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112 Cards in this Set
- Front
- Back
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What lab findings is checked for in hepatocellular carcinoma?
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elevated alpha-fetoprotein
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What is the image finding in bronchiectasis?
Can it be reversed? Most common cause? Others? What is a potential complication? |
dilated central bronchi larger than adjacent pulm arteries and thickened bronchial walls
-Irreversible -CF (50% of pts), infxn (tb, pna, abscess), Ig deficiencies, tumor/foreign body, allergic bronchopulm aspergillosis (ABPA), RA (collagen-vasc dz), immotile cilia syndrome/kartageners -Hemoptysis is main complication |
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What are the most common glomerular defects in adults vs. kids w/ nephrotic syndrome?
What causes each of them and in what pop? |
Kids: minimal change dz (hodgkins dz, NSAIDs)
Adults: FSGS vs. Membranous -FSGS: 50% blacks, obesity, heroin/IV drug use, AIDS -Membranous: solid tumors, NSAIDS, SLE |
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Name 3 reasons for postcholecystectomy pain?
How to differentiate? |
Common bile duct stone, sphincter oddi dysfunction, functional pain
1st U/S->if dilated bile duct w/ up LFTs=common stone vs oddi->do ERCP->remove stone or sphincterotomy ->if not dilated and normal LFTs->functional pain |
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What is the presentation of pseudogout?
Cause? Dx Test? TMT? |
Pt after stressor/surgery/illness w/ acute pain, swelling, redness, limited motion of joint/knee or wrist (not DIP, PIP->DJD, MCP foot->gout)(possible fever, leukocytosis w/ L shift)
-release oc calcium pyrophosphate dehydrate (CPPD) crystals from sites of chondrocalcinosis (calcification salt deposits in articular cartilage of joint), risk factors: hemochromatosis, hyperPTH, Wilson, DM, hypothyroid -Athrocentesis w/ RHOMBOID shape positively birefringent crystals w/ synovium having less than 50000wbc -NSAIDS, if not responsive, steroid inj, colchicine ppx |
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What is found in synovium of rhum arthritis?
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anti-citrulinated peptide (anti-CCP)
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How to differentiate synovial fluid analysis?
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DJD: <200wbcs, osteophytes, joint space narrowing
Gout: 2000-50000wbc, neg birefring needles pseudogout/CPPD: 2000-50000wbc, pos birefring rhombo RA: anti-ccp Septic arth: >50000wbc mostly PMNs, cx of fluid |
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When to give IM vs intranasal influenza vacc?
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IM after 50yo
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What is recommendation for HPV vaccine?
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males and females 9-26yo (preferably b4 starting sex activitiy)->decreases genital wart, abn paps, cervic ca
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Dx test for polymyositis? Best initial test?
Findings? Differentiate from myasthenia g and polymalg rheum TMT? What if dermatomyositis? |
Muscle bx (CPK and aldolase best initial since hi r/o polymalgia rheumatica)
-mononuclear infiltrate surrounding necrotic and regenerating fibers -No facial/ocular weakness (myasth gr has facial weak) and only 25% have tenderness (polym rheum is tender) -Steroids, if not helpful->immunosuppressive -same dx and tmt->add hydroxychloroquine for skin lesions |
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What is the hawthorne effect?
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tendency of study population to affect the outcome because they are aware that they are being studied (can reduce by randomizing and keeping unaware, but can be unethical)
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What is sample distortion bias?
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when the study sample is not an accurate representation of the target population
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What is information bias?
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It is errors in measuring the exposure and outcome in a study (used bad calculator, bad lab technique), improve by using standardized technique and having trained observers
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What is the side effects of levodopa?
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Most common: hallucination, confusion, agitation, dizziness, somnolence, nausea
-others: involuntary movement (dyskinesia, dystonia) after 5yrs therapy |
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Side effeects of amantadine?
use? |
ankle edema, livedo reticularis
-parkinsons |
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Side effect of entacapone/tolcapone?
