Uword Flashcards
(217 cards)
1
Q
Mucormycosis - facial rhino-orbital - BUG?
A
Rhizopus
2
Q
Fever, jaundice, RUQ pain (with poss hypotension and confusion) - Likely diagnosis? What seen on imagin?
A
Acute cholangitis
Common bile duct dilation on CT or US
3
Q
Hypercalcemia presentation?
Treat with?
A
Volume depleted with weakness, GI distress, and neuro-psych sx
Saline fluids, calcitonin, and poss bisphosphonates
4
Q
Flaccid bullae and mucosal erosions? Likely dx?
Caused by?
Biopsy shows?
A
Pemphigus vulgaris
Auto-Ab to desmogleins (adherence between epidermal keratinocytes)
Intracellular IgG deposits in epidermis
5
Q
PCP in HIV. Bactrim AND steroids if what?
A
PaO2 <70 mmHg or A-a >35 mmHg on RA
6
Q
Amiodarone side effects? Big 2 and 4 others
A
Thyroid (hypo or hyper), liver probs
plus bradycardia/heart block, pneumonitis, neuro, visual disturbances
7
Q
Positional changes causing changes in O2 sat? Think?
A
V/Q mismatch caused by intrapulmonary shunt (2/2 PNA)
8
Q
Key pathogenic factor in devleopment of T2DM and associated abnormalities (HTN, HLD)?
A
Insulin resistance with central-type obesity
9
Q
First degree relative with colon cancer, start screening when?
A
40 instead of 50
10
Q
Which requires workup in young aysmptomatic adults - diastolic or midsystolic murmurs?
A
diastolic
11
Q
Immune thrombocytopenia - dx of exclusion - due to?
Treat with? And when?
A
IgG Ab to PLT glycoproteins
Treat with systemic glucocorticoids if count <30 or severe bleeding
12
Q
Hemodynamic shock - are these low, high, or nml: CO? SVR? CVP? PCWP? Volume?
A
CO: low SVR: high CVP: low PCWP: low Volume: low
13
Q
Gradual loss of peripheral vision, esp in African Americans? Think?
A
Open angle glaucoma
14
Q
Macular degeneration affects central or peripheral vision?
A
Central
15
Q
Poor night vision, curtain falling with vitreous bleed, floaters on vitreous bleed resolution? Think?
A
Diabetic retinopathy
16
Q
Test reliability means?
A
That the test gives the same result when repeated
17
Q
Stuck with a Hep B needle? Action for immune vs nonimmune?
A
Immune: reassure
Nonimmune: HBIG and HBV vaccine
18
Q
Pneumococcal vaccines: PPV13 vs PPV23 when to give?
A
PPV13 for all adults >65 then followed by PPV23 (and HIGH risk <65 sickle cell, asplenia, immunocomp, CKD, CSF leaks)
Just PPV23 for <65 if smoker, diabetic, lung, heart, or liver dz
19
Q
Drug to prevent re-modeling after MI?
A
ACEi
20
Q
First line for reactive arthritis?
A
NSAIDs! (NOT abx)
21
Q
Drug for SVTs?
A
Adenosine
22
Q
Causes of hyperkalemia?
A
AKI, CKD, meds, dz impairing RAAS
23
Q
Meds causing hyperkalemia?
A
ACEi, ARBs, non-selective BB, NSAIDs, K-sparing diuretics (spiro, eplerenon, triamterene)
24
Q
Hypercalcemia, hilar adenopathy, non-caseating granullooams that can satin for acid fast or fungal? Dx and rx?
A
Sarcoidosis, if symptoamtic then give steroids
sx: dyspnea, fatigue, nonproductive cough
25
Avoid AKI from acyclovir toxicity by doing what?
Aggressive IV hydration
26
Infective endocarditis - CXR findings and murmur?
Round alveolar lesions on CXR (septic pulmonary emboli)
| Holosystolic murmur increases with inspiration (indicates tricuspid involvement)
27
Liver abscess with travel history? Think and treat?
Entameoba histolyca - treat with metronidazole
28
Diffuse pain, fatigue, mood/cognitive sx with normal infl/rheum workup - think?
Fibromyalgia
29
6 hours of pain after fatty meals then resolution, no fever, abd tenderness, TTP or WBC?
Biliary colic 2/2 gallstones
30
Wernicke's enceph vs Hepatic enceph - physical exam finding and tx?
HE has asterixis and Wernicke does not
| Thiamine for Wernicke, lactulose for HE
31
Severe lymphocytosis with hepatosplenomegaly, LAD and anemia/thrombocytopenia (esp in elderly) - think? and daignose?
