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Shelf Exams > IM > Flashcards

IM Flashcards

1
Q

Amiodarone sfx and how to monitor

A

Pulmonary toxicity - interstitial pneumonitis, ARDS

Obtain CXR and PFTs at baseline

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2
Q

S4 indicates

A

stiff/hypertrophied ventricle

DDX

  • acute MI
  • HTN
  • aortic stenosis
  • hypertrophic cardiomyopathy
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3
Q

rheumatic heart disease murmur

A

mitral stenosis

aortic stenosis

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4
Q

what should you avoid giving someone on cocaine?

A

beta blocker

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5
Q

aortic dissection treatment/management

A

1) pain control
2) beta blocker
3) Na nitroprusside

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6
Q

Dihydropyridine Calcium Channel Blocker sfx

and how to reduce it

A

sfx = peripheral edema

treatment = ACEi/ARB

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7
Q

What should be avoided in treatment of an Acute MI that becomes Flash Pulmonary Edema?

A

Avoid beta blockers in the presence of flash pulmonary edema

Tx =

  • ASA, Clopidogrel
  • Statin
  • Loop diuretic
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8
Q

EKG:

High voltage QRS
Lateral (v5-v6) ST depression
Lateral (v5-v6) T inversions

A

LVH

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9
Q

Treatment of beta blocker overdose

A

presentation = bradycardia, hypotension, AV block, diffuse wheezing, seizures, cardiogenic shock

treatment =

1) Airway
2) Isotonic fluid bolus
3) IV atropine (to fix bradycardia and hypotension)
4) IV glucagon

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10
Q

Nitroprusside sfx

A

Cyanide toxicity

  • occurs when pt is receives high doses or if someone has renal failure (elevated Cr)
  • symptoms = AMS, lactic acidosis, seizures, coma
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11
Q

When do you give IVIG for tetanus prophylaxis?

A

If un-immunized or received <3 toxoid doses or patient unsure AND large/dirty wound

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12
Q

What is the CD4 cut off for receiving live vaccines?

A

Patients with CD4<200 should not receive live vaccines

  • MMR
  • VZV
  • oral polio
  • nasal influenza
  • rotavirus
  • yellow fever
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13
Q

Malaria prophylaxis

A
  • Mefloquine - starts before, throughought ends after return
  • Atorvaqone-Proguanil
  • Doxycyline
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14
Q

Osteomyelitis - which two bacteria?

A

Staph aureus

Pseudomonas

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15
Q

Young + HTN + Diuretic-induced hypokalemia

A

Primary hyperaldosteronism (Conn)

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16
Q

Polydipsia + Polyuria DDX (5)

A
  • DM
  • Diuretic use
  • Central DI (serum Na elevated)
  • Nephrogenic DI (serum Na normal)
  • Primary polydipsia (serum Na low)
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17
Q

What does a positive Prussian blue stain indicate?

A

positive hemosiderin (indicates hemolysis)

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18
Q

cirrhosis + ascites + low grade fever + abdominal discomfort + altered mental status =

tx

A

SBP
-fluid is positive if there are >250 PMNs or >500 WBCs

tx = IV Abx
-3rd generation cephalosporins to cover gram negative (EColi, Klebsiella) and gram positive (Enterococcus)

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19
Q

What does OCP induced liver damage look like in lab and biopsy

A

Lab = abnormal LFTs

Biopsy = no evidence of necrosis or fatty changes

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20
Q

IgA Nephropathy vs Post-Streptococcal Nephropathy

A

IgA Nephropathy = 5 days post-URI, normal compliment

Post-Streptococcal Nephropathy = 10-14 days post-URI/pharyngitis, low compliment (C3)

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21
Q

What lab value indicates saline responsive metabolic alkalosis?

What lab value indicates saline resistant metabolic alkalosis?

