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x Medicine 200 > UWorld Educational Objectives > Flashcards

UWorld Educational Objectives Flashcards

1
Q

tx for hyperthyroid induced tachysystolic afib

A

beta-blockers

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2
Q

Can hyperPTH cause hypertension

A

Yes, a rarer cause of secondary HTN

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3
Q

HOCM murmur is where

A

LLSB

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4
Q

Most common cause of constrictive Pericarditis in the third world

A

TB

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5
Q

Common causes of constrictive pericarditis

A

Radiation therapy, viral infections, and Cardiac surgery

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6
Q

CHF in young patient

A

Consider viral myocarditis from coxsackie B

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7
Q

First line medical tx for HOCM

A

Beta-blocker or non-dihydropyridine CCB like diltiazem

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8
Q

tx for aortic regurg.

A

decrease afterload, dihydropyridine CCB or ACEi

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9
Q

When does mitral stenosis usually present

A

in pregnancy

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10
Q

What are reversible risk factors for PACs

A

tobacco and alcohol

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11
Q

tx in symptomatic PACs

A

beta-blockers

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12
Q

Tx for cardiac tamponade

A

Massive volume resuscitation and emergency pericardiocentesis

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13
Q

First line tx for PVCs symptomatic

A

beta-blockers

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14
Q

First study for AAA

A

abd. u/s

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15
Q

Mitral prolapse murmur softened with what maneuvers

A

Softened with increased preload

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16
Q

Diagnostic criteria for ARDS

A

Acute onset; Bilateral patchy airspace disease on CXR; PCWP<200

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17
Q

First line tx for Cocaine induced cardiac ischemia

A

Benzos, nitrates, and aspirin. (Nitrates help vasodilate the coronaries)

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18
Q

MItral stenosis patients develop what

A

They develop afib from the L atrial dilation

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19
Q

HOCM inheritance

A

Aut. Dom.

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20
Q

When does ventricular free wall rupture occur

A

3-7 days post-anterior wall MI

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21
Q

What meds to hold before stress testing

A

Inotropes like digoxin and beta-blockers

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22
Q

What blood vessels supply the different areas of the heart

A 
Inferior wall: R coronary artery >>> L circumflex
Anterior Wall: L anterior descending 
Lateral Wall: LAD and L circumflex
Right ventricle: RCA
Posterior wall: RCA
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23
Q

Lone afib tx

A

Aspirin, if they dont have stroke, tia, DM, HTN, HF, Age>75, or valvular heart dz. Hence no one is on aspirin therapy.

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24
Q

CK-MB or troponin for immediate MI recurrence

A

CK-MB, because it returns to normal in 2 days, troponin is more specific but is present for 10 days

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25
Q

Dresslers syndrome

A

Improved leaning forward. Tx with NSAIDs. Avoid anticoagulation to prevent hemorrhagic pericardial effusion

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26
Q

Megaesophagus, megacolon, and cardiac dysfunction

A

Chagas dz

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27
Q

Amiodarone side effects

A

Pulm fibrosis, thyroid (hypo or hyper), hepatotoxcity, corneal deposits, and skin discoloration

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28
Q

Loop diuretics electrolyte effects

A

HypoK and HypoMag

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29
Q

Tx WOlf-Parkinson-White patients

A

Avoid AV nodal blockers like beta-blockers, CCBs, digoxin, and adenosine because of increased conductance through the accessory pathway

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30
Q

One of the most deadly consequences of aortic dissection

A

Cardiac tamponade

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31
Q

Most common cause of daeth with acute MI

A

Reentrant ventricular arrhythmia (vetricular fibrillation)

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32
Q

Treating strep viridans endocarditis

A

IV pencillin G or IV ceftriaxone

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33
Q

Tx congenital long QT syndrome

A

beta blockers

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34
Q

Post-MI persistent ST elevations

A

Ventricular Aneurysm

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35
Q

Dipyramidole effect on stress testing

A

Coronary steal: it diverts blood to the healthy tissues because it dilates all the vessels but the diseased vessels are already maximally dilated so you get less perfusion

