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Questions--March 2017 Flashcards

(126 cards)

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1
Q

Disseminated gonococcal infection: Clinical presentation

A

Purulent monoarthritis and/or triad of (1) dermatitis, (2) assymetric migratory polyarthralgias, and (3) tenosynovitis

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2
Q

Disseminated gonococcal infection: diagnostic testing

A

Blood and pustule cultures may be negative.

NAAT of urethra, cervix, pharynx, or rectum usually will come back positive.

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3
Q

Two types of contact dermatitis

A

allergic vs irritant

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4
Q

Allergic contact dermatitis: pathophys, triggers, appearance

A

pathophys: type IV hypersensitivity
triggers: poison oak, poison ivy, nickel, rubber, meds
appearance: primarily on exposed skin and well demarcated, with erythema, papules/vesicles, and chronic lichenification

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5
Q

Irritant contact dermatitis: pathophys, triggers, appearance

A

pathophys: physical or chemical
triggers: soaps, detergents, chemicals
appearance: commonly on hands, with erythema and fissures

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6
Q

VIPoma: clinical presentation

A

watery diarrhea, hypo or achlorhydia due decreased gastric acid secretion, associated flushing, NN/V, muscle weakness, cranps

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7
Q

VIPoma: lab findings

A

hypokalemia, hyperclacemia, hyperglycemia, stool studies showing secretory diarrhea and increased sodium and osmolol gap less than 50

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8
Q

VIPoma: diagnostic criteria

A

watery diarrhea with VIP level greater than 75; abdominal CT or MRI to localize tumor in the pancreas (usually the pancreatc tail)

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9
Q

Acute interstitial nephritis: Clinical features and number of days until symptom onset

A

maculopapular rash, fever, new drug exposure (penicillins, TMP SMX, cephalosporins, NSAIDS), +/- arthralgias

NOTE: 5days to several weeks after use of offending agent

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10
Q

Acute interstitial nephritis: lab findings

A

AKI
Pyuria, hematuria, WBC casts
Eosinophilia, urinary eosinophils
Renal biopsy: inflammatory inflitrate, edema

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11
Q

stevens-johnson syndrome: triggers

A

Drugs: allopurinol, antibiotics, anticonvulsants, NSAIDs, sulfasalazine

Other: Mycoplasma pneumo, vaccination, graft-vs-host disease

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12
Q

steven-johnson syndrome: clinical features

A

4-28 days after exposure to trigger
Acute influenza-like prodrome
Rapid-onset erythematous macules, vesicles, bullae
Necrosis and sloughing of epidermis
Mucosal involvement (this is distinction with toxic epidermal necrolysis, which does not have mucosal involvement and involves >30% body surface area as opposed to <10%)

Systemic signs: AMS, fever, HDinstability

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13
Q

true positive vs flase positive rate

A 
true positive (sensitivity)
false positive (1-specificity) the higher the false positive rate the lower the specificity
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14
Q

Trichinellosis infection: clinical presentation

A

Intestinal stage (within one week of ingestion): asymptomatic or GI upset including abdominal pain, N/V/D

Muscle stage (up to 4 weeks after ingestion): myositis, fever, subungal splinter hemorrhages, periorbital edema, eosinophilia (usually >20%) with possible elevated CK and WBC

NOTE: severe disease can involve the heart, lungs, and CNS

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15
Q

Bacteria in viridans group streptococci

A

strept mutans/mitis/oralis/sanguinis

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16
Q

Major modified Duke criteria for infective endocarditis

A

Blood culture positive for typical organism (s. viridans, staph aureus, entercoccus), Echo showing valvular vegetation

NOTE: definite IE = 2 major OR1 major + 3 minor criteria

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17
Q

Minor modified Duke criteria for infective endocarditits

A

Predisposing cardiac lesion, IVDU, febrile, immunologic phenomena (glomerulonephritis), positive blood cx not meeting above criteria

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18
Q

6 clinical features of inectious mononucleosis

A 
fever
tonsillitis/pharyngitis +/- exudates
Posterior or diffuse cervical lymphadenopathy
Significant fatigue
\+/- hepatosplenomegaly
\+/- rash after amoxicillin
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19
Q

Equation for appropriate respiratory compensation for a metabolic acidosis

A

PaCo2 = 1.5 x bicarb + 8 +/- 2

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20
Q

Digoxin toxicity

A

N/V, decreased appetite, confusion, weakness, scotoma/blurry vision with changes in color/blindness

NOTE: Inciting events include anything that leads to volume depletion (viral illness or excessive diuretic use)

