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200 Cards in this Set
- Front
- Back
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What drug commonly used in MI treatment should not be used if it is due to cocaine-induced vasospasm?
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Beta blockers (use CCBs instead)
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IV drug user w/ recurrent infections now presenting w/ nephrotic syndrome, hepatomegaly, cardiomyopathy, and peripheral neuropathy
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Secondary amyloidosis (from chronic inflammation)
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Microcytic anemia non-responsive to iron supplementation in a Mediterranean pt
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Beta-thalassemia
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When should post-exposure prophylaxis be started after a dog bite (3 scenarios)
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Dog known to be rabid (or appears so after observation)
Unknown dog Head or neck bite |
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S3 and S4
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S3- hypertrophy
S4- dilation |
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S3 likely indicates (and best Rx)
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Left heart failure
Diuretics |
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Inheritance of HOCM
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AD
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Decreased preload causes most murmurs to?
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Decrease (b/c there is less flow)
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Why does decreased preload cause the HOCM murmur to become louder?
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Decreases size of ventricular cavity and causes increased outflow obstruction
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What maneuver decreases preload and therefore makes the HOCM murmur louder?
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Valsalva
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Smudge cells (fragile lymphocytes that undergo breakdown during slide preparation) indicate
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CLL
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Very poor prognostic factor in CLL
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Thrombocytopenia
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Staging of CLL
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0: only lymphocytosis
I: lymphocytosis + adenopathy II: splenomegaly III: anemia IV: thrombocytopenia |
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Older man who loses consciousness while peeing
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Situational syncope
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Sudden loss of vision and onset of floaters w/ difficult to visualize fundus on fundoscopy
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Vitreous hemorrhage
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Most common cause of vitreous hemorrhage
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Diabetic retinopathy
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Vision loss w/ shower of floaters; fundoscopy w/ elevated retina w/ folds and a tear
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Retinal detachment
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Sudden painless unilateral loss of vision in pt w/ history of HTN; fundoscopy w/ disk swelling, venous dilation, retinal hemorrhage, cotton wool spots
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Central retinal vein occlusion
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Difference btwn hordeolum and chalazion
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Hordeolum: abscess over upper or lower eyelid
Chalazion: chronic granulomatous inflammation of meibomian gland; appears as a hard painless nodule |
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Degenerative joint disease, joint deformation, and functional limitation w/ XR showing loss of cartilage, osteophyte dev't, and loose bodies
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Charcot's joint: neurogenic arhtropathy
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Acid base changes in pregnancy
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Progesterone --> tachypnea --> mild respiratory alkalosis w/ metabolic compensation
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Most common cause of phototoxic drug eruption
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Tetracyclines
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Hemolytic anemia, venous thrombosis and diminished hematopoiesis
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Paroxysmal nocturnal hemoglobinuria
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Pathophys of paroxysmal nocturnal hemoglobinuria
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Abnormal cell membrane protein so cell surface molecules that protect RBCs can't bind, so RBCs are attacked by complement
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How to distinguish autoimmune hemolytic anemia from paroxysmal nocturnal hemoglobinuria?
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PNH is predisposed to venous thrombosis esp w/in hepatic veins
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High alk phos with bilateral hearing loss
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Paget's disease of the bone
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Pathophys of Paget's
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High bone turnover (remodeling) and aberrant osteoid formation
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Concern w/ Paget's disease
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As bones reshape they become soft and susceptible to fracture
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Rx for Paget's disease of the bone
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Bisphosphonates
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When is lidocaine used in ACS?
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Only to treat ventricular fibrillation; it increases the risk of asystole, so it isn't used prophylactically
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How does RMSF spread?
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From wrists and ankles --> centrally
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Maculopapular rash w/ posterior cervical and posterior auricular (suboccipital) lymphadenopathy
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Rubella
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What is an abnormal Rinne test and what does it indicate?