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36
Q

Premature atrial beats tx and f/u

A

they are benign and need nothing

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37
Q

Thiazides bad side effects

A

Hyperglycemia, hyperTGs, inc. LDL, hypoNa/K and hyperCa

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38
Q

Surgery for AAA

A

> 5cm, symptomatic, rapid rate of growth

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39
Q

Best way to slow AAA progression

A

smoking cessation

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40
Q

What lowers preload-meds

A

nitrate and diuretics

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41
Q

Heat stroke definition

A

temp >105

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42
Q

Can cocaine cause STEMIs

A

yes

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43
Q

Pathology of HTN emergency

A

fibrinoid necrosis of small arterioles

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44
Q

Papilledema on ophthalmoscopy in HTN >200

A

Confirms the diagnosis

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45
Q

Digitalis toxicity heart effects

A

A.fib and AV block (from increased ectopy and vagal tone, respectively)

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46
Q

Mobitz type II origin

A

His Purkinje fucked up

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47
Q

Long term prognosis in STEMI most effected by

A

time to coronary blood flow restoration

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48
Q

best tx for ventricular tachycardia

A

Amiodarone or lidocaine

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49
Q

What to avoid in variant (printzmetal’s angina)

A

beta blockers and aspirin because they promote vasoconstriction

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50
Q

BP >30 mmHg between arms and tearing chest pain

A

Aortic dissection

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51
Q

tests for suspected aortic dissection

A

TEE!!!!! or CT with contrast

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52
Q

Drug for stable angina and HTN

A

beta-blockers

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53
Q

Quickest drug to relieve pulm. edema

A

nitroglycerin

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54
Q

Causes of pulsus paradoxus

A

Cardiac tamponade, tension pneumothorax, severe asthma

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55
Q

aortic dissection EKG

A

normal

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56
Q

Before TEE for aortic dissection, do what first

A

control HTN

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57
Q

what is tilt table testing

A

used to dx vasovagal syncope: pt strapped in goes from supine to standing position very quickly

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58
Q

TB pleural effusion is notable for what

A

High adenosine deaminase concentration

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59
Q

Causes of ARDS

A

sepsis, severe infection, extreme bleeding, toxic ingestions, burns

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60
Q

theophylline toxicity chracaterized heavily by

A

excess epinephrine: GI upset, headache/insomnia, arrhythmia

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61
Q

Theophylline and erythrmoycin/ciprofloxacin

A

Those antibiotics increase the plasma concentration by decreasing clearance leading to toxicity

