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Step 2 CK > Medicine 1 > Flashcards

Medicine 1 Flashcards

1
Q

3 Stages with Chronic HepB Infection with Serum Studies to Define Each

A
  1. Immune Tolerant
    - HBV DNA / HBsAg +
    - ALT nl, b/c no liver inflammation
  2. Immune Active/Clearance
    - HBV DNA / HBsAg +
    - ALT elevated b/c liver inflammation 2/2 immune rxn
  3. Immune Carrier
    - Requires 3x nl HBV DNA AND 3x nl ALT in 12 months
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2
Q

HOCM Tx

A

Beta blockers = decrease HR = increase diastole = increase filling

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3
Q

Type 1 (Distal) RTA:

  • Paph
  • Serum K
  • Urine pH
  • Association / Disease
A
  • Paph: Failure to secrete H
  • Serum K: low
  • Urine pH: high
  • Association / Disease: Stones
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4
Q

Type 2 (Proximal) RTA:

  • Paph
  • Serum K
  • Urine pH
  • Association / Disease
A
  • Paph: failure to reabsorb HCO3
  • Serum K: low
  • Urine pH: normal b/c acidification in distal tubule maintained
  • Association / Disease: bones/fancones
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5
Q

Type 4 RTA:

  • Paph
  • Serum K
  • Urine pH
  • Association / Disease
A
  • Paph: defect in Na/K tx or Aldosterone
  • Serum K: high
  • Urine pH: high/normal
  • Association / Disease: hypoaldosterone
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6
Q

4 Steps in Management of Ascites

A
  1. Fluid/Na Restriction
  2. Spironolactone > Lasix
  3. Frequent Therapeutic Taps
  4. Peritoneal-Jugular Shunt / TIPS (Refractory Ascites)
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7
Q

Define Massive Hemoptysis.

A

Massive = ≥100c/hr or 600cc/day

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8
Q

What determines if CDiff is Mild/Moderate vs. Severe?

A

WBC >15k

Cr >1.5x baseline

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9
Q

CYP Inducers (8)

A

Inducers = Mrs. Barb Steals Phen and Refuses Greasy Carbs Chronic

  • Modafenil
  • Barbiturates
  • St. John Wart
  • Phenytoin
  • Rifampin
  • Griseofulvin
  • Carbamazepine
  • Chronic EtOH
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10
Q

CYP inhibitors (12)

A

MAGIC RACKS in GQ

  • Macrolide
  • Amiodarone
  • Grapefruit Juice
  • INH
  • Cipro
  • Ritonivir
  • Acute EtOH
  • Cimetidine
  • Ketoconazole
  • Sulfas
  • Gemfibrozil
  • Quinidine
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11
Q

Describe Eye Findings in Vitreous Hemorrhage

A

new onset floaters / difficult to visualize fundus / 2nd MCC - diabetic retinopathy

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12
Q

Describe Eye Findings in Retinal Detachment

A

new onset flashes of light / MCC 2/2 vitreous detachment

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13
Q

Describe Eye Findings in CRAO

A

pale optic disk, cherry red fovea, boxcar veins

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14
Q

Describe Eye Findings in CRVO

A

dilated tortutous veins, cotton wool spots, retinal hemorrhage

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15
Q

Describe Eye Findings in AMD

A

b/l progressive loss of CENTRAL vision / first sign is distortion of vertical lines

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16
Q

Describe Eye Findings in choroidal rupture

A

2/2 trauma, hemorrhage with crescenting around optic nerve

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17
Q

Describe Eye Findings in amaurosis fugax

A

pale retina 2/2 to emboli from carotids

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18
Q

Eye findings in Primary Open Angle Glaucoma

A

cupping of optic disk / “increase cup-disk ratio”

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19
Q

Describe Eye Findings in DM (3) + HTN (3)

A

DM

  1. Early: hard exudates, aneurysms, bleeding
  2. Progressive: Cotton Wool Spots
  3. Late: neovascularization

HTN

  1. Arterial Narrowing
  2. Cu/Silver Wiring
  3. Cotton Wool Spots
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20
Q

HSV vs. CMV Retinitis in HIV

  • 1st Line Treatment for CMV retinitis
  • 3x 2nd Line Rx
A

HSV: p/w PAINFUL vision loss 2/2 central necrosis of retina
CMV: p/w PAINLESS vision loss 2/2 fluff/granular deposits on retina with hemorrhages* (Occurs with CD4

