ABIM October 2021 Flashcards
(458 cards)
1
Q
ALS signs
A
40s-60s, bilateral extremities, hyperreflexia (upper motor neurons), fasciculations (lower motor neurons). Cramping
2
Q
West Nile transverse myelitis
A
anterior horn cells, polio like. Reflexes decreased not increased.
3
Q
CIDP (chronic inflammatory demyelinating polyneuropathy)
A
lower motor neuron weakness, areflexia, GBS
4
Q
ALL
A
> 45y, blasts stain for TdT, CD19, CD20.
5
Q
AML
A
CD13, CD33, CD34
6
Q
DM diagnosis
A
- sxs + glucose >200
- FBG >=126 (two occasions) or post OGTT >200
- HbA1c >=6.5%
7
Q
Thrombosis and prolonged aPTT
A
APLA. performed 1:1 mixing study. With APLA, doesnt correct with addition of normal plasma. Mixing study clots blood if due to clotting factors (need only half), not if due to inhibitors.
8
Q
DVT ppx high risk surgeries
A
TKR then THR then pelvic/cancer
9
Q
CAH
A
CYP21A2 (17-hydroxyprogesterone not converted). high cortisol and DHEAS. Increase ACTH -> hyperpigmentation, advanced bone age, precocious puberty.
10
Q
Yersinia pestis
A
necrotizing pna, contagious - can cause epidemic
11
Q
OSA-HS
A
neck circumference >16 inches (women), >17 inches (men)
AHI 5-14: mild, 15-30 moderate, >30 severe
12
Q
Associated with latex allergy
A
spina bifida
Nasal polyps: ASA allergy
Eos gastroenteritis: food allergies
13
Q
signs of OA
A
DIP (heberden nodes)
knee (genu varus)
bunion (lallux valgus of great toe)
14
Q
neutropenic fever
A
Vanc and Cefepime. Day 4-7 if still febrile, add fungal coverage.
15
Q
subacute thyroiditis
A
After vial illness AKA de Quervain, granulomatous. Hyperthyroid sxs (cell destruction) then euthyroid then hypothyroid then back to euthyroid when resolved. Causes tender thyroid. uptake low as thyroid released via destructive process rather than increased uptake. Hashimotos : chronic autoimmune, nontender
16
Q
Increased RAI uptake
A
more synthesis of thyroid hormone
Graces, Toxic multinodular goiter
17
Q
Tropical sprue
A
macrocytosis, glossitis, decreased folate. Causes malbsorption with partial villous atrophy. Carribean, SA, Venezuela, India. Rx: tetracycline and folate replacement.
Other diarrhea:
C. Diff: fidoxamin
18
Q
H. Pylori
A
14d OCLAM: omemprazole, clarithromycine, amox
fu: urea breath test or stool antigen.
confirm cure 4-6w after. Cannot be on PPI for breath test, off abx for 4 wks.
19
Q
Anti seizure during pregnancy
A
AVOID valproate (high risk of neural tube defects) Phenytoin and topiramate also associated with brith defects.
20
Q
delayed hypersensitivity (type 4)
A
days later.
Examples: TB, contact dermatitis.
Type 1: immediate, mast cells (peanut allergy)
Type 2: drug induced cytopenias, antibody ITP and hemolytic anemia)
Type 3: serum sickness, Ag-AB complexes (vasculitis, drug fever, arthus reactions)
21
Q
High iodine causes…
A
decreased thyroid RAIU bc gland saturated and cannot take up more.
Thyroiditis - destroy cells and causes low RAIU
22
Q
Pleural tests and lights criteria
A
Cholesterol>45 high sensitivity and specificity for exudative effusions.
LDH: elevated in setting of chronic diuretic use.
Lights criteria:
pleural fluid to protein >0.5
pleural LDH to serum LDH >0.6
pleural fluid LDH >2.3ULN of serum LDH
HF: transudative
parapenumonic: exudative (low glucose, high neurtrophils)
Exudative:
pleural chol>45
pleural LDH> 0.45 ULN
chylous if TG>110. THINK NON-HODGKINS IF CA
Adenosine deaminase = TB!
23
Q
acoustic neuroma
A
HA, vertigo, tinnitus, cerebellopontine signs
24
Q
weber test
A
lateralized hearing loss, tuning fork on head
25
blastomycosis
lung and draining skin/bone lesions.
Central, southeast and mid-atlantic states.
Inhalation of spores via soil.
Histoplasmosis: Mississipi and Ohio River (erythema nodosium or erythema multiforme). Similar to Coccidoidiomycosis (seen in SW US).
Aspergillosis: immunocompromised
26
Strep
Strep Pneumoniae - skin and soft tissue infections
| Strep pyogenes - skin infections, impetigo, erysipelas.
27
HCC
paraneoplastic syndrome
elevated AFP
hyperca, hypoglycemia, erythrocytosis, FUO, watery diarrhea.
28
screen for liver cancer in cirrhosis
AFP and US
| Caused by cirrhosis and hepC, not hepB
29
Testicular
```
15-35y,
germ cell tumors, curable with 5-year survival 90-95%.
solid painless mass.
>50y -> lymhoma
No biopsy (can seed)
Do us and if solid do orchiectomy
```
30
hemochormatosis
iron stored intracellularly.
liver, heart, pancreas, pituatary
rx: phlebotomy
(wilson's rx: penicillamine)
31
Factor 7 deficiency
prolonged PT
normal aPTT
increased risk of bleeding.
32
C. diff relapse
if flagyl, use po vanc
if vanc, use fidaxoxcicin or pulsed vanc
IV flagyl and po vanc if fulminant disease - ileus, megacolon, hypotension.
Stool transplant after 2nd relapse.
33
Critically ill patients with low TSH
1. Rule out adrenal insuff (random cortisol)
2. Replace thyroid.
Avoid IV T3 in those wth cardiac disease. T4 is safer.
34
Pregnant vaccines
Tetanus with Tdap ok (after 20 w)
Inactivated flu ok.
NO: MMR, Varicella (live), nasal flu, zoster, polio, typhoid, yellow fever.
35
PMR
giant cell arteritis
20% develop GCA (visual changes, jaw pain, HA)
PMR - limb girdle pain
Rx PMR: low dose prednisone.
Rx GCA: high dose prednisone.
36
MV surgery
sxs or LVEF <60% of LVESD >= 40 mm
37
Tb testing
No controls.
Never choose 250 TU
2 step for those who work in prisons
38
Impingement syndrome
impingement of surpspinatus tendons
passive abduction to 90 degrees causes pain in deltoid region.
subacromial bursitis - pain at rest and with motion
rotatory cuff tear: pain during active than passive abdiction, positive drop arm test.
TOS: pain from base of neck to top of shoulder, down the arm
39
Sensitivity
TP/(TP+FN)
those who have disease, how many will test positive.
Test sensitivity not affected by disease prevalence
40
Asthma PFTs
response to bronchodilator.
| mild increase in DLCO
41
HF PFTs
decrease DLCO
| no repsonse to bronchodilators
42
Emphysema PFTs
decreased DLCO
increased TLC (hyperinflation)
no repsonse to bronchodilators
43
ILD PFTs
reduced DLCO
lower TLC
no response to bronchodilators
44
Sarcoidosis PFTs
reduced DLCO
| no response to bronchodilators
45
treatment of rashes
erythema multiforme - targetoid lesions on palm: HSV - valcyclovir
erythema migrans - doxycycline (lyme)
latent syphilis - PCN
46
testicular seminoma
AFP not elevated (elevated in nonseminoma germ cell tumor)
Testicular ca: check AFP, beta subunit of HCG and LDH
AFP - not elevated, b-HCG infrequently elevated. LDH usually elevated.
AFP half life 5-7 days. b-HCT 1.5-3 d
47
klinefelters
high FSH and LH and small testes
48
prolactinoma
low FSH and LH
49
testicular tumor
elevated b-HCG and estradiol
50
sarcoidosis
AA
lung involvement
arthritis (symmetric and LEs)
anterior uveitis
51
pseudocyst
recurrence of pain after pancreatitis
never do ERCP
Rx: bowel rest and IVF, drain or surgery only after 3-6 mo
52
RA
doesn't affect lumbar spine
53
Hairy cell leukemia
```
dry tap
splenomegaly
pancytopenia
CD11c+, CD20+, CD103+
BRAF mutation (~100%)
Rx: cladrabine, pentostatin.