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62
Q

INtermittent hemoptysis with mobile cavitary lesion in lung

A

Aspergilloma

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63
Q

Inpatient tx for CAP

A

levofloxacin for antipneumococcus. O/p therapy azithro or doxy

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64
Q

Dx PCP

A

bronchoalveolar lavage

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65
Q

what do you fear most with bronchiectasis

A

fatal hemoptysis

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66
Q

Clubbing and sudden-onset joint arthropathy in a chronic smoker

A

Hypertrophic osteoarthropathy: often associated with lung cancer

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67
Q

Characteristic extrapulmonary manifestation of Mycoplasma pneumonia

A

erythema multiforme

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68
Q

Mild hemoptysis in pts with smoking history

A

chronic bronchitis

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69
Q

DLCO in emphysema and chronic bronchitis

A

low in emphysema and normal in chornic bronchitis

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70
Q

Postpartum woman with pulm. symptoms and multiple nodules on xray

A

Suspect choriocarcinoma, elevated beta-hCG confirms diagnosis

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71
Q

Second episode of clot tx

A

Lifetime coagulation

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72
Q

Nonseminomatous GCTs markers

A

AFP and beta-hCG

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73
Q

WHAT HAPPENS when you lay on side of consolidation

A

can get arteriovenous shunting and hypoxia

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74
Q

Most common causes of SVC syndrome

A

small cell lung cancer and non-Hodgkin’s lymphoma

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75
Q

Tube thoracotomy indications

A

effusion pH <60

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76
Q

When to do embolectomy for PE

A

if there is a contraindication to fibrinolysis

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77
Q

what decreases mortality in COPD

A

home oxygen and smoking cessation

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78
Q

sweat chloride test is positive if

A

Cl>60

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79
Q

muscle side effect of cocaine

A

rhabdo

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80
Q

What level CPK needed to cause ATN in rhabdo

A

CPK >20,000 U/L

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81
Q

What can raise the left mainstem bronchus and cause a persistent cough

A

Enlarged left atrium from mitral stenosis from rheumatic fever

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82
Q

Old person with PNA, abdominal pain, confusion, and hyponatremia

A

Legionella pneumonia

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83
Q

A1AT deficiency organs affected

A

lungs and liver

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84
Q

Legionella key

A

ABDOMINAL PAIN/GI COMPLAINTS and CONFUSION

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85
Q

Anaerobic lung infection tx

A

Clindamycin

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86
Q

Aspirin allergy

A

Pseudo-allergic reaction: avoid NSAIDs and use leukotriene receptor antagonists

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87
Q

When to use thrombolytics in PE

A

When there is hemodynamic instability. R ventricluar strain is a relative indication

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88
Q

Histoplasma environment

A

Mississippi or Ohio River valleys and Central America where there is lots of bird or bat shit

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89
Q

Sarcoid extrapulmonary manifestations

A

Skin: erythema nodosum Eyes; uveitis

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90
Q

new clubbing in COPD patients

A

new lung cancer

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91
Q

PCP CXR findings

A

bilateral diffuse interstitial infiltrates beginning in the perihilar region is characteristic

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92
Q

A-a gradient in restrictive diseases

A

Wider due to lower DLCO and V/Q mismatch

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93
Q

difference between neuromuscular diseases and restrictive lung disease

A

DLCO normal in neuromuscular disease

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94
Q

Blastomycosis geography

A

Great lakes, mississippi, and ohio river valley

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95
Q

Skin and bone lesions, productive cough from the midwest

A

Blastomycosis

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96
Q

blastomycosis tx

A

itraconazole or amphotericin B

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97
Q

Allergic rhinitis tx

A

H1 receptor antagonists decrease nasal inflammation and post-nasal drip

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98
Q

Hypercalcemia and what GI complaint

A

Constipation, can be severe

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99
Q

Hypercalcemia presentation

A

Severe constipation, anorexia, weakness, renal tubular dysfunction, and neurologic symptoms

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100
Q

When to suspect ischemic colitis

A

Patients with evidence of atherosclerotic vascular disease, presenting with abd. pain followed by bloody diarrhea with minimal abd. exam findings. Splenic flexure most commonly affected.

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101
Q

Tx for asymptomatic diverticulosis

A

high-fiber diet

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102
Q

First step in mgmt of patients with dyspepsia <45 years with no alarm sxs

A

Noninvasive tests for H. pylori

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103
Q

dx esophageal spasm

A

manometry

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104
Q

Zinc deficiency sxs

A

alopecia, skin lesions, abnormal taste, and impaired wound healing

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105
Q

dx of achalasia

A

manometry, endoscopy to r/o malignancy

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106
Q

explain d-xylose test

A

D-xylose is purely absorbed without digestion needed, so it tests the integrity of the gut mucosa. Will have low urine excretion with bacterial overgrowth and celiacs, but overgrowth will normalize with abx

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107
Q

skin finding and celiacs

A

dermatitis herpetiformis

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108
Q

carcinoid triad

A

flushing, wheezing, diarrhea

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109
Q

what to supply carcinoid syndrome with

A

niacin; used up in formation of 5-HT

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110
Q

MEN I associated diseases

A

Primary hyperPTH, pituitary tumors, enteropancreatic tumors

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111
Q

Suspect crohn’s in….

A

young patient with chronic diarrhea, abd. pain, and weight loss

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112
Q

what drug causes digoxin toxicity

A

verapamil

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113
Q

risk factors for polyp developing into malignancy

A

Villous adenoma, sessile adenoma, and size>2.5 cm

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114
Q

Whipple’s disease histology

A

PAS-positive material in the lamina propria of the small intestine

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115
Q

Whipple’s disease presentation

A

arthralgias, weight loss, fever, diarrhea, and abd. pain

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116
Q

UC extraGI manifestations

A

PSC, uveitis, erythema nodosum, and spondyloarthropathy

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117
Q

Severe complications of UC

A

toxic megacolon and colon cancer

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118
Q

Which IBD improves with Cigarette smoking (decreased likelihood)

