Medicine stuff Flashcards by Richard Froude

Fever, leukocytosis, LUQ pain - think?

Associated condition?

splenic abscess

Infective endocarditis

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Drug Rx for Primary Biliary Cholangitis?
When to start?
Tx if advanced dz?
Assoc lab findings?

UDCA (ursodeoxycholic)
As soon as dz identified
Liver transplant
Positive AMA, elev Alk Phos

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Positive GGT with elevated alk phos?

Biliary etiology rather than bone (if neg)

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Diclofenac is what sort of drug?

NSAID

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Pneumaturia or fecaluria with UTI like findings - think?

Confirm with what etst?

Colovesical fistula

CT with oral or rectal contrast (not IV contrast)

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Best measure to reduce risk of CAUTI?

clean, intermittent catheterizationa

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Minimal BRBPR - next best test and age cutoffs?

> 50 or suggesting malignancy - colonoscopy

<40 and no other risk factors anoscopy

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Most common inherited hyercoagulable disorder for whites?

Pts unable to respond to what?

Factor V leiden

Activated protein C

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Firm, freely moveable dome shaped nodule with small central punctum, can grow or produce cheesy white d/c - think?
Treat?

Epidermal (inclusion) cyst

Spontaneous resolution usually

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Fibromylagia tx? 1st and 2nd and 3rd lines?

1st Sleep hygiene and aerobic exercise
2nd Amitriptyline (TCAs)
3rd Pregabalin, duloxetien, milnacipran if not responding to TCAs

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Back pain with gradual onset, age <40, does not improve with rest but improves with activity - etiology think?

Inflammatory

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wedge shaped lesion in lung on CT - think?

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Sudden or subacute painless monocular vision loss with “blood and thunder” on funduscopic exam - retinal hemmorhages, dilated veins, cotton wool spots, optic disk swelling - think?

central retinal vein occlusion

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OD on TCAs - give what?

sodium bicarb

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electrical alterans and sinus tach on ECG - think?

Treat?

pericardial effusion - poss tampenade

If tamponade and hemodynamic compromise - emergency pericardiocentesis

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What do you need for solid testicular mass diagnosis?

Then do what?

painless hard testicular mass and suggestive ultrasound
radical orchiectomy (testic and assoc cord)

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Aminoglycosides are used to treat what bugs?

Potentially toxic to what organs?

Serious GN infections

Kidneys

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Hydatid liver cysts come from what organism?

Transferred by?

Echinococcus granulosus, a dog tapeworm

Dog feces

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pH and glucose cutoffs for pleural effusion that suggest bacteria in there?

pH 7.2 and glucose <60

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Most common liver cancer?

Mets from somehwere else!

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Epigastric pain, often worse on empty stomach, with intermittent melena - think?
Treat?

duodenal ulcer (gastric ulcer worse after eating)
Triple tx: amoxi, clarithromycin and PPI

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Prolactin level diagnostic of proloactinoma?

Effect on TSH level?

> 200

Normal or low depending on compression of thryrotophs

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Virus common to kids that can cause an acute symmetric arthritis in adults?

Parvovirus B19

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Multiple stomach ulcers and thickened gastric folds on endoscopy - suspect?
Confirm diagnosis with?

Gastrinoma (Zollinger-Ellision syndrome)

fasting serum gastrin of >1000

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Right heart failure sx with a pericardial knock (mid-diastolic), pericardial calcifications on CXR - think?

Constrictive pericarditis

How to confirm tinea coporis (ringworm - ring-shaped scaly patches with central clearing and sitnic borders)?

potassium hydroxide prep of skin scrapings

Concurrent use of NSAIDs and aspirin can cuase what anemia?

Iron defic from occult bleedings

Glucocorticoid defic with hypogonadism and hypothyroidism - think?

Hypopoituitarism (so normal aldosterone)

Isolated septic arthritis (or with tenosynovitis and rash) in young sexually active patient, often migrating polyarthralgias leading to purulent monoarthritis - think?

Gonococcal infection

What does rheumatoid arthritis do to risk of osteopenia, osteoporosis and bone fracture?

risk goes up

Resp alkalosis in a patient on a vent - make what vent adjustment?

Decrease resp rate

When to begin colonoscopies with IBD? | Then how often?

8 years after diagnosis | Every 1-2 years

How long after injury do you see fat embolism?

12-24 hours (at LEAST)

What lipid levels indicate statin therapy in diabetics aged 40-75?

