Medicine #2 Flashcards
(458 cards)
1
Q
familial hypocalciuric hypercalcemia
A
hypercalcemia with an elevated PTH but low urinary calcium excretion (<100)
2
Q
Indications for parathyroidectomy
A
- Age < 50 as likely to have complications later in life
- Symptomatic hypercalcemia
- risk for complications (serum Ca > 1mg/dL above normal), urine calcium excretion > 400
3
Q
most common presentation of primary hyperparathyroidism?
A
aymptomatic hypercalcemia with elevated parathyroid level
4
Q
How would you position a patient with left sided lobar pneumonia? why?
A
Lye patient on their right side. gravity causes more blood to flow to right side (the side with better ventilation. This improves V/Q mismatch)
5
Q
Dead space ventilation (area of ventilated lung not perfused with blood) occurs in what acute process?
A
PE
6
Q
carboxyhemoglobin from CO posioning shifts the oxygen dissociation curve to the _____? causing?
A
left. impairing ability of heme to unload oxygen at the tissue level resulting in tissue hypoxia.
7
Q
Why do patients with CO poisoning often have secondary polycythemia?
A
Kidney responds to tissue hypoxia by producing more EPO and more RBCs are made.
8
Q
Why cant pulse ox be used in the diagnosis of CO posioning
A
it doesn’t differentiate between carboxyhemoglobin and oxyhemoglobin
9
Q
Babesiosis presentation
A
flu-like (fever, chills, malaise) anemia, intravas hemolysis, thrombocytopenia)
10
Q
babesiosis diagnosis
A
peripheral blood smear (intraerythrocytic rings) “maltese cross”
11
Q
Treatment for babesiosis
A
7-10 days atovaquone plus azithromycin
quinine plus clindamycnin (severe)
12
Q
Erlichiosis
A
tick borne illness that causes nonspecific symptoms (fever, myalgias, HA, leukopenia, thrombocytopenia)
13
Q
tourniquet test
A
helps diagnose dengue fever
14
Q
Lab testing in Paget disease shows?
A
elevate alk phos
elevated bone turnover markers (PINP, urine hydroxyproline)
Nml calcium and phosphorus
15
Q
target BP for patients with diabetic nephropathy?
A
130/80
16
Q
most beneficial therapy to reduce progression of diabetic nephropathy is?
A
strict BP control
17
Q
axonopathy of large and small nerve fibers occurs in what disease process?
A
DM
18
Q
small fiber axonopathy symptoms?
A
pain, paresthesias, allodynia
19
Q
large fiber axonopathy symptoms?
A
numbness, loss of proprioception, vibration sense, diminished ankle reflex
20
Q
hypercalcemia of malignancy
A
severe, symptomatic hypercalcemia due to release of parathyroid hormone related protein by tumor cells
21
Q
Neurocysticercosis is caused by? symptoms?
A
Taenia solium pork tapework. seizure and signs of increased ICP.
22
Q
Treatment of patients with neurocysticercosis?
A
antiepileptic: phenytoin
antiparasite: albendazole
corticosteroid for brain inflammation
23
Q
infectious oocytes in feline feces?
A
toxoplasmosis
24
Q
neurotropic virus acquired from infectious animal bite?
A
rabies
25
Treatment for legionella
flouroquinolone or newer macrolide
26
Management of stable and unstable patients with WPW and Afib with RVR?
stable: procainamide
unstable: electrical cardioversion
27
Why shouldn't you use AV nodal blocking agents (adenosine, B-blockers, CCBs, Dig) in patients with WPW and Afib?
can promote conduction across accessory pathway and lead to transition into Vfib.
28
Management of cocaine toxicity?
IV benzo, aspirin, nitro and CCBs
29
why are B-blockers contraindicated in cocaine tox?
unopposed alpha adrenergic stimulation
30
Mees lines (horizontal striation of fingernails) is characteristic of?
aresenic toxicity
31
dimercaprol can treat ____ toxicity
aresenic
32
acute arsenic toxicity can cause?
_____ is a very early manifestation of arsenic poison
pancytopenia and hepatitis
hypo/hyperpigmentation
33
fever, back pain, focal spinal tenderness, increased muscle spasm, suggests?
vertebral osteomyelitis
34
how do you diagnose vertebral osteomyelitis?
CBC, blood cultures (+ in 50-70%), ESR and CRP will be elevated, leukocyte count (normal or high),
*MRI is diagnostic study
35
What is needed to confirm diagnosis of osteomyelitis?
CT guiged aspiration and culture of infected interverbral space
36
preferred diagnostic test for aortic dissection in hemodynamically stable patients with good kidneys?
preferred test in unstable patients with kidney injury?
CT angio
TEE
37
Edema caused by glomerular nephritis is caused by what mechanism?
decreased GFR and retention of Na and water by the kidneys
38
antidote for cyanide poisoning
hydroxycobalamin or sodium thiosulfate
Nitrites to induce methemoglobinemia because cyanide binds avidly to Fe#+
39
when does methemoglobinemia occur?
exposure to oxidizing agents (oxidizing Fee2+ to Fe3+) (left shift in O2 dissociation curve)
dapsone, nitrates, topical/local anesthetics
40
List common causes of diarrhea in patients with HIV/AIDS
Cryptosporidium
Microsporidium
MAC
CMV
41
CD4 count and symptoms for HIV associated: Crypto
CD < 180
Severe watery diarrhea
low grade fever
weight loss
42
CD4 count and symptoms for HIV associated microsporidium diarrhea
CD < 100
watery diarrhea
crampy abd pain
weight loss
**fever rare
43
CD4 count and symptoms for HIV assocated MAC diarrhea
CD4 < 50
watery
*high fever (39, 102.2)
weight loss
44
CD4 and symptoms for HIV associated CMV diarrhea?
CD4 < 50
```
frequent, small volume** diarrhea
hematochezia**
abd pain
low grade fever
weight loss
```
45
Thyrotoxicosis with normal or increased radioactive iodine uptake?
graves disease; toxic multinodular goiter; toxic nodule
46
painless thyroiditis is considered a variant of ______ and is associated with what autoantibodies?
hashimotos. thyroid peroxidase autoantibodies
47
Multiple system atrophy (Shy-drager syndrome)
degenerative disease characterized by Parkinsonism, autonomic dysfunction, widespread neuro sings
48
Person with parkinson's experiences orthostatic hypotension, impotence, incontinence - consider what diagnosis?
Multiple system atrophy
Shy-Drager Syndrome
49
In a women < 50 with 1 of the following you should consider:
- severe or resistent htn
- onset of htn before 35
- increase in creatinine after starting ACE, ARB
- systolic-distolic epigastric bruit
FIbromuscular dysplasia
50
Adrenal vein sampling differentiates between?
adrenal hyperplasia and adenoma (primary hyperaldo)
51
Type I HIT (non-immune) usually presents ___ days after HEP exp
2 days
52
Type II HIT (autoimmune antibodies to platelet factor 4) (PF4)- presents _____ days after Hep exp
5-10 days
53
Diagnosis of ankylosing spondylitis?
x-ray of pelvis or MRI if x-ray doesn't show anything
54
associated with JAK2 mutation
polycythemia vera
55
Treatment for Polycythemia vera?
serial phlebotomy
56
What ventilator strategy improves mortality in patients with ARDS
low tidal volume ventilation
57
coverage for human bite wounds?
amoxicillin-clavulanate
58
Mixed cryoglobulinemia is an immune complex disorder commonly associated with what illnesses?