A

Smoking associated with Crohn’s

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119
Q

Screening for UC

A

yearly colonoscopies 8-10 yrs after diagnosis

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120
Q

Dx whipple’s

A

Upper IG endoscopy and biopsy small intestine

121
Q

LES in diffuse esophageal spasm

A

Normal relaxation response

122
Q

When to tx chronic hep B

A

persistently eelvated ALT, detectable serum HBsAg, HBeAg, and HBV DNA with interferon or lamivudine

123
Q

recurrent pancreatitis with no known cause w/u

A

ERCP

124
Q

non-alcoholic fatty liver disease pathophys

A

insulin resistance increases rate of lipolysis and elevating the circulating insulin levels

125
Q

liver metastases

A

GI tract, lung, breast

126
Q

chronic liver disease vaccinations

A

hep A and B

127
Q

Hydatid cyst cause

A

Echinococcus granulosus

128
Q

AST and ALT lels in alcoholic liver disaease

A

<500 IU/L almost always

129
Q

Risk factors for cholangiocarcinoma

A

PSC patients who smoke and have UC

130
Q

pancreatic cancer risk factors

A

FH, chronic pancreatitis, smoking, diabetes, obesity, high fat diet. NOT ALCOHOLISM

131
Q

best test for acute panceatitis

A

serum amylase and lipase

132
Q

chronic Hep A infection presentation

A

DOESN’T EXIST

133
Q

first step in acute renal failure

A

foley catherization is a critical first step to r/o post-renal obstructions

134
Q

RFs for non-alcoholic steatohepatitis

A

obesity, diabetes, hyperlipidemia, TPN, some meds

135
Q

tx for asymptomatic esophageal varices

A

non-selective beta-blockers

136
Q

30% of hemochromatosis patients die from this

A

HCC

137
Q

ADPKD presentation

A

intermittent flank pain, hematuria, UTIs, and nephrolithiasis

138
Q

HIV kidney disease

A

collapsing focal and segmental glomerulosclerosis

139
Q

FSGS presentation

A

nephritic range proteinuria, azotemia, normal sized kidneys

140
Q

tx for dehydration

A

NSS

141
Q

most common nephropathy with carcinoma

A

membranous nephropathy

142
Q

Hodgkin’s lymphoma kidney disease

A

Minimal change disease

143
Q

most common cause of renal vein thrombosis in patient with nephrotic syndrome

A

membranous glomerulonephritis (it is the most common one)

144
Q

fibromuscular dysplasia angiogram

A

string of beads

145
Q

IgA nephropathy presentation

A

MCC of glomerulonephritis in adults, recurrent gross hematuria, 1-3 days after upper respiratory infection. Serum complement levels are normal

146
Q

Major toxicity of azathioprine

A

dose-related diarrhea, leukopenia, hepatotoxicity

147
Q

major toxicity of mycophenolate

A

Bone Marrow suppression. M for marrow and mycophenolate.

148
Q

RHabdo signs

A

Disproportionate elevation in creatinine as compared with BUN, positive blood on dipstick but no RBCs

149
Q

tx for rhabdo

A

aggressive IV hydration, alkalinize urine, forced mannitol diuresis may be required

150
Q

MC presentation of cryoglobulinemia

A

palpable purpura, glomerulonephritis, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, peripheral neuropathy, and hypocomplementemia. Most patients also have Hep C

151
Q

classic findings in amyloidosis histology

A

renal amyloid deposits that show apple-green birefringence under polarized light after staining with congo red

152
Q

acute post-strep glomerulonephritis presentation

A

10-20 days after strep throat or skin infection. Hematuria, HTN, red cell casts, and mild proteinuria

153
Q

Goodpasture’s tx

A

emergent plasmapheresis

154
Q

wegener’s tx

A

cyclophosphamide and steroids in combo

155
Q

when to image pyelo

A

if it doesnt respond after 48-72 hrs of abx

156
Q

most common drug cause of priapism

A

prazosin

157
Q

MCC of abnormal hemostasis in CRF patients and tx

A

platelet dysfunction, tx with DDAVP (release VIII and vWF multimers). Do not use PLATELETS!

