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200 Cards in this Set

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What drug commonly used in MI treatment should not be used if it is due to cocaine-induced vasospasm?
Beta blockers (use CCBs instead)
IV drug user w/ recurrent infections now presenting w/ nephrotic syndrome, hepatomegaly, cardiomyopathy, and peripheral neuropathy
Secondary amyloidosis (from chronic inflammation)
Microcytic anemia non-responsive to iron supplementation in a Mediterranean pt
Beta-thalassemia
When should post-exposure prophylaxis be started after a dog bite (3 scenarios)
Dog known to be rabid (or appears so after observation)

Unknown dog

Head or neck bite
S3 and S4
S3- hypertrophy
S4- dilation
S3 likely indicates (and best Rx)
Left heart failure
Diuretics
Inheritance of HOCM
AD
Decreased preload causes most murmurs to?
Decrease (b/c there is less flow)
Why does decreased preload cause the HOCM murmur to become louder?
Decreases size of ventricular cavity and causes increased outflow obstruction
What maneuver decreases preload and therefore makes the HOCM murmur louder?
Valsalva
Smudge cells (fragile lymphocytes that undergo breakdown during slide preparation) indicate
CLL
Very poor prognostic factor in CLL
Thrombocytopenia
Staging of CLL
0: only lymphocytosis
I: lymphocytosis + adenopathy
II: splenomegaly
III: anemia
IV: thrombocytopenia
Older man who loses consciousness while peeing
Situational syncope
Sudden loss of vision and onset of floaters w/ difficult to visualize fundus on fundoscopy
Vitreous hemorrhage
Most common cause of vitreous hemorrhage
Diabetic retinopathy
Vision loss w/ shower of floaters; fundoscopy w/ elevated retina w/ folds and a tear
Retinal detachment
Sudden painless unilateral loss of vision in pt w/ history of HTN; fundoscopy w/ disk swelling, venous dilation, retinal hemorrhage, cotton wool spots
Central retinal vein occlusion
Difference btwn hordeolum and chalazion
Hordeolum: abscess over upper or lower eyelid

Chalazion: chronic granulomatous inflammation of meibomian gland; appears as a hard painless nodule
Degenerative joint disease, joint deformation, and functional limitation w/ XR showing loss of cartilage, osteophyte dev't, and loose bodies
Charcot's joint: neurogenic arhtropathy
Acid base changes in pregnancy
Progesterone --> tachypnea --> mild respiratory alkalosis w/ metabolic compensation
Most common cause of phototoxic drug eruption
Tetracyclines
Hemolytic anemia, venous thrombosis and diminished hematopoiesis
Paroxysmal nocturnal hemoglobinuria
Pathophys of paroxysmal nocturnal hemoglobinuria
Abnormal cell membrane protein so cell surface molecules that protect RBCs can't bind, so RBCs are attacked by complement
How to distinguish autoimmune hemolytic anemia from paroxysmal nocturnal hemoglobinuria?
PNH is predisposed to venous thrombosis esp w/in hepatic veins
High alk phos with bilateral hearing loss
Paget's disease of the bone
Pathophys of Paget's
High bone turnover (remodeling) and aberrant osteoid formation
Concern w/ Paget's disease
As bones reshape they become soft and susceptible to fracture
Rx for Paget's disease of the bone
Bisphosphonates
When is lidocaine used in ACS?
Only to treat ventricular fibrillation; it increases the risk of asystole, so it isn't used prophylactically
How does RMSF spread?
From wrists and ankles --> centrally
Maculopapular rash w/ posterior cervical and posterior auricular (suboccipital) lymphadenopathy
Rubella
What is an abnormal Rinne test and what does it indicate?
When pt doesn't hear air vibration 2x as long as bone vibration

Conductive hearing loss
Rx for Afib (3 scenarios)
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
How to distinguish polymyositis from polymyalgia rheumatica
Weakness is primary complaint in polymyositis; pain in the absence of weakness is more consistent with polymyalgia rheumatica
Which type of cancer is most likely to develop into cancer?
Villous adenoma (higher risk than tubular adenomas)
Management of hyperplastic polyps and hamartomatous polyps
Hyperplastic: nothing
Hamartomatous: removed b/c of bleeding risk

Both are non-malignant
Which polyp shape is most likely to be pre-malignant?
Sessile (vs. pedunculated)
Most common pathogen of a hordeolum and management
Staph