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When pt doesn't hear air vibration 2x as long as bone vibration
Conductive hearing loss |
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Rx for Afib (3 scenarios)
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Hemodynamically unstable: cardiovert
Stable and present for <48hrs: cardiovert Stable and >48hrs: risk of thromboembolism, so rate control and 3-4wks of anticoag before attempting cardioversion |
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How to distinguish polymyositis from polymyalgia rheumatica
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Weakness is primary complaint in polymyositis; pain in the absence of weakness is more consistent with polymyalgia rheumatica
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Which type of cancer is most likely to develop into cancer?
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Villous adenoma (higher risk than tubular adenomas)
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Management of hyperplastic polyps and hamartomatous polyps
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Hyperplastic: nothing
Hamartomatous: removed b/c of bleeding risk Both are non-malignant |
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Which polyp shape is most likely to be pre-malignant?
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Sessile (vs. pedunculated)
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Most common pathogen of a hordeolum and management
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Staph
Warm compresses; only I&D if doesn't begin to regress in 48hrs |
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Rx for chalazion
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Incision and curettage
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Rx for stroke in a sickle cell pt
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Exchange transfusion (makes additional stroke less likely)
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Negative predictive value varies with
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The pretest probability of a disease (the NPV is higher if your pretest probability was low)
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What causes the low glucose concentration in exudative effusions?
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High metabolic acitivty of leukocytes within the pleural fluid
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4 drugs w/ mortality benefit after MI
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ASA
ACEIs Beta blockers Statins |
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Indications for clopidogrel (3)
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For 12mo after unstable angina/NSTEMI
30 days after bare metal stent PCI One yr after drug eluting stent PCI |
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Pts with celiac disease are at increased risk for what malignacy
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GI lymphomas
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Hip pain worsened by activity w/ a hip that is not tender on exam, no systemic Sx, but pain on rotation
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OA/ degenerative joint disease
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Complications of PEEP
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High pressures can cause alveolar damage, tension pneumo, and hypotension
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Rx for hepatic encephalopathy (3)
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Lactulose (acidifies colon causing catharsis and decrease in circulating ammonia)
Laxative (for catharsis) Abx (neomycin and rifaximin) |
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Heart failure after a traumatic injury
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Development of a symptomatic AV fistula (lots of blood shunts thru, --> decreased SVR, increased preload, and increased CO)
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Pulm nodule w/ a halo sign or with an air crescent
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Aspergillus
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Hyperparathyroidism causes what bone disease?
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Osteitis fibrosis cystica (Von Recklinghausen's): osteoclastic resorption leads to replacement of bone with fibrous tissue (brown tumors)
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What is required for a diagnosis of malignant HTN
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BP >200/140
AND Papilledema |
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What is the pathologic change responsible for end-organ damage in malignant HTN?
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Fibrinoid necrosis of small arterioles
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Intubated pt growing gram-negative bacilli; most likely pathogen?
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Pseudomonas
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Pt w/ chest pain and barium swallow w/ corkscrew esophagus
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Diffuse esophageal spasm
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Rx for pt with high probability of PE
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Start heparin (and O2/fluids if needed), and then do diagnostic work-up
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Pt w/ nephrotic syndrome who suddenly develops abdominal pain, fever, and hematuria
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Renal vein thrombosis (b/c antithrombin III is lost in the urine so increased risk of thrombosis)
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Renal vein thrombosis develops most commonly in which nephrotic syndrome?
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Membranous glomerulonephritis
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Rx for MI causing acute heart failure w/ pulmonary edema ("flash pulmonary edema")
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Furosemide
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What drug commonly used in MI treatment should be avoided in flash pulmonary edema
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Beta blockers (can exacerbate the heart failure)
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Rx for peritonsillar abscess
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Needle aspiration and IV Abx
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What are Light's criteria for an exudative pleural fluid?
