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Flashcards in 5/11 Deck (86)
1

When are symptoms during somatic symptom disorder usually worse? tx?

During periods of stress
Focus on discussing the role of psychosocial stressors and promote stress reduction/healthy behaviors

2

Meds to withhold before stress testing? how long?
exception?

B-blockers, CCBs and nitrates for 48 hours
Exception: in pt's with known CAD to asses efficacy of anti-anginal drugs

3

Why low intubation threshold in burns

Progressive airway edema may preclude incubator later in clinical course

4

Pre-patellar bursitis features

Anterior knee pain, tenderness, and localized swelling
By S. aureus

5

Who gets patellar tendonitis

Athletes in jumping sports or occupations with repetitive forceful knee extension

6

What test can be considered in a woman w/ very strong hx of ovarian Ca

BRCA1 and 2

7

Think of what in a patient w/ erythema gangrenosum

IBD, RA, or AML (underlying systemic disease)

8

Most useful test for re-occlusion following recent MI

CK-MB (typically returns to normal w/in 1-2 days)

9

3 things that dec HOCM murmur

Sustained hand grip
Squatting
Passive leg raise

10

What does valsalva do to pre-load

Decreases it

11

Best step for undiagnosed pleural effusion on CXR

Thoracentesis, except inpatients w/ clear-cut evidence of CFH

12

Acid/Base status of Conn's

Metabolic alkalosis

13

MC site of ulnar nerve entrapment

Elbow where the ulnar nerve lies at the medial epicondylar groove

14

Why UA for bedwetting after age 5

Screen for UTI, DM, and DI

15

4 tests for all pt's w/ new HTN diagnosis

1. UA (occult hematuria and protein/cr ratio)
2. Chemistry panel
3. Lipid profile
4. Baseline EKG

16

Erlichiosis labs

Leukopenia
Thrombocytopenia
Elevated LFTs and LDH

17

What should be considered when a pt suspected of sarcoidosis decompensated following steroids

Histoplasmosis (closely mimics - normally caseating granulomas but can have non)

18

Type 2 RTA causes

Defective tubular HCO3 reabsorption

19

What differentiates acute Hypercarbia from chronic CO2 retention in COPD

Acute has associated acidosis and low bicarb level

20

What can happen with changes in head position in papilledema

transient vision loss lasting a few seconds

21

4 big pancreatitis complications

1. Pleural effusion
2. ARDS
3. Ileus
4. Renal failure

22

What causes morton's neuroma

Mechanically induced neuropathic degeneration of the interdigital nerves

23

Pleural fluid indicators of empyema? what do you do

pH

24

Always do what in croup before intubation

Give a trial of race-epi

25

What is eliminated in a case control study when neighbors of pt's are chosen

Confounders

26

Euthyroid sick syndrome characterized by

Fall in total and free T3 levels w/ normal T4 and TSH

27

Chikungunya fever presentation

Caribbean trip and back with Polyarthralgias, rash, lymphopenia, and thrombocytopenia

28

What classifies saline response vs unresponsive metabolic alkalosis

Saline responsive will have low urinary chloride (

29

3 PE findings of aortic stenosis

1. Pulsus parvus et trades (delayed and diminished)
2. Mid to late peaking systolic murmur
3. Soft and single second heart sound

30

Why single soft S2 in aortic stenosis

Aortic valve closure is delayed and occurs simultaneously w/ pulmonic valve closure

31

Duodenal hematoma mgmt

Conservatively w/ nasogastric suction and parenteral nutrition

32

Odansetron MOA

Blocks 5HT3 receptors
*for preventing chemotherapy induced nausea and vomiting*

33

Next step if a CXR identifies a new suspicious pulmonary nodule

CT scan

34

High risk pulmonary nodule features

Size > 2.0cm
> 60 years old
Current or

35

CXR diagnostic indicator of diaphragmatic rupture

Nasogastric tube in the pulmonary cavity

36

why is aldosterone normal in pan-hypopituitarism

Aldosterone secretion from adrenal glands is ACTH independent and primarily regulated by RAAS

37

Vit D def labs

Low Ca and PO4
elevated PTH

38

What mediates Vit D absorption in the intestine

Chylomicrons

39

Why is insulin good for GDM

It does not cross the placenta

40

Gold standard dx for bowl ischemia

Mesenteric angiography

41

Suspect PML in who

HIV infected patient with focal neurological signs and multiple non-enhancing lesions w/ no mass effect on CT scan

42

When does subacute sclerosing panencephalitis occur?
What does CT scan show?

Many years after antecedent measles infection
CT scan shows scarring and atrophy

43

MCC of thyrotoxicosis w/ low RAI uptake? why?

