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Step 2 CK > Medicine 2 > Flashcards

Medicine 2 Flashcards

1
Q

MCC Adrenal Failure

  • USA
  • WW
  • Overall
A
  • USA = AI Adrenal Destruction
  • WW = Diss TB
  • Overall = Chronic Steroid Use –> Withdrawal (produces TERTIARY = CENTRAL HYPOADRENALISM with low ACTH, low cortisol and normal aldosterone)
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2
Q

Ortner’s Syndrome

A

Hoarse voice 2/2 LA enlargement; look for elevation of L primary bronchus too

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3
Q

Malaria

  • Bug
  • Reservoir
  • P/w (2) and Why
  • 2 Protected Populations
  • Dx
  • Vs. Babesiosis?
A
  • Bug: Plasmodium (Vivax, Ovale, Malariae, Falciparum)
  • Reservoir: ANOPHELES Mosquito
  • P/w (2) and Why: Cyclical FEVERS + HA as leave liver –> RBC
  • 2 Protected Populations: Sickle Cell (not favorable RBC) + Prior Infection
  • Dx: Thick and thin blood smear with Gimesa+ stain
  • Vs. Babesiosis? Caused by IXODES deer tic and found in USA NE area; causes similar presentation
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4
Q

Histoplasmosis

  • Microbiology
  • Location
  • Presentation / Dx / Tx
A
  • Micro: Histo hides in macrophages, this is why disseminated infection produces hepatosplenomegaly + palate ulcers
  • Location = Ohio + MS River Valleys, caves + bats
  • Fx: Diss infection as above; tx with Ampho B + Itraconazole
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5
Q

Blastomycosis

  • Microbiology
  • Location
  • Presentation / Dx / Tx
A
  • Micro: Broad Based Budding Yeast
  • Location = E of MS River
  • Fx: Disseminated = Pancytopenia (bone) + skin problems (warty like lesions + ulcers)
  • Tx: PO Itraconazole (mild) –> Severe with Amphotericin B
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6
Q

Coccidiomycosis

  • Microbiology
  • Location
  • Presentation / Dx / Tx
A
  • Micro = Endospore spherules
  • Location = SW USA
  • Fx = Valley Feve
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7
Q

Paracoccidio

  • Microbiology
  • Location
  • Presentation / Dx / Tx
A
  • Micro: Captain’s Wheel Appearance

- Fx: Latin America

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8
Q

gluten sensitive; IgA Ab to gliadin, Dermatitis Herpetiformis. Dx gold standard = biopsy with villous flattening

A

Celiac

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9
Q

as Celiac, need h/o of living in endemic area

A

Tropical Sprue

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10
Q

SI bacterial overgrowth

A

the little SI bacteria are overtaken by other growth 2/2 ∆anatomy or ∆gastric motility; diagnose with jejunal aspirate >10*5 bacteria, Tx = Rifaxamin/Augmentin

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11
Q

Whipple dz

A

PAS+ cells in old white men

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12
Q

MCCOD in Dialysis

A

Cardiovascular Disease

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13
Q

Nasal Septal Perforation

  • P/w
  • 4 MCC
A

P/w = Persistent whistling noise

4 MCC

  • S/p Rhinoplasty
  • Trauma (nose picking)
  • Wegener’s (ELK)
  • Cocaine
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14
Q

MoA + ADE

  • Didanosine
  • Abacavir
  • Indinavir
  • Nevirapine
  • Lamivudine
  • Efavirenz

General AADE for

  • NRTI
  • NNRTI
A
  • Didanosine (NRTI) = Pancreatitis
  • Abacavir (NRTI) = Hypersensitivity
  • Indinavir (Protease I, all end in -navir) = Needle Shaped Crystals
  • Nevirapine (NNRTI) = Liver Failure
  • Lamivudine = Liver Failure
  • Efavirenz (NNRTI) = Vivid Dreams/Hallucinations

General AADE for

  • NRTI (all end in -ine except Abacavir) = Lactic Acidosis
  • NNRTI (Nevirapine, Efavirin) = SJS
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15
Q

Flagyl Indications (7)

A

GET GAP on metRo

  • Giardia
  • Entoamoeba
  • Trich
  • Gard. (BV)
  • Anaerobes
  • (H) Pylori
  • Rosacea
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16
Q

Caution in Using Nitroglycerin (4)

A
  1. Aortic Stenosis
  2. Right Ventricular Infarct
  3. With PDE-I (Sildenafil; also watch PDE and alpha-blocker use)
  4. Hypotension
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17
Q

MoA Plavix

A

PGy-12 Receptor Blocker

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18
Q

MEN Syndromes and PT-adenoma vs. hyperplasia?

