DECK6 Flashcards
(95 cards)
1
Q
what are common adverse effects of Cisplatin?
A
nephrotoxicity tinnitus and hearing loss! electrolyte abnormalities severe n/v neurotoxicity
2
Q
what are the significant CNS and psych side effects that can be caused by the non-nucleoside reverse transcriptase inhibitor Efavirenz?
A
Efavirenz can cause:
- dizziness
- insomnia with vivid or bizarre dreams
- depression, anxiety
- confused thinking
- aggression
- use cautiously in pts with a hx of psych illness
3
Q
what are potential side effects of TMP-SMX?
A
GI upset
Stevens-Johnson syndrome
agranulocytosis
4
Q
what is the first-line, nonmedical tx for urge incontinence in females?
A
urge incontinence is usually associated with bladder detrusor overactivity
first-line, non-medical therapy = BLADDER TRAINING
next line med tx = Oxybutynin (an antimuscarinic/anticholinergic) – it relaxes the detrusor muscle and reduces spasm
5
Q
Henoch-Schonlein Purpura (HSP) is a childhood illness. what are clinical findings? what pathologic findings are seen on skin biopsy?
A
palpable, nonblanching, symmetric purpuric lesions, most commonly on the butt and lower extremities; joint pain; abdominal pain and renal failure
skin biopsy demonstrates a leukocytoclastic vasculitis (neutrophilic small vessel vasculitis) in the postcapillary venules, with extensive deposition of IgA
6
Q
what are symptoms of a cataract?
A
painless blurring of vision, glare, and halos around lights
pts frequently experience a worsening of distance vision initially (myopic shift), which may occur before opacification bcs evident
with increasing opacification, the RED REFLEX IS LOST and retinal detail becomes less visible
7
Q
what is the first-line tocolytic at 32-34 weeks of gestation? what are its side effects?
A
Nifedipine (CCB)
Maternal side effects include tachycardia/palpitations, hypotension (peripheral vasodilator, so leads to decreased SVR) nausea, flushing, headache
8
Q
what is the first-line tocolytic at <32 weeks of gestation? what are side effects (maternal and fetal)?
A
Indomethacin (COX inhibitor)
Maternal side effects include gastritis and platelet dysfunction
Fetal side effects include oligohydramnios and closure of the ductus arteriosus
9
Q
what is used as a short-term tocolytic in the inpatient setting? what are side effects?
A
Terbutaline (beta agonist)
Maternal side effects include tachycardia/arrhythmias, hypotension, hyperglycemia, and pulmonary edema
10
Q
pt presents with pancreatitis after drinking and he has grossly lipemic serum and palmar xanthomas. what does he most likely have? what medicine can be used for tx?
A
Severe hypertriglyceridemia – possibly secondary to dysbetalipoproteinemia
alcohol consumption in the setting of severe hypertriglyceridemia may cause repeated bouts of pancreatitis
Tx with a fibric acid derivative such as FENOFIBRATE
11
Q
what are potential predisposing factors for torsades de pointes (a type of polymorphic ventricular tachycardia)?
A
antiarrhythmic drugs
(sotalol, used to maintain sinus rhythm, has the potential side effect of prolongation of the QT interval, which predisposes to torsades de pointes)
structural heart disease
hypokalemia and/or hypomagnesemia (like could result from diarrhea)
12
Q
what findings indicate a pt’s small bowel obstruction is “complicated” and warrants emergent surgical exploration?
A
changes in the character of the pain, fever, hemodynamic instability (hypotensive, tachycardic), guarding, leukocytosis, and significant metabolic acidosis
13
Q
what are risk factors for cervical cancer?
A
TOBACCO USE!! immunosuppression (HIV) early onset of sexual activity multiple or high-risk sexual partners previous STI hx of vulvar or vaginal cancer
14
Q
Besides stopping the offending agent and supportive care, what medications can you give to tx neuroleptic malignant syndrome?
A
Bromocriptine (or amantadine) - reverse dopamine blockade
Dantrolene - direct acting muscle relaxant
15
Q
if you see pericardial calcifications on a CXR, and the pt also has signs of right heart failure and a pericardial knock (middiastolic sound), what is this likely?
