All subjects Flashcards
(128 cards)
0
Q
Relate quotidian fevers, systemic inflammatory disorder, evanescent rash, arthritis, elevated ferritin and multisystem involvement to?
A
Adult onset stills dz
1
Q
How often and when to colo in pts with UC?
A
Every 1-2 yrs and 8-10 yrs after dx
2
Q
Name complications after subarachnoid hemorrhage? Both earky and late
A
First 48- aneurysm rerupture and hydrocephalus
Day 5 and after can have cerebral artery vasospasm(presents as decline in neuro function
3
Q
Note:Results of a D dimer assay performed after a period of anticoagulation therapy have been shown to be predictive of thrombotic recurrence.
A
.
4
Q
Gottron Papules and heliotrope rash. Proximal weakness, +Ana,
A
Dermatomyocytis
5
Q
In patients with HCM. What to avoid and why?
A
Patients can present with hemodynamic collapse secondary to acute severe left ventricular outflow tract obstruction. This may be spontaneous or precipitated by inotropic agents like dopamine or dobutamine, withdrawal of negative inotropic agents like beta blockers or calcium channel blockers, volume depletion, vasodilators, sustained atrial arrhythmias or sinus tachycardia
6
Q
Drugs used in apkd to treat infection
A
Cipro has good cyst penetration. Ampicillin , cephalosporins, and nitrofurantoin do not
7
Q
20 yof 4 week hx of fatigue, poly arthritis, le edema, creatinine bump, cytopenias, oral ulcers, htn.
A
Proliferative lupus nephritis
8
Q
Treatnent of significant metabolic alkalosis and hypervolemia in a patient given blood products( citrate metabolized leads to production of extra bicarb.
Especially in a pt with impaired renal function
A
Acetazolamide
9
Q
Bilirubin in urine think…
A
Sever liver dz, or obstructive jaundice
10
Q
Urobilinogen is produced in the gut from the metabolism of Bilirubin…
A
A positive urine dipstick for urobilinogen results from hemolytic anemia or hepatic necrosis and not from obstructive causes
11
Q
What are the causes of sterile pyuria?
A
Mycobacterium tuberculosis infection
Acute interstitial nephritis cause by antibiotics and nsaids or proton pump inhibitors
Kidney stones and kidney transplant rejection
12
Q
Name some causes of hypernatremia and their associated urine osmolality
A
Hypotonic fluid loss G.I. losses > 600 Diuretics 150 Pure water loss Insensible water losses > 600 Diabetes insipid us <200
13
Q
Drugs used in apkd to treat infection
A
Cipro has good cyst penetration. Ampicillin , cephalosporins, and nitrofurantoin do not
14
Q
Causes of central diabetes insipid us
A
Malignancy, neurosurgery, trauma, sarcoidosis, histiocytosis X, Wegener’s, hypoxic encephalopathy, Sheehan syndrome
15
Q
Causes of nephrogenic diabetes insipidus
A
Lithium, other medications and filters amphotericin B, foscarnet
Sickle cell nephropathy, urinary tract infection, amyloidosis
16
Q
Causes of anion gap met acidosis
A
Advanced kidney dz, etoh/dm ketoacid, lactic acidosis (sepsis, metformin, salicilates), liver failure. Propofol
17
Q
Name some signs and symptoms of cryoglobulinemia
A
Purpura, gangrene, arthralgias, renal, neurologic, liver
18
Q
When treating patients with CKD, it is acceptable to allow a 25% increasing creatinine for blood pressure control
A
Note
19
Q
What is fibromuscular dysplasia?
A
A non-inflammatory vascular disease involving almost any artery but most often the renal and carotid.
20
Q
Causes of nephrotic syndrome
A
FS GS, membranous glomerulopathy, amyloidosis, systemic diseases like diabetic nephropathy, HIV nephropathy, multiple myeloma, hepatitis B
21
Q
Causes of membranoproliferative glomerukonephritis
A
HIV, chronic liver dz, ibd, celiac
22
Q
Hcv glomerulonephritis can associated with…
Hbv glomerulonephritis can be associated with…
A
MPgs and Systemic cryoglobunemic vasculitis
Mpgs and poly arteritis nodosa
23
Q
How long after acute progenic infection do I get post infectious GLom nephritis
A
> 1w
24
Anti gbm if lung and kidney think.. Then treat?...