Chronic Hep C, Hep B, HIV
and SLE
59
mixed cryooglobulinemia syndrome is caused by?
presents with?
immune complex deposition into small-medium size blood vessels
presents with fatigue, palpable purpura, arthralgia, renal disease, peripheral neuropathy, htn.
60
C4 levels in mixed cryoglobulinemia are?
low
61
Cryoglobulinemia type I is associated with what diseases?
```
Lymphoproliferative disease (multiple myeloma)
Hematologic disease
```
62
Clinical findings in cryoglobulinemia type I
asymptomatic, hyperviscosity (burry vision, thrombosis, raynauds), levido reticularis
63
complement levels in cryoglobulinemia type I?
normal
64
Why are patients on TPN or prolonged fasting more likely to get gallstones?
The normal stimulus for CCK release and gallbladder contraction is absent
65
How does a small bowel resection contribute to the formation of gallstones?
decreased enterohepatic circulation of bile acids. this means bile becomes supersaturated with cholesterol.
66
What is the mechanism for gallstone formation during pregnancy and OCP users.
Estrogen-induced increase in cholesterol secretion
Also in pregnancy progesterone causes reduction in bile acid secretion and slows gallbladder emptying
67
An elevated serum alk phos level in a patient with UC should raise suspicion for?
PSC
68
What are the most common causes of PTH independent hypercalcemia?
malignancy, Vit D toxicity, extrarenal conversion of 25-hydroxyvitamin D to 1,25 dihydroxyvitamin D in Sarcoidosis
69
Most common PTH dependent causes of hypercalcemia?
primary hyperparathyroidism
tertiary hyperparathyroidism
70
What is secondary hyperparathyroidism? it is commonly seen in what disease? why?
increased secretion of PTH in response to hypocalcemia
chronic kidney disease due to inadequate phos excretion and decreased 1,25-hydroxy vitamin D levels
71
abdominal pain, vomiting, diarrhea often with neuro symptoms of agitation, paresthesias, confusion and chronically elevated LFTs
acute intermittent porphyria
72
Describe recommendations for PCV13 and PPSV23 vaccines
- PCV13 vaccination is recommended for all adults > 65 followed at a later time by the PPSV23
- Sequential PCV13 and PPSV23 are rec for < 65 with (csf leak, cochlear imlpant, sickle cell, asplenia, immunocompromise, CKD)
- For adults < 65 with other chronic diseases (heart, lung, DM, smoking) - PPSV23 is recommended
73
describe recs for Tdap/Td
Adults ahsould receive a one time Tdap vaccine in place of Td. Then Td every 10 years.
74
Attributal risk percent is calculated by?
subtract risk in unexposed population from the risk in the exposed population. Divide the result by risk in exposed pop.
or RR-1/RR
75
mechanism of systolic hypertension in thyrotoxicosis?
hyperdynamic circulation from increased HR and myocardial contractility
76
Thyrotoxicosis causes an increased sensitivity to?
catecholamines via upregulation of B1 receptors
77
hypothyroidism causes elevated BP through
increase in systemic vascular resistance
78
gold standard confirmatory teset for type 2 HIT?
serotonin release assay
79
Therapy for type II HIT
- Stop ALL Hep products
| - Start a direct thrombin inhibitor (argatroban) or fondaparinux
80
aspirin toxicity causes what acid base disturbance?
mixed respiratory alkalosis and metabolic acidosis
81
3 cardinal signs of Parkinson's disease?
how do you diagnose it?
Resting tremor, rigidity, bradykinesia
At least 2 of these signs on physical exam
82
Accumulation of alpha-synuclein in substantia nigra?
Parkinson's
83
hydroxyurea as a treatment for sickle cell disease? what is MOA?
increase hemoglobin F
84
USPSTF screening recs for AAA?
screen male active or former smokers 65-75 1X
85
Indications for carotid endarterectomy in men?
asymptomatic: 60-99% stenosis
symptomatic
50-69% stenotic
70-99% stenotic
86
Indications for carotid endarterectomy in women?
70-90% both symptomatic and asymptomatic
87
oral leukoplakia
reactive precancerous lesion representing hyperplasia of squamous epithelium
88
oral leukoplakia may progress to?
squamous cell carcinoma
89
What is first line treatment for increasing appetite in cancer patients with anorexia/cachexia syndrome?
Progesterone analogue: megestrol acetate
Or steroids
90
Good treatment for cachexia in advanced HIV?
Dronabinol (synthetic cannabinoid)
91
Rapidly progressive dementia
myoclonus, akinetic mutism, cerebellar or visual disturbance, hypokinesia, periodic sharp wave complexes on EEG, positive 14-3-3 CSF assay is indicative of?
Creutzfeld Jakob disease
92
Gold standard diagnosis for creutzfeld jakob?
brain biopsy***
or PRNP gene mutations
93
Spongiform changes on postmortem brain biopsy?
creutzfeld jakob
94
Bi or tri phasic sharp wave complexes on EEG typical of?
Creutzfeld Jakob
95
Contraindications to subcutaneous sumitriptan?
ischemic cardiac disease, pregnancy
96
Treatments for cluster HA?
100% oxygen by facemask
Subcutaneous sumitriptan
97
acute, severe periorbital pain with autonomic manifestations (ipsilateral miosis, conjunctival injection, lacrimation) =
cluster HA
98
Prophylactic management of cluster HA?
Verapamil
Lithium
99
Treatment for pseudotumor cerebri?
Acetazolamide
100
orbital massage is good management for?
central retinal artery occlusion (unilateral acute painless vision loss)
101
Mycosis of the desert southwest that causes CAP, arthralgias, erythema nodosum, erythema multiform
Coccidiodes
102
Appropriate management of patient with post-ictal lactic acidosis?
repeat chemistry panel in 2 hours
lactic acidosis typically resolves without treatment in 90 minutes
103
Peak prevelance of influenza?
January and February
104
presentation of influenza?
abrupt fever, malaise, myalgia, HA, rhinorrhea sore throat, nonproductive cough
105
Who should receive antiviral therapy for flu?
Those with risk factors (age 65, chronic medical problems, pregnancy) or those w/o risk factors who come to office within 48 hours of symptom onset
106
Compare and contrase a viral URI with Influenza according to
symptom onset:
URI symp:
systemic symp:
onset: viral URI is slow, stepwise, migratory. Influenza is abrupt and dramatic onset
URI symp: viral URI with rhinorrhea, coryza, sneezing, mild pharyngitis. Flu URI symp are often mild
Systemic symp: Viral URI w/ mild. Flu with prominent fever, myalgia, HA
107
Patient < 40 with minimal bright red blood per rectum should have what test?
