MKSAP 5 Flashcards
(276 cards)
1
Q
What is the recommended treatment for peritonsillar abscess?
A
- Amoxicillin-sulbactam OR
- Parenteral Penicillin G + Metronidazol
* Clindamycin for penicillin allergic
2
Q
Treatment of RMSF?
A
Doxycycline
3
Q
What is familial Mediterranean fever? & 5 features
A
Autosomal recessive disorder in pts of jewish, turkish, arabic or armenian, 95% present before age 20, features: 1. 1-3 day periods of fever 2. serositis 3. abdominal pain 4. pleuritis 5. synovitis also see elevated ESR & leukocytosis
4
Q
what drugs cause neuroleptic malignant syndrome?
A
- haloperidol & fluphenazine msot common
- all drugs that cause central dopamine receptor blockade
- occurs within 2 weeks of initiating the drug
5
Q
what drugs cause malignant hyperthermia?
A
exposure to volatile inhalation anesthetics (halothane, isoflurane, enflurane, desflurane, etc) and the depolarizing muscle relaxants succinylchoine and decamethonium
6
Q
what is malignant hyperthermia?
A
inherited skeletal muscle disorder that leads to a hypermetabolic state when exposed to gas anesthetics and mm relaxants
7
Q
when should you use activated protein C in pts sepsis?
A
when sepsis is severe and APACHE score >25
8
Q
what is a relative contraindication for administering activated protein c in pts w severe sepsis?
A
platelet count <30,000
9
Q
what virus is the most common cause of pharyngitis?
A
rhinovirus
10
Q
what is Lemierre syndrome?
A
septic thrombophlebitis of the internal jugular vein, unilateral neck swelling
- caused by fusobacterium necrophorum (also increasing cause of pharyngitis in adolescents)
11
Q
Sensitivity and specificity for GABHS pharyngitis RADT?
A
sensitivity = 80-90% specificity = 95%
12
Q
treatment of strep pharyngitis?
A
10 day course of penicillin or erythromycin if allergic
13
Q
what are the 3 diagnostic criteria for bacterial sinusitis?
A
- Symptoms lasting >7 days
- Facial Pain
- Purulent nasal discharge
(should have >2)
14
Q
First line agents for bacterial sinusitis?
A
- Amoxicillin
- Doxycyline
- TMP-SMX
15
Q
Sensitivity & Specificity of tympanic membrane immobility in otitis media?
A
Sens: 89%
Specificity: 80%
16
Q
what are the centor criteria? (4)
A
- Fever
- Tonsillar exudates
- Tender anterior cervical lymphadenopathy
- Absence of cough
- used to diagnose GABH strep pharyngitis, 0-1 = no RADT or tx, 2 = RADT then tx, 3-4= neg RADT, obtain throat clx
17
Q
how do u treat asymptomatic bacteriuria in a pregnant woman?
A
ampicillin
or amoxicillin or nitrofurantoin
18
Q
how do you treat recurrent UTIs in an otherwise young, healthy woman?
A
TMP-SMX 180-800mg BID for three days when symptoms occur
19
Q
how do you cover for both gonorrhea and chlamydia?
A
Ceftriaxone + either doxycycline or asithromycin
20
Q
How does disseminated gonococcal infection present? tx?
A
- may cause septic or sterile immune mediated arthritis and tenosynovitis and frequently involves the knees, hips and wrists
- Dermatitis = sparse peripheral necrotic pustules
- tx = ceftriaxone (or 3rd gen ceph)
21
Q
when do you add corticosteroids to TMP-SMX for the treatment of PJP PNA in pts w HIV?
A
when theres evidence of hypoxia:
- arterial PO2 35mmHg
22
Q
Symptoms of prosthetic joint infection?
A
paid can be the only sx! fever and leukocytosis are frequently absent
23
Q
what do you use to treat diabetic nephropathy?
A
ACE inhibitor (or ARBs)- lower blood pressure, decrease proteinuria, and slow disease progression
24
Q
how is VRE transmitted??
A
via direct contact
25
what are 3 airborne bugs? ie airborne precautions (not just droplet)
1. TB
2. Measles
3. Varicella
26
what are the Rome III criteria for IBS?
1. Pain relieved w defecation
2. Onset assoc with change in stool frequency
3. Onset assoc w change in the consistency of the stool
* requires at leads 2 occurring for 3 months in a 12 mos period
27
metformin is contraindicated in what pts?
pts with renal insufficiency: Cr >1.4 women and >1.5 men
28
when should pts with IBD initiate screening for colorectal cancer?
after 8 years disease duration
29
how do you confirm the diagnosis of patellofemoral pain syndrome?
reproducing the pain by firmly moving the patella along the femur
30
what is patellofemoral pain syndrome?
most common cause of chronic knee pain in active adults
- pain by going down stairs
- knee stiffness and pain at rest when knee is flexed for a while
31
How do you diagnose PCOS? (must have 2 of 3 features)
1. Ovulatory dysfunction
2. Laboratory or clinical evidence of hyperandrogenism
3. US evidence of polycystic ovaries
32
what lab values do you see in PCOS?
- Increased testosterone (rarely greater than 150 though) and dehydroepiandorsterone
- LH: FSH > 2:1
33
what are the 4 symptoms of drug induced lung toxicity?
1. Fatigue
2. Low-grade fever
3. Cough
4. Peripheral eosinophilia
34
why does alcohol intoxication lead to rhabdo?
hypyophosphatemia
35
besides the liver, what else releases AST?
heart and skeletal muscle
36
what do you see on peripheral blood smear in a pt with HUS?
schistocytes
37
ICD therapy is indicated in what type of pts?
