IM COMAT Flashcards
1
Q
Symptoms of acute angle glaucoma
A
rapid onset of severe eye pain
halos around lights
affected eye’s pupil will be dilated and poorly responsive to light
nausea and vomiting
headache
vision loss in 2-5 hours of symptom onset
2
Q
Symptoms of optic neuritis and what it indicates
A
acute vision loss pain afferent pupillary defect Most common in women age <50 initial presentation of multiple sclerosis
3
Q
What medications are shown to improve long-term survival in patients with LV systolic dysfunction?
A
ACE inhibitors, ARBs, beta blockers, mineralocorticoid receptor antagonists (eplerenone, spironolactone) and hydralazine/nitrates only in African Americans
4
Q
Symptoms of chronic pancreatitis
A
Chronic epigastric pain with pain-free intervals, malabsorption (steatorrhea, weight loss), diabetes mellitus
5
Q
how do you diagnose chronic pancreatitis?
A
CT scan looking for calcifications
6
Q
What should you think in a patient with pancytopenia, thrombosis, and hematuria in the mornings? What causes this? How do you diagnose it?
A
paroxysmal nocturnal hemoglobinuria
caused by deficiency of CD55 and CD59 on cell surface
Diagnose with flow cytometry
7
Q
schistocytes and helmet cells indicate what?
A
microangiopathic hemolytic anemia
8
Q
What are the three types of microangiopathic hemolytic anemia?
A
DIC, HUS, TTP
9
Q
What are the two disorders you should think of with spherocytes and/or elliptocytes?
A
hereditary spherocytosis/autoimmune hemolytic anemia
10
Q
What disorder should you think of with bite cells and Heinz bodies?
A
G6PD deficiency
11
Q
What should you think of with a patient with an increased LDH, decreased haptoglobin, anemia, splenomegaly and/or jaundice?
A
hemolytic anemia
12
Q
What test diagnoses autoimmune hemolytic anemia?
A
Coomb’s test
13
Q
What blood test diagnoses hereditary spherocytosis? What makes the definitive diagnosis?
A
osmotic fragility test; the definitive diagnosis is made by the presence of Howell-Jolly bodies on smear
14
Q
What is the most common cause of asymptomatic microcytic anemia in an Asian patient?
A
alpha thalassemia
15
Q
What are classic B symptoms and what do they indicate?
A
fever, pruritus, fatigue, night sweats, weight loss
indicate Hodgkin’s lymphoma
16
Q
How do you diagnose Wegener’s granulomatosis?
A
biopsy of lung nodule
17
Q
What chemotherapy drug can cause hearing loss and chronic kidney disease?
A
carboplatin
18
Q
What chemotherapy drug can cause an acute gout attack?
A
6-mercaptopurine
19
Q
What chemotherapy drug can cause pancytopenia and abortions?
A
methotrexate
20
Q
What chemotherapy drug used to treat breast cancer can cause hot flashes and increase risk of endometrial cancer?
A
tamoxifen
21
Q
What chemotherapy drug can cause acute renal failure and thrombocytopenia?
A
mitomycin
22
Q
What chemotherapy drug can cause glove and stocking paresthesias?
A
vincristine
23
Q
p-ANCA, asthma, eosinophilia
A
Churg-Strauss
24
Q
c-ANCA, sinus, kidney, lung involvement
A
Wegener’s
25
Child with hematuria after an infection with arthralgias, purpura, and abdominal pain
Henoch-Schonlein Purpur
26
p-ANCA, no lung involvement, and they might have HepB
PAN (polyarteritis nodosa)
27
What is the treatment of TTP? What are the levels of coagulation factors?
emergent plasmapheresis (do NOT give platelets), normal coagulation factors
28
best test to find kidney stones?
CT
29
kid with a family history of kidney stones will have what kind of stones?
cysteine
30
chronic indwelling Foley catheter with very alkaline pee will have what kind of stones?
struvite
31
child with leukemia being treated and develops kidney stones will be what type of stones?
uric acid stone
32
how do you treat small stones?
pass them
33
How do you treat large stones? how large is large?
>2 cm = surgical removal
34
Most common cause of nephrotic syndrome in adults?
membranous
35
Most common cause of nephrotic syndrome in heroin user or patient with AIDS?
focal segmental glomerulonephritis
36
Most common cause of nephrotic syndrome associated with chronic hepatitis?
membranoproliferative
37
A nephrotic patient suddenly develops flank pain. What are you worried about? Why?
renal vein thrombosis, they are peeing out coagulation factors
38
What will the TIBC in anemia of chronic disease?
low TIBC
39
What will the TIBC in iron deficiency anemia? What about ferritin?
high TIBC, low ferritin
40
What are you thinking if your patient has high homocysteine but normal methylmalonic acid?
folate deficiency
41
What are you thinking if your patient has high homocysteine and high methylmalonic acid? What other symptoms might be present?