Class? use? |
dyskinesia, hallucination, confusion, nausea, orthostatic hypotension
-COMT i -parkinsons |
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side effect of bromocriptine/pramipexole/ropinerole/apomorphine?
Class? Use? |
somnolence, hypotension, confusion, hallucinations (like levodopa)
-dopamine agonists -parkinsons |
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Side effect of selegiline
class use primarily |
insomnia and confusion
MAO-Bi -parkinsons |
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What are indications for surgery in peptic ulcer dz?
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perforation, gastric outlet obstruction, bleeding that cannot be controlled by endoscopic therapy
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What are risk factors for boerhaave syndrome?
What can cause those? |
Excess vomiting, straining
medical instrumentation (endo, esophageal dilation) pill esophagitis (POTASSIUM CHLORIDE, doxy) infectious esophagitis (candida, CMV, Herpes->HIV pt) Ingestion caustic substance |
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What is most sensitve test for disseminated fungal antigen?
most rapid? |
Antigen in serum or urine
same |
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TMT for disseminated pulm histoplasmosis?
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mild-moderate dz: Itraconazole
severe (fever>39.5/103, fungemia, lab change): IV liposomal amphotericin B x 2wks and then itraconazole for 1yr |
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What can flucytosine be used for?
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cryptococcus and candida
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What is tamoxifen used for?
What are you at increased risk for? |
breast ca
-up risk endometrial ca, uterine sarcoma (muscle of uterus), and DVTs (since tamoxifen is partial estrogen receptor agonist and antagonist) |
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How to tell between chronic bronchitis and emphysema?
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DLCO is normal, increased bronchopulm markings on cxr in chronic bronchitis,
decreased DLCO, less markings in emphyema |
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How to Dx PCP?
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1. sputum induction w/ hypertonic saline
2. if unsuccessful: bronch w/ BAL |
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State order of therapies for chemo?
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Neoadjuvant->surgery w/ Adjuvant->Induction (done when <5% tumor burden)->consolidation->maintenance (once in remission to keep their long term)
-Salvage (if recurrence) |
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How do nitrates (nitroglycerin) work in relieving angina?
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venodilation->pooling of blood in venous system->decreased preload to heart->decreased filling LV->decreased ventricular volume and wall stretch->decreased myocardial O2 demand
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What is the one infxn that causes SAAG>1.1
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SBP
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Electrical alternans=?
describe it? TMT? |
Pericardial effusion
-swinging motion of heart in pericardial cavity causes beat-to-beat change in QRS amplitude (qrs spikes, then down, then spikes) -Pericadiocentesis |
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When do you get fixed splitting of S2?
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atrial septal defect
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What cardiac problem is associated w/ marfan's?
What cardiac probs are Marfan's at greater risk for? What heart sounds will appear? |
mitral valve prolapse and regurge
-risk of aortic dissection -aortic regurg->S4 |
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What are common clinical findings in marfan's
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ligamenous laxity of joints, long thin digits and limbs, blood vessels fragil, spontaneous pneumo, MVP and mitral regur, retinal detachment
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What are the deficits in malabsorptive dz and sx?
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Vit A: hyperkeratosis
Vit K: easy bruising, bleeding Vit D: osteomalacia, hypocalcemia Iron (in gluten ent): anemia, pallor |
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anti-centromere ab=?
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CREST syndrome
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Anti-scl-70=?
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scleroderma (look for dysphagia)
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Criteria for IBS?
TMT? |
pain associated w/ diarrhea (mucus cover), constipation, or both w/: (no weight loss)
1. relieved by bowel movement 2. less at night 3. relieved by change in bowel habit TMT: 1. fiber, 2.antispasmodic (hyoscyamine, dicyclomine), 3.TCA or SSRI, 4. loperamide (antimotility) |
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What are RA pts at increased risk for?
Why? |
osteoporosis and osteopenia
-from dz, from steroid therapy, more female, less ability to do weight-bearing excercise |
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Extra-articular findings in RA?
