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PGY-2 > Inpatient Medicine > Flashcards

Inpatient Medicine Flashcards

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1
Q

Anti-Hu Antibodies

A

small cell lung carcinoma

encephalopathy/neuropathy

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2
Q

Anti-NDMA

A

encephalopathy

autoimmune or paraneoplastic

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3
Q

Hutchinson’s sign

A

vesicle on nose

may indicate ophthalomogical zoster

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4
Q

Leimerre Syndrome

A
  • septic emboli in IJV
  • sore throat, tonsillar abscess
  • fusobacterium
  • thrombophlebitis, septic pulmonary emboli, septic arthritis
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5
Q

Shingles treatment timeline

A

start if less than 72 hour or new lesions erupting

otherwise limited benefit

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6
Q

VAP

A

48-72h after endotracheal intubation

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7
Q

Definitive Infectious Endocarditis

A

2 major
1 major + 3 minor
5 minor

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8
Q

Saddle Nose in GPA

A

bone and cartilage destruction

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9
Q

Osler Nodes

A

subcutaneous violet nodules on pads of fingers and toes

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10
Q

Rhythm complications of endocarditis

A

AV or complete block, or BBB

due to paravalvular extensions

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11
Q

Janeway Lesions

A

nontender erythematous macules on palms and soles (clots in capillaries)

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12
Q

Hep C Antibody Positive w/ Positive RNA

A

acute or chronic infection

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13
Q

Hep C Antibody Positive w/ Negative RNA

A

cleared infection or false positive

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14
Q

Classic Leukomid Reaction

A

WBC more than 50k, early precursors

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15
Q

HAP- Risk Factors for MRSA

A
  • IV antibiotic use in last 90 days
  • Hospital w/ more than 20% MRSA isolates
  • High risk for mortality
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16
Q

