Medicine - Things I Keep Forgetting

Front 1

What does CREST syndrome stand for?

Back 1

calcinosis, Raynaud's phenomenon, esophageal motility disorders, sclerodactyly, and telangiectasia

Front 2

What are the Rome Criteria?

Back 2

Diagnosis for IBS:
at least 12 weeks (which need not be consecutive) in the preceding 12 months of abdominal discomfort or pain that has two of the following three features: relieved with defecation; onset associated with a change in the frequency of stool; and onset associated with a change in the form (appearance) of stool.

Front 3

What are the Manning Criteria?

Back 3

pain relief with defecation, often; looser stools at pain onset, often; more frequent stools at pain onset, often; visible abdominal distention; mucus per rectum; feeling of incomplete evacuation, often.

Front 4

What is the best test to assess for iron deficiency anemia?

Back 4

ferritin (less than 15 mcg/L, it is pathognomonic for iron deficiency)

Front 5

How does a vertebral artery stroke present?

Back 5

Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo.

Front 6

How does an ACA stroke present?

Back 6

contralateral leg weakness

Front 7

How does an MCA stroke present?

Back 7

contralateral face and arm weakness greater than leg weakness, sensory loss, visual field deficit, and either aphasia due to left hemispheric stroke or hemi-inattention (neglect) due to right hemispheric stroke

Front 8

How does a PCA stroke present?

Back 8

contralateral visual field deficit

Front 9

What is the difference in skin findings between diffuse and limited systemic sclerosis?

Back 9

Limited systemic sclerosis presents with skin thickening distal to the elbows and knees; diffuse systemic sclerosis is associated with skin thickening proximal to the elbows and knees.

Front 10

What are the findings in Behçet's disease?

Back 10

recurrent aphthous oral ulcers and at least two of the following features: recurrent genital ulcers, inflammatory eye disease, cutaneous lesions, and 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)

Front 11

What are the 11 SLE classification criteria?

Back 11

SOAP BRAIN MD: Serositis (pleuritis, pericarditis); Oral or nasopharyngeal ulcerations (painless); Arthritis (nonerosive) involving more than two peripheral joints with synovitis; Photosensitivity; Blood dyscrasias (Coombs'-positive hemolytic anemia with reticulocytosis or leukopenia <4000/µL on more than two occasions, or lymphopenia <1500/µL on two occasions, or thrombocytopenia < 100,000/µL); Renal disease (persistent proteinuria >500 mg/day or cellular casts in the absence of infection); Antinuclear antibody (titer of >1:80); Immunologic disorder (anti–double-stranded DNA antibody, anti-Smith antibody, antiphospholipid antibody, positive lupus anticoagulant, or false-positive rapid plasma reagin [RPR] or VDRL test); Neurologic disorder (seizures or psychosis); Malar rash; Discoid rash (erythematous raised patches with scaling and follicular plugging).

Front 12

How does polymyalgia rheumatica present?

Back 12

typically develops in patients >50 years of age, manifests as proximal pain, sometimes is accompanied by a sense of weakness of the upper and lower extremities, and usually is associated with an elevated erythrocyte sedimentation rate

Front 13

How is PMR treated?

Back 13

corticosteroids

Front 14

How does acute interstitial nephritis present?

Back 14

classic triad of fever, rash, and arthralgias, associated with a medication exposure, urinalysis reveals sterile pyuria and occasionally eosinophiluria

Front 15

What are the lab findings in AIN?

Back 15

muddy brown casts and tubular epithelial cell casts. In an oliguric patient, high urine sodium and a fractional excretion of sodium (FENa) >1%.

Front 16

What's the equation for FENa?

Back 16

(UNa * PCr)/(PNa * UCr)*100

Front 17

How does TTP present?

Back 17

fever, renal failure, thrombocytopenia, microangiopathic hemolytic anemia, and neurologic findings

Front 18

How does acute glomerulonephritis present?

Back 18

hypertension, edema, and findings of proteinuria and glomerular hematuria on urinalysis

Front 19

What diseases are associated with low C3 and normal C4 levels?

Back 19

SLE nephritis and postinfectious glomerulonephritis

Front 20

What is the test for goodpasture's syndrome?

Back 20

anti–glomerular basement membrane antibody assay

Front 21

How do myeloma-related kidney disorders present?

Back 21

anemia, a low anion gap, and renal failure

Front 22

What is seen in Wegener's granulomatosis?

Back 22

upper and lower airway disease, glomerulonephritis, and positive findings on a proteinase-3 antineutrophil cytoplasmic antibody assay

Front 23

What is the definition of microalbuminuria?

Back 23

urine albumin–creatinine ratio of 30 to 300 mg/g

Front 24

What is the definition of macroalbuminuria?

Back 24

urine albumin–creatinine ratio of >300 mg/g on two separate urine samples performed at least 6 months apart

Front 25

What's the equation for serum osms?

Back 25

2 × [Na+] + [glucose]/18 + [BUN]/2.8

Front 26

What is an electrolyte complication of ACE-inh? What should be considered instead?

Back 26

hyperkalemia, hydralazine/nitrate combination

Front 27

What is the electrolyte imbalance seen with thiazides?

Back 27

hyponatremia

Front 28

What are the major criteria for PCV?

Back 28

elevated red blood cell mass, a normal arterial oxygen saturation, and the presence of splenomegaly

Front 29

What are the iron studies in anemia of chronic disease?

Back 29

low or low-normal iron levels and total iron-binding capacity
normal or high ferritin levels

Front 30

What are the lab findings in hereditary spherocytosis?

Back 30

mild, Coombs'-negative hemolytic anemia, and an elevated mean corpuscular hemoglobin concentration

Front 31

What are the peripheral blood smear findings in iron deficiency anemia?

Back 31

hypochromic red blood cells, abnormalities in the size and shape of red blood cells, and occasional bizarre-shaped red blood cells

Front 32

What are the peripheral smear findings in alpha thal?

Back 32

mild microcytic anemia with prominent target cells on peripheral blood smear.

Front 33

What does ferritin measure?

