Medicine Qbank 3 Flashcards
(314 cards)
1
Q
unexplained congestive heart failure, low voltage, increased left ventrulcar wall thickness in patients w/o HTN
A
cardiac amyloidosis
2
Q
h. pylori in gastric adenocarcinoma
A
not curative. (is in MALT lymphoma). treat if tumor is resectable after CT, PET
3
Q
CD4 less than 200, or candidiasis
A
pneumocystis jirovecii, trimethoprim-sulfamethoxazole
oral candiasis is risk factor
4
Q
CD4 less than 100
A
toxoplasma gondii, trimathoprim-sulfamethaxazole
5
Q
CD4 less than 50
A
mycobacterium avium complex, azithromycin
6
Q
CD4 less than 150
A
Histoplasma, itraconazole
ohio and mississippi river walleys
7
Q
acyclovir and valacyclovir in HIV
A
used in recurrent herpes simplex regardless of CD4
8
Q
fluconazole prophylaxis
A
for cryptococcal, but not done in US. treats candidiasis as needed
9
Q
peripheral edema, hypoalbuminemia, urinary protein excretion greater than 3g/day
A
nephortic syndrome. (can cause dyslipidemia leading to athrosclerosis, stroke and MI.)
10
Q
antipseudomonal betalactam that coversgram +/-; empiric tx for febrile neutropenia
A
piperacillin-tazobactam, cefepime or meropenem
11
Q
10 minutes of morning stiffness
A
OA. More would suggest inflammatory arthritis. crepitus is also a sign of OA
12
Q
treat osteoathritis that is refractory to NSAIDs and steriods
A
colchicine
calcium pyrosphosphate can be present in joints
13
Q
three definitive tests for syphilis
A
VDRL, FTA-ABS, and spirochetes on dark field microscopy. Test positive syphilis pt for HIV
14
Q
chronic epigastric pain (on and off), malabsorption (steathorrhea, wt loss), DM
A
chronic pancreatitis: alcoholic, CF, ductal obstruction or autoimmune
15
Q
ELevated CA19-9 levels
A
pancreatic cancer. most patients die within one year
16
Q
chornic cough, mainly nocturnal
A
check PFTs for asthma
17
Q
tx hypersensitivity pneumonitis
A
(ground glass or haziness of lower fields, wt loss, clubbing, honeycombing)
avoid antigen! (parrots, molds). systemic steroids can treat acute symptoms
18
Q
dull low-back pain, worse at night, improves throughout the day
A
inflammatory arthritis: AS, psoriatic arthritis, reactive arthritis, arthritis of IBD. AS affects apophyseal joints
19
Q
high intraocular pressyre with cupping of optic disk, tunnel vision
A
open angle glacoma. AAs, runs in familys, diabetes.
20
Q
poor nightvision, curtain falling with vitreous bleed, or floaters
A
DM retinopathy (leading causeof aquired blindness)
21
Q
blurred vision, problems withnighttime driving, and glare
A
cataracts
22
Q
immune rxn that lookslike acute syphilis
A
jarish-herxheimer reaction to dead syphilis in syphilis treated with penicillin
23
Q
symptomatic relief in new diagnosis of hyperthyroidism
A
beta blockers
24
Q
indication for propylthiouracil
A
when radioactive iodine is contraindicated,like pregnancy. inhibits thyroid hormon synthesis and conversion of T3 to T3. Relapse post-tx in 2/3 of patients
25
most common mets to the liver
GI, breat, lung
26
contraindications for liver transplant
cardiopulmonary dz causing prohibitive risk, incurable or recent cancer (
27
trimethoprim-sulfamethazole AE
rash, neutropenia, hyperkalemia, elevated transaminases
28
minimizepulmonry complications beforegiving antibiotics
give corticosteroids if PaO235
29
PAD tx
low dose aspirin, statin, smoking cessation, supervisedexerciseprogram
30
PAD tx persistent symtpomsdespite exercise therapy
cilostazol and percutaneous or surgical revasculazation
31
evaluated back pain: normal x-ray, increased ESR/CRP
MRI, then CTbiopsy if needed
32
asymptomatic or HA, deafness, neuropathy andbone/back pain
paget's
33
DM screening
USPSTF: pts with BP over 135/80
ADA: all patients over 45
34
ABG inPE
High Aa,decreased PaCO2
35
Low testosterone workup
measure serum prolactin!pituitary MRI indicated in pt with elevated prolactin, testosterone
36
fixed splitting of s2
atrial spetal defects. also may have midsystolicpulmonary flowmurmur
37
fall in systemic arterial pressure more than 10mmHg during inspiration
pulsus paradoxus, cardiac tamponade
38
pulsus parvus and tardus
decreased amplitudeand delyaed upstroke, associated with aortic stenosis
39
Metabolic syndrome definition
```
Waist over 40 in men, 35 in women
fasting glucose 100-110
blood pressure over 130/80
triglycerides over 150
HDL
```
40
indications for chest tube in pleural effusion
pH
41
weakness, back pain and dizziness in pt on warfarin
think bleeding. retroperitoneal hematoma!
