Medicine Flashcards
(329 cards)
1
Q
Bradycardia and hypotension are seen in (right/left) sided MI
A
right
2
Q
Treatment for salicylate toxicity
A
sodium bicarb
3
Q
Treatment for methanol or ethylene glycol toxicity
A
fomepizole
4
Q
What is one of the first treatments for patients with suspected upper GI bleed?
A
IV omeprazole
5
Q
When you suspect a SAH, when is the next best test to order?
A
LP to evaluate for RBCs/xanthochromia, increased opening pressure
6
Q
What is the confirmatory test for multiple myeloma?
A
serum protein electrophoresis (SPEP)
7
Q
What drug decreases mortality in patients with systolic heart failure?
A
spironolactone
8
Q
How do you treat acute adrenal insufficiency?
A
IV hydrocortisone
9
Q
What is the mainstay of treatment for acute pericarditis?
A
NSAIDs
10
Q
How do you diagnose sarcoidosis?
A
tissue biopsy shows noncaseating granulomas
11
Q
Cardiogenic shock
- CO?
- SVR?
- PCWP?
A
- CO: decreased
- SVR: increased
- PCWP: increased
12
Q
Hypovolemic
- CO?
- SVR?
- PCWP?
A
- CO: decreased
- SVR: increased
- PCWP: decreased
13
Q
Neurogenic
- CO?
- SVR?
- PCWP?
A
- CO: decreased
- SVR: decreased
- PCWP: decreased
14
Q
Septic
- CO?
- SVR?
- PCWP?
A
- CO: increased
- SVR: decreased
- PCWP: decreased
15
Q
What is the most common cause of mitral stenosis?
A
rheumatic heart disease
16
Q
Opening snap followed by a low-pitched diastolic rumble
A
mitral stenosis
17
Q
Harsh crescendo-decrescendo systolic murmur
A
aortic stenosis
18
Q
widened pulse pressure, diastolic decrescendo murmur best heard at left sternal border
A
aortic regurg
19
Q
Does murmur increase or decrease in intensity with handgrip for aortic regurg?
A
increases (handgrip increases SVR, which causes an increased “backflow” through incompetent aortic valve)
20
Q
holosystolic murmur
A
mitral regurg
21
Q
What is the usual cause of tricuspid regurg?
A
RV dilation
22
Q
Blowing holosystolic murmur
A
tricuspid regurg
23
Q
Mid-to-late systolic click
A
mitral valve prolapse
24
Q
What are the effects of standing and squatting on mitral valve prolapse?
A
standing: decreases LV chamber size –> increased murmur
squatting: increases LV chamber size –> decreased murmur
25
ALT levels in the 1000s should make you think of...
Budd-Chiari, autoimmune hepatitis, acute viral, shock liver, tylenol, etc.
26
What is the cause of the liver problem when labs show...
- elevated alk phos, d. bili
- elevated AST/ALT
- elevated alk phos, d. bili: obstruction
| - elevated AST/ALT: hepatocellular injury
27
How do you treat SVR problems in shock?
vasoconstrictors: phenylephrine, vasopressin, epinephrine
28
What drugs can be used to address contractility problems in shock?
ino-dilators: dobutamine, milrinone
| ino-constrictors: levophed, DA
29
What are the 3 components of Virchow's triad?
- venous stasis
- endothelial trauma
- hypercoaguability
30
What are some signs of cirrhosis?
- portal HTN
- decreased albumin
- decreased oncotic pressure
31
How do you diagnose and treat spontaneous bacterial peritonitis?
- dx: paracentesis (>250 polys)
| - tx: IV CTX
32
What do different values of serum ascites albumin gradient (SAAG) mean?
- >1.1
- <1.1
- >1.1: more protein in blood than ascites = portal HTN
| - <1.1: less protein in blood than ascites = infxn or cancer
33
What is the biggest difference between seizure and syncope?
seizure has a post-ictal period
34
DIC labs:
- Plt:
- Fibrinogen:
- D-dimer:
- PT:
- PTT:
- INR:
- Schistocytes:
- Plt: decreased
- Fibrinogen: decreased
- D-dimer: increased
- PT: increased
- PTT: increased
- INR: increased
- Schistocytes: present
35
TTP labs:
- Plt:
- Fibrinogen:
- D-dimer:
- PT:
- PTT:
- INR:
- Schistocytes:
- Plt: decreased
- Fibrinogen: nml
- D-dimer: nml
- PT: nml
- PTT: nml
- INR: nml
- Schistocytes: present
36
What is the difference between Lambert Eaton and myasthenia gravis?
Lambert Eaton: antibodies against Ca-channel
| Myasthenia gravis: antibodies against Ach-r
37
How do you terminate SVT?
vagal maneuvers (Valsalva, carotid sinus massage)
38
How do you treat osteoporosis?
- vitamin D
- calcium
- zolendronic acid (bisphosphonate)
39
Which of the following is most helpful for HTN treatment?