---
Philadelphia t (9;22):CML
t(14;18) DLBCL, follicular lymphoma
JAK2- PCV, ET, myelofibrosis
```
54
alzheimers Rx
cholinestarese inhibitor (donepezil).
55
hyperparathyroidism
elevated PTH despite elevated Ca
| vit D suppresses PTH
56
pseudohyperparathyroidism
shortened 4th and 5th metacarpals.
57
protein in urine
Albumin: Cr ratio:
<30 mg/g - normal
30-300 - microalbuminuria
>300 - macroalbuminuria
58
PFTs
```
If FEV1/FVC <0.7 the COPD is classified as obstructive:
FEV1:
>=80% - mild obstruction
50-80% - moderate obstruction
30-50% - severe obstruction
<30% - very severe obstruction.
```
TLC> 120% c/w hyperinflation.
TLC <80% restrictive pattern
59
medullary thyroid cancer
sporadic or familial
RET protooncogene
Rx: screen family, thyroidectomy
60
Zollinger Ellison Syndrome
gastrin secreting
serum calcium level after gastrin test
MEN1
61
tularemia
```
Arkansas, Missouri, Oklahoma
Franciesella Tularensis
goats, sheep, cows
can go in skin, eyes, LN
dx: serial serologies.
--
Brucella - FUO - goats
--
Ehrlichia - missouri and arkasnsa, fever, HA, thrombocytopenia, leukopenia, pancytopenia
rash is ~30%
Morulae in white cells
```
62
Photosensitivity
Flouroquinolones, tetracycylines, NSAIDs, HCTZ, furosemide, amiodarone, diltiazem, statins
63
dermatitis herpetiromis
gluten senstivity (celiac disease)
Rx: dapsone
--
zinc deficiency: acrodermatiis enteropathica (dry patches and plaques) on mouth and anus
64
depression meds - qt prolongation
TCA, CELEXA, LEXAPRO, VENLAFAXINE (SNRI), mirtazapine, bupropion
65
RMSF
Fever, arthralgia, maculopapular rash-> petechial rash on trunk. Rx: doxycycline Dx: biopsy and IF on petechiae.
66
sinusitis
augmentin. if PCN allergic, then doxy>levofloxacin
67
pseudogout
calcium phyrophosphate deposition
positive birefringent, rhomboid crystals
gout: monosodium urate crystals
68
aplastic anemia
parvovirus B19, high epo
69
acute pap muscle rupture
crescendo-decresendo at apex
70
vsd
holosystolic LSB thrill
71
neurosyphilis
pcn g iv - crosses bbb
72
acute dystonic reaction (i.e haldol)
Rx: benztropine or benadruyl
73
CRC screening
every 5 yrs if CRC in first degree relative or adenoma <60 years
74
occult GERD
24 h ph probe
| esophageal contraction over normal peristalsis.
75
babesia mircoti infection
```
Northeast USA
like malaria
hemolytic anemia in splenectomized people
RX: moderate - atovaquone and azithro
severe: clindmycin and quinine
```
76
ADHD
before 12 years of age
sleep, social interactions, outbursts
PD - after 12 years of age
77
retina detachment
floaters or flashing lights
78
thyroid cancer risk factors
FH, XRT to neck, pain in anterior neck, dysphagia, <20 or >70 y, hoarseness (vocal cord paralysis), fixed, growing, LAN, M>F.
79
Pregnancy
no floroquinolones, ok to use macrolides, vancomycin, cephalosporins
ok to use erythtromycin
avoid: ACe, statin, doxy, cipro
80
iron deficiency anemia >50 yrs
colorectal cancer
81
AIDS associated malignancy
EBV associated CNS lymphoma in immunocomprommised
HPV oral cancers
HHV-8 Kaposis sarcoma
Merkel cell polyoma virus - merkel cell carcinoma
82
gout
"marginal erosions" on XR, hyperuricemia
HCTZ increases UA
negatively birefringent crystals
83
Correction of prolonged aPTT with 1:1 mixing (provides 50% of normal factor)
Prolongation after normal correction = inhibitor (takes a while to kick in).
Prolongation sustained = Factor deficiency (assay each of them).
Warfarin - prolonged PT
84
Coagulation cascade
PT: Vitamin K dependent (2,7,9,10 or fibrinogen)
PTT: 8,9,11,12
Factor 12 def: normal PT, prolonged aPTT (AR, no bleeding issues)
85
RA
anti-CCP and RF antibodies portends poor prognosis and extra-articular manifestations (vasculitis, rheumatoid lung and skin nodules). Rx: dmard
86
Metabolic acidosis
expected PCO2 = (15 + bicarb). Does it equal the actual PCO2. (Tells you if respiratory acid base disorder)
Anion gap = (Na+K)-(HCO3+Cl). Normal 12.
High anion gap metabolic acidosis: renal failure, lactic acidosis, ketosis, ingestions, D-lactic acidosis (short gut).
Lab assays only measuere L-lactic acid.
87
ethylene glycol
antifreeze, calcium oxalate crystals in urine, elevated osmol gap
88
hereditary retinoblastoma
associated with osteosarcoma (metaphyseal region of long bones, lytic lesion).
89
Crohns stricture
if >5 cm, cant do balloon dilation with colo; need surgery
90
Measles
Kopliks spots and rash
cough, conjunctivitis and coryza
rash: back of neck and goes downwards
Needs two shots of MMR
91
Anemia
Decrease production or increased destruction.
IDA: if ferritin <40, microcytic, hypochromic
Decreased EPO: normocytic
B12 or folate: macrocytosis
92
lithium
reduced suicide in bipolar
| hypothyroidism is a side effect (inhibits secretion of thyroid)
93
ZES
gastrinoma (gastrin secreting tumor) - diarrhea
stop PPi and check gastrin
If see multiple ulcers, think ZES
94
Lyme carditis
3rd degree AVB, Rx: CTX and temp pacer (permanent not required)
95
hyponatremia
normal BUN and glucose - hypoosmolar hyponatremia.
During hypoN, the urine OSM should be low to pee out free water. If urine inapprorpiate concentrated, then SIADH (high urine Na and urine OSM>200).
96
acid base
expected PCO2 = 1.5xHCO3 + 8 +/- 2 (to see if respiratory disorder)
To see if nonanion gap, see if the drop in HCO3 (normal 24) is the same as the increase in AG (normal 6).
97
sarcoidosis
noncaseating granulomas (also seen in beryllium exposure)
uveitis, arthritis, fever, erythema nodosum
vitamin d excess, PHTN, cardiac sarcoid
proteinuria, inflammatory arthritis.
98
cullen sign (bluish near umbilicus)
hemoperitoneum in pancreatitis
| also flank discoloration
99
carcinoid
mostly occur in jejunum, duodenum, ileum, right colon
100
Endocarditis
MSSA (nafcillin or oxacillin) or strep viridans (beta lactam and aminoglyocisde)
101
false positive HIV test
SLE, HLA antibodies, pregnancy
| Dx: (p24 antigen/antibody), viral load, antigen testing
102
PPD interpretation
>5 - immunocompromised (HIV, prednisone >15 mg)
103
parapneumonic effusion
ph<7.2, pleural fluid glucose <60, LDH>3x ULN.
| Organisms/pus -> chest tube
104
Vitamin A intoxication
causes hypercalcemia, increases resorption of bone, causes muscle pain.
105
aplastic anemia Rx
ATG --> serum sickness.
caused by drugs (sulfa, valproate, chloramphenicol) or virus (HIV, Parvovirus B19)
dx: hypocellular (<20% marrow), low retic, pancytopenia
106
CJD
dementia and myoclonus, precipitated by startle
| 14-3-3 protein in csf
107
Prolactinoma
macroadenoma prolactin usually >200
if <100, look for other effects like thyrotroph (hypertrophies thyrotroph cells in repsonse to high TRH).
