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Random Flashcards

1
Q

how much do I love Katie Jo

A

like crAzy forever and ever no matter what

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2
Q

Docusate sodium

MOA

A

an emulsifier, like surfactant or bile, facilitates mixture of fat and water

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3
Q

commercial name for docusate sodium

A

Colace

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4
Q

generic name for Colace

A

Docusate sodium

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5
Q

Senna MOA

A

mucosally stimulates enteric ns for peristalsis/motility

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6
Q

presentation of multiple

A

we lost fatigue bone pain

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7
Q

normal calcium range

A

8.4–10.2

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8
Q

what is a protein gap

A

difference between total protein and albumin greater than four

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9
Q

what oh FTE abnormality will be seeing in multiple myeloma what LFT abnormality

A

protein gap

Total protein minus album in greater than four, indicating increased non-album proteins

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10
Q

how do you determine if serum protein is due to monoclonal or polyclonal source

A

SPEP

Serum protein electrophoresis

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11
Q

what is the peripheral blood smear finding seen with elevated serum protein

A

what are our OU L EA X
Rollo formation
Our oh you LE a S
Letter ROULE a SROULletter ROULE a UX formation

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12
Q

Rollo formation on peripheral smear indicates

ROUL EA ask

A

elevated serum protein

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13
Q

diagnose multiple myeloma

A

serum protein electrophoresis shows monoclonal M spike

Diagnosis then confirmed by bone marrow biopsy showing greater than 10% clonal plasma cells

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14
Q

what cell lines does a plastic anemia affect

A 
also lines
Results in pancytopenia
Anemia is a misnomer
Pancytopenia would be better
a plastic pancytopenia
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15
Q

megaloblastic erythroid hyperplasia is typically caused by

A

vitamin B 12 or folate deficiency

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16
Q

mean corpuscular volume MCV, and megaloblastic anemia

A

greater than 100

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17
Q

m-spike stands for

A

monoclonal protein elevation

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18
Q

what standard lab findings are classic for multiple myeloma

A

Hypercalcemia
Anemia
Protein gap greater than 4

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19
Q

if clot disorder treated with heparin develops H IT the most appropriate next step in management is

A 
stop heparin
Start our Gacha van
ARGHEROBAN
aRGaTROBaN
or fondaparinux
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20
Q

what signs raise suspicion of H IT

A

Drop and platelets greater than 50%

Or new thrombus within 5 to 10 days of initiating heparin

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21
Q

our patients with H IT at greater risk of bleeding or thrombus

A

thrombus
Thrombotic risk is roughly 50% and untreated H IT
Antibody mediated thrombocytopenia is mild to moderate, rarely less than 20,000, with minimal bleeding risk

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22
Q

T/F

The patient with H IT can we switch to low molecular weight heparin

A

false all heparin products including low molecular weight heparin should be avoided in patients with H IT

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23
Q

when can a patient with an H IT be switched to warfarin

A

when platelets are greater than 150

E a RG a TROB AN or fondaparinux are used before that time

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24
Q

why is initial treatment with warfarin contraindicated in patients with H IT

A

because it rapidly lowers protein C levels which may transiently increase the risk of thrombus

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25
Q

what is the pre-bolus prodrome that may precede bolus pemphigoid Bylas pen for Gordon BULL a S pemphigoid

A

urticaria or eczema

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26
Q

what is the first line treatment for bolus pemphigoid miss spelled BULL a S and annoyed

A

hey high potency glucocorticoid
I call betazole club bed is all call Verizon
CLOE
CLOBET a S OL

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27
Q

what is used to treat ball is pemphigoid one topical corticosteroids are not possible

A

oral steroids can be used but they are not preferredas they are associated with treatment complications

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28
Q

what is the rash seen with gluten allergy

A

dermatitis herpetiformis
pruritic vesicles buttocks and extensor limb surfaces

biopsy demonstrates dermal papillary necrosis and anti-tissue transglutaminase IGA antibodies (anti-TTG)

treatment is dapsone and gluten restriction

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29
Q

unasyn =

A

ampicillin/sulbactam

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30
Q

ampicillin/sulbactam comm name =

A

unasyn

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31
Q

tx hyper K
3 shift
3 remove

A

Ca gluconate
glucose + insulin
bicarb

k-exalate (binding resin GI)
lasix
dialysis

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32
Q

estimate normal weight

A

5 ft 100lb
+7/lb male
+5/lb female

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33
Q

how to spot rca infarct on ekg

A

get r sided ekg

ste in V4R

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34
Q

rbbb on ekg

A

v1 rsr

v6 qr slurred s

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35
Q

targey glucose inpt

A

140-170

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36
Q

define fever celcius

A
  1. 3x1

38. 0x2 at least 1hr apart

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37
Q

uvea =

A

cilia + iris
so anterior uveiitis = iritis
posterior uveiitis = ciliitis

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38
Q

uvea =

A

cilia + iris
so anterior uveiitis = iritis
posterior uveiitis = ciliitis

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39
Q

3 clinical features of legionella pneumonia

A

high fever (>39 C; >102.2 Fw bradycardia
headache and confusion
watery diarrhea

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40
Q

high fever w bradycardia
headache and confusion
watery diarrhea

think this kind of pneumonia…

A

legionella

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41
Q

2 lab findings of legionella pneumonia

A

hyponatremia (watery diarrhea)

sputum gram stain w neutrophils but no other organisms (intracellular poor staining GNR)

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42
Q

hyponatremia
sputum gram stain w neutrophils but no other organisms

think this kind of pneumonia

A

legionella

diarrhea; does not gram stain well (intracellular poor staining GNR)

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43
Q

dx legionella

A

legionella urine antigen test

+/- cx

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44
Q

tx legionella

A 
newer macrolides
or fluoroquinolones (faveored when severe enough for hospitalization)
(both high intracellular concentration)
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45
Q

travel-associated lug infiltrates, confusion, diarrhea due to contaminated water supplies e.g. cruise ship or hotel think…. this bug

A

legionella pneumonia

legionnaires’ disease

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46
Q

what is a high grade fever

A

> 39 C

> 102.2 F

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47
Q

symptoms that help distinguish legnionella from other CAP

A

high grade fever (>39C or 102.2F)
GI (diarrhea)
neurologic (confusion, ataxia)

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48
Q

lung examination finding in legionella

A

rales (crackles)

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49
Q

legionella on gram stain of sputum cultures

A

many neutrophils but no organisms

intracellular weak stain GNR

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50
Q

why are ___ and ___ antibiotics used to treat legionella

A

new macrolides
fluoroquinolones (pref if sev enough for hosp)

because achieve high intracellular conc
(legionella is intracellular weak stain GNR)

