FireCracker 12/9 + Qbank Flashcards Preview

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Flashcards in FireCracker 12/9 + Qbank Deck (351):
1

parietal periotneum pain

constant
severe

2

antibiotics in pancreatitis if

pseudocyst or abscess

3

acute abdomen etiology

periotnitis
obstruction

4

peritonitis PE findings

rigidity

5

Trousseau's syndrome

migratory superficial thrombophlebitis
associated with pancreatic/visceral cancer

6

PPSV23 alone

adults <65 with chronic health conditions

7

viral conjunctivitis treatment

warm/cold compresses

8

bacterial conjunctivitis treatment

eryhtomycin/antibacterial drops

9

bacterial conjunctivitis treatment in contact lens users

fluroquinolone

10

Glucagonoma

necrolytic migratory erythema
DM
GI symptoms
glucagon >500

11

thiazide diuretic mechanism

inhibit NaCl co transport in DCT

12

thiazide - decreased levels of

K, Na, H
hypokalemia, hyponatremia, metabolic alkalosis

13

thiazide - increased levels of

Glucose, Lipids, Uric Acid, Calcium

14

loop diuretics mechanism

block Na/K/2CL symporter in thick ascendling limb of loop of Henle

15

loop diuretic toxicities

ototoxicity, hypokalemia, hypocalcemia, hypomagenseimia, dehydration, allergy-sulfa, nephritis (AIN), gout

16

potassium sparing diuretics mechanism

act on collecting tubule

17

spironolactone and eplerenone

competitive inhibitors of aldosterone receptors
only work in presence of aldosterone

18

spironolactone AE

hyperkalemia
gynecomastia
amenorrhea
anti-androgen effects

19

carbonic anyhdrase inhibitors

acetazolamide
PCT
inhibit production/reabsorption of filerted bicarb

20

carbonic anhydrase inhibitors use

treatment of ICHTN

21

acetazolamide toxicities

hyperchloremic metabolic acidosis
hypokalemia
NH toxicity
neuropathy
sulfa allergy

22

mannitol

osmotic diuretic, increases tubular fluid osmolarity --> increase urine flow

23

mannitol toxicity

pulmonary edema
intravascular dehydration

24

stable angina treatment

BB, CCB, nitrate

25

localized complex empyema treatment

surgery

26

pneumonia in HIV - most commona

pneumococcal or streptococcal

27

ectoptic ACTH

small cell lung cancer

28

massive PE symptoms

hypotension and right heart strain

29

symptoms of right heart strain

jugular venous distension
RBBB on ECG

30

atb for human bite

amoxicillin-clauvanate

31

untreated hiatal hernia can lead to

esophageal adenocarcinoma

32

aspirin toxicity

resp alkalosis followed by increased AG metabolic acidosis

33

ventricular aneurysm following MI

5d-3months
decomponsenated heart failure

34

ventricular aneurysm ECG

peristent ST elevation and deep Q waves

35

when is CT approriate in pyelonephritis

no clinical improvement for 72 hrs

36

gallbladder biliary carcinoma blood tests

increased CEA and CA 19-9 but not sensitive/specific

37

gold stage 1

sa bet agnoist

38

gold stage II

la bronchodilator: anticholergic or laba

39

gold stage III

inhaled corticosteroids

40

gold stage IV

o2

41

hypertrophic cardiomyopathy

-ventricular hypertrophy
- impaired ventricular relaxation

42

familial hypertrophic cardiomyopathy

pts 20-40
AD mutation in myosin
Freidreich's ataxia

43

HCM murmur

sysytolic
diamond shaped, LSB

44

HCM treatment

asymptomatic - no treatment
surgery, alcohol ablation reduce outflow obstruction
beta blockers, ndh CCB

45

non-dhydropyridine CCB

diltiazem
verpamil

46

HCM pts should avoid

strenous exercise
drugs that increase LVOT (diuretics, nitrates, vasodilators)

47

risk factors for Budd-Chiari

myeloproliferative disease, oral contraceptives, pregnancy, malignancy, hypercoaguable dz

