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IM & Step 2 > Master the Boards > Flashcards

Master the Boards Flashcards

1
Q

6 drugs/drug classes that are known to cause major allergic reactions: SJS, AIN, hemolysis, thrombocytopenia, etc

A
  1. Penicillins
  2. Sulfa drugs
  3. Rifampin
  4. Allopurinol
  5. Quinidine
  6. Lamotridine
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2
Q

in which patients with ITP would you give IVIg over prednisone?

A

bowel or brain bleeding (ex- symptoms of melena)

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3
Q

a platelet type of bleeding with a normal platelet count should raise suspicion of…

A

Vonwillebrand’s disease

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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

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5
Q

what is c14 serotonin release assay used for?

A

heparin induced thrombocytopenia

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6
Q

initial tx of vonwillebrands disease?

A

Desmopressin: causes a release of endothelial stores of of factor 8 and VWF

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7
Q

treatment of hemophilia A: severe vs mild?

A 
Mild= desmopressin
Severe = recombinant factor VIII
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8
Q

what is the most accurate diagnostic test for heparin induced thrombocytopenia?

A

Platelet factor four antibodies

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9
Q

what drug can cause HUS/TTP?

A

Clopidogrel

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10
Q

what medications cause underexcretion of uric acid? (3)

A

Thiazides, Niacin and ASA

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11
Q

Side effects of colchicine?

A

Diarrhea & Bone marrow suppresion

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12
Q

When do you give steroids in a pt with gout?

A
  1. No response to NSAIDs

2. Contraindication to NSAIDs ie renal insufficiency

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13
Q

What do you use for HTN meds in a pt with gout?

A

Losartan (lowers uric acid)

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14
Q

in rheumatoid arthritis, what do you find in the synovial fluid analysis?

A

Anti-CCP antibodies (cyclic citrulinated peptide)

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15
Q

what maneuver is highly suggestive of cord compression?

A

point tenderness at the spine with percussion of the vertebra

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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
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17
Q

best initial test for cord compression or abscess? most accurate?

A

Best = x ray

most accurate = MRI

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18
Q

What is the best initial therapy for fibromyalgia? 2 alternatives?

A
  1. Amitriptyline
  2. Milnacipran (inhibitor of Serotonin and NE specifically approved for fibromyalgia)
  3. Pregabalin
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19
Q

What’s tinel sign?

A

reproduction of carpal tunnel pain and tingling with tapping or precussion of median nerve

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20
Q

what/s phalens sign?

A

reproduction of carpal tunnel pain with flexion of the wrists to 90 degrees

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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)

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22
Q

lung invovlement of rheumatoid arthritis?

A
  • pleural effusion and nodules of lung parenchyma
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23
Q

What is Felty syndrome? (triad)

A
  1. Rheumatoid arthritis
  2. Splenomegaly
  3. Neutropenia
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24
Q

What is Caplan Syndrome? (triad)

A
  1. Rheumatoid arthritis
  2. Pneumoconiosis
  3. Lung Nodules
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25
Q

most common cause of death in rheumatoid arthritis?

A

coronary artery disease

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26
Q

What are the DMARDs? disease modifying antirheumaticc drugs (5)

A
  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)
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27
Q

adverse effect of hydroxychloroquine?

A

retinal toxicity!

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28
Q

Symptoms of Juvenile Rheumatoid Arthritis (5)

A
  1. High spiking fever (>104*F)
  2. Salmon colored rash on chest and abdomen
  3. Splenomegaly
  4. Pericardial effusion
  5. Mild joint symptoms
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29
Q

what lab abnormality is found in Juvenile rheumatoid arthritis?

A

Ferritin!

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30
Q

what lab abnormalities would one see in an acute lupus flare?

A
  • decrease in complement levels

- increase in anti-DS DNA

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31
Q

cause of death in SLE:

young vs old

A

young: infection
old: MI from acceleration of atherosclerosis

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32
Q

when can hydroxychloroquine be used in SLE?

A

to control mildly chronic disease limited to skin and joint manifestations

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33
Q

treatment of lupus nephritis?

A

with steroids alone or in combination with cyclophosphamide or mycophenolate

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34
Q

when should you be suspicious of antiphospholipid syndrome w miscarriages?

A
  • two or more first trimester miscarriages OR

- a single second trimester event

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35
Q

what is the treatment to prevent recurrence of abortion in antiphospholipid syndrome?

A

heparin and aspirin

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36
Q

what is the most specific test for lupus anticoagulant?

