DIVINE! Flashcards
1
Q
Sickle cell disease vaccines?
A
SHIN
Streptococcus Pneumonia
Haemophilus influenzae
Neisseria Meningitidis
(also klebsiella and and psuedomonas)
2
Q
Light’s Criteria!
A
- Pleural fluid protein/serum protein < 0.5
- Pleural fluid LDH/serum LDH < 0.6
- Pleaural fluid LDH < 0.67 ULN of serum LDH.
- If one of these rules are violated, the fluid is exudative (malignancy, PE, ARDS)
- Normal pleural fluid pH is 7.6
- Transudative fluid is 7.4-7.55
- Exudative is 7.3-7.45
3
Q
Common causes of pleural effusions?
A
- Transudative
- CHF
- Cirrhosis
- Nephrotic Syndrome
- Peritoneal dialysis
- Exudative
- infections
- malignancy
- Inflammatory disorders
- Fluid from abdomen to pleural space
- coronary artery bypass surgery
- pulmonary embolism
4
Q
RUQ pain, fever, +ve Murphy’s sign
A
Cholecystitis
5
Q
RUQ pain, fever, scleral icterus, BP 80/48 (hypotension), altered MS
A
Ascending cholangitis
6
Q
HLA-B27 diseases?
A
PAIR
Psoriasis
Ankylosing Spondylitis
Irritable bowel disease
Reiter’s Syndrome (reactive arthritis post bacterial infection, re-can’t see; uveitis, can’t pee; urethritis, can’t climb a tree; arthritis)
7
Q
MEN syndomes?
A
- MEN1 (3 Ps)
- Pituitary adenoma
- Parathyroid hyperplasia
- Pancreatic islet cell tumors (gastrinoma, insulinoma, glucagonoma)
- MEN2a (MPH)
- Calcitonin (medullary carcinoma of the thyroid with elevated calcitonin level)
- Calcium (parathyroid hyperplasia, which causes elevated calcium levels)
- Catecholamines which are made in the chromocytes (as in pheochromocytoma)
- MNE2b (MPM)
- Medullary thyroid carcinoma
- Pheochromocytoma
- Mucosal neuromas
MEN1
- Hypercalcemia: brittle bones (fractures, due to osteoporosis), kidney stones, abdominal moans (abdominal pain), and psychiatric overtones (confusion).
- Treatment-resistant peptic ulcer disease (gastrinoma) or hypoglycemia (insulinoma).
MEN2A
- Hypercalcemia: brittle bones (fractures, due to osteoporosis), kidney stones, abdominal moans (abdominal pain), and psychiatric overtones (confusion).
- Severe, treatment-resistent hypertension (particularly paroxysmal in nature, with headaches, palpitations, and diaphoresis).
8
Q
Child with retinoblastoma, cancer later?
A
Osteosarcoma
9
Q
CLL
A
indolent, derived from B cells, CD5+ (usually only in T cells). smude cells on histology, SEVERE leukocytosis
10
Q
Multiple myeloma
A
CRAB symptoms
hyperCalcemia
Renal insufficiency
Anemia
Bone pain
11
Q
65 yo M with pancytopenia. A peripheral smear reveals tear drop shaped RBCs
A
Primary myelofibrosis
12
Q
88 yo F has a 6 mo hx of recurrent infections. WBC is 87000. A peripheral smear reveals “smudge cells”
A
CLL
13
Q
78 yo M. A peripheral smear is notable for RBCs stacked like coins
A
Multiple myeloma (Rouleaux formatin)
14
Q
78 yo M with pancytopenia. Bone marrow aspiration is consistent with a “dry tap”-
A
Primary myelofibrosis
15
Q
66 yo F presents with a 6 mo hx of recurrent infections, WBC is 47k with a preponderance of cells in different stages of maturation. These cells have reduced leukocyte alkaline phosphatase activity-
A
CML (9/22 translocation, Philadelphbia, give imatinib)
16
Q
55 yo M is S/P Day 5 from recent treatment for a hematologic malignancy. Plts are 40K, D-dimers are elevated, he is bleeding from every IV Site-
A
Acute promyelocytic leukemia (Auer rods can trigger DIC, low plts, High FDPs/PT/PTT, give ATRA to promote myeloblast maturation)
17
Q
5 yo F presents with a 6 week hx of weight loss and fever. CBC is notable for pancytopenia. Cytologic studies reveal TDT +ve cells
A
ALL
18
Q
55 yo M presents with fever, weight loss, and night sweats. Peripheral smear reveals B cells with a bilobate nucleus
A
Hodgkin’s lymphoma
19
Q
45 yo F with a hx of CML presents with a 3 week hx of diffuse lymphadenopathy and fever-
A
AML
20
Q
45 yo F with a 6 month history of intense pruritus. BMP is notable for conjugated hyperbilirubinemia. Abdominal imaging reveals dilation of intrahepatic bile ducts
A
This is primary biliary cholangitis associated with anti-mitochondrial antibodies. Treatment involves the use of Ursodiol. Liver transplantation is the only definitive treatment.