48

Budd Chiari presentation

HSM
ascites
abdominal pain
renal impairement

49

budd chiari gold standard for diagnosis

venography

50

long term complications of budd chiari

liver failure
renal failure
SBP
portal htn

51

treatment of budd chiari

anticoag with heparin + warfarin
venous stenting
diuretics
TIPS
liver transplant

52

hypOkalemia EKG changes

flattened/inverted T waves
U waves
ST depression
PVC/PAC, arrhythmias

53

rhonchi

larger airways

54

crackles/rales

inhalation/airway opening

55

first line bacterial sinusitis

amoxicillin clauvanate

56

centor criteria

fever, tonsillar exudates, tender anterior cervical LAD, absence of cough
RADT with 2

57

strep throat antibiotic

penicillin

58

microcytic anemia differential

iron def
heavy metal toxicity
anemia of chronic dz
thalesemmia minor
sideroblastic anemia

59

TCA toxicity - mechanism

fast Na channels slowed

60

TCA toxicity EKG

QRS>100

61

splenectomy

impaired antibody mediated opsonization in phagocytosis

62

MGUS diagnosis

<10% plasma cells

63

MGUS next step

metastatic skeletal bone survery

64

HF and alcohol abuse in pt

think alcholic dilated cardiomyopathy

65

heparin binds

ANTI-THROMBIN III

66

heparin inactivates

THROMBIN
Factors IXa, Xa, XIIa
Fibrin

67

Fondaparinux

binds antithrombin III but mainly inactivates factor Xa

68

monitoring of heparin

aPTT

69

Heparin/LWMH reversal

protamine

70

Warfarin mechanism

blocks vit-k dependent clotting factors (II, VII, IX, X, Protein C & S)

71

monitoring of warfarin

INR/PT

72

warfarin antidote

hold warfarin, let normalize
Vit K
FFP

73

days to achieve target INR

2-5
bridge with heparin

74

plasminogen activators

urokinase
streptokinase
alteplase
t-PA

75

desmopressin

treats hemophilia A & vWD by releasing vWF from storage sites

76

aspirin mechanism

inhibits both COX 1&2

77

clopidogrel

adp-receptor blocker

78

abciximab

gpIIb/IIIa inhibitor

79

dipyridamole

PDE III inhibitor

80

cilostazole

PDE III inhibitor

81

blocking PDE

increases cAMP
reduced platelet aggregation
vasodilation

82

ADP-receptor blockers, GP iib/iiia inhib/PDE inhibitors used...

after ACS
PCI

83

what to do when you suspect meningitis

cultures
empiric antibiotics + corticosteroids
lumbar puncture

84

corticosteroids are effective for what cause of meningitis

streptococcus

85

airborne isolation

tb, measles, varicella

86

ampicillin added to empiric menigitis treatment if

>50 yr old
alcohol abuse
immunocomprimised

87

headache red flags

over age 50/new onst
hx of malignancy
acute in onset

88

prophrylaxis in transplant pts

tmp-smx for pcp

89

digoxin toxicity

nausea, vomiting

90

non-inflammatory chronic prostatitis

a febrile, normal leukocyte count
irritable voiding symptoms

91

primary hyperaldosteronism

HTN, metabolic alkalosis
hypokalemia
mild hypernatremia
aldosterone-plasma renin greater than 20

92

hypersensitivity pneumonitis treatment

avoid exposure

93

bacillary angiomatosis

HIV pts, Bartonella
treat w/ eryhtomycin

94

pigment gallstones

calcium bilrubinate

95

actinic keratosis

sandpaper-like
"cutaneous horns"

