Medicine Flashcards
(495 cards)
1
Q
Elevated BUN/Cr > 20:1 indicates?
A
Prerenal AKI
2
Q
Describe the physiology of RAA axis and prerenal AKI leading to elevated BUN/Cr > 20:1
A
Decreased renal blood flow -> decreased GFR -> Increased Renin -> elevated angiotensinogen ->Angiotensin I -> Angiotensin II -> sodium retention -> aldo production -> vasoconstriction
With the reabsorption of sodium, urea is passively reabsorbed.
3
Q
If decreased renal perfusion is prolonged, this can lead to?
A
Acute tubular necrosis
4
Q
Etiologies of prerenal acute kidney injury
A
Decreased renal perfusion
- true volume depletion
- decreased circulating volume (heart failure, cirrhosis)
- sepsis, pancreatitis
- renal artery stenosis
- afferent arteriole vasoconstriction (NSAIDs)
5
Q
NSAIDs constrict the?
A
afferent arteriole
6
Q
What will the FENA be with prerenal AKI?
A
FENA < 1%
7
Q
Ciprofloxacin can cause what type of kidney injury?
A
Acute interstitial nephritis
8
Q
What other findings will you typically see with AIN drug reaction?
A
skin findings and WBC casts
9
Q
Nodular glomeruloscerosis occurs in?
A
diabetic nephropathy
10
Q
What are the osmotic and non-osmotic stimuli for ADH secretion?
A
Osmotic: serum osmolality > 285
Nonosmotic: nausea, pain, physical/emotional stress, hypotesion, hypovolemia, hypoxia, hypogycemia
11
Q
The elderly, especially demented patients, are particularly susceptible to what type of kidney injury?
A
Prerenal
12
Q
Name common pathogens for UTI/Pyelo
A
E.coli (80%)
Proteus
Klebsiella Pneumoniae
Staph Saphrophyticus
13
Q
The presence of urinary alkalization (pH >8) raise suspicion for what types of UTI pathogens?
A
Urease-producing bacteria like PROTEUS (most commonly) or KLEBSIELLA
14
Q
How do urease producing organisms alkalinize the pH?
A
Split urea into ammonia and CO2. Ammonia converts into ammonium and alkalinizes urine.
15
Q
High urine pH increases the likelihood of developing what type of stone? why?
A
STRUVITE stone (magnesium/ammonium phosphate) because alkalinization reduces solubility of phosphate
16
Q
Corkscrew pattern on esophagram can be indicative of?
A
Esophageal spasm
not sensitive or specific finding
17
Q
Treatment for esophageal spasm?
A
calcium channel blockers
Nitrates
Tricyclics
18
Q
Impaired inhibitory innervation of esophagus can lead to?
A
diffuse esophageal spasms
19
Q
Esophageal manometry for esophageal spasms would show?
A
multiple simultaneous contractions
20
Q
Food impaction, dysphagia, heartburn that does not respond to standard meds?
A
EoE
21
Q
Endoscopy reveals esophageal rings and strictures- what is the dx?
A
EoE
22
Q
Globus sensation (feeling that something is stuck in your throat) is worse when swallowing _______ and is typically associated with ______
A
saliva
anxiety
23
Q
What HBV markers will be positive in the early phase?
A
HBsAg, HBeAg, IgM anti-HBc, HBV DNA
24
Q
What HBV markers are positive in the window phase?
A
IgM anti-HBc and HBV DNA
25
HBV markers in recovery phase?
IgG anti HBc, Anti HBs, Anti HBe, (+/- HBV DNA)
26
Chronic HBV carrier markers?
HBsAg, IgG anti HBc
27
Vaccinated for HBV?
anti-HBs
28
What markers for acute flare of chronic HBV
chronic markers plus HBeAg and IgM anti-HBc
29
Immune due to natural HBV infection?
IgG anti-HBc and Anti HBs
30
Among healthy adults, acute HBV infection is self limited in what percent of cases
95%
31
Following acute exposure to HBV, HBsAg can be seen alone for ______ before symptoms
1-2 weeks
32
In most patients with drug induced liver injury, what other symptoms are present?
rash, arthralgias, fever, leukocytosis, eosinophilia
33
Extrahypatic manifestations of drug induced liver injury are characteristically absent for what drug?
Isoniazid
34
Cholestasis leading to liver injury is caused by what drugs?
chlorpromazine, nitrofurantoin, erythromycin, anabolic steroid
35
Fatty liver is caused by what meds?
tetracycline, valproate, anti-retrovirals
36
Hepatitis is caused by what meds?
halothane, phenytoin, isoniazid, alpha-methyldopa
37
toxic-fulminant liver failure is caused by what meds?
carbon tetra chloride, acetaminophen
38
granulomatous liver injury is caused by
allopurinol, phenylbutazone
39
oral contraceptives cause abnormalities in _______ without causing signs of necrosis or fatty change
LFTs
40
TB hepatitis would be characterized by ____ on liver biopsy
granulomas
41
An elevated PCWP in addition to elevated pulm artery and right atrial pressures suggests?
left sided heart failure leading to right sided heart failure
42
Elevated PA and RA pressurs with normal PCWP suggest?
elevated pulm pressures are due to an intrinsic pulmonary process
43
Obstructive shock can be acutely caused by a?
PE
44
Treatment for HER2 positive breast carcinoma
Trastuzumab
45
known adverse affect of Trastuzumab?
Cardiotoxicity (asymptomatic decline in LVEF)
46
Cardiotoxicity effects of trastuzumab increase when used in combo with what chemo drug that is also cardiotoxic?
Doxorubicin
47
Prior to initiating traztuzumab, patients should undergo what test?
baseline cardiac function testing with ECHO
48
Anthracycline chemo-induced cardiotoxicity does what damage to heart? is it reversible?
Myocyte necrosis and destruction (fibrosis)
| Progression to overt clinical heart failure (less likely reversible)
49
Is trastuzumab cardiotoxicity reversible?
Yes usually
50
Baseline audiometry for concerns of ototoxicity should be performed before what types of chemo?
cisplatin and carboplatin
51
What treatments for breast cancer increase risk of osteoporosis? what mechanism?
Aromatase inhibitors (anastrozole, letrozole) (used to treat estrogen receptor positive breast cancer)
52
Tamoxifen (used in treatment of estrogen receptor positive breast cancer) increases the risk of?
venous thromboembolism
53
Bleomycin can cause?
pulmonary fibrosis. PFT testing should be obstained before bleomycin therapy
54
TNF-alpha inhibitors can cause reactivation of?
latent TB
55
cholestatic pattern of LFTs
predominantly elevated alk-phos with smaller increases in aminotransferases
56
Presbycusis
sensorineural hearing loss that occurs with aging
57
Describe onset and presenting symptom development of presbycusis
starts in 6th decade of life, symmetrical, high-frequency hearing impairment, difficulty hearing in crowded and noisy places
58
Otosclerosis
chronic conductive hearing loss associated with bony overgrowth of stapes (low-frequency hearing loss in middle aged individuals)
59
Middle ear effusion is seen in patients with? and usually produces?
serious otitis media and produces tinnitus and sensation of pressure in addition to conductive loss
60
Meniere's disease
tinnitus, vertigo, sensorineural hearing loss
61
Dressler's syndrome (post-MI pericarditis) usually occurs how long after MI?
usually occurs within 1-6 weeks after MI
62
First line agents for viral pericarditis or idiopathic?