158
Q

EPO side effects

A

HTN worsening, HA, flu like symptoms

159
Q

tx for hepatorenal syndrome

A

liver txp

160
Q

woman with chronic headaches with painless jaundice

A

analgesic nephropathy (papillary necrosis)

161
Q

MCC of drug induced CRF

A

analgesic nephropathy (papillary necrosis and chronic tubulointerstial nephritis)

162
Q

Analgesic abuse causes

A

premature aging, atherosclerosis, and urinary tact cancer

163
Q

Alport’s presentation

A

recurrent hematuria, sensorineural deafness, FH of renal failure

164
Q

hep B ifxn and nephrotic syndrome

A

membranous glomerulonephritis

165
Q

acute tx of hypercalcemia

A

IV NSS followed by loop diuretic, then bisphosphonates, then calcitonin, then dialysis

166
Q

primary hyperTH urine presentation

A

normal or eleavated urinary calcium excretion

167
Q

succinylcholine bad side effect

A

life-threatening hyperK

168
Q

severe hyperNa

A

0.9% Na

169
Q

mild hyperNa

A

D51/2NS

170
Q

vomitizing leads to what disturbance

A

hypochloremic metabolic alkalosis with hypoK

171
Q

most common drug causes of hyperK

A

ACEIs, spironolactone, trimethoprim!

172
Q

lithium and what kidney dysfunction

A

nephropgenic DI, tx with salt restriction and cease lithium

173
Q

hypocalcemia common presentation

A

Hypeactive deep tendon reflexes in patients undergoing major surgery and requiring lots of transfusions

174
Q

lactic acidsosi in patients with atherosclerosis or afib

A

unrecognized bowel ischemia

175
Q

type 4 RTA presentation

A

diabetic patient with non-anion gap metabolic acidosis, persistent hyperK and renal insufficiency

176
Q

aspirin intoxication presentation

A

triad of fever, tinnitus, and tachypnea

177
Q

common acid-base disorder after a GTC seizure

A

postictal lactic acidosis that resolves in 60-90 minutes

178
Q

AVN of femoral head presentation

A

progressive hip/groin pain without restriction of motion and normal radiographs early on. MRI is gold standard dx.

179
Q

RA with septic arthritis cause

A

Staph aureus

180
Q

subacromial bursitis presentation

A

pain with active range of shoulder motion, passive itnernal rotation and forward flexion elicits tenderness. caused by repeititive overhead motions.

181
Q

Page disease (osteitis deformans) blood work

A

normal serum calcium and phosphate levels and increased alk phos and urinary hydroxyproline levels

182
Q

tx for lupus nephritis

A

immunosuppressants

183
Q

test for temporal arteritis

A

elevated ESR and temporal artery biopsy

184
Q

dermatomyositis presentation

A

violaceous rashes on face with periorbital edema and proximal muscle weakness, ovarian cancer as well.

185
Q

viral arthritis presentation

A

symmetric small joint inflammatory arthritis, resolves within 2 months. ANA and RF positive possibly.

186
Q

disseminated gonoccocemia

A

high fever, chills, tenosynovitis, migratory polyarhtrlagias and asmall number of hemorrhagic pustular lesions ont he extremities

187
Q

bone metastases prez.

A

progressive pain worsened at rest

188
Q

dx of polymyositis or dermatomyositis

A

muscle biopsy

189
Q

polycythemia vera and what rheum disease

A

gout

190
Q

AVN of bone risk factors

A

chronic steroids and chronic alcohol abuse

191
Q

hyperthyroid myopathy

A

progressive proximal muscle weakness

192
Q

OA presentation

A

age>50, crepitus, bony enlargement, bony tenderness, lack of warmth/morning stiffness

193
Q

ankylosing spondylitis presentation

A

seronegative spondyloarhtorpathy in men<40 yrs, low back pain worst in morning improving over the day

194
Q

ankylosing spondylitis extraspinal manifestation

A

anterior uveitis

195
Q

prosthetic joint septic arthritis

A

staph aureus

196
Q

hydroxychloroquine side effect

A

retinopathy

197
Q

osteomylelitis risk groups

A

IV drug users and diabetics

198
Q

fibromyalgia tx

A

amitryptyline and cyclobenzaprine to restore phase 4 sleep

199
Q

OA affects what joints

A

DIP joints

200
Q

reactive arthritis presentation

A

seronegative from enteric or GU infection, may include urethritis, conjunctivis, mucocutaneous lesions, ethesitis, and asymmetric oligoarthritis, NSAIDs are first line

