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195 Cards in this Set
- Front
- Back
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What screening test is recommended for men ages 65 to 79 years, if current or former smokers?
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One-time ultrasonographic screening for abdominal aortic aneurysm.
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What is the strongest predictor of chlamydia infection in men and women?
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Age 25 years or younger
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In asymptomatic persons, what periodic health screening tests should be performed?
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Hypertension, high cholesterol, cervical, breast, and colon cancer; smoking; and alcoholism in age- and sex-appropriate asymptomatic populations.
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Oseltamivir is effective as prophylaxis against which form(s) of the flu virus?
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Influenza A and B
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Which population of people should AVOID the live intranasal flu vaccine?
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-Persons over 50 years
-People with chronic medical conditions |
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What are some common, normal cardiovascular changes seen in pregnancy?
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-systolic murmur
-S3 gallop -mild peripheral edema are normal |
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Under what conditions is it warranted to order a ECHOCARDIOGRAM (EKG)?
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-patients with cardiac symptoms,
-systolic murmurs that are continuous - >3/6 intensity murmur - When any diastolic murmur is present |
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What type of cardiomyopathy is assoc'd w/ a systolic heart murmur that increases in intensity w/ the Valsalva maneuver?
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Hypertrophic cardiomyopathy
NOTE: Hypertensive, dilated, and restrictive cardiomyopathy are not associated with heart murmurs that increase in intensity w/ Valsalva |
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What diagnostic test has the highest sensitivity for diagnosing neurocardiogenic syncope?
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Tilt-table testing
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Name the two classifications of urinary tract infections.
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Comlicated and uncomplicated
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What are some examples of COMPLICATED urinary tract infections?
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-Pt w/ indwelling urinary catheter, neurogenic bladder, kidney stones,urinary obstruction, immunosuppression, pregnancy, renal disease, diabetes
-immunosuppression - |
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80% of all urinary tract infections are caused by what organism?
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E.coli
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Name some other bacteria that cause UTI's other than E. coli?
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enterococcus, proteus, Klebsiella, serratia, pseudomonas, staph aureus
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What is the best method of treatment of uncomplicated UTI?
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TMP-SMX x 3 days, but if resistance to TMP-SMX is suspected then use a fluorquinolone x 3 days
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What are some of the most common healthcare associated (nosocomial) infections?
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ventilator-associated pneumonia, c.difficile abx-assoc'd diarrhea, UTI (catheter assoc'd), blood stream infections (central venous catheter)
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How do you define a healthcare associated infection (nosocomial)?
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A systemic or localized infection that begins 48 hrs or more after admission to the hospital OR occurs 48-72 hrs after being discharged
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What is the agent of choice for decontaminating the skin prior to catheter insertion?
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Chlorhexidine wash. This is prefered over iodine/providone!!!
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Patients receiving hospital ventilation are at HIGHEST RISK of developing what?
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Hospital acquired pneumonia (HAP) - pneumonia that develops 48 hrs or more after admission
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Gastric bypass surgery is indicated in persons with at BMI score of what or greater?
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BMI > 40
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What disease should you suspect in a person with recurrent gastrointestinal infection (especially giardia) and respiratory infections?
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Common variable immunodeficiency
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What pharmacological treatment is used to treat bacterial vaginosis?
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Metronidazole and clindamycin
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What are the three most likely diagnoses in a patient with a vaginal discharge?
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Candidal infection, trichomoniasis, and bacterial vaginosis.
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Is gonorrhea/chlamydia more likely to cause vaginitis or cervicitis?
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Cervicits! Vaginitis is associated with bacterial vaginosis and trichominiasis.
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What condition should you suspect in patients in whom a new drug, particularly beta-lactam antibiotics, was recently started and who have fever without other obvious signs of infection or inflammation?
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Drug fever
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SIRS in response to a confirmed infectious process
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Sepsis
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Sepsis with organ dysfunction, hypoperfusion, or hypotension
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Severe sepsis
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Sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation
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Septic shock
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What are the criteria for Systemic Inflammatory Response Syndrome (SIRS)?
