High Yield Internal Medicine Review

Front 1

Signs & tx of a right ventricular infarct

Back 1

Signs: hypotension, tachycardia, clear lungs, elevated JVP, and NO pulsus paradoxus

Tx: fluid resuscitation, don't give nitro!

Front 2

Tx for CHF exacerbation

Back 2

LMNOP: lasix, morphine, nitro, O2, position (elevate head) or positive pressure ventilation

Front 3

Tx for stable CHF that has mortality benefit

Back 3

ACEi, Beta-blockers, spironolactone

Front 4

Tx for ACS (UA, NSTEMI, STEMI)

Back 4

BEMOAN: beta-blockers, enoxaparin, morphine, O2, ASA, nitro

Front 5

Long-term tx post-MI

Back 5

"ASA-Beta-Stati-Pril": ASA, Beta-blocker, Statin, ACEi

Front 6

Most common cause of death post-MI

Back 6

Arrhythmias (VFib)

Front 7

Post-MI complication: New systolic murmur 5-7 days after

Back 7

Mitral regurgitation due to papillary muscle rupture

Front 8

Post-MI complication: Cause of acute severe hypotension

Back 8

Cardiac tamponade due to ventricular free wall rupture

Front 9

Post-MI complication: "step-up" in O2 concentration from RA to RV

Back 9

Ventricular septal rupture leading to left-to-right shunt

Front 10

Post-MI complication: persistent ST elevation ~1mo later + systolic murmur

Back 10

Ventricular wall aneurysm

Front 11

Post-MI complication: Cannon A-waves

Back 11

AV dissociation either due to VFib or 3rd degree heart block

Valve bwtn artia and ventricular not going through (AV dissociation) - bounding pulse in JV

Front 12

Post-MI complication: pleuritic chest pain and fever 5-10 wks later

Back 12

Dressler's syndrome (likely autoimmune pericarditis). Tx with NSAIDs and ASA.

Front 13

Diagnose: chest pain worse with inspiration, better with leaning forward, friction rub, and diffuse ST elevation

Back 13

Pericarditis

tx w/ NSAIDS

Front 14

Diagnose: chest pain worse with palpation

Back 14

Costochondritis

Front 15

Diagnose: chest pain with vague hx of recent viral infection and murmur

Back 15

Myocarditis

Front 16

Diagnose: chest pain that occurs at rest, worse at night, few CAD risk factors, with migraine H/As, transient ST elevation during episodes

Back 16

Prinzmetal's angina (tx with CCB or nitrates)

dx w/ ergonovine stimulation test

Front 17

EKG rhythm: progressive prolongation of PR interval followed by a dropped beat

Back 17

2nd degree AV block - Type I

Front 18

EKG rhythm: Cannon-a waves on physical exam and regular P-P interval and regular R-R interval

Back 18

3rd degree AV block

Front 19

EKG rhythm: varrying PR interval with 3 or more morphologically distinct P waves in the same lead; seen in older person with chronic lung dx (COPD) in pending resp failure

Back 19

MAT: multifocal atrial tachycardia

Front 20

EKG rhythm: short PR interval followed by QRS>120 ms with a slurred initial deflection representing early ventricular activation via the bundle of Kent

Back 20

WPW: Wolff-Parkinson-White syndrome

tx w/ procainamide

Do NOT give B-blockers, digoxin, CCB (V+D) --> anything that slows AV node

Front 21

EKG rhythm: regular rhythm with a ventricular rate of 125-150 bpm and atrial rate of 250-300 bpm

Back 21

Atrial flutter

Front 22

EKG rhythm: prolonged QT interval leading to undulating rotation of the QRS complex around the EKG baseline in a pt with low Mg, low K, lithium overdose, or TCA overdose

Back 22

Torsades de pointes

Front 23

EKG rhythm: renal failure pt OR crush injury OR burn victim with peaked T-waves, widened QRS, short QT and prolonged PR

Back 23

Hyperkalemia

Front 24

EKG rhythm: undulating baseline, no P waves, irregular RR interval in a pt with hyperthyroidism OR old pt with SOB/dizziness/palpitations with CHF or valve disease

Back 24

AFib

Front 25

Murmur: systolic ejection murmur, crescendo-decrescendo, louder with squatting, softer with valsalva, +parvus et tardus

Back 25

Aortic stenosis

Front 26

Murmur: systolic ejection murmur louder with valsalva, softer with squatting or handgrip

Back 26

Hypertrophic cardiomyopathy

Front 27

Murmur: late systolic murmur with click, louder with valsalva and handgrip, softer with squatting