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51
Q

When is amoxicillin/clavalunate typically used

A

sinusitis, otitis media, some CAP

active against beta-lactamase producing Haemophilus and Moraxella

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52
Q

what kind of pneumonia is ceftriaxone used to treat

A

pneumococcus (s pneumo)
haemophilus
moraxella

(CAP not Legionella or other atypicals)

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53
Q

what kind of pneumonia is clindamycin used to treat

A

aspiration pneumonia

anaerobes above the diaphragm

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54
Q

what kind of pneumonia is vanc used to treat

A

nosocomial (HAP, HCAP)

when MRSA probability higher

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55
Q

T/F

Vanc has activity agains atypical pneumonias

A

F

used in nosocomial HAP/HCAP when MRSA prob higher

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56
Q

cutaneous verrucae =

A

skin warts

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57
Q

T/F

warts are most common cutaneous manifestation of HPV infection

A

T

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58
Q

where can HPV cause warts

A

various locations

plantar, palmar, genital common

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59
Q

what demographic and what disease is associated with more plantar warts from HPV infection

A

young adults

decreased cellular immunity (AIDS, transplant)

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60
Q

how are cutaneous verrucae (warts) caused by HPV transferred?

A

through tiny cuts on contact with infected person

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61
Q

describe lichen planus

A

purple
flat-topped papules or plaques
pruritic, planar, or polygonal
commonly on flexural surfaces (extremities, trunk, genitalia)

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62
Q

purple
flat-topped papules or plaques
pruritic, planar, or polygonal
commonly on flexural surfaces (extremities, trunk, genitalia)

=…

A

lichen planus

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63
Q

t/f

lichen planus = white lesions on bottoms of feet

A 
FALSE
PURPLE
flat-topped papules or plaques
pruritic, planar, or polygonal
commonly on FLEXURAL surfaces (extremities, trunk, genitalia)
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64
Q

molluscum contagiousum is caused by

A

poxvirus

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65
Q

describe molluscum contagiosum

A

single or multuple skin-colored papules w central punctum/umbilicus/put

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66
Q

t/f

molluscum contagiousum is a common condition caused by poxvirus

A

T

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67
Q

molluscum contagiosum is caused by…

A

poxvirus

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68
Q

describe seborrheic keratosis

A 
solitary or multiple
well-circumscribed
hyperpigmented lsions
can have "stuck-on" / warty appearance
usuallly on trunk, face, upper extremities
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69
Q

are subhorrheic keratoses solitary or multiple

A

either

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70
Q

are subhorrheic keratoses well or poorly circumscribed

A

well-circumscribed

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71
Q

what color are subhorreic keratoses

A

hyperpigmented

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72
Q

where do subhorreic keratoses typically occur

A

trunk, face, UE

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73
Q

erythematous skin lesion scaly, ulcerative, growing irregularly, slowly, non-resolving…. think…

A

squamous cell carcinoma

espec in sun-exposed area but that would have given it away a bit to easily

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74
Q 
low grade fever
acute watery diarrhea
abdominal pain
guaiac positive stool
in setting of prolongued omeprazole use

think…

A

C Diff colitis

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75
Q

which abx inc risk of c diff

A

clindamycin
penicillins
cephalosporins
fluoroquinolones

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76
Q

T/F
PPI or anti H2 antihistamine
inc risk of c diff

A

T

prolongued gastrc acid suppresion

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77
Q

confirm dx of c diff

A

PCR for stool c diff toxins A and B

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78
Q

risks of prolongue PPI

A

c diff colitis (gastric acid suppression)
impaired Ca absorption (^ risk osteo porosis)
inc upper gi pathogen colonization –> inc risk PNA

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79
Q

dyspepsia =

A

epigastric pain
post prandial fullness
early satiety

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80
Q

T/F

urea breath teast is noninvasive

A

T

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81
Q

urea breath test for…

A

h pylori in setting of dyspepsia
epigastric pain
post prandial fullness
early satiety

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82
Q

chronic diarrhea w foul-smelling/greasy stool and weight loss suggestive of…

A

steatorrhea and malabsorption

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83
Q

T/F

fever and guaiac positive stool are characteristic of celiac disease

A

F
+aTTG ab
chronic diarrhea / malabsorbtion (weight loss, nutrient deficiencies)

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84
Q

when to measure serum gastrin level

A

suspected gastrinoma
(Zollinger-Ellison syndrome)
-recurrent duodenal peptic ulcers, GERD, diarrhea

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85
Q

when to eval stool for O&P

A

persistent diarrhea & risk exposures for protozoa
-exposed to infants in daycare
travel
drinking from mountain streams

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86
Q

T/F
dx of parasitic infection and O & P in stool is unlikely if not recently exposed to infants in daycare, travel, or drinking from mountain streams

A

T

unlikely if not exposed to risks such as these

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87
Q

define pulsus paradoxus

A

drop in systemic (S or D?) BP > 10mmhg on inspiration

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88
Q

mechanism of pulsus paradoxus in severe asthma or copd

A

overexpansion of lungs can constrict space for heart

also intrathoracic pressure can drop 40mmhg with inspiration (normal 2-5mmhg) causing blood to pool in pulm vasculature

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89
Q

how does aortic regurge prevent pulsus paradoxus

A

inc end diastolic pressure of lv preventing shift of interventricular septum during inspiration

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90
Q

pyoderma gangrenosum

A

neutrophilic ulcerative skin disease

assoc w chronic inflam disease like ibd, ra (arthropathies), aml (heme conditions)

clinical dx, eclude others, comfirm w biopsy

tx w local or systemic corticosteroids

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91
Q

inflam nods w pur drainage w scar formation in chronic phase. in axilla, groin, scalp usually

A

hydradenitis suppurtiva

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92
Q

t/f

hiv is a risk for vte

A

t

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93
Q

t/f

hiv is a risk for vte

A

t

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94
Q

some clinical manifestations of sarcoid

A 
multisystem noncaseating granulomas
hilar adenopathy
uveiitis
LAN, hepatosplenomeg
acute polyarthralgias (ankle esp)
hypercalcemia w bone resorb
central DI
e nodosum
lofgren (e nod, hilar ad, migratory polyarthralgias, fever)
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95
Q

sarcoid mos common in

A

young adult black women

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96
Q

presentation of sarcoid

A

incodental bilat hilar lan on cxr

cough dyspnea fever fatigue weight loss

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97
Q

dx sarcoid

A

biopsy noncaseating granulomas

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98
Q

tf

nystagmus possible w etoh intox

A

t

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99
Q 
tachycard
htn
dry mouth
conjunctival inj
inc appetite
impaired shirt term memory loss

what kind of intox

A

marijuana

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100
Q 
tachycard
htn
mydriasis
self conf
good attention/vigilance
arousal
euphoria

what kind of intox

A

cocaine

withdrawal can inc appetite

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101
Q

mydriasis

A

dilated pupil

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102
Q

dilated pupil

A

mydriasis

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103
Q

depressed mental status
depressed respiratory rate
meiosis

what kind of tox

A

opiod

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104
Q 
tachycard
htn
impaired judgement
aggressiveness
ataxia
multidirectional nystagmus

what kind of tox

A

pcp

phencyclidine

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105
Q

confusion
nystagmus
ataxia
opthalmoplegia

short term memory loss
confabulations

what kind of tox

A

not tox
thiamine deficiency
b1

wernicke encephalopathy
korsakoff syndrome (chronic)
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106
Q

vrdl test stands for

A

vinereal disease research lab test

high sns for syphillis
but lower sp so confirm w fta-abs
fluorescent treponemal absorption