A

Saline responsive: urine Cl <20
tx = NS MIVF + K

Saline resistant: urine Cl >20
tx = spironolactone

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22
Q

COPD treatment with maximal impact on mortality

A
  • smoking cessation

- home O2

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23
Q

Treatment of an acute exacerbation of COPD (5)

A
  • O2 (target SpO2 88-92%)
  • inhaled bronchodilators
  • systemic glucocorticoids
  • antibiotics (if there are >2 symptoms)
  • NPPV if respiratory failure
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24
Q

woman + chronic dry cough + malaise + bilateral hilar lymphadenopathy =

A

Sarcoidosis (Chronic Granulomatous Inflammation)

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25
Q

What 3 cancers can cause malignant pleural effusions?

A
  • Lung ca
  • Breast ca
  • Lymphoma
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26
Q

“dysmorphic RBC on the urinalysis”

A

Goodpasture’s disease

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27
Q

treatment for spinal cord compression

A

1) IV glucocorticoids

2) MRI

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28
Q

elevated homocystiene + DVT or history of DVTs

What to do next?

A

Give pyridoxine

Pyridoxine, Vit B12, Folate are required for the metabolism of homocystiene

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29
Q

treatment for Cancer Related Anorexia/Cachexia Syndrome (CACS)

A
  • progesterone analogues

- corticosteroids

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30
Q

sfx of Epo therapy (4)

A
  • worsening HTN
  • headaches
  • flu-like symptoms
  • red cell aplasia
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31
Q

treatment of organophosphate poisoning

A

1) Atropine

2) Take off all clothes and wash body

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32
Q

how to dx arsenic poisoning

A

urine level

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33
Q

“variant lymphocytes with large vacuolated cytoplasms”

A

atypical lymphocytes of EBV

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34
Q

pneumaturia occurs in what disease?

A

pneumaturia = air in urine

Occurs in colovesical fistulas in Diverticular disease, Chrons, Malignancy

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35
Q

4 main substrates of gluconeogenesis

A
  • alanine (-> pyruvate)
  • glutamine (-> Krebs)
  • Lactate (-> pyruvate)
  • glycerol-3-phosphate (-> glucose)
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36
Q

young patient (<55 yo) with unexplained heart block or unexplained ECG changes

A

Cardiac sarcoidosis

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37
Q

Hodgkin’s lymphoma treated with chemo + radiation before the age of 30 increases your risk for _

A

a secondary malignancy

Lung, Breast, Thyroid, Bone, GI, Acute leukemia, NonHodgkin’s

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38
Q

wedge shaped infarct + pleuritic chest pain + hemoptysis =

A

PE

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39
Q

what two drugs to avoid in an asthmatic who just had an MI

A
  • ASA
  • Beta blocker

may trigger bronchoconstriction

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40
Q

a firm, non-tender, solitary lymph node in the head/neck is most likely _

A

squamous cell carcinoma

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41
Q

elderly patient + severe lymphocytosis + hepatosplenomegaly + lymphadenopathy + anemia + thrombocytopenia =

A

CLL

  • elevated lymphocytes
  • low platelets
  • low Hgb
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42
Q

JAK2 mutation is associated with _

A

Myeloproloferative disease/ Polycythemia Vera

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43
Q

Lab values in tumor lysis syndrome and its consequences (2)

A

elevated uric acid
elevated K
elevated P
low Ca (because the elevated P binds to Ca)

Arrythmias due to elevated K
AKI due to uric acid deposition

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44
Q

epitrochlear lymphadenopathy is pathognomonic for _

A

Syphilis

  • gray mucous patches
  • maculopapular rash taht spreads from the trunk->out (including palms and soles)
  • diffuse lymphadenopathy
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45
Q

sudden onset RUQ pain + fever + vomiting + leukocytosis =

A

acute cholecystitis

stone in cystic duct

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46
Q

CT scan - pulmonary nodule surrounded by ground glass opacities

A

Halo sign

-Invasive aspergilosis

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47
Q

after an endoscopy a patient gets L sided small pleural effusion + acute chest pain + subcutaneous emphysema =

A

esophageal perforation

-gastrograffin swallow to dx

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48
Q

mechanism of HTN in thyroid disease

  • Thyrotoxicosis/Hyperthyroid =
  • Hypothyroid
A

Thyrotoxicosis/Hyperthyroid = HTN, tachycardia, wide pulse pressure
+inotropic
+chronotropic
decrease in systemic vascular resistance

