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NBME/ General Things to remember for shelf Flashcards

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1
Q

paroxysmal v tach may present as

A

syncope

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2
Q

clubbing should always raise red flag for?

A

lung cancer, order CXR

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3
Q

High pitched bowel sounds+ air fluid levels=

A

obstruction of bowel

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4
Q

direct current countershock =

A

SCD

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5
Q

U/A finding specific for rhabdo….

A

+ for blood, - for RBCs

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6
Q

Pre-renal azotemia definition

A

BUN:Cr greater than 20

FeNa less than 1

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7
Q

FeNa & BUN: Cr for intrarenal azotemia

A

BUNCr lower than 20

FeNa higher than 5

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8
Q

isolated systolic hypertension cause

A

decreased compliance

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9
Q

Phases of ATN

A

oliguric –> diuretic –> recovery

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10
Q

Four stages pressure ulcers

A

1- skin intact
2- skin gone
3- crater like
4- involves bone/muscle/tendons

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11
Q

Management pressure ulcer by stage

A

1- prevent
2- wet to dry dressing
3 & 4- debridement

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12
Q

Location mycoplasma PNA on CXR

A

can be segmental or nonsegmental

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13
Q

Treatment of HyperPTH in squamous cell

A

bisphosphonates (–dronate)

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14
Q

Prevention of anemia in CKD

A

EPO

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15
Q

Cold/nonfunctioning nodule thyroid management

A

FNA

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16
Q

Knee pain and swelling that self resolves?

A

gout

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17
Q

Common predisposing feature to gout

A

alcoholism

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18
Q

Most sensitive test for osteo

A

MRI

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19
Q

Lung hyperressonance=

A

pneumothorax

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20
Q

Increased tactile fremitus on lung exam=

A

consolidation

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21
Q

lung conditions that cause mediastinal shift

A

Peff (away), TPTX (away), lobar collapse (towards)