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21
Q

5 clinical features of primary hyperparathyroidism

A

nephrolithiasis, osteoporosis, nausea, constipation, and neuropsychiatric sxs (stones, bones, abdominal moans,and psychic groans)

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22
Q

Conditions associated with secondary amyloidosis

A 
inflammatory arthritis (RA)
Chronic infections (Tb)
IBD
Malignancy
Vasculitis
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23
Q

Clinical presentation and treatment of secondary amyloidosis

A

Clinical presentation: multi-organ dysfunction–asymptomatic proteinuria or nephrotic syndrome, cardiomyopathy with heart failure, hepatomegaly, mized sensory and motor peripheral neuropathy and/or autonomic neuropathy, visible organ enlargement (macroglossia), bleeding diathesis, waxy thickening/easy bruisability of skin

Treatment and ppx: colchine

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24
Q

Infective endocarditis: vascular phenomena

A

systemic emboli, mycotic aneurysm, janeway lesions (macular, erythematous, nontender lesions on the palms and soles)

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25
Infective endocarditis: immunologic phenomena
``` Osler nodes (painful, violacious nodules seen on the fingers and toes) Roth spots (edematous and hemorrhagic lesions of the retina) ```
26
hepatitis A virus vaccine: indications
chronic liver disease (including HBV and HCV) Risk factors for HIV (men who have sex with men, IVDU) or HIV itself
27
Chronic pancreatitis: clinical presentation
chronic epigastic pain with intermittent pain free periods, malabsorption (steatorrhea, weight loss), DM, partial relief when leaning forward
28
Chronic pancreatitis: appropriate labs and imaging
CT scan or MRCP (can show calcifications, dilated ducts, and an enlarged pancreas) NOTE: Amylase/lipase in CPcan be nl or nondiagnostic, while they will be elevated 3xnl in AP
29
Adult Still Disease
An uncommon inflammatory d/o characterized by recurrent high fevers, arthritis/arthralgias, and a salmon-colored macular/maculopapular rash. ESR may be markedly elevated NOTE: distinguished from infective endocarditis by absence of active urine sediment, painful fingertips, and pulmonary symptoms
30
MEN1
Primary hyperparathyroidism (hypercalcemia) Pituitary tumors (prolactin, visual defects) Pancreatic tumors (especially gastrinomas)
31
MEN2A
Medullary thyroid cancer (calcitonin) pheo parathyoid hyperplasia
32
MEN2B
Medullary thyroid cancer (calcitonin) Pheo Mucosal neuromas/marfanoid habitus
33
Porphyris cutanea Tarda: clinical features and associations
Clinical: blisters, bullae, scarring on sun-exposed skin Scarring and calcification can look similar to scleroderma Progressive buildup of porphorin lends itself to more severe presentations over time Association: HCV, HIV, ecessive alcohol consumption, smoking, estrogen use
34
Scleroderma renal crisis
Occurs in 20% of those with systemic scleroderma (for most within first 5 years) Presents with acute renal failure (w/ out previous kidney disease) and malignant HTN (HA, blurry vision, and nausea). UA may show mild proteinuria. PBScan show microangiopathic hemolytic anemia with schistocytes and thrombocytopenia
35
3 prokinetic agents used in diabetic gastroparesis
metoclopramide, erythromycin, and cisapride
36
Treatment of primary biliary cholangitis
ursodeoxycholic acid
37
relative risk vs exposure odds ratio
Relative risk: risk of one group having a certain outcome vs another group (cohort study where people tracked over time ) Exposure odds ratio: used in case-control (retrospective) studies where expousre of people already known to have the disease is compared to the exposure of those without the disease
38
ABG findings: COPD vs decompensated CHF
COPD: respiratory acidosis and hypoxia CHF: respiratory alkalosis and hypocapnia as well as hypoxia
39
3 criteria in COPD exacerbation
Increased dyspnea Increased cough (more frequent or severe) Change in sputum production (color or volume) Use antibiotics if fits 2 or more criteria, especially with increased sputum purulence
40
antibiotic tx of moderate-severe COPD exacerbation
macrolides (azithro) fluoroquinolones (levofloxacin, moxifloxacin) penicillin/beta-lactamase inhibitors (amoxicillin-clavulante)
41
Etiologies of interstitial lung disease
