Master the Boards Flashcards
(270 cards)
1
Q
6 drugs/drug classes that are known to cause major allergic reactions: SJS, AIN, hemolysis, thrombocytopenia, etc
A
- Penicillins
- Sulfa drugs
- Rifampin
- Allopurinol
- Quinidine
- Lamotridine
2
Q
in which patients with ITP would you give IVIg over prednisone?
A
bowel or brain bleeding (ex- symptoms of melena)
3
Q
a platelet type of bleeding with a normal platelet count should raise suspicion of…
A
Vonwillebrand’s disease
4
Q
What drug do you not give to someone with vonwillebrands?
A
Aspirin: unlocks VW disease, many ppl w VWD have enough functioning VWF to achieve hemostasis under normal conditions, the added inhibitory effect of ASA will result in bleeding
5
Q
what is c14 serotonin release assay used for?
A
heparin induced thrombocytopenia
6
Q
initial tx of vonwillebrands disease?
A
Desmopressin: causes a release of endothelial stores of of factor 8 and VWF
7
Q
treatment of hemophilia A: severe vs mild?
A
Mild= desmopressin Severe = recombinant factor VIII
8
Q
what is the most accurate diagnostic test for heparin induced thrombocytopenia?
A
Platelet factor four antibodies
9
Q
what drug can cause HUS/TTP?
A
Clopidogrel
10
Q
what medications cause underexcretion of uric acid? (3)
A
Thiazides, Niacin and ASA
11
Q
Side effects of colchicine?
A
Diarrhea & Bone marrow suppresion
12
Q
When do you give steroids in a pt with gout?
A
- No response to NSAIDs
2. Contraindication to NSAIDs ie renal insufficiency
13
Q
What do you use for HTN meds in a pt with gout?
A
Losartan (lowers uric acid)
14
Q
in rheumatoid arthritis, what do you find in the synovial fluid analysis?
A
Anti-CCP antibodies (cyclic citrulinated peptide)
15
Q
what maneuver is highly suggestive of cord compression?
A
point tenderness at the spine with percussion of the vertebra
16
Q
How does epidural abscess present and most common bug?
A
- same way as cord compression but with high fever and elevated ESR
- Staph aureus
17
Q
best initial test for cord compression or abscess? most accurate?
A
Best = x ray
most accurate = MRI
18
Q
What is the best initial therapy for fibromyalgia? 2 alternatives?
A
- Amitriptyline
- Milnacipran (inhibitor of Serotonin and NE specifically approved for fibromyalgia)
- Pregabalin
19
Q
What’s tinel sign?
A
reproduction of carpal tunnel pain and tingling with tapping or precussion of median nerve
20
Q
what/s phalens sign?
A
reproduction of carpal tunnel pain with flexion of the wrists to 90 degrees
21
Q
what is the ocular manifestation of rheumatoid arthritis?
A
episcleritis: mild eye pain and redness of the episclera (layer on top of sclera)
22
Q
lung invovlement of rheumatoid arthritis?
A
- pleural effusion and nodules of lung parenchyma
23
Q
What is Felty syndrome? (triad)
A
- Rheumatoid arthritis
- Splenomegaly
- Neutropenia
24
Q
What is Caplan Syndrome? (triad)
A
- Rheumatoid arthritis
- Pneumoconiosis
- Lung Nodules
25
most common cause of death in rheumatoid arthritis?
coronary artery disease
26
What are the DMARDs? disease modifying antirheumaticc drugs (5)
1. Methotrexate (best initial)
2. TNF inhibitors (second line or if cannot tolerate methotrexate)
3. Rituximab
4. Hydroxychloroquine
5. Sulfasalazine, leflunomide, abatacept (add to methotrexate if tnf don't work)
27
adverse effect of hydroxychloroquine?
retinal toxicity!
28
Symptoms of Juvenile Rheumatoid Arthritis (5)
1. High spiking fever (>104*F)
2. Salmon colored rash on chest and abdomen
3. Splenomegaly
4. Pericardial effusion
5. Mild joint symptoms
29
what lab abnormality is found in Juvenile rheumatoid arthritis?
Ferritin!
30
what lab abnormalities would one see in an acute lupus flare?
- decrease in complement levels
| - increase in anti-DS DNA
31
cause of death in SLE:
| young vs old
young: infection
old: MI from acceleration of atherosclerosis
32
when can hydroxychloroquine be used in SLE?
to control mildly chronic disease limited to skin and joint manifestations
33
treatment of lupus nephritis?
with steroids alone or in combination with cyclophosphamide or mycophenolate
34
when should you be suspicious of antiphospholipid syndrome w miscarriages?
- two or more first trimester miscarriages OR
| - a single second trimester event
35
what is the treatment to prevent recurrence of abortion in antiphospholipid syndrome?
heparin and aspirin
36
what is the most specific test for lupus anticoagulant?
