Med Flashcards
(319 cards)
1
Q
how to manage acetaminophen overdose?
A
- if less than 4 hours, give charcoal
obtain acetaminophen serum levels to determine if pt needs N acetylecysteine via Rumack Matthew nomogram.
pt can be asymptomatic for first 24 hours, and liver failure can ensue
2
Q
environmental risks for pancreatic ca
A
- smoking
- nonheriditary pancreatitis
- obesity + sedentary
3
Q
parapneumonic effusion characteristics
A
- low glucose <60
- low pH <7.2
- high protein
4
Q
interstitial lung disease due to Idiopathic pulmonary fibrosis
A
TLC is decreased
DLCO is decreased
FEV1/FVC is normal
5
Q
meds that cause hyperkalemia
A
ACEi and ARBS cardiac glycosides (digoxin) B blocker K sparing dieuretics NSAIDS
6
Q
how to tell apart venous vs arterial causes for ischemia
A
venous- red, tender/ painful, not as acute,
arterial- pulseless, acute, sharp pain
7
Q
what are the 6 Ps of acute arterial occlusion
A
pain pallor paresthesia pulselessness poikilothermia paralysis
8
Q
arterial thrombosis vs emboli
A
emboli is from the heart
thrombus is originated locally
9
Q
nail changes+ joint deformities + skin plaque
A
Psoriatic Arthritis
10
Q
what is the guidelines for PCI after STEMI
A
within 12 hrs of symptom onset
within 90 mins of medical contact at a medical center with PCI
within 120 mins of medical contact at medical center w/o PCI
11
Q
acute STEMI treatment
A
PCI, O2, aspirin P2Y12 inhibitor, NG, BB, anticoagulation
12
Q
synchronized cardioversion vs unsynchronized cardioversion
A
synch: persistent tachyarrhythmia which shows signs of hemodynamic instability, ex-hypotension
unsynch: for pulseless tachyarhythmia
13
Q
how to work up bright red blood in stool
A
under 40 yo: anoscopy
40-50 : sigmoidoscopy
50+ : colonoscopy
** assuming no other risk factors
14
Q
Crohn’s labs
A
leukocytosis, thrombocytosis, elevated ESR
15
Q
how does adding estrogen pills affect a pt’s levothyroxine dose
A
oral estrogen pill (patches dont do the same!) cause decreased clearance of TBG, which causes lower concentrations of free T4 in a pt who doesn’t have endogenous thyroid function to compensate. So need to provide increase levothyroxine dose
16
Q
whats the first step if epidural spinal cord compression is suspected (even if its by cancer)?
A
IV glucocorticoids even before MRI imaging
17
Q
how to work up bright red blood in stool
A
under 40 yo: anoscopy
40-50 : sigmoidoscopy
50+ : colonoscopy
18
Q
how to treat latent TB
A
Isoniazid and pyridoxine
19
Q
what is HIT and what are its dangers?
A
-antibody mediated thrombocytopenia
can cause increased clot risk
stop heparin and start agatroban or fondaparinaux
20
Q
whats the first step if epidural spinal cord compression is suspected (even if its by cancer)?
A
IV glucocorticoids even before imaging
21
Q
what does a ventricular aneurysm look like on EKG?
A
usually few months post MI, scar tissue forms convexity, leading to aneurysm
looks like deep Q waves, and persistent ST elevation
22
Q
dermatomyositis pts have increased risk of ___
A
malignancy
23
Q
post ictal anion gap, what is it? whats the management?
A
- anion gap due to lactic acidosis
- should resolve in 90 min so repeat abg in 2 hr.
24
Q
how to tell the difference about the etiology of a rash from amoxicillin ?
A
- due to EBV: occurs 24 hours+ after dose
- due to HSType1: occurs immediately after.
25
whats the difference between direct current cardioversion and defibrillation? whats the indication for each?
direct current= synchronized. Gives shock to QRS, used in afib with pulse
defib= unsynchronized, given generalized shock not specific to point at cardiac cycle, used for pulseless or Vfib
26
widened mediastinum, deviated trachea, widened aortic knob on XRAY is indicative of
descending aortic aneurysm most commonly due to atherosclerosis
27
what are the symptoms of cushings myopathy?
muscle atrophy, hirsutism, bone loss, wt gain, htt
28
whats the pathophys of B12 in megaloblastic anemia?
