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170 Cards in this Set
- Front
- Back
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Smudge cells are highly characteristic of what?
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Chronic Lymphocytic Leukemia (CLL)
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Male + LAD + lymphocytosis + recurrent infx's + smudge cells = ?
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CLL
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Sx of hypokalemia?
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weakness
fatigue muscle cramps |
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Sx of severe hypokalemia?
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paralysis
arrhythmia |
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EKG findings in pt. with hypokalemia?
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broad, flat T waves
U waves PVC's |
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Si/Sx Lewy body dementia
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decreased alertness
visual hallucinations EPS |
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What is a Lewy body?
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eosinophilic nuclear inclusion - accumulations of alpha-synuclein protein
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Where are Lewy bodies found?
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susbstantia nigra
locus ceruleus dorsal raphe substantia innominata |
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Tx. for Lewy body dementia?
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acetylcholinesterase inhibitors: Rivastigmine
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Lewy body dementia vs. Parkinson's
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LBD: early appearance of dementia
Parkinson's: motor sx. |
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MCC of ascites
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portal HTN - usually due to cirrhosis from chronic liver disease
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Paradoxical Embolism
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passage of an embolus from the venous circulation across the foramen ovale or ASD into systemic circulation
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Bell's Palsy vs. Central Facial Paresis
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Bell's Palsy: unable to furrow forehead
Central Facial paresis: able to furrow forehead, contralateral motor innervation of forehead remains intact |
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Main MoA of nitroglycerin in decreased anginal pain?
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dilatation of veins
decr. ventricular preload |
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significant smoking hx (>45y) + hyper Ca + hilar mass
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Sca++mous cell cancer
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What is hepatic encephalopathy?
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reversible decline in neurologic fx. ppt'd by hepatic damage
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MC form of kidney damage in HIVpos pts.?
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collapsing focal and segmental glomerulosclerosis
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What type of kidney damage do you suspect if HIVpos + HepB?
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membranous glomerulonephritis
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HIVpos + nephritic range proteinuria + azotemia + normal sized kidneys = ?
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collapsing focal and segmental glomerulosclerosis
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Nephritic syndrome is characterized by?
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Proteinuria
Hematuria Azotemia Rash Oliguria HTN Edema |
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When is surgery the best option for atherosclerotic lesions in the carotids?
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irregular atherosclerotic lesion with blockage =/> 60%
(although, 100% stenosis is a contraindication) |
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HTN + hypercholesterolemia + peripheral vascular ds. = what meds?
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CCB
- good peripheral vasodilating properties -metabolically neutral, no affect on plasma lipid profile |
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HTN + worsening peripheral vascular ds. = d/c which meds?
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beta blockers
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What is Obstructive Sleep Apnea?
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nocturnal hypoventilation
pt. cont's to contract diaphragm but airflow is impeded by upper airway obstruction |
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OSA v. OHS (Obesity Hypoventilation Syndrome)
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OSA: normal ABG
OHS: underventilation of lungs - chronically elevated PaCO2 and decr. PaO2 |
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Five common SE's of Amiodarone
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1. Pulm toxicity - pulm. fibrosis
2. Thyroid dysfx. 3. Hepatotoxicity 4. Corneal deposits 5. Skin changes - blue-gray skin |
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Amiodarone treats?
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atrial/ventricular arrhythmias
Class III |
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Procainamide treats?
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atrial/ventricular arrhythmias
Class IA |
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Procainamide SE's?
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1. nausea
2. drug-induced lupus 3. agranulocytosis (decr. neutrophils) 4. QT prolongation |
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Lidocaine treats?
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ventricular arrhythmias
Class IB |
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Lidocaine SE's?
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1. confusion
2. seizures 3. resp depression |
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Quinidine treats?
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atrial arrhythmias
Class IA |
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Quinidine SE's?
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diarrhea
tinnitus QT prolongation torsades de pointes hemolytic anemia thrombocytopenia |
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Digoxin treats?
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atrial arrhythmias
inotrope |
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Digoxin SE's?