A 
MEN1 = Adenoma
MEN2 = Hyperplasia
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19
Q

Ca and PTH Levels in:

  • Familial HyperCa HypoCaUria
  • PseudohypoPTH (Albrights)
A

FHH: Mutation in Ca Sensing Receptor in PTH Gland

  • Increase Ca
  • Increase PTH

PseudohypoPTH (Albrights): xEnd Organ Damage to Ca

  • Low Ca
  • Increase PTH
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20
Q

How to approach Acetaminophen OD?

A
  1. Activated Charcoal ≤4 hours s/p ingestion

2. Plot Acetaminophen level @4hrs on Rumack-Matthew Nomogram

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21
Q

CO tox

  • Risks
  • P/w
  • SaO2
  • Tx
A
  • Risks: space heater, garage
  • P/w: Cherry Red Skin, High HCT
  • SaO2: normal b/c COHb
  • Tx: Hyperbaric (100%) O2
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22
Q

Methemoglobinemia

  • Risks
  • P/w
  • SaO2
  • Tx
A
  • Risks: Rx (Sulfas, nitrates, dapsone)
  • P/w: Chocoloate Brown Blood
  • SaO2: normal
  • Tx: Methylene Blue
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23
Q

CN Toxicity

  • Risks
  • P/w
  • SaO2
  • Tx
A
  • Risks: nitroprusside, burning plastic
  • P/w: Pink skin, burnt almond smell
  • Tx: Amyl Nitrate (induce methem) –> sodium thiosulfate
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24
Q

(T/F) In atrial fibrillation with dilated ventricle, digoxin is treatment of choice?

A

FALSE. Dilated ventricle is 2/2 to atrial fibrillation, control the afibb with typical RATE control

25
Q

Pulsus Bisferiens Def + 2Dz

A

Defined as biphasic systolic pulse with midsystolic dip. Seen in:

  • Aortic Regurge
  • HOCM
26
Q

2 Stones that PPT in low pH and 2 Treatments

A

Uric Acid + Ca Oxalate

Give K Citrate + NaHCO3

27
Q

2 CHF Exacerbation Protocols

What is never included?

A
  1. CHF with nl/high BP
    - O2 + Lasix + Nitroglycerin
  2. CHF with low BP
    - O2 + Lasix + NorEpi Pressor

Never included = beta blocker (in acute CHF exacerbation, increase survival for chronic management)

28
Q

Chondrocalcinosis - 2 DZ?

A
  1. CPPD (Pseudogout) ~ wrap around patella

2. Hemochromatosis

29
Q

4 Steps in Progression of Diabetic Nephropathy

What is key treatment and why?

A
  1. Glomerular Hyperfiltration
  2. GBM Thickening
  3. Mesangial Expansion
  4. Glomerulosclerosis (KW Nodules)

Give ACE-I to decrease efferent arteriole constriction = decrease glomerular HTN = decrease progression of disease

30
Q

3 MC Malignancies found in Malignant Effusions?

A
  1. Lung
  2. Breast
  3. Lymphoma
31
Q

Chalazion

  • Def
  • P/w
  • Management
A

Def: chronic granulomatous inflammation of meibomian gland 2/2 obstruction

P/w: rubbery lesion on eyelid

Mgmt: warm compresses (Same as Stye = Hodeolum) –> I+D –> BIOPSY (increase risk for conversion to carcinoma)

32
Q

Gold Standard PNA Dx in Outpatient Setting

A

CXR (≠Sputum Culture)

33
Q

4 ARDS Criteria

A
  1. New Onset
  2. Noncardiogenic (nl PCWP)
  3. B/l Fluffy Infiltrates on CXR
  4. ## Hypoxia (P/F Ratio)
34
Q

Beck’s Triad

Underlying Physiology

A

Triad = JVD, Muffled Heart Sounds, Hypotension

Decrease PRELOAD

35
Q

2 Neuro Signs for Immediate Back Imaging in DM?

A

UMN Signs or Motor Weakness

DM are at increase risk for abscess

36
Q

Triad of EPO Abuse

A

HA, HTN and Flu Symptoms

37
Q

Cystercercosis

  • Bug
  • Intermediate vs. Definitive Host
  • Transmission
  • 3 Organs
A
  • Bug = Taenia Solium (pork tapeworm)
  • Humans are only definitive host (only humans can become infected)
  • Intermediate: pig (can eat eggs and not beome infected)
  • Transmission: when humans eat eggs they become infected
  • 3 Organs: Skeletal Muscle, Eye, Brain (Scolex)
38
Q

How does insulin resistance cause NALFD?

A

Increase insulin resistance = increase peripheral lipolysis = increase Fatty acid delivery to liver = increase fatty oxidation = inflammation

39
Q

Older patient with known presbyopia is peeing a lot and suddenly their vision gets better?