A

Russell viper venom test (RVVT)- prolonged with APL antibodies

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37
Q

what is the best INITIAL test for antiphospholipid syndrome?

A

mixing study

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38
Q

what do the coags look like in antiphospholipid syndrome?

A
  • normal PT & INR

- prolonged aPTT

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39
Q

what is the most specific test for scleroderma?

A

SCL-70 (anti-topoisomerase)

anticentromere antibody is extremely specific for CREST scleroderma

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40
Q

tx of raynauds in CREST scleroderma?

A

calcium channel blockers

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41
Q

tx of pulmonary fibrosis in CREST scleroderma?

A

cyclophosphamide

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42
Q

what are gottron papules?

A

scaly patches over the back of the hands, particularly the PIP and MCP joints

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43
Q

4 presentations of dermatomyositis?

A
  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
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44
Q

best initial diagnostic test for dermatomysitis? most accurate??

A

Best initial: CPK and aldolase

Accurate: Muscle biopsy

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45
Q

anti-jo antibodies are associated with what in dermatomyositis?

A

lung fibrosis

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46
Q

what is the most dangerous complication of sjogren syndrome?

A

lymphoma (occurs in 10% of patients)

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47
Q

best initial test of sjogrens syndrome?

A

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

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48
Q

What is the link between dermatomyositis and cancer?

A

seen in 25% of cases:

  • ovary
  • lung
  • GI
  • lymphoma
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49
Q

what is the most accurate test for sjogrens syndrome?

A

lip or parotid gland biopsy

- revels lymphoid infiltration in the salivary glands

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50
Q

what organ system is spared in Polyarteritis Nodosa?

A

lung!

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51
Q

what diseases are assoc w Polyarteritis Nodosa?

A

chronic hep B and C

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52
Q

best initial versus mot accurate test for Wegener’s granulomatosis?

A

Initial: C-ANCA (anti-proteinase 3 antibodies)
Accurate: Lung > renal > sinus biopsy

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53
Q

biopsy finds leukocytoclasic vasculitis- what is it?

A

Henoch-schonlein purpura

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54
Q

what is cryoglobulinemia?? (4 manifestations)

A
  • 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
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55
Q

what is pathergy and what disease is it related to?

A

pathergy: sterile skin pustules from minor trauma like a needle stick
- occurs in Behcet syndrome

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56
Q

what is enthesopathy? what is it seen in?

A

Enthesopathy: inflammation where tendons and ligaments attach to bones

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57
Q

best initial treatment of ankylosing spondylitis?

A

NSAIDs and exercise program, if they dont respond try anti-TNF drugs

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58
Q

3 major symptoms of psoriatic arthritis?

A
  1. SI joint pain
  2. Sausage digits (from enthesopathy)
  3. Nail pitting
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59
Q

what do you see on xray in psoriatic arthritis?

A

xray of joint showing a pencil in a cup deformity

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60
Q

what 3 GI bugs are linked to reactive arthrtitis (Reiter syndrome)?

A
  1. Yersinia
  2. Salmonella
  3. Campulobacter
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61
Q

rare but BAD side effect of bisphosphonates?

A

osteonecrosis of the jaw

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62
Q

most common organism for recently placed artificial joints?

A

staph epidermidis

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63
Q

if recurrent gonococcal infection is described, what should you test for?

A

terminal complement deficiency (a favorite subject of USMLE)

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64
Q

what 5 medications can cause macrocytic anemia?

A 
Antimetabolite Meds:
1. Azathioprine
2. 6-mercaptopurine
3. Hydroxyurea
plus:
4. Zidovudine
5. Phenytoin
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65
Q

this is the only form of microcytic anemia in which the circulating iron level is elevated

A

sideroblatic

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66
Q

what thalassemia is associated with HgH and an increased reticulocyte count?

A

3 gene deletion of Alpha Thalassemia

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67
Q

What drugs can cause folate deficiency?

A

Phenytoin
Sulfa drugs
Methrotrexate

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68
Q

How do you confirm pernicious anemia?

A
  1. Anti-intrinsic factor &

2. Anti-parietal cell antibodies

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69
Q

what is a major complication of B12 and Folate replacement in deficiency?

A

hypokalemia: cells in the marrow are produced so rapidly that the marrow packages up all the potassium

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70
Q

what do you see in pts without a spleen on blood smear?

A

howell-jolly bodies

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71
Q

what is the most accurate test for parvovirus B-19? what is best initial therapy?

A

Test: PCR DNA
Therapy: Intravenous immunoglobulin

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72
Q

what is the first clue for parvovirus in sickle cell patients?