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22
Q

Best osteoarthritis prevention

A

weight loss

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23
Q

Pain over delt with abduction

A

supraspinatus tendon tear

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24
Q

(noncardiac) Cancer causing heart murmur

A

gastric carcinoma

carcinoid tumor

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25
Cause of AMS in respiratory failure
Hypercarbia
26
methimazole serious ADR
neutropenia
27
Sudden onset severe hypertension, normal labs
renal artery stenosis
28
Imaging for unexplained pancreatitis
ERCP
29
Adult with recurrent pna/ diarrhea/ sinusitis....screen for?
CVID
30
Urgent Dialysis indications
``` AEIOU acidosis electrolye change ingestion toxin overload uremia ```
31
K^ drugs
ACE/ARBs spiro/amiloride BBer
32
Acute UTI empiric treatment
Bactrim nitrofurantoin fosfomycin
33
Met alkalosis --> next step
Cl measurement low= vomiting/prior diuretic high= endo (aldo/ACTH/cushings); diuretic or barter/gitleman
34
Metabolic alkalosis with low Cl is _____ _____
saline responsive
35
Three steps in evaluating Hyponatremia?
Serum osm above 290? Urine osm below 100? Urine Na greater/less than 25?
36
Hyponatremia 2/2 CHF/Cirrhosis presents how?
serum osm below 290; urine osm above 100; urine sodium LES THAN 25
37
How does SIADH present?
serum osm below 290; urine osm above 100; urine sodium ABOVE 25 (not peeing out any water)
38
Causes of hyponatremia that present similar to SIADH
hypothyroid | adrenal def
39
Causes of hyponatremia with high serum osm
very high hyperglycemia | advance renal failure
40
Cause of hyponatremia with low urine osm
primary polydipsia/beer potomania
41
Drug preventing calcium stones? Uric acid stones?
Calcium- thiazides (avoid loops) | Uric acid- give K+
42
Hexagonal stones are? | Envelope stones are?
hexagonal- uric acid | envelope- Ca Ox
43
AGAP equation
sodium -cl - bicarb
44
winters formula
paco2= 1.5xbicarb + 8 +/- 2
45
Bicarb changes in respiratory alkalosis/acidosis?
acidosis ^10 CO2= ^1 bicarb | alkalosis ^10 CO2= ^2 bicarb
46
CO2 change assc with met alkalosis
^bicarb 1= ^CO2 0.75
47
What is the add back method?
Calculate actual AGAP - calculated. Add difference back to bicarb.
48
FeNa/FeUrea in pre renal disease
FeNA is LESS THAN 1 | Fe Urea is less than 35
49
Intra/post renal AKI test of choice
noncontrast CT/US
50
GFR and staging of CKD
``` I- above 90 II- 60-89 III- 30-59 IV-15-29 V- under 15 ``` **HD at stage 5, start preparing at stage IV
51
DM goals in CKD
A1C under 7; glucs 80-120
52
Cinacalcet- role in CKD?
Give to prevent ^^PTH due to low Ca
53
Hb goal in CKD
above 10
54
Causes of low K
vomiting/diarrhea | high aldo, loops, thiazides, barters, gittlemans
55
K+ EKG changes
classic= T waves but can be anything!
56
Hypernatremia treatment
mild- oral water moderate- D5 severe- NS
57
How are Na and gluc related in low Na/hyperosmolarity
for every ^100 glucose= ^1.6 Na (ie 500 gluc= 400^ gluc= ^4.6 Na) measured Na= 130; actual = 136 just give insulin
58
UNa ~ | Uosm ~
UNa~aldo | Uosm~ADH
59
Treatment of hypercalcemia
FLUIDS --> calcitonin --> bispohs
60
Cause of ^^ vitamin D?
granulomas- sarcoid, TB | =^^Ca and PO4; low PTH
61
How to evaluate low Ca?
check albumin, check ionized Ca
62
Contrast hyperCa in mets vs Squamous Cell
Squamous Cell- ^^Ca; low PO4 Mets to Bone- ^^ Ca & PO4 **Order vitamin D to r/o granulomatous disease**
63
Which kidney stones are radiolucent
uric acid and cysteine
64
When do stones require surg?
greater than 1.5 cm
65
RCC produces
EPO
66
MUDPILES
``` methanol uremia dka propylene glycol iron/inh lactic acidosis ethylene glycol salicylates ```
67
Causes of respiratory acidosis
hypoventilations- opiates, asthma, copd, OSA, poor muscle strength
68
When to use stress echo?
baseline EKG changes
69
Wide complex tachy --> next step
SCD
70
MMSE suggestive of dementia
25 or less
71
Subchondral cysts=
OA, first line = NSAIDs
72
Acute MI blood gas finding
lactic acidosis= MI
73
Management of esophageal perforation=
Surgery
74
Gram stain -; papules on palms; arthritis=
gonorrhea
75
STE =
MI | **Tamponade = alternans
76
Midshaft fracture of the humerus=
radial nerve damage
77
High platelets + pain in finger tips: dx and tx?
tx: polycythemia, therapeutic phlebotomy
78
Options for pyelo treatment
Oral FQs, IV ceftriaxone, amp + aminoglycoside | 7-14 days
79
Labrynthitis findings
dull TMs distorted light reflex dizziness **tx= antihistamines
80
+ Fecal Occult... Next step
colonoscopy
81
alopecia + rash= what mineral deficiency
Zinc
82
PPD considered positive in HIV
5+ mm
83
Scleroderma pathogenesis & MC antibody & population
excess collagen MC antibody = ANA middle aged women
84
Two most common complications of scleroderma
pulm fibrosis | esophageal dysmotiliy
85
CREST syndrome findings
``` C-calcinosis of digits R- raynauds E- esophageal dysmotility S- sclerodactyly T- telangiectasias ```
86
Cheilosis and corneal vascularization = deficiency of what mineral/ vitamin
B2/ riboflavin "the 2 C's of B2"
87
Describe "dermatitis" assc with B3/niacin deficiency
broad collar rash
88
dermatitis, alopecia, adrenal insufficiency cause
B5/ pantothenic acid deficiency
89
B6/ pyridoxine anemia type
siderblastic anemia + neuro findings
90
``` Folate is vitamin B ______ Niacin is vitamin B _________ Pyridoxine is vitamin B _______ Pantothenic acid is vitamin B _____ Riboflavin? ```
``` Folate= 9 niacin = 3 pyridoxine= 6 pantothenic acid = 5 riboflavin = 2 ```
91
Scurvy findings
corkscrew hair swollen gums bleeding
92
Vitamin E deficiency findings? | How different from vitamin B6?
``` E= hemolytic anemia, acanthocytosis, neuro findings B6= sideroblastic anemia ```
93
Cause of vitamin K deficiency in adults
prolonged use abx
94
``` Delayed wound healing Alopecia Rash Dysgeusia Cause ```
``` Zn def (assc with IBD) ```
95
