldosteronism
|
|
|
Target BP for pts with DM or renal failure
|
<130/80
|
|
|
Rx for HTN in pregnancy (2 drugs)
|
Methyldopa or labetalol
|
|
|
What is erysipelas?
|
Type of cellulitis w/ inflammation of superficial dermis --> prominent swelling, usually w/ fever and chills, commonly from S. pyogenes
|
|
|
Similarities/ differences btwn retinal emboli (amaurosis fugax), CRAO, and CRVO
|
All cause sudden, painless, unilateral vision loss
Emboli shows a whitened, edematous retina on exam CRAO shows pallor of optic disk and cherry red fovea CRVO shows disk swelling, venous dilation/ tortuosity, cotton wool spots |
|
|
Weakness, fatigue, depression, irritability, hypotension, lymphocytosis, eosinophilia
|
Glucocorticoid deficiency
|
|
|
What does skin pigmentation indicate about the cause of a pt's adrenal insufficiency?
|
It is primary adrenocortical deficiency (due to increased ACTH); secondary deficiency (hypothalamic or pituitary) has decreased ACTH, so no pigmentation
|
|
|
Primary problem in Klinefelter's
|
Seminiferous tubule dysgenesis --> increased LH and FSH but hypogonadism/ fibrotic testicles
|
|
|
Diuretic used for hypercalciuric renal stones vs. diuretic that can predispose to calcium stone formation
|
HCTZ (Rx) vs furosemide (stop)
|
|
|
Which stones are radiolucent?
|
Uric acid stones
|
|
|
Rx for uric acid stones
|
Hydration
Alkalinization of urine w/ potassium citrate or potassium bicarb (to pH >6.5) Low purine diet |
|
|
Vitiligo, hyperpigmentation, hypotension, dehydration
|
Addison's
|
|
|
Flushing, valvular heart disease, and diarrhea
|
Carcinoid syndrome
|
|
|
2 complications of bronchiectasis
|
Hemoptysis
Right-sided heart failure |
|
|
Choledochal cysts are at risk for degenerating into this malignancy
|
Chlangiocarcinoma
|
|
|
Most pts with Paget's disease of the breast have this underlying condition
|
Adenocarcinoma
|
|
|
Most common side effect of digoxin?
|
GI (anorexia, nausea, diarrhea, etc.)
|
|
|
Pts with this lab value are unlikely to respond well to HBV Rx (lamivudine or interferon)
|
Normal ALT
|
|
|
Post-exposure prophylaxis for HBV
|
HBIG and the HBV vaccine
|
|
|
Five signs of acute limb ischemia
|
5 Ps
Pain, pulselessness, paresthesias, poikilothermia (cold), pallor |
|
|
Dysphagia, regurgitation, foul-smelling breath, aspiration, palpable neck mass in an elderly male
|
Zenker's Diverticulum
|
|
|
Best diagnostic test for Zenker's diverticuli
|
Contrast esophagram
|
|
|
Most common kidney disease in Hodgkin's pts
|
Minimal change (can also get FSGS, but is almost always nephrotic syndrome)
|
|
|
Most common nephropathy associated with carcinoma?
|
Membranous nephropathy
|
|
|
Why is there increased work of breathing in COPD?
|
Increased lung volumes --> flattening of diaphragm --> difficulty decreasing intrathoracic pressure during inspiration
|
|
|
Rx for unmetastasized gastric MALT lymphoma?
|
H. pylori treatment (omeprazole, clarithromycin, amoxicillin)
|
|
|
Best Rx for hypersensitivity pneumonitis
|
Avoidance of antigen trigger
|
|
|
Rx for primary biliary cirrhosis
|
Ursodeoxycholic acid
|
|
|
HTN, hypokalemia, metabolic alkalosis, low renin (mostly from adrenal adenomas)
|
Primary hyperaldosteronism
|
|
|
Diagnosis of primary hyperaldosteronism
|
AM plasma aldosterone to plasma renin activity (PA/PRA) ratio > 30
|
|
|
Muscle cramps, polyuria, high glucose
|
Hypokalemia
Resistance to ADH --> polyuria Impaired insulin secretion --> high glucose |
|
|
Hypokalemia, HTN, and high plasma renin (2 causes)
|
Atherosclerotic renal artery stenosis
Fibromuscular dysplasia |
|
|
Butterfly appearance of brain tumor
|
GBM
|
|
|
Lactic acidosis in pt with atherosclerosis and atrial fibrillation
|
Bowel ischemia
|
|
|
Chronic pressure overload --> ___ hypertrophy
vs. Chronic volume overload --> ___ hypertrophy |
Concentric for pressure
Eccentric for volume |
|
|
Flushing, diarrhea, cyanosis
|
Carcinoid syndrome
|
|
|
BP goal during fibrinolytic therapy for acute stroke
|
<185/110
|
|
|
When to start ASA in pt with acute ischemic stroke?
|
If giving fibrinolytics, hold for 24hrs
Otherwise, immediately |
|
|
Ataxia, broad-based gait, dysmetria, intention tremor, difficulty with rapid alternating movements, and nystagmus are indicative of dysfxn where?
