Medicine Shelf Flashcards
(465 cards)
1
Q
Coombs test uses
A
1) blood types in transfusion 2) pregnancy 3) cause of hemolytic anemia
2
Q
most common head and neck cancer type
A
squamous cell carc
3
Q
causes of folic acid deficiency
A
1) diet/nutrition and alcoholism 2) drugs: anti-epileptics (phenytoin, phenobarb, primidone) disrupt absorption and TMP and methotrexate impair production
4
Q
lab values indicative of RBC destruction
A
incr LDH and bilirubin, decr haptoglobin
5
Q
3 common signs of paroxysmal nocturnal hemoglobinuria
A
1) hemolytic anemia 2) pancytopenia 3) venous thrombosis
6
Q
TTP findings
A
FATRN: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal, neuro
7
Q
treatment for TTP
A
plasma exchange
8
Q
treatment for DIC
A
cryoprecipitate which incl coag factors, fibrinogen, and vWF
9
Q
best first test for palpable head or neck lymph node
A
panendoscopy looks at esoph, bronchi, and larynx for primary tumor
10
Q
pica often indicative of
A
iron defic anemia
11
Q
smudge cells seen in
A
CLL
12
Q
Reed-Sternberg cells
A
Hodgkin
13
Q
starry sky cells
A
Burkitt lymphoma (assoc with EBV)
14
Q
Auer rods
A
AML
15
Q
imatinib treats
A
CML
16
Q
what should ppl diag’d with ITP be tested for
A
HIV and HepC
17
Q
causes of autoimmune hemolytic anemia
A
warm (IgG): drugs (penicillin), viral infec, SLE, immunodefic, lymphoprolif (CLL); cold (IgM): mycoplasma, mono, lymphoprolif
18
Q
gold std test for HIT
A
serotonin release assay
19
Q
manifestations of HIT
A
Plt reduction >50%, thromboses, necrotic skin lesions at injection site, anaphylactic rxn
20
Q
what causes risk of bleeding when first starting warfarin?
A
sharp decr in prot C (anticoag) before decr in clotting factors. Risk of clots when you lose anticoags and still have clotting factors
21
Q
migratory superficial thrombophlebitis
A
Trousseau’s syndrome that often indicates occult malignancy, most commonly pancreatic
22
Q
major manifestations of waldenstrom macroglobulinemia
A
hyperviscosity, neuropathy, hepatosplenomeg
23
Q
monoclonal ab in waldenstrom, MM, and MGUS
A
IgM in wald, IgG and IgA in MM and MGUS
24
Q
cells seen on BM biopsy in MM
A
> 10% clonal plasma cells
25
cells seen on BM biop in Waldenstrom
>10% clonal B cells
26
what's the mutation in factor V leiden?
mutation in factor 5 that makes it nonresponsive to activated prot C. Prot C is anticoag that usually binds and inactivates factor 5 so excess factor 5 leads to hypercoag state. Most common hereditary thrombophilia
27
what causes antithrombin deficiency?
not usually inherited; usually from DIC, cirrhosis, nephrotic syndrome
28
what does periumbilical bluish discoloration indicate?
pancreatitis (Cullen sign of hemoperitoneum)
29
What's another sign of pancreatitis?
reddish-brown around flanks --> retroperitoneal bleed (Grey-Turner)
30
erysipelas features
warm, tender, erythem rash with raised demarcated borders, assoc with systemic sx's and lymphadenitis
31
What tiss layers are affected by cellulitis?
deep dermis and subQ fat
32
What tiss layers are affected by erysipelas
superficial dermis and lymphatics
33
cellulitis features
flat edges with poor demarcation
34
What organisms cause erysipelas?
S pyog
35
What orgs cause cellulitis?
S aureus, enterococcus, H flu, PSA
36
type of bias that can result from pts crossing over in treatment arms in studies
selection bias - susceptibility is confounding by indication
37
cortisol, ACTH, and aldo changes in central adrenal insuffic (pituitary or hypothal dysfunc)
Low cort and ACTH, normal aldo (aldo controlled by renin system not pituitary
38
cortisol, ACTH, and aldo changes in primary AI
low cort, high ACTH, low aldo
39
presenting sx's of cardiac tamponade
Beck's triad: hypotension, jug venous distention, muffled heart sounds + pulsus paradoxus
40
pulsus parvus et tardus (delayed and diminished carotid pulse) is sign of
AS
41
signs of aortic dissection
abrupt onset chest pain radiating to back and widened mediastinum
42
early dias murmur heard at L and R sternal border
L side is A regurg from valve dz, R side is aortic root
43
meds that improve survival in L ventric systolic dysfunc
1) ACE/ARB, 2) BB, 3) mineralocorticoid recep blocker (spironolac or eplernone) 4) hydral and nitrates
44
mitral regurg murmur
holosystolic best heard at apex with axillary radiation
45
HOCM murmur: what positions make it louder or quieter
Valsalva makes it louder and squatting makes it quieter. Valsalva = less venous return and lower preload so obstruction is worse (mitral valve sits close to enlarged interventric septum and impedes outflow). With squatting, there's incr venous return which helps relieve obstruction
46
electrical alternans on EKG
pericardial effusion
47
prolonged PR interval
1st degree heart block
48
F waves in EKG
A-flutter
49
delta wave on EKG
upslope prior to QRS signifying accessory pathway like in Wolff-Park-White
50
widened pulse pressure seen in what type of valvular disorder
aortic regurge
51
major drugs given for angina
beta-block (decr contractility and HR, lowering O2 demand), Ca blockers (sim mech as BB). nitrates (dilation decr preload)