Hypervolemic hypenatremia cause
``` cushings hyperaldo bicarb TPN saltwater drowning ```
96
Euvolemic hypernatremia causes
DI | insensible respiratory
97
Hypovolemic hypernatremia causes
diuretics, glycosuria, renal failure | sweating, diarrhea, respiratory sensible
98
In true hyponatremia serum osmolality is
low; under 280
99
Cause of "pseudohyponatremia" (serum osmolality above 280)
mannitol glycerol high protein high triglycerides
100
Causes of hyponatremia with urine sodium under 25
CHF cirrhosis depleted volume
101
Causes of hyponatremia with urine sodium above 25
SIADH adrenal hypothyroid
102
Hep B antibody assc with vaccination
Hep B surface; core = true infection
103
How to screen for CKD in HTN
creatinine
104
Pilonidal cyst first approach to treatment
surgical drainage
105
Typical blood product given in GI bleed
packed RBCs
106
diuretic induced hypernatremia pattern
hypovolemic | normal response to water deprivation
107
Cause of respiratory distress in sepsis
increased vascular permeability
108
New onset PKD inheritance pattern
still assume AD
109
Treatment SIADH
fluid restriction
110
Cause of hypotension in MI
decreased contractility
111
harsh systolic ejection murmur, peaking in late systole, with slow rising carotid pulse =
aortic sten- bicuspid esp if young
112
Calcium levels in pancreatitis
low
113
Murmur assc with bicuspid aortic valve
can be AR or AS
114
AR murmur
decrescendo diastolic
115
Subauricular bruit is a clue for
FMD
116
Cause of differential BP in upper extremities
supravalvular aortic stenosis
117
V1-2 STE =
LAD infarct- anteroseptal
118
V3-4 STE=
distal LAD infarct- anteroapical
119
V5-6 STE =
anterolateral infarct- LAD or LCX
120
I, AVL STE=
lateral infarct - LCX
121
II, III, aVF STE=
inferior infarct- RCA
122
V7-9 STE + V1-3 depression=
Posterior MI - PDA (usually originates from RCS)
123
How does myocardial infarction lead to pulmonary edema?
acute mitral regurg = increased LA/LV filling pressures
124
Treatment of afib in wolff Parkinson white syndrome
SCD | procainamide
125
Drugs that are contraindicated in WPW
CCB adenosine dig
126
Severe AS =
soft s2 | delayed carotid pulse
127
AAA rupture risks
large diameter rapid expansion cigarette smoking
128
Afib origin | Aflutter origin
``` fib= pulm veins flutter= tricuspid annulus ```
129
ISH cause
thickened arteries
130
For purposes of boards... latent TB therapy?
isoniazid + B6
131
+ CXR, - AFB=
latent TB
132
Interpretation of PPD
+ if induration greater than: 5mm in immunocompromised 10 with risk factors 15 for anyone
133
Pyrazinimide ADRs
gout
134
SIRS criteria
temp above 38, below 36 WBC above 12, below 4 HR above 90 RR above 20 2/4 = +
135
Therapy sepsis
2-3 L fluid empiric abx pressors if pressure doesn't stay above 90 with IVF
136
fever, headache, focal deficit=
abscess or cancer
137
Criteria for safety of LP
``` FAILS focal neurologic deficit AMS immunosuppressed lesion seizures ```
138
If LP is not safe, what is next best step?
CT scan to rule out mass lesion | if +... check for toxo/biopsy
139
LP appearance in encephalitis
mostly leukocytes | check for HSV
140
bacterial meningitis appearance on LP + empiric abx
``` lots of polys (more than 1000) ceftriaxone vanc steroids +amp only if immunosuppressed ```
141
Treatment of cryptococcal meningitis
amphotericin
142
Treatment of Lyme/ RMSF meningitis
ceftriaxone
143
Treatment of neurosyphillis
IV penicillin q4 x 10-14 days
144
Crytpococcal meningitis LP findings
high opening pressure | ++Cryptococcal antigen
145
Toxo: management
TMP-SMX; rescan in 6 weeks
146
Cellulitis layer most common bugs clue
subQ well demarcated staph strep
147
Treatment for cellulitis if toxic
strep: zosyn/ ampclauv staph: vanc/ linezolid/ clinda
148
Treatment for cellulitis if nontoxic
strep: 1st gen ceph staph: TMP-SMX/Bactrim
149
Osteo presentation
refractory cellulitis
150
osteo treatment
debridement; 4-6 weeks IV antibiotics
151
Gas gangrene presentation bug treatment
infected wound c perfiringes PCN + clinda
152
Nec Fac presentation bugs xray
weird cellulitis (blue and black, rapid, crepitus) staph, strep xray
153
Treatment Nec Fac
1st gen ceph clinda amp & debride THREE
154
Diabetic foot treatment
vanc and zosyn
155
Oster + cirrhosis + osteo=
vibrio
156
PrEP drugs
emcitbrabine | tenofovir
157
PEP drugs
emcitrabine tenofovir +/- raltegravir
158
Highest risk method of HIV transmission
vertical
159
Opportunistic bugs at 200, 100, 50 CD4 count
200- PCP 100- Toxo 50- MAC
160
What are the NRTIS to remember? (5)
``` ziDOVEudine ABBAcavir DIDanOsine LAMBivudine Tenofovir ```
161
Protease inhibitors suffix
-cavir except ABBAcavir= NRTI
162
NNRTI drugs (2)
- Nevirapine | - Efavirenz
163
HIV testing in anti-retroviral syndrome
PCR load
164
CAP empiric therapy
1) FQ (sickly) 2) 3rd gen ceph + macrolide (hosp) 3) macrolide alone
165
HCAP empiric therapy
vanc and zosyn
166
Meningitis empiric therapy
vanc ceftriaxone steroids +/- amp if immunocompromised
167
UTI in pregnant pt empiric therapy
amoxicillin
168
TMP-SMX should be avoided as empiric therapy for UTI in what patients?
renal failure | warfarin
169
Treatment for pyelo
inpatient: IV ceftriaxone outpt: oral Cipro
170
pseudomonas coverage
zosyn carbapenems cefepime
171
anaerobe coverage
clinda most places | metro if vaginal/abdomen
172
FQ for gram-; gram +?
gram- Cipro | gram+ moxi
173
Treatment for lung abscess
3rd gen ceph + clinda
174
When is asx bacteruria treated?
pregnancy, procedure | amoxicillin --> repeat screen
175
``` duration of treatment for simple cystitis complex cystitis pyelo perinephric abscess ```
3,7,10,14 respectively
176
What makes cystitis complicated?
``` pregnant penis plastic procedure pyelo ```
177
Empiric treatment options for cystitis
Bactrim nitro fosfomycin
178
Empiric treatment options for prostatitis
Bactrim FQ doxy
179
Perinephric abscess treatment
I&D | 14 days IV ceftriaxone
180
When to get CT scan in pyelo