201
Q

RA spine problem

A

cervical spine C1-C2 instability subaxial subluxation

202
Q

De Quervain tenosynovitis prez

A

new mothers who hold babes with thumb outstretched

203
Q

methotrexate SEs

A

stomatitis, nausea, anemia, and hepatotoxicity. tx with folate

204
Q

systemic sclerosis antibodies

A

ANA and anti-topoisomerase-I

205
Q

sjogren antibodies

A

anti-RO and LA (SSA and SSB, respectively)

206
Q

Hyperparathyroidism and rheum

A

pseudogout

207
Q

disseminated gonococcus infexion prez

A

triad of polyarthralgias, tenosynovitis, and vesiculopustular skin lesions

208
Q

serum sickness-like from drugs presntation

A

1-2 weeks after penicillin, amoxicillin in setting of viral illness. Fever, urticarial rash, polyarthralgia, and LAD

209
Q

serum sickness preesntation

A

non-human proteins lead to immune compelx mediated hypersensitivity, resolves with withdarwal of ofending agent, not a true drug allergy

210
Q

erythema nodosum presentation

A

painful, subQ, pretibial nodules. seen in sarcoid, TB, histo, recent strep, IBD

211
Q

distinguish the leg claudications

A

both worse pain with walking, neurogenic remains painful standing still, and neurogenic has normal ABI and arterial pulses

212
Q

ruptured baker’s cyst

A

can look like DVT

213
Q

methotrexate blood effect

A

macrocytic anemia

214
Q

behcet’s syndrome presentation

A

recurrent oral and genital ulcers, skin lesions, most common in turkish, asian, and arabs

215
Q

artery complications of giant cell or temporal arteritis

A

aortic aneurysms

216
Q

psoriatic arthritis presentation

A

DIPs, morning stiffness, deformity, dactylitis, nail infolvement. tx with NSAIDs, anti-TNF agents, and methotrexate, NO STEROIDS

217
Q

Cyclophosphamide side effects

A

long term leads to acute hemorrhagic cystitis and bladder carcinoma

218
Q

HLA-B27

A

PAIR: Psoriatic arthritis, ankylosing spondylitis, IBD, reitiers?.

219
Q

IBD and ankylosing can have what antibody in common

A

p-ANCA espite no vasculitis

220
Q

most common causes of cellulitis

A

group A strep and staph aureus

221
Q

parvovirus presentation

A

MCP, PIP, wrist, and ankle arthritis.

222
Q

Anti-B19 IgM

A

Parvovirus. diagnostic

223
Q

CREST syndrome presentation

A

Calcinosis cutis (Ca in skin), raynaud, esophageal dysmotility, sclerodactyly, and telangiectasis

224
Q

Exercise and fibromyalgia pain

A

WoRSENS IT!

225
Q

Fibromyalgia presentation

A

fatigue, IBS, depression w/o any joint swelling or muscle weakness

226
Q

anserine bursitis presentation

A

sharply localized pain over the anteromedial part of the tibial plateau just below the joint line of the knee. Valus stress test fails to reproduce the pain, ruling out damage to the medial collateral ligament, radiographs are classically normal.

227
Q

viral arthritis vs RA

A

acute onset, lack of elevated inflammatory markers, and resolution w/i two months

228
Q

ankylosing spondylitis and fractures

A

increaed risk for dz >2 decades.

