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Flashcards in NBME/ General Things to remember for shelf Deck (571):
1

paroxysmal v tach may present as

syncope

2

clubbing should always raise red flag for?

lung cancer, order CXR

3

High pitched bowel sounds+ air fluid levels=

obstruction of bowel

4

direct current countershock =

SCD

5

U/A finding specific for rhabdo....

+ for blood, - for RBCs

6

Pre-renal azotemia definition

BUN:Cr greater than 20
FeNa less than 1

7

FeNa & BUN: Cr for intrarenal azotemia

BUNCr lower than 20
FeNa higher than 5

8

isolated systolic hypertension cause

decreased compliance

9

Phases of ATN

oliguric --> diuretic --> recovery

10

Four stages pressure ulcers

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

11

Management pressure ulcer by stage

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

12

Location mycoplasma PNA on CXR

can be segmental or nonsegmental

13

Treatment of HyperPTH in squamous cell

bisphosphonates (--dronate)

14

Prevention of anemia in CKD

EPO

15

Cold/nonfunctioning nodule thyroid management

FNA

16

Knee pain and swelling that self resolves?

gout

17

Common predisposing feature to gout

alcoholism

18

Most sensitive test for osteo

MRI

19

Lung hyperressonance=

pneumothorax

20

Increased tactile fremitus on lung exam=

consolidation

21

lung conditions that cause mediastinal shift

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

22

Best osteoarthritis prevention

weight loss

23

Pain over delt with abduction

supraspinatus tendon tear

24

(noncardiac) Cancer causing heart murmur

gastric carcinoma
carcinoid tumor

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