no improvement x72 hours
181
Best diagnosis method for primary, secondary, tertiary syphilis
1- dark field 2- RPR --> TP abs 3- LP PRP and TP abs
182
Treatment of primary syphilis, early latent, late latent, tertiary.
primary- 1x IM pen early latent- 1x IM pen late latent- weekly x 3 weeks tertiary- IV q4 x 10-14 days
183
Interpretation RPR results...
#:# not a fraction second # should drop with treatment
184
Treatment LGV, how distinguished from primary syphilis?
syphilis: chancre and LN are Nontender LGV: chancre Nontender, LN tender +/- drainage
185
Treatment LGV
doxy
186
Chancroid dx and tx
gram stain and cx | azithro or Cipro
187
dx HSV
PCR
188
OM vs OE on exam
OM- pain relieved with tugging of pinna | OE- painful if pinna moved
189
OM treatment
amox or cefdininr
190
OE treatment
supportive or cipo + steroid drops
191
Mastoiditis signs
bulging behind ear anteriorly rotated ear tx is surgical
192
Sinusitis treatment
augmentin
193
Phayngitis scoring of symptoms
``` CENTOR c-cough +1 e- exudate +1 n- nodes +1 temp above 38 + 1 OR under 14 +1 (-1 if over 44) ``` 1- do nothing 2-3 do rapid strep 4 empiric treatment
194
Treatment of strep pharyngitis
augmentin
195
Treatment anterior/ posterior epistaxis
cauterization with silver nitrate | posterior = packing + px abx
196
Treatment of acute endocarditis with a native valve?
vanc
197
Treatment of acute endocarditis with a prosthetic valve
young (less than 65 days) = vanc, gent, cefepime | old (greater than 65) = vanc, gent, ceftriaxone
198
subacute endocarditis treatment
gent and ceftriaxone
199
Alternative to vanc in treatment of endocarditis
dapto
200
Acute endocarditis culture guidelines
culture until negative | treat with abx until cx is negative
201
Subacute endocarditis culture guidelines
culture until + | don't treat until +
202
Who gets surgery for endocarditis?
``` vegetation above 15 mm above 10 + emboli florid CHF abscess fungus ```
203
What are the three major criteria for endocarditis
bacteremia new murmur +echo
204
Two pansystolic murmurs
VSD | MR
205
systolic murmur- early ejection
AS
206
Drugs that decrease morality in [CHF] ? 3
ACEi BBer Spiro +/- hydral with nitro (AA, FMT)
207
Location of VSD? MR?
VSD- everywhere | MR- axilla, apex
208
Maneuvers that increase MVP and HCOM
standing | valsalva
209
Post prandial pain- ddx
mesenteric ischemia | DPU
210
S4 cause
atrial contraction against stiff ventricle
211
Becks Triad
distant heart sounds low BP JVD/ Hypotension = Tamponade
212
Cardiac conditions that require fluid (3)
RHF shock tamponade
213
When to give IV metoprolol
severe HTN | afib
214
Dobutamine use
pressor
215
MI type that causes hypotension
posterior/inferior= RHF
216
BP that is absolute/ relative CI to thrombolytics
``` 220= absolute 180= relative ```
217
Time window for thrombolytics in MI
12 hours
218
MI type that most commonly causes arrhythmias
RCA; supplies SA node
219
Aside from congenital VSD, what may cause VSD?
post MI ventricular free wall rupture
220
Persistent STE post MI=
aneurysm
221
Head nodding/ fingernail pulsations is a clue for
AR (hyperdynamic) AS= hypodynamic
222
When to give px before oral procedures
- prosthetic - congenital cyanotic disease - history of IE - cardiac transplant
223
Which murmurs need echo?
diastolic 3/6 thrill symptomatic
224
How does valsalva cause increased HCOM murmur
decreased blood= increased contact of leaflets
225
Exhalation increases what murmurs?
exhalation- L sided | inspiration- R sided
226
Bicuspid aortic valve management?
annual echo | screen first degree relative
227
Which valve is normally bicuspid?
mitral
228
Bicuspid aortic valve causes what complications?
AS AR aneurysm
229
Drugs that decrease mortality in [MI]? (3)
ASA BBer statin
230
most common risk factor for IHD
HLP
231
Family history of MI at what age is worrisome?
women earlier than 55 | men earlier than 45
232
Time limit for PCI
must be able to transfer within 2 hours otherwise do thrombolytics
233
Best troponin for ACS
troponin I
234
When can adenosine not be used for chemical stress test?
COPD/ asthma
235
When can CABG be done?
left main 3 vessels 2 vessels + DM 1 vessel that FMT
236
Stenting always gets what medical therapy?
double antiplatelet (ASA, plavix)
237
Who gets statins (4)
risk above 7.5 LDL above 190 ACS/stroke diabetics age 45-75
238
Who gets aspirin? (2)
older than 50 risk above 10 no contraindications
239
Drugs for everyone with MI
``` MONA ACE BBer clopidogrel statin ```
240
Paracentesis: Polys under 250 + SAAG above 1.1 causes (2)
cirrhosis | CHF
241
Paracentesis: Polys under 250 SAAG below 1.1 causes (1)
nephrotic
242
Paracentesis: High white count- more than half polys: ddx? (3 things)
SBP (above 1.1) secondary infection (SAAG varies) pancreatitis (high amylase, above 100, SAAG under 1.1)
243
Paracentesis: High white count- mostly lymphocytes- ddx? (two things)
malignancy | TB
244
Normal FEV1 FVC ratio
0.7
245
Normal DLCO
0.8
246
PFT clue to NMJ d/o
low max inspiratory/expiratory pressures
247
Platypnea is a clue to?
hepatopulmonary syndrome
248
Lights criteria
Pp/Sp above 0.5 Pldh/Sldh above 0.6 LDH more than 2/3 ULN
249
Criteria for draining
below 7.2 | below 60 gluc
250
Treatment for effusion with loculation
VATS (surgery)
251
loud P2 fixed split S2 TR =
Pulmonary hypertension
252
PAH PFT pattern
restrictive
253
TB effusion clue
risk factors for TB | bloody effusion
254
What causes increased fremitus?
consolidation | effusion decreases
255
How to confirm TB effusion
pleural biopsy
256
Chylothorax dx
high triglycerides in effusion fluid
257
When does anemia lead to MI/CVA etc?
Hgb 4-5
258
DcO2=
CO x Hgb x %sat
259
Retic levels in destructive anemia
More than 2%
260
Macro, micro, normocytic anemia are destructive or productive, most commonly?
Macro/ Micro = production failure | Normocytic= destruction
261
Microcytic anemia --> next step in narrowing diagnosis?
