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Step 2 CK UW > 7/26/16 > Flashcards

7/26/16 Flashcards

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1
Q

tx for trigeminal neuralgia

A

carbamazepine

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2
Q

what dx should be suspected in a pt with long-term use of 1 or multiple analgesics (e.g., aspirin, ibuprofen) for chronic pain who presents with painless hematria, sterile pyuria, WBC casts, and trace proteinuria?

A

tubulointerstitial nephritis (hematuria is due to papillary necrosis)

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3
Q

acute, severe retroorbital pain that wakes pt from sleep, accompanied by redness of ipsilateral eye, tearing, and ipsilateral horner syndrome

A

cluster headache

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4
Q

what class of abx is associated with tendinopathy and tendon rupture?

A

fluoroquinolones

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5
Q

where are broca’s and wernicke’s areas?

A

broca: dominant FRONTAL lobe
wernicke: dominant TEMPORAL lobe

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6
Q

recurrent sinusitis and otitis, bloody/purulent nasal discharge, arthralgias, oral or auditory canal ulcers, hematuria, proteinuria, renal insufficiency = what is the dx and initial test?

A

granulomatosis with polyangiitis (Wegener granulomatosis); check serum autoantibodies (antineutrophil cytoplasmic antibodies [ANCA])

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7
Q

what should a pt found to have chondrocalcinosis (pseudogout), diabetes, and hepatomegaly be checked for?

A

hereditary hemochromatosis

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8
Q

what are the important secondary causes of pseudogout that should be investigated in pts with chondrocalcinosis?

A

hyperparathyroidism, hypothyroidism, and hereditary hemochromatosis

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9
Q

pts with hereditary hemochromatosis are at risk for what infections?

A

Very Yucky Liver: Vibrio vulnificus, Yersinia enterocolitica, Listeria

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10
Q

pathogenesis of milk-alkali syndrome

A

caused by excessive intake of calcium and absorbable alkali; the resulting hypercalcemia causes RENAL VASOCONSTRICTION and decreased glomerular blood flow. in addition, inhibition of the Na-K-Cl cotransporter and impaired ADH activity lead to loss of sodium and free water, which leads to hypovolemia and increased reabsorption of bicarbonate. Findings include METABOLIC ALKALOSIS, ACUTE KIDNEY INJURY

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11
Q

what pathogen is associated with infective endocarditis related to colonic polyposis?

A

strep gallolyticus (strep bovis biotype I)

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12
Q

what pathogen is associated with infective endocarditis related to peridontal infection or dental procedures that involve manipulation of gingival or oral mucosa?

A

Eikenella corrodens

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13
Q

what predisposes pts to calcium oxalate kidney stones?

A

small bowel disease, surgical resection or chronic diarrhea that leads to malabsorption of fatty acids and bile salts (fat malabsorption leads to increased absorption of oxalic acid because the unabsorbed fatty acids chelate calcium, making oxalic acid free for absorption)

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14
Q

recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, and part of the ear

A

glossopharyngeal neuralgia (CN9)

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15
Q

what is the presentation, lab findings, and treatment of ehrlichiosis?

A

flu-like illness, confusion, THROMBOCYTOPENIA, LEUKOPENIA, ELEVATED LIVER ENZYMES a few weeks after tick bite; doxycycline

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16
Q

best abortive tx for cluster headaches

A

100% nasal oxygen

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17
Q

how can you distinguish between plantar fasciitis and tarsal tunnel syndrome?

A

tarsal tunnel syndrome pain WORSENS WITH USE whereas pain of plantar fasciitis is WORST IN THE MORNING and IMPROVES WITH WALKING A FEW STEPS

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18
Q

episodic anterior knee pain in an athlete who jumps a lot, tenderness at inferior patella

A

patellar tendonitis

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19
Q

young female athlete with subacute to chronic pain increased with using stairs, running, prolonged sitting

A

patellofemoral syndrome

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20
Q

young obese pt with headaches, vision disturbances (diplopia, transient vision loss), tinnitus, papilledema, CN 6 palsy (lateral rectus palsy) = dx, test, and tx

A

pseudotumor cerebri; LP (after MRI has ruled out intracranial mass); weight loss and acetazolamide

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21
Q

tx for urge incontinence refractory to bladder training and pelvic floor muscle exercises

A

oxybutynin (antimuscarinic agent)

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22
Q

unilateral neck pain and numbness over posterior surface of ipsilateral arm, limited neck rotation and lateral bending = dx and radiographic findings

A

cervical spondylosis (sensory deficit is due to osteophyte-induced radiculopathy); radiographic findings include BONY SPURS and sclerotic facet joints, narrowing of disk spaces and hypertrophic vertebral bodies

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23
Q

what are the sx of drug-induced interstitial nephritis? what drugs commonly cause this?