Anoscopy
108
Patient <40 with bright red blood and nothing seen on anoscopy should have?
sigmoidoscopy or colonoscopy
109
Patients 40-49 with bright red blood per rectum without red flags should have what test
sigmoid or colonoscopy
110
patients >50 or any age with red flags and with bright red blood should have what test?
colonoscopy
111
Presentation of CLL
elderly with mean age of 70, often asymptomatic. can have extreme fatigue, B symptoms (night sweats, fevers), infection, weight loss. lymphadenopathy. hepatosplenomegaly.
112
Diagnostic tests for CLL
CBC with dramatic lymphocytosis and mature lymphocytes and smudge cells on peripheral smear
113
smudge cells are pathognomonic for?
CLL
114
CML
myeloproliferative dsiease of neutrophils .
115
Hairy cell leukemia presentation
splenomegaly and pancytopenia
116
hodgkin lymphoma presentation
painless lymphadenopathy with B symptoms (night sweats, fevers) with normal CBC and peripheral blood smear
117
chronic prostatitis/chronic pelvic pain syndrome is?
pelvic pain of perineum/testes for >3 months without a cause. presents with voiding difficulty, pain with ejaculation or blood in semen.
118
etiology of chronic prostatitis/chronic pelvic pain syndrome?
Etiology unclear. due to NONinfectious chronic prostate inflammation
119
Management of chronic prostatitis/pelvic pain syndrome?
alpha blockers (tamsulosin)
5 alpha reductase inhibitors (finasteride)
Antibiotics (cipro)
120
Epididymitis
bacterial sequestration in epididymis presents with irritation with voiding, scrotal pain, scrotal swelling, tenderness and purulent urethral discharge
121
FFP contains? and is used when?
clotting factors and plasma proteins. indicated for severe coagulopathy
122
ST depression in leads V1 and V2 is suggestive of?
posterior wall MI
123
RCA supplies blood to the _____ node and can cause ______ block
AV node
AV nodal block
124
In COPD, FRC is higher or lower?
higher - new pressure equillibrium is reached at higher lung volumes
125
3 treatments for Graves Disease
antithyroid drugs (methimazole, propylthiouracil)
radioactive iodine
thyroidectomy
126
When is potassium iodide used?
preparation for thyroidectomy in graves disease or for treatment of thyroid storm.
It inhibits thyroid hormone synthesis
127
Best management for bone pain in patients with prostate cancer who have undergone orchiectomy?
Radiation therapy
128
What should the SAAG be in patients with SBP?
>1.1
129
treatment for SBP?
third gen cephalosporin
Flouroquinolones
130
brain death is a legally acceptable definition of?
death
131
does life support need to be continued when a patient is deemed brain dead? do you need family permission to decide?
no, no
132
Classify mild, moderate, severe hypothermia?
mild: 32-35 (90-95)
tachypenia, tachycardia, shivering
mod: 28-32 (82-90_
brady, lethargy hypoventilation, atrial arrhythmia, decreased shivers
severe: <28 or <82
coma, card collapse, V-arrhythmia
133
General treatment for hypothermia
warmed (42C) 107F crystalloid for hypotension
endotracheal intubation if comatose
134
Rewarming techniques for mild, mod, severe hypothermia
mild: passive external (remove wet clothes, cover with blankets)
mod: active external. (warm blankets, heating pads, warm bath)
severe: active internal (warmed pleural or peritoneal irrigation, warmed humidified oxygen)
135
Does hypothermic bradycardia respond to atropine or cardiac pacing? why/why not?
NO. decreased reactivity of cardiac pacemaker cells
136
hypothermia caused by myxedema is treated with?
levothyroxine
137
excessive production of monoclonal IgM antibody?
Waldenstrom macroglobulinemia
138
Bone marrow biopsy confirmation of waldenstrom macroglobulinemia will show?
>10% clonal B cells
139
Periphral blood smear in waldenstroms will show?
rouleaux formation or erythrocyte agglutination
140
presentation of waldenstroms?
hyperviscosity syndrome (diploplia, tinnitus, HA, dilated fundoscopic findings, neuropathy, hepatosplenomegaly, anemoa, thrombocytopenia.
141
how to differentiate MGUS from Waldenstroms?
MGUS (monoclonal IgM spikes are smaller <3), bone marrow biopsy shows < 10% monoclonal cells, and no end organ effects!
142
monoclonal IgG or IgA light chain spike is characteristic of?
multiple myeloma
143
RA predisposes patients to 2X risk for developing?
osteoporosis
144
Polymyalgia rheumatica presents as?
```
Age >50
Bilateral pain and morning stiffness > 1 month
Involvement of neck or torso
Shoulders or proximal arms
Proximal thigh or hip
Constitutional symptoms
```
145
Lab studies in polymyalgia rheumatica
ESR > 40, sometimes > 100
Elevated CRP
Normocytic anemia
146
Treatment for polymyalgia rheumatica?
Response to glucocorticoids
147
Polymyalgia rheumatica is associated with?
Giant Cell Arteritis
148
non-gonococcal urethritis, asymmetric oligoarthritis and conjunctivitis, mucocutaneous lesions and enthesitis (achilles tendon pain) are common in?
Reactive arthritis
149
Management for reactive arthritis?
NSAIDs
150
Common causes of priapism?
1. sickle cell disease and leukemia
2. perineal or genital trauma (laceration of cavernous artery)
3. neuro lesios
4. medications- trazodone, prazosin
151
Most common cause of priapism is?
Prazosin
152
What 3 conditions cause >90% of chronic cough (>8 weeks) in non-smokers?
Post-nasal drip
GERD
Asthma
153
Treatment of post-nasal drip?
first-gen antihistamine (chlorpheniramine)
154
Recommendation for mammogram screening?
biennial (every 2 years) for women aged 50-74
155
Screening for mammography is not necessary beyond age?
75
156
cholesterol screening guidelines?
men at avg risk starting at 35 and women at inreased risk at 45 (5 year intervals)
157
smokers with asbestos exposure have a 59 fold increase of having what cancer?
bronchogenic carcinoma
158
More common for patients with asbestos exposure to have mesothelioma or bronchogenic carcinoma?
bronchogenic carcinoma
159
Does testosterone level increase with anabolic steroid use?
Anabolic steroids are not picked up as testosterone on screening. Likely see normal or low T levels with low FSH/LH levels due to suppression by GnRH.
160
inherited disorder characterized by teste fibrosis, azoospermia, gynecomastia, decreased intelligence, high FSH and LH
Klinefelter syndrome
161
testicle atrophy, muscular atropy, weakness, low T level, high FSH and LH
myotonic dystrophy
162
Type B adverse drug reaction that is dose independent and causes mental status change, rigidity, fever, autonomic dysreg?
neuroleptic malignant syndrome
163
Lamotrigine causing stevens johnson syndome dose dependent or dose independent?
dose independent
164
how do vagal maneuvars help stop AVNRT?
increase parasympathetic tone and result in slowing of conduction through AV node (increase in AV node refractory period)
165
When is PT appropriate for back pain?
when it has persisted 6-12 weeks. most patients with acute pain <4-6 weeks haev back pain that improves without intervention and symptomatic NSAID or acetaminophen treatment is best
166
Factor in an experiment that has properties linking it to an exposure and the outcome?