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107
Q

fta-abs test

stands for

A

(fluorescent treponemal antibody absorption)

high sp for syphillis
use to confirm after positive vrdl (high sns, lower sp)

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108
Q

anti-phospholipid ab syndrome (APS)

commonly causes false positive ____ test

A

vrdl

venereal research disease lab test for syphillis

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109
Q

aps
antiphospholipid ab syndrome

summary

A 
risk of a and v thromboses
prone to miscarriage
false pos vrdl
thrombocytopenia
long ptt

should get lmwh in subseq pregnancies to reduce risk to fetus

vit k antag warf if not preg (teratogen)

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110
Q

treat early or latent syphillis with

A

benzathine penicillin

(benzylpenicillin

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111
Q

how to treat aps
antiphospholipid ab syndrome

not preg vs preg

A

not preg warfarin vit k antag

preg lmwh bc warf ci

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112
Q

bilateral trigeminal neuralgia suggestive of

A

ms

teigeminal nerve nucleus demyelination

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113
Q

herpes zoster usually affects which trigeminal branch and what is the scary complication

A

v1
blindness
herpes zoster opthalmicus

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114
Q

clinical manifestations of cavernous sinus thrombosis after facial venous infection

A 
fever
headache
proptisis
cn iii iv v vi deficits
(v1&v2 opth and max)
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115
Q

dihydropyridines preferentially dilate

A

precapillary arterioles

risk edema

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116
Q

how do acei’s reduce the risk of ccb peripheral edema

A

cause post capillary venodilation to normalize pressure from ccb pre cap arteriolar dilatiom

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117
Q

why are acei’s renoprotective

A

preferentially constrict efferent arteriole, preserving gfr

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118
Q

tf

acei’s cause peripheral edema

A

f

angioedema

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119
Q

solitary pulm nodule size vs ct vs sc resection indications

A

resect any size if high malig risk (size age smoke stop border)

^8mm resect if high malig risk pet if low risk resect if pet+ serial ct if pet-

v8mm & low risk can serial ct if 5-7mm can stop workup if v4mm

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120
Q

lung nodule vs mass

A

3cm v^

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121
Q

5 ways to class solitary lung nod risk of malig

A 
size age smoke stop marg
low mod high
v8mm .8-2mm ^2mm
v40yo 40-60 ^60
former current current
^15y 5-15y v5y
smooth scalloped spiculated corona

serial image growth, pet+, path

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122
Q

these 3 bugs causing infectious granulomas are responsible for majorityof benign pulm nodules

A

histoplasma
coccydioidomycosis
tb

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123
Q

1 cause isolated aortic stenosis in elderly

A

age dependent idiopathic sclerocalcification

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124
Q

tf

bacterial endocarditis can lead to aprtic stenosis

A

f

aortic insufficiency

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125
Q

hyposthenuria

A

impairment in kidney ability to conc urine

sickle cell
and sickle cell trait

prob from ss occlusion of vasa rectae, impairing countercurrent multiplier system

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126
Q

acute gout pain reaches max intensity in what timeframe

A

12-24 hr

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127
Q

tf

gout can be dxd by hyperuricemia

A

false
not correlated well, can be caused by acute delta urate up or down
need negative birefringent synovial urate crystals

can use urate levels to monitor, not dx

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128
Q

enthesetis

A

inflammation at tendon insertions

eg w spondyloarthropathies

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129
Q

tf

neuropathic arthropathy can occur in longstanding dm

A

t

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130
Q

meralgia paresthetica

A

burning pain and paresthesias in lateral thigh unaffected by motion caused by compression of lat fem cutaneous nerve at waist

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131
Q 
holocranial headache
vision changes (blurry, diplopia)
papilledema
cn vi palsy
pulsatile tinnitus whooshing
empty sella...

suggest

A

idiopath intracran hypertens

pseudotumor cerebri

young obese women
tetracyclines hypervitA

dx w high opening press LP

tx wt loss acetazolamide

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132
Q

tf

papilledema ci lp

A

f

not unless onstructive/noncommunicating hydroceph or slace occupying midline shifting lesion

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133
Q

tf

lp is unsafe in pseudotumor cerebri

A

f

communicating, cerebral press equiv to lumbar, safe, high opening press diagnostic

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134
Q

what is diagnostic opening pressure for pseudotumor cerebri/ iih

A

^250mmh2o

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135
Q

amaurosis

A

loss of vision

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136
Q

how does prolactinoma cause hypogonadism in men

A

prolactin inhibits gnrh release

not by mass overgrowing gonadotrophs, at least early

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137
Q

tf

tsh normal in symptomatic prolactinoma

A

tish

normal early, can get low if big compressive effect later

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138
Q

what level of prolactin is virtually diagnostic of prolactinoma

A

^200 ng/ml

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139
Q

what does bivalirudin do?

A

directly reversibly inhibits thrombon

bival (reversible)
rudin ~ “thrombin”

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140
Q

STEMI mgmt

A
  • o2 for sat v90%
  • nitrates (caution r infarct, hypot, aortic stenosis)
  • asa & p2y12 inhib (grel)
  • cath lab reperfuse v90min capable v120min if transfer needed v12 h sympx onset pci>fibrinolysis unless outside window
  • bb but not if hf, risk shock
  • ufh lmwh bivalirudin
  • statin
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141
Q

acute pericarditis on ekg

A

diffuse ste w std in limb and left precordial leads

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142
Q

tf

it is within ethical guidelines to practice procedures on deceased pt

A 
t
if pt (prior to death) or family consents
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143
Q

prevent mi in cad

A

asa
bb
behavior mod

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144
Q

why appetite suppressants ci in cad

A

because sympathomimetic and can elevate hr and bp

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145
Q

why avoid metformin in cad

A

can exacerbate lactic acidosis

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146
Q

tf

ankylosing spondylitis risks vertebral fracture with minimal trauma

A

t
chronic inflammation, osteoclast activation, bone loss

also spinal rigidity makes prone

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147
Q

describe ankylosing spondylitis pain

A

insidious, unilateral, intermittent, may eventually become bilateral and persistent

not usually acute onset

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148
Q 
presentation
exam
compx
lab
imaging

ankylosing spondylitis

A
  • inflam back pain, insidious age v40, relieved w ex, nocturnal
  • enthesitis, arthritis, dactylitis, uveitis, kyphosis, diastolic murm
  • osteopor vert fractures, cauda equina, aortic regurge
  • esr crp hla-b27
  • xr sacriloiliac, mri sacroiliac
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149
Q

dementia
gait disturbance
bladder incontinence

triad for

A

nph

normal pressure hydrocephalus

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150
Q

how to diff normal pressure hydrocephalus from brain atrophy on mri

A

both have enlarged ventricles, atrophy has enlarged sulci

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151
Q

typical mmse score in alzheimers

A

v24

amnesia first, confusion only late advanced

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152
Q

tf

cml has high LAP leukocyte alk phos

A

false

cml immature pmn precursors (promy metamyelocytes), LAP comes from mature leukocytes