Russell viper venom test (RVVT)- prolonged with APL antibodies
37
what is the best INITIAL test for antiphospholipid syndrome?
mixing study
38
what do the coags look like in antiphospholipid syndrome?
- normal PT & INR
| - prolonged aPTT
39
what is the most specific test for scleroderma?
SCL-70 (anti-topoisomerase)
| anticentromere antibody is extremely specific for CREST scleroderma
40
tx of raynauds in CREST scleroderma?
calcium channel blockers
41
tx of pulmonary fibrosis in CREST scleroderma?
cyclophosphamide
42
what are gottron papules?
scaly patches over the back of the hands, particularly the PIP and MCP joints
43
4 presentations of dermatomyositis?
1. Malar rash
2. Shawl sign: erythema of shawl area
3. Heliotrope rash: purplish edema of eyelids
4. Gottron papules: scaly patches on PIP and MCP
44
best initial diagnostic test for dermatomysitis? most accurate??
Best initial: CPK and aldolase
| Accurate: Muscle biopsy
45
anti-jo antibodies are associated with what in dermatomyositis?
lung fibrosis
46
what is the most dangerous complication of sjogren syndrome?
lymphoma (occurs in 10% of patients)
47
best initial test of sjogrens syndrome?
Schirmer test: a piece of filter paper is placed against the eye and then observed for the amount of tears produced by the amount of wetness on the filter paper
48
What is the link between dermatomyositis and cancer?
seen in 25% of cases:
- ovary
- lung
- GI
- lymphoma
49
what is the most accurate test for sjogrens syndrome?
lip or parotid gland biopsy
| - revels lymphoid infiltration in the salivary glands
50
what organ system is spared in Polyarteritis Nodosa?
lung!
51
what diseases are assoc w Polyarteritis Nodosa?
chronic hep B and C
52
best initial versus mot accurate test for Wegener's granulomatosis?
Initial: C-ANCA (anti-proteinase 3 antibodies)
Accurate: Lung > renal > sinus biopsy
53
biopsy finds leukocytoclasic vasculitis- what is it?
Henoch-schonlein purpura
54
what is cryoglobulinemia?? (4 manifestations)
- associated with hep C, as well as endocarditis and connective tissue disorders (Sjogrens)
- manifests as:
1. Joint pain
2. Glomerulonephrtis
3. Purpuric skin lesions
4. Neuropathy
55
what is pathergy and what disease is it related to?
pathergy: sterile skin pustules from minor trauma like a needle stick
- occurs in Behcet syndrome
56
what is enthesopathy? what is it seen in?
Enthesopathy: inflammation where tendons and ligaments attach to bones
57
best initial treatment of ankylosing spondylitis?
NSAIDs and exercise program, if they dont respond try anti-TNF drugs
58
3 major symptoms of psoriatic arthritis?
1. SI joint pain
2. Sausage digits (from enthesopathy)
3. Nail pitting
59
what do you see on xray in psoriatic arthritis?
xray of joint showing a pencil in a cup deformity
60
what 3 GI bugs are linked to reactive arthrtitis (Reiter syndrome)?
1. Yersinia
2. Salmonella
3. Campulobacter
61
rare but BAD side effect of bisphosphonates?
osteonecrosis of the jaw
62
most common organism for recently placed artificial joints?
staph epidermidis
63
if recurrent gonococcal infection is described, what should you test for?
terminal complement deficiency (a favorite subject of USMLE)
64
what 5 medications can cause macrocytic anemia?
```
Antimetabolite Meds:
1. Azathioprine
2. 6-mercaptopurine
3. Hydroxyurea
plus:
4. Zidovudine
5. Phenytoin
```
65
this is the only form of microcytic anemia in which the circulating iron level is elevated
sideroblatic
66
what thalassemia is associated with HgH and an increased reticulocyte count?
3 gene deletion of Alpha Thalassemia
67
What drugs can cause folate deficiency?
Phenytoin
Sulfa drugs
Methrotrexate
68
How do you confirm pernicious anemia?
1. Anti-intrinsic factor &
| 2. Anti-parietal cell antibodies
69
what is a major complication of B12 and Folate replacement in deficiency?
hypokalemia: cells in the marrow are produced so rapidly that the marrow packages up all the potassium
70
what do you see in pts without a spleen on blood smear?
howell-jolly bodies
71
what is the most accurate test for parvovirus B-19? what is best initial therapy?
Test: PCR DNA
Therapy: Intravenous immunoglobulin
72
what is the first clue for parvovirus in sickle cell patients?
sudden drop in reticulocyte count: normally SC pts have a very high reticulocyte count, however parvovirus b-19 can cause an aplastic crisis that freezes the bone marrow
73
what is isosthenuria?
defect in the ability to concentrate the urine (seen in sickle cell trait)
74
what 4 drugs can cause autoimmune (warm or IgG) Hemolysis?
