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Medicine stuff 3 Flashcards

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1
Q

Malignant hypertension is sever hypertension asscoiated with what findings?

A

retinal hemorrahges, exudates and/or papilledema

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2
Q

Worst polyps to find on colonscopy?

A

Large (>1 cm), adenomatous, villous, sessile (nonpedunculated)

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3
Q

Alcoholic with macrocytic anemia - likely to be B12 or folate defic?

A

Folate

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4
Q

What does pharm stress test do to heart vessels (difference between obstructed and non-obstructed)?

A

Big increase in flow through non obstructed and v small increases in obstructed

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5
Q

Spider angiomas in cirrhosis are caused by excess estrogen - which other cirrhosis sx is also caused by excess estrogen?

A

Palmar erythema

also decreased body hair, smalltesticles and gynecomastia but those are obvious

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6
Q

ROULEAUX stacking of RBCs on smear, with hypercalcmia, normocytic anemia, protein gap of >4, and renal insuff - THINK?

A

multiple myeloma

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7
Q

Incidence vs prevalence?

A 
Incidence = new cases in set time
Prevalence = incidence x time
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8
Q

A-fib with hx of Wolf Parkinson White - tx?

A

Cardioversion or antiarryhtmics (procainamide)

NOT AV nodal blocks like B-blockers, vera/dilt, digoxin or adenosine

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9
Q

Lidocaine for what arrythmias?

A

ventricular

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10
Q

ADPKD - presenting as HTN and bilateral flank masses - most likely complication?

A

Interncranial bleed due to berry aneurysm

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11
Q

Asymptomatic rise in alk phos in elderly pt - most likely cause?

A

Paget dz of bone

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12
Q

Bruising in old people is due to senile purpura which is a defect in what?

A

elastic fibers in perivascular CT

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13
Q

Tests for acute Hep B infex?

A

HBsAg and anti-HBc

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14
Q

Acute decompensated HF - tx?

A

O2, aggressive diuresis, possible vasodilators

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15
Q

In tachycardia, vagal maneuvers (PSNS, eg cold water) slow down heart rate by slowing what?

A

AV conduction

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16
Q

Upper AND lower resp granulomatous infl with glomerulorephritis …. think?

A

Wegener’s aka GPA (granulomatosis with polyangitis)

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17
Q

Pleural effusion pH:
Normal:
Transudative:
Exudative:

A
  1. 6
  2. 4-7.55
  3. 3-7.45
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18
Q

Acute MI heart sound?

A

S4 (atrial gallop)

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19
Q

Flulike state, POLYARTHRALGIAS, rash with low WBC and low PLT - after travel to Latin America, Africa, South Asia - think?

A

Chikungunya fever

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20
Q

Secretory diarrhea with melanosis coli (dark pigmentation in proximal colon), woman, health care field - think?

A

Laxative abuse

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21
Q

Test to compare two means?
Three means?
Proportions?

A

t-test or z-test
ANOVA
chi-square

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22
Q

Young patient (<45) with COPD like sx and basilar predominant dz - think?

A

Atlpha-1 antitrypsin defic

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23
Q

Chest xray with hilar LAD and non caseating-granulomas and yeast - and the patient likes CAVING, erythema nodosum too, think of what bug?
Transmitted by?

A

histoplasma

Soil with bird or bat droppings

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24
Q

DM nephropathy four stages in order?

