deck 38

Question 1

diverticulosis diagnosis

Answer 1

CT scan

Question 2

diverticulosis GI presentation

Answer 2

acute diverticulosis more associated with N/V than diarrhea

Question 3

management of gonorrhoea infection

Answer 3

Need to also screen for syphilis, hep B, chlamydia (high rate of coinfection)

Question 4

secondary syphilis presentation

Answer 4

fever/malaise + widespread lymphadenopathy + diffuse maculopapular rash that begins on trunks and EXTENDS to extremities, including palms and soles + grey, mucous patches in mouth

Question 5

cause of gallstones in TPN patients

Answer 5

gallbladder stasis

Question 6

cause of mitral valve abnormality in HOCM

Answer 6

presence of systolic anterior motion of mitral valve leads to anterior motion of mitral valve leaflets toward the inter ventricular septum
- contact between the mitral valve and the thickened septum during systole leads to LV outflow tract obstruction

Question 7

classic de quervain tenosynovitis pt

Answer 7

mother holding infant with thumb outstretched

Question 8

de quervain tenosynovitis presentation

Answer 8

• tenderness in radial side of wrist at base of hand

- tenderness with passive stretching of tendons by grasping flexed thumb into palm

Question 9

initial management of lumbosacral radiculopathy

Answer 9

• NSAIDS or acetaminophen. NO IMAGING.

Question 10

most common findings of x ray in its with cervical spondylosis

Answer 10

osteophytes

Question 11

amyloidosis etiology

Answer 11

• *can also be secondary to chronic inflammation (eg chronic infections, IBD, RA)

Question 12

drug used for treatment and prophylaxis of amyloidosis

Answer 12

colchicine

Question 13

most common condition associated with dermatomyositis

Answer 13

malignancy (over 15% of patients)

Question 14

most common cause of primary adrenal insufficiency

Answer 14

autoimmune (over 90%) in developed world

Question 15

key distinguishing features between primary and secondary adrenal insufficiency

Answer 15

hyperkalemia + hyperpigmentation

Question 16

demographic most effected by pernicious anemia

Answer 16

whites of northern European ancestry

Question 17

length of time it would take for vegan to develop b12 deficiency

Answer 17

4-5 yrs of pure vegan diet (very high total body store)

Question 18

preferred treatment of vasospastic angina

Answer 18

CCBs (dilitazem, amlodipine)

Question 19

presentation of mild primary hyperparathyroidism

Answer 19

mild, asymptomatic hypercalcemia

Question 20

how to distinguish between exogenous thyroid intake vs. thyroiditis

Answer 20

serum thyroglobulin level (low with exogenous uptake, high with thyroiditis)

Question 21

well known complication of giant cell or temporal arteritis

Answer 21

aortic aneurysm

Question 22

major concern with hydroxychloroquine

Answer 22

retinal toxicity

Question 23

most common pathologies seen with analgesic nephropathy

Answer 23

papillary necrosis + chronic tubulointerstitial nephritis

Question 24

metabolic side effects of thiazide duiretics

Answer 24

hyperglycemia, increased LDL cholesterol and triglycerides, hyperuricemia,
hyponatremia, hypokalemia, hypomag, hypercalcemia

Question 25

presentation of amyloidosis

Answer 25

asymptomatic proteinuria + nephrotic syndrome + waxy skin + anemia + easy bruising + hepatomegaly

Question 26

cardiac amyloidosis presentation

Answer 26

CHF manifestations (progressive dyspnea, lower extremity edema, JVD, ascites) + LVH and non dilated LV cavity, especially absent HTN history

Question 27

why do high dose steroids cause adrenal insufficiency?

Answer 27

1) central mechanism. steroids act on pituitary to decrease release of ACTH.

Question 28

why do you get muscle weakness in cushings syndrome?

Answer 28

cortisol catabolizes skeletal muscle, leading to muscle atrophy.

Question 29

tachycardia-mediated cardiomyopathy pathophys

Answer 29

Chronic tachycardia causes LV dilation and myocardial dysfunction. This leads to LV dysfunction with decreased ejection fraction.

Question 30

treatment of tachycardia-mediated cardiomyopathy

Answer 30

aggressive rate control OR restoration of normal sinus rhythm

Question 31

why is adenosine used for narrow complex tachycardia?

Answer 31

1) slows sinus rate + increases AV nodal conduction delay + can cause a transient block in AV node conduction 2) allows you to identify P waves to clarify diagnosis of A flutter or atrial tachycardia. 3) can terminate PSVT by interrupting the AV nodal reentry circuit

Question 32

what does SVT refer to?

Answer 32

any tachycardia originating above His-bundle (sinus tachycardia, multifocal atrial tachycardia, a flutter, a fib, AVNRT, AVRT, junctional tachycardia)

Question 33

supraventricular arrhythmias on ECG

Answer 33

- narrow complex - no regular P waves (buried in QRS complexes, - retrograde P waves: seen in beginning or end of QRS complex

Question 34

what is torsades de pointes?

Answer 34

polymorphic v tach occurring in the setting of a congenital or acquired prolonged QT

Question 35

torsades de pointes management

Answer 35

1) if hemodynamically unstable, then immediate defib | 2) if stable, then IV mag sulfate

Question 36

aortic regurg murmur

Answer 36

early diastolic

Question 37

perivalvular abscess setting

Answer 37

patient with infective endocarditis who develops a new conduction abnormality (AV block) (abscess extends into adjacent conduction tissues) (usually happens in aortic valve in IV drug abusers)

Question 38

fluid dynamics of acute MR

Answer 38

leads to excessive diastolic volume overload, which causes elevated left ventricular end diastolic pressure. This elevated filling pressure is reflected back in the left atrium and pulmonary circulation and is responsible for signs/symptoms of acute pulmonary edema and CHF

Question 39

ECG with myocarditis

Answer 39

nonspecific ST segment changes

Question 40

signs of RV failure

Answer 40

``` elevated JVP RV 3rd heart sound tricuspid regurg hepatomegaly hepatojugular reflex lower extremity edema, ascites, pleural effusions ```

Question 41

hearing loss in HIV patient

Answer 41

serous otitis media (lymphadenopathy or obstructing lymphoma leads to auditory tube dysfunction)

Question 42

AAA screening recommendation

Answer 42

aged 65-75 active or FORMER smokers with one time abdominal ultrasound

Question 43

carotid endarterectomy indications

Answer 43

patients with symptomatic carotid artery stenosis of 70-99%

Question 44

a fib with RVR definition

Answer 44

a fib with pulse over 100

Question 45

BNP value for CHF

Answer 45

high sensitivity

Question 46

cord compression management

Answer 46

IV glucocorticoids without delay, then get MRI