1. Penicillin
2. Alpha methyldopa
3. Rifampin
4. Phenytoin
75
Cold agglutinin disease develops in association with what 3 pathologies?
1. EBV
2. Waldentrom magroglobulinemia
3. Mycoplasma pneumonia
76
what are the 5 things that can cause TTP? (both drugs and diseases)
1. Ticlopidine
2. Clopidogrel
3. Cyclosporine
4. AIDS
5. SLE
77
how do you look for metastatic disease in a gastrinoma?
1. CT and MRI of abdomen, if this is negative,
| 2. Somatostatin receptor scintigraphy (nuclear octreotide scan) with endoscopic US
78
treatments of diabetic gastroparesis?
erythromycin or metoclopromide
79
treatment steps of esophageal and gastric varices?
1. Octreotide: reduces portal pressures
2. Banding
3. TIPS: decreases portal pressure in those not responding to octreotide and banding
4. Propanolol
5. Antibiotics to prevent SBP with ascites
80
treatment of whipple disease?
ceftriaxone followed by TMP/SMZ
81
what is the most accurate test for chronic pancreatitis?
secretin stimulation testing
82
when should screening occur in IBD for colon cancer?
after 8-10 years of the disease, then every 1-2 years
83
when should you screen a pt for HNPCC?
when they have at least 3 family members w/ colon cancer, across 2 generations and at least 1 before age 50
- screen them starting at age 25 with colonoscopy every 1-2 years
84
Frequency of screening: history of previous adenomatous polyp
colonoscopy every 3-5 years
85
Frequency of screening: previous history of colon cancer
colonoscopy 1 year after resection then at 3 years then at 5 years
86
Frequency of screening: FAP
start wtih sigmoidoscopy at age 12 years, every year
87
when do you add antibiotics in pancreatitis? what do you add?
when there's >30% necrosis on CT scan: use imipenem or meropenem
88
when do you do a needle biopsy in pancreatitis?
when theres >30% necrosis to determine the presence of infection
89
how do you treat infected necrotic pancreatitis?
with surgical debridement to prevent ARDS and death
90
All clotting factors except for ___ are made in the liver
factor VIII
91
SAAG <1.1 points to what 3 causes?
1. Infections (except SBP)
2. Cancer
3. Nephrotic Syndrome
92
SAAG >1.1 points to what 4 causes?
1. Portal Hypertension
2. CHF
3. Hepatic vein thrombosis
4. Constrictive pericarditis
93
what is orthodexia and when is it seen?
Hypoxia upon sitting upright
| - seen in hepatopulmonary syndrome from renal failure
94
Treatment of primary biliary cirrhosis?
Ursodeoxycholic acid
95
what is the only cause of cirrhosis for which a biopsy is not the most accurate test? what is the diagnostic test?
Primary Sclerosing Cholangitis
| - ERCP!! see beading/narrowing/strictures in the biliary system
96
what 3 types of organisms are found in hemochromatosis??
1. Vibrio vulnificus
2. Yersinia
3. Listeria
- occur bc these guys feed on iron
97
what is the mutation found in hemochromatosis?
mutation of the C282y gene
98
Acute hep C is treated with what 3 meds?
1. Interferon
2. Ribavirin
3. Telaprevir or boceprevir
99
what is the most accurate diagnostic test in wilson's disease?
abnormally increased amount of copper excretion into the urine after giving penicillamine
100
If a patient is already on ASA at the time of the ischemic stroke, what do you do?
1. Add dipyridamole OR
| 2. Switch to clopidogrel
101
what are the only two things that give you bilateral facial palsy?
1. Lyme
| 2. Sarcoid
102
On EKG you see ST segment elevation EVERYWHERE...
pericarditis
103
what do you commonly see on the CXR of a patient with sarcoid?
bilateral hilar adenopathy
104
what is the most common laboratory abnormality found in sarcoid?
increased ACE levels
105
most accurate diagnostic test for sarcoid?
lymph node biopsy
106
what medication should be avoided in sarcoidosis?
interferon: promotes the formation of granulomas
107
what is the mechanism of hypercalcemia in sarcoidosis?
granulomas increase synthesis of vit D via macrophages
108
when would you take a stroke pt to endarterectromy?
when stenosis >50%, do NOT in pts with <50% stenosis
109
Treatment of cluster HA?
1. 100% oxygen
2. Steroids
3. Lithium
110
Prophylaxis of cluster HA?
Verapamil
111
when should someone w migraines be started on prophylactic treatment? what meds?
```
when pt has >3 migraines a month,
best tx: propanolol
- CCB
- TCAs
- SSRIs
```
112
treatment of trigeminal neuralgia?
