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435 Cards in this Set
- Front
- Back
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what kidney damage can occur in a woman presenting with chronic headaches and painless hematuria
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papillary necrosis 2/2 alangesic nephropathy
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therapeutic INR for afib or venous thromboembolism
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2.0 - 3.0
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therapeutic INR for patient with prosthetic valve
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2.5 - 3.5
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what should you suspect in a young patient with chronic diarrhea, abd pain and weight loss
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Crohn's disease
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what are the values of Ca, Phos, ALP, and urine hydroxyproline in a patient with Paget's disease
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Ca - normal
Phos - normal ALP - increased urinary hydroproline - increased |
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pigmented, warty, stuck-on appearance
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seborrhic keratosis
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mechanism of axn for cyclosporine and tacrolimus
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inhibits calcineurin which is responsible for activation of IL-2
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differentiate side effects between tacrolimus and cyclosporine
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tacrolimus - nephrotoxicity, hyperkalemia, HTN
cyclosporine - ALL of tacrolimus + gum hypertrophy and hursitism |
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treatment for patient with HIV and PPD > 5mm
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INH + pyridoxine for 9 months
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patient presents on day 3 post-op with jaudice and needs lots of blood product replacement. ALP is elevated with normal AST and ALT
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postoperative cholestasis
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patient presents with asthma-like symptoms at night requires which medication
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PPI
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treatment of choice for filamentous, partial acid-fast gram(+) rod
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TMP/SMX - Nocardia
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3 treatments required for patient with recurrent hypercalcinuria
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1. thiazide
2. increased fluid 3. Na restriction |
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most common type of diabetic neuropathy
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symmetrical distal sensorimotor polyneuropathy
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ring-enhancing lesion on CT in immuno competent patient with known extra cranial infection
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brain abscess 2/2 anaerobic bacteria
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DOC for pnemocystis jerovecci
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TMP/SMX
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what two types of cancers are associated with HNPCC
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colon and endometrial cancer
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patient presents with arthritis symptoms in MCP, PIP, wrist, and ankle joints for less than 6 month duration. what is the best diagnostic study of choice
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anti-B19 IgM; most likely 2/2 parvovirus
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three things associated with pulsus paradoxes
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tamponade
asthma tension pneumothorax |
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what is the treatment of choice for a grade 3 ulcer
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surgical debriment and IV antibiotics
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what should you think in a patient with both decreased Ca and Phos
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malabsorption because Vit. D deficiency is present
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treatment of patient with severe asthma exacerbation
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B2 agonist
inhaled anticholinergics IV steroids |
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when should a patient with asthma exacerbation be intubated
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respiratory failure marked with hypercapnia or hypoxia (SaO2 <88% or PaO2 < 55)
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chronic widespread pain in women associated with fatigue, poor sleep, and depression
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fibromyalgia
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what OTC medication should you be careful with in a patient on warfarin
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Multivitamin due to Vit. E ability to increase warfarin
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skin disorder that has hyperpigmentation and some thickening associated with insulin resistance and GI malignancies
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acanthosis nigracans
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this treatment for breast cancer can lead to increased risk of endometrial cancer and venous thrombosis
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tamoxifen
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what two drugs are associated with priapism
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prazosin
trazadone |
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two most common causes of avascular necrosis (>90% of cases) leading to disruption of bone vaculature
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alcoholism
chronic steroid use |
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Na, K, Aldo, and renin seen in primary hyperaldosteronism
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Na - increased
K - decreased Ald - increased renin - decreased |
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what is associated with absence of peristaltic waves in the lower 2/3 of the esophagus and decreased LES
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scleroderma esophageal dysmotility
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how can a patient with a hx of DM present with increased PVR
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autonomic neuropathy leading to overflow incontinence from decreased detrusor muscle activity
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what medication should be avoided in patients with asthma
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B-blockers in general, even B1-blockers (metoprolol) in high enough doses can cause bronchoconstriction
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differentiate Ca and PTH levels in patients with primary hyperparathyroidism vs. chronic renal failure
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CRF - higher levels of PTH with normal Ca
primary hyperparathyroidism - elevated PTH with very high levels of Ca |
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what is the most common complication of peptide ulcer disease
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hemorrhage
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what 4 lab tests are used to ***** liver function
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PT, bilirubin, albumin, cholesterol
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treatment in patient with fever and new right sided heart murmur
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vancomycin
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what physical exam finding confirms the diagnosis of malignant HTN
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papilledema
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what test is both sensitive and specific for mononucleosis
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heterophile antibody
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what test is used to diagnose mononucleosis if heterophile antibody test is negative, but mono is still suspected
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EBV-specific antibody test
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DOC for dermatitis herpetiformin in patients with celiac disease
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dapsone
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what size renal stone typically resolves spontaneously with fluid intake
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<5 mm
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patient presents with hx of tick bite with No RASH, leukopenia, thrombocytopenia, and elevated transaminases
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ehrlichosis
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patient presents with hx of tick bite with No RASH. past medical hx of significant for splectomy. patient has decreased hgb and elevated indirect bilirubin
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babesiosis
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what is the best way to decreased a pts BP who is DM, overweight, hyperlipidemia, and has HTN
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weight loss
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what is associated with eletrical alternans
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pericardia effusion
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what should always be considered in female pt with unexplained myopathy and elevated CK
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hypothryoidism
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what is indicated in a pt with pyelonephritis who does not repond to therapy 48-72 hrs after appropriate therapy
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renal US
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what is the cut-off for decision making in a pt with acetaminophen toxicity
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4 hours after ingestion is when you decide to give N-acetylcysteine or not
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what is required in a pt about to be treated with trastuzumab
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echocardiogram due to cardiotoxicity
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how can a loop diuretic be the cause for VT or potentiate digoxin toxicity
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may cause decrease in both K or Mg
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patient presents with transient vision loss lasting only a few seconds with change in head position
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papilledema
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patient presents with acute back pain with absence of radiculopathy and negative straight leg test
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lumbosacral strain
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what is the hgb goal in a patient with pre-existing heart disease
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>10