Back 33

Intracellular stores (depleted in iron def, increased in ACD)

Front 34

What does TIBC measure?

Back 34

Surrogate for transferrin concentration (decreased ferritin causes transferrin to be synthesized, which increases the TIBC)

Front 35

What is increased in vWD?

Back 35

aPTT and bleeding time

Front 36

What are the anticoagulant options for individuals with HIT?

Back 36

argatroban (HIT with or without thrombosis) and lepirudin (HIT with thrombosis)

Front 37

What is the pentad of TTP?

Back 37

fever, neurologic abnormalities, thrombocytopenia, microangiopathic hemolytic anemia, and renal insufficiency

Front 38

What is the treatment of choice for TTP?

Back 38

plasmapheresis

Front 39

What are the lab findings in CML?

Back 39

elevated leukocyte count and increased numbers of granulocytic cells in all phases of development on the peripheral blood smear

Front 40

What are the lab findings in CLL?

Back 40

increased leukocyte count and increased numbers of mature lymphocytes (>5000/µL) and “smudge” cells

Front 41

What are the findings in MGUS?

Back 41

serum monoclonal γ-globulin without the clinical features of multiple myeloma, a paraprotein level <3.5 g/dL, and <10% plasmacytosis in the bone marrow

Front 42

Which cancers cause malignant pericardial effusion?

Back 42

breast and lung

Front 43

What is the treatment for extensive small cell carcinoma of the lung?

Back 43

Chemotherapy (only surgery if stage I), whole brain radiation if mets

Front 44

What is the treatment for ulcerative colitis and dysplasia of any grade detected on surveillance colonoscopy?

Back 44

colectomy

Front 45

What can be given to reduce prostate cancer risk?

Back 45

Finasteride (decreased by 25%, but many side effects)

Front 46

What should be evaluated in a pt with repeated GI and resp infections?

Back 46

Serum IgG for CVID

Front 47

What's the definition of SIRS?

Back 47

presence of two or more of the following (in the absence of a known cause): temperature >38.0 oC (100.4 °F) or <36.0 °C (96.8 °F); heart rate >90/min; respiration rate >20/min or PCO2 <32 mm Hg; leukocyte count >12,000/µL or <4000/µL, or >10% band forms.

Front 48

What's the definition of sepsis?

Back 48

SIRS in response to a confirmed infectious process.

Front 49

What's the definition of severe sepsis?

Back 49

sepsis with organ dysfunction, hypoperfusion, or hypotension.

Front 50

What's the definition of septic shock?

Back 50

sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation.

Front 51

What should be given for immunosuppressed patients exposed to influenza virus?

Back 51

Postexposure prophylaxis with zanamivir or oseltamivir and trivalent inactivated influenza vaccine. Not live nasal spray!

Front 52

What is the contraindication for use of zanamivir?

Back 52

asthma, b/c causes bronchospasm (use oseltamivir)

Front 53

What is the first line tx for acute bacterial rhinosinusitis?

Back 53

narrow-spectrum antibiotic, such as amoxicillin, trimethoprim–sulfamethoxazole, or doxycycline

Front 54

What is the initial therapy for acute uncomplicated urinary tract infection in a young, healthy, nonpregnant woman?

Back 54

3 days TMP-SMX (amoxicillin if culture-proven enterococcus)

Front 55

When should ARV treatment be started?

Back 55

CD4 cell count <200/µL, even if the patient is asymptomatic OR a major AIDS-related opportunistic infection

Front 56

What is a risk of inflixamab?

Back 56

increased risk of reactivation TB

Front 57

What is the recommended tx for CAP in an inpatient on the general medical floor?

Back 57

1) an intravenous β-lactam plus an intravenous or oral macrolide or doxycycline or 2) monotherapy with an intravenous fluoroquinolone

Front 58

What is the recommended tx for CAP in an inpatient in the ICU?

Back 58

intravenous β-lactam plus either an intravenous macrolide or an intravenous fluoroquinolone

Front 59

What are the options for treatment of community-acquired pneumonia in an outpatient without additional risk factors?

Back 59

advanced-generation macrolide (such as azithromycin or clarithromycin), a ketolide (telithromycin), or doxycycline

Front 60

What is empiric therapy for patients with underlying medical conditions and community-acquired pneumonia?

Back 60

macrolide and a β-lactam agent; alternatively, a fluoroquinolone alone may be used

Front 61

What are normal cholesterol, LDL and TG levels?

Back 61

choles = <200, LDL = <130, TG = <125

Front 62

What are borderline cholesterol, LDL and TG levels?

Back 62

choles = 200-240, LDL = 130-160, TG = 125-250

Front 63

What are high cholesterol, LDL and TG levels?

Back 63

choles = >240, LDL = >160, TG = >250

Front 64

What is the target LDL goal with no established CHD?

Back 64

<130

Front 65

What is the target LDL goal with CHD or diabetes?

Back 65

<100

Front 66

What are the tests for L4 root function?

Back 66

ankle dorsiflexion, sensation anteromedial leg, patellar reflex

Front 67

What are the tests for L5 root function?

Back 67

Dorsiflexion of ankle and big toe against resistance, sensation along lateral shin and dorsum of foot

Front 68

What are the tests for S1 root function?

Back 68

ankle plantar flexion, achilles reflex, sensation lateral foot and heel

Front 69

What are the Ottowa rules?

Back 69

Ankle radiographs not necessary if pt can walk 4 steps at time of injury and eval, and there is no body tenderness over distal 6 cm of either malleolus

Front 70

When do you get an echo?

Back 70

patients with cardiac symptoms, with systolic murmurs that are continuous or >3/6 in intensity, or when any diastolic murmur is present

Front 71

What drug is contraindicated in a pt who comes in with cocaine use and chest pain?

Back 71

The use of β-blockers alone to treat cocaine-induced myocardial ischemia can result in unopposed α-receptor stimulation, further increasing vascular tone and worsening the cardiovascular effects.

Front 72

When is drug therapy considered in weight loss treatment?

Back 72

patients with a BMI ≥30 or ≥27 with comorbidities

Front 73

When is bariatric surgery considered in weight loss treatment?

