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Flashcards in Davis' Deck (51)
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1

basic tx of CHF (systolic)

B blocker, loop diuretic, ACE-I

2

tx of diastolic heart failure

diuretics and b blockers (improve ventricular filling by dec HR) and nondihydropyridine CCB, verap and dilt (improve ventricular compliance)

Diastolic due to aquired LVH (HTN, AS), or congenital LVH (HOCM, coarct of aorta), or infiltrative dx (amyloidosis), MI (transient stiffness)

3

Increased serum level of _____ appears to be more sensitive for dx of b12 def as red cell indices and b12 levels may be normal

methylmalonic acid

4

normal pressure hydrocephalus presents with

dementia PLUS abnormal gait AND urinary incontinence / urgency

5

G6PD

x-linked
acute hemolysis related to infection, meds or stress
elevated unconjugated bili

6

triad of cholangitis

abdominal pain, jaundice and fever

7

medications causing hepatotoxicity

methotrexate (folate reduces this risk)
amiodaroneisoniazid
Statins
Niacin

8

cocaine-induced MI/ CP

BENZOS!
no B blockers!!!!
also ASA, NTG, CCV, alpha blocker
combined b and alpha (labetalol) may be used

9

Common causes of SVC syndrome

small cell carcinoma of lung
non-hodgkins
thrombosis around indwelling central venous cath

10

MCC constrictive pericarditis in US

prior chest radiation

others: cardiac surgery, conn tissue dx, bacterial/TB pericarditis
Rare from viral pericarditis

11

Preferred initial test in aortic dissection

TEE

12

extraintestinal manifestation of crohns

arthritic (lg joint arthritis and spondylitis) - also UC
clubbing - also UC
cholelithiasis - malab of bile salts from terminal ileum

13

primary biliary cirrhosis

high alk phos
ANA found; antimitochondrial antibodies in 95%

14

SE of lithium therapy

tremor, hypothyroidism (inhibits thyroid hormone synthesis and release), cogwheel rigidity

thiazide diuretics (not loop) increase lithium levels

take w meals; avoid pregnancy

15

meds to monitor for hypothyroidism with

lithium, amiodarone, interfeon alfa, interleukin-2

16

hirschsprungs disease - cause and dx

absense of ganglion cells in colon
suction biopsy and rectal manometry

17

dx of CF w mecnium ileus

newborn screening via immunoreactive trypsin (IRT)
follow w sweat chloride tsting (hard in first 6 mo)

18

SE of prednisone

hyperglycemia
osteoporosis (ca + vit d if on >3mo) (all men and post-meno women take bisphosphonate)
Peptic ulcer
cataracts
skin thinning w purpura

19

diseases associated with acanthosis nigricans

obesity, DM, GI cancer, cushing's syndrome

20

complications of MONO

aseptic meningitis, bell's palsy, hemolytic anemia, pericarditis, guillian-barre, thrombocytopenia, neutropenia, pericarditis (uncommon)

21

tumor lysis syndrome

from rapid tumor cell death
common in leukemia/lymphoma
give hyperkalemia, hyperphophatemia, hyperuricemia
may cause ARF

22

carcinoid syndrome

from carcinoid tumors primarily found in GIT and bronchi
release humoral factors
flushing, diarrhea, wheezing
tricuspid or pulm valve dx may occur
dx by urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA)

23

dx of sarcoidosis

elevated serum ACE (50%) and serum calcium (3-5%)

24

PFTs in restrictive lung disease

reduced total lung capacity and decreased CO diffusing capacity
FEV1/FVC ratio is normal or increased

25

PFTs in obstructive lung disease (asthma/chronic bronchitis)

decreased FEV1/FEV ratio
ratio in normal person is dep on age... 80% in 20-39 y/o and 70% in pt 60-80

26

Causes of diplopia

Cranial nerve III palsy
myasthenia gravis
multiple sclerosis (VI palsy - assoc w nystagmus)
inflamm/metabolic/vascular/neoplastic dx
cerebral aneurysms
DM (**PUPIL SIZE NORMAL - otherwise III palsy)
Wernicke's (+nystagmus and disorientation/inattentive)

27

Cranial n III palsy

ptosis, lateral deviation of eye, dilated pupil

28

horner's syndrome

ptosis, miosis, anhydrosis

29

ABG in restrictive lung disease

siffness of lungs = hyperventilation and reduced oxygen diffusion. No outflow obstruction.

hypoxemia with hypocapnia
respiratory akalosis

30

if b12 levels are borderline or pernicious anemia is suspected, test _______

methylmalonic acid levels

31

Causes of clubbing of fingers and toes

Lung mets/CA, cyanotic congenital heart dx (ex: tetrology of fallot), endocarditis (late), cystic fibrosis, mesothelioma, bronchiectasis, lung abscess, idiopathic pulmonary fibrosis, hepatic cirrhosis, Crohn's dx

***COPD is not assoc with clubbing ; look for another cause

32

Hypertrophic osteoarthropathy (HO) is found in pts with clubbing who have

lung cancer, mesothelioma, bronchiectasis, cirrhosis

33

QT prolongation is assoc with what electrolyte abn

hypomagnesemia
hypocalcemia

34

when to use verapamil in place of adenosine for PSVT

when adenosine is contraindicated or ineffective. **adenosine may worsen bronchospasm in pt with obstructive lung disease!!!!!

35

palpable purpura

henoch-schonlein purpura

post-URI; renal manifestation of acute glomerulonephritis, arthritis, and abdominal pain

36

Polycystic kidney dx and coarctation of aorta both have a risk of what congenital problem??

congenital cerebral aneurysm (can result in rupture = SAH)

cerebral aneurysm that is not congenital can result from smoking, HTN, or HLD.

37

Treatment of bacterial meningitis (neonates-3mo)

Ampicillin + cefotaxime/ceftriaxone

38

Treatment of bacterial meningitis (3mo-55 y/o)

vancomycin + cefotaxime or ceftriaxone

39

Treatment of bacterial meningitis (older than 55 of adults with alcoholism / debilitating illness)

vancomycin + cefotaxime or ceftriaxone + ampicillin

40

Treatment of bacterial meningitis (hospital-aquired, posttraumatic, post neurosurgery, or if immunocompromised)

vancomycin + cefazidime + ampicillin

41

Treatment of brain abscesses

IV PCN + chloramphenicol, metronidazole or both
add Nafcilin if staph aureus is suspected.

42

Brown-sequard

unilateral cord lesion resulting ipsilateral motor disturbance with impairment of proprioception
contralateral loss of pain and temperature below lesion.

43

Treatment: CAP typical

doxy, erythro, macrolides (clarithro, azithro), or fluoroquinolones
ceftriaxone/cefotaxinme +azithro or fluoro if admission needed

44

pneumovax

>65 y/o q 6 yrs
earlier if cardiopul dx, sickle cell, splenectomy, liver dx

45

atypical PNA tx

erythromycin (mycoplasma/legionella)
tetracycline (chlamydia)

46

HCAP MC pathogens

staph aureus, gram-neg
**pseudomonas in ICUs

47

tx HCAP

empiric: cefepime, ticarcillin/calvulanic acid, piperacillin/tazobactam, meropenem

48

HIV-related PNA (MCC and tx)

Pneumocystis jiroveci
**BACTRIM

49

caseating granulomas

TB

50

ghon complexes and ranke complexes

TB

51

MCC croup

parainfluenza