NSAIDs and/or colchicine
63
Leser-Trelat sign
sudden onset of multiple SKs indicating occult internal malignancy
64
acrochordon is a ?
skin tag
65
Systemic sclerosis (SSc)
Disease characterized by progressive tissue fibrosis and vascular dysfunction
66
Clinical features of systemic sclerosis
Systemic: fatigue, weakness
skin: telangiectasia, sclerodactyly, digital ulcers, calcinosis cutis
Ext: arthralgias, myalgias, contractures
GI: esoph dysmotility, dysphagia, dyspepsia
Vasc: raynauds
67
Serology for systemic sclerosis
ANA
Anti-topoisomerase I (anti-Scl-70) antibody
Anticentromere antibody
68
In patients with systemic sclerosis, esophageal manometry will show?
hypomotility and incompetence of LES
69
Atrophy and fibrosis of smooth muscle in lower esophageal sphincter can be seen in what disease? (associated with other systemic skin, GI, vasc issues)
systemic sclerosis
70
How can you differentiate polymyositis (which can also have esophageal dysmotility issues) and systemic sclerosis
Polymyositis: symmetric proximal muscle weakness (Not distal arthralgias!)
71
How to differentiate achalasia from systemic sclerosis
Achalasia shows increased LES pressure and incompelte relaxation, whereas SSc causes decreased LES pressure
72
Blastomycosis occurs?
south/south-central states
Mississippi + Ohio River Valley
Upper midwest
Great lakes
73
Blasto skin lesions have this characteristic appearance?
heaped up verrucous/nodular lesions with violaceous hue
74
Actinomyces and Nocardia are gram positive ___
rods
75
Characteristic granular yellow pus "sulfur granules" and abscesses
Actinomyces
76
Skin manifestations of coccidiomycosis?
uncommon but include erythema nodosum and erythema multiforme
77
Disseminated Blastomycosis can occur in immmunocompromised and immunocompetent individuals? True/false
True
78
Disseminated histoplasmosis can occur in immunocompromised and immunocompetent individuals? true/false
false- extremely rare in immunocompetent
79
Anterior cerebral artery stroke is characterized by?
contralateral motor or sensory deficits (more pronounced in lower limb than upper limb)
Abulia (lack of will/initiative)
Dyspraxia, emotional disturbance, urinary incontinence
80
conns syndrome is usually due to ?
adrenal adenoma or bilateral adrenal hyperplasia
81
What are causes of secondary hyperaldosteronism?
renovascular htn
malignant htn
renin-secreting tumor (rare)
diuretic use
82
What drug can be used in patients with ypervolemia and metabolic alkalosis?
Acetazolamide
83
Function of Acetazolamide
diuretic that inhibits proximal renal bicarb reabsorption
84
Acute treatments for low back pain?
maintain moderate activity
NSAIDs or acetaminophen
Muscle relaxants, spinal manipulation, brief course of opioids
85
Treatment for chronic low back pain
Intermittent NSAIDs / acetaminophen
Exercise therapy (stretch/strength, aerobic)
TCAs, duloxetine
86
Secondary prevention for low back pain
education, exercise therapy
87
chronic back pain is defined as?
12 weeks or more
88
are back braces effective for prevention or treatment of LBP?
No
89
Regular vaccination schedule for meningococcal?
Primary vaccination at age 11-12
| Booster at 16-21 (if primary at age less than 16)
90
Primary vaccination for meningococcal for people greater than 18 should still be given if they have what risk factors?
complement deficiency
functional or anatomic asplenia
91
which flu vaccine is inactivated?
IM
92
rhino-orbital cerebral mucormycosis is usually caused by?
Rhizopus species
93
Risk factors for rhino-orbital-cerebral mucormycosis
Diabetes mellitus (ketoacidosis), Hematologic malignancy, solid organ or stem cell transplant
94
manifestations of mucormycosis
acute/aggressive
fever, nasal congestion, purulent nasal discharge, headache, sinus pain
necrotic invasion of palate, orbit, brain
95
diagnosis of mucormycosis is made by?
sinus endoscopy with biopsy/culture
96
treatment of mucormycosis?
surgical debridement
liposomal amphotericin B
Elimination of risk factors
97
slow growing bacteria of oral cavity that may cause painless, slow-growing mass with draining sinus tracts on or near jaw
Actinomyces
98
endophthalmitis manifests as and commonly caused by
acute ocular pain and decreased visual acuity after eye trauma or surgery.
caused by pseudomonas
99
Treatment for pregnant women, lactating patients or children < 8 years old with lyme disease?
amoxicillin
100
Serum triglyceride levels generally must be > ______ to be considered as a potential cause of pancreatitis
> 1,000
101
Pancreatitis with an elevated ALT > 150 suggests?
biliary pancreatitis
102
What study is done to evaluate biliary pancreatitis?
ERCP
103
ERCP should also be considered in patients with > ____ episode of acute pancreatitis of unknown cause
1
104
List the common causes of vertigo
```
Meniere disease
BPV
Vestibular neuritis
Migraine
Brainstem/cerebellar stroke
```
105
Meniere disease presents as?
recurrent episodes of vertigo lasting 20 minutes to several hours. sensorineural hearing loss. tinnitus or feeling full in ear.
106
BPPV
brief episodes triggered by head movement. Dix-hallpike maneuver causes nystagmus
107
Vestibular neuritis
| labyrinthitis
acute, single episode that can last days. often follows virus. abnormal head-thrust test
108
migraine
vertigo associated with HA or other migraine features (Resolve completely in between)
109
Brainstem/cerebellar stroke vertigo
sudden-onset, persistent vertigo usually other neuro symptoms
110
endolymphatic hydrops
increased volume and pressure of endolymph -> Menieres disease
111
initial management for menieres disease
restriction of Na, caffeine, nicotine, alcohol. diuretics considered for long-term management. benzo, anti-histamine, anti-emetics can relieve acute symptoms
112
Common causes of nephrotic syndrome in adults?
membranous glomerulonephropathy
focal segmental glomerulosclerosis
minimal change
amyloidosis
113
Clues that amyloidosis may be cause of nephrotic syndrome?
history of other autoimmune disease (RA, enlarged kidneys, hepatomegaly)
114
randomly arranged thin fibrils on microscopy in a patient with nephrotic syndrome signals?