96

WPW treatment

cardioversion
antiarrythmics like procainamide

97

vitiligo

hypopigmentation
association with autoimmune dzs like pernicious anemia

98

cool extremities

cardiogenic shock, hypovolemic shock
blood shunted away from extremities

99

warm extremities

distributive shock - anayphylaxis, sepsis, spinal shock

100

wide complex tachycardia

qrs >120
indicates dz below AV node --> ventricular tachycarida

101

rate control in a fib

digoxin, CCB, BB

102

pressures in mitral stensosis

increased LA pressure
increase LA-LV pressure gradient

103

fish mouth valve

scarring/narrowing of mitral valve with fusion of commissures in RHD/MS

104

MS ausculation

low pitched diastolic rumble
opening snap
loud S1

105

MS ausculation with increasing severity

gap between oepning snap and s2 decreases

106

MS CXr

dilated left atrium
straightening of left heart border
elevation of mainstem bronchus

107

MS echo

LAE
possible RV enlargement

108

other symptoms associated with mitral stenosis

PA HTN --> right sided heart failure
stroke
TE, A fib

109

mitral stenosis drugs

diuretics
sodium restriction
BB

110

SIADH

excess ADH
impaired water excretion
excessive water retention

111

causes of SIADH

ectopic production of ADH
CNS disorder/trauma
pul dz
surgery
drugs

112

ectopic production of ADH

small cell carcinoma

113

CNS trauma disorder/SIADH

stroke
hemorrhage
infection
psychosis

114

pulm disease/SIADH

pneumonia

115

surgery/siadh

transphenoidal pituitary surgery

116

main lab concepts in SIADH

HYPOnatreium
serum HYPOosmolality
uirne osmolality >100 (dilute)

117

lab values in SIADH

low sodium, low serum osm, submax dilute urine osm
normal urine na excretion
reduced AG
low BUN
low uric acid

118

SIADH treatment - first line, emergency

3% hypertonic saline
raise 0.5-1meq/hr

119

SIADH treatment - non emergent

fluid restriction (force kidneys to excrete free water)
vasopression receptor antagonists
loop diuretics
demeclocycline

120

V2 receptor antagonists

reduce aquaporin channels in renal collecting ducts
decrease permeability to water, reduces amount of wtaer resaborbed

121

aspirin intox s/sx

hyperventilation
tinnitius
N/V
AMS

122

arrythmia treatment in TCA overdose

- na bicarb
- lidocaine
- shock

123

TCA toxicity =

anticholinergic + cardiac

124

aspirin + respiratory system

hyperventilation + resp alkalosis

125

aspirin toxicity managed thru

IV hydration, GI decontimation, glucose, alkalization of serum and urine, possible hemidialysis

126

ECG in opioid toxicity

methadone - OTc prolongation

127

TCA toxicity treatment approach

cardiac monitoring, treat seizures, arrhythmias, hypotension

128

TCA toxicity, treat hypotension w/

Nabicarb
crystalloid solutions
Epi/Norepi

129

TCA cardiotoxicity

Widened QRS, prolonged QT and PR intervals
ventricular tachycardia, AV block

130

aspirin + metabolism

interferes with kreb cycle, oxidative phosphorylation

131

organophosphate =

acetylcholinesterase inhibitor
cholinergic agent

132

organophosphoate - what receptors

nicotinic
muscarinic

133

organophosphate symptoms

Salivation, Lacrimation, Urinating, Diaphoresis, GI, Emesis
Bradycardia, Bronchospasm, bronchorrhea

134

signs of organophosphate poisoning related to nicotinic

paralysis, muscle weakness, fasiculations

135

treatment of organophosphate poisoning

atropine
pralidoxime (regenerate achesterase)
decontamination of skin and clothes

136

atropine

competitivre muscarinic receptor antagonist
prevent resp arrest

137

pralidoxime

acetylcholinesterase reactivaing agent

138

OPIDP

organophosphate induced delayed polyneuropathy
1-5 weeks after
painful stocking glove paresthesias
weakness in LE