Hypothyroid = HTN
increase in systemic vascular resistance

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49
Q

First step when you find a thyroid nodule

A

1)TSH + ultrasound

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50
Q

elevation of L mainstem bronchus on CXR indicates

A

L atrial enlargement

-MS

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51
Q

mineral deficiency

  • brittle hair
  • skin depigmentation
  • peripheral neuropathy
  • ataxia
  • sideroblastic anemia
  • osteoporosis
A

Copper

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52
Q

mineral deficiency

  • alopecia
  • pustular skin rash
  • hypogonadism
  • impaired wound healing
  • impaired taste
  • immune dysfunction
A

Zinc

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53
Q

mineral deficiency

  • hyperpigmented rash
  • diarrhea
  • dementia
A

Niacin (vit B3)

“Pellagra”

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54
Q

RBC casts

A

glomerulonephritis

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55
Q

WBC casts (2)

A
  • interstitial nephritis

- pyelonephritis

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56
Q

broad/waxy casts

A

chronic renal failure

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57
Q

What type of kidney stones are seen in someone with fat malabsorption disease

A

Calcium oxalate stones

Normally, calcium binds to oxalate in the gut to prevent its absorption
Fat Malabsorption diseases, there is increased fat in the gut that binds up calcium therefore leaving less calcium to bind with oxalate therefore the oxalate is absorbed and then secreted into the urine

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58
Q

Glomerular disease associated with lymphoma

A

minimal change disease

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59
Q

Glomerular disease associated with solid cancers

A

membranous glomerulonephritis

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60
Q

ASO titers are used to diagnose =

A

recent strep pharyngitis

NOT infectious endocarditis

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61
Q

DDX pulus paradoxicus (3)

A
  • Cardiac tamponade
  • Asthma
  • COPD
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62
Q

fluids used to resuscitate (fix volume status)

A

Normal saline (0.9% NS)

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63
Q

fluids used to fix hypernatremia

A

1/2NS + D5

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64
Q

diastolic sound with a squeaking quality at L sternal border

A

pericardial friction rub

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65
Q

How to know if someone is adequately compensated in their metabolic acidosis?

A

Winters Formula

compensated PCO2 = 1.5 (HCO3) + 8 +/- 2

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66
Q

melanosis coli is pathognomonic for

A

factitious diarrhea/laxative abuse

67
Q

autoimmune melanocyte injury

A

vitiligo

  • occurs progressively
  • complete depigmentation (not hypopigmentation)
  • tx = topical corticosteroids
68
Q

malasezia infection

A

tinea versicolor

69
Q

RA + Neutropenia + Splenomegaly =

A

Felty syndrome

  • extra-articular RA manifestations = necrotizing skin ulcers/lesions, vascuilits, mononeuritis multiplex, nodules
  • increased risk for bacterial infections due to neutropenia
  • Positive RF, Positive anti-CCP (RA), Elevated ESR
  • Treatment = improves with RA treatments
70
Q

higher BP in L arm vs R arm =

A

subclavian steal/stenosis

71
Q

higher BP in R arm vs L arm

A

coarctation of the aorta

72
Q

treatment of unilateral adrenal adenoma

A

surgery + spironolactone (Aldo antagonist)

73
Q

treatment of bilateral adrenal hyperplasia

A

spironolactone (aldo antagonist)

74
Q

what is the only detectable Hepatitis B lab finding during the window period?

A

Anti-HBcAb IgM

75
Q

3 causes of traveler’s diarrhea

A
  • Cryptosporidium
  • Cyclospora
  • Giardia

Prolonged, profuse watery diarrhea

76
Q

first line treatment for peripheral artery disease (PAD)

A

aspirin + statin + exercise program

77
Q

male + large anterior mediastinal mass + elevated AFP + elevated beta-HCG

A

noneminomatous germ cell tumor

78
Q

sudden onset eye pain + headache + nausea + conjunctival erythema + mid-dilated pupil (nonreactive) =

A

Acute angle closure glaucoma

tx = urgent tonometry

79
Q

which oral diabetes medication can be added to metformin for weight loss

A

GLP-1 agonists (“-tide”)