21
Q
45 yo M with a history of ulcerative colitis presents with a 6 month history of pruritus. Abdominal imaging reveals dilation of intra and extrahepatic bile ducts
A
this is Primary Sclerosing Cholangitis associated with p-ANCA. Note the difference in biliary duct pathology. Ursodiol does not work as well here. Liver transplantation and occasionally endoscopic dilation of strictures may suffice.
22
Q
25 yo M presents with a multi year history of sinusitis, hemoptysis, and hematuria
A
Wegener’s granulomatosis. Associated with c-ANCA. Could present as RPGN. Treat with steroids and cyclophosphamide.
23
Q
25 yo M presents with new onset asthma. Urinalysis reveals dysmorphic erythrocytes
A
this is Churg-Strauss Syndrome. Associated with p-ANCA (like microscopic polyangiitis). Consider this diagnosis in the setting of asthma and associated RPGN/nephritic syndromes.
24
Q
35 yo F presents with episodic discoloration of her fingers when she steps out of her home in winter. PE is notable for diffuse skin thickening
A
scleroderma (anticentromere antibodies for CREST scleroderma), anti-SCL 70 (topoisomerase) for diffuse scleroderma.
25
Recent spleen repair, referred pain to the left shoulder
subphrenic abscess
26
Recent treatment for acute pancreatitis, isolated gastric varices
splenic vein thrombosis
27
Gnawing epigastric pain, on chronic treatment for OA
PUD
28
Epigastric pain radiating to the back, alcoholic/sickle cell patient
pancreatitis
29
Periumbilical pain progressing to the RLQ
appendicitis
30
Flank pain radiating to the groin, hematuria
urolithiasis (renal calculi)
31
23 yo F, severe RLQ pain, inconsistent condom use
ectopic pregnancy
32
15 yo F with hx of adnexal mass, sudden onset severe abdominal pain
ovarian torsion
33
Cervical motion tenderness, adnexal tenderness, vaginal discharge
PID
34
LLQ pain in an 80 yo F with fever
diverticulitis
35
LLQ pain in an 80 yo M, air bubbles/poop in the urine
colovesical fistula
36
Patient on chemotherapy, thickened cecum on abdominal CT
typhlitis
37
# What is the bug?
Watery Diarrhea after returning from a trip
Enterotoxigenic E. Coli (MCC of Travellers diarrhea)
38
# What is the bug?
Watery Diarrhea with Rice Water Stools
Vibrio Cholerae (you lose a ton of fluid, tetracycline or a macrolide may help)
39
# What is the bug?
Watery Diarrhea in a hiker/camper
Giardia Lamblia (also consider this in a Q stem detailing an IgA deficiency, give metronidazole)
40
# What is the bug?
Watery Diarrhea on a cruise ship
Norovirus/Norwalk Virus.
41
# What is the bug?
Watery Diarrhea in an infant
Rotavirus (vaccine associated with increased risk of intussusception)
42
# What is the bug?
Watery Diarrhea in an AIDS patient
Cryptosporidium Parvum (acid fast, give paromomycin or nitazoxanide)
43
# What is the bug?
Bloody Diarrhea after consuming beef
Shigella (maybe EHEC/Campylobacter as well)
44
# What is the bug?
Bloody diarrhea after consuming poultry/eggs
Salmonella (Enteritidis)
45
# What is the bug?
Bloody diarrhea in the setting of a Lactose Fermenter
EHEC
46
# What is the bug?
Most common cause of bloody diarrhea in the US
Campylobacter Jejuni
47
# What is the bug?
Diarrhea and Ascending Paralysis
Campylobacter Jejuni (Guillain Barre Syndrome)
48
# What is the bug?
Diarrhea after treatment for an anaerobic infection
Clostridium Difficile (re-Clindamycin and above the diaphragm).