Warm compresses; only I&D if doesn't begin to regress in 48hrs
Rx for chalazion
Incision and curettage
Rx for stroke in a sickle cell pt
Exchange transfusion (makes additional stroke less likely)
Negative predictive value varies with
The pretest probability of a disease (the NPV is higher if your pretest probability was low)
What causes the low glucose concentration in exudative effusions?
High metabolic acitivty of leukocytes within the pleural fluid
4 drugs w/ mortality benefit after MI
ASA
ACEIs
Beta blockers
Statins
Indications for clopidogrel (3)
For 12mo after unstable angina/NSTEMI

30 days after bare metal stent PCI

One yr after drug eluting stent PCI
Pts with celiac disease are at increased risk for what malignacy
GI lymphomas
Hip pain worsened by activity w/ a hip that is not tender on exam, no systemic Sx, but pain on rotation
OA/ degenerative joint disease
Complications of PEEP
High pressures can cause alveolar damage, tension pneumo, and hypotension
Rx for hepatic encephalopathy (3)
Lactulose (acidifies colon causing catharsis and decrease in circulating ammonia)
Laxative (for catharsis)
Abx (neomycin and rifaximin)
Heart failure after a traumatic injury
Development of a symptomatic AV fistula (lots of blood shunts thru, --> decreased SVR, increased preload, and increased CO)
Pulm nodule w/ a halo sign or with an air crescent
Aspergillus
Hyperparathyroidism causes what bone disease?
Osteitis fibrosis cystica (Von Recklinghausen's): osteoclastic resorption leads to replacement of bone with fibrous tissue (brown tumors)
What is required for a diagnosis of malignant HTN
BP >200/140
AND
Papilledema
What is the pathologic change responsible for end-organ damage in malignant HTN?
Fibrinoid necrosis of small arterioles
Intubated pt growing gram-negative bacilli; most likely pathogen?
Pseudomonas
Pt w/ chest pain and barium swallow w/ corkscrew esophagus
Diffuse esophageal spasm
Rx for pt with high probability of PE
Start heparin (and O2/fluids if needed), and then do diagnostic work-up
Pt w/ nephrotic syndrome who suddenly develops abdominal pain, fever, and hematuria
Renal vein thrombosis (b/c antithrombin III is lost in the urine so increased risk of thrombosis)
Renal vein thrombosis develops most commonly in which nephrotic syndrome?
Membranous glomerulonephritis
Rx for MI causing acute heart failure w/ pulmonary edema ("flash pulmonary edema")
Furosemide
What drug commonly used in MI treatment should be avoided in flash pulmonary edema
Beta blockers (can exacerbate the heart failure)
Rx for peritonsillar abscess
Needle aspiration and IV Abx
What are Light's criteria for an exudative pleural fluid?
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
4 criteria for a complicated pleural fluid
Positive gram stain
Positive culture
pH <7.2
Glucose <60
Rx for complicated pleural effusion
Chest tube drainage (unlikely to resolve spontaneously w/ Abx)
Most frequent cause of infective endocarditis in pts w/ prosthetic valves
Staph epidermidis
Most frequent cause of infective endocarditis in IV drug users
Staph aureus
Most frequent cause of subacute bacterial endocarditis
Viridans group streptococci
What pts develop subacute bacterial endocarditis?
Those with preexisting valvular disease
Absence of peristaltic waves in lower 2/3rds of esophagus and decreased in LES tone
Esophageal dysmotility associated w/ scleroderma
Absence of peristaltic waves and increased LES tone
Achalasia
Lipoid pneumonitis that develops after Rx for ventricular tachy was likely due to
Amiodarone
5 side effects of amiodarone
Lungs (pulmonary fibrosis)
Thyroid (hypo most commonly)
Liver (elevated LFTs)
Corneal deposits
Skin changes (blue-gray face)
Procainamide is associated w/ what 3 side effects?
Drug-induced lupus
Agranulocytosis
QT prolongation
Why do multiple myeloma pts develop kidney failure?
IgG antibodies (paraproteins) produced by myeloma cells collect in glomeruli
What is the paraprotein gap seen in multiple myeloma?
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
Differentiate the meningococcemia rash from that of TSS
Meningococcemia: stellate purpura w/ central gray color

TSS: Generalized erythema (confluent) that later desquamates
Predisposing factors to TSS (other than tampons) (2)
Infections
Foreign bodies (nasal packing)
Definition of and Rx for febrile neutropenia
Neutropenic pt (ANC <1500) w/ fever >100.9 (or >100.4 sustained for an hour)