- DASH diet
- weight loss
- decreasing EtOH consumption
- increasing exercise
- smoking cessation
weight loss!
40
How does HIV present acutely?
mono-like syndrome w/ fever, LAD, HA, myalgias/ arthralgias, sore throat, maculopapular rash
41
Anemia, low back pain, increased ESR, and renal dysfxn suggest a diagnosis of...
multiple myeloma
42
A peripheral smear of multiple myeloma shows...
rouleaux formation (stacked appearance of RBCs)
43
What drugs can be used to treat migraines?
- chlorpromazine (IV)
| - sumatriptan (oral)
44
Thin body habitus, hyperkalemia, hypoglycemia, metabolic acidosis, and hyperpigmentation are symptoms of...
adrenal insufficiency
45
What labs are elevated in pancreatic cancer?
alk phos, bilirubin
46
When should a whipple procedure be performed?
with resectable pancreatic cancer of the head
47
What type of hypersensitivity reaction is described?
| chronic graft rejections, purified protein derivative, latex, nickel, poison ivy
type IV
48
What type of hypersensitivity reaction is described?
| hemolytic reactions, Goodpasture syndrome, hyperacute graft rejection
type II
49
What type of hypersensitivity reaction is described?
| IgE-mediated reactions quickly after exposure, associated with allergens (bee stings, peanuts, latex, etc.)
type I
50
What type of hypersensitivity reaction is described?
| hypersensitivity pneumonitis, SLE, polyarteritis nodosa, serum sickness
type III
51
What kind of mutation do people with polycythemia vera have?
JAK2
52
What does CURB65 stand for and what is it used for?
```
Confusion
Uremia
RR >30
BP low
65 years old
*used for inpatient vs outpatient treatment determination of CAP
```
53
Which type of renal tubular acidosis is described?
| distal tubule defect prevents acid from being excreted, pH >5.5, low K+, positive urine anion gap
RTA type I
54
Which type of renal tubular acidosis is described?
| defect in bicarb reabsorption in the proximal convoluted tubule, pH <5.5, low K+, positive urine anion gap
RTA type II
55
Which type of renal tubular acidosis is described?
| hypoaldo or resistance to aldosterone, pH <5.5, high K+, positive urine anion gap
RTA type IV
56
What are some risk factors for kidney stones?
- age >40
- gender (male)
- FH
- diet: high sodium, protein, sugar
- high BMI
- medical conditions: RTA, cystinuria, hyperPTH, IBD, short bowel, hypocitraturia, sarcoidosis, Crohns
57
What is a systemic vasculitis characterized by immune complexes containing IgA?
henoch-schonlein purpura
58
What is one side effect that CCBs and anticonvulsants have in common?
gingival hyperplasia
59
What is the difference between anchoring and availability heuristics?
- anchoring: holding onto an initial impression (ie: accepting referring physician's diagnosis at face value)
- availability: making diagnosis based on what is available in your mind (ie: diagnosed someone last week with something, so diagnose person this week who presents similarly with the same thing)
60
What test is it important to do in someone with BPH?
UA (abnormal bladder emptying --> increased risk for infection --> exacerbates BPH)
61
How does arrhythmogenic syncope present?
brief or absent prodrome and palpitations immediately preceding the event
62
How should a breast mass be evaluated?
ultrasound --> aspirate if cystic, FNA or core bx if solid
63
Vertigo accompanied by nystagmus that is immediate, prolonged (>1 minute), and has a positive Dix-Hallpike is characteristic of (central/peripheral) origin
central
64
What is the diagnosis?
| Anterior knee pain made worse with prolonged sitting and with going up and down stairs
patellofemoral pain syndrome
65
What is an effective non-hormonal medication for reducing menopausal vasomotor symptoms?
venlafaxine
66
Acute onset of painless blurry vision and optic disc swelling, dilated and tortuous veins, flame-shaped retinal hemorrhage, cotton-wool spots ("blood and thunder")
central retinal vein occlusion
67
What is the best option for reducing LDL cholesterol in women with HLD who want to become pregnant?
bile acid sequestrants (colesnvelam)
68
Diverticula are small outpouchings of the bowel associated with chronic ___________ that can be treated with __________
constipation, fiber
69
What does CSF analysis show in Guillain Barre?
elevated protein, nml WBC, RBC, glucose
70
Herpes simplex keratitis presents with what eye findings?
corneal vesicles, dendritic ulcers
71
Burning pain on the plantar surface of the foot between the 3rd and 4th digits causes...
Morton neuroma
72
___________ is pain that occurs with thumb use, characterized by pain and swelling over the radial styloid that is elicited with resisted thumb abduction and extension
de Quervain tenosynovitis
73
Vertigo, tinnitus, and hearing loss are characteristic of...
Meniere disease
74
How can carpal tunnel be confirmed?
nerve conduction studies (shows slowing in the median nerve at the wrist)
75
Small skin-colored papillose with indented centers that occur throughout the body are suggestive of _______, an infection caused by ___________
molluscum contagiosum, poxvirus
76
How do you treat infective endocarditis?