1. Oxcarbazepine
2. Carbamazepine
- if medications dont control it, then use gamma knife surgery or surgical decompression
113
what are the steps in treating status epilepticus?
1. BZDs
2. Fosphenytoin
3. Phenobarbitol
4. Neuromuscular blocking ie succinylcholine/vecuronium to allow for intubation prior to giving PROPOFOL!
114
what are the exceptions for starting antiepileptic tx after a single seizure?
1. Presentation in status epilepticus or with focal neurological signs
2. Abnormal EEG or lesion o CT
3. Family history of seizures
115
why does a fever occur in Subarachnoid hemorrhage?
blood irritates the meninges
116
what is the ratio of WBC to RBCs in CSF? what is the ratio in subarachnoic hemorrhage versus meningitis?
1 WBC: 500-1000 RBCs
SAH: normal ratio (wbc increases a little, rbc increses a lot)
Meningitis: abnormal ratio- WBC increases a LOT
117
what two things can cause subacute combined degeneration of the cord?
1. Vitamin B12 deficiency
| 2. Neurosyphillis
118
how do you diagnose syringomyelia?
MRI!
119
how do you diagnose syringomyelia?
MRI!
120
what drugs have been found to cause parkinsonism?
1. Antipsychotic meds: thorazine
2. Reserpine
3. Metoclopromide
121
what drugs have been found to cause parkinsonism?
1. Antipsychotic meds: thorazine
2. Reserpine
3. Metoclopromide
122
in Pts with mild parkinsons, what can you use for tx? 1st and 2nd line
1. Anticholinergics: benztropine & trihexyphenidyl in younger pts
2. Amantadine (increases the release of DA from the substantia nigra)- use in pts >60yrs intolerant of anticholinergics
123
Treatment of severe parkinsons?
1. Dopamine agonists: pramipexole and ropinirole
2. Levodopa/carbidopa
3. COMT inhibitors: tolcapone, entacapone- extend the duration of levodopa/carbidopa by blocking the metabolism of DA
4. MAO inhibitors: block metabolism of DA, can be used as mono or adjuvant therapy
124
Side effect of levodopa/carbidopa?
"on-off" phenomena: episodes of insufficient DA = bradykinesia, and off effect: too much DA leading to dyskinesia
125
what group of meds is assoc with slowing the progression of parkinsonism?
MAO Inhibitors
- Selegiline
- Rasagiline
126
What are 3 treatments for spasticity?
1. Baclofen
2. Dantrolene
3. Tizanadine
127
What are 3 treatments for spasticity?
1. Baclofen
2. Dantrolene
3. Tizanadine
128
treatment of restless leg syndrome?
pramipexole: DA agonists
129
what drug used in Multiple sclerosis known to cause PML? MOA?
natalizumab: inhibitor of alpha 4 integrin
130
What are the best first choices of meds for the prevention of relapse in MS?
1. Glatiramer
| 2. Beta interferon
131
what is charcot-marie-tooth disease?
- genetic disorder leading to loss of both motor and sensory innervation
- distal weakness and sensory loss
- wasting in legs
- decreased DTRs
- high arch (pes cavus)
132
what bug is associated with Guillan barre syndrome?
campylobacter jejuni
133
what two values in the PFT are poor prognostic indicators in Guillian barre syndrome?
1. Forced vital capacity
2. Peak inspiratory pressure
(inspiration is the active part of breathing)
134
Best initial test of myasthenia gravis?
acetylcholine receptor antibodies (80-90% sensitive)
| - if these are negative, get anti-MUSK antibodies
135
tx of myasthenia gravis?
neostigmine or pyridostigmine: longer acting versions of edrophonium, acetylcholinesterase inhibitors
136
what is a serious complication of Graves disease proptosis?
corneal ulceration bc of proptosis (from deposition of mucopolysaccharide behind the eye)
137
what is a serious complication of Graves disease proptosis?
corneal ulceration bc of proptosis
138
difference between subacute thyroiditis and silent thyroiditis?
```
subacute = tender!!
silent = pt is SILENT when palpating, aka nontender
```
139
multifocal atrial tachycardia is associated with what??
only COPD
140
what EKG finding is associated with tachycardia?
A fibb
141
what is a wandering atrial pacemaker?
- when the pacemaker site shifts from the SA node, to the atria, to the AV node
- see multiple shapes of P waves in lead II
142
what is a wandering atrial pacemaker?
- when the pacemaker site shifts from the SA node, to the atria, to the AV node
- see multiple shapes of P waves in lead II
143
best initial therapies for graves/hyperthyroidism?
-PTU or methimazole
144
best initial therapies for graves/hyperthyroidism?
-PTU or methimazole
145
when would surgery be the option in hyperthyroidism?
1. If its compressing the airway
| 2. Pregnancy
146
side effect of both PTU and methimazole?