Confounding variable
167
Treatment for myasthenia crisis (generalized and oropharyngeal weakness with resp insufficiency and dyspnea)?
Plasmapharesis or IVIG and corticosteroids
168
Anterior cord syndrome
injury to anterior spinal artery affecting anterior 2/3 of spinal cord. Bilateral hemiparesis at level of injury and diminished pain and temp 1-2 levels below the corresponding level. Intact vibration and proprioception!
169
Central cord syndrome
decreased sensation and motor function in the arms. relative sparing of the legs. (occurs with forced hyperextension- fall, whiplash)
often seen in elderly with cervical spondylotic myelopathy
170
Brown-Sequard Syndrome occurs with what types of injuries?
stab wound, cord compression, hemisection of spinal cord
171
Findings in Brown-Sequard syndrome?
Ipsilateral hemiparesis
Ipsilateral loss of proprioception, vibration, ight touch
Contralateral diminished pain and temp** (1-2 levels below cord injury)
172
Protozoan Trypanosoma cruzi?
Chagas disease- megaesophagus, megacolon, cardiac dysfunction
173
hepatic hydrothorax?
hydrothorax due to cirrhosis occuring on the right side of the lung
174
most common cause of community acquired bacterial meningitis?
Strep Pneumonia
175
In a patient of African descent, what tests should be used to scren for hemoglobinopathies?
CBC and hemoglobin electrophoresis
176
In a patient of non-African descent, what screening test is needed to check for hemoglobinopathies?
CBC
177
Pes anserinus pain syndrome
localized pian over anteromedial tibia (anserine bursa) valgus stress does not aggrevate pain
178
Name causes of renal transplant dysfunction in early post-operative period
```
ureteral obstruction
acute rejection
cyclosporine toxicity
vascular obstruction
acute tubular necrosis
```
179
How do you treat acute rejection of renal transplant?
IV steroids
180
Amikacen is an aminoglycoside. what serious side effect do you need to monitor for with all aminoglcosides?
Nephrotoxicity
181
Nafcillin can cause what kidney injury?
AIN
182
Cancers in tail of pancreas presents w/w.o abd pain and w/w.o jaundice?
With abdominal pain and without jaundice
183
Characteristic imaging findings for cancer of head of pancreas?
intra and extra hepatic biliary tract dilation
184
Viral conjunctivitis (pink eye) presents as? management?
conjunctival inflammation, watery discharge, often in setting of URI. often seen in kids and caregivers in late summer and early fall. often adenovirus.
Manage with warm or cold compresses +/- antihistamine or decongestant drops
185
Bacterial conjunctivitis
more severe pain. grossly purulent exudate. treat with erythromycin ointment, polymxin-trimethoprim drops, azithromycin crops.
186
preferred treatment for bacterial conjunctivitis in contact lens wearers?
fluoroquinolones
187
Mast cell stabilizing agents (olopatadine and azelastine) are indicated for treatment of?
allergic conjunctivitis
188
The measure of random error in a study is?
Precision
189
How can you measure a studies precision?
narrow confidence interval = more precision
190
How can you increase the precision of a study?
increase the sample size
191
Most common causes of bloody diarrhea?
most common cause in absence of fever?
E.coli, shigella, campylobacter
E.coli
192
How can you confirm diagnosis of EHEC?
Shiga toxin in stool
193
Widened pulse pressure, strong carotid upstroke, systolic flow murmur, tachy and flushed extremities should make you think of?
arteriovenous fistula
194
Name causes of high output cardiac failure?
thyrotoxicosis
Paget disease
Anemia
Thiamine deficiency
195
Multiple and refractory peptic ulcers, ulcers distal to duodenum, chronic diarrhea should make you think of?
Zollinger-Ellison Syndrome
196
How does Z-E syndrome lead to diarrhea and steatorrhea?
excess gastric acid in small intestine can inactivate pancreatic enzymes and injure mucosal brush border
197
overdose causing nausea, fever, abd pain, tinnitus and vertigo, tachypnea?
Aspirin
198
Trihexyphenidyl
anticholinergic used to treat tremor in parkinson's disease
199
Pathogenesis of tabes dorsalis?
Treponema pallidum spirochetes directly damage dorsal sensory roots
200
sensory ataxia, lancinating pains, neurogenic urinary incontinence, argyll robertson pupils, reduced/absent DTRs?
Late neurosyphillis, tabes dorsalis
201
Risk factors for c.diff
recent abx use
advanced age >65
PPI use (acid suppression)
202
Condition that classically affects new moms who hold infants with their thumbs outstretched
De Quervain Tenosynovitis
203
Trigger thumb results in pain when?
thumb in flexion and it hurts over the palmar aspect of first MCP
204
Causes of papillary necrosis
NSAID
```
NSAIDs
Sickle Cell
Analgesic abuse
Infection
Diabetes
```
205
Causes of AIN
Drugs: Penicillins, TMP-SMX, cephalosporins, NSAIDs, rifampin
206
Keratoacanthoma
cutaneous tumor- presents as dome shaped nodules with central keratinous plug (typically benign)
207
How can you differentiate MAC and CMV diarrhea in HIV?
MAC: watery, high fevers > 102!
CMV: frequent small volume diarrhea, hematochezia, abd pain, (low grade fever**)
208
how to diagnose CMV diarrhea in HIV?
colonoscopy with biopsy. eosinophilic and basophilic inclusions
209
Patients with graves ophthalmopathy, including proptosis, should not be treated with? IF they are, they should also be given?
what is the preferred treatment for ophthalmopathy patients?
radioactive iodine therapy
glucocorticoids with therapy
thyroidectomy
210
Risks of hyperthyroid drug therapy
agranulocytosis
methimazole: teratogen in1st trimester; cholestatic
propylthiouracil: hepatic failure, ANCA-associated vasculitis
211
Common causes of aortic regurg?
aortic root dilation: marfan, syphilis
postinflammatory (rheumatic heart disease, endocarditis)
congenital bicuspid aortic valve
212
Patients with early syphilis who have penicillin allergy receive alternate treatment with?
oral doxycycline
213
best initial test when you suspect squamous cell carcinoma of the mucosa of the head and neck?
panendoscopy (esoohagus, bronchus, larynx)
214
Hypoxemia PaO2/FiO2 ratio < 300?
RDS
215
Low TV, high PEEP, high FiO2 is good management for?