Back 27

Mitral valve prolapse

Front 28

Murmur: Holosystolic murmur radiates to axilla with left atrial enlargement

Back 28

Mitral regurgitation

Front 29

Murmur: Holosystolic murmur with late diastolic rumble in kids

Back 29

VSD

Front 30

Murmur: Continuous machine-like murmur

Back 30

PDA

Front 31

Murmur: wide fixed and split S2

Back 31

ASD

Front 32

Murmur: rumbling diastolic murmur with an opening snap, left atrial enlargement, and AFib

Back 32

Mitral stenosis

Front 33

Murmur: blowing diastolic murmur with widened pulse pressure

Back 33

Aortic regurgitation

Front 34

Diagnose CXR: hyperlucent lung fields with flattened diaphragms

Back 34

COPD

Front 35

Diagnose CXR: opacification, consolidation, air bronchograms

Back 35

Pneumonia

Front 36

Diagnose CXR: heart>50% AP diameter, cephalization, Kerly B lines, interstitial edema

Back 36

CHF

Front 37

Diagnose CXR: cavity containing air-fluid level

Back 37

Abscess

Front 38

Diagnose CXR: Upper lobe cavitation, consolidation, +/- hilar lymphadenopathy

Back 38

TB

Front 39

Common causes of transudative pleural effusion

Back 39

CHF, nephrotic, cirrhotic

Front 40

Diagnose: transudative pleural effusion low in pleural glucose

Back 40

Rheumatoid arthritis

Front 41

Diagnose: transudative pleural effusion high in lymphocytes

Back 41

TB

Front 42

Common causes of exudative pleural effusion

Back 42

Cancer or parapneumonic (pleural effusion secondary to pneumonia)

Front 43

Light's criteria

Back 43

Exudative pleural effusion if:
1. LDH > 2/3 of upper limit of normal
2. LDF effusion/serum >0.6
3. Protein effusion/serum >0.5

Front 44

Sx of a PE

Back 44

Sx: pleuritic chest pain, hemoptysis, tachypnea, tachycardia

Front 45

Signs of a PE

Back 45

right heart strain on EKG, sinus tachycardia, decreased vascular markings on CXR, wedge infarct, ABG with low CO2 and O2

Front 46

Causes and tx of ARDS

Back 46

Sepsis, gastric aspiration, trauma, low perfusion, pancreatitis
Tx: mechanical ventilation with PEEP

Front 47

Tx for COPD that has mortality benefit

Back 47

Quitting smoking and continuous O2 therapy >18 hrs per day

Front 48

Important vaccinations for COPD pts

Back 48

Pneumococcus with a 5yr booster and yearly influenza vaccine

Front 49

Diagnose: 1 cm nodules in upper lung lobes with eggshell calcifications

Back 49

Silicosis

Front 50

Diagnose: Hilar lymphadenopathy, increase ACE, erythema nodosum

Back 50

Sarcoidosis = syndrome involving abnormal collections of chronic inflammatory cells (granulomas) that can form as nodules in multiple organs

Front 51

Diagnose: pt with kidney stones, constipation, low PTH, and CENTRAL lung mass

Back 51

Squamous cell carcinoma of the lung (paraneoplastic syndrome secondary to secretion of PTH-rP = low PO4 and high Ca)

Front 52

Diagnose: pt with shoulder pain, ptosis, constricted pupil, facial edema, wt loss, cough + hemoptysis

Back 52

Superior Sulcus Syndrome from Small Cell Carcinoma (also a central lung cancer)

Front 53

Diagnose: pt with ptosis that improves after 1 min of upward gaze

Back 53

Lambert Eaton Syndrome (autoimmune Ab production against pre-synpatic Ca channels)
-Around 60% of those with LES have underlying malignancy, most commonly Small Cell lung cancer; it is therefore regarded as a paraneoplastic syndrome

Front 54

Diagnose: old smoker presenting with hemoptysis, wt loss, Na=125, moist mucus membranes, and normal JVP

Back 54

SIADH from small cell lung cancer (produces euvolemic hyponatremia)
Tx: fluid restrict (if Na>112, add 3% saline)

Front 55

Diagnose: pt with hemoptysis and wt loss, with CXR showing PERIPHERAL cavitation and CT showing distant mets

Back 55

Large Cell Carcinoma of lung

Front 56

IBD that increases risk for Primary Sclerosing Cholangitis

Back 56

Ulcerative colitis (PSC leads to higher risk of cholangiocarcinoma)

Front 57

IBD in which fistulas, granulomas, and transmural inflammation are likely

Back 57

Crohn's

Front 58

Tx of IBD

Back 58

Corticosteroids to induce remission, ASA and sulfasalazine to maintain remission. For Crohn's, give metronidazole for any ulcer or abscess. If severe disease, give azathioprine, 6MP, and methotrexate.