153
Q

what blood stain for malaria

A

girmsa stain

154
Q

tf

auer rods in cml

A

f

Auer rods in Aml

155
Q

which is more mature, myelocyte or metamyelocyte

A

meta

blast pro my meta band pmn

myeloast promyelocyte myelocyte metamyelocyte band neutrophil

156
Q

how will mys and metamys compare cml vs leukemoid rxn

A

metas more mature
more metas in leukemoid
more mys in cml

157
Q

on urine dipstick,
esterase signifies
nitrites signify

A

leukocytes (pyuria)

enterobacter e.g e.coli (converts urine nitrates to nitrites)

158
Q

tf

atheroembolism is a complication of vasc procedures such as cardiac cath

A

t

159
Q

tf

cholesterol embolism is synonymous with atheroembolism

A

t

160
Q

tf

hashimoto pts are hypothyroid

A

f
eu or hypo
ai thyroid destruction

161
Q

another name for hashimotos

A

chronic lymphocytic thyroiditis

162
Q

graves disease hyper or hypo thyroid

A

hyper

ai activation of thyroid

163
Q

another name for grave’s

A

diffuse toxic goiter

164
Q

dreaded complication of status

A

cortical laminar necrosis from excitatory toxicity

165
Q

new soft cresc decresc systolic murm in setting of fever suggests

A

flow murmur
from hyperdynamic state induced by fever and hypoxia

(vs harsh murmer w fever in endocarditis)

166
Q

a a gradient refers to

A

A-a

Alveolar-arterial

167
Q

alveolar hypoventilatiom signifies

A

uniform fall in inspired o2 in All regions of the lungs

168
Q

new harsh murmur w ^ pulm cap wedge pressure in setting of fever suggests

A

infective endocarditis with mitral valve involvement

169
Q

ara-c…

A

cytirabine
arabinofuranosyl cytidine

pyrimidine (cytosine) analogue
blocks dna/rna synth

eg used to treat ALL

170
Q

tf

poor urine output with intermittent high output can be consistent with obstructive uropathy

A

t

this is called post obstructive diuresis which occurs when obstruction overcome by high retained volume

171
Q

quantify microscopic hematuria

A

^ 3 rbcs/hpf

172
Q

tf

renal artery stenosis often presents with flank pain

A

f

htn w/o flank pain or urinary sympx usually

173
Q

tf

there is an HAV vaccine

A 
t
for pts w
chronic hepatitis (HBV,HCV)
MSM
IVDU
travel to hav endemic area
174
Q

HPV vaccine recommended for

A

all pts age 11-26 ish
11-12 yo m&f
11-26 f
11-21 m, -26 if hiv+

175
Q

meningococcus acwy vaccine for

A

all pts 11-18
large groups in small quarters
asplenia or complement deficiency

176
Q

how often to repeat TDaP vaccine

A

every pregnancy for women

TD q10yrs everyone else

177
Q

pneumococcal vacc sched for hiv pts

A

pcv13

ppsv23 8 wks later, 5 yrs later, and age 65

178
Q

hav vaccine for

A 
for pts w
chronic hepatitis (HBV,HCV)
MSM
IVDU
travel to hav endemic area
179
Q

tf

mmr requires a redo later in life

A

f

not even in hiv pts

180
Q

red firm friable exophytic nodules in hiv pt

A

bacillary angiomatosis
gnr bartonella henslae
po erythromycin

181
Q

extrapulmonary pneumocystis

A

nodular and papular cutaneous lesions of external auditory meatus
(tx pneumocystis w tmp-smx)

182
Q

molluscum contagiousum

A

dome shaped umbilicated non-pruritic papules

poxvirus

183
Q

mama cyst w multiple daughter cysts (anywhere but usually liver or lung) in a sheel farmer caused by

A

echinococcus tapeworm
dogs definitive host
sheep intermediate host
humans collateral damage

tx azoles or surgical cyst removal

184
Q

parasites
sheep farmers get
pig farmers get

A

sheep echinococcus

pigs neurocystercercosis

185
Q

neurocystercercosis often in __ farmers

A

pig farmers

186
Q

treat isoniazid induced peripheral neuropathy

A

give pyridoxine B6 100mg qd

187
Q

which tb antibiotic cam cause peripheral neuropathy and how do you treat it

A

INH isoniazid
give pyridoxine b6 100mg qd

RIPE P after I, Periph neurop, Pyridox

188
Q

2 known side effects of inh isoniazid

A

peripheral neuropathy (so always give w 10mg qd pyridoxine b6, tx w 100mg)

hepatitis

189
Q

key vitamin to always give with RIPE therapy

A

pyridoxine b6 10mg qd to prevent inh induced peripheral neuropathy

190
Q

hemobilia

A

blood in biliary tree
rare
from surgery or trauma

191
Q

typical setting of gi stress ulcers

A

prolongued physiologic stress eg icu or burn unit

192
Q

fever night sweats weight loss
cough ab pain diarrhea
splenegaly ^alk phos
hiv cd4 v50

A

MAC
disseminated mycobact avium or intracellulare

should have prevented w azithromycin ppx

ddx tb or cmv
so check ppd cxr cmv-IgG

193
Q

positive ppd criteria

A

> 15mm no risks
10mm from endemic area, health care workers or high risk setting, ivdu
5mm hiv, transplants, known recent exposure, suspicious cxr nodules or fibrotic

194
Q

negative ppd criteria

A

v5mm

v15mm no risk factors
v10mm from endemic area, health care workers or high risk setting, ivdu
v5mm hiv, transplants, known recent exposure, suspicious cxr nodules or fibrotic

195
Q

alternative pneumocystis ppx

A

dapsone
competes w paba to inhib folate synth
alternative to preferred tmpsmx

196
Q

signs of liver cirrhosis

A

jaundice, edema (low prot), ecchymoses (low clot factors)

portal htn, ascites, esoph and anorectal varices, splenomeg, caput medusae

hyperestrinism, gynecomast, testicular atrophy, loss of sex hair, spider angiomata (subtype of telangiectasia – swollen bv’s beneath skin), palmar erythema