Back 73

BMI ≥35 with comorbidities or ≥40 without comorbidities in whom attempts at weight loss, including drug therapy, were unsuccessful

Front 74

What are the drugs for weight loss and what are their contraindications?

Back 74

Orlistat - lipase inhibitor that increases fecal fat. SE are GI. Sibutramine - appetite suppressant. Not for people with poorly controlled HTN. Fluoxetine - unclear mxn.

Front 75

What are the treatments of choice for herpes zoster?

Back 75

Famciclovir and valacyclovir, or acylovir

Front 76

What findings suggest hyperaldosteronism?

Back 76

HTN, unprovoked hypokalemia, renal potassium wasting, metabolic alkalosis

Front 77

What are the side effects of thiazide diuretics?

Back 77

hypokalemia, metabolic alkalosis, hyperglycemia

Front 78

What are the side effects of ACE inhibitors?

Back 78

ARF, hyperkalemia, cough, angioedema

Front 79

What is the target BP for pts with diabetes or renal failure?

Back 79

<130/80 mm Hg

Front 80

What are the classic symptoms of pheochromocytoma?

Back 80

hypertension, headaches, palpitations, and diaphoresis

Front 81

What symptoms are characteristic of carcinoid?

Back 81

flushes, fall in BP, rise in HR

Front 82

What medication is needed before surgery for pheochromocytoma?

Back 82

α-blockade therapy (e.g., phenoxybenzamine)

Front 83

What should be screened for in patients with HTN and episodes of pulmonary edema?

Back 83

renovascular disease (edema from episodes of hyperreninemia)

Front 84

What is the treatment of choice in scleroderma renal crisis?

Back 84

short-acting angiotensin-converting enzyme (ACE) inhibitor, such as captopril

Front 85

What is the treatment of choice for M. pneumonia?

Back 85

Erythromycin

Front 86

What should be suspected in a young, previously healthy male presents with verrucous skin
lesions, bone pain, fever, cough, and weight loss, chest x-ray shows nodular infiltrates?

Back 86

Blastomycosis - chronic resp infection, bone pain from osteolytic lesions

Front 87

What infection is associated with pancreatitis?

Back 87

mumps

Front 88

What is the most common CNS complication of varicella?

Back 88

acute cerebellar ataxia, (also sometimes a polyneuritis or transverse myelitis)

Front 89

What is a SE of imipenem?

Back 89

seizures, esp at high doses

Front 90

What is a SE of aminoglycosides?

Back 90

neuromuscular blockade (esp when given with neuromuscular blocking agents)

Front 91

What is the CXR pattern of PCP?

Back 91

diffuse perihilar infiltrates, dx'ed by silver methenamine stain

Front 92

What causes erysipelas and how do you distinguish it from cellulitis?

Back 92

S. pyogenes group A hemolytic strep, often has a preceding event (damage to skin), rapidly spreading, less likely to cause furuncles or abscesses

Front 93

What should be suspected in a pt who develops a pulmonary nodule after travel through the American Southwest?

Back 93

Coccidiomycosis (from inhalation of spores)

Front 94

What should be suspected in a previously health pt who develops pulmonary edema without known cause and has thrombocytopenia?

Back 94

Hantavirus, from aerosolized rodent urine or a bite

Front 95

What is the test and Ab for Sjogren's syndrome?

Back 95

Anti-Ro (SSA), Schirmer test (measures amount of wetness on a filter paper after 5 min on lower lid)

Front 96

What are the x-ray findings in pseudogout? What diseases are associated?

Back 96

linear calcification, hyperparathroidism, hemochromatosis

Front 97

What is seen in Felty syndrome?

Back 97

rheumatoid arthritis, splenomegaly, leukopenia (mostly from granulocytopenia), tends to occur in people who have had RA for a long time, high titers of RF and extra-articular disease

Front 98

What are side effects of gold therapy for RA?

Back 98

exfoliative dermatitis, stomatitis, nephrotic syndrome, bone marrow suppression

Front 99

What is a side effect of chloroquine therapy?

Back 99

retinitis, from deposition in the pigmented layer of retina

Front 100

What ab is found in Wegener's granulomatosis?

Back 100

c-ANCA

Front 101

What ab is found in PAN?

Back 101

p-ANCA

Front 102

What is the differential diagnosis in eosinophilic pneumonia?

Back 102

allergic bronchopulmonary aspergillosis, parasitic infections, drug reactions (eg, nitrofurantoin or sulfonamides)

Front 103

What are the findings in an empyema exudative effusion?

Back 103

very low pH, PMN predominance, drain when pH<7.20, pus or fluid shows gram positive stain/culture

Front 104

What are the findings in a rheumatoid effusion?

Back 104

exudative, lymphocytic, very low glucose leels

Front 105

How do you diagnose sarcoid?

Back 105

transbronchial biopsy (mononuclear cell granulomatous inflammatory process)

Front 106

What are the respiratory findings in PE?

Back 106

acute respiratory alkalosis

Front 107

What are the ABG findings in chronic lung disease?

Back 107

hypercapnia, compensatory increase in serum bicarb, which brings the pH close to normal

Front 108

What are the pulmonary capillary wedge pressures in ARDS and CHF?

Back 108

normal or low in ARDS, high in CHF

Front 109

What must be done after establishing a diagnosis of primary pulmonary hypertension?

Back 109

acute drug testing with pulmonary vasodilators (inhaled NO, IV adenoside or IV prostacyclin)

Front 110

What are the possible treatments for primary pulmonary hypertension?

Back 110

1) long acting CCB 2) prostacyclin 3) lung transplantation

Front 111

What is the acute treatment for unstable angina?

Back 111

O2, morphine, nitrates, ASA, B-blockers, LMWH/heparin, +/- abcixamab/tirofiban

Front 112

What are SE of lidocaine?

Back 112

confusion, tremor, convulsions, respiratory depression, bradycardia, hypotension

Front 113

What are the major Framingham criteria for CHF?

