TEST 14-16 Flashcards

(45 cards)

1
Q

HIGH FEVER/ MALAISE/ THROAT PAIN + yellow-grayish white papulovesicles = ?

A

HERPANGINA - coxsackie virus

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2
Q

What is the Tx for COCAINE-INTOXICATION STEMI?

What medication is absolutely CONTRA-INDICATED in this pt (normally used for STEMI tx)?

A

IV BENZODIAZEPINE

CONTRA-INDICATED: BETA BLOCKER - unopposed alpha agonist activity of cocaine -> worsened vasoconstriction

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3
Q

What are the EKG changes of ACUTE PERICARDITIS?

A

PR INTERVAL DEPRESSION + DIFFUSE ST ELEVATIONS

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4
Q

ECHO FINDINGS OF STRESS-INDUCED CARDIOMYOPATHY (Older pts in response to physical/emotional stress or ACUTE medical illness)

A

TRANSIENT SYSTOLIC DYSFUNCTION of apical and/or mid-segments of LV + Hyperkinesis of basal segments =
BALLOON-LIKE APPEARANCE OF LV DURING SYSTOLE

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5
Q

After diagnosis of SOLID TESTICULAR MASS is made by ultrasound, what is the initial management?

A

RADICAL ORCHIECTOMY - removal of testis and cord

= HIGH INGUINAL ORCHIECTOMY

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6
Q

TOXICITY of what drug = SLURRED SPEECH + UNSTEADY GAIT + DROWSINESS + normal pupil size (2-5mm)

A

BENZODIAZEPINE

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7
Q

TOXICITY of what drug = HORIZONTAL NYSTAGMUS + CEREBELLAR ATAXIA + CONFUSION + MEGALOBLASTIC ANEMIA

A

PHENYTOIN

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8
Q

TOXICITY of what drug = TREMOR + HYPER-REFLEXIA + ATAXIA/SEIZURES + NEPHROGENIC DI

A

LITHIUM

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9
Q

What is the INITIAL TX MONOTHERAPY of HYPERTROPHIC CARDIOMYOPATHY?

A

NEGATIVE INOTROPES
**BETA BLOCKERS - Prolong diastole, decrease myocardial contractility -> Decreases LVOT obstruction -> Improves anginal sx

VERAPAMIL, DISOPYRAMIDE can also be used but beta blockers are first line

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10
Q

Tx for ORAL DEHYDRATION in ELDERLY pt

A

IV CRYSTALLOIDS (Na-containing solution) = 0.9% NaCl

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11
Q

What’s difference between IV CRYSTALLOID AND IV COLLOIDS?

A

IV COLLOIDS = ALBUMIN SOLUTIONS (used for burns and hypoproteinemia)

IV CRYSTALLOID = Na-containing solution used for rehydrating elderly

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12
Q

INTERMITTENT ELEVATIONS of ALT/AST + PORPHYRIA CUTANEA TARDA (Fragile skin, photosensitivity, vesicles, erosions of hands)

A

CHRONIC HEP C

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13
Q

What are the most appropriate tests to diagnose ACUTE HEPATITIS B INFECTION?

A

HBsAg + anti-HBc (IgM Ab)

**anti-HBc: tested bec it’s the only one elevated during window period (Between HBsAg and anti-HBs

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14
Q

GUIDELINES for pain management in metastatic cancer:

A

1) NON-narcotic (NSAIDS/OTC)
2) SHORT-acting narcotic (morphine) + adjuvant - Titrate subsequent doses
3) LONG-acting narcotics

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15
Q

In a pt who has HASHIMOTO THYROIDITIS (Rubbery enlarged goiter + anti-TPO Abs), there is increased risk for developing __.

A

THYROID LYMPHOMA

CT SCAN: doughnut sign - pseudocystic pattern

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16
Q

DRAMATIC LEUKOCYTOSIS + LAD + HSM + PANCYTOPENIA + infection = high clinical suspicion for ____

How does one make the diagnosis?