Goodpastures
| Treat with plasmapheresis!! And cyclophosphamide and steroids.
25
Types of pauci immune glomerulonephritis?
Polyangitis(wegener), microscopic polyangitis, churg strauss.
Remember these r absence of immune complex and anti gbm.
+anca
26
Clinical presentation of fever, hemolytic anemia, consumptive thrombocytopenia, neuro findings, kidney failure. Think...
Ttp and hus.
27
Cryoglobulinemia is associated usually with..
Hepatitis C!
28
Classic presentation of AIN
| Causes of AIN
Fever, rash, eosinophilia with elevated Cr.
Meds: b-lactams, flouriquinolones, sulfonamides, indanavir, abacavir, NSAIDs, cox2 inh, ppi, 5asa, allopurinol, phenytoin, sle, sarcoidosis, mm, lymphoma, leukemia, HIV
29
Diagnostic criteria for hepato renal syndrome
Liver dz: cirrhosis with ascites
Kidney dz: cr>1.5
Kidney function not improved after fluid challenge, diuretics held, and albumin given
All other Etiologies ruled out(shock, nephrotixic agents
No evidence if parenchymal dz
30
Findings in TLS
hyperkalemia, hyperphosphatemia, hyperuricemia and hyperuricosuria, hypocalcemia, and consequent acute uric acid nephropathy and acute renal fail
31
Which statin is better if pt is on fluconazole?
Pravastatin
32
Define first-degree AV block
| Define second degree AV block
PR interval of greater than 200 ms
Mobitz type 1 wenkenbach- Progressive lengthening of the PR interval until a QRS complex is dropped
Type 2- characterized by a drop QRS complex with no change in preceding PR interval. This is more worrisome. Suggests his-perkinje dz
Note: in patients with 2 to 1 AV block it is impossible to differentiate between Mobitz type 1 and 2 AV block
33
Indications for permanent pacemaker
Symptomatic bradycardia with heart rates less than 40 or sinus pauses
Symptomatic complete heart block or second degree heart block
Atrial fibrillation with pauses greater than five seconds
Alternating bundle branch block
34
```
Antiarrhythmic medications
Class 1A, class 1b, class 1C, class 2, class III, class iv
```
Class 1-sodium channel blockade
Class 2- beta blockade
Class III- potassium channel blockade
Class iv- calcium channel blockade
35
Class two and class iv (beta and ca) agents should be avoided in patients with...
Decompensated systolic heart failure or or Wolff-Parkinson-White syndrome
36
Class one and class 3 agents have greater antiarrhythmic effects but
Have toxicities that limit their use
37
Class 1c medications are often prescribed for atrial flutter and atrial fib but are contraindicated in
Coronary artery disease especially after myocardial infarction because they increase the risk of polymorphic VT
Note: often these agents are used with an AV nodal blocker to avoid rapid one-to-one AV nodal conduction
38
Class 1a eg
Class 1b
Class 1c
Quinidine, Procainamide, disopyramide
Lidocaine, mexiletine, phenytoin
Flecainide, propafenone
39
Eg class ii meds
Metoprolol, propranolol, atenolol
40
Class iii
Sotalol amiodarone dofetilide Dronedarone
41
Class iv
Verapamil, dilt
42
Do you shock atrial fibrillation with synchronized or unsynchronized
Synchronized cardioversion on r wave to prevent r on t shock and induction v fib
43
Name the types of supra ventricular tachycardias
Atrial fibrillation and atrial flutter
| A V N RT(avnodal reentrant tachy), AVRT(av reciprocating tachy), and atrial tachycardia
44
What is the Koebner phenomenon
Development of typical lesions following injury to the skin
45
Name some common presentations for lichen planus
Pruritic pink to purple flat top papules or plaques and wickham striae which is a reticulated network a fine white lines
46
Pan cytopenia, thrombophilia, hemolytic anemia??
