IM mix UWQ - may31st 2021 Flashcards
(87 cards)
1
Q
anaphylactic reaction.
-> occurs seconds to minutes after initiation of transfusion due to massive histamine release
sym?
rx?
A
respiratory distress (eg, dyspnea, hypoxia) -> bronchospasm
angioedema
hypotension
rx: IM Epi
IgA def inc risk
2
Q
Acute hemolytic transfusion reaction from ABO incompatibility
sym?
A
- > hypotensive
- > fever,
- > flank pain
- > hemoglobinuria.
3
Q
Febrile nonhemolytic transfusion reaction
sym?
A
most common adverse reaction to transfusion
- > within 1-6 hours of transfusion.
- > leukocytes release cytokines
- > transient fevers, chills, and malaise.
NOT resp distress, shock
4
Q
hepatic encephalopathy triggered by: recent initiation diuretics
-> lead to low Intravascular voln
rx?
A
K repletion + lactulose, rifaximin
neomycin if unable to tolerate rifaximin
5
Q
fibromyalgia (FM)
rx?
A
1st rx: Tricyclic antidepressants (eg, amitriptyline)
2nd line:
-> Serotonin
- > norepinephrine reuptake inhibitors (eg, duloxetine, milnacipran)
- > pregabalin
6
Q
MG
moa?
A
- > autoantibodies (originating in the thymus) directed against nicotinic acetylcholine receptors at the NMJ
- > decrease available receptor available
- > impaired action potential propagation and muscle weakness.
7
Q
Lambert-Eaton syndrome (LES)
moa?
A
decreased acetylcholine release from the presynaptic terminal of motor neurons
8
Q
Achalasia
moa?
A
degeneration of neurons within the myenteric plexus
uncoordinated peristalsis and failed relaxation of the lower esophageal sphincter (LES)
9
Q
Norovirus
etio: chronic diarrhea in immunocompromised patients (eg, HIV, solid-organ transplant)
sym?
A
symptoms are typically brief (eg, 1-2 days)
10
Q
Neisseria gonorrhoeae
sym?
A
- > pharyngitis
- > pharyngeal edema, erythema –> versicupustular rash at distal ext (2-10 lesions)
- > nontender cervical LAD
- > pelvic inflammatory disease
rx: 3rd gen cephalosporin IV
dx: screen for chlamydia
11
Q
EBV
CMV
sym?
A
tender cervcial LAD
12
Q
min ventilation = ?
A
min vent= respiratory rate x tidal volume
-> inc ventilation
13
Q
acute viral hepatitis
-> fever, jaundice, indirect hyperbilirubinemia
lab?
A
inc AST, ALT >1000 U/L
HAV:
-> etio: day care
- Budd-chiari syndrome:
- -> RUQ pain, ascites, HSM
- rupture hepatic adenoma: OCP
- > RUQ pain, hemorrhagic shock, fever, liver enz elevated, anemia, hypotension, tachycardia
14
Q
MM
RCC
often spread to spine
XR?
A
pure Osteolytic lesions
ALP normal
15
Q
acne mechanica
moa?
sym?
A
pressure or friction is applied
Recurrent mechanical pressure damages pilosebaceous follicles
-> obstruction, comedone formation, and acneiform lesion
16
Q
Irritant contact dermatitis
sym?
A
erythema, edema, vesicles, bullae
- > lichenification (in chronic cases),
- > burning or stinging sensation
affects exposed skin (eg, hands);
-> axillary involvement is uncommon.
17
Q
acute calcium pyrophosphate dihydrate (CPPD) crystal arthritis (pseudogout)
XR?
A
- > onset at age >65
- > monoarticular arthritis
- > chondrocalcinosis (calcification of articular cartilage)
- > inflammatory effusion (15,000-30,000 cells/mm3)
- > rhomboid-shaped
- > weakly positively birefringent CPPD crystals.
18
Q
Plantar fasciitis
sym?
A
subacute to chronic pain on the plantar surface of the hindfoot.