139

anticholinergics MOA

block ach in CNS and PNS
often have anti-muscarinic properties

140

anticholinergic toxicity treatment

physostigmine

141

other components of anticholinergic toxicity treatment

sedatives-benzos
cooling mechanisms
bladder emptying

142

elevated RDW

mixed population of cells
micro + macro

143

reticulocyte production index

% retic x pts hct divided by normal hct x reticulocyte maturation time

144

lyme dz treatment

doxycycline

145

lyme dz treatment in pregnancy

amoxicillin

146

Babesiosis

ixodes tick, NE US
hemolytic anemia/jaundice

147

zenker diverticulum

dysphagia, halitosis
~ neck mass

148

cortisol associated electroylte abnormality

hypokalemia

149

endopthalmitis

post op
pain, decreased visual acutity
culture vitreous

150

metabolic alkalosis is due to...

gain in HCO3- or loss of H+

151

most common cause of alkalosis

Vomiting
loss of H+ in GI fluids

152

metabolic alkalosis and effects on kidney

usually impaired renal fxn
- decreased GFR
- chloride depletion
= volume contraction
- hypokalemia

153

kidney ability to secrete HCO3- depends on

countertransport of Cl-

154

metabolic alkalosis overview

ph high
low H+
high HCO3-
high PCO2
compensate with hypoventilation

155

s/sx of metabolic alkalosis

similar to hypocalemia
confusion/paresthesias, tetany, muscle cramping

156

Urine Cl

less than 20: responsive
greater than 20: chloride unresponsive

157

urine k in metabolic alkalosis

usually low

158

treatment of chloride responsive metabolic alkalosis

saline (increases filtered cl- and hco3- secretion)

159

treatment of chloride unresponsive metabolic alkalosis

correct hypokalemia + saline
acetazolamide

160

ph > 7.7 with hypervolemia

Hcl through central line

161

babieosis etiology

tick bite
transfusion
perinatally

162

babiesosis symptoms

fevers/chills/myalgia
--> anemia, jaundice

163

babesiosis blood smear

maltese cross
intra-rbc ring form

164

babesiosis treatment

atovaquone + azithromycin
OR
clindamycin + quinine

165

cut off for kidney stones

greater than 5 cm

166

increased homocysteine

b12/folic

167

BNP associated with

ventricular stretch
(S3)

168

cyclophosphamide adverse effect

bladder carcinoma

169

tricupsid insuff, on the differential

carcinoid syndrome

170

smudge cells

cll

171

hypocalcemia

hyperactive DTR
blood transufions

172

before intubation in COPD exacerbation

2 hr trial of NPPV

173

amikacin, class of drugs

aminoglycoside

174

acyclovir AE

nephrotoxicity

175

sebhorrehic dermatitis

yellow greasly looking scales

176

sebhorreic dermatitis association with

HIV, parkinson dz

177

superior vena cava sydrome

swelling of head/neck/arms
usually associated with malignancy

178

porphyria cutanea tarda

painless blisters on dorsum of hands
facial hypertrichosis
hyperpigmentation

179

recurrent renal stone - diet changes

decrease na, protein
increase citrate

180

recurrent kidney stone - medication

thiazides
potassium citrate
bicarbonate

181

increased renin, increased aldosterone

2ndry hyperaldosteronism (renin secreting tumor)

182

decreased renin, increased aldosterone

primary hyperaldosteronism

183

primary hyperaldosteronism

sodium retention --> HTN
hypokalemia
metabolic alkalosis

184

primary hyperaldosteronism causes

adrenal adenoma - conn's syndrome
bilateral adrenal hyperplasia
adrenal carcinoma

185

aldosterone-to-renin ratio in primary alderstonism

greater than 30

186

MEN 1

parathyroid
pancreatic
pituitary

187

MEN 2A

MTC
pheochromocytoma
parathyroid

188

MEN 2B

MTC, pheochromocytoma
marfanoid
mucous and intestinal neuromas

189

sickle cell trait manifestations

hematuria (renal papillary necrosis)
UTI, renal medullary carcinoma
splenic infarcations, VTE, priapism

190

phemphigus vulgaris

flaccid bullae - painful, rupture
Nikolsky's sign (epidermal separation/acantholysis)
autoantibodies against desmoglein

191

tinea corporis

ring shaped, annular patches w/ central clearing
itchy
associated with immunosuppresion

192

mixed cryoglobulinemia - triad

palpable purpura, proteinuria, hematuria.