Amyloidosis
115
AL (light chain) amyloidosis is associated with ?
multiple myeloma
| waldenstrome macroglobulinemia
116
AA amyloidosis is associated with?
chronic inflamm conditions (RA, IBD)
chronic infection (osteomyelitis, TB)
117
Preventive and abortive treatment for vasospastic angina?
CCB- preventive (Diltiazem!)
Sublingual nitroglycerin - abortive
118
Why should aspirin be avoided in patients with vasospastic angina?
it can inhibit prostacyclin production and worsen coronary atery vasospasm
119
Cilostazol is used for? mechanism?
phosphodiesterase III inhibitor that causes arterial vasodilation and inhibits platelet agg (used for lower ext claudication)
120
What type of coronary vasospasm are benzos helpful for?
Cocaine-induced
121
Main danger associated with CPK levels greater than 20,000 is?
acute renal tubular necrosis due to myoglobinuria
122
Acute hemolytic transfusion reaction
Develops within 1 hour of transfusion. ABO incompatibility. fever, chills, hemoglobinuria, flank pain, discomfort at infusion site
123
How to diagnose acute hemolytic transfusion reaction by ABO incompatibility>
positive direct Coombs test, pink plasma (plasma free hgb > 25)
124
What is the preferred medication for HTN associated with ADPKD?
ACE inhibitors
125
Captopril radionuclide renal scan is occasionally used to diagnose?
suspected renovascular disease or renal artery stenosis
126
Amiodorone is a class III antiarrhythmic drug often used for management of?
ventricular arrhythmias
127
AV conduction delay occurs when? typically caused by?
occurs when conduction through AV node is slowed. B-blockers or ischemic heart disease. typically results in bradycardia
128
syncope in a young patient with a crescendo/decrescendo murmur at left lower sternal border is most likely due to?
HOCM
129
When should you suspect cardiac amyloidosis? (form of restrictive cardiomyopathy)
patients who have manifestations of LVH, CHF in the absence of a htn history.
130
Asymptomatic proteinuria, waxy skin, anemia, easy bruising, enlarged tongue, neuropathy can be signs of?
AA
131
Negative pressure pulmonary edema occurs when?
When a patient has upper airway obstruction (laryngospasm after extubation)
132
Angiotensinogen causes the _____ arteriole to constrict thus increasing GFR
efferent
133
Insulin resistance and GI malignancy are associated with what skin process?
Acanthosis Nigricans
134
Insulin resistance, pregnancy, crohn disease are associated with what skin process?
skin tags
135
Hep C is associated with what skin processes
porphyria cutanea tarda
| cutaneous leukocytoclastic vasculitis (palpable purpura)
136
celiac disease skin rash?
dermatitis herpetiformis
137
HIV infection is ass with what skin process
sudden-onset severe psoriasis
recurrent herpes zoster
disseminated molluscum
seborrheic dermatitis
138
PArkinson disease ass skin rash?
seborrheic dermatitis
139
IBD associated skin disease
pyoderma gangrenosum
140
sudden appearance of acanthosis nigricans in middle aged or elderly patients is suggestive of
underlying malignancy
141
Recent travel, cruise, hotel stay, contaminated potable water (nursing homes) and patient presenting with pneumonia should make you suspicious for?
Legionella
142
clinical vital sign and presenting symptom clues and lab clues for legionella
```
Fever > 39 (102.2)
Bradycardia relative to high fever
neuro symptoms (confusion)
GI symptoms (diarrhea)
Hyponatremia
hepatic dysfunction
hematuria, proteinuria
gram stain showing neutrophils but few organisms
```
143
relative bradycardia despite high fever is classic for?
Legionella
144
how can you test for legionella?
urine antigen test
145
therapy for legionella
macrolide or flouroquinolone
146
myasthenia gravis presenting symptoms
fluctuating fatigable muscle weakness that worsens with repetitive motions
147
cause of MG?
caused by autoantibodies originating in the thymus directed against nicotinic acetylcholine receptors at neuromusclar junction
148
decreased acetylcholine release from presynaptic terminal of motor neuron?
botulism
149
degeneration of neurons within myenteric plexus?
achalasia
150
inflammatory demyelination of axons in CNS
MS
151
progressive degeneration and death of motor neurons
ALS
152
contact lens-associated keratitis
Medical emergency! due to gram negative organisms such as Pseudomonas and Serratia
153
Keratitis includes involvement of the
cornea
154
chylothorax causes an exudative or transudative effusion?
exudative- high in cholesterol content and milky white in appearance
155
Recurrent bacterial infections in an adult should raise suspicion for?
Common variable immunodeficiency
156
How to test for CVID
Quantitative measurement of serum immunoglobulin
157
Manifestations of CVID
recurrent pneumonia, sinusitis, otitis, GI (salmonella, campy), autoimmune disease, chronic lung dsiease,
158
CVID with have low IgG and low IgA/IgM but the IgG will be lowest. true/false?
true
159
Treatment for CVID?
immunoglobulin replacement therapy
160
most diagnosis of CVID occur from what age?
20-45
161
low CD4 lymphocyte counts occur in ?
DiGeorge syndrome and HIV
162
signs of laxative abuse?
women, healthcare field, 10-20 BMs day, diarrhea awakens you from sleep.
163
how do you diagnose laxative abuse?
positive stool screen for diphenolic (bisacodyl)
164
Colonoscopy with laxative abuse will show?
melanosis coli- dark brown discoloration of colon with pale patches of lymph follicles that give the appearnace of alligator skin.
165
If melanosis coli is not seen on colonscopy what can you look for?
pigment in macrophages of lamina propria
166
"tea-colored stool"
VIPoma
167
management of HOCM
avoid volume depletion
BB, CCBs
surgery if symptoms persist
168
what are the 3 main categories of diabetic retinopathy?
1. background/simple
2. pre-proliferative
3. proliferative or malignant
169
background simple/retinopathy:
microaneurysms, hemorrhage, exudate, retinal edema
170
pre-proliferative
cotton wool spots plus background
171
proliferative
newly formed vessels plus cotton wool spots plus background
172
Abx therapy for prostatitis?
TMP-SMX or Fluoroquinolone for 4-6 weeks
173
Idiopathic intracranial htn (pseudotumor cerebri) is most common in?
young obese women
174
what drugs can cause IIH
growth hormone, tetracyclines, minocycline, doxycycline, Vit A derivatives
175
Thrombotic Thrombocytopenic Purpura pathophysiology
life threatening disorder of microvasculature characterized by formation of small vessel thrombi (that consume platelets, shear RBCs and often cause renal and CNS damage.