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The presence of 2 or more of the following in the ABSENCE of a known cause:
-HR > 90 -RR > 20 or pCO2 < 32 mmHg -Temp > 100.4 F (38 C) or < 98.6 F (36 C) -WBC >12,000 or < 4,000 or > 10% band forms |
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What pharmacological treatment is effective against BOTH influenza A and B?
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Oseltamavir and zanamavir. These are neuramidase inhibitors.
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Which influenza drug is contraindicated in persons with asthma and why?
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Zanamavir because it can cause bronchospasm.
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Name this condition:
Persistent rhinitis symptoms in the setting of chronic use of nasal decongestant sprays |
rhinitis medicamentosa.
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What is the best pharmacologic treatment of pyelonephritis? What drug should be avoided due to increased resistance?
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Treat pyelo with levofloxacin x 7-10 days. TMP-SMX is no longer the preferred treatment.
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What is the drug of choice for UTI due to culture-proven Enterococcus?
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Amoxicillin
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What is the best initial therapy for acute uncomplicated urinary tract infection in a young, healthy, nonpregnant woman?
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A 3-day course of trimethoprim– sulfamethoxazole is recommended
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What is the most appropriate antiviral agent for a patient with genital herpes simplex virus infection WITHOUT systemic complications?
What do you use in a pt with systemic complications (meningitis, urinary retention)? |
ORAL valacyclovir.
If systemic complications are present, use IV acyclovir |
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What is the most common esophageal disorder in patients with HIV infection?
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Candidiasis
(Approximately two-thirds of patients with Candida esophagitis have concomitant thrush) |
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Patients with HIV infection and odynophagia associated with oral thrush should receive an empiric trial of what drug?
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fluconazole, to treat fungal infection
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What is the most appropriate and most sensitive test for diagnosing acute HIV infection?
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Measurement of HIV viral load.
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What is a better PROGNOSTIC determinant of HIV progression - HIV viral load or CD4 cell count?
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CD4 cell count
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What type of drug places a pt at increased of developing ventilator-assoc'd pneumonia and why?
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H-2 receptor blockers b/c they reduce gastric acidity; and stomach acid is needed to help kill ingested bacteria.
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What is the PPD cut-off threshold for 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)?
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> 5 mm
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A PPD skin test cut off threshold of >10 mm is for what population of people?
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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.
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What is the PPD skin test cut-off threshold all persons with a low-risk for development of TB?
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>15 mm
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What is the best initial therapy for acute uncomplicated urinary tract infection in a young, healthy, nonpregnant woman?
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A 3-day course of trimethoprim– sulfamethoxazole is recommended
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What is the most appropriate antiviral agent for a patient with genital herpes simplex virus infection WITHOUT systemic complications?
What do you use in a pt with systemic complications (meningitis, urinary retention)? |
ORAL valacyclovir.
If systemic complications are present, use IV acyclovir |
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What is the most common esophageal disorder in patients with HIV infection?
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Candidiasis
(Approximately two-thirds of patients with Candida esophagitis have concomitant thrush) |
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Patients with HIV infection and odynophagia associated with oral thrush should receive an empiric trial of what drug?
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fluconazole, to treat fungal infection
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What is the most appropriate and most sensitive test for diagnosing acute HIV infection?
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Measurement of HIV viral load.
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What is a better PROGNOSTIC determinant of HIV progression - HIV viral load or CD4 cell count?
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CD4 cell count
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What drug class places a pt at increased risk of developing ventilator-assoc'd pneumonia and why?
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H-2 receptor blockers b/c they reduce gastric acidity; and stomach acid is needed to help kill ingested bacteria.
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What is the PPD cut-off threshold for 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)?
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> 5 mm
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A PPD skin test cut off threshold of >10 mm is for what population of people?
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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.