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At least one of:
Pleural protein/serum protein >.5 Pleural LDH/serum LDH >.6 Pleural LDH > 2/3 upper limit of nml for serum LDH |
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4 criteria for a complicated pleural fluid
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Positive gram stain
Positive culture pH <7.2 Glucose <60 |
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Rx for complicated pleural effusion
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Chest tube drainage (unlikely to resolve spontaneously w/ Abx)
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Most frequent cause of infective endocarditis in pts w/ prosthetic valves
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Staph epidermidis
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Most frequent cause of infective endocarditis in IV drug users
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Staph aureus
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Most frequent cause of subacute bacterial endocarditis
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Viridans group streptococci
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What pts develop subacute bacterial endocarditis?
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Those with preexisting valvular disease
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Absence of peristaltic waves in lower 2/3rds of esophagus and decreased in LES tone
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Esophageal dysmotility associated w/ scleroderma
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Absence of peristaltic waves and increased LES tone
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Achalasia
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Lipoid pneumonitis that develops after Rx for ventricular tachy was likely due to
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Amiodarone
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5 side effects of amiodarone
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Lungs (pulmonary fibrosis)
Thyroid (hypo most commonly) Liver (elevated LFTs) Corneal deposits Skin changes (blue-gray face) |
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Procainamide is associated w/ what 3 side effects?
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Drug-induced lupus
Agranulocytosis QT prolongation |
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Why do multiple myeloma pts develop kidney failure?
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IgG antibodies (paraproteins) produced by myeloma cells collect in glomeruli
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What is the paraprotein gap seen in multiple myeloma?
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The paraproteins contribute to the total serum protein count but not the albumin concentration, so the gap btwn them is > the normal 3-4 range
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Differentiate the meningococcemia rash from that of TSS
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Meningococcemia: stellate purpura w/ central gray color
TSS: Generalized erythema (confluent) that later desquamates |
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Predisposing factors to TSS (other than tampons) (2)
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Infections
Foreign bodies (nasal packing) |
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Definition of and Rx for febrile neutropenia
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Neutropenic pt (ANC <1500) w/ fever >100.9 (or >100.4 sustained for an hour)
Cefipime, meropenem, or imipenem |
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What TB drug causes red urine?
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Rifampin (makes body fluids orange/red)
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Difference in dysphagia of a motility lesion vs. obstructive lesion?
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Motility: both solids and liquids
Obstructive: starts as solids, eventually liquids |
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Which test is usually ordered first in a dysphagia work-up?
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Barium esophagram
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Joint xray w/ periarticular osteopenia and joint margin erosions
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RA
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Eye pain and redness w/ corneal vesicles and dendritic ulcers
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Herpes simplex keratitis
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Which pts are predisposed to bacterial keratitis?
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Contact lens wearers (or after foreign body)
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Management of a pt with persistent pyelo Sx after 72hrs of appropriate Abx
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CT to evaluate for obstruction, abscess, etc.
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Diarrhea, recent travel abroad,hyperactive bowel sounds and borborygmi
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Tropical sprue
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Biopsy in tropical sprue shows
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Blunting of villi and infiltration of chronic inflammatory cells
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Skin contact with sandboxes followed by pruritic erythematous papules --> serpiginous reddish brown lesions
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Cutaneous larva migrans
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Pt w/ renal failure, neuro Sx, hemolytic anemia and thrombocytopenia
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TTP-HUS
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Pentad of thrombotic thrombocytopenic purpura
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Thrombocytopenia
Microangiopathic hemolytic anemia Neuro features Kidney failure Fever |
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Cause of TTP-HUS
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Autoantibody against specific von Willebrand factor-cleaving protease (ADAMTS-13) --> platelet aggregation
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Rx for TTP-HUS
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Plasmapheresis
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What should be avoided in TTP-HUS?