197
Q

why hyperestrinism in cirrhosis

A

impaired cyt p450 metabolism of circulatimg estrogens

198
Q

what are spider angiomas and why do they occur from cirrhosis

A

central dilated arteriole with radiating distal vessels

cirrhosis, impaired p450 metab of circulating estrogens, vessel wall dilation

199
Q

why does palmar erythema occur from cirrhosis

A

hyperestrinism (impaired p450 metab of circulating e), vessel wall dilation, increases normal speckling of palm from vasculature

200
Q

dupytren contracture

A

thickening of palmar aponeurosis contracts fingers, 4th and 5th digits first usually

etiology not specific… possible ox stress and free rads for some reason…

201
Q

senile purpura vs solar purpura/ actinic purpura

A

superficial bleeds from loss of perivascular elastic tissue in elderly vs middle aged w lots of sun exposure

202
Q

which tb drug has urinary se’s

A

rifampin turns urine red

203
Q

diff hematuria from glomerulonephritis from bladder cancer

A

glomneph has rbc casts

204
Q

most common cause of gross hematuria in smoker age ^35

A

bladder cancer

205
Q

gross hematuria more common w bph or prostate ca?

A

bph

206
Q

hematuria from bladder ca painful or painless?

A

painless

207
Q

presentation and dx of glucagonoma

A
  • necrolytic migratory erythema - papules into patches blister crust scale w central clearing perineum perioral extrem
  • diabetes mild controllable
  • gi sympx d/c pain anorex wloss
  • neuropsych, venous thrombosis

hypergly w glucagon ^500
normocytoc anemia of chronic disease/epo suppression from glucagon
tumor vs mets on imaging

208
Q
  • necrolytic migratory erythema - papules into patches blister crust scale w central clearing perineum perioral extrem
  • diabetes mild controllable
  • gi sympx d/c pain anorex wloss
  • neuropsych, venous thrombosis

what is dx and how make it

A

glucagonoma

hypergly w glucagon ^500
normocytoc anemia of chronic disease/epo suppression from glucagon
tumor vs mets on imaging

209
Q

anti-glutamic acid antibidies and low insulin levels amd ralid progression to insulin dependence

A

indolent late onset type 1 DM

210
Q

induration

A

firmness

211
Q

dx workup of bph

A

1 dre for smooth enlarge (bph) vs nodules (prost ca)

2 UA for hematuria (bladder ca, stone) or infection to rule these out

3 psa for prost ca for men w le >10yrs

212
Q

tf

Cr is a good lab to trend in bph

A

f

no different risk for renal dysfunction than gen pop

213
Q

when is transrectal us of prostate indicated

A

for biopsy when nodules on dre or persistent psa ^4

214
Q

1st step in mgmt of svt

A

adenosine or vagal maneuver, will slow an help determine type of svt

215
Q

tx panic attack

A

alprazolam (BZD)

216
Q

amiodarone and lidocaine treat

A

vtach

ami also tx afib

217
Q

how does adenosine affect heart

A

slows sinus node rate
slows av node conduction

tx/dx of svt

218
Q

acute pericarditis post mi

A

usually within days
sharp, pleuritic, better sitting up leaning forward
diffuse ste espec w pr dep
friction rub

219
Q

how long to interventricilular free wall or papillary muscle rupture after mi

physical exam finding

A

3-7 days

new systolic murmur

220
Q

free wall rupture after mi

A

3-7 days

rapid deterioration to pericardial tamponade and pulseless electrical activity

221
Q

what renal labs are affected by upper gi bleed

A

bun/cr ratio ^
hb breakdown and absorb by gut
inc urea retention 2/2 hypovolemia

222
Q

inc alk phos w what kind of disease

A

biliary obs
osteoblastic bone d (paget’s)
mild in ibd and gi infection

223
Q

tf

apthous ulcers can be seen in crohns celiac or folate deficiency

A

t

apthous ulcers = small shallow ulcers in mouth

224
Q

hairy cell leukemia

A

pancytopenia, splenomeg sometimes leukocytosis
rare b cell lymphocytic leukemia
fine hair-like irregular cytoplasmic projectioms
fibrotic bone marrow dry taps
TRAP tartrate resistant acid phosphatase stain
CD11+

225
Q

paresthesias a sign of hyper or hypocalcemia

A

hypocalcemia

226
Q

why might pt get tingling in toes and fingers after large transfusion

A

paresthesias from hypocalcemia

while blood donations stored w citrate anticoagulant, chelates calcium, makes hypocalcemic. packed rbcs derived from those donations, can also be hypocalcemic. usually only affects pts of large transfusions

227
Q

what electrolyte leaks out of stored rbc’s and can cause hyper__ in transfused pt

A

k+ leaks out

can get hyperkalemic when transfused

228
Q

how do glucocorticoids affect wbc’s

A

inc pmns by demarg slight inc production and inhib apop

dec lympho eo by extrav dec production inc apop

overall leukocytosis

229
Q

describe heat stroke and compx

A

temp ^40C (104F) + AMS
hot no water or shade
elderly can’t move non-exertional
young exertional

compx coagulopathy (epistaxis) ARDS ARF rhabdo

230
Q

tf

heat stroke can present w epistaxis

A

t
coagulopathic bleeding is a complication

also rhabdo ARDS ARF

231
Q

typical upper limit of infection induced fever

A

40.5C

105F

232
Q

tf

infections rarely cause fever ^105F 40.5C

A

t

233
Q

tf

latex allergy can cause anaphylactic shock

A

t

234
Q

what endocrine abnorm should be suspected in pt suddenly hypotensive in stressful sitch such as surgery

A

adrenal insufficiency

primary called addison’s

235
Q

riluzole

A

glutamate inhib
tx ALS
prolong time to tracheostomy, not reverse or halt
se’s dizzy nausea weight loss skeletal weakness elevated liver enzymes

236
Q

tf

ALS tx involves steroids, ivig, cyclophosphamide

A

f
als neurodgen, not immunologic like
MS (steroids for acute exacerbations)
or GBS (ivig ~ plasmapheresis)

