Miscellaneous Flashcards
(101 cards)
1
Q
Specificity formula
A
TN over (TN + FP) *Proportion of patients who have a negative test result among all those who don't have the disease of interest
2
Q
sensitivity formula
A
- TP over (TP + FN)
* Proportion of true positives among all those who don’t have the disease of interest
3
Q
HSV genital ulcers presentation
A
painful + tender LAD + pustules, vesicles, or small ulcers on an erythematous base
4
Q
INitial workup of suspected bronchiectasis after hi res CT chest
A
Immunoglobulin quantitation, sputum culture and smear, CF testing (need to rule out reversible causes, including CVID and chronic infection)
5
Q
return to play guidelines after concussion
A
graduated return to play protocol (athletes evaluated for recurrence of symptoms while performing stepwise increases in physical activity)
6
Q
treatment of G6PD
A
avoid oxidative stressors (medications, fava beans, infection, metabolic abnormalities)
7
Q
timing of G6PD presentation
A
typically 2-4 days after an oxidatively stressful event
8
Q
C-peptide level in insulinoma
A
normal to high
9
Q
Initial workup of dyslipidemia
A
TSH (hypothyroidism is a common cause of dyslipidemia)
10
Q
Pericarditis clinical features
A
- pleuritic chest pain (worse when leaning back and improved with leaning forward)
- fever
- pericardial friction rub
11
Q
Mediastinitis clinical features
A
- typically following open heart surgery
- fever + chest pain + signs of sternal wound infection (purulent drainage)
12
Q
latent TB treatment options
A
- INH + rifapentine weekly for 3 months
- INH mono therapy for 6-9 months
- Rifampin for 4 months
13
Q
Silent brain infarcts are correlated with an increased risk of
A
dementia (vascular dementia)
14
Q
Factitious disorder
A
falsifying symptoms for the purpose of assuming the sick role
15
Q
silicosis clinical features
A
- upper lung fields
16
Q
silicosis sequela
A
- increased risk of lung cancer and active TB
17
Q
Other features of minimal change disease
A
- can be explosive-onset with heavy proteinuria
- can be following a URI
18
Q
Next step after suspected minimal change disease
A
biopsy
19
Q
Erythema multiforme clinical feature
A
- frequently after bacterial or viral infection
20
Q
holter monitor vs. loop recorder
A
- always loop recorder if very infrequent
21
Q
Midbrain stroke (Weber syndrome) clinical features
A
- ipsilateral cranial nerve III palsy
- contralateral lower facial weakness, hemiplegia
22
Q
Lateral medulla stroke (Wallenberg syndrome) clinical features
A
- ipsilateral horner syndrome
- contralateral loss of body pain and temperature
- hoarseness, dysphagia
23
Q
Medial medulla stroke clinical features
A
- ipsilateral tongue weakness
- contralateral hemiplegia
24
Q
cerebellar stroke clinical features
A
- nystagmus, ataxia, nausea, vomiting
25
localization of acute CN deficits in stroke
Brainstem (most cranial nerves originate in the brainstem + many motor and sensory fibers cross the midline in the brainstem)
26
TST interpretation in a patient with recent TB exposure
IF less than 5 mm, repeat TST in 8-12 weeks (may take a while to become positive because of immune response)
27
Management of flu outbreak in nursing homes
- prophylactic antiviral therapy for all residents (even if previously vaccinated)
28
Antibiotics for skin abscesses
- bactrim or doxy
| * not keflex (no MRSA coverage?)