176
What is the pentad of TTP?
thrombocytopenia, microangiopathic hemolytic anemia, renal insufficiency neuro changes, fever
177
TTP is caused by?
aquired autoantibody to ADAMTS13- plasma protease that cleaves vWF off endothelial surface. So vWF multimers accumulate on endothelial wall and trap platelets at areas of high shearing force -> lead to thrombi formation
178
TTP is most commonly seen in?
young adults
179
thrombocytopenia, indirect bili elevation, AST, ALT, LDH elevation should always raise suspision for>
TTP
180
What will be seen on peripheral blood smear in work up of TTP?
Schistocytes
181
systolic-diastolic abdominal bruit is a specific finding for?
RAS
182
how do you confirm diagnosis of primary biliary cholangitis?
anti-mitochondrial antibody
183
antismooth antibody?
autoimmune hepatitis
184
drug-induced acne is a common side effect of?
steroids
185
HIV infected patient with altered mental status, EBV DNA in CSF and solitary, weakly ring enhancing periventricular mass on MRI? suspect?
Primary CNS lymphoma
186
Presence of EBV in DNA in the CSF is specific for?
CNS lymphoma
187
Is a positive toxo seroloy specific for toxo?
no its common in normal subjects in US.
188
progressive multifocal leukoencephalopathy lesions are? enhancing/non-enhancing?
non-enhancing
189
How do you treat hypovolemic hypernatremia?
.9 IV normal saline
190
Euvolemic hypernatremia can be treated with?
5% dextrose in water
191
Serum sodium should be corrected at what rate?
.5mEq/L/hr (dont exceed 12 mEq/L/24 hour)
192
What will happen if sodium is corrected too quickly
cerebral edema
193
if NSAIDs are not working for cancer related pain, what should be offered next for severe pain?
short acting opioids (morphine, hydromorphone, oxycodone)
194
Classic triad of trichinellosis
periorbital edema, myositis, eosinophilia
195
Trichinellosis
parasitic infection caused by roundworm trichinella. (occurs after ingesting undercooked meat- pork)
Patients develop GI pain, subungual splinter hemorrhages, conjunctival and retinal hemorrhage, periorbital edema, chemosis.
196
Lab studies show what in cases of trichinellosis?
eosinophilia, elevated CK, leukocytosis.
197
For an unprovoked first-time thrombus in young (<45) patients or those with an unusual site of thrombus, what disease should you test for?
Factor V Leiden (most common inherited hypercoag disease in Whites)
198
Factor V leiden mechanism?
activated protein C resistance (protein C is an innate anticoagulant) This leads to slowed degradation of procoagulant factor V
199
How do you treat hemophilia A?
Administer factor VIII or Desmopressin if Hemophilia A is mild
200
Treatment for hemophilia B?
Factor IX
201
Unilateral visual impairment that is sudden and often upon wakening in the morning
Retinal vein occlusion
202
disc swelling, venous dilation and tortuosity, retinal hemorrhages and cotton wool spots on opthalmoscope exam?
Central retinal vein occlusion
203
Central vision is affected in?
macular degeneration
204
Smoking increases the risk of what eye disease?
macular degeneration
205
Unilateral blurred vision that progressively worsens?
Retinal detachment
206
gradual loss of peripheral vision, resulting in tunnel vision. Ophthalmoscopy shows pathologic cupping of optic disc.
open angle glaucoma
207
Clinical htn clues to renovascular disease
- resistant htn (uncontrolled despite 3 drug regimen)
- malignant htn (end organ damage)
- onset of severe htn (>180/120) after age 55
- severe htn with diffuse atherosclerosis
- recurrent flash pulmonary edema
208
Is an abdominal bruit typically present with aortic aneurysm?
NO
209
Hypertension or hypotension more common with acute aortic dissection
hypertension
210
primary biliary cirrhosis
chronic liver disease characterized by autoimmune destruction of INTRAhepatic bile ducts
211
Autoimmune hepatitis is associated with elevated titers of?
ANA and anti-smooth antibodies
212
Acute papular (monomorphic) inflammatory rash might be consistent with?
drug-induced acne
213
drug induced acne is often associted with?
glucocorticoids
214
Predisposing factors for osteoarthritis?
age, obesity, DM
215
Where is the pain of hip osteo felt?
groin, buttock, pelvis and can radiate to lower thigh
216
Meralgia paresthetica
compression of lateral femoral cutaneous nerve at waist- causes burning and paresthesias at lateral thigh
217
Pain localized to the lateral hip and worsened by direct pressure?
Trochanteric bursitis
218
Treat hypovolemic hypernatremia without symptoms with?
5% dextrose
219
Treat hypovolemic hypernatremia with symptoms with?
.9% saline until euvolemic then 5% dextrose
220
Hemodialysis is indicated for serum lithium level > ____
4
221
Lithium level > ____ plus signs of lithium toxicity (seizures, depressed mental status)
2.5
222
why use a water deprivation test?
differentiate between central (decreased ADH from pituitary) and nephrogenic (normal ADH with renal ADH resistance)
223
describe water deprivation test
-no water 2-3 hours prior to test
-measure urine volume and osmolality every hour
-serum sodium and osmolality every 2 hours
-once plasma osm >295
or plasma Na > 145 -> GIVE DESMOPRESSIN
-Monitor urine Osm anm and volume
224
If urine Osm > 600 on water dep test what is diagnosis?
primary polydipsia
225
How do you diagnose central DI on water deprivation?
increase urine osm 50-100%
226
how do you diagnose nephrogenic DI on water deprivation?
small or no increase in urine Osm
227
ascariasis
lung phase with nonproductive cough or worms obstructing small bowel or bile ducts
228
dengue fever
fever, HA, **retro-orbital pain**, rash, myalgia, arthralgia (hemorrhage in skin or nose)
229
typhoid fever
presents in progressive manner with fever in 1st week. abdominal pain and salmon rash in 2nd week.
hepatosplenomegaly w/ abdominal perf, bleeding during 3rd week.
230
herpetic whitlow
viral infection of hand caused by HSV
231
MEN 1 syndrome manifestations
pituitary adenomas
Primary hyperparathyroidism
pancreatic/GI neuroendocrine tumors
232
The most common esophagitis in patients with advanced HIV, especially with CD4 counts < 50-100?
Candida!
233
In patients with HIV esophagitis whose predminant symptom is severe odynophagia (pain) without (dysphagia)- difficulty swalling - > what is most likely diagnosis?
viral esophagitis is more likely than candida
234
Most common viruses to cause esophagitis in HIV patients?
HSV and CMV
235
How to differentiate HSV and CMV lesions on GI endoscopy?
HSV lesions- circular or ovoid vesucular and ulcerated
CMV- large, linear, distal esoph ulcers
236
antibody against acetylcholine receptor in postsynaptic membrane?
myasthenia gravis
237
antibody against presynaptic membrane voltage gated calcium channels
Lambert-Eaton
238
Muscle fiber injury that caues symmetrical and more proximal muscle weakness
dermatomyositis/polymyositis
239
50% of cases of lambert eaton syndrome are associated with what malignancy?
small cell lung cancer
240
diminished or absent deep-tendon reflexes in conjunction with proximal muscle weakness indicates what disease?
lambert eaton
241
Acute inflammatory demyelinating polyneuropathy?