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What is the PPD skin test cut-off threshold all persons with a low-risk for development of TB?
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>15 mm
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What type of TB disease is monotherapy with isoniazid indicated?
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For latent tuberculosis only, not active TB disease. Use isoniazid x 9 months. If active disease is present, you must administer empiric therapy with isoniazid, pyrazinamide, ethambutol, and rifampin.
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Name some risk factors for developing aspiration pneumonia:
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Difficulty swallowing, episodes of depressed consciousness, and mechanical factors such as esophageal obstruction.
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LISINOPRIL
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An ACE inhibitor that lowers blood pressure by reducing peripheral vascular resistance w/ out reflexively increasing cardiac output; side effects include COUGH!
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FUROSEMIDE
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A loop diuretic that inhibits the Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle.
Side effects include OTOTOXICITY, hyperuricemia, hypovoluemia due to rapid reduction of blood volume, increase Ca2+ loss into the urine and hypomagnesemia. |
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IPRATROPIUM BROMIDE
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A cholinergic antagonist of ACh at the muscarinic cholinergic receptors on bronchial smooth muscle
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DIGOXIN
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An antiarrhythmic drug that blocks the Na+/K+ ATPase pump in cardiac cells causing an increase in intracellular Na+ levels which lead to increased intracellular calcium. TOXIC DOSES can cause ectopic ventricular beats that can lead to ventricular tachycardia and fibrillation.
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METOPROLOL
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A beta 1 receptor blocker (beta 1 receptors are located mostly in cardiac muscle) used in the treatment of HTN to lower blood pressure.
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What are the limitations of treating community acquired pneumonia with TMP-SMX or ciprofloxacin?
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TMP-SMX provides limited coverage of Streptococcus pneumoniae and no coverage of atypical bugs.
Ciprofloxacin provides effective coverage against atypicals, but no coverage against Strep pneumoniae |
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What are some ATYPICAL bacterial causes of community acquired pneumonia?
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-Mycoplasma pneumoniae, -Chlamydophila pneumoniae (formerly Chlamydia pneumoniae)
-Legionella pneumophila |
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HCTZ
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A thiazide diuretic that targets the distal tubule of the kidney; they decrease reabsorption of Na+ by inhibiting the Na+/Cl- transporter on the luminal membrane of the of DCT.
Side effects include K+ loss, Mg2+ loss; but they decrease Ca2+ loss into the urine so they can be used to increase bone mineral density. |
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What type of pneumonia is associated with this clinical profile: A patient with extrapulmonary manifestations and hyponatremia, azotemia, and elevated liver enzymes or creatine kinase?
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Legionella pneumonia
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Bronchiectasis is a risk factor for the development of community-acquired pneumonia caused by what organism?
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Pseudomonas aeruginosa.
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In a patient with sickle cell disease, what are the 3 most common bacterial causes of osteomyelitis?
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-Staphylococci
-Streptococci -Salmonella |
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What are the imaging procedures of choice in the diagnosis of patients with suspected osteomyelitis?
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MRI and CT scans
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What disease do these physical findings suggest:
increased JVP, crackles, an S3 gallop, peripheral edema? |
Heart failure
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Name some examples of heart disease induced by radiation
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-constrictive pericarditis
-myocardial fibrosis -valve dysfunction -premature coronary artery disease |
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Jugular venous pressure (JVP) is elevated in nearly all persons who have what type of heart disease?
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Constrictive pericarditis
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What is the difference between a primary and secondary pneumothorax?
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Primary = spontaneous, no underlying lung disease
Secondary = due to underlying lung disease |
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If you confirm that a patient has a pneumothorax, what is the NEXT BEST STEP in the management of their care?
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IMMEDIATELY place a chest tube to drain the fluid! (Tube thoracostomy)
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What two lab tests contribute the most to the diagnosis of pancreatitis?
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Serum amylase and lipase.
But, lipase is more specific and stays elevated longer than amylase! |
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What are the 3 main causes of pancreatitis?