A

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

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73
Q

what is isosthenuria?

A

defect in the ability to concentrate the urine (seen in sickle cell trait)

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74
Q

what 4 drugs can cause autoimmune (warm or IgG) Hemolysis?

A
  1. Penicillin
  2. Alpha methyldopa
  3. Rifampin
  4. Phenytoin
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75
Q

Cold agglutinin disease develops in association with what 3 pathologies?

A
  1. EBV
  2. Waldentrom magroglobulinemia
  3. Mycoplasma pneumonia
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76
Q

what are the 5 things that can cause TTP? (both drugs and diseases)

A
  1. Ticlopidine
  2. Clopidogrel
  3. Cyclosporine
  4. AIDS
  5. SLE
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77
Q

how do you look for metastatic disease in a gastrinoma?

A
  1. CT and MRI of abdomen, if this is negative,

2. Somatostatin receptor scintigraphy (nuclear octreotide scan) with endoscopic US

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78
Q

treatments of diabetic gastroparesis?

A

erythromycin or metoclopromide

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79
Q

treatment steps of esophageal and gastric varices?

A
  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
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80
Q

treatment of whipple disease?

A

ceftriaxone followed by TMP/SMZ

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81
Q

what is the most accurate test for chronic pancreatitis?

A

secretin stimulation testing

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82
Q

when should screening occur in IBD for colon cancer?

A

after 8-10 years of the disease, then every 1-2 years

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83
Q

when should you screen a pt for HNPCC?

A

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

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84
Q

Frequency of screening: history of previous adenomatous polyp

A

colonoscopy every 3-5 years

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85
Q

Frequency of screening: previous history of colon cancer

A

colonoscopy 1 year after resection then at 3 years then at 5 years

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86
Q

Frequency of screening: FAP

A

start wtih sigmoidoscopy at age 12 years, every year

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87
Q

when do you add antibiotics in pancreatitis? what do you add?

A

when there’s >30% necrosis on CT scan: use imipenem or meropenem

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88
Q

when do you do a needle biopsy in pancreatitis?

A

when theres >30% necrosis to determine the presence of infection

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89
Q

how do you treat infected necrotic pancreatitis?

A

with surgical debridement to prevent ARDS and death

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90
Q

All clotting factors except for ___ are made in the liver

A

factor VIII

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91
Q

SAAG <1.1 points to what 3 causes?

A
  1. Infections (except SBP)
  2. Cancer
  3. Nephrotic Syndrome
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92
Q

SAAG >1.1 points to what 4 causes?

A
  1. Portal Hypertension
  2. CHF
  3. Hepatic vein thrombosis
  4. Constrictive pericarditis
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93
Q

what is orthodexia and when is it seen?

A

Hypoxia upon sitting upright

- seen in hepatopulmonary syndrome from renal failure

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94
Q

Treatment of primary biliary cirrhosis?

A

Ursodeoxycholic acid

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95
Q

what is the only cause of cirrhosis for which a biopsy is not the most accurate test? what is the diagnostic test?

A

Primary Sclerosing Cholangitis

- ERCP!! see beading/narrowing/strictures in the biliary system

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96
Q

what 3 types of organisms are found in hemochromatosis??

A
  1. Vibrio vulnificus
  2. Yersinia
  3. Listeria
    - occur bc these guys feed on iron
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97
Q

what is the mutation found in hemochromatosis?

A

mutation of the C282y gene

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98
Q

Acute hep C is treated with what 3 meds?

A
  1. Interferon
  2. Ribavirin
  3. Telaprevir or boceprevir
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99
Q

what is the most accurate diagnostic test in wilson’s disease?

A

abnormally increased amount of copper excretion into the urine after giving penicillamine

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100
Q

If a patient is already on ASA at the time of the ischemic stroke, what do you do?

A
  1. Add dipyridamole OR

2. Switch to clopidogrel

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101
Q

what are the only two things that give you bilateral facial palsy?

A
  1. Lyme

2. Sarcoid

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102
Q

On EKG you see ST segment elevation EVERYWHERE…

A

pericarditis

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103
Q

what do you commonly see on the CXR of a patient with sarcoid?

A

bilateral hilar adenopathy

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104
Q

what is the most common laboratory abnormality found in sarcoid?

A

increased ACE levels

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105
Q

most accurate diagnostic test for sarcoid?

A

lymph node biopsy

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106
Q

what medication should be avoided in sarcoidosis?

A

interferon: promotes the formation of granulomas

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5
Perfectly
107
Q

what is the mechanism of hypercalcemia in sarcoidosis?