Front 59

Diagnose: AST>ALT (2x) + high GGT

Back 59

Alcoholic hepatitis

Front 60

Diagnose: ALT>AST and in the 1000s

Back 60

Viral hepatitis

Front 61

Diagnose: AST and ALT in the 1000s after surgery or hemorrhage

Back 61

Ischemic hepatitis (shock liver)

Front 62

DDx of elevated direct bili

Back 62

Obstructive liver dx (stone, cancer), Dubin-Johnson syndrome, Rotor syndrome

Front 63

DDx of elevated indirect bili

Back 63

Hemolysis, Gilbert's syndrome, Criglr-Najjar syndrome

Front 64

Diagnose: elevated ALP and GGT

Back 64

Bile duct obstruction. If pt has IBD, consider PSC

Front 65

Diagnose: elevated ALP, normal GGT, normal Ca

Back 65

Paget's disease of the bone (excessive breakdown and formation of bone causing bone pain, back pain, increase hat size, hearing loss, headache).
Tx with bisphosphonates.

Front 66

Diagnose: liver disease pt with elevated antimitochondrial Abs

Back 66

Primary Biliary Cirrhosis

Front 67

Diagnose: liver disease pt with elevated ANA + antismooth muscle Abs

Back 67

Autoimmune hepatitis

Front 68

Diagnose: pt with low ceruloplasmin and high urinary Cu

Back 68

Wilson's disease (hepatitis, psych sx due to Cu deposition in the basal ganglia, corneal deposits=Kayser-Fleischer rings)

Front 69

Diagnose: liver disease pt with high Fe, low ferritin, low Fe binding capacity

Back 69

Hemachromatosis (hepatitis, DM, golden skin)

Front 70

Most common bugs causing meningitis

Back 70

Strep pneumo
H. influenza
N. meningitidis

Front 71

Tx for meningitis

Back 71

Ceftriaxone, Vancomycin, Ampicillin (for Lysteria), and Dexamethasone

Front 72

Pneumonia: most common bug?

Back 72

Strep pneumo

Front 73

Pneumonia: most common bug in healthy young people?

Back 73

Mycoplasma

Front 74

Pneumonia: most common bug in hospitalized pts?

Back 74

Pseudomonas, Klebsiella, E. coli, MRSA

Front 75

Pneumonia: most common bug in old smokers with COPD?

Back 75

H. influenza

Front 76

Pneumonia: most common bug in alcoholics with currant jelly sputum?

Back 76

Klebsiella

Front 77

Pneumonia: most common bug in old men with headache, confusion, diarrhea, and abdo pain?

Back 77

Leigionella

Front 78

Pneumonia: most common bug in pt who just delivered a baby cow and has vomiting and diarrhea

Back 78

Coxiella burnetti

Front 79

Pneumonia: most common bug in pt who just skinned a rabbit?

Back 79

Franciella tularensis

Front 80

Pneumonia: most common bug in pt who just had the flu?

Back 80

MRSA

Front 81

Positive TB test interpretation

Back 81

Induration >15 mm is positive TB test in general pop
Induration >10 mm is positive if prisoner, healthcare worker, nursing home, DM, EtOH, chronically ill
Induration >5 mm if AIDS or immunosuppressed

Front 82

Tx regimen for TB

Back 82

RIPE: rifampin, INH (isoniazid), pyrazinamide, ethambutol

Front 83

TB tx: s/e of Rifampin

Back 83

body fluids turn orange/red, induces CYP450

Front 84

TB tx: s/e of INH

Back 84

peripheral neuropathy and sideroblastic anemia (prevent by giving vit B6), hepatitis with mild bump in LFTs

Front 85

TB tx: s/e of Pyrazinamide

Back 85

benign hyperuricemia

Front 86

TB tx: s/e of ethambutol

Back 86

optic neuritis, other color vision abnormalities

Front 87

Acute endocarditis: most common bug?

Back 87

Staph aureus

Front 88

Subacute native valve endocarditis: most common valve affected and most common bug responsible?

Back 88

mitral valve and Viridens group strep

Front 89

IV drug use endocarditis: most common valve affected and most common bug?

Back 89

tricuspid valve and Staph aureus

Front 90

Endocarditis complications

Back 90

CHF is #1 cause of death, septic emboli to lungs or brain

Front 91

What is the next step if you find endocarditis caused by Strep bovis bacteremia?