RDS
216
Treatment for Pagets disease
bisphosphonates
217
Acalculous cholecystitis
most often seen in?
acute inflammation of gallbladder in absence of gallstones
seen in hospitalized patients who are critically ill
218
Risk factors for acalculous cholecystitis
recent surgery (esp cardiopulm, aortic, abdominal),
severe trauma
extensive burn
sepsis/shock
prolonged fasting/TPN because all of these conditions lead to gallbladder stasis or ischemia
219
treatment for acalculous cholecystitis?
enteric abx coverage
cholecystostomy for initial drainage
cholecystectomy once clinically stable
220
Cullen sign
periumbilical bluish coloration indicating hemoperitoneum that is a sign of severe pancreatitis
221
Grey-Turner sign
reddish-brown coloration around flanks- indicating retroperitoneal bleed
222
Causes of recurrent pneumonia?
local airway obstruction
- extrinsic bronchial compression (neoplasm, adenopathy)
- intrinsic bronchial obstruction (bronchiectasis, foreign body)
Recurrent aspiration
-seizure, alcoholism, GERD, dysphagia
223
how does common variable immunodeficiency present?
In adulthood with recurrent infections of the lung and respiratory tract
224
most common causes of encephalitis in immunocompetent adults?
herpes, varicella, EBV
225
Bone pain, fractures
weight loss, fatigue
recurrent infections
think of?
multiple myeloma
226
long term therapy for asthma vs COPD?
inhaled corticosteroids for asthma. long acting anti-cholinergic inhaler for COPD
227
most efficient test to differntiate asthma from COPD?
spirometry before and after bronchodilator
228
Most common site of ulnar nerve entrapment?
Elbow. Ulnar nerve lies at the medial epicondylar groove.
229
Hemi-neglect syndrome is caused by a lesion of the _____ lobe
right (non-dominant) parietal lobe
230
The higher the prevalence of a disease, the greater the?
PPV
231
What is the prob that a patient with a positive test result actually has the disease? - this measures?
PPV
232
muffled voice and deviation of uvula suggest?
peritonsillar abscess
233
emergency laryngoscopy is required in patients with?
epiglottitis
234
Entamoeba histolytica
protozoan found in developing countries transmitted through consumption of contaminated food and water
235
clinical manifestations of entamoeba histolytica?
most asymptomatic. 10% develop colitis or extraintestinal (liver, pleura, brain) disease
236
most common form of extraintestinal disease for E. histolytica
amebic liver abscess that is seen as a single subcapsular cyst on CT
237
Treatment for E. hystolitica?
Metronidazole and intraluminal paromomycin
238
Echinococcus granulosis can cause? presentation
hydatid liver cyst (fever is rare, patients asymptomatic for years)
239
40-50 year old with behavioral disturbances and sudden jerky movements?
Huntington's
240
atrophy of lenticular nucleus?
wilsons disease
241
atrophy of caudate nucleus
huntingtons disease
242
D-xylose test?
What is it used for?
Differentiate between celiac disease and enzyme deficiency related malabsorption syndromes.
D-xylose is absorbed in small intestine without any degradation by enzymes needed and excreted in urine. Patients with celiac disease cannot absorb the D-xylose in the intestine so urinary and venous blood levels will be low.
Patients with enzyme deficiency (pancreas related) absorb D-xylose normally.
243
When can you see a false positive D-xylose test?
delayed gastric emptying or impaired GFR, small intestinal bacterial overgrowth
244
amyloid angiopathy is the most common cause of?
spontaneous lobar hemorrhage in adults >60
B-amyloid deposition in walls of medium/small arteries
245
most common cause of intracranial hemorrhage in kids?
AV malformation
246
rupture of bridging veins?
subdural hematoma crescent shaped
247
meningeal artery tear?
epidural hematoma biconvex pattern
248
management of acute attack of MS?
IV glucocorticoids. methylprednisolone.
plasma exchange if patients dont respond
249
long term management of MS?
interferon beta, natalizumab, glatiramer
250
management of anticholinergic overdose?
physostigmine (cholinesterase inhibitor)
251
Cause of nephrotic syndrome in african american, hispanic, obese, HIV, heroin users
focal segmental glomerulosclerosis
252
cause of nephrotic syndrome in patients using NSAIDs or with lymphoma?
minimal change disease
253
most common form of nephropathy associated with malignancies?
membranous glomerulonephropathy
| usually solid cancers- lung, colon, prostate, breast
254
Nephrotic syndrome due to amyoidosis is seen with what malignancy?
multiple myeloma
255
hep C, B and chronic bacterial and autoimmune infections associated with what type of nephropathy?
membranoproliferative
256
Associated symptoms of cluster headache include?
sweating, facial flushing, nasal congestion, lacrimation, pupillary changes
257
Adenomas are considered malignant/non-malignant?
malignant
258
Which adenomatous polyps should concern you for higher malignant potential?
>1cm n size, high grade of dysplasia, villious features or sessile features or a high number (>3 concurrent adenomas)
259
hyperplastic polyps, hemartomatous polyps (juvenile, peutz-jeghers, inflammatory pseudopolyps, lipomas, lympoid aggregates are all malignant/non-malignant
non-malignant
260
mitral stenosis is most commonly due to?
rheumatic heart disease
261
what changes might you see on cxray with a patient with mitral stenosis?
elevated main stem bronchus due to LAE
262
```
Thrombocytopenia
microangiopathic hemolytic anemia
renal insufficiency
neuro changes
fever
```
TTP
263
Treatment for TTP?
plasma exchange
264
Without emergent plasma exchange, the mortality rate for TTP is?
90%
265
CT scan with small kidneys and bilateral renal papillary calcifications?
Analgesic nephropathy
266
Chronic tubulointerstitial nephritis and papillary necrosis occur due to?
analgesic overuse
267
CYP450 inhibitors increase or decrease effects of warfarin?
increase
268
CYP450 inhibitors?
acetaminophen, NSAIDs, abx, antifungals amiodorone cranberry juice, Vit E, omeprazole, thyroid, SSRI
269
Lateral epicondylitis is due to overuse of ______?
extensor muscles
270
Pain with lateral epicondylitis occurs with?
Passive wrist flexion and resisted wrist extension or supination
271
management for lateral epicondylitis
activity modification, NSAIDs, counterforce bracing
272
Posterolaeral elbow pain is found in _____ syndrome?
radial tunnel
273
Decreased cortisol, decreased aldo, increased ACTH, hyperpigmentation, hyonatremia, hyperkalemia, hypotension signify what disorder?
Primary adrenal insufficiency
274
decreased cortisol, decreased ACTH, normal aldo indicate?
central adrenal insufficiency
275
Lyphocytic hyophysitis (lymphocytic infiltration of pituitary gland) and Sheehan Syndrome (pituitary infarct) are common causes of?
Secondary adrenal insufficiency post-partum
276
Most common cause of secondary adrenal insufficiency is?
chronic glucocorticoid therapy
277
Appropriate initial response for persistent bradycardia with hypotension, shock, AMS, chest discomfort, heart failure
IV atropine (.5mg bolus) evry 3-5 mins
278
If patients with bradycardia have no response to atropine, what are the next steps?