Back 113

paroxysmal nocturnal dyspnea, neck vein distension, rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased venous pressure, hepatojugular reflux

Front 114

What are the two meds that should be given in post-MI LV dysfunction?

Back 114

ACE-inhibitor and diuretic (?B-blocker)

Front 115

When does radionucleotide imaging need to be used instead of stress test?

Back 115

LBBB, WPW, paced rhythm, RBBB with >1mm resting ST segment depression

Front 116

What are the classic findings in aortic stenosis?

Back 116

exertional dyspnea, angina pectoris, syncope, narrow pulse pressure and harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border

Front 117

What is the murmur of mitral stenosis?

Back 117

diastolic rumbling apical murmur

Front 118

What is the murmur of ASD?

Back 118

A systolic murmur at the pulmonic area and a diastolic rumble along the left sternal border

Front 119

What is the murmur of VSD?

Back 119

A holosystolic murmur at the mid-left sternal border

Front 120

What is the treatment of choice for PVCs?

Back 120

If minimally symptomatic, nothing. If symptomatic, B-blocker

Front 121

What are the initial treatments of a patient with paroxysmal supraventricular tachycardia?

Back 121

vagotonic maneuvers, adenosine 2x6mg, then 2x5mg. Diltiazem and digoxin may be useful in rate control

Front 122

What is the initial treatment for Mobitz type I second-degree AV block?

Back 122

observation, benign condition

Front 123

What is the treatment for ventricular fibrillation?

Back 123

Defibrillation at 200j, 300j, 360j. Epinephrine 1mg IV push every 3-5 min. If persistent then amiodarone 300mg IV push or lidocaine 1.0-1.5mg IV push.

Front 124

What medications are used to treat hypertensive emergency?

Back 124

IV nitroprusside or IV labetalol (not not in asthma)

Front 125

What is the treatment for complete AV block?

Back 125

pacemaker placement (atropine as a temporary measure)

Front 126

What is pulsus paradoxus?

Back 126

>10mmHg inspiratory decline in systolic arterial pressure (see in pericarditis)

Front 127

What are the ECG findings in pulmonary HTN?

Back 127

tall peaked p waves in II, III, aVF (R atrial enlargement), tall R waves in V1-V3 and deep S in V6 with ST-T wave changes (from RVH), R axis deviation

Front 128

What causes paradoxical splitting of S2?

Back 128

LBBB, (or any electrical or mechnical event that delays L ventricular systole)

Front 129

What is the murmur of hypertrophic cardiomyopathy?

Back 129

Crescendo-decrescendo systolic murmur beginning well after S1,
heard best at the lower left sternal border; rapidly rising carotid arterial
pulse

Front 130

What is given for sinus bradycardia with hypotension in acute MI?

Back 130

atropine

Front 131

What is used to treat accelerated idioventricular rhythm post–myocardial
infarction?

Back 131

nothing, observation

Front 132

What is the treatment for hypertrophic cardiomyopathy?

Back 132

B-blockers (if not responding, CCBs)

Front 133

What are the SE of propranolol?

Back 133

bronchospasm, decrease HDL and raise TG

Front 134

What is the SE of clonidine?

Back 134

rebound HTN

Front 135

What is the SE of hydralazine?

Back 135

lupus-like syndrome

Front 136

What are the EKG findings in hypokalemia?

Back 136

U waves

Front 137

What are the EKG findings in hyperkalemia?

Back 137

tall, peaked T waves, then widened QRS

Front 138

What are the EKG findings in hypocalcemia?

Back 138

prolonged QT interval

Front 139

What is the upper limit of serum osms?

Back 139

serum osmolality greater than 320 mOsm/L

Front 140

What test should be done following a clinical diagnosis consistent with hypothyroidism?

Back 140

TPO Ab, present in 90-95% of people with autoimmune thyroid disease

Front 141

What are treatment options for Paget's disease?

Back 141

bisphosphonates and calcitonin

Front 142

What is the screening test for hyperaldosteronism?

Back 142

plasma aldo to renin ratio >30, can do further w/u of saline infusion test (aldo doesn't decrease after saline infusion)

Front 143

How does Addison's disease present?

Back 143

weakness, fatigue, weight loss, hypotension, extensor hyperpigmentation

Front 144

What is the treatment for Addison's disease?

Back 144

Hydrocortisone twice per day plus fludrocortisone (glucocorticoid plus mineralcorticoid)

Front 145

What is found in MEN I?

Back 145

Parathyroid hyperplasia, Pancreatic islet cell tumors, Pituitary tumors

Front 146

What is found in MEN IIa?

Back 146

Medullary thyroid carcinoma, Pheochromocytoma, Hyperparathyroidism

Front 147

What is found in MEN IIb?

Back 147

Mucosal neuromas, Medullary thyroid carcinoma, Marfinoid body habitus, Pheochromocytoma

Front 148

What provocative tests can be used to diagnose gastrinoma?

Back 148

Secretin or calcium infusion (will result in elevated gastrin levels in in gastrinoma)

Front 149

What are Ranson's criteria at presentation?

Back 149

Age greater than 55, leukocytosis greater than 16,000, glucose greater than 200 mg/dl, LDH greater than 400 IU, AST greater than 250 IU/L.

Front 150

What is the cutoff for SAAG and what does it mean?

Back 150

serum ascites albumin gradient, if >1.1 portal HTN is very likely

Front 151

Which glomerular disease: Hypertension, nephrotic syndrome, renal insufficiency, microhematuria,
sclerotic changes in juxtamedullary nephrons

Back 151

Focal segmental sclerosis

Front 152

Which glomerular disease: Mild hypertension, nephrotic syndrome, microhematuria, venous thromboses (especially renal vein thrombosis), thickened glomerular basement membrane with immunoglobulin deposition

Back 152

Membranous nephropathy

Front 153

Which glomerular disease: Normal blood pressure, anasarca, severe nephrotic syndrome, normal
light microscopy, fusion of foot processes on electron microscopy

Back 153

Minimal change disease

Front 154

Which glomerular disease: Hypertension, nephrotic syndrome, mild renal insufficiency, RBC casts
in urine, depressed third component of complement (C3), dense deposits on electron microscopy

Back 154

Membranoproliferative glomerulonephritis

Front 155

What is the definitive diagnosis for multiple myeloma?