B12 deficiency, neurological symptoms
42
anemia with high MCV and acanthocytes?
liver disease
43
normal MCV, high LDH, high indirect bilirubin, low haptoglobin?
hemolytic anemia
44
sudden onset of hemolytic anemia after taking drugs (penicillins, cephalosporins, sulfas)? Caused by what kind of immunoglobulin?
warm agglutinins, IgG (cold is caused by IgM)
45
large spleen, positive fam hx, bilirubin gallstones, mean cell hemoglobin is high? Treatment?
hereditary spherocytosis, splenectomy
46
young woman, heavy periods, recurrent epistaxis, petechiae, low platelets? Treatment?
ITP; prednisone 1st line, splenectomy 2nd
47
young woman, heavy periods, petechiae, recurrent epistaxis, but bleeding time and PTT are high?
von Willebrand
48
male, recurrent bleeding, hemarthrosis, bruising, hematuria, elevated PTT, corrected with mixing studies?
hemophilia; mixing with normal blood corrects it, means something was missing from pt's blood
49
50 year old carnivore, hemarthrosis, woozing at venipuncture sites, took clindamycin
vit K def
50
What are the two factors not depleted in liver failure?
factor 8 and vWF (made in endothelial cells)
51
Treatment of DIC?
correct underlying disorder
52
Low platelets but clotting still?
HIT (heparin-induced thrombocytopenia)
53
Skin necrosis following warfarin therapy indicates what?
protein C/S deficiency
54
CHADS-VAC score of >/= 2, treat with what?
warfarin/newer anticoagulants
55
CHADS-VAC score <2, treat with what?
aspirin
56
Strep CENTOR criteria >/= 4, treat with what?
penicillin empirically
57
Strep CENTOR criteria 2-3, do what?
rapid strep test
58
1st line Abx for inpatient pneumonia?
fluoroquinolone
59
1st line Abx for outpatient typical pneumonia?
amoxicillin
60
1st line Abx for outpatient atypical pneumonia?
azithromycin
61
SIRS criteria?
temp < 36 or > 38
WBC < 4,000 or > 12,000
HR > 90 bpm
Tachypnea > 20 or PaCO2 > 32mmHg
62
Definition of sepsis?
SIRS + source of infection
63
Definition of severe sepsis?
sepsis with end organ damage or hypotension
64
Definition of septic shock?
sepsis + hypotension and not responding to fluid
65
LIGHTS criteria
serum protein: pleural fluid protein > .5 = exudative
serum LDH: pleural fluid LDH > 0.6 = exudative
or pleural LDH > 2/3 normal
66
causes of exudative pleural fluid?
malignancy, infection, autoimmune disease, pancreatitis, post-CABG, PE, esophageal rupture
67
causes of transudative pleural fluid?
hypoalbuminemia (cirrhosis, nephrotic syndrome), CHF, constrictive pericarditis
68
Wells criteria >/= 4, do what?
CT angiogram to look for PE
69
Wells criteria < 4, do what?
D-dimer to look for PE
70
What Glasgow coma scale score indicates intubation?
= 8
71
Ascites analysis with 250+ neutrophils indicates what?
SBP (spontaneous bacterial peritonitis)
72
Ascites analysis with SAAG > 1.1 indicates what?
portal hypertension
73
1st line treatment for stable angina?
nitrates, aspirin, beta blocker
74
1st diagnostic test to order with chest pain?
EKG
75
1st line treatment for unstable angina?
MONA C BASH - morphine, oxygen, nitrates, aspirin, clopidogrel, beta blockers, ACE-inhibitors, statins, heparin
76
Indications for CABG?
3 vessel disease or LAD with >/=70% blockage
77
Tx prinzmental angina with?
calcium channel blockers or nitrates
78
What helps with an inferior wall MI? What hurts? What leads will this show in?
fluids help, nitrates harm, leads II, III, avF
79
What will CSF WBC, glucose, and protein levels be in bacterial meningitis?
WBC very high, glucose low, protein pretty high
80
What will CSF WBC, glucose, and protein levels be in TB meningitis?
WBC fairly high, glucose low, protein high
81
What will CSF WBC, glucose, and protein levels be in viral meningitis?
WBC high, glucose normal, protein slightly elevated or normal
82
What will CSF WBC, glucose, and protein levels be in Guillain-Barre?
WBC normal, glucose normal, protein elevated
83
What is the difference between primary hyperparathyroidism and familial hypocalciuric hypercalcemia?
both can have elevated or inappropriately normal PTH; patients with primary hyperparathyroidism will have increased urinary calcium excretion whereas patients with FHH will have decreased urinary calcium excretion (<100 mg/24 hours or UCCR of < 0.01)
84
What infections should you test someone for when you suspect idiopathic thrombocytopenia?
hep C and HIV
85
What is the treatment of choice for agitation in the elderly?
haloperidol
86
What are the clinical features of cholesterol crystal embolism?