B12 is needed to synthesize thymidylate and purine molecules. defective dna synthesis leads to slow maturation of RBC causing megaloblastic anemia. LDH and indirect bilirubin is also elevated from hemolysis
29
how to tell apart primary and secondary hypoaldosteronism
general symptoms: fatigue, anorexia/abdominal pain,
primary (adrenal): hyperpigmentation (high ACTH), hypotension (low EPI, NE)
secondary (pituitary): no hyperpig, no mineralocorticoid effects like hyperkalemia or hypotension bc thats regulated by RAAS.
30
hypertrophic cardiomyopathy is inherited in what fashion?
AD
31
what are the characteristics of HCM
young man, exertional dyspnea, systolic ejection murmur (crescendo decrescendo) at LLSB which is made better by increasing preload aka squat
32
whats the difference between DHEA and DHEAS
```
DHEA= both ovaries and adrenals make
DHEAS= only adrenals make
```
33
bicuspid aortic valve murmur for regurg?
- early decrescendo diastolic murmur, best heard with pt sitting up, leaning forward, breath held at end expiration
LLSB at 3/4th ICS
34
AAA suspicion? best imaging for diagnosis?
US
35
kidney stone suspicion? best imaging for diagnosis?
US or CT noncontrast
36
Erlichiosis?
"rocky mt fever without the spots"
tick bite, tx= doxy
elevated LFTs, alt mental status, leukopenia/thrombocytopenia
37
how to measure osmolal gap? what does it indicate?
osmolal gap= 2Na + glucose/18+ BUN/2.8
if this is elevated from the measured osmolal gap AND you have anion gap= consider ETHANOL,ETHYLENE GLYCOL, and METHANOL as sources
38
how to differentiate folate vs B12 def via labs
folate:only elevated homocyteine (bc homocysteine becomes methionine with B12 and folate)
B12: elevated homocysteine, and elevated methylmalonic acid (B12 converts methylmalonic to succinyl coa)
39
how to manage hypercalcemia?
normal saline infusion, calcitonin- acute effects
| bisphosph- can decrease ca over 2-4 days
40
how to work up suspicion of hypoaldosteronism?
1. ) morning cortisol level
2. ) plasma ACTH (can take a while to come back)
3. ) ACTH stimulation test
41
how do you know if metabolic acidosis will respond to saline or not?
- responsive: low urine chloride (<20), etiology of MA s usually due to low intake/vomitting
- resistant: normal urine chloride
42
what is Light's criteria?
pleural fluid:serum protein is >0.5
pleural LDH: serum LDH >0.6
pleural LDH > 2/3 ULN serum LDH
43
what is SAAG?
"serum to ascites albumin gradient" can help differentiate btw portal htt and nonportal htt causes of ascites.
if the serum albumin:ascites albumin is >1.1 its due to portal htt causes
44
how do sodium levels correlate with HF?
hyponatremia correlates with severity of CHF
45
actinomyces tx
penicillin
46
how to differentiate primary hyperparathyroidism and familial hypercalcemia hypocalcuria syndrome?
- primary hyperparathy: has normal urine Ca to creat clearance ratio
- familial: has a decreased urine Ca to creat cx ratio
47
what is a cardiac manifestation of carcinoid?
- fibrous plaques on the tricuspid, causing TR
48
what medicine do you avoid in STEMI due to cocaine abuse ?
- do not give B Blocker
49
air under the diaphragm
- pneumoperitonitis, PUD
50
how to manage caustic ingestion
clean skin, change clothes
get xray
do endoscopy
51
how to tell apart Grave's and painless thyroiditis?
- grave's shows increased uptake of radioactive iodide, painless thyroiditis doesnt bc its releasing preformed T3
52
PSGN vs IgA nephropathy
both follow URI
IgA is 5 days after, occurs in young men, nl C3 C4 levels
PSGN is 10-21 days after, occurs in children decreased C3 levels
53
cardiac myxoma vs myxomatous valve degen
myxoma= benign tumor
| myxomatous valve degen= etiology of MVP
54
concerning solitary pulm nodule vs nonconcerning solitary
>0.8 cm, smoker, spiculated is concerning
55
duodenal ulcer
cause= Hpylori, NSAID
| better with food
56
heart failure following URI
dilated cardiomyopathy due to acute myocarditis
57
diabetic gastroparesis
delayed gastric emptying with sx of anorexia,nausea, vom, and poor glycemic control
tx- prokinetics like metoclopromide,erythromycin, cisparide
58
T/F ACL and MCL have hemarthrosis
F, only ACL has this.
59
HCM medication
metoprolol 1st line
| Ca ch blocker 2nd line
60
leads for inferior wall MIs
II, III, AVF
61
leads for posterior wall MI
V1, V2
62
only C3 deposits on basement wall is indicative of
membranoproliferative GN, IgG against C3 convertase causes excess levels of C3/ complement activation
63
suspicion for IE, what next?
do 3 blood cultures
64
clinical symptoms of gonoccocemia?