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ocular: episcleritis
Lung: pleural effusions and parenchymal nodules Vasculitis: skin, bowel, peripheral nerves Cervical join: C1-C2 subaxial subluxation Serositis: pericarditis and pleural dz Carpal tunnel dz |
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Dx criteria for RA?
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total of 6 pts needed:
-joint involved (up to 5pts) -up ESR or CRP -duration >6wk -RF or anti-CCP |
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Osteitis Fibrosis Cystica=?
Cause? |
Von Recklinghausen dz of bone: brown tumor from osteoclastic resorption bone and replace w/ fibrous tissue
HYPERPARATHYROIDISM |
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Most common cause avascular necrosis bone?
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steroids and ETOH
Others: SLE, sickle cell |
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Felty syndrome=?
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RA, splenomegaly, neutropenia
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Caplan syndrome=?
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RA, pneumoconiosis, lung nodules
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RA TMT? and major side effects
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For pain: NSAIDS->if not controlled: steroids (and when waiting for DMARDS to work)
For DMARD (chronic control): 1. Methotrexate (liver tox, myelosuppression, lung tox, stomatitis, macrocytic folate def anemia) 2. TNFi infliximab, adalimumab, etanercept if mtx fails, interolerant of it (reactivate TB->check PPD prior to use, infxn) 3. Rituximab CD20i (infxn) 4. Hydroxychloroquine (retinal tox->eye exam) 5. Sulfasalazine (bone marrow tox, G6PD def, rash) 6. Gold salts (nephrotic synd) |
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Pt w/ chronic renal failure having abnormal bleeding after IV placement.
ML Dx? Lab findings TMT? |
Platelet dysfunction from uremic coagulopathy
-normal PT/PTT/INR, prolonged blleeding time, up BUN: Cr -DDAVP (release vWF) |
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Wegener's dz sx?
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Triad: systemic vasculitis (palp purpura, painful subq nodules, pyoderma-gangernosum-like lesions), Upper and lower airway granulomatous inlam (sinusitis, otitis media, mastoiditis, saddle nose, nasal septal defect, epistaxis), glomerulonephritis
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Dx test for wegener's? initial and best
TMT? |
initial: C-ANCA (antiproteinase-3)
best: lung bx TMT: prednisone + cyclophosphamide |
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What is the heritability of congenital adrenal hyperplasia?
What is the most common type? Findings? Dx Test? TMT? |
aut recessive
-21-hyroxylase def -salt wasting, hypotensive, (hyponatremia, hypochloremia, hypoglycemia, hyperkalemia w/ acidosis), female w/ ambiguous genitalia becomes virilized, male pseudohermaphrodite (no DHT) early -low cortisol (do cosyntropin stim test), mineralocorticoid, hi 17-alpha hydroxyprogesterone -fluid/electrolytes, lifelong steroids, pscyh counseling |
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What are less common types CAH and findings?
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17-hydroxylase deef: delayed puberty w/ mineralocorticoid excess (Hypotension + masculinization/female pseudohermaphrodite w/ cliteromegaly)
11-beta-hydroxylase def: androgen and mineralocorticoid excess (HTN from 11=deoxycorticosterone that acts like aldo even tho no aldo + masculinization/fem w/ ambig genitalia) |
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What is timeline of various types of plasmodium?
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Malaria (protozoal dz)
P vivax/P ovale=q48h spike fever P malariea=q72hr spike fever P falciparum=constant cold phase chills/shiver->hot phase fever->sweat stage 6hrs later->fever done All have nau/vom/HA/anorexia/myalgia, SPLENOMEGALY and ANEMIA->AFRICA |
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TMT of frostbite?
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rapid rewarming w/ warm water (40-44C) that is continuously circulated
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When to image in appendicitis?