A

granulomas increase synthesis of vit D via macrophages

How well did you know this?
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108
Q

when would you take a stroke pt to endarterectromy?

A

when stenosis >50%, do NOT in pts with <50% stenosis

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109
Q

Treatment of cluster HA?

A
  1. 100% oxygen
  2. Steroids
  3. Lithium
110
Q

Prophylaxis of cluster HA?

A

Verapamil

111
Q

when should someone w migraines be started on prophylactic treatment? what meds?

A 
when pt has >3 migraines a month,
 best tx: propanolol
- CCB
- TCAs
- SSRIs
112
Q

treatment of trigeminal neuralgia?

A
  1. Oxcarbazepine
  2. Carbamazepine
    - if medications dont control it, then use gamma knife surgery or surgical decompression
113
Q

what are the steps in treating status epilepticus?

A
  1. BZDs
  2. Fosphenytoin
  3. Phenobarbitol
  4. Neuromuscular blocking ie succinylcholine/vecuronium to allow for intubation prior to giving PROPOFOL!
114
Q

what are the exceptions for starting antiepileptic tx after a single seizure?

A
  1. Presentation in status epilepticus or with focal neurological signs
  2. Abnormal EEG or lesion o CT
  3. Family history of seizures
115
Q

why does a fever occur in Subarachnoid hemorrhage?

A

blood irritates the meninges

116
Q

what is the ratio of WBC to RBCs in CSF? what is the ratio in subarachnoic hemorrhage versus meningitis?

A

1 WBC: 500-1000 RBCs
SAH: normal ratio (wbc increases a little, rbc increses a lot)
Meningitis: abnormal ratio- WBC increases a LOT

117
Q

what two things can cause subacute combined degeneration of the cord?

A
  1. Vitamin B12 deficiency

2. Neurosyphillis

118
Q

how do you diagnose syringomyelia?

A

MRI!

119
Q

how do you diagnose syringomyelia?

A

MRI!

120
Q

what drugs have been found to cause parkinsonism?

A
  1. Antipsychotic meds: thorazine
  2. Reserpine
  3. Metoclopromide
121
Q

what drugs have been found to cause parkinsonism?

A
  1. Antipsychotic meds: thorazine
  2. Reserpine
  3. Metoclopromide
122
Q

in Pts with mild parkinsons, what can you use for tx? 1st and 2nd line

A
  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
Q

Treatment of severe parkinsons?

A
  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
Q

Side effect of levodopa/carbidopa?

A

“on-off” phenomena: episodes of insufficient DA = bradykinesia, and off effect: too much DA leading to dyskinesia

125
Q

what group of meds is assoc with slowing the progression of parkinsonism?

A

MAO Inhibitors

  • Selegiline
  • Rasagiline
126
Q

What are 3 treatments for spasticity?

A
  1. Baclofen
  2. Dantrolene
  3. Tizanadine
127
Q

What are 3 treatments for spasticity?

A
  1. Baclofen
  2. Dantrolene
  3. Tizanadine
128
Q

treatment of restless leg syndrome?

A

pramipexole: DA agonists

129
Q

what drug used in Multiple sclerosis known to cause PML? MOA?

A

natalizumab: inhibitor of alpha 4 integrin

130
Q

What are the best first choices of meds for the prevention of relapse in MS?

A
  1. Glatiramer

2. Beta interferon

131
Q

what is charcot-marie-tooth disease?

A
  • 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
Q

what bug is associated with Guillan barre syndrome?

A

campylobacter jejuni

133
Q

what two values in the PFT are poor prognostic indicators in Guillian barre syndrome?

A
  1. Forced vital capacity
  2. Peak inspiratory pressure
    (inspiration is the active part of breathing)
134
Q

Best initial test of myasthenia gravis?

A

acetylcholine receptor antibodies (80-90% sensitive)

- if these are negative, get anti-MUSK antibodies

135
Q

tx of myasthenia gravis?

A

neostigmine or pyridostigmine: longer acting versions of edrophonium, acetylcholinesterase inhibitors

136
Q

what is a serious complication of Graves disease proptosis?

A

corneal ulceration bc of proptosis (from deposition of mucopolysaccharide behind the eye)

137
Q

what is a serious complication of Graves disease proptosis?

A

corneal ulceration bc of proptosis

138
Q

difference between subacute thyroiditis and silent thyroiditis?

A 
subacute = tender!!
silent = pt is SILENT when palpating, aka nontender
139
Q

multifocal atrial tachycardia is associated with what??

