Unknown Concepts Flashcards
(148 cards)
1
Q
Since hyperuricemia is uncommon with the invention of rasburicase, why is AKI still common in chemo patients?
A
Rasburicase does not affect levels of phosphate and calcium so calcium phosphate precipitation remains common.
2
Q
What are the long-term effects of IVC filters?
A
Lower the risk of PE’s by half but increase the risk of recurrent DVT by roughly 2 fold.
3
Q
I’m trying to rule out acute mesenteric ischemia, your patient is unable to undergo the gold standard CTA due to contrast allergy. What test should you order then?
A
MR Angiography
4
Q
What is the consequence of untreated acute mesenteric ischemia?
A
Bowel infarction, sepsis, and death.
5
Q
What are the risk factors for candida endophthalmitis? Floaters, progressive loss of visual acuity and eye pain in a hospitalized patient.
A
Indwelling central catheter, GI surgery/perforation, neutropenia, TPN.
6
Q
Treatment for candida endopthalmitis?
A
Fluconazole and voriconazole and intravitreal injection with amphotericin B or voriconazole and vitrectomy
7
Q
What causes AKI in patients with Tumor lysis syndrome ?
A
Calcium phosphate stones and uric acid stones
8
Q
Treatment for hydradenitis suppurativa?
A
Weight loss, smoking cessation, daily skin cleansing, topical clindamycin, intralesional steroids or oral abx for flares, tetracyclines, clindamycin plus rifampin for refractory cases.
9
Q
2/3 criteria a patient must meet for the diagnosis of acute pancreatitis?
A
Acute onset of persistent severe epigastric pain.
Elevated serum lipase or amylase > = 3x the upper limit of normal lipase. Characteristic findings of pancreatitis on abdominal imaging (contrast -enhanced CT scan, MRI)
10
Q
Antibiotic used in the treatment of infected pancreatic necrosis?
A
Meropenem, fluoroquinolone + metronidazole.
11
Q
How to diagnose scabies and tinea?
A
Scabies = skin scrapings from lesions revealing mites, ova and feces under light miscroscopy.
Tinea = KOH prep to look for segmented hyphae and arthrospores.
12
Q
Treatment for scabies?
A
5% permethrin cream
13
Q
Microbe reponsible
For otitis externa and the treatment?
A
Pseudomonas aeruginosa and should treat with fluoroquinolone like Cipro. Other tx options: peperacillin, ceftazidime,
14
Q
Since ANA is so non-specific, what is a most specific test for diagnosing SLE?
A
Anti-double stranded DNA antibodies.
15
Q
Sensitive for the detection of CREST variant of scleroderma?
A
Anti-centromere antibodies
16
Q
Sensitive for the detection of primary biliary sclerosis?
A
Anti-mitochondrial antibodies
17
Q
Low sensitivity test for detecting SLE?
A
Anti-Smith antibodies = 25% sensitivity but highly specific
Anti-dsDNA antibodies = 70% sensitivity.
18
Q
Most sensitive test for Sjögren’s syndrome
A
Anti-Ro/SSA antibodies
19
Q
Test to use to follow the course of disease in pious patients?
A
High -titer ANA antibodies
20
Q
Medication used for lupus patients who have significant organ involvement and have had incomplete response to prednisone alone.
A
Methotrexate
21
Q
Things that can cause transient elevation in PSA?
A
Urine retention, mild acute prostate infection/inflammation
Urologic procedure
DRE
Recent ejaculation
Repeat a positive test in 6-8 weeks
22
Q
3 things that can cause persistent elevation in PSA?
A
BPH
Prostate cancer
Severe or chronic prostatitis
23
Q
What are the characteristic features if poly myalgia rheumatica?
A
Age > 50
Sub-acute to chronic (> 1 month) pain in the shoulder and hip girdles
Morning stiffness lasting > 1 hr
Constitutional symptoms: malaise, weight loss
Elevated ESR > 40mm/hr
Unexplained symptoms
24
Q
What are the symptoms of cauda equina syndrome?