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what is associated with curved lines when looking at a grid of parallel lines
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macular degeneration
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what is associated with tartrate-resistant acid phosphtase (TRAP)
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hairy cell leukemia
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when are diuretics indicated in a pt with recent MI
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if pulmonary edema is present
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how does the body compensate for hypercapnia
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retains HCO3 via the kidneys
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in pt on mechanical ventilation, how does one measure: lung compliance, airway resistance, PEEP
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lung compliance - end-inspiratory hold
airway resistance - peak airway pressure PEEP - end-expiratory hold |
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associated with IgG and C3 deposits linearly along dermal-epidermal junction
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bullous pemphigoid
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what is indicated in a pt with bright red blood per rectum who does not have risk factors for colon CA and is <50
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anoscopy/proctoscopy
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majority of cause of aortic stenosis in patients < 70
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bicuspid aortic valve
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yellow-white patches of retinal opacification and hemorrhage in patient with CD4 < 50
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CMV retinitis
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pt presents with painless jaundice, elevated ALP, and conjugated hyperbilirubinemia
|
pancreatic cancer
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what skin lesion is parkinson's associated with
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seborrhic keratosis
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what is post-exposure prophylaxis against rabies
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both passive and active immunization
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when does rabies immunization be given immediately
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1. exposure to head and neck area
2. dog is not found *If dog is found and not rabid, observe for 10 days |
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what is a tea and toast diet associated with
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folic acid deficiency
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what is the first test done a patient presenting with a thyroid nodule
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TSH
-low - radionuclide scan -high - ultrasound |
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what should all pts with chronic hepatitis (HCV) be immunized against
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HBV, HAV, TdaP q10 years, influenza q1 year, pneumovax q5 years
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what should be suspected in a pt presenting with back pain and signs of blood loss who is taking warfarin
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retroperitoneal hematoma
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first-line treatment for RA
|
methotrexate
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DOC for prophylaxis against MAC in pt with CD4 <50
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azithromycin
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pt with testicular cancer has elevated testosterone and estrogen with decreased LH and FSH
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leydig cell tumor
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what should you consider in post-transplant patient presenting with pneumonia
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CMV pneumonia
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what is the PTH and Ca levels seen in hypercalcemia of malignancy
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suppressed PTH with elevated Ca
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most common cause of septic arthritis in sexually active young adult
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N. gonorrhoeae
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why is renal vein thrombosis a frequent manifestation in patients with nephrotic syndrome
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hypercoagulable state due to renal losses of AT III
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differentiate treatment of VT in stable vs. unstable patient
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stable - IV amiodarone
unstable - cardioversion |
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what is the make-up of pleural effusion 2/2 PE
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small and exudative
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light's criteria
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protein plasma fluid/protein serum > 0.5
LDH plasma fluid/LDH serum >0.6 |
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prophylactic medication used in patients with esophageal varicies found on EGD
|
B-blockers
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what should be suspected in patient with decreased TSH, elevated T3 and T4, with decreased iodine uptake
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exogenous thyroid hormon consumption
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treatment for patients with acute mechanical back pain with no neurologic signs
|
qearly mobilization, muscle relaxants, NSAIDs
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what has been shown to prolong survival in patients with COPD with PaO2 <55 or SaO2 <88
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supplemental O2
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most specific test for GERD
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24-hour pH monitoring
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treatment for coccaine related cardiac ischemia
|
benzodiazepine
nitrates aspirin |
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differentiate the DLco in chronic bronchitis vs. emphysema
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normal - chronic bronchitis
decreased - emphysema |
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what causes orthostatic hypotension in the elderly
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decreased baroreceptor responsiveness
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what is associated with false positive VDRL, prolonged PTT, thrombocytopenia, and spontaneous abortion
|
antiphospholipid syndrome
*treated with LMWH |
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cause of pt being treated for acne who presents with photoxic eruptions
|
doxycycline
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what bug should you suspect in an adult presenting with pneumonia who had flu-like symptoms just days earlier
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S. aureus
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what antiarrhythmic should be avoided in pts with pre-existing lung disease
|
amiodarone
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what should be suspected in pt with diarrhea presenting with: FOBT+, thrombocytosis, elevated ESR
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inflammatory diarrhea
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|
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what antibodies are associated with dermatitis herpetaformis
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anti-endomysial antibodies
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what anesthetic muscle relaxant is safe to use in patients with kidney and liver disease
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atracurium
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treatment of choice in patients with WPW who develop a.fib
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antiarrhythmics; avoid B-blockers, CCB, digoxin, and adenosine because may worsen arrhythmia
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study of choice for diagnosis of AAA
|
abdominal US
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treatment for 3rd degree AV block
|
pacemaker placement
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3 conditions associated with elevated BUN/Cr
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1. pre-renal failure
2. GI bleed 3. steroids |
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how do vagal maneuvers such a emmersing head in cold water reduce paroxysmal supraventricular tachycardia
|
decreased conduction through AV node
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first-line agent used in patient presenting with arrhythrmia and elevated K
|
clacium gluconate
-this will likely resolve arrhythmia |
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what is associated with joint space narrowing and osteophytes
|
osteoarthritis
|
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preferred therapy for Grave's disease, except during pregnancy
|
radioactive therapy
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differentiate SJS and toxic epidermal necrolysis
|
SJS - covers up to 10% surface area
toxic epidermal necrolysis - covers >30% surface area |
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two drugs of choice in pts with advanced metastatic cancer presenting with decreased appetite and catabolism of fat and muscle
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progestins
corticosteroids |
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|
first-line agent in a pt with mild acne
|
topical retinoids
-oral doxycycline used for papular -isoretinoin used for noculocystic |
|
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what part of the heart is suspected to be infarcted in patient presented with hypotension and bradycardia
|
inferior wall MI
|
|
|
CHADS2
|
C - CHF
H - HTN A - age (>75) D - DM S - stroke *score >2 is indicated for warfarin use |
|
|
disseminated gonococcemia typically have negative blood cultures
|
**
|
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what are the treatment option for B-blocker overdose
|
IV fluids and atropine are first-line agents
glucagon if cardiac symptoms don't resolve |
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what is associated with both decreased Testosterone as well as decreased FSH and LH
|
secondary hypogonadism, usually due to prolactinoma
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pancreatic mass associated with diarrhea and hypokalemia
|
VIPoma
|
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most beneficial treatment for diabetic nephropathy
|
blood pressure control
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treatment fo new onset acute bronchitis with blood tinged sputum without signs of serious disease
|
observation
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what infection is porphyria cutanea tarda associated with
|
HCV
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patient with hx of asthma is taking aspirin, lisinopril, simvastatin, and hydrochlorothiazide presents with runny noice, itchy eyes, coughing and wheezing.