IV ceftriaxone or penicillin G for 4 weeks
77
Patients with hyperosmolar hyperglycemic state (HHS) have a total body K+ (excess/deficit) due to excessive urinary (retention/loss) caused by ________________
- deficit
- loss
- glucosuria-induced osmotic diuresis
78
Decreased sensation over the 4th and 5th digits and weak grip are due to damage where?
elbow (ulnar nerve compression)
79
What kind of gifts can be accepted by physicians from pharmaceutical companies?
small gifts that benefit patients (i.e.: drug samples)
80
Heparin-induced thrombocytopenia is caused by...
antibodies that bind to and activate platelets
81
People with Raynauds should be tested for..
autoantibodies and inflammatory markers
82
What is the most common organism that causes epididymitis?
e. coli
83
All adults ages 18+ should be screened for HTN every ____ year(s) if their BP is <120/80
2 years
84
How do you treat acute sinusitis?
treat sxs (analgesics and decongestants)
85
What is expressive aphasia?
can comprehend and follow commands but cannot verbalize or write properly (expressive aphasia)
86
Chest pain, new holosystolic murmur, biventricular failure, and shock several days after MI suggests...
interventricular septum rupture
87
What is the finding on path with acute tubular necrosis?
muddy brown casts
88
When should colonoscopy not be performed first in someone with minimal bright red blood per rectum?
when patient is <40 years old
89
What is the most effective treatment for uremic pericarditis?
dialysis
90
What is the difference in presentation between bed bugs and scabies?
bed bugs: small, punctate lesions w/ erythema, classically in linear tracks or clusters
scabies: delayed type IV hypersensitivity rxn; intensely pruritic rash w/ small, crusted red papules and burrows, vesicles and pustules on wrist and fingers
91
What eye findings are commonly seen with poorly controlled diabetes?
CN III palsy ("down & out")
92
What arrhythmia is most specific for digitalis toxicity?
atrial tachycardia with AV block
93
In a patient with ascending aortic aneurysm, what may have occurred if they suddenly develop worsening chest pain, hypotension, and pulmonary edema?
retrograde extension of intimal tear --> aortic regurg
94
How does nitroglycerin work to improve chest pain?
direct vascular smooth muscle relaxation --> vasodilation --> decreased LV end-diastolic and end-systolic volume
95
What is the first line medication for chronic pain in the elderly?
acetaminophen
96
When should osteoporosis be screening for?
Women 65+ or earlier if higher risk
97
How do you manage a patient with T2D post-operatively?
give long and short-acting insulin to control glucose level
98
Fatigue, elevated transaminases, arthralgias, porphyria cutanea tarda suggest...
hepatitis c
99
What does free air under the diaphragm suggest?
perforated peptic ulcer
100
What portion of the spine is involved in rheumatoid arthritis?
cervical
101
diffuse telangiectasias (blanching papules on lips), recurrent epistaxis, AV malformations
hereditary telangiectasia
102
Hemineglect syndrome is characterized by neglecting the (right/left) side of a space and involves the (right/left) ____________ lobe
- neglecting the left
- involves the right (non-dominant)
- parietal lobe
103
What is the cause of a metabolic alkalosis with low urine chloride?
vomiting
104
Hypomagnesemia can cause _____________, especially in alcoholics
hypocalcemia
105
Diverticulosis is associated with chronic ________ so patients should be advised to increase __________
- chronic constipation
| - dietary fiber intake
106
What is the difference between small fiber and large fiber axonal neuropathy?
- small fiber: positive sxs (pain, paresthesias, allodynia)
| - large fiber: negative sxs (numbness, loss of proprioception and vibration sense, diminished ankle reflexes)
107
What is the first line treatment for non-inflammatory (comedonal) acne?
topical retinoids
108
What is the most common source of liver metastases?
colorectal cancer
109
What cardiac finding can you have with pulmonary arterial hypertension?
RV enlargement --> RV heave
110
What lung finding can be seen in IVDU with tricuspid endocarditis?
septic pulmonary emboli
111
Unilateral intermittent stabbing pain near the ear that radiates down the jaw and is triggered by chewing is suggestive of _________________ and is usually treated with __________________
- trigeminal neuralgia
| - carbamazepine
112
What is dacrocystitis?
infection of the lacrimal sac
113
Meniere's disease is caused by...
elevated endolymphatic pressure
114
Low-frequency tinnitus, episodic vertigo, and sensorineural hearing loss are suggestive of...
Meniere's disease
115
______________ is due to a postural inflammatory process and is often preceded by an upper respiratory illness
subacute thyroiditis
116
Labs in osteomalacia:
- alk phos:
- PTH:
- Ca2+
- 25 OH-D:
- alk phos: increased
- PTH: increased
- Ca2+: decreased
- 25 OH-D: decreased
117
Atropine is a ____________ and is used for...
