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Flashcards in random3 Deck (121):
1

recent URI followed by sudden onset of cardiac failure in an otherwise healthy pt -- think?

Dilated cardiomyopathy (2dary to acute viral myocarditis)

2

most common virus to cause myocarditis?

Coxsackievirus B

3

Dilated ventricles w/ diffuse hypokinesia on echo - think?

Dilated cardiomyopathy

4

asymmetric septal hypertrophy can be found in what?

Hypertrophic cardiomyopathy

5

when is concentric hypertrophy of the heart seen?

Chronic pressure overload
- AS
- Untreated HTN

6

Eccentric hypertrophy of heart dev when?

Chronic volume overload
- valve regurg

7

mid-diastolic murmur w/ an opening snap?

Mitral Stenosis

8

what is Mitral Stenosis effect on the R side of the heart?

- RVH
- RV heave 2dary to pulm HTN

9

In primary pulm HTN what will not be present?

b/l crackles

10

amiodarone side fx?

- Cardiac: sinus brady, heart blok, risk of QT prolong, & torsades
- Pulm: Chronic interstitial pneumonitis
- HypO/ERthyroid
- Elevated tansaminases, hepatitis
- Optic neuropathy, corneal microdeposits
- Blue-gray skin discoloration
- Peripheral neuropathy

11

prior to starting Amiordarone be sure to get what tests?

- PFTs
- CXR
- Thyroid
- LFTs
- ECG

12

childhood vax complete + minor scrape on fence + last booster

none

13

childhood vax complete + minor scrape on fence + last booster >=10 yrs ago - what tetanus prophylaxis required?

Tetanus toxoid containing vaccine (Td or Tdap)

NO immuneglobulin

14

complete childhood vaxs, deep dirty wound, booster >=5yrs ago - what tetanus prophylaxis required?

Tetanus toxoid vax (Td or Tdap)

NO immuneglobulin

15

When do you give tetanus immuneglobulin?

when pt is unimmunized or immunecompromised
AND
wound is severe/dirty

16

most severe mutation types/

- Nonsense
- Frameshift

17

missense mutation is?

single nucleotide changed

18

nonsense mutation is?

codon changed to a chain terminating codon --> severe mutation

19

Hyper conjugated bilirubinemia w/ normal AST, ALT, and alk phos - think (2)?

- Rotor syndrome
- Dubin-Johnson syndrome

Defects in hepatic secretion of bili

20

positive urine bilirubin - think?

1) It's conjugated bili
2) Due to: hepatic dysfunction, biliary obstruction, or defect in hepatic bili secretion (ie rotor or dubin johnson)

21

necrolytic migratory erythema -- think?

Glucagonoma

22

necrolytic migratory erythema looks like?

erythematous papules or plaques that coalesce to form a large, painful, and inflammatory blister/crusting w/ central clearing. Found commonly on perineum, extremities, and face.

23

serum glucagon >500 -- think?

glucagonoma

24

erythematous plaque w/ central clearing + mild DM + Diarrhea + weight loss + normocytic, normochromic anemia - think?

Glucagonoma

25

episodic flushing = think?

carcinoid syndrome

26

episodic flushing, diarrhea, weight loss - think

carcinoid syndrome

27

low leukocyte alkaline phosphatase + leukocytosis w basophilia - think?

CML

28

leukocytosis + high leukocyte alkaline phosphatase (LAP) + metamyelocytes > myelocytes -- think?

Leukemoid rxn

29

metamyelocytes and bands are?

late/mature neutrophil precursors
- found more in leukemoid rxn (compared to CML)

30

myelocytes and promyelocytes are?

early neutrophil precursors
- found more in CML (compared to leukemoid rxn)

31

painless gross GI bleeding w/ cause missed on colonoscopy -- think?

Angiodysplasia

32

maroon stools + painless + nothing seen on colonoscopy -- think?

angiodysplasia (often missed on colonoscopy)

33

continuous abdominal bruit suggestive of?

renovascular disease

34

resistent HTN + diffuse atherosclerosis, asymmetric kidney size, recurrent flash pulm edema, or serum creatinine >30% from baseline post ACE/ARB therapy -- think?

renovascular HTN

35

resistent HTN + abdominal bruit + recurrent flash pulm edema -- think?

renovascular HTN

36

Crigler Najjar syndrome type 2 can be treated w/ what to help reduce serum bili?

IV phenobarbital or clofibrate

37

In which crigler najjar does phenobarbital not help?

