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Flashcards in UW9 Deck (66):
1

What causes epididymitis in young adults? Elderly?

C. trachomatis and N. gonorrhea; E. coli

1

T/F: statins are indicated in nephrotic syndromes

True

3

Why would a pt with SLE have pancytopenia? What about a pt with cirrhosis?

There can be immune mediated destruction of all 3 cell lines (i.e. Coombs pos hemolytic anemia) so there can be loss of all or just 1? Due to hypersplenism

3

What is the causal agent of seborrheic dermatitis? What are 2 associations?

Pityrosporum ovale; HIV (screen) and Parkinson dz

4

What is the most common cause of febrile neutropenia?

P. aeruginosa so they need to have pseudomonal coverage (cefepime, piperacillin-tazobactam, or meropenem)

4

If a pt is is being treated for hypertensive emergency and develops seizures and coma what should you think? Tx?

Nitroprusside can cause cyanide toxicity; Tx = sodium thiosulfate and hydroxycobalamin

5

Who gets screened for AAA?

Men 65-75 who have ever smoked

6

What 2 markers are fairly specific for Hairy Cell Leukemia?

CD11c and TRAP positivity

6

How do you tx TTP? What should you follow clinically?

Emergent plasmapheresis; follow the platelet count and LDH

7

What is the cause of angina whether due to anemia, AS, or angina?

Mismatch of O2 supply and demand

7

What is Hungry Bone Syndrome?

Occurs when a pt with primary hyperparathyroidism with preoperative bone dz gets parathyroidectomy; the bones then suck up all the Ca and there is no PTH to increase it so they get a symptomatic HYPOcalcemia

7

What is the way to localize the bad parathyroid gland prior to parathyroidectomy for primary hyperparathyroidism?

Sestamibi scan

8

What is the halo sign on CXR classic for?

Aspergilloma

10

What commonly forms after trauma or insect bites and has a classic dimple sign when squeezed? Cause?

Dermatofibroma; fibroblast proliferation

11

What is the most common extraarticular manifestation of ankylosing spondylitis

Anterior uveitis

12

What is the Uhthoff phenomenon

When lesions of multiple sclerosis get worse in the heat

12

What effect can androgen abuse have on a CBC

Can cause polycythemia; so if an athlete comes in with polycythemia but other signs of androgen abuse suspect androgen abuse over EPO

12

How do you treat pulmonary nocardiosis?

TMP-SMX; if spreads to brain add carbapenems

12

Who gets serous otitis media?

AIDS pts

13

Why is an FNA inadequate for follicular CA of thyroid

You need to see invasion of the capsule; FNA is still best step though bc most are going to be papillary which has characteristic nuclear features

14

What is the use of a 24 hour free urinary cortisol to diagnose adrenal insufficiency?

USELESS, though the cortisol may be low it is not used for this. You use this when looking for cushings (hypercortisolism) as an initial screening test

16

Why would laying a pt with R lower lobe PNA on his right side cause a drop on SaO2?

More flow goes to the lung in the dependent position but if there is consolidation it wont get oxygenated so this can lead to drops in O2 sat

17

What should you think if a young person with nephrotic syndrome had crushing substernal chest pain?

MI; Nephrotic syndrome causes accelerated atherosclerosis because it causes the liver to overproduce lipids, it also overproduces fibrinogen leading to hypercoagulability

18

What should you suspect in a pt with DOE and achalasia-like sx?

Systemic sclerosis (anti-topoisomerase ab)

20

What is the MC cause of COPD exacerbation?

URI i.e. viral or bacterial which is why you put the pt on abx

20

What evaluation should a pt with chronic hepatitis about to be started in Pegylated IFN alpha receive?

Psychiatric because it can worsen underlying psychiatric diagnoses

21

Prolonged use of PPIs can theoretically predispose to infection with what?

C. diff

23

What infection is a known risk factor for TTP?

HIV

25

What is the next best diagnostic step in a pt with recurrent superficial venous thromboses?

CT of abdomen (i.e. Trousseau sign of malignancy)

26

In a stable pt whose EKG shows electrical alternans what is the next best step

Echo to confirm presence of effusion; if unstable you'd do pericardiocentesis

26

What is the mgmt of peritonsillar abscess?

Needle aspiration and IV abx (if cannot drain the fluid then get ENT)

26

What are the 2 feared complications of hepatic adenoma? Assoc?