CLL
| Diagnosed with flow cytometry
32
Catecholmaine surge induced by anesthesia or surgery - underlying problem?
Pheochromocytoma
33
kidney stone tx?
HYDRATION
34
AV block with infective endocarditis - think?
Perivalvular abscess
35
Case control study gives you?
Exposure odds ratio
36
Cohort studies give you?
Relative risk and relative rate
37
Median survival rates come from?
Cohort or RCT
38
Prevalence odds ratio comes from?
Cross sectional study
39
Proximal muscle weakness and elevated CK? Think?
| First treatment?
Polymyositis
| Steroids
40
Electrolyte disturbance form high dose B-agonists?
Hypokalemia
41
3 possible heart sound findings in cor pulmonale?
Loud P2 (pulmonic component of S2)
RV 3rd heart sound
Tricuspid regurg murmur (holosystolic, LLSB, increases with insp)
42
Schilling test is for?
B12 defic due to pernicious anemia or malabsorption
43
ITP (idiopathic low platelets) - test for what?
HCV and HIV
44
Most common vaccine preventable dz among travelers?
Hep A
45
Autoimmune disorder characterized by tense bullae and pruritus?
DIagnosed by?
Treated with?
Bullous pemphigoid
Skin biopsy showing IgG, C3 deposits at dermal/epidermal
High potency steroid topical (clobetasol)
46
Cause of Graves opthamology?
Orbital tissue expansion (following T-cell activation and stimulation of orbital fibroblasts and adipocytes by TRAB)
47
Initial frostbite tx?
Rapid heating with warm water
48
Flu antiviral window?
Within 48 hours of sx onset
49
Toxic megacolon can be initial presentation of what?
If suspected then first step?
And treat?
IBD
KUB
Steroids
50
HIV prophylaxis - needlestick/infected body fluids?
Draw serologies, 3 drug tx for 4 weeks
51
Lynch syndrome cancers? (3)
Colorectal and endometrial (and ovarian)
52
```
Octreotide - class of drug?
MoA?
```
Somatostatin analog
| Inhibit vasoldilation so induce splanchnic vasoconstriction and thus decrease portal flow
53
Clot in setting of increased homocysteine - along with AC give what?
B6 (pyridoxine) - cofactor for homocysteine to cystathionine
54
Acute massive increases in AST and ALT with mild increases in T-bili and Alk phos (in setting of hypotension)?
Ischemic hepatic injury
55
Why could you see celiac DZ without anti-transglutaminase Ab or IgA?
Could be concurrent selective IgA deficiency
| Still suspect if malabsorption (foul smelling bukly floater stools) and Fe defic anemia
56
Palpable cervical lymph node in smoker with EtOH hx - suspect?
Best diagnostic test?
Squamous cell carcinoma of mucosa of head and neck
| Panendoscopy
57
TB like signs, with brain abscess in immunocomrimpised - aid fast, but GRAM STAIN POSITIVE - think?
Treat?
Nocardia (TB no gram stain)
| Tx with Bactrim
58
Mode of spread to osteomyelitis from diabetic foot ulcer?
| Monomicrobial or poly?
Contiguous
| Polymicrobial
59
How does NG relieve chest pain?
systemic vasodilation that decreases LV end diastolic voume and thus wall stress and thus myocardial O2 demand
60
How to tell lead toxicity from nutritional Fe defic?
| Diagnx and treat?
Lead tox has hypertension and nephropathy alongside microcytic anemia and nonspecific sx
Diagnx with blood lead levels and treat with chelation
61
Meds that improve survival in pts with LV systolic dysfucntion?
BB, ACEi, ARBs, spiro/eplenerone
| plus hydralazine and nitrates in black pts
62
Joint pain, INCLUDING DIPs, with "sausage digits," morning stiffness, and nail involvement?
Treat with?
```
Psoriatic arthritis (5-30% of psoriasis pts)
Tx: NSAIDs, methotrexate, anti-TNF meds
```
63
Boerhaave syndrome is?
Rupture of esophagus
64
Likely diagnx of Nephrotic syndrome in obese people, black people, HIV pos and IV drug users?
FSGS
65
Pseudogout crystals? Made of and shape?
| Predisposing condition?
CPPD (calcium pyrophosphate), rhomboid
| Hyperparathyroid (elev Ca)
66
Acetaminophen ingestion - tx?
| Toxic level?
Charcaoal and get level. May not be symtomatic in first 24 hours
>7.5g
67
Young women with anterior knee pain, worse when climbing stair - think?