-> Inflammatory features
19
Q
acute exacerbation of COPD (AECOPD)
lab?
rx?
A
Noninvasive Positive pressure ventilation:
- > decreases work of breathing
- > improves alveolar ventilation
- > decrease in RR and (PaCO2),
- > with an increase in tidal volume, minute ventilation, and arterial oxygen tension (PaO2).
20
Q
Invasive mechanical ventilation
indicated in?
A
more severe condition
hypercapnic patients
- > poor mental status (eg, somnolence, lack of cooperation, inability to clear secretions)
- > hemodynamic instability
- > profound acidemia (pH <7.1).
21
Q
colon ca screening earlier
etio?
dx?
rx?
A
hx abdominal radiation -> 4 times the risk of colon ca
- > Lynch syn: germline DNA mismatch repair gene –> colorectal ca, endometrial ca, ovarian ca
- > FAP
dx: colonscopy
rx: ASA/ NSAIDS, high fiber diet
22
Q
Age-related macular degeneration (AMD)
vision?
A
- > progressive and bilateral loss of central vision.
- > Peripheral fields maintained
exam:
- > drusen deposits
- > degeneration and atrophy of the central retina (macula)
- >retinal pigment epithelium
- >Bruch’s membrane
- > choriocapillaries.
23
Q
Tumor lysis syndrome
induce:
- > AKI
- > electro imbalance
- > cardiac arrhythmia
lab?
etio?
rx?
A
cytotoxic chemotherapy or immunotherapy
lab:
inc PO4, K, UA
dec Ca
rx: IV fluid
- > allopurinol, rasburicase, febuxostat
24
Q
Leucovorin
moa?
rx?
A
rx:
methotrexate or other folic acid antagonists
-> prevent adverse events from damage to rapidly dividing cells in the gastrointestinal system and liver.
25
N-acetylcysteine
rx?
moa:
antioxidant precursor to glutathione
rx:
acetaminophen poisoning and acute liver failure.
26
Raynaud phenomenon
common related to?
african american
sign?
lab?
rx?
CREST syndrome
-> vasospastic angina
Pulmonary arterial hypertension (PAH)
--> hyperplasia intimal smooth muscle layer
Asso with: interstitial lung disease
sign:
-> Left parasternal lift, right ventricular heave
-> Loud P2
-> right-sided S3
-> Pansystolic murmur of tricuspid regurgitation
JVD, ascites, peripheral edema, hepatomegaly
lab:
- > anti-Scl 70 topoisomerase 1 ab (diffuse)
- > anti-RNA polymerase III ab (diffuse)
- > anticentromere ab ) limited)
rx: CCB
27
resting tremor
dx?
rx?
PD
- > improves with action
- > 5-7 Hz freq
- > inv one hands first than bilateral hands
rx:
Trihexphenidyl (antiAch)
Younger age <65 yo
28
action tremor
dx?
rx?
essential tremor with action
rx:
beta blockers + primidone ( anticonvulsants)
clonazepam (lims)
29
lymphoma
sym?
mao: BM infiltration dx
- > generalized lymphadenopathy
- > splenomegaly,
- > constitutional symptoms
30
first-line treatment for chemotherapy-induced nausea?
Serotonin (5HT) receptor antagonists (eg, ondansetron)
-> target 5HT3 receptor
31
Rx?
| help reduce motion sickness
primary anticholinergic
-> treat vomiting: scopolamine
32
refractory vomiting
rx?
Dopamine antagonists such as metoclopramide and prochlorperazine
33
promote gastrointestinal motility
rx?
Erythromycin
- > antibiotic, motilin receptor agonist
- > help treat nausea secondary to gastroparesis.
34
organophosphate poisoning
sym?
antidopt?