- muscarinic antagonist
| - reversing bradycardia and pupillary dilation and cycloplegia
118
What is the first-line treatment for TIA?
- modify risk factors
- start statin and ASA
- BP control
119
What are the extramuscular findings of dermatomyositis?
- ILD
- dysphagia
- myocarditis
- malignancy
120
What is the heterophiles antibody test used for?
testing for mono
121
Gilbert syndrome presents with elevated levels of __________ and, clinically, the patient appears __________
- elevated levels of unconjugated bilirubin
| - appears jaundiced
122
What are the three main etiologies of constrictive pericarditis?
- idiopathic or viral
- cardiac surgery or radiation therapy
- TB pericarditis
123
Early onset HTN and bilateral upper abdominal masses is suggestive of...
ADPKD
124
Why should patients with cirrhosis have an EGD?
bc esophageal varices are a common complication
125
What is the difference between the pneumococcal polysaccharide vaccine and pneumococcal conjugate vaccine?
- polysaccharide vaccine: polysaccharides alone can't be presented to T cells so vaccine induces T-cell independent B-cell response that is less effective
- conjugate vaccine: induces a T-cell-dependent B-cell response --> improved immunogenicity due to formation of higher-affinity antibodies and memory cells
126
Exudate levels of...
- glucose:
- pH:
- protein:
- glucose: low
- pH: low
- protein: high
127
What is an adverse effect of methimazole?
agranulocytosis
128
What immediate therapy should be given to patients with ischemic stroke?
IV alteplase (TPA)
129
Variant/Prinzmetal angina should be treated with...
diltiazem (CCB)
130
Patients with an MS exacerbation should be treated with...
- glucocorticoids (IV methylprednisolone)
| - plasmapheresis if refractory to glucocorticoids
131
Hereditary spherocytosis has a (positive/negative) Coomb's test
negative
132
Candida (can/can't) be scraped off while leukoplakia (can/can't) be scraped off
- candida can
| - leukoplakia can't
133
What is the EKG finding for coarctation of the aorta?
- sinus rhythm
- high-voltage QRS complexes
- downsloping ST-segment depression
- T-wave inversion
134
What drug has been approved for treatment of ALS and what is its mechanism of action?
riluzole - glutamate inhibitor
135
What DM drug can help with weight loss?
GLP-1 agonists (exenatide, liraglutide)
136
1 - false positive = ______________ rate
sensitivity
137
Lab values for Paget's disease of the bone:
- Ca2:
- Phosphorus:
- Alk Phos:
- Urine hydroxyproline:
- Ca2: normal
- Phosphorus: normal
- Alk Phos: high
- Urine hydroxyproline: high
138
Bone pain, HA, unilateral hearing loss, femoral bowing are suggestive of...
Paget disease of bone
139
What medication can be given to facilitate passage of kidney stone?
tamsulosin (alpha 1 blockers act on distal ureter, lowering muscle tone and reducing reflex spasm secondary to stone impaction)
140
How does bacillus cereus cause quick onset vomiting?
ingestion of preformed enterotoxin in food (reheated rice)
141
What EKG finding is associated with pericardial effusion?
electrical alternans
142
Where do patients with pets anserinus pain syndrome experience pain?
conjoined tendons of gracilis, sartorial, semitendinosus
143
What is the treatment of choice in pregnant and lactating women with lyme disease?
oral amoxicillin
144
What is progressive multifocal leukoencephalopathy?
JC virus reactivation in patients with advanced HIV
- neuro changes (AMS, motor deficits, ataxia)
- imaging: multiple non-enhancing brain lesions without edema
145
CSF analysis in Guillain-Barre syndrome
- protein:
- WBC:
- RBC:
- Glucose:
- protein: elevated
- WBC: normal
- RBC: normal
- Glucose: normal
146
How do you treat vasospastic angina?
CCBs (diltiazem, amlodipine)
147
Growth hormone stimulates hepatic ____________, which is responsible for most of the symptoms of acromegaly
insulin-like growth factor-1 (IGF-1)
148
What symptoms do patients with a thalamic stroke have?
contralateral sensory loss
149
How often should people with ulcerative colitis have a colonoscopy?
start 8-10 years after diagnosis and continue q1-3 years
150
hypocalcemia, hyperphosphatemia, and increased PTH are characteristic of...
secondary hyperparathyroidism from chronic renal failure
151
Molluscum contagiosum is caused by _______ and is associated with what condition?
- caused by poxvirus
| - related to cellular immunodeficiency
152
What are some common sxs of opioid withdrawal?
nausea, cramps, diarrhea, rhinorrhea, lacrimation, arthralgias
153
Where are lesions in ALS?
upper and lower motor neurons
154
Exudates have (high/low) protein and (high/low) LDH
- high protein
| - high LDH
155
Transudates have (high/low) protein and (high/low) LDH
- low protein
| - low LDH
156
What kind of thrombophilia is associated with activated protein C resistance?