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21
Q

HSV Keratitis

  • Epidemiology
  • Exacerbating Factor
  • Eye Finding
  • Tx
  • vs. Zoster Opthalmitcus
A
  • Epidemiology: MC Corneal Blindness
  • Exacerbating Factor: Sun exposure (like all HSV, need stress)
  • Eye Finding: Dendritic Ulcers +/- Corneal Vesicles
  • Tx: Topical/PO Acyclovir
  • vs. Zoster Opthalmitcus: Same eye, but zoster has rash on skin
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22
Q

5 Indications for Imaging in Back Pain

3 Things Causing Pain with Percussion of Back

A

Image Back Pain

  1. IVDU
  2. Malignancy
  3. Chronic Steroid Use
  4. Constitutional Symptoms
  5. New Neuro Symptoms

Percussion = Pain:

  1. Abscess
  2. Metastatic / Lytic Lesion
  3. Compression Fracture
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23
Q

Chronic Pancreatitis

  • MCC
  • Presentation (Triad)
  • Confirmation Test
  • Treatment (NBME**)
A

MCC = Chronic EtOHism

Presentation

  1. Chronic Epigastric Pain
  2. Steatorrhea (2/2 xExocrine Function)
  3. DM (2/2 xEndocrine Function)

Confirm: CT with Pancreatic Calcifications

Treatment: replace pancreatic enzymes

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24
Q

RA patient suddenly develops trigger finger. Paph?

A

Tenosynovitis of Palm

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25
Q

2 Patient populations with increased risk of atlanto-axial instability?

A
  1. Downs Syndrome

2. RA Patients

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26
Q

(T/F) Hypoalbuminemia can cause perioral numbing and Chovstek sign?

A

FALSE. Hypoalbuminemia can cause low TOTAL, but not low IONIZED Ca, which is what will produce these symptoms.

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27
Q

Why increase Estrogen in cirrhotics? 4 Consequences?

A
  1. Increased Estrogen b/c decrease E metabolism
  2. Consequences
    - Palmar Erythema
    - Spider Angiomata
    - Gynecomastia
    - Testicular Atrophy
28
Q

Diagnostic test in possible amebic liver cyst?

A

Serology for E. Histiolytica

29
Q

What is Friedlander’s PNA?

  • Encapsulated Bugs (8)
  • Hint for growth of Friedlander’s Bug
A

Klebsiella PNA

  • Grows in Mucoid Colonies
  • Encapsulated Bugs = SHIN SKES

*PC, HFlu, NM, Salmonella, Kleb, EColi, Group A S

30
Q

W/u Suspected Meningitis (3)

A

W/u Suspected Meningitis:

  1. BCx
  2. CTH (except in
31
Q

Give MC Bugs and Empiric Treatment

- 2-50y/o

A

*PC, NM, H. Flu –> Vanc + 3rd Gen Ceph

32
Q

Give MC Bugs and Empiric Treatment

-IC + 50

A

*PC, NM, H. Flu + LISTERIA –> Vanc + 3rd Gen Ceph + AMP

33
Q

Give MC Bugs and Empiric Treatment

- NSG/Shunt/Skull Trauma

A

*GNR, Staph, Coag- Staph –> Vanc + Cefipime

34
Q

Provoked vs. Unprovoked DVT Management

  • Duration
  • Goal INR
A 
Provoked = 3 months
Unprovoked = 6-12 months

INR 2-3 for both

35
Q

∆Lytes in Vomiting Explanation

A

Vomit = HypoKalemic, HypoChloremic, Metabolic Alkalosis

  • Low K/Cl = direct loss of vomit
  • Low H = loss of vomit + contraction alkalosis
36
Q

Contents and Indications for Giving:

- pRBC (2 Indications)

A
  • Contents = RBC

- Indications = Hb

37
Q

Contents and Indications for Giving:

- FFP (3 Indications)

A
  • Contents = all clotting factors
  • Give = DIC, Liver Dz or Warfarin OD
  • this includes chronic liver disease patients who have acquired VitK Deficiency
38
Q

Contents and Indications for Giving:

- Cryo (3 Indications)

A

Cryo

  • Contents = Factor 8, vWF, Fibrinogen
  • Give when these are low
39
Q

Give Liver Histology with:

  • ASA Toxicity / Reyes
  • Acute Viral Hepatitis / INH Toxicity
  • Heavy EtOH Use vs. EtOH Hepatitis
  • Chronic Viral Hepatitis
  • NASH
A
  • ASA Toxicity / Reyes = Fatty vacuolization
  • Acute Viral Hepatitis / INH Toxicity = Panlobular monocellular infiltrate with necrosis
  • Heavy EtOH Use vs. EtOH Hepatitis: Steatosis –> PMN + multicellular infiltrate with necrosis, Mallorgy Bodies
  • Chronic Viral Hepatitis: fibrosis/piecemeal necrosis
  • NASH: looks just like EtOH, which is why we say “non-alcoholic)
40
Q

Hereditary vs. Acquired Angioedema

  • Paph
  • C4 Levels vs. C1q Levels
  • Tx of Each
A

Hereditary Angioedema

  • AD deficiency in C1 esterase inhibitor
  • C4 levels are LOW, C1q are NORMAL
  • Tx = Danazol / Androgen = increase hepatic synth of C1 esterase inhibitor

Acquired Angioedema

  • Paph = ACE-I blocks ACE’s destruction of bradykinin = increase kinins
  • CV levels are LOW, C1q are LOW
  • Tx: Switch to ARB
41
Q

Sexually active patient with sore throat and mono-like illness is tested HIV-. Most likely cause of symptoms.

A

HIV! He just hasn’t seroconverted. Recall, HIV initially presents with mono type symptoms.

42
Q

MC Primary Immunodeficiency?

A

IgA Deficiency; think anaphylaxis to blood products

43
Q

DiGeorge is x3rd + 4th Pharyngeal Pouches. What comes from each?

A 
3rd = Thymus + INFERIOR Parathyroids
4th = SUPERIOR parathyroids
44
Q

Patient with HIV needs PCP PPx, but can’t tolerate sulfas. 3 Alternate Rx?

A
  1. Dapsone
  2. Inhaled Pentamidine
  3. Atorvaquone
45
Q

(T/F) HIV Patient with any opportunistic infections / AIDS defining illness has “AIDS” as soon as CD4

A

True

46
Q

2 Pathogens that cause chronic diarrhea only in AIDS patients?

A

Cryptosporidium

Isospora

47
Q

2 Tests to ID Isolated Alk Phos to

  • Liver
  • Gallbladder
A
  • Liver = 5’ Nucleotidase

- Gallbladder = GGT

48
Q

What ∆Lytes (2) seen with DKA/HHNKS

A

HypoK

HypoPO4

49
Q

(T/F) HIV patients need PPx for Toxo?

A

True = Bactrim

50
Q

Mechanism of Carpal Tunnel

  • Pregnancy
  • Hypothyroid
  • Amyloid
  • Acromegaly
  • Rhuematoid
A
  • Pregnancy: E-mediated fluid retention
  • Hypothyroid: increase deposition of myxoma
  • Amyloid: amyloid deposition
  • Acromegaly: tendon hyperplasia
  • Rhuematoid: synovial hyperplasia
51
Q

Indications for CT with Pyelonephritis (4)

A
  1. Persistent Symptoms despite ABx
  2. Complicated Pyelo (abscess, etc)
  3. Nephrolithiasis
  4. Unusual Urine (Gross Hematuria)
52
Q

Osteoid Osteoma vs. Giant Cell Tumor of Bone Fx + Management

A

Osteoid Osteoma

  • Think PM pain responsive to NSAID
  • Treatment = NSAID / Sx

GCTB

  • Think female with epiphyseal lytic “SOAB BUBBLE” lesion
  • Treatment = Surgery (Curretage + Graft)
53
Q

6 Malignancies a/w EBV

A 
Primary CNS Lymphoma (HIV)
Oral Hairy Leukoplakia (HIV)
Burkitt's Lymphoma
Hodgkin's Lymphoma
Nasopharyngeal Caricnoma
Immunoblastic Lymphoma (BMT)
54
Q

(T/F) Aminoglycoside induced renal damage will produce urine with eosinophils and WBC casts.

A

False, this urine describes AIN 2/2 PCN/sulfa/cephs. Aminoglycosides causes AKI so you’ll see EPITHELIAL casts and NO WBC.