Muscarinic:
```
Diarrhea/diaphoresis
Urination
Miosis
Bronchospasms, bronchorrhea, bradycardia
Emesis
Lacrimation
Salivation
```
Nicotinic:
muscle weakness, paralysis, fasciculations
rx:
- > Atropine reverses muscarinic symptoms
-> Pralidoxime reverses nicotinic and muscarinic symptoms (administer after atropine)
35
anticholinergic toxicity
antidopt?
sym:
- > flushing, mydriasis, anhidrosis, fever, urinary retention
physiostigmine
| -> AchEase inhibitor
36
Primary biliary cholangitis
sym:
-> insidious onset of fatigue & pruritus
- > Progressive jaundice, hepatomegaly, cirrhosis
- > Cutaneous xanthomas & xanthelasmas
lab?
rx?
asso with?
lab: Antimitochondrial antibody
rx: Ursodeoxycholic acid (delays progression)
inc risk:
-> Malabsorption, fat-soluble vitamin deficiencies
- > Metabolic bone disease (osteoporosis, osteomalacia)
- > Hepatocellular carcinoma
37
Ascending cholangitis is associated with primary sclerosing cholangitis (PSC)
asso with?
asso with:
| IBD, UC, CRC
38
controlling confounding
allow ?
randomization distribution of all potential confounders even
39
Poor sleep hygiene
rx?
rx:
- >avoiding late afternoon naps
- > nicotine, caffeine
- > alcohol, and heavy meals in the evening.
40
glucagonoma, a pancreatic neuroendocrine tumor
sym?
-> unregulated release of glucagon >500pg/ml
-> weight loss
-> Necrolytic migratory erythema: erythematous papules
large, indurated plaques with central clearing
-> Diabetes mellitus/hyperglycemia
Gastrointestinal symptoms
41
humoral hypercalcemia of malignancy (HHM) due to?
parathyroid hormone-related protein (PTHrP) by malignant cells
squamous cell
renal + bladder, breast, ovarian ca
lab:
- > dec PTH
- > inc PO4 excretion
- >
42
breast, MM
lab?
osteolysis inc
- > dec PTH
- > dec vit D
43
sarcoidiosis
lymphoma
lab?
inc ca absorption
-> inc 1,25 OHD3
- > dec PTH
- > inc PO4
-> inc Vit D
44
Milk-alkali syndrome
lab?
excessive Ca intake
- > hypercalcemia
- > met alkalosis
- > AKI
- > HCO3 inc
45
AIN
lab?
sym?
- > acute renal failure
- > fever, disseminated maculopapular rash
- > a recent history of para-aminobenzoic acid analogue antibiotic (sulfonamide)
- > white blood cell (WBC) casts
- > esinophiluria
sym:
arthralgias
sym appears after 5 days
46
Renal vein thrombosis (RVT) + other thromboembolism
biopsy?
moa?
sym?
Bx:
membranous glomerulopathy
moa:
loss antithrombin III
inc urine
increase risk of venous / arterial thrombosis
47
AR
dx?
dx: echocardiogram
** diastolic / continuous murmur are pathologic !!!
sound:
early and gradually decreasing (decrescendo) diastolic murmur @ left sternal border 3-4th ICS
-> begins immediately after A2 (aortic component of the second heart sound)
48
how to increase PPV testing?
PPV = TP/TP + FP
dep on prevalence in the POPULATION
-> increase dx prevalence -> more TP, few TN
49
transverse myelitis
etio?
sym?
HIV
sym:
- > sensory level loss
- > flaccid paralysis
- > NO fever
- > acute Urinary retention
- > motor wkness
50
scleroderma renal crisis
hist?
diffuse :
| schistocytes + thrombocytopenia
51
Burr cell (echinocytes) / spur cell (acanthocytes)
indicate?
RBC
etio: liver disease / ESRD
52
howell jolly bodies
indicate?
basophilic remnants nucleus -> splenectomy / functional asplenia
53
target cell
ind?