Neutropenia
147
treatment of choice for rapid A fibb seen in hyperthyroidism?
propanolol
148
Thyroxine is not essential for the metabolic rate of what 3 organs?
1. Brain
2. Uterus
3. Gonads
149
Thyroxine is the only hormone in the body that is...
NOT released in a pulsatile fashion
150
what is the underlying cause of cretinism??
hypothyroidism -> decreased levels of free t4
| free t4 is necessary for CNS growth and maturation
151
pt has CAD and hypothyroidism... what do you have to be careful of??
rapid replacement of thyroid function via levothyroxine and rev up the heart and cause a MI -> sudden death
152
How do you detect allergic interstitial nephritis?
via wright and hansel stains- detect eosinophils in the urine
153
How do you detect allergic interstitial nephritis?
via wright and hansel stains- detect eosinophils in the urine
154
dysmorphic red cells in urine
glomerulonephritis
155
Association: red cell casts
glomerulonephritis
156
Association: white cell casts
pyelonephritis
157
Association: eosinophil casts
acute (allergic) interstitial nephritis
158
Association: Hyaline casts
dehydration concentrates the urine and the normal tamm-horsfall protein precipitates or concentrates into a cast
159
Association: broad, waxy casts
chronic renal disease
160
Association: granular "muddy-brown' casts
acute tubular necrosis (collections of tubules)
161
Medications to hold 48 hours prior to cardiac stress testing (4)
1. Beta Blockers
2. CCBs
3. Nitrates
4. Dipyridamole (prior to a vasodilator)
162
medications to hold 12 hours prior to a vasodilator stress test?
Caffeine containing foods and drinks
163
when should you be concerned of agranulocytosis in a pt taking PTU or methimazole?
- when a pt has fever and sore throat within 90days of starting it
- if a WBC 1500 = antithyroid drug toxicity is unlikely
164
when should you be concerned of agranulocytosis in a pt taking PTU or methimazole?
- when a pt has fever and sore throat within 90days of starting it
- if a WBC 1500 = antithyroid drug toxicity is unlikely
165
what are the anti-anginal effects of nitrates?
- venodilators and coronary vasodilators
- primary effect = systemic vasodilation rather than coronary vasodilation bc this decreases preload and LVEDV, and decreases myocardial oxygen demand by reducing wall stress
166
treatment of choice for central retinal artery occlusion?
emergency situation- carotid massage and high flow oxygen administration
167
what disorders are associated with vitiligo?
1. Pernicious anemia
2. Autoimmune thyroid disease (usually graves)
3. Type 1 DM
4. Primary adrenal insufficiency
5. Hypopituitarism
6. Alopecia areata
168
what disorders are associated with vitiligo?
1. Pernicious anemia
2. Autoimmune thyroid disease (usually graves)
3. Type 1 DM
4. Primary adrenal insufficiency
5. Hypopituitarism
6. Alopecia areata
169
occular exam shows red eye with leukocytes in anterior chamber
anterior uveitis
170
occular exam shows red eye with leukocytes in anterior chamber
anterior uveitis
171
how do you confirm presence of poststrep glomerulonephritis?
ASO (antistreptolysinO) titers and anti-DNAse antibody
172
difference in therapy between mild lupus nephritis and severe proliferative like membranous lupus nephritis?
```
Mild = glucocorticoids
Severe = glucocorticoids + cyclophosphamide or mycophenolate
```
173
treatment of amyloidosis?
melphalan & prednisone
174
```
what nephrotic syndromes are associated with the following buzz words:
Cancer (solid organ):
Children:
IV Drug users/AIDS:
NSAIDs:
SLE:
```
```
Cancer: membranous
Children: minimal change disease
IV Drug users/AIDS: focal-segmental
NSAIDs: minimal change & membranous
SLE:any of them
```
175
most common cause of death in ESRD patients?
cardiac disease (atherosclerosis)
176
what are the 4 phosphate binders?
1. Calcium acetate
2. Calcium carbonate
3. Sevelamer
4. Lanthanum
177
Typical ECG manifestations of acute pericarditis?
diffuse ST elevations with PR depressions
178
psychotic patient presents with "lead pipe rigidity"
neuroleptic malignant syndrome-plus confusion, fever, mudcle rigidity, and diaphoresis
179
most common type of thyroid cancer?
1. Papillary**
2. Follicular
3. Anaplastic
4. Medullary
180
most common cause of thyroid nodules?
colloid nodules
181
what bug is the most common cause of PNA in pts with chronic lung disease like COPD?
h influenza
| morazella catarrhalis is also associated
182
when do you place an IVC filter in pts with DVT? (3)
1. contraindications to anticoagulation
2. hx of complications for anticoags (HIT)
3. Pts who developed dvt/pe despite anticoag
183
what is one complication of pressors in pts with decreased BF?
ischemia of distal fingers and toes (or mesenteric ischemia/renal failure) secondary to vasospasm
184
bitter almond odor
cyanide poisoning
185
hypertensive pt presenting with hypokalemia
think of primary hyperaldosteronism
186
what medications should a pt who had a MI be discharged with?