When to not do surgery appendicitis? Do you give abx in acute appendicits? |
atypical presentation or pregnant->do U/S if pregnant to r/o pelvic etiology
-if pt has had longstanding appendicitis >5days->suspect phlegmon w/ walled off abscess->tmt conservative w/ IV abx, bowel rest, delayed appe wks later -abx pre and postop |
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When Rh testing in preg?
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Rh blood typing and test at 1st prenatal visit and rpt test at 28 wks if Rh negative woman w/ Rh+ or Rh-unknown partner to look for maternal alluminization
-if at 28wks remain Rh negative->give Rhogam (anti-D Ig) |
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When to give MMR in preg?
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DON'T since live. advise them to stay away from peeps w/ rubella (get MMR 3mos prior to getting pregnant)
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When HIV screen in preg?
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1st prenatal screen (to give anti-retrovirals) and rescreen in 3rd trim prior to 36wks if HIGH risk only
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When give pneumococcus in preg?
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DON"T
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Pt had hepatitis, transaminases are trending down.
What does it mean? |
Either: recovery from liver injury
Or: very few hepatocytes left that are functional (look at other tests and if PT up->fulminant hepatitis since not making clotting factors, PT is the most sensative test for liver function) |
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What is the most common infxn in prosthetic joint septic arthritis?
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Staph aureus
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When suspect squamous cell ca of skin, what is next steps?
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Punch bx to confirm
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First step in pt w/ possible TB? (hemoptysis cough from endemic area, upper lobe involved, nodular opacity, cavity)?
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Resp Isolation
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TMT of massive hemoptysis?
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>600mL/24 hr or >100ml/hr->intubate secure airway/b/c->if still bleeding->put patient in lung dependent lateral position, bronch to localize bleeding, suction, and balloon tamponade vs. electrocautery)
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Waddling gait=?
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muscular dystrophy (from weakness of gluteal muscles)
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festinating gait=?
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Parkinson's dz
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Colors of galactorrhea?
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white, clear, brown, yellow, even Green!
Do pregnancy test 1, serum prolactin and TSH levels 2, MRI brain to r/o prolactinoma 3 |
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central vs. peripheral CN VII lesion?
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Peripheral=Bell's palsy=loss all one side face
Central=only lower loss face (will have forehead furrows) |
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Pregnant mom w/ active hepB, what should newborn receive?
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HBIG and HBV vaccine
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What happens in Sheehan's syndrome?
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from pregnancy w/ blood loss->anterior pituitary necrosis from hypoperfusion->loss prolactin, TSH, FSH (also ACTH and GH and LH)
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Why are lactating moms amenhorrheic?
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prolactin inhibits GnRH (GnRH pulses needed from hypothalamus to produce LH/FSH and release from ant pituitary->no ovulation)
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Pt w/ HTN on OCP.
Next step? |
discuss switching contraceptive methods since OCP can increase BP by 3-6systolic and 2-5diastolic. If stop and still HTN->then it is essential bp->do excercise and diet modification if obese->if fails->medical mgmt (low dose thiazide diuretic)
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Signs of vasa previa in delivery?
TMT? |
antepartum hemorrhage w/ fetal HR going from tachy->brady->sinusoidal pattern suddenly after ROM->do emergent C-section
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Define Malignant HTN?
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Sever HTN w/ retinal hemorrhage 1, exudates 2, PAPILLEDEMA 3
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Define Hypertensive Emergency?
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Severe HTN w/ malignant HTN or hypertensive encephalopathy
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Define Hypertensive encephalopathy?
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Sever HTN w/ cerebral edema, non-localizing neuro sx/signs
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Define Hypertensive Urgency?
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Severe HTN >180/120 w/ no sx or acute end-organ damage
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TMT of sinus bradycardia?
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IF SYMPTOMATIC: IV atropine (increases HR by decreasing vagal input)->transcu pacing
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What is indication for hemodialysis?