A
Severe lower back pain, urinary or bowel incontinence, motor weakness, sensory loss in the legs bilaterally and saddle anesthesia
25
What level of the spinal cord does the cremaasterix reflex correspond to?
L1-L2
Also responsible for hip flex ion and adduction.
26
Region of the spinal cord responsible for normal anal sphincter tone.
S2- S4
27
A reflex regulated at L1-L2 that can be diminished or lost seconds to diabetic neuropathy?
The cremasterix reflex
28
Treatment for cataplexy and norcolepsy
Norcolepsy: Modafinil
Cataplexy: SNRI, SSRI’s, TCA, sodium oxybate
29
Imaging for subarachnoid hemorrhage?worse headache of my life?
Non contrast CT
30
Headache red flags and papilledema
Brain MRI with contrast
31
Treatment for latent TB infection
Rifamycin-based therapy : Rifampin daily x 4 months
Rifampin+ INH daily x 3 months
Rifampin + ONH weekly x 3 months
INH mono therapy for 6-9 months
32
True or false. Patients who are stable with acute hepatitis B and liver enzymes in the thousands can be treated out-patient?
True: outpatient supportive care and close follow-up because it will resolve spontaneously.
33
What is the etiology of diverticula bleed ?
Arterial erosion due to colonic mucosal outcropping.
34
Results of Arthrocentesis that confirms gout ?
Monosodium irate crystals
Also Negatively birefringent, needle shaped crystals under polarizing light.
35
Acute Gout medication for patients with NSAID contractions such as CKD, HF, PUD, and patients on anticoagulation?
Colchicine 0.6 mg BID - avid in severe liver or renal disease.
36
First line tx for gout ?
Indomethacin and other NSADS
37
Beside nyastatin suspension, what other drug can be used to treat oral candidiasis?
Clotrimazole troches
38
A patient with an AKI in combination with peripheral eosinophilia, skin rash, pyuria, with WBC casts have what diagnosis?
Acute interstitial nephritis: antigen hypersensitivity aiding inflammation with the renal tubulointerstitium, which leads to tubular accumulation of WBC (pyuria).
39
Name an anti-TNF agent that will improve anemia of chronic inflammation in a patient with untreated RA.
Infliximab
40
Skin manifestation of hereditary hemochromatosis?
Hyperpigmentation (bronze diabetes)
41
MSK manifestation of hereditary hemochromatosis?
Arthralgia, arthropathy, chondrocalcinosis
42
GI manifestations of hereditary hemochromatosis
Elevated hepatic enzymes with hepatomegaly
Cirrhosis
Increased risk of HCC
43
Endocrine manifestations of hereditary hemochromatosis?
Diabetes Mellitus, secondary hypogonadism and hypothyroidism
44
Cardiac manifestations of hereditary hemochromatosis?
Restrictive or dilated cardiomyopathy and conduction abnormalities.
45
Infections associated with hereditary hemochromatosis?
Increased susceptibility to listeria, vibrio vilnificus and yersinia enterocolitoca.
46
What is this condition?
MS
Onset is 15 - 50
Optic neuritis, Lhermitte sign, inter nuclear opthalmoplegia, fatigue, uhthoff phenomenon, numbness and parenthesia/sensory symptoms, paraparesia and spasticity, bowel/bladder dysfunction
47
Which condition has T2 MRI lesions disseminated in time and space (periventricular, juxtacortical, infratentorial, or spinal cord)
Oligoclonal IgG bands on cerebrospinal fluid analysis.
MS
48
Medication used for long term management of MS
Beta-interferon and glatiramer acetate
49
Criteria for stress ulcer prophylaxis?