80
Q

mechanism of anticolinergic urinary retention

A

detrusor hypocontractility

81
Q

treatment of hypersensitivity pneumonitis

A

avoid triggers

82
Q

Ventilator:

PaO2 is influenced by _ and _

A

FiO2

PEEP

83
Q

Ventilator:

PaCO2 is influenced by _ and _

A

RR

TV

84
Q

time limit for giving activated charcoal to someone with acetaminophen OD is _

A

4 hrs since ingestion

85
Q
  • elevated JVP
  • 3rd heart sound
  • tricuspid regurgitation murmur
  • hepatomegaly
  • lower extremity edema
  • ascites
  • pleural effusion
A

RV failure

86
Q

impaired RV function secondary to pulmonary HTN secondary to underlying lung disease or pulmonary vasculature disease or OSA =

tx?

A

Cor Pulmonale

tx

  • treat the underlying disorder
  • O2 if hypoxic
  • use diuretics carefully bc they might be preload-dependent
87
Q

Acute Liver Failure 3 requirements

A
  • elevated AST, ALT
  • hepatic encephalopathy symptoms
  • synthetic liver dysfunction
88
Q

non-smoker + chronic/recurrent cough + productive of sputum + resolves with abx =

tx =

A

Bronchiectasis

tx

  • abx
  • inhaled bronchodilators
  • fluids
  • chest physiotherapy
89
Q

What is next step when someone is in Vfib or pulseless Vtach

A

Defibrilator

90
Q

2 most common infections in multiple myeloma patients

A
  • respiratory
  • UTI

etiology = neoplastic infiltration into bone marrow alters the lymphocytic production therefore resulting in ineffective Abs

91
Q

increased tactile fremitus =

decreased tactile fremitus =

A

increased tactile fremitus = consolidation - solid

decreased tactile fremitus = air, fluid

92
Q

first line medical therapy for fibromyalgia =

A

amytriptyline

93
Q

DDX chronic cough (3)

A

chronic = lasting for 8+ weeks

  • upper airway cough syndrome (post nasal drip)
  • asthma
  • GERD
94
Q

elderly + acute back pain + point tenderness + mid-line

A

vertebral compression fracture

-can occur after lifting someone or very minor trauma due to underlying osteoporosis

95
Q

how to distinguish cause of ascites?

A

Serum-to-Ascites Albumin Gradient (SAAG)
if >1.1, then portal HTN is the cause (cirrhosis, cardiac/R heart failure)
if <1.1, then other cause (malignancy, pancreatitis, nephrotic, TB)

96
Q

exertional heat stroke vs heat exaustion

A

exertional heat stroke =

  • Body loses its ability to themoregulate when the humidity is >75% and the temperature is elevated
  • Symptoms = Temp >40 C, altered mental status, hypotension, tachycardia, tachypnea
  • May lead to rhabdo or other organ damage

heat exaustion

  • Inadequate sodium and water replacement during physical activity
  • No altered mental status, Temp <40 C
97
Q

Pica is associated with what medical condition

A

iron deficiency anemia

-responds to iron supplementation

98
Q

“expansile and eccentric lytic area in the epiphysis”

A

Giant Cell Tumor

  • benign
  • tx = surgery
99
Q

Tx of hypercalcemia

A

1) IV NS fluids

2) Loop diuretics

100
Q

Next step in patient with Torsades

  • if hemodynamically unstable =
  • if conscious and stable =
A
  • if hemodynamically unstable, then defibrillation

- if conscious and stable, then IV magnesium (effective even if patient’s serum Mag is normal)

101
Q

Management of Paroxysmal Supraventricular Tachycardia (PSVT)

A
  • Vagal maneuvers

- Adenosine

102
Q

medical management of atrial/ventricular tachycardia

A

-Amiodarone

103
Q

obese + bilateral leg swelling + worse at night + ulcer on foot + varicose veins =

A

Chronic Venous Insufficiency (not edema secondary to HF - no JVD, do not give lasix!)