Back 91

Colonoscopy to look for colon cancer!

Front 92

Criteria for diagnosing endocarditis?

Back 92

Modified Duke Criteria:
A definite diagnosis of IE can be established if the following conditions are fulfilled: 2 major criteria, 1 major + 3 minor criteria, or 5 minor criteria.

Front 93

When to suspect HIV...

Back 93

1. young pt with new/bilateral Bell's palsy
2. young pt with unexplained thrombocytopenia & fatigue
3. young pt with unexplained wt loss >10%
4. young pt with thrush, Zoster, or Kaposi sarcoma
5. pt who "travels a lot for work" and have a lot of sex

Front 94

Acute retroviral syndrome (initial post-HIV infection sx)

Back 94

Sx of HIV infection can occur 2-3 wks after exposure but 3 wks before seroconversion (so ELISA is still negative): fever, fatigue, lymphadenopathy, HA, pharyngitis, N/V, diarrhea, +/- aseptic meningitis

Front 95

Most common bug in HIV pt complaining of dyspnea, dry cough, fever, and chest pain? Findings on CXR? 1st line tx?

Back 95

Pneumocystis jiroveci
CXR shows bilateral diffuse symmetric interstitial infiltrates
Tx: tmp-smx

Front 96

Diagnose: HIV+ pt with multiple ring-enhancing lesions on CT or MRI

Back 96

CNS Toxoplasmosis
Tx: empiric pyramethamine sulfadiazine + folic acid for 6 wks; if no improvement, consider biopsy for CNS lymphoma

Front 97

Diagnose: HIV+ pt with one ring-enhancing lesion on CT or MRI

Back 97

CNS lymphoma, associated with EBV infection of B-cells
Tx: HAART

Front 98

Diagnose: HIV+ pt with seizure with de ja vu aura and 500 RBCs in CSF

Back 98

HSV encephalitis (predisposed for temporal lobe)
Tx: Give Acyclovir as soon as suspected

Front 99

Diagnose: HIV+ pt with signs/sx of meningitis

Back 99

Cryptococcal meningitis
Diagnosis: positive India ink stain
Tx: Amphotericin B (antifungal)

Front 100

Diagnose: HIV+ pt with hemisensory loss, visual impairment, and +Babinski

Back 100

PML: Progressive Multifocal Leukoencephalopathy (widespread demyelinative lesions due to infection of oligodendrocytes by a polyomavirus)
Diagnosis: brain biopsy is gold standard
Tx: experimental only (antiretrovirals)

Front 101

Diagnose: HIV+ pt with memory problems and gait disturbance

Back 101

AIDS-Dementia complex

Front 102

Definition of febrile neutropenia

Back 102

FEVER: single oral temp equal to or greater than 38.3C or 101F AND a febrile state of >38C for at least 1h
NEUTROPENIA: absolute neutrophilic count of <0.5, or a count of <1 with a predicted decline to <0.5 in the next 24 to 48 hours

Front 103

Common cause of febrile neutropenia

Back 103

Mucositis secondary to chemo that causes bacteremia (usually from the gut)

Front 104

Work-up for febrile neutropenia

Back 104

Tx: blood cx, then 3rd or 4th gen cephalosporin (ie. ceftazadime or cefipime); add Vanco if line infx suspected or if septic shock develops; add Amphotericin B if no improvement and no source found in 5 d

Front 105

Diagnose: pt with target rash, fever, CN7 palsy, meningitis, and AV block

Back 105

Lyme Disease
Tx: Doxycycline po; heart or CNS disease needs IV Ceftriaxone

Front 106

Diagnose: pt with rash at the wrists and ankles (palms and soles), fever, and headache

Back 106

Rickettsia
Tx: Doxycycline po

Front 107

Diagnose: pt with a tick bite, no rash, myalgia, fever, HA, decreased platelets and WBCs, and increased ALT

Back 107

Ehrlichiosis (tick-borne bacterial infection; bacteria live within WBCs of host)
Tx: Doxycycline po

Front 108

Diagnose: immunosuppressed pt with cavitary lung disease, purulent sputum, weight loss, and fever; Gram+ aerobic branching, partially acid-fast

Back 108

Nocardia (bacteria normally found in soil; disease is one of the "great imitators" bc produces nonspecific sx)
Tx: tmp/smx

Front 109

Diagnose: pt with neck or face infection with draining yellow material (+sulfur granules); Gram+ anaerobic branching

Back 109

Actinomyces
Tx: high dose PCN for 6-12 wks

Front 110

Nephro: causes of hypervolemic hypoNa

Back 110

CHF, nephrotic, cirrhotic causes

Front 111

Nephro: causes of hypovolemic hypoNa

Back 111

diuretics or vomiting

Front 112

Nephro: causes of euvolemic hypoNa

Back 112

SIADH (check CXR if smoker!), Addison's, hypothyroidism

Front 113

If pt has hyponatremia, why should you not rapidly correct their serum Na?