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Platelet transfusion (can worsen renal failure and neuro Sx)
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MOA of nitroglycerin for anginal pain
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Dilation of capacitance vessels (which decreases preload)
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Repetitive overhead motion causing shoulder pain w/ internal rotation and forward flexion (Neer sign)
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Subacromial bursitis
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ABG in pts with obesity hypoventilation syndrome
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Chronically elevated PaCO2 ad reduced PaO2
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Concern w/ long-term OSA or obesity hypoventilation (3)
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Polycythemia, pulmonary HTN, RV failure
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Rx for hypercalcemia 2/2 bone mets
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Bisphosphonates (usually zoledronic acid)
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Rx for hypercalcemic crisis
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IVF and furosemide
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DDx for a microcytic anemia (4 categories)
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- Iron deficiency (intake or blood loss)
- Defective utilization (anemia of chronic disease) - Reduced globin production (thalassemia) - Reduce heme synthesis (lead poisoning or sideroblastic anemia) |
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Eggshell calcification of a liver cyst
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Hydatid cyst
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What animals are the hosts for Echinococcus granulosus (cause of hydatid cysts)?
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Dogs
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Management of hydatid cysts?
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Surgical resection w/ while covering w/ albendazole
DON'T aspirate b/c of risk of anaphylactic shock with content spilling |
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Photopsia (flashes of light) and floaters + a curtain over eyes
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Retinal detachment
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Ophthalmoscopy findings in retinal detachment
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Gray, elevated retina
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Ophthalmoscopy findings in CRAO
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Pallor of optic disc, cherry red fovea, boxcar segmentation of blood in retinal veins
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Serum LDH level in B12 deficiency vs. folic acid deficiency
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Increased in B12 deficiency, normal in folic acid deficiency
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Best chemoprophylaxis for malaria (3 options)
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Chloroquine
Mefloquine in areas w/ chloroquine-resistant Plasmodium falciparum (SS Africa and Indian subcontinent) Primaquine (for Plasmodium vivax or ovale) |
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Lab abnormality in antiphopholipid syndrome and why
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IgM or IgG that binds phospholipids in the PTT assay, prolonging PTT but not promoting bleeding
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Young woman with proximal muscle weakness, fatigue, tremor, weight loss, and tachycardia
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Hyperthyroidism (causing thyroid myopathy)
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Mechanism of pneumococcal vaccine
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Capsular polysaccharides --> T-cell independent B-cell response
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Mechanism of vaccines coupled w/ bacterial toxoids (e.g. tetanus)
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T-cell-dependent B-cell reponse
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Cause of ACEI-induced angioedema
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Increasesed levels of bradykinin: (pro-inflammatory) promotes edema, inflammation, and sensation of pain
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How can ACEIs precipitate ARF in pts?
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If they have pre-existing bilateral renal artery stenosis
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When should TGs be treated and with what?
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>500; 200-500 if CV risk factors
Fibrates |
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What is Zollinger-Ellison syndrome?
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Gastrinoma
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Total iron binding capacity and transferrin saturation (iron/TIBC) in iron deficiency
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TIBC is increased, so the transferring saturation is low
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Ferritin, TIBC, and transferrin saturation in anemia of chronic disease
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Ferritin is increased (acute phase reactant)
TIBC: low Transferrin saturation: normal (low/low), but can be low |
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Side effects of cyclophosphamide (4)
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Acute hemorrhagic cystitis, bladder carcinoma, sterility, and myelosuppression
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Cause of the urinary side effects of cyclophosphamide and how to lower the risk
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Acrolein (bladder-toxic metabolite)
MESNA (+ fluids and frequent voiding) |
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Which chemo agents cause cochlear dysfunction
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Cisplatin and carboplatin
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Pt with muscle weakness after asthma attack
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Beta-2 agonists drove potassium intracellularly --> hypokalemia
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How to distinguish ARDS from cardiogenic pulmonary edema?
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PCWP >18: cardiogenic (impaired LV function)
PCQP <18: non-cardiogenic (ARDS) |
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Loculated effusion w/ thick peel after a hemothorax: diagnosis and management
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Empyema; surgery
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Rx for cryptococcal meningitis (2 stages)
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IV amphotericin B plus oral flucytosine (induction)
When clinically improving, d/c thos eand start oral fluconazole (maintenance) |
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What is electrical alternans and what does it indicate?