Tx = compression stockings, leg elevation

104
Q

renal vein thrombosis is most commonly associated with which nephrotic syndrome

A

membranous glomerulonephritis - due to loss of ATIII therefore hypercoagulable

105
Q

chronic epigastric pain that is relieved by leaning forward or sitting up + malabsorption =

how to dx

A

chronic pancratitis

-dx via CT or ERCP

106
Q

Glomerular hematuria vs Nonglomerular hematuria

A

Glomerular =

  • microscopic > macroscopic bleeding
  • no dysuria
  • positive for blood, positive for protein
  • RBC casts

Nonglomerular =

  • microscopic < macroscopic bleeding
  • yes dysuria
  • positive for blood, no protein
  • no casts
107
Q

How to dx carpal tunnel syndrome

A

nerve conduction studies + clinical findings

108
Q

Modified Well’s Criteria

  • number cut off between likely and unlikely
  • what is the next step if likely vs unlikely
A

3 points = clinical DVT, most likely dx

  1. 5 points = previous DVT/PE, HR >100, recent surgery or immobilization
  2. 5 points = hemoptysis, cancer

if >4 = likely -> Anticoagulate
if <4 = unlikely -> CT angiogram or VQ scan

109
Q

if suspected PE but patient has an absolute contraindication to anticoagulation, what is the next step?

what are the absolute contraindications to anticoagulation?

A

if cannot anticoagulate, then obtain a definitive test (CT angio/ VQ scan) and if still yes -> IVC filter

absolute contraindications to anticoagulation

  • active bleeding
  • hemorrhagic stroke
110
Q

siladenosis indicates

A

Siladenosis = benign, noninflammatory, nontender enlargement of the submandibular glands

Indicates

  • Advanced liver disease (alcoholic or nonalcoholic)
  • Altered dietary pattern (diabetes, bulimia, malnutrition)
111
Q

Acute limb ischemia after an MI suggests embolization from what potential 3 sources

and how can you rule them in/out

A
  • LV thrombus - echo
  • LA thrombus - echo
  • atherosclerosis from aorta
112
Q

calcium relationship with blood pH

A

elevated pH (alkalosis) -> more Ca bound to Albumin -> hypocalcemia

low pH (acidosis) -> less Ca bound to Albumin -> hypercalcemia

113
Q

Treatment of DM gasroparesis

A

metaclopromide - prokinetic + antiemetic

114
Q

Treatment of large-medium nonbleeding esophageal varices

A

beta blockers

115
Q

Hypotension + Elevated JVD + Muffled heart sounds or Cannot palpate PMI =

A

Beck’s Triad

-Cardiac tamponade

116
Q

Low frequency tinnitus + episodic vertigo + unilateral sensorineural hearing loss

A

Meniere disease

-etiology = increased volume and pressure in inner ear

117
Q

treatment of hypercalcemia

A

1) NS IVF

2) Bisphosphonates

118
Q

Types of watery diarrhea (3)

A
  • Osmotic = high Osmotic gap
  • Functional
  • Secretory = low Osmotic gap, occurs when fasting and asleep, large volume per day
119
Q

elevated PCWP =

A

Cardiogenic shock

120
Q

MALToma is associated with _

A

H Pylori

-treat H Pylori and the MALToma will regress

121
Q

smoking, increased salt diet, N-nitroso compounds are associated with what cancer?

A

gastric adenocarcinoma

122
Q

how to dx upper airway cough syndrome

A

via treatment - first generation H1 blockers

123
Q

Normal distribution

  • 68% = _ SDs
  • 95% = _ SDs
  • 99.7% = _ SDs
A
  • 1
  • 2
  • 3
124
Q

prophylaxis of uric acid stones

A
  • Fluids
  • Alkalinization of urine (potassium citrate)
  • Low protein diet
125
Q

Anti-topoisomerase Ab

A

Systemic Scleroderma

126
Q

Anti-centromere Ab

A

CREST/Limited Scleroderma

127
Q

Anti-cardiolipin Ab

A

Antiphospholipid Ab Syndrome

128
Q

AntiCCRP Ab

A

RA

129
Q

Antismooth muscle Ab

A

Autoimmune hepatitis

130
Q

How to dx pneumocystis pneumonia?