29
Indications for antibiotics with skin abscesses
- greater than 2 cm
- extensive surrounding cellulitis
- systemic signs of infection
- neutropenia
- multiple abscesses
- extremes of age
30
Relation of hyperthyroidism to hypercalcemia
- thyrotoxicosis can cause parathyroid hormone-independent hypercalcemia (thyroid hormone acts on osteoclasts to increase bone turnover)
31
labs in hyperthyroid bone disease
- hypercalciuria
| - PTH is suppressed
32
Medications causing NAGMA
- carbonic anhydrase inhibitors (topiramate, acetazolamide)
- chemo (ifosfamide, cisplatin)
- antibiotics (ahminoglycosides, bactrim)
- amphotericin B
- lithium
- pentamidine
- rifampin
- inhaled toluene
33
mixed connective tissue disease clinical features
(overlap of systemic sclerosis, SLE, polymyositis)
| - swollen hands, myositis, synovitis, Raynaud's
34
Antibody associated with systemic sclerosis
- RNA polymerase II and III
| - Scl-80 and anti-topoisomerase I
35
Antibody associated with limited scleroderma
centromere
36
Antibody associated with poly and dermatomyositis (general name)
Aminoacyl-tRNA syntheses
37
Antibody associated with MPA
Myeloperoxidase
38
Antibody associated with GPA
proteinase-3
39
rhino-orbital-cerebral mucormycosis clinical features
* can also be in maxillary or orbital area
| - uncontrolled diabetic with frequent DKA
40
primary ovarian insufficiency presentation
- amenorrhea + menopausal symptoms (hot flashes, dyspareunia)
41
primary ovarian insufficiency lab features
elevated FSH + low estradiol
42
Functional hypothalamic amenorrhea clinical featrues
relative caloric deficiency (endurance athlete, etc)
43
Functional hypothalamic amenorrhea lab features
- low GnRH, FSH, estrogen
44
treatment of ascites in decompensated cirrhosis
```
high-dose spironolactone
low dose furosemide
(Oral lasix 40, aldactone 100)
*therapeutic para if refractory
*don't use IV lasix (increased risk of acute prerenal azotemia)
```
45
additional treatment of NSTEMI
- beta blockers
46
Treatment of parkinson's disease in relatively young and old people
IF severe disease OR older 65 -- levodopa, carbidopa
IF younger than 65 or mild to moderate disease -- dopamine agonists (pramipexole) (fewer motor fluctuations)
*anticholinergics if under 70 and just have a tremor
47
Other features of Cushing's syndrome
- DM2 with no FH
- proximal muscle weakness
- fungal skin infections
- amenorrhea
- hypokalemia
48
COPD step up therapy
SABA
THEN -- add LAMA (tiotropium) or LABA
THEN -- LABA + ICS
THEN - LAMA + LABA + ICS (triple therapy
49
Management of patient with high pretest for PAD but normal ABI
exercise testing with repeat ABI
50
ABI cutoff for PAD
less than 0.9
51
Cause of postoperative hyponatremia
- infusion of fluids or surgical stress-related vasopressin release
52
Treatment of sigmoid volvulus
- sigmoidoscopy
53
sigmoid volvulus radiographic features
- elderly patient + unstructured + X-ray showing large air-filled sigmoid colon with *absence of air in the rectum (due to twisted colon)
* CT with dilated sigmoid colon creating a bird beak appearance
54
How to monitor respiratory status of patients with myasthenic crisis
- serial measurements of vital capacity + maximal inspiratory (FIC)
* Intubate when VC below 20 ml per kg
55
Treatment of myasthenic crisis
plasma exchange or IVIG + high-dose steroids
56
Low fat compared to low carbohydrate diets in terms of weight loss and CV mortality
- similar long term weight loss and improvement in BP.
- low-carb diets can produce rapid weight loss and may decrease CV and all cause mortality but are associated with increased incidence of GI side effects
57
Management of bilateral renal artery stenosis
1) diuretic
2) ACE or ARB (bilateral renal ischemia induces RAAS activation)
* If failed medical therapy or recurrent flash pulmonary edema or heart failure -- renal angioplasty with stenting
58
Indication for mammography after Chest radiaion
- any patient who has chest radiation needs mammogram annually starting 8 years after radiation therapy
* annual TSH also recommended
59
Mean length of time between exposure to radiation therapy and presentation of breast cancer
15 years
60
Frequent complications of gastric bypass surgery
- stomal stenosis
- cholelithiasis
- dumping syndrome
61
Treatment of ovulatory dysfunction in subclinical hypothyroidism
- synthroid
| * ovulatory dysfunction is common in both overt and subclinical hypothyroidism
62
Treatment of ovulatory dysfunction in PCOS
- initial is weight loss
| - then clomiphene citrate (verify)
63
Presentation of migraine with brainstem aura
woman with history of migraine having migraine + brainstem symptoms (vertigo, dysarthria, ataxia, diplopia)
64
Initial step in management of migraine with brainstem aura
MRI and MR angiography (rule out posterior cerebral circulation lesions like basilar aneurysm and TIA, which can mimic symptoms)
65
Typical migraine aura symptoms
- visual -- flickering light, diagonal lines
- sensory (numbness)
- aphasia
66
Abx for suspected MRSA secondary PNA
- vanc or linezolid (preferred in hospitals where a major portion of MRSA isolates have a vanc mimimum inhibitory concentration of greater than 2)
67
Management of zoster involving face (zoster ophthalmic)
- IV acyclovir + urgent ophtho evaluation
68
Why do patients with DM2 gradually require more treatment?