193

bronchiectesis, history will include

recurrent bacterial infections

194

Secondary HyperParaThyroidism

decrease Ca
increased Phos
increased PTH

195

rash involving palms and soles think

syphillis

196

toxic shock syndrome

fever, hypotension, diffuse macular erythroderma

197

toxic shock syndrome - risk factors

nasal packing

198

amiodarone - 5 main side effects

pulm tox
hepatotox
thyroid
skin changes
corneal deposits

199

basal cell carcinoma on face

moh's surgery

200

febrile neutropenia treatment

anti-pseudomonal agent

201

no breath sounds after endotracheal intubation, consider...

ETT advanced too far

202

increased alk phos, always consider

paget's disease

203

increase pH and calcium

increased affinity of albumin for calcium --> decrease calcium

204

Enthesitis

tenderness over heels, tibial tuberosities, iliac crests
associated wtih AS/B27

205

dissolve gallstones with

UDA

206

warfarin induced skin necrosis think

protein c def

207

low magnesium can cause

low calcium

208

small cell vs squamous cell

small - acth
squamous - pth

209

giant cell tumor of bone

eccentrically placed lytic area/soap bubbles
epiphyses

210

neutropenia =

ANC less than 1500
less than 500 - very high risk of infection

211

therapuetic approaches to hepatic encephalopathy

lactulose
rifaximin, neomycin
diet - protein and energy
branched chain AA, probiotic supplementation

212

3 common causes of neutropenia

bone marrow failure - drugs/toxins
bone marrow invasion - malignancy/metastatic
isolated neutropenia - granulocytosis

213

work up for neutropenic fever

CXR - pulmonary infection
pan culture (including LP)
CBC with diff
CMP

214

pancreatic cancer - all risk factors

smoking
chronic panc, obesity, DM, post family hx

215

most common location of pancreatic cancer

head of pancreas

216

Toursseau's sign

migratory thrombophlebitis (pancreatic cancer)

217

pancreatic cancer diagnosis

ct abdomen
ca 19-9, cea may be elevated

218

What is the classic presenting sign for a patient with underlying pancreatic cancer?

painless jaundice

219

What surgical procedure is indicated in patients with early stage pancreatic cancer?

resection by whipple - pancreaticodudoenectomy

220

groups at greatest risk for pancreatic cancer

african americans, men

221

What palliative surgical procedures can be done for patients with pancreatic cancer?

biliary stenting to prevent jaundice and permanent ablation of the celiac nerves to decrease back pain.

222

What causes the deficiency of uroporphyrinogen decarboxylase seen in porphyria cutanea tarda?

80% acquired
20% autosomal dominant

223

What is porphyria cutanea tarda?

deficiency of hepatic uroporphyrinogen decarboxylase (UROD) that results in chronic blistering skin and liver manifestations.

224

What cutaneous manifestations are associated with porphyria cutanea tarda?

Chronic blistering skin lesions on sun exposed areas of the body (face, ears, neck, forearms, back of the hands, etc…) because the porphyrins that accumulate are photosensitizing.
hyperpigment, hypertrichosis

225

What notable pharmacology correlate is associated with acute exacerbations of porphyrias?

barbituates (p450 inducers)

226

What are some hepatic manifestations associated with porphyria cutanea tarda?

Mild elevations in liver enzymes (ALT and AST)
Advanced liver disease in older patients with recurrent disease
Increased risk of cirrhosis and hepatocellular carcinoma

227

What risk factors are associated with porphyria cutanea tarda?

Alcoholism
Hepatitis C
Iron overload
Estrogen use
Smoking
Hepatic siderosis

228

What biochemical evidence can be used to support the diagnosis of porphyria cutanea tarda?

Increased total plasma porphyrin
Increased urine porphyrin
Decreased uroporphyrinogen decarboxylase
Elevated AST and ALT

229

preferred treatment of Porphyria cutanea tardia?

repeated phlebotomy

230

In addition to repeated phlebotomy, what other treatment options are available for patients with porphyria cutanea tarda?