Transcutaneous pacing OR IV dopamine or IV epi
279
Glucagon is effective in treating toxicity for?
B-block and CCB
280
Ecthyma gangrenosum
hemorrhagic pustules with surrounding erythema that evolve into necrotic ulcers
Due to psedomonas aeruginosa typically in setting of profound neutropenia
281
Compression of spinal nerve roots leading to decrease in anal sphincter tone?
cauda equina syndrome
282
A cauda equina lesion causes upper or lower motor neuron symptoms?
lower motor neuron symptoms because nerve roots are part of peripheral nervous system
283
Where does the spinal cord end in adults?
L1-L2
284
biateral severe radicular pain, saddle hypoanesthesia, asymmetric motor weaknes, hyporeflexia and bladder dysfunction should make you think of?
Cauda equina! (contrast with conus medullaris which will show symmetric motor weakness and hyperreflexia)
285
With conus medullaris syndrome, numbness is confined to the _____?
perianal area
286
organophosphate poisoning?
acetylcholinesterase is non-functional leading to symptoms of cholinergic excess
287
what should be given to counteract the effects of organophosphate poisioning?
Atropine
288
First thing you should do for someone with organophosphate poison?
remove clothing and wash body so poison stops being absorbed through skin
289
Physostigmine's mechanism of action?
acetylcholinesterase inhibitor
290
Lisch nodule
golden brown spots in eyes- indicative of NF1
291
Cafe-au-lait spots, lisch nodules, freckling in skin folds is suggestive of?
NF1
292
Optic pathway glioma tumors can grow large enough to compress optic nerve and cause decreased visual acuity and proptosis. these tumors are associate with?
NF1
293
bilateral acoustic neuromas are associated with?
NF2
294
how can you differentiate between cardiac and liver disease related causes of lower extremity edema?
hepatojugular reflex
295
IV fluid management of DKA and HHS?
normal saline initially
| Add 5% dextrose when serum glucose is < 200
296
Insulin management for DKA and HHS?
-Initial continuous IV insulin infusion
Switch to SQ (basal bolus) insulin when BG <200, able to eat, anion gap is < 12, serum bicarb >15
Overlap SQ and IV insulin by 1-2 hours
297
Potassium management in DKI
Add IV K for K <5.2
| Hold insulin for serum K < 3.3
298
When to consider bicarb in DKA?
pH < 6.9, plasma bicarb < 5
299
Anion gap =
Na - (Cl + Bicarb)
300
Why can patients with DKA have pseudohyponatremia?
due to hyperglycemia (use corrected Na) (observed sodium + 2meQ for every 100mg glucose is over 100)
301
external hodeolum (stye) etiology and treatment
acute inflammatory disorder of eyelash follicle, tear gland often due to infectious staph aureus. warm compress. if persistes >1-2 weeks or is growing large- may require incision and drainage
302
Hypertension
hyperglycemia
weight gain may suggest?
Cushing syndrome
303
common causes of cushing syndrome?
glucocorticoid intake, ACTH producing pituitary adenoma, ectopic ACTH production
304
Associated hypokalemia with Cushing's features suggests what as the etiology?
ACTH producing tumor
305
Initial testing for hypercortisolism can include?
24 hour urine free cortisol
late night salivary cortisol
low-dose DEX suppression test
306
After you establish hypercortisolism, what should next test be?
ACTH level
307
Patients with elevated ACTH should have what test done next? What will it tell you?
High dose DEX suppression test
Determine whether ACTH production is pituitary (Dex will suppress it) or ectopic (Dex will not suppress it)
308
How can hypothyroidism cause hypertension?
Increased NE and Aldo leading to increased vasc resistance
309
What organisms are most responsible for infections following deep puncture wounds?
Staph aureus and Pseudomonas aeruginosa
310
Treatment for deep wound infection with pseudomonas?
Cipro, Pip-Tazo and debridement
311
broad based budding yeast
blastomycosis
312
Treatment for blastomycosis?
itraconazole or amphotericin B
313
Osteosarcoma most often affects ?
adolescents. distal femur.
314
1st line treatment for B-block overdose?
Treatment for refractory hypotension in B-block overdose?
secure airway, IV fluids and atropine
IV glucagon
315
What two arrhythmias should be managed with immediate defibrillation?
V.fib or pulseless VTach
316
Vtach with a pulse should be managed with?
synchronized cardioversion
317
When is low dose chest CT recommended yearly for lung cancer screening?
patients 55-80 with 30 pack year smoking history and who are currently smoking or quit < 15 years ago
318
Isolated thrombocytopenia without anemia or leukopenia?
idiopathic thrombocytopenic purpura (ITP)
319
Thrombocytopenia can be the presenting finding in 5-10% of patients with?
HIV
320
Before diagnosing ITP, always test for?
HIV and Hep C
321
postcholecystectomy syndrome. definition, etiology
persistent abdominal pain or nausea that occurs either postoperatively or months to years later.
due to biliary (retained common bile duct or cystic duct stone, biliary dyskinesia (sphincter of Oddi dysfunction)
extra-biliary (pancreatitis, peptic ulcer, coronary artery disease)
322
next step in evaluation of suspected postcholecystectomy syndrome?
ERCP
323
anti-mitochondrial antibodies are elevated in?
primary biliary cirrhosis
324
Cortical laminar necrosis is the hallmark of ?
prolonged seizures. status epilepticus can cause permanent injury due to excitatory toxicity.
325
postoperative endophthalmitis
most common form of endophthalmitis. swollen eyelids, conjunctiva, corneal edema and infection.
326
calcinosis cutis
deposition of calcium and phosphorus in the skin. Scattered whitish papules, plaques, nodules.
327
most common behavioral risk factor for TB?
substance abuse
328
cancers that metastasize to the spine?
lung, breast, prostate, multiple myeloma
329
In a patient with suspected epidural spinal cord compression, what should be given right away and without delay
IV glucocorticoids
330
What do you need to worry about when stopping chronic steroid treatment?
hypothalamic-pituitary-adrenal axis insufficiency. normal HPA axis function may not return fully for up to 6-12 months
331
Why are aldo levels normal in central adrenal insufficiency?
aldo is regulated primarily by RAAS
332
Treatment for Toxoplasma gondii encephalitis?
Sulfadiazine and Pyrimethamine plus leucovorin
Prophylaxis with TMP-SMX
333
mixture of enhancing and non-enhancing calcified lesions after traveling to south america?
Neurocystercosis
334
Treatment for Neurocystercosis?
Albendazole
335
Treatment for cryptococcal meningitis?
Amphotericin B and Flucytosine
336
Clarithromycin and ethambutol are used to treat?
MAC
337
Treat narrow complex QRS tachycardia with?
IV adenosine
| can use vagal manuevars
338
Likely microbe implicated in endocarditis for patients with nosocomial urinary tract infections?
Enterococcus
339
_______ is the most common cause of healthcare associated endocarditis
staph infection
340
_____ is the most common cause of community acquired IE?
strep
341
Strep bovis endocarditis should make you think of?
colon carcinoma. IBD
342
suspected pathogen involved in infective endocarditis after respiratory tract biopsy?
strep viridans
343
coxiella burnetti causes?