A
constrictive pericarditis
16
Q
what are potential side effects of amiodarone?
A
hypo- and hyperthyroidism
hepatotoxicity - elevated transaminases, hepatitis
bradycardia and heart block
chronic interstitial pneumonitis (cough, fever, dyspnea, pulmonary infiltrates) **most common
peripheral neuropathy
visual disturbances
blue-gray skin discoloration
17
Q
what are the 3 main categories of diabetic retinopathy and what characteristics do you see on exam with each one?
A
- Background or simple retinopathy - microaneurysms, hemorrhages, exudates, and retinal edema
- pre-proliferative retinopathy - cotton wool spots
- proliferative or malignant retinopathy - consists of newly formed vessels
* visual impairment occurs with development of macular edema
18
Q
gradual loss of peripheral vision, resulting in tunnel vision. Ophthalmoscopy shows cupping of the optic disc. may also be a diabetic pt. what is this?
A
open angle glaucoma
19
Q
in a cirrhotic pt with medium- large sized esophageal varcies, what med do you give to reduce the risk of variceal hemorrhage?
A
nonselective beta blockers!! (propranolol, nadolol)
20
Q
nonalcoholic fatty liver disease is associated with what? what is the mechanism behind it?
A
associated with insulin resistance – this leads to increased peripheral lipolysis, triglyceride synthesis, and hepatic uptake of fatty acids but decreased clearance of free fatty acids (due to decreased VLDL production)
21
Q
what is trihexyphenidyl?
A
an anticholinergic agent, typically used to tx younger pts with Parkinson’s disease where tremor is the predominant symptom
22
Q
what mineral might you be deficient in if you complain of food not tasting anymore, alopecia, pustular skin rash around the mouth and on the extremities?
A
Zinc deficiency!
may also have hypogonadism, impaired wound healing, and immune dysfunction
23
Q
what drugs have been shown to increase appetite and weight gain in pts with cancer-related anorexia/cachexia syndrome?
A
progesterone analogues (megestrol acetate and medroxyprogesterone acetate) and corticosteroids
24
Q
pt with HIV just moved to Missouri, they have fever, wt loss, cachexia, cough, dyspnea, mucocutaneous lesions (papules, nodules), hepatospenomegaly, and LAD. Labs show pancytopenia and trasaminitis. CXR shows b/l reticulonodular opacities with hilar lympadenopathy. what do they have?
A
Disseminated histoplasmosis!
get a urine Histoplasma antigen
25
how does diaphragmatic rupture after a trauma typically present? what side is more common?
more common on the left side bc the right side tends to be protected by the liver
pts usually have respiratory distress and can have deviation of the mediastinal contents to the opposite side
elevation of the hemidiaphragm on CXR might be the only abnormal finding
CXR showing an NG tube in the pulmonary cavity is diagnostic
26
pt with shoulder dystocia presents with extended wrist, hyperextended MCP joints, flexed interphalangeal joints ("claw hand"), and absent grasp reflex. They also have horners syndrome. Moro and biceps reflexes are intact. What is the name of this palsy? what nerves were damaged to cause it?
Klumpke palsy
8th cervical and 1st thoracic nerve injury
(associated damage to the sympathetic fibers that run along C8 and T1 manifest as ipsilateral miosis and ptosis of Horner syndrome)
27
pt presents with anasarca (full body edema), pulmonary and facial edema, HTN, and abnormal UA with proteinuria and microscopic hematuria. what is this most likely? what is the mechanism of the edema?
acute nephritic syndrome -- due to primary glomerular damage
- primary glomerular damage leads to decreased GFR with eventual development of significant volume overload (eg, pulm edema, distended neck veins, anasarca)
(causes include PSGN, IgA nephropathy, lupus nephritis, membranoproliferative GN, and rapidly progressive GN)
28
what are the most common causes of osteomyelitis in pts with Sickle cell disease?
Salmonella!!
| and staph aureus
29
what statistical test is used to compare the means of two groups of subjects?
two-sample t test
30
what change in heart sounds can often be heard during the acute phase of myocardial infarction due to left ventricular stiffening and dysfunction induced by myocardial ischemia?