1. ASA
2. Beta blockers
3. ACE inhibitors
4. Statin
and if has NSTEMI/unstableangina/PCI stent: Clopidogrel! for 1-12mos
187
Clopidogrel is a class of drugs called what? and MOA?
Thienopyridine: includes ticlopidine
MOA: anti-platelet effect and act by antagonizing ADP
188
what is an abnormal A-a gradient?
>30!
| normal is 30 is high regardless of age
189
what type of anemia is seen in ESRD? when do you initiate tx w recombinant epo?
```
normocytic normochromic
Start tx:
1. HTN
2. HA
3. Flu like illness
```
190
which types of kidney stones are radioopaque and radiolucent?
Radioopaque: calcium
Radiolucent: urica acid
191
Electron microscopy shows alternating areas of thinned and thickened capillary loops with splitting of the GBM
Alport syndrome
192
what is the earliest renal abnormality present in pts with diabetes??
glomerular hyperfiltration
193
gram stain in a pt w pulmonary symptoms shows crooked, branching beaded gram + and partially acid fast filaments
Pulmonary nocardiosis
| tx = TMP-SMX
194
what pulmonary-renal syndrome requires emergency plasmapheresis??
Goodpasture's syndrome!
| - unclear of benefit of emergency plasmapheresis in pts w wegeners, severe PAN
195
what are the symptoms of generalized resistance to thyroid hormones?
- hypothyroidism despite having elevated circulating thyroid hormone levels
196
in the acute setting, one of the primary treatments for stroke in sickle cell patients is what?
exchange transfusion
197
What is babesia and where is it endemic?
- transmitted by Ixodes tick
- northeastern US
- hemolysis, jaundice, hemoglobinuria, renal failure, and death
- no rash!
198
treatment of babesia? 2 regimens
1. Quinine-clindamycin
| 2. Atovaqone-azithromycin
199
What is ehrlichiosis?
spotless rocky mountain spotted fever
- tick born illness
- fever, HA, n/v, leukopenia, thrombocytopenia
200
what is q fever?
caused by coxiella burnetii
- cattle, goat and sheep
- flu like syndrome, hepatitis, PNA
- meat processing workers and vets
201
what is prinzmetal's angina?
temporary spasm of the coronary arteries (as opposed to atherosclerotic narrowing)
- typically seen in young women smokers
- see transient ST elevations with return of ST segments to baseline upon resolution
202
what's beck's triad?
triad of cardiac tamponade:
1. Hypotension
2. Distended neck veins
3. Muffled heart sounds
203
mechanism of pulsus paradoxus?
- seen in cardiac tamponade as a >10mmHg drop in systolic pressure during inspiration
- cardiac tamp decreases RV compliance and shifts the interventricular septum toward the left ventricular cavity to further reduce LV filling
204
Source of energy during fasting:
1. First 12 hours
2. 24 hours
First 12: glycogen stores
| 24 hours in: gluconeogenesis
205
What are the main 3 substrates for gluconeogenesis?
1. Amino acids: protein from mm
2. Lactate: from anaerobic glycolysis
3. Glycerol 3 phosphate (from TAG in adipose)
206
What is the major gluconeogenic amino acid?
Alanine: converted into pyruvate in the liver by ALT
207
an infection of Strep gallolyticus (S bovis biotype 1) increases risk of what?
Colorectal cancer & Endocarditis
| as opposed to s bovis bioptype 2
208
what is cervical spondylosis and how does it present?
- chronic neck pain due to osteoarthritis and secondary muscle spasm
- sensory deficit due to osteophyte-induced radiculopathy
209
what are the typical radiographic findings in cervical spondylosis?
bony spurs and sclerotic facet joints
210
MOA of warfarin induced skin necrosis?
- since protein C's half life is only 9 hours, warfarin's inhibition can lead to protein C deficiency in the first days of treatment
- results in a hypercoagulable state and placing the pt at risk for thrombus formation and kin necrosis
211
what is malignant otitis externa and what bug causes it most of the time?
- ear discharge and severe ear pain, worse w chewing
- worsens even after topic antibiotics, presence of granulation tissue in the external auditory meatus
- DM and immunosuppression are risk factors
- Pseudomonas!!
212
antibodies found in pernicious anemia?
anti-intrinsic factor antibodies
213
Tetrad of multiple myeloma signs and symptoms?