Q fever via inhalation of contaminated aerosols from livestock or unpasteurized milk
344
skin papule with ulceration and nonpurulent odorless drainage
sporotrichosis
345
treatment for sporotrichosis?
3-6 months of oral itraconazole
346
Diagnosis of sporotrichosis requires?
aspiration or biopsy with culture
347
cisplatin and carboplatin side effect?
cochlear dysfunction
348
hypertrophic osteoarthropathy
digital clubbing is accompanied by sudden onset arthropathy commonly affecting wrists and hands
349
Development of a new conduction abnormality in patients with endocarditis should raise suspicion for?
perivalvular abscess
350
Tricuspid endocarditis typically presents with what type of murmur?
Tricuspid regurg. Systolic murmur accentuated with inspiration
351
Nondihydropyridine CCBs are
Diltiazem and Verapamil
| Decrease heart rate and contractility
352
Dihydropyridine CCBs
amlodipine and felodipine increase myocardial O2 supply through coronary artery vasodilation and reduce demand through systemic arterial vasodilation and a reduction in cardiac afterload
(monotherapy with these can result in reflex tachy)
353
Ranolazine
alternative therapy for angina refractory to B-blockers, CCBs, Nitrates (It decreased myocardial calcium influx)
354
facial plethora, ruddy cyanosis should make you think of?
Increased hematocrit. polycythemia vera
355
If a patient requires more glycemic control, what drugs other than metformin can you give them that will also help with weight loss?
GLP-1 agonists (exenatide, liraglutide)
356
side effects of sulfonyureas
weight gain and hypoglycemia
357
GLP-1 agonist risks?
acute pancreatitis
358
When should you add insulin to metformin?
HBA1c > 8.5 %
359
how to calculate serum osm?
(2X serum Na) + (glucose/18) +(BUN/2.8)
360
number needed to treat is calculated as?
1/ARR
| 1/absolute risk reduction
361
treatment for dermatitis herpetiformis other than cutting gluten from diet?
dapsone
362
splenomegaly, anemia, thrombocytopenia, leukocytosis and blood smear showing WBC with thin projections
hairy cellleukemia
363
reciprocal translocation of chromosome 9 and 22 forming BCR -ABL fusion gene
CML
364
BCR_ABL fusion gene creates a constitutively active _____
tyrosine kinase
365
imatinib
tyrosine kinase inhibitor used to treat CML
366
Most common complication of influenza?
2ndary bacterial pnuemonia
367
most common organisms leading to 2ndary bacterial pneumonia post influenza?
staph aureus and strep pneumo
368
How do you measure a tests validity?
sensitivity and specificity
369
Chronic hyperthyroid myopathy
proximal muscle weakness and possible muscle atrophy with other clinical features of hyperthyroid
370
How does acute HIV present?
Mono like- fever, night sweats, lymphadenopathy, arthralgias, diarrhea, painful mucocutaneous ulcers, skin rash
371
oliguria is defined as?
372
Management for SIADH mild and severe cases?
Fluid restriction +/- salt tablets
Hypertonic (3%) saline for severe hyponatremia
373
How to differentiatie SIADH (euvolemic) from hypovolemic hyponatremia?
In SIADH, urine sodium concentration will be elevated where as with hypovolemia, people will be reabsorbing sodium
374
Why does restricting sodium intact, decrease likelihood of developing Ca kidney stones?
Low sodium promotes calcium reabsorption
high sodium promotes calcium excretion
375
Why is restricting calcium not a great idea for calcium stone formers?
calcium restriction can increase free oxalate absorption leading to calcium oxalate stone formation.
376
Increased vitamin C increases?
hyperoxaluria
377
Appropriate treatment for ehrlichiosis
doxycycline
378
Why can pulsus paradoxus be seen in severe asthma and COPD?
Drops in intrathoracic pressure are greatly exaggerated and this causes pooling of blood in pulmonary vasculatrure leading to decreased LV preload
379
What is a well known complication of giant cell arteritis?
Aortic aneurysm so patients with GCA should be followed with serial chest x-rays
380
Anti-Jo1 and anti-mi-2 are classic antibodies associated with?
Dermatomyositis
381
Screening for ______ should be done for patients with dermatomyositis?
Internal malignancies
382
Why are patients with crohns disease or any malabsorptive disease predisposed to kidney stones?
hyperoxaluria. typically calcium binds oxalate in the gut and prevents it from being reabsorbed. In patients with fat malabsorption, calcium binds the fat and leaves free oxalate.
383
Indications for urgent dialysis?
Acidosis: pH <7.1 and refractory to therapy
Electrolyte: ECG or ventricular arrhythmias due to hyperkalemia
K>6.5 refractory to med therapy
Ingestion: toxic alcohols (methanol, ethylene glycol), salicylate, lithium, valproate, carbamazepine
Overload: volume refractory to diuretics
Uremia: encephalopathy, pericarditis, bleeding
384
causes of asterixis?
hepatic encephalopathy, uremic encephalopathy, hypercapnia
385
Approach to hypocalcemia?
1. correct serum Ca for albumin
2. Is mag low? Is it due to a drug? Is there a recent blood transfusion?
3. Measure PTH
386
Causes of low or normal PTH with hypocalcemia?
Surgical
Autoimmune: polyglandular autoimmune syndrome
Infiltrative disease: metastatic cancer, Wilson's disease, Hemochromatosis
387
Elevated PTH and hypocalcemia causes?
```
Vitamin D deficiency
Chronic Kidney disease
Pancreatitis
Sepsis
Tumor lysis
```
388
How do you diagnose vit D deficiency?
Check 25-hydroxy vitamin D
389
what are the cancers with osteoblastic mets that can cause hypocalcemia?
breast, prostate
390
hydatid cysts are caused by infection with? what is the host?
echinococcus granulosis. Dogs.
391
Hepatic cyst with eggshell calcification is highly suggestive of?
hydatid cyst- echinococcus
392
Treatment for hydatid cyst?
surgical resection with albendazole
393
exudative pleural effusion with low pH, high amylas is indicative of?
boerhaaves
394
antismooth titers are sensitive and specific for?
autoimmune hepatitis
395
antimitochondiral antibodies indicate?
primary biliary cirrhosis
396
Most common meds to cause hyperkalemia?
non-selective B-blockers, K sparing diuretics (amiloride), ACE, ARB, NSAIDs, Digoxin
397
When should you give calcium gluconate or IV insulin for hyperkalemia?
K >7 or symptomatic or ECG changes
398
Dig toxicity presents as?
anorexia, nausea, vomiting, abd pain, fatigue, confusion, weakness, color vision changes
399
how can amiodorone lead to Dig toxicity?
Amiodarone increases serum levels of digoxin. Dig dose should be decreased by 25-50% before dual therapy
400
epitrochlear LAD is pathognomonic for?
2ndary syphillis
401
how do you measure adequate treatment of syphilis?