Mild prolactin elevation - nipple stimulation, pregnancy
108
hep c
associated with porphyria cutaneous tarda
| resolved with hepatits Rx
109
sickle cell
parvovirus b19, cva, avn
110
PMR
20% develop GCA
Rx: asa, steroids 60 mg/d
if visual sxs, solumedrol 1g/d X3d, then oral
111
menieres
vertigo, hearing loss, tinnitus
112
hyperthyroid before surgery
delay and give bb
| if cannot delay, give bb, ptu, iodine and steroids
113
B12 deficiency
hypersegmented neutrophils, impaired DNA synthesis
114
MDS
hypercellular marrow, dysplastic maturation
115
Myelofibrosis
teardrop cells on smear, "dry" tap
116
ACD
inhibition of absorption of iron from GI tract (hepcidin) (normal or increased iron stores)
G6PD- reduced glutathione so oxidative stress
hereditary sphreocytosis - memrabe fragility
117
acute cholangitis
biliary colic, fever, jaundice
| Rx: IV abx and ERCP
118
osmolalality
= 2xNa + glu/18 + BUN /2.8
osmolal gap = measured vs calculated
>10 is increased
119
HAGMA
toxic ingestion
"GOLDMARK"
glycols: propylene hlycol, ethylene glycol
oxoprolyine: acetaminophen
L-lactic acidosis - shock, tissue ischemia
D-lactic acidosis - short gut, malabsoroption.
Methanol (also increases osmolal gap)
Aspirin (salicylates)
renal failure (uremia)
ketoacidosis: DM, etoh, starvation
120
sle
ANA TITER >1:160
121
GIARDIA
watery frothy diarrhea,
| dx: antigen in stool
122
tetanus rx
tetanus toxoid (vaccine), tetanus IVIG, flagyl
123
postpartum thyroiditis
```
1 mo hyper then hypo
measure TSH (high), FT4 (low)
check anti-TPO ab
Rx: thyroxine
check tsh monthly as this may resolve
```
124
risk factors for osteoporosis
BMI<19, menopasue <40y, wt <127
125
chemo agents side effects
```
trastuzamab - cardiotoxicity
vincristine - nerves
cisplatin - nephrotoxicity
capecitabine - diarrhea and volume loss
eGFR (cetuximab)- acneiform skin rash
```
126
Retin-A
pancreatitis and hyper Tg
Can give with fibrate
Contraindicated: doxycycline (pseudotumor cerebri)
127
alports disease
X linked, hematuria, sensorineural deafness, progresses to ESRD
128
tramadol
associated with seizures
129
cancers with hyperCa
Rx: IVF, then lasix
| squamous cell, breast, MM, T cell lymphoma, renal cell
130
dermatomyositis
"shawl sign", proximal muscle weakness, +myositis Ab, , photosensitive rash.
Newly dx polymyositis - dermatomyositis - possibly paraneoplastic (especially if ANA with anti-ANA p-155/p140). LOOK FOR CANCER -
131
Takayasus arteritis
fatigue, ha, weight loss, fever
large vessel vasculitis
womem
132
behcets
HLA-B51
| UVEITIS, oral/genital ulcers
133
flushing ddx
```
hereditary angioedema - C1-INH level
Urine metanephrine and VMA - pheo
5-HIAA - carcinoid
tryptase - systemic mastocytosis
elevated vasoctive intestinal polypeptide, VIPoma.
```
134
silicosis
upper lung lobes
135
thryroid nodule
TSH. if low, then scan. "HOT" nodule
| If high or normal, then biopsy.
136
breast cancer
HR+ positive prognosis
137
erythromycin-clindamycin D test x
inducible resistance of MRSA isolate
| + test - susceptible to clinda in vitro, resistace in vivo
138
cushings dx
2 negative 24h urinary free cortisol or dst
139
SIADH
urine osm high
| urine na >40
140
postpartum thyroiditis
tsh low
do RAIU to see if graves (high) or acute or subacute thyroiditis (low RAIU) - improves on its own.
Can't do RAIU if nursing.
Sestamibi for PTH
141
pseudolymphoma
secondary to phenytoin use
| fever, elevated ALT/AST and LAN.
142
peritonsillar abscess
Group A strep or anaerobes
fever, throat pain, "hot potato" voice (muffled), uvular deviation.
vs.
RP abscess - fever, drooling, dysphagia
143
nephrotic syndrome/membranous GN
hypercoag
| renal vein thrombosis or PE
144
asa overdose
resp alkalosis
fever and hyperventilation.
chronic - tinnitus, vertigo and hearing loss
145
specificity
those who do not have the disease
| TN/ (TN+FP)
146
sensitivity
those who do have the disease
| TP/(TP+FN)
147
asa overdose
resp alkalosis
fever and hypervent
chronic - tinnitus and hearing loss.
148
grapefruit juice
CYP3A4
| simvastatin, nifedipine and lovastatin
149
pcp rx
bactrim + steroids (if PaO2<70)
150
blastomycosis
ohio and mississipi valley
rx: itraconazole
always Rx as colonization does not occur.
151
Lithium
interacts with CCB - may increase or decrease lithium, need to monitor lithium levels.
Thiazide increase lithium, ace inhibitors increase lithum,, MRA decrease lithium, loop can increase or decrease lithium
152
AKI from NSAIDS
prerenal azotemia (benign ua with hyaline casts and low fena)
AIN (weeks to months) -> nephrotic syndrome, biopsy with minimal change disease (urine eos).
ATN - abnormal US (dirty brown or cellular casts) increased FeNa.
Acute papillary necrosis - flank pain like renal colic.
153
pityriasis rosea
self limited rash
Rx; UVB, steroid
solitary oval patch on trunk (herald patch) --> 7-10d small, oval pink papules on trunk, extremeties and neck. last 6-8 wks. Follow lines of skin cleavage (christmas tree pattern).
154
prolonged aPTT
factor 8,9,11,12 deficiency or inhibitor.
1:1 mixing. If corrects, factor def. If corrects then prolongs, then inhibitor.
vWD - prolonged aPTT but mucocutaneous bleeding.
(ristocetein-platelet aggregation).
155
howell-jolly bodies
after splenectomy (black pellets on smaer)
B12 - hypersegmented polys
schistocytes - heart lave
basophilic stippling (blue granules in cytoplasm) - thalassemia or etoh abuse.
156
hand-schuller-christian syndrome
langerhans histiocytosis.
Triad: lytic bone lesions, DI, exopthalmus.
Treacher-Collins - malar hypoplasia, cleft in zygoma.
Loefflers- pulmonary infiltrates and peripheral eos.
157
pituitary apoplexy, hemorrhage
Rx: steroids.
1st: Polyuric, DI, hyperenatremia
2nd: transient SIADH, hyponatremia (cells release ADH).
3rd: recurrence of DI
158
renal sediment
```
no - edema - minimal change unlikely.
memranoproliferative GN (assoc with hep C) and IgA nephropathy - hematuria
MM - hypercalcemia, mismatch between proetinuria on dipstick (trace) and urine protein:cr ration (high).
```
159
endocarditis ppx
none for gi or gu procedures
160
positive exercise challenge test
FEV1 falls by >10%
(flow-volume loop - upper airway obstruction).
161
sulfasalazine
reversible cause of infertility with low sperm count
162
uncomplicated salmonella gastroenteritis
no abx unless very old, very young or immunocompromised.
163
skin testing vs allergen-specific IgE testing
better NPV with skin testing
164
hereditary angioedema
```
A/D
C1-INH function decreased
nonpitting edema 1-3 days, face and lips
doesnt respind to epi
NEVER USE ACEI in these pts
```
165
antibiotics in pregnancy
macrobid (after 1st trimester), PCN, cephalosporin, aztreaonam, fosfomycin.
166
HIT
5-10d, plts<50% baseline, thrombosis
PF4
Rx: stop hepatin and start DTI
(DIC: measure fibrin degradation products)
167
sputum with salty taste
adenocardcinoma (BAC)
| peripheral loctaion, growth along intact alveola septa ("lepidic" growth pattern).
168
lipoid pneumonia
"cholesterol pna"
169
RAIU interp
low - subacute thyroiditis
high diffuse - Graves (rx: methimazole for 18 mo then see if remission)
focal - hot nodule (rest low due to suppression). Rx: 131I
If laryngeal nerve changes, get thyroid us
170
auer rods
azurophilic needle-shaped crystals in the cytoplasm of immature cells = myeloblasts (AML).
(light blue granules in neutrophils = Dohle bodies, infection or inflammation).
171
AML
median age 65y, pancytopenia.
CD 117, CD33
(CD19 - lymphoblastic cell lineage).
172
eggshell calcifications
silicosis (shell-like calcifications in hilar nodes).
173
CVT
thrombophilic state (SLE), APLAS
OCP, pregnancy, infection, caner
Sxs: HA, focal neurological signs, papilledema.