52
contraindications to NSAID use
peptic ulcers and kidney dz
53
acetaminophen OD affects which organ
liver toxicity
54
3 EKG findings in WPW
short PR, delta wave, QRS widening
55
first line treat for bradycardia
IV atropine
56
Mobitz type I vs II
progressive prolong of PR in 1 with eventual dropped beat; constant PR in 2 and sudden beat drop. 1 is usually benign; 2 can progress to 3rd degree
57
Afib on EKG
irregularly irreg rhythm and no P waves
58
most common cause of sudden cardiac death in immediate post-MI
reentrant vent arrhythmia
59
tricuspid regurge sounds
holosystolic that incr in intensity with inspiration
60
treatment for uremic pericarditits
hemodialysis
61
sound of MS murmur
opening snap after S2 with diastolic rumble
62
types of lung cancer that are located peripherally
adeno and large cell
63
presentation of AAT defic
COPD and liver dz (hepatitis, hepatocell carc)
64
phys exam findings for interstitial lung dz
crackles during mid-late inspiration and digital clubbing
65
CT in interstitial lung dz
honeycombing
66
empyema
pleural effusion with pus or bacterial in pleural space (often complication of pneum)
67
Light's criteria
Exudative if pleural prot/serum prot>0.5, pleu LDH/serum LDH>0.6 and pleural LDH>2/3 upper limit of normal
68
pulm art hypertension lung exam
right-vent heave due to RV enlargement
69
CREST syndrome sx's
calcinosis cutis, raynaud, esoph dysmotility, sclerodactyly (thickening and tightening of skin on hands and fingers), telangiectasia
70
CREST syndrome assoc with
systemic sclerosis
71
what part of the lung is affected by AAT COPD
lower lobes
72
what part of lungs is affected by smoking-induced COPD
upper lobes
73
what is cor pulmonale
R heart failure due to pulm HTN (not due to L side)
74
most common cause of cor pulm
COPD
75
signs of R heart fail
JVD, loud P2, R ventric heave, hepatomeg, edema, ascites
76
organs affected by Goodpasture's
lungs (cough, dysp, hemoptysis), kidney (nephritic)
77
most common cause of euvolemic hyponat and treatment
SIADH; treat with fluid restrict
78
what effect do glucocorticoids have on WBCs?
leukocytosis due to mobilization of marginated neutrophils
79
clinical manifestations of granulomatosis with polyangiitis
Resp sx's: saddle nose, pulm cavitary lesions; glomerulonephritis; livedo reticularis and ulcers on skin
80
complications of pos pressure ventilation
alveolar damage, pneumothorax, hypotension
81
symptoms/signs of renal cell carc
classic triad of flank pain, hematuria, and mass. Also unreducible scrotal varicoceles
82
which diabetic drug should not be used in pts with kidney dz?
metformin b/c it can cause lactic acidosis
83
indications for urgent dialysis
aeiou: acidosis, electr abnorm (esp hyperK), intox, overload, uremia
84
causes of asterixis
hep enceph, uremic enceph, hypercapnia
85
what type of drugs in OD may necessitate dialysis?
salicylate, alchohol, lithium, valproate, carbamaz
86
effect of aldo on Na, K, H+
saves Na (to raise BP), secretes K and H
87
WBC casts in urine
AIN
88
RBC casts in urine
glom nephritis
89
drugs that can cause AIN
Abx: TMP-SMX, PCN, ceph, rifampin; NSAIDs; diuretics; allopurinol; PPIs
90
clinical assoc with FSGS
Af Am and Hispanic, HIV, heroin, obesity
91
type of nephrotic syndrome often seen after URI
IgA nephrop
92
ions lost with vomiting
H, K, Cl
93
what type of med can be used to prevent nephrolithiasis?
thiazide diuretics: vol depletion causes reab of Na and passive reab of Ca
94
bad SE of aminoglycosides
nephrotox
95
meds that can cause hyperK
nonselect beta block (p-z names), ACE, ARB, K+ spare diuretic (triamterene, amiloride), digoxin (cardiac glycoside), NSAIDs
96
what heart sounds is associated with AS?
soft, single S2 b/c aortic valve has less mobility and doesn't close quickly, making a quieter sound and delaying closure
97
ecg post-MI with ST elevation and q waves
ventric aneurysm (late complication a week-months after)
98
mass in atrium
cardiac myxoma
99
HOCM murmurs sounds (w/o movement)
cres-decres systolic along left sternal border
100
bronchoscopic biopsy showing granulomas with budding yeast
histo
101
breath sounds and tactile fremitus in pneum: incr or decr?
incr b/c sound travels faster in solid than air
102
pts with ascites and hepatojugular reflux commonly have
R-sided heart failure
103
SEs of amio
thyroid probs, hepatotox, bradycard, heart block, pneumonitis, neuro sx's, vision disturb
104
what causes isolated systolic HTN
increased stiffness of arteries which is why it's common in elderly
105
pleural plaques on imaging diagnostic for
asbestosis
106
clinical presentation of asbestosis
dyspnea, clubbing, basilar crackles, pleural plaques on imaging
107
cause of CAP, arthralgias, and erythema nodosum
coccidiomycosis
108
where's coccidio endemic?
Amer SW
109
prophy for pneumocystis
TMP-SMX
110
pts most likely to develop mucormycosis have what dz
diabetes (poorly controlled, esp with ketoacidotic episodes)
111
ludwig angina
cellulitis of submandibular and sublingual spaces, often d/t infected molar
112
who should get PPSV23 vaccine alone?