Back 113

HypoNa: Correcting the serum Na faster than 12-24 mEq/day can cause Central Pontine Myelinolysis (severe damage of myelin sheath of neurons in the pons, causing paralysis, dysphagia, dysarthria, etc)

Front 114

If pt has hypernatremia, why should you not rapidly correct their serum Na?

Back 114

HyperNa: Correcting serum Na faster than 12-24 mEq/day may cause cerebral edema.

Front 115

Diagnose electrolyte abnormality: pt with peri-oral numbness, +Chvostek or Trousseau sign, and prolonged QT interval

Back 115

Hypocalcemia

Front 116

Diagnose electrolyte abnormality: "Bones, stones, groans, and psychiatric overtones", shortened QT interval

Back 116

Hypercalcemia

Front 117

Diagnose electrolyte abnormality: muscle weakness, ileus, ST depression, U waves

Back 117

Hypokalemia

Front 118

Diagnose electrolyte abnormality: peaked T waves, prolonged PR and QRS, sine waves

Back 118

Hyperkalemia
Tx: Ca-gluconate, then insulin +glucose, kayexalate, salbutamol, and NaHCO3; Dialysis is last resort

Front 119

Diagnose: muddy brown casts in a pt taking Amphotericin or Aminoglycosides or Cisplatin

Back 119

Acute tubular necrosis (ATN)
Tx: fluids, avoid nephrotoxins, dialysis if indicated

Front 120

Diagnose: protein, blood, & eosinophils in the urine, fever and rash, pt took tmp-smx 2 wks ago

Back 120

Acute interstitial nephritis (AIN)

Front 121

Diagnose: crush victim with very high serum CK, +blood on urine dipstick, but no gross hematuria

Back 121

Rhabdomyolysis, causing hyperkalemia

Front 122

Indicators for emergent dialysis

Back 122

AEIOU:
A-acidosis
E-electrolyte imbalance (esp high K>6.5)
I-intoxication (esp antifreeze and Li)
O-overload of volume (sxs of CHF or pulmonary edema)
U-uremia (pericarditis, altered mental status)

*Dialysis not urgently indicated for rising Cr or oliguria alone!!

Front 123

#1 cause of CKD

Back 123

Diabetes mellitus

Front 124

#2 cause of CKD

Back 124

HTN

Front 125

#1 cause of death in a CKD pt

Back 125

Cardiovascular disease

Front 126

Cx of CKD

Back 126

HTN, fluid retention = CHF
normochromic normocytic anemia (loss of EPO)
hyperK
hyperPO4 (can cause precipitation of Ca into tissues = renal osteodystrophy and calciphylaxis (skin necrosis))
hypoCa
Uremia (confusion, pericarditis, pruritus, increased bleeding secondary to uremic-induced platelet dysfunction)

Front 127

Diagnose: elderly pt with painless hematuria

Back 127

bladder cancer until proven otherwise

Front 128

Diagnose: pt with hematuria and progressive hearing loss & deafness

Back 128

Alport Syndrome ( genetic disorder characterized by glomerulonephritis, endstage kidney disease, and hearing loss); mutation in collagen IV

Front 129

Diagnose: pt with hematuria 1-2 wks after sore throat or skin infection

Back 129

Post-strep glomerulonephritis

Front 130

Diagnose: child with viral URI, abdominal pain, arthralgia, and purpura; can cause renal failure

Back 130

Henoch-Schonlein Purpura

Front 131

Diagnose: child who ate a hamburger and now has diarrhea, renal failure, petechiae, and MAHA (microangiopathic hemolytic anemia)

Back 131

Hemolytic uremic syndrome (HUS) = Most cases are preceded by an episode of infectious, sometimes bloody, diarrhea caused by E. coli O157:H7 or Shigella, which is acquired as a foodborne illness or from a contaminated water supply.
Tx: supportive; don't tx with ABx bc causes release of more toxins
Mnemonic: DART - diarrhea, anemia, renal failure, thrombocytopenia

Front 132

Diagnose: cardiac pt with renal failure, MAHA, thrombocytopenia, fever, and altered mental status; pt treated with ticlopidine (plt aggregation inhibitor)