A

fever, MACULOPAPULAR RASH, renal failure, UA with WBC casts (may have eosinophiluria), RBCs, mild proteinuria; PENICILLINS, TMP-SMX, CEPHALOSPORINS, NSAIDS

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24
Q

tx for penicillin-sensitive Strep endocarditis

A

IV ceftriaxone or penicillin G (NO ORAL ABX)

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25
diabetic pt with severe ear pain that radiates to temporomandibular joint, ear discharge, granulation tissue in ear canal, UNRESPONSIVE TO TOPICAL ABX = likely pathogen?
malignant otitis externa caused by PSEUDOMONAS AERUGINOSA
26
RA-like sx of bilateral, polyarticular arthritis involving hands, knees, ankles, morning joint stiffness, along with fever, diarrhea, mild skin itching and patchy redness
parvovirus B19
27
most common cause of bloody diarrhea without fever
E. coli (EHEC)
28
what are the important PFT findings in asthma?
decreased FEV1 and FVC (with a greater decrease in FEV1), decreased ratio of FEV1:FVC, increase in FEV1 of more than 12% and 200 mL with albuterol, decrease in FEV1 of more than 20% with methacholine or histamine, INCREASED diffusion capacity of lung for carbon monoxide
29
tx for acute asthma exacerbation
oxygen, albuterol, steroids
30
role of magnesium in acute asthma exacerbation
helps relieve bronchospasm, only used in acute, severe asthma exacerbation not responsive to SEVERAL rounds of albuterol while waiting for steroids to take effect (takes 4-6 hours)
31
what type of agent helps control sx in COPD but not in asthma?
anticholinergic agents (tiotropium, ipratropium)
32
recurrent episodes of VERY HIGH VOLUME PURULENT SPUTUM production with hemoptysis, dyspnea and wheezing = what is the most likely finding on CXR? what is the tx?
bronchiectasis; DILATED, THICKENED BRONCHI, sometimes with "TRAM-TRACKS"; CHEST PHYSIOTHERAPY and ABX
33
asthmatic pt with recurrent episodes of brown-flecked sputum and transient infiltrates on CXR = dx and tx
allergic bronchopulmonary aspergillosis (ABPA); ORAL STEROIDS (inhaled steroids are NOT EFFECTIVE), ITRACONAZOLE for recurrent episodes
34
what is a pilocarpine test?
test used to diagnose cystic fibrosis; pilocarpine increases acetylcholine levels which increases sweat production. increased chloride levels in sweat is diagnostic for CF
35
what pathogen causes community-acquired PNA associated with COPD?
haemophilus influenzae
36
what pathogen causes community-acquired PNA associated with alcoholism and diabetes?
klebsiella pneumoniae
37
what pathogen causes community-acquired PNA associated with animals at time of giving birth, veterinarians, farmers?
coxiella burnetii
38
what pathogen causes community-acquired PNA associated bullous myringitis (multiple reddened, inflamed blebs on tympanic membrane)?
mycoplasma pneumoniae
39
what pathogen causes community-acquired PNA associated with GI sx (diarrhea, abdominal pain) and CNS sx (headaches, confusion)?
legionella
40
what are the 5 agents that cause atypical PNA?
mycoplasma, coxiella, pneumocytis, chlamydia, viruses
41
what are the criteria for an exudate? what are the causes of exudate?
LDH greater than 60% of serum or protein greater than 50% of serum suggest an exudate. exudates are caused by infection and cancer.
42
what pathogens are more commonly seen in HAP compared to CAP? what is the preferred abx therapy?
gram negative bacilli such as E. coli and Pseudomonas. NO MACROLIDES! Antipseudomonal cephalosporins (cefepime or ceftazidime) OR antipseudomonal penicillin (piperacillin and tazobactam) OR carbapenems (imipenem, meropenem, or doripenem)
43
tx for ventilator-associated PNA
antipseudomonal beta-lactam PLUS a second antipseudomonal agent (aminoglycoside or fluoroquinolone) PLUS a MRSA agent (vancomycin or linezolid)
44
aspiration pneumonia occurs in the _____ lobe when lying flat
upper
45
what are the alternative tx for PCP pneumonia if TMP/SMX causes toxicity?
clindamycin and primaquine OR pentamidine (pentamidine is esp indicated if pt has G6PD deficiency)
46
side effects of TMP/SMX
RASH, BONE MARROW SUPPRESSION (HEMOLYTIC ANEMIA in pts with G6PD DEFICIENCY!), type 4 RTA (hyperkalemia), megaloblastic anemia (antifolate drug), teratogen, photosensitivity, drug-induced lupus