<65 with another chronic condition (lung, heart dz, diabetes, smoking, renal fail)
113
AIDS pts with systemic sx's, splenomegaly and high alk phos
Myco avium complex
114
prophy against MAC
azithromycin
115
dangerous complications of mono
splenic rupture, hemolytic anemia, thrombocytopenia
116
treatment for toxoplasmosis
sulfadiazine and pyrimethazone, plus leucovorin
117
prophy for toxo
TMP-SMX
118
pts with asplenia are at highest risk for what infections
Strep pneumo, H flu, Neiss meningitidis (encap'd)
119
chondrocalcinosis in joint with inflammatory arthritis is usually caused by
calcium pyrophosphate dihydrate crystals (pseudogout)
120
nontender subcutaneous nodules assoc with joint stiffness
rheumatoid arthritis
121
biggest risk factor for antiphospholipid syndrome
SLE
122
clinical presentation of antiphospho syndrome
venous/art thrombus, adverse pregnancy outcomes
123
symmetrical proximal muscle weakness and erythematous rash
dermatomyositis
124
young male with polyarthritis
reactive arthritis: classic triad of urethritis, conjunctivitis, arthritis
125
long term management of hemochromatosis
phlebotomy
126
tenderness at tibial tubercle
osgood-schlatter
127
back pain is improved with activity in which disorder
ankylosing splondylitis
128
atrial tachy with AV block can be caused by which drug
digitalis causes increased ectopy and incr vagal tone
129
common cause of conductive hearing loss in women in 20s/30s
otosclerosis
130
dd for erythema nodosum
infectious (strep, TB), autoimmune (sarcoidosis, Behcet), inflammatory (IBD)
131
hereditary spherocytosis presentation (triad)
hemolytic anemia, jaundice, splenomegaly
132
drug for supraventricular tachy
adenosine
133
treatment for severe thalassemia
monthly transfusions
134
treatment for iron overload (can get from transfusions for thal)
deferoxamine
135
levels of LDH, haptoglobin, and bili in hemolytic anemia
incr LDH and bili, decr hapto
136
treatment for occlusive crisis of sickle cell
IVF, oxygen, pain control
137
treatment for long term control of sickle cell
hyrdoxyurea which promotes HbF
138
what do you see on smear for G6PD defic?
bite cells and heinz bodies
139
what can precipitate hemolytic anemia in G6PD defic person?
oxidant stress from drugs: dapsone, TMP-SMX (test those with HIV for G6PD since these drugs used for toxo and PCP), nitrofurantoin
140
best test for hereditary spherocystosis
osmotic fragility
141
what does Coombs test look for
autoimmune hemolytic anemia
142
cold hemolytic anemia: causes and treatment
IgM expansion, Caused by mycoplasma, mono, avoid cold since anemia in extremities is precip'd by it
143
warm hemolytic anemia, causes and treatment
IgG expansion, caused by autoimm and cancer, treat with steroid, rituximab
144
antibody mediated plt activation leading to thrombosis is characteristic of what condition
HIT
145
antithyroid peroxidase antibody can be found in
autoimmune thyroid conditions incl Hashimoto's and Graves
146
thyrotropin receptor autoAbs can be found in
Graves: stim thyroid hormone pdtion
147
MEN1
parathyroid, pituitary, pancreatic/GI (gastrinoma-->ZE)
148
MEN2A
Parathyroid, pheo, medullary thyroid
149
MEN2B
Medullary thyroid, pheo, mucosal neuroma, marfanoid body habitus
150
signs of hyperandrogenism
acne, hirsutism, male pattern hair loss (alopecia)
151
extraintestinal UC manifestations
arthritis, uveitis, erythema nodosum, PSC
152
pellagra due to and sx's
d/t niacin (B3) defic and sx of dermatitis, diarrhea, dementia
153
Rifaximin used to treat
traveler's diarrhea, IBS, hepatic enceph
154
Wilson dz affects which systems
liver (liver fail, hepatitis, cirrhosis), neuro (parkinson, gait issues, dysarthria), psych (depr, personality changes)
155
manifestations of hemochromatosis
liver dz, diabetes, hyperpigment, arthritis, cardiac enlarge
156
use of octreotide
diarrhea (often from tumors), bleeding esoph varices, to prevent growth hormone release
157
use of lactulose
constipation, hepatic enceph
158
diarrhea with PAS-positive material in small intest
Whipple's
159
sx's of Whipple's disease
diarrhea, arthralgias, heart involve-->CHF or regure, cough
160
how to eval ascites for trans vs exudative
serum to ascites albumin gradient. When >1.1 indicates portal HTN, when less indicates non-portal cause (malignancy, pancreatitis, nephrotic syndrome)
161
A1-AT deficiency pts have
COPD and cirrhosis (A1-AT gets stuck in liver-->cirr and can't get to lung where it normally stops elastase from breaking down too much tiss-->COPD)
162
What ducts are affected in PSC? PBC?
Extrahepatic in PSC (males are not subtle), intrahepatic in PBC
163
What is imaging of PSC, PBC?
PSC is beads on a string and onion skin fibrosis, PBC is normal
164
What is most common cause of sick sinus syndrome?
Degen of SA node and replacement with fibrous tiss
165
What age most often affected by sick sinus?
elderly
166
What is clinical presentation of sick sinus?
bradycardia that can lead to dizziness, fatigue, dyspnea, syncope or brady-tachy with Afib and palpitations
167
systolic murmur at right sternal border
AS
168
how does murmur of AS differ from HOCM?