Paroxysmal nocturnal hemoglobinuria
| Check flow cytometry
47
What is propofol related infusion syndrome
Characterized by lactic, acidosis rhabdomyolysis, hyper triglyceridemia and myocardial abnormalities
48
How do you manage acute chest syndrome in patients with sickle cell disease
Empiric broad-spectrum antibiotics, supplemental oxygen, pain medication, avoidance of overhydration, bronchodilators as needed, and erythrocyte transfusion for persistent hypoxia despite supplemental oxygen
49
Patients that present with acute lower extremity arthritis and erythema nodosum, fever, anterior uveitis.. Think...
Löfgren syndrome. Or acute sarcoidosis.
| The classic triad is hilar lymphadenopathy, acute oligo arthritis, and erythema nodosum
50
Painless jaundice, elevated Billy Rubin, elevated IgG4... Think
Autoimmune pancreatitis
| Treated with corticosteroids first (not ercp) even if Narrowed pancreatic
51
How to reverse warfarin induced subdurAl hematom
Intra-Venus vitamin K and PCC (prothrombin complex concentrate)
52
Diarrhea, bloating, weight loss, macrocytic anemia secondary to vitamin B 12 deficiency and an association with an elevated serum folate is classic for what
Small intestinal bacterial overgrowth
53
Community acquired meningitis antimicrobial therapy
1. Age less than one month
2. Age 1 to 23 months
3. Aged 2 to 50 years
4. Age greater than 50 years
What are the common bacterial pathogens for each and selected antimicrobial therapy?
1. GBS, E.col I, Listeria, klebsiella- ampicillin plus cefotaxime
2. S. Pneumonie, gbs, h flu, E. coli, neisseria- vanc and cefotaxime or ceftriaxone
3. S pneumonie, neisseria,- vanc and cefotaxime or ceftriaxone
4. S pneumo, neiserria, listeria, aerobic gram neg- vanc and cefotaxime or ceftriaxone and ampicillin
54
Treatment of CA MRSA?
Bactrim, doxy, clinda, linezolid
55
Dx criteria of staph toxic shock
Fever greater than 102,
Systolic blood pressure less than 90
Diffuse macular rash with subsequent desquation Especially on palms and soles
Involvement of three of the following organ systems
1.gi
2. muscular
3. Mucous membrane
4. kidney
5. liver
6. blood platelet counts less than 100,000
7.central nervous system
For Rocky Mountains spotted fever leptospirosis and measles.
56
Thiazolidinediones
Name some..
Contraindicated in..
Pioglitazone
| Can't use in chf 3 or 4
57
What are first-line agents for the Esbl organisms
carbepenems, including mero
58
An acute febrile illness with thrombocytopenia, leukopenia and increased liver enzymes in travelers returning from Asia is highly suggestive of
Dengue fever
Can also maculopapular are petechial rash
59
What is the treatment of cryptococcal meningitis in HIV-infected patients
Induction therapy is amphotericin b plus flucytosine for at least two weeks it is then followed by oral fluconazole for eight weeks
60
Can improve mortality in severe ards
Prone
| Neuromuscular blockage
61
Goal for ards volume
6 ml/ kg (ideal body weight)
Vs 12
62
Spirometry
| Gold classification
Post bronchodilator <30
63
Mgmt of copd
Reduce exposure-smoking cessation
Physical activity/pulm rehab
Flu and pneumovax shot
Short acting b agonist Or anticholinerrhic (ipra)
Long acting of the above 2 (tio)
+corticosteroids AFTER frequent exac despite being in laba or lama!!!!
Phosphodiesterase 4 inh
Cpap for osa pts with copd
Lung reduction surgery?!?
Lung transplant (survival data is limited)
64
Def of copd exac...
Precipitated by...
Mgmt
Precip by infections usually (strep, h flu, morax)
Other cause mi, pe, chf, aspiration, environmental air pollution
Acute onset change in sxs
Leads to change in meds
Systemic steroids-30-40mg/day, 60mg if critically ill (maybe only need to give for 5 days not 14!!)