Iron panel (TIBC, Fe, ferritin, %sat)
262
Normocytic anemia --> next step in dx
LDH, billi, haptoglobin
263
Causes of normocytic anemia
Hemolytic Bleeding Ca CKD
264
Causes of microcytic anemia
IDA Thal Sideroblastic ACID
265
B12, folate def are what kind of microcytic anemia?
Megalocytic (hypersegmented neutrophils)
266
Aside from B12/ folate def, what causes macrocytic anemia?
Liver Alcohol Drugs Metabolism
267
B12/folate: | Which has high MMA? Homocysteine?
``` MMA = B12 Homocysteine = both ```
268
Test that narrows causes of B12 def?
Schillings rules out pernicious anemia | Give IM/oral B12 ---> check urine for B12, none = PA
269
Drugs that cause megaloblastic anemia (3)?
5FU AZT Ara-C
270
2 metabolic disorders that cause megaloblastic anemia
Leach nyhan | Hereditary orotic aciduria
271
How does chrons cause B12 def?
Terminal ileum destruction = site of IF+B12 absorption
272
How long must B12 be deficient from diet before becoming symptomatic?
Years!
273
Neuro symptoms assc with B12 def? How treated?
DCML destruction Tabes dorsalis Loss of propioception etc Irreversible
274
Who is generally folate deficient
Alcoholics | Depressed widows not eating
275
Iron studies suggestive of IDA | Fe Ferritin TIBC
Low Fe Low ferritin High TIBC
276
Two common causes IDA
Colon Cx | Menorrhagia
277
Iron studies suggestive of anemia of chronic disease
Low Fe High Ferritin Low TIBC
278
Give causes sideroblastic anemia
``` Drugs Alcohol Lead B6 def MDS ```
279
HgF is elevated in which Thal type?
Beta
280
Treatment of major Thal
Transfuse | Deferoxamine in case of iron overload
281
Normocytic anemia that is not hemolytic- causes
CKD Ca MDS Leukemia
282
PNH cause
PIG-A def Lack of CD55 cells Increased complement/attack complex formation
283
Treatment of PNH
Eculizumab
284
Two diseases with spherocytes on smear
HP | AIHA
285
Bite Cells + Heinz Bodies =
G6PD def
286
Three Meds that cause crisis in G6PD Def
Bactrim nitrofurantoin dapsone
287
How to dx G6PD def
Check level 6-8 weeks after attack
288
Hereditary sphrocytosis Dx Tx
Osmotic fragility | Splenectomy
289
AIHA | Cold/IgM are assc with what infections
Mono | Mycoplasma
290
Warm AIHA/IgG is assc with what disease, Dx? tx?
AI, cancer Dx Coombs +++ Tx steroids --> rituxumab --> splenectomy
291
Sickle cell stroke treatment
Exchange transfusion
292
Appearance of chronic vs acute leukemia cells
``` chronic= large nucleus acute= small nucleus ```
293
WBC count suggestive of leukemia? acute?
greater than 60 | acute if more than 20% blasts
294
Acute leukemia, next steps in diagnosis
analyze smear --> BMBx
295
Treatment AML? Treatment ALL?
AML- vitamin A for M3/ auer rods; other= chemo | ALL- chemo, +++CNS px
296
CML, CLL, ALL, AML: Which is seen in kids? Which is seen in middle age people? (other= old)
``` CML= middle age ALL= kids ```
297
Chronic leukemia, next steps in dx?
Diff ---> BMBx
298
Treatment CML? CLL?
CML- imantinib | CLL- HSCT is young, chemo if old with sx, nothing if old and asx
299
AML cell markers? | ALL cell markers?
AML- myeloperoxidase | ALL- tdt, cALLa
300
AML assc exposures
benzene, radiation
301
CML- genetic assc?
t(9,22)..philidelphia chromosome; BCR-ABL; treat with TKi (imantinib)
302
Nontender lymphadenopathy- next step in dx?
excisional biopsy
303
How to stage lymphoma
CXR, CT CAP/Pet, BMBx
304
How to stage hodgkins
1-1 node 2- 2+ nodes, same side of diaphragm 3- 2+ nodes, opposite sides 4- mets
305
Cyclophosphamide ADR Cisplatin ADRs (2) Vincristine/blastine ADR
cyclophosphamide hemorrhagic cystitis cisplastin- ear and kidney toxic vin- neuropathy
306
Which is more severe- Hodgkins or nonhodgkins?
non
307
Two types of non hodgkins
Burkitts | Extranodal
308
ETOH LNs /Pel Epstein are assc with?
Hodgkins
309
Hodgkins chemo regimen
ABVD
310
Non-Hodgkins chemo regimen
R-CHOP
311
Multiple Myeloma three serum/urine findings
high Ig osteoclast stim factor Bence Jones Proteins
312
How do MM patients become immunocompromised
^^Ig but its dysfxnal
313
Four tests to evaluate plasma cell d/o
spep upep skeletal survey (not nuc med) BMBx
314
Treatment waldenstroms
(lymph predominates) rituximab +/- plasmapheresis
315
``` spep upep skeletal survey BMBx results in MM ```
MM- +spep, upep +/- skeletal survey BMBx more than 10% plasmas
316
``` spep upep skeletal survey BMBx results in MGUS ```
``` spep+ protein gap + upep ---- skeletal survery ---- BMBx les than 10% plasmas ```
317
``` spep upep skeletal survey BMBx results in Waldenstroms ```
+spep -upep, skeletal survey BMBx more than 10% lymphocytes
318
Contrast platelet vs factor bleeding
platelet- gingiva, skin, vagina | factor- hemarthrosis, hematoma
319
Test of choice for platelet bleeding
platelet count
320
Test of choice for factor bleeding
PT/PTT and mixing studies
321
Three general causes of thrombocytopenia
1) sequestration 2) destruction 3) poor production
322
Four diseases that cause platelet destruction
``` ITP TTP HIT DIC (alphabet soup) ```
323
Two processes that cause sequestration
splenic crisis | cirrhosis
324
Platelet bleeding, platelets within normal limits... | what are causes of platelet dysfunction?
drugs (ASA, NSAIDs) uremia VWD (which causes VIII instability), BS, Glanzmans
325
VWD dx tx
platelet bleeding --> normal counts --> vwf assay | tx: DDAVP, VIII supplementation in case of bleeding
326
Bernard Souiler deficiency
GP1B
327
Glanzmanns deficiency
GP2b3A
328
How to diagnose inhibitors as a cause of factor bleeding
PT/PTT increases --> mixing study negative= inhibitor
329
Factor I is? II is?
II prothrombin | I fibrin
330
Four causes of thrombophilia directly related to factors
prothrombin 20210A mutation factor 5 leiden mutation protein C,S def antithrombin def
331
Antiphospholipid syndrome: path dx
lupus anticoag | Russell viper venom assay
332
When to anticoagulate in thrombophilias
most- after second clot | APl- after first clot
333