174
Wernickes aphasia
word salad
| lesion in posterio temporal gyrus of dominant hemisphere
175
toxic shock syndrome
diffuse rash, multiorgan injury
S. aureus (purulent skin lesions) or S. pyogenes (hours to days incubation).
Pasteurella - colonizes dogs but causes local reaction
Bartonella - cat scatch disease - cellulitis and LAN,
lesions initially vesicular then papular.
176
hypoPTH
can be due to hypo MG
pseudoPTH - low Ca, high Phos and high PTH (abnormal PTH receptor)
177
AVN
long term steriod use
178
Anthrax
Bacillus anthracis
incubation 1 to 6 days
influenza like illness followed by respiratory distress and septic shock.
SIRS
Enlarged mediastinal nodes (wide mediastinum)
179
yersinia pestis (plaque)
airbone precautions.
| via rodents from flea bite or infected animal.
180
Tularemia
francisella tularensis
hemorrahci PNA no hilan LAN
Rabbit carcasses.
no isolation needed
181
eyrthema nodosum
sarcoidosis, IBD, TB, drug alelrgy, strep infection.
| Arrthralgias/arthritis + LNA = lofgen syndrome
182
cluster headache
```
15-180 min
unilateral, stabbing
autonomic sxs on that side - tearing, rhinorrhea, horners, (miosis or ptosis),
Male>female
Rx: O2, triptans.
```
183
scleroderma
>80% have esophageal involevement
reduced LES pressure (achalasia - high)
decreased contraction amplitude and peristalis.s
Raynaud's, dry MM
184
esophageal high grade dysplasia
dont do esophagectomy 1st line - do RF ablation or photodynamic therapy along with endoscopic mucosal resection (if nodule present)
185
hereditary sphreocytosis
```
A/D
chronic hemolysis
jaundice, splenomegaly, anemia.
Cholelithiasis due to bilirubin stones
Dx: osmotic fragility test or EMA binding test.
```
186
g6pD deficiency
hemolytic anemia
ppt by oxudative stressors, infections, meds (dapsone, sulfa drugs,antimalarial), fava beans, DKA.
Dx; Heinz bodies or bite cells
187
TDAP booster
dirty wounds and Tetanus >5y
188
cyclosporine
can increase UA and cause gout
189
Hodgkins lymphoma
chemo and xrt
| ABVD
190
CELLULITIS
purulent - s aureus
nonpurulent - s pyogenes
Moderate purulent - bactrim
severe - vanco, linezolid
191
murmurs
R sided - louder with inspiration
HOCM- increase with valsalva. decrease with leg raise or squatting.
AS - increase with squatting
192
mucormycosis
rhizopus, mucor and rhizomucor
DM
necrosis in nasal cavity, palate
193
spororhyrix schenckii
gardner pricking finger on thorn
194
serotonin syndrome
SSRI (fluoxetine) + MAOi (selegiline)
| confusion, agitation, hallucination, diaphorsis, HTN, hyperthermia, dilated pupils, hyperreflexia, myoclonus
195
GCA
dx: temporal artery biopsy
ESR high
50% have PMR, (20% PMR develop GCA)
196
histoplasmosis
bird/barn cleaning
self limited
no Rx unless HIV or chemo or disseminated
Rx: itraconazole.
197
diarrhea
E coli O157:H7 and shigella - blood
| Enteroxigenic E.Coli (travelers nonbloody, veggies or ice)
198
food poisoning
```
B Cereus (rice) or S.aureus (eggs, produce, meat)
toxin mediated, within 2 hours
```
Salmonella -1-3 day incubation, nonbloody diarrhea
199
hyponatremia in lung cancer
Small cell
200
lung cancer
small cell - central, SIADH, dermatomyositis
Large cell - peripheral
AdenoCa- less association with smoking
squamous cell - central, cavitary, hyperCa
201
photosensitive rash with drugs
```
tetracycline = doxycycline
fluroquinolones
amiodarone
thiazide
furosemide
```
202
CO poisoning
normal pO2 and high pulse Ox.
HA and nausea
Check carboxyhemoglobin.
203
acid-base
```
Write down teh variables:
ph, AG, HCO3, pCO2
(expected PCO2 - winters: Expected pCO2 = 1.5 x [HCO3] + 8 (range: +/- 2)
1. acidosis or alkalosis?
2. expected PCO2 vs actual?
3. HCO3< 22 --> met acidosis
4. Calculate AG: Na - (Cl + HCO3)
5. Has HCO2 FALLEN BY AMT THAT AG HAS INCREASED?
```
204
DM screning
Annually:
urine spot albumin:cr
eye screen (DM 1 after 5y, DM 2 immediately, regardless of HbA1c)
205
sick euthyroid
TSH low or low-normal
low T4, low T3, low or low normal FT4
high rT3
206
gilberts
elevated TB due to indirect (unconjugated)
207
diffuse proliferative lupus nephritis
induction rx:
solumedrol 250-1000 mg IV daily x3d then..
prednisone 1mg/kg/d then..
cyclophasphamide or cellcept
(azathioprine and cyclosporine for maintenance but not induction rx)
208
PITUATARY INCIDENTALOMA
1. is it inhibiting pituatary hormones
2.is it secreting something.
<1 cm --> hypersecretion
>1 cm --> hyper-, hypo-, visual field.
dx: igf-1m prl, dst
209
NPH
magnetic gait, urine incontinence, dementia
210
emphysema
high TLC, low DLCO
211
large breast tumors, HR+
mrm, adjuvant chemo (if >1mm, +LN), hormone rx
1. local control: lumpectomy, xrt
2. systemic control: chemo, hormonal therapy
212
PTLD
| post transplant lymphoproliferative disease
5% after solid organ
usu in 1st year
EBV in setting of chronic Tcell immunosuppression.
LDH high, fever, LAN, night sweats
(H. pylori - MALT)
213
GBS
Campylobacter infections
214
Reactive arthitis
shigella, salmonella, campylobacter
215
painless thyroiditis
```
silent thyroiditis
TPO antibodies positive
Variant if chronic hashimotos.
sometimes s/p pregnancy
hyperthyroid -with low 123I uptake, then hypothydoi then euthyroid
```
216
vaccinations
```
Tdap >7y
HPV 9-26y
Hep A >1y
Hep B at birth
MMR
Meningococcal if in college.
Pneumococcal >65y or if <65y and smoke, CHF, COPD, alcoholic
```
217
Wiscott Aldrich syndrome
X-linked recessive
thrombocytopenia, atopic dermatitis, recurrent infections
EBV associated malignancy (B-cell lyphoma and leukemia)
Cure with BMT
218
Parvovirus B19
slapped cheek rash
expsoure to children
adults can have small joint arthritis and lacy reticular rash
dx: Parvoirus B19 IgM Ab
219
isoelectric axis
I or aVF show positive=negative deflection
220
SVC SYNDROME
small cell lung, lymphoma, mediastinal germ cell
221
wasp sting anaphlaxis
do immunotherapy
222
erythema migrans rash
start doxy
| dont check Lyme IgM
223
eosinophilic granulomatosis with polyangiitis (EPGA)
medium-small vessel vasculitis with necrotizing granulomas with eos.
adult onset asthma
eos>10%
fever, malaise, weight loss
arthrotos, skin rashes, peripheral neuropathy, sinusitis.
p_ANCA, elevated EST
224
PAN
abdominal pain, rash, peripheral neuropathy, acute renal failure
not ANCA positive
small to medium vessels
spares the lungs
225
ANCA associated
small vessel
p-ANCA/anti-MPO:
1.Microscopic polyangiitis - necrotising, crescentic GN
2.Eosinophilic granulomatosis with polyangiitis (EGPA)
c-ANCA/anti-pR3
Granulomaosis with polyangiiti
upper respiratory (sinuses)
226
renal papillary necrosis
ischemia of distal renal papillae
| Risk fxs: Pyelo, DM, sickle cell, chronic analgesic use (acetaminophen, salicylates, NSAIDs).
227
when to admit PID
```
tubo-ovarian abscess
pregnant
no response to Rx after 72h
unable to tolerate op therapy
fever, n/v
```
228
AV infections
MRSA
| 2ND common: staph epideriditis
229
Prolactin microadenoma
<2% chance of growth during pregnancy
| Prolactin levels increase during pregnancy
230
neck pain
retropharyngeal abscess - hurts on flexion of neck
epiglotitis - hurts on extension of neck
Ludwig angina - infection of submandibular space beneath the tongue.