Factor V Leiden
157
What class of antiarrhythmics cause widening of the QRS complex?
class 1C antiarrhythmics (i.e.: flecainide)
158
What is electrical alternans?
varying amplitude of the QRS complexes
159
Electrical alternans is suggestive of...
pericardial effusion
160
How do you treat a fib?
warfarin
161
What drug is used to control cardiac sxs of hyperthyroidism?
beta-blocker
162
Adenosine is used to treat...
SVT
163
CCBs are used for (rate/rhythm) control
rate
164
What causes wolff-parkinson-white syndrome?
an accessory pathway that bypasses the AV node and directly connects the atria to the ventricles
165
In addition to meds for diabetes, what other meds should diabetics use?
- ACE or ARBs for HTN treatment if microalbuminuria is present
- ASA
- statins to treat LDL to <100mg/dL
166
What are levels of the following with primary hyperparathyroidism?
- calcium
- phosphate
- PTH
- calcium: hyercalcemia
- phosphate: hypophosphatemia
- PTH: elevated
167
Renal tubular acidosis usually has a (low/high) bicarb
low (<20)
168
What are levels of the following with an impaired liver?
- PT
- ammonia
- bilirubin
- albumin
- PT: elevated
- ammonia: elevated
- bilirubin: elevated
- albumin: low
169
Why is PT or INR one of the most sensitive tests of liver function?
because liver is the site of synthesis of many clotting factors
170
Elevated total bilirubin with low conjugated bilirubin suggests...
- extravascular hemolysis
| - ie: Gilberts, neonatal jaundice, Crigler-Najar, post-transfusion hemolysis
171
Elevated total bilirubin with high conjugated bilirubin suggests...
- obstructive jaundice
| - ie: bile duct obstruction, sepsis, PBC, PSC, cirrhosis, TPN, Dubin-Jonson syndrome
172
How should acute alcoholic hepatitis be treated?
corticosteroids (prednisone)
173
What is the treatment for hepatitis c?
interferon alpha, ribavirin
174
What are some common complications of cirrhosis?
varices, ascites, SBP, hepatic encephalopathy, HCC
175
Elevations in AST and ALT are associated with ______ while alk phos and GGT are associated with _______
- AST and ALT: liver injury
| - alk phos, GGT: cholestatic, hepatocellular injury
176
What is the triple therapy used for H. pylori eradication?
PPI, amoxicillin, clarithromycin
177
What drugs can be used for long-term gout prevention?
xanthine oxidase inhibitors, allopurinol, febuxostat
178
Older women with pain and stiffness in the cervical spine and shoulder/hip girdles may have...
polymyalgia rheumatica
179
How should HSV and VZV be treated?
acyclovir, famcyclovir, valacyclovir
180
Mild-moderate headaches that last a day and have a bilateral, "headband-like" distribution of pain
tension-type HA
181
What types of meds can be used for migraine prophylaxis?
antidepressants, anticonvulsants, CCBs, BB, muscle relaxants, etc.
182
How do leukotrienes work?
-block airway inflammatory response, preventing smooth muscle contraction and airway edema
183
Cromolyn is used for _________ treatment because it stabilizes ____________ cells
- asthma
| - mast cells
184
What is the most common cause of bronchiolitis?
RSV
185
What are treatments for CAP?
macrolide (azithromycin, erythromycin, clarithromycin), doxycycline, beta lactam (amoxicillin-clavulonate)
186
What does CURB-65 stand for and what is it used to help decide?
```
-decide if pt w/ CAP should be hospitalized
Confusion
Uremia
RR
BP low
65 years old
```
187
exudative tonsils, tender anterior cervical LAD, hx of fever, abdominal pain, absence of cough suggests...
pharyngitis
188
URI sxs for >10 days or worsening after 7 days are suggestive of...
sinusitis
189
Influenza presents with (upper/lower) respiratory sxs while pneumonia presents with (upper/lower) respiratory sxs
- influenza: upper
| - pneumonia: lower
190
What is the mainstay of treatment for patients w/ COPD?
bronchodilators
191
Persistent activation of the alternative complement pathway causes what renal disease?
membranoproliferative glomerulonephritis
192
Hyperthyroidism increases (osteoclast/osteoblast) activity
osteoclast
193
What type of thyroid cancer originates from the parafollicular c cells that produce calcitonin?
medullary thyroid cancer (old people or runs in families)
194
What antibody is present in people with Hashimoto's?
antithyroid peroxidase
195
What drugs are given to treat people with HF?
- ASA, statin
- BB, ACEi
- loop diuretic (furosemide)
- spironolactone
- inotropes (dobutamine, milrinone)
196
Rheumatic fever causes what type of heart disease?
mitral stenosis
197
Diastolic murmur w/ opening snap heard best at the apex
mitral stenosis
198
What type of lung cancer is associated with Cushings and SIADH?
small cell
199
Shoulder pain, Horner syndrome (ptosis, miosis, anhidrosis), weakness of hand muscles, supraclavicular LNs, and weight loss suggest...