A

First try induced sputum but if that does not yield an adequate sample, do a bronchoscopy + bronchiolar lavage
Needs to be stained with special stain

  • PCP cannot be cultured (blood cultures will not yield dx)
  • Often found in immunocompromised/immunosuppressed patients
131
Q

what to do when patient enters PEA (pulseless electrical activity)

A

CPR + vasopressors (Epi every 3-5 min)
investigate reversible causes

Defibrillation or synchronized cardioversion has no role in management

132
Q

Reversible Causes of Asystole/PEA

5Hs + 5Ts

A

5Hs

  • Hypovolemia
  • Hypoxia
  • Hydrogen ions (acidosis)
  • Hypo or Hyperkalemia
  • Hypothermia

5Ts

  • Tension pneumothorax
  • Tamponade, cardiac
  • Toxins (narcotics, benzos)
  • Thrombosis (pulmonary or coronary)
  • Trauma
133
Q

Empiric therapy for Infective Endocarditis

A

Vancomycin

134
Q

Skin lesion that is stuck on, warty, hyperpigmented on trunk, face or upper extremities

A

Seborrheic keratosis

135
Q

how to screen for an AAA?

when to repair?

A

USPSTF: men 65-75 yo who have previously or currently smoked cigarettes can have a one time screen via abdominal ultrasound

surgical repair of 5.5 cm or greater

136
Q

BR found in urine is unconjugated or conjugated?

A

Conjugated

Unconjugated BR in urine = urobilinogen

137
Q

Corneal vesicles and dendritic ulcers in the eye

A

Herpes Simplex Keratitis

  • pain, photophobia, blurry vision, tearing, redness
  • precipitated by excessive sun exposure, outdoor occupation, fever, immunodeficiency
  • epithelial scrapings will show multi-nucleated giant cells
  • tx = antiviral topical or oral
138
Q

Older woman with hx of recurrent pneumonia and sinusitis and rib fractures. Normocytic anemia. Constant low grade fever.

A

Multiple Myeloma

  • Monoclonal plasma cell proliferation -> impaired effective antibody production
  • Bone pain, fractures, constitutional symptoms, recurrent respiratory and urinary infections
  • CRAB
139
Q

Problems with the compliment system predisposes to what kind of infections?

A

Compliment system helps form the MAC. Deficiencies cause problems with the innate immune system.
Patients are vulnerable to encapsulated bacteria infections.

140
Q

Destruction of CD4 lymphocytes occurs in what infection

A

HIV

141
Q

Impaired pahgocytic oxidative metabolism is see in what disease?

A

Chronic Granulomatous Disease

Defects in phagoytic oxidative metabolism results in an impairment in the ability of phagocytes to produce reactive oxygen intermediates that help in the destruction of cancerous cells and pathogens.

142
Q

Infiltrating T lymphocytes and macrophages leading to segmental demyelination of peripheral nerves =

A

Guillian Barre disease

143
Q

What bugs and what ppx for HIV Opportunistic infections (<200 CD4) (4)

A

PJP

  • CD4<200
  • ppx = TMP/SMX

Histoplasma

  • CD4<150
  • ppx = itraconizole

Toxoplasmosis

  • CD4<100
  • ppx = TMP/SMX

MAC

  • CD4<50
  • ppx = azithromycin
144
Q

Erythema with raised edges =

A

Erysipelas

-Group A strep

145
Q

Contact lens associated keratitis is due to what bug?

Treatment?

A

Pseudomonas

Medical emergency - may lead to corneal perforation, scaring and permanent vision loss
Tx = remove contact, topical broad spectrum antibiotics

146
Q

Hemolysis + Hypercoagulable + Middle aged woman

A

Paroxysmal Nocturnal Hemoglobinuria

  • autoimmune - intravascular + extravascular hemolysis
  • Dx via flow cytometry
  • Treatment = iron, folate, eculizumab
147
Q

How to calculate AG

A

AG = Na - (Cl + HCO3)

148
Q

If you see digital clubbing, you should then look for

A

an occult malignancy

DDX of primary clubbing
-hereditary

DDX of secondary clubbing

  • lung malignancy
  • cystic fibrosis
  • R->L cardiac shunt
  • Hypertrophic Osteoarthropathy - painful joint enlargements, periostosis of long bones, synovial effusions, clubbing
149
Q

Dense deposits within glomerular basement membrane that stain positive for C3 =

pathogenesis

A

Membranoproliferative glomerulonephritis Type 2

  • IgG against C3 convertase (“C3 nephritic factor”)
  • results in persistent activation of the alternative compliment pathway
  • leads to persistent compliment activation and kidney damage
150
Q

High K, Low Na, Morning cortisol <15

What is the next step?