231
acid base
1. write down the ph, pco2 and the HCo3-
2. Look at HcO3 - what is the disorder?
3. Winters formula if metabolic acidosis.
If respiratory alkalosis - look at formula.
232
metabolic change for respiratory alkalosis
ACUTE: decrease in HCO3 is 2 per 10 in PCO2
CHRONIC: decrease in HCO3 is 5 per 10 in PCO2.
233
paresthesias
tingling, carpopeal spasm
234
Toxic shock syndrome
Toxic shock: fever, rash and 3 organ dysfunction.
staph aureus or group A beta hemolytic strep.
strawberry tongue (also in Kawasaki and scarlet fever)
Rx; Clinda and nafcillin or vanc
235
S. viridans
endocarditis.
236
lithium toxicity
N/V/D and ataxia on exam, fasciultaions, cogwheel rigidity, hyperreflexia.
Ace inhibitors inhibit renal excretion of lithium.
237
Carbamazepine toxicity
dose dependent.
>20 mg/kg, mild to moderate CNS and anticholinergic effects
>50 mg/kg - delta MS, intermittent agitation
238
lithium drug interactions
ace inhibitors inhibit renal excretion
239
neuroleptic malignant syndrome
blockade of central dopamine receptors
hyperthermia, autonomic dysfunction, muscular rigidity
Resembles serotonin syndrome (nausea, vomiting, shivering, hyperreflexia)
NMS: elevated CK, LDH, AST and WBC; myoglobinuria from rhabdo (normal in serortonin syndrome).
seen in patients with rapidly escalating doses of neuroleptics, like haldol.
RX; bromocriptine, amantadine, dantrole, stop haldol
240
CLL (small lymphocytic lymphoma) in elderly
indolent non-hodgkins lymphoma
incurable.
treat only symptomatic patients (painful LAN, fever, cytopenias)
Diagnose with peripheral flow cytometry; dont need BM biopsy.
Is not PET avid as it is indolent (vs. Hogkins or DLBCL).
241
acute rheumatic fever
```
strep infection untreated (ASO titer) 1 major + 2 minor:
MAJOR:
arthritis, polyarthritis (migratory)
carditis and valvulitis
CNS (syndehams chorea)
subcutaeneous nodules
erythema marginatum
```
```
MINOR:
previous RF
arthralgia
fever
ESR or WBC eleveated
prolonged PR on ecg.
```
Rx: IM PCN or oral PCN for 10 days
242
PMR
shoulder and hip girdle weakness
ACD
elevated ESR
Rx: prednisone 15-20 mg/day (use 60 mg if GCA present)
243
fibromyalgia rx
TCAs
244
homosexual men
give Hep A and B vax
245
pneumococcal vaccine
chronic liver, lung, heart dx, DM, asplenia, immunocompromised.
246
gram positive rods
listeria, clostridia (skin infection), erysipelothorix, bacillus, corynebacterium (acne or line sepsis), nocardia, actinomyces (rods in branching chains)
listeria monocytogenes - bacteria diarrhea, bactermia, meningitis, decreased cell mediated immunity.
RX; PCN or AMP. If allergic, Bactrim. Dont use after 32 weeks due to increased risk of fetal hyperbili and kernicterus
247
pseudoa-achalsia
cancer that looks like achalasia (birds beak).
usually GE jxn
also see weight loss, older, smoking.
248
viral meningitis
In viral meningitis, the opening pressure is 90-200 mm H2 O, and the WBC count is 10-300/µL. Although the glucose concentration is typically normal, it can be below normal in meningitis from lymphocytic choriomeningitis virus (LCM), herpes simplex virus (HSV), mumps virus, and poliovirus. The protein concentration tends to be slightly elevated, but it can be within the reference range.
249
HSV encephalitis
HSV Type 1
CSF with lymphocytic predominance and increased RBcs
dx: HSV PCR in >90%
rapid onset delta ms and focal EEG or exam (frontotemporqal area)
MRI abnormal
250
pseudohyperkalemia
small increase in K with normal platelets
| more pronounced in thrombocytosis.
251
pseudohyponatremia
thiazide diuretics (falsely low Na measurements)
252
irregular menstrual bleeding
<18d interval = luteal abnormality
Rx: OCPs
prolonged bleeding with normal intervals = fibroids
253
SCD (sick cell disease)
```
hemoglobin SC (heterozygous) - less pain crisis, can have splenic sequestration; hemolysis when RBCs trapped in spleen
Presents with painful splenomegaly, drop in Hb of >2 g/dL, low platelets and reticulosytosis.
```
```
Rx: fluids, blood transfusion. consider splenectomy when resolved.
Hemoglobin SS (homozygous)
```
RX in emergences (aplastic critis, acute chest) = exchange transfusion.
254
sjogrens and associated malignancy
40X higher risk of B cell lymphoma.
255
associations of diease
IBD = Akylosing spondylitis
Scleroderma = esopageal involvement
Aortic aneurysm = GCA
256
5mm PPD positive
after close contact with known case
organ transplant, HIV or when fibrotic changes on CXR present (i.e prior TB).
>10 mm: healthcare workers, IVDU, prisoners, homeless.
257
OA
PIP and DIP
No chondrocalcinosis
RA spared the DIPs.
Psoriatic can present with "pencil in cup" deformities.
Gout: marginal erosions with "rat bite" erosions or no radiographic changes
258
transfusion reactions
febrile, nonhemolytic - fever, chills, subjective dyspnea, no hemolysis on labs
Rx: tylenol
hemolytic transfusion reactions- hyptension, ARF
Dx: DAT and measurement of free plasma Hb
Others:
delayed hemolytic, analphylactic, urticarial, TRALI.
259
severe poison ivy reaction
give 2-3 weeks steroids.
260
addisons disease
hypotension, weight loss, chronic abd pain, hyponatremia
| primary adrenal insuff.
261
asymptomatic bactiuria (>100,000 CFU) in pregnancy
treat bc of risk of pyelo, low birth weight etc.
PCN, cephalosporin or fosfomycin.
Macobid ok after 1st trimester
Screen all women at least once in early pregnancy
262
MV repair
severe MR with sxs or asx with LV dysfunction (LVESD >= 40 mm)
263
alcoholic ketoacidosis
hypoglycemia, hx of alcohol binge, HAGMA
| Refeeding syndrome can occur - severe hypophasphatemia which can lead to rhabdomyolysis (3+ blood on urine dipstick)
264
Ethylene glycol intoxication
calcium oxalate crystals in urine
like methanol and isopropyl alcohol with increased osmolal gap (>10 mOsm/L)
calculated osmolal gap: 2XNA + glucose/18 + BUN/2.8
265
HRS
with cirrhosis
low urine Na (<10)
no response to volume resuscitation
266
microscopic colitis
Dx: colo with biopsy (grossly normal mucosa).
| older, stool output 500g/day
267
hypokalemia ecg changes
STD, decreased T wave amplitude, prolonged QTc, U wave (vs. digoxin where all the same but with short QT)
Normal U is smaller than T and usually seen in v2 and v3.
268
U wave
Normal U is smaller than T and usually seen in v2 and v3.
negative U wave is ischemic or systemic HTN
Increase amplitude with hypokalemia, dig effect, ICH and Class I and III antiarrhythmics and bradycardia.
269
hypocalcemia ecg
prolonged QT (due to st prolongation)
270
nonsmall cell lung cancer adjuvant chemo
>3 cm
| LN+ (stage IB or II)
271
antidote for TCA poisoning
sodium bicarb
272
empiric abx for animal bites
```
use if high risk for infection (face, tissue destruction, edema or near joint or on hand).
Empiric Augmentin (covers cats/dogs and pasteurella)
```
Tetanus toxoid if >5yrs since immunization or toxoid + IG if not had at least three prior tetanus shots.
273
muscle pain vs weakness
pain: think PMR if ESR up (vs. fibromyalgia) and try prednisone 12.5-15 mg and check SPEP (if weight loss present)
weakness: test for Ach R antibodies (for myasthenia, which worsens with use and imrpves with rest), CK (myositis)
274
flu antiviral
oseltamivir, zanamavir
275
PE ECG
ST
| S1Q3T3
276
HTN crisis in scleroderma
| renal crisis
use IV ace inhibitors (also treat renal crisis) even in setting of ARF
renal crisis usually in AA
277
exercise induced hyponatremia
low serum Na
high urine Osm
Due to excess fluid with high ADH from prolonged exercise
278
WPW with orthodromic tachycardia or AVRT
RP >100 msec.
vs.