HOCM best heard at lower left sternal border; AS at upper R
169
which murmur radiates to carotids?
AS
170
which murmur radiates to axilla?
MR
171
defibrillator is used for what types of arrhythmias
v-fib or pulseless v-tach
172
synchronized cardioversion is used for what types of arrhythmias
QRS complex tachy: Afib, a-flutter, v-tach with pulse
173
treatment for persistent symptomatic premature atrial contract
beta block
174
fibrosis of thyroid gland is also known as
Riedel thyroiditis (hard)
175
thyroiditis after respiratory infection
de Quervain (painful)
176
suppurative thyroiditis caused by
gram positive, most often S aureus
177
hand joint findings of OA
heberden (distal) and bouchard (prox) nodes
178
most specific antibody for mixed connective tiss dz (which has symptoms of SLE, sys sclerosis, and polymyo)
anti-U1 ribonucleoprot
179
levels of Ca and phos in Paget dz of bone
usually normal
180
triad of disseminated gonococcal infec
arthritis, tenosynovitis, vesiculopustular skin lesions
181
polymyalgia rheum assoc with
giant cell/temporal arteritis
182
contraind for treatment with MTX
renal insuff, liver dz, excess alcohol, pregnancy, hep B&C, TB
183
toradol and tramadol drug classes
tor is NSAID, tram is opioid (when you go on tor, you sing)
184
cancer types that metas to bone
BLT with kosher pickle: breast, lung, thyroid, kidney, prostate
185
positive straight leg test indicates what type of injury
herniated disc
186
what helps, what hurts in spinal stenosis: flexion and extension
flexion helps, extension hurts
187
anti-topoisomerase assoc with what condition
systemic sclerosis
188
Takayasu arteritis presentation
young Asian women with claudication (from occlusion), BP discreps, pulse deficits
189
cause of back pain that's relieved with activity
ankylosing splondylitis
190
MRI finding in ankylosing splon
bamboo spine
191
best marker for resolution of DKA or HHS
serum anion gap and beta-hydroxybutyrate levels
192
what can you look for to determine whether hyperthyroid is endogen vs exogenous?
thyroglobulin: low in exogenous (when ppl take it to lose weight)
193
hyperthyroidism post viral infect
Subacute/deQuervain thyroiditis
194
presentation of suppurative thyroiditis
infectious: high fever, pain, euthyroid
195
endocrine effect of CKD
hyperparathyroidism: CKD leads to low Ca and high phos leading to incr PTH
196
why should you not test thyroid levels in person who is acutely ill?
euthyroid sick syndrome: there can be low total and free T3 levels but person isn't actually hypothyr
197
how does pH affect calcium levels?
in acidotic state, excess H2 binds to albumin displacing Ca so ionized Ca incr (acid-->hypercalc); alkalotic, H2 dissociates allowing Ca to bind to albumin, lowering ionized Ca (alk-->hypocalc)
198
sx's hypocalcemia
tetany, carpopedal spasm, paresthesia, Chvostek sign (face), Trousseau sign (blood press cuff), seizure
199
sx's hypercalcemia
bones, stones, groans, psych overtones
200
osteomalacia pathophys
defective mineralization of osteoid matrix, often from vit D defic
201
estrogen effect on thyroid hormones
estrogen incr T4-binding globulin (TBG) so body makes more T4 to maintain same amount free T4
202
meds to treat prolactinoma
dopaminergic agonists: bromocriptine, cabergoline
203
painful oral and genital ulcers
Behcet
204
proximal muscle weakness diag
polymyositis
205
shoulder, hip, neck stiffness diag
polymyalgia rheumatica
206
hydroxychloroquine can be used to treat what? and what's bad side effect?
treats SLE; side effect of retinopathy
207
MTX toxicity
hepatotox, BM suppression (cytopenia), oral ulcers (stomatitis), pulm
208
neutropenia and splenomegaly in someone with longstanding RA
felty syndrome
209
virus that often causes viral arthritis in adults
parvovirus (slapped cheek in kids)
210
psoriatic arthritis presentation
DIP joints involved, sausage fingers (dactylitis), nail issues (onycholysis)
211
chondrocalcinosis seen in
pseudogout--calcification of articular cartilage
212
what markers are elevated in polymyositis?
musc enzymes like creatine kinase, autoAbs (ANA, anti-Jo)
213
what markers are elevated in polymyalgia rheum?
ESR and CRP
214
polymyositis presentation: what activities are limited
difficulty climbing stairs, getting into/out of car/chair, arms overhead like combing hair
215
reactive arthritis follows what types of conditions
GI infecs with salmonella, yersinia; GU infecs with chlamydia
216
what kind of arrhythmias is digoxin good for?
supravent: a-fib, flutter, tachy
217
when do you use defibrillation (unsynchronized shock)?
pulseless v-tach, v-fib
218
most common form of paroxysmal supraventricular tachy
AV nodal reentrant tachy
219
lab test for CHF
BNP: reflects stretch of ventricles due to incr filling press
220
heart sounds in pulm HTN
tricuspid regurge (pansystolic murmur at lower sternal border that incr with inspiration), split S2 with loud P2
221
what antiarrhythmic is good for ppl with LV dysfunction who are prone to ventricular tachyarrhythmias?
amiodarone
222
what are first line drugs for A-fib?
beta block and CCBs
223
where is pulmonic stenosis murmur heard?
L 2nd intercostal space
224
what other murmur is heard at L 2nd intercostal space?