chronic inhalation of organic/inorganic dust (asbestos berylium, silicon dioxide) Drug toxicity (amiodarone, bleomycin, nitrofurantoin) radiation systermic connective tissue disease (RA, scleroderma)
42
Adverse effects of ACE inhibbitors
Acquired angiodema cough hyperkalemia acute renal failure in pts with bilateral renal artery stenosis
43
pulmonary capillary wedge pressure =
left atrial pressure and left-sided heart function
44
Pseudogout
An acute inflammatory arthritis caused by calcium pyrophosphate crystals Occurs in the setting of recent surgery or medical illness Diagnosed with synovial fluid showing rhomboid-shaped positively birefringent crystals and radiographic evidence of chondrocalcinosis ( caalcified articular cartilage)
45
Theophylline toxicity: 2 main manifestations
central nervous system stimulation (HA, insomnia, seuzures) and cardiac toxicity (arrythmia) in the setting of medication changes
46
Bronchiectasis
A disease of bronchial wall damage and airway dilation due to a recurrent cycle of infection, inflammation, and tissue damage in combinatio with impaired bacterial clearance (d/t impaired immmune defenses, structural airway defect, etc)
47
Modified Wells criteria for pretest probability of PE
+3 points--clinical signs of DVT, alternate diagnosis less likely +1.5 points--previous PE or DVT, hr greater than 100, recent surgery or immobilization +1 point--hemoptysis, cancer Greater than 4 points = PElikely
48
DKA: Lab findings
``` metabolic acidosis (shownn by low bicarb) with an elevated anion gap Hyperkalemia (d/t extracellular shift and loss of insulin dependent cellular uptake. however, osmotic diuresis is actually promoting total body depletion of potassium) ```
49
Anion gap calculation
sodium - (chloride + bicarb) nl is 10-14
50
Treatment of DKA: 3 must-haves +/- 2
IVfluids + potassium (when K<5.2 as nearly all pts K depleted even when hyperkalemic) Insulin Bicarb for pH < 6.9 Phosphate if cardiac dsyfunction PIKIB
51
Polymyalgia rheumatica: symptoms and treatment
Age > 50 BL pain and morning stiffness > 1 month Involvement of 2 of the following: Neck or torso, shoulders or proximal arms, proximal thigh or hip, constitutional TX: glucocorticoids
52
Time frame for reinfarction after acute MI
hours-2 days
53
Time frame for ventricular septal rupture after acute MI
hours-1 week
54
Time frame for free wall rupture after acute MI
hours-2 weeks
55
Time frame for post-infarction angina after acute MI
hours-1 month
56
Time frame for papillary muscle rupture after acute MI
2days-1week
57
Time frame for pericarditis after acute MI
1day-3months
58
Time frame for left ventricular aneursym after acute MI
5days-3months NOTE: presents with ECGfindings of persistent ST-segment elevation after a recent MI and deep Q waves in the same leads
59
Anti-pseudomonal agents
cefepime (4th) or ceftazidime (3rd) piperacillin/ticarcillin-tazobactam Aminoglycosides (amikacin, gentamicin) Fluoros (cipro, levofloxacin) Monobactams (aztreonam) carbapenems (imipenam, meropenam)
60
Most commonly seen infections in MM (2)
respiratory (streptococcal pneumonia)and UTIs
61
Mitral stenosis: PEfindings
mitral facies (pink/purple patches on cheeks) Loud S1 Loud P2 if pulmonary HTN diastolic sounds Opening snap mid-diastolic rumble
62
Diabetic neuropathy affecting the large nerve fibers
negative sxs: numbness, loss of proprioception and vibration sense, diminished ankle reflexes
63
Diabetic neuropathy affecting the small nerve fibers
positive sxs: pain, paresthesias, allodynia
64
CD4 count where reactivation of toxo becomes high
<100 | 30% reactivation
65
Cyanide toxicity
Presents with confusion, seizures Often seen with prolonged nitroprusside drip (as you could see in treatment of HTNemergency), higher doses of nitrop, or baseline CKD
66
Most sensitive indicator of hypovolemia in labwork
Decreased urine sodium (FeNa <1%)
67
Acute urinary retention: 6 major risk factors
``` Male sex Advanced age BPH Neurologi disease Recent surgery Anticholinergics UTI ``` For diagnosis in someone unable to void, bladder US demonstrates >300mL urine
68
Diagnosis of CAP
CXR showing a lobar, interstitial, or cavitary infiltrate NOTE: clinical and physical findings have a <50% sensitivity at predicting presence of pna
69
A person with a 44pack year smoking ho coming in with wt loss, constipation, increased thirst, fatigue, and a calcium level of 14.5 likelt has ________