- progressive insulin deficiency (patients are generally insulin resistant initially, this causes pancreatic beta cells to overproduce insulin to compensate, but beta cells eventually decline and produce less insulin)
- this is why patients gradually typically require more therapy over time to maintain glycemic control
69
Medication for antithrombotic therapy of mechanical valves
Aspirin + warfarin
70
Target INR in mechanical valves
IF no RFs -- 2-3
| IF high risk RF's -- 2.5-3.5
71
High risk features indicating higher INR in mechanical valve antithrombosis
- AF, EF less than 30%, prior thromboembolism, *mechanical mitral valve
72
Leptomeningeal carcinomatosis is
- neoplasm or metastatic disease involving brain and spinal cord
73
Cancer types in which leptomeningeal carcinomatosis occurs
- breast, lung, melanoma
| * same cancer types associated with brain mets
74
m avium treatment
- macrolides, ethambutol, rifamycins
75
Typical setting + presentation + cause of refeeding syndrome
- refeeding or giving D5-containing fluids to nutritionally depleted individuals
- new onset weakness
- severe hypophosphatemia
76
Work up of gastroparesis
- first step always EGD to rule out mechanical or mucosal causes
* definition of gastroparesis requires proving delayed gastric emptying in the *absence of obstruction*
77
Chronic Subdural hematoma clinical features
- elderly patient --> (history of falls and alcohol abuse) --> new confusion + headache + focal weakness + lethargy
78
Indications for aldosterone antagonists
1) Post STEMI with LVEF less than 40% + symptomatic or DM2
| 2) NYHA class II to IV heart failure with EF less than 35%
79
When to avoid aldosterone antagonists in heart failure patients
- creatinine clearance less than 30
| - K greater than 5
80
Initial step in management of insomnia
2 week sleep diary
81
Pathogens necessitating catheter removal in CLABSI
- pseudomonas
- staph aureus
- fungi
82
Cancer which Klinefelter's syndrome patients are at risk for
- breast cancer
83
Treatment of hypothyroidism in celiac disease
- increasingly high synthroid requirements (malabsorption of levothyroxine)
84
Management of thyroid strom
Initial treatment: beta-blocker + PTU
| Subsequently: steroids (given afterward to inhibit peripheral T4 to T3 conversion)
85
Management of patient with new diagnosis of AF and RVR following cardioversion
- still need anti arrhythmic therapy
86
Preferred antiarrhythmic drugs in patients with AF
IF no CAD or structural heart disease -- flecainide or propafenone
IF LVH -- amiodarone
IF CAD without heart failure -- sotalol or dronedarone
IF heart failure -- amio
87
Gilbert's syndrome presentation
- asymptomatic + isolated unconjugated hyperbilirubinemia typically after hemolysis or infection or medication use
88
Clinical + pathologic features of weakness from colchicine
- symmetry myopathy
| - cytoplasmic vacuolization
89
papillary muscle rupture presentation with acute MR
- sudden onset hypotension + pulmonary edema
| - systolic murmur
90
LV free wall rupture presentation
- tamponade + chest pain + PROFOUND shock + rapid progression to PEA and death
91
Ventricular septal rupture vs. acute MR after STEMI
* based on murmur
- septal rupture = loud holosystolic murmur at left lower sternal border
- MR = systolic murmur at apex
- (both can present with hypotension and CHF)
92
Presentation of phenytoin toxicity
- nystagmus, ataxia, slurred speech, mental status changes
93
Unique SE of omeprazole as opposed to other PPIs
- inhibits P450, leading to increased serum phenytoin levels
94
medical term for charcot joint
diabetic neuropathic arthropathy
95
charcot joint presentation
diabetic patient + foot or ankle erythema, warmth, swelling + often looks septic but is not
(its progressive bony and soft tissue destruction that leads to joint dislocation and deformities)
96
treatment of charcot joint
- casting, avoid weight bearing
97
Retroperitoneal fibrosis clinical features
- low back, flank pain
- CKD due to perioartic fibrosis
* ureteral obstruction without ureteral dilation
98
Malaria clinical features
- acute febrile illness + anemia + splenomegaly + jaundice
99
tertiary syphilis features
- sensory ataxia
- lancinating pains
- argyll robertson pupil
- cardiovascular syphilis
100
physiology of pseudothrombocytopenia
EDTA-induced platelet clumping
101
Management of nocturnal angina
- work up for OSA