42
nonspecific symptoms(fatigue, irritability, insomina), myalgias, hypertension, nephropathy, cognitive deficits, and neuropathy
lead toxicity. think occupational exposure
43
chronic renal failure in pt w/history of anagelsic use
papillary necrosis or chronic tubulointersistial nephritis
44
muddy borwn casts
acute tubular necrosis. ischemic or nephortoxic acute renal failure
45
hematuria (RBC casts), edema, hypertension, proteinuria
glomerulonephritis (nephritic syndrome)
46
chronic pylonephritis may cause
chronic tubulointerstitial nephritis (like analgesics cause. WBC casts)
47
HIV esophagitis: white plaques
candida, tx fluconazole
48
HIV esophagitis: large linear ulcers
CMV, tx ganciclovir
49
HIV esophagitis: vesicles and round/ovoid ulcers ("volcano-like")
herpes simplex, tx acyclovir
50
HIV esophagitis: endoscopy with biopsy indications
sore throat w/nonresponse to two weeks of fluconazole for thrush
51
CT shows pulmnary nodules with halosign, or lesions with an air crescent
aspergillus
52
ucleratedpapule at sight ofinfection, then papules alonglymph flow
sprortrichosis
53
fever, dry cough, wt loss, pleuritic chest pain; erythema multiformeand nodosum, arthalgias
coccidiodomycosis (SWUS, central and south america)
54
joint deformation in SLE
SLE arthritis is nondeforming
55
distal phalangeal resorption, "pencil in cup"
psoriatic arthritis, mutilans varient
56
tx for fibromyalgia
regular aerobic exercise, sleep hygiene, duloxetine & TCAs if all else fails
(fibromyalgia pts have pt tenderness on midtrapezius, lateral epicondyle, costochondrial junction, and greater trochanter)
57
increased dental caries, enlargedsalivary lymph nodes, dry mouth and eyes
sjogren's syndrome, serum antibodies aginst SSA (RO)/SSB (La)
58
acute pulmnary edema, new S3,peripheral edema and JVD
perioperativeMI
59
arthritic/gout symptoms after eneteric or genitourinary infection
reactive arthrits, tx NSAIDs
| other signs: mouth ulcers, urethritis, enthesitis
60
waxy skin, macroglossia, asymptomatic nephrotic syndrome, restrictive cardiomypoathy, peripheral or autonomic neuropathy, bleeding diathesis
amyloidosis (can be primary AL or secondary AA to chronic inflammation as in RA, IBD, chronic infection. Can cuase nephoritc syndrome
61
chronic sterile granulomatous inflammation of meibomian gland (inner eyelid)
chalazion
62
purulent eyelid gland infection
hordeolum, usually staph
63
small external hordeolum, zeis or molls glands
stye
64
purulent arthritis without skin lesions
| or triad: tenosynovitis of wrists, ankles, fingers, knees; dermatitis, migratory purulent arthritis
disseminated gonnacoccal infection. cultures may be neg, screening for hiv and syphilis recommended.
