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Medicine Flashcards

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1
Q

Gram pos filamentous rod

A

Actinomyces

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2
Q

What bug causes Craniofacial infections after dental procedures?

A

Actinomyces

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3
Q

What are 3 features of actinomyces infections?

A
  1. Abscess formation
  2. Sinus tracts
  3. Sulfur granules
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4
Q

What is the best abx for actinomyces infections

A

Penicillin

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5
Q

What are 4 EKG findings in ischemia?

A
  1. ST changes
  2. New LBBB
  3. T-wave inversions
  4. Pathologic Q waves
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6
Q

What lung cancer is associated with SIADH?

A

Small cell

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7
Q

What is the initial therapy for SIADH and why? What if severe?

A

Water restriction (if serum Na >120 and pt asx) to increase serum sodium, but can give hypertonic saline + furosemide if pt develops symptoms of hyponatremia

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8
Q

What are sx of severe hyponatremia?

A

Lethargy
Altered mental status
Seizures
Coma

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9
Q

How do you differentiate between folate and vitb12 deficiencies

A

Folate – elevated homocysteine, normal MMA levels, no neuro sx
VitB12 – elevated homocysteine, elevated MMA levels, neuro sx

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10
Q

What is the initial treatment of tachycardia or afib secondary to hyperthyroidism?

A

Beta blocker (if HD stable) or cardioversion (if unstable)

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11
Q

inflammation, fibrosis and segmental constriction and dilation of infra and extrahepatic bile ducts

A

Primary sclerosing cholangitis

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12
Q

Dx test for primary sclerosing cholangitis

A

ERCP or MRCP

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13
Q

Decreased ceruloplasmin

A

Wilson’s disease

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14
Q

Elevated CA 19-9

A

Cholangiocarcinoma
Colon cancer
Pancreatic cancer

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15
Q

Positive antimitochondrial antibodies

A

Primary biliary cholangitis

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16
Q

What Antibody is found in primary biliary cholangitis?

A

Antimitochondrial Antibody

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17
Q

Dx test for Wilson’s disease

A

Low plasma ceruloplasmin

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18
Q

Nonsuppartive granulomatous destruction of intrahepatic bile ducts

A

Primary biliary cholangitis

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19
Q

treatment of Hodgkin Lymphoma

A

BEACOPP – bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone

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20
Q

Adverse effect of doxorubicin

A

Cardiotoxicity

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21
Q

Which chemotherapy agent is associated with cardiomyopathy?

A

Doxorubicin

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22
Q

Adverse effect of bleomycin

A

Pulmonary fibrosis

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23
Q

What chemotherapeutic agent is associated with pulmonary fibrosis?

A

Bleomycin

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24
Q

What are the 2 side effects of vincristine?