Crigler Najjar type 1 (severe)
-- phototherapy, plasmapheresis short term
-- long term needs liver transplant

type 2 is helped by phenobarbital

38

smudge cells - think?

CLL

39

lymphocytosis w/ small mature lymphocytes - think?

CLL

40

elderly pt + lymphadenopathy + hepatosplenomegaly + lymphocytosis w/ smudge cells - think

CLL

41

Hairy cell leukemia findings?

- pancytopenia
- splenomegaly

42

painless lymphadenopathy + night sweats + fevers + nL CBC and blood smear - -think?

Hodgkin lymphoma

43

dead space means?

ventilation fine, but perfusion dec (ie PE)

44

physiological shunting in lung means?

perfusion fine, but ventilation dec --> shunting of deoxygenated bld to L heart

45

Pneumonia --> what type of v/q mismatch?

physiological shunting (vent dec, perfusion fine)

46

serum progesterone measurement for infertility should be done when?

mid-luteal phase
(b/t ovulation --> menses)

47

conductive hearing loss ?

obstruction of external sound to inner ear

48

sensorineural hearing loss involves?

involves inner ear, chochlea, auditory nerve

49

rinne test?

tuning fork on mastoid bone --> abnl suggests CONDUCTIVE hearing loss

air conducting should be heard longer than bone (so nL AC>BC, abnl BC>AC)

50

abnl rinne test indicates?

CONDUCTIVE hearing loss

51

weber test?

tuning fork middle of forehead

* nL - same in both
* conductive - lateralize to obstructed/effected ear
* sensiorineural - lateralize to unaffected ear

52

abnl rinne test w/ weber laterilzes to same ear?

conductive hearing loss

53

shoulder pain radiating in an ulnar distribution where is leision?

pulm apex at thoracic inlet (superior sulcusl invade C8, T1 n.)-- > compress inf portion of brachial plexus --> Pancoast syndrome

54

normal rinne test b/l, weber lateralizes -- think?

sensorineural hearing loss

55

abl rinne in 1 ear, weber lateralizes to opposite ear - think?

mixed hearing loss

56

serous otitis media symp?

- middle ear effusion w/o evidence of acute infx
- conductive hearing loss
- hypomobile dull tympanic membrane

57

serous otitis media seen in what population?

AIDS/HIV

58

Pt w/ HIV w/ hypomobile, dull typmanic membrane and conductive hearing loss -- think?

serous otitis media (non-infx effusion)

59

expansile, eccentric lytic lesion on epiphysis - think?

Giant cell tumor of bone
"soap-bubble appearance"

60

soap bubble appearance on XR of femur -- think?

giant cell tumor

61

popliteal synovial cyst is?

baker's cyst
- enlarged gastrocnemius-semimembranous bursa in medial side of popliteal fossa

62

osgood schlatter disease is?

overuse injury caused by repetitive strain
- typically young kids and adolescents who have recently undergone a rapid growth spurt

63

xray apperance of osgood schlatter disease?

avulsion of the apophysis of tibial tubercle

64

osteitis fibrosa cystica aka?

von recklinghausen disease of bone

65

osteitis fibrosa cystica commonly due to ?

hypERparathyroidism from parathyroid CA

66

osteitis fibrosa cystica (von recklinghausen) is?

osteoclastic resorption of bone --> replacement w/ fibrous tissue (brown tumors) --> bone pain

67

salt and pepper appearance of skull think?

osteitis fibrosa cystica

68

distal clavicular tapering + bone cysts + brown tumors - think?

osteitis fibrosa cystica

69

brown tumors in bone think?

osteitis fibrosa cystica

70

findings of OA (4)?

- joint space narrowing
- osteophyte formation
- subchondral sclerosis
- subchondral cysts

71

osteoid osteoma on xray?

sclerotic, cortical lesion w/ central nidus of lucency

72

giant cell tumor of bone most commonly effects?

epiphyseal regions of distal femur and proximal tibia

73

memory issues w/ weight gain, fatigue, constipation, and hoarseness - think?

hypOthyroidism

74

walking in normal pressure hydrocephalus?

broad-based, shuffling gait

75

wernicke korsakoff syndrome findings:?

Wernicke - ataxia, ophthalmoplegia, confusion

Korsakoff - confabulation and amnesia

76

vesicular rash on forehead on eye w/ dendriform ulcers on cornea and conjunctivitis + fever, malaise -- think?

Herpes zoster opthalmicus

77

treatment of herpes zoster opthalmicus?

w/in 72hrs --> high dose acyclovir

78

eye pain, photophobia, dec vision w/ clear vesicles on corneal epi and dendritic ulcers -- think?