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Alcohol abuse
Gall stones Elevated triglycerides |
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What is the first line test to diagnose acute panreatitis?
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Abdominal ultra sound, and NOT abdominal CT. CT scans cannot detect gallstones or biliary sludge.
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What is Grey-Turner's sign?
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Ecchymosis of the flanks that suggests pancreatic hemorrhage due to necrosis
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What is the most common physiological cause of involuntary weight loss?
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Malignancy
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What test/procedure should be performed in a patient with gallstone pancreatitis to relieve the obstruction and minimize complications and recurrences?
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Urgent endoscopic retrograde cholangiopancreatography (ERCP) w/ biliary sphincterotomy
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What disease should you suspect in a patient who presents with the following:
multiple ulcers, ulcers in unusual locations, and ulcers that recur frequently, particularly in the absence of NSAID use or H. pylori infection |
Gastrinoma = Zollinger-Ellison syndrome
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The classic symptoms of this disease include substernal heartburn and acid regurgitation
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GERD
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What disease should you expect in a person with aminotransferase values >5000 U/L?
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acetaminophen hepatotoxicity, hepatic ischemia, and hepatitis due to unusual viruses
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Fever, a history of alcoholism, tender hepatomegaly, examination findings consistent with chronic liver disease, and an aspartate aminotransferase to alanine aminotransferase ratio (AST:ALT) >2 suggests what disease?
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Alcoholic hepatitis
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What type of Hepatitis is associated in people who have multiple sex partners and partake in injection drug use?
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Hepatitis B
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When is chest tube drainage of a pleural effusion indicated?
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For complicated parapneumonic effusions, defined as the presence of pus or Gram stain–positive pleural fluid or a pleural fluid pH that is <7.0.
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When is thoracocentesis indicated?
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In the setting of pneumonia, presence of free-flowing pleural fluid >10 mm in height on a lateral decubitus chest radiograph.
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What is Light's criteria?
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Determines whether a pleural effusion is an exudate or transudate.
Exudative PE's is characterized by a pleural fluid to serum total protein ratio >0.5; pleural fluid to serum lactate dehydrogenase (LDH) ratio >0.6; or pleural fluid LDH value >two thirds of the serum value) |
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In what organ(s) are the following receptors most likely to be found?
-Beta 1 receptors -Beta 2 receptors |
Lungs = beta 2
Heart = beta 1 |
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What are the 3 most common causes of chronic cough?
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1. postnasal drip
2. asthma 3. GERD |
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What can you do to make the diagnosis of occupational asthma?
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1. take an occupational history
2. comparative serial peak expiratory flow rate measurements taken at home and while at work |
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Name this disease:
Basilar-predominant infiltrates on chest radiography, restrictive lung physiology, and evidence of impaired gas exchange. |
Idiopathic pulmonary fibrosis
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erythema nodosum is associated with what lung disease?
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Sarcoidosis
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What is the preferred test to diagnose a pulmonary embolism in a patient with clinical risk factors for PE, normal renal function, and an abnormal chest radiograph?
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Contrast-enhanced helical CT scan of the chest
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What type of DVT prophylaxis is indicated in hospitalized patients at moderate to high risk in whom unfractionated heparin and LMW heparin are contraindicated?
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intermittent pneumatic compression devices
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Obstructive lung diseases are associated with an FEV1/FVC ratio of what?
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< 70%
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A ≥12% increase in either the FEV1 or FVC and an increase of 200 mL or more from baseline in either pulmonary fx parameter following administration of an inhaled bronchodilator are compatible w/ what type of lung disease?
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Asthma
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Name some clinical features that increase the probability of myocardial infarction:
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1. Ches pain that simultaneously radiates to BOTH arms
2. An S3 heart sound 3. Hypotension |
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What disease should you suspect in a person with the following:
Sudden onset of chest pain with radiation along the trapezius edge Pain that gets worse w/ inspiration and lying flat; that subsequently is alleviated w/ sitting and leaning forward |
Pericarditis
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What disease should suspect in a person who presents with the following:
A pulse differential - diminished pulse compared with the contralateral side - on palpation of the carotid, femoral, or radial arteries? |
Thoracic aorta dissection
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What radiographic feature should you see in a person with suspected aortic dissection?