S4 (atrial gallop)
31
in postpartum hemorrhage, initial tx begins with bimanual massage and uterotonic meds. What are the 3 uterotonic meds? and what are contraindications to their use?
1. Oxytocin = first line (IV infusion)
2. Methylergonovine - causes smooth muscle constriction, uterine contraction, and vasocontriction. A hx of HTN is a contraindication!!
3. Carboprost - synthetic prostaglandin that stimulates uterine contraction. it causes bronchoconstriction, and ASTHMA is a contraindication!!
32
Name this vitamin deficiency:
angular cheilosis, stomatitis (hyperemic/edematous oropharyngeal mucous mebranes), glossitis; normocytic anemia; seborrheic dermatitis
Riboflavin (B2) deficiency!!
**it's riboFLAVIN, so the FLAVIN is like your mouth -- angular cheilosis, cracked lips, swollen big tongue to taste the FLAVIN
more common in underdeveloped countries w/ severe food shortages
33
what drug used in the tx of RA causes a macrocytic anemia? what are other side effects of this drug?
Methotrexate
- it works by inhibiting dihydrofolate reductase
- other side effects include: nausea, stomatitis, rash, hepatotoxicity, interstitial lung dz, alopecia, and fever (likely due to depletion of folate)
- some of these rxns can be alleviated with folic acid supplementation (w/o changing the efficacy of MTX)
34
how should pts be managed that present with persistent tachyarrhythmia (narrow- or wide-complex) causing hemodynamic instability?
immediate synchronized cardioversion
35
a pt with Parkinsonism experiences orthostatic hypotension, impotence, incontinence, and other autonomic sxs such as dry mouth and dry skin. what is this suggestive of?
Multiple system atrophy (Shy-Drager syndrome)
36
an unimmunized child presents with fever and bilateral swelling and tenderness anterior to the ears extending inferiorly and obscuring the angle of the mandible. what is this? and what are possible complications?
Mumps!! - viral infx that presents w/ fever and parotitis after a nonspecific prodrome
ASEPTIC MENINGITIS is the most common complication of mumps (HA, fever, nucal rigidity)
ORCHITIS is another complication that occurs primarily in postpubertal males and can impair fertility
37
what bug is a common cause of nosocomial-acquired endocarditis, particularly in pts with associated nosocomial urinary tract infections?
Enterococci species (eg, Enterococcus faecalis)
38
pt had a ROux-en-Y gastric bypass surgery 2 years ago. she has now developed bloating, flatulence, and abdominal discomfort with significant diarrhea with steatorrhea and weight loss. these episodes are often severe after a meal but the pt hasn't noticed specific dietary triggers. stool test demonstrates increased fecal fat. lab work shows a macrocytic anemia. what is the most likely cause?
Small intestinal bacterial overgrowth
- due to an increased bacterial load that alters the normal flora and causes excessive fermentation, inflammation, and malabsorption.
- may be a macrocytic anemia due to nutritional deficiencies
39
in a pt with a first episode of venous thromboembolism, and no evidence of any clear provoking factors, what is the next step in evaluation?
age-appropriate cancer screening (eg, colonoscopy in a pt >50)
40
what is the most common cause of spontaneous lobar hemorrhage, particularly in adults >60?
Amyloid angiopathy
- it occurs as a consequence of beta-amyloid deposition in the walls of small to medium size cerebral arteries, resulting in vessel wall weakening and predisposition to rupture
- the amyloidogenic proteins are usually the same as those seen in Alzheimer dementia
- most often involves the occipital and parietal lobes
41
a girl returns from gymnastics camp with a scaly, erythematous, pruritic patch with centrifugal spread on her leg. it develops a raised annular border and central clearing. what is this and what is the first-line tx?
```
Tinea corporis (ringworm)
1st line tx for localized infection = topical antifungals -- Clotrimazole or Terbinafine
```
42
how do you calculate serum-to-ascites albumin gradient (SAAG)? and what does it tell you based on the values?
SAAG = [serum albumin] - [peritoneal fluid albumin]
a SAAG >/= 1.1 indicates Portal HTN (eg, cirrhosis) as the etiology of ascites -- due to increased hydrostatic pressure within hepatic capillary beds
a SAAG < 1.1 suggest other causes of the ascites
43
a surge in which hormone is responsible for the constellation of derangements that occur in refeeding syndrome?