- 2-10 pustules, tenosynovitis, arthralgias
65
wide complex ventricular tachy management
if stable give amiodarone
| if unstable give electric cardioversion
66
TMPSMX common metabolic side effect
HYPERkalemia
67
management of acute LE arterial occlusion
anticoagulant like IV heparin BEFORE imaging
68
common extraarticular manifestation of ankylosing spondylitis?
ant uveitis
69
how does sodium bicarb prevent TCA overdose toxicity?
TCA can bind fast sodium channels in the heart causing arrhythmia and death. the bicarb alkalinizes the blood and the NA displaces TCA from the heart
70
LFT elevation in pt being treated for TB
INH hepatitis, mild and self limited, keep doing the treatment
71
hyperkalemia with stroke and cardiac abnormalities whats the tx?
IV calcium gluconate
72
afib ectopic beat origin?
Pulmonary Veins
73
Atrial flutter beat origin?
tricuspid annulus
74
to fix hypokalemia you need to fix what?
HYPOMAGNESEMIA
| magnesium is needed to block ROMK channels in the kidney, these channels excrete K+
75
paget disease labs
elevated urine hydroxyproline, phosporus, calcium
normal serum calcium, phosphorus
elevated serum alk phosph
76
prostate ca bone lesions vs MM bone lesions
osteoblastic vs osteolytic
77
whats hhs?
hyperosomotic hyperglycemic state happens in type 2 diabetics with little ketoacidosis. there is also neurologic defecits due to hyperosmolar state
78
whats the etiology of spondylarthritis in <40 yo male
inflammatory of the ligamentous insertion leading to articular damage of the SI jt etc.
79
hypothyroid metabolic abnormalities
hyponatremia, hyperlipidemia, elevated Cr, elevated transam, hypertriglyceridemis
80
whats a factorial design study group
2+ interventions, with 2+ independently studied variables
81
what is a blood abnormality seen in EBV
2-3 wks following infection pt may have hemolysis induced anemia and thrombocytopenia with elevated bilis
82
signs of desseminated mycobacterium avium complex? ppx?
- fever cough nightsweats in HIV CD<50, splenomegaly
| - ppx- azithromycin
83
what pain meds are not effective in osteoarthritis?
```
acetaminophen
opiods (oxycodone)
```
84
what electrolyte abnormalities does furosemide cause?
hypomagnesemia, hypokalemia
| which can lead to Vtach
85
WPW AFIB tx
procainamide
86
pericarditis ekg
diffuse ST elevation except avR which shows depression
87
Dressler's syndrome
pericarditis 2-3 wks following MI
| tx= NSAIDs
88
hemochromatosis signs
diabetes, hepatomegaly, jt pain with calcinosis
89
leukemoid vs CML vs AML
leukemoid - metamyelocyte
CML- myelocyte
AML- myeloblast
90
leukemoid vs CML
leukemoid- high LAP
| CML - low LAP
91
what anticoagulants are contraindicated in kidney disease?
LWMHeparin (enoxaparin), Fondaparinaux, rivaroxaban
92
what medication can cause asthma, chronic rhinusitis like symptoms
Aspirin
93
primary biliary cholangitis side effects?
- osteomalacia/porosis
| - HCC
94
how to manage variceal bleed
1. fluid
2. antibiotics
3. OCREOTIDE
95
warts on the foot, palm, or genitals think..
HPV
96
chronic prostatitis symptoms
- perineal pain
- pain with ejaculation
- back pain
97
splenic abscess is most commonly caused by
IE
98
AVNRT
a type of paroxysmal supraventricular tachy, seen in young people with nl hearts. 2 conduction pathways in the AV node, one slow and one fast, if a PAC happens at just the right moment, the slow pathway can ALSO be activated causing a slow-fast loop
99
RVMI leading to cardiogenic shock, whats the treatment
problem is with preload, give a BOLUS
100
CHF renal response
notes decreased RBF, so constricts aff and eff arterioles to maintain GFR
RAAS activated, so decreased Na delivery to CD
101
suspecting achalasia, whats next?
do endoscopy to rule out pseudoachalasia (due to tumor)
102
polysaccharide conjugation vs toxin(protein)- polysaccharide conjugation?
just polysaccharide causes t-cell independent B cell response
but conjugating to a protein, allows t-cell dependent B cell response
103
vfib tx is_____
| vtach tx is _____
defib for vfib
| synchronized cardioversion for vtach
104
Spontaneous Bacterial Peritonitis?
cirrhosis w/ mental status changes or fever
105
hemolytic anemia with evidence of thrombosis (cerebral veins or intra-abdominal)
paroxysmal nocturnal hemoglobinuria, usually presents in 4th decade of life
106
what are the electroyte abnormalities in TLS?