237
Q

dx pancreatitis

A

2/3
epigast pain rad to back
amylase or lipase ^3x uln
imaging findings

238
Q

causes of pancreatitis

A 
alc 40%
gallstones 40%
#3 Hyper TAG ^1000
drugs azt vpa thiazide diurs
azathioprine valproic acid
inection cmv
ercp
trauma
239
Q

yellow red papules on extensor surfaces

+ elugastric tenderness

A

xanthomas and pancreatitis caused by hylertriglyceridemia

240
Q

what key lab suggests biliary pancreatitis

A

ast ^150

241
Q

4 uses if tmpsmx

A

gnrs (uncomplicated uti)
pcp pneumonia ppx
mrsa skin infections
nocardia

242
Q

8 drugs that cause hyperkalemia

A 
bb's (cell k uptake b2)
acei arbs k+ sparing diurs
cyclosporine blocks aldo
heparin blocks aldo synth
nsaids dec renal perfusion
succinylcholine k leak from cells
tmpsmx blocks enac like amiloride
243
Q

how dors tmp smx work

A

sequential block of bacterial thf

244
Q

what electrolyte to monitor in high dose tmpsmx tx

A

k
blocks enac, hyperkalemia
also blocks renal tubular creatinine secretion so gets high but glomerular function normal

245
Q

se’s of macrolides

A

long qt

cholestasis

246
Q

ceftriaxone se

A

cholestasis

247
Q

how does prednisone affect k+

A

some k+ wasting

because glucocorticoid with some mineralcorticoid activity

248
Q

tick borne paralysis

A
  • tick must feed 4-7 days to release neurotoxin
  • ascending motor paralysis arms or legs, can affect one side more than another (unlike gbs)
  • develops over hours (vs days to weeks gbs)
  • no fever or prodromal illness (unlike gbs)
  • does not affect ANS, (unlike gbs)
  • normal csf (unlike gbs)

tx meticulous search and removal of tick makes better

249
Q

guillan barre

A
  • ascending paralysis
  • days to weeks gradual onset
  • often affects ANS (tachycardia, arrhythmias, urinary dysf)
  • often csf albuminocytologic dissoc (high alb few cells)

tx ivig plasmapheresis

250
Q

botulism

A

descending paralysis with early cn involvement (eg pupil)

251
Q

tf

fever with tick borne paralysis

A

f

no prodrome

252
Q

tf

removal of the tick usually results in spontaneous improvement of tick borne paralysis

A

t

253
Q

hyponatremia with normal serum osmolarity caused by

A

hyperproteinemia

hyperlipidemia

254
Q

hyponatremia with high osmolality caused by

etiology

A 
hyperglycemia
exogenous solutes (mannitol, radiocontrast)
255
Q

hypoosmotic hypovolemic hyponatremia with urine sodium v10

etiology

A

dehydration
vomiting
diarrhea

256
Q

hypoosmotic hypovolemic hyponatremia with urine sodium ^20

etiology

A

renal salt loss

  • acei
  • diuretics
  • mineralcorticoid deficiency
257
Q

why treat siadh with demeclocycline

A

it is an antibiotic known to cause reversible nephrogenic diabetes insipidus

258
Q

how much can kidneys dilute urine sodium

A

Una v 10meq/__

259
Q

tf

gonoccocal arthritis may present with migratory polyarthralgias

A

t

or mono or oligoarthritis

260
Q

what % gonococcal arthritis is “silent” without noticed preceeding gu or pharyngeal infection

A

75%

261
Q

tf

purulent arthritis in a sexually active individual is gonoccocal until proven otherwise

A

t
confirm w
synovial gram stain and cultures (each only 25% positive)
and pharyngeal or gu mucosal nucleic amplification (90% positive)

262
Q

sympx of acute hiv

A 
non specific
2-4 weeks after exposure
fever
arthralgias
sore throat
LAN
mucocutaneous lesions
diarrhea
weight loss
263
Q

what kind of glomerulonephritis do you get with lupus

A

focal proliferative gn

264
Q

define malignamt hypertension

A 
extreme htn (urgent emergent range) w
retinal hemorrhages, exudates, or papilledema

arf from nephrosclerosis also possible but not required to dx

265
Q

mechanism of hypertensive encephalopathy

A

breakthru vasodilation from failure of autoreg

266
Q

common organ damage in hypertensive emergency

A

malignant htn

  • retinal hemorrhage, exudate, papilledema
  • nephrosclerosis and arf

hypertensive encephalopathy

subarachnoid hemorrhage
intracerebral hemorrhage

267
Q

tf
cerebral salt wasting (hypovolemic hyponatremic w high Una ^20)
is always due to surgery or trauma

A

t

268
Q

what electrolyte abnorms does vomiting cause

A

hypovolemia
hypokalemia
hyponatremia

269
Q

most common cause of isolated aortic regurge in developed countries

A

bicuspid aortic valve

270
Q

most common cause of airtic regurge in developing countries

A

rheumatic heart disease

271
Q

how to hear aortic regurge better

A

firm pressure w steth at lsb let 3rd or 4th interspace

patient sot up lean forward hold breath at full expiration

272
Q

uses of carbamazepine

A

atypical bipolar depression

trigeminal neuralgia

reduces post tetanic potential… certain seizures too…

273
Q

treatment for trigeminal neuralgia

A

carbamazepine
if that fails
surgical gangliolysis
or suboccipital craniectomy to decompress trigeminal are options

274
Q

key followup in pt treated w carbamazepine chronically

A

routine cbc’s

carbamazepine se aplastic anemia

275
Q

primary therapeutic agent for manic depression

A

lithium

276
Q

another name for manic depression

A

bipolar disorder

277
Q

moa sumatriptan

A

ssra
selective serotonin agonist
ag 5HT1a, vasoconstriction

278
Q

tx upper airway cough syndrome (post nasal drip)

A

1st gen antiH1
eg chloropheniramine

or combined antih1-decongestant
eg brompheniramine-pseudoephedrine

279
Q

another name for upper airway cough syndrome

A

postnasal drip

280
Q

another name for postnasal drip

A

upper airway cough syndrome

281
Q

moa psudoephedrine

A

stim a1
vasoconstrict
reduce nasal congestion

282
Q

some manifestations of renal cell carcinoma

A 
flank/abdominal pain/mass
left sided scrotal varicocele
anemia or erythrocytosis
thrombocytosis
fever
hypercalcemia
c
283
Q

left varicocele fails to empty when recumbent

A

think obstruction of gonadal vein into renal vein

284
Q

left varicocele
hematuria
polycythemia (or anemia)
thrombocytosis

A

renal cell carcinoma
invasion of collecting system hematuria
obstruction of gonadal vein varicocele
epi polycy thrombocy vs anemia

285
Q

sports advice for mono pts

A

avoid contact sports (also strenuous sports that inc ab pressure) for three weeks or more, splenic rupture risk

286
Q

what muscles does lambert eaton affect

A

proximal limb muscles

also autonomics.. dry mouth, erectile dysfunction

287
Q

another name for guillan barre

A

acute inflammatory demyelinating polyneuropathy

288
Q

define chronic bronchitis

A

productive cough
greater than 3 mos
over more than 2 consecutive yrs

289
Q

chrin bronchitis vs emphysema

which has prominent bronchovascular markings which has decreased vascular markings