Coagulopathyn platelets Less that 50,000
INR > 1.5
PTT > 2x normal control
Mechanical ventilation > 48 hrs
GI bleeding or ulceration in the last 12 months
Head trauma, spinal cord injury, major burn
Glucocorticoid therapy
> 1 week ICU stay
Occult GI bleeding > 6 days
Sepsis
50
Treatment for Bell’s palsy?
Glucocorticoids with or without acyclovir
51
Reactive arthritis is a spondyloarthropathy that presents with peripheral asymmetric oligoarthritis and often associated with what other symptoms.
Uveitis, Urethritis, Achilles enthesitis, dactylitis, keratoderma blennorrhagica and circinate balanitis
52
Immunologically mediated skin disorder affecting mostly middle-aged adults. Skin lesions are shiny, discrete, intensely pruritic, polygonal-shaped violaceous plaques and papules that are frequently on the flexural surfaces of the ext? Name this disorder?
Lichen planus
53
Liver disease associated with lichen planus ?
Hepatitis C
54
One action that can significantly improve symptoms in a patient with suspected tick borne illness?
Remove the tick
55
True or false tumor lysis syndrome can occur in patients who have not started chemotherapy?
True
Check uric acid levels
56
Treatment for tumor lysis syndrome?
IV fluids and Rasburicase
57
First one therapy for heat strokes?
Evaporaive and convective cooling with water misters, fans, icepaks or ice water baths.
58
For a patient with type 2 HIT, what do you do after stopping infractionated Heparin?
Start direct thrombin inhibitors: argatroban, bivalirudin and fondaparinux
59
Wat are the familial syndromes that predispose a patient to pheochromocytoma
MEN2, NF1 and VHL
60
After biochemical
Confirmation of a pheochromocytoma, what is the next step?
CT or MRI of the abdomen to localize the pheochromocytoma which are usually located on the adrenal glands. Usually > 4-4.5 cm in diameter.
61
Drugs used to treat hypertensive crisis during surgery for pheochromocytoma?
IV nitroprusside
Phentolamine or nicardipine
62
Treatment for ischemic priapism?
Intracavernosal phenylephrine which is an alpha agonist
63
True or false? Patients with hypoparathyroidism are treated with thiazide diuretics to decrease urinate calcium and increase serum calcium levels
True
64
What do you give a patient needing antimicrobial prophylaxis following Neisseria meningitidis exposure
Ciprofloxacin 500mg single oral dose , Rifampin 600 mg BID x 2 days and Ceftriaxone 250 mg single dose . All 3 are good
65
What is the first step in management of HHS?
Aggressive fluid resuscitation with isotonic saline.
66
Diarrhea that becomes bloody in 1-3 days, accompanied by microangiopathic hemolytic anemia, thrombocytopenia and AKI. Rarely causes a fever?
Shiga Toxin producing E-coli
67
High fever, abdominal pain, watery diarrhea with tenesmus, mucoid and or bloody diarrhea. Can even cause seizures in children.
Shigella
68
Oral therapy for severe C-diff and fulminant C-diff?
severe: Fidaxomicin and oral vancomycin.
Fulminant: Higher dose oral vancomycin & IV metronidazole, fecal transplant and surgical consultation
69
What are the side effects of giving a patient with dementia with lewy bodies risperidone, an antipsychotic?
They are extremely sensitive to antipsychotics. Causing worsening confusion, parkinsonism or autonomic dysfunction.
70
Treatment of suspected transverse myelitis
High dose steroids for 3-5 days. Get MRI of the spine.
71
Treatment for disseminated gonococcal infection
3rd generation cephalosporin
72
initial test of choice and confirmatory test for dermatomyositis?
Initial test: Antinuclear antibody test, + in 80% of the patients
Confirmatory test: Anti-jo 1 and anti-Mi2
73
cancers associated with dermatomyositis since this is a paraneoplastic syndrome.
Cancer of the cervix, ovaries, lung, pancreas, bladder, and stomach.
74
The 2 vaginitis that have odor and can both be treated with Flagyl?