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1. nausea
2. anorexia 3. AV block 4. ventricular/supraventricular arrhythmias |
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Arrhythmia most specific for digitalis toxicity?
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atrial tachycardia + AV block
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How does digitalis cause arrhythmias?
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Ectopy and increased vagal tone:
Ectopy = atrial tach incr. vagal tone = AV block |
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What is porphyria cutanea tarda characterized by? (3)
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1. painless blisters
2. hypertrichosis 3. hyperpigmentation |
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Porphyria Cutanea Tarda is often assoc. with?
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Hep C
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What can trigger Porphyria Cutanea Tarda?
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ethanol
estrogen |
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Class I antiarrhythmics
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membrane stabilizing agents - decr. excitogenicity of plasma mmbr
Na channel |
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Class II antiarrhythmics
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anti-sympathetic/beta blockers
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Class III antiarrhythmics
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K+ efflux
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Class IV antiarrhythmics
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Ca++ channels / AV node
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Class V antiarrhythmics
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direct nodal inhibition
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MCC nephrotic syndrome in adults in the US?
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focal segmental glomerulosclerosis
esp. in hispanics and blacks |
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What does amyloid deposition do to the heart?
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restrictive cardiomyopathy with thickened ventricular walls and diastolic dysfx.
systolic fx. and ventricular dimensions are preserved and remain unchanged |
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Describe the heart in alcohol related heart disease.
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dilated cardiomyopathy
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Organs commonly involved in amyloidosis.
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Heart: restrictive cardiomyopathy
Kidneys: proteinuria Liver: inhibit synth. of coag factors, easy bruising |
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Classic findings in hemachromatosis
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restrictive cardiomyopathy
pancreatic dysfx. bronze skin hepatomegaly |
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Classic Findings in Sarcoidosis
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restrictive cardiomyopathy
bilateral hilar adenopathy erythema nodosum |
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Hypertrophic cardiomyopathy murmur?
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- systolic ejection murmur at left lower sternal border
- strong apical impulse - worsened by maneuvers that decr. preload (valsalva, standing) |
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Why does the hypertrophic cardiomyopathy murmur increase as preload decreases?
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decr. preload lessens the size of the ventricular cavity and causes increased outflow obstruction
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prolonged tachysystolic afib + LV dysfx.: How do you improve LV fx.?
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control rhythm and rate
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Effect of prolonged tachysystolic afib on LV?
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significant LV dilation, depressed EF
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prolonged tachysystolic afib --> LV dysfx.: HOW?
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- tachycardia
- neurohumoral activation - absence of an atrial 'kick' - atrial-ventricular desynchronization |
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MCC nephrotic syndrome in children/adolescents?
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minimal change ds.
may occur following URT infx or in assoc with tumors |
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MCC nephrotic range proteinuria in adults
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membranous glomerulonephritis
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MCC of nephrotic syndrome in AA adults
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Focal Segmental Glomerulosclerosis (FSGS)
(also in HIV pts. and IVDA's) |
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2 major side effects of statins:
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1. incr. liver enzymes
2. myopathy |
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Why do statins cause myopathy?
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decr. synth of non-cholesterol products such has CoQ10 may be implicated in myopathy
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MoA of statins
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inhibit HMG CoA reductase, a rate limiting enzyme in the synth of cholesterol - converts HMG CoA --> mevalonate
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dyspepsia
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pain/discomfort centered in the upper abdomen
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Pt. <45y/o + dyspepsia: 1st step in management?
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H. pylori breath test
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What is a leukemoid reaction?
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marked increase in leukocytes due to severe infection or inflammation
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What is typically found in a leukemoid rxn.?
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incr. LAP (leukocyte alkaline phosphatase)
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Leukemoid rxn v. chronic myeloid leukemia (CML)
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Leukemoid rxn: incr. LAP
CML: decr. LAP |
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absence of peristaltic waves in lower 2/3 of esophagus + significant decr. in LES tone =
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esophageal dysmotility assoc. with scleroderma
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MCC of non traumatic subarachnoid hemorrhage?