- left ventricular ejection fraction less than 35%
38
what do you see on radiograph of Rheumatoid arthritis?
erosions of cartilage and bone and joint space narrowing
39
elevated rheumatoid factor is increased in RA and what else?
most notably Hepatitis C (and other autoimmune disorders and infections)
40
what kind of pleural effusion does TB present with?
- lymphocyte predominant
| - exudative effusion
41
treatment of inflammatory cystic and pustular acne?
oral antibiotics
42
When using NPPV in COPD exacerbation, who is a candidate?
1. Pts with moderate to severe dyspnea
2. Use of accessory respiratory muscles
3. Respiration rate greater than 25/min
4. pH less than 7.35 with Pco2 greater than 45mmHg
43
what are the contraindications to using NPPV in COPD exacerbation?
1. Impending respiratory arrest
2. Cardiovascular instability
3. AMS
4. High aspiration risk
5. Production of copious secretions
6. Extreme obesity
7. Surgery/trauma/deformity of the face or upper airway
44
what is the first line therapy for induciton and maintenance of remission in mild to moderate ulcerative colitis? MOA?
Mesalamine: 5-ASA, anti-inflammatory drug that's gut specific
45
what improves mortality in patients with hypoxic COPD?
continuous oxygen therapy (min of 15hrs/day)
46
when is an MRI indicated in a pt with a herniated lumbar disk?
1. evidence of motor impairment
2. No response to therapy
3. Symptoms increasing
47
at what BNP level would you suspect acute heart failure?
BNP >100
48
what's the common presentation of platelet related bleeding disorder?
- occurs immediately after injury
| - effects the mucous membranes or skin ie petechiae
49
whats the common presentation of coagulation related bleeding disorder?
- delay in onset
- deep tissue bruises: ecchymoses
- hemarthroses
50
what antibodies are found in antiphospholipid antibody syndrome?
anticardiolipin antibody or lupus inhibitor assay
51
how soon does acute dystonia reactions occur in pts starting neuroleptics/antiemetics/serotoninergics?
usually occurs within 5 days
52
What are three drugs you can use to treat acute dystonia?
1. Diphenhydramine
2. Benztropine mesylate
3. Biperiden
53
c-ANCA and anti-proteinase-2 antibodies
Wegener's granulomatosis
54
in compensated metabolic alkalosis, for ever 1 meq/L increase in serum bicarb, the Pco2 is expected to increase by what?
0.7mmHg
55
how do you calculate the anion gap?
Na- (Cl + Bicarb)
| normal anion gap <12 +-2
56
what is the MOA of bisphosphonates?
theyre pyrophosphate derivatives that bind to the bone surface and inhibit osteoclastic bone resorption
57
when should you start tx with high dose corticosteroids in pts with SLE?
when theres a strong suspicion for lupus nephritis
58
what physical exam finding suggests anserine bursitis?
focal tenderness o the upper inner tibia about 5cm distal to the medial articular line of the knee
59
treatment of anserine bursitis?
corticosteroid injection at the bursal site
60
what labs could you see in RMSF?
1. Thrombocytopenia
2. Relative Leukopenia
3. Elevated Transaminases
61
what does A flutter look like on EKG?
saw-tooth pattern in the inferior leads II, III, aVF
62
what is the classic triad of acute anterior uveitis?
1. Pain
2. Sensitivity to light
3. Blurred vision
63
what infection is most commonly associated with DIC?
gram negative sepsis
64
What is the first line tx for limited stage SCLC?
Chemotherapy: platinum agent (carboplatin or cisplatin) and etoposide or irinotecan
RT
65
whats the mechanism behind hypocalcemia in acute gallstone pancreatitis?
- generates free fatty acids that avidly chelate insoluble calcium salts in the pancreatic bed = saponification
66
in pts who have had a TIA or stroke, what is the LDL cholesterol goal?
<100mg/dL
| The goal in CAD equivalent diseases
67
when should a person receive the pneumococcal dose and how often?
If pt is before the age of 65 when they receive their first pneumococcal vaccine, then they should receive a one-time revaccination dose 5 years after the first dose
68
what are anti-cyclic citrullinated peptide antibodies?
highly specific for rheumatoud arthritis
69
treatment of an acute pseudogout attack?
NSAIDs but corticosteroids or colchicine would be appropriate alternative choices
70
What types of pts benefit from antibiotics during a COPD exacerbation?
1. Pts with severe COPD exacerbations
2. On mechanical ventilation
3. Moderate-Severe COPD exacerbation characterized by increased: dyspnea, sputum volume/purulence, or need for hospitalization
71
What is Long QT Syndrome?
- congenital or acquired
- sx = syncope and cardiac arrest due to torsades de pointes v tach
- Risk factors = female, hypokalemia, hypomagnesemia, structural heart disease, previous QT interval prolongation, and hx of drug induced arrhythmia
72
how does hypercalcemia occur in sarcoidosis? tx?
- activated macrophages in granuloma tissue cause unregulated production of 1alpha hydroxylase activity
- this increases the production of 1,25 vit D -> increased GI absorption of Ca
tx: Corticosteroids via decreasing the number of activated macrophages
73
Pneumonia + GI symptoms + Hyponatremia
Legionella
74
What are the two types of diabetic retinopathy?
1. Nonproliferative: ie hard exudates, microaneurysms, and minor hemorrhages- not assoc w vision loss
2. Proliferative: cotton wool spots & neovascularization- assoc w vision loss
75
how do you save vision in diabetic retinopathy?