ASD
225
difference between pulm stenosis and ASD murmurs?
pulm stenosis splitting widens with inspiration; ASD has fixed splitting
226
electrical alternans (beat to beat variation in QRS axis and amplitude) is pathognomonic for?
pericardial effusion
227
most common cause for bright red blood in adult stool
diverticulosis (painless)
228
most common cause of iron defic anemia in elderly
GI bleed
229
positive urine urobilinogen is from buildup of what type of bilirubin
unconjugated (not water soluble)
230
positive urine bilirubin is from buildup of what type of bili
conjugated (conj is water soluble)
231
most common cause of ascites
cirrhosis
232
most common cause of cirrhosis
alcohol and hep C
233
what other electrolyte abnormality can lead to refractory hypokal?
hypomag
234
what med should be given to diabetics with microalbuminuria?
ACEIs
235
what is best step to prevent progression of diabetic nephropathy?
intensive BP control - use ACE or ARB
236
best test for diabetic nephrop
albumin to creatinine ratio
237
what med can cause edema as side effect?
dihydro CCBs like amlodipine
238
target cells seen in
hemoglobinopathies like thal or liver dz
239
type of HF that can follow viral infection in otherwise healthy person
dilated cardiomyopathy with diffuse hypokinesia
240
what is hematology lab finding with antiphos syndrome?
prolonged PTT that doesn't correct with mixing
241
first line treatment for cocaine intox
benzos
242
antiarrhythmic that widens QRS
class Ic: flecainide and propafenone; exhibit use dependence with greater efficacy at faster HRs
243
how to differentiate b/w chlamydial and gonococcal urethritis
gonoc grows on gram stain but chlamydia doesn't
244
how does superior vena cava syndrome present?
with swelling of head, neck, and arms, dyspnea, venous congestion
245
what's the most common cause of sup vena cava syndrome?
malignancy
246
initial therapy for aortic dissections
beta block
247
pink morbilliform widespread rash
drug reaction
248
what are causes of erythema multiforme?
HSV, mycoplasma, drugs (sulfa)
249
infant with fever that develops rash
staph aureus scalded skin syndrome
250
pruritic rash with scaly border and central clearing
tinea corporis (ring worm)
251
illicit substance with long duration of effect
bath salts (amphetamine analogues) and effect can last a week
252
empiric monotherapy for ppl with febrile neutropenia
they are at risk for PSA so use broad spec with pseud coverage: piptazo, cefepime, meropenem
253
malignant otitis externa often caused by
pseudomonas
254
what is usual onset for delirium tremens?
48-96 hrs post last drink
255
what are cardiac sx's of lyme disease?
conduction abnormalities like AV block
256
viral myocarditis can lead to what in young adults
dilated cardiomyopathy
257
pruritic rash on wrist, fingers, and finger webs
scabies
258
first line treatment for carpal tunnel
wrist splint
259
acanthosis nigricans seen in pts with
insulin resistance (DM, PCOS), GI malignancy
260
dermatitis herpetiformis assoc with
celiac
261
pyoderma gangrenosum assoc with
IBD
262
skin findings in diabetes
acanthosis nigricans and skin tags
263
most common cause of necrotizing otitis externa and treatment
PSA, treat with cipro
264
first line treatment for extreme hyperK
IV calcium to stabilize cardiac membrane
265
treatment for COPD exac
O2, systemic steroids, inhaled bronchodilators +/- Abx
266
worst SE of antithyroid meds
PTU and methimazole can cause agranulocytosis
267
PTU can be toxic to which organ
liver
268
lead toxicity presentation
GI: constipation Neuropsych: sensorimotor neurop and memory loss Heme: microcytic anemia with basophilic stippling (LEAD: lead line, enceph, erythrocyte basophil stippling, ab colic and anemia, drops wrist and foot)
269
NNT equation
NNT = 1/ARR
270
study type that compares dz incidence
cohort (start with risk factors and then determine outcome)
271
study type that compares risk factor freq
case control (start with outcome, then look back to find risk factors)
272
study type that compares dz prevalence
cross sectional (looks at exposure and outcome at single time point)
273
how to differentiate primary from central adrenal insuff
in primary, there's hyperpigment (cosecretion of melanocyte-stim hormone and ACTH) and hyperK from low aldo
274
cause of aplastic anemia
acquired defic of pluripotent stem cells resulting in pancytopenia
275
treatment for symptomatic sarcoidosis
glucocorticoids
276
treatment for pericarditis
NSAID + colchicine
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 fail
282
pts who have organ transplant are at risk for which impt opportunistic infections and how do they present
CMV (multiorgan-pneum, hepatits, gastroenteritis), PCP (pulm sxs)
283
ecthyma gangrenosum assoc with
pseudomonas. They start as painless macules that quickly become gangrenous ulcers
284
what's best method to decr mortality in those with COPD
smoking cessation
285
features of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu)
telangiectasia (macules that blanch), epistaxis, AVMs
286
short periods of substernal chest pain in young person assoc with ST changes
vasospastic angina (Prinzmetal)
287
treatment for vasospastic angina
CCBs
288
types of lesions that can progress to squamous cell carc
actinic keratosis (ACT on it before it becomes cancer)
289
lesions with stuck on appearance
seborrheic keratosis (stuck on benign)
290
triggers for G6PD
meds (dapsone, TMP-SMX, primaquine), infection, food (fava beans)
291
type of metal that can cause type iv hypersens
nickel
292
vit B and folate participate in what conversion rxn
homocysteine to methionine (defic of either results in elev homocys)
293
when does ain occur in relation to offending drugs?