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rupture of saccular aneurysms
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When to start screening for colon ca? What is 1st degree relative with colon ca?
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50
ten years before the age the relative was diagnosed |
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Leading organisms implicated in cellulitis
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streptococcal
staphylococcal |
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IVDA + new onset murmur =
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infectious endocarditis, usually Staph aureus
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Empiric antibiotic for IVDA and IE? Why?
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vancomycin and gentimycin:
- covers staph, enterococci, strep - beta lactam antibiotics are synergistic with aminoglycosides |
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When does lipid screening start?
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men = 35
women = 45 |
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Goal LDL's?
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0 - 1 RF: <160 mg/dL
2 RF: <130 mg/dL CAD/DM/AAA: <100 mg/dL |
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CAD risk factors
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+ FamHx
smoking HTN low HDL age |
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getting lost in own neighborhood (visuospatial problems) + difficulty making new memories (anterograde formation) + well preserved old memories =
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Alzheimers
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Normal Pressure Hydrocephalus is characterized by what?
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- dementia
- abnormal gait (broadbased, shuffling) - urinary incontinence "wet, wobbly and wacky" |
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Huntington's disease affects which part of the brain?
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caudate and putamen
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Wernicke's =
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ataxia
ophthalmoplegia confusion |
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Korsakoff =
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confabulation
amnesia |
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syncopal episode with following disorientation + hearing impairment + FamHx sudden cardiac death =
Tx.? |
congenital long QT syndrome / Jervell-Lange-Nielson syndrome
Tx.: beta blockers |
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Tx. of Jervell-Lange-Nielson syndrome
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beta blockers
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In mechanically ventilated pats., the end inspiratory hold maneuver calculates?
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Lung compliance
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In mechanically ventilated pts., the positive end expiratory hold maneuver calculates?
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Positive End Expiratory Pressure (PEEP) / typically ='s atmospheric P but not in obstructive lunch ds. b/c alveoli cannot empty completely
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How is airway resistance calculated in mechanically ventilated pts.?
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examining peak airway pressures
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DoC for cancer assoc. anorexia
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megestrol acetate
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What is Waterhouse Friderichson syndrome?
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acute adrenal insufficiency caused by profound, usually b/l bleeding into the adrenal glands b/c of disseminated Intravascular Coagulation (DIC)
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A very serious complication of meningococcal meningitis caused by N. meningitidis
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Waterhouse-Friderichson syndrome
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Characteristic signs of circulatory collapse
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clammy skin
cold extremities high fever tachycardia precipitous drop in BP possible coma |
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Horner's Syndrome
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ptosis
miosis anhidrosis |
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high grade fever + severe sore throat + odynophagia + drooling + harsh shrill
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epiglottitis
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MCC of epiglottitis
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H. influenza
Strep pyogenes |
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Normal liver span?
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6-12 cm in mid-clavicular line
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3 major pathologic stages of alcohol liver disease:
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1. Fatty liver (steatosis)
2. Alcoholic hepatitis 3. Alcoholic fibrosis/cirrhosis |
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Liver bx shows Mallory's hyaline and neutrophilic infilrate: Dx?
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Alcoholic hepatitis
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Alcohol hepatitis is characterized by what pathology?
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- Mallory bodies
- infiltration by neutrophils - liver cell necrosis - perivenular distribution of inflamm. |
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True cirrhosis is characterized by?
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regenerative nodules
(irreversible) |
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What do regenerative nodules look like in true cirrhosis?
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round nodules with fibrous pseudo capsule with bile ductules due to obstruction of bile flow
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What stages of alcoholic liver ds. are reversible with cessation of alcohol?
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1. Fatty liver, steatosis: reversible
2. Alcoholic hepatitis: reversible 3. Alcoholic fibrosis/cirrhosis: early stages still reversible |
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When do you order an upper endoscopy in management of GERD?