Bacterial vaginosis and Trichomoniasis
75
This antibiotic can be used to treat bacterial vaginosis if the patient is allergic to flagyl
Clindamycin
76
Name the febrile vasculitis of childhood that is diagnosed based on fever for over 5 days and > 4 of the following: conjunctivitis, mucous membrane changes, rash, lymphadenopathy and extremity edema/erythema?
Kawasaki disease, order CRP and ESR
77
Treatment for Kawasaki's disease?
IBUPROFEN, IVIG & Aspirin
78
Name the condition caused by a streptococcal infection that presents with sandpaper rash, strawberry tongue and circumoral pallor?
Scarlet fever/Tx with oral amoxicillin
79
The cardiac echocardiogram is a must for patients dx with Kawasaki's disease due to the development of this after the 10th day of fever.
Coronary artery aneurysms
80
A low erythropoetin level in a patient with markedly elevated Hgb/Hct suggests what disorder?
Polycythemia vera/chronic myeloproliferative disorder
81
Medications that predispose a patient to gout?
Diuretics, low dose ASA, immune suppressants
82
Treatment options for a patient with acute gout with a history of renal transplant or renal failure?
Low dose colchicine and systemic and intra-articular glucocorticoids.
83
A diuretic that is more likely to cause a photosensitivity reaction because it is a sulfanomide?
Thiazide diuretics/Will cause an erythematous rash on exposed parts of the body.
84
First line treatment for acute bacterial rhinosinusitis
Augmentin then Doxycycline or fluoroquinolones
85
How cyanide causes metabolic acidosis?
It inhibits the mitochondrial oxidative phosphorylation thereby blocking production of ATP.
86
Anion gap is helpful in the interpretation of metabolic acidosis. How do you calculate it?
serum sodium - (serum chloride + serum bicarb)
Normal is 12
mudpiles cause this
87
picture of a spinal epidural abscess
88
Since most diuretics decrease the fractional excretion of urate, what is the first line treatment for hypertension in a patient with gout?
Losartan (ACEI & ARB) are good as well.
89
Treatment for refractory gastroparesis?
Gastric electrical stimulators & or Jejunal feeding tubes.
90
symptoms of carbon monoxide poisoning.
HA, nausea, AMS, Lactic acidosis, seizure, syncope, coma,
91
Diptheria infection in an unvaccinated child puts them at risk for what?
Myocarditis, complete heart block and heart failure in 2/3 of pts. Take your Tdap. gram positive bacillus, tx with Erythromycin,pen G and Diptheria antitoxin.
92
What should never be used to treat plaque psoriasis - it induces pustular psoriasis.
systemic steroids
Tx: Topical high-potency steroids, topical vitamin D derivatives, methotrexate and biologics for systemic therapy, topical tacrolimus, low potency corticosteroids and phototherapy
93
Red man syndrome/AKA Vancomycin infusion reaction is caused via what mechanism?
Drug-induced direct mast cell activation through a non-IGE-medicated pathway.
94
progressive painless proximal muscle weakness with elevated muscle enzymes and inflammatory markers, dysphagia with regurg and aspiration. =
polymyositis and inflammatory myopathy triggered by unknown possibly viral antigens.
95
Difference between polymyositis and polymyalgia rheumatica
Polymyositis: proximal muscle weakness, elevated muscle enzymes, autoantibodies (anti jo 1, ANA), endomysial infiltrate, patchy necrosis.
Polymyalgia rheumatica: systemic S&S, stiffness > pain in shoulders, hip girdle, neck, associated with giant cell arteritis, elevated ESR, CRP and rapid improvement with glucocorticoids.
96
What condition is associated with multiple skin tags?
insulin resistance, pregnancy, crohn's disease (perianal)
obesity, overt diabetes, metabolic syndrome
97
Condition associated with acanthosis nigricans?