A

only COPD

140
Q

what EKG finding is associated with tachycardia?

A

A fibb

141
Q

what is a wandering atrial pacemaker?

A
  • 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
Q

what is a wandering atrial pacemaker?

A
  • 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
Q

best initial therapies for graves/hyperthyroidism?

A

-PTU or methimazole

144
Q

best initial therapies for graves/hyperthyroidism?

A

-PTU or methimazole

145
Q

when would surgery be the option in hyperthyroidism?

A
  1. If its compressing the airway

2. Pregnancy

146
Q

side effect of both PTU and methimazole?

A

Neutropenia

147
Q

treatment of choice for rapid A fibb seen in hyperthyroidism?

A

propanolol

148
Q

Thyroxine is not essential for the metabolic rate of what 3 organs?

A
  1. Brain
  2. Uterus
  3. Gonads
149
Q

Thyroxine is the only hormone in the body that is…

A

NOT released in a pulsatile fashion

150
Q

what is the underlying cause of cretinism??

A

hypothyroidism -> decreased levels of free t4

free t4 is necessary for CNS growth and maturation

151
Q

pt has CAD and hypothyroidism… what do you have to be careful of??

A

rapid replacement of thyroid function via levothyroxine and rev up the heart and cause a MI -> sudden death

152
Q

How do you detect allergic interstitial nephritis?

A

via wright and hansel stains- detect eosinophils in the urine

153
Q

How do you detect allergic interstitial nephritis?

A

via wright and hansel stains- detect eosinophils in the urine

154
Q

dysmorphic red cells in urine

A

glomerulonephritis

155
Q

Association: red cell casts

A

glomerulonephritis

156
Q

Association: white cell casts

A

pyelonephritis

157
Q

Association: eosinophil casts

A

acute (allergic) interstitial nephritis

158
Q

Association: Hyaline casts

A

dehydration concentrates the urine and the normal tamm-horsfall protein precipitates or concentrates into a cast

159
Q

Association: broad, waxy casts

A

chronic renal disease

160
Q

Association: granular “muddy-brown’ casts

A

acute tubular necrosis (collections of tubules)

161
Q

Medications to hold 48 hours prior to cardiac stress testing (4)

A
  1. Beta Blockers
  2. CCBs
  3. Nitrates
  4. Dipyridamole (prior to a vasodilator)
162
Q

medications to hold 12 hours prior to a vasodilator stress test?

A

Caffeine containing foods and drinks

163
Q

when should you be concerned of agranulocytosis in a pt taking PTU or methimazole?

A
  • when a pt has fever and sore throat within 90days of starting it
  • if a WBC 1500 = antithyroid drug toxicity is unlikely
164
Q

when should you be concerned of agranulocytosis in a pt taking PTU or methimazole?

A
  • when a pt has fever and sore throat within 90days of starting it
  • if a WBC 1500 = antithyroid drug toxicity is unlikely
165
Q

what are the anti-anginal effects of nitrates?

A
  • 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
Q

treatment of choice for central retinal artery occlusion?

A

emergency situation- carotid massage and high flow oxygen administration

167
Q

what disorders are associated with vitiligo?

A
  1. Pernicious anemia
  2. Autoimmune thyroid disease (usually graves)
  3. Type 1 DM
  4. Primary adrenal insufficiency
  5. Hypopituitarism
  6. Alopecia areata
168
Q

what disorders are associated with vitiligo?

A
  1. Pernicious anemia
  2. Autoimmune thyroid disease (usually graves)
  3. Type 1 DM
  4. Primary adrenal insufficiency
  5. Hypopituitarism
  6. Alopecia areata
169
Q

occular exam shows red eye with leukocytes in anterior chamber

A

anterior uveitis

170
Q

occular exam shows red eye with leukocytes in anterior chamber

A

anterior uveitis

171
Q

how do you confirm presence of poststrep glomerulonephritis?

A

ASO (antistreptolysinO) titers and anti-DNAse antibody

172
Q

difference in therapy between mild lupus nephritis and severe proliferative like membranous lupus nephritis?

A 
Mild = glucocorticoids
Severe = glucocorticoids + cyclophosphamide or mycophenolate
173
Q

treatment of amyloidosis?

A

melphalan & prednisone

174
Q 
what nephrotic syndromes are associated with the following buzz words:
Cancer (solid organ):
Children: 
IV Drug users/AIDS:
NSAIDs:
SLE:
A 
Cancer: membranous 
Children: minimal change disease
IV Drug users/AIDS: focal-segmental
NSAIDs: minimal change & membranous
SLE:any  of them
175
Q

most common cause of death in ESRD patients?