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1. nausea/vomiting
2. wt. loss, anemia, melena/blood in stool 3. long duration of sx. (>1-2yrs) esp. in Caucasian males >45y/o 4. failure to respond to PPI's |
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Pt. with PE most commonly presents with what Sx.? (4)
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- dyspnea
- tachypnea - cough - pain worsened with respiration |
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Drugs that may cause priapism
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trazodone
prazosin |
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short h/o fever + malaise + pharyngitis + posterior cervical LAD
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infectious mononucleosis due to EBV
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diagnostic tests for infectious mono due to EBV?
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heterophile Ab test
anti-EBV Ab test |
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HIV v. infectious mono?
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Same: fever, malaise, generalized LAD, sore throat
Differences: HIV: rash, GI Sx. Mono: tonsillar exudate |
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How do diffuse esophageal spasms manifest?
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chest pain
dysphagia |
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Two conditions in which the LES does not relax and manometry shows absent peristalsis:
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1. achalasia
2. Trypanosoma cruzi |
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Barium swallow reveals "corkscrew" esophagus
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diffuse esophageal spasm
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What is scleroderma?
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collagen vascular disorder - loss of distal peristalsis of esophagus
- fibrosis & complete atrophy of esophageal smooth muscle - LES becomes incompetent |
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Isolated liver mass - more likely metastatis or primary?
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metastatic - usually GI, lung or breast
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Common cause of combined low back pain and leg pain + normal neuro exam
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lumbar spinal stenosis
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How does lumbar spinal stenosis occur?
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any condition that narrow the spinal cord and compresses nerve roots
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MCC of spinal stenosis:
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vertebral degeneration disk disease - DJD
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What is neurogenic claudication?
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leg pain exacerbated by extension of spine or narrowing of spinal canal (walking, standing) and improved by flexion or widening of the spinal canal (sitting, lying down)
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Neurogenic claudication v. claudication of PVD (peripheral vascular disease)
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Neuro - presence of normal arterial pulses
PVD - exertional pain rather than positional pain / no low back pain |
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back pain + paralysis + hyperreflexia + urinary/fecal incontinence / urinary retention =
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spinal cord compression
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low back pain that worsens with sitting + sciatica + positive straight leg test =
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herniated disk
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2 initial tests recommended in all pts. with possible BPH (benign prostatic hyperplasia)
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serum creatinine
UA |
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hydralazine
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- direct acting smooth muscle relaxant
- tx's HTN by acting as vasodilator in arteries and arterioles |
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What is incidence?
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Frequency of new cases arising in a population at risk over a specified period of time
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What is a cohort study?
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prospective observational study in which groups are chosen based upon presence or absence of one or more RF's: all subj.'s are then observed over time for development of specified disease allowing estimation of incidence with tot. pop. & comparison of incidences betw. subgroups
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What is prevalence?
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total # of cases in a population at a given time
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What does Vit K do?
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important cofactor for liver exzyme gamma glutamyl carboxylase which adds carboxyl groups to glutamate residues of several coag factors (II, VII, IX & X, protein C & S) - these extra carboxyl groups incr. affinity of these proteins for phospholipids on the surface of platelets
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h/o tick bite + fever + HA + malaise + leukopenia + thrombocytopenia + elev. AST & ALT = ?
Tx.? |
Ehrlichiosis (RMSF)
Tx.: doxycycline |
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Tx. FMSF/Ehrlichiosis in pregnancy?
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chloramphenicol
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DoC for Legionnaire's disease
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erythromycin
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Most feared complication of bronchiectasis?
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life-threatening hemoptysis (rupture of hypertrophied & tortuous bronchial arteries) & lung abscesses
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Paget's disease is characterized by?
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high bone turnover
aberrant osteoid formation |
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Elev. alk phos + normal Ca, phosphorous, other liver enzymes =
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Paget's bone remodeling
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acute onset of epigastric pain that radiates to the back + N/V + tenderness =
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acute pancreatitis
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cause of hypovolemic shock as an early complication of acute pancreatitis?