Low dose chloroquine or hydroxychloroquine (for patients who do not tolerate phlebotomies)
Sunscreen use (to mitigate photosensitivity)
Avoidance of triggers (alcohol, tobacco, estrogens, iron supplements)

231

transcellular K shift causing hyperkalemia

insul def
acidosis
tumor lysis syndrome/cell destruction
beta blockers

232

SLE - photosensitivity

rash
fever, fatigue, joint pain

233

pseudohyperkalemia

hemolysis
leukocytosis
fist clenching

234

SLE antibodies

anti-dsDNA
anti-Sm
decreased C3,C4

235

SLE - renal disorders

Class IV - diffuse prolif GN (nephritic)
Class V - MGN (nephrotic)

236

what causes the rise in systemic pressure in chronic constrictive pericarditis

reduced right ventricular EDV

237

SLE treatment

NSAIDs - pain
hydroxychloroquine - skin, renal
corticosteroids
anticoag

238

discoid rash

red raished patches
keratotic scaling

239

SLE rare complications

LSE
abortions
anti-ro(SSA) ab crossing placenta
interstitial lung fibrosis

240

electrolyte abn in hyperaldosteronism

hypokalemia, alkalosis
decreased free ca concentration

241

primary hyperaldosteronism complications

metabolic aklalosis, hypernatremia
increased GFR w urinary albumin excretion
increased risk of CVD

242

treatment post unilateral adenalectomy

monitor aldosteron, K
d/c HTN, spirolactone meds
sodium rich diet

243

SOAP

serositis
oral ulcers
arthritis
photosensitivity

244

BRAIN

blood disorders
renal
ANA
immunological
neurological

245

SLE - serositis

pleuritis
pericarditis
pneumonitis

246

osteomyelitis presentation

bone pain
fever, chills, fatigue

247

osteomyelitis - 3 lab findings

WBCs
ESR
CRP

248

osteomyelitis - imaging

Xray - lytic lesion surrounded by sclerosis
MRI - soft tissue involvement

249

osteomyelitis - organims specific to patient populations

sickle cell - salmonella
diabetics/IV drugs - pseudomonas

250

most common cause of osteomyelitis

s aureus

251

osteomyelitis complications

amputation
pathologic fractures

252

osteomyelitis - physical exam

tenderness over bone
erythema

253

development of osteomyelitis

hematogenous spread
local extension
direct inoculation

254

osteomyelitis risk factors

immunodef
iv drug use
poor vascular supply
recent trauma/surgery

255

MVP

myxomatous degeneration of mitral valve leaflets

256

flattening of diaphragm in COPD due to

increased work of breathing

257

renal disorder requiring emergency plasmapheresis

good pastures

258

mediastinal mass differential

thymoma
teratoma
thyroid neoplasm
terrible lymphoma

259

seminoma

elevated bhcg only

260

DI treatment

desmopressin

261

positive prussian blue

hemosidering
hemolytic episodes (G6PD def)

262

G6PD def pathophys

underlying oxidative stress

263

Bullous pemphigoid

blisters
often caused by meds
itching

264

Bullous phemphigoid - biopsy

igg and c3 deposits

265

med for decreased appetite in cancer pt

progesterone analog - megestrol acetate

266

infiltrating ductal carcinoma prognosis

TNM staging

267

palpable masses + HTN

ADPCKD

268

hypopigmented patches - summer, tropical location

tinea versicolor

269

malassezia globosa

tinea versicolor

270

pleural fluid glucose less than 60

rheumatoid, tb, lupus
parapneumonia
malignant

271

amyloid deposits

apple-green birefringence

272

amyloidosis renal failture

nephrotic

273

epiglottis common organisms

h flu
streptococcus pyogenes

274

solitary pulmonary nodule

rounded opacity
less than 3 cm
completely surrounded by pulmonary parenchyma
no associated LAD

275

hypertrophic osteoarthropathy

digital clubbing
sudden onset arthropathy - usually wrist and hand joints
can be assocciated with lung dz