49
# What is the bug?
Diarrhea that feels like Appendicitis (after Pork Consumption)
Yersinia Enterocolitica (RLQ pain, mesenteric adenitis, terminal ileitis)
50
# What is the bug?
Protozoal cause of bloody diarrhea
Entamoeba Histolytica (give metronidazole, iodoquinol if theres liver abscesses).
51
# What is the bug?
Bloody Diarrhea requiring a small inoculum
Shigella
52
# What is the bug?
Bloody Diarrhea and Hemolytic Uremic Syndrome (kidney issues)
EHEC
53
# What is the bug?
Diarrhea after consuming Oysters/Seafood
Vibrio Parahaemolyticus
54
# What is the bug?
Diarrhea after consuming Oysters + Elevated Liver Function Tests
Vibrio Vulnificus
55
# What is the bug?
Diarrhea after swimming in freshwater
Aeromonas (theres also an Aquarium association)
56
# What is the bug?
Diarrhea with massive amounts of fluid/electrolyte loss
Vibrio Cholerae (most likely cause)
57
# What is the bug?
Diarrhea after consuming reheated rice
Bacillus Cereus (theres also an Asian, usually Chinese restaurant association).
58
# What is the bug?
Diarrhea 2 hours after consuming potato salad
S. Aureus
59
# What is the bug?
Diarrhea 6-15 hours after consuming meat/poultry left out for long
Clostridium Perfringens (nonspecific, but they may say something about an anaerobe causing diarrhea/an organism that forms spores).
60
# HY association?
Refractory HTN, hypokalemia, mild hypernatremia
Conns Syndrome.
61
# HY association?
Patient looks tan, hyperkalemia, hypoNa, hypoTN
Addisons disease (eosinophilia).
62
# HY association?
High PTH, high phosphate, low Ca
kidney disease/pseudohypoparathyroidism.
63
# HY association?
Albumin 1.5, peripheral edema, foamy urine, HIV patient
FSGS.
64
# HY association?
HTN, Hep B patient, hematuria, dysmorphic RBCs
MPGN.
65
# HY association?
Hirsutism, lesions on the hands, Hep C patient
Porphyria Cutanea Tarda (UROD).
66
# HY association?
GI bleeding, old guy, systolic murmur at RUSB with radiation to the carotids
Vascular ectasia (Heydes syndrome).
67
# HY association?
Offending bug in a sickle cell patient with osteomyelitis
Salmonella.
68
# HY association?
MCC of Osteomyelitis
S. Aureus.
69
# HY association?
Flushing, chronic diarrhea, wheezing on PE
Carcinoid syndrome.
70
# HY association?
Watery diarrhea, K is 2.8, achlorhydria
WDHA syndrome (VIPoma).
71
# HY association?
30 yo F, pleuritis, photosensitivity, hematuria, Hct is 24%
Lupus.
72
# HY association?
pH is 7.17, blood glucose is 398, Na is 133, vomiting, diarrhea, ketonuria
DKA.
73
# HY association?
Painful oral/genital ulcers, patient speaks Farsi
Behcets disease (pathergy testing).
74
# Causes of secondary HTN?
35 yo F, BP is 151/90. Her PE is completely benign
most likely OCP use.
75
# Causes of secondary HTN?
23 yo F, BP is 175/110. She has received HCTZ, losartan, and amlodipine which have all failed to control her pressures. A bruit is heard on abdominal auscultation
Fibromuscular dysplasia, stent the vessel, plasma renin and aldo are high.
76
# Causes of secondary HTN?
69 yo M, BP is 175/110. He has received HCTZ, losartan, and amlodipine which have all failed to control his pressures. A bruit is heard on abdominal auscultation. Arteriovenous nicking is observed on funduscopic exam
Renal artery stenosis.
77
# Causes of secondary HTN?
34 yo M, BP is 160/95 poorly controlled on multiple meds. Na 147, K is 2.9, HCO3- is 29
Conn Syndrome. Aldosterone high, renin appropriately low. Contrast with RAS and FMD. Surgery preferred, give Spironolactone/eplerenone as a bridge. PAC/PRA \> 30.