- hypocalcemia
| - hyperkalemia, hyperpotassium, hyperuricemia
107
when giving Nirtoprusside watch out for?
cyanide toxicity
108
cardiac tamponade symptoms
Beck's triad: distended jugular, muffled heart sounds, hypotension
109
the proper diagnosis of a "night owl" is?
Delayed Sleep Wake Disorder
110
what are haustra? what do they indicate?
- thick indentations/markings that do not extend the entire lumen
- toxic megacolon
111
IDA vs ACD in labs?
both have low iron
| but check the ferritin! ACD has high to normal ferritin, IDA has low ferritin
112
Anti phospholipid syndrome lab abnormalities
a prolonged PT and PTT are a LAB ERROR common in this syndrome bc Lupus Anticoagulant binds the phosphorus in assays.
113
patellofemoral pain syndrome
seen in young female athletes, due to overuse, PE shows tenderness at patella, tx- strengthening exercises
114
how does false positive relate to specificity?
1-specificity= FP
115
when mech ventilating someone whats the target FiO2
FiO2 is weaned to less than 60 as quickly as possible
116
why can hepatic encephalopathy be worsened in pts with on dieuretics
hypokalemia and metabolic alkalosis can worsen HE
117
what are the HIV prophylaxis?
<200, TMPSMX
<50 Azithromycin for MAC
<150 and in a histoplasma endemic area, do Itraconazole
118
whats a reason RBC will be seen on UA but not urine sediment
UA cant diff btw myoglobin and hemoglobin but urine sediment can, so causes of increased myoglobin in urine is likely culprit
119
some type of nephrotic syndrome followed by sudden kidney pain, fever, and gross hematuria
caused by renal vein thrombosis. most commonly seen in membranous glomerulopathy
120
whats the multiple myeloma picture?
hypercalcemia (causes constipation and fatigue), anemia, back pain
121
60+ yo with painless rectal bleeding likely due to?
angiodysplasia
122
mediastinal mass with elevated AFP and bHCG is
nonseminomatous germ cell tumor (bc afp is high)
123
rouleaux RBC seen in?
MM
124
febrile nonhemolyticreaction to transfusion occurs 1-6 hrs after?
due to cytokines released by leukocytes can be prevented by leukoreduction
125
pt with megaloblastic anemia gets folate supplementation what remains?
hematologic abnormalities like megaloblasts will no longer be seen with folate supp. But neurologic abnormalities can get worse.
126
what are the signs on PE of aortic stenosis
pulsus parvus et tardus
mid to late peaking of systolic murmur
presence of soft and SINGLE second heart sound.
127
scrotal varicocele, polycythemia, hemturia is most likely is caused by
RCC
128
why does SLE cause pancytopenia
peripheral immune destruction
129
transudate, exudate, vs normal pleural fluid pH
nl pleural fluid pH= 7.6
transudate = 7.4-7.55
exudate= 7.3-7.4
130
diverticulitis has urinary symptoms T/F?
T , it can irritate the bladder
131
how long does a tick need to attach to treat for lyme?
36 hours
132
sodium correction..
HIGH to LOW
LOW to HIGH
High to Low the brain will blow , cerebral edema
| Low to high, the pons will die
133
how to treat symptomatic bradycardia?
IV atropine
| then if that doesn't work dopamine or epi
134
tachy, lid lag, tremor and htt following surgery is caused by?
thyroid storm
135
esophageal varices management
B blocker
136
S. viridans vs S aureus
S.viridans is subacute,
| S.aureus is acute
137
work up for acromegaly suspicion?
IGF1 first, if elevated do oral glucose suppression test and check for GH supression
138
if medullary thyroid cancer is suspected, what else should you test for?
could be in the MEN2/2b, which is associated with pheochromocytoma, check for urine metanephrines, this could be a risk if pt needs surgery.
139
dermatofibroma vs epidermal inclusion cyst
dermatofibroma most commonly on lower extremities, often hyperpigmented
EIC- central punctum, skin color, on trunk, UE, and face
140
MI <12 mo after stent placement
most likely due to stent thrombosis bc the pt was not adhering to anti platelet medications
141
what is hepatorenal syndrome
cirrhosis of the liver causes increased NO production, causing splanchnic vasodilation, so the RBF is decreased, in response to this renal hypoperfusion, the RAAS is activated, causing decreased urine output
142
enlarged thyroid with face/UE congestion?
thyroid lymphoma- this often has a rapidly growing thyroid, which extends into the retrosternal space and causes facial plethora and other signs of congestion
143
RA 1st line medication?