276

lumbar spinal stenosis exacerbated by

extension - standing, walking downhill

277

rx for dermatitis herpetiformis

dapsone

278

GVHD - cause

activation of donor T lymphocytes

279

variocele

soft scrotal mass
decreases when supine/increases when standing
doesn't illuminate

280

What medications have been linked to bullous pemphigoid?

furosemide
NSAIDS
ACEI
antiobiotics

281

What is bullous phemphigoid?

autoimmune supepidermal blistering disease

282

How is bullous pemphigoid diagnosed?

skin biopsy with direct immunofluoresence
igg and C3

283

bullous phemphigoid - oral lesions?

rare

284

What do the skin lesions look like on physical exam in bullous pemphigoid?

tense fluid filled blisters on flexor surfaces
negative nikolsky's sign

285

Describe the classic presentation in bullous pemphigoid.

prodrom - pruritis, plaque-like lesions for weeks
then fluid filled blistesrs

286

Complications seen with bullous phemphigoid?

bacterial infection

287

What is the first-line treatment of bullous pemphigoid?

corticosteroids

288

What is the treatment of bullous pemphigoid in patients who are refractory to medical therapy?

IVIG

289

How does G6PD deficiency lead to hemolysis?

oxidative injury to RBC

290

G6PD classic presentation

sudden anemia
dark urine
jaundice

291

What are the 2 common findings on peripheral smear in a patient with G6PD deficiency?

heinz bodies
bite cells

292

What are the two man precipitants of hemolytic episodes in patients with G6PD deficiency?

infections
medications

293

What is the inheritance pattern of G6PD deficiency? In whom is it most commonly seen?

X linked recessive
men

294

What drugs can precipitate a hemolytic episode in patients with G6PD deficiency (remember the mnemonic!)?

hemolysis IS D PAIN
inh, sulfonamides, dapsone, primarquine, aspirin, ibuprofen, nitrofurantoin

295

What is the most appropriate initial test for patients with suspected hemolytic episode due G6PD deficiency?

perpiheral blood smear

296

What test is diagnostic for G6PD deficiency? When should the test be performed?

quantification of g6pd with enzyme assay

297

What psychiatric disorders have been associated with mitral valve prolapse?

anxiety/panic

298

What is mitral valve prolapse and what is its cause?

prolapse of mitral valve intro atrium during systole
cause: excess leaflet tissue or myxomatous degen of valve or chodae tedinae

299

What is the murmur of mitral valve prolapse?

midsystolic or late systolic click
mid-to-late systolic murmur

300

MVP symptoms

asymptomatic
palpitations, chest pain

301

myxomatous degeneration

increase in spongiosa (dermatan sulfate)
decrease in fibrosa
increased size

302

What is the effect of standing and valsalva on the murmur of mitral valve prolapse?

decrease preload
decrease LVV
cordae tendinae slack
makes murmur louder

303

What is the effect of squatting on the murmur of mitral valve prolapse?

increase preload
increase LVV
tighten mitral apparatus
delays click, quieter murmur

304

conjugated, direct bilirubin

water soluble
non toxic

305

unconjugated indirect bilirubin

not soluble in water
neurotoxic

306

hepatocytes convert

indirect --> direct

307

How is hyperbilirubinemia diagnosed in an infant?

nomogram (age in hrs)

308

Elevated indirect bilirubin and absence of bilirubin in the urine indicates what 2 possible processes?

Excess bilirubin production (likely due to hemolysis) OR
Impaired uptake/conjugation by the liver (e.g. Gilbert’s, Crigler-Najjar, or physiologic in the newborn)

309

What are the three patterns of hyperbilirubinemia?

obstructive
hepatocellular
hemolytic

310

hepatocellular jaundice

mixed direct/indirect
increased urine bilil
increase urine urobili to nromal

311

obstructive jaundice

increased direct
increased urine bili
decreased urobili

312

urobili formed in

intestines

313

What are possible treatments for a neonate with hyperbilirubinemia?

id cause
nothing/phototherapy/blood transfusion

314

hemolytic jaundice

increased indirect
no urine bili
increased urine bili

315

jaundice =

yellow
dark colored urine
light colored stool
pruritis

316

Elevated direct bilirubin and presence of bilirubin in the urine indicates what 2 possible processes?

intrahepatic
extrahepatic obstruction

317

In a patient with ADPKD (autosomal dominant polycystic kidney disease), when does renal function start to decrease?