A

cardiac disease (atherosclerosis)

176
Q

what are the 4 phosphate binders?

A
  1. Calcium acetate
  2. Calcium carbonate
  3. Sevelamer
  4. Lanthanum
177
Q

Typical ECG manifestations of acute pericarditis?

A

diffuse ST elevations with PR depressions

178
Q

psychotic patient presents with “lead pipe rigidity”

A

neuroleptic malignant syndrome-plus confusion, fever, mudcle rigidity, and diaphoresis

179
Q

most common type of thyroid cancer?

A
  1. Papillary**
  2. Follicular
  3. Anaplastic
  4. Medullary
180
Q

most common cause of thyroid nodules?

A

colloid nodules

181
Q

what bug is the most common cause of PNA in pts with chronic lung disease like COPD?

A

h influenza

morazella catarrhalis is also associated

182
Q

when do you place an IVC filter in pts with DVT? (3)

A
  1. contraindications to anticoagulation
  2. hx of complications for anticoags (HIT)
  3. Pts who developed dvt/pe despite anticoag
183
Q

what is one complication of pressors in pts with decreased BF?

A

ischemia of distal fingers and toes (or mesenteric ischemia/renal failure) secondary to vasospasm

184
Q

bitter almond odor

A

cyanide poisoning

185
Q

hypertensive pt presenting with hypokalemia

A

think of primary hyperaldosteronism

186
Q

what medications should a pt who had a MI be discharged with?

A
  1. ASA
  2. Beta blockers
  3. ACE inhibitors
  4. Statin
    and if has NSTEMI/unstableangina/PCI stent: Clopidogrel! for 1-12mos
187
Q

Clopidogrel is a class of drugs called what? and MOA?

A

Thienopyridine: includes ticlopidine
MOA: anti-platelet effect and act by antagonizing ADP

188
Q

what is an abnormal A-a gradient?

A

> 30!

normal is 30 is high regardless of age

189
Q

what type of anemia is seen in ESRD? when do you initiate tx w recombinant epo?

A 
normocytic normochromic 
Start tx:
1. HTN
2. HA
3. Flu like illness
190
Q

which types of kidney stones are radioopaque and radiolucent?

A

Radioopaque: calcium
Radiolucent: urica acid

191
Q

Electron microscopy shows alternating areas of thinned and thickened capillary loops with splitting of the GBM

A

Alport syndrome

192
Q

what is the earliest renal abnormality present in pts with diabetes??

A

glomerular hyperfiltration

193
Q

gram stain in a pt w pulmonary symptoms shows crooked, branching beaded gram + and partially acid fast filaments

A

Pulmonary nocardiosis

tx = TMP-SMX

194
Q

what pulmonary-renal syndrome requires emergency plasmapheresis??

A

Goodpasture’s syndrome!

- unclear of benefit of emergency plasmapheresis in pts w wegeners, severe PAN

195
Q

what are the symptoms of generalized resistance to thyroid hormones?

A
  • hypothyroidism despite having elevated circulating thyroid hormone levels
196
Q

in the acute setting, one of the primary treatments for stroke in sickle cell patients is what?

A

exchange transfusion

197
Q

What is babesia and where is it endemic?

A
  • transmitted by Ixodes tick
  • northeastern US
  • hemolysis, jaundice, hemoglobinuria, renal failure, and death
  • no rash!
198
Q

treatment of babesia? 2 regimens

A
  1. Quinine-clindamycin

2. Atovaqone-azithromycin

199
Q

What is ehrlichiosis?

A

spotless rocky mountain spotted fever

  • tick born illness
  • fever, HA, n/v, leukopenia, thrombocytopenia
200
Q

what is q fever?

A

caused by coxiella burnetii

  • cattle, goat and sheep
  • flu like syndrome, hepatitis, PNA
  • meat processing workers and vets
201
Q

what is prinzmetal’s angina?

A

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
Q

what’s beck’s triad?

A

triad of cardiac tamponade:

  1. Hypotension
  2. Distended neck veins
  3. Muffled heart sounds
203
Q

mechanism of pulsus paradoxus?

A
  • 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
Q

Source of energy during fasting:

  1. First 12 hours
  2. 24 hours
A

First 12: glycogen stores

24 hours in: gluconeogenesis

205
Q

What are the main 3 substrates for gluconeogenesis?