Guillain-Barre
242
CNS inflammation and demyelination?
MS
243
upper and lower motor neuron degeneration
ALS
244
Dyspnea, PND, hemoptysus afib, voice hoarseness - can be clinical features of what valve issue?
mitral stenosis
245
On physical exam what skin finding can you see with mitral stenosis?
mitral facies (pink-purple patches on cheeks)
246
In a young patient from a developing country, presentation of progressive SOB, nocturnal cough and hemoptysis is highly suggestive of
Rheumatic mitral stenosis
247
Three major mechanical complications of MI?
Papillary muscle rupture
Left ventricular free wall rupture
Interventricular septum rupture
248
Adverse effects of antithyroid drugs (methimazole and propylthiuracil)
Methimazole: 1st trimester teratogen, cholestasis
Propylthiouracil: hetpatic failure, ANCA vasculitis
AGRANULOCYTOSIS for both
249
Risks of radioiodine ablation for hyperthyroidism?
permanent hypothyroid
worsening of ophthalmopathy
radiation side effects
250
most common adverse effect associated with use of any inhaled corticosteroid is
oropharyngeal candidiasis
251
Adverse cardiovascular effects of phosphodiesterase inhibitors (sildenafil)
Hypotension (esp if used with nitraets and alpha blockers)
252
Ocular effects of phosphodiesterase inhibitors
blue discoloration of vision
| anterior ischemic optic neuropathy
253
GU effects of phosphodiesterase inhibitors
priapism
254
Another name for mucosal tear at the GE junction?
mallory-weiss tear
255
Anemia types with decreased MCV
- Iron deficiency
- Lead
- Thalassemia
- Sideroblastic anemia
256
Anemia with increased MCV?
- B12
| - Folate
257
How do you differentiate anemia types with normal MCV?
Order reticulocyte count
258
Normal MCV anemias with low reticulocyte count?
- leukemia
- aplastic anemia
- infection
- medications
259
normal MCV anemia with increased retic count?
-hemorrhage
-hemolysis
(Intrinsic: inherited defects of hemoglobin, RBC membrane, enzymes)
(Extrinsic: autoimmune, paroxysmal nocturanl hemoglobinuria)
260
Disorder with increased mean corpuscular hemoglobin concentration
(MCHC), hemolytic anemia, jaundice, splenomegaly
Hereditary spherocytosis
261
Does drug induced immune hemolytic anemia have a positive or negative Coombs test?
positive
262
What complication of chronic hemolytic anemia can lead to a megalobblastic anemia picture?
folate deficiency because hemolysis process consumes folate
263
Acute cholecystitis from pigmented gallstones in a northern european person?
think hemolysis. think hereditary spherocytosis
264
How can you differentiate osmotic from secretory diarrhea?
stool osmotic gap
Osmotic- elevated osmotic gap
265
Type 2 heparin-induced thrombocytopenia (HIT) clinical presentation
a drop in platelets by > 50% or a new thrombus within 5-10 days of hep administration
thrombocytopenia and thrombus
266
management of suspected HIT
discontinue all heparin products immediately. anticoag initiated with non-hep medication (argatroban and fondaparinux)
267
diagnosis of HIT?
serotonin release assay (gold standard)
high-titer immunoassay of blood
268
of diseased subjects/overall subjects at risk calculates?
RISK
269
PEEP is calculated using what maneuvar?
end-expiratory hold maneuvar
270
Plateau pressure is measured during an?
inspiratory hold maneuvar (pulm airflow and resistive pressure are both at 0)
271
Plateau pressure equals
elastic pressure + PEEP
272
Pathology of increased peak pressure with normal plateau pressure
bronchospasm, mucus plug
273
increased peak pressure with increased plateau pressure
pneumothorax, pulm edema, pneumonia, atelectasis, right mainstem intubation
274
Cyanide toxicity is a risk in what patients?
prolonged infusions or higher does of nitroprusside
275
in HTN emergencies, MAP should be lowered by ___ in 1st hour and ____ in next 23 hours
10-20%
5-15%
276
Broad casts and waxy casts are seen in patients with?
chronic renal failure
277
Muddy brown casts
ATN
278
RBC casts
glomerulonephritis
279
WBC casts
AIN, pyelo
280
Fatty casts
nephrotic syndrome
281
broad and waxy casts
chronic renal failure
282
acute back pain and point tenderness after lifting suggests?
vertebral compression fractrue
283
Positive straight leg raise indicates?
radicular pain- herniated disc
284
Lumbar spinal stenosis improves with?
leaning forward or lying down
285
chondrocalcinosis (calcification of articuar cartilage) is associated with?
pseudogout
286
Heberden nodes
enlarged bony spurs that occur at DIP joints in osteoarthritis
287
flashes of light, spots in visual field, curtain coming down over eye is indicative of?
retinal detachment
288
With retinal detachment, opthalmoscopic exam reveals?
grey, elevated retina
289
opthalmoscopic exam with pallor of optic disc, cherry red fovea, boxcar segment of blood in retinal veins and painless loss of vision in one eye
Central retinal artery occlusion
290
painless progressive blurring of central vision with central scotoma, abnoral vessels in retina,
exudative macular degeneration
291
OA affects what joints in the hand?
DIP and PIP
292
progressive fibrosis of palmar fascia with nodule or thickening?
dupuytren contracture
293
charcot joint
decreased sensation in lower extremity (patients unknowingly traumatize weight bearing joints)
294
RA involves what joints?
MCP
295
traumatic deceleration injury can cause what significant cause of morbidity?
diffuse axonal injury
296
numerous punctate hemorrhage and blurring of grey white interface on CT is indicative of?
diffuse axonal injury
297
biconvex collection on CT ?
epidural
298
crescentic collection on CT
subdural
299
Behcet disease presents as?
multiple oral/genital ulcers
| uveitis
300
Felty syndrome
advanced RA. splenomegaly and neutropenia
301
MMR, zoster, varicella are contraindicated if CD4 count is < _______
200
302
What vaccines should HIV patients receive?
```
HBV if no immunity
HAV if chronic liver disease, MSM, IV drugs
HPV if not given
Influenza (IM)
Meningococcus (if not received)
Pneumococcus (PCV13 one and PPSV23 8 weeks later)
Tdap once and Td every 10 years
Varicella if not immune and CD > 200
```
303
management of COPD exacerbation
```
Oxygen with target O2: 88-92%
Inhaled bronchodilator
systemic glucocorticoid
Antibiotics if > 2 cardinal symptoms
Oseltamivir if evidence of influenza
NPPV if vent failure
Trach intubation if needed
```
304
cardinal symptoms that indicate giving abx to COPD patients?
mod to sever exacerbation. increased sputum. mech ventilation requirement.