Back 155

>10% plasma cells on bone marrow biopsy

Front 156

What does chemo start in CLL?

Back 156

Stage III or IV, which is associated with anemia and thrombocytopenia

Front 157

What are risk factors for ovarian cancer?

Back 157

infertility, frequent miscarriages, family hx. OCPs and pregnancies are protective.

Front 158

What is the classic triad for renal carcinoma?

Back 158

hematuria, flank pain, palpable flank mass. Multiple paraneoplastic syndromes

Front 159

What is the treatment for metastatic prostate cancer?

Back 159

GnRH analogue or surgical castration

Front 160

What is the paraneoplastic syndrome of retroperitoneal sarcoma?

Back 160

Hypoglycemia due to IGF-2

Front 161

What is the paraneoplastic syndrome of pancreatic cancer?

Back 161

Trousseau syndrome - migratory superficial thrombophlebitis

Front 162

What is the paraneoplastic syndrome of squamous cancers?

Back 162

Humoral hypercalcemia of malignancy that resembles hyperparathyroidism but is caused by PTHrP

Front 163

What is the paraneoplastic syndrome of oat cell carcinoma (small cell undifferentiated)?

Back 163

Hyponatremia due to inappropriate ADH secretion (sometimes also ACTH production)

Front 164

What is the treatment for ALS?

Back 164

Riluzole, only delays death by 3-5 months

Front 165

What causes erythema multiforme?

Back 165

can follow HSV infection, or sulfa drugs, PCN, phenytoin, allopurinol, or barbiturate use

Front 166

What is the treatment for rosacea?

Back 166

low dose erythromycin, tetracycline, and metronidazole

Front 167

What is the LDL goal for people with known CAD?

Back 167

<100

Front 168

What is the LDL goal in a patient with no CAD and 0-1 risk factor?

Back 168

<160

Front 169

What is the LDL goal in a patient with no CAD and 2+ risk factors

Back 169

<130

Front 170

What is a risk of hypertriglyceridemia?

Back 170

pancreatitis

Front 171

What are high cardiac risk indicators in the setting of noncardiac surgery?

Back 171

recent MI, unstable or advanced angina, significant arrhythmias, decompensated CHF, severe aortic stenosis

Front 172

What drug should be avoided in acute gout?

Back 172

Diuretics - predispose to hyperuricemia

Front 173

What are the contraindications to nonselective B-blockers?

Back 173

asthma, can worsen PVD, CHF, and diabetes

Front 174

What immune deficiency will give recurrent meningococcemia?

Back 174

Complement deficiency C5–C9 - can't form MAC

Front 175

What immune deficiency will give disseminated apergillosis?

Back 175

Neutropenia - high risk of fungal and pseudomonas infections

Front 176

What immune deficiency results in disseminated mycobacteria?

Back 176

Interleukin 12 receptor deficit - can't stimulate IFN-g production

Front 177

RTA associated with aldosterone defect? What is distinctive about it?

Back 177

Type IV (distal), hyperkalemia and acidic urine

Front 178

Meningitis in infants. Causes? Treatment?:

Back 178

Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin

Front 179

Meningitis in neonates. Causes? Treatment?:

Back 179

Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin

Front 180

HUS triad?:

Back 180

Anemia, thrombocytopenia, and acute renal failure

Front 181

Drugs that slow AV node transmission?

Back 181

β-blockers, digoxin, calcium channel blockers

Front 182

Which arrhythmias require pacemaker implantation?

Back 182

Second degree Mobitz type II and third degree AV block

Front 183

What are the p-450 inducers?

Back 183

Quinidine, Barbiturates, St. John's wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine (Queen Barb Steals Phen-phen and Refuses Greasy Carbs)

Front 184

What are the p-450 inhibitors?

Back 184

Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erythromycin, Grapefruit juice (Inhibit drinking from a KEG because it makes you SICk)

Front 185

What is found in Fanconi’s anemia?

Back 185

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia

Front 186

A patient from California or Arizona presents wutg fever, malaise, cough, and night sweats. Diagnosis? Treatment?

Back 186

Coccidiomycosis, Amphotericin B

Front 187

What are the ankle-brachial index cutoffs for PVD and severe PVD?

Back 187

PVD - ankle-brachial index (ABI) <0.9, and those with severe disease (rest ischemia) have an ABI <0.4.

Front 188

What does an ABI >1.3 indicate?

Back 188

vascular calcification

Front 189

What is the initial treatment for acute viral pericarditis? If chronic?

Back 189

high-dose nonsteroidal anti-inflammatory drug (indomethicin or ibuprofen); 7- to 10-day tapering course of corticosteroids

Front 190

What is the classic EKG finding in digitalis toxicity?

Back 190

Atrial tachycardia with variable block (ectopic beats, A fib possible)

Front 191

What is recommend for a pt with multivessel CAD and diabetes mellitus?

Back 191

better outcomes with CABG compared with percutaneous angioplasty

Front 192

Which pts with CAD merit ICD placement?

Back 192

ejection fraction ≤30%, (but CABG if multivessel disease is present)

Front 193

What EKG finding is pathognomonic for acute pericarditis?

Back 193

PR-segment depression (with ST segments that are upwardly concave)

Front 194

What is the CHADS2 score and what does it measure?

Back 194

≥3 suggests

Congestive heart failure, Hypertension, Age >75 years, Diabetes, Stroke or transient ischemic attack (TIA). 2 points for a history of stroke or TIA (the strongest risk factor) and 1 point for all other risk factors.

Front 195

What are the EKG findings in inferior infarction?

Back 195

ST elevation in leads II, III, and aVF

Front 196

What are the EKG findings in anteroseptal infarction?

Back 196

ST elevation in leads V1–V3

Front 197

What are the EKG findings in lateral and apical infarctions?

Back 197

ST elevation V4–V6

Front 198

What are the EKG findings in acute posterior wall myocardial infarction?