Abx if hcap or cap treat but if no change in X-ray or change in sputum maybe don't have to
O2 titrate to low 90s
Consider noninvasive vent if dyspneic
65
Which Statin is contraindicated in patients taking HIV protease inhibitor's and why
Simvastain because of cytochrome P4 50 drug metabolism which would raise Simvastatin concentrations to dangerous levels (use atorv!)
66
When do you perform a CT or ultrasound in patients with UTI
It is indicated for those with pyelonephritis persistent pain or fever after 72 hours of antimicrobial therapy to exclude a perry nephric or intrarenal abscess
67
When do you treat asymptomatic bacturea?
In pregnant women and men and women undergoing invasive urologic procedures
68
Interpretation of ppd by induration
>5- hiv,
recent contact with person with active tb,
Person with fibrotic change on cxr,
Transplant pts(receiving immunosupp agents)
>10- recent arrival from tb area,
Ivdu,
Resident of prison, nursing, hospital, homeless shelter,
>15- all others
69
Basic uses for fluconazole
Cocci, crypto, candida (not glabrata or cruzzi)
70
Basic uses for voriconazole
Aspergillosis, ?fuziform
71
Basic uses for itraconazole
Endemic mycosis like histo, blasto,
72
How to treat candida glabrata or cruzzi
Think micafungin
73
Treatment for tb and ltbi?
Active tb- 2 month of rifampin, isoniazid, pyrazinamide, ethambutol. Then 4-7 months of just rifampin and isoniazid
Ltbi- 9 months of isoniazid and b6
74
How do you treat sporotrichosis
Intraconazole
75
What is the treatment for MSSA prosthetic valve endocarditis
Nafcillin and rifampin for six weeks plus a two week course of gentamicin
76
This noninvasive measurement reflects active airway inflammation and generally correlates with airway eosinophilia.
Exhaled nitric oxide levels
| - decreased in response to corticosteroid therapy and can be used to determine adherence to therapy.
77
Asthma
Mild
Mod
Severe
Mild >2x week (sxs or Saba use), 3-4x month
Mod- daily or weekly at night
Severe -
78
When there is concern for primary immunodeficiency syndrome, frequent infections by which pathogens are suspect?
Streptcoccus pna, Neisseria species, H influenza
79
What is the most common primary immunodeficiency and what is unique about it
I G A deficiency
| Some patients have severe anaphylactic reactions to administration of IV IG or blood products
80
Who frequently developed chronic lung disease, autoimmune disorders, Malibu, recurrent infections, and lymphoma and their response to vaccination is poor
Patients with common variable immunodeficiency cvid
81
This is a Graham positive boxcar shaved aerobic non-Motile Bacillus
Bacillus anthracis
82
Clinical manifestations of this consist of a classic triad of the descending flaccid paralysis with prominent bulbar signs,normal body temperature and normal mental status
Botulism
83
What are bulbar signs
Dysphasia diplopodia dysarthria dysphonia
84
Symptoms of this include fatigue fever (usually last 4-8 weeks if untreated )headache cough anorexia and a time of presentation patients are usually constipated (though diarrhea may be present early)
Typhoid fever
| Treat with flouroquinolones or 3rd gen cef
85
Diarrheal illness caused by ingestion of pork intestines
Yersinia
86
Diarrheal illness caused by fresh versus salt water contaminated fish
Salt think vibrio
| Fresh think aeromonas or plesiomonas
87
Diarrheal illness and can cause a bloody diarrhea and a late complication Guillan barre or reactive arthritis
Campy
88
Diarrheal on this bloody diarrhea high fever and is known for causing diarrhea with very low infectious inoculum
Shigella
89
Although a rare complication this diarrheal illness should be considered in patients with known arthrosclerosis disease and persistent bacteremia despite antibiotic therapy
Salmonellosis (remember association with osteo and sickle cell too)
90
Liver abscesses and well described complication of this parasite
Entamoeba histolytica
91
Most transplant centers use a three drug regimen consisting, calcineurin inhibitor and an anti-metabolite given example of each
```
Cytotoxic agents (anti metabolites)-Mycophenolate mofetil, azathioprine, mtx, cyclophosphamide
Calcineurin inhibitors- cyclosporine and tacrolimus.