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Amplitude of the QRS alternates as heart moves in fluid-filled pericardial sac
Pericardial effusion |
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Most common bone affected in osteosarcoma
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Distal femur
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Rx for blastomycosis
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Itraconazole or amphotericin B
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Positive Nikolsky's sign indicates
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Pemphigus vulgaris
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Pathophys for pemphigus vulgaris
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Autoantibodies against desmoglein (adhesion molecule)
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Rx for pemphigus vulgaris
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Prednisone or stronger immunosuppresants
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How to distinguish pemphigus vulgaris from bullous pemphigoid
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Bullous pemphigoid is a benign, pruritic disease w/ tense blisters (vs. flaccid in pemphibus) and no oral lesions
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Back pain w/ leg pain that worsens while standing/walking
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Lumbar spinal stenosis (extension of the spine causes it to narrow further)
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How to diagnose chronic pancreatitis
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Serum elastase (indicates malabsorption 2/2 pancreatic exocrine insufficiency)
Amylase and lipase may be elevated, but commonly normal |
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Pt w/ chronic headaches presenting w/ painless hematuria (+ pathophys)
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Analgesic nephropathy --> chronic tubulointerstitial damage
Analgesics --> vasoconstriction of vasa recta --> renal papillary necrosis --> hematuria |
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What is Hampton's hump?
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Wedge-shaped areas on CXR indicated PE
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Ear pair worsened with chewing
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Likely TMJ, esp if associated w/ nocturnal teeth grinding
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Management of minimal BRBPR in a pt <50
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In-office anoscopy/protoscopy (hemorrhoids are most likely); if no etiology found, then colonoscopy
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Fever, abd pain, diarrhea and a CXR w/ colonic dilation
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Toxic megacolon 2/2 ulcerative colitis
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Rx for toxic megacolon (5)
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IVF, Abx, bowel rest
IV steroids if IBD-induced Surgery if doesn't resolve |
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Rx for a fight bite injury (clenched hand hitting opponents teeth)
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Augmentin (indicated for any human bite infection)
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Rx for PEA w/o a shockable rhythm (e.g. are in A-fib)
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Chest compressions
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12 treatable causes of PEA
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6Hs and 6Ts
Hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia, hypoglycemia, hyper/hypokalemia Tamponade, tension pneumo, thrombosis (MI or PE), trauma (hypovolemia), tablets, toxins |
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Definition of conjugated hyperbilirubinemia
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>50% of an total bilirubin (normally is <10%)
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Caused of conjugated hyperbilirubinemia (2 categories)
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Intrahepatic (liver conditions or congenital defects in biliary excretion e.g. Dubin Johnson and Rotor's)
Extrahepatic obstruction (more likely w/ elevated alk phos) |
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Test to look for lytic lesions in multiple myeloma
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Xray, NOT bone scan (can't see them as well since there is no associated new bone formation)
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How to distinguish CML and leukemoid reaction (to severe infection/inflammation)
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Increased leukocyte alkaline phosphatase (LAP) score seen in leukemoid reaction
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What other condition has an increased leukocyte alkaline phosphatase score?
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Polycythemia vera
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Best drug in a pt with stable angina and HTN
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Beta blocker
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Path in Crohn's disease
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Granulomatous inflammation
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Most common complication of peptic ulcer disease (and 3 less common complications)
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Hemorrhage (perforation, penetration, obstruction)
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What concurrent medication may cause neutropenic pts to not develop a fever?