Methotrexate
144
in aotic dissection whats the drug of choice?
Labetalol (or other IV beta blockers) not hydralazine or nitroprusside bc it can cause reflex sympathetics
145
GCA cardiac side effect?
aortic aneurysm
146
HHS treatment
NS saline for first few hours then 0.45% saline
147
whats the algorithm for a hypernatremia work up?
if the pt is euvolemic- give free water orally
if the pt is hypovolemic and asymptomatic give 5% dextrose
if the pt is symptomatic give 0.9% saline, until euvolemic, and then give 5% dextrose
148
when you step on a rusty nail whats the guidelines for tetanus care?
if youve had the 3 tetanus shots, and the wound is clean, you need a toxoid vacc if you havent for 10 yr, if the wound is dirty you need it if you havent had one in 5 yr
if you never got 3 vacc, and the wound is clean get the toxoid vacc, if its dirty you need the toxoid vacc and IVIG
149
melena and food relieving abdominal pain is?
PUD in the duodenum
150
signs of arsenic poisoning
stocking glove distribution sensory deficiency
pancytopenia
hepatitis
skin hyper and hypo-pigmentation
151
hepatic hyperechoic lesion in young woman
hepatic adenoma
152
what are the hyperestrinism signs of cirrhosis?
palmar erythema, spider angioma, gynecomastia, testicular atrophy, decreased body hair
153
what are the PPD guidelines for TB
POSITIVE IF
>5 in HIV, immunocomp, previous TB
>10 in immigrant, IVDU
>15 in someone healthy with no risk
154
why should pts on prednisone (or other glucocorticoids) receive TMPSMX
ppx for PJP
155
what drug can cause peripheral edema
Ca channel blocker
156
pts with porphyria cutanea tarda should be screened for?
Hep C
157
babesiosus signs?
fever, malaise, intravascular hemolysis
158
SVT vs VT ? tx?
SVT, regular and narrow complex tachycardia tx is adenosine
VT is wide QRS complex tachy, tx is amiodarone or lidocaine
159
OA vs Rheumatoid Arthritis
OA is at DIP and PIP, you will see Heberden's nodes and Bouchard nodes
RA mainly occurs at MCP
160
alcoholic hepatitis labs show
AST, ALT are elevated but usually <300
AST:ALT >2
elevated TTG and ferritin
161
fastest way to reverse hyperkalemia
Insulin + glucose or B antagonists will rapidly place potassium in cells
162
what else do you need to treat hyperkalemia
calcium to stabilize the cardiac membrane
| Kayexelate to excrete the K+
163
homocysteine elevation concerns
can cause hypercoagulable state, make sure to decrease it! how? give B6 and folate (usually B12 not needed unless there is a defeciency)
164
3 causes of hypocalcemia to consider before getting a PTH
1. hypomagnesemia
2. drugs
3. recent blood transfusion
165
what is obesity hypoventilation syndrome
BMI> 30
| hypercapnia at daytime
166
9;22
cml
167
what is first degree AV block, management?
PR >0.20 (5small boxes)
if alone, do nothing just observe
if assn with prolonged QRS, do EP testing
168
how to characterize and manage intermittent asthma
= 2 a wk daytime sx
<2/= 2 a month night time sx
SABA prn
169
multilobar cavitary infiltrates after getting better from flu
bacterial superinfection, most likely S Aureus
170
ISOLATED thrombocytopenia (without anemia) and normal PT and PTT is most likely
ITP, autoantibodies against platelet receptors
171
PJP tx
TMP SMX
| if pt has PaO2<70 or A-a gradient >35 corticosteroids added to TMPSMX have been shown to help mortality
172
thrombotic thrombocytopenic purpura
1. MAHA
2. thrombocytopenia
3. renal insuff
4. neuro changes
5. headache
note PT and PTT are normal unlike DIC
173
TTP tx
plasma exchange
174
PCT triggers
estrogen, alcohol
| history of Hep C
175
labs for salicylate tox
resp alk so PaCO2 is low
met acidosis soHCO3 is low
these are opposing so pH is near normal
176
how to tell apart primary and secondary hyperparathyroidism
primary will have elevated ca
| secondary will not have elevated ca
177
NNT=
inverse of ARR
178
an arc of echymosis on medial malleolus is indicative of
burst popliteal bursa
179
howto treat hypernatremia
first IV 0.9% saline to become euvolemic, then 0.45% saline to replace the free water defecit
180
loss to follow up is what kind of bias?