```
CRAB:
hperCalcemia
Renal impairment (IgG antibodies collect in glomeruli)
Anemia
Bone (lytic lesions, fractures)
```
214
side effects of:
1. Methimazole
2. PTU
3. Both
1. Teratogenic in 1st trimester, cholestatic jaundice
2. PTU = vasculitis
3. Both = rash, arthralgias, hepatitis, agranulocytosis
215
the negative predictive value will vary with what?
the pretest probability of a disease- remember that the prevalence of a disease is directly related to the pre-test probability and also affects the NPV
216
what medications are used to reduce intraocular pressure in glaucoma?
1. Mannitol
2. Acetazolamide
3. Timolol
4. Pilocarpine
217
PPD testing in HIV, when is it positive and what do u give for ppx?
positive = >5mm
| Give Isoniazid and pyridoxine for 9 months, even if CXR is neg
218
What are two important diagnostic clues for waldenstroms macroglobulinemia?
1. IgM spike
| 2. Hyperviscosity
219
how do you diagnose ankylosing spondylitis?
Xray of the sacroiliac joints showing fusion of the SI joints and or bamboo spine
220
how long does it take an acutely sick person to become vitamin K deficient while NPO?
7-10 days
| normally you have a 30 day store
221
Why does DDAVP help in uremic coagulopathy?
- it increases the release of factor VIII: vWF multimers from endothelial stores
222
How do NSAIDs cause SIADH?
they potentiate the action of ADH
223
what two steps can be taken to improve oxygenation in mechanical ventilation?
1. Increasing FiO2 (but keep below 40%)
| 2. Adding PEEP
224
what are the 5 extra-renal complications of ADPKD?
1. intracranial berry aneurysm
2. hepatic cysts (most common)
3. Valvular heart disease- MVP and aortic regurg
4. Colonic diverticula
5. Abdominal wall and inguinal hernia
225
what are the 3 types of MEN syndromes?
- Type 1: pituitary, parathyroid, and enteroPancreatic tumors
- Type 2a: medullary thyroid, pheo, parathyroid hyperplasia
- Type 2b: medullary thyroid, pheo, neuroma + marfanoid habitus
226
what are the genetics of MEN 2a & 2b?
Autosomal disorders due to germline mutations in the RET proto-oncogene
227
what is pulsus parvus et tardus?
slow rising and low amplitude pulse- seen in aortic stenosis
228
treatment of ITP?
Plt >30,000: observe
| Plt <30,000 or bleeding: corticosteroids (first line), splenectomy or rituximab (second-line)
229
what is bernard soulier syndrome?
- autosomal recessive disorder
- absent platelet glycoprotein 1b-9-5, which acts as a receptor for vWF
- mild thrombocytopenia w giant platelets
- bleeding out of proportion to thrombocytopenia
230
how do TCAs cause QRS prolongation? tx?
- inhibits cardiac fast sodium channels leading to the QRS prolongation
- tx: sodium bicarb increases the extracellular sodium concentration
231
what is the treatment of choice of lyme disease in a pregnant woman?
amoxicillin
232
treatment of torsades de pointes?
magnesium sulfate & stop offending agent
233
Pt with recent bone marrow transplant with intestinal and respiratory symptoms?
CMV pneumonitis! usually occurs 2wks-4months after BMT
- CXR: multifocal diffuse patchy infiltrates
- CT: parenchymal opacification or multiple small nodules
- Bronchoalveolar lavage is diagnostic
234
what are the metabolic effects of thiazide diuretic therapy?
1. Decreased glucose tolerance -> hyperglycemia
2. Increased LDL & TG cholesterol
3. Induces uric acid retention (beware in gout)
4. Electrolyte abnormalities: hyponatremia, hypokalemia, hypercalcemia
235
treatment of CML?
Imatinib: tyrosine kinase inhibitor, binds to the ATP binding site of the BCR-ABL protein prohibiting its conformation change to its active form
236
what hormone is specific to androgen producing adrenal tumors?
DHEA-S
(dehydroepiandrosterone sulfate)
- produced by the adrenal glands only
- whereas androstenedione, DHEA, and testosterone are produced by the ovaries
237
MOA of demeclocylcine?
used for treating SIADH by inhibiting the ADH-mediated aquaporin insertion in the cortical collecting tubule and helps dilute the urine
238
what is fibromuscular dysplasia?
- most commonly affects women age 15-50
- noninflammatory, nonatherosclerotic condition caused by abnormal cell development in the arterial wall that can lead to vessel stenosis, aneurysm, or dissection
- commonly involves the renal, carotid and vertebral arteries
239
Ct scan of an immunocompromised pt shows pulmonary nodules with the halo sign or lesions with an air crescent
Invasive aspergillosis
240
what is the most common extra-articular manifestation of ankylosing spondylitis?
anterior uveitis
241
what is the most frequent origin for the ectopic foci that cause atrial fibrillation?
pulmonary veins!
| wtf?!
242
what med is contraindicated in cocaine intoxication?
beta blockers
243
what causes kaposi sarcoma in HIV pts?