47
explain effect of TMP/SMX on levels of other drugs
displaces drugs from albumin, causing increased toxicity. for example, warfarin can be displaced from albumin, increasing risk for bleeding. it can also displace bilirubin from albumin causing kernicterus in neonates who were exposed in utero during last month of pregnancy. it also inhibits cytochrome P450 system so it can increase toxicity of many drugs.
48
alternate abx for PCP prophylaxis in those with TMP/SMX toxicity
ATOVAQUONE or DAPSONE
49
RIPE therapy for TB: list the side effects and management
Rifampin: red color to body secretions Isoniazid: peripheral neuropathy; prevent with pyridoxine (vit B6) Pyrazinamide: hyperuricemia (tx if symptomatic) Ethambutol: optic neuritis/color vision (decrease dose in renal failure)
50
when should steroids be used in TB?
pts with pericardial involvement or meningitis (decrease risk of constrictive pericarditis and decrease neurologic complications, respectively)
51
what is considered a positive test on PPD?
5 mm: HIV pts, glucocorticoid users, close contacts of those with ACTIVE TB, abnormal calcifications on CXR, organ transplant recipients 10 mm: recent immigrants (past 5 years), prisoners, healthcare workers, close contacts of those with TB, hematologic malignancy, alcoholics, diabetics 15 mm: those with no risk factors
52
what should you do if a pt who has never had a PPD skin test before and their test comes back negative?
get a second test within 1-2 weeks
53
what should you do if PPD test was positive and CXR ruled out active disease?
isoniazid therapy for 9 months
54
medication management for TB
RIPE for 2 months, then rifampin and isoniazid only for 4 more months (6 total months of tx)
55
6 drugs that cause pulmonary fibrosis
ABC BMN (ABC Big Man Now): Amiodarone, Bleomycin, Cyclophosphamide, Busulfan, Methylsergide, Nitrofurantoin
56
pneumoconiosis associated with shipyard workers, pipe fitting, insulators
asbestosis
57
pneumoconiosis associated with cotton
byssinosis
58
pneumoconiosis associated with electronic manufacture
berylliosis
59
pneumoconiosis associated with moldy sugar cane
bagassosis
60
what are the important PFT findings in pulmonary fibrosis?
decreased FEV1, FVC, TLC, residual volume, NORMAL ratio of FEV1:FVC (greater than 70%), DECREASED diffusion capacity of lung for carbon monoxide
61
which pneumoconiosis shows granulomas on biopsy?
berylliosis
62
likely and possible sx of sarcoidosis
likely: young African American female with dyspnea on exertion, erythema nodosum, and lymphadenopathy possible: parotid gland enlargement, facial palsy, heart block, restrictive cardiomyopathy, CNS involvement, iritis and uveitis
63
biopsy of sarcoidosis
noncaseating granulomas
64
lab findings, PFT findings, and tx of sarcoidosis
elevated ACE level, hypercalciuria, hypercalcemia (granulomas in sarcoidosis make vitamin D!), PFT shows restrictive pattern; tx with PREDNISONE
65
what are the options for pts with PE/DVT who experience HIT?
fondaparinux, argatroban, lepirudin
66
which drugs can be used instead of warfarin that do not require INR monitoring after DVT/PE?
rivaroxaban and dabigatran
67
what is obesity/hypoventilation syndrome?
sleep apnea with increased bicarbonate
68
how much tidal volume should be given for mechanical ventilation for ARDS?
6 mL per kg
69
what should you suspect in a pt whose pneumonia has not cleared up after 4-6 weeks on follow-up CXR?
bronchoalveolar carcinoma (type of adenoma)
70
tx of acute gout attack in a pt with renal insufficiency
steroid injection or oral steroids (triamcinolone)
71
what medications should be stopped in a pt found to have gout?
THIAZIDE DIURETICS, ASPIRIN, and NIACIN
72
gout medications: ______ is effective at preventing second gout attack. _____ decreases production of uric acid.
colchicine is effective at preventing second gout attack. allopurinol decreases production of uric acid
73
what antihypertensive is best in gout pts?
losartan (lowers uric acid)
74
positive straight leg raise test
herniated disk
75
knee jerk reflex lost = what nerve root impinged?
L4
76
ankle jerk reflex lost = what nerve root impinged?
S1
77
tx for sciatica