AVNRT (RP usually <70 msec)
(WPW with antidromic = WCT)
279
Bactrim interaction with...
MTX
increase in marrow suppression
(use doxyclycline instead for S. Aureus coverage)
280
Dicloxacillin
doesnt cover MRSA
| like doxy or bactrim
281
prognosis for DLBCL
Poor: age >60y, LDH, > nodal involvement site (both sides of diaphragm or DM involement) and functional status.
282
ostium secundumum defect
diastolic murmur rarely heard
flow murmur in PA heard because of high flow.
fixed splitting of S2.
283
primary adrenal insuff
thin, decreased body hair, hyperK with met acidosis. low glucose
dx; cosyntropic/ACTH stimulation test (nromal >20; if low, then confirms)
rx; start dexamethasone
Tan skin: from excess ACTH to overcome adrenal insuff.
Loses aldo activity too so use hydrocort instead of dexa (as hydrocort has mineralocorticoid activity).
284
CML
```
t(9;22) - Philadelphia chromosome
low leukocyte alkaline phosphatase (LAP) score
BCR-ABL
neutrophilia
HSM
uncontrolled mature neutrophils
```
285
HUS
diaeehar E. Coli
increased immune complement
ADAMTS13 activity (low in TTP but normal is aHUS)
RX; plasmaphresis but less responsive to plasmaphresis than TTP
vs. DIC - coagulopathy in setting of hemolytic anemia and thrombocytopenia.
286
tularemia
pna unresponsive to CTX - consider "strange" organism.
Dx: serologically or through indirect fluorescence AB; not on blood cxs.
Rx: streptomycin
287
Yersinia pestis
bubonic plague - GNR (coccobacillaus - safety pin)
W and SW USA.
rats/fleas, rodents
raidly progressive and fatal
CXR with bilateral infiltrated and effusions
Rx: IV gent or IV doxy
288
mycobacterium marinum
saltwater and freshwater pathogen
infect skin, joints, bone after traumatic inoculation
chronic bone and join infections
Nodular skin lesions and noncaseating granulomas
Rx: clarithromycin, Bactrim or doxycycline
289
nocardia brasiliensis
soil contamination.
noncaseating granulomas
purulent cellulitis
gram positive branching chains
290
blastomyces dermatidis
soil exposure and verrucous skin lesions.
| gram stain/fungal stain
291
MALT
linked to H. pylori
292
Burkitts lymphoma
linked to EBV
293
Whipple disease
diarrahe and dementia
| Tropheryma whipplei
294
Hepatocellular carcinoma
HBV
295
Castleman disease
HHV
| diffuse systemic LAN
296
ZES
gastrinoma, multiple ulcers in upper jejunal region, diarrhea.
Dx: fasting gastrin level or secretin stimulation test
PPI can cause vitamin B12 deficiency, so check B12 annually
Rx: B12 supplementation
297
sideroblastic anemia
usually microcytosis
| Hb usually <7 g/dL
298
renal infarct
acute flank pain and elevated LDH
| look for AF
299
renal papillary necrosis
rare severe form of ATN
| with analgesic abuse, sickle cell, pyelo or postpartum hemorrhage
300
reactive arthritis
seronegative spondyloarthropathy
ReA triad: urethritis, conjunctivity, arthritis (esp with achilles tended) - cant see, cant pee and cant climb a tree.
Infections: Chlamydia, salmonella, shigella, yersinia, campylobacter, C. Diff.
301
target cell microcytic anemia
iron def (reduced serum ferritin, low iron sat)
or
hemoglobinopathy.
Dx: get iron studies.
(dx for thalassemia - Hb electrophoresis, normal iron and normal or elevated ferritin should get this)
ACD: low iron, low to normal TIBC, elevated ferritin
302
internuclear opthalmoplegia
small stroke on ipsilateral medial longitudinal fasciculus
ipsilateral eye cannot adduct. convergence is preserved.
old patient: stroke
young: MS
303
tylenol overdose
NAC within 8-16h of ingestion
| charcoal if within 4 hours
304
burr cell
echinocyte -
uremia, pyruvate kinase deficience, lymphosarcoma, GN and ulcers.
acid- base disorder.
305
HTN urgency
lower BP by no more than 25% in first hour, then to 160/100 in 2-6 hours then to normal over 24-48h.
306
RCC
secondary erhythrocytosis in 1-5%
| clots (Budd-Chiari, PE, migrating IVC vlot)
307
sudden painless loss of vision with cherry spot
retinal artery occlusion.
| common with carotid athero
308
RMSF
Rickettsia rickettsii
Myalgias, HA, petechial rash with centrifugal distribution (due to vasculitis)
May to October - eastern coast, southeasterm, far western
Labs: Hyponatremia, thrombocytopenia, elevated ALT/ASK, leukopenia and anemia
Rx: doxycycline.
(Legionella also with HypoNa)
309
metformin risks in inpatient
AKI, Lactic acidosis, contrast
310
Sulfonylureas
cause hypoglycemia if fasting.
311
thiazide diuretics and kidney stones
reduce urinary calcium and prevent recurrent stones.
To reduce stones: DRINK H2O!
(increased risk with: sodium, protein and oxalate)
312
opioids in renal dysfunction
fentanl and methadone safest
dilaudid and oxycodone ok
dont use morphine.
313
headache
migraine: abortive - triptan
ppx: propanolol, valproate, amitryptiline
Cluster rx: verapamil
314
SIBO
due to poor peristalsis
assoc with scleroderma
bacteria impair carbohydrate metabolism -> distention
Vitamin Def common
Scleroderma and gi tract: decreased esoph peristalsis, decrease LES tone, reflux, barretts, stricture, decreased peristalsis.
Rx: rifaximin, augmentin, flagyl, bactrim, cipro, doxy/tetracycline
315
Ataxia-telangiectasia
A/R
neurodegeneration, immunodeficiency, sensitive to radiation, predisposition to cancer.
Cerebellar atxia and telangecctasias
Chronomose 11 - ATM gene
defects in celluar and humoral immunity and chronic lung disease (bronchiectasis) and sinopulmonary infections.
316
SCID
T and B cel immunity
p/w severe bacterial, viral, fungal infection, ILD, diarrhea, FTT, Ear infections, PJP PNA, oral thrush.
fatal unless treated with BMT.
317
Freidrichs ataxia
A/R
| progressive limb and gait ataxia, sensity loss, weakness and dysarthria.
318
CF
CFTR gene
abnormal sodium and chloride transport
lung, live, pancreas and intestinal disease.
319
von Willebrands disease
normal PT, elevated (or normal if mild) pTT
normal CBC
reduced ristocetin induced platelet aggregation
prolonged bleeding time.
320
normal aPTT, prolonged PT
Vit K def
| Factor 7 def.
321
Bernand-Soulier
giant platelet syndrome
| have abnormal RIPA but giant platelets.
322
A-a gradient
Different between alveolar concentration (A) of oxygen and arterial concentration (a)
calculated PAO2= 150 - (pCO2X1.25)
A-a gradient: calculated - measured (normal 5-20, elevated 25).
Elevated A-a: suggests a defect in V/Q perfusion, diffusion, R to L shunt or intrapulmonary shunt.
323
ovarian tumor
germ cell tumors most common in young women (10-30y).
Ovarian Ca: 4th leading cause of cancer death; >50% of cases in pts >65y, epithelial or germ cell.
Only 5% of ovarian cancers are germ cell; 85% epithelial
324
breast cancer
risk is 3X higher with first degree relative
BRCA 1 and 2 -> 30-50% of inherited cancers.
only 5-10% due to genetic abnormality.
325
pyoderma gangrenosum
neutrophilic dermatoses
associated with MM, RA, IBD
Rx: steroids, dapsone, TNF inhibitors, immunosuppressive.
Worse with trauma
326
Hepatitis tests interpretation
Anti-HAV IgM - looks for acute Hep A
HbsAg - acute infection and carrier states
Anti-HBc IgM - acute infection in "window"
Anti-HBc IgG - hepB infection in past. Doesn't tell you if still infectious (required HBsAg).