Any. They should all be on statins.

Infective endocarditis - what step first, blood cultures or start ABX?

culture before starting ABX (serial cultures, at least 3)

C diff risk factors (4)?

Hospitalization Recent ABX PPI (gastric acid suppression) Age >65

Notching of the ribs seen in what cardiovascular condition?

Coarctation of the aorta

Gram positive rod (beaded or branching), partially acid-fast, aerobic, immunocompromised pt - bug? Treatment?

Nocardia | Bactrim

What happens to TBG levels after starting estrogen? So effect on free T4? And if on levothyroxine, requirement goes up or down?

They go up FREE T4 goes down but total stays the same Up

Side effect of hydroxychloroquine for lupus?

retinal toxicity

White paque on oral mucosa in smoker/drinker - think?

Leukoplakia

3 causes of hyperventilation --> resp alkalosis?

PNA, high altitude, salicylate intox

When is acalculous cholecystitis most commonly seen?

hospitalzied, criticalluy ill patients, post-surgery

Excessive IgM but also end-organ damage and >10% clonal lymphocytes on bone marrow biopsy- think? Presenting with? Neoplasm of which cell? Differs form MGUS how?

Waldenstrom macroglobinemia hyperviscosity, neruopathy, cryoglobulinemia Plasma cell neoplasm MGUS would have <10% clonal lymphocytes on biopsy

Indications for carotid endartectomy?

men and women if symptomatic 70-99% | also men if symptomatic 60-99%

Hemolytic anemia with thrombocytopenia, renal inuff, neuro sx and fever - think? Due to? Treat?

TTP (thrombotic thrombocytopenic purpura) Auto-Ab to plasma protease Emergent PLASMA EXCHANGE

Hereditary spherocytosis labs?

Anemia, high retics, low MCV, increased MCHgb concentration, high RDW

Varices - drugs for prophylactic vs active treatment?

Propanolol (or nadolol - non selective B-blockers) for prophylaxis, octreotide for active bleeding

2 meds that can trigger bronchoconstriction in patients with asthma?

B-lockers and aspirin

Frequent complication of IBD? | Effect of NSAIDs?

Spondylarthritis | Help joint pain but makes IBD worse

Unilateral varicoceles that fail to empty when recumbent - think? Best diagnostic test?

Underlying pathology eg RCC | CT abd

Pain at tendon and ligament insertion sites (enthesitis), onset <40, for >30 months, better with use, worse with rest - think? What HLA assoc?

Ankylosing spondylitis and other spondyloartropathies | HLA-B27

Anticardiolipin Ab assoc with? | Lupus anticoagulant is a pro-thrombotic that does what to partial thromboplastin time?

``` antiphospholipid syndrome prolongs it (PTT) ```

ABX class with photosesnitivity?

tetracyclines

What defines resistant HTN? | Most common cause (with a systolic-diastolic abd bruit)?

persists with 3 or more anti-hypertensives | renovascular HTN

Appearnce of nasal mucosa in allergic vs non-allergic rhinitis? Tx for each?

pale/bluish in allergic, erythematous in non-allergic Intranasal antihistamines glucocorticoids or both in non-allgx Allgx: intrasnasal steroids, PO antihistamines

Loss to follow up means what kind of bias?

Selection (specifically attrition)

Chronic abd pain, weight loss, food aversion - think? | Mostly due to?

chronic mesenteric ischemia | atherosclerosis of celiac artery or SMA

First branch point in evaluation of hypercalcemia?

PTH level (low PTH likely malignancy, and elevated or inappropriately normal PTH likley primary hyperparathyroidism)

Imaging in back pain: MRI (3)? Xray (3)?

MRI: sensory deficits, cauda equina sx, suspected epidural abscess/infection Xray: compression fracture/osteoporosis, malignancy, ank spondy

Infective endocarditis - most common valvular abnomralitty? 2nd most commoan valve? Most common valve in IE with IVDU?

mitral prolapse with coexisting mitral REGURGITATION aortic stenosis tricupsid regurg

Common bugs for opportunistic infx post-transplant? | Systemic illness with multiple organ systems and without prophylaxis - suspect?

pneumocystis and CMV | CMV

Positive Prussin blue means presence of what? Which means what process?

Hemosiderin so hemolysis

``` Acute MI mech and artrery involved: RV failure? Papillary muscle rupture? Septal rupture? Free wall rupture? ```

RCA RCA LAD if apical, RCA if basal LAD

HIV eye problems - most common serious prob but painless? | Painful with keratitis?