Acute DHF, preload reduction

A

diuretics

nitrates

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17
Q

When to consider cardioverter-defibrillator (ICD) in HF

A

EF at or below 35%

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18
Q

HF in African americans, consider…

A

hydralazine isosorbide dinitrate

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19
Q

Cardiac resynchronization therapy in HF

A

ef below 35% + QRS more than 120 + LBBB

or 150 w/o LBBB

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20
Q

Causes of hypovolemic hyponatremia - RENAL

A

Nephropathies

ATN recovery

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21
Q

Causes of hypovolemic hyponatremia - NONRENAL

A

Dehydration

Vomiting/Diarrhea

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22
Q

MEN type 1

A

parathyroid, pancreatic islet cell tumors, pituitary tumors

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23
Q

Men type IIA

A

MTC
pheo
hyperparathyroidism

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24
Q

Men type IIB

A

MTC
mucosal neuromas
marfonid like habitus
pheo

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25
Aspergillus- clinical syndromes
allergic bronchopulmonary aspergillus pulmonary aspergilloma (fungus ball) invasive aspergillus
26
air cresent sign =
aspergillus fungal ball
27
Aspergillus Rx
IV amph or vori
28
Cryptococcus Rx
fluconazole for mild | severe: amph+flucytosine x 2 weeks then fluconazole
29
Cryptococcal Meningitis
india ink w/ encapsulated organisms | latex agglut w/ cryptococcal antigen
30
Pigeon Dropings
cryptococcus
31
Histoplasmosis Rx
PO itraconazole | Amph B if severe
32
Differential of High Ferritin
HLH - hemophagocytic lymphohistoryctosis Hemochromatosis Still's Disease
33
Thrombotic Thombocytopenia Purpura
Fever, AMS, thrombocytopenia, AKI, MAHA
34
Most common form of erythema multiforme
HSV
35
Hepatopulmonary Syndrome
platypnea orthodeoxia dx w/ echo w/ bubble to see transplumonary shunting
36
treatment myxedema coma
IV steroids | IV synthroid
37
thyroid storm treatment
propranolol PTU or methimazole steroids
38
Diagnosis of Cryptococcoal Pneumonia
culture in immunocompetent persons | serum antigen in immunocompromised
39
Adrenal Incidentaloma workup
- BMP for glucose, potassium - Low dose cortisol stimulation test - consider PRA/PAC if HTN or hypokalemia
40
Erhlichiosis tick
lone star tick
41
Erhlichiosis possible lab abnormalities
leukopenia, thrombocytopenia transaminitis peripheral blood smear- buffy coat
42
rocky mountain spotted fever rash
maculopapular 4 days following exposure progresses to petechiae or purpura starts and wrists and ankles, spreads centrally and to palms and soles
43
E/e' ratio
greater than or equal to 15 in DHF
44
E/A
greater than 2
45
hematuira
greater than 3 RBC
46
Loop diuretic side effects
OH DANG | Ototoxicity, hypokalemia, dehyadration, allergy (sulfa), Nephritis (AIN), Gout
47
Mentzer Index
MCV/RBC | more than 13 - IDA
48
myxedema coma treatment
IV synthroid | IV steroids
49
HIT treatment
Direct thrombin inhibitors | Factor Xa inhibitor
50
Contraindications to TIPS
pulmonary HTN, heart failure
51
Main Indications for TIPS w/ data that shows efficacy
recurrent/uncontrolled variceal bleeding | refractory ascites
52
Hydralazine + CAD/Angina
increases arterial vasoconstriction --> worsening chest pain | use in combination with nitrate
53
Susceptibility of Clindamycin
check if organism is susceptible to erythromycin
54
Autoimmune Pancreatitis- IgG
IgG4
55
transmission of hepatitis B and C
B: paraenterally, sexually, perinatal C: parenterally >>> sexually + perinatal
56
Acute Liver Failure Definition
coagulopathy + encephalopathy
57
When to fluid restrict cirrhortics
if sodium less than 130 (dilutional hyponatremia) and/or ascites
58
Cirrhosis, ratio of spirolactone and lasix
40mg:100mg
59
Indications to discontinue BB in cirrhosis
SBP less than 90 Na less than 120 AKI
60
Treatment of Varices
IV antibiotics, ceftriaxone | IV octreotide
61
Variceal Prevention with beta blockers
primary and secondary prevention | window period is with mod-to-large varices w/o bleeding
62
SBP Organisms
E coli Strep Pneumo Klebsiella
63
SBP Diagnosis
PMN > 250
64
SBP Treatment
third generation cephalosporin | albumin to prevent HRS on d1 and d3
65
Stigmata of Liver Disease
caput medusa spider angiomas gynecomastia palmar erythema
66
Lung Cancer- Common Metasasis
Brain Bone Adrenal Glands Liver
67
Nerve Palsies associated with lung cancer
phrenic nerve: hemidiaphragmatic paralysis | Recurrent laryngeal nerve: hoarseness
68
Horner Syndrome
apical tumor invading CERVICAL SYMPATHETIC chain Anhidrosis (no sweating) Miosis Ptosis
69
Pancoast Tumor
Tumor of C8, T1-T2 nerve roots Shoulder/arm pain, UE weakness +/- Horner Syndrome
70
Paraneoplastic Syndromes associated with lung cancer