RBC -> bull eye appearance
thalassemia / Chronic liver dx
54
contact lens asso keratitis
dx?
pseudomonas/ serratia keratitis
rx: ER
sym:
corneal perforation, scarring, permenant vision loss
55
episcleritis
etio?
sym?
sym: localizes / patchy
mild pain/ discharge
asso with:
RA
56
RRR = (rate control - rate Rx) / rate control
rate control = #/total population of control
rate rx= #/ total pop intervention
57
Sporotrichosis
sym?
rx?
Sporothrix schenckii is a fungus found in decaying vegetation and soil.
sym:
- > A papule forms at the site of entry and soon ulcerates, draining an odorless, nonpurulent fluid.
- > Several proximal lesions may develop along lines of lymphatic drainage
rx: itraconazole
58
ARDS
PaO2 <60mmHg (hypoxia)
PaO2 > 90 (hyperoxia)
Adjusting Oxygenation!!!
rx?
etio:
sepsis, lung injury, trauma, pancreatitis
moa: intrapulmonary shunt effect
- > neutrophil lung inflammation
--> dec lung COMPLIANCE!! -> inc work breathing
--> severe V/Q mismatch: severe hypoxemia
--> inc hypoxic pul vasoconstriction: inc RV afterload + acute Pul HTN
--> dec SVR: reduced after load
PEEP improve O2 by propping alveoli OPEN
Increase PEEP >10cm H2O -> reduce shunting
risk: barotrauma
** FiO2 <60% to avoid potential o2 toxicity --> PaO2 > 90 mmHg
59
ARDS
adjust ventilation!!!
PaCO2/ Ph --> inc/ dec
inc PaCO2 + Ph <7.25
--> resp acidosis
rx: inc: RR and TV
* * PaCO2 dec + Ph >7.45
- -> resp alkalosis
rx: dec TV, dec RR
60
multiple sclerosis
sym?
CSF?
-> neurologic deficits disseminated in space and time --> eg, trigeminal neuralgia, spastic lower limb paralysis, left upper limb sensory loss
CSF:
-> oligoclonal bands
61
HIV prophylaxis?
1. PCP: CD4< 200/mm3
- > TMP-SMX
2. toxoplasmosis:
- > TMP-SMX
3. Primary prophylaxis against MAC
- > (azithromycin) is no longer required.
--> No other primary prophylaxis is routinely given
-> patients in Histoplasma-endemic areas with CD4 counts ≤150/mm3 given prophylactic itraconazole.
62
Mixed cryoglobulinemia associated with hepatitis C
sym?
- > immune complex deposition in small blood vessels, -> endothelial injury and end-organ damage.
- > palpable purpura, arthralgias, and glomerulonephritis
63
porphyria cutanea tarda
moa?
sym?
moa:
inhibit uroporphyrinogen decarboxylase
sym:
- > abdominal pain and neuropsychiatric manifestations (eg, psychosis, neuropathy)
- > photosensitivity with blisters
RF:
HCV, estrogen, Etho
rx:
phlebotomy
hydrochloroquine
64
Laxative abuse
lab?
hypotension, hypovolemia
eg. bisacodyl, senna, glycerol
- > for constipation ( GI loss)
65
Diuretic abuse
lab?
lab:
- > hyponatremia, and hypokalemia
- > Urinary sodium and potassium will be elevated ( cuz inc excretion)
66
CMT diarrhea
rx
loperamide/ diphenoxylate -atropine
IV fluid and electrolyte repletion
67
pancreatitis related steatorrhea
rx ?
pancrelipase
68
warfarin-induced skin necrosis
moa?
sym?
moa:
-> Warfarin inhibits production of vitamin K–dependent clotting factors II, VII, IX, and X, pn C, pn S
sym:
- > transient hypercoagulable state.
- > increases the risk for venous thromboembolism and skin necrosis,
69
Factor V Leiden mutation
sym?
- > risk for venous thromboembolism (deep venous thrombosis or pulmonary embolism)
- > increases the risk for cerebral, mesenteric, and portal vein thrombosis
70
upper GI bleeding with AMS
rx?
prevent aspiration --> endotracheal intubation
rx: prophylactic ab + octreotide
71
spontaneous bacterial peritonitis
| dx?
diagnostic paracentesis
72
polymyalgia rheumatica (PMR)
sym?
asso with?
lab?
rx?