NSAIDs with continuation of ordinary activities (NO BED REST!)
78
tx for fibromyalgia
AMPed up for fibromyalgia!!: Amitriptyline, Milnacipran, or Pregabalin (NOT STEROIDS!)
79
what is dupuytren's contracture and what conditions is it associated with?
hyperplasia of palmar fascia leading to nodule formation and contracture of the 4th and 5th digits; alcoholism and cirrhosis
80
anti-cyclic citrullinated peptide = what dx
rheumatoid arthritis
81
rheumatoid arthritis, splenomegaly, neutropenia
felty syndrome
82
rheumatoid arthritis, pneumoconiosis, lung nodules
caplan syndrome
83
what is the most important thing to do with pts with RA before surgery
cerivical spine x-ray (RA is associated with C1/C2 subluxation)
84
what DMARD for RA causes retinal toxicity?
hydroxychloroquine
85
what DMARDs are safe in pregnancy?
hydroxychloroquine and sulfasalazine
86
presentation of juvenile RA
high, spiking fever in a young person associated with a salmon-colored rash on chest and abdomen that occur only with fever spikes. splenomegaly, pericardial effusion, joint sx, anemia, and leukocytosis may also be present
87
is complement decreased or increased in SLE?
decreased
88
what are the laboratory findings that can specify acute lupus flare vs an infectious cause?
DECREASED complement and INCREASED anti-dsDNA
89
what drug can control progression of SLE?
BELIMUMAB
90
PT and PTT findings in antiphospholipid syndrome
ELEVATED PTT and normal PT
91
what are the two best tests (initial and most specific) for antiphospholipid syndrome?
initial: mixing study (PTT will remain elevated even when normal plasma is added because of the APL antibodies) specific: Russel viper venom test (prolonged with APL antibodies and does not correct on mixing with normal plasma)
92
when should a mother be investigated for anticardiolipin antibody as cause of spontaneous abortion?
two or more first-trimester events or a single second-trimester event
93
what should be given to prevent recurrence of spontaneous abortion caused by anticardiolipin antibody?
HEPARIN and ASPIRIN (remember -- warfarin is contraindicated in pregnancy!!)
94
sx of limited scleroderma
CREST syndrome: Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasias
95
what are the serious manifestations of scleroderma in lung and renal systems?
lung: restrictive lung disease and pulmonary hypertension renal: sudden HYPERTENSIVE CRISIS (may lead to microangiopathic hemolytic anemia)
96
what antibodies are extremely specific to scleroderma? what test is most specific?
specific: antiCENTROMERE antibodies | most specific: antiTOPOISOMERASE (SCL-70) antibodies
97
tx for following parts of scleroderma: long-term, renal crisis, pulmonary fibrosis, pulmonary HTN
long-term: methotrexate renal crisis: ACE inhibitors pulmonary fibrosis: cyclophosphamide pulmonary HTN (same with idiopathic pulmonary HTN): bosentan, sildenafil, prostacyclin analogs (iloprost, treprostenil, epoprostenol)
98
what is the most dangerous complication of Sjogren syndrome?
lymphoma (evaluate in everyone)
99
best initial test for Sjogrens
Schirmer test: filter paper is placed against eye
100
peroneal neuropathy leading to foot drop in a young pt vs asthma plus foot drop in an adult
polyarteritis nodosa
101
all pts with polyarteritis nodosa should be tested for what disease?
hepatitis B and C
102
what is mononeuritis multiplex?
sx of polyarteritis nodosa where there is multiple peripheral neuropathies of nerves large enough to have a name
103
pt over age 50 with pain and stiffness in shoulder and pelvic girld muscles, difficulty combing hair and rising from chair, elevated ESR
polymyalgia rheumatica; Churg-Strauss
104
expected lab findings of polymyalgia rheumatica
elevated ESR, normochromic normocytic anemia, normal CPK and aldolase
105
child recovering from recent URI with GI bleeding, painless palpable purpura, arthralgias, and hematuria
henoch schonlein purpura
106
biopsy shows leukocytoclastic vasculitis
henoch schonlein purpura
107
presentation of cryoglobulinemia
pt with hepatitis C who has joint pain, glomerulonephritis, non-blanching purpuric skin lesions, and neuropathy
108
abnormal lab tests in cryoglobulinemia
positive RHEUMATOID FACTOR and COLD PRECIPITABLE IMMUNE COMPLEXES
109