Cefipime, meropenem, or imipenem
What TB drug causes red urine?
Rifampin (makes body fluids orange/red)
Difference in dysphagia of a motility lesion vs. obstructive lesion?
Motility: both solids and liquids
Obstructive: starts as solids, eventually liquids
Which test is usually ordered first in a dysphagia work-up?
Barium esophagram
Joint xray w/ periarticular osteopenia and joint margin erosions
RA
Eye pain and redness w/ corneal vesicles and dendritic ulcers
Herpes simplex keratitis
Which pts are predisposed to bacterial keratitis?
Contact lens wearers (or after foreign body)
Management of a pt with persistent pyelo Sx after 72hrs of appropriate Abx
CT to evaluate for obstruction, abscess, etc.
Diarrhea, recent travel abroad,hyperactive bowel sounds and borborygmi
Tropical sprue
Biopsy in tropical sprue shows
Blunting of villi and infiltration of chronic inflammatory cells
Skin contact with sandboxes followed by pruritic erythematous papules --> serpiginous reddish brown lesions
Cutaneous larva migrans
Pt w/ renal failure, neuro Sx, hemolytic anemia and thrombocytopenia
TTP-HUS
Pentad of thrombotic thrombocytopenic purpura
Thrombocytopenia
Microangiopathic hemolytic anemia
Neuro features
Kidney failure
Fever
Cause of TTP-HUS
Autoantibody against specific von Willebrand factor-cleaving protease (ADAMTS-13) --> platelet aggregation
Rx for TTP-HUS
Plasmapheresis
What should be avoided in TTP-HUS?
Platelet transfusion (can worsen renal failure and neuro Sx)
MOA of nitroglycerin for anginal pain
Dilation of capacitance vessels (which decreases preload)
Repetitive overhead motion causing shoulder pain w/ internal rotation and forward flexion (Neer sign)
Subacromial bursitis
ABG in pts with obesity hypoventilation syndrome
Chronically elevated PaCO2 ad reduced PaO2
Concern w/ long-term OSA or obesity hypoventilation (3)
Polycythemia, pulmonary HTN, RV failure
Rx for hypercalcemia 2/2 bone mets
Bisphosphonates (usually zoledronic acid)
Rx for hypercalcemic crisis
IVF and furosemide
DDx for a microcytic anemia (4 categories)
- Iron deficiency (intake or blood loss)
- Defective utilization (anemia of chronic disease)
- Reduced globin production (thalassemia)
- Reduce heme synthesis (lead poisoning or sideroblastic anemia)
Eggshell calcification of a liver cyst
Hydatid cyst
What animals are the hosts for Echinococcus granulosus (cause of hydatid cysts)?
Dogs
Management of hydatid cysts?
Surgical resection w/ while covering w/ albendazole

DON'T aspirate b/c of risk of anaphylactic shock with content spilling
Photopsia (flashes of light) and floaters + a curtain over eyes
Retinal detachment
Ophthalmoscopy findings in retinal detachment
Gray, elevated retina
Ophthalmoscopy findings in CRAO
Pallor of optic disc, cherry red fovea, boxcar segmentation of blood in retinal veins
Serum LDH level in B12 deficiency vs. folic acid deficiency
Increased in B12 deficiency, normal in folic acid deficiency
Best chemoprophylaxis for malaria (3 options)
Chloroquine
Mefloquine in areas w/ chloroquine-resistant Plasmodium falciparum (SS Africa and Indian subcontinent)
Primaquine (for Plasmodium vivax or ovale)
Lab abnormality in antiphopholipid syndrome and why
IgM or IgG that binds phospholipids in the PTT assay, prolonging PTT but not promoting bleeding
Young woman with proximal muscle weakness, fatigue, tremor, weight loss, and tachycardia
Hyperthyroidism (causing thyroid myopathy)
Mechanism of pneumococcal vaccine
Capsular polysaccharides --> T-cell independent B-cell response
Mechanism of vaccines coupled w/ bacterial toxoids (e.g. tetanus)
T-cell-dependent B-cell reponse
Cause of ACEI-induced angioedema
Increasesed levels of bradykinin: (pro-inflammatory) promotes edema, inflammation, and sensation of pain
How can ACEIs precipitate ARF in pts?
If they have pre-existing bilateral renal artery stenosis
When should TGs be treated and with what?
>500; 200-500 if CV risk factors