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AEIOU:
Acidosis: <7.2 Electrolyte abd: refractory hyperkalemia Ingested substance: barbituates, salicylates, lithium Overload or pulm edema nonresponsive to diuretic Uremia (uremic pericarditis, uremic encephalopathy, uremic neuropathy) also coagulopathy (uremic cause) |
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Pt w/ constrictive pericarditis w/ renal failure.
TMT? |
Hemodialysis: this is uremic pericarditis given renal failure-> NO NSAIDS
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TMT of idiopathic or viral pericarditis?
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NSAIDS, colchicine for prevent recurrences
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What drugs can cause Hyperkalemia?
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nonselective b-blockers
ACE/ARB K spare diuretic Dig Cyclosporine Heparin NSAIDS Succinylcholine |
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If given the relative risk of a dz based on an exposure in comparison to pop w/out that risk, How to calculate the percent of women with dz and risk factor that is actually attributed to that risk factor?
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Its the Attributable Risk Percent (ARP)=(risk in exposed pop-risk in unexposed pop)/risk in exposed OR
ARP=(RR-1)/RR |
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hepatolenticular degeneration=?
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Wilson's dz
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What hgb should be kept at?
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7 in healthy pts w/ normal cardiac pts
10 in older pts or w/ cardiac dz |
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What is the risk factor w/ highest rate of aneurysm expansion and rupture in aortic aneurysm?
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active smoking
-repair if >5.5cm or rate>.5cm/6mo or 1cm/yr |
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Pt w/ asymptomatic thrombocytopenia.
1st step? |
HIV test (can be presentation in up to 10% pts)
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What is most sensitive screening test for diabetic nephropathy?
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microalbumine urine/creatinine ratio (either spot urine or timed urine collection , 24hr urine is only slightly more accurate but cumbersome and rarely used)
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TMT of osteoarthritis?
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1. Acetaminophen
2. NSAIDS (since SE of renal and GI sx) |
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1st gen antihistamines have what major side effect?
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anticholinergics: dry eyes, dry oral mucosa/resp passage, urinary retention (detrusor inactivity), dysuria
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Pt w/ likely compartment syndrome from supracondylar fracture humerus.
Major complication? |
Volkmann's Ischemic Contracture (dead muscle is replaced w/ fibrous tissue), final sequence of compartment syndrome
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20yo female w/ chest pain that is sharp left of sternum for 5 sec at time. exam w/ short systolic murmur at apex disappears w/ squatting.
ML Dx? |
Mitral valv prolapse syndrome (MVP pts have commonly unexplained chest pain compared to normal pts)
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Pt w severe pree in labor found to have hyporeflexia.
ML Dx? TMT? |
Mag Sulfate Toxicity (1st sign=decreased reflex, 2nd sign=resp depression)
-Stop Mag, give calcium gluconate |
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What is diagnostic criteria on bx for follicular carcinoma of thyroid?
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invasion of tumor capsule and blood vessels (this differentiates it from follicular adenoma->cells will appear normal)
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What is diagonostic criteria on bx for papillary ca of thyroid?
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psammoma bodies, large cells w/ ground glass cytoplasm, pale nuclei, inclusion bodies
Papillary is unencapsulated whereas follicular has capsule |
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What is presenting sx of hereditary spherocytosis?
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ranges, but severe anemia w/ jaundice and splenomegaly in white kid
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What is criteria for at home long-term oxygen therapy in COPD pt?
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1. all COPD pts w/ PaO2<55 or SaO2<88% on RA
2. pts w/ cor pulmonale, pulm HTN, or HCT>55 3. become hypoxic during excercise or sleep (nocturnal hypoxia) |
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Vitiligo presentation?
Location? Cause? |
20-30yo, depigmentation to pale whitish macules w/ hyperpigmented borders
-around body orifices (mouth edges), acral areas (peripheral body) -autoimmune destruction of melanocytes |
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Main pathophys cause of pickwickian?
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Decreased chest wall compliance->increased work of breathing->CNS chemoreceptors set pCO2 set point higher->hypoventilation, hypercapnia, hypoxemia
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Define febrile neutropenia?