Small cell: ACTH, SIADH | NSCLC/Squamous: PTH
71
Hypertrophic pulmonary osteoarthropathy
bone pain, associated with SCC
72
Eaton-Lambert Syndrome
small cell lung cancer | similar to MG, muscle weakness, decreased deep tendon reflexes
73
Risk Factors for Pancreatic Cancer
Smoking >>> Chronic Pancreatitis Alcohol
74
Syndromes associated with Pancreatic Cancer
Migratory thrombophlebitis | Courvoisier sign
75
Aldosterone: what causes excretion, function
- Stimulated by angiotensin (RAAS) - Acts on distal tubules and collecting ducts - Reabsorb Na - Excretion of K
76
RAAS activated by
low sodium | low blood pressure (decreased RBF)
77
ACE
converts angiotensin I to angiotensin II
78
Plasma Osmolality in DI vs Primary Polydipsia
PP: 255-280 DI:280-310
79
Most common cause of nephrogenic DI
lithium use
80
Cushing Disease =
ACTH-secreting adenoma of pituitary high cortisol, high ACTH, no suppression w/ low dose, suppression w/ high dose
81
Low Dose Dexamethasone Testing
initial screening test for CS 1mg dex at 11pm; measure cortisol next morning at 8am Normal response is cortisol <5 High normal = CUSHING SYNDROME
82
High Dose Dexamethasone Testing
8mg after 11pm, measure cortisol at 8am low cortisol = Cushing Disease normal/high = Adrenal Cushings or Ectopic ACTH
83
Anterior MI- leads and vessel
V3,V4 | LAD
84
Lateral MI- leads and vessel
I, avL, V5-V6 | left circumflex
85
Inferior MI- leads and vessel
II, III, avf | RCA > LCX
86
Septal MI- leads and vessel
VI, V2 | LAD
87
Normal Axis in EKG
positive in I and AVF
88
LAD in EKG
positive in I, negative in AVF
89
RAD in EKG
negative in I, positive in AVF
90
Extreme RAD in EKG
negative in I and aVF
91
Acute onset atrial fibrillation IV medications
metoprolol 5mg, repeat x1 | dilt 10mg
92
P2Y12 Blockers in STEMI
PCI- ticagrelor or prasugrel Fibrinolytics- clopidogrel No intervention- ticagrelor
93
DAPT following Stents
DES: 1 year | Bare Metal: 1 year for ACS, 1 month for non-ACS
94
Sensitivity, mnemonic
SNOUT: | high sensitivity rules out a disease
95
Specificity, mnemonic
SPIN: high specificity to rule IN a disease
96
LIver Disease with extremely elevated AST, ALT ddx
Viral hepatitis Toxins Shock Liver Autoimmune
97
Albumin/Cr Ratio in DM
less than 30 - normal A1 A2 - 30-300 A3 300+
98
Non di hydropyridine CCB
verapamil, dilt
99
Thiazide and CKD
ineffective when GFR less than 30
100
ACEI and Cr
initial 30% decrease
101
HIV screen in CAP pts
all pts 13-75
102
MM Symptoms
``` CRAB HIP Hypercalcemia, renal failure, anemia, bone lesions or bence jones proteinuria Hyperviscotity Infection Plasmacytosis ```
103
CHADSVASC - when to consider anticoag
1 - consider (unless just female) | 2 - recommend
104
Wernicke encephalopathy triad
delirium oculomotor disturbances ataxia
105
Thiamine def can cause
neuropathy cardiomyopathy Wernicke's
106
Choice for asymptomatic HTN
PO hydra 10 PO clonidine .1 mg PO lasix
107
HTN Emergency- End organ damage
``` pulm edema encephalopathy MI Retinopathy Renal failure ```
108
ACS therapy
MOAN: nitro, aspirin, o2, morphine | consider BMOAANS: bb, ACEI, statin
109
cardiac tamponade
hypotension pulsus paradoxus elevated JVP
110
Spirolactone in HF
Systolic, Class III or IV | CI in renal failure
111
BB and heart failure
reduce mortality w/ POST MI heart failure
112
Hypervolemic Hyponatremia - RENAL
ARF NS CRF
113
Hypervolemic Hyponatremia - NONRENAL
CHF Ascites/CIrrhosis (increased RAS/Aldo)
114
Causes of Euvolemic Hyponatremia
``` SIADH Addison's Hypothyroidism Beer Potamania Psychognic Polydypsia HCTZ/meds/diuretics ```
115
Hyperparthyroidism symtpoms
stones - nephrolithiasis bones - aches, pains, osteitis fibrosa cystica groans - muscle pain, weakness, pancreatitis, PUD, gout, constipation psych overtones - fatigue, dperesseion etc
116
Diverticulosis imaging
barium enema
117
Diverticulitis imaging
CT w/ contrast
118
Acute Mesenteric Ischemia imaging
mesenteric angiography
119
CAP diagnosis
new infiltrate + 2 symptoms consistent with PNA
120
Prinzmetal
coronary vasospasm transient ST elevation treat w CCB
121
Spinal Stenosis
narrowing of spine due to deg changes neurogenic claudication broad base gait
122
neurogenic claudication
leg buttock pain worse w/ walking relieved with sitting improves with forward flexion/leaning on grocery cart
123
SBP Prevention
Cipro weekly or nofloxacin daily
124
Virchow's triad
endothelial injury venous stasis hypercoagability
125
MGUS diagnosis
less than 10% plasma cells | no end organ damage
126
MM diagnosis
10%+ plasma cells + 1 of the following - bone lesions - M protein in urine - M protein in serum
127
MM Ig Spike
IgG or IgA
128
Waldenstrom's Macroglobulinemia
malign prolif of plasmacytoid lymphocytes IgM para protein hyperviscoity
129
Most common pancreatitis complications
- necrosis - pseudocyst - hemorrhagic pancreatitis
130
Grey Turner's Sign