55
Q

Rabies

  • Reservoir (2)
  • Presentations (2)
A

Reservoir = Bats + Raccoon

Presentations

  1. Encephalitis (think aerophobia / hydrophobia = pharynx spasm)
  2. Ascending Flaccid Paralysis
56
Q

Basophilic Stippling (4) vs. Target Cells (4)

A

Basophilic Stippling = MALT

  • Macrocytic Anemia
  • ACD
  • Lead Poison
  • Thal

Target Cells = HALT

  • HbC
  • Asplenia
  • Liver Disease
  • Thal
57
Q
  1. Definition of Acute Liver Failure (3) and MCC (3)
  2. Stipulation for “Fulminant Hepatic Failure”
  3. Single best prognostic indicator of ALF/FHF
  4. Tx of FHF
A
  1. Definition of Acute Liver Failure (3) and MCC (3)
    - Hepatic Injury (AST/ALT >10x ULN)
    - Encephalopathy
    - xSynthetic Function (INR >1.5)

*MCC = Ischemic (Shock Liver), Toxin (≠EtOH) and Viral

  1. Stipulation for “Fulminant Hepatic Failure”
    - Onset of encephalopathy within 8 weeks of ALF
  2. Single best prognostic indicator of ALF/FHF
    - PT/INR
  3. Tx of FHF = immediate liver transplant
58
Q

Recall vs. Observer Bias

A
  • Recall: knowledge of OUTCOME ∆info RECALLED

- Observer: knowledge of STUDY ∆info REPORTED

59
Q

Susceptibility vs. Performance Bias

A
  • Susceptibility: Tx given ∆with severity of disease

- Performance: Tx given ∆2/2 error in procedure

60
Q

(T/F) Both bronchogenic carcinoma and mesothelioma will have plaques on CXR.

A

True, but:

  • If Mass/Cavitary Lesion = Bronchogenic
  • If Effusion and NO Mass = Mesothelioma
61
Q

Best Screening for Acute HBV Infection?

A
  1. HbSAg

2. Anti-HBc IgM

62
Q

Which sCHF and dCHF can be reversed?

A 
sCHF = EtOH; reversible with EtOH cessation
dCHF = Hemocrhomatosis; reversible with phlebotomy
63
Q

4 EColi Diarrheas

  • Paph
  • Presentation

**What is unique about EHEC’s presentation compared to the other bloody diarrhea bugs (YCASES?)

A
  1. ETEC = Traveler’s Diarrhea
    - 2/2 Heat Labile + Stabile Toxin
  2. EPEC = blunts aPical villi = diarrhea in Peds
  3. EIEC = invasive, produces Bloody Diarrhea
  4. EHEC = 2/2 Shiga-like toxin (o157:h7) 2/2 ingestion of undercooked beef –> Triad of Anemia/Thrombocytopenia/ARF (HUS) after bloody diarrhea

***B/c it is TOXIN mediated = NO FEVER

64
Q

Infective Endocarditis

  • When to suspect?
  • 1st Step
  • Empiric Rx?
  • Rx when confirmed Staph vs. Strep?
  • MC Acute/Native vs. Subacute/Damaged Valve
  • Who gets Enteroccus vs. Strep Bovis
  • Duke Major Criteria
  • Duke Minor Criteria (6)
  • Complication = Fever, Leuk and LUQ Pain + Tx
A
  • When to suspect? = Fever + New Murmur
  • 1st Step = 3x BCx from separate lines
  • Empiric Rx? = Vanc (Staph, Strep and Entero Coverage)
  • Rx when confirmed Staph = Home IV Vanc, strep = Ceftriaxone or PCN IV
  • MC Acute/Native = Staph
  • vs. Subacute/Damaged Valve = Strep
  • Who gets Enteroccus (UTI/urinary tract instrumentation)
  • vs. Strep Bovis (CRC –> Colonoscopy)
  • Duke Major Criteria: BC+, TEE-evidence of Endocardial Damage
  • Duke Minor Criteria (6): BC+, Fever, Predisposing Factor, IVDU, Embolic Event / Immune Event
  • Complication = Fever, Leuk and LUQ Pain + Tx = Splenic Abscess (Embolic Event); Tx = Splenectomy
65
Q

Tx for Molluscum in IC Patients (2)?

A

Curretage

Liquid N2

Step 2 CK (8 decks)

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