65
tx disseminated gonnacoccal infection
IV ceftriazone for 7-14 days, switch to po cefixime when clinically improved, empire azithromycin once or seven days of doxy for chlamydia
66
toxic shock presentation
diffuse rash, fever and HYPOtension
67
tx severe symptomatic hypercalcemia
vigorous IV normal saline (Ca over 12)
hemodialysis with calcium free dialysate if unresponsive.
long term tx is bisphosphonates
avoid loops except in heartfailure
68
hypercalcemia symptoms
salt wasting, volume depletion, dry membranes, high BUN/Cr ratio
69
arrhythmia in digoxin toxicity
atrial tach with AV block
70
tx chalazion
incision and cutterage ( v. hot compress for stye, plus antibiotic ointment if needed)
71
associated with hyperpigmentation
primary adrenal insufficiency, usually autoimmune. hyperkalemia, hyponatremia, hypotension
72
low cortisol, high ACTH, low aldo
primary adrenal insufficiency, autoimmune
73
low corticol, low ACTH, normal aldo
secondary adrenal insufficiency. possible hyponatremia, but no severe symptoms. usually from taking glucocorticoids, but can be lymphocitc invasion of pitiatuary or sheehans syndrome (pituiatry infarct) in paptpartum F
74
p waves unrelated to QRS, dx and tx
complete heart block, cardiac pacing
75
abscence of measurable erythropoetin in urine
polycythemia vera
76
increased bone marrow iron
hemachromatosis, anemia of chronic diseae, sideroblastic anemia
77
auer rods
acute promyelocytic leukemia
78
difference between AML and CML
fever is uncommon in AML and suggests infection, splenomegaly is rare, and peripheral smear shows myleoblasts
79
tartrate restitant acid phophatase
hairy cell
80
low leukocyte alkaline phosphate activity
chronic myelogenous leukemia (phil. chrom. BCR-ABL1 inhibits tk phos)
81
myeloblasts
AML
82
most common US leukemia
CLL
83
blast cells
lymphoblastic leukemia
84
reed sternberg cells
on biopsy in Hodgkins
85
leukocytosis, basophilia, splenomegaly
CML
86
pruritic rash on wrists and hands
scabies
87
scabies tx
permethrin 12%, oral ivermectin
88
lyme tx
orl doxycycline, IV ceftriazone if disseminate, severe, amoxicillin in pregnant or kids under eight
89
doxycycline in kids
discolors teeth, skeletal malformation
90
dx ankylosing spondylitis
xray showing fused sacroiliac joints or bamboo spine
91
prussian blue
when positive indicates hemolysis (presence of hemosiderin) in urine
92
dark urine after meds (antibiotics, antimalarials, nitrofuratoin) or infection
think G6P deficiency, oxidative stress. heinz bodies
93
hemolysis caused by alphahethyldopa or pencillin
autoimmune 2/2 igG binding to RBCs, Coombs +
94
epidural hematoma cause
middle meningeal artery (lentiform)
95
subarachnoid hemorrhage cause
ruptured aneurysm, sometimes trauma
96
subdural hematoma cause
torn bridging veins
97
Post-transplant patient w/pneumonia and colitis
CMV
98
IgG autoantibodies against platelet membrane glycoproteins
ITP: antecedent viral infection, petechiae and ecchymosis, mucocutaneous bleeding. tx systemic glucocorticoids
99
mild thrombocytopenia, giant platelets, disproportionate bleeding
Bernard-Soulier, AR absence of platelet glyocprotein Ib-IX-V
100
common acquired causes of aplastic anemia
parvovirus, EBV, drugs, chemo, radiation
101
platelets remain over 30,000; no clinical bleeding
hypersplenism
102
thrombocytopenia, microangiopathic hemolytic anemia, low clotting factors, long PT
DIC
103
recurrent chalazion tx
histology for sagacious carcinoma, basal cell carcinoma. Then steroid injection and/or incision and cuttrage
104
parenchymal atrophy due to calyceal dilation
obstructive uropathy
105
pathologic hallmark of diabetic nephropathy
nodular glomerulosclerosis, though diffuse is more common (Kimmelstiel-Wilson nodules, basement membrane changes
106
shoulder: decrease in passive or active motion, more stiffness than pain
adhesive capsulitis
107
shoulder: pain with abduction, external rotation, subacromial tenderness, normal range of motion
rotator cuff tendinopathy (tear in pts over 40)
108
anterior shoulder pain, with lifting, carrying, reaching overhead; weakness uncommon
biceps tendinopathy/rupture
109
uncommon trauma-induced gradually onset of deep/anterior shoulder pain. decreased active and passive abduction, external rotation
glenohumeral osteoarthrits
110
most important prognostic indicator in breast cancer
TNM stage (tumor burden)
111
prog in breast cancer, most to least