A

Areflexia

Peripheral neuritis

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25
Which chemotherapeutic agent is associated with peripheral neuritis
Vincristine
26
Most common cause of Endocarditis in IV drug users
Staph aureus
27
Features of acute hypocalcemia
Tetany Seizures Papilledema
28
Features of chronic hypocalcemia
Dental problems Cataracts Basal ganglia calcification Extrapyramidal symptoms
29
Ferruginous bodies are associated with what
Asbestosis
30
Asbestos exposure increases risk of what?
Bronchogenic carcinoma | Mesothelioma
31
What causes calcified pleural plaques
Asbestosis
32
Acid base disturbance in aspirin toxicity
Combined AG metabolic acidosis and respiratory alkalosis
33
Isoprotenerol
Nonselective B1 and B2 agonist
34
2 examples of nonselective alpha and beta blockade
Labetalol | Carvedilol
35
Diffuse alveolar damage causing increased alveolar capillary permeability
ARDS
36
Bronchiectasis
Dilated airways caused by chronic necrotizing pulmonary infections, obstructions or congenital anomalies causing dyspnea, purulent cough and hemoptysis
37
what is the treatment of chronic granulomatous disease?
IFN-y
38
What 5 diseases is IFN-a used for?
``` Hep B Hep C Kaposi sarcoma Malignant melanoma Leukemia ```
39
What is IL11 used to treat?
Thrombocytopenia
40
What 2 diseases is IL2 used to treat?
Metastatic RCC | Metastatic melanoma
41
Abdominal pain, diarrhea, bloating all relieved with bowel movements
IBS
42
Treatment of IBS
``` High fiber diet Water intake Exercise Avoid caffeine Antidiarrheals (loperamide) acutely ```
43
What drug can be used to treat gastroparesis?
Erythromycin
44
What is bismuth used for?
Peptic ulcers
45
What are 4 indications for treatment with octreotide?
Acromegaly Carcinoid tumors VIPomas Esophageal variceal bleeds
46
What is the mechanism of action of aspirin?
Irreversibly inhibits COX1 and COX2 preventing conversion of arachidonic acid to thromboxane which mediate platelet aggregation
47
Which heart sound is associated with longstanding HTN?
S4
48
Which heart sound is benign in patients under 40?
S3
49
Which heart sound is associated with CHF?
S3
50
What is the diagnosis -- headache, fever, hypesthesia in eye, photophobia, keratitis, crusted lesions on face
Herpes zoster ophthalmicus
51
What is the best treatment of herpes zoster ophthalmicus
IV acyclovir, valacyclovir or famciclovir
52
What is a feared complication of untreated herpes zoster ophthalmicus
Acute retinal necrosis
53
What are the iron studies in iron-deficiency anemia?
Serum iron low Ferritin low Transferrin saturation low TIBC high
54
What are the iron studies in hemochromatosis?
Serum iron high Ferritin high Transferrin saturation high TIBC low
55
What are the iron studies in anemia of chronic disease?
Serum iron low Ferritin high Transferrin saturation low TIBC low
56
What vitamin deficiency condition is associated with celiac sprue?
Iron deficiency anemia
57
What is the treatment of iron deficiency anemia?
PO Iron sulfate
58
A pt with Crohns presents with periumbilical pain, N/V, fever, weight loss, and palpable RLQ mass. Diagnosis and next best step?
Abscess | CT Abd with PO and IV contrast
59
What is a complication of hepatic adenomas?
Rupture causing intraperitoneal hemorrhage and shock
60
What is the next best step in diagnosing hepatic adenoma?
Ultrasound then CT
61
What is the treatment of hepatic adenomas?
Watchful wait, unless there is a danger of rupture, pt is symptomatic or it involves most of the liver the surgical resection
62
Liver lesion that is well-circumscribed with a fibrous capsule and hemorrhagic core
Hepatic adenoma
63
Which microbe can cause bilateral adrenal calcification and insufficiency?
TB
64
MCC of adrenal insufficiency
Rapid discontinuation of chronic steroids
65
What is the gold standard treatment of active TB?
RIPE for 6 months followed by rifampin and isoniazid for another 6 months
66
What is the diagnostic test for suspected TB?
CXR then sputum acid fast then confirm with sputum culture
67
What 3 findings could be seen on CXR in a patient with TB and what do they indicate?
Apical cavitary lesions -- reactivated TB Hilar and lower lobe nodes (Ghon) -- primary TB Multiple, fine, nodular densities -- miliary TB
68
What is the treatment for an asymptomatic patient with positive PPD?
Isoniazid for 9 months
69
What is the BEST treatment for Lyme Disease?
Doxycycline (except in kids <8, pregnant women)
70
Why shouldn't doxycycline be used in children?
Causes discolored teeth ad delayed bone growth
71
What symptoms occur in Stage 1 Lyme Disease?
Fever, rash, chills, fatigue, malaise
72
What symptoms occur in Stage 2 Lyme Disease? When?
Joint pain, facial nerve palsy, heart block (4-6 weeks)
73
What symptoms occur in Stage 3 Lyme Disease? When?
Arthritis, synovitis, subacute encephalitis (Months-years)
74
What is the mechanism of action of doxycycline?
Inhibits Attachment of amino-acyl tRNA and halts translation
75
What are 4 adverse effects of doxycycline?
GI upset Photosensitivity Discolored teeth Inhibited bone growth
76
What is the treatment of Lyme Disease in kids?
Amoxicillin if <8 (macrolide if penicillin allergy) | Doxycycline if >8
77
What is the treatment of advanced or disseminated Lyme disease?
IV ceftriaxone or penicillin for 2-4 weeks
78
What drug is associated with Gray baby syndrome
Chloramphenicol
79
What antibiotic is associated with ototoxicity?
Aminoglycosides
80
What antibiotic is associated with a metallic taste i mouth?
Metronidazole
81
What is the mechanism of action of heparin?
Binds to and increases activity of anti-thrombin III
82
What is the mechanism of HIT and when is the onset?
Heparin binds to PF4 and antibodies are generated against heparin-PF4-platelet complexes causing destruction, starts 5-14 days after starting heparin
83
What is the criteria for diagnosing HIT?
Drop in platelet count >30% within 5-10 days of starting heparin, increased bleeding time with normal PT/PTT
84
What are symptoms of HIT?
Fever, chills, dyspnea, bleeding, DVT/PE, skin necrosis, stroke
85
How is HIT treated?
1. Stop heparin 2. Start direct thrombin inhibitor (argatroban, bivalirudin) 3. Transition to warfarin when plts up
86
For which 4 drugs would you need to monitor the absolute neutrophil count?
Clozapine Ganciclovir PTU Methimazole
87
What is the pathophysiology of DKA?
Stressor/insulin non-compliance --> hyperglycemia, loss of insulin --> breakdown of fatty acids --> ketogenesis, increased glucagon, GH, E/NE
88
Diagnostic criteria for DKA
BG >250 PH < 7.3 bicarbonate < 15 Ketonuria or ketonemia
89
What lab test do you follow during treatment of DKA?
Anion gap
90
What is the treatment of DKA?
IVF Insulin + glucose Replete K and PO4
91
What are the causes of acute pancreatitis?
PANCREATITIS -- posterior perf peptic ulcer, Alcohol, neoplasm, cholelithiasis, renal disease, ERCP, anorexia, trauma, infections, toxins/drugs (thiazides, AZT, protease inhibitors), incineration, stings (scorpion), hypertriglyceridemia
92
What is a potential finding on KUB in acute pancreatitis?
Sentinel loop -- isolated dilated loop of small bowel from nearby inflammation
93
What finding can be seen on CXR with acute pancreatitis?
Left-sided pleural effusion
94
What are the Ranson criteria used for?
Determining prognosis of acute pancreatitis
95
What is the treatment of acute pancreatitis?
IVF NPO NG tube decompression Pain control
96
What are 6 complications of acute pancreatitis?
``` ARDS Mediastinal abscess Atelectasis Pleural effusion Pseudocyst Splenic vein thrombosis ```
97
What is Goodpasture Syndrome?
Antibodies against GBM and alveolar basement membrane following upper respiratory infection
98
Fever, cough, hemoptysis, arthralgias, peripheral edema, high blood pressure after a recent upper respiratory infection
Goodpasture's syndrome
99
How is the diagnosis of Goodpasture Syndrome made?
1. CXR (diffuse opacities) 2. Anti-GBM antibodies in blood 3. Kidney biopsy showing linear staining on IF
100
What is the treatment of Goodpasture Syndrome?
1. Airway protection 2. Plasmapheresis to remove antibodies 3. Corticosteroids + cyclophosphamide

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