Laser photocoagulation
76
How does microscopic colitis present?
- nonbloody diarrhea
- colonoscopy shows normal mucosa macroscopically
- microscopically shows increased intraepithelial lymphocytes
77
what is the first line medication for essential tremor?
propanolol
78
when can the screening interval of pap smears be increased to every 3 years?
women older than 30 with three previous normal annual pap smears
79
What are the characteristics of MGUS?
1. Low serum monoclonal protein (M-protein) <3.0 grams
2. Less than 10% plasma cells in bone marrow
3. Absence of lytic bone lesions, anemia, hypercalcemia, or renal insufficiency
* the higher the M protein level, the greater the risk
80
What is AL Amyloidosis?
- monoclonal plasma cell dyscrasia in which secreted immunoglobulin is deposited as fibrils in the kidneys, heart, and peripheral nerves
- detection of monoclonal immunoglobulin in serum, blood or tissues differentiates AL from other forms of amyloidosis
81
What is lymphoplasmacytic lymphoma?
associated with a monoclonal serum paraprotein of IgM (waldenstrom's macroglobulinemia) not IgG
82
What are the confirmatory tests for SLE?
1. Anti-doublestranded DNA antibody testing (specificity 75-100%)
2. Complement levels of C3, C4 and total hemolytic compliment CH50
83
in pts w SLE, a positive anti-SS-A antibody is associated with what?
subacute cutaneous lupus erythematosus
84
Anti-SSA and anti-SSB?
Sjogrens syndrome
85
Positive rheumatoid factor could mean what? (3 things)
1. SLE
2. RA
3. Chronic infections: including chronic active hepatitis C virus infection
86
Muddy brown casts on urinalysis?
Acute tubular necrosis
87
What drugs are commonly known to cause Acute tubular necrosis? (3)
1. Cisplatin
2. IV Aminoglycosides (tobramycin)
3. Radiocontrast
88
Physical Manifestations of Acute interstitial Nephritis? (4)
- Rash
- Pruritis
- Eosinophilia
- Fever
89
UA of Acute Interstitial Nephritis shows what? (4)
1. Pyuria
2. Leukocyte casts
3. Microscopic hematuria
4. Tubular-range proteinuria
90
When do you do a methacholine challenge in pts?
- suspected asthma who have episodic symptoms and normal baseline spirometry (metacholine induces bronchoconstriction)
91
False positive methacholine tests are seen in what 5 populations?
1. Allergic Rhinitis
2. COPD
3. CHF
4. CF
5. Bronchitis
92
When should you initiate prophylactic meds in pts with migraines? What meds are these?
- Pts who experience >2 migraines per week
- Use propanolol, topiramate, valproic acid, amitriptyline, metoprolol, timolol, and extract from the plant Butterbur root
93
What extract can be used in migraine prophylaxis?
Butterbur rootPetasites hybridus
94
The presence of what is associated with an increased risk of ILD in pts w dermatomyositis/polymyositis?
Presence of Anti-Jo-1 antibodies
| * ILD is one of the leading causes of death in these pts
95
How do you diagnose radiation proctitis?
= endoscopic findings of mucosal telangiectasia
| - biopsy shows submucosal fibrosis and arteriole endarteritis
96
What is radiation proctitis?
- occurs in pts receiving pelvic radiation
- acute = within 6 weeks of therapy
- sx = diarrhea and tenesmus
- proctitis is due to direct radiation injury to the rectal mucosal, resolves when therapy is dc'd
- chronic proctitis = months to years after and assoc w worse prognosis
97
what is the initial treatment of idiopathic DVT (or dvt w a transient risk factor)?
1. Immediate acting anticoagulant such as unfractionated heparin, LMW heparin, or fondaparinux for ~5 days
2. Plus Warfarin (usually 5mg)
- overlap drugs until INR reaches therapeutic range >2 measured on 2 occasions approximately 24 hours apart
98
What are the contraindications to giving the zoster vaccine?
1. Pts with active, untreated TB
2. Pregnant women
3. Immunocompromised patients
4. Pts receiving chemo, radiation therapy, or large doses of corticosteroids
5. Pt living w an immunocompromised person
99
What is the classic triad of thrombotic thrombocytopenic purpura?
1. Microangiopathic hemolytic anemia
2. Thrombocytopenia with normal coagulation
3. CNS Symptoms
100
What lab values do u see in microangiopathic hemolytic anemia?
1. Schistocytes (erythrocyte fragments) on peripheraml smear
2. Reticulocytosis
3. Elevated LDH level
101
What pt populations are assoc with Listeria monocytogenes meningitis?
1. Extremes of age (neonates and pts >50)
2. Alcoholism
3. Malignancy
4. Immunosuppression
5. Diabetes
6. Hepatic and renal failure
7. Iron overload
8. Collagen Vascular diseases
9. HIV Infection
102
what is the response to vasopressin in pts with central versus nephrogenic DI?
In CDI- urine osmol will increase and volume will decrease
| NDI: no effect of vasopressin
103
Medications used to treat nephrogenic DI?
1. Hydrochorothiazide
2. Amiloride
3. Prostaglandin inhibitors ie NSAIDs (indomethacin)
104
3 Causes of Acromegaly? aka overproduction of GH
1. Pituitary adenoma (most common)
2. Lymphoma (rare, ectopic production of GH or GHRH)
3. Bronchial Carcinoid: rare, ectopic production of GH or GHRH
105
what are the best initial and most accurate tests done to diagnose acromegaly?