|
aspirin sensitivity syndrome
-watch out for combination of asthma, nasal polyps, and aspirin sensitivity |
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what is required for all patients with new onset lupus nephritis
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renal biopsy
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what can high doses of acyclovir due to the kidney
|
cause renal tubular obstruction
|
|
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thyroid carcinoma associated with propensity to invade tumor capsule and blood vessels
|
follicular thryoid carcinoma
|
|
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thyroid carcinoma associated with psomma bodies
|
papillary thyroid carcinoma
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what two types of arrhythmias are known as shockable arrhythrmias
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VT and VF
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unconscious patients presents with afib on cardiac monitoring with no palpable pulse; what is the next step in treatment
|
CPR
|
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flaccid bullae associated with IgG deposits intracellularly within epidermis
|
pemphigous vulgaris
|
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ruptured submucosal arteries of distal esophagus and proximal stomach
|
mallory-weiss
|
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DOC for mild to moderate hypercalcemia due to malignancy
|
bisphosphonates
|
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what are used to treat hypercalcemia crisis
|
IV fluids and furosemide
|
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when is screening for AAA indicated
|
in patients who are currently or formerly smokers ages 65-75
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what should you suspect in pt with recurrent PNA in same anatomic location
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lung cancer
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what is associated with steatorrhea and epigastric pain
|
pancreatitis
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dacryocystitis
|
inflammation of the medial canthal region of the eye
|
|
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autoimmune destruction of melanocytes, especially in peri-oral area
|
vitiligo
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what is the most common cause of toxic megacolon
|
ulcerative colitis
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what is required in patients with goodpasture's syndrome
|
emergency plasmaphoresis
|
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most sensitive and specific test to diagnose pancreatic exocrine failure found in chronic pancreatitis
|
fecal elastase
|
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what test should be done after alcohol and gallstones are ruled out as causes for acute pancreatitis
|
fasting lipid profile
|
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why is lidocaine not used prophylatically in patients with ACS
|
may increase risk of asystole
|
|
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in a non-obese person, what is the most effective way to lower their blood pressure
|
diet high in fruits and vegetables followed by low-salt diet
*apparently smoking cessation doesn't matter |
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generalized muscle pain that is worse with exercise in middle-aged woman
|
fibromyalgia
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patient presents with morning stiffness in DIP with sausage digits (dactylitis), nail involvement, and scaly lesions
|
psoriatic arthritis
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side effect associated with propylthiouracil and methimazole
|
agranulocytosis
|
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what electrolyte abnormality is a bad prognostic factor in patients with heart failure
|
hyponatremia
|
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how can you distinguish between benzo and opioid overdose
|
benzo overdose lacks pupillary constriction and severe respiratory depression
*phenytoin overdose has presence of nystagmus |
|
|
rapidly developing hyperandogenism and viriluzation in a woman is highly suggestive of what
|
adrogen-secreting neoplasm of ovary or adrenal
*measure serum testosterone and DHEAS to find site of production *testosterone - adrenal *DHEAS - ovarian source |
|
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pt presents with bilateral hearing loss as well as elevated ALP with normal GGT
|
Paget's disease
|
|
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what liver dysfunction is associated with prolonged oral contraceptive use in younger woman
|
hepatic adenoma - enlarged hepatocytes containing glycogen and lipid deposits
|
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treatment for patient with lung cancer and severe hyponatremia
|
fluid restriction 2/2 SIADH
|
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|
which acid-base disturbance is associated with aldosterone deficiency
|
normal anion gap metabolic acidosis - RTA type IV
*decreased Na *elevated K |
|
|
inheritance pattern of hypertrophic cardiomyopathy
|
autosomal dominant
|
|
|
patients present with bullae formation and skin necrosis who is being anticoagulated for recent PE
|
warfarin-induced skin necrosis
|
|
|
number of PMN needed in paracentesis for SBP to be diagnosed
|
>250
|
|
|
patient presents with elevated Na and decreased K, what is the initial screening test
|
plasma aldosterone to plasma renin activity ratio
*once primary hyperaldosteronism is confirmed an adrenal CT is performed |
|
|
complication associated with temporal arteritis
|
aortic aneurysm
*these patients should be followed with serial CXR |
|
|
patients presents with periorbital and facial edema who is taking isosorbide, ACE-I, simvastatin, and clopidogrel
|
angioedema 2/2 ACE-I
|
|
|
what should you do if a patient who is intubated develops fever and pneumonia is given cetriaxone and is still deteriorating over the next 24 hours
|
stop ceftriaxone and start piperacillin-tazobactam
*think of pseudomonas in this patient; cefepime is also effective |
|
|
what is the first step in managing severe symptomatic hypercalcemia
|
vigorous hydration with IV normal saline
|
|
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what is the first step in ventillator management of ARDS
|
decrease the FiO2 to relatively non-toxic values (<60%)
|
|
|
most common risk factor in the development of foot ulcers
|
diabetic neuropathy
|
|
|
medical therapy of aortic regurge
|
afterload reduction with CCB or ACE-I
|
|
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what should be checked in pt with acute asthma exacerbation treated with IV corticosteroids and albuterol that develops tremors and muscle weakness
|
serum electrolyte panel due to high doses of B2-agonist developing hypokalmia
|
|
|
4 causes for syncope
|
arrhythmia
seizure vasovagal orthostatic |
|
|
patient presents with low back stiffness with restrictive pattern on PFTs
|
ankylosing spondylitis
*increased FEV1/FVC 2/2 chest wall motion restriction |
|
|
when is urine culture no needed for cystitis
|
uncomplication cystitis - young, healthy, non pregnant women
|
|
|
all patients with cirrhosis of the liver should be screened for esophageal varicies
|
**
|
|
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what is a strong risk factor for malignancy in pt with a mole
|
recently changed mole
|
|
|
BP goal for patients with DM
|
<130/80
*to slow end-organ damage |
|
|
what is the best screening test for acute hepatitis B infection
|
HBsAg
anti-HBc |
|
|
treatment of choice for mucormycosis
|
surgical debridement + amphotericin B
|
|
|
what other condition is associated with dermatomyositis
|
10% of patients develop internal malignancy, most commonly ovarian cancer
|
|
|
pt presents with conjugated hyperbilirubinemia and dark granular pigment in hepatocytes
|
Dubin-Johnson syndrome
|
|
|
drugs associated with drug-induced nephritis
|
cephalosporins
penicillins sulfonamides NSAIDs rifampin phenytoin allpurinol |
|
|
schizophrenic patient presents with fever, AMS, muscle rigidity, and elevated DK