A
  1. Amino acids: protein from mm
  2. Lactate: from anaerobic glycolysis
  3. Glycerol 3 phosphate (from TAG in adipose)
206
Q

What is the major gluconeogenic amino acid?

A

Alanine: converted into pyruvate in the liver by ALT

207
Q

an infection of Strep gallolyticus (S bovis biotype 1) increases risk of what?

A

Colorectal cancer & Endocarditis

as opposed to s bovis bioptype 2

208
Q

what is cervical spondylosis and how does it present?

A
  • chronic neck pain due to osteoarthritis and secondary muscle spasm
  • sensory deficit due to osteophyte-induced radiculopathy
209
Q

what are the typical radiographic findings in cervical spondylosis?

A

bony spurs and sclerotic facet joints

210
Q

MOA of warfarin induced skin necrosis?

A
  • 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
Q

what is malignant otitis externa and what bug causes it most of the time?

A
  • 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
Q

antibodies found in pernicious anemia?

A

anti-intrinsic factor antibodies

213
Q

Tetrad of multiple myeloma signs and symptoms?

A 
CRAB:
hperCalcemia
Renal impairment (IgG antibodies collect in glomeruli)
Anemia
Bone (lytic lesions, fractures)
214
Q

side effects of:

  1. Methimazole
  2. PTU
  3. Both
A
  1. Teratogenic in 1st trimester, cholestatic jaundice
  2. PTU = vasculitis
  3. Both = rash, arthralgias, hepatitis, agranulocytosis
215
Q

the negative predictive value will vary with what?

A

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
Q

what medications are used to reduce intraocular pressure in glaucoma?

A
  1. Mannitol
  2. Acetazolamide
  3. Timolol
  4. Pilocarpine
217
Q

PPD testing in HIV, when is it positive and what do u give for ppx?

A

positive = >5mm

Give Isoniazid and pyridoxine for 9 months, even if CXR is neg

218
Q

What are two important diagnostic clues for waldenstroms macroglobulinemia?

A
  1. IgM spike

2. Hyperviscosity

219
Q

how do you diagnose ankylosing spondylitis?

A

Xray of the sacroiliac joints showing fusion of the SI joints and or bamboo spine

220
Q

how long does it take an acutely sick person to become vitamin K deficient while NPO?

A

7-10 days

normally you have a 30 day store

221
Q

Why does DDAVP help in uremic coagulopathy?

A
  • it increases the release of factor VIII: vWF multimers from endothelial stores
222
Q

How do NSAIDs cause SIADH?

A

they potentiate the action of ADH

223
Q

what two steps can be taken to improve oxygenation in mechanical ventilation?

A
  1. Increasing FiO2 (but keep below 40%)

2. Adding PEEP

224
Q

what are the 5 extra-renal complications of ADPKD?

A
  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
Q

what are the 3 types of MEN syndromes?

A
  • Type 1: pituitary, parathyroid, and enteroPancreatic tumors
  • Type 2a: medullary thyroid, pheo, parathyroid hyperplasia
  • Type 2b: medullary thyroid, pheo, neuroma + marfanoid habitus
226
Q

what are the genetics of MEN 2a & 2b?

A

Autosomal disorders due to germline mutations in the RET proto-oncogene

227
Q

what is pulsus parvus et tardus?

A

slow rising and low amplitude pulse- seen in aortic stenosis

228
Q

treatment of ITP?

A

Plt >30,000: observe

Plt <30,000 or bleeding: corticosteroids (first line), splenectomy or rituximab (second-line)

229
Q

what is bernard soulier syndrome?

A
  • 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
Q

how do TCAs cause QRS prolongation? tx?

A
  • inhibits cardiac fast sodium channels leading to the QRS prolongation
  • tx: sodium bicarb increases the extracellular sodium concentration
231
Q

what is the treatment of choice of lyme disease in a pregnant woman?

A

amoxicillin

232
Q

treatment of torsades de pointes?

A

magnesium sulfate & stop offending agent

233
Q

Pt with recent bone marrow transplant with intestinal and respiratory symptoms?

A

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
Q

what are the metabolic effects of thiazide diuretic therapy?

A
  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
Q

treatment of CML?

A

Imatinib: tyrosine kinase inhibitor, binds to the ATP binding site of the BCR-ABL protein prohibiting its conformation change to its active form

236
Q

what hormone is specific to androgen producing adrenal tumors?

A

DHEA-S
(dehydroepiandrosterone sulfate)
- produced by the adrenal glands only
- whereas androstenedione, DHEA, and testosterone are produced by the ovaries

237
Q

MOA of demeclocylcine?