Back 132

Thrombotic thrombocytopenic purpura (TTP)
Tx: plasmapheresis; don't give plts
Distinguished from DIC bc PT and PTT are normal ins HUS/TTP
Mnemonic pentad of TTP: FARTN = fever, anemia, renal failure, thrombocytopenia, neuro signs

Front 133

Diagnose: + c-ANCA, kidney/lung/sinus involvement

Back 133

Wegener's Granulomatosis
Dx: most accurate test is biopsy
Tx: steroids or cyclophosphamide

Front 134

Diagnose: + p-ANCA, renal failure, asthma, and eosinophilia

Back 134

Churg-Strauss Disease (medium and small vessel autoimmune vasculitis, leading to necrosis. It involves mainly the blood vessels of the lungs (it begins as a severe type of asthma), gastrointestinal system, and peripheral nerves, but also affects the heart, skin, and kidneys)
Dx: best test is lung bx
Tx: cyclophosphamide

Front 135

Diagnose: + p-ANCA, NO lung involvement, 30% pts are Hep B+

Back 135

Polyarteritis Nodosa (PAN) = affects small/med arteries of every organ except the lungs!
Tx: cyclophosphamide

Front 136

Types of kidney stones and most common

Back 136

Most common: calcium oxalate
Others: cysteine, struvite (Mg/Al/PO4), and uric acid stones

Front 137

Diagnose: pt receiving chemo tx for leukemia who develops flank pain radiating to groin + hematuria

Back 137

Uric acid stone (secondary to increased production of uric acid from purine breakdown during periods of active cell proliferation, especially following chemo treatment in pts with leukemia)

Front 138

What are the 4 histological subtypes of nephrotic syndrome?

Back 138

1. MCD = minimal change disease
2. FSGS = focal segmental glomerulosclerosis
3. MN = membranous nephropathy
4. MPGN = membranoproliferative glomerulonephritis

Front 139

Most common cause of nephrotic syndrome in kids

Back 139

Minimal change disease (fusion of podocyte foot processes on electron microscopy)
Tx: steroids

Front 140

Most common cause of nephrotic syndrome in adults

Back 140

Focal Segmental Glomerulosclerosis (FSGS)
= The individual components of the name refer to the appearance of the kidney tissue on biopsy: focal—only some of the glomeruli are involved (as opposed to diffuse), segmental—only part of each glomerulus is involved (as opposed to global), glomerulosclerosis—refers to scarring of the glomerulus

Front 141

Second most common cause of nephrotic syndrome in adults

Back 141

Membranous glomerulonephritis (MGN)
= slowly progressive disease of the kidney affecting mostly patients between ages of 30 and 50 years, usually Caucasian; 85% idiopathic (aka unknown cause)

Front 142

Which secondary cause of nephrotic syndrome is associated with chronic hepatitis and low complement?

Back 142

Membranoproliferative glomerulonephritis (MPGN)

Front 143

Which secondary cause of nephrotic syndrome is associated with heroin use and HIV?

Back 143

Focal Segmental Glomerulosclerosis (FSGS)

Front 144

What should you suspect if a nephrotic syndrome suddenly develops flank pain?

Back 144

Suspect renal vein thrombosis secondary to hypercoagulable blood b/c loss of anticoagulants in urine (antithrombin III, protein C & S)

Front 145

Diagnose: 30 yo F with thrombocytopenia, recurrent epistaxis, menorrhagia, and petechiae. Decreased plts only.

Back 145

ITP
Tx: prednisone 1st line, then splenectomy

Front 146

Diagnose: 20 yo F with recurrent epistaxis, menorrhagia, petechiae, NORMAL plts, increased bleeding time and PTT

Back 146

VWD
Tx: dDAVP for bleeding or pre-op; replace Factor 8 (which contains vWF) if bleeding continues

Front 147

Diagnose: 20 yo M with recurrent bruising, hematuria, hemarthroses, and increased PTT

Back 147

Hemophilia
Tx: if mild, use dDAVP, otherwise replace factors

Front 148

Diagnose: pt develops arterial clot 1 wk post-op. Her plts are 50% less than pre-op.