selection bias
181
icthyosis vulgaris
diffusely scaly skin due to mutation in filaggrin gene
182
shoulder stiffness with little pain is likely
adhesive capsulitis
183
whats the BUN level for uremic pericarditis
BUN>60
184
what does a low cardiac index mean
low myocardial contractility
185
crypto meningitis tx
flucytosine and amphotericin B
186
drug induced acne vs acne vulgaris
drug induced- no comedones, all are the same age, mainly upper back, shoulders and arms caused by glucocorticoids
187
diarrhea and spondylarthritis
IBD arthritis
188
TIGHT glycemic control decreases the risk of what
microvascular complications ex- retinopathy
189
what findnig is suggestive of follicular thyroid cancer
invasion of the capsule and blood vessels
190
mixed cryoglobulinemia syndrome vs TTP
MCS has PALPABLE purpura, RF+, arthralgia, renal dx, and peripheral neuropathy
TTP has NONpalpable purpura, renal dx, severe anemia and thrombocytopenia
191
sore throat, muffled voice, and drooling
Epiglottitis
192
how to differentiate COPD and asthma
does bronchodilator fully reverse (which means does FEV1 increase by >12)
193
Polycythemia Vera
constitutively active JAK2, but low EPO
194
hair loss due to stress ex pregnancy
telogen effluvium
195
painful bladder syndrome =
interstitial cystitis
196
anorexia in cancer pts tx
| vs anorexia in HIV pt tx
cancer- progesterone anologue
| HIV-cannaboid
197
how to work up mild htn
urine analysis and chem panel, lipid profile, baseline EKG
198
whats step1 and step2 of step up asthma therapy
step 1- SABA
| step 2- SABA+ICS
199
AAA screening
one time screening for men between 65-75 who are smoker or prior smoker
200
what does thyroglobulin level tell you about hyperthyroidism
if its high, the thyroid hormone is endogenously produced
| if its low, the hormone is exogenously entering
201
how to monitor and measure DKA
follow anion gap
| get betahydroxybutyrate assay
202
pathophysiology of HIT
- heparin causes a change to the platelet receptor, exposing a neoantigen, causing antibody mediating platelet activation
203
when do you initiat fibrate therapy
when TG>1000
204
gonococcal arthritis vs reactive arthritits
gonococcal- give antibiotics
| reactive- give nsaids
205
Malaria prophylaxis
Chloroquine in non-endemic areas ex: CentralAmerica or Carribean
Mefloquine etc in endemic areas like India and Africa
206
miliary TB vs mycoplasma pneumo
both have retinculonodular patten
myco is 2-3 weeks
TB will last months
207
what is AERD?
aspirin exacerbated respiratory disease
| - taking NSAIDs causes asthma and chronic rhinusitis with nasal polyps
208
management of febrile neutropenia without a cause?
<1500 neutrophils
| need empiric tx with Pseudamonas coverage
209
electrical alterans
pericarditis
210
Osler Weber Rendeau
telengecttasia, avms
recurrent epistaxis
hypoxia
211
Chikingunya
seen in carribean
| fever, rash, thrombocytopenia, lympcytopenia, polyarthralgia
212
acute MI causing pulmonary edema tx
furosemide
213
uretral stones management
fluids, analgesics, and alpha blockers
214
dermatitis herpetiforms is related to
celiac's
215
osmotic vs secretory diarrhea
secretory diarrhea- decreased stool osmotic gap, seen in infections and post abdominal surgery
osmotic diarrhea- elevated stool osmotic gap
216
Bath salt intoxication
agitation, psychosis, elevated BP and tachy, seizures, neg urine tox, can last for a WEEK (vs PCP which is much more short acting)
217
most common liver malignancy
mets
218
cocaine MI, how to manage
O2
Benzo
consider NG and Ca Ch blocker
DO NOT USE BBLOCKER
219
DEXA screen
women >65, or with risk factors
220
cystinuria
hexagonal crystals
impaired AA transport
cyanide nitroprusside test for diagnostics
221
SLE diagnostic tests
- ANA high sensitivity
| - Anti-dsDNA, anti SMITH high specificity
222
motor (Morton's) neuroma
plantar pain when toes are squeezed together
223
Endocarditis can be RF pos
TRUE
224
diarrhea in AIDS
1. cryptosporidium (CD4<100), LOW temp
| 2. MAC (CD4<50) HIGH temp
225
common meds that cause SIADH
- SSRI
- carbamazepine
- NSAID
226
hemachromatosis has elevated risk of what
HCC
227
IgM M spike is
Waldenstrom Macroglobulinemia
228
asbestos causes
bronchogenic carcinoma, (much more likely than mesothelioma)
229
DeQuervain's tenosynovitis
often seen in new moms (hold baby with thumb outstretched and abducted)
due to APL and EPB irritation
230
acute rejection of organ
IV steroids
231
Penicillin G vs V
V is oral
| G is IV
232
how to step up acne care for inflammatory acne
topic retinoids and benzoyl perox
topical antibiotics
oral antibiotics
233
BCC vs SCC lip
BCC top lip
| SCC bottom lip
234
Trastuzumab, AE?