Pancoast tumor
200
Elevated TSH receptor antibody
Graves disease
201
Plasma-free metanephrines are elevated in...
a pheochromocytoma
202
What is the fastest acting and most effective way to abort a cluster HA?
100% oxygen
203
Oral ulcers, acute rise in serum transaminases, alopecia, pulmonary toxicity, bone marrow suppression (macrocytic anemia, leukopenia, thrombocytopenia) are sxs of what medication toxicity?
MTX
204
What is the most common cause of sudden cardiac arrest in the immediate post-infarction period?
reentrant ventricular arrhythmias
205
What are causes of a transudate?
CHF, nephrosis, gastrosis, cirrhosis
206
What are causes of an exudate?
malignancy, pneumonia, TB
207
What are values of the following for a normocytic anemia?
- LDH
- Haptoglobin
- Bilirubin
- LDH: increased
- Haptoglobin: decreased
- Bilirubin: increased
208
Elevated methylmalonic acid is indicative of what type of megaloblastic anemia?
B12 deficiency
209
What are levels of the following in Fe-deficiency anemia?
- ferritin
- TIBC
- ferritin: low
| - TIBC: high
210
What are levels of the following in anemia of chronic disease?
- ferritin
- TIBC
- ferritin: high
| - TIBC: low
211
CRAB stands for _____________ and is associated with...
Calcinosis, Renal failure, Anemia, Bone pain
| -multiple myeloma
212
Decreased ADAMTS-13 is associated with...
thrombotic thrombocytopenic purpura
213
How is community-acquired pneumonia treated?
3rd generation cephalosporin, macrolide or FQ
214
Orphan Annie nuclei are associated with what type of cancer?
papillary thyroid cancer
215
A female with papilledema, FND, n/v, and a negative head CT has _________ and should be treated with _____________
- idiopathic intracranial HTN (pseudotumor cerebri)
| - treat with acetazolamide
216
8-10x/day unilateral eye pain and Horner syndrome suggests ___________ and should be treated with ____________
- cluster HA
| - O2; ppx = verapamil
217
Post-viral vertigo lasting 1-10 minutes w/ hearing loss and n/v suggests...
vestibular neuritis/labrynthitis
218
Fixed split S2 is associated with what heart murmur?
ASD
219
What are the signs of benzo withdrawal?
HTN, tachycardia, seizures, psychosis
220
What are signs of opiate intoxication?
euphoria, pupil constriction, respiratory depression
221
What are signs of opiate withdrawal?
yawning, lacrimation, sweating, itching, pain
222
Psychomotor agitation, HTN, tachycardia, psychosis, dilated pupils, and angina/HTN crisis are suggestive of ___________ intoxication
cocaine
223
Dilated pupils, psychosis, fever, tachycardia are suggestive of __________ intoxication
amphetamine
224
RR is used for what type of study design and means what?
- cohort
| - probability of disease in exposed/probability of disease in unexposed
225
OR is used for what type of study design and means what?
- case-control
| - odds of exposure in the disease/odds of exposure in those without disease
226
What is the most common location of ectopic foci that cause a fib?
pulmonary veins
227
Multiple system atrophy is a degenerative disease characterized by...
- Parkinsonism
- Autonomic dysfxn (postural hypotension, abnormal sweating, disturbance of bowel and bladder control, abnormal salivation or lacrimation, impotence, gastroparesis)
- Widespread neurological signs
228
What is the most common cause of death in the dialysis population?
cardiovascular disease
229
What is the cause of each of the following findings?
- muddy brown granular casts:
- RBC casts:
- WBC casts:
- Fatty casts:
- Broad and waxy casts:
- muddy brown granular casts: ATN
- RBC casts: glomerulonephritis
- WBC casts: (drug-induced) interstitial nephritis and pyelonephritis
- Fatty casts: nephrotic syndrome
- Broad and waxy casts: chronic renal failure
230
What kind of acid-base disturbance does salicylate intoxication cause?
respiratory alkalosis (stimulates respiratory center --> tachypnea --> CO2 blown off)
231
What are some precipitating factors for hepatorenal syndrome?
- reduced renal perfusion
- GI bleed, vomiting, sepsis, excessive diuretic use, SBP
- NSAID use (constricts afferent arterioles)
232
How is the diagnosis of hepatorenal syndrome made?
- renal hypoperfusion
- FENa <1%
- absence of tubular injury
- no RBC, protein, or granular casts in urine
- no improvement in renal function w/ fluids
233
Auer rods are present in what type of cancer?
AML
234
A positive hydrogen breath test suggests what diagnosis?
lactose intolerance
235
What treatment should be used for tine versicolor?
selenium sulfide
236
For an overweight person, what can lead to the greatest decrease in BP?
10% weight loss
237
What is the physical exam finding for coarctation of the aorta on CXR?
erosions of the inferior costal surfaces
238
Symptoms of confusion, TIA-like sxs, tinnitus, blurred vision, ruddy complexion, and HA are suggestive of...
polycythemia vera
239
Polycythemia vera has what gene mutation?