TNM, ER+ and PR+ (good), Her-2neu (bad), poor differentiation (bad)
112
most common neuro symptom in Lyme (borrelia burgdorferi)
facial nerve palsy
113
triad of ipsilateral facial pain, ear pain, and vesicles in auditory canal
Ramsay Hunt syndrome (herpse zoster oticus)
114
most common cause of idiopathic facial nerve palsy
herpes simplex and varicella zoster reactivation
115
graft v host pathogenesis
activation of donor T lymphocytes (affects skin, intestine, liver)
116
expansive soap-bubble lytic area on x-ray
giant cell tumor: benign and locally aggressive bone tumor of young adults, often on distal femur or proximal tibia near knee
117
pain at night, unrelated to activity but responsive to NSAIDs, cortical lesions with central lucency on xray
osteiod osteoma
118
osteoclast resorbtion of bone leads to fibrous replacement, brown tumors, salt and pepper on imaging
osteolitis fibrosa cystica (Von Recklinghausen dz of bone)
119
pain with flexing long finger while patient extends fingers and wrist
radial tunnel syndrome, may accompany lateral epicondylitis
120
anterior MI vessel and leads
LAD, V1-6
121
inferior MI vessel and leads
RCA or LCX. ST elevation in II, III, aVF
122
posterior MI vessel and leads
LCX or RCA, ST depression in V1-3, elevation in 1 and aVL (LCX), depression in 1 and aVL (RCA)
123
lateral MI vessel and leads
LCX, diagonal; ST elevation in Leads I, aVL, V5, V6; ST depression in II, III, and aVF
124
right ventricular MI vessel and leads (occurs in 1/2 of inferior MI)
RCA, ST elevation in leads V4-V6
125
leading cause of B12 deficiency
pernicious anemia! anti-intrinsic factor antibodies. associated with 2x risk of gastric cancer
126
microcytic anemia, elevated RBCs, hypochromia on smear with target cells
beta thalassemia
127
macro-ovalocytes, megoblasts and hypersegmented neutrophils on smear
cobalamin (B12) deficiency
128
treat iron overload in transfusion-dependent thalassemia or sickle cell
deferoxamine
129
tx anemia of chronic disease, CKD, transient bone marrow failure
erythropoetin
130
folic acid deficiency anemia
megaloblastic
131
increases hemoglobin f levels
hydroxyurea (sickle cell)
132
tx autoimmune hemolytic anemia
prednisone
133
tx symptomatic hereditary spherocytosis
splenectomy (also used in autoimmune hemolytic anemia, beta-thalassemia and hemoglobin H dz)
134
tx beta-thalessemia
no tx required
135
BUN/Cr in dehydration
greater than 20. give crystalloid solutions (normal saline. colloid solutions are used in burns, hypoproteinemia)
136
severe polyarthralgias, HA, myalgia, fever, rash, recent travel to tropical area
chikungunya fever (from aides mosquito). tx supportive
137
Direct Coombs +
Autoantibodies are on the surface of RBCs (autoimmune hemolysis)
138
Indirect Coombs
Screens for autoantibodies to RBCs in the serum. Used in cross matching, prevention newborn hemolytic disease
139
pyroxidine
tx sideroblastic anemia (isoniazid!). normo/hypochromic (is B6: also in EtOH, drug malnutrition)
140
acid-fast oocytes in stool of HIV pt
cryptosporidium (CD under 180)
141
spores in HIV pt stool
microsporidia
142
abx cause this type of hearing loss
neurosensory
143
hyperthyroid with low I uptake
thyroiditis, stroma ovari (rare, nonpalpable thyroid)
144
double duct sign
biliary obstruction in pancreatic cancer
145
vitiligo associated dz
autoimmune, including perncious anemia
146
risk factors for constrictive pericarditis
idiopathic, prior surgery(CABG or valve), TB, malignancy, anemia
147
constrictive pericarditis v cardiac amyloid
amyloid has LVH, periorbital purpura, heavy proteinuria and hepatomegaly
148
LH and FSH in PCOS
LH:FSH ratio increased
149
nonclassical congential adrenal hyperplasia
young adults w/hyperandrogenism, increased 17-hydroxyprogesterone
150
target BP in DM nephropathy
130/80
151
acute adrenal insuffiency symptoms
hypotension, ab pain, vomiting, diarrhea, wt loss, weakness, orthostasis
152
tx acute adrenal insufficiency
dexamethasone, fluids
153
thyroid storm symptoms
tachycardia, arrhythmia, HTN, mental status change and lid lag
154
anti-topoisomerase I
systemic sclerosis
155
extrapulmonary small cell lung cancer
endocrine (SIADH, hyperCa, cushings), heme (trouseaus'. DVTs), neuro (lambert-eaton, neuropathy), MSK (clubbing, dermo/polymyositis)
156
mobitz I cause and tx
AV block (avoid digoxin, beta-blockers, or calcium channel blockers.)
