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100 Cards in this Set

  • Front
  • Back
manifestations of hypercalcemia
severe constipation, anorexia, weakness, neuro abdnormalities
manifestations of multiple myloma
back pain, anemia, renal dysfunction, elevated ESR, hypercalcemia
acid-base status and seizures
pt following tonic cloinc seizures often have postictal lactic acidosis and is seen as a transient anion gap metabolic acidosis that will resolve in 60-90 minutes post seizure

repeat the labs in 2 hours to reassess acid base status
rotator cuff tendonitis vs tear
tendonitis will resolve with injection of lidocaine into the joint
lupus anticoag
the antiphospholipid in lupus binds the phospholipids used in the PTT assay, so they have a prolonged PTT, though it is not a true reading of their coag status
brain death
absent CN reflexes, fixed/dilated pupils, no spont breaths

no medical causes that can mimic brain death, temp > 32C, and must be agreed upon by 2 docs
immunity needed to clear molluscum contagiosum
cellular immunity
pt with DVT and hx of recent surgery, hemorrhagic stroke, bleeding diathesis, or active bleeding
placement of IVC filter, as they would have contra indications for anticoag therapy
what does an ateriovenous fistula do to circulation
as volume is moved from the arterial side to venous side via shunting, cardiac preload is increased

will lead to high outpt failure as oxygen demands can not be met
causes of AV fistula
congenital: PDA, angoimas, pulmonary or CNS AVF

aquired: trauma, cancer, iatrogenic (as with femoral cath)
Charcot's joint
damage to joints from repeated joint trauma, seen in diabetics due loss of nerve sensation

also called neurogenic arthopathy

will occur in weight bearing joints and will show as deformity, DJD, loose bodies, and osteophytes on imaging
treatment of prolactinoma
first line are DA agonists like bromocriptine or cabergoline

2nd line is surgery
Lights criteria for determination of pleural fluid as an exudate
effusion/serum protein > 0.5

effusion/serum LDH > 0.6

complicated effusion listed as pH < 7.2, glucose < 60, or positive Gram stain or culture; complicated require chest tube and drainage
MCC of thyroid cancer
papillary thyroid is 70%
follicular cancer is 20%
anaplastic is 5%
medullary is 2%
lymphoma is < 2%
lithium metabolism
through the kidneys, so if there is kidney dysfunction, you can not give lithium ;for bipolar then give valproic acid
MCC of foot drop
neuropathy, L5 radiculopathy, and traumatic damage
pica for ice
called pagophagia, and is often seen in pt with Fe def anemia
possible consequence of chemo and radio therapy for Hogkins
3.2% will develop secondary malignancy in 20 years, the most common sites being lung and breast
treatment of enuresis
enuresis is recurrent invol voiding into clothses/bed after 5 y/o

1st line behavioral techniques
2nd line is desmopressin
3rd line is TCA imipramine (it is last due to safety profile)
UC vs Crohns
treatment route for endocarditis
must treat IV!!!
kidney disease seen in pt with active HBV ifx
PAN, membranoproliferative glomerulonephritis, and membranous glomerulonephritis
lifestype modificiation to reduce BP
reduce Na intake, weight loss, avoid excessive alcohol
1st line treatment in OA
charact of Waldenstrom's macrogloulinemia
hyperviscosity do to excess IgM which will show as a spike on the SPE, increased spleen, liver, and LNs, tiredness, HA, neuropathies
what to do with newly dx Lupus pt
renal biopsy

note that SLE renal disease is one of the leading causes of mortality, up to 40-75% of pts
ways that cancer can cause hypercalcemia
metastatic solid tumors via cytokines

Hodgkin's via calcitrol

nonmetastatic tumors via PTHrP
drugs used in stress testing when exercise is not an option
dobamine or dipyridamole
Somogyi effect in diabetics
when there is hyperglycemia in the early morning due to counerregulatory hormones like Epi, NE, adn glucagon due to too much insulin at bedtime ;when the extra insulin is given at bedtime, there is hypoglycemia at like 3am that causes these hormones to kick in and increase glucose, but they overshoot
treatment of Tourettes
typical antipsychotics like haldol or pimozide
Hawthorne effect
when the study pop changes outcomes since they know they are being studied
treatment of Paget's disease of bone
only treat if symptomatic with bone pain, neuro defect, high output heart failure, or involement of weightbearing joints
how to treat acute renal transplant rejection
high dose IV steroids
hepatitis problem that has waxing and waning ALT/AST lvls