cardiotoxicity
235
Warfarin induced skin necrosis
Protein C deficiency
236
Marfan's murmur
aortic regurg
237
peripheral edema is a side-effect of what anti-hypertensive?
CCBs
238
hydroxychloroquine
IL1 and TNFa suppressor, used for SLE, watch out for retinal damage
239
Erisypelas
superficial skin only, ex: external ear, GAS
240
most common cause of primary adrenal insuff
autoimmune adrenalitis
241
digitialis toxicity arrhythmia
- atrial tachycardia with AV block
242
indicationfor HepC screen
IVDU or blood transfusion before 1992
243
what gifts can you accept as a doctor?
small monetary value only if it benefits patient care
244
actinic keratosis
scaly white papules usually on face/scalp/hands
| risk of progression to SCC
245
if you are sure that a pt has celiac's but the IgA antiTTG is negative, whats the explantation
IgA deficiency
246
how can supplemental O2 cause AE in COPD
causes CO2 retention while improving hypoxia. this causes acidosis in brain and cerebral vasodilation which can lead to sz
247
crohn's
skip lesions, transmural, rectal sparing, throughout bowels
| noncaseating gran, fistula
248
what can worsen ophthalmopathy in Gravs?
RAI tx by increasing levels of TRAB. give prednisone w RAI if opthalmopathy present or do surgery
249
when you suspect CML what should you check to identify it is not leukemoid rx
high LAP, metamyelocytes> myelocyte is leukemoid
250
small vs squamous cell paraneoplastic syndrome
small- SIADH, ACTH
| squamous - PtHRP
251
how to tell apart Mobitz type 1 vs type 2 block
type 1- PR interval gets long and longer then drop
| type 2- PR interval is constant then drop
252
UTI with urine pH basic
proteus
253
primary hyperaldosteronism medical tx (although surgery is preferred)
Spironolactone
| Epelerone
254
how to tell ethylene glycol poisoning apart from methanol poisoning
methanol poisoning shows eye damage
| ethylene glycol will show kidney damage
255
longterm home oxygen therapy indication
PaO2<55
O2 ulse ox <88
HCT >55
256
lyme disease tx in pregnancy pt
amoxicilin
257
why are people with Crohn's at greater risk for kidney stones?
malabsorption of Ca and fatty vitamins causes too much free oxalate. Hyper oxaluria, will cause oxalatestones
258
arthritis, neutropenia, splenomegaly is what syndrome
Felty's
259
meniere's pathophys
increased endolymph volume and pressure
260
multiple ulcers, esp if present in jejunum should raise suspicion for?
gastrinoma (ZES)
261
mediastinal mass by location
medial - bronchogenic cyst
anterior - thymoma
posterior - neurogenic
262
types of MEN
MEN1- primary hyperPTH, pit tumor, panc tumor
MEN 2A- med thyroid ca, pheo + primary hyper PTH
MEN2B- med thy ca, pheo+ mucosal neuroma/marfinoid
263
nephrotic syndrome has increased risk of what
atherosclerosis and hypercoagulbility
264
isolated systolic htn
arterial stiffness
265
lynch syndrome
CRC, endometrial ca, ovarian
266
PMR and GCA
do not have to occur together
PMR tx is low dose steroids
if GCA is suspected do temporal A bipsy and give high dose steroids
267
BPH management
1st line - alpha 1 blocker
| can add 5 areductase inhibitor but takes months to effect
268
nephrotic syndrome associated with malignancy?
membranous
269
nephrotic syndrome associated with Hodgkin lymphoma
minimal change disease
270
anaphylaxis to blood transfusion
IgA def
271
osteomalacia
low phosphate, high Alk phosph, low to normal calcium
| usually due to poor vit D absorbtion
272
acute promyelocytic leukemia is related to
DIC
273
Behcet syndrome
oral ulcers, genital ulcers, eye lesion, skin lesion, thrombosis
274
zinc def
pustular rash around mouth
alopecia
hypogonadism
impaired taste
275
primary biliary cholangitis vs primary sclerosing cholangitis
PBC-middle age women with pruiritus
| PSC- men, UC,
276
what murmur decreases with squatting
MVP
277
loop diueretics cause what acid/base disturbance?