|
Cerebellum
|
|
|
What does albumino-cytologic dissociation mean, and what disease does it point to?
|
Elevated protein w/ normal cell count in CSF
Guillain-Barre |
|
|
What valve disease classically presents in women during pregnancy?
|
Mitral stenosis
|
|
|
Acute onset dyspnea in pt with food allergies and urticaria is due to?
|
Laryngeal edema (obstructing the upper airway)
|
|
|
Back pain, anemia, renal dysfunction
|
Multiple myeloma
|
|
|
Severe constipation may be from an abnormality in this electrolyte
|
Calcium
|
|
|
Rx for CMV retinitis
|
Ganciclovir or foscarnet
|
|
|
3 most common causes of death in dialysis pts
|
CVD (50% of deaths), withdrawal from dialysis, infection
|
|
|
Stroke localization: motor impairment + visual field abnormalities w/o cortical dysfxn
|
Lacunar infarction
|
|
|
Stroke localization: "alternates" w/ contralateral hemiplegia and ipsilateral CN involvement
|
Brain stem
|
|
|
Stroke localization: contralateral LE weakness, emotional disturbances
|
ACA occlusion
|
|
|
Stroke localization: contralateral hemiplegia, conjugate eye deviation toward lesion, hemianesthesia
|
MCA occlusion
|
|
|
Stroke localization: aphasia if in dominant hemisphere, hemineglect if in non-dominant hemisphere
|
MCA occlusion
|
|
|
Rx for severe hypovolemic hypernatremia
|
Isotonic 0.9% saline; .45% saline once volume deficit is restored
|
|
|
Rx for euvolemic hypernatremia or hypervolemic hypernatremia
|
5% dextrose in water (D5W)
|
|
|
Fever, severe jaundice, and RUQ abdominal pain
|
Charcot's triad of acute ascending cholangitis
|
|
|
Fever, jaundice, RUQ pain, confusion, hypotension
|
Reynold's pentad of suppurative cholangitis
|
|
|
Rx for acute ascending cholangitis
|
Supportive care, broad spectrum Abx
20% of pts have persistent pain: then do ERCP |
|
|
Glutamic acid decarboxylase Abs may be seen in this disease
|
Type I diabetes
|
|
|
Distinguishing benzo from opioid toxicity
|
Both present with sedation; opioid intoxication also has respiratory depression and miosis
|
|
|
Overdose w/ tremor, hyperreflexia, ataxia, and seizures
|
Lithium
|
|
|
Overdose w/ horizontal nystagmus, cerebellar ataxia, confusion
|
Phenytoin
|
|
|
Management of solitary brain met w/ stable extracranial disease
|
Surgical resection followed by whole brain XRT
|
|
|
Management of multiple brain mets
|
Palliative whole brain radiation
|
|
|
Pts with long-term (>2 decades) ankylosing spondylitis are at risk for
|
Vertebral fractures
|
|
|
Rx for diphenhydramine overdose
|
Physostigmine (cholinesterase inhibitor)
|
|
|
Overdose w/ tinnitus, N/V, fever, AMS
|
Salicylates
|
|
|
Test for paroxysmal nocturnal hemoglobinuria
|
Sugar water test
|
|
|
Test for hereditary spherocytosis
|
Osmotic fragility test
|
|
|
Cause of bleeding in a dialysis pt
|
Platelet dysfunction 2/2 uremia
|
|
|
Rx for coagulopathy in uremic pts
|
DDAVP, cryprecipitate, conjugated estrogens
|
|
|
Dry cough, exertional dyspnea, and fever in an HIV pt (+ bilateral interstitial infiltrates, significant hypoxia, elevated LDH)
|
PCP
|
|
|
Bilateral arthralgias in PIP, MCP, and wrists in a day care worker
|
Parvovirus B19 viral arthritis
|
|
|
This joint is usually affected by psoriatic arthritis
|
DIP (usually with dactylitis)
|
|
|
Differentiate orbital cellulitis from preseptal cellulitis
|
Orbital involves fat and muscles, not just superficial tissue
Orbital has proptosis and decreased visual acuity (and has pain w/ eye movement more commonly than preseptal) |
|
|
Differentiate orbital cellulitis from anterior uveitis
|
Both have painful red eyes; anterior uveitis does not involve eyellid
|
|
|
Differentiate orbital cellulitis from cavernous sinus thrombosis
|
CST is usually bilateral, causes ptosis, and causes rapid visual loss
|
|
|
What is enthesitis and what disease does it implicate?
|
Inflammation and pain at site of tendon and ligament attachment to bone; ankylosing spondylitis
|
|
|
Pts at increased risk for acalculous cholecystitis?
|
Extensive burns
Severe trauma Prolonged TPN or fasting Mechanical ventilation |
|
|
Inferior wall MI is caused by an occlusion in this artery
|
RCA
|
|
|
Inferior wall MI is caused by an occlusion in this artery
|
RCA. No really. Don't **** this up.
|
|
|
Rx for herpes zoster ophthalmicus
|
Acyclovir
|
|
|
What does dullness to percussion of the lung indicate?