Subacute painless thyroiditis
From leakage of thyroid hormones into the circulation

44

2 drugs that cause serum-sickness like reaction

B-lactams (penicillin, amoxicillin, cefaclor) or TMP-SMX

45

Hx of CAD + severe dyspnea after fluids likely

Pulmonary edema

46

SEM of alports? big 3 features?

Alternating areas of thinned and thickened capillary loops w/ splitting of GBM
Recurring hematuria, sensorineural deafness, and fam hx of renal failure

47

What is chlorpheniramine

1st gen antihistamine

48

Fever and sore throat in patient on anti-thyroid drugs suggestive of

Agranulocytosis --> stop taking and count WBC

49

Volvulus Abdominal xray

"corkscrew"

50

Gold standard for diagnosing malrotation

Upper GI contrast study

51

When does pyloric stenosis manifest

1-2 year olds

52

Most common source of PE

Proximal deep leg veins (Iliac, femoral, popliteal)

53

Cutaneous findings of coccidioidmycosis

Erythema multiform and erythema nodosum

54

2 big screenings all patients with cirrhosis need

1. Endoscopy for varies
2. HCC screening w/ US every 6 months

55

Tx for asymptomatic variceals

Non-selective B-blockers

56

What characterizes normal hyperventilation of pregnancy

1. Increased TV
2. Inc minute ventilation
3. Chronic respiratory alkalosis

57

Presentation and cause of dysarthria-clumsy hand syndrome

Bulbar dysfunction (dysarthria, dysphagia)
Contralateral facial and limb weakness
Due to infarction in paramedic basis points

58

Risk w/ Hashimoto's thyroiditis

Thyroid lymphoma

59

Langerhan's histiocytosis presentation

Solitary, painful lytic long bone lytic lesion w/ overlying swelling and hypercalcemia

60

What are ahminoglycosides used for

Serious gram negative infections

61

What is present in AIN urine

WBCs and eosinophils

62

Hallmark EKG of ventricular aneurysm

Persistent ST-segment elevation after a recent MI and deep Q waves in the same leads

63

Immunofluorescence of bullous pemhigoid

IgG and C3 distributed linearly along BM zones

64

Pemphigus vulgaris Ab

Surface bound IgG to desmoglein

65

What is adjustment disorder characterized by

Increased anxiety, depression, or disturbed behavior that develops in response to a stressor

66

4 features of atypical depression

1. Hypersomnia
2. Increased appetite
3. Rejection sensitivity
4. Leaden paralysis

67

Most important steps in management of lactic acidosis from septic shock

IV Normal saline with or without vasopressor therapy to maintain the intravascular pressure and Ab

68

Can laboring patients w/ placental abruption deliver?

Yes, unless mother is hypotensive w/ severe bleeding or if the condition of the fetus deteriorates

69

Inevitable vs Incomplete abortion

Inevitable: products of conception may be seen or felt at or above cervical os
Incomplete: some products of conception expelled and some remain

70

Arrhythmias after MI

Immediate (0-10 min) - reentrant ventricular (f-fib)
Delayed (10-60 min) from abnormal automaticity

71

3 causes for travelers diarrhea lasting longer than 2 wees

1. Cryptosporidium
2. Cyclospora
3. Giardia

72

What causes Amebiasis

Entamoeba histolytic (bloody diarrhea from Asia)

73

How does type IV RTA present? Who gets it?

Hyperkaelmia, mild renal insufficiency, and non anion-gap metabolic acidosis
-Pt's with poorly controlled DM get it

74

GAS treatment in kids vs adults

Always test in children w/ rapid streptococcal antigen testing prior to starting Ab

75

What is needed to make dx of delayed sleep phase syndrome

Accurate history and/or sleep diary

76

Caustic poisoning presentation

Dysphagia, severe pain, heavy salivation, and mouth burns
*not change in consciousness*

77

Bitter almond odor with

Cyanide inhalation

78

2 things elevated in Pagets

Alk phos
Urinary hydroxyproline levels

79

5 AE w/ amioderone

1. Pulm fibrosis
2. Thyroid dysfunction
3. Hepatotoxic
4. Corneal deposits
5. Blue skin color

80

Levodopa/Carbidopa AE

1. Hallucinations
2. Dizziness
3. Headache
4. Agitation

81

TSS presentation

Fever, myalgias, marked hypotension, and diffuse erythematous macular rash

82

Azathioprine tox

Dose related diarrhea, leukopenia, and hepatoxocity

83

major tox of mycophenolate

bone Marrow suppression

84

Main cyclosporine AE

Nephrotoxicity
Hyperkaelmia
Hypertension
Gum hypertrophy
Hirsutism
Tremor

85

MC cyclosporine AE

Nepphrotoxicty

86

What causes HTN in thyrotoxicosis

Hyper dynamic circulation resulting form increased myocardial contractility and heart rate