305
Metabolic alkalosis can be categorized into what 2 branches
saline responsive
saline unresponsive
306
saline responsive met alkalosis is often due to?
loss of gastric secretions (self-induced or spontaneous vomiting or nasogastric suctioning)
307
Another way to divide metabolic alkalosis is based on?
urine chloride
high or low
308
low urine chloride met alkalosis indicates?
vomiting
prior diuretic use
309
all forms of RTA cause?
non-gap metabolic acidosis
310
most common causes of secondary clubbing are?
lung malignancy and CF and right to left cardiac shunts
311
When you see scrotal varicocele what should you consider on the diff dx?
RCC
312
Left sided varicocele that fails to empty when patient is recumbent in a patient with hematuria - its important to consider?
RCC (gonadal vein empties into renal vein on left side)
313
If PE or DVT with hemodynamic instability or life threatening ischemia- > what is first step?
thrombolytics unless contraindication
314
if no hemodynamic instability or massive DVT with severe swelling that may cause ischemia what is first step?
anticoagulation unless contraindication
315
esophageal webs cause dysphagia to solids? solids and liquids?
solids only
316
Esophageal webs are associated with?
iron deficiency. Plumber vinson syndrome
317
polymyositis affects what portion of the esophagus?
upper 3rd (striated muscle)
318
diagnosis of AAT?
serm AAT levels and PFTs
319
A PAC/PRA > 20 with plasma aldo > 15 suggests?
primary hyperaldosteronism
320
If you suspect primary aldo, what test should you do?
adrenal suppression test. salt load and confirm inabilit to suppress aldo
321
If you have (+) adrenal suppression test, you should then?
CT adrenals
322
If CT does not reveal a discrete adrenal mass, what do you do next?
adrenal vein sampling
323
Dex suppression test can diagnose?
cushing syndrome
324
Approach to wide complex tachycardia. what is your first question to help diagnose?
Is there AV dissociation or fusion/capture beats?
325
fusion beats are diagnostic of?
monomorphic ventricular tachycardia
326
how do you treat patients with hemodynamically stable SMVT
IV amiodorone
327
SVT is a narrow or wide complex tachy?
narrow.
328
what is a good first step for SVT management?
carotid sinus massage or vagal maneuvars
329
unstable Vtach management?
synchronized cardioversion
330
Dig is used for rate control in what types of arrythmias?
SVTs
331
Patients with vfib or pulseless VT should be managed with?
defibrillation (unsynchronized shock)
332
serum/urine protein electrophoresis, peripheral blood smear, serum free light chain analysis are screening tests for?
multiple myeloma
333
renal insufficiency, anemia and hypercalcemia should make you think about?
Multiple myeloma
334
senile purpura (solar or actinic purpura) is caused by?
loss of elastic fibers in perivascular connective tissue
335
Lymph node aspiration is used to diagnose?
Klebsiella granulomatis infection
336
pathergy test (inserting needle into skin and checking the site 24-48 hours later for dvelopment of > 2mm papule) is used to test for ?
behcet syndrome (recurrent oral and genital ulcers)
337
frontotemporal dementia (Pick's disease) presnts with?
early personality changes
| apathy, disinhibition, compulsive behavior
338
dementia with lewy body presents as?
visual hallucinations**
spontaneous parkinsonism
fluctuating cognition
339
normal pressure hydrocephalus prsents as?
ataxia
urinary incontinence
dilated ventricles on imaging
340
prion disease presetns as
behavioral changes
rapid progression
myoclonus, seizures
341
vascular dementia presents as?
stepwise decline
| early executive dysfunction
342
Fidaxomicin
bactericidal abx reserved for recurrent colitis
343
c.diff with WBC < 15,000 can be treated with?
PO metronidazole
344
c.diff with WBC > 15,000 treated with?
PO vancomycin (IV does not get into colon) w. or w.o IV metronidazole
345
First step in evaluating solitary pulmonary nodule?
previous x-rays
346
if a solid lesion revealed on imaging is stable for > 2 years then malignancy is?
ruled out and no further testing needed
347
If there are no previous x-rays to compare with the solitary lung nodule, what should be done?
CT scan
348
When would you get PET or biopsy of a solitary lung nodule?
when intermittent suspicion of malignancy
349
Oligoclonal IgG bands on CSF analysis?
multiple sclerosis
350
Albuminocytologic dissociation (elevated CSF protein with a normal cell count)
characteristic of Guillain-Barre syndrome
351
14-3-3 protein in CSF?
neurodegenerative prion disease- Cruetzfeld Jakob
352
studies have shown that what type of CPR improves outcomes for sudden cardiac arrest patients outside of hospital?
compression only CPR
353
What is the strongest predictor of stent thrombosis in the first 12 months?
premature discontinuation of antiplatelet therapy
354
presbyopia
common age related eye disorder resulting from decreased elasticity of the lens
355
Presence of middle ear infusion without evidence of acute infection is indicative of?
serious otitis media in an HIV patient
356
combination of liver diease and neuropsych symptoms (involuntary movements and tremors) in a young adult is highly suggestive of?
Wilson disease
357
ichthyosis vulgaris
chronic, inherited skin disorder characterized by diffuse dermal scaling
358
RA most commonly affects what part of the spine?
cervical
359
Major duke criteria?
1. blood culture positive for typical microorganism
| 2. echo showing valv vegetation
360
Minor duke criteria
1. predisposing cardiac lesion
2. IV drug use
3. Temp > 38
4. Embolic phenom
5. immune phenom
6. positive blood culture
361
How do you diagnose IE based on duke criteria?
DEFINITE: 2 major IE or 1 major and 3 minor
Possible: 1 major and 1 minor or 3 minor
362
Spinal stenosis improves when you?
Flex spine. "lean over a shopping cart"
363
bone pain that is constant and worse at night with point tenderness on exam?
metastasis to bone
364
pronator drift is a sensitive and specific sign for ________
upper motor neuron or pyramidal tract lesions
365
What is the first step you should take after you identify a thyroid nodule?
TSH level and thyroid US
366
If cancer risk factors or specific US findings with thyroid nodule, what should you do next?
FNA
367
a cold thyroid nodule indicates?
higher risk of cancer. should be evaulated with an FNA
368
anti-thyroid peroxidase antibodies can identify what?
hashimoto thyroiditis
369
Radionuclide scan is indicated in patients with low or high TSH?
low
370
How do you diagnose a colovesical fistula?
abdominal CT with oral or rectal contrast (will show contrast media in bladder)
371
Emphysematous pyelonephritis
pyelo due to gas-producing infection (typically in patients with diabetes)
372
What abx is used in HIV patients with CD 4 < 50 to prevent MAC?
Azithromycin
373
Patients with suspected acute stroke should initially receive what test? why?