humoral hypercalcemia of malignancy due to secretion of PTH related protein volume depletion from hypercalcemia-induced nephrogenic DI and decreased PO
70
Use ___ and ___ immediately and ____ long-term to treat severe hypercalcemia, defined as a calcium over ___
NS hydration, calcitonin, bisphosphonate, 14
71
splenic abscess presents with triad of _____
fever, leukocytosis, and LUQpain
72
_____ is most commonly associated with splenic asbcess
infective endocarditis
73
5 features of pancoast tumors
pancoast tumors = superior sulcus tumor Squamous cell lung carcinoma and adenocarcinoma most common types (1) shoulder pain (2) Horner syndrome (PMAVE) (3) C8-T2 neurological involvement (weakness and paresthesias in hands) (4) supraclavicular lymph node involvement (5) weight loss
74
otosclerosis VS presbycusis
otosclerosis = chronic conductive hearing loss associated with bony overgrowth of the stapes, often beginning in middle-age and affects low-frequencies presbycusis = sensorineural hearing loss that occurs with aging, most commonly starting in the 6th decade. High-frequency hearing loss
75
______ is the causative organism ofg bacillary angiomatosis
Bartonella (gram negative bacillus)
76
____ is the antibiotic of choice for bacillary angiomatosis
oral erythromycin
77
3 must-haves in acuteliver failure
markeeldly elevated transaminases (>1000) hepatic encephalopathy hepatic synthetic dysfxn (INR >1.5)
78
3 cancers in Lynch syndrome
colorectal endometrial ovarian
79
3 cancers in familial adenomatous polyposis
colorectal desmoids/osteomas brain
80
3 most common causes of cough
Postnasal drip GER asthma
81
Indications for an x-ray of back (3) =
osteoporotic fracture ankylosing spondylitis suspected malignancy
82
Indications for an MRI of back =
epidural abscess/infection sensory/motor deficits cauda equina syndrome
83
Causes of macrocytic anemia
meds (chemotherapy, DMARDs, hydroxyurea) ``` hypothyroidism nutritional deficiencies (b12, folate) ``` liver disease alcoholism Myelodysplastic syndromes acute leukoblastic leukemia
84
People ages __ to ___ should receive statin regardless of baseline lipid panels
40-75
85
Clinical manifestation of chromium deficiency
Impaired glucose control in diabetics
86
Clinical manifestations of zinc deficiency
alopecia perioral and extremity pustular skin rash impaired taste, wound healing, and immune system hypogonadism
87
Clinical manifestations of selenium deficiency
thyroid dysfunction cardiomegaly immune dsfxn
88
Clinical manifestations of copper deficiency
Ataxia (and peripheral neuropathy) Brittle hair Sideroblastic anemia Depigmentation (skin) Osteoporosis (ABCD-O)
89
Risk factors for trace mineral deficiency
iron, copper, selenium, zinc, chromium TPN poor nutritional intake malabsorption bowel resection
90
Supravalvular aortic stenosis
Second most common cause of AS Can present with CP 2/2 LVH Can lead to coronary aortery stenosis Signs: suprasternal thrill midsystolic murmur at right second intercostal space
91
Kussmaul sign
Increase or lack of decrease of JVP on deep inspiration in constrictive pericarditis
92
Normal JVP
8
93
2 agents used for lowering serum ammonia
in hepatic encephalopathy lactulose and lactilol (nonabsorbable dissaccharides)
94
Transudative causes of pleural effusions
CHF (most commonly bl) liver cirrhosis peritoneal dialysis nephrotic syndrome ph > 7.4
95
Exudative causes of pleural effusion
``` malignancy infection Connective tissue disorders inflammatory disorders PE ``` fluid LDH/serum LDH > .5 Fluid protein/serum protein >.6 LDH fluid is 2/3 uln of serum LDH
96
AL amyloidisis
Associated with MM and waldenstrom macroglobulinemia (IgM) Light chains (usually lambda)
97
AA amyloidosis
Associated with inflammatory conditions (RA, IBD) and chronic infections (osteomyelitis, tb) abnormally folded proteins (beta 2 microglobulin, apolipoprotein, or transthyretin)
98
initial tx for renovascular stenosis or HTN
ACE-is/ARBs NOTE: renal artery stenting of surgical revascularization reserved for pts with resistant hypertension or ruecurrent flask pulmonary edema
99
3 causes of vitamin K deficiency
inadequate dietary intake intestinal malabsorption hepatocellular disease
100
Indications for acute hemo dialysis
``` Acidosis Elecrolytes (K or Ca) Intoxication Overload Uremia (encephalopathy, pericarditis) ```
101
Casts seen in different intrarenal conditions
golmerulonephritis--RBCcasts (nephrotic syndromes) AIN--WBCcasts (infection or antibx) ATN--muddy casts (ischemia or contrast)