Herpes simplex keratitis


(locally limited w/o rash -- distinguish from herpes zoster opthalmicus)

79

dacrocystitis is?

infx of lacrimal sac due to obstruction of nasolacrimal duct

80

bacterial keratitis seen w/?

contact lens wearers following corneal trauma

81

hypopyon is?

inflammatory cells in ant chamber of eye --> leukocytic exudate

82

eye appearance in bacterial keratitis?

cornea appears hazy w/ central ulcer and adjacent stromal abscess
- hypopyon may also be seen

83

complication of giant cell arteritis?

aortic aneurysm
--> pts should have serial CXR

84

headache, jaw claudication, muscle fatigue, visual distrubances, ESR >50, tender cord at temporal area -- think?

giant cell arteritis

85

confusion, wheezing, and aseizure post smoke inhalation -- think?

carbon monoxide poisoning

86

treatment of CO poisioning?

100% oxygen via nonrebreather facemask

- hyperbaric O2 if unresponsive to facemask

87

cardioversion and defibrillation have no role w/ which pts?

- Pulseless electrical activity
- Asystole

88

reversible causes of pulseless electrical activity/asystole?

5H's and 5 T's
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
HypO/ERKalemia
HypOthermia

Tension pneumo
Tamponade
Toxins
Thrombosis
Trauma

89

pulselss VT or ventricular fibrillation - treat?

Defibrillation

90

pulseless electrical activity or asystole should be managed w/

uninterrupted CPR w/ vasopressor therapy

91

most common nephrotic syndrome in adults in US?

focal segmental glomerular sclerosis

92

FSGS associated w/?

HIV, heroin use, morbid obesity

*african american and hispanic

93

Membranous nephropathy associated w?

- Hep B
- adeocarcinoma (breast, lung)
- NSAIDs
- Lupus

94

Membranoproliferative GN - associated w/?

Hep C>>Hep B
lipodystrophy

95

minimal change disease associated w/?

Kids
NSAIDs
lymphoma (often Hodgkin)

96

Amyloidosis in kidney associated w.?

- Multiple myeloma
- chronic inflam disease (ie RA, bronchiectasis)

97

crystal induced nephropathy side effect of?

Indinavir (protease inhibitor; HIV treatment)

98

indinavir is ?

protease inhibitor
- HIV treatment

99

indinavir side effect?

Crystal-induced nephropathy
--> hematuria w/ needle-shaped crystals in sediment

100

main organ of concern w/ indinavir (protease inhibitor)?

Nephrotoxicity
- due to crystal induced nephropathy

101

major rxns w/ HIV therapy? (6)

* Didanosine --> pancreatitis
* Abacavir --> hypersensitivity syndrome
* NRTIs --> lactic acidosis
* NNRTIs --> Steven-Johnson's syndrome
* Nevirapine --> Liver failure
*Indinavir - nephrotoxicity (crystals)

102

Main concern w/ didanosine?

pancreatitis

103

Main concern w/ Abacavir?

hypersensitivity syndrome

104

Main concern w/ NRTIs?

lactic acidosis

105

Main concern w/ NNRTIs?

Steven Johnson

106

Main concern w/ Nevirapine?

Liver failure

107

Most common causes of osteomyelitis in sickle cell disease? (2)

1) Salmonella
2) Staph

108

Empiric treatment of osteomyelitis for children w/ sickle cell disease?

- 3rd gen Cephalosporin (ie ceftriaxone, cover salmonella)
AND
- Anti-staph med (ie vanco, oxacillin, etc)

109

most common causes of osteomyelitis in children

- GBS
- E.coli

110

most common cause of osteomyelitis in children 2mo-4yrs?

Kingella kingae (gram- bacillus)

111

most common cause of osteomyelitis >4yrs?

Staph aureus

112

bilateral trigeminal neuralgia - what is one of the main causes?

Multiple sclerosis

113

bilateral trigeminal neuralgia + eye issues + arm weakness -- think?

multiple sclerosis

114

Pill rolling tremor + bradykinesia + rigidity + mask-like face -- think?

parkinson

115

caudate atrophy found w/?

Huntington's

116

depression + choreiform movements + subcortical dementia - think?

Huntington's

117

aseptic meningitis usually happens when?

summer

118

aseptic meningitis often caused by?

Echovirus

119

young female bilateral trigeminal neuralgia -- concern for?

MS

120

pleural plaques - think

asbestosis

121

asbestos risk in what jobs?

- pipe work (plumbing)
- mining
- shipbuilding
- insulation