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Widening of the mediastinum
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What is the diagnostic study of choice for diagnosis of suspected aortic stenosis?
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A transthoracic ECHOcardiogram
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Musculoskeletal causes of chest pain include what?
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1. Costochondritis
2. Fibromyalgia (look for tender pressure points on the chest) 3. Arthritis |
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Name the diseases that make up the ACUTE CORONARY SYNDROME:
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-Unstable angina
-STEMI -NSTEMI |
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How can you distinguish NSTEMI from unstable angina?
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Look at cardiac markers. Elevation in cardiac markers (troponin, CK, CK-MB) are only seen w/ NSTEMI!
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What is the most common cause of STEMI?
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An occluded thrombus
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Name the characteristics of STEMI
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- ST elevation > 1mm in two or more contiguous leads
- new LBBB -evidence of true posterior infarction on EKG |
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An elevation in cardiac markers and no evidence of ST segment elevation on EKG
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NSTEMI
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How is morphine sulfate effective in the management of acute MI/ACS?
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-It provides analgesia
-Reduces sympathetic tone via anxiolytic effects -Reduces myocardial oxygen demand by reducing pre-load and reducing the HR |
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How is nitroglycerine effective in the management of acute MI/ACS?
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-Potent vasodilator that decreases pre-load and after-load requirement of the heart
-Decreases cardiac work -Lowers myocardial oxygen demands |
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If you suspect an acute coronary syndrome in a patient who is allergic to aspirin, what anti-thrombolitic drug can you give them?
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Clopidogrel (Plavix) : an platelet aggregation inhibitor
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What is the initial treatment for acute viral pericarditis?
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a high-dose NSAID (indomethacin, ibuprophen)
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What is the first-line treatment for life-threatening digitalis toxicity?
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Administration of digoxin-specific antibody fragments - digibind
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What is the classic electrocardiographic finding in digitalis toxicity?
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Atrial tachycardia with variable block
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Measurement of blood gases in patients who are hypoventilating would affect PCO2 and pH in what way?
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elevated PCO2 and a decreased pH (respiratory acidosis).
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Cardinal signs of this disorder include
1) acute onset or fluctuations in mental status over a 24-hour period 2) inattention 3) disorganization of thinking 4) an altered level of consciousness at the time of the evaluation. |
Delirium
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What class of drugs is frequently implicated as causing delirium and exacerbating pre-existing cognitive impairment in elderly patients?
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Benzodiazepines
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What is the POUND criteria for migraine headaches?
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POUND:
Pulsatile One-day duration Unilateral Nausea or vomiting Disabling |
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Name this condition:
-Headache that lasts 30 min - 7 days. -typically bilateral -nonpulsating pressing or tightening sensation or as a “band-like” constriction around the head. -The pain is mild to moderate in intensity -Does not prohibit activity -Not associated with nausea or vomiting. |
Tension headaches
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characterized by fluctuating cognition, parkinsonism, and/or visual hallucinations
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Dementia with Lewy bodies
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characterized by primary dementia with prominent amnesia
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Alzheimer's disease
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Cognitive impairment accompanied by fluctuating lethargy and inattention, hallucinations, and asterixis
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toxic encephalopathy
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Is the mini mental status examination a good screening test for Alzheimher's dementia?
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YES! It has a sensitivity of 87% and specificity of 82% for detecting Alzheimer's disease
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What is the most common cause of fatal sporadic encephalitis in the United States?
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Herpes encephalitis
Herpes encephalitis is characterized by the rapid development of fever, headache, seizures, focal neurologic signs, and impaired consciousness. |
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Name some characteristics of Herpes encephalitis:
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Rapid development of fever, headache, seizures, focal neurologic signs, and impaired consciousness.