INSULIN!
- carbohydrate intake stimulates insulin activity, which in turn promotes cellular uptake of phosphorus, K+, and Mg2+
- clinical manifestation include arrhythmias and cardiopulmonary failure
44
what are the parasitic organisms that are responsible for most cases of prolonged travelers' diarrhea (profuse and watery)?
Cryptosporidium parvum
Cyclospora
Giardia
45
a 16 yo female that presents with hirutism, menstrual irregularities, elevated steroid precursors (17-hydroxyprogesterone), androgens (DHEA, testosterone), and gonadotropins (LH, FSH) most likely has what?
nonclassic Congenital Adrenal Hyperplasia
- due to a deficiency of 21-hydroxylase -- low plasma cortisol stimulates the pituitary to increase ACTH production, leading to adrenal hyperplasia
- the marked increase in 17-hydroxyprogesterone is diverted toward adrenal androgen synthesis and leads to hyperandrogenism.
- LH and FSH are also increased bc the excess androgen impairs the hypothalamic sensitivity to progesterone, resulting in rapid GRH secretion and hypersecretion of LH and FSH
46
name this congenital heart defect:
| ECG shows left axis deviation in a newborn, and CXR shows decreased pulmonary markings.
Tricuspid valve atresia
47
pts taking chronic supraphysiologic doses of glucocorticoids develop what type of adrenal insufficiency? what do hormone levels look like?
Central Adrenal insufficiency
| low ACTH and low cortisol levels (normal aldosterone)
48
what acid-base disturbance do you see with Primary adrenal insufficiency (Addison's disease)? what is the mechanism?
Deficient aldosterone leads to decreased reabsorption of Na+, and decreased secretion of K+ and H+ (serum Na+ decreases while serum K+ and H+ increases).
the increase in serum H+ leads to a non-anion gap METABOLIC ACIDOSIS
49
what are potential side effects of loop diuretics (like furosemide)?
hypokalemia
Metabolic alkalosis (loss of H+ with loss of K+)
prerenal kidney injury
50
pt develops well-circumscribed and raised erythematous plaques with a central pallor, along with intense pruritus and resolution of individual skin lesions within 24 hrs. what is this lesion called?
urticaria!
51
a 23yo on OCPs has a normal TSH level and elevated total T4 concentration. what is the reason for these lab findings?
increased thyroid hormone-binding protein
- high levels of estrogen (pregnancy, OCPs, HRTs) increase the level of TBG by decreasing its catabolism and increasing its synthesis in the liver
- as additional TBGs bind more thyroid hormone, thyroid hormone production increases to maintain a euthyroid state
- so total T4 is elevated, but free T4 would be expected to be normal
52
after trauma to the leg (like a big stab wound), a pt can develop an AV fistula. What is the mechanism by which an AV fistula can cause high-output cardiac failure?
blood is shunted from the arterial to the venous side of the fistula, thereby increasing cardiac preload. SVR is decreased and cardiac output is increased.
clinical signs = widened pulse pressure, strong peripheral arterial pulsation (eg, brisk carotid upstroke), systolic flow murmur, tachycardia, and usually flushed extremities.
the left ventricle hypertrophies, and the PMI displaces to the left
53
what are levels of calcium, phosphate, and PTH in pts with osteomalacia due to vitamin D deficiency (like due to malabsorption)?
low-nl Ca
low phosphate
increased PTH
54
young female presents with fever, vomiting, lower abdominal tenderness, intermenstrual spotting, and abdominal pain worse during menses. now has RUQ pain that is worse with breathing. she is sexually active and does not use contraception. urine pregnancy test is negative. what is this?
Pelvic inflammatory disease, complicated by perihepatitis (Fitz-Hugh-Curtis disease)
55
how do you dx fibromuscular dysplasia? also what is its clinical presentation?
young woman with elevated BP, may have sxs such as amaurosis fugax (transient monocular vision loss).
FMD decreases perfusion to the kidneys, which increases both renin and aldosterone levels (secondary hyperaldosteronism)! the aldosterone:renin activity ratio is ~ 10.