Hepatitis C Ab - tells if infected (not chronic or resolved)
327
animal bites
staph, strep, gram negatives, anaerobes, Pasteurella
Rx: amp-sulbactam (IV), augentin (PO)
Tetanus >5y
328
chlamydia pna
fever, malaise, hoarseness, nonproductive cough
uri sxs 1-2 wks before pna onset.
Rx: macrolides, cipro.
329
legionella
hyponatremia, gi tract vomiting, diarrhea
330
what to check when a woman is pregnant
RPR
HIV
urine culture
331
bleomycin
IPF in up to 10%
332
doxorubicin
cardiac toxicity; CHF
333
cyclophasamide
hemorrhagic cystitis
334
vincristine
neuropathy
| vomiting, myelosuppression
335
psoriatic arthritis
nail pitting
| sausage digits
336
Wiskott Aldrich syndrome
X-linked
eczema, thrombocytopenia, recurrent infections
low IgM and high levels of IgA and IgE
Rx: BMT
337
prostate cancer staging
do a bone scan
| TNM
338
vaccines in HIV
annual influenza
dual pneumococcal vaccination
Hep A
Tetaunus
339
travelers bloody diarrhea
Entamoeba histolytica - protozoan
(vibrio, norovirus, B. cerus and S. aureus produce watery, not bloody).
340
brain abscess
HA, fever, and focal neurological defects
341
reactions to antipsychotics
acute dystonic reaction - abnormal posture, twisting
Tardive dyskinesia - chronic expsosure
(NMS: diffuse rigidity, delta MS and high temps)
342
CMV retinitis
(usually a reactivation so CMV IgM may be negative)
pizza pie eye
HIV with CD4< 50 (AIDS-defining illness)
(fluffy exudates and scattered hemorrhages)
Rx: IV ganciclovir
343
Meningitis
Empiric rx: Vanc and CTX bc 5-10% of S. pneumoniae is resistant to CTX.
S. pneumo > N. meningitis
344
hematuria
Decide if upper or lower urinary tract
| If see casts, it is GN and send for biopsy and check complement, lupus seroloy, ANCA, hep serology and anti-GMB testing
345
conjunctivitis
adenovirus
346
Parvovirus B19
Kids: slapped cheek
rash worse in sun
adults: arthritis
worry if: pregnant (risk of fetal loss), HIV (red cell aplasia) and those with chronic hemolysis (sickle cell, who can have aplastic crisis)
347
Roseola
HHV 6
| Pna and meningitis in immunocompromised adults
348
crohns disease
early osteo from disease and steroid use
| consider BMD.
349
IgA deficiency
recurrent sinoupulmonary and GI illnesses
| Rx: abx as needed, avoid blood and plasma products (as anti-IgA antibodies can cause anaphylactic reactions).
350
chronic granulomatous disease
CGD disease, rare immunodeficiency
| severe bacterial infections.
351
DiGeorge syndrome
complete - in infancy with hypocalcemia due to hypoparathyroidism, thymic hypoplasia, congenital heart defects, facial features.
352
normal anion gap
toluene ingestion, severe diarrhea, renal failure.
353
necrotizing fasciitis
rapid onset cellulitis, systemic infection (fever, hypotension, tachycardia, tachypnea), risk factors (like DM)
354
rheumatic MS
```
opening snap (heard after S2) followed by low pitched diastolic rumble.
caused by Group A strep
```
355
sensitivity
of those with the disease, how many test positive.
356
specificity
of those without the disease, how many test negative
357
PPV
Of those with + tests, how many are true positives
358
NPV
of those with - tests, how many are true negatives
359
prevalence
```
# cases at a given time.
the higher the number, the higher the PPV
```
360
grid
Test Result on Left
| Disease state on Top
361
morphine iv to po
1 mg IV = 3 mg PO (SR) = 2 mg oxycodone.
362
dilaudid iv to po
1.5 mg IV = 7.5 po dilaudid
363
fentanyl
0.1 mg IV fentanyl = 1.5 IV dilaudid = 10 mg morphine
364
HCAHPS survey
| hospital consumer assessment of healthcare providers and systems.
hospital inpatient experience survey tied to reimbursement and required by CMS.
Asks about: communication with doctors, cleanliness and nurse communication.
Pts surveyed after discharge.
365
RA scoring system
1. # and site of involved joints
2. RF or anti-CCP Ab positive
3. Elevated ESR or CRP
4. symptom duration
366
neurofibromatosis
10% will have sarcoma
367
fabry disease
lysosomal storage disorder with stroke and neuropathy
368
germ cell tumor of testes
pulmonary mets
| increased estrogen production (gynecomastia)
369
acute angle-closure glaucoma
painful red eye with reduced visual acuity
associated with symphatomimetics like pseudoephedrine.
Rx: urgent reduction of elevated IOP
370
constipation
fiber and water
| 2nd line: polyethylene glycol.
371
kidney stones with crohns, bypass, small bowel resection.
calcium oxalate stones
| mechanism: increased oxalate excretion into urine
372
bifid pulse
HCM
373
water-hammer pulse
chronic AR
374
thready pulse
acute AR
375
Giant R sided a waves
tricuspid stenosis
376
MEN1
multiple parathyroid adenomas
(serum calcium and PTH levels) p/w asx hypercalcemia or kidney stones, weakness, arthralgia.
PPP - parathydoi, pitutary, pancreas (gastrin producing)
multiple lipomas
377
CREST
cutaneous systemic sclerosis
calcinosis, Raynauds, esoph dysmotility, sclerodactyly and telangectasias.
Dx: anticentromere AB specific for limited cutaneous systemic sclerosis
378
noncaseating granulomas in lung
ddx: sarcoid, hypersensitivity pna, aspiration pna, infectious granulomatous disease, berrylium/aluminum expsire, rarely Wegeners (granulomatosis with polyangiitis)
379
chronic eosinophilic PNA
fever, night sweats, eosinophilia.
More common in women
50% have asthma
CXR: "negative" of pulmonary edema.
380
ABPA (allergic bronchopulmonary aspergillosis)
coughing brownish sputum and mucus plugging
| segmental atelectasis on CXR
381
Type 4 RTA
due to bladder outlet obstruction or prostate hypertrophy.
also possible due to diabetic nephropathy.
Defect in renal acidication.
hyperkalemia due to hyporeninemic hypoaldo
382
Type 1 and 2 RTA
hypokalemia
383
cancer of unknown primary
70% adeno
| do PET-CT
384
shock and "menses"
think TSS or disseminated gonococcal infection.
385
RA effusions
pleural fluid <30 mg/dL
| low glucose, normal protein, normal WBC
386
statistics
disease prevalence increases --> # FP decreases and FN increases.
Prevalence increases --> PPV increases
Sensi and speci not affected by prevalence (qualities of test).
PPV and NPV affected by prevalence
387
drug induced lupus
```
procainamide
arthritis/arthralgias prsenr
anti-histone Ab in 95%
rash less common
renal involvement rare
```
388
clues that it is ZES
unusual location of ulcer - past the duodenal bulb
FH of ulcers
having diarrhea
refractory to medical rx
ulcer recurrence after acid reducing rx
frank complications (bleeding, obstruction, perforation)
389
thyroid drug interactions
levothyroxine poor absorption with iron and calcium.
also PPIs and sucralfate or cholestyramine
lower effects: SSRIs (sertraline) - monitor thyroid function.
levothyroxine can enhance warfarin effect.
390
"red flag: sxs of low back pain
cancer hx, IVDU, immunocompromised, osteoporosis
| MRI if severe or progressive neuro deficits
391
CML
splenomegaly
theombosis
stage based on % blasts: chronic <10%, accelerated 10-19%, blast phase (>19%)
Rx: TKI (remission in 90%); imatinib, bosutinib, ponatinib
t9;22 - good prognosis
392
SLE in pregnancy
Increased risk of preeclampsia, IUGR and premature delivery.
Anti Ro/SSA antibodies cross placenta and can cause neonatal lupus (congenital heart block). Rx: hydroxychloroquine.
pregnancy increases sle flares as does HTN, APLA Ab,
dsDNA Ab associated with higher risk of renal involvement but not neonatal lupus.
393
PDE5 inhibitors
sildenafil, avanafil
hearing loss
2nd line rx for ED: alprostadil penile injections
394
anorexia nervosa
low phos, K, Na, Cl
| sick euthyroid
395
hidradenitis suppurativa (HS)
sterile abscesses, scarring
| Rx: topical and systemic antibiotics, intralesional steroids, anti-TNF agents or other biologics.