|
NMS 2/2 typical antipsychotic- give dantrolene
|
|
|
associated with accumulcation of endolymph within the inner ear
|
Meneire's disease
|
|
|
what prophylaxis antibiotic should be prescribed to patients with recent renal transplant
|
TMP/SMX to prevent PCP
|
|
|
when should patients under the age of 65 be given pneumococal vaccine
|
chronic CV, pulm, hepatic, renal, DM, or immunosuppression
|
|
|
pt presents with fever, fatigue, muscle aches with atypical lymphocytes and negative monospot test
|
CMV infection
|
|
|
skin condition characterized by pale, velvety pink, hypopigmented macules that do not tan but scale on scraping
|
tinea versicolor
|
|
|
treatment of choice for tinea versicolor
|
selenium sulfide lotion and ketoconazole shampoo
|
|
|
pt presents with macrocytic anemia and vitiligo
|
think pernicious anemia as cause
|
|
|
what maneuver causes an HCM murmur to increase in intensity
|
valsalva, standing
*both cause the LV to become smaller |
|
|
what other electrolyte should be corrected in an alcoholic with refractory hypokalemia
|
magnesium
|
|
|
what is associated with decreased haptoglobin and increased LDH
|
hemolytic anemia
|
|
|
when is aortic valve replacement indicated
|
in a symptomatic patient with aortic stenosis
|
|
|
alcoholism is not a risk factor for pancreatic cancer
|
**
|
|
|
pt suddenly develops SOB, hypotension, tachycardia, and unilateral breath sounds while on the ventilator with PEEP for ARDS
|
tension pneumothorax
|
|
|
what PCO2 is an indicator of a severe asthma attack
|
normal-to-increased
|
|
|
next step in management of a patient with refractory hypoxemia on inspired oxygen and intubated
|
Add positive end-expiratory pressure (PEEP)
|
|
|
first step in management in an elderly patient presenting with fatigue and DOE with low hemoglobin
|
colonscopy
|
|
|
most likely diagnosis in a patient who presents with adrenal insufficiency and calcifications in the adrenal glands from a developing country
|
tubuerculosis
|
|
|
patient presents with back pain, low-grade fever, and elevated ESR
|
vertebral osteomyelitis
|
|
|
how is MGUS differentiated from multiple myeloma
|
absence of renal insufficiency, hypercalcemia, and lytic bone lesions
|
|
|
most common causes of SVC syndrome
|
1. small cell lung cancer
2. non-hodgkin lymphoma |
|
|
in which type of patients does acalculous cholecystitis present in
|
hospitalized patients for:
extensive burns severe trauma prolonged TPN mechanical ventilation |
|
|
patient presents with polyarthralgias, tenosynovitis, and vesiculopustular skin lesions
|
disseminated gonococcal infection
|
|
|
two diagnostic studies of choice for suspected aortic dissection
|
1. TEE
2. CT w/ contrast |
|
|
what value of BNP helps distinguish CHF from other causes of dyspnea
|
BNP >100 pg/mL
|
|
|
patient presents with recent hx of intracerebral hemorrhage develops a DVT in the hospital, what is the next step in management
|
placement of an IVC filter
|
|
|
organism that causes malignant otitis externa in a diabetic patient
|
pseudomonas aeruginosa
|
|
|
pt presents with recent onset of left-sided weakness and fever. echocardiography shoes mass in left atrium
|
atrial myxoma
*leads to tumor embolization, fever, and weight loss |
|
|
most sensitive and specific tests for the diagnosis of acute pancreatitis
|
serum amylase and lipase
|
|
|
formula to calculate expected PaCO2 compensation during metabolic acidosis
|
PaCO2 = 1.5(HCO3) + 8
|
|
|
treatment of supraventricular tachycardia in stable vs. unstable patient
|
stable - vagal maneuver followed by adenosine and AV nodal blockers
unstable - DC cardioversion |
|
|
treatment of choice for fibromuscular dysplasia
|
percutaneous angioplasty with stent placement
|
|
|
most common cause of asymptomatic elevation of ALP in an elderly patient
|
Paget's disease of bone
|
|
|
ACTH and cortisol levels in a patient that was chronically on corticosteroids
|
low ACTH and low cortisol
*due to suppression of CRH release from the hypothalamus |
|
|
most probable cause of sustained leukocytosis in a pt hospitalized for SOB from asthma exacerbation with elevated neutrophils and decreased lymphocytes
|
glucocorticoid induced neutrophilia
|
|
|
treatment of patient with suspected temporal arteritis
|
high-dose steroids
*this prevents damage to the retinal artery |
|
|
most likely organism that causes osteomyelitis resulting from a nail puncture
|
pseudomonas
|
|
|
pt presents with difficulty swallowing and a neck mass which increases in size while drinking fluids
|
zenker's diverticulum
|
|
|
surgical treatment of choice for zenker's diverticulum
|
excision and cricopharyngeal myotomy
|
|
|
differentiate central retinal vein occlusion vs. amaurosis fugax
|
central retinal vein/artery occlusion - persistent vision loss
amaurosis fugax - temporary vision loss |
|
|
treatment of choice for solitary brain mass
|
surgical resection followed by whole brain radiation
|
|
|
type of shock associated with depressed CO combined with elevated PCWP
|
cardiogenic shock
|
|
|
differentiate lab values in acute cholecystitis vs. common bile duct obstruction
|
common bile duct obstruction would have jaundice and very high ALP
|
|
|
pt taking heparin presents with thrombocytopenia and thrombosis
|
heparin-induced thrombocytopenia
|
|
|
new clubbing in patient with COPD often indicates what
|
development of lung cancer
|
|
|
most common cause of massively elevated liver enzymes (thousands)
|
medication-induced liver damage, usually combined with alcohol use
|
|
|
which blood disease commonly manifests with gout due to increased uric acid production
|
myeloproliferative disorder
|
|
|
patient from greece with hypochromic microcytic anemia
|
think B-thalassemia minor
|
|
|
know how to use weber/rinne to distinguish between conduction and sensorineural hearing loss
|
rinne - BC > AC suggests conductive hearing loss
weber - sound lateralizes to affected ear in conductive hearing loss |
|
|
patient taking corticosteroids chronically develops pain in their hip, what is the next step in management
|
MRI of the hip to look for corticosteroid-induced avascular necrosis of the femoral head
|
|
|
typical antipsychotic associated with hypothermia
|
fluphenazine
|
|
|
fist step in management of a patient with suspected acute renal injury
|
place a foley catheter
|
|
|
patient presents with headache, low-grade fever, periorbital edema, and cranial nerve palsies
|
cavernous sinus thrombosis
|
|
|
most common cause of abnormal hemostasis in patients with chronic renal failure with normal PT, PTT and platelet count
|
platelet dysfunction 2/2 uremia
|
|
|
gallstones are most common in what type of patient
|
fat, female, fertile, and forty
|
|
|
treatment of choice for histoplasmosis
|
itraconazole
|
|
|
cause of massive increase in liver enzymes with subsequent milder elevation in Tbili and ALP in patient with hypotension
|
ischemic hepatic injury
|
|
|
two organisms associated with epiglotttitis
|
haemophilus influenzae
streptococcus pyogenes |
|
|
possible blood complication associated with infectious mononucleosis
|
autoimmune hemolytic anemia
|
|
|
treatment of choice in patient with palpitations with EKG showing narrow QRS complexes without definite P waves
|
adenosine
*supraventricular tachycardia |
|
|
treatment of choice for HIV patient with bilateral interstitial infiltrate with CD4 count < 200
|
SMX/TMP + steroids
|
|
|
first step in management in patient with heparin-induced thrombocytopenia
|
stop the heparin, do not switch to LMWH
|
|
|
what is associated with bite cells and red cell inclusions in an AA patient, they experience episodic hemolysis in response to oxidant drugs and infections
|
G6PD deficiency
|
|
|
disease associated with increased head size, decreased hearing, and elevated ALP
|
Paget disease
*abnormal bone remodeling |
|
|
what is associated with hepatomegaly, ascites, and elevated JVP in a patient post-radiation therapy
|
constrictive pericarditis
|
|
|
most rapidly acting medication to relieve the symptoms of pulmonary edema (pt presents with paroxysmal nocturnal dyspnea, bibasilar rales, scattered wheezes)
|
nitroglycerin
|
|
|
bright red, firm, friable, exophytic nodules in an HIV patient are most likely what? treatment of choice?