229
Q

secondary amyloidosis cause

A

chronic systemic inflammation as may occur in autoimmune disorders, chronic infections, IVDA

230
Q

amyloidosis presentation

A

nephrotic syndrome, hepatomegaly, cardiomyopathy, pseudohypertrophy of muscles, and peripheral neuropathy

231
Q

Paget’s disease pathophys

A

osteoclast dysfunction leading to mosaic pattern of lamellar bone, incr. alk phos, and characteristic xray findings like femoral bowing. bone and joint pain, skeletal deformities, and hearing loss are common sxs

232
Q

SIAD presentaiton

A

hypotonic hyponatremia with euvolemia. Low plasma osmolality (100-150 mOsm/kg) is diagnostic in suspected patients

233
Q

dx of acromegaly

A

GH levels following oral glucose load, no suppression of GH levels following oral glucose load

234
Q

tx hyperthyrodism

A

propranolol genreally used for sx relief until underlying cuase is identified and definitively treated

235
Q

most important causes of thyrotoxicosis with low radioactive iodine uptake

A

subacute painless thyroiditis; subacute granulomatous thyroiditis; iodine-induced thyroid toxicosis; levothyroxine overdose; struma ovarii (thyroid tissue in ovaries)

236
Q

osteomalacia electrolytes

A

low or low-normal serum calcium, low serum phosphate, and increased serum PTH

237
Q

adrenal insufficiency and calcifications in adrenal glands is…

A

adrenal TB

238
Q

primary adrenal insufficiency MCC in developed countries

A

autoimmune adrenalitis

239
Q

factitious thyrotoxicosis presentation

A

hyperthyroid sxs, but no goiter or exophthalmos, low TSH and elevated T3 and T4. decreased diffusely iodine uptake by thyroid. biopsy shows follicular atrophy.

240
Q

most thyroid nodules are

A

benign colloid nodules

241
Q

hypophoshatemic rickets presentation

A

normal serum ca, normal alk phos, normal vit.d, low phospahte

242
Q

preferred tx for graves’ disease

A

radioactive iodine therapy

243
Q

contraindications to radioactive iodine tx

A

pregnancy and very severe ophthalmopathy

244
Q

what ratio for primary hyperaldo plasma aldo:plasma renin activity

A

ratio >30 suggests primary aldo. can’t suppress it with NSS or oral salt solution also supports priamry. then use CT to look for adrenal adenoma

245
Q

early side effect of radioactive iodine tx

A

initial worsening of hyperthryoid sxs

246
Q

pH effect affecting calcium

A

alkalosis leads to increased albumin binding of Ca leading to decreased ionized calcium.

247
Q

hashimoto’s antibodies

A

Anti-TPO

248
Q

rapidly developing hyperandrogenism

A

androgen-secreting neoplasm of ovary or adrenal. testosterone for ovarian source and DHEAS for adrenal source.

249
Q

toxic nodule presentation

A

radioactive iodine uptake in nodule with suppression of uptake in the rest of the gland. NO INFILTRATIVE OPHTHALMOPATHY.

250
Q

MEN type 1

A

The 3 P’s: pituitary adenoma, pancreatic islet cell tumor, and hyperPTH. Tumor suppressor gene Menin.

251
Q

MEN type 2 inheritance

A

aut. dom.

252
Q

MEN type 2a and 2b both share

A

Medullary carcinoma of the thyroid and pheochromocytoma

253
Q

MEN type 2a unique

A

Primary hyperPTH (hyperplasia)

254
Q

MEN type 2b unique

A

mucosal neuromas and marfanoid habitus

255
Q

MEN type 2

A

2a: medullary thyroid cancer; pheo; primary PTH hyperplasia
2b: medullary thyroid cancer; pheo; mucosal neuromas and marfarnoid habitus

256
Q

bones and hyperthryoid patients

A

rapid bone loss from increased osteoclastic activity

257
Q

vit D toxicity

A

hyperCa, constipation, abd. pain, weight loss, polyuria, polydipsia. (ALL SIGNS OF HYPERCALCEMIA)

258
Q

cause of graves ophthalmopathy

A

proptosis 2/2 autoimmune lymphocytic infiltration of the extraocular muscles resulting in fibroblast proliferation, hyaluronic acid deposition, edema, and fibrosis

259
Q

most common thyroid malignancy

A

papillary carcinoma of the thyroid

260
Q

when to suspect TSH adenoma

A

high T3/T4 with normal or high TSH

261
Q

fever and sore throat in patient taking antithyroid drugs

A

agranulocytosis, stop drugs and check WBCs

262
Q

CRF and calcium metabolism

A

hypocalcemia, hyperphosphatemia, and increased PTH are characteristic of secondary hyperPTH

263
Q

tx DM gastroparesis

A

Reglan, bethanechol, and erythromycin

264
Q

MEN IIa syndrome cause

A

RET proto-oncogene mutation, total thyroidectomy indicated

265
Q

high estrogen production in young males with secondary inhibition of LH and FSH

A

leydig cell tumor

266
Q

best screening test for suspected adrenal insufficiency

A

cosyntropin (analog ACTH) stimulation test

267
Q

what is elevated in medullary thyroid cancer

A

serum calcitonin

268
Q

hypoPTH presentation

A

low ca and elevated phos with normal renal function.