CT scan of head w/o contrast
| to rule out hemorrhage
374
theophylline toxicity
```
narrow therapeutic window.
CNS stimulatino (HA, insomnia, seizure)
GI (n/v)
Card tox (arrhythmia).
```
375
What drug can decrease clearance of theophylline?
ciproflox
376
trigeminal neuralgia is treated with ?
carbamazepine
377
headache with acute, intermittent, severe retro-orbital pain
cluster
378
HA with constant pressure in temp/orbital region
tension
379
HA unilateral, pulsatile, throbbing ass with n/v
migraine
380
A normal A-a gradient is?
< 15
381
An A-a gradient > ____ is considered elevated regardless of age
30
382
The A-a gradient is normal when the cause of hypoxemia is?
reduced inspired O2 or hypoventilation
383
clinical features of mycoplasma pneumonia?
indolent HA, malaise, persistent dry cough**, pharyngitis, macular/vesicular rash
384
Diagnostic lab studies for mycoplasma pneumonia?
normal leukocyte count
subclinical hemolytic anemia (cold agglutinins)
**Interstitial infiltrate (not lobar) (cxray)
385
Abx used to treat mycoplasma pneumonia?
Azithromycin
386
poor retention of study subjects falls under what type of bias?
selection
387
attrition bias is a type of _____ bias where?
selection bias where patients are lost to follow up
388
surveillance bias?
exposed group undergoes increased monitoring relative to general population and this increases disease diagnoses
389
basic lab analysis or tests for patients initially diagnosed with HTN?
urinalysis (occult hematuria and/or protein creatinine ratio)
chemistry panel, lipid profile (risk for CAD), baseline ECG
390
24 hour urine cortisol is used to evaluate?
Cushing syndrome
391
Indications for statin therapy (Primary prevention)
Estimated 10 year risk of ASCVD: > 7.5%
392
(Secondary prevention) and indication for statin therapy
Known ASCVD. (MI, stroke)
| LDL > 190
393
In patients with significant hyperkalemia who develop ECG changes what should you give?
IV calcium gluconate
394
ECG findings found with hyperkalemia?
tall peaked T waves, PR prolongation, QRS widening, disappearance of P wave, conduction blocks, bradycardia
395
Angiotensin II leads to a net increase or decrease in renal blood flow? why?
Net decrease! it constricts afferent and efferent arterioles
396
how does angiotensin II increase GFR?
preferential vasoconstriction of efferent
397
tumor lysis syndrome
develops in patients with aggressive heme malignancies who undergo chemo.
1. hyperuricemia
2. hyperkalemia and hyperphosphatemia
3. hypocalcemia (due to phosphate binding)
398
How can you prevent tumor lysis syndrome?
pretreatment with IV fluids and allopurinol
399
adverse affects of hydroxychloroquine?
retinopathy with potential irreversible vision loss
400
painless thyroiditis (silent thyroiditis)
acute thyrotoxicosis with mild thyroid gland enlargement and suppressed TSH
401
radio-iodine uptake is increased/decreased with painless thyroiditis?
decreased (suggesting release of preformed thyroid hormone)
402
In graves disease, radio-iodine uptake will be increased/decreased?
increased (increased synthesis of thyroid hormone)
403
which types of thyroiditis (hyperthyroid) have spontaneous recovery?
painless thyroiditis and subacute thyroiditis
404
what are the 2 most common bacterial pathogens causing solitary brain abscess?
Viridans strep
Staph aureus
gram negative
405
Pathogenesis of brain abscesses?
direct from adjacent infection -> sinusitis, otitis, dental infection
hematogenous: endocarditis, osteomyelitis
406
hypodense lesions in temportal lobe?
herpes encephalitis
407
malignant otitis externa
severe infection typically seen in elderly diabetic patients most commonly caused by Pseudomonas aeruginosa
408
granulation tissue seen in ear canal and ear pain and drainage that is not responsive to topical meds makes you think of?
malignant otitis externa
409
In ARDS you want to maintain PaO2 at? and O2sat at?
PaO2: 55-80
O2sat: 88-95
410
FiO2 levels
60%
411
Diagnostic requirements for severe acute liver injury?
```
ALT and AST > 1000
hepatic encephalopathy (confusion, asterixis)
Synthetic dysfunction (INR >1.5)
```
412
upper lung lobe bronchiectasis is particularly characteristic of?
CF
413
sialadenosis is often found in patients with?
advanced liver disease or malnutrition
414
Without alveolar ventilation (inflammatory exudate filled alveoli in pneumonia) are you able to correct hypoxemia with increased concentration of FiO2?
NO
415
Management for TCA overdose?
concern for CNS depression, hypotension and QRS prolongation. Secure ABCs. Administer sodium bicarb.
416
most common complication of influenza in patients > 65
secondary bacterial pneumonia
417
Young patients are at risk for secondary bacterial pneumonia after influenza with what pathogen?
CA-MRSA
418
CA-MRSA pneumonia is characterized by?
severe necrotizing pneumonia that is rapidly progressive and often fatal. high fever, productive cough with hemoptysis, leukopenia, multilobar cavitary infiltrates
419
fever, pleuritic chest pain, hemoptysis?
aspergillus
420
corrected calcium equation =
(measured total calcium) + .8 (4 - serum albumin)
421
most common form of drug induced chronic renal failure?
analgesic nephropathy
| most commonly seen in women age (50-55) who habitually use (aspirin/naproxen)
422
CA-19 is helpful as a postop monitoring tool for what type of cancer?
pancreatic cancer
423
Sensory innervation of cornera comes from?
opthlamnic branch of trigeminal nerve (CN V)
424
Clinical features of primary adrenal insufficiency
fatigue, weakness, anorexia/weight loss, salt craving, GI symptoms, hyperpigmentation, hypotension, hyponatremia, hypokalemia
425
More common in african americans. asymptomatic initial stages followed by gradual loss of peripheral vision over period of years
Open angle glaucoma
426
Open angle glaucoma exam findings
cupping of the optic disc
427
Management of open angle glaucoma
Timolol eye drops
428
osteonecrosis (aseptic necrosis)
| of femoeral head is a common complication of?
sickle cell disease
429
Clinical manifestations of avascular necrosis of the hip
groin pain on weight bearing
pain on hip abduction and internal rotation
no erythema, swelling, point tenderness
430
decreased leukocytes due to viral suppression, and atypical lymphocytes on blood smear are a sign of?
EBV mono
431
plasmodium vivax
organism responsible for malaria
432
Osmolal gap causes of anion gap acidosis
ethylene glycol (calcium oxalate crystals)
methanol (blindness)
propylene glycol
433
calculated serum osmolality =
2(Na) + Gluc/18 + BUN/2.8
434
Osmole gap =
meausred serum osm - calculated serum osm
435
mixed anion gap metabolic acidosis and resp alkalosis
Aspirin (salicylate tox)
436
most common cause of nutritional folate deficiency in the US?
alcoholism
437
defective mineralization of organic bone matrix?
osteomalacia due to severe Vit D deficiency
Rickets in kids (defective mineralization at the growth plate)
438
Vit D deficiency can be caused by?
malabsoprtion, intestinal bypass, celiacs, chronic liver or kidney disease
439
what do you treat myesthenia gravis with?
acetylcholinesterase inhibitor (pyridostigmine)
440
Treatment for unilateral adrenal adenoma?
bilateral adrenal hyperpasia?