|
bacillary angiomatosis (Bartonella)
erythromycin is the DOC |
|
|
use of phenytoin can lead to deficiency in what vitamin
|
folic acid
|
|
|
pt with long smoking history presents with barrel-shaped chest and bilateral scattered wheezes, he also has hepatomegaly and peripheral edema. what led to his RHF
|
elevated pulmonary artery systolic pressure 2/2 chronic hypoxemia
|
|
|
test of choice in a man with foul-smelling breath and a fluctuant mass of the neck
|
contrast esophagram
*zenker diverticulum |
|
|
emperic antibiotic treatment for meningitis
|
ceftriaxone, vancomycin, and ampicillin
|
|
|
pleuritic chest pain, tachycardia, and dyspnea in a young female taking OCP
|
pulmonary embolism with subsequent pulmonary infarction
|
|
|
what is the sequelae of rheumatic fever
|
mitral stenosis --> enlarged left atrium --> elevated left main steam bronchus + afib + persistent cough
|
|
|
what sequelae can happen from a stab wound to the thigh
|
AV fistula formation and lead to high-output cardiac failure
|
|
|
what is a classic heart sound associated with an recent MI
|
S4 due to ischemic damaged leading to diastolic dysfunction
|
|
|
malignant metastatic tumors that are associated with bleeding in the brain
|
melanomas
|
|
|
first line of treatment for a pt with TTP (low plts, fragmented RBCs, elevated Cr)
*autoantibody against ADAMTS-13 causes accumulation of large von Willebrand factor multimers and platelet aggregation |
plasmapheresis
|
|
|
first diagnostic study of choice in pt suspected of having esophageal cancer
|
barium swallow followed by endoscopy
|
|
|
UTI organism associated with alkaline urine
|
proteus
|
|
|
why give sodium bicarb to patient with TCA toxicity
|
prevents development of arrhythmia by narrowing the QRS complex
|
|
|
gene associated with MEN II
|
RET proto-oncogene
|
|
|
young pt presents with bloody diarrhea and back pain, what two markers are associated with this disease
|
HLA-B27
p-ANCA *IBD |
|
|
drugs associated with drug induced esophagitis
|
Alendronate
KCl |
|
|
how would you know the etiology of the a pleural effusion
|
light's criteria
-fluid protein/serum protein > 0.5 -fluid LDH/serum LDH >0.6 *These equal exudative (increased capillary permeability) **transudative is caused by increased hydrostatic pressure |
|
|
what do you use to determine pulmonary cardiogenic or ARDS
|
PCWP < 18 = ARDS (Sepsis, truama, toxic injury)
PCWP > 18 = Cardiogenic |
|
|
what lab value is askew in patients with anti-phospholipid syndrome
|
prolonged PTT
|
|
|
which drug is associated with pulmonary fibrosis and thyroid dysfunction
|
amiodarone
|
|
|
drug of choice in a patient with a dissecting aortic aneurysm
|
beta-blocker
|
|
|
first step in management of an HIV patient with esophagitis
|
oral fluconazole
*failure to respond warrants endoscopy |
|
|
how do you distinguish between viral and rheumatoid arthritis
|
viral - acute onset, lack of elevated inflammatory markers, resolution within two months
rheumatoid - present for at least 6 weeks, morning stiffness longer than 30 minutes |
|
|
most common organism associated with epididymitis in order vs. younger patients
|
older - E. coli
younger - C. trachomatis and N. gonorrhea |
|
|
pt presents with complaints of pain and itching red streak in their extremity, had similar symptoms a few weeks ago in a different extremity, but went away on its own. what is the next step in management
|
CT scan abdomen to look for pancreatic malignancy
*Trousseau's syndrome |
|
|
MAC prophylaxis
|
Azithromycin
|
|
|
Mississippi + lung nodule
|
Histoplasmosis
|
|
|
infections with what organisms are patients with hemochromatosis at increased risk of developing
|
listeria monocytogenes
*iron-loving |
|
|
what infection should be suspected in a patient with fever, descending rash, occipital and posterior cervical lymphadenopathy, and arthritis
|
Rubella
*arthritis not seen in measles |
|
|
what pathologic marker has an important impact on future management of breast carcinoma
|
HER2 - found by amplification by FISH
ER/PR positivity |
|
|
three physical exam findings in opioid intoxication
|
miosis
bradycardia hypotension |
|
|
differentiate hereditary spherocytosis and autoimmune hemolytic anemia
|
spherocytosis - positive family history and negative direct coomb's test
AIHA - negative family history and positive direct coomb's test *both will show spherocytes without central pallor |
|
|
three tumors associated with MEN I
|
parathyroid
pituitary enteropancreatic |
|
|
elderly man complains of increased itching, especially after bathing, and complains of headaches and dizziness. hematocrit, hemoglobin, and platelets are all elevated
|
polycythemia vera
|
|
|
next step in management of a patient presenting with erythema nodosum
|
chest x-ray
*look for sarcoidosis, TB, histo **strep infection and IBD are also associated |
|
|
what organism is associated with subacute bacterial endocarditis (SBE) after urologic procedure
|
entercocci
|
|
|
pulmonary function tests seen in restrictive lung disease
*lung volume, DLCO, FEV1/FVC |
decreased lung volumes
decreased DLCO normal/increased FEV1/FVC |
|
|
treatment of choice for central DI
|
desmopressin
*HCTZ for nephrogenic DI to increase aldosterone production |
|
|
prophylaxis for PCP
|
SMX-TMP and oral prednisolone
|
|
|
treatment of choice for CML with associated Philadelphia chromosome (t9:22)
|
Imatinib
*tyrosine-kinase inhibitor |
|
|
emergent treatment for an elderly patient with pain loss of vision in one eye
|
ocular massage and high flow oxygen
|
|
|
which lab test would be most useful in a patient with chest pain who had an acute MI a few days prior
|
CK-MB
*Troponins stay elevated for up to 10 days |
|
|
avascular necrosis is most commonly associated with the use of what two things
|
glucocorticoids
alcohol |
|
|
patients with deficiency in what can have a paradoxical hypercoagulable state when taking warfarin
|
protein C deficiency
|
|
|
what would indicate that a chest tube is needed when evaluating pleural fluid
|
pH < 7.2
glucose < 60 |
|
|
nephrotic syndrome can lead to what sequela causing abdominal pain, fever, and gross hematuria
|
renal vein thrombosis
*losing AT III |
|
|
differentiate prolonged QRS interval vs. prolonged QT interval
|
QRS - bradyarrhythmia (bundle branch block)
QT - tachyarrhytmia (torsades de points - hypomagnesemia) |
|
|
antihistamines can lead to what urologic problem
|
urinary retention - anticholinergic properties
|
|
|
high-risk patients (prisoners or IV drug users) presenting with fever and chills should be suspected of what
|
infectious endocarditis
*septic embolic can be seen in spleen, brain, kidney, or liver |
|
|
next step in management of a patient presenting with microcytic/hypochromic anemia with elevated iron and decreased TIBC
|
pyridoxine
*sideroblastic anemia - caused by B6 deficiency from alcohol or drugs (isoniazid) |
|
|
next step in management of a patient with uremic pericarditis, chest pain + elevated Cr
|
hemodialysis
|
|
|
next step in management of a patient with a history of chronic pancreatitis presenting with several month history of recurrent epigastric pain and weight loss
|
CT abdomen
|
|
|
what two things lead to decrease in absorption of D-xylose
|
celiac disease
bacterial overgrowth *D-xylose absorption because normal in bacterial overgrowth after antibiotic treatment |
|
|
first step in management in patient with acute variceal bleeding
|
establish vascular access
|
|
|
what two things are associated with decreased calcium with elevated phosphate
|
chronic renal failure
primary hypoparathyroidism |
|
|
what leads to increased hematocrit in an obese person with obstructive sleep apnea
|
hyposemia-induced erythropoietin
|
|
|
gold standard for making diagnosis of acromegaly
|
measure growth hormon levels following an oral glucose load