4 fold decrease in serologic titers at 6-12 months
402
secondary syphilis is characterized by?
widespread LAD, grey mucous patches, raised genital papules (condyloma lata), diffuse maculopapular rash that involves palms and soles, malaise, sore throat, headache
403
destruction of melanocytes is also known as?
Vitiligo
404
1st line intervention for vitiligo?
topical or oral steroids
405
Idiopathic guttate hypomelanosis
common finding with aging. small macules in sun exposed areas
406
Piebaldism
autosomal dominant disorder characterized by patchy absence of melanocytes confined to head and trunk
407
broad flat T waves, U waves, ST depression in setting of weakness is likely due to?
hypokalemia
408
Euthyroid sick syndrome
any patient with an acute, severe illness may have abnormal thyroid funciton tests (low T3) with normal T4 and TSH
409
Immune thrombocytopenia
| idiopathic thrombocytopenic purpura
autoimmune disorder presenting with increased platelet destruction due to IgG antibodies against platelet membrane proteins
410
Bernarnd-Soulier syndrome
autosomal recessive disorder with absent receptor for vWF. circulating "giant" platelets, severe platelet dysfunction, bleeding out of proportion to degree of thrombocytopenia
411
Which drugs cause ototoxicity and can also cause damage to motion sensitive hair cells in the inner ear to cause selective vestibular damage?
aminoglycosides (gentamicin specifically causes vestibular issues)
412
cardiac myxomas are most often located?
80% in LA
413
Patients with antiphospholipid antibody syndrome should be started on what medication when they are pregnant?
Low molec weight heparin and aspirin
414
Long term management of Antiphoslipid syndrome in patients who are not pregnant?
Warfarin
415
Significant HTN with primary hyperparathyroid syndrome might suggest what disease?
MEN 2 with pheochromocytoma
416
Patients with bone pain, kidney stones, psych symptoms and high blood pressure? what is cause of HTN?
Primary HPT
417
How does steatorrhea lead to hypocalcemia?
decreased absorption of fat soluble vitamins including vitamin D. So less Ca and Phos reabsorption from bowel. This leads to secondary hyperparathyroidism
418
first line treatment or prophylaxis against MAC in HIV?
Azithromycin
419
rapid increase in transaminases with modest elevation in Tbili and alk phos in setting of sepsis?
Shock liver
420
patient with AIDS and neuro symptoms with nonenhancing white matter lesions?
progressive multifocal leukoencephalopathy
421
progressive multifocal leukoencephalopathy is caused by? diagnosed how?
JC virus. CSF fluid evidence of JC virus by PCR
422
well-defined enhancing focal lesion in a patient with HIV?
primary CNS lymphoma
423
Donepezil, Rivastigmine, Galantamine MOA? treat?
acetylcholinesterase inhibitors. slow cognitive decline in Alzheimer's
424
diagnostic test of choice for Zenker diverticulum?
contrast esophagram
425
acute confusion, hyperthermia, tachy and persistent epistaxis under direct sunlight? diagnosis?
heat stroke
426
Forehead sparing with bells palsy is suggestive of a lesion where? why?
intracranial (above the facial nucleus in the pons) because there is bilateral upper-motor neuron innervation to forehead
427
where is the lesion for bells palsy (full unilateral upper and lower facial paralysis)
peripheral neuropathy of CN VII (lesion below the pons)
428
Splanchnic arterial dilation is the cause of what?
hepatorenal syndrome
Splanchnic vasodilation activates RAAS and induces local vasoconstriction with decreased perfusion and GFR
429
hepatic hydrothorax
pleural effusion due to small defects in diaphragm. peritoneal fluid passes into the pleural space
430
what therapy should you avoid in hepatic hydrothorax?
chest tube placement: it can result in large-volume protein, fluid and electrolyte losses
431
Acyclovir, Sulfonamides, methotrexate, ethylene glycol, protease inhibitors can all cause what type of kidney injury?
Crystal Induced. crystal precipitates cause direct intratubular obstruction and diret renal tubular toxicity
432
What obstructive disease may have an increased DLCO?
Asthma
433
Treatment for papillary thyroid cancer?
surgical resection
434
Why do patients at risk of thyroid cancer recurrence require thyroid hormone replacement?
TSH can stimulate growth of occult or metastatic disease
435
focal dystonia of the SCM is also known as?
torticollis
436
hemiballismus
unilateral violent arm flinging caused by damage to contralateral subthalamic nucleus
437
culture negative urethritis should raise suspicion for?
chlamydial urethritis
438
Fever and sore throat in a patient taking antithyroid drugs suggest?
agranulocytosis
439
What therapy should be given for ischemic stroke that presents within 3.5-4 hours of symptom onset?
IV alteplase
440
Therapy after ischemic stroke if patient not currently on any meds?
Aspirin
441
Stroke already on aspirin therapy. what should be added?
aspirin + dipyridamole OR clopidogrel
442
Spherocytes with central pallor should make you thin of what 2 conditions?
- Autoimmune hemolytic anemia
| - Hereditary spherocytosis
443
How to differentiate AIHA from HS?
positive family history and negative coombs test suggests HS
444
how do you differentiate intravasc vs extravasc hemolysis?
Intravasc: very high LDH, very low haptoglobin, elevated indirect bili
Extravasc: slightly elevated LDH, slightly elevated haptoglobin
445
positive osmotic fragility test is significant for?
H. spherocytosis
446
viral URI, cough lasting >5 days, sputum production is typical for? fever not typical
bronchitis
447
bronchiectasis is associated with a history of?
recurrent respiratory tract infections
448
history of recurrent stones since childhood, family history of stones, hexagonal crystals and positive urinary cyanide nitroprusside test =
Cystinuria (hard and radioopaque stones)
449
What is the etiology of cystinuria?
amino acid transport abnormality
450
Nodular glomerulosclerosis (with Kimmelstiel-Wilson nodules) is pathognomonic for?
Diabetic nephropathy
451
breath sounds with lung consolidation?
increased (crackles and egophony present)
452
What forms of anticoagulant are contraindicated in patients with severe renal insuficiency?
factor Xa inhibitors (fondaparinux and rivaroxaban)
453
What diseases is primary biliary cholangitis associated with?
Hepatocellular carcinoma
Severe hyperlipidemia
Osteoporosis or Osteomalacia
454
aliskiren is what type of drug
direct renin inhibitor
455
characteristic CSF for HSV encephalitis
lymphocytic pleocytosis.
| increased number of erythrocytes due to hemorrhagic destruction of temporal lobes and elevated protein
456
1st line therapy for BPH?
| what can be used in addition or as an alternate therapy for those who dont tolerate alpha blockers?
alpha-blockers
5-alpha reductase inhibitors (inhibit test conversion to dihydrotest and reduce prostate gland size)
457
If a htn patient develops hypokalemia with diuretic use, suspect?
mild primary hyperaldosteronism
458
What can you do to reduce CCB (dihydropyridine) associated lower extremitiy edema?
Add ACE inhibitor to regimen