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What is the most appropriate empiric therapy for Streptococcus pneumoniae meningitis?
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vancomycin plus ceftriaxone and dexamethasone.
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Features of this disorder include:
Patients are quadriplegic, have paralysis of horizontal eye movements and bulbar muscles, and can communicate only by moving their eyes vertically or blinking |
locked-in syndrome
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Name this condition: Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo
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Vertebral artery stroke
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In patients with acute stroke, thrombolytic therapy must be started within ????? of the onset of symptoms or ?????
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3 hours; or at the time the patient was last known to be well
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Can MRI's diagnose carotid artery disease?
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NO! It can determine whether there is evidence of prior cerebrovascular disease or other disorders
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Name this condition:
Characterized by proximal and distal weakness, autonomic symptoms, cranial nerve involvement, and respiratory failure. |
Guillain–Barré syndrome
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What disease should you suspect when there is an abrupt increase in serum creatinine concentration or a decrease in urine volume?
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Acute Kidney injury
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What renal disease should you suspect if a person presents with any of the following:
hx of volume loss (N/V/D), feeling light headed on standing, decreased urine volume, urine that appears more concentrated |
Pre-Renal acute kidney injury
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Pyuria, leukocyte casts, urinary eosinophils, extensive use of NSAIDS suggest what type of renal disease?
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Acute interstitial nephritis (AIN)
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Muddy brown casts, tubular epithelial cell casts suggest what type of renal disease?
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Acute Tubular necrosis (ATN)
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Livedo reticularis is characteristic of what type of renal disease?
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Atheroembolic acute renal failure. This can occur after pts have a cardiac cath that can dislodge small emboli
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What condition should be suspected in elderly men with abdominal pain or suprapubic fullness?
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Urinary tract obstruction - Place a catheter to drain the bladder
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What class of drugs have been recognized as a cause of acute rhabdomyolysis presenting with muscle weakness, kidney failure, and an increase in creatine kinase levels?
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Statins
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The most common cause of non-anion gap metabolic acidosis is?
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Severe Diarrhea - diarrhea leads to loss of HCO3 b/c the interstitial fluid below the stomach is relatively alkaline.
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Vomiting, nasogastric suction, and diuretic therapy are common causes of what type of acid-base disorder?
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Metabolic alkalosis
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Name some common causes of respiratory acidosis:
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-caused by increased pCO2
-Hypoventilation (due to narcotics, neurological disorders, respiratory muscle weakness - Myasthenia Gravis, chest wall deformity, obstruction of the airways, ventilation-perfusion mismatch) |
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Name some causes of respiratory alkalosis:
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-hyperventilation that causes excess blowing off of CO2 leading to rise in pH
-Anxiety, asthma, PE, ASPIRIN toxicity, sepsis, hypoxia, pregnancy |
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HYPOnatremia is defined as a serum sodium value of what?
HYPERnatremia is defined as a serum sodium value of what? |
Na+ < 136 meq/L
Na+ > 145 meq/L |
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What are some common disorders/disease that can lead to the development of hyponatremia?
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Volume overload: CHF, cirrhosis, nephrotic syndrome, renal failure
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Defective thirst mechanisms, inadequate access to water and/or renal concentrating defect should make you think about what type of electrolyte disorder?
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HYPERnatremia
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What is the difference btwn central and nephrogenic diabetes insipidus?
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Central = the body does not make and/or release ADH (vasopressin), so the body is unable to concentrate the urine
Nephrogenic = the body makes ADH, but the kidney's cannot respond to it |
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Lithium and foscarnet are drugs that have what side effect in common?
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Nephrogenic diabetes insipidus
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HYPOkalemia is defines as what level of K+?
What are the 2 most common causes of K+ loss? |
K+ < 3.5 meq/L
GI losses and diuretics (renal loss) |
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Clinical features of this electrolyte disorder include:
muscle cramps, ileus, paralysis, rhabdomyolysis, cardiac arrthymias |
HYPOkalemia
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The presence of U-waves and inverted T waves on EKG suggest what type of electrolyte disorder?