HHV-8
244
tx of choice for nocardiosis?
TMP-SMX
245
what is bacillary angiomatosis and tx?
- bright right firm friable exophytic nodules in HIV pts
- caused by Bartonella, a gram neg bacillus
- tx = oral erythromycin
246
mechanism of kidney damage in SLE?
immune complex mediated: immune complexes circulate in the blood and are deposited in renal glomeruli via complement activation (why C3 level is decreased)
247
why do 10% of patients with Renal cell carcinoma present with varicocele?
- due to tumor obstruction of the gonadal vein where it enters the renal vein
- varicocele fails to empty when the patient is recumbant
248
pts with ulcerative lesions of the colon due to colonic neoplasia or IBD have an increased predilection to develop IE due to what bug?
strep bovis type I:
| Strep gallolyticus
249
what is kussmaul's sign?
failure of the JVP to decrease on inspiration- seen in constrictive pericarditis
250
what is presbycusis?
sensorineural hearing loss that occurs with aging
251
what is Dressler's syndrome?
a pericarditis that occurs weeks after an MI, thought to be due to immunologic phenomena
- ESR typically elevated
- Tx: NSAIDs
252
what is the triad of Osler Weber Rendu syndrome?
aka hereditary telangiectasia, autosomal dominant
1. Diffuse telangiectasias
2. Recurrent epistaxis
3. Widespread AV malformations: AVMs in the lungs can shunt blood from the R to the L side of the heart, causing chronic hypoxemia and reactive polycythemia, pulmonary AVMs can cause massive and fatal hemoptysis
253
what do you find in the anterior mediastinum vs middle vs posterior
Anterior: thymoma
Middle: bronchogenic cysts
posterior: neuroenic tumors
254
what is presbyopia?
common age-related disorder that results from the loss of elasticity in the lens
255
what is the major cause of abnormal ABGs (resp acidosis- hypercapnia and hypoxemia) in pts with OHS?
- decreased chest wall compliance leads to increased work of breathing, this becomes so high that the CNS chemoreceptors establish a higher pCO2 set point causing resultant hypoventilation, hypercapnia, and hypoxemia
256
what is one of the earliest signs of macular degeneration?
distortion of straight lines so that they appear wavy
257
what is the mechanism of HIT type 2?
- heparin binds to platelet factor 4
- this complex then triggers IgG antibodies which bind to the PF4-hep complex
- this activates platelets by binding to the platelet Fc receptor
- thrombocytopenia occurs when splenic macs remove the activated platelet-antibodies-heparing-PF4 complexes
258
what is malignant hypertension?
severe hypertension with retinal hemorrhages, exudates or papilledema
259
what is analgesic nephropathy?
occurs after many years of using analgesics
- chronic tubulointerstitial damage
- hematuria from renal papillary necrosis
- results from papillary ischemia induced by analgesic-mediated vasoconstriction of medullary blood vessels (vasa recta)
260
what lab abnormalities are found in pagets disease of bone?
- normal Ca and phosphate
- elevated alk phosph and urinary markers of bone degeneration: hydroxyproline, deoxypyridinoline, N-telopeptide, and C-telopeptide
261
tx of Neuroleptic Malignant Syndrome?
1. Dantrolene (muscle relaxant)
2. Bromocriptine (a DA agonist)
3. Amantadine (antiviral w DA properties)
262
when do you see renal vein thrombosis and how does it present?
- in nephrotic syndrome: specifically membranous glomerulonephritis bc antithrombin III is lost in the urine and puts pt at increased risk of venous and arterial thrombosis
- sudden onset of abdominal pain, fever and hematuria
263
what is enthesitis and what is it associated with?
- inflammation and pain at sites where tendons and ligaments attach to bone
- Assoc with HLA-B27 assoc arhtropathies: Ankylosing spondy, psoriatic, reactive arthritis
264
what bug causes post-viral URI necrotizing pulmonary bronchopneumonia with multiple nodular infiltrates that can cavitate to cause small abscesses?
staph aureus
265
what bugs are urease producing and can form struvite stones?
struvite = magnesium ammonium phosphate
Klebsiella
Proteus
266
what are two functions of von willebrand factor?
1. Supports platelet adhesion
| 2. Carrier protein for factor VIII
267
when is a beta blocker indicated in heart failure?
for all stages of systolic heart failure- even asymptomatic patients with LV EF<50%
268
how does fluphenazine cause hypothermia?
- its a typical antipsychotic that is injected every 2-3 weeks in schizophrenics with poor compliance
- more potent than haloperidol, it inhibits the body's shivering mechanism and/or inhibits autonomic thermoregulation
269
nontraumatic SAH is most commonly due to what?
ruptured saccular or berry aneurysms (>2/3 of cases)
270
Arrhythmia most specific to digitalis toxicity?
atrial tachycardia with AV block