Back 148

Heparin-induced thrombocytopenia (HIT)
Tx: stop heparin, reverse warfarin with Vit K

Front 149

DDx of unprovoked thrombus

Back 149

-CANCER
-OCPs or HRT
-nephrotic syndrome
-lupus anticoagulant
-protein c/s deficiency
-+Factor 5 Leiden gene
-Antithrombin III deficiency

Front 150

What are examples of "great imitator" diseases? (diseases which can be confused with others and which feature nonspecific sx)

Back 150

-cancer
-fibromyalgia
-MS
-systemic lupus erythematosus
-sarcoidosis
-Infectious diseases: Lyme disease, Syphilis, & Nocardiosis
-Celiac
-Addison's
-PE

Front 151

Diagnose: pt with knee pain, DIP involvement, no swelling or warmth at joints, worse at the end of the day, crepitus

Back 151

OA

Front 152

Diagnose: pt with arthritis at PIP and wrists bilaterally, worse in the AM, low grade fever

Back 152

RA

Front 153

Diagnose: pt with arthritis at DIP joints, rash with silvery scale on elbows and knees, pitting nails, and swollen fingers

Back 153

Psoriatic arthritis

Front 154

Diagnose: symmetric bilateral arthritis, malar rash, oral ulcers, proteinuria, thrombocytopenia. Arthritis is not erosive or have lasting sequelae.

Back 154

SLE

Front 155

Diagnose: Pt with acute swollen painful joint and aspirated fluid with needle-shaped, negatively birefringent crystals

Back 155

Gout (monosodium urate crystals)

Front 156

Acute and chronic tx of gout

Back 156

Acute tx: indomethacin & colchicine (steroids if CKD)
Chronic tx: Allopurinol if overproduction of crystals, Probenecid if undersecretion of crystals

Front 157

Diagnose: pt with acute swollen painful joint and aspirated fluid with rhomboid-shaped, positively birefringent crystals

Back 157

Pseudogout (calcium pyrophosphate)
Tx: NSAIDs, colchicine, corticosteroids

Front 158

Which Abs are most sensitive for SLE?

Back 158

Anti-dsDNA and Anti-Smith

Front 159

Abs positive in Sjogren's syndrome

Back 159

Anti-Ro and Anti-La

Front 160

Ab positive in CREST syndrome

Back 160

Anti-Centromere

Front 161

Abs positive in Systemic Sclerosis

Back 161

Anti-Scl-70 and Anti-topoisomerase

Front 162

What is CREST syndrome?

Back 162

Limited cutaneous form of systemic scleroderma:
C - calcinosis
R - Raynaud's
E - esophageal dysmotility
S - sclerodactyly
T - telengiectasia

Front 163

Name this skin sign of systemic disease (may indicate internal malignancy): explosive onset of multiple seborrheic keratoses

Back 163

Sign of Leser-Trelat

Front 164

Diagnose: pt has this skin finding and also has difficulty combing hair and getting up from a chair

Back 164

Dermatomyositis features:
-heliotrope rash
-Gottron's papules
-periungal erythema
-proximal muscle weakness

Front 165

Pruritic rash that begins on extremities, lasts 7-10 d, unknown cause

Back 165

Erythema multiforme

Front 166

What is the Ddx of this skin findings (brown to black, poorly defined, velvety hyperpigmentation of the skin)

Back 166

Acanthosis nigricans:
-occurs in individuals younger than age 40, may be genetically inherited, associated with obesity or endocrinopathies, such as:
- hypothyroidism or hyperthyroidism,
-acromegaly,
-polycystic ovary disease,
-insulin-resistant diabetes,
-Cushing's disease

Front 167

Diagnose: 50 yo male presenting with blisters which become ulcerated in areas of the skin exposed to sunlight, especially on the face, ears and dorsum of the hands; his labwork shows iron overload

Back 167

Porphyria cutanea tarda:
-a genetic photosensitive skin disease with onset in adult life with substances called uroporphyrins in the urine due to a deficiency of uroporphyrinogen decarboxylase (UROD), an enzyme required for the synthesis of heme
-The hallmarks of porphyria cutanea tarda (PCT) are blisters which become ulcerated in areas of the skin exposed to sunlight
-Iron overload is frequently present in porphyria cutanea tarda and may be associated with varying degrees of damage of the liver

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What is the precursor lesion of squamous cell carcinoma?

Back 168

Actinic keratosis

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What are the 4 subtypes of melanoma?

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1. Superficial spreading (most common, best prognosis)
2. Nodular (poor prognosis)
3. Acral-lentiginous (palms, soles, mucous membranes, more prevalent in darker skin individuals)
4. Lentigo maligna (head & neck, good prognosis)

Front 170

What is the #1 prognostic indicator for melanoma?

Back 170

Breslow's depth: tumor thickness remains the most powerful prognostic indicator hence why it's critical to get a full-thickness biopsy

Front 171

Most common pituitary adenoma?

