FireCracker 12/9 + Qbank Flashcards
1
Q
parietal periotneum pain
A
constant
severe
2
Q
antibiotics in pancreatitis if
A
pseudocyst or abscess
3
Q
acute abdomen etiology
A
periotnitis
obstruction
4
Q
peritonitis PE findings
A
rigidity
5
Q
Trousseau’s syndrome
A
migratory superficial thrombophlebitis
associated with pancreatic/visceral cancer
6
Q
PPSV23 alone
A
adults <65 with chronic health conditions
7
Q
viral conjunctivitis treatment
A
warm/cold compresses
8
Q
bacterial conjunctivitis treatment
A
eryhtomycin/antibacterial drops
9
Q
bacterial conjunctivitis treatment in contact lens users
A
fluroquinolone
10
Q
Glucagonoma
A
necrolytic migratory erythema
DM
GI symptoms
glucagon >500
11
Q
thiazide diuretic mechanism
A
inhibit NaCl co transport in DCT
12
Q
thiazide - decreased levels of
A
K, Na, H
hypokalemia, hyponatremia, metabolic alkalosis
13
Q
thiazide - increased levels of
A
Glucose, Lipids, Uric Acid, Calcium
14
Q
loop diuretics mechanism
A
block Na/K/2CL symporter in thick ascendling limb of loop of Henle
15
Q
loop diuretic toxicities
A
ototoxicity, hypokalemia, hypocalcemia, hypomagenseimia, dehydration, allergy-sulfa, nephritis (AIN), gout
16
Q
potassium sparing diuretics mechanism
A
act on collecting tubule
17
Q
spironolactone and eplerenone
A
competitive inhibitors of aldosterone receptors
only work in presence of aldosterone
18
Q
spironolactone AE
A
hyperkalemia
gynecomastia
amenorrhea
anti-androgen effects
19
Q
carbonic anyhdrase inhibitors
A
acetazolamide
PCT
inhibit production/reabsorption of filerted bicarb
20
Q
carbonic anhydrase inhibitors use
A
treatment of ICHTN
21
Q
acetazolamide toxicities
A
hyperchloremic metabolic acidosis hypokalemia NH toxicity neuropathy sulfa allergy
22
Q
mannitol
A
osmotic diuretic, increases tubular fluid osmolarity –> increase urine flow
23
Q
mannitol toxicity
A
pulmonary edema
intravascular dehydration
24
Q
stable angina treatment
A
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