A

CHRONIC LYMPHOCYTIC LEUKEIMIA

DIAGNOSIS: Flow cytometry (clonality of mature B cells)

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17
Q

How do you distinguish between EBV IM and CLL?

A

Both can present with FEVER, MALAISE, LAD BUT

EBV = + PHARYNGITIS, MILD leukocytosis (12-18K), NO pancytopenia

CLL = MASSIVE leukocytosis (>40K) + PANCYTOPENIA

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18
Q

Following an MI, which drug is given to lessen VENTRICULAR REMODELING (LV dilation + thinning of ventricular walls -> CHF)?

A

ACE INHIBITORS

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19
Q

What is the mainstay Tx for DRESSLER SYNDROME (Acute pericarditis weeks after an MI)?

Why should ANTICOAGULANTS be avoided for this syndrome?

A

NSAIDs

If NSAIDs are contra-indicated or if it is refractory, use CORTICOSTEROIDS

AVOID anti-coagulants to prevent dvlm HEMORRHAGIC PERICARDIAL EFFUSION

20
Q

What is ASPIRIN-EXACERBATED RESPIRATORY DISEASE?

What is the Tx?

A

Wheezing, cough, SOB, chest tightness (non-IgEmediated) reaction due to ASA-induced PG/leukotriene imbalance

LOW PG (pro/anti-inflammatory), ELEVATED LT (pro-inflammatory)
in pt with history of ASTHMA, CHRONIC RHINOSINUSITIS/ NASAL POLYPS  

Tx = AVOID NSAIDS, DESENSITIZE If NSAIDS are required, LEUKOTRIENE INHIBITORS (ZILEUTON) or LEUKOTRIENE-R ANTAGONISTS (MONTELUKAST)

21
Q

How does one diagnosis AMYLOIDOSIS?

A

Tissue biopsy (abdominal fat pad mostly used) showing AMYLOID DEPOSITS

22
Q

What is the difference between ACUTE INTERSTITIAL NEPHRITIS and CRYSTAL-INDUCED AKI?

A

AIN - Presents 7-10d after drug exposure (6P’s)

Crystal-induced AKI - Presents 24-48hrs after drug exposure -> Precipitates in renal tubules -> INTRA-TUBULAR OBSTRUCTION -> Direct renal toxicity

23
Q

What are the possible drug causes of CRYSTAL-INDUCED AKI?

A

SPAME

S - SULFA, P - PROTEASE INHIBITORS, A- ACYCLOVIR, M- MTX, E - ETHYLENE GLYCOL

24
Q

What tests should be ordered if pt has IDIOPATHIC THROMBOCYTOPENIA?