269
Q

using viagra and an alpha-blocker

A

keep them 4 hrs apart due to risk of hypotension

270
Q

tx of paget’s

A

asymptomatic: no tx. Symptomatic: oral or IV bisphosphonates

271
Q

PTH in most patients with hyperCa of malignancy

A

mostly suppressed

272
Q

Serum calcium in primary hyperPTH vs. hyperCa of malignancy

A

higher in Malignancy

273
Q

primary hyperaldo presentation

A

young patient with HTN, muscle weakness, and numbness with high aldo/renin ratio

274
Q

differentiating folicular cancer from adenomas

A

invasion of the capsule and blood vessels

275
Q

which thyroid cancer metastasizes often

A

follicular thyroid cancer because it invades the blood vessels

276
Q

Alanine turns into what in gluconeogenesis

A

pyruvate

277
Q

Sheehan’s syndrome typical presentation

A

Failure to lactate and other features of pituitary hormal deficiency. overt DI is uncommon.

278
Q

HLD, unexplained hypoNa and elevated serum muscle enzymes means you should do…

A

thyroid function tests (hypothyroid)

279
Q

androgen producing adrenal tumors test

A

elevated serum DHEA-S levels

280
Q

Hashimoto’s and cancer

A

Increased risk of thyroid lymphoma

281
Q

Antithyroid drug therapy serious side effect

A

Agranulocytosis

282
Q

MCC of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

283
Q

When to do parathyroidectomy in asymptomatic patients with primary hyperPTH

A

serum ca >1 mg/dL above upper limit of normal; high urinary calcium 24 hr >400 mg, young age <50, BMD less than T-2.5 at any site; reduced renal function

284
Q

tx for prolactinoma

A

bromocriptine or cabergoline

285
Q

tx for central DI

A

desmopressin which is administered intranasally

286
Q

genrealized resistance to thyroid hormones presentation

A

high serum T4 and T3 with normal/mildly elevated TSH evels with hypothyroid sxs

287
Q

sick euthyroid syndrome

A

Pt with acute, severe illness with fall in T3 but normal T4 and TSH

288
Q

MCC of death in acromegaly

A

cardiovascular

289
Q

bartter’s syndrome presentation

A

hypoK, urine chloride >20 mEq/L, met. alkalosis, normal BP

290
Q

screening for microalbuminuria

A

spot urine collection for microalbumin/creatinine ratio

291
Q

rickets is characterized by

A

defective mineralization of both bone and growth plate cartilage

292
Q

aldosterone secretion in central adrenal insufficiency

A

It is relatively preserved, does not rely on ACTH as much. Angiotensin II is a main driver. absence of ACTH does not lead to zona glomerulosa atrophy

293
Q

tenosynovitis presentation

A

swelling over involved tendon, linked to gonococcus, pain swelling and decreased range of motion, can treat with NSAIDs,

294
Q

Kussmaul’s sign

A

Paradoxical rise in JVP on inspiration due to decreased R ventricular filling. Can be seen in constrictive pericarditis, restrictive cardiomyopathy, cardiac tamponade

295
Q

ABPA leads to what

A

bronchiectasis

296
Q

Treatment for Toxoplasmosis

A

Prevention: Bactrim. Active disease: Pyrimethamine

297
Q

Normal human serum osmolality

A

285-295 mOsm/L

298
Q

Preventing Pneumocystis

A

Pentamidine…or Bactrim….???

299
Q

Buerger’s disease

A

Also known as Thromboangiitis obliterans. Recurring inflammation and thrombosis of small and medium arteries and veins of the hands a nd feet strongly associated with smoking tobacco.

x Medicine 200 (14 decks)

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