A
  1. Glomerular hyperfiltration
  2. Thickening of GBM
  3. Mesangial expansion
  4. Nodular sclerosis
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25
AMS with Metabolic acidosis with hypocalcemia and calcium oxalate crystals (rectangular, envelope shaped) in urine - what toxicity? Treat?
ethylene glycol | fomepizole or ethanol, sodium bicarb for acidosis and dialysis if severe
26
Hyperthyroid with painful neck, fever, after URI - think?
Subacute (de Quervain) thyroiditis
27
Hep B vacciantion and previous cleared infection both are +ve for HBsAb but which one also has anti-HBc +ve?
Previous infx NOT vaccination
28
When is HBeAg +ve?
during acute infx
29
Nephrotic syndrome in patient with RA - likely to be due to what co-morbidity?
``` AA amyloidosis (AL version due to multiple myeloma) ```
30
mL cutoff for oliguria?
<250mL / hr
31
Pathophysioloyg of Rotor's syndrome?
defect in hepatic secretion of bilirubin
32
Plethora and swelling of upper extremities and face - suspect? Associated with?
SVC syndrome | Malignancy
33
Bright red, firm, friable, exophytic nodules in HIV pt - AND CAN PROGRESS TO SYSTEMIC DZ - diagnx? Bug? Tx?
bacillary agiomatosis bartonella erythromycin (or doxy)
34
Warfarin necrosis due to rapid drop off of what?
protein C
35
Autiimmune adreanlitis vs Sheehan as cause of adrenal insuff?
Hyperpigmentation and mineralocorticoid defic suggest automimmune
36
First-line med tx for stable patient with recurrent TORSADES?
Mg
37
Acute aortic dissection - initial meds?
IV B-blokcer (like labetalol)
38
Recent URI followed but sudden onset CHF sx in otherwise healthy patient - think? Bug?
dilated cardiomyopathy 2/2 acute viral myocarditis | Coxsackie B
39
Syphilis - what if SEVERE PCN allergy?
don't desensitize give doxy
40
Wafarin like necrosis but at Heparin injection sites think? | Pathophys?
HIT | Ab against PLT component
41
Back pain with spinal cord compression sx - med tx?
IV steroids
42
Hypoxia in PNA is casued by alveloar hypoventialtion or V/Q mismatch?
V/Q mismatch (alveolar hypo refers to unifrom chage across whole lung)
43
Classic side effect of metformin? | SO do not give in what 3 coditions?
Lactic acidosis | Acute renal failure, liver failure, sepsis
44
Recurrent oral and genital ulcers, uveitis, thrombosis, Turkish, Middle Eastern and Asian young people, amybe they ulcerate with a needle - dz?
Bechets
45
When do you intervene emergently in hypercalcemia (level)? | What intervention?
>14 NS, then start bisphosphonates (Only HD if renally impaired)
46
Common complication of Paget's dz of bone casues by involvement of cranial bones?
hearing loss
47
Uric acid kidney stones: prevention?
Alkalinize urine to pH6-6.5 with oral potassium citrate
48
Vitiligo due to what pathophys? | Tx?
Destruction of melanocytes | Topical or systemic steroids
49
Low T3 but normal T4 and TSH levels - esp in a acutely and severely sick patient?
Euthyroid sick syndrome
50
HIV, infx prophylactic drugs, cutoffs for CD4?
<200 bactrim | <50 azithro or clarithro
51
If you suspect melanoma then what kind of biopsy?
Excisional with 1-3mm margins
52
Common B-1 agonist?
Dobutamine
53
Cause recurrent painless GI bleeds that is FREQUENTLY MISSED on colonoscopy?
Angiodysplasia
54
PE (and the resulitng resp alkalosis) does what to Ca levels?
Hypocalcemia | More bound to albumin as H has dissociated
55
``` Neprotic sydnrome, most common: Kids, lympphoma, NSAIDs? HIV, obese, balck or hispanic, heroin? Hep B, carcinoma, lupus (and NSAIDs)? URI? ```
minimal change FSGS Membranous nephropathy IgA
56
Slow growing notender mass in the mouth after dental trauma, draining yellow granules - bug? Drug?
Actinomyces | PCN
57
Digoxin (digitalis) toxicity - heart arrythmia?
Atrial tachycardia with AV block
58
Most beneficial tx to reduce progression of diabetic nephropathy? Goal?
Strict blood pressure control, goal of 130/80
59
Risk factors for AAA rupture (3)?
large diameter, rapid rate of expansion, current smoking
60
Adrenal insuff - tests? | When to do a dexa suppression test?
8AM cortisol and plasma ACTH PLUS ACTH stim test (cosyntropin) Dexa suppresion in HYPERcortisolism
61
Acute limb ischemia post-I - check what? Why?
Echo, possible LV thrombus
62
Get PFTs before you start what anti-arryhtmic? | Why?
Amiodarone | So you have baseline expecting lung injury
63