Back 171

Prolactinoma
-consider if pt presents with amenorrhea or hypothyroidism

Front 172

Treatment of prolactinoma

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1. Bromocriptine = dopamine agonist that decreases synthesis and secretion of prolactin; long track record and safety, dosed daily
2. Cabergoline = long-acting dopamine agonist, better safety and efficacy profile; convenience of twice-weekly administration

Front 173

What are the causes of hypopituitarism? (mnemonic: 8 "I"s)

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❏ Mnemonic: eight “I”s
• Invasive: generally primary tumours
• Infarction: e.g. Sheehan’s syndrome
• Infiltrative disease e.g. sarcoidosis, hemochromatosis, histiocytosis
• Iatrogenic: following surgery or radiation
• Infectious: e.g. syphilis, TB
• Injury: severe head trauma
• Immunologic: autoimmune destruction
• Idiopathic: familial forms, congenital midline defects

Front 174

In hypopituitarism, what is the sequence of hormone loss?

Back 174

A compressive adenoma in the pituitary will impair hormone production in this order (i.e. GH-secreting cells are most sensitive to compression)
Mnemonic: “Go Look For The Adenoma Please”
1. GH
2. LH
3. FSH
4. TSH
5. ACTH
6. Prolactin

Front 175

Diagnose: pt presents with polyuria, polydipsia, hyperNa, and dilute urine

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Diabetes Insipidus (lack of ADH)

Front 176

How do you distinguish between central and nephrogenic Diabetes Insipidus.

Back 176

Do a water deprivation test:
Central DI = urine osmolality still decreased after water deprivation test, but increases with administration of dDAVP
Nephrogenic DI = urine osmolality still decreased after water deprivation test and administration of dDAVP (1st line tx: HCTZ and amiloride to reduce flow to the ADH-sensitive distal nephron)

Front 177

What are the 5 types of thyroid cancer?

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1. Papillary = most common, characterized by psammona bodies on histology (round collection of Ca), spreads via lymphatic system, good prognosis
2. Follicular = hematogenous spread, more aggressive, must do total thyroidectomy
3. Medullary = associated with MENII (look for pheochromocytoma and hyperparathyroidism=hyperCa), amyloid on histology, secrets calcitonin
4. Hurthle cell
5. Anaplastic/undifferentiated = giant cells on histology, poor prognosis

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7 "P"s of papillary thyroid carcinoma

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PAPILLARY CANCER:
Popular (most common)
Psammoma bodies
Palpable lymph nodes (bc lymphatic spread)
Positive Iodine131 uptake
Positive prognosis
Postoperative Iodine131 scan to dx/tx metastases
Pulmonary metastases

Front 179

3 "F"s of follicular thyroid carcinoma

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FOLLICULAR CANCER:
Far-away metastasis (spreads hematogenously)
Female (3 to 1 ratio)
Favorable prognosis

Front 180

4 "M"s of medullary thyroid carcinoma

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MEDULLARY CANCER:
MEN II
aMyloid (histology)
Median lymph node dissection
Modified neck dissection if lateral nodes are positive

Front 181

Diagnose: female pt presenting with osteoporosis, central obesity, diabetes, and hirsutism

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Suspect Cushing's syndrome
Best screening test: 1 mg overnight dexa suppression test or 24h urine cortisol
If dexa test abnormal, next best test is 8 mg overnight dexa suppression
If suppression <50% of control = pituitary adenoma (Cushing's Disease)
If no suppression = either adrenal neoplasia OR ectopic ACTH (measure plasma ACTH, chest CT if smoker, abdo CT)

Front 182

Diagnose: pt presenting with weakness, weight loss, hypotension, hyperpigmentation, hyperK, and hypoNa

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Suspect adrenal insufficiency = main cause is Addison's Disease (autoimmune adrenal destruction)
Tx: long-term replacement of aldosterone (ie. with fluodrocortisone) and cortisol (ie. with hydrocortisone or prednisone), androgen replacement tx in women

Front 183

ST elevation in II, III, aVF

Back 183

RCA, inferior infarct

Front 184

Diagnose: pt involved in MVA with whip-lash presents with loss of pain and temperature sensation on neck and arms and intact sensation

Back 184

Suspect post-traumatic syringomyelia = CSF from the central spinal canal dissects into the surrounding white matter, forming a cystic cavity or syrinx

Front 185

Diagnose: pt with chronic high cholesterol presents with acute onset of flaccid paralysis below the waist, loss of pain/temp with preserved vibration of position sense

Back 185

Suspect anterior spinal artery occlusion (aka Beck's Syndrome)
-affects the spinothalamic tract (pain/temp) and corticospinaltract (motor), but not the dorsal columns (proprioception)