Best initial: IGF-1 levels
| Most Accurate: glucose suppression test, normally glucose should suppress growth hormone levels
106
3 Medications used to tx Acromegaly? MOA?
1. Cabergoline: DA agonist inhibits GH release
2. Octreotide: Somatostatin inhibits GH release
3. Pegvisomant: GH receptor antagonist, inhibits IGF release from livver
107
What calcium channel blocker raises prolactin level?
verapamil
108
What 6 medications cause hyperprolactinemia?
1. Antipsychotics
2. Methyldopa
3. Metoclopromide
4. Opioids
5. TCAs
6. Verapamil
109
what medication can cause hypothyroid?
Amiodarone
110
Why is propanolol used in acute hyperthyroidism/thyroid storm?
- blocks target organ effects by inhibiting peripheral conversion of T4 -> T3
111
whats the best initial treatment for pts w graves ophthalmopathy?
steroids!
112
What is the MOA of thiourea drugs? major side effect?
aka methimazole (preferred) & PTU
- blocks thyroid hormone production via inhibiting thyroperoxidase
- SE = agranulocytosis
113
when do you biopsy a thyroid nodule?
When thyroid nodules >1cm and there is normal thyroid function
114
how does hypercalcemia present cardiovascularly?
short QT syndrome
| hypertension
115
why do you get peptic ulcers in hyperparathyroidism?
bc calcium stimulates gastrin release
116
what are the best initial tests for the presence of hypercortisolism?
1. 24-hour urine cortisol (more specific)
| 2. if thats not the answer, then: 1mg overnight dexamethasone suppression test
117
what can cause a false positive 1 mg dexamethasone suppression test?
1. Depression
2. Alcohol
3. Obesity
118
what are common causes of Addison disease? (4)
1. Autoimmune destruction of the gland (80%)
2. Infection (TB)
3. Adrenoleukodystrophy
4. Metastatic cancer to the adrenal gland
119
What electrolyte abnormalities do you see in Addison disease?
1. Hyponatremia
| 2. Hyperkalemia
120
What two rashes do NOT spare the nasolabial folds?
1. Rosacea
| 2. Seborrheic dermatitis
121
what are gottron papules?
purplish plaques on the dorsal hands, more prominent over the joints
- seen in dermatomyositis
122
what 3 antibodies are seen in autoimmune hepatitis?
1. ANA
2. Anti-smooth muscle ab
3. Anti-LKM1 (liver kidney microsome type 1)
123
pt has an incidental finding of adrenal adenoma- what two tests should you get?
1. Plasma metanephrines
| 2. Overnight dexamethasone suppression test
124
what is rhinophyma?
the presence of a bulbous, red nose - variant of rosacea
125
vertebral osteomyelitis: most common bug?
staph aureus, but must send for blood cultures before treating!
126
When is antibiotic endocarditis prophylaxis recommended?
1. Prosthetic cardiac valves
2. Hx of prior infective endocarditis
3. cardiac transplant recipients with known valve abnormalities
4. Unrepaired congenital cyanotic heart diseases
5. Complex congenital heart disease with residual abnormalities
127
when is it appropriate to obtain an endometrial biopsy?
- in pts older than 35yrs with abnormal uterine bleeding
128
what test do you do in a pt with renal dysfunction who has a high probability of PE?
VQ scan (avoid the contrast of CT angio)
129
what are the HR ranges for :
1. V tach
2. Torsades
3. V Fibb
1. V tach: 140-250bpm
2. Torsades: 200-300bpm
3. V Fibb: >300bpm
130
Sudden development of hypophosphatemia causes what 4 symptoms?
1. Confusion
2. Rhabdomyolysys
3. Hemolytic anemia
4. Severe muscle weakness (can lead to resp failure)
131
What is the classic triad of TTP? pentad?
1. Microangiopathic hemolytic anemia (schistocytes or erythrocyte fragments)
2. Thrombocytopenia w normal coagulation
3. CNS symptoms
pentad includes
- fever
- renal failure
132
what deficiency is seen in TTP?
ADAMTS13
133
what is Evans syndrome?
Combination of
1. Coombs positive warm autoimmune hemolytic anemia- microspherocytes on smear
2. ITP
134
what is the progression of treatment in OA?
1. Acetaminophen->
2. NSAIDs: ibuprofen ->
3. Intra-articular corticosteroid or hyaluronan injections
135
symptoms of multiple myeloma? 6
1. Hypercalcemia
2. Diffuse Osteopenia
3. Anemia
4. Leukopenia
5. Renal insufficiency
6. Hx of encapsulated organism related pneumonia
136
conversion of IV to oral morphine?
multiple by 3- 10mg of IV = 30mg PO
137
what is orthostatic proteinuria and what is it associated with??
- increase in urinary protein excretion only in the upright position
- mostly seen in young adults, UA is otherwise normal, benign condition, resolves spontaneously
- Associated with Nutcracker syndrome: entrapment of the left renal vein between the aorta and SMA
138
Contraindications to estrogen replacement therapy in postmenopausal women?
1. Undiagnosed vaginal bleeding
2. Breast ca or other hormone sensitive cancers
3. Hx of venous/arterial thrombosus
4. Liver dysfunction or disease
139
treatment of graves??
1. Methimazole (fewer side effects than PTU)
| 2. Atenolol (tachy)
140
what meds are used in the treatment of acute gout attacks?
1. Indomethacin (NSAIDs)
2. Colchicine (most effective w/in 24hrs of onset)
3. Steroids
141
What meds are used for pts who have recurrent gout attacks/uric acid tophi/renalstones?