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HYPOkalemia
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Peaked T waves, flattened P waves, and a wide QRS on EKG indicate what type of electrolyte disorder?
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HYPERkalemia
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Unilateral contraction of the facial muscles when the facial nerve is tapped is assoc'd with what?
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Chvostek's sign - caused by HYPOcalcemia
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What is Trousseau's sign?
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carpal spasm after occluding the brachial artery after occlusion with a blood pressure cuff - this is assoc'd with HYPOcalcemia
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What is the most common cause of low total calcium levels?
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Hypoalbuminemia - total calcium decreases by 0.8 mg/dL for each 1 g/dL decrement in plasma albumin concentration
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What is the most common cause of hypercalcemia in outpatients?
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primary hyperparathyroidism
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What is the most common cause of hypercalcemia in hospitalized patients?
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Malignancy
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The urine findings of muddy brown casts, tubular epithelial cell casts, high urine sodium concentration (>20 meq/L) in an oliguric patient, and a fractional excretion of sodium (FENa) >1% are characteristic of what condition?
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ATN - the most common cause of acute renal failure in the hospital setting
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What renal disease may present 3 weeks after onset of the inciting strep infection and is associated with LOW C3 levels and NORMAL C4 levels?
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Postinfectious glomerulonephritis
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This disease is associated with circulating anti–glomerular basement membrane Ab's that cause rapidly progressive glomerulonephritis and alveolar injury (renal-pulmonary vasculitis syndrome)
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Goodpasture's syndrome
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The presence of oval fat bodies on urinalysis is a hallmark for?
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excess protein in the urine
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What is the most common cause of the nephrotic syndrome in children and young adults?
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Minimal change disease
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Name this condition:
edema, hypoalbuminemia, hypercholesterolemia, urine protein excretion >3.5 g/24 h, and numerous oval fat bodies seen on urinalysis |
Minimal change disease
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characterized by upper and lower airway disease, glomerulonephritis, and + p-anca Ab's
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Wegener's granulomatosis - a renal/pulmonary vasculitis syndrome
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How can you distinguish Wegener's Granulomatomis from Goodpasture's syndome since they are both renal-pulmonary vasculitis syndromes?
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Wegener's = more common in OLDER persons, and affects both the UPPER and LOWER lung lobes
Goodpasture's = more common in YOUNGER men, and only affects the LOWER lung lobes (rarely causes upper respiratory tract dz) |
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What is the screening test of choice for diabetic nephropathy?
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Measurement of urine microalbumin
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What is the best procedure for removing cancers of the head of the pancreas?
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Whipple procedure
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What are some of the most common causes of malignant pericardial disease?
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Breast and lung cancers
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Combination hormone replacement therapy for menopause increases a woman's risk of developing what type of cancer?
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Breast cancer
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Between small cell lung cancer and non-small cell lung cancer, which one is more responsive to CHEMOTHERAPY?
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Small-cell lung cancer is very chemosensitive compared with non–small-cell lung cancer.
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Do patients with a poor performance status and widely metastatic non–small-cell lung cancer of squamous cell histology respond well to chemo or radiation tx?
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They almost never respond to any type of therapy and require hospice care.
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What type of cancer is the most common malignancy in humans?
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Basal cell carcinoma
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A transmural ischemia is assoc'd with what type of ST segment changes on ECG?
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ST segment ELEVATION.
When acute ischemia during an MI is limited to the subendocardium only, it produced ST segment DEPRESSION |
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How is STEMI defined?
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An elevation >0.1 mV in the ST segment found in 2 or more contiguous leads (leads within the same vascular territory)
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TRUE or FALSE:
In general, 2 sets of normal troponin levels 4-6 hrs apart exclude MI. |
TRUE
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In an acute MI, a troponin-I is most likely to rise how many hours after infarct?