Fibrates
What is Zollinger-Ellison syndrome?
Gastrinoma
Total iron binding capacity and transferrin saturation (iron/TIBC) in iron deficiency
TIBC is increased, so the transferring saturation is low
Ferritin, TIBC, and transferrin saturation in anemia of chronic disease
Ferritin is increased (acute phase reactant)

TIBC: low

Transferrin saturation: normal (low/low), but can be low
Side effects of cyclophosphamide (4)
Acute hemorrhagic cystitis, bladder carcinoma, sterility, and myelosuppression
Cause of the urinary side effects of cyclophosphamide and how to lower the risk
Acrolein (bladder-toxic metabolite)

MESNA (+ fluids and frequent voiding)
Which chemo agents cause cochlear dysfunction
Cisplatin and carboplatin
Pt with muscle weakness after asthma attack
Beta-2 agonists drove potassium intracellularly --> hypokalemia
How to distinguish ARDS from cardiogenic pulmonary edema?
PCWP >18: cardiogenic (impaired LV function)
PCQP <18: non-cardiogenic (ARDS)
Loculated effusion w/ thick peel after a hemothorax: diagnosis and management
Empyema; surgery
Rx for cryptococcal meningitis (2 stages)
IV amphotericin B plus oral flucytosine (induction)

When clinically improving, d/c thos eand start oral fluconazole (maintenance)
What is electrical alternans and what does it indicate?
Amplitude of the QRS alternates as heart moves in fluid-filled pericardial sac

Pericardial effusion
Most common bone affected in osteosarcoma
Distal femur
Rx for blastomycosis
Itraconazole or amphotericin B
Positive Nikolsky's sign indicates
Pemphigus vulgaris
Pathophys for pemphigus vulgaris
Autoantibodies against desmoglein (adhesion molecule)
Rx for pemphigus vulgaris
Prednisone or stronger immunosuppresants
How to distinguish pemphigus vulgaris from bullous pemphigoid
Bullous pemphigoid is a benign, pruritic disease w/ tense blisters (vs. flaccid in pemphibus) and no oral lesions
Back pain w/ leg pain that worsens while standing/walking
Lumbar spinal stenosis (extension of the spine causes it to narrow further)
How to diagnose chronic pancreatitis
Serum elastase (indicates malabsorption 2/2 pancreatic exocrine insufficiency)

Amylase and lipase may be elevated, but commonly normal
Pt w/ chronic headaches presenting w/ painless hematuria (+ pathophys)
Analgesic nephropathy --> chronic tubulointerstitial damage

Analgesics --> vasoconstriction of vasa recta --> renal papillary necrosis --> hematuria
What is Hampton's hump?
Wedge-shaped areas on CXR indicated PE
Ear pair worsened with chewing
Likely TMJ, esp if associated w/ nocturnal teeth grinding
Management of minimal BRBPR in a pt <50
In-office anoscopy/protoscopy (hemorrhoids are most likely); if no etiology found, then colonoscopy
Fever, abd pain, diarrhea and a CXR w/ colonic dilation
Toxic megacolon 2/2 ulcerative colitis
Rx for toxic megacolon (5)
IVF, Abx, bowel rest
IV steroids if IBD-induced
Surgery if doesn't resolve
Rx for a fight bite injury (clenched hand hitting opponents teeth)
Augmentin (indicated for any human bite infection)
Rx for PEA w/o a shockable rhythm (e.g. are in A-fib)
Chest compressions
12 treatable causes of PEA
6Hs and 6Ts
Hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia, hypoglycemia, hyper/hypokalemia

Tamponade, tension pneumo, thrombosis (MI or PE), trauma (hypovolemia), tablets, toxins
Definition of conjugated hyperbilirubinemia
>50% of an total bilirubin (normally is <10%)
Caused of conjugated hyperbilirubinemia (2 categories)
Intrahepatic (liver conditions or congenital defects in biliary excretion e.g. Dubin Johnson and Rotor's)