1. Allopurinol
2. Febuxostat
- xanthine oxidase inhibitors reducing uric acid levels
142
one strange use of morphine?!?!
- effective in treating cancer-related dyspnea and end stage cardioplmonary disorders
143
severe explosive psoriasis in a young adult
think HIV, cd4 usually less than 200
144
new onset back pain and fever
think vertebral osteomyelitis: get a MRI of spine, will also see elevated ESR
145
What are cameron lesions?
linear gastric ulcers or erosions in the hiatal hernia sac, usually an incidental finding but some can cause chronic/acute blood loss
146
dark blue or black berry-like lesion that are mostly symmetric, elevated and one color
nodular melanoma
147
what is podophyllin?
powder made from the american mayapple used against HPV induced genital wards bc it contains antiwart lignans: antimitotic agent that leads to cell death
SE: enteritis and severe depression, teratogenic
148
what is the MOA of glucocorticoids used in epidural spinal cord compression (usually from malignancy)?
- decrease vasogenic edema (caused by obstructed epidural venous plexus)
- this helps alleviate pain and restore neurologic function
149
How does dipyridamole work in a stress test to diagnose ischemic heart disease?
- its a coronary vasodilator
- infusion into a non CAD pt increases coronary BF 3-5x above baseline
- in a pt w CAD, the diseased vessels distal to the obstruction are already maximally dilated and their ability to increase myocardial perfusion is limited
- redistribution of coronary BF to non diseased areas occurs and the perfusion of diseased segments diminishes = coronary steal phenomenon
150
what is aspirin sensitivity syndrome?
- pseudo-allergic reaction
- ASA induced prostaglandin/leukotriene misbalance (via COX inhibition) leading to nasal polyps and bronchoconstriction
- tx: leukotriene receptor antagonists
151
Signs of cardiac tamponade? 4
1. JVD
2. Distant heart sounds
3. Pulsus paradoxus
4. Hypotension
152
What's CHADS2?
```
calculates risk of having a stroke or thromboembolic event
CHF
HTN
Age >75
DM
Stroke or TIA hx
```
153
Management of CHADS2 score of:
0
1
2
```
0 = no anticoagulation
1= anticoagulation>ASA
2-6 = Anticoagulation
```
154
what cardiac problem can cause hemoptysis?
mitral stenosis/acute pulmonary edema
155
What 3 systemic diseases can cause hemoptysis?
1. Wegener's granulomatosis
2. Goodpasture's syndrome
3. SLE: vasculitis
156
whats the difference between bronchiectasis and chronic bronchitis?
bronchiectasis is more likely associated with a hx of recurrent resp tract infections and chronic cough with daily production of copious mucopurulent sputum
157
what drug should be used to slow progression of diabetic neuropathy?
ACE inhibitors: reduces urinary albumin excretion and the decline in Cr clearance
158
what is the MOA of Theophylline?
methylxanthine phosphodiesterase inhibitor that causes bronchodilation
159
What are the 4 most common causes of priapism?
1. Sickle cell disease and leukemia: children and adolescents
2. Perineal or genital trauma: results in laceration of the cavernous artery
3. Neurogenic lesions: spinal cord injury, cauda equina compression
4. Medications: trazadone and prazosin
160
What is the Hawthorne effect?
study bias:
the tendency of a study population to affect the outcome because they are aware that they are being studied leading to a conscious change in behavior
161
what is empyema? tx?
- intrapleural collection of pus (purulent pleural effusion)
- bacterial seeding of a parapneumonic effusion in the setting of bacterial pneumonia
tx: drainage and abx
162
What is Hamptom's hump?
a wedge shaped opacity in the infarcted segment of the lung (in pulmonary infarction)
163
what is the pathophys behind membranoproliferative glomerulonephritis?
1. caused by IgG antibodies (termed C3 nephritic factor) directed against C3 convertase of the alternative complement pathway-> leads to persistent complement activation and kidney damage
164
Anti-GBM antibodies?
Goodpasture's syndrome
165
what is presbycusis?
sensorineural hearing loss that occurs in adults with advanced age
166
What are the contraindications of radioactive iodine treatment?
1. Pregnancy
| 2. Very severe ophthalmopathy
167
what is pulsus paradoxus?
an exaggerated decrease (>10mmHg) in the systemic arterial blood pressure with inspiration
- seen in cardiac tamponade
168
what disorder is associated with warfarin-induced skin necrosis?
protein c deficiency
169
tx of warfarin induced skin necrosis?
vitamin K!
170
what is the usual cause of renal artery stenosis in young adults?
fibromuscular dysplasia
171
what is the definitive diagnosis of Wegener's (granulomatosis with polyangiitis?
biopsy from site of active disease (nasopharyngea)
172
what is the most common malignant tumor of the eyelid?
Basal cell carcinoma (and most common malignancy of mankind)
| - specifically on lower eyelid
173
how do you describe basal cell carcinoma?
slow growing nodules with a pearly quality and a rolled border
174
what arrhythmia is most specific for digoxin toxicity?
Atrial tachycardia with AV block
175
how can dihydropyridine CCBs be harmful in STEMI?
they are contraindicated in STEMI bc they cause vasodilation and reflex tachycardia which ca worse cardiac ischemia
176
when does heparin induced thrombocytopenia/thrombosis present?
5-10 days after initiation of heparin therapy
| *however if pt recently exposed to heparin the onset of HIT may be ~10 hours
177
After pregnancy is excluded, the initial evaluation of secondary amenorrhea includes what 3 labs?