Clot types in TTP vs DIC
TTP- hyaline | DIC- fibrin
334
TTP- cause & sx
``` ADAMST 13 def FAT RN fever anemia thrombocytopenia ``` renal failure neuro sx
335
lab findings in TTP
low platelets + shistocytes | normal PT/PTT/fibrinogen/ddimer
336
Treatment TTP
exchange transfusion
337
DIC lab findings (platelets, smear, PT/PTT, finbrinogen, d-dimer)
low platelets schistocytes high PT/PTT, d-dimer low fibrinogen
338
Timeline HIT
heparin --> 7-14 days --> low platetlets
339
Management HIT
stop heparin start argatroban bridge to heparin
340
ITP: cause dx
ab to platelets | diagnosis of exclusion, low platelets, AI d/o pt
341
Treatment ITP
steroids IVIG splenectomy/rituximab if FMT
342
Cause of pigmented gallstones
hemolysis
343
IV abx for gallbladder disease
amp&gent + metro | cipro + metro
344
Cholelithiasis- 2 tx options
chole | ursodeoxycholic acid if not candidate
345
Define cholelithiasis, cholecystitis, cholangitis, choledocolithiasis
cholelithiasis- stones in gall bladder, colicky cholecystitis- stones at cystic duct + inflammation, constant cholangitis- ascending infection, dilated ducts choledocolithiasis- obstruction at common duct by stone, "painful jaundice"
346
Cholecystitis findings on US
pericholecystic fluid | thickened gallbladder wall
347
Workup for - cholelithiasis - cholecystitis - choledocolithiasis - cholangitis
- cholelithiasis: U/S - cholecystitis: U/S then HIDA - choledocolithiasis: U/S then MRCP then urgent ERCP - cholangitis: U/S then EMERGENT ERCP chole always an option later, only emergent ERCP= cholangitis
348
Medical therapy for all gallbladder disease
IVF IV abx (metro +ampgent or cipro) NPO
349
Triad/Pentad of cholangitis
- RUQ pain - jaundice - fever - +AMS/ hypotension - (see dilated ducts on US) -note choledocolithiasis also = painful jaundice but not SAS
350
Common bugs in cholangitis
gram - anaerobes
351
Workup for dysphagia
barium swallow --> EGD +Bx --> manometry if mechanical
352
Achalasia- absence of ____ plexus best treatment
myenteric | myotomy
353
Treatment of diffuse esophageal spasm
CCB; NG PRN
354
Esophageal webs are assc with? | Strictures are assc with?
Webs- Plummer Vinson | Strictures- severe longstanding GERD
355
Appearance of stricture vs cancer on barium swallow
``` stricture= SYMMETRIC loss cancer= assymetric ```
356
Describe plummer vinson syndrome
IDA dysphagia webs female
357
Dx of esophagitis
EGD with biopsy | If infectious screen for HIV
358
Drugs that cause esophagitis
tetracyclines NSAIDs bisphosphonates HAART
359
Clues to eosinophilic esophagitis
atopy asthma allergies (trial of PPi--> FMT may do aerosolized steroids)
360
What treatments should never be done for caustic esophagitis
neutralization of ph | induced emesis
361
Alarm symptoms that warrant immediate EGD in GERD
anemia | weight loss
362
``` Treatment of GERD metaplasia dysplasia cancer ```
GERD- PPI metaplasia- high dose PPI BID, surveillance dysplasia- location ablation + surveillance cancer- stage and resect
363
PUD which location is worse with food? better with food?
worse- stomach | better- duodenum
364
Cause of cushings ulcers
^^ICP steroids ventilators
365
Endoscopy findings below suggest what ulcer types: - many and shallow - heaped margin, necrotic center - single
- many = NSAIDs - heaped margins w/ necrotic centers - single= H pyolori
366
Triple therapy for h pylori
clarithromycin amoxicillin PPI
367
Dx for Zollinger Ellison
If ^^^ gastrin (normal 25)... check secretin stim test | decreased pH should decrease gastrin
368
ZE- benign or malignant
benign but induces malignancy
369
Gastric adenocarcinoma bx findings
signet rink cells | assc = asia and nitrites
370
Treatment for gastroparesis
metaclopromide PO daily | erythromycin IV for acute
371
BG level- Clue to gastroparesis
low glucs after meals | give insulin but no food gets absorbed
372
What is considered a +++ emptying study in gastroparesis
more than 60% of contents at 2 hrs or 10% at 4 hrs
373
Diabetics with gastroparesis will also have?
neuropathy!!
374
5 types of invasive (bloody diarrhea, +WBCs, + lactoferrin):
1) Salmonella 2) Shigella 3) EHec 4) E Histolytica 5) campy
375
6 types of enterotoxic (watery) diarrhea
1) c diff 2) vibrio 3) ETEC 4) SA 5) B cereus 6) giardia
376
When can loperamide be used in gastroenteritis
viral
377
Triad HUS
bloody diarrhea ARF anemia (supportive or plasma exchange therapy)
378
Secretory diarrhea: clue + labs
occurs at day + night | no gap, WBC, RBC, mucous, fat etc in stool
379
Infalammatory diarrhea lab findings
+WBC, RBC, mucous
380
Osmotic/malabsorption diarrhea lab findings
high osm gap in both | fecal fat + if malabsorption
381
Stool osm gap equation
measured osms - calculated osms (2xNa+K)
382
Stool osm gap interpretation
below 50 = secretory | above 100= osmotic/malabsorption
383
Secretory diarrhea types
1) hormone secreting tumor 2) celiac sprue 3) c diff
384
Three tumors that cause diarrhea
VIPoma Zollinger Ellison Carcinoid
385
ZE dx
high gastrin above 250; secretin stim fails to decrease gastrin; SRS to localize
386
Carcinoid causes symptoms when?
lung/ mets; not intestinal
387
What is absorbed from terminal ileum
B12, fats, bile salts
388
How to dx malabsorption
100g fat diet--> more than 14 g fat in stool --> give pre-digested xylose --> absorbed = pancreas; unabsorbed = intestinal border
389
tropical Sprue- clue
carribean farmer
390
Whipples disease: - bx clue - meds
PAS+ organism | Bactrim or doxy
391
Presentation of: Diverticular spasm D hemorrhage Diverticulitis/perforation
spasm: post prandial LLQ pain relieved with BM hemorrhage: large volume painless BRBPR perforation/ diverticulitis: "left sided appendicitis"
392
Abx for diverticulitis
cipro+metro or ampgent + metro same as gallbladder path
393
Cirrhosis causes
``` VW HAPPENS Very Weird (stuff) Happens Viral Wilsons Hemochromatosis A1AT PSC PBC Ethanol NASH/ NAFLD Something else ```
394