396
ARDS
low tidal volume ventilation
(<6 mL/kg) and Plateau <30
prone
paralyze
397
Naive B cells
first produce IgM
398
E. Coli O157
No abx (can make worse and cause HUS)
399
ischemic colitis
IVF and if severe, abx (flagyl)
surgery if evidence of gangrene
painless hematochezia (diverticular)
400
nasal foreign body
malodorous, sometimes bloody discharge.
401
hot tub folliculitis
psuedomonas folliculitis
48h to 5d
papules and pustules around hair follicles
No Rx, self limied
402
multinodular goiter and normal TSH/euthyroid
get thyroid us not RAI uptake to determine biopsy
403
high risk features for pulm nodule
large
noncalcified
in a smoker
404
nail in tennis shoe
pseudomonas (colonizes glue in shoe)
| rx: cefepime if osteo present
405
pseudomonas coverage
cefepime, ceftaz
cipro
others: zosyn (pip/tazo), aztreonam, carbapenem (except ertapenem), aminoglycosides
BACTRIM DOES NOT COVER
406
addisons
adrenal insuff
rx: dexamethasone and ACTH stim test (also hydrocort ok but ALL STEROIDS EXCEPT DEXA cross react with ACTH stimulation test)
```
Clues:
hypotension
tanned male (excess ACTH) with sparse hair
hypoNa and hyperK (low aldo)
pre-renal
```
407
steroid equiv
4 dexa = 50-100 hydrocort
| stress doses
408
treponema whipplei
whipple disease
present after a long time.
weight loss, diarrhea, arthopathies
skin hyperpigmentation in sun exposed areas
LAN
REMEBER: PAS STAIN with FOAMY MACROGHAPES
Rx: IV Ctx or PRN for 2 wks, then bactrim X 1yr
409
Q fever
Coxiella burnetii
flu-like illness, hepatitis, PNA
Dx; serology
410
Multiple Myeloma Clues
```
CRAB
Calcium (elevated)
Renal dysufnction
Anemia
Bone pain or lesions (lytic not blastic)
```
411
acute angle glaucoma
increased IOP due to obstruction of outflow from aqueous humor
visual loss
colorful halos
needs gonioscopy to diagnose with slit lamp
412
HIV-related thrombocytopenia
treat the HIV.
413
NPH peak effect
8 hours
414
meth use
associated with HIV
415
idiopathic intracranial hypotension
obese
visual changes
papilledema.
416
HA
can be caused by OCPs
417
urine sxs Rx
stress incotinence: kegel
overactive bladder: oxybutynin
BPH: doxazosin
418
A-a gradient
alveolar-arterial gradient
| distinguishes hypoventolation, poor gas exchange and circulation issues.
419
acute rhinosinusitis indications for Rx
7-10 daus
high fever, purulent discahrge or facial pain
worsening after initial improvement.
420
autosomal dominant polycystic kidney disease
increase in cerebral aneurysms.
screen patients
hematuria, proteinura, kidney stones. HTN, UTIs
421
alport syndrome
sensorineural hearing loss
| hematuria with renal cysts.
422
Nonanion grap acidosis
RTA or GI losses (diarrhea or laxative misuse
UAG = (Na +K) - Cl.
If neGUTive, then NH4 present which makes RTA unlikely.
423
leukemoid reaction
has expansion of the myeloid cell line
424
think CLL
persistently elevate lymmphocytes (mature but dysfunctional, no blasts)
425
HIV ppx
blood, semen, vaginal fluids
(possibly CSF, synovial, pleural, peritoneal, pericardial, amniotic)
NONINFECTOIUS: urine, sweat, stool, saliva, nasal secretions, tears, sputum and vomit.
If intact skin, no ppx needed
if nonintact or mucus membranes, need ppx
PPX: bictergravir + tenovifir + efavirenz
426
when to do ECG for epigastric pain
Healthy/young and no "alarm" sxs: check H. Pylori
Do EGD if anorexia, dysphagia, GIB, >60y or mass, anemia, weight loss, vomiting.
427
affects INR
bactrim, raises it!
| antibiotics
428
cystic fibrosis
recurrent sinusitis, bronchitis, P. aerugonisa.
Dx: sweat Cl- testing and genetic testing.
429
hearing loss
Rinne test - checks for conductive hearing loss in affected ear (bone conduction louder than air conduction in affected ear).
Weber test - lateralized to ear with conductive hearing loss.
Conductive hearing loss = otosclerosis
AG toxicity/Menieres: sensory hearing loss.
430
hypothyroid sxs
dry skin
elevated cholesterol
constipation
muscle pain
iron interacts with levothyroxine absorption.
431
IgA deficiency
IgA 1st line of defense - lungs, GI tract, GU tract
1/300 (common)
frequent URIs, diarrhea, chronic bronchiectasis,
Asthma, alllergies, autoimmune
432
indications for intubation in astham
"normal" ABG - pt tiring (should see resp alkalosis early)
accessory muscles
leabing forward.
433
pregnant patient with AF and pulm edema
think MS or secundum ASD
434
Sjogrens associated with which lymphoma
NHL (20-40X higher risk)
look for fever, malaise, weight loss, LAN and new anemia
Most MALT - amenable to treatment.
435
perioral dermatitis
variant of rosacea
Rx:
Mild - metronidazole or calcienueuin inhibitors
Severe - doxycycline.
436
ethambutol toxicity
problems with visual acuity, especially color perceptions.
437
ethambutol toxicity
| TB drug toxicity
problems with visual acuity, especially color perceptions.
| INH, rifampin, pyrazinamide - hepatotoxic.
438
prior to starting biologics for RA...
check for TB
| skin or blood
439
Liddle syndrome
hypokalemia and HTN
| Autosomal dominant
440
lactoferrin in stool
iron binding protein
present in PMNs in pts with bacterial and IBD diarrhea
Shigella, Salmonella, EHEC (O157), Campylobacter, Yersinia
441
essential tremor
```
resting and action
bilateral
seldom interferes with function
improved with alcohol
familial
```
(Parkinsons. pill rolling at rest, improved with action and unilateral)
442
thyroid nodules
FNA if risk features: >1 cm in size and microcalfications.
443
TPO Ab
Hashimotos (can have goited)
| Increased risk of thyroid cancer with Hashimotos
444
when to get a RAIU
if TSH is low
| If just nodule, get US or do FNA
445
dermatomyositis
```
periorbital heliotrope rash
proximal muscle weakness
erythema and telangectasias of cuticle
palmar arythema
papules over joints (Gottron papules)
>50y - think canccer (GU, GI, lung)
```
446
cluster headache Rx
young to middle aged males
unilateral, lacrimation, facial flushing, nasal discahrge
several times a day
Rx; O2 (15-20 min by face mask), short-acting triptans
Prevention: verapamil, valproic acid, lithium, topiramate
447
IgA nephropathy
hematuria after viral illness.
Recur for months/years intermittently
Serum completment normal. Microscopic hematuria can persistent.
Post-strep GN: 1-3 weeks following pharyngitis
complement low, ASO titer high
448
PNH
fatigue, jaundice, red urine
| hemolysis and hemogliobinuria
449
Rhabdo
false positive on dipstick for blood
| actually myoglobinuria.
450
symptomatic anemia in CKD
treat with EPO
| Target Hb 10-11.5
451
osteoporosis
goal: reduce fx in femoral neck
| Rx if T score
452
SSRIs and sex
delayed ejaculation, difficult orgasm
453
endocarditis ppx
prosthetic valves
previoue IE
CHD - unrepaired, repaired w/in 6 mo or repaired with residual defects
Transplant with regurgitation
None for GU or GI unless biopsy
454
cushings syndrome
dont do 1 mg DST if on OCP (can give FP due to change in cortisol binding globulin).
diagnostic cutoff of >1,8 mcg/dL
1st line tests: 24h urinary free cortisol, late-night salivary cortisol (not influenced by OCP)
455
anklylosing spondylitis
lumbar Xrays
456
Associated with HLA-27
reactive arthritis
ankylosing spondylitis
IBD
anterior uveitis
457
Behcets
HLA-B51
458
androgen secreting tumor of adrenals (secreting DHEAS)
```
increased testosterone
higher estradiol (peripheral aromatization)
```