Dx is confirmed with CT angiography of the abdomen or duplex US
56
a newborn has macrosomia, macroglossia, hemihyperplasia, and a medial abdominal wall defect (umbilical hernia, or omphalocele). what is this? what type of screenings do these pts require?
Beckwith-Wiedemann syndrome
- these pts are at increased risk of Wilms tumor and hepatoblastoma
- screening ABDOMINAL US and alpha-fetoprotein levels should occur q3months from birth - 4yo; abdominal US q3months from 4-8yo; and then renal US from 8yo-adolescence
- (also the newborns must be monitored closely for hypoglycemia)
57
in pts with sickle cell disease, painless hematuria along with UA that only shows normal-appearing RBCs is likely due to what?
Renal papillary necrosis
- episode are usually mild and resolve spontaneously
- gross hematuria and normal-appearing RBCs on UA suggest an extra-glomerular etiology
58
unconjugated hyperbilirubinemia and dehydration in the first week of life. what is this? how do you tx it?
breastfeeding failure jaundice
- inadequate stooling results in suboptimal bilirubin elimination and increased enterohepatic circulation of bilirubin
- best tx is to increase the frequency and duration of feeds to stimulate milk production, maintain adequate hydration, and promote bilirubin excretion (feed q2-3 hrs for > 10-20 mins/breast)
59
a young white man with no risk factors presents with a DVT and PE. He has no known risk factors. prothrombin time and activated partial thromboplastin time are normal. what is the most likely contributor to this pts condition?
Factor V Leiden disorder
- most common hereditary thrombophilia in white people
- ACTIVATED PROTEIN C RESISTANCE!
60
overdose of what should be suspected in pts with the triad of fever, tinnitus, and tachypnea? what is the acid base disturbance?
Aspirin intoxication
| mixed respiratory alkalosis and anion gap metabolic acidosis (with a normal pH)
61
the pneumonia polysaccharide vaccine induces immunity by what mechanism?
23-valent pneumococcal vaccine contains capsular polysaccharides and induces a relatively T-cell-independent B-cell response.
in contrast, the 13-valent pneumococcal vaccine contains capsular polysaccharides conjugated to a protein antigen, which allows for a more robust T-cell-dependent B-cell response.
62
what are secondary causes of pseudogout?
hyperparathyroidism
hypothyroidism
Hemochromatosis
63
how do you tx a severely depressed geriatric pt with psychotic features who is not eating or drinking?
electroconvulsive therapy!
| used to achieve a rapid response
64
loss of peripheral vision and cupping of the optic disc. what is this?
primary open angle glaucoma
65
pubertal boys can have unilateral, bilateral, or painful gynecomastia that is normal. true or false?
true!
it occurs in a lot of pubertal boys and presents as unilateral or bilateral firm subareolar nodules (sometimes tender to the touch)
66
a baby is teething and his mom puts a "numbing cream" on his gums that she used when she had a toothache. the baby turns blue. at the hospital his pulse ox reads 85% and his blood is dark chocolate-colored. what is this? why did it happen? what would his PaO2 be?
Methemoglobinemia
due to exposure to oxidizing agents (dapsone, nitrites, LOCAL/TOPICAL ANESTHETICS such as benzocaine/lidocaine)
methemoglobin is a form of hgb where one of the iron molecules is oxidized to the ferric state (Fe3+).. this state has a decreased affinity for oxygen, but the remaining 3 ferrous heme sites have increase oxygen affinity --> decreased oxygen delivery to peripheral tissues
PaO2 is NORMAL (overestimates the degree of true oxygen saturation)
67
in a pt suspected of having methemoglobinemia, what should be administered ASAP?
methylene blue!!
68
in a baby <4 months old with suspected developmental dysplasia of the hip, what imaging do you do for further evaluation?
b/l hip ULTRASOUND
*after age 4 months, the femoral head and acetabulum are ossified, and x-rays are preferred to evaluate acetabular development and positioning
69
older male pt with dementia with severe abdominal pain and suprapubic fullness is taking amitryptyline. hx of bph. what is the next best step in management?
urinary catheterization!
| he has amitriptyline-induce urinary retention (also probz some from bph)
70
how would you classify this type of diarrhea? -- larger daily stool volumes and diarrhea that occurs even during fasting or sleep. The stool osmotic gap is reduced (<50).