*unable to suppress growth hormone following glucose load |
|
|
elderly male presents with sever pain in the back of his chest that began suddenly, he also complains of difficulty walking due to leg weakness. BP is elevated at 210/120 and he is tachycardic. what is the most likely diagnosis
|
aortic dissection
|
|
|
most likely mechanism for bilateral leg edema in patient with CHF
|
activation of RAAS due to renal hypoperfusion
|
|
|
treatment of choice in patient with sphincter of oddi dysfunction
|
ERCP with sphincterotomy
|
|
|
young asian child presents with signs of nephrotic syndrome, on further lab evaluation the patient is found to have HBV. what is the most likely glomerulopathy
|
membranous glomerulonephritis
|
|
|
next step in management of an elderly patient with a significant smoking history presenting with SOB and CXR findings of pleural effusion
|
diagnostic thoracentesis
*do not do in patients with clear-cut CHF |
|
|
what drugs are associated with causing oxidative stress in patients with G6PD deficiency
|
sulfa drugs
antimalarials nitrofurantoin |
|
|
next step in management of a patient with a high clinical suspicion of a PE
|
initiate heparin protocol
*then perform diagnostic testing |
|
|
patient presents to the ED after a syncopal episode. he presents with hypotension, tachycardia, and an EKG showing electrical alternans (amplitute of the QRS alternates). he stated he a recent URI. what is the next step in management
|
pericardiocentesis
*cardiac tamponade |
|
|
best treatment for a patient with frostbite
|
rapid rewarming with warm water
|
|
|
somogyi effects
|
occurs when counterregulatory hormones (epinephrine, norepinephrine, and glucagon) react to nocturnal hypoglycemia, thereby resulting in early morning hyperglycemia
|
|
|
most common predisposing factor for aortic dissection
|
hypertension
|
|
|
next step in management of a patient with history of BPH symptoms presenting with elevated serum creatinine during routine lab work
|
abdominal ultrasound to look for hydronephrosis
|
|
|
what plays a central role in the pathogenesis of metabolic syndrome
|
insulin resistance
|
|
|
diagnosis of a patient with swelling of the right knee with synovial fluid analysis showing rhomboid-shaped, positively birefringent crystal as well as radiographic evidence of chrondrocalcinosis
|
pseudogout
|
|
|
most common tumor of the eyelid
|
basal cell carcinoma
|
|
|
what single test helps differentiate between CML and leukoemoid reactions
|
leukocyte alkaline phosphatase
*elevated in leukemoid *low in CML |
|
|
what is the mechanism of the niacin flushing, pruritis side effects, what can counteract this side effect
|
prostaglandin-induced peripheral vasodilation
reduced by low-dose aspirin |
|
|
diagnosis in a patient a post-op patient who presents with JVD and new-onset RBBB
|
massive PE
|
|
|
stepwise approach of the treatment of ascites
|
1. sodium and water restriction
2. spironolactone 3. loop diuretic 4. abdominal paracentesis |
|
|
most common thyroid malignancy
|
papillary carcinoma
|
|
|
what electrolyte abnormality is a contraindication for the use of succinylcholine
|
hyperkalemia
*depolarizing neuromuscular blocker (Na+ rushes in while K+ rushes out of the cell) |
|
|
most common side-effect of recombinant erythropoietin used in patient with end stage renal deficiency
|
worsening of the hypertension and headaches
|
|
|
patient presents with palpable purpura, glomerulonephritis, hepatosplenomegaly, and hypocomplementemia. what infection is associated with these condition
|
hepatitis C
*mixed essential cryoglobulinemia |
|
|
what is associated with a mobile cavitary lung mass
|
aspergilloma
|
|
|
what anti-TB drug is associated with hepatitis
|
isoniazid
|
|
|
common cause of bowel hypomotility and malabsorption after bowel surgery
|
bacterial overgrowth
|
|
|
sexually active young adults presents with knee pain and tenderness over his achilles tendon. synovial fluid analysis from the right knee is negative for gram stain
|
reiter syndrome (reactive arthritis) to chlamydia
*NSAIDs are first line drug |
|
|
elderly patients presents with productive cough and sever dyspnea after recovering from and URI. CXR shows multiple thin-walled cavities
|
staph aureus pneumonia
|
|
|
what mechanism leads to foot deformity in a diabetic patient
|
nerve damage --> Charcot's joint due to repeated joint trauma
|
|
|
which drug is associated with elevated PTT and can induce thrombocytopenia in some patients
|
heparin
*HIT |
|
|
what should be screened for in all sexually active women age 24 years and younger
|
chlamydia
|
|
|
differentiate HSV keratitis and CMV retinitis in HIV patients
|
HSV - keratitis and uveitis are painful, central retinal necrosis
CMV - retinitis is painless, hemorrhages around the retinal vessels |
|
|
treatment of choice for patients with moderate-to-severe acne that is predominantly nodulocystic form
|
oral isoretinoin
|
|
|
what is the cause of a patients hemolytic anemia with a malignant lymphoproliferative disorder
|
warm autoimmune type - anti-red blood cell IgG antibodies
*prednisone therapy |
|
|
treatment of choice for Paget's disease (bone pain, hypercalcemia, hearing loss, high output cardiac failure)
|
bisphosphonates
|
|
|
elderly patient presents with bone pain, renal failure, and hypercalcemia
|
multiple myeloma
|
|
|
streptococcus bovis endocarditis is associated with what
|
colorectal cancer
*colonoscopy should be done |
|
|
treatment of choice in a young AA patients presenting with stroke symptoms
|
exchange transfusion to decrease the percentage of sickle cells and prevent a second infarct
|
|
|
what lab test should be check in a patients complaining of headaches with elevated BP (230/110) and elevated calcium
|
calcitonin
*MEN II (pheochromocytoma, hyperparathyroidism, medullary carcinoma of the thyroid) |
|
|
what is the most common cancer associated with asbestos exposure
|
bronchogenic carcinoma > mesothelioma
|
|
|
drug of choice in a pregnant patient with lyme disease
|
amoxicillin
|
|
|
multiple myeloma mnemonic CRAB
|
calcium (hyper)
renal impairment anemia bones (lytic lesion, pain) *associated with increased risk for infection due to decrease in functional antibodies |
|
|
x-ray of a patient's spine shows decreased bone density and blurring of the spine as well as pseudofractures, what is the serum Ca, Phos, and PTH if the 25-OH vitamin D in found to be low in this patient
|
low serum Ca
low serum Phos elevated PTH low serum 25-OH vitamin D *osteomalacia secondary to vitamin D deficiency |
|
|
what is the drug of choice in a patient presenting with ear pain, drainage, and granulation tissue within the ear canal
|
ciprofloxacin
*malignant otitis externa caused by pseudomonas |
|
|
the presence of bilirubin is indicative of what
|
conjugated hyperbilirubinemia (water soluble)
*rotor syndrome is associated with defect of hepatic storage of conjugated bilirubin |
|
|
what should be suspected in a patient with digital clubbing, recurrent nose bleeds, and oral lesions, and increased hematocrit
|
Osler-Weber-Rendu syndrome
*hereditary telangiectasia **AVMs lead to right-to-left shunting |
|
|
what electrolyte disturbance is associated with constipation
|
hypercalcemia
*seen in MM and metastatic bone cancers |
|
|
what disease is associated with an elderly male presenting with increasing back pain and constipation. Labs results show anemia, renal dysfunction, and elevated ESR
|
Multiple Myeloma
|
|
|
most reliable indicator of metabolic recovery in patients with DKA
|
anion gap closure
|
|
|
what helps minimize the risk of contrast-induced nephropathy
|
adequate IV hydration
|
|
|
what is associated with flushing, valvular heart disease, and diarrhea. what vitamin deficiency is associated with this.