7-10 days after drug exposure
294
bone disorder that can lead to hearing loss
Pagets
295
bone dz with malabsorption of calc and vit D
osteomalacia
296
effect of acetaminophen and NSAIDs on warfarin
cyp inhibs that incr warf conc leading to incr bleeding risk
297
effect of OCPs on warfarin
cyp inducer that decr warf conc leading to risk of thrombosis
298
presentation of arsenic poisoning
stocking-glove neuropathy, skin changes, burning hypersens, pancytopenia, hepatitis
299
examples of thiazide diuretics, loop diuretics, K-sparing
thiazide: hydrochlori, chlorthalidone; loop: furosemide; K-sparing: spirono, epleronine, triamterene, amiloride
300
SEs of thiazides
hyperglycemia, incr LDL and triglyc, hyperuricemia
301
most common cause of B12 defic
pernicious anemia
302
cancer assoc with pernicious anemia
gastric cancer
303
nonenhancing brain lesions on MRI in person with AIDS
progressive multifocal leukoencephalop (caused by reactivation of JC virus)
304
what does imaging of cerebral toxoplasmosis look like?
ring-enhancing lesions with surrounding edema
305
cause of bloody diarrhea in AIDS pt
cytomegalovirus
306
first line therapy for BPH
alpha antags: tamsulosin
307
for whom <65 is PPSV23 rec'd for
chronic conditions that incr chance of pneumococcal dz like heart and lung disease, diabetes, smoking, liver dz
308
what's assoc with incr risk of AAA rupture?
size, growth rate, and smoking
309
who should get AAA screening and how often?
one time screening for men 65-75 who have ever smoked
310
who should get screened for lung cancer and how often?
yearly for anyone age 55-80 who has smoked 30+ pack-years
311
sx's of cholinergic excess vs antichol excess
antichol: hot as hare, dry as bone, blind as bat, red as beet, mad as hatter, bloated as toad (retention), heart runs alone (tachy). Chol: bradycardia, miosis, salivation, lacrimation, urination, diarrhea, musc fasciculations
312
antidote for chol and antichol excess
atropine for chol excess; physostigmine for antichol excess
313
what anticoags can be used in ppl with renal insuff?
unfractionated (but not LMW) heparin, warfarin
314
pharm treatment for Raynaud
CCB (similar path to vasospastic angina)
315
med with side effect of tendon rupture
fluoroquinolone
316
urease producers that can cause UTI
Proteus and klebsiella
317
drug that treats PBC
ursodeoxycholic acid (UDCA)
318
what's often present in urine when there's blood on UA but few RBCs?
myoglobin
319
lifestyle modifications that result in BP reduction in HTN from most to least effective
1) weight loss 2) DASH diet 3) exercise 4) dietary salt 5) alcohol
320
what androgen is made by adrenals but not by ovaries?
DHEAS
321
murmur in ppl with infective endocarditis
mitral valve prolapse plus mitral regurge
322
signs that indicate primary over central adrenal insuff
primary has hyperpigment (from incr ACTH) and hyperkalemia, hypotension (from low aldo)
323
what type of neurons are lost in Huntington's
GABA
324
loss of acetylcholine seen in what disorder
Alzheimers
325
what type of neurons are lost in Parkinson's
dopamine
326
pneumococcal vaccines in ppl with HIV
PCV13 once, then PPSV23 in 8 weeks, 5 years, and at 65
327
most common risk factor for aortic dissection in ppl>60
HTN
328
seborrheic dermatitis features
pruritic, erythematous plaques with greasy scales on eyebrows, nasolabial, ear, dandruff
329
anesthetic hypopigmented lesions with nerve involvement charac of what disorder
leprosy
330
hearing loss assoc with which BP med
loop diuretics like furosemide
331
Lynch syndrome neoplasms
colorectal, endometrial, ovarian
332
familial adenomatous polyposis neoplasms
colorectal, osteomas, brain
333
vHL neoplasms
clear cell renal, pheo, hemangioblastoma
334
acute MI has which abnormal heart sound
S4
335
effect of estrogen on thyroid
estrogen increases TBG so ppl with hypothyroid will need to incr meds to keep up with incr binding sites
336
what's most common anatomic origin of Afib
pulm veins
337
anatomic origin of a-flutter
reentrant circuit around tricuspid annulus
338
drug to treat opioid OD
naloxone
339
positive PPD for regular person w/ no risk factors
>15mm
340
positive PPD for HIV or immunosuppressed
>5mm
341
positive PPD for recent immigrant
>10mm
342
separation of epidermis by light friction
pemphigus vulgaris
343
SJS vs TEN
<10% = SJS; >30%=TEN
344
drugs that can cause SJS/TEN
abx (sulfonamides), NSAIDs, anticonvulsant, allopurinol, sulfasalazine
345
elevated hemoglobin in someone with OSA caused by
incr erythropoietin pdtion
346
ppl with porphyria cutanea tarda (fragile, photosensitive skin that develops vesicles with trauma or exposure) should be tested for
Hep C
347
CHADS-VASc score
CHF, HTN, Age>75, diabetes, stroke/TIA, vasc dz, age 65-74, sex
348
what happens to pulse in septic shock?
bounding periph pulses from incr pulse pressure
349
in what condition do you see equalization of heart chamber pressures?