|
Consolidation (or pleural effusion, though the former has increased breath sounds and the latter has decreased)
|
|
|
Four signs of consolidation on lung exam
|
Egophany
Dullness to percussion Bronchial breath sounds (louder and with pronounced expiratory phase) Crackles |
|
|
Latex allergy is particularly common in pts with this disease
|
Spina bifida
|
|
|
Rx for cocaine-associated myocardial ischemia (not infarction, which requires cardiac cath)
|
Benzos (also aspirin and nitrates)
|
|
|
Complement deficiency predisposes to infection with
|
Neisseria
|
|
|
HIV pts should get these two vaccines annually
|
Influenza and pneumococcal
|
|
|
Who should get the HAV vaccine?
|
Pts with HBV, HCV, preexisting liver disease, IV drug users, and MSM
|
|
|
DDx for normotensive pts with hypokalemia and metabolic alkalosis
|
Diuretic use, surreptitious vomiting, Gitelman Syndrome, Bartter Syndrome
(latter two have elevated urine chloride (>20) b/c is defective Na and Cl reabsorption --> RAA system activation) |
|
|
Indications for immediate treatment of hyperkalemia
|
Cardiac toxicity (EKG changes), muscular paralysis, K+ > 6.5
|
|
|
Three drug classes that cause hyperkalemia
|
K+ sparing diuretics, ACEIs, NSAIDs
|
|
|
Rx for subconjuctival hemorrhage
|
Observation
|
|
|
Mechanism of QRS prolongation in TCA poisoning
|
Inhibition of cardiac fast sodium channels
|
|
|
Rx for acute QRS prolongation
|
Sodium bicarb (reverses prolongation by increasing extracellular sodium concentration)
|
|
|
Rx for IV drug associated endocarditis
|
Vanc (b/c is often staph, so can't just use Amoxicillin-sulbactam like you can for most strep or enterococci endocarditis cases)
|
|
|
Common finding in exfoliative dermatitis
|
Gynecomastia
|
|
|
Common adverse effect with hydroxychloroquine
|
Retinopathy (need eye exams q 6mo)
|
|
|
Most common site of lacunar infarct, and what it causes
|
Posterior internal capsule
Pure motor stroke |
|
|
Pathophys of lacunar stroke
|
Small vessel hyalinosis
|
|
|
Test used to confirm diagnosis of primary hyperaldosteronism (given high aldosterone to renin ratio)
|
Aldosterone suppression test (failure to suppress after loading with IV saline)
|
|
|
CHF with proteinuria and easy bruisability
|
Amyloidosis
|
|
|
Necrotizing dermatitis, weight loss, anemia, and persistent hyperglycemia
|
Glucagonoma
|
|
|
Severe watery diarrhea, hypokalemia --> muscle cramps, dehydration
|
VIPoma
|
|
|
Visual defect in which straight lines look wavy
|
Macular degeneration
|
|
|
B12 and folate deficiencies both cause increased ___ and decreased ____
|
Homocysteine
Methionine |
|
|
B12 and folate deficiencies can be differentiated by the presence of increased ____ in B12 deficiency
|
Methylmalonic acid
|
|
|
Rx for amebic liver abscess
|
Metronidazole
|
|
|
Rx for variant angina (vasospasm)
|
CCBs or nitrates
|
|
|
How can alkalosis cause paresthesias and cramps?
|
Increased pH increases affinity of serum albumin to calcium, decreasing the levels of ionized calcium; hypocalcemia --> paresthesias/ cramps
|
|
|
Rx for symptomatic sinus bradycardia
|
IV atropine (long-term might need pacemaker)
|
|
|
Gummas indicate what stage of syphilis?
|
Tertiary
|
|
|
Tick bite and hemolysis
|
Babesiosis
|
|
|
Tick bite with leukopenia and thrombocytopenia
|
Erlichiosis
|
|
|
Why is amitryptyline useful in fibromyalgia?
|
Increases amt of restorative phase 4 sleep
|
|
|
Causes of osteonecrosis (also known as aseptic or avascular necrosis)
|
Corticosteroids, chronic alcohol use, trauma, antiphospholipid syndrome
|
|
|
Ring-shaped scaly patches w/ central clearing and distinct borders
|
Tinea corporis
|
|
|
Familial colon cancer + brain cancer
|
Turcot's Syndrome
|
|
|
Familial colon cancer + skin/bone cancer
|
Gardner's Syndrome
|
|
|
Calcium, phosphate, alk phos, and urinary hydroxyproline measurements in Paget's
|
Normal Ca and PO4
High alk phos and urinary hydroxyproline |
|
|
Bilirubin encephalopathy indicates this disease
|
Crigler-Naajar Type 1
|
|
|
Rx for Crigler-Naajar Types 1 and 2
|
1: Phototherapy and plasmapheresis, though only liver transplant is curative
2: none/ occasional phenobarbital or clofibrate |
|
|
Rx for CRAO
|
Ocular massage and high flow oxygen
|
|
|
Asymptomatic but with black liver
|
Dubin-Johnson Syndrome
|
|
|
Rx for PCP
|
Bactrim + oral prednisolone if PaO2 < 70
|