what diseases are cold agglutinins associated with?
EBV, mycoplasma, lymphoma, waldenstrom macroglobulinemia
110
presentation of behcet syndrome
asian or middle eastern person with: 1. painful oral and genital ulcers 2. erythema-nodosum like lesions of skin 3. ocular lesions leading to uveitis and blindness
111
sterile skin pustules from minor trauma like a needle stick
pathergy = BEHCET syndrome
112
tx for ankylosing spondylitis refractory to NSAIDs
anti-TNF drugs (infliximab, adalimumab, etanercept)
113
presentation of psoriatic arthritis
psoriasis, SAUSAGE DIGITS, NAIL PITTING, "PENCIL IN A CUP" deformity on x-ray
114
tx for psoriatic arthritis refractory to NSAIDS
methotrexate or anti-TNF drugs (NO STEROIDS)
115
triad of reactive arthritis
JOINT pain, OCULAR findings (uveitis, conjunctivitis), GENITAL abnormalities (urethritis, inflammation of foreskin and head of penis)
116
scary side effect of bisphosphonates
osteonecrosis of jaw
117
empiric tx of septic arthritis
CEF and VANC
118
tx for septic arthritis of prosthetic joint
remove the joint, give abx for 6-8 weeks, then replace joint
119
recurrent gonorrhea infections = what should you test for?
C5-C9 (terminal complement) deficiency
120
what are the unique sx of gonococcal arthritis compared to septic arthritis?
POLYARTICULAR involvement, TENOSYNOVITIS (inflammation of tendon sheaths, making finger movement painful), petechial RASH
121
best initial test to order for osteomyelitis and best second test to order if the first one is negative
x-ray; if x-ray is normal, order MRI
122
arthritis in an adult that resembles RA but is RF negative
psoriatic arthritis or parvovirus B19
123
arthritis in a child that resembles RA but is RF negative
JRA (rheumatoid factor is often negative in a pauciarticular variant)
124
anemia with high iron
sideroblastic anemia (inability of iron to be incorporated with heme; most commonly caused my alcohol's suppressive effect on bone marrow)
125
in iron deficiency anemia, is the platelet count high or low?
high
126
how can you distinguish iron deficiency anemia from a thalassemia?
both are microcytic anemias, but thalassemia has normal RDW, normal iron and ferritin, RBC count is normal, and target and teardrop cells are seen on smear
127
what deficiencies are seen in celiac disease?
B12, folate, and iron
128
what can cause macrocytic anemia other than folate and B12 deficiency?
direct alcohol effect on bone marrow or liver disease (always get a peripheral smear before ordering folate or B12 labs!)
129
only way to distinguish B12 deficiency from folate deficiency by labs
increased methylmalonic acid levels
130
how does pancreatic function relate to B12 deficiency?
pancreatic enzymes are needed to absorb B12. they free it from carrier proteins so it can bind with intrinsic factor
131
what electrolyte abnormality do you need to watch for when replacing folate or B12?
hypokalemia
132
what are the manifestations of sickle cell trait?
defect in ability to concentrate urine (isothenuria), occasional hematuria
133
best initial therapy for parvovirus B-19 infections in sickle cell pts
IVIG
134
tx for cold agglutinins
rituximab, other immunosuppressive agents (cyclophosphamide, cyclosporine). STEROIDS AND SPLENECTOMY DO NOT WORK!
135
distinguishing features of cryoglobulins from cold agglutinins
cryoglobulins are associated with hepatitis C, joint pain, and glomerulonephritis
136
does renal cell cancer cause increased EPO or decreased? is Hct low or high?
increased EPO, so high hematocrit
137
most accurate test for polycythemia vera
JAK2 mutation
138
what is the tx for essential thrombocytosis and who should be treated?
hydroxyurea; if pt is over age 60 and there are thromboses OR platelet count is above 1.5 MILLION
139
tx for myelofibrosis
TNF inhibitors THALIDOMIDE and LENALIDOMIDE
140
sudden pain and redness in medial canthal region with purulent discharge
dacryocystitis
141
hereditary hemochromatosis increases risk of what?
hepatocellular carcinoma
142
tx for aplastic anemia in pts too old for BMT (over age 50) or there is no matched donor
antithymocyte globulin (ATG) and cyclosporine (goal is to suppress T cells!)

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