cardiac tamponade
350
treatment for painless thyroiditis (variant of Hashimoto)
propanolol for symptomatic management
351
type of bias with poor retention of study subjects
selection
352
Chagas disease causes (2 big ones)
megacolon and cardiac disease
353
parasites that can cause traveler's diarrhea
cryptosporidium, giardia
354
paraneoplastic presentation of squamous cell carc of lung
hypercalcemia from pdtion of PTHrP (sCA++mous)
355
paraneoplastic presentation of small cell carc on lung
ACTH pdtion and SIADH
356
hyper and hypocalc effect on QT interval
hyper: shortened hypo: prolonged
357
antibody present in granulomatosis with polyangiitis
c-ANCA (and less freq p-ANCA)
358
what conditions are assoc with p-ANCA
vasculitidies like microscopic polyangiitis and eosinophilic granulomatosis
359
presentation of polycythemia vera
incr viscosity leads to HTN, transient visual disturb, erythromelalgia (burning cyanosis in hands and feet), aquagenic pruritis, gouty arthritis due to incr RBC turnover
360
phys exam findings for PV
ruddy cyanosis/facial plethora, splenomeg
361
treatment for PV
phlebotomy +/- hydroxyurea
362
colonoscopy findings in laxative abuse
melanosis coli: dark brown discolorations
363
periorbital edema, myositis, and eosinophilia is triad found in
trichinellosis
364
complication of influenza in pt who develops worsening fever or pulm sx's
secondary bacterial pneum often Strep pneumo or S aureus
365
cause of metab alkalosis with low urine chloride
loss of gastric secretions thru vomiting and NG suctioning
366
cause of metab alkalosis with high urine chloride
excess aldo that leads to K and H loss in urine
367
first step for treating acetaminophen OD
activated charcoal
368
what med can be used to treat acetaminophen toxicity?
N-acetylcysteine
369
mechanism of change in stress test that allows you to see areas of ischemia
augmentation of blood flow in nonobstructed vessels
370
presentations of pernicious anemia
vit B12 defic-->macro anemia, glossitis, vitiligo, hypothyroid, neuro abnormalities
371
AIDS pt with watery diarrhea and low grade fever
cryptosporidium
372
AIDS pt with watery diarrhea and high fever
MAC
373
AIDS pt with diarrhea and hematochezia
cytomegalovirus
374
most common cause of healthcare-assoc infective endocarditis
staph
375
most common cause of community-acquired IE
strep
376
what causes IE after dental procedures?
viridans strep
377
prophy treatment for cirrhotic pts with nonbleeding varices
nonselec beta block (prop, nadolol)
378
cyclosporine toxicity
nephrotox, neurotox (tremors) hyperK, HTN (same as tacro) + gum growth and hirsutism
379
tacrolimus tox
nephrotox, neurotox (tremors) hyperK, HTN (no hirsut or gum)
380
azathioprine tox
diarrhea, leukopenia, hepatotox
381
mycophenolate tox
bone marrow suppress
382
polyuria with low serum Na
primary polydipsia
383
polyuria with normal or high serum Na
diabetes insipidus
384
treatment for HHS
saline, insulin, K
385
nephrotic syndrome assoc with HIV
FSGS
386
how does lead cause microcytic anemia (what's the mech)
disrupts heme synth
387
leukocyte alkaline phosphatase is elevated in what condition
leukemoid reaction to infection
388
markers for SLE
ANA (sensitive so checked first), anti-dsDNA, anti-Smith (specific so checked second)
389
post-transplant pts should be on which prophy abx
tmp-smx to cover for PCP and cytomegalo
390
vitamin defic in carcinoid syndrom
niacin leads to pellagra
391
incr or decr of preload in 1) septic 2) hypovolemic 3) cardiogenic shock
1) decr 2) decr 3) incr
392
incr or decr of afterload in 1) septic 2) hypovol 3) cardio shock
1) decr 2) incr 3) incr
393
incr or decr of cardiac index (func) in 1) septic 2) hypovol 3) cardio shock
1) incr 2) decr 3) decr
394
impt drug interactions to consider with PDE-5 inhibitors like sildenafil
not good to take with nitrates and careful when taking with alpha blockers (tamsulosin) due to risk of hypotension
395
what should you test for in pt with HTN and hypokalemia
hyperaldo
396
digoxin toxicity sx's
GI: anorexia, N/V, pain Neuro: color vision changes, weakness, fatigue, confusion
397
diabetes meds that can cause weight loss
metformin and GLP-1 agonists (exenatide)
398
condition with lots of blistering often in someone with hep C
porphyria cutanea tarda
399
how do you test for PCP
must use microscopy so sputum or bronchoalveolar lavage
400
chemo agents that are cardiotoxic
doxorubicin, trastuzumab
401
treatment for torsades
IV mag or defib if hemodynamically unstable
402
cause of IE after urinary tract infect/proceufre
enterococci
403
which cells responsible for transplant rejection in acute rejection vs graft v host dz
host T cells in acute reject and donor T cells in GVHD
404
Sjogren's sx's
dry eyes and mouth, dysphagia, dental caries, thrush, raynaud, vasculitis, arthritis
405
Abs in Sjogren's
SSA (Ro) and SSB (La)
406
what RPI is used to determine probs with RBC pdtion vs destruction
>2 is hemolytic anemia <2 is underpdtion anemia
407
4 conditions with anemia and thrombocytopenia
HELLP, DIC, TTP, HUS
408
aspirin intox causes what acid-base disturbance
mixed pic: resp alkalosis from incr resp drive and metab acidosis from incr organic acids
409
cause of neurocysticercosis
Taenia solium eggs from undercooked pork
410
person with tricuspid endocarditis is at risk for what
septic emboli, most often Staph aureus in IVDU
411
how to treat pulseless electrical activity
chest compressions and epi (vasopressor) No role for shock
412
treatment for acute decomp heart fail
LMNOP: lasix, morphine, nitrates, o2, position
413
what causes hearing difficulty in meniere
incr volume and pressure of endolymph
414
elevated mean corpuscular hemoglobin conc in what condition
hereditary spherocytosis
415
intestinal angina caused by
mesenteric ischemia
416
urate crystal tumors
tophi (in gout)
417
painful genital ulcer with lymphadenopathy
chancroid from haemophilus ducreyi
418
what's the ulcer of syphilis?