metabolic alkalosis
278
pathophys of hepatorenal syndrom
splanchnic vasodilation secondary to cirrhosis causes RAAS activation leading to decreased GFR
279
cyclosporine vs tacrolimus ae
cyclosporine=hirsutism, gum hyperplasia, hyperkal, htn nephrotox,
tacrolimus- all of these except hirsutism, and gun hyperplasia
280
most common kidney stone
ca oxalate
281
sciatica tx
NSAIDs
282
comedonal acne treatment
topical retinoids, salicylates,
283
inflammatory acne
topical antibiotics/oral abs
284
nodular cystic severe tx
oral isoretinoids.
285
calcium correctionformula
= Ca + 0.8*(4-albumin)
286
when to use hypertonic (3%) saline
when Na<120
287
what acid base disorder can TB cause
nongap metabolic acidosis
288
metabolic syndrome criteria
1. abdominal obesity
2. fasting sugars >100
3. BP >130/80
4. TG>150
5. HDL <50
289
how to check if respiratory compensation is enough for met acidosis
Winter's formula = CO2 with comp=
1.5*(HCO3) + 8 +/- 2
290
Factor V Leiden Def
- AD mut in Factor V so that it can't respond to Prot C leading to slow degradation of Factor V causing hypercoag state.
- note, PT and aPTT may be normal
291
when to start statins?
if ASCVD > 7.5%
292
GI, confusion, pneumonia (after travel on cruise ship)
Legionella
293
low T3, normal T4 and normal TSH
euthyroid sick sndrome
| often seen following illness
294
systemic sclerosis
- anti-topomeriase
- anti-RNA poly III
- anti centromere ab
295
carcinoid syndrome causes what deficiency?
Niacin deficiency bc more of tryptophan becomes serotonin and less becomes niacin
296
PS13 then PP23 is for who?
| just PPS23 is for who?
>65, or with major medical condition like SCD
| <65 if smoker or chronic heart or kidney dx
297
Conn's syndrome, what is the serum bicarb
HIGH bc hypokalemia causes excess bicarb reabs
298
nocardia tx
TMPSMX
299
Calcium kidney stones nutritional advice
increase water intake
decrease Na intake
dont change dietary Ca intake
300
small fiber vs large fiber axonopathy
- sm: POS symptoms - pain
| - lg: NEG symptoms - numbness
301
uremic coagulopathy
CKD causing platelet dysfunctions and increased bleeding time
302
pulsus paradoxus
>10 mmHg drop in BP
most likely cardiac tamp
can also be asthma or copd
303
human bite wound tx
amoxicillin-clavulanate
| -gram pos, gram neg, and beta lactamase pos
304
Fibromuscular dysplasia affects?
renal and ICA
305
how does pH affect calcium levels
Basic/HIGH pH- low ionized ca (bc most of it is sticking to albumin)
Acidic/Low pH- HIGH ionized Ca
306
trousseau's syndrome
- migratory thrombophlebitis
| - indicative of malignancy in abdomen usually pancreas
307
PBC marker
anti-mitochondiral abs
308
what does the D-xylulose test show
how much the villi are absorbing
- can indicate Celiac's
- not dependent on enzymes so wont be different in lactose def or pancreatic enzyme def
309
when can odds ratio equal risk ration
if incidence is low
310
pleural effusion with high amylase
think esophageal perf
311
thyroid hormone effect on bone?
- increase osteoclast activity, can cause hypercalcemia, hypercalcuria, osteoporosis, and increased risk of bonce fracture
312
confounding bias vs effect modification
the 3rd variable is related to both the result and whats being studied (smoking, alcohol, and cancer)
effect modification- the 3rd variable is related to only the result but not whats being studied (OCP, fam hx of brca, and brca)
313
vitiligo etiology
autoimmune destruction of melanocytes
314
diabetic med that helps in weight loss
GLP1 inhibitor
315
TdP treatment
hemo stable- IV Mg
| hemo unstable- defib
316
after rbc transfusion
1. DIC, abdominal/flank/injection site pain
2. anaphlaxis
3. fever
1. ABOincompatible
2. Iga def
3. cytokines in blood
317
colonoscopy for UC?
yes 8 years post diagnosis and then every 1-2 yrs
318
FHH vs Phyperparathyroid
look at urine!
ca cx<0.01 its FHH
>0.02 its PPTH
319
TMP-SMX can cause what electrolyte abnormality?
hyperkalemia