|
carcinoid syndrome
niacin deficiency due to increased formation of serotonin from tryptophan |
|
|
An elderly patient presents with microcytic anemia and symptoms of vague abdominal pain. physical exam reveals RUQ tenderness and hepatomegaly. what is the most likely diagnosis
|
metastatic colon cancer
|
|
|
what must be done prior to radioactive iodine treatment for patients with hyperthyroidism
|
antithyroid medication to avoid initial exacerbations of the thyrotoxic state
|
|
|
which vaccinations are recommended in all HIV-infected patients whose CD4 count is greater than 200
|
annual influenza
pneumococcal vaccine |
|
|
what should be suspected in any patient with hyperglycemia, necrolytic migratory erythema, weight loss, and diarrhea
|
glucagonoma
|
|
|
indications for hemodialysis
|
A - acidosis (pH <7.2)
E - electrolytes (hyperkalemia) I - intoxication O - volume overload U - uremia (uremic pericarditis, renal failure) |
|
|
acute arthritis with rhomboid crystals with positive birefringence in the setting of hyperparathyroidism
|
pseudogout
|
|
|
patient presents with abdominal pain, bloody diarrhea, but lack of fever and travel history
|
EHEC
|
|
|
Beck's triad of cardiac tamponade
|
hypotension
JVD muffled heart sounds *decreased left ventricular preload |
|
|
treatment of choice for acute cholangitis
|
IV antibiotics followed by ERCP is no improvement
|
|
|
symptoms associated with ABO mismatch
|
rapidly develop (within an hour) fever, hemolysis, shock, and DIC
|
|
|
what drug should be be given to patients with pheochromocytoma to help decrease their blood pressure
|
Beta-blockers without alpha-blockers
*this can precipitate a dangerous increase in blood pressure |
|
|
differentiate what is associated with MEN IIa and IIb
|
IIa - parathyroid hyperplasia
IIb - mucosal neuroma *both have medullary thyroid cancer and pheochromocytoma |
|
|
what is a deadly sequalae of aortic dissection which presents with: hypotension, JVD, and tachycardia
|
cardiac tamponade
|
|
|
patient presents with hypotension and tachycardia after passing out at work, he has had difficulty walking over the past couple of days due to infected wound. right heart cath shows elevated right atrial pressure and pulmonary artery pressure, PAWP is within normal range
|
massive pulmonary embolism
|
|
|
drug of choice in patient with variant angina (Prinzmetal's)
|
CCB or nitrates
*beta-blockers and aspirin should be avoided because they can promote vasoconstriction |
|
|
what type of medications is contraindicated in acute coronary syndrome
|
dihydropyridine CCB (nifedipine) due to peripheral vasodilation and reflex tachycardia
|
|
|
treatment of choice in patient with torsades de points
|
magnesium sulfate
*alcoholism, TCAs, antibiotics, or antifungals can induce this |
|
|
what is the next step in management of a simple renal cyst; thin walls, no solid component, no contrast enhancement seen on CT scan
|
reassurance
|
|
|
two most common causes of acute pancreatitis
|
alcohol
gallstones |
|
|
differentiate causes of symmetric and asymmetric narrowing of the esophagus in a patient with history of GERD
|
symmetric - stricture
asymmetric - cancer |
|
|
cause of patient with hyperthyroid symptoms that have low iodine uptake on the thyroid scan. TSH is low and T4 is elevated
|
thyroiditis
*subacute painless thyroiditis in the postpartum period is the most common |
|
|
what should be suspected in a patient that fell on an outstretched hand and presents with weakness when lifting the arm above the head and with pushing or pulling motion
|
rotator cuff tear
*MRI is study imaging of choice |
|
|
which organism is associated with cough, fever, lung consolidation, and GI symptoms
|
Legionella
*treat with Levofloxacin or Azithromycin |
|
|
initial drug of choice in a patient with RA
|
methotrexate
|
|
|
T3, T4, and TSH seen in sick euthyroid syndrome
|
low T3
normal T4 and TSH *seen in patients with an acute, severe illness |
|
|
is antiviral therapy needed in a patient with Hep C and normal LFTs
|
No treatment necessary
|
|
|
most common composition of kidney stones
|
calcium oxalate
|
|
|
development of clubbing and sudden-onset joint arthropathy in a chronic smoker suggests what
|
hypertrophic osteoarthropathy
*associated with lung cancer |
|
|
most common cause of B12 deficiency
|
pernicious anemia
*associated with increased risk of gastric cancer |
|
|
is histoplasmosis or blastomycosis associated with skin findings
|
blastomycosis
*verrucous lesions that are crusted, warty, with a violaceous hue |
|
|
MMR is okay to give to an HIV patients with no vaccinated before
|
**
|
|
|
drug of choice in a homeless patient with flank pain, CV tenderness, afebrile, with elevated BUN and Cr, hypocalemic
|
Fomepizole
*Ethylene glycol poisoning |
|
|
patient with recent travel history presents with diarrhea and abdominal cramping
|
Most likely cause is E. coli (ETEC)
|
|
|
suspect toxicity of what medication in a patient with fever, tinnitus, and tachypnea
|
aspirin
*respiratory alkalosis with metabolic acidosis |
|
|
what is suspected in a young AA patient with nocturia
|
hyposthenuria
*inability for kidneys to concentrate urine, commonly seen in sickle cell disease and trait |
|
|
patients with alkalosing spondylitis for more than 20 years are at increased risk of what
|
vertebral fracture
|
|
|
drug of choice in patients with sinus bradycardia who are symptomatic
|
IV atropine to decrease vagal input
|
|
|
how do nitrates help chest pain during symptoms of angina
|
decreases oxygen demand by decreasing ventricular volume via a decrease cardiac preload
|
|
|
cervical cancer screening recommendations
|
every 3 years until age 65, need three consecutive negatives to stop
|
|
|
healthy young adult male presents with thrombocytopenia
|
HIV may initially present with thrombocytopenia in up to 10% of patients
|
|
|
what should you think of in a patient with restrictive cardiomyopathy, proteinuria, and easy bruisability
|
amyloidosis
*can affect the heart, kidneys, and liver |
|
|
treatment of choice in a patient with elevated ALT and detectable HCV RNA
|
interferon and ribaviron
*combination therapy is more beneficial |
|
|
what should you suspect in a postpartum woman with pulmonary symptoms, multiple nodules on CXR, and elevated B-hCG
|
choriocarcinoma
|
|
|
why are asplenic patients at risk to infection by encapsulated organisms
|
because they have impaired antibody-mediated opsonization for phagocytosis
|
|
|
what sequelae can develop from HIT in a patient given either unfractionated or low molecular weight heparin
|
arterial or venous thrombosis
|
|
|
most common valvular abnormality observed in patients with infective endocarditis no related to IV drug abuse
|
mitral regurge
*tricuspid regurge is associated with IV drug abuse |
|
|
LDL goals in patients with CAD risk factors
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0-1 = <160