Insulin resistance
GI malignancy
98
Condition associated with porphyria cutanea tarda, palpable purpura secondary to cryoglobulinemia
Hepatitis C
99
Condition associated with dermatitis herpetiformis?
Celiac disease
100
Condition associated with sudden-onset severe psoriasis, recurrent herpes zoster, disseminated molluscum contagiosum
HIV infection
Parkison disease
101
Condition associated with severe seborrheic dermatitis
HIV infection
Parkinson's disease
102
Condition associated with explosive onset multiple, itchy seborrheic keratosis
GI malignancy
103
Condition associated with pyoderma gangrenosum
inflammatory bowel disease
104
Drugs for HTN that do not affect lithium levels
CCB & Loop diuretics
105
The most common causative agents of otitis externa/swimmers ear?
Staph aureus and pseudomonas aeruginosa
106
Best broad abx for tx of otitis externa
The broad spectrum abx like CIPRO
107
What is the best way to monitor cardiotoxicity in a patient receiving anthracyclin chemotherapy like doxorubicin and daunarubicin
Radionuclide ventriculogram AKA Multigated acquisition scan
108
What are the blood pressure goals for a patient with acute ischemic stroke who received TPA?
Use labetalol to keep B/P < 180/105 mmHg
109
Should you give full-dose anticoagulation with heparin or oral anticoagulation to a stroke patient within the first 24 hrs after TPA?
No
110
How do dopamine antagonists like pramipexole and bromocriptine work?
Directly activate dopamine receptors in the brain w/o the need for metabolism to the active form,unlike levadopa.
111
Since dopamine cannot cross the blood brain barrier, which medication that is the pre-cursor to dopamine is used?
Levadopa, L-Dopa
112
What is the role of carbidopa in the sinemet combo drug for PD?
Carbidopa blocks DOPA decarboxylase and therefore prevents coversion of L-DOPA to dopamine in the liver and peripheral blood making more dopamine available to the brain. It also decreases many of the unpleasant adverse effects due to the peripheral effects of dopamine like N/V, postural hypotension, tachy arrhythmias. So increase the dose if patient have those side effects.
113
How does scleroderma renal crisis present?
Severe hypertension and renal failure in a patient with evidence of underlying scleroderma, such as raynaud phenomenon and GERD.
114
Treatment of hypertension in scleroderma renal crisis?
Ace Inhibitors like Captopril, if CNS manifestations like papilledema is present, give IV meds like nitroprusside, a peripheral vasodilator. Monitor renal function closely.
115
How do you assess a patient's decision making capacity?
Patient is able to communicate a choice
Patient is able to understand their condition and and likely consequences of treatment options
Patient is able to appreciate the consequences of treatments options including no treatment and acknowledges having the condition
Patient is able to weigh the risks and benefits and offfers reasons for decisions.
116
What is brain death?
Irreversible absence of cerebral and brainstem reflexes including pupillary, oculocephalic, oculovestibular (caloric), corneal, gag, sucking, swallowing and extensor posturing.
117
How does a positive apnea test confirm brain death?
It documents An absence of respiratory response off the ventilator for 8-10 minutes with a PaCo2 >60 mmHg or > 20 mmHg from baseline and a final arterial PH of <7.28 (acidosis).
118
True or false, patients with brain death can have spontaneous movements from peripheral nerves or the spinal cord?
True
119
Treatment for dumping syndrome: This is common in patients who have had a gasterectomy
High protein diet, low carbohydrate, smaller but more frequent meals throughout the day
120
Prostate cancer screening is not recommended for men of what age groups?
<55, and >70 or men with a life expectancy of < 10 years
121
Best age to screen men for prostate cancer with PSA?
Age 55 to 69
122
What are some reversible causes of incontinence?
DIAPPERS: Delirium, Infection, Atrophic urethritis/vaginitis, Pharmaceuticals (alpha antagonist, anticholinergics, opiates, CCB, diuretics), Psychological, Excessive urine output, Restricted mobility, Stool impaction.