Treatment Hep C
INF + ribavirin
395
Wilsons treatment
penicillamine
396
Hemochromatosis tx
phlebotomy | deferoxamine
397
A1At treatment
transfer
398
PSC/PBC treatment
transplant
399
NASH/NAFLD/alcoholic liver treatment
transplant
400
Treatment of hepatic encephalopathy
lactulose | rifamixin
401
SAAG in portal HTN/ CHF
above 1.1
402
Marker for HCC
AFP; triple phase CT washout
403
Treatment SBP
rocephin
404
Management GIB
stabilize (fluids, PPI, type and cross, call GI..octreotide if cirrhotic) endoscopy
405
Four causes of LGIB
- Hemorrhoids - Diverticular Hemorrhage - Mesenteric Ischemia - Ischemic Colitis
406
Mesenteric ischemia vs ischemic colitis
mesenteric ischemia- s/sx of vasculopathy CAD of gut ischemic colitis- death at watershed, heavy painful bleeding
407
Diagnosis pancreatitis
CT with fluid around pancreas
408
Medical mangagement of pancreatitis
IVF NPO pain control ERCP if gallstones
409
Complications of early pancreatitis
ARDS (leaky caps) low Ca (saponification) pleural effusion/ ascites
410
Prognosis measurement for pancreatitis
BUN
411
When to drain pancreatic cyst
greater than 6 wks old
412
p-ANCA is assc with what IBD?
UC
413
Direct jaundice- painless causes
cancer stricture PBC PSC
414
Two enzymatic causes of indirect jaundice
Crigler Najar | Gilbert (mild)
415
Two enzymatic causes of direct jaundice
``` Dubin Johnson (black liver) Rotors ```
416
Urine is dark in what type of jaundice
direct
417
HBSAB IgG vs IGM
``` IGM = early infection IGG= immune, vaccine ```
418
Two markers for active Hep B infection
HSBAG | HBEAG
419
Sand blasting, rock quarries=
silicosis
420
aeronautics, electrical work=
berylliosis
421
Hypersensitivity Pneumonitis tx
remove source | no steroids
422
DPLD CXR and CT findings
``` reticulonodular infiltrates ground glass (CT) ```
423
Best test for DPLD
bx
424
Treatment DPLD
steroids --> biologics
425
Two drugs that cause DPLD
bleo | amio
426
Define acute interstitial pneumonitis vs IPF
``` IPF = longer than 6 mo's acute= under 6 weeks ```
427
Rheum diseases that cause fibrosis
SLE RA SS
428
Three extra pulm clues to sarcoidosis
heart block bells palsy EN
429
Tx sarcoid
steroids
430
Asbestosis: Ca effect CXR findings bx findings
high Ca pleural plaques, mesothelioma barbell bodies
431
O2 is _________limited | CO2 is ______
``` O2= diffusion CO2= perfusion ```
432
Result of ARDS leaky caps on O2/CO2 movement
CO2 moves but O2 does not so low CO2= alkalosis
433
Three causes ARDS
drowning transfusion injury septic shock
434
PCWP and LVF in ARDS
low PCWP | normal LV filling
435
PCWP and LVF in CHF
high PCWP | low LV filling
436
Ventilator settings in ARDS
low TV high RR high PEEP
437
COPD treatment order
1. SABA 2. LAMA 3. LABA (what dingess is on) if above does not work: 4. ICS 5. PDE4i 5. OCS
438
Goal O2 sat in COPD
88-92
439
COPDE antibiotics
doxy | azithro
440
PE ABG findings are same as
``` ARDS low CO2 (perfusion limited)-- moves out O2 low (cant get in--diffusion limited) ```
441
Treatment PE
heparin then bridge to wardarin
442
Massive PE is accompanied by _____ and need ____
hypotension | TPA
443
Wells Criteria
``` DDTTT2CC Don't Die Tell The Team 2 Calculate Criteria (3) -DVT symptoms -Dx most likely (1.5) -Tachy -TE in past -Three days immobile (1) -Cancer -Coughing up blood ```
444
Wells score 2 and under --> F/U Score above 4? Score above 6?
2: D-Dimer --> CTA 4+: CTA 6+: VQ
445
How to bx mass in periphery, middle lung, small airways, large airways
periphery: perc biopsy w/ CT guiding middle: surg small airways: EBUS (endobronchial w/ US) large: bronchoscopy
446
When to bx lung mass
more than 2 cm + risks | age above 70, smoking, spiculations
447
When to get serial CTs for lung mass
under 2 cm | low risk
448
First thing to do in case of lung mass
get old films
449
Two paraneoplastic syndromes assc with small cell
Cushings | SIADH
450
Exudative effusion causes
malignancy pneumonia TB
451
Transudative effusion causes
1 CHF 2 nephrosis 3 cirrhosis 4 gastrosis
452
When LABA is given in Asthma what must also be given?
ICS or ^ mortality
453
Stage 1-4 asthma daily symptoms
I- 2x/week II less than 1x/daily III daily IV all day
454
Stage 1-4 asthma nightly symptoms
I less than 2x/mo II less than 1x/ week III more than 1x/ week IV nightly
455
CCP ab is + in what rheum disease
RA
456
Smooth muscle AB is + in what rheum disease
AI hepatitis
457
Ro, la are + in what rheum disease
sjogrens
458
jo is + in what rheum disease
PM | DM
459
AMA is + in what rheum disease?
PBC
460
Non inflammatory chronic joint pain =
OA | no fever, ESR, CRP
461
Seropositive rheum diseases causing joint pain? negative?
sero+: lupus, RA | sero-: CT d/o
462
``` WBC in joint that is normal OA inflammatory septic ```
normal under 200 OA under 2k inflammatory 2k-50k septic more than 50k
463
Spetic arthritis gram stain negative =
gonorrhea
464
Drugs that cause SLE (3)
hydral procainamide methyl dopa
465
Lupus nephritis tx
cyclophosphamide
466
General lupus tx | RA tx
lupus: HF RA: MTX steroids for flare, cyclophosphamide/myco for nephritis
467
Lupus nephritis ab
dsDNA
468
Complement changes in lupus
low C3,4
469
Cause of miscarriage in lupus
APL disease
470
1st line RA tx is
MTX
471
Xray finding specific to lupus
C1-2 spine disease/ periarticular osteopenia
472
RA spares what joint
DIP spared
473
``` Scleroderma: sclerodactyly tx raynauds tx GERD tx renal crisis tx ```
scleor- penicillamine raynauds- CCB GERD- PPI renal- ACEi, no steroids
474
Clue for nephrogenic systemic sclerosis
gadolinium/ MRI
475
Sjogrens ab + 3 findings
``` dry shit (eyes, mouth, parotid swells) ro, la ```
476
Tests for IIM
mi, jo abs high CK best is bx can do EMG to r/o neuropathic cause
477
Gout vs pseudogot
gout- negative birefringent, needles | pseudo- positive birefringent, rhomboid
478
Diuretic that causes gout
thiazide | but protects from osteoporosis
479
gonorrhea arthritis tx method
IV
480