Hemorrhage into the tumor and malignant transformation; OCPs

27

How do you treat pemphigus vulgaris?

Mtx and steroids

28

What is the MC cause of nutritional folate def in the US?

Alcoholism (macrocytic with basophilic stippling)

30

What is the likely cause of jaundice in a pt with mono?

AIHA; Probably cold (also called Anti-I antibodies)

32

Which liver pathology classically has xanthelasmas?

PBC

33

What is the most likely cause of a mobile cavitary mass in the lung with intermittent hemoptysis?

Aspergilloma

34

When does a pt have febrile neutropenia?

Fever with ANC less than 1500

34

What medication is required to prophylax against further damage in SAH?

Nimodipine to prevent cerebral vasospasm; note vasospasm occurs in days 3-10 if there are worsening sx before this it is probably a rebleed

36

What are 4 things to consider in a pt with metabolic alkalosis?

Vomiting, Diuretic use, and Bartler and Gittelman's syndrome

37

What is Lhermittes sign

Electric shock like feeling with flexion of the neck in MS

39

How do you calculate plateau pressure on a ventilator?

During an inspiratory hold maneuver and it equals the sum of the elastic pressure plus the PEEP

40

What are the results of a normal cosyntropin stimulation test (i.e. negative for adrenal insufficiency)

A rise in serum cortisol by 20 above baseline within 30 to 60 min after administration

42

How do you treat bilateral aldosterone tumors

Aldosterone antagonists (spironolactone or eplerenone)

43

What is one of the few things that may cause bilateral trigemina neuralgia?

MS; usually tic is just unilateral

44

What is a mid diastolic sound in a pt whose CT shows calcifications around the heart

Pericardial knock assoc with restrictive pericarditis; diuresis and pericardiectomy

45

What must you do if a pt has recurrent chalazions, why?

Get a biopsy as there is increased risk of sebaceous carcinoma, i.e. arising from the meibomian glands

46

What causes ateriosclerotic lesions in the afferent and efferent arterioles and glomerular tufts

HTN i.e. benign nephrosclerosis

48

What are 2 common reversible risk factors for PACs

Alcohol and tobacco; note that the condition is benign but you should still discuss with the pt about stopping these activities

49

What should be checked in any pt with new onset atrial fibrillation as part of the diagnostic workup?

TSH and Free T4 as thyrotoxicosis often presents with Afib

50

What is the mgmt of giant cell arteritis?

High dose IV methylprednisolone (solumedrol) with transition to PO and taper

51

Why would a pt on phenytoin be anemic?

It causes decreased absorption of folate = megaloblastic anemia

52

What does HTN with bilateral flank masses suggest?

ADPKD

53

What are 2 common drugs to cause priapism?

Prazosin is most common but also trazodone

54

What should you consider in an HIV pt with a painful loss of vision

HSV/VZV retinal necrosis; CMV is usually painless

55

Discuss Sympathetic Ophthalmia

Injury to the spared eye after injury to the contralateral eye; this occurs because antigens that were spared from the immune system were exposed and now the other eye gets damaged

57

What is the most common AE of INHALED corticosteroids?

Thrush

58

What is the medical treatment for actinic keratoses

5 FU

59

What may a ruptured baker cyst be confused for?

A DVT; it can spill into the calf; Baker cysts may complicate RA

60

What parkinson medications can cause hallucinations?

Carbidopa and levodopa therapy can cause this early on! So don?t just assume because there is PD with hallucinations that you have Lewy Body dementia it could be med side effect

61

In general when is parathyroidectomy indicated in pts with primary hyperparathyroidism? (5)

Any symptomatic pts, Serum Ca > 1 mg/dl above upper limit normal, Young age (under 50), T score less than -2.5, or GFR less than 60

62

What do you do if the symptoms are very compelling for SAH but the CT is negative for acute bleeding?

LP to look for xanthochromia or blood

63

What is the most appropriate diagnostic test for pancreatic pseudocyst?

Abdominal US

64

How do you treat an external hordeolum (stye)? Most common bug?

Warm compresses and if not better in 48 H then I and D? S. aureus

65

What is hemisensory loss with severe dysesthesia concerning for?

Thalamic stroke i.e. VPL nucleus; pure sensory stroke

66

What is a potential serious complication of pancreatic pseudocyst?

Can hemorrhage into the pseudocyst because it contains lots of enzymes etc.