Secretory diarrhea!
-can be due to bacterial or viral infxs, congenital disorders of ion transport, early ileocolitis, and POSTSURGICAL CHANGES
* in contrast, osmotic diarrhea causes an elevated stool osmotic gap
* stool osmotic gap calculates the difference between plasma osmolality and double the sum of Na and K ions in stool
71
what is the MOA of statins?
statins are HMG-CoA reductase inhibitors
they prevent the synthesis of intracellular mevalonic acid from HMG CoA
the decreased hepatic cholesterol leads to an increase in the number of LDL receptors on liver cell membranes, which causes removal of circulating LDL and it's delivered to the cell's interior for digestion (reducing serum LDL)
statins also decrease coenzyme A10 synthesis (which may contribute to statin-induced myopathy)
72
pt with sickle cell has increasing unilateral hip pain, reduced range of motion, and normal findings on x-ray. what is this?
osteonecrosis! (aseptic necrosis) of the femoral head!
occurs in sickle cell due to occlusion of end arteries supplying the femoral head, leading to necrosis and collapse of the periarticular bone and cartilage
73
what are the precentages that differentiate toxic epidermal necrolysis and Stevens-Johnson syndrome?
```
<10% = SJS
10-30% = SJS/TEN overlap syndrome
>30% = TEN
```
74
describe cluster headaches.
more common in men, onset may occur during sleep. occur behind one eye and are excruciating, sharp and steady in nature. may last 15-90 minutes. associated symptoms include sweating, facial flushing, nasal congestion, lacrimation and pupillary changes.
75
describe tension headaches.
female > male. occur when pts are under stress. occur in a band-like pattern around the head (b/l) and are dull, tight, and persistent. may last 30 mins to 7 days. accompanied by muscle tenderness in the head, neck, or shoulders.
76
a bigger lady is exercising and all of a sudden has posterior knee and calf pain, with tenderness and swelling of the calf and ankle. an arc of ecchymosis is visible distal to the medial malleolus ("crescent sign"). what is this?
Rupture of a popliteal (Baker) cyst!
- US can r/o DVT and confirm the popliteal cyst
- politeal (Baker) cysts may present as a painless bulge in the popliteal space, and are most common in pts w/ underlying arthritis
77
acute HIV infection causes a febrile illness that closely resembles infectious mononucleosis (eg, malaise, generalized LAD). what are some distinguishing features?
in acute HIV, rash and diarrhea are common, while tonsillar exudates are uncommon
78
what is the most common cause of gross lower GI bleeding in adults?
Diverticulosis
bleeding is typically painless, but large-volume bleeding can be associated w/ lightheadedness and hemodynamic instability
Dx is confirmed on colonoscopy
79
how is CLL diagnosed?
FLOW CYTOMETRY!! of peripheral blood
| -it shows a clonality of mature B cells
80
a pt with direct hyperbilirubinemia and elevated alk phos. what does this pattern of LFTs indicate? and what is the most appropriate next test?
cholestasis in the setting of extrahepatic or intrahepatic biliary obstruction
next step is to obtain an ABDOMINAL US to assess hepatic parenchyma and biliary ducts
81
pt spends a lot of time training birds. she has repeated episodes of cough, breathlessness, fever and malaise over the past few months. she has a restrictive pattern on PFTs consistent with fibrosis. CXR shows ground glass opacity or "haziness" in the lower lung fields. what is this and how is it treated?
Hypersensitivity pneumonitis -- inflammation of lung parenchyma caused by antigen exposure (like aerosolized bird droppings -- "bird fancier's lung") (mold associated with farming can cause "farmer's lung")
HP management = AVOIDANCE of the responsible antigen (avoid exposure to birds)
82
a pt fractures his clavicle. a loud bruit is heard just beneath the clavicle. what study should you get to evaluate further (after xray)?