```
surgery (preferred)
Aldo antagonists (spironolactone, eplerenone)
```
hyperplasia: aldo antags
441
What is a toxic dose of acetaminophen in adults? in kids?
>7.5g adults
> 150mg/kg in kids
442
When do you administer charcoal for acetiminophen ingestion?
When toxic ingestion of >7.5 or greater than 150mg/kg in kids and if its been <4 hours since ingestion
443
anidote for acetiminophen tox?
N-acetylcysteine
444
muscle and joint paints, retroorbital pain, rash, leukopenia after traveling to kenya
Dengue fever
445
Etiology of primary adrenal insufficiency
Autoimmune
Infections (TB, HIV, dissemintated fungal)
Hemorrhagic infarct
Cancer
446
risk for epiglotittis is much higher in which individuals?
non immunized (most often due to H flu
447
What are the radiolucent stones?
uric acid stones
| xanthine stones
448
treatment for uric acid stones?
hydration
alkalinization of urine with PO potassium citrate
low purine diet
449
Management of recurrent hypercalciuric stones?
hydrochlorothiazide (decreases urinary calcium excretion)
450
Greatest risk factor for both ischemic and hemorrhagic stroke?
hypertension (4X the risk of CVA compared to normotensive)
451
Presentation of rotator cuff impingement or tendinopathy
- pain with abduction and external rotation
- subacromial tenderness
- positive impingement test
- normal ROM
452
Rotator cuff tear presentation
> 40 yoa (usualy after fall on outstretched arm)
| weakness with external rotation
453
adhesive capsulitis (frozen shoulder) presentation
decreased passive and active ROM
| More stiff than painful
454
Biceps tendinopathy/rupture presentation
sudden onset, audible pop, visible bulge
anterior shoulder pain
pain with lifting, carrying, overhead reaching
weakness less common
455
glenohumeral osteoarthritis presentation
uncommon.
usually caused by trauma.
gradual onset of anterior/deep shoulder pain
decreased ROM
456
Jarisch-Herxheimer reaction
Seen in patients with early Syphillis treated with antibiotic.
rapid destruction of spirochetes causes an acute febrile illness with myalgia, HA, rigors, sweats, worsened syphilitic rash (self limiting in 48 hours)
457
Immune reconstitution inflammatory syndrome
occur in patients with HIV initiated on highly actie antiretroviral treatment-> paradoxical worsening of symptoms due to immune system improvement
458
Lynch syndrome associated neoplasms
colorectal, endometrial, ovarian
459
FAP associated neoplasm
colorectal
desmoid (CT) and osteoma
brain tumor
460
von Hippel-Lindau syndrome associated neoplasms
hemangioblastoma
clear cell renal carcinoma
pheochromocytoma
461
MEN 1 neoplass
pituitary
parathyroid
pancreas
462
MEN 2 neoplasms
med thyroid
parathyroid
pheo
463
For patients with lynch syndrome, what endometrial screening should they have?
annual endometrial biopsy at age 30-35
464
If child bearing is complete, what prophylactic surgery should lynch syndrome patients have
oophorectomy and hysterectomy at age 40
465
Criteria for long term O2 therapy in patients with COPD?
Resting PaO2 < 55 or SaO2 < 88%
PaO2 <59 or SaO2 <89 in patients iwth cor pulmonale, RHF, hematocrit > 55%
466
Treatment for polymyositis (proximal muscle weakness and elevated CK)
Systemic glucocorticoids
467
Definitive diagnostic test for polymyositis?
muscle biopsy showing endomysial infiltrate and patchy necrosis
468
Beta interferon is used to treat?
MS
469
Riluzole is used to treat
ALS
470
Age of Zenker?
Age > 60.
471
what causes ZD?
upper esophageal spincter dysfunction and esophageal dysmotility
472
A common cause of a wide confidence interval that also decreases study power?
small sample size
473
Treatment/management of aortic dissection
pain control: morphine
IV B-blockers
Sodium nitroprussife if SBP > 120
Urgent surgical repair
474
Thick haustral markings that do not extend across the entire lumen should make you think about?
toxic megacolon
475
How do you diagnose toxic megacolon?
plain abdominal x-ray and 3 or more of: fever > 38, pulse >120, WBC > 10,500 and anemia
476
A ruptured ______ cyst can cause anaphylaxis with eventual shock
anaphylaxis
477
Differential diagnosis of hyperadrogenism in females
PCOS, nonclassic CAH, ovarian/adrenal tumor, hyperprolactinemia, Cushing, Acromegaly
478
rapid onset hirsutism suggests what diagnosis?
androgen-secreting neoplasm of ovaries or adrenal glands
479
Women with suspected androgen producing tumor should be evaluated with?
serum testosterone and DHEAS
480
Elevated T levels with normal DHEAS levels suggest _____ source for tumor
ovarian
481
17-OHP is used to screen for?
CAH due to 21-hydroxylase
482
Why might hgb be elevated in patients with excess T?
T stimulates erythropoiesis
483
Polycythemia vera predisposes patients to developing______ due to clonal hyperproliferation of red cells, white cells, platelets
GOUT
484
prutitis with hot baths, hepatosplenomegaly and gout? diagnosis-
Polycythemia vera
485
Genetic deficiency of hypoxanthine -guanine transferase in a patient with self-injurious behavior
Lesch-Nyhan sydrome
486
Prolactin levels should be > _____ to suggest prolactinoma vs a nonfunctioning adenoma
200
487
therapy for afib due to hyperthyroidism?
beta blockers
| propranolol (it also decreases conversion of T4 to T3)
488
Most common cause of an isolated, asymptomatic elevation of alk phos in elderly patient?
PAGET disease of bone (osteitis deformans)
489
what imaging modality is useful to stage paget disease?
radionuclide bone scan
490
Treatment for paget dsiease
bisphosphonates
491
Fever, weight loss rhinosinusitis and nectrotizing pulm vasculitis are commonly seen in what disease?
Wegener's
492
Ondansetron MOA
serotonin receptor antagonist
493
serotonin receptor antagonists (ondansetron) are first line for?
chemo induced nausea
494
What antibiotic can be used as a motilin agonist to treat nausea secondary to gastroparesis
Erythromycin
495
How to treat symptomatic microprolactinoma or a macroprolactinoma > 10mm
DA agaonists (Cabergoline, Bromocriptine)
Resection for tumor > 3cm