78
# Causes of secondary HTN?
35 yo M presents with severe headache. His BP is 220/130. 30 mins later his BP is 130/80. 3 hrs later his BP is 230/150. These headache episodes occur without warning about 4x a month
Pheochromocytoma. Dx with urine VMA/HVA/metanephrines. Block alpha receptors first before beta (e.g. phenoxybenzamine before metoprolol).
79
# Causes of secondary HTN?
35 yo F has cool extremities. BP is 167/110 in her left arm. There is a bruit heard over the scapula
coarctation of the aorta. Common in Turners syndrome.
80
# Causes of secondary HTN?
40 yo F presents with a BP of 159/99. PE is notable for bilateral flank masses. BUN and Cr are elevated. She recently had an aneurysm of the anterior communicating artery clipped. Her father died of a hemorrhagic stroke at 45
ADPKD. Remember association with circle of willis aneurysms, liver cysts, and renal disease
81
# Causes of secondary HTN?
23 yo M has a BP of 167/95. PE reveals facial and UE plethora. There are purple streaks on his abdomen. Na is 147, K is 3.1, HCO3- is 28
Cushings syndrome. MCC is iatrogenic use of steroids. Steroids have mild mineralocorticoid receptor activity.
82
# Causes of secondary HTN?
13 yo M has a BP of 170/110. He had a URI 6 weeks ago. UA is notable for dysmorphic RBCs
PSGN, a kind of nephritic syndrome. HTN is common with nephritic syndrome.
83
# Causes of secondary HTN?
73 yo M has a BP of 155/85. He was previously healthy and has no history of HTN. He recently started taking a standing dose of naproxen for chronic knee pain
NSAIDs can cause HTN secondary to hypoperfusion of the afferent arteriole and subsequent RAAS activation (also systemic vasoconstriction). Remember the other HY NSAID associations-ATN, renal papillary necrosis (also sickle cell dz/trait), GI bleeds, first line tx of acute gout/CPPD, tx of pericarditis, tx of superficial thrombophlebitis, etc
84
27 yo F with dry eyes and difficulty swallowing
Sjogrens syndrome (Anti Ro/SSA-can cross the placenta and cause heart block in neonates of SLE moms, La/SSB antibodies)
85
Asymmetric arthritis in the setting of Campylobacter Jejuni infection
Reactive arthritis (re-cant see uveitis, cant pee (urethritis), can't climb a tree (arthritis)
86
Sacroiliitis, XR reveals a bamboo spine
Ankylosing spondylitis (HLA-B27, PAIR mnemonic)
87
Pencil in cup nail deformity, silvery scale on extensor surfaces, arthritis
Psoriatic arthritis
88
Autoantibodies associated with SLE (4)
ANA, anti-dSDNA (nephritis), anti-smith, anti-histone (Drug induced lupus-INH, hydralazine, procainamide)
89
Autoantibodies associated with diffuse scleroderma
anti-topoisomerase antibodies (SCL-70)
90
Autoantibodies associated with limited cutaneous systemic sclerosis
anti-centromere antibodies
91
Autoantibodies in Mixed Connective Tissue Disease
Anti U1-RNP
92
Autoantibodies associated with poly/dermatomyositis
anti-Jo/Mi-2
93
Autoantibodies in Rheumatoid arthritis
Anti CCP AND rheumatoid factor (IgM against IgG)
94
Antibodies against the glomerular basement membrane
Goodpastures syndrome
95
c-ANCA associated
Wegeners granulomatosis (Granulomatosis with polyangiitis)
96
p-ANCA associated (3)
Churg Strauss (EGPA), microscopic angiitis, polyarteritis nodosa
97
HLA-B57 association
Severe hypersensitivity to Abacavir
98
Confusion, ophthalmoplegia, ataxia/+amnesia, confabulation
Wernickes/Korsakoff Syndrome (B1)
99
Fever, RUQ pain, jaundice/+hypotension, Altered mental status
Charcots triad/Reynolds pentad of ascending cholangitis (NBSIM is an emergent ERCP, give Cipro + MTZ as well)
100
Antihypertensives that are safe in pregnant women
hydralazine, methyldopa, labetalol, nifedipine
101
Antihypertensives that are contraindicated in pregnant women
ACE-I, ARBs, Thiazides
102
Grouped vesicles on the penis/vagina, Tzanck smear, PCR, give acyclovir -\> foscarnet
HSV
103
Most important bug implicated in PUD, urea breath test, IgG antibody testing, antigen in stool, MALToma, EGD with biopsy, triple therapy (clarithromycin, amoxicillin, and omeprazole)
H. Pylori
104
Unilateral headache, 50 yo F, pain with chewing
Temporal arteritis (ESR will be elevated, give high dose steroids as an early step, confirm with temporal artery biopsy later, associated with polymyalgia rheumatica)
105
Pallor, fatigue, MCV is 110, smear reveals hypersegmented neutrophils
Megaloblastic anemia.
