What causes epididymitis in young adults? Elderly?
C. trachomatis and N. gonorrhea; E. coli
T/F: statins are indicated in nephrotic syndromes
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
What is the causal agent of seborrheic dermatitis? What are 2 associations?
Pityrosporum ovale; HIV (screen) and Parkinson dz
What is the most common cause of febrile neutropenia?
P. aeruginosa so they need to have pseudomonal coverage (cefepime, piperacillin-tazobactam, or meropenem)
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
Who gets screened for AAA?
Men 65-75 who have ever smoked
What 2 markers are fairly specific for Hairy Cell Leukemia?
CD11c and TRAP positivity
How do you tx TTP? What should you follow clinically?
Emergent plasmapheresis; follow the platelet count and LDH
What is the cause of angina whether due to anemia, AS, or angina?
Mismatch of O2 supply and demand
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
What is the way to localize the bad parathyroid gland prior to parathyroidectomy for primary hyperparathyroidism?
What is the halo sign on CXR classic for?
What commonly forms after trauma or insect bites and has a classic dimple sign when squeezed? Cause?
Dermatofibroma; fibroblast proliferation
What is the most common extraarticular manifestation of ankylosing spondylitis
What is the Uhthoff phenomenon
When lesions of multiple sclerosis get worse in the heat
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
How do you treat pulmonary nocardiosis?
TMP-SMX; if spreads to brain add carbapenems
Who gets serous otitis media?
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
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
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
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
What should you suspect in a pt with DOE and achalasia-like sx?
Systemic sclerosis (anti-topoisomerase ab)
What is the MC cause of COPD exacerbation?
URI i.e. viral or bacterial which is why you put the pt on abx
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
Prolonged use of PPIs can theoretically predispose to infection with what?
What infection is a known risk factor for TTP?
What is the next best diagnostic step in a pt with recurrent superficial venous thromboses?
CT of abdomen (i.e. Trousseau sign of malignancy)
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
What is the mgmt of peritonsillar abscess?
Needle aspiration and IV abx (if cannot drain the fluid then get ENT)
What are the 2 feared complications of hepatic adenoma? Assoc?
Hemorrhage into the tumor and malignant transformation; OCPs
How do you treat pemphigus vulgaris?
Mtx and steroids
What is the MC cause of nutritional folate def in the US?
Alcoholism (macrocytic with basophilic stippling)
What is the likely cause of jaundice in a pt with mono?
AIHA; Probably cold (also called Anti-I antibodies)
Which liver pathology classically has xanthelasmas?
What is the most likely cause of a mobile cavitary mass in the lung with intermittent hemoptysis?
When does a pt have febrile neutropenia?
Fever with ANC less than 1500
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
What are 4 things to consider in a pt with metabolic alkalosis?
Vomiting, Diuretic use, and Bartler and Gittelman's syndrome
What is Lhermittes sign
Electric shock like feeling with flexion of the neck in MS
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
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
How do you treat bilateral aldosterone tumors
Aldosterone antagonists (spironolactone or eplerenone)
What is one of the few things that may cause bilateral trigemina neuralgia?
MS; usually tic is just unilateral
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
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
What causes ateriosclerotic lesions in the afferent and efferent arterioles and glomerular tufts
HTN i.e. benign nephrosclerosis
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
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
What is the mgmt of giant cell arteritis?
High dose IV methylprednisolone (solumedrol) with transition to PO and taper
Why would a pt on phenytoin be anemic?
It causes decreased absorption of folate = megaloblastic anemia
What does HTN with bilateral flank masses suggest?
What are 2 common drugs to cause priapism?
Prazosin is most common but also trazodone
What should you consider in an HIV pt with a painful loss of vision
HSV/VZV retinal necrosis; CMV is usually painless
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
What is the most common AE of INHALED corticosteroids?
What is the medical treatment for actinic keratoses
What may a ruptured baker cyst be confused for?
A DVT; it can spill into the calf; Baker cysts may complicate RA
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
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
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
What is the most appropriate diagnostic test for pancreatic pseudocyst?
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
What is hemisensory loss with severe dysesthesia concerning for?
Thalamic stroke i.e. VPL nucleus; pure sensory stroke
What is a potential serious complication of pancreatic pseudocyst?
Can hemorrhage into the pseudocyst because it contains lots of enzymes etc.