-> Age >50
Subacute-to-chronic (>1 month) pain in the shoulder and hip girdles
- > asso with: GCA
- > Morning stiffness lasting >1 hour
- > Constitutional symptoms (eg, malaise, weight loss)
- > Elevated ESR >40 mm/h
- > elevate CRP
rx:
low dose glucocoticoids
73
delirium
rx?
inc risk for?
agitation
rx:
haloperidol
risk : cognitive decline
74
NNT = ?
ARR= ?
1/ ARR
ARR = Rate control - Rate rx
```
eg. 0.1 = 0.16- x
x = 0.06 rate Rx
Rate rx = # inf/ n
0.06 = 12 / n
n = 200
```
75
bronchiolitis obliterans
moa?
proliferative narrowing med + small bronchioles
asso with:
Rheumatologic dx
76
Hodgkin lymphoma CMT/ RT
inc risk?
- > Secondary CA: radiation exposure -> hema Ca
| - > CVD
77
bact meningitis
ICP
etio?
rx?
MC:
-> step pn, Neisseria meningitis, listeria
- > GN rods
rx: VNC ( Ceph resistant) + AMP (listeria) + cefepime (4th gen cover most bact + pseudomonas)
78
lights criteria?
1. pleural fluid Pn/ serum pn ratio >0.5
2. pleural LDH/ serum LDH > 0.6
3. pleural fluid LDH > 2/3 upper limit
exudates:
- > infection
- > CA
- > RA
79
MS
heart sound?
echo?
risk?
rx?
dx:
-> Opening snap with middiastolic rumble at the apex
- > Echocardiography: ↑ transmitral flow velocity
- -> irregular irregular rhythm + absent P wave ( AFib)
- > Lt atrial dilation --> acute decompensated HF
risk:
higher thrombogenic risk
rx: anticoagulants
80
addison dx
lab?
primary: autoimmune adrenalitis (TB, histoplasmosis), inf, Ca
-> dec aldo, dec cortisol (hypoglycemia) + peripheral eosinophilia
-> Increase ACTH
XR: miliary TB
sym: inc all 3 layers (adrenal cortex)
- > hypovolemia, hyperkalemia, hypoNa (( dec aldo))
- > hyperpigmentation
secondary (central axis ): chronic glu rx, infiltrative dx (sarcoidosis)
- > dec cortisol, dec ACTH
- > normal ALDO
81
Takayasu arteritis
moa?
chronic vasculitis affects aorta
-> cell -mediated inflammation
82
seperation anxitey dx
asso with?
somatic sym + functional impairment
83
Tardive dyskinesia
sym?
rx?
abnormal involuntary movements of the face, lips, tongue, trunk, or extremities result of prolonged exposure to antipsychotic medication.
rx: causative medication should be tapered and discontinued.
** akathisia: restlessness, inability to sit still --> rx: Beta blocker
84
Small cell lung Ca
sym?
inc ACTH ectopic:
- > hypercortisolism
- > WG, hyperglycemia
85
CKD -> IDA
rx?
microcytic anemia -> EPO + iron IV
-> IDA is the most common cause of inadequate response to ESAs in patients on dialysis.
86
Sjögren syndrome
autoimmune dx : lymphocytic inflammatory infiltrate exocrine glands
sym?
dx?
exocrine:
-> Keratoconjunctivitis sicca
-> Dry mouth, salivary hypertrophy
Xerosis
extraglandular:
-> raynaud phenomenon
dx:
+ anti-Ro (SSA), + anti-La (SSB)
-> salivary gland bx with focal lym sialoadenitis
87
age-related sicca syndrome (ARSS)
dx?
sym:
- > older women with dry eyes and mouth
- > exorcine output from lacrimal and salivary glands decline with age
- > atrophy , fibrosis, ductal dilation of the glands
- > impaired vision