123
The most common cause of acute cholangitis?
Gallstones
124
Imaging to confirm that a patient with predominant elevations in serum bolirubin and alkaline phosphatase does indeed have acute cholangitis?
RUQ US will show biliary dilation, MRCP will identofy biliary strictures or biliary tumor
125
Best source of calcium and vitamin D for post-menopausal patients since supplements have increased risk of adverse effects?
Milk, Yogurt, dark green leafy vegetables for calcium
fortified milk, fatty fish, sunlight (15 minutes twice a week)
126
Treatment for invasive squamous cell carcinoma of the skin ?
Moh's surgery
127
Treatment for squamous cell carcinoma in situ?
Excision of 4-6 mm Margins, C&E, Cryotherapy, Topical 5-FU, Imiquimod
128
What is the fort line treatment for Erysipelas?
Penicillin such as ampicillin and amoxicillin
129
Drug to give for acute vericeal bleed?
Octreotide
130
Drug to give for upper GI bleed?
Protonix drip then upper endoscopy, crystalloids
131
Best time when albumin administration is considered?
SBP or large volume paracentesis
132
Type of gall bladder calcification that put a patient at increased risk for gall bladder cancer and requires prophylactic cholecystectomy?
punctate or curvilinear gall bladder calcifications/porcelain gall bladder
133
Treatment for blepharosmasm/a form of focal dystonia
Botox injections to weaken w/o paralyzing the sustained contractions of the orbicularis oculi muscles
134
Treatment of paget's disease? increased bone turn over and abnormal remodeling
Bisphosphonates
135
What is the alternative medication for a heart failure patient on spironolactone who has developed gynacomastia?
Eplerenone
136
What should a patient with with high grade carotid stenosis and s/p TIA be getting done to reduce future risk of strokes?
Carotid ebdarterectomy
137
name& describe the test used to determine if a patient has a complete achilles tendon rupture
Thompson Test - Absence of plantar flexion with calf squeeze when the patient is in prone position.
138
Name the rare pancreatic tumor associated with mild diabetes, erythematous scaly rash which clears in the center and has elevated and crusty borders.
Glucagonoma
139
Vaccines contraindicated in patients with HIV/CD4 count <200
Live vaccines: MMR, Live intranasal influenza vaccine
140
In patients receiving chronic opiod therapy, increased repiratory drive AEB dyspnea, tachypnea should alert me to what?
A more acute pulmonary process and non-opioid related
141
What condition has episodic pain and tenderness at the inferior patella?
Patellar tendonitis/jumper's knee/athletes
142
What condition in adolescents with recent growth spurts that causes increased pain with sports which is relived by rest, tenderness and swelling at tibia tubercle
Osgood-Schlatter disease
143
What condition in young female athletes causes subacute to chronic pain with increased squatting, running, prolonged sitting, using stairs?
patellofemoral syndrome, do the patellofemoral compression test
144
short and long term management of hypertriglyceridemia associated pancreatitis?
plenty of IV fluids, antiemetics, and pain control, Apheresis to filter triglycerides out of blood, insulin if not severe of if apherisis is unavailable, Fibrate slike fenofibrate and gemfibrozil to prevent recurrence.
145
Name this condition: shoulder pain, horner's syndrome, hand muscle atrophy and weakness, asymmetric lower-extremity deep-tendon reflexes and back pain and a lung mass?
Pancoast tumor
146
What should your patients with lupus who take glucocorticoids long term also do to reduce the risk of osteoporotic fractures?
Daily supplementation of calcium and vitamin D
147
What is the best way to evaluate a pancreatic cyst to differentiate malignancy from nonmalignant cause?
Endoscopic Ultrasound
148
Treatment for idiopathic intracranial hypertension common in obese women wit acne on isotretinoin.
Weight loss, bariatric surgery, carbonic anhydrase inhibitor (acetazolamide, topiramate)