106
Megaloblastic anemia, loss of vibratory sense, methylmalonic acidemia, vegan, hyperhomocysteinemia
B12 deficiency.
107
Megaloblastic anemia, neural tube defects, no peripheral neuropathy, alcoholic, hyperhomocysteinemia
Folate deficiency.
108
SIADH, Cushings syndrome, muscle weakness that improves with use
Small cell lung cancer.
109
Cavitary central lesion in a smoker, hypercalcemia with low PTH
Squamous cell lung cancer.
110
Anti endomysial antibodies, IgA against tissue transglutaminase, anti gliadin antibodies, chronic malabsorption, biopsy reveals villous atrophy and blunting
Celiac disease (gluten sensitive enteropathy, d. herpetiformis)
111
High CO, low PCWP, low SVR, recent history of infection, warm extremities
septic shock.
112
Low CO, low PCWP, high SVR
hypovolemic shock.
113
Low CO, High PCWP, High SVR
cardiogenic shock.
114
DOC in the setting of anaphylactic shock
Epinephrine.
115
DOC in the setting of septic shock
Norepinephrine.
116
Low SVR, bradycardia, unresponsive pregnant woman after epidural placement
Neurogenic shock.
117
Painless chancre, +ve RPR and VDRL, +ve FTA-ABS, tx with penicillin G (or doxycycline in PCN allergic), Tabes dorsalis, rash on the palms and soles, Argyll Robertson pupils
Syphilis (T. Pallidum).
118
Can be caused by hypercalcemia, hypertriglyceridemia, scorpion bites, didanosine, gallstones, extensive ROH consumption, handlebar injury, recent ERCP
Pancreatitis.
119
Malar rash in a patient being treated for a UTI
Drug induced lupus (TMP-SMX, hydralazine, INH, Phenytoin, Procainamide), remember the association with anti-histone antibodies
120
Recent MI, patient suddenly drops down and dies
Ventricular Fibrillation.
121
Recent MI, bilateral crackles on lung auscultation, hypotension
Cardiogenic shock.
122
Recent MI, holosystolic murmur at the left sternal border
Interventricular septal rupture.
123
Recent MI, holosystolic murmur at the apex with radiation to the axilla
Mitral regurgitation (papillary muscle rupture).
124
Recent MI, BP 80/50, JVD, alternating amplitudes of QRS intervals on EKG
Ventricular free wall rupture (presenting as cardiac tamponade, dont give steroids-impairs wound healing).
125
Recent MI, 4 days after revascularization, CKMB begins to rise again
reinfarction.
126
Recent MI, sudden onset abdominal POOP to exam findings
Acute mesenteric ischemia.
127
2 days after an MI, pleuritic chest pain worsened by lying back
Postinfarction pericarditis (NSAIDS).
128
3 weeks after an MI, pleuritic chest pain worsened by lying back
Dresslers syndrome (NSAIDS).
129
Evolving MI, patient becomes unresponsive after nitroglycerin is administered
RCA infarct (2, 3, avF these patients are preload dependent).
130
NBSIM of a patient that snores loudly during the night, BMI is 32
OSA, Polysomnography (CPAP, lose wt.)
131
HR 150, palpitations, sawtooth pattern on an EKG
atrial flutter.
132
Palpitations, wide complex, regular tachyarrhythmia
Ventricular tachycardia.
133
Wide QRS, no P waves, HR 25 bpm
Ventricular escape rhythm (SA node is gone, ventricles setting the tone). If the QRS was narrow and HR was 60ish, this would be a junctional escape rhythm (AV junction).
134
Bizarre appearing wide QRS with increased amplitude, different from preceding QRS complexes
PVC
135
DOC in the treatment of a lady with hypogonadism and VF deficits
bromocriptine, cabergoline (prolactinoma)
136
DOC in the tx of chest pain brought on by exercise and relieved with rest
Nitroglycerin (stable angina, reduces myocardial workload).