1. FSH (>20 suggests ovarian failure)
2. TSH
3. Prolactin
178
treatment of toxoplasmosis in HIV pt?
Sulfadiazine plus pyrimethamine and folinic acid
179
how does one diagnose polycythemia vera?
1. Hct >60% in males or >56% in women in the absence of secondary causes
2. Presence of splenomegaly
- JAK2 mutation present in 95% of patients
180
what are the 3 criteria for diagnosing pericarditis? (must have 2/3)
1. Pleuritic chest pain
2. Friction rub
3. Diffuse concordant ST segment elevation on ECG
181
how should you interpret the results of a TB test in a pt who received the BCG vaccine?
with the same criteria as those who didnt receive it
182
who do you give prophylactic INH for 0 months
1. Pt who use prednisone (>15mg) or any other immunosuppressive agent
2. Who have 5mm or more of induration on TB testing
183
What are the cutoffs for a + TB test?
1. 5mm = in pts at high risk (HIV, immunosupp, close contact, cxr consistent w/ prior, those taking prednisone)
2. 10mm= those who have immigrated to the US from high risk countries in the past 5 years, IV drug users, prisoners, health care workers, pt with silicosis, DB, cancers
3. 15mm = low risk pts
184
tx of choice for trochanteric bursitis?
corticosteroid injections
185
what 4 patient populations do you treat salmonella gastroenteritis?
1. 50 yrs
2. Severe illness requiring hospitalization
3. Known or suspected atherosclerotic plaques or endovascular or bone prostheses because of seeding of salmonellae
4. Immunocompromised
186
what is the most predictive risk factor for osteoporosis in women?
weight below 70kg (154 lbs)
187
who gets the pneumococcal vaccine before the age of 65?? (4 populations)
1. Live in long term care facilities
2. Have chronic illnesses
3. Who are Alaskan natives or American Indians
188
what is the only drug approved by the FDA as first line tx of moderate to advanced Alzheimer dementia?
Memantine: N methyl d aspartate receptor antagonist
| - improves cognition and global assessment of dementia
189
what drugs cause drug induced lupus? how does the presentation differ from SLE?
- TNF-alpha inhibitors cause it (infliximab)
| - Presentation is similar, mainly cutaneous and pleurocardial involvement (renal and neurologic are extremely rare)
190
definitive diagnosis of polyarteritis nodosa?
sural nerve biopsy or kidney angiography
191
what does kidney angiography show in polyarteritis nodosa?
microaneurysms or a beaded pattern with areas of arterial narrowing and dilation
192
serum ferritin levels lower than ___ to ___ may reflect iron deficiency anemia in pts with inflammatory states
100-120ug/L
193
when a primary percutaneous coronary intervention lab is not available, what should you do in the case of STEMI?
- thrombolytic agents within 12 hours after the onset of the chest pain
194
What drugs can cause toxic epidermal necrolysis (TEN)?
1. Sulfonamides
2. Barbiturates
3. Phenytoin
4. NSAIDs
195
what is the difference between toxic epidermal necrolysis and SJS?
SJS = 30% of body surface involved
196
what is a common finding in exfoliative dermatitis?
gynecomastia
197
Tamoxifen has been shown to increase the risk of what two types of uterine cancers?
1. Endometrial
| 2. Uterine sarcoma
198
what does disseminated gonococcal infection look like? aka triad
1. Tenosynovitis
2. Dermatitis (vesiculopustular, few in #, rarely involves face)
3. Migratory asymmetric polyarthralgias
199
Describe the characteristics of V tach?
widened QRS complex and a ventricular rate that is greater than 100/min
200
When should you drain a parapneumonic effusion via chest tube?
1. Loculated pleural fluid
2. Pleural pH 1000
5. + Gram stain
6. Gross pus observed in the pleural space
201
what types of heart block should you put in a pacemaker?
1. Intermittent 3rd degree
2. Type II AV block
3. Alternating bundle branch block
202
When should you initiate corticosteroids in a pt with ITP?
who have symptomatic bleeding and platelet counts below 50,000 or those with severe thrombocytopenia and platelet counts below 15,000
203
What are the EKG findings of Wolff-Parkinson White Syndrome?
- short PR interval
- delta wave
- tachycardia
204
how do you administer insulin in a pt with DKA?
insulin drip
205
At what triglyceride level would you be concerned about hypertrigliceridemic pancreatitis?
>1,000mg/dL
206
what lab results will you see in von willebrand disease?
1. Prolonged bleeding time
2. A borderline elevated aPTT
3. A low factor VIII level
207
inheritance of von willebrands disease?
autosomal dominant
208
what is the function of von willebrands factor??
supports platelet adhesion and serves as a carrier protein for factor VIII
209
How do you diagnose antiphospholipid antibody syndrome?
- hx of thrombotic event (including recurrent fetal loss) w/:
- persistent lupus anticoagulant or
- elevated levels of IgG anticardiolipin or B2 glycoprotein I antibodies
210
what 3 drugs are associated with antiphospholipid antibody syndrome?
1. Hydralazine
2. Procainamide
3. Phenothiazines
211
What do factor V leiden mutation and prothrombin G20210A mutation lead to?
1. Factor V Leiden: resistance to activated protein C
| 2. Prothrombin G20210A: increase in prothrombin antigen and activity by ~30%
212
In patients with nonvalvular AFibb, what is the target INR with warfarin?
INR 2.0-3.0
213
how do you know when to start a pt w a fibb on anticoagulation?