CMV | HSV or VZV

RUQ pain, mild elevation in liver enzymes, firm hepatomegaly - think? Confirm with?

Liver mets! | Abd CT

4 point differential for hypokalemia, alkalosis and normotension?

Surreptitious vomiting Diuretic abuse Bartter syndrome Gitelman's syndrome

3 hemolytic anemia labs?

low haptoglobin, high LDH and bilirubin

Acute or subacute renal failure, skin probelms (eg mottling/livedo reticularis) AFTER RECENT CATH - suspect?

Cholesterol emboli

Medication to help passage of ureteral stones?

Tamsulosin and other alpha agonists that let the ureter smooth muscle relax

Temporal headaches, jaw claudication and vision loss - think? Treat?

Giant cell artertitis | High does systemic glucocorticoids

Bug responsible for tinea versicolor? Appearance? Diagnosis and tx?

Malassezia Hypo- hyper- or salmon colored lesions KOH prep and tx with topical antifungals

Pulsus paradoxus is a drop in BP during inspiration associated with (the big one?) but also?

tamponade/pericardial effusion | but also severe asthma and COPD

Rash, joint pains, kidney problems, low complement AND PATIENTS USUALLY HAVE Hep C?

cryoglobulinemia

ARDS results in these 3 big things?

Impaired gas exchange, decreased lung compliance, pHTN

Common cause of esphagitis in HIV (CD4 <100)?

candida

Fluids to give in HypOvolemic HYPERnatremia (if mild? or severe?)

Mild: D5 in 0.45 NS Severe: NS (0.9)

Why does niacin for lipid abnormalities cause itching and flushing? And to reduce it?

PG induced peripheral vasodilation | Low dose aspirin

How to diagnose PCP (pneumocystis PNA)?

NO CULTURE! so sputum stain, and if cannto get sputum, bronchoscopy with bronchoalveolar lavage

Breath sounds in lung consolidation - increased or decreased?

Increased

3rd heart sounds associated with what?

LV failure

2 nasty Cyclophosphamide side effects?

acute hemorrhagic cystitis, bladder carcinoma

Hx of gastrectomy and glossitis with anemia think??

b12 defic

Blisters and skin fragility assoc with Hep C?

Porphyria cutanea tarda

Heart finding in Lyme? | Bacterial morphology of borellia (eg. cocci, bacilli, spirochete?)

AV block | Spirochete

Spondylitis increases risk for ...?

Vertebral fractures

Marfans: complication of aortic dissection that present with early diastolic murmur?

aortic regurg

Cushings workup (two steps)?

1) cortisol test (late night saliva, 24 hr urine free cortisol or low-dose DEXAmethasone suppression test 2) If high cortisol then check ACTH levels

Dry cough, fever, high LDH, even in a non-HIV patient (but immunosuppressed eg steroids)?

PCPna

HFpEF is aka ...

Diastolic dysfunction

Vasospastic angina shows ST elevations during chest pain episodes AT REST OR DURING SLEEP, smoking risk factor - same pathopshysiology as what?

Raynaud's (hyperactvie smooth muscle)

Case control vs Retrospective cohort?

Case control knows outcome then looks at risk factors, retrospective knows risk factors then looks at outcome

Steroid therapy in SLE increases risk of what (presenting eg. as hip pain)? Best test?

ostenecrosis | MRI

Infective endocarditis - ABX?

Start with vanc then narrow - if PCN sesntive then use IV pen G or ceftriaxone (4 weeks)

Another name for the heterophile antibody test?

monospot

Microcytic anemia with hemolysis in patients with artificial heart valves think?

Macrovascular hemolysis

Both have red cell casts m but IgA nephropahty arises when compared to post-infectious glomerulonephritis? Complement levels differentiation?

Within 5 days compared to 10-21 days | Normal complement levels in IgA neph (Low C3 in postinfectious)

Fungal meningoencephalitis in HIV bug? CD4 count? Start antiviral tx?

Cryptococcus <100 2 weeks after antifungal and possible serial LP to reduce pressure

Fungal CAP, Arizona, with erythema nodosum/erythema multiform, arthralgias - bug? Tx?

Coccidioides | Healthy don't need rx, but immunocomp get ketoconazole or fluconazole

Spike in WBC to >50K with severe infx, high alk phos, high bands, no basophilia - think?

Leukemoid rxn, not leukemia

Medicine stuff Flashcards

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