ROME criteria for IBS (so fucntional prob) - 3?
sx improve after BM Change in stool frequency and form (without worrying sx)
64
Intermittent claudication in limbs - tx?
exercise/PT! pharm and surg only for persistent sx if exercise fails
65
Hypovolemic hypERnatremia - intial tx?
NS
66
Cavitary lung lesion containing fluid/debris with cancer like sx - think? Confirm diagnx with?
aspergillosis | IgG serology
67
Rash on body starting from trunk, grey mucus patches in mouth - and sexual partners?
Secondary syphilis
68
What else dose MEN2B have as well as the cancers?
Marfanoid habitus
69
Electrolyte sign of hyPOvolemia?
decreased URINE sodium
70
Not treating hypERthyroid puts you at risk for what (2)?
A fib and bone loss
71
Effect of increased prevalance on PPV and NPV?
PPV goes up, NPV goes down
72
Lupus like facial rash but also affected by EtOH, flushing, and does not spare nasolabial folds?
Rosacea
73
Glaucoma emergency meds (M.A.P.T.) and avoid what?
mannitol, acetazolamide, pilocarpine or timolol | Avoid mydriatics like atropine
74
Likely pathology of vitiligo? | So linked to what other kinds of diseases?
Autoimmune destruction of melanocytes | Autoimmunes pathology
75
Best study for determinng incidence of dz? | Comparing incidence is 2 populations with or without a particular risk factor gives you what?
Cohort | RR
76
dysphagia evaluative study?
barium swallow (videofluroscopic)
77
Hyponatremia: when hypertonic saline not 0.9%?
If <120 with severe sx
78
Can't fall asleep at normal times becasue of a disrupted circadian rhythm - diagnx?
Delayed sleep phase syndrome
79
Secretory diarrhea and flushing but with a mass int he PACNREAS too?
VIPoma, carcinoid probably wouldn't have mass in pancreas
80
Giant cell/temproal arteritis complication?
Aortic aneurysm
81
UTI - urine pH >8 which bug?
Proteus
82
Macrocytic anemia, shiny tongue, vitiligo, thryoid dz and neuro probs in a Northern European white - what kind of anemia?
Pernicious anemia causing B12 defic
83
Electrolytes in tumor lysis: | Phos, K, Uric acid, Ca - up or down?
Ca down rest up
84
Erysipelas bug (well demarcated edges)?
Strep pyogenes
85
Aortic dissection - imaging test to confirm diagnosis? When to get it? If not what test?
TEE (trans-esophageal echo) If HD unstable or renal insuff CT angio
86
What happens to Na and K in adrenal insuff?
Hyponatremia due to increased ADH | Hyperkalemia due to decreased Aldosterone
87
Location of ectopic foci ... A fib? A flutter?
pulmonary veins | around tricuspid annulus
88
R sided HF after pacemaker placement - suspect what valvular problem?
triscuspid regurg
89
AKI on acyclovir - think?
RENAL TUBULAR OBSTRUCTION (with crystals)
90
Nephrotoxicity, hyperkalemia, hypertension, tremor WITH gum hypertropthy and hirsutism - which immunosuppresant toxicity?
Cyclosporine
91
Nephrotoxicity, hyperkalemia, hypertension, tremor WITHOUT gum hypertrophy and hirsutism - which immunosuppresant toxicicty?
Tacrolimus
92
Dose-related diarrhea, leukopenia, hepatotoxicity - which immunosuppressant toxicity?
Azathioprine
93
Bone marrow suppression - which immunosuppressant toxicity?
mycophenolate
94
Caustic ingestion - alkali. First step within 12-24 hours?
Endoscopy to assess damage
95
S gallolyticus (S bovis) is assocated with what neoplams?
Colonic
96
In Crohn's increased absoroption of what increases kidney stones?
oxalate
97
Anaerobic coverage options (3)?
Clinda, metro with amoxicillin, amoxi-clav
98
Moderate to high probability of DVT, don't start anti-coag yet - confirm with this test (equivalent of CTPE for PE)?
Compression US
99
Empiric abx in meningitis age 2-50, >50, and immunocomprimized?
3rd gen ceph + vanc, then add ampicillin to cover listeria if >50, if immunocomprimized then swtich 3rd gen ceph to cefepime for pseuodmonas coverage
100
Panacinar vs centriacinar emphysema - which with smoking and which with a-1 antitrypsin defic?
Panacinar a-1, centracinar smoking
101
PCT (porphyria cutanea tards) presents with photosensitve skin rash - associated with what dz?
Hep C
102
Phenytoin assoc with what anemia?
Folate defic macrocytic
103
Low vit D can lead to what changes to Ca, Phos, PTH?
low Ca, low Ph, high PTH
104
Straight lines appear wavy - problem?
macular degeneration
105
What 10 year ASCVD risk do you get a statin?
>7.5%

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