4 seronegative arthritis types MC sex? tx?
``` PAIR psoriatic ank spon IBD assc reactive ``` males NSAID and local steroids
481
Takayasu & GCA: age, dx, tx
GCA-elderly, bx, steroids | Takayasu- aortic, young adult, CTA, steroids
482
Clue to takayasu
pulselessness
483
``` PAN- medium vasculitis assc with what infection 3 symptom clues dx tx ```
Hep B mesenteric ischemia, purpura, sensory loss angiogram steroids + cyclo
484
Small vasculitis: c-ANCA? p-ANCA?
``` Wegners/GPA= c-anca eosinophilis/MPA= p-anca ```
485
Two small vessel vasculitis caused by immune complexes
cryoglobulinemia | HSP
486
Cryoglobulinemia assc clue tx
Hep C purpura plasmapheresis
487
AKI, not pre-renal.... next best step
CT non con or US
488
Pre-renal AKI types
leak (nephrosis, gastrosis, cirrhosis) pump failure hole (bleed, diarrhea) clog (RAS, FMD)
489
``` Goals for: BP a1c BG in CKD patients ```
130/80 less than 7 80-120
490
How to prevent PTH ^^ in CKD
cincalcet
491
How to stabilize in ^^K
Ca for EKG
492
how to temporize in ^^K
insulin & D50 bicarb b agonists
493
How to decrease total body K
loop kayexelate dialysis
494
Diruetics that lower K
loops | thiazides
495
Refractory low K =
low mag!
496
When to give hypertonic saline in low Na?
seizures (3%)
497
UNa ~ | Uosm ~
``` aldo= Na osm= ADH ```
498
Euvolemic hyponatremia causes
``` RATS Thyroid low Addisions RTA SIADH ```
499
Serum Osm calculation n
2xNa +gluc/1.8 + BUN/2.8 | normal ~280
500
How are ca and albumin related
change 1 in albumin = change 0.8 Ca opposite direction
501
Simple renal cyst treatment
no treatment if asx
502
ADPKD = screen for
aneurysm, MRI
503
How to diagnose exogenous insulin use
low C-peptide | or + secretalogue score
504
C-peptide in insulinoma
high
505
How to monitor DKA severity
gap
506
DM dx a1c Fasting GTT
a1c- 5.7, 6.5 fasting- 100, 125 GTT- 140, 200
507
When is a1c not helpful?
early DM | gestational DM
508
Ab type in DM1
GAD | IA2
509
Oral hypoglycemic that cause weight gain? | weight loss?
``` gain = TZD, --glitazone loss= GLP1i, --glutides ```
510
Three rapid acting insulins
- lispro - aspart - glulisine
511
Two long acting insulisn
- glargine | - detemir
512
MEN1 tumors
hard P's - pituitary - pancreatic - parathyroid
513
MEN2a tumors
parathyroid pheo medullary thyroid
514
MEN2b tumors
pheo medullary neuronal
515
Pancreatic tumors
ZE | insulinoma
516
Gene assc with MEN2a,b
RET
517
How does thyroid hormone affect prolactin?
TRH ----I prolactin | T4 -----I TRH
518
How does dopamine effect prolactin?
inhibits | so dopa antagonists increase
519
How are GH and BG related?
GH increases glucose glucose should decrease growth hormone insulin shoud increase GH
520
Dx for high growth hormone
IGF1 | glucose suppression test
521
How to dx hypopituitarism
insulin/ vasopressin stim test (should ^ GH in healthy pt) LH FSH also low
522
SIADH treatment
fluid restriction | demeclocycline
523
Treatment thyroid storm
BB methimazole steroids
524
Tx for follicular thyroid cancer
radioactive iodine
525
Which thyroid cancer has highest mortality rate
anaplastic
526
Cushing dx
low then high low dose dexa suppression ACTH levels high dose dexa suppression (responds to low dose, normal ACTH= adrenal tumor// no response to low dose, high ACTH, no response to high dose= ectopic// no response to low dose, high ACTH, response to high dose = pituitary tumor)
527
Addisons lab values + dx
low cushings AND aldo | early AM cortisol --> cosyntropin test
528
Medical treatment pheo
a blocker --> b blocker --> resect
529
Incidentaloma management
R/O conns pheo cushings | if above 4 cm resect, or if functioning resect
530
SVT drug
adenosine
531
brady drug
atropine, only sinus, first degree, 2nd degree
532
Old person no disease BP goal
150/90
533
Person under 60 or with disease BP goal
140/90
534
3 first line drugs BP control
CCB Thiazide ACE
535
Who doesn't get ACE
Above 75 black no CKD
536
Stage 1 HTN drug
1 drug (CCB Thiaizde ACE)
537
Stage 2 HTN drug
2 drugs (CCB, Thiazide, ACE)
538
Old (more than 48 hours) afib needs....
echo
539
Vtach appearance
monomorphic
540
Normal PR length
one big box
541
Shockable rhythms
pulseless vtach | vfib
542
Shockable rhythm drugs
epi amio
543
Pulseless person drugs
epi absent epi absent
544
Who can get aspirin in afib
``` no CHADSS 2 risks CHF HTN age above 75 DM stroke stroke ```
545
How to count rate on EKG
300 150 100 75 60 50 43 37
546
What type of heart failure cannot get nitro
RHF
547
Three symptoms for determining chest pain type
substernal or l increased with exercise decreased with NG 3= typical 2= atypical 1= noncardiac
548
CHF treatment cascade
``` ACE and BBer all classes diuretic class 2 spiro/iso class 3 ionotrope class 4 ```
549
Opening snap=
mitral stenosis
550
MVP murmur is same as ____ except ___
MR except increased with Valsalva
551
HCOM is caused by what mutation
sarcomere
552
4 murmurs that decrease with Valsalva
MS MR AS AR
553
What murmur gets balloon valvulopasty
MS
554
Treatment HCOM and MVP
BBer
555
Three diseases causing restrictive heart failure
amyloid sarcoid hemochromatosis
556
Amyloid dx
fat pad bx
557
Clues to sarcoid amyloid hemo restrictive CHF
amyloid- neuropathy sarcoid- lung disease hemo- cirrhosis
558
Sarcoid restrictive heart disease dx
endomyocardial bx
559
Two common causes of pericarditis
viral | uremia
560
NSAIDs treat pericarditis except when?
PUD low platelets CKD
561
Pericardial knock=
constrictive pericarditis --> need pericardectomy
562
1st line tx pericarditis
NSAIDs and colchicine
563
3 causes of + orthostatics
elderly parkinsons DM
564
MAP=
CO x SVR
565
CO=
HR x SV
566
SV=
contractility x preload
567
Neurogenic syncope clue
FND
568
+ orthostatics
20 change SBP 10 change DBP pulse change 15
569
What are high dose statins
atorva 40-80 | rosuva 20-40
570
ezetimibe causes
diarrhea
571
niacin causes
flushing, give aspirin

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