```
use CHADS2!!
CHF
HTN
Age >75
DM
Stroke/TIA
```
score 0 = no anticoag
score 1-2 = assessed on individual ASA vs warfarin
score >3 w hx stroke/TIA = anticoag w warfarin
score 6 = warfarin!!
214
what med is used to tx malignancy related hyperuricemia to prevent tumor lysis syndrome?
rasburicase
215
MOA of Acetazolamide and metabolic/electrolyte side effects?
- acts in PT as a carbonic anhydrase IV inhibitor
- this impairs bicarbonate reabsorption but not diluting capacity
- SE: Hypokalemia and metabolic acidosis
216
how does lyme carditis present?
- acute onset, high grade (grade III) atrioventricular conduction defects
- may be assoc w myocarditis
217
difference between mobitz type I and type II av block?
- Mobitz type I (Wenckebach): Progressive PR intervals until a dropped beat, does not progress to complete heart block
- Mobitz type II: a dropped beat without progressive PR interval prolongation, usually assoc w a BBB, typicall progresses to third degree heart block
218
first line treatment for tx postmenopausal women with osteoporosis?
Bisphosphonates-
1. Alendronate & Risedronate: reduce risk of fractures, but can aggrevate GERD, so then use:
2. Once yearly IV Zoledronate (or use if contraindicated)
219
Contraindications to oral bisphosphonates?
1. Esophageal stricture
| 2. Achalasia
220
What is teriparatide and when is it used?
- Recombinant human PTH is reserved for treating patients at high risk of fracture ie those with a T score below -3.0 with a hx of vertebral fracture and contraindications to hisphosphonate use
221
Calcitonin levels are elevated in what to patient populations?
1. Medullary thyroid cancer
| 2. C-cell hyperplasia (bc secreted by parafollicular C cells)
222
what is the imaging modality of choice for diagnosing nephrolithiasis?
noncontrast helical abdominal CT
223
uric acid stones are related to use of what drug?
idinavir
224
what are the 3 criteria for initiating treatment of hyperuricemia in a pt with symptomatic gout?
1. Presence of tophi or renal stones
2. Multiple attacks of acute gout
3. Hx of decreasing time period between gout attacks
225
what 2 medications raise uric acid levels?
1. Thiazide diuretics
| 2. low-dose salicylates
226
what's assoc with anti-cyclic citrullinated peptide antibodies?
rheumatoid arthritis
227
epiric therapy of acute bacterial meningitis in an older adult should include what 3 abx?
1. Third generation cephalosporin
2. Vancomycin
3. Ampicillin
228
what is the primary cause of morbidity in pts w systemic scleroderma?
pulmonary disease: PAH is most common
229
What is Factor H deficiency?
- Factor H (a protein in the complement pathway) normally protects cells from damage by the alternative complement pathway
- deficiency allows C3 to potentiate autoantibody-mediated or immune complex mediated injury to glomerular cells, leading to exposure of subendothelium and activation of both platelets and coagulation
230
What do you see in urinalysis of Acute Interstitial Nephritis?
1. Leukocyte casts
| 2. Eosinophils (bc its a hypersensitivity reaction)
231
what are the diagnostic criteria for hyperglycemic hyperosmolar syndrome? (5)
1. Plasma glucose level >600
2. Arterial pH greater than 7.30
3. Serum bicarb >15mg/dL
4. Serum osmolality >320
5. Absent urine or serum ketones
232
What is the initial management in pts w hypergylcemic hyperosmolar syndrome?
IV Fluids w 0.9 NS- until BP is restored and urine output is established
233
What medication is used to tx Raynaud's in whom cold avoidance does not provide sufficient relief?
Dihydropyridine calcium channel blockers: Amlodipine
| can also use peripherally acting alpha-1 blockers, phosphodiesterase inhibitors, and endothelin receptor antagonists
234
What are the symptoms of systemic sclerosis with limited cutaneous involvement (CREST) and how does this differ from diffuse cutaneous systemic sclerosis?
CREST: Calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiectasias
- differs bc limited involvement manifests as skin thickening distal to the elbows and knees whereas diffuse involvement is assoc w skin thickening proximal to elbows and knees
235
Steps of management of acute esophageal bleeding (3)
1. Rapid volume replacement with PRBCs
2. Esophagogastroduodenoscopy and band ligation
3. IV Octreotide: reduces portal venous blood inflow through inhibition of the release of vasodilatory hormones and controls bleeding
236
how does joint involvement of rheumatoid versus osteoarthritis differ?
- both can involve the proximal interphalangeal joints of the hands
- metacarpophalangeal joint involvement occurs in RA
- Distal interphalangeal joints occurs in OA
237
the is first line tx for mild alzheimer dementia?
Acetylcholinesterase inhibitor: donepezil, rivastigmine, and galantamine
238
Diffuse parenchymal lung disease is most likely in patients with systemic sclerosis who develop what?
antitopoisomerase I antibody (anti-Scl-70)
239
what is hepatopulmonary syndrome?
- manifests as:
1. dyspnea at rest or on exertion
2. Platypnea
3. hypoxemia
in the setting of chronic liver disease (clubbing, cyanosis, and hypoxemia + liver disease on PE)
- results from pulmonary vascular dilatation with intrapulmonary shunt and V/P mismatch which may worsen when the individual is in an upright position leading to orthodeoxia and platypnea
240
what are orthodeoxia and platypnea?
Orthodeoxia: fall in partial pressure of oxygen when sitting upright
Platypnea: dyspnea worse when sitting upright
241
what is the followup for a pt at low risk for malignancy and an incidentally noted pulmonary nodule on CT?