A

Look for New DM. Persistent hyperglycemia = corrects presbyopia

40
Q

Corneal arcus in young person?

A

Think Familial HyperCholesterolemia

41
Q

Whats the difference in Metabolic Syndrome Key Features and CAD Risk Factors (used in LDL goals too?)

A

Met Syndrome = SHODDy

CAD Risk = SHAFDy

  • Age: >45 men, >55 women
  • FMHx CAD:
42
Q

What 3 things increase HDL?

A

Moderate Alcohol Consumption
Exercise
Estrogen

43
Q

Tx of Viral vs. Allergic vs. Bacterial Conjunctivitis?

A

Allergic (itchiness + B/L) = Topical Antihistamines / Mast Cell Stabilizers / Vasoconstrictors

Viral (no itch + U/L + close contacts) = hand washing

Bacterial = ABx

***High Yield: Viral/bacterial are U/L and use the discharge to tell the difference. B/L = Allergic!!!

44
Q

(T/F) Topical Steroids should be given on the eye?

A

FALSE FALSE FALSE

  • Increase cataracts / glaucoma
  • Worsen HSV / Fungal keratitis
45
Q

Who gets UV keratitis? (3)

Treatment? (2)

A

UV Keratitis = welders, skiers (snow blind) and tanners

Tx = Patch the eye +/- Topical Abx

46
Q

What high yield DZ is associated with CRAO?

A

Temporal Arteritis

47
Q

What is presbyopia? What is treatment?

What is the disease associated with ∆corneal shape?

A

Loss of lens elasticity –> cannot accommodate (holding objects @distance to see) –> need bifocals for NEAR Vision

Don’t confuse with ∆Corneal shape = astigmatism; blurry vision regardless of distance

48
Q

Massive PE Definition (2) + Unique Treatment

A
  1. PE with Hypotension
  2. PE with Acute Heart Strain as evidence by JVD (b/c RV dilation) or RBBB

Unique Treatment = candidate for fibrinolytic therapy

49
Q
  • MCC Folate Deficiency

- 3 Rx Causing Folate Deficiency

A
  • MCC Folate Deficiency: EtOHism (Nutritional)

- 3 Rx Causing Folate Deficiency: MTX, Trimethoprim (DHFR) and Phenytoin (xIntestinal Absorption)

50
Q

cANCA vs. pANCA Targets

A 
cANCA = anti proteinase 3
pANCA = anti MPO
51
Q

Casts

  • Muddy Brown
  • RBC
  • WBC
  • Fatty
  • Waxy
  • Epithelial
A
  • Muddy Brown: ATN
  • RBC: Glomerular Damage / Nephritic Syndrome
  • WBC: AIN (PCN, Sulfa, Ceflacor) / Pyelo
  • Fatty: Nephrotic Syndrome
  • Waxy: Chronic Renal Disease
  • Epithelial: Acute INTRARENAL Injury (Aminoglycoside)
52
Q

Hypersensitivity Pneumonitis

  • Definition
  • P/w
  • 2 Examples
  • Treatment
A
  • Def: inflammation of lung parenchyma 2/2 antigen exposure (vs. PNA = infectious inflammation)
  • P/w: Fever, Cough, SOB (recurrent mini-PNA)
  • 2 Examples: Farmer’s Lung + Bird Fancier’s Lung
  • Tx: Avoid exposure to antigen
53
Q

2 Associations with Reactive Arthritis (other than triad)

Treatment of Reactive Arthritis

A

Associations = PO Ulcers + Enthesitis

Tx = NSAID

54
Q

3 Predictors of AAA Expansion / Rupture

A
  1. Size >5.5 cm
  2. Active Cig Smoking
  3. Rate of expansion >.5cm/6mo or ≥1.0 cm/yr
55
Q

4 Fx of Legionella PNA

A
  1. PNA
  2. Watery Diarrhea
  3. HypoNa
  4. Elevated LFTs
56
Q

Clubbing: 2/2 low O2 or 2/2 malignancy?

A

Depends; in cyanotic heart, pHTN, CF = chronic hypoxia. BUT, in COPD = 2/2 HOA = Malignancy

57
Q

W/u Testicular Mass (1)

A

ULTRASOUND IS ALL THAT IS NEEDED!!!! No biopsy / FNA b/c of seeding theory. This is a cancer that you shoot (operate) first and ask questions later.

58
Q

5 ∆Lifestyle for High BP?

A
  1. Weight Loss
  2. DASH Diet
  3. Regular Exercise
  4. Low Salt Diet
  5. xEtOH

Step 2 CK (8 decks)

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