157
aminosalicylates
methalazine, sulfasalzine. anti-inflammatory, tx UC (IBD), Crohns, RA
158
raised, well-circumscribed itchy plaques, quick to form and resolve
urticaria: infxn, drugs, allergy. idio
159
Dubin Johnson v Rotor
Dubin has black pigmented liver
160
spared eye injury
hidden antigen response
161
SLE eye
circulated immune complexes
162
IgE reagin in eye
allergic conjunctivitis
163
beta blockers in CHF
bad in decompensation (systolic dysfunction)
164
cord-like veins in smoker
trouseau's sign (hypercoag)! CT abdomen for occult visceral malignancy
165
Burr cells
ESRD
166
Howell-Jolly bodies
black pellets in RBCs, asplenia, post-splenectomy
167
spur cells (acanthocytes)
liver disease
168
target cells
beta-thal, liver dz
169
low in sick euthyroid
T3! T4 and TSH normal
170
false positive VDR-L
antiphospholipid. tx (in preg) w/low molecular weight heparin
171
rubella v measles
both start on face, spare palms. measles spreads more slowly, has fever over 104
172
anti-basement membrane, linear Ig (dx, symptoms)
Goodpasture's (young coughing men w/bad kidneys)
173
sinitis, kidney problems, older adults, fever and malaise
Wegner's
174
erythropoetin AE
increased CV risks, embolism, stroke
175
tx cardiogenic shock
nitrates can cause. give saline for hypotension, then dobutamine if needed (beta-adrenergic agonist like epi)
176
tx anaphylactic shock
epinephrine (hyotension, bronchospasm)
177
cardiac index
proportional to CO, refelcts left ventricular function
178
PCWP
reflects left atrial pressure
179
vit. D OD: symptoms, causes
hypercalcemia! ab pain, constipation, polydipsia. supplements, granulomatous dz (sarcoid), lymphoma
180
prolactinoma labs
prolactin over 200, low LH, norml TSH
181
prolactinoma symptoms (M, W)
men: infertility, impotence, gynocomastia. women: menopausal symptoms
182
asthma, rhinosinitis, nasal polyps
aspirin-exascerbated respiratory dz (AERD: pseudo-allergy, also caused by NSAIDs)
183
meniere's triad
vertigo, tinnitus, fullness.