TMT? |
ANC <500 w/ temp >38.3 (100.9) or 38(100.4) for over 1hr
-IV cefepime, ceftazidime, imipenim, meropenim -OR combo aminoglycoside + anti-pseudo penicillin (piperacillin + tobramycin) |
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TMT of septic arthritis?
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Sample and cx synovial fluid
start empiric IV vanco Surgical drainage w/ debride & irrigate if purulent fluid Adjust abx to sensitivity whenback |
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What is cause of foot droP?
What is another name for it? |
trauma or radiulopathy to common peroneal nerve or spinal roots (L4-S2) or congenital in Charcot-Marie Tooth Dz
-Steppage gait (unable to doriflex foot) |
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What is the murmur of VSD?
How does the kid look? What is dx Test? TMT? What can this lead to? |
pansystolic murmur loudest at LLSB, can have diastolic rumble at apex from increased flow across mitral valve
-SOB, NO cyanosis -Echo w/ bubble study (cardiac cath is dxstic -Eisenmenger syyndrome w/ RVH on EKG and shift to R->L shunt |
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What is murmur of Atrial septal defect?
How does the kid look? What is Dx Test? TMT? Risk of what? |
fixed wide splitting of S2
-No cyanosis, asymptomatic -cardiac cath dxstic (echo good) -Will close spontaneously, surgery/transcath closure if symptomatic -dysrhythmia and paradoxical emboli from DVT if not closed |
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What is murmur of transposition of great vessels?
How does kid look? What is Dx Test? TMT? |
Single S2 (aorta from RV and pulm art from LV, must have PDA/ASD/or VSD)
-early severe cyanosis -CXR w/ egg on string appearance -PgE1 to keep PDA open (NO NSAIDS->close pda), 2-step surgery |
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What is abnormal in TAPVR?
How does kid look? Dx Test? TMT? |
pulm veins go to SVC (not LA) so no blood flow out of left heart (can be obstructive if veins to SVC is sharp angle
-if obstruction: early severe resp distress/cyanotic, if NO obstruction: 1-2yrs R heart failure and tachy -CXR w/ snowman or fig 8 sign, echo is best test -Surgery for both |
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What is murmur of hypoplastic L heart syndrome?
How does kid look? Dx Test? TMT? |
absent pulses, single S2, increased RV impulse (no LV in this dz)
-neonate GRAY cyanosiss -CXR w/ globular shape heart and pulm edema (echo best test) -3 stage surgery |
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What is signs of truncus arteriorosis?
How does kid look? Dx Test? TMT? |
early multiple resp infxn, single S2 w/ systolic eject murmur, bounding peripheral pulses
-Severe sob -CXR w/ cardiomegaly and increased pulm vasc marking -Surgery w/in 4 months to prevent pulm HTN |
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What is murmur of PDA?
Who gets it? Dx test? TMT? |
machinery like murmur, wide pulse pressure, bounding pulses
-normal in 1st 12hrs life, after 24hrs=pathologic, failure PO2>50, hi altitude, pulm compromise in prematurity -ECHO is best initially, cardiac cath accurate -Indomethacin |
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What key findings=Long QT syndrome?
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boy, hearing loss, syncope, normal vitals, fam hx of sudden cardiac death
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Coarctation of aorta=think of?
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Turner's syndrome (webbed neck, streak ovaries, shield chest, horseshoe kidney, shorted 4th metacarpal, lymphedema)
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What conditions can result in hi amylase in pleural fluid?
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acute pancreatitis or esophageal rupture (boerhaaves) or cancer
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What is an alternative CF test than sweat chloride?
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Fecal elastase testing
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TMT of CF?
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1. routine abx (inhaled tobramycin->must work against pseudomonas)
2. recombinant human DNAse (rhDNAse)-> breakup DNA from PMNS stuck in mucus 3. Inhaled SABA (albuterol) 4. influenza and pneumococcal vaccine |