A

chron bronch prom vasc marks

290
Q

meticlopramide moa and uses and ses

A

D antag
tx nausea vomiting gastroparesis

agitation
loose stools
extrapyrimidal sympx - tardiv dyskinesia, dystonia, parkinsonism
neuroleptic malignamt syndrome

291
Q

tf

neck tenderness assoc w meningitis

A

f

neck stiffness, not neck pain

292
Q

palpable bilateral abdominal masses

A

probs adpkd

293
Q

common early finding in adpkd and how to manage

A

htn

acei

294
Q

tf

palpable upper abdominal masses and htn think pheochromocytoma

A

f
pheos too small to palpate

think adpkd

295
Q

adpkd presentation

A 
htn 
hematuria 
proteinuria
palpable masses bilat
renal insufficiency

pain from cyst rupture hemorrhage calculi uti

296
Q

tx nafld nash

A

diet
exercise
consider bariatric sx if bmi ^35

297
Q

ast/alt in nafld

A

v1

298
Q

tf

it is safe to give statins in nafld

A

t

299
Q

define light-moderate etoh unlikely to cause alc liver disease

A

v15 drinks/wk men

v10 drinks/wk women

300
Q

young obese female w headache suggestive of tumor but no imaging abnorms and csf elevated

A

pseudotumor cerebri

benign intracranial htn

301
Q

physical findings in pseudotumor ceribri benign intracranial htn

A

papilledema
visual field defects
cnVI palsy

302
Q

tx pseudotumor cerebri

benign intracranial htn

A 
weight loss
acetazolamide
shunting
optic nerve sheath fenestration
  to prevent blindness
303
Q

large globular cardiac solhouette with clear lung fields

A

pericardial effusion / tamponade

304
Q

hypotension
elevated jvp
muffled heart sounds

A

beck’s triad for cardiac tamponade

305
Q

malignant necrotizing otitis externa

demographs

bug

tx

A

elderly, poorly controlled diabetic, immune suppressed

pseudomonas usually

cipro #1, other antipseudomonals

306
Q

antipseudomonals

A

ticarcillin pileracillin

ceftazidime cefipime

amikacin gentamycin tobramycin

cipro levo

aztreonam

307
Q

OE vs MOE
otitis externa
vs
malignant (necrotizing) otitis externa

A

pain severity
granulation tissue
elevated esr in moe

antipseudomonal moe
tooical abx or steroid oe

308
Q

test to diagnose lactose intolerance

A

hydrogen breath test

rise in breath hydrogen after lactose ingestion indicates bacterial carbohydrate metabolism (because human lactase not doing it)

309
Q

stool osmotic gap

A

290 - 2 stool Na - stool K+

high in all osmotic diarrheas… due to other osmotic substances…

310
Q

stool ph in lactase deficiency

A

acidic

due to fermentation products

311
Q

initial stabilizationof acute mi – 3 steps

A

o2 asa p2y12i statin slnitrate anticoag bb (not brady hypot heart block hf)

chf loop
pain morphine
unstable brady atropine
htn hf nitro (not hypot rvmi as)

cath v90min, thrombolysis if no cath v120min

312
Q

stool ph in lactase deficiency

A

acidic

due to fermentation products

313
Q

stool ph in lactase deficiency

A

acidic

due to fermentation products

314
Q

initial stabilizationof acute mi – 3 steps

A

o2 asa p2y12i statin slnitrate anticoag bb (not brady hypot heart block hf)

chf loop
pain morphine
unstable brady atropine
htn hf nitro (not hypot rvmi as)

cath v90min, thrombolysis if no cath v120min

315
Q

pronator drift indicates

A

umn
or
pyramidal or cst disease
(cortex-antlat pons-antlat medulla-…)

316
Q

pyramidal signs

A 
pronator drift
weakness
spasticity
hyperreflexia
babinski
317
Q

this drug causes hyperammonemia

A

vpa
valproic acid
encephalopathy
neuromuscular bradykinesia asterixis

318
Q

tf

pronator drift indicates impaired proprioceotion

A

f
umn pyramidal disease

proprioceotion rhomberg and moving fingers w pt eyes closed

319
Q

sympx if PBC

primary biliary cirrhosis

A

ruq pain
jaundice
pruritus
fatigue

320
Q

tf

pnc usually shows a dilated duct on imaging

A

f

321
Q

uses for urso

ursodeoxycholic acid

A

mild cholesterol gallstones in pt not cholecystectomy candidate

pnc, psc… questionable…

322
Q

all new onset afib should be screened for this endocrine abnorm

A

hyperthyroid

tsh free t4

323
Q

tf

afib is a common finding in cushing syndrome

A

f

hyperthyroid, diabetes, not cushing

324
Q

kussmaul sign

A

paradoxical inc jvp w inspiration

325
Q

3 categories of pericarditis etiology

A

idiopathic or viral
sx / radiation
tuberculous pericarditis

326
Q

why do cardiac complications occur in Hodgkin lymphoma

A

10-20 yrs post mediastinal radiation of lymph nodes

327
Q

tx pericarditis

A

diuretics

pericardiectomy if refractory

328
Q

2 top predisposers to portal htn

A

decompensated cirrhosis

hypercoagulable state

329
Q

tf

elevated jvp in portal vein thrombosis

A

f

330
Q

lab to diff hirsutism from adrenal vs ovarian

A

both high T
adrenal high dhea
ovary high dheas

331
Q

how does testosterone affect epo

A

t inc epo by inhib hepcidin

332
Q

where does pain from perforated peptic ulcer localize

A

maybe eoigastric injtially but spreads over entire abdomen, chemical peritonitis

333
Q

gram positive
partially acid fast
filamentous branching rods

bug and tx

A

nocardia - can clinically resemble tb

tmpsmx respiratory
add carbapenem brain
long course 6-12 mos
sx drain abscesses

334
Q

aztreonam coverage

A

gram negative

pseudomonas coverage

335
Q

tf

clindamycin covers nocardial lung abscesses

A

f
tmpsmx for nocardia lung
carbapenem for nocardia brain

clinda for anaerobe oral flora aspiration lung abscesses, not good against nocardia

336
Q

tf

tb is afb weakly gram pos

A

f
tb doesn’t gram stain

nocardia af branching filamentous rods weakly gram pos

337
Q

actinomyces
pres
dx
tx

A

can present like nocardia or tb (lung, brain, cavities/abscesses, fev ns wl… etc)

anaerobic filamentous gram pos rod, sulfur granules, not afb

penicillin G

338
Q

nocardia

aerob or anaerob

A

aerob

afb branching filamentous rods weakly gram pos

339
Q

tx lung aspergillosis

A

voriconazole

340
Q

how can otc cold meds potentiate warfarin assoc intracerebral hemorrhage

A

acrtaminophen tylenol potentiates warf anticoag

decongestants phenylephrine can inc bp

341
Q

tx warf assoc intracerebral hemorrhage

A

prothrombin complex concentrate pcc (has pt vit k dep coag factors) or ffp if pcc not available (longer to prep and give and larger vol infusion)

vit k (12-24 hr onset to get coag factors produced)