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6 hours, this is why we check cardiac enzymes Q6H for 3 sets
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To diagnose an acute MI, you have have 2 out of 3 of the following criteria?
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1. Chest pain lasting >30 min
2. Typical ECG findings 3. Elevated cardiac enzymes |
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Why do we give beta blockers in pts who are experiencing an acute MI?
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BB's decrease myocardial oxygen demand, and thus help to limit infarct size
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Why do we give nitrates in pts who are experiencing an acute MI?
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As vasodilators, they help increase coronary blood flow
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What are the 3 main likely complications (that can result in death) of an acute MI
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1. Pump failure
2. Ventricular arrhythmias (VT, VF) 3. Cardiogenic shock |
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Why is sinus bradycarida often seen in pts with inferior wall MI (ST segment elevation in leads II, III, and aVF)?
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Because the RCA supplies the inferior wall of the LV and the SA node
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What are the lateral leads on and ECG?
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I, aVL, V5 and V6
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What drugs have been shown to reduce mortality in pts with congestive heart failure?
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ACE inhibitors/ARB's
Beta blockers (carvedilol, metoprolol) |
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What is the treatment of choice for aortic stenosis?
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Surgical replacement of the aortic valve
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The pain assoc'd with what type of ulcer is often relived with the consumption of food or after taking an antiacid?
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Duodenal ulcers
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What are some alarm symptoms assoc'd with peptic ulcer disease?
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Weight loss
Anemia Bleeding Recurrent vomiting Dysphagia Pts with these sx should be referred for endoscopy |
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What pt populations are more likely to develop H.pylori infection?
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Older age
Low socioeconomic status Institutionalized pts Living in a developing country |
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TRUE or FALSE:
The H. pylori breath test is used to establish the presence of prior infection and will remain positive for life even after successful treatment. |
FALSE! The breath test in only good for identifying CURRENT, active infection.
The test described in the question describes the H. pylori antibody test |
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What are the 3 main causes of acute pancreatitis?
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Alcoholism
Gallstones Increased triglycerides |
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If a pt is found to have peptic ulcer dz and they do not test + for H. pylori infection and do not use NSAIDS, what other condition should you suspect?
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Zollinger-Ellison syndrome (gastrin-producing tumor) causing hypersecretiopm of gastric acid
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What is the mainstay treatment of H. pylori infection?
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Triple Therapy (2 abx plus a PPI):
1. Clarithromycin 500 mg PO BID plus. . . 2. Amoxicillin 1000 mg PO BID (or substitute metronidazole 500 mg PO BID if allergic to PCN) 3. Esomeprazole 40 mg PO BID or omeprazole 20 mg PO BID Duration of Treatment = 14 days |
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What is the hallmark of a TIA?
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Complete resolution of all neurologic deficits within 24 hrs of sx onset. Most TIA's usually resolve within 1 hour or less
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What is amaurosis fugax?
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Tansient monocular blindness that often is described as a gray shade being pulled down over the eye caused by ischemia to the retinal artery
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Most common cause of a stroke or TIA is?
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Carotid artery atherosclerosis, cardioembolism, or lipohyalinosis
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Why is a head CT not the best imaging modality to identify a stroke or TIA?
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Non-contrast head CT is very sensitive for detecting acute cerebral hemorrhage. But is is not good for identifying acute ischemic strokes
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What are some first line agents for the diagnosis of stroke/TIA?
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Cerebral angiography
Doppler ultrasound of the carotid arteries MR Angiography |
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TRUE or FALSE:
Combination therapy with ASA and clopidogrel has been shown to be more beneficial in stroke prevention. |
FALSE.
It acutally increases the risk of bleeding complications |
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In a pt who has suffered a TIA or stroke, and is found to have >70% stenosis in an ipsilateral carotid vessel, what procedure should be performed that has been shown to decrease the risk of development of a subsequent stroke?
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Carotid endarterectomy
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