40s-50s

318

What are the first-line agents in treating hypertension in ADPKD?

ACEI/ARB

319

What are the possible complications associated with autosomal-dominant polycystic kidney disease?

renal/liver failure
stroke/mi
ruptured intracrainial aneurysm
RCC

320

Aside from imaging and genetic testing, what other tests may be performed to aid in the diagnosis of autosomal dominant polycystic kidney disease?

urinalysis/culture
gfr
cbc
serum calcium/phosphorus

321

What 2 mutations are associated with autosomal-dominant kidney disease?

PKD1 polycystin-1
PKD2 polycystin 2

322

In general, development of renal cysts leads to the development of what structural and physiological defects?

massive bilateral kidney enlargement
destruction of renal parenchyma
renal failure

323

What are the common causes of renal failure in patients with autosomal dominant polycystic kidney disease (ADPKD)?

pyelonephritis
nephrolithiasis

324

What is the most common presenting symptom in patients with autosomal dominant polycystic kidney disease and what other symptoms can accompany it?

hypertension
abd mass
polyuria/flank pain/polydipsia

325

polycystin

transmembrane protein important for CT cohestion

326

What are some common extra-renal findings in autosomal dominant polycystic kidney disease?

extrarenal cysts (liver, pancreas, spleen)
berry aneursyms
MVP
colonic diverticular

327

isolated systolic hypertension

decreased elasticity of arterial wall

328

malloy weiss tears

after repeated vomitting

329

immobilization can cause

hypercalecemia due to increased osteoclastic activity

330

lactose interolance testing

+ hydrogen breath test
+ stool for reducing substances
low stool pH
increased stool osmotic gap

331

leukemoid reaction

increase in leukocytes due to severe infection/inflamm
increased leukocyte alkaline phosphatase score

332

primary parahyperthyroidism sympstoms

hypercalcemia
kidney stones
neuropsych
HTN

333

scleroderma esophageal dysmotility manometry

absence of peristaltic waves in lower 2/3
decrease in LES tone

334

hyperthyroidism with reduce radioactive iodine uptake

subacute granulomatous thyroiditis (deq's)
synthyroid overdose
iodine-induced thyrotoxicsosis

335

estrogen and thyroid hormones

increase TBG concentration
need to increase synthroid dose

336

after trauma with fluid resustication, what might be present on urinalysis

hypovolemia = atn
muddy brown casts

337

causes hyponatremia with <100 serum Osm

primary polydisia
malnutrition (beer potmania)

338

aspirin exacerbated resp disease

pseudoallergic rxn
asthma, chronic rhinosinusitis with nasal polyposis

339

Esophageal strictures

circumferential narrowing
dysphagia to solids

340

hematuria following pharyngitis

IgA nephropathy

341

hemodilaysis indictations

refractory hyperkalemia/metabolic acidosis
volume overload/pulm edema
uremic pericarditis, encephalopathy, neuropathy
coagulopathy due to RF

342

membranoproliferative gluomerolonephritis

dense deposits within GBM
increased C3 - activation of complement system

343

methimazole AE

agranulocytosis

344

differential with peluritic pain with IV druge use

infective endocarditis

345

contact lens associated keratitis

pseudomonas, serratia

346

post cholecystectomy pain

dysfunction of sphincter of oddi

347

chondrocalcinosis

pseudogout

348

high velcoity eye injury - next step

slit lamp (flurocein exam)

349

otitis externa treatment

ciprofloxacin

350

cupping of optic disc

open angle glaucoma

351

erysipelas

sharply demarcated
raised borders
fevers and chills
GAS - pyogenes