A

Evaluation of primary adrenal insufficiency (Addison’s disease)

-Cosyntropin (ACTH) stim test

151
Q

Treatment of pulmonary HTN caused by L heart failure

A

Loop diuretics + ACEi/ARB

Normal treatment for L heart failure

152
Q

A high RAIU suggests _

A low RAIU suggests _

next steps

A

High = de novo hormone synthesis

Next step if High = diffuse pattern vs nodular pattern

Low = release of preformed hormone (thyroiditis) or exogenous hormone intake)

Next step if Low = measure thyroglobulin

  • High = endogenous release
  • Low = exogenous intake
153
Q

gnawing epigastric pain + better after eating + occasional melena =

A

= Duodenal ulcer

  • worse pain on an empty stomach, pain improves with food
  • etiology = H pylori or NSAIDs

Gastric ulcer
-pain is worse with eating bc of increased acid secretion

154
Q

To Dx acute pancreatitis =

A
  • Typical abdominal pain that radiates to back
  • Elevated lipase and amylase 3x normal limit

If those are equivocal, then get imaging

  • CT abdomen with contrast
  • ultrasound if you think it is gallstone pancreatitis
155
Q

How to diagnose alveolar hypoventilation as the cause of respiratory acidosis?

A

resp acidosis = low pH, high HCO3 (compensation), high PaCO2

alveolar hypoventilation = high PaCO2, low PaO2
OR the PaCO2 is high and between 50-80mmHg

Etiologies:

  • COPD, OSA, Obesity hypoventilation, Scoliosis
  • Myasthenia gravis, Lambert eaton, Guillian barre
  • Brainstem lesion, infection, stroke
156
Q

Treatment of dermatitis herpetiformis

A

Dapsone + gluten-free diet

157
Q

What kind of shock has elevated Mixed venous O2 saturation?

A

Septic/Distributive shock =

  • low SVR (low afterload) 2/2 peripheral vasodilation
  • low PCWP -> low preload
  • elevated mixed venous O2 saturation 2/2 inability of tissues to effectively extract oxygen

This is the only type of shock that has elevated MVO2

158
Q

CAP treatment

  • outpatient
  • inpatient
  • icu
A

Outpatient

  • macrolide
  • doxycycline
  • fluoroquinolone
  • beta lactam + macrolide

Inpatient

  • fluoroquinolone
  • beta lactam + macrolide

ICU

  • beta lactam + macrolide
  • beta lactam + fluoroquinolone
159
Q

fever + tinnitus +tachypnea + history of OD =

A

Aspirin

  • mixed respiratory alkalosis + elevated anion gap metabolic acidosis
  • pH will be close to normal
160
Q

Homeless man + Optic disc hyperemia + epigastric pain + anion gap metabolic acidosis + bicarb very low + normal Cr

A

Methanol intoxication/poisoning

Methanol and Ethylene gylcol are very similar and both are used instead of alcohol. Both will give you an elevated anion gap metabolic acidosis with a very low bicarb.
Methanol -> damages eyes
Ethylene glycol -> damages kidneys

161
Q

Pancreatic cancer modifiable risk factors (3)

A
  • smoking
  • obese, low physical activity
  • nonhereditary chronic pancreatitis
162
Q

fever + polyarthralgia + tenosynovitis + painless vesiculopustular rash +recent history of unprotected sex =

A

disseminated gonococcal infection

tenosynovitis = pain elicited along tendon sheaths
often there is no history of venereal disease

163
Q

Psoriasis treatment =

A
  • high potency glucocorticoids

- Vit D

Shelf Exams (3 decks)

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