Angiogram
-the clavicle is in close proximity to the subclavian artery and brachial plexus, thus a careful neurovascular exam should be done
83
a simple breast cyst is a common, benign, palpable breast mass in women that has no echogenic debris or solid components on US. aspiration can provide relief to a painful mass and would yield clear fluid and the disappearance of the mass. when should the pt f/u in clinic?
f/u clinical breast exam in 2-4 months, as cystic fluid can reaccumulate
84
methotrexate is a folate antimetabolite that is the preferred initial DMARD in pts with moderate-to-severe RA. what are common side effects of it?
Oral ulcers
acute rise in serum transaminases
other possible side effects = alopecia, pulmonary toxicity, and bone marrow suppression (macrocytic anemia, leukopenia, thrombocytopenia)
85
vasomotor symptoms (hot flashes or "night sweats"), insomnia, and irregular menses could be due to what in a middle-aged woman? what labs do you get?
hyperthyroidism or menopause
Serum TSH and FSH levels should be measured
(during menopause, circulating estrogen decreases and thus FSH increases due to the lack of negative feedback)
86
raising the cut-off point of a test with do what to specificity and sensitivity?
increase specificity
decrease sensitivity
(false and true positive decrease, while false and true negatives increase)
87
what medications have been shown to improve long-term survival in pts with left ventricular systolic dysfunction?
ACE inhibitors/ARBs
beta blockers
Mineralocorticoid receptor antagonists, such as Spironolactone and eplernone
(and in African American pts a combo of hydralazine and nitrates)
88
what do you see in RBCs when a pt is asplenic?
Howell-Jolly bodies!!
"HOWell-JOLLY arth though to not have a spleen"
89
pts with RA are at increased risk of developing what bone related conditions?
osteopenia, osteoporosis, and bone fractures!
90
pt has recurrence of prostate cancer (diagnosed with elevated PSA) and he undergoes radiation to kill residual tumor cells. what type of therapy is this radiation treatment considered?
Salvage therapy -- a form of tx for a disease when a standard treatment fails
91
pt presents with coarse facial features, arthralgias, uncontrolled HTN, enlargement of the digits and carpal tunnel syndrome. What do you suspect and what lab value do you measure first?
Acromegaly (excessive secretion of GH)
measure INSULIN-LIKE GROWTH FACTOR 1 (IGF-1)
-- growth hormone stimulates hepatic secretion of IGF-1 and it is consistently elevated throughout the day (in contrast, GH levels can fluctuate widely)
92
what is initial treatment for chronic venous insufficiency? (most commonly caused by incompetence of venous valves leading to venous HTN in the deep venous system of the legs -- pts have leg discomfort, pain or swelling worse in the evening or following prolonged standing, that improves after walking or leg elevation.)
initial tx = leg elevation, exercise, and compression stockings
93
pt returned from a trip to mexico two weeks ago. one week ago he had abdominal pain, n/v, and diarrhea that have since resolved. now he has fever, subungual splinter hemorrhages, conjunctival and retinal hemorrhages, periorbital edema, and chemosis. his muscles are painful, tender and swollen. Lab studies show eosinophilia (>20%) with elevated creatinine kinase and leukocytosis. what is this infection?
Trichinellosis!!!
- caused by a parasitic infx with the roundworm Trichinella
- Mexico, China, Thailand, central Europe and Argentina
- eating undercooked or raw meat (usually pork) containing encysted Trichinella larvae
- Dx clinically: classic Triad of PERIORBITAL EDEMA, MYOSITIS, and EOSINOPHILIA!!!
94
pt with a hx of IV drug abuse and track marks on arms presents with pulmonary symptoms (f/c, pleuritic CP, and SOB for 3 days) and cavitary lesions on lung imaging. what does this suggest? what is the most likely organism?
Septic embolism from infective endocarditis!
most commonly due to Staph aureus
IV drug users usually with tricuspid IE
-imaging may show pulmonary septic emboli as pulmonary infiltrates, abscesses, infarction, pulmonary gangrene, or cavities (typically located in the lung periphery)
95
what is first-line tx for acute mania?
Antipsychotics, lithium, and valproate
Both first and 2nd generation antipsychotics are effective in managing mania and associated acute behavioral agitation (or psychosis)
*Risperidone is a good rapid acting 2nd gen one to use