184
treat stones this size w/fluids and pain management
under 5mm
185
spider angiomas and gynocomastia
estrogen not converted to testosterone in liver dz
186
lung infilterates, diarrhea, confusion and fever (non-IC)
think of legionella! tx macrolides (-omycin), quinolones (-floxacin)
187
amoxicillin-clavulanate (augmentin)
fight bite, cat scratch, sinusitis, CAP (good for beta-lactamase producing haemophilus, moraxella)
188
cephtriaxone
beta-lactam, 3rd gen cephalosporine, active against gram positives, some gram neg (NOT for atypical pneumonias)
189
macrolides (-omycin) cover
gram positives, limited negatives (pertussis, h. flu). common substitute for penicillin if allergies
190
quinolones (-floxacin) cover
broad-spectrum gram pos and neg
191
uric acid stone tx
potassium citrate (alkalizes urine), hydration, low purine diet
192
furosemide and stones
increases urine Ca, increase Ca stones
193
HCTZ and stones
decreases urine Ca, may decrease Ca stones
194
most stones
Ca oxolate. (cysteine in IEM, struvite in proteus UTI)
195
ADAMST13
low in familial TTP
196
anti-cardiolipin antibody
high in anti-phospholipid syndrome (AV thrombus, miscarriage, microlytic anemia, neurofindings)
197
most common nursing home pneumonia
strep pneumo
198
dx rotator cuff tear
inject lidocaine to r/o tendonitis, then MRI
199
postmeal ab pain, obstipation, nausea
small bowel obstruction
200
prior surgery (cholesistectomy), acid suppression, motility disorders (DM, s.sclerosis), immunosuprression
SIBO! diarrhea, malabsorption and wt loss due to bacterial overgrowth
201
BRBPR and neg colonoscopy
RBC scintography (tagged RBC scan), less invasive than angiography
202
elevated C-peptide and proinsulin elevation
beta cell tumor (high insulin, hypoglycemia)
203
common phototoxic ance treatment
tetracyclines (doxy)
204
neuro deficits appear or worsen with folate
cobalamin (B12) deficiency
205
INR for DVT, a fib
2-3
206
INR for pros. valves
2.5-3.5
207
3 Ds of pellagra
diarrhea, dermatitis, dementia (and death! naicin deficiency from corn-based diets. Africa, india, china, alcoholics, carcinoid syndrome, Hartnup's dz)
208
AR amino acid transport disorder, particularly affecting tryptophan
Hartnup's dz, looks like pellagra (niacin def.)
209
smaller confidence interval
more precise. increaing sample size decrease CI
210
validity is measured by
sensitivity/specificity
211
lactose intolerance tests
positive hydrogen breath test, positive stool reducing agents, low stool pH, high stool osmotic gap
212
tx hypertrophic cardiomyopathy
BBs (it's AD)
213
peripheral Ca blocker, arterial dilation
amlodipine
214
cardiac acting Ca blocker
verapamil, diltiazem, can treat hypertrophic cardiomyopthy
215
pericarditis and renal dysfunction
uremic pericarditis! tx dialysis
216
tx idiopathic or viral percarditis
indomethacin (NSAID) + colchicine
217
impaired osteoid matrix mineralization
osteomalacia. low Ca or Phos! malabsorption, sprue, CLD, CKD
218
defect in collagen I formation
osteogenesis imperfecta
219
prophylax for lyme with doxy if
deer tick (ixodes scapularis), and 36hr exposure (or engorged), and within 72hr, and lyme rate in area >20%, and doxy not contraindicated
220
meningococcal vaccine age
11-12, booster at 16-21
221
no live vaccines in patients on
TNF inhibitors (infliximab)
222
tx CKD anemia
erythropoetin and Fe
223
abdominal lymphoma and high IgA
heavy chain dz
224
hyperviscosity and high IgM
Wallenstrom's macrogloblemia
225
causes of clubbing
malignancy, CF, cardiac shunting
226
Fe, ferritin, and tranferrin sat in iron deficiency
low, low, low
227
Fe, ferritin, and tranferrin sat in thalassemia
high, high, high
228
Fe, ferritin, and tranferrin sat in anemia of chronic dz
low, normal, normal
229
mupirocin
tx impetigo, and nares MRSA
230
AD ankyrin deficiency
hereditary sphereocytosis. high MCHC, high osmotic fragility on acified glycerol lysis test, abnormal eosin-5-maleimide test
231
hereditary sphereocytosis tx
folate, transfusions, splenectomy
232
hereditary sphereocytosis complication
bilirubin gallstones, aplastic crisis in parvo B19 infection
233
absent CD55
paroxysmal noctural hematuria
234
risks in mono
splenic rupture, AI hemolytic anemia and thrombocytopenia 2-3 weeks post infection
235
bethanechol
cholinergic agent for urinary retention, atonic bladder
236
tamsulosin
relaxes distal ureter (helps pass stones)
237
phenazopyridine
ureter analgesic, may promote stones
238
secondary amyloid causes
inflammatory arthritis, chronic infection, IBD, vasculitis, cancer.