Back 198

ST depression in leads V1–V2

Front 199

What is the treatment for acute myocarditis?

Back 199

generally, the same as CHF (ACE-i if no contraindications)

Front 200

What is the treatment for multifocal atrial tachycardia?

Back 200

treat underlying disease! If refractory, add calcium-channel blocker such as diltiazem or verapamil

Front 201

What is the EKG of atrioventricular re-entrant tachycardia (Wolff-Parkinson-White syndrome)?

Back 201

short PR segment, delta wave, and tachycardia.

Front 202

What meds are indicated for all pts with systolic dysfunction, regardless of symptoms?

Back 202

angiotensin-converting enzyme inhibitor and a β-blocker

Front 203

What are the criteria for using spironolactone in CHF?

Back 203

Severe heart failure, left ventricular ejection fraction ≤35%, serum creatinine ≤2.5 mg/dL, and serum potassium ≤5 meq/L

Front 204

What is the treatment for patients with sustained ventricular tachycardia in the setting of significant structural heart disease?

Back 204

ICD placement

Front 205

What is the treatment for a stable patient with v-tach?

Back 205

lidocaine, procainamide, or amiodarone

Front 206

What is the treatment for an unstable patient with v-tach?

Back 206

direct-current cardioversion

Front 207

What maneuvers increase and decrease the murmur of hypertrophic cardiomyopathy?

Back 207

increases after a Valsalva maneuver and decreases with standing to squatting.

Front 208

What happens with Valsalva maneuver or the squat-to-stand maneuver?

Back 208

venous return is transiently decreased, left ventricular chamber size decreases and the septum and mitral leaflet are brought closer together.

Front 209

What happens with the stand-to-squat maneuver and passive leg lift?

Back 209

transiently increase venous return (preload) and therefore increase left ventricular chamber size and volume, the end-systolic dimension of the left ventricle increases

Front 210

What do isometric handgrip exercises do?

Back 210

Increase afterload (increase regurgitrant murmurs)

Front 211

What are the findings of mitral prolapse?

Back 211

midsystolic click followed by a late systolic murmur, Valsalva maneuver and standing from a squatting position move the click-murmur complex closer to S1

Front 212

When should chest tube drainage (tube thoracostomy) of a parapneumonic effusion should be instituted?

Back 212

if pus or gram-positive pleural fluid is detected or if the pleural fluid pH is <7.0.

Front 213

In the setting of pneumonia, when is thoracentesis indicated?

Back 213

presence of free-flowing pleural fluid >10 mm in height on a lateral decubitus chest radiograph

Front 214

What is indicated for asthma control in previously well-controlled patients following a respiratory tract infection?

Back 214

short course of oral corticosteroids

Front 215

What is indicated for a pt who presents with acute severe asthma?

Back 215

IV corticosteroids, Prompt administration of bronchodilators and anticholinergics, magnesium sulfate (intravenous or inhaled)

Front 216

What should be done in patients with persistent asthma not adequately controlled with daily low- or moderate-dose inhaled corticosteroids?

Back 216

adding a long-acting β-agonist improves asthma control and quality of life.

Front 217

What underlying conditions merit treatment in acute bronchitis?

Back 217

COPD, or if it is B. pertussis

Front 218

What is Löfgren's syndrome?

Back 218

sarcoidosis, presenting acutely with bilateral hilar lymphadenopathy, polyarthralgias, and erythema nodosum

Front 219

What do flat neck veins tell you?

Back 219

No right sided circulatory collapse (as in massive PE)

Front 220

What is the treatment for patients with acute venous thromboembolism in association with metastatic cancer?

Back 220

Chronic low-molecular-weight heparin at therapeutic doses reduces the risk for recurrent venous thromboembolism compared with standard-intensity warfarin

Front 221

What is the long term treatment for patients heterozygous for factor V Leiden mutation with recurrent thrombosis?

Back 221

anticoagulation therapy with warfarin

Front 222

What PFTs are found in obstructuvve lung disease?

Back 222

FEV1/FVC ratio <70%

Front 223

What is the difference between Wegener's and Goodpasture's syndromes?

Back 223

Goodpasture's syndrome is a renal-pulmonary vasculitis syndrome; it usually affects young men and does not cause upper respiratory tract disease. Wegener's = proteinase-3 antineutrophil cytoplasmic antibody assay. Goodpasture's = anti-GBM ab

Front 224

What is the acid base disorder associated with severe liver failure?

Back 224

AG metabolic acidosis, decreased clearance of lactate from the circulation can lead to lactic acidosis

Front 225

What acid base disturbance does acetazolamide cause?

Back 225

non–anion gap metabolic acidosis

Front 226

What does a low pH and decreased bicarbonate level tell you?

Back 226

metabolic acidosis

Front 227

What is the serum sodium correction for glucose?

Back 227

correcting the serum sodium by 1.6 to 2.4 meq/L for each 100 mg/dL increase in plasma glucose concentration above 100 mg/dL

Front 228

What's the cause of hyperphosphatemia in chronic kidney disease?

Back 228

low glomerular filtration rate

Front 229

What presents like hypoparathyroidism in alcoholic pts?

Back 229

Hypomagnesemia in a patient with alcoholism can mimic hypoparathyroidism, including severe hypocalcemia and hyperphosphatemia

Front 230

What is indicated for empiric treatment of a highly compliant, nonpregnant patient with acute pyelonephritis who can eat and drink?

Back 230

Oral levofloxacin

Front 231

What is the CV finding in endocarditis?

Back 231

Worry about perivalvular abscess, causing conduction abnormaliities

Front 232

What is the biliary disease associated with UC?

Back 232

Sclerosing cholangitis

Front 233

What is the biliary disease of young women?

Back 233

primary biliary sclerosis

Front 234

What are spherocytes seen in?

Back 234

WAIHA, and hereditary spherocytosis

Front 235

TTP pentad (other)

Back 235

fever, neuro abnl, thrombocytopenia, anemia, schistocytes, elevated LDH

Front 236

Who fits the category for cut-off threshold of >5 mm for PPD?