137
Needle shaped, negatively birefringent crystals
Gout (first MTP, NSAIDs-\>colchicine-\>steroids).
138
Positively birefringent rhomboid shaped crystals
CPPD (Ca-Pyrophosphate deposition disease, shows up as thin lines of Ca on an XR in bone-chondrocalcinosis)/Pseudogout/associated with hemochromatosis
139
NBSIM of a crush injury patient with peaked T waves on EKG
IV Ca gluconate (also insulin w/glucose, albuterol, Na bicarb, dialysis, kayexalate-bowel necrosis, loop diuretics).
140
Episodic HTN, diaphoresis, and headache, urinary metanephrines +ve
Pheochromocytoma (give phenoxybenzamine and then add a beta blocker).
141
Bug-\>50 yo M or HIV patient with high fever, lobar consolidation on CXR
S. Pneumoniae.
142
Bug-\>23 yo college student, low grade fever, 2 wk hx of cough, interstitial infiltrates on CXR
M. Pneumoniae.
143
Bug-\>Consolidation on CXR, ICU patient on a ventilator, fruity smell”
P. Aeruginosa (also otitis externa).
144
Bug-\>High LDH, interstitial infiltrates, significant hypoxia, HIV patient
P. Jirovecii (steroids, TMP-SMX).
145
Bug-\>erythema nodosum, bilateral interstitial infiltrates, earthquake victim in California
C. Immitis (spherules)
146
Bug-\>Class trip to watch bats at the mammoth caves in Kentucky, pneumonia
H. Capsulatum.
147
Bug-\>Pet store owner, low grade fever, bilateral interstitial infiltrates on CXR
Chlamydia Psittaci.
148
Patient being treated for atypical pneumonia has a QT interval of 700 ms
Macrolide toxicity.
149
Midsystolic click at the apex, history of ADPKD
Mitral valve prolapse (regurgitation if holosystolic).
150
Afib, diastolic murmur with an opening snap at the apex
Mitral Stenosis.
151
DOC in the tx of transient STEMI that is worse at night in a 23 yo smoker
Diltiazem (variant angina)
152
Patient population with high incidence of skin necrosis on Warfarin
Protein C deficiency.
153
35 yo F, history of recurrent URIs, pneumonia, and Giardia infections
IgA deficiency.
154
Class trip to Vermont 2 months ago, seizures, bilateral facial weakness
Lyme disease (for this stage, give Ceftriaxone, doxycycline is for earlier stages like the bulls eye rash).
155
NBSIM of a chronic alcoholic with malabsorption and steatorrhea
Pancreatic enzyme supplementation.
156
Pain worse with activity, weight bearing joints, minimal morning stiffness, acetaminophen is the DOC, bony outgrowths on the PIPs (Bouchards) or DIPs (Heberdens), joint space narrowing, subchondral cysts, osteophytes, risk reduced with weight loss
Osteoarthritis.
157
Morning stiffness \> 1hr, small joints, symmetric arthritis, PIP extension with DIP flexion (Swan-Neck deformity), PIP flexion with DIP extension (Boutonnieres deformity), start with MTX
Rheumatoid arthritis.
158
Deafness, abnormal synthesis of T4 collagen, visual problems
Alport Syndrome (COL4A5 mutation)
159
Unpredictable episodes of chest pain, no troponin elevation
Unstable angina.
160
Bloody diarrhea, recent use of antibiotics
C. Difficile (pseudomembranous colitis-MTZ, PO Vancomycin, Fidaxomicin).
161
Severe, tearing chest pain with radiation to the back
Aortic dissection (HTN is a RF, IV Labetalol).
162
T score on a DEXA scan = -2.6 in a 66 yo F
Osteoporosis (screen women \> 65 or \< 65 with risk factors).
163
Drug to be started in a HIV patient with a CD4 \< 50
Azithromycin (MAC)
164
Psychosis, liver failure, Kayser-Fleischer rings
Wilsons disease.
165
DM, facial and extremity plethora, restrictive cardiomyopathy
hereditary hemochromatosis (phlebotomy)
166
Buffalo hump, purple abdominal striae, osteonecrosis, osteoporosis, DM, VF deficits
Cushings disease.
167
Sudden onset of "worst headache of my life", loss of consciousness, may have stiff neck/photophobia?