it also has arthralgias and myalgias
triad of Meniere's disease
dizziness, hearing loss, and tinnitus
lung cancer with increased sercum Ca
squamous cell that makes PTHrP

think aCa++mous

note that small cell associated with ACTH production
an anticholinergic used in Parkinson's, similar to benztropine
Fe def anemia and arthritis
if it is RA, this anemia of chronic disease

if it is OA, think NSAID use causing ulcers and GI bleeding
dx of vasovagal syncope
upright tilt table test
what electrolyte is bad prognostic factor in CHF
hyponatremia, as it shows a high lvl of the RAAS system and water retention trying to keep up CO
primary CNS lymphoma
seen in HIV pt

can cause altered mental status and can have EBV DNA in the CSF, MRI can show solitary, weakly ring-enhancing periventricular mass
infection of the pleural space
anything entering the pleural space can cause them, one common one is a hemothorax

reatment is surgery to remove pus, clotted blood, and fibrinous peel
well known renal complication seen in Hodgkin's lymphoma
minimal change disease
s/s of glucagonma
hyperglycemia, necrolytic migratory erythema, and diarrhea
Gilbert's vs Crigler Najjar
treatment of cancer induced anorexia
progestins like medasterol (megase)
effect of current or previous dx of anorexia on preg
increased risk for miscarriage, premie, small for gest age, hyperemesis gravidarum, postpartum depression
suspect in pt with GI issues followed by triad of periorbital edema, myositis, and eosinophilia

can also have splinter and retinal hemorrhages
an antimitotic agent leading to cell death, used in condylomata acumiata caused by HPV
treatment of HPV warts
chemical agents: 5-FU, podophyllin

immune therapy: imiquimod, interferon alpha

surgery: cyro, laser, excisional
Serum ascites albumin gradient found by different in albumin conc in serum vs ascites fluid

SAAG of 1.1 or greater shows transudative process consistent with portal HTN
isoniazid and the liver
isoniazid causes indosyncratic liver injury with histology that looks like viral hepatitis

this is NOT dose dependent
what causes anion gap metabolic acidosis with an osmolar gap
ethylene glycol, methanol, and ethanol intox

osmlar gap = observed osm - calculated osm

calculated = 2Na +Glu/18 + BUN/2.8
how to calculate osmolar gap
osmolar gap = observed osm - calc osm

calc osm = 2Na+ Glu/18 + BUN/2.8
ethylene glycol poisoning
will cause calcium oxalate crystals that are rectangular and envelope shaped

it causes anion gap met acidosis with osmolar gap

they will be stuporous, agitated , and disoriented
Duke's criteria for infective endocarditis
must have 2 major, one major and 3 minor, or 5 minor

major are: 2 positive blood cultures, endocardial involve on echo, new murmur

minor are: predispising condition, fever > 38C, septic emboli, immunologic phenom, one pos blood culture
electrolyte changes in tumor lysis syndrome
hyperkal and hyperphos from being released from intracell

excess phos binds Ca making hypocalcemia

cellular protein breakdown leads to hyperuricemia
treatment of uncomplicated cystitis
TMP-SMX or nitrofurantoin
homocystenuria and pyridoxine
what causes the pain in a pulmonary embolism?
associated minor to massive pulmonary infarctions
colonoscopy recommendations in ulerative colitis pts
start screen 8 years after the dx, then repeat every 1-2 years after

note: some say you can extend the 1st window if only the left colon is involved
treatment of herpes zoster
valacyclovir or acyclovir

postherpetic neuralgia can be treated with TCAs like amitriptyline
UA results
leukocyte esterase indicates pyuria

nitries indicate Enterobacteriaceae, like E. coli, the MCC of UTI
tick-borne paralysis
rapid ascending paralysis (hours to days), absence of fever or sensory abnormalities and normal CSF, treatement is removal of the tick

NOTE: Guillian Barre is days to weeks with sensory defict
radiation therapy use in prostate CA
radiation therapy is useful for managing bone pain in pts with prostate cancer s/p orchiectomy
pt with organophosphate poisoning
1st take off clothes and wash skin, as it is absorbed through the skin

treatment is then use atropine and pyridoxime
area of the brain damaged in hemi-neglect
the right (non-domiant) parietal lobe
1st step in pt on heparin with drop in platelets
pt has heparin induced thrombocytopenia (HIT) due to Ab against heparin-platelet factor 4