102
Treatment of mild, mod, severe hypernatremia
mild: PO h20 mod: NS (N/V, headaches) severe: d5w or 1/2NS (seizures, coma)
103
Treatment of mild, mod, severe hyponatremia
mild: disease-specific mod: NS severe: 3% NS
104
serum osmoles =
2 x Na + glucose/18+ BUN/2.8 NLis 280
105
Hypertonic hyponatremia
low Na, but high serum osmoles Happens in DM, with high glucose and or BUN Remember: serum osm = 2 x NA + glucose/18 + BUN/2.8
106
Sodium correction with hyperglycemia
(glucose-100) x 4 +Na
107
Categories of hypotonic hyponatremia
hypervolemic (ESRD, CHF) euvolemic hypovolemia (V,D, decreased PO, sepsis, burns)
108
Euvolemic hyponatremia
Rta Addisons Thyroid SIADH (tx with volume restriction, diuresis, demecycline)
109
treatment of symptomatic hypercalcemia
ALWAYS DILUTE Ca (IVF) Immediate phase and super symptomatic: calcitonin ALWAYStreat with long term: bisphosponate Consider diuretics
110
Assessment of hyperparathyroidism
high Ca high PTH low phosphorous sestamibi scan: multiple areas of uptake (tertiary) or one area (primary --> resection NOTE: secondary hyperPTH is from CKD
111
Hyperparathyroidism from cancer (2 types of findings)
Metastatic cancer affecting bone: high Ca, high phosphorous, LOWPTH Cancer that secretes PTH-rp: high ca, low phosphrous, low PTH, PTH-rp (PTH-rp acts on kidneys just like PTH)
112
2 types of granulomatous diseases causing increased vit D
TB and sarcoid Secrete 1-25 vit D high calcium, high phosphorous, low PTH (gut affected to absorb ca and P)
113
3 signs of severe aortic stenosis
pulsus pardus and tardus soft or absent S2 late peaking SEM in 2nd right ics
114
CHADSVASC score for risk of thromboembolic event in a person with nonvalvular AF
``` Congstive heart failure Hypertension Age > 75 (2) DM Stroke/TIA/thromboembolism (2) Vascular disease (prior MI, PAD, or aortic plaque) Age between 65-74 Sex (F-->1) ``` Max score is 9
115
Proximal vs distal SBO presentations
Proximal: early vomiting, abdominal discomfort, and abnl contrast filling on XR Mid/Distal: colicky abdominal pain, delayed vomiting, prominent abdominal distension, constipation/obstipation, hyperactive bowel sounds, and dilated loops of bowel on XR Note: both of these can have the complication hypokalemia (from K loss in emesis and through contraction alkylosis) and of strangulation, which would additionally present with peritoneal signs and shock with feverm tachycardiam and leukocytosis being late findings.
116
Rotator cuff impingement/tendinopathy vs rotator cuff tear
impingement /tendinopathy--pain with abduction, external rotation but normal range of motion tear--weakness with abduction and external rotation; age >40 MRI scan will confirm diagnosis
117
Differential diagnosis of anterior medistinal mass
The 4 Ts! Thymoma Teratoma Thyroid neoplasm Terrible lymphoma
118
Concerned for ____ in a pt s/p cardiac cath who is hypotensive and complaining of flank/back pain
retroperitoneal hematoma
119
Scaphoid fxs diagnosis options
Xray at time of injury not sensitive for fx --> either get CT or MRI ORimmobilize in thumb sicca splint and repeat XR i 7-10 days
120
Presentation of acute mediastinitus
Complication of cardiothoracic surgery, often within 14 days post-op fever, tachycardia, CP, leukocytosis XR showing mediatinal widening sternal wound cloudy/prurulent drainage
121
2 most common peripheral artery aneurysms associated with AAAs
popliteal and femoral artery aneurysms
122
Lab values seen in alcoholic hepatitis
AST/ALT > 2 AST and ALT under 500 elevated ggt elevated ferritin
123
Invasive aspergillosis: risk factor, clinical findings, and management
RF: immunocompromise Clinical: Triad of fever, CP, and hemoptysis pulmonary nodules with halo sign Tx: voriconazole +/- caspofungin
124
Chronic pulmonary aspergillosis: risk factors, clinical findings, and Tx
RF: lung disease/damage (cavitary tb) Clinical: >3 months wt loss (seen in 90% of pts), cough, hemoptysis, fatigue, cavitary lesion +/- fungus ball, positive aspergillus IgG Tx: resect aspergilloma, voriconazole, embolization(if severe hemoptysis)
125
3 most common malignancies responsible for pleural effusion
lung, breastm lymphoma
126
Acute post-streptococcal glomerulonephritis
occurs 10-20days after streptococcal throat or skin infections Presents with hematuria, HTN, RBCcasts, and mild proteinuria --> periorbital edema

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