Back 236

persons at highest risk of developing active tuberculosis (e.g., HIV-infected patients, immunosuppressed patients, persons with close contact with anyone with active tuberculosis, or those with a chest radiograph consistent with prior tuberculosis)

Front 237

Who fits the category for cut-off threshold of >10 mm for PPD?

Back 237

persons who have immigrated to the United States from high-risk countries within the past 5 years, injection drug users, prisoners, health care workers, and patients with silicosis, diabetes mellitus, chronic renal failure, leukemia and lymphoma, carcinoma of the head and neck or lung, recent significant weight loss, and a history of gastrectomy or jejunoileal bypass, healthy adolescents exposed to high-risk adults

Front 238

What is the treatment of choice for aspiration pneumonia?

Back 238

Clindamycin

Front 239

What should be considered in a patient with hyponatremia, azotemia, and elevated liver enzymes or creatine kinase?

Back 239

Legionella, tx with azithromycin and cefuroxime

Front 240

What are the goal uric acid levels in patients with tophaceous gout?

Back 240

Uric acid levels should be reduced to 6 mg/dL to dissolve tophi and other urate deposits in the tissue.

Front 241

How do patients with hereditary hemochromatosis present? with abnormal liver chemistry test results, arthropathy, fatigue, and impotence.

Back 241

with abnormal liver chemistry test results, arthropathy, fatigue, and impotence

Front 242

What disease is associated with a synovial fluid leukocyte count of <2000/µL?

Back 242

osteoarthritis

Front 243

What disease is associated with a synovial fluid leukocyte count of 2000/µL and 50,000/µL?

Back 243

Gout and calcium pyrophosphate deposition disease (pseudogout)

Front 244

What disease is associated with a synovial fluid leukocyte count of 10,000/µL and 50,000/µL?

Back 244

septic arthritis

Front 245

What should be done in a patient with a diagnosis of polymyositis, dermatomyositis, or inclusion-body myositis?

Back 245

careful evaluation for an occult malignancy, beginning with routine age- and sex-appropriate screening tests

Front 246

What is the difference between polymyalgia rheumatica and polymyositis?

Back 246

PMR - hip and should pain and stiffness, significantly elevated erythrocyte sedimentation rate but a normal creatine kinase level. Polymyositis - high creatine kinase level and proximal muscle weakness (less likely to be painful)

Front 247

How does peripheral nervous system vasculitis usually present? with asymmetrical weakness and sensory loss in specific nerve distributions

Back 247

with asymmetrical weakness and sensory loss in specific nerve distributions

Front 248

What is the treatment for PMR?

Back 248

Corticosteroid therapy often resolves polymyalgia rheumatica symptoms within 24 hours.

Front 249

What disease has pancytopenia and hypocellular bone marrow?

Back 249

aplastic anemia

Front 250

What disease is characterized by anemia, an elevated reticulocyte count, and microspherocytes on the peripheral blood smear?

Back 250

Autoimmune hemolytic anemia

Front 251

What are the best lab tests to diagnose vitamin B12 deficiency?

Back 251

elevated serum methylmalonic acid and homocysteine concentrations. (methylmalonic acid distinguishes from folate deficiency)

Front 252

What are the best lab tests to diagnose folate deficency?

Back 252

elevated homocysteine concentration only

Front 253

What are basic labs distinguishing Hereditary spherocytosis?

Back 253

mild, Coombs'-negative hemolytic anemia, and an elevated mean corpuscular hemoglobin concentration (occurs because spherocytes contain more hemoglobin per unit of volume than normal red blood cells)

Front 254

What is the initial treatment in warm-antibody autoimmune hemolytic anemia?

Back 254

corticosteroid therapy

Front 255

What is the treatment for CML and what is the mechanism?

Back 255

Imatinib mesylate treatment, specifically targets and inhibits BCR-ABL tyrosine kinase activity and leads to suppression of the CML clone

Front 256

What is the treatment for MGUS?

Back 256

A routine follow-up examination to identify any signs and symptoms of progression to multiple myeloma and periodic measurement of monoclonal protein concentration are sufficient

Front 257

What is empiric therapy for Streptococcus pneumoniae meningitis?

Back 257

vancomycin plus ceftriaxone and dexamethasone

Front 258

What is the presentation of locked-in syndrome?

Back 258

quadriplegic, have paralysis of horizontal eye movements and bulbar muscles, and can communicate only by moving their eyes vertically or blinking

Front 259

What is the presentation of a vertebral artery stroke?

Back 259

Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo

Front 260

What is the treatment for stroke not eligable for TPA?

Back 260

Early administration of aspirin, 160 to 325 mg daily, results in a modest reduction in the risk of recurrent stroke in the short term and slightly less death and disability in the long term.

Front 261

What is the treatment for stroke presenting w/in 3 hrs of onset?

Back 261

tPA, antiplatelet agents and anticoagulants should be withheld for 24 to 48 hours following thrombolysis

Front 262

When is alteplase contraindicated?

Back 262

in patients with mean arterial pressure >130 mm Hg or blood pressure >185/110 mm Hg

Front 263

What are the indications for carotid endarterectomy in symptomatic pts?

Back 263

carotid artery ultrasonography showing a >50% stenosis of the internal carotid artery

Front 264

What is characteristic of a demyelinating polyneuropathy?

Back 264

symmetric proximal and distal muscle weakness, decreased deep tendon reflexes, and distal loss of vibration and position senses

Front 265

Which medication should be avoided when using IV contrast?

Back 265

metformin, which accumulates in patients with renal insufficiency, worry for lactic acidosis

Front 266

What are the ADA guidelines for a DM diagnosis?

Back 266

fasting plasma glucose ≥126 mg/dL, a 2-hour plasma glucose ≥200 mg/dL after a 75-g oral glucose load, or a random plasma glucose ≥200 mg/dL plus symptoms of diabetes. If any abnl, must be confirmed by a second test.

Front 267

What are the cutoffs for impaired glucose tolerance?

Back 267

2-hour glucose level of 140–199 mg/dL during an oral glucose tolerance test, and impaired fasting glucose, defined as a fasting glucose level of 100–125 mg/dL

Front 268

What are desirable postprandial excursions?