painless chancre
419
causes of central vertigo
stuff in the brain: stroke, tumor, bleed, MS, cerebellar infarct. Also migraine
420
causes of peripheral vertigo
Meniere, vestib neuritis, BPPV, acoustic neuroma
421
how do you improve oxygenation in mech ventilated pt? (2 ways)
1) PEEP (good for ARDS b/c opens up more alveloi) 2) incr FiO2
422
medication for gastroparesis
metoclopramide
423
livedo reticularis (mottled, bluish discoloration that blanches) and blue toe syndrome are characteristic of what
chol emboli (often precipitated by vasc procedures)
424
nodular regions with surround ground-glass opacity on in lung
halo sign charac of aspergillosis
425
what test is used to screen for AAA?
ultrasound
426
Abx for CAP
beta-lactam + macrolide (cef + azithro), or fluoroquin like moxiflox
427
causes of interstitial lung dz
inhalation of asbestos, bery, silicone, drug tox, conn tiss dz, radiation
428
first line drugs for erectile dysfunc
pde-5 inhibs: sildenafil
429
nerve injured by tight belts and area it affects (also what is this called?)
lat fem cutaneous, lateral thigh, meralgia paresthetica
430
Kussmaul sign (incr or lack of dec of JVP on inspiration) is most commonly assoc w/ which condition
constrictive pericarditis
431
probability that dz is present when test result is positive
pos predictive value
432
probability that test result corresponds to whether dz is there or not
sens and spec
433
in DKA, what type of fluid should be used for hydration
normal saline
434
organisms that cause IE in ppl with prosthetic valves or implanted devices
S aureus and epidermidis
435
what is assoc w/ IE caused by strep gallolyticus (bovis)
colon cancer and IBD
436
post-MI complication with persistent ST elevation
ventricular aneurysm
437
what meds improve long-term survival of pts with LV systolic dysfunc
ACE, ARB, beta, mineralocorticoid
438
tests to check for PAD vs venous insuff
ankle brachial for PAD, doppler for venous
439
high or low for best management of ARDS: tidal vol, PEEP, FiO2
low TV, high PEEP, FiO2 <60% for extended ventilation to prevent O2 toxicity
440
pulsus paradoxus seen in (3)
cardiac tamponade, COPD, asthma
441
intermittent asthma daytime sx's and nighttime awakenings
day: <=2/wk; night: ,<=2/month
442
what are pts w/ asbestos exposure at highest risk for?
bronchogenic carc (also mesothel but less common)
443
most common cause of AR in developed world? Developing world?
bicuspid aortic valve in developed and rheumatic fever in developing
444
pt with signs and sx's of mono and negative heterophile test
CMV instead of EBV
445
passage of stool improves which GI condition
IBS
446
prophylaxis for varices in cirrhotic pts
beta blocker: causes unopposed alpha vasoconstriction which lessens blood flow
447
rapidly acting agents to treat hyperK
insulin and glucose, beta-2 agonists, sodium bicarb
448
slow-acting treatment for hyperK
dialysis, diuresis
449
metabolic derangements following vomiting
low Cl,K,H-->hypochloremic, hypoK metab alk
450
recurrent headache and HTN in young woman
fibromusc dysplasia
451
in mech ventilation, what 2 things influence PaO2? PaCO2?
O2: FiO2 and PEEP CO2: RR and TV
452
atrial tachy with AV block assoc with toxicity of what drug
digitalis
453
what is body's response to decr cardiac output?
neurohormonal activation (renin, norepi, ADH) that incr SVR
454
anterior mediastinal mass differential
4 Ts: thymoma, thyroid neoplasm, teratoma (and other germ cell tumors), terrible lymphoma
455
drug that helps prevent ventricular remodeling after MI
ACE inhib
456
causes of anion gap metab acidosis
MUDPILES: methanol, uremia, diabetic ketoacidosis, paracetamol/tyl, inh and iron, lactic acidosis, ethylene glycal, salicylate
457
treatment for myasthenia gravis crisis
plasmapharesis or IVIG
458
treatment for complete AV block
pacemaker
459
reversible causes of complete AV block
MI, incr vagal tone, metab abnorms (hyperK), AV node blocking agents
460
what tumor marker is elevated in about 50% of cases of HCC?
AFP (also yolk sac marker)
461
clinical features of IgA defic
recurrent sinopulm and GI infecs, autoimmune; atopy, anaphylaxis during blood transfusion
462
test to look for cancer of head of pancreas? body/tail?
ultrasound for head (pt presents with jaundice), CT for others
463
musc atrophy and weakness without pain (painless myopathy)
glucocorticoid myopathy. Often from exogenous but can also be from Cushing
464
treatment for polymyalgia rheum
glucocorticoids (inflamm condition)
465
which veins are most common source of DVTs that become PEs
proximal thigh like fem, iliac, popliteal