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inflamm. effects of locally released activated pancreatic enzymes --> incr. in vascular permeability with exudation of large vol. of plasma into retroperitoneum
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AIDS + CD4 Ct. <50/ul + yellow white patches of retinal opacification & hemorrhages
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CMV retinitis
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low calcium + elev. phosphorous =
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chronic renal failure - primary hypoparathyroidism
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4 causes of primary hypoparathyroidism
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1. post-surg
2. congenital absence 3. autoimmune 4. defective Ca-sensing receptor on parathyroids |
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How does hypocalcemia usually present?
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neuromuscular irritability
perioral tingling numbness muscle cramps tetany carpopedal spasms seizures prolonged QT |
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Congenital hypoplasia of parathyroid glands is seen in pts. with _____.
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DiGeorge Syndrome
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What is pseudohypoparathyroidism?
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resistance to PTH
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hypercalcemia + hypoparathyroidism =
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hyperparathyroidism
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secondary hyperparathyroidism
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renal failure
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tertiary hyperparathyroidism
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chronic stimulation of the parathyroid glands - autonomous production of PTH
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Describe Nocardia asteroides
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gram +
partially acid fast filamentous aerobe soil bacterium |
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What does Nocardia asteroides cause?
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pulmonary or disseminated ds. in immunocompromised host
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What does a Norcardiosis CXR look like?
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alveolar infiltrates & nodules
cavitation chest wall invasion |
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Describe 3 main sx. of Nocardiosis:
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wt loss
fever night sweats |
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Tx. for Nocardiosis asteroides
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TMP-SMX
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Toxic SE's of aminoglycosides
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nephrotoxicity
ototoxicity |
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Mechanism underlying aminoglycoside-induced ototoxicity:
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damage to motion sensitive hair cells in the inner ear
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Vertigo + gait imbalance suggests what kind of insult?
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vestibular
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What abx is particularly vestibulotoxic?
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gentamicin
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What is Meniere's disease?
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disorder of the inner ear - presents with triad of dizziness, hearing loss, tinnitus
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Viral myocarditis is most commonly seen following ________.
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Coxsackie B infection
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blood transfusion + fever + chills + flank pain + hemoglobinuria =
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acute hemolytic transfusion rxn.
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MC blood transfusion rxn?
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febrile nonhemolytic rxn - rxn to cytokines stored in tranfused blood products (during blood storage, leukocytes release cytokines which cause fevers, chills, malaise when transfused
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Low grade hemolysis 2-10 days s/p transfusion
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delayed hemolytic transfusion rxn - secondary to amnestic Ab response to an RBC Ag
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MC non-neoplastic colonic polyp
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hyperplastic
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MC type of colonic polyp
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adenoma
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Cancer is seen more commonly in sessile or stalked (pedunculated) polyps?
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sessile
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As the villus OR tuberous component increases, the risk of malignancy increases (in colonic adenomatous polyps).
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villus
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At what size are colonic polyps considered to have a substantial risk of invasive cancer?
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>2.5cm
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Prostate Ca + back pain + brisk LE reflexes + weak rectal sphincter tone + tenderness over L5/S1 region =
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acute cord compression with cauda equina - promp admin of IV steroids
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mobile cavitary mass in lung + intermittent hemoptysis =
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aspergilloma
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air fluid level on CXR + incr. WBC
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lung abscess
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prelim investigation of choice in management of pleural effusion
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diagnostic thoracentesis; unless CHF, then diuretic trial
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DDx for hemoptysis
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Bronchitis, bronchiectasis
Aspergillosis TB TU Lung abscess Embolism Cocaine use AVM Mitral stenosis Pneumonia |
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During which decades does Ankylosing spondylitis most often occur?
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2nd and 3rd
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young pt. + progressive low back pain + morning stiffness + improvement with exercise =
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ankylosing spondylitis
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plain film xray demonstrating fused sacroiliac jts. and/or bamboo spine
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ankylosing spondylitis
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MCC of ductopenia ("vanishing bile duct syndrome") in adults
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Primary Biliary Cirrhosis
Others: failing liver transplant, Hodgkins, GVH ds., sarcoid, CMV, HIV, meds |
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post-bone marrow transplant (~45 days) + pneumonitis + colitis =
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CMV
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