239
BBS in pheochromcytoma
cause rapid elevation in heartrate. give with alpha blockers (-zosins, losins)
240
tx mysethnia gravis
pyridostigmine
241
leukocytosis w/lymphocytosis and smudge cells
CLL
242
ipratropium
inhaled nti-muscarinic agent for COPD
243
malaria prophylaxis in chloroquin resistant areas (subsaharan Africa, amazon basin, southern and SE Asia)
mefloquine, atovaquone-proguanil, and doxycycline
244
cutaneous and visceral angioa-like blood vessel growths
bartonella (immunocompromise)
245
most common cause of folate deficiency anemia (megaloblastic!) in the US
alcoholism
246
most frequent case of acute epididymitis
e.coli
247
postherpetic neuralgia tx
TCAs, acute antivirals (valacyclovir, acyclovir)
248
most common viral encephalitis in immunocompetent adults
herpes! simplex, varicella, EBV
249
CSF in viral encephalitis
high WBC (lymphocytes), normal glucose, high protein
250
empiric antibiotics: age 2-50
vanc plus 3g cephalosporin (N. menigitis, s. pneumo)
251
empiric antibiotics: over 50
vanc, ampicillin, 3g cephalosporin (n. meningitis, s. pneumo, listeria)
252
empiric anitbiotics: neurosurgery/shunt
vanc plus cefepime (GNRs, s. aureus, co-ag negative staph)
253
empiric antibiotics: immunocompromise
van, ampicillin, cefepime (s. pneumo, n. meningitis, listeria, GNRs)
254
empiric antibiotics: penetrating injury to skill
van, cefepime (GNRs, s. aureus, co-ag negative staph)
255
alternatives to cefepime
ceftazidime, meropenem
256
alternative to ampicillin
trimethoprim-sulfamethazole for listeria
257
potassium in addisons
high! Na is low! anorexia, fatigue, hyper pigmentation, vitiligo,
258
most gallstones
cholesterol or mixed, radiolucent
259
alpha-1-antitrypsin
emphysema! panlobular (not central as in smoking). also at risk for liver dz
260
PFTS in emphysema
low FEV/FCV, high TLC, low DLCO
261
common tumors that met to bone
lung, breast, thyroid, prostate
262
bone pain worse at night, constant, with point tenderness
metastatic cancer (more common that compression fracture in men under 65)
263
PPV/NPV in increased prevalence
PPV goes up, NPV goes down (PPV is proportional to prevalence)
264
new pneumonia w/in weeks of flu
s. aureus
265
SAAG over 1.1
cardiac ascites or cirrhosis (increased capillary hydrostatic pressure)
266
SAAG under 1.1
malignancy, pancreatitis, nephrotic syndrome, TB (increased capillary permeability)
267
periorbital swelling, hematuria and oliguria 10-20 days post throat or skin infxn
post-strp glomerulonephritis
268
drug induced interstitial nephritis presentation
fever, rash, arthralgia, hematurtia, WBC casts
269
hematurtia after URI w/normal complement levels
IgA nephropathy
270
rare cause of hematuria w/nephritis and and low complement
membranoproliferative glomerulonephritis
271
tx V. fib
(fibrillary waves w/o QRS. defib, and give epi)
272
cath in PE
elevated r. atrial and pulmonary arterial pressures, normal PCWP
273
AE: hypothermia
fluphenazine (typical antipsychotic, inhibits shivering)
274
AE: TCAs
wt change, dizziness, insomnia
275
numbness, weakness and swelling of arm, weakened radial pulse
thoracic outlet syndrome (vascular obstruction)
276
positive Neers
pain with passive arm raise over 60 degrees
277
murmurs that get louder w/standing and valsalva
decreased venous return! HCM, MVP
278
murmurs that get louder with squatting, handgrip
(increased BP and regurg fraction!) AR, MR, VSD
279
tx amebic liver abscess
metronidazole, plus luminal agent (paromomycin), do not drain!