A

used for treating SIADH by inhibiting the ADH-mediated aquaporin insertion in the cortical collecting tubule and helps dilute the urine

238
Q

what is fibromuscular dysplasia?

A
  • 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
Q

Ct scan of an immunocompromised pt shows pulmonary nodules with the halo sign or lesions with an air crescent

A

Invasive aspergillosis

240
Q

what is the most common extra-articular manifestation of ankylosing spondylitis?

A

anterior uveitis

241
Q

what is the most frequent origin for the ectopic foci that cause atrial fibrillation?

A

pulmonary veins!

wtf?!

242
Q

what med is contraindicated in cocaine intoxication?

A

beta blockers

243
Q

what causes kaposi sarcoma in HIV pts?

A

HHV-8

244
Q

tx of choice for nocardiosis?

A

TMP-SMX

245
Q

what is bacillary angiomatosis and tx?

A
  • bright right firm friable exophytic nodules in HIV pts
  • caused by Bartonella, a gram neg bacillus
  • tx = oral erythromycin
246
Q

mechanism of kidney damage in SLE?

A

immune complex mediated: immune complexes circulate in the blood and are deposited in renal glomeruli via complement activation (why C3 level is decreased)

247
Q

why do 10% of patients with Renal cell carcinoma present with varicocele?

A
  • due to tumor obstruction of the gonadal vein where it enters the renal vein
  • varicocele fails to empty when the patient is recumbant
248
Q

pts with ulcerative lesions of the colon due to colonic neoplasia or IBD have an increased predilection to develop IE due to what bug?

A

strep bovis type I:

Strep gallolyticus

249
Q

what is kussmaul’s sign?

A

failure of the JVP to decrease on inspiration- seen in constrictive pericarditis

250
Q

what is presbycusis?

A

sensorineural hearing loss that occurs with aging

251
Q

what is Dressler’s syndrome?

A

a pericarditis that occurs weeks after an MI, thought to be due to immunologic phenomena

  • ESR typically elevated
  • Tx: NSAIDs
252
Q

what is the triad of Osler Weber Rendu syndrome?

A

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
Q

what do you find in the anterior mediastinum vs middle vs posterior

A

Anterior: thymoma
Middle: bronchogenic cysts
posterior: neuroenic tumors

254
Q

what is presbyopia?

A

common age-related disorder that results from the loss of elasticity in the lens

255
Q

what is the major cause of abnormal ABGs (resp acidosis- hypercapnia and hypoxemia) in pts with OHS?

A
  • 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
Q

what is one of the earliest signs of macular degeneration?

A

distortion of straight lines so that they appear wavy

257
Q

what is the mechanism of HIT type 2?

A
  • 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
Q

what is malignant hypertension?

A

severe hypertension with retinal hemorrhages, exudates or papilledema

259
Q

what is analgesic nephropathy?

A

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
Q

what lab abnormalities are found in pagets disease of bone?

A
  • normal Ca and phosphate
  • elevated alk phosph and urinary markers of bone degeneration: hydroxyproline, deoxypyridinoline, N-telopeptide, and C-telopeptide
261
Q

tx of Neuroleptic Malignant Syndrome?

A
  1. Dantrolene (muscle relaxant)
  2. Bromocriptine (a DA agonist)
  3. Amantadine (antiviral w DA properties)
262
Q

when do you see renal vein thrombosis and how does it present?

A
  • 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
Q

what is enthesitis and what is it associated with?

A
  • inflammation and pain at sites where tendons and ligaments attach to bone
  • Assoc with HLA-B27 assoc arhtropathies: Ankylosing spondy, psoriatic, reactive arthritis
264
Q

what bug causes post-viral URI necrotizing pulmonary bronchopneumonia with multiple nodular infiltrates that can cavitate to cause small abscesses?

A

staph aureus

265
Q

what bugs are urease producing and can form struvite stones?

A

struvite = magnesium ammonium phosphate

Klebsiella
Proteus

266
Q

what are two functions of von willebrand factor?

A
  1. Supports platelet adhesion

2. Carrier protein for factor VIII

267
Q

when is a beta blocker indicated in heart failure?

A

for all stages of systolic heart failure- even asymptomatic patients with LV EF<50%

268
Q

how does fluphenazine cause hypothermia?

A
  • 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
Q

nontraumatic SAH is most commonly due to what?

A

ruptured saccular or berry aneurysms (>2/3 of cases)

270
Q

Arrhythmia most specific to digitalis toxicity?

A

atrial tachycardia with AV block

IM & Step 2 (4 decks)

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