A

HIV
HEPC

Tx of underlying infection can affect PLT ct

25
What is the most sensitive test for detecting DIABETIC NEPHROPATHY? Why not routine dipstick of urine for protein?
RANDOM URINE MICROALBUMIN/CREATININE RATIO - Se = 30-300mg/24hr DIABETIC MICROALBUMINURIA NOT routine dipstick because not sensitive enough - Se >300mg MACROALBUMINURIA
26
Vast majority of HEAD AND NECK CANCER is ___?
SQUAMOUS CELL CARCINOMA
27
RADIOLUCENT KIDNEY STONES = ? | RADIOPAQUE KIDNEY STONES = ?
RADIOLUCENT (not visible on X-ray) = URIC ACID CRYSTALS = acidic pH RADIOPAQUE (visible on X-ray) - calcium oxalate, ammonium mg phosphate, cystine crystals = basic pH
28
How does SIBO, SURGICAL RESECTION, or CHRONIC DIARRHEA result in CALCIUM OXALATE CRYSTALS?
MALABSORPTION of free fatty acids -> Chelate calcium -> Increased absorption of oxalic acid -> Increased calcium oxalate stones
29
3 most common causes of VIT K DEFICIENCY and thus THROMBOPHILIA (ELEVATED PT, PTT, BLEEDING EPISODES)
1. INADEQUATE ORAL INTAKE 2. UNDERLYING LIVER DISEASE (alcoholism, hepatocellular carcinoma) 3. INTESTINAL MALABSORPTION
30
How to distinguish between ASTHMA and COPD | Hint: PFT value DLCO, response to bronchodilator
ASTHMA: 1. DLCO - NORMAL or INCREASED 2. FEV1 YES, reversible with bronchodilator (>12% increase in FEV1) COPD: 1. DLCO - DECREASED or normal 2. FEV1/FVC NOT reversible with bronchodilator
31
ANTIBIOTIC for CLENCHED FIST INJURY (HUMAN BITE) or DOG BITE = ?
Covering for POLYMICROBIAL INFECTION - AMOXICILLIN/CLAVULANIC ACID
32
Pathogenic mechanism for DIABETIC FOOT ULCER pt resulting in OSTEOMYELITIS?
DIRECT CONTIGUOUS SPREAD OF INFECTION
33
YOUNG FEMALE ATHLETE: POPPING sensation of knee during injury + RAPID onset of HEMARTHROSIS
ACL tear
34
DIABETIC ULCER risk assessment is tested by ___?
10G MONOFILAMENT TEST - Diabetic neuropathy is most common cause of DIABETIC ULCER
35
What test is used to assess FIBROMYALGIA, OSTEOARTHRITIS (CHRONIC PAIN CONDITIONS)?
6-minute WALK TEST - How far pt can walk in standardized time
36
What is the most PREFERRED Tx for GRAVE'S DISEASE in terms of best long-term outcome?
RADIOACTIVE IODINE THERAPY Contra-indications: PREGNANCY + OPHTHALMOPATHY
37
YOUNG OBESE WOMAN: Headache + blurry vision/diplopia + pulsatile tinnitus = ? DIAGNOSIS made by?
IDIOPATHIC INTRACRANIAL HTN Diagnosis: Ocular exam -> Neuroimaging -> LP with elevated opening pressure (>250mmH2O)
38
What toxicities are related to CYCLOSPORINE and TACROLIMUS immunosuppressants? Which AE are unique to CYCLOSPORINE?
Both are CALCINEURIN INHIBITORS - Inhibit IL-2 Tx and other cytokines (mainly Th cells) NEPHROTOXICITY, HYPERKALEMIA, HTN, TREMOR - Unique to CYCLOSPORINE: GUM HYPERTROPHY + HIRSUTISM
39
What is the major toxicity of AZATHIOPRINE?
Dose-related DIARRHEA, HEPATOTOXICITY, LEUKOPENIA
40
What is the major toxicity of MYCOPHENOLATE?
MYELOSUPPRESSION
41
What is the critical distinction between CASE CONTROL STUDIES and RETROSPECTIVE COHORT STUDIES?
CASE CONTROL: First determine OUTCOME (diseased or not diseased) -> Then look for associated risk factors RETROSPECTIVE COHORT: First ascertain RISK FACTORS -> Determine outcome
42
What is the most common cause of MR in DEVELOPED countries?
MITRAL VALVE PROLAPSE
43
SUDDEN ONSET odynophagia + retrosternal chest pain causing difficulty swallowing = ? What are medications that cause this?
PILL ESOPHAGITIS ``` TAAP: Tetracyclines ASA, NSAIDs Alendronate, risedronate Potassium chloride, Fe ```
44
What is the purpose of OPTIMIZING GLYCEMIC control in DIABETES? (A1c)
Preventing MICROVASCULAR COMPLICATIONS (nephropathy, retinopathy) UNCERTAIN effect on MACROVASCULAR complications (MI, stroke, all-cause mortality)
45
What diagnostic test will CONFIRM diagnosis of ZENKER DIVERTICULUM
CONTRAST ESOPHAGRAM