2+ = <130 CAD or CAD equivalent (multiple risk factors)= <100 DM2 = <70 *initiate drug therapy if LDL is 30 above goal in the lower risk category and initiate if above goal at all in the higher risk groups |
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what organism is associated with cutaneous and visceral angioma-like blood vessel growths in immunocompromised patients
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Bartonella
|
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what is associated with hypokalemia, metabolic alkalosis, urinary chloride >60 and normal BP
|
Bartter syndrome
|
|
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what is associated with hyponatrmia and maximally diluted urine
|
primary polydipsia
|
|
|
lower GI endoscopy with biopsy reveals dark brown discoloration of the colon with lymph follicles shining through as pale patches
|
melanosis coli
*laxative abuse |
|
|
pulmonary cavitation seen in an HIV-infected patient that is partially acid-fast
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Nocardia
|
|
|
what is the best way to confirm PCP infection in an HIV-infected patient before beginning treatment
|
Bronchoalveolar lavage
|
|
|
what is C1 esterase inhibitor deficiency associated with
|
angioedema
*elevated levels of bradykinin |
|
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drug of choice for catch scratch disease
|
azithromycin
|
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patient presents with SOB, JVD, hepatomegaly, lower extremity edema, and faint heart sounds. Lungs auscultation reveals clear breath sounds
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Cor pulmonale
|
|
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what is associated with a "water bottle" shaped heart, normal JVD, CTAB, and muffled heart sounds; patient recently had URI symptoms
|
pericardial effusion 2/2 viral infection
|
|
|
which form of syncope is associated with prodrome of lightheadedness and blurred vision and has rapid recovery of consciouness. syncope is provoked by an emotional situation
|
vasovagal
*upright tilt table test |
|
|
which form of glomerulonephritis is associated with HCV infection
|
membranoproliferative glomerulonephritis
|
|
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what is associated with recurrent episodes of hematuria, sensorineural deafness, and a family history of renal failure
|
Alport's syndrome
|
|
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the best initial screening test in a patient with suspected adrenal insufficiency
|
cosyntropin (ACTH) stimulation test
|
|
|
most common cause for iron deficiency anemia in an adult male or post-menopausal woman
|
chronic GI blood loss
|
|
|
which organism is associated with PNA, hyponatrmia, and GI symptoms
|
Legionella
|
|
|
best next step in management of a patient with recurrent painful swelling of the eye lid that progresses to a nodular rubbery lesion
|
histopathological exam due to risk of underlying sebaceous carcinoma or basal cell carcinoma
*chalazion |
|
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what should be suspected in a patient with new-onset diabetes, arthropathy, and hepatomegaly
|
hemochromatosis
|
|
|
what is associated with persistent ST elevations and a holosystolic (pansystolic) murmurs at the apex in a post-MI patient suggest
|
ventricular aneurysm
|
|
|
precipitating and reversible risk factors for premature atrial complexes
|
tobacco
alcohol caffeine stress *B-blockers are used in symptomatic patients |
|
|
cleaves angiotensinogen into angiotensin I
|
renin
|
|
|
differentiate acute cholangitis and emphasymatous cholecystitis
|
cholangitis - high fever, jaundice, and RUQ pain (Charcot's triad) causes by biliary tract obstruction; markedly elevated WBC, Tbili, and ALP
emphy cholecystitis - infection of gallbladder wall with gas-forming bacteria; no increase in ALP or Tbili |
|
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what is the best next step in management of a patient presenting with pain from a radiolucent kidney stone
|
alkalinization of the urine with potassium bicarb or potassium citrate
|
|
|
differentiate the joints affected in RA vs. Osteoarthritis
|
RA = MCP and PIP
OA = DIP |
|
|
multi-systemic inflammatory condition characterized by recurrent oral and genital ulcers and skin lesions
|
Behcet's syndrome
|
|
|
what should you be concerned about in a young patient presenting with signs of IBD, previously undiagnosed, but has worsening symptoms accompanied by signs of sepsis
|
toxic megacolon
|
|
|
treatment of choice for a cervicofacial infection with multiple abscesses, fistulae, an draining sinus tracts with sulfur granules (yellow)
|
IV penicillin for 6-12 weeks
*actinomycosis |
|
|
what should be suspected in an HIV-infected patient presenting with bloody diarrhea and normal stool studies
|
CMV colitis
|
|
|
next step in management in a patient with VF or pulseless VT
|
defibrillation
|
|
|
what is the next step in management in a patient with morning back stiffness that lasts for an hour and goes away with use
|
x-ray looking for fusion of the sacroiliac joints and/or bamboo spine
|
|
|
what three things can chagas disease lead to
|
megaesophagus
megacolon cardiac dysfunction |
|
|
what is the most frequent origin for ectopic foci causing atrial fibrillation
|
pulmonary veins
|
|
|
what is the next best step in management of a patient presenting with hemolytic anemia, thrombocytopenia, and renal failure
|
peripheral blood smear to look for schistocytes
*TTP |
|
|
what is a useful test to help differentiate liver and cardiac causes for lower extremity edema
|
hepato-jugular reflux
*positive indicates cardiac related edema **negative suggests liver disease |
|
|
what should be suspected in a patient with hemolytic anemia and venous thrombosis (especially hepatic)
|
paroxysmal nocturnal hemoglobinuria
*defective binding of CD55 and CD59 which leads to autoimmune destruction of RBCs |
|
|
what should be suspected in a patient with periorbital edema, myositis, and eosinophilia
|
trichinellosis
|
|
|
treatment option for a patient presenting in afib who is stable
|
<48 hours = electrical or pharmocologic cardioversion
>48 hours = rate control due to risk of thromboembolism with cardioversion |
|
|
what can lead to falsely low levels of calcium
|
low serum albumin
|
|
|
what electrolyte abnormalities are seen in iatrogenic cortisol use
|
hypernatremia
hypokalemia *corticosteroids have some mineralcorticoid activity |
|
|
what is suspected in a patient with kidney stones that are hexagonal shape in a patient with a family history of kidney stones
|
cystinuria
*urinary cyanide nitroprusside test is screening test, detects elevated cystine levels |
|
|
what ares some side effects associated with thiazide diuretics
|
hyperglycemia
increased LDL cholesterol |
|
|
most commonly used drug in the treatment of primary biliary cirrhosis as it relieves symptoms and lengthens transplant-free survival time
|
ursodeoxycholic acid
|