```
derm (livedo reticularis, ulcers, gangrene, blue toe syndrome)
Renal (acute or subacute kidney injury)
CNS (stroke)
Ocular involvement (Hollenhorst plaques)
GI (intestinal ischemia, pancreatitis)
```
87
What are the lab findings in cholesterol crystal embolism?
elevated serum creatinine, eosinophilia, hypocomplementemia
| Urinalysis - begins with few cells or casts, may have eosinophilia
88
How do you definitively diagnose cholesterol crystal embolism if clinical diagnosis isn't enough?
skin or renal biopsy
89
What ECG rhythm is typical of digitalis toxicity?
Atrial tachycardia with AV block
90
How is exertional heat stroke defined?
body temp > 40 (104) with central nervous system dysfunction and other tissue/organ dysfunction
91
What is the definitive way to diagnose CAD?
CT angiography
92
What is first line for cariogenic shock?
dobutamine
93
What is the treatment for cariogenic shock with bradycardia due to inferior wall MI?
atropine
94
Drugs proven to decrease mortality in MI?
aspirin, beta blockers, ACE-inhibitors
95
Drugs proven to decrease mortality in CHF?
beta blockers, ACE inhibitors, spironolactone
96
Treatment of 1st degree and 2nd degree Mobitz type 1 heart block?
No treatment
97
Complete AV block as well as Mobitz type 2 heart block treatment?
pacemaker
98
Symptoms of Dressler syndrome?
2 weeks post MI, fever, leukocytosis, symptoms of pericarditis
99
Treatment of Dressler syndrome?
aspirin
100
Bilateral hilar LAD, dry cough, uveitis, and erythema nodosum, restrictive cardiomyopathy?
sarcoidosis
101
Treatment for acute decompensation of CHF?
NO LIP - nitrates, O2, loop diuretics, inotropes, positioning (elevate bed)
102
Supraventricular tachycardia treatment?
vagal maneuvers then stable - adenosine
| unstable - cardioversion
103
Causes of restrictive pericarditis?
sarcoidosis, amyloidosis, hemochromatosis
104
Treatment of ventricular tachycardia?
stable - amiodarone
| unstable - cardioversion
105
V fib and pulseless V tach treatment?
defibrillation
106
What will you find on CXR of constrictive pericarditis?
calcifications (can be caused by TB or lupus)
107
Treatment of constrictive pericarditis?
pericardiectomy
108
Treatment of viral pericarditis?
NSAIDs (usually caused by Coxsackie)
109
What is Beck's triad, and what does it indicate?
Indicates cardiac tamponade
Beck's Triad - hypotension, JVD, muffled heart sounds
Also associated with pulses paradoxus (systolic pressure drops by >10 with inspiration), low voltage QRS, Kusmal sign (JVD increases with inhalation)
110
What symptoms will you see with Carcinoid syndrome?
flushing, right heart murmurs, diarrhea, bronchospasm
111
Three causes of holosystolic murmurs?
mitral regurgitation, tricuspid regurgitation, VSD
112
Patient with fever, leukocytosis, and new onset murmur has what? What's the empiric treatment?
Viral endocarditis - treat with vancomycin and an aminoglycoside
113
What is the definition of hypertensive emergency? Treatment?
180/120; IV hydralazine, nitroprusside, or labetalol; to be considered an emergency, there must be evidence of end organ damage (if emergency, treat with IV meds. If urgency, treat with oral meds)
114
What would you expect to find on lumbar puncture in subarachnoid hemorrhage? When would you get lumbar puncture?
xanthochromia (bilirubin in CSF); order this with negative non contrast head CT but still high suspicion of subarachnoid hemorrhage
115
How do you diagnose an aortic dissection? Treatment?
Diagnose with CT angiogram or TEE; Type A (proximal to left subclavian, treat with surgery), Type B (distal to left subclavian ONLY), treat with beta blocker
116
Number one risk factor for peripheral artery disease? How to diagnose?
smoking, ankle brachial index (<0.9 = disease)
117
What is the first step for treatment of a PE? 2nd?
Give heparin, then get spiral CT
118
In what condition will you see medial malleolus ulcer?
venous insufficiency
119
How do you treat neurogenic shock?
IV fluids
120
What are the two greatest risk factors for stroke?
age and hypertension
121
What is amaurosis fugax? What condition does it indicate?
cholesterol plaque that embolisms through ophthalmic artery that causes transient curtain blindness; indicates TIA
122
Most common area of the brain to have a stroke?
middle cerebral artery
123
What artery could be affected with lower extremity signs of stroke?