- if <4mm = no followup
242
what is a keratoacanthoma?
an epithelial neoplasm that is characterized by rapid growth over 2-6wks
- a crater like configuration, hard erythematous nodule with a keratotic center
- typically occur on sun damaged skin, usually in older persons w a peak age of 60 years
- capable of spontaneous resolution
243
First line therapy for hepatic encephalopathy?
lactulose
244
PFTs of neuromuscular respiratory failure?
1. Increased residual volume/TLC ratio
2. Normal FEV1/FVC ratio
3. Low maximum respiratory pressures
4. Normal DLCO
ie ALS or myasthenia gravis
245
how does a VSD following a STEMI present? (4)
usually within 2-7days following MI
- Respiratory distress
- Hypotension
- New systolic murmur
- palpable thrill
246
what other syndrome is associated with Giant cell arteritis?
polymyalgia rheumatica is present in ~33% of patients
247
What is the grind test?
movement of the thumb in a circular motion ellicits pain in osteoarthritis
248
What are heberden nodes?
boney enlargement of the distal interphalangeal joints seen in OA
249
what are bouchard nodes?
boney enlargement of the proximal interphalangeal joints seen in OA
250
what action makes lateral epicondylitis worse?
```
wrist extension
(there is no limitation of motion or inflammation of the elbow joint)
```
251
What is sinoatrial node dysfunction?
comprises a collection of pathologic findings (sinus arrest, sinus exit blocks, and sinus bradycardia) that result in bradycardia
- symptomatic sinus node dysfunction is an indication for pacemaker placement
252
What are 3 antianginal meds?
1. Beta blockers
2. Ca Channel blockers
3. Nitrates
253
What are vascular-protective meds in CAD? (3)
1. ASA
2. ACEinhibitors
3. Statins
254
What is red man syndrome?
most common adverse reaction to vancomycin
| - flushing + erythema + pruritis of the upper body, neck, and face
255
If a pt is symptomatic from premature ventricular contractions, what can be used as first line therapy?
Beta blocker: ie metoprolol
| CCB:verapamil
256
what is the classic triad of a right ventricular myocardial infarction?
1. Hypotension
2. Clear lung fields
3. Elevated CVP
however most predictive finding is ST-segment elevation on R sided lead V4R
257
Best initial treatment of right ventricular myocardial infarction?
- Volume expansion: improves the hemodynamic abnormalities
- reperfusion therapy
- ionotropic support (IV dobutamine) in pts whose hypotension is not corrected after 1L of saline infusion
258
Tetanus booster vaccination can be omitted in what two pt types presenting w a wound?
1. Pts who rcd a tetanus booster within the past 5 years
| 2. Pts w clean minor wounds who have received vaccination within the past 10 years
259
what are the two types of microscopic colitis?
1. Collagenous: avg 60 yrs old, W>M, see increase in collagen beneath lining of the colon
2. Lymphocytic: avg 70 yrs old, increased number of lymphocytes
260
Initial therapy of microscopic colitis?
1. Loperamide
2. Diphenoxylate
3. Bismuth subsalicylate
261
what is the most common cutaneous manifestation of IBD? how does it present?
erythema nodosum: small, equisitely tender nodules on the anterior tibial surface, usually preceded by a prodrome of fever, malaise, and arthralgia
- seen more commonly in Crohns
262
what are the cutaneous manifestations most commonly seen in Crohns versus UC? celiac disease?
Crohns: erythema nodosum
UC: pyoderma hgangrenosum
Celiac disease: dermatitis herpetiformis
263
jaundice, pruritus, and elevated alk phos in a pt w ulceratiave colitis?
primary sclerosing cholangitis
264
imaging modality to detect vertebral osteomyelitis?
MRI of Spine
265
How do you diagnose hepatocellular carcinoma without a liver biopsy?
- screening abdominal US is + and AFP >500ng/mL
266
what 3 meds reduce morality in patients with NYHA III or IV heart failure?
1. ACE inhibitors
2. Beta blockers
3. Spironolactone
267
in PUD from H pylori, what is triple therapy?
1. PPI
2. Amoxicillin
3. Clarithromycin
268
what are two anticholinergic agents that are effective for treating urge urinary incontinence?
1. Tolterodine
| 2. Oxybutynin
269
for how long do you treat depression?
- maintenance w an antidepressant drug for 4-9 months after remission of symptoms
270
What is Naltrexone and what is it used for?
- an opioid receptor antagonist
| - effective in short term treatment as well as in decreasing the frequency of relapse
271
in what patients do you initiate 2 antihypertensive meds?
1. Pts w stage 2 HTN
| 2. Those whose blood pressure is greater than 20 systolic or 10 diastolic above target
272
what is IV fomepizole used for?
treatment of ethylene glycol and methyl alcohol poisoning
273
what is a poor prognostic sign in COPD?
unexplained weightloss
274
Mnemonic for new onset urinary incontinence?
```
DIAPERS:
Drugs
Infection
Atrophic vaginitis
Psychological (depression, delirium, dementia)
Endocrine (hyperglycemia, hypercalcemia)
Restricted mobility
Stool impaction
```
275
What statistical value changes with disease prevalence?
predictive value: as the prevalence of disease decreases- the PPV decreases and NPV increases, whereas as the prevalence of a disease increases the PPV increases and NPV decreases
276
what is the target BP for pts with DM2 or nondiabetic CKD in the absence of proteinuria?
130/80 mmHg