1st thing to do is stop the heparin

then start other form of anticoag like danaparoid or lepirudin
recommened screening mammograms
every 2 years for women 50 and older
DeQuervain tenosynovitis
inflammation of abd pollicis and extensor pollicis when mothers hold newborns with their thumbs outstretched
blastomycosis s/s
pulmonary infection with fever, sweats, productive cough, and weight loss

if it becomes systemic it can lead to ulcerated skin lesions and bone lesions
accidental preg within 3 months of MMR vaccine
you should wait 3 months to get preg after rubella vaccine, but if it happens, just reassure them, as there have been NO cases of congenital rebella syndrome from vaccinations
fever, chills, and elevated ESR

common in IVDA, and can include the spine
disseminated histoplasmosis s/s and dx
palatal ulcers, hepatoslpenomegaly, and pancytopenia
treatment of essential tremors
1st line is propranolol, but can not be give if contra as in bradycardia or COPD

2nd line is primidone an antiseizure that is converted to phenobarbital, SE of primidone is acute intermittent porphyria with abd pain, neuro and psych abd
causes of acalculous cholecystitis
extensive burns, severe trauma, prolonged TPN, prolonged fasting, mechanical ventilation
cause of mortality in SAH
vasospasm that induces infarction, occurs in 30% of pt s/p SAH

prevent with Ca channel blockers like nimodipine
treatment of uric acid renal stones
uric acid renal stones are 10% of renal stones and do not show up on xray

treat by alkalinization of the urine to pH > 6.5 with oral potassium bicarb or potassium citrate
causes of renal colic that do not show on xray
radiolucent stones like uric acid

Ca stones less than 3mm

nonstone causes like obstuction via tumor or clot
potassium citrate
used to alkalize the urine as it is metabolized into bicarb by the liver
MCC of epiglottitis
H. influ and strep pyogenes
treatment of Lyme disease
doxycycline, but if pt is preg it is contra so use amoxicillin
Meniere's disease
abnormal accumulation of endolymph in the inner ear

s/s are vertigo, tinnitus, hearing loss, or a sense of ear fullness
dx of ARDS
acute onset resp distress in setting of predisposing condition

PaO2/FiO2 ratio < 200

bilateral infiltrates and a normal PCWP (<18)
electrolytes in OSA
it can cause chronic hypercapnia and hypoxia causing resp acidosis

renal compensation increases bicarb and decreases chloride reabsorption
thalamic stroke
a painful stoke due to damage of the VPL that routes sensory information from the contralateral side of the body
role of digoixin and furosemide in CHF
they reduce symptoms and hospitalizations, but do NOT improve survivial
psoriatic arthritis
usually involves the DIP of the hand, morning stiffness, dactylitis (sausage digit), and nail involvement
treatment of Grave's diesease
radioactive iodine therapy unless contra by preg or severe ophthalmopathy

2nd line is antithyroid drugs like propthyouricil or methimidizole (sp?)
SE of abrupt withdrawal for short acting benzos
generalized seizures and confusion
MCC of suspected brain abscess
aerobic and anaerobic strep as well as Bacteroides (also anaerobic)

staph is only responsible for 15%
amnioglycosides and the renal system
they are used to treat gram neg infections and can be nephrotoxic

examples are gentamicin, neomycin, strptomycin, tobramycin, and amikacin
soap bubble appearance in the epiphyseal of bones
think giant cell tumor and needs referral to ortho surgeon
electrolytes in Conn's
primary hyperaldosteronsism leads to increased Na, decreased K, increased bicarb causing metaboic alkalosis
what can cause S4 heart sound
prolonged HTN causing left vent hypertrophy that causes decreased ventricular compliance
risk of having bipolar disorder
general population: 1%

if pt has 1st degree relative, risk is 5-10%

if both parents are, child is 60%
ethylene glycol poisoning
calcium oxalate in the kidneys, extra oxalate binds Ca, so hypocalcemia

treat with fomepizole or ethanol to reduce further metaboilsm of the ethylene glycol with alcohol dehydrogenase
indication for removal of pleual fluid
if the pH < 7.2 or glucose < 60, it is suggestive of empyema and needs to be drained via thoracostomy
lumbar spinal stenosis
pain termed "neuropathic claudication" is seen in lumbar spinal stenosis. Similar to pain with PVD, but this pain is position dependent, worse with standing

pain reduced by sitting or walking uphill

dx with MRI of the spine
next step in a newly dx 1st degree heart block
just observation if they are asymptomatic