Extrahepatic obstruction (more likely w/ elevated alk phos)
Test to look for lytic lesions in multiple myeloma
Xray, NOT bone scan (can't see them as well since there is no associated new bone formation)
How to distinguish CML and leukemoid reaction (to severe infection/inflammation)
Increased leukocyte alkaline phosphatase (LAP) score seen in leukemoid reaction
What other condition has an increased leukocyte alkaline phosphatase score?
Polycythemia vera
Best drug in a pt with stable angina and HTN
Beta blocker
Path in Crohn's disease
Granulomatous inflammation
Most common complication of peptic ulcer disease (and 3 less common complications)
Hemorrhage (perforation, penetration, obstruction)
What concurrent medication may cause neutropenic pts to not develop a fever?
Steroids
Most common drug that causes priapism (NOT trazodone)
Prazosin
Rx for endocarditis due to strep viridans
IV penicillin G or IV ceftriaxone
HTN w/ bilateral abdominal masses and hematuria
Polycystic kidney disease
How to diagnose renal artery stenosis
Captopril renal scan
Pulselessness 5 days after MI
LV free wall rupture --> pericardial tamponade
New holosystolic murmur 5 days after MI
Interventricular free wall rupture
New holosystolic murmur at apex 5 days after MI w/ hypotension
Papillary muscle rupture --> MR
Diarrhea, dermatitis, dementia
Pellagra (niacin deficiency)
Episodic abdominal pain, N/V, diarrhea, sweating, agitation, anxiety
Acute intermittent porphyria
Verrucous skin lesions that are crusted, warty, and a violaceous hue which also show yeast
Blasto
Yeast skin infection w/ erythema multiforme, erythema nodosum, and pulmonary involvement
Coccidiomycosis
Infection after finger prick while gardening
Sporotrichosis
Common complications in AD polycystic kidney disease (4)
Berry aneurysms
Hepatic cysts
Valvular disease
Diverticulosis
Akinesis of LV wall, arrhythmia, and systemic embolization 1mo after MI
Ventricular aneurysm
Rx for disseminated pulmonary histo in HIV pts
Itraconazole if mild, 2 wks of amphotericin followed by itraconazole if severe
DLCO in asthma vs. COPD
High, low
Hyperkalemia in pt receiving chemo
Tumor lysis syndrome
Generic name for kayexalate
Sodium polystyrene sulfate
Fastest way to reverse hyperkalemia
Insulin and glucose
Most common cause of subacute infection endocarditis after dental work
Strep mutans, a type of viridans group strep
When to start screening lipid panels
Men >35, women >45
Tumor with elevated beta-hCG
Seminoma
Tumor with elevated AFP
Other germ cell tumor
Smear in thalassemia shows
Target cells
Rx for alpha or beta thalassemia minor
Observe
Common side effect of fluphenazine (an atypical antipsychotic)
Hypothermia
Pearly skin cancer on eyelid
Basal cell carcinoma
BNP is beth correlated w/ what 3 things
Severity of LV filling pressure elevation
Therefore, also with an S3
Mortality
What are Mallory Weiss tears and what causes them?
Ruptured submucosal arteries of the distal esophagus and proximal stomach due to increased intragastric pressure
Mechanism of clopidogrel
Blocks platelet surface aDP receptors
MOA of ASA
Inhibits cyclooxyegnase-1, therefore inhibiting thromboxane A2 synthesis
MOA of heparin
Activates antithrombin III, which inactivates thrombin, IXa, and Xa
Unilateral headache (sharp pain in upper face), fever, periorbital edema
Cavernous sinus thrombosis
Cause/ Rx for cavernous sinus thrombosis
Infection around eyes/ nose

IV Abx
How to distinguish cavernous sinus thrombosis from orbital celulitis
CST has CN abnormalities and bilateral periorbital edema
Red eye w/ hazy ornea
Acute angle closure glaucoma
Clotting disorder that can cause a falsely positive VDRL
Antiphospholipid syndrome
Water brash (regurgitation of sour fluid into mouth)
GERD
1st test of AKI
Foley cath
Effect of COPD on dead space ventilation
Increases dead space ventilation, which worsens their respiratory acidosis
2 miscarriages w/ thrombocytopenia and a prolonged PTT
Antiphospholipid antibody syndrome
Rx for antiphospholipid syndrome in pregnancy
Prophy w/ low dose ASA and LMWH to avoid pregnancy loss
Management of pt receiving high O2 levels (>80%) while intubated w/ a pO2 of 105
Decreased FiO2 slowly until <60% (to decrease oxygen toxicity to lungs; normal is .21 or 21%)
If PaCO2 values of an intubated pt are too high or low, what needs to be adjusted?
Tidal volume or RR
Best way to decrease BP (3, in order)
Weight loss (then exercise, then decreasing salt; quitting smoking doesn't help)
Diarrhea w/ acid fast stool stain showing oocysts
Cryptosporidium
22yo w/ fever, sore throat, malaise and on exam pharyngitis, hepatosplenomegaly, and generalized lymphadenopathy
Infectious mononucleosis