280
mixed cryoglobinemia
HCV arthralgias, also associated with chronic vasculitic syndrome (palpable purport, lymphadenopathy, nephropathy, neuropathy)
281
tx acute closed angle glaucoma
NOT atropine! IV mannitol (diuretic), acetozolomide (carbonic anhydrase inhibitor, prevents aqueous humour formation), pilocarpine (opens schlemm channel, topical), timolol (BB, reduces humor)
282
wegner's triad and tx
systemic vasculitis, upper and lower airway granulomatous inflammation, and glomerulonephritis. cyclophosphamide
283
loculated, abnormally contoured effusion with adjacent pulmonary infiltration
empyema in untreated pneumonia
284
velcro crackles
idiopathic pulmonary fibrosis
285
hepatic hydrothorax w/o response to dieuretics
TIPs
286
retrospective cohort study v. case control
both are retrospective. cohort compares disease incidence in risk factor + and - patients. cohort compares risk factor frequency in dz + and - patients
287
hep C treatment criteria
over 18, serum HCV RNA, fibrosis on liver biopsy and chronic hepatitis, compensated liver dz, stable labs
288
contraindications to hep C treatment
alcohol and drug use, uncontrolled major depression
289
hep c tx
peginterferon plus ribavirin, also protease inhibitor (tela/boceprevir) if genotype 1
290
thin discharge, fish odor, no inflammation. pH over 4.5, amine odor w/KOH
bacterial vaginosis (gardnerella), tx metronidazole
291
thin yellow-green frothy discharge, inflammation, pH over 4.5
trichomoniasis. motile trichomonads, metronidazole, treat sexual partner
292
thick lumpy discharge, inflammation, normal pH (3.8-4.2), pseudohyphae
candida vaginitis, tx fluconazole. (risk factors: pregnancy, DM, recent antibiotics)
293
nocturnal headaches and morning vomitting
red flags for intracranial pathology
294
diffuse abdomenal pain, tympani, hyperactive bowel sounds
consider SBO. most often adhesions (post-surgical)
295
bacterial meningitis in children
empiric abx (ceftriaxone and vanc) and LP; CT if coma, focal findings, or hx of neurosurg
296
eval signs of adrenal insufficiency
cortisol and ACTH levels, cosyntropin stimulation test
297
low basal cortisol, high ACTH, minimal response to cosyntropin
primary adrenal insufficiency (cosyntropin is ACTH analog)
298
low basal cortisol, low ACTH, suboptimal response to cosyntropin
secondary or tertiary adrenal insufficiency
299
bone malformation in DM, osteoporosis
osteoblast dysfunction
300
hypercalcemia in sarcoid, TB
overproduction of calcitriol (active vitamin d)
301
"mosaic pattern" of lamellar bone, high alk phos, femoral bowing
osteoclast dysfunction, as in Paget's
302
severe or dirty wound, immunocompromised, or incomplete/uncertain vaccine hx
give TIG and TT booster (no one else gets TIG; booster for dirty would and more than 5y since booster)
303
Northern Africa vaccine recommendations
Hep A, Hep B, typhoid, and polio booster
304
yellow fever vaccine when
subsaharan africa, equitorial south america
305
when to get meningococcal vaccine for travel
some Asia, sub-Saharan Africa, pilgrims making the hajj to Mecca
306
initial treatment for SIADH
fluid restriction. demeclocycline rarely necessary
307
tx exercise-induced bronchospasm
inhaled albuterol 10min before (if not daily), otherwise corticosteroids or antileukotrienes (-lukasts)
308
rapid bilateral cellulitis of submandibular and sublingual spaces
Ludwig angina, causes by tooth infection. asphyxiation is fatal complication
309
complications of ulcerative colitis
sclerosing cholangitis, uveitis, erythema nodosum, spondyloarthropathy, colon cancer, toxic megacolon
310
UC colon cancer screening
beginning 8-10 years after diagnosis
311
causes Q fever via inhalation from livestock or unpastuerized milk
coxiella burnetii
312
restricitive lung dz in ankylosing spondilytis
diminished chest wall and spinal mobility
313
anti-intrinsic factor abs
pernicious anemia (leads to b12 def., shiny tongue, gastric cancer)
314
characteristics of Graves opthalmopathy
decreased convergence, diplopia, exopthalmos, gritty sensation