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Steroids
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Most common drug that causes priapism (NOT trazodone)
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Prazosin
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Rx for endocarditis due to strep viridans
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IV penicillin G or IV ceftriaxone
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HTN w/ bilateral abdominal masses and hematuria
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Polycystic kidney disease
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How to diagnose renal artery stenosis
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Captopril renal scan
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Pulselessness 5 days after MI
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LV free wall rupture --> pericardial tamponade
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New holosystolic murmur 5 days after MI
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Interventricular free wall rupture
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New holosystolic murmur at apex 5 days after MI w/ hypotension
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Papillary muscle rupture --> MR
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Diarrhea, dermatitis, dementia
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Pellagra (niacin deficiency)
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Episodic abdominal pain, N/V, diarrhea, sweating, agitation, anxiety
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Acute intermittent porphyria
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Verrucous skin lesions that are crusted, warty, and a violaceous hue which also show yeast
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Blasto
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Yeast skin infection w/ erythema multiforme, erythema nodosum, and pulmonary involvement
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Coccidiomycosis
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Infection after finger prick while gardening
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Sporotrichosis
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Common complications in AD polycystic kidney disease (4)
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Berry aneurysms
Hepatic cysts Valvular disease Diverticulosis |
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Akinesis of LV wall, arrhythmia, and systemic embolization 1mo after MI
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Ventricular aneurysm
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Rx for disseminated pulmonary histo in HIV pts
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Itraconazole if mild, 2 wks of amphotericin followed by itraconazole if severe
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DLCO in asthma vs. COPD
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High, low
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Hyperkalemia in pt receiving chemo
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Tumor lysis syndrome
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Generic name for kayexalate
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Sodium polystyrene sulfate
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Fastest way to reverse hyperkalemia
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Insulin and glucose
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Most common cause of subacute infection endocarditis after dental work
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Strep mutans, a type of viridans group strep
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When to start screening lipid panels
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Men >35, women >45
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Tumor with elevated beta-hCG
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Seminoma
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Tumor with elevated AFP
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Other germ cell tumor
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Smear in thalassemia shows
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Target cells
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Rx for alpha or beta thalassemia minor
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Observe
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Common side effect of fluphenazine (an atypical antipsychotic)
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Hypothermia
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Pearly skin cancer on eyelid
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Basal cell carcinoma
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BNP is beth correlated w/ what 3 things
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Severity of LV filling pressure elevation
Therefore, also with an S3 Mortality |
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What are Mallory Weiss tears and what causes them?
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Ruptured submucosal arteries of the distal esophagus and proximal stomach due to increased intragastric pressure
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Mechanism of clopidogrel
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Blocks platelet surface aDP receptors
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MOA of ASA
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Inhibits cyclooxyegnase-1, therefore inhibiting thromboxane A2 synthesis
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MOA of heparin
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Activates antithrombin III, which inactivates thrombin, IXa, and Xa
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Unilateral headache (sharp pain in upper face), fever, periorbital edema
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Cavernous sinus thrombosis
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Cause/ Rx for cavernous sinus thrombosis
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Infection around eyes/ nose
IV Abx |
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How to distinguish cavernous sinus thrombosis from orbital celulitis
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CST has CN abnormalities and bilateral periorbital edema
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Red eye w/ hazy ornea
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Acute angle closure glaucoma
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Clotting disorder that can cause a falsely positive VDRL
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Antiphospholipid syndrome
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Water brash (regurgitation of sour fluid into mouth)
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GERD
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1st test of AKI
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Foley cath
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Effect of COPD on dead space ventilation
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Increases dead space ventilation, which worsens their respiratory acidosis
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2 miscarriages w/ thrombocytopenia and a prolonged PTT
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Antiphospholipid antibody syndrome
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Rx for antiphospholipid syndrome in pregnancy
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Prophy w/ low dose ASA and LMWH to avoid pregnancy loss
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Management of pt receiving high O2 levels (>80%) while intubated w/ a pO2 of 105
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Decreased FiO2 slowly until <60% (to decrease oxygen toxicity to lungs; normal is .21 or 21%)
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If PaCO2 values of an intubated pt are too high or low, what needs to be adjusted?
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Tidal volume or RR
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Best way to decrease BP (3, in order)
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Weight loss (then exercise, then decreasing salt; quitting smoking doesn't help)
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Diarrhea w/ acid fast stool stain showing oocysts
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Cryptosporidium
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22yo w/ fever, sore throat, malaise and on exam pharyngitis, hepatosplenomegaly, and generalized lymphadenopathy
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Infectious mononucleosis
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