JAK2 mutation
240
What is lentigo maligna?
slow-growing melanoma seen on face of older fair-skinned people who have received a substantial amount of sun exposure
241
How do you treat fibromyalgia?
TCA, pregabalin, SNRI
242
How do you treat community-acquired pneumonia in the outpatient setting?
macrolide (azithromycin)
243
Hypertension, headaches, palpitations, and diaphoresis are the classic sxs of...
pheochromocytoma
244
Episodic flushing and hypotension are characteristic of...
carcinoid syndrome
245
What type of HIV testing should people have?
HIV antibody enzyme immunoassay
246
CMV retinitis is a complication of what?
HIV
247
What are the effects of excess parathyroid hormone?
- increased vitamin D levels
- increased osteoclast-mediated bone resorption
- increased GI resorption
- increased kidney absorption
248
What are the criteria for metabolic syndrome?
3 of 5:
- increased waist circumference
- elevated systolic or diastolic BP
- decreased HDL
- elevated TG
- elevated fasting plasma glucose
249
What are risk factors for pseudomonas?
smoking, chronic lung disease, recent hospitalization
250
What prophylactic medication is used for cluster headaches?
verapamil
251
How do you treat paroxysmal SVT?
vagal maneuvers, adenosine
252
How do you treat a fib or atrial flutter?
control rate w/ BB, DC cardioversion, anticoagulation
253
How do you treat ventricular tachycardia?
amiodarone (DC cardioversion if unstable)
254
LDL should be less than...
100
255
Triglycerides should be less than...
150
256
What would you advise for a teenager with acne besides oral antibiotics and topical retinoid therapy?
avoid sun exposure
257
Depression/apathy, dementia, and writhing of the extremities are suggestive of...
Huntington's disease
258
What are the three criteria of an exudate?
- pleural fluid protein/serum protein ratio >0.5
- pleural fluid LDH/serum LDH ratio >0.6
- pleural fluid LDH >2/3 of the upper limit of normal serum LDH
259
How do you treat sinus bradycardia?
atropine
260
What are the three acute changes in a COPD exacerbation?
- increased cough
- increased sputum production
- worsening dyspnea
261
What is the quickest way to lower serum K+?
insulin and glucagon
262
What is the most important for preventing ESRD?
- tobacco cessation
- TG control
- glycemic control
- weight control
- sodium restriction
glycemic control
263
What syndrome is described?
Bilateral, severe radicular pain, saddle anesthesia, asymmetric motor weakness, hyporeflexia, late onset bowel & bladder dysfunction
cauda equina syndrome
264
What syndrome is described?
sudden-onset severe back pain, perianal anesthesia, symmetric motor weakness, hyperreflexia, early onset bowel & bladder dysfunction
conus medullaris syndrome
265
The following are signs of what secondary cause of HTN?
- elevated Cr
- abnormal UA (proteinuria, RBC casts)
renal parenchymal (solid part of kidney) disease
266
The following are signs of what secondary cause of HTN?
- severe HTN
- recurrent flash pulmonary edema or resistant HF
- elevated Cr
- abdominal bruit
renovascular disease
267
The following are signs of what secondary cause of HTN?
- hypokalemia, hypernatremia
- HTN with adrenal incidentaloma
primary aldosteronism
268
The following are signs of what secondary cause of HTN?
- paroxysmal elevated BP with tachycardia
- pounding HA with diaphoresis
- HTN with adrenal incidentaloma
pheochromocytoma
269
The following are signs of what secondary cause of HTN?
- central obesity, facial plethora
- abdominal striae, proximal muscle weakness
- amenorrhea, erectile dysfunction
- HTN with adrenal incidentaloma
Cushing's
270
The following are signs of what secondary cause of HTN?
- fatigue, dry skin, cold intolerance
- constipation, weight gain, bradycardia
hypothyroidism
271
The following are signs of what secondary cause of HTN?
- hypercalcemia (polyuria, polydipsia)
- kidney stones
- neuropsychiatric presentation (confusion, depression, psychosis)
primary hyperparathyroidism
272
What physical exam finding most strongly suggests dysfunction of a prosthetic aortic valve?
new diastolic murmur (aortic regurg)
273
Most Ca2+ ions are bound to...
albumin
274
PTH (increases/decreases) bone resorption, thus (increasing/decreasing) Ca2+ and (increasing/decreasing) PO4
- increases bone resorption
- increases Ca2+
- decreases PO4
275
Calcitonin (increases/decreases) bone resorption, thus (increasing/decreasing) Ca2+ and (increasing/decreasing) PO4
- decreases bone resorption
- decreases Ca2+
- increases PO4
276
Vitamin D (increases/decreases) bone resorption, thus (increasing/decreasing) Ca2+
- increases bone resorption
| - increasing Ca2+
277
Serum PO4 is (high/low) in hypoparathyroidism and (high/low) in renal insufficiency
-high in both
278
What should you give when hyperkalemia is severe?