Back 268

30 to 50 mg/dL

Front 269

What are recommended treatment goals in DM?

Back 269

hemoglobin A1c <7.0%, preprandial glucose 90–130 mg/dL, 2-hour postprandial glucose <180 mg/dL, blood pressure <130/80 mm Hg, triglycerides <150 mg/dL, HDL cholesterol >40 mg/dL, and LDL cholesterol <100 mg/dL.

Front 270

Which DM meds shouldn't be used in patients with New York Heart Association class III congestive heart failure?

Back 270

Metformin and thiazolidinediones

Front 271

What is contraindicated in contraindicated in patients with type 2 diabetes mellitus and heart failure?

Back 271

Thiazolidinediones

Front 272

What is contraindicated in contraindicated in patients with type 2 diabetes mellitus and renal insufficiency?

Back 272

Metformin

Front 273

What is seen in myxedema coma?

Back 273

progressive obtundation, hypothermia, hypotension, and bradycardia

Front 274

How do you identify a hyperfunctioning adenomatous thyroid nodule?

Back 274

palpable on thyroid examination, is associated with increased iodine uptake, and a thyroid scan that localizes the adenoma as a “hot” focus.

Front 275

How do you identidy toxic multinodular goiter?

Back 275

a goiter that is nodular to palpation, an elevated iodine uptake, and a thyroid scan demonstrating heterogeneous uptake of the tracer

Front 276

How do you identify Graves disease?

Back 276

diffusely enlarged thyroid gland, elevated iodine uptake, and a thyroid scan demonstrating homogeneous uptake of the tracer.

Front 277

where would a lesion cause the classic cape distribution?

Back 277

central cervical cord lesion (C5-C6 is the lateral arm):
Bilateral loss due to destruction of ventral commisure, damages spinothalamic fibers crossing.

Front 278

What is Schmidt's syndrome?

Back 278

concurrence of autoimmune thyroid disease and Addison's disease (An isolated elevation in TSH has also been described in patients with adrenal insufficiency as a result of an absence of the suppressive effect of cortisol upon TSH synthesis and release from the anterior pituitary.)

Front 279

What are the 2 screening tests for Cushings?

Back 279

measurement of urine free cortisol (increased) and the overnight dexamethasone suppression test (not suppresssable)

Front 280

When is osteoporosis screening initiated?

Back 280

all women ≥65 years and women <65 years who have one or more risk factors for osteoporosis.

Front 281

Which LN require immediate excision?

Back 281

rapid onset of enlarged lymph nodes and size >2 cm

Front 282

What is seen in primary sclerosing cholangitis?

Back 282

laboratory results compatible with cholestatic liver disease (high alkaline phosphatase concentration, normal or minimally elevated bilirubin level, and modestly elevated aminotransferase values) Dilatation of the peripheral bile ducts on ultrasonography without evidence of apparent obstruction in the common bile duct

Front 283

What is seen in cholangiocarcinoma?

Back 283

a moderate dilatation of the intrahepatic bile ducts

Front 284

What treatment is indicated for early-stage breast cancer?

Back 284

Breast-conserving surgery with radiation therapy results in similar and sometimes superior survival in patients with early-stage breast cancer regardless of patient age compared with mastectomy. Consider adjuvant systemic therapy with hormonal therapy, chemotherapy, or both

Front 285

What are the characteristics of malignant lung lesions?

Back 285

spiculated margins, little or no calcification, and intermediate doubling times (between 30 and 500 days)

Front 286

أَنشَأَ - يُنشِىء - الإنْشاء

Back 286

to found, erect, establish

Front 287

What are the cancer associations with combination hormone replacement therapy?

Back 287

increases the risk for breast cancer

Front 288

What are the most common causes of aminotransferase values >5000 U/L?

Back 288

acetaminophen hepatotoxicity, hepatic ischemia, and hepatitis due to unusual viruses such as herpes simplex virus

Front 289

Which two syndromes are associated with an indirect hyperbilirubinemia?

Back 289

Gilbert's and Crigler-Najjar

Front 290

What lab values are seen in hepatic ischemia?

Back 290

marked elevations in aminotransferase values that rapidly improve within several days.

Front 291

What is the treatment for uncomplicated diverticulitis?

Back 291

broad-spectrum antibiotics such as ciprofloxacin and metronidazole for 7 to 10 days and a soft, low-residue diet

Front 292

What are treatments for IBS?

Back 292

TCAs and SSRIs; diarrhea-predominant irritable bowel syndrome (IBS) - loperamide (alosetron if severe)

Front 293

What biliary disease are IBD patients at high risk of developing?

Back 293

primary sclerosing cholangitis

Front 294

What is fulminent liver failure and how is it treated?

Back 294

clinical syndrome of severe acute liver failure and hepatic encephalopathy (asterixis and depressed consciousness) in a patient without pre-existing liver disease, immediate eval for transplant

Front 295

What should be done for patients with a positive assay for antibodies to hepatitis C virus (anti-HCV)?

Back 295

test for HCV RNA to determine if viremia is present.

Front 296

How does autoimmune hepatitis present? What is the Ab test?

Back 296

Autoimmune hepatitis can manifest as acute hepatitis with elevated aminotransferase values and jaundice; the AST:ALT ratio is typically <2.0. Antinuclear antibody and anti–smooth muscle antibody titers ≥1:80 support a diagnosis of autoimmune hepatitis.

Front 297

What findings suggest primary biliary cirrhosis?

Back 297

Pruritus, hypercholesterolemia, laboratory evidence of cholestatic liver disease, and a positive antimitochondrial antibody titer

Front 298

What is the preferred initial evaluation for patients with suspected abdominal aortic aneurysm?

Back 298

Abdominal ultrasonography

Front 299

What is the treatment for comedonal-only acne?

Back 299

topical retinoids are the mainstay of treatment

Front 300

Which diuretics stimulate renal tubular calcium reabsorption and may lead to a mild hypercalcemia?

Back 300

thiazide diuretics