```
92
What are the most common viral infections and transplant recipients
CMP, EBV, polyoma BK virus, hepatitis B and hepatitis C
93
Removal of the central line is important during Central and infections but it is specially important when these three pathogens are present
S aureus, pseudomonas, candida
94
How do you treat Carbepenem resistant Enterobacteriace
Fosfomycin and tigecycline
95
Which Carbepenem cannot be used in Pseudomonas
Ertapebem
96
Infective endocarditis prophylaxis is recommended for patients with?
1. a prosthetic cardiac valve
2. a previous episode of infective endocarditis
3. congenital heart disease characterized by unrepaired cyanotic congenital heart disease or recently repaired in the last six months
4. for cardiac transplantation recipients
97
Which antiretrovirals should never be given to pregnant women with HIV
Efavirans
Preferred antiretroviral regimen and pregnancy is zidovudine, lamivudine and lopinavir/ritonavir
98
Why should you not use topical steroids in patients with HIV in the Symplex virus is known or suspected?
it is known to cause ocular infections if used
99
When is herpes zoster vaccination indicated
And persons aged 60 or older
100
What are some newer agents that are useful for treating MRSA
Daptomycin is indicated complicated skin and soft tissue infections involving staph strep and enterococcus faecalis
Telavancin- $$$, longer half life so daily dosing
Linezolid- oral therapy-!- causes Milo suppression notably thrombocytopenia and requires weekly complete blood counts
Ceftaroline-
101
What drug can be used for MRsa, Vre and multi drug resistant gram-negative organisms
Fosfomycin
102
Name the drug that is important in the treatment of Gram negative bacilli that are resistant to other anti microbial's including Carbepenem resistant enterobacteriacaea, pseudomonas, acinetobacter
Polymyxins
103
What are some absolute contraindications to hyperbaric oxygen therapy
Pneumothorax and the recent chemotherapy with doxorubicin or cisplatin
104
What are the alarm symptoms that would prompt endoscopy as a first step for the evaluation of GERD or dyspepsia
Dysphasia, anemia, vomiting, or weight loss, age of onset after 50, odynophagia, family history of upper G.I. malignancy, personal history of PUD, gastric surgery, abdominal mass or lymphadenopathy on examination
105
What condition starts with a single pink 2 to 4 cm in shape to plaque the scale at the periphery followed by development of many smaller lesions days to week later
Piryriasis rosea
| No treatment necessary
106
Lung ca staging basic
1a 3m
2 Hilar nodes
3 mediastinal node
4 Mets include pleural effusion
107
Molecular markers lung ca
Egfr
Alk tyrosine kinase
Ras
These have implication for treatment
108
How to determine proper cuff size for taking bp
The bladder should encircle 80% of arm without overlap.
| Too small of a cuff will cause falsely elevated readings.
109
Stages of htn
```
Nml is less than 120/80
Pre htn 120-139/80-89
Htn
Stage 1 140-159/90-99
Stage 2 >160/100
```
110
Name some manifestations of an organ damage and hypertensive emergency both acute and chronic
Acute:::Hypertensive encephalopathy he putting headache altered mental status seizure nausea vomiting, intracranial hemorrhage, unstable angina, acute myocardial infarction, left ventricular failure with pulmonary edema, acute aortic dissection, eclampsia
Chronic:::lvh, cad, stroke, retinovascular dz, atherosclerosis, claudication, diminished pulses, esrd
111
What are the major causes of secondary hypertension
Renal artery stenosis, pheochromocytoma, hyperaldosteronism, hypercortisolism
112
What is the pathophysiology of clinical presentation diagnosis of renal artery stenosis
Pathophysiology-under perfused kidney produces excess Renin
clinical presentation- sudden onset hypertension and abdominal bruit
Diagnosis- mra, cta, renal Doppler
113
What is the pathophysiology, clinical presentation, diagnosis and treatment of pheo
Pathophysiology – tumor in the adrenal medulla that releases catecholamines
Presentation: headache, sweating, palpitations, anxiety, weight loss
Dx- screen with plasma free metanephrines confirm with 24 hour urine for catecholamines, the VMA, metanephrines
Txt- remove
114
What is the pathophysiology, clinical presentation, diagnosis, treatment of hyperaldosteronism
Pathophysiology is an adenoma the produces aldosterone
Pres.- spontaneous hypokalemia and a hypertensive patient
Dx- screen with plasma aldosterone and serum renin a ratio in greater than 20 suggest disease. Confirmed by measuring 24 hour urine aldo
115
What is the pathophysiology,, diagnosis and treatment of hypercortisolism
Pathophysiology, ACTH secreting tumor, adrenal adenoma, excellent topic ACTH secretion
Pres.-Truncal obesity, moon faces, proximal weakness, hirsutism, hyperglycemia
Dx-screen with 24 hour urinary frequency, salivary cortisol, or 1 mg overnight dex suppression test.