flank ecchymoses, pancreatitis
131
Cullen's Sign
periumbilical ecchymoses, pancreatitis
132
Fox's Sign
ecchymosis of inguinal ligament, pancreatitis
133
Thiamine supplementation in hospitalized alcholics
100mg daily | thiamine prior to IV infusion to prevent precipitation of Wernicke
134
Aortic Stenosis symptoms
syncope angina DOE
135
Aortic Stenosis Murmur
mid SEM, RSB, radiates to right neck | early peaking less severe, late peaking more severe
136
Diastolic Heart Failure on Echo
E/e' more than 15 (elevated LAP, elevated PCWP) | E/e' more than 8 and BNP >200
137
CRP in monitoring IBD
associated more with TRANSMURAL than mucosal inflammation
138
Boerhaave's Syndrome
acute chest pain following vomiting (esophageal perforation)
139
Peritonitis vs Renal Colic
lying still vs writhing around
140
achalasia
LES doesn't relax
141
abnormal ABI
less than 0.9
142
severe seborrheic dermatitis with what diseases
HIV | PD
143
Ecthyma gangrenosum
Pseudomonas infection | hemorrhage, ulceration, necrosis
144
Duke Major Criteria
1) Positive blood cultures | 2) Echo w/ vegetation, abscess, dehiscence of prosthetic valve or new valvular regurg
145
Minor Duke Criteria
``` Predipsoition Fever Vascular Phenomena Immunologic Phenomena Microbiologic Evidence ```
146
IE Immunologic phenomena
GN osler nodes roth spots RF
147
IE Vascular phenomena
``` arterial emboli pulmonary infarcts mycotic aneurysm ICH conjunctival hemorrhage Janeway lesions ```
148
Time for HIV EIA to become positive
3 weeks
149
Hydromorphone, ratio to morphine
1mg = 7mg morphine
150
Tramadol risks
seizures, serotonin syndrome
151
When to treat asymptomatic HTN
multiple readings >180/110
152
anemia of chronic dz
hepcidin-induced block on iron release from stores
153
Acute Mesenteric Ischemia Causes
- arterial thrombus (arteriosclerosis) - Venous thrombus (hypercoagulable) - arterial occlusion from emboli - hypoperfusion (blood loss, CHF)
154
AMI treatment
fluid resuscitation, NG tubes, IV antibiotics | embolectomy + thrombolytic agent
155
CMI - classic age
60
156
CMI - vessels
celiac trunk SMA IMA
157
CMI - symptoms
post-prandial pain | weight loss, N/V diarrhea
158
Kerley B lines
thin pulmonary opacities caused by fluid in the interstitium of the lung
159
anterior mediastinal mass
lymphoma thyoma thoracic aorta teratoma
160
Choledocholithiasis
gallstole impacted in CBD | ERCP, no antibiotics
161
Diverticulitis- antibiotics
GN + anerobes | Cipro + flagyl
162
Pulm HTN pathophys
increased pulmonary arterial pressure leads to RV dysfxn
163
Diagnostic Criteria for Pulm HTN
pulm arterial pressure >25
164
HIT - antibody
IgG aginst PF4 on platelets
165
Drugs associated with interstitial lung disease
amiodarone nitrofuratonin izoniazide
166
When to consider measuring alpha-1 levels
less than 50 with emphysema
167
COPD - acid base status in long term
respiratory acidosis w/ metabolic alkalosis as compensation
168
Criteria for oxygen supplementation in COPD
o2 less than 88% | or PaO2 55
169
Budd-Chiari Syndrome
occlusion of hepatic venous outflow --> ischemia
170
Bigeminy
sinus beat followed by PVC
171
trigeminy
two sinus beats followed by PVC
172
couplet
two PVCs
173
Pericarditis - EKG
diffuse ST elevation and PR depression
174
Types of Stroke
- Embolic - Thrombotic - Lacunar Stroke
175
Embolic stroke
embolis from heart w/ a fib | paradoxical (blood clots in peripheral veins, go through ASD/PFO or pulm AVF)
176
Thrombotic Stroke
atherosclerotic lesions in large arteries
177
Lacunar Stroke
small vessel thrombotic disease (basal ganglia, thalamus, brain stem, etc) HTN is main RF
178
Polymyalgia Rheumatic Symptoms
hip and shoulder muscle pain normal muscle strength +/- systemic symptoms, joint pain
179
Pre-renal AKI urine analysis
``` hyaline cases BUN/Cr ratio >20:1 Fena <1% Urine osm >500 Urine Na <20 ```
180
Intrinsic Renal AKI urine analysis
Bun/cr <20:1 FeNa 2-3%+ Urine osm 250-300 Urine Na >40
181
Causes of Intrinsic Renal Disease
Tubular (ATN) Glomerular Vascular (RAoccl, TTP, HUS) Intersitital (AIN)
182
Causes of ATN (two categories)
Ischemic (severe decline in renal blood flow) | Nephrotoxic
183
ATN phases
onset oliguric phase diuretic phase recovery phase
184
Muddy brown casts
ATN
185
RBC casts
glomerular disease
186
WBC casts
pyelo or AIN
187
Polyarteritis Nodosa
vasculitis associated with hep B, HIV, drug reactions | often involves nervous system, GI tract (bowel angina)
188
Pancolitis Ddx
IBD Infectious - E coli Ischemia - hypotension or drugs
189
Vasculitis (small vs medium vs large)
Small: Palpable Purpura Medium: Thrombosis/Infarction Large: Pulseless
190
Factors for Complicated UTI
Flank pain, CVA tenderness | Systemic symptoms- fever, chills
191
Central Vein Stenosis
vein dilation --> chronic edema, recurrent infections after HD catheter placement

PGY-2 (21 decks)

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