ACA
124
What artery could be affected with upper extremity signs of stroke?
MCA
125
What part of the brain is Broca's area in? What artery supplies it?
left inferior frontal lobe, MCA
126
What part of the brain is Wernicke's area in? What artery supplies it?
temporal lobe (opposite side of hand of dominance); MCA
127
What disorder is associated with berry aneurysms?
autosomal dominant polycystic kidney disease
128
What is included in a post-stroke work-up?
1. carotid doppler
2. Echo
3. EKG
129
What is the most common cause of a lacunar stroke?
hypertension
130
What will a lacunar stroke affecting the thalamus (specifically VPL) present like?
pure sensory stroke
131
What will a lacunar stroke affecting the internal capsule present like?
pure motor stroke
132
What are the three ways to lower intracranial pressure?
1. hyperventilation
2. mannitol
3. elevated head of bed
133
Treatment of ischemic stroke?
within 3 hours -> tPA
| after 3 hours -> aspirin
134
Diagnosis of Tourette's? Treatment?
Diagnosis requires a phonic and motor tick for 1 year
| Treatment = clonidine
135
Symptoms of essential tremor? Treatment?
tremor with movement, better at rest, goes away with alcohol
| Treat with beta blocker
136
Symptoms of Fredreich's ataxia?
triad of scoliosis, hypertrophic obstructive cardiomyopathy, and dorsal column problems
137
What is Charcot's triad of multiple sclerosis?
scanning speech, internuclear ophthalmoplegia, intention tremor, nystagmus (SIIN)
138
How do you diagnose MS? What will you see on lumbar puncture?
MRI, will see periventricular plaques
| Lumbar puncture will show oligoclonal bands (IgG Ab)
139
What is the treatment of MS?
Disease-modifying - interferon
| Acute flares - steroids
140
What is the treatment of myasthenia gravis?
Pyridostigmine (ACh esterase inhibitor)
141
What is the ASHLEAF mnemonic for tuberous sclerosis?
```
A - Ashleaf spots
S - Shagreen patches
H - heart rhabdomyosarcoma
L - lung hamartomas
E - epilepsy from cortical tubers
A - angiomyolipoma in kidney
F - facial angiofibroma
```
142
What is Sturge Weber syndrome?
port-wine stains on face with retardation
143
What is the triad of VHL?
renal cell carcinoma, pheochromocytoma, cavernous hemangiomas of the brain
144
What are the symptoms of Brown Sequard syndrome?
ipsilateral paralysis, ipsilateral loss of pressure, proprioception, vibration, and touch, and loss of contralateral pain and temp
145
What are the symptoms of a lower motor neuron injury?
fasciculations, flaccid paralysis
146
What are the symptoms of upper motor neuron injury?
spastic paralysis, hyperreflexia
147
What is the treatment for BPPV?
meclazine
148
What is the triad of Meneiere's disease?
1. tinnitus
2. vertigo
3. hearing loss
149
What is the treatment for trigeminal neuralgia?
carbamazepine (sodium channel blocker)
150
What spinal tract is affected with tabes dorsalis? What is the treatment?
Dorsal columns - vibration, proprioception, pressure, touch
| Penicillin (tertiary syphilis)
151
Subacute combined degeneration is caused by what?
Vit B12 def/megaloblastic anemia
| dorsal columns problems as well as corticospinal tract problems (UMN injuries)
152
What malignancy is Hashimoto's thyroiditis associated with?
thyroid lymphoma
153
What disorder causes a painful thyroid following a URI? What is the treatment?
subacute/DeQuervain's thyroiditis
| Tx = NSAIDs/aspirin
154
Which thyroid cancer arises from the parafollicular C cells? What's the next best step?
medullary thyroid cancer
| Check for other aspects of MEN 2A/2B (like urine metanephrines for pheochromocytoma)
155
MEN 2A?
PPM = pheochromocytoma, hyperparathyroidism, medullary thyroid cancer
156
MEN 2B?
MMP = medullary thyroid cancer, marfinoid habitus/mucosal neuromas, pheochromocytoma
157
What is the first blood test to get with acromegaly?
IGF-1
158
If HTN with hypernatremia and hypokalemia, what do you want to check? What will the results tell you?
Renal to aldosterone ratio
If aldosterone is high and renin is low -> adrenal problem (Conn syndrome)
If renin is high and aldosterone is high -> renal artery stenosis or fibromuscular dysplasia
159
What are the three ways you can diagnose diabetes mellitus?
1. fasting glucose of >126 twice
2. random glucose reading of >200 with symptoms of polyphagia, polydipsia, polyuria, dehydration, weight loss
3. HgA1C > 6.5%
160
When is metformin contraindicated?
kidney failure and CHF