If positive form high-dose dexamethasone suppression test
Txt- resect
116
Name some drugs that can be used in the treatment of hypertensive emergency
Nitroprusside, nitroglycerin, nicardipine, labetalol, fenoldopam, enalaprilat, esmolol
117
Differential diagnosis for hypertriglyceridemia
Alcohol consumption, obesity, pregnancy, diabetes, hypothyroidism, chronic renal failure, medications like nonselective beta blocker's, high dose diuretics, estrogen replacement therapy
118
Clinical identification of metabolic syndrome
Abdominal obesity and then greater than 40 inches wide 35 inches, I glycerides greater than 150, HDL and then less than 40 and 50, blood pressure greater than 130/85, fasting glucose greater than 100
119
When Statin therapy does not lower LDL should screen for this
Lipoprotein a
120
What are some features of a high risk stress test that may warrant a cardiac catheterization
Angina or ischemic ECG changes at low workload, ST segment depression greater than 2 mm, ST segment elevation, ST segment depression persisting greater than six minutes into the recovery period, exercise-induced hypotension
121
What is the definition of an STEmi
Presence of more than 1 mm ST segment elevation two or more continuous Limley's or more than 2 mm ST segment elevation and two or more continuous precordial leads or a new left bundle branch block
122
```
Timi score
(Low 0 to 1-2 intermediate to 3-4 high-risk is five and six)
```
Age. >65
At least three coronary artery disease risk factors (cigarette smoking, hypertension or on hypertensive medicine, Family history of coronary artery disease, remember if HDL greater than 60 subtract one point)
Coronary stenosis greater than 50%
ST changes on EKG
Use of aspirin in the last seven days
At least two anginal episodes in past 24 hours
Elevated troponin
123
Treat chronic systolic heart failure and
```
Ace inhibitor beta blockers, diuretics (add spiro in class 4), low salt
Add hydral and isosorbide dintrate for aa pts who cont to be symptomatic , icd when ef <35
```
124
What drugs to Avoid and chronic systolic heart failure and
On the steroid anti-inflammatory agents, calcium channel blocker's, antiarrhythmics( only amio and dofetilide do not negatively effect survival), alcohol, cocaine, tobacco
125
In patients with ventilator associated pna which antibiotic can be used to replace vanco if allergic
Linezolid
| Note: Daptomycin is bound by surfactant and effective in the treatment of the pna
126
When does a pleural effusion require not only antibiotics but pleuraldrainage
Large Ephesians greater than one half of the hemithorax, septations and areas of a loculation, plural fluid pH less than 7.2, glucose level less than 60 and positive Gram stain or culture
127
What is the definition of the transfer data versus exudative pleural effusion and the importance of Ph, glucose
And exudative the fusion is coming to find as their own fluid total protein to see you're in total protein ratio greater than .5 and or pleural fluid LDH level greater than two thirds the upper limit of normal.
**calc prot or alb gradient in the setting of ongoing diuresis
Plural fluid glucose levels less than 60 is commonly due to TB, parapneumonic effusion, malignant the fusion or rheumatoid disease
Plural fluid pH less than 7.2 is seen in complicated here in a Monica fusion, esophageal rupture, rheumatoid and TB, malignant disease...