342
Q

tf

treat warf assoc intracerebral hemorrhage w protamine sulfate

A

f

protamine sulfate reverses heparin not warfarin

343
Q

tranexamic acid
moa
uses

A

antifibrinolytic
reduce menstrual bleed
reduce surgical bleed

344
Q

tf

use inhaled corticosteroid like fluticasone to tx copd exacerbation

A

f
systemic corticosteroids oral pred or iv methyl prednisolone for exacerbation

inhaled fluticasone for persistent asthma… maybe some advanced copd but not exacerbations

345
Q

when to use methylxanthine pdei’s theophylline aminophylline in asthma and copd

A

rarely, bad se profile

346
Q

tf

laba like salmeterol used in copd exacerbation

A

f
laba for maintanence

saba, po or iv steroid ~5days for exacerbation

abx, o2, ventilatory support when indicated

347
Q

spikes

A

step by step for fam meetings or breaking news

set up (environment)
perception (pt fam starting point)
invitation (from pt fam to give info)
knowledge (give info)
empathy
strategy/plan
348
Q

presentation of acute hiv

A 
mono-like
-fever LAN sore throat arthralgias
macular rash
gi sympx
mucocutaneous ulcer
349
Q

tf

hiv ab testing may be neg in acute hiv

A

t
presents 2-4 wks post inf usually
(but acute hiv = sympx in first 6 mos)
may not have seroconverted yet

but high viral load
cd4 may be normal

350
Q

tx of choice in elderly with agitation

A

low dose haloperidol
(1st gen antipsychotic)
(D2 antag)
acute only, not in lewy bod dem

2nd line 2nd gen risperidone quietapine
D2 5ht antag.. tx bipolar more commonly

351
Q

tf

tx agitation in elderly w amitriptyline

A

f
tca inhib ne and serot reuptake to tx depression, sleep disorders, neuropathic pain

but has anticholinergic effects
potentiates delirium AVOID IN ELDERLY

352
Q

hypothyroid sympx w elevated free t3 t4 and normal tsh

dx

A

thyroid hormone resistance

can present young w growth and mental retardation

can present a little older if milder form

353
Q

se’s of mtx methotrexate

A

stomatitis (oral ulcers)
hepatotox
cytopenias

354
Q

tx RA

A

mtx (folate purine antimetab) #1
leflunomide (pyrimidine inhib)
hydroxychloroquine (anti il1 tnf)
sulfasazine (anti il1 tnf)

biologics for severe - anti tnf infliximab rituximab etanercept (vacc tb fungus screens first)

prednisone for flare

355
Q

hepatotox and stomatitis in RA pt a result if

A

mtx methotrexate treatment se’s

356
Q

felty syndrome

A

neutropenia and splenomegy in pt treated for RA for long time

357
Q

neutropenia and splenomegy in pt treated for RA for long time

A

felty syndrome

358
Q

normal hpa axis function canntake how long to recover after stopping chronic steroid

A

6-12 mos

359
Q

5 clinical features of toxic shock syndrome

A
  • fever usually ^38.9C 102F
  • hypot sbp v90
  • diffuse macular erythroderma
  • skin desq incl palm sole 1-2 wks post onset
  • ^3 multisystem involv
360
Q

4 etiologies of (staph a) toxic shock syndrome

A 
50% tampon use
also
sx wound infection
urti (sinusitis, nasal packing)
septorhinoplasty
361
Q

tf

confluent erythematus macules on trunk and extremities in setting of urti can be consistent with toxic shock syndrome

A
  • fever usually ^38.9C 102F
  • hypot sbp v90
  • diffuse macular erythroderma
  • skin desq incl palm sole 1-2 wks post onset
  • ^3 multisystem involv
362
Q

usual interval from onset of menstruation or infection (eg sx urti septorhinoplasty) to TSS toxic shock syndrome

A

2-3 days

363
Q

diffuse macular erythroderma in tss toxic shock syndrome is similar to what more typical more benign rash

A

sunburn

364
Q

tf
TSS toxic shock syndrome
always gets leukocytosis

A

f
not always leukocytosis
but bands immature pmns elevated (3-5% is wnl)

365
Q

wnl for pmn bands

A

3-5%

366
Q

cbc in tss toxic shock syndrome

A

wbc can be normal
but bands elevated
thrombocytopenia

367
Q

skin findings in acute meningococcemia

A

petechial rash progressing to exchymoses, bullae, vesicles, and into gangrenous necrosis

368
Q

describe rocky mountain spotted fever rash in 2 adjectives

A

petechial

starts in extremities

369
Q

scarlet fever
presentation
s&s

A

peds
prior GAS pharyngitis/tonsilitis
prodrome of fever ha vom sorethroat
12-48 hrs later, fine pink blanching sand paper texture rash neck and upper trunk quickly generalizes

370
Q

generic for Lyrica

A

pregabalin
-| VCaCs
antinociceptive anticonvulsant

371
Q

what is enteroclysis

A

xray of contrast through small bowel

372
Q

solid organ transplant imunnosuppression greatest risk of which two bugs and how to ppx

A

pcp tmpsmx bactrim
covers listeria, toxoplasma, many other urtis giis utis

cmv valcyclovir or valgancyclovir
depending on serostatus of donor and recipient

373
Q

whipple disease

A

infection by tropheryma whipplei (intracellular gram +, PAS + foamy macrophages)
damage to small intestinal villi causes inflammation, weight loss, diarrhea, joint pain, arthritis most commonly, but presentation variable (Whip cream in a CAN cardiac arthralgias, neurologic symptoms)

374
Q

presentation of normal pressure hydrocephalus

A

ataxia
then dementia
and urinary incontinence

not fnd’s

375
Q

cushing reflex

A

htn
bradycardia
resp dep
caused by brainstem compression

376
Q

how to separate acute angle closure glaucoma from intracranial htn using eye exam in ddx of headache and blurry vision

A

acute angle glaucoma often has conjunctival erythema amd mildly dilated pupil poorly reactive to light

ichtn eye exam normal but for papilledema

377
Q

s&s of intracranial htn

A 
headache worse at night
n/v
mental status changes
papilledema
"fnd's" -- vision change, unsteady date
cushing reflex -- htn, bradyc, respdep from brainstem compression
378
Q

is ataxia caused by cerebellar lesion ipsi or contralat?

A

ipsilat

corticopontocerebellar tracts decussate twice

379
Q

lesions of what areas of the cerebellum cause truncal vs limb ataxia

A

trunk ataxia – vermis

limb ataxia – cerebellar hemispheres

Medicine (13 decks)

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