Subarachnoid hemorrhage (SAH)
Usually located in anterior portion of circle of willis
Get CT first
Most accurate is LP showing blood (xanthrochromia)
168
Trauma to the sphenoid bone with tearing of the middle meningeal artery
Brief loss of consciousness with lucid interval
Biconvex shape
Impaired consciousness, HA N V (increased ICP)
Epidural hematoma
169
Rupture of the bridging veins
Elderly and alcoholics (cerebral atrophy), fall risk
anticoagulant use
Gradual onset (1-2 days) after injury
Impaired consciousness, confusion, HA N V (increased ICP)
Crescent shaped density on CT crossing suture lines
Subdural hematoma
170
abx CAP
ceftriaxone (3rd gen cephalosporin) and azithromycin (macrolide)
(or moxifloxacin)
171
abx HAP
vancomycin AND zosyn (piperacillin and tazobactam)
172
abx UTI
Ceftriaxone inpatient
Ciprofloxacin ambulatory pyelonephritis
nitrofurantoin cystitis
173
abx meningitis
Vancomycin and ceftriaxone and steroids
+ampicillin in immunocompromised
174
abx cellulitis
vancomycin or clindamycin (MRSA)
Cephalexin (keflex) or cefazolin (ancef) for strep
175
Furosemide side effects
Loop diuretics most commonly cuases hypokalemia and hypomagnesemia
176
Spironolactone side effects
Potassium sparing diuretic
177
Eosinophilia DDX?
1. Drugs, methicillin, ceftriaxone
2. Neoplasms
3. Addison’s disease
4. Asthma
5. Acute interstitial nephritis
6. Colleagen vascular disaease
7. Parasites
178
H pylori treatment?
CAO (think Holy Cow, like H pylori cao)
clarithomycin, amoxicillin, omeprazole
179
HUS/TTP
Deificiency of ADAMTS-13
HUS - e coli 0157:H7
TTP (neuro + fever) - ticlopidine, clopidogrel, AIDS, SLE
schistocytes, thrombocytopenia, renal insuffiency, normal PT/aPTT (DIC has prolonged)
180
DIC
think sepsis, burns, cancer
elevation of PT/aPTT (not so in TTP/HUS)
thrombocytopenia
elevated d-dimer and fibrin split products
decreased fibrinogen
Tx with FFP
181
Refractory hypertension and hypokalemia
Mild hypertension and hypokalemia and striae
Hypotension and hyperkalemia and tan skin
Conn's Syndrome (Hyperaldosterone)
Cushing's Syndrome
Addison's Disease (adrenal insufficiency, hypoaldosterone, high ACTH)
182
Which do you defibrillate?
Ventricular fibrillation
Pulseless VT
(DO NOT cardiovert PEA or asystole, use epi and amiodarone)
183
amiodarone side effects?
lung fibrosis
Thyroid disorders (thyrotoxicosis and hypothyroidism)
liver damage
184
Metabolic acidosis acryonym
* Methanol
* Uremia
* DKA, drugs (metformin)
* Paracetamol (acetaminophen)
* Iron, INH
* Lactic acidosis
* Ethlyene glycol, ethanol tox
* Salicylates (ASA)
185
Normal anion gap acidosis acronym
* Diarrhea
* Ureteral diversion
* Renal tubular acidosis
* Hyperalimentation
* Addison's disease, acetazolamide, ammonium chloride
* Misc (VIPoma, amphotericin B, topiramate)
186
Squamous cell carcinoma
PTHrP (High parathyroid, High calcium, low po4)
187
small cell lung cancer
super sulcus tumor (SVC syndrome)
Lambert eaton syndrome (ab to pre-synaptic calcium channel)
SIADH (euvolemic hyponatremia, fluid restrict patient)
188
Renal tubular acidosis
* Type 1 (distal)
* Urine pH \>5.4, can't excrete H+, tx with oral bicarb
* Hypokalemia
* Type II (proximal)
* Urine pH variable, can't resorb bicarb, tx with thiazides
* Hypokalemia
* Type IV (hypoaldosterone)
* Hyperkalemia
* Urine pH \<5.4, 50% caused by DM, then Addisons and SSD
* Tx with fludrocortisone
189
Viral ulcers
CMV - linear (gancyclovir, gang up on CMV)
HSV - punched out (acyclovir)
190