IV calcium gluconate (stabilizes resting membrane potential)
279
What do aldo and K+ look like in Addison's disease
- low aldosterone
| - hyperkalemia
280
___________ controls phosphorus absorption in GI tract and _________ controls phosphate excretion in kidneys
- absorption: vitamin D
| - excretion: PTH
281
What heart problem is common in patients with previous chest radiation?
aortic regurg
282
HF and liver failure cause (transudate/exudate)
transudate
283
Malignancy, infection, and inflammation cause (transudate/exudate)
exudate
284
After treating H pylori with PPI and Abx, what needs to be done?
test stool for H pylori
285
Refractory HTN, hypokalemia, aldo:renin >20
hyperaldo
286
Weight loss, sweating, heat intolerance, palpitation
hyperthyroid
287
Renal bruit, hypokalemia, aldo:renin <10
renovascular disease
288
Pallor, palpitations, pain, perspiration, pressure, 24-hr urinary metanephrines
pheochromocytoma
289
How do you treat v tach?
amiodarone
290
Narrow QRS means the rhythm is...
atrial
291
Wide QRS means the rhythm is...
ventricular
292
If heart rhythm is fast + narrow + stable, treat with...
adenosine
293
If heart rhythm is fast + wide + stable, treat with...
amiodarone
294
How do you treat thyroid storm?
IVF, cooling, BB, PTU or methimazole, steroids, idodide
295
Anti-TSH-R antibody is characteristic of what thyroid condition?
Graves disease
296
A patient who is hyperthyroid with palpable nodules has...
toxic goiter
297
What test is used to rule out Cushing's?
dexamethasone suppression test
298
What test is used to rule out pheo?
24 hr urine metanephrines
299
What test is used to rule out Conn's syndrome?
aldo/renin
300
SAAG > 1.1 (is/is not) associated with portal HTN
is (cirrhosis, R-sided CHF, Budd-Chiari, Portal/Splenic Thrombosis, schistosomiasis)
301
SAAG < 1.1 (is/is not) associated with portal HTN
is not (cancer, peritoneal TB, nephrotic syndrome, post-op)
302
Dyspnea, clear lungs, pedal edema, and jugular vein engorgement with inspiration raise concern for...
constrictive pericarditis
303
How does nitroglycerin help with angina?
direct vascular smooth muscle relaxation --> systemic vasodilation, decreased preload --> decreased LV end-diastolic and end-systolic volume
304
An acquired deficieny of pluripotent stem cells is called...
aplastic anemia
305
How does TTP present?
```
FAT RN
Fever
Anemia
Thrombocytopenia
Renal failure
Neurologic sxs that wax and wane
```
306
How do you treat TTP?
plasma exchange or transfusion (NO PLATELETS!)
307
Is the following describing osmotic or secretory diarrhea?
- large daily stool volumes
- occurs during fasting or sleeping
- small difference between plasma osmolality and fecal Na+ and K+
secretory
308
Elevated WBCs. If polys, think ________. If lymphocytes, think _______.
polys: CML
lymphocytes: CLL
309
How should a fib be managed?
BB or CCB (diltiazem)
310
What different findings on blood smear would be expected for ITP vs TTP?
ITP: schistocytes
TTP: spherocytes
311
What is the gold standard for diagnosing kidney stones?
non-contrast abdominal helical CT
312
High Ca2+, high PTH, low PO4 can be...
- hyperparathyroidism
| - FHH
313
High Ca2+, low PTH, high PO4 can be...
malignancy mets, immobilization, vitamin D excess
314
High Ca2+, really high PTH, high PO4 can be...
pseudohypoparathyroidism
315
Low Ca2+, high PTH, low PO4 can be...
vitamin D deficiency, pancreatitis
316
Low Ca2+, high PTH, high PO4 can be...
chronic renal failure
317
Low Ca2+, low PTH, low PO4 can be...
hypoparathyroidism
318
MI in II, III, and aVF suggest involvement of what artery?
RCA
319
MI in V1-V4 suggests involvement of what artery?
LAD
320
MI in I, aVL, and V4-6 suggests involvement of what artery?
circumflex
321
New systolic murmur 5-7 days post-MI?
papillary muscle rupture
322
Acute severe hypotension after MI?
ventricular free wall rupture
323
"Step-up" in O2 concentration from RA --> RV after MI?
ventricular septal wall rupture
324
Persistent ST elevation ~1 month after MI + systolic MR murmur?
ventricular wall aneurysm
325
Pleuritic CP 5-10 weeks after MI, low grade fever?
```
Dressler syndrome (autoimmune pericarditis)
-treat with NSAIDs and ASA
```
326
What is first line treatment for SVT?
carotid massage (then can think about adenosine)
327
What can cause osmotic diuresis besides medications?
high glucose (causes additional water to be pulled into urine)
328
How do you test for Addison's disease?
ACTH stimulation test
329
Someone with DKA has accumulated what?
B-hydroxybutyrate