Diagnx?
Tx?
Patellofemoral syndrome
Pain on extension on knee
Tx by stretching thigh muscles and avoiding painful activity
68
Long term recurrent infx of lungs - leads to?
| Diagnx with?
Bronchiectasis
| Hi-res CT of chest
69
Hypotension, tachycardia, distended neck veins, pulsus parodoxus - complication of aortic dissection?
Tampenade 2/2 pericardial fluid accumulation
70
Presbyopia - age related near vision caused by?
Decrease in lens elasticity
71
>70 yo pt, extreme fatigue, leukocytosis with mature lymphocytes and smudge cells - diagnx?
CLL
72
Most common adverse rxn, 1-6 hours after transfusion?
| How to prevent?
Febrile non hemolytic transfusion (fever chills and malaise without hemolysis)
Prevent by leuko reduction of blood
73
```
SEVERE hyperlgycemia (often >1000) in T2DM?
What happens to potassium?
```
HHS (hyperosmolar hyperglycemia)
| Normal serum levels on BMP but total body depletion
74
Sudden loss of vision and onset of floaters?
| Happens in patient with what?
Vitreous hemorrhage, in pts with diabetic retinopathy
75
HTN workup? (5 steps)
```
5 steps
UA for hematuria and protein:Cr ration
CMP
Lipid panel
ECG
```
76
Isolated systolic HTN - often seen in what demographic?
| HTN due to?
Seen in elderly
| Due to arterial wall rigidity
77
Subacute onset of low grade fever, headache and increased ICP in HIV positive patients - suspect?
Diagnx with?
Crytococcal meningitis
| Check the CSF for antigen or organism
78
Aspirin given to pts with history of asthma or chronic rhinosinusits with nasal polyps can cause?
Treat with?
AERD, asa exacrebated resp DZ (non IgE mediated, due to PG/LKT imbalance)
Avoid NSAIDs and use LKT recpetor antagonists
79
Before starting trastuzumab (herceptin) do what?
echo, as can be cardiotoxic, esp in low EF
80
Valve problem in HoCM?
Abnromal anterior leaflet motion of mitral valve - moves toward thickened septum during systole, creating LV outflow tract obstruction
81
Rapid resp distress and hypotension following transfusion (within minutes)?
Population at risk?
```
Anaphylaxis
IgA defic (suscpetible to anti-IgA Ab)
```
82
Abx for human bite wounds (i.e to cover polymicrobial oral bacteria)"?
Amoxi-clav
83
Myalgias, proximal muscle weakness, elevated serum CK? Cosndier?
Hypothyroid myopathy
84
CURB-65
```
Confusion
Urea>20
RR>30
BP<90 or DBP<60
Age >65
0=outpt, 1-2=likely inpt, 3-4=urgent admit, >4 ICU
```
85
CAP tx (outpt, floor, ICU)
Outpt: mac or doxy (healthy) or see floor if comorbidities
Floor: FQ or ceftri/azithro(IV)
ICU: Ceftriaxone with FQ or azithro (IV)
86
Most common cause of death in both renal transplant and dialysis patients?
Cardiovascular DZ
87
Beta blocker overdose - symptoms and tx?
Bradycardia with AV block, hypotension, hypoglycemia, wheezing, delirium, seizures, cardiogenic shock
1st line: IVF and atropine, then glucagon if refractory hypotension
88
Asian woman <40, weight loss and arthlragias, then aneurysm formation and hemodynamic sx?
Treat with?
Takayasu arteritis
| Treat with systemic steroids
89
Excercise induced ashtma tx?
albuterol 10 min before exercise, add anti-LKT or inhaled steroids in daily exercise
90
Avascular necrosis of femur in sickle cell - Xrays normal or abnormal? How?
Deficiris in what movements?
Normal
| Int rotation and abduction are limited
91
Aortic stenosis heart findings on PE? (3)
Mid to late peaking systolic murmur
Pulsus parvus and tardus in carotids
Soft and single S2
92
Why does low serum albumin mean low Ca?
| Formula to correct Ca?
Because 40-45% of Ca binds albumin
Thus does snot effect ionized Ca
So have to correct Ca for low albumin:
Ca + 0.8 (4 - serum alb)
93
Rhabdo signs and risks?
| Causes?
Incr K and CPK (>20)
Immobility, cocaine use
Acute kidney failure (acute tubular necrosis due to myoglobinuria)
94
Low K and HTN - Suspect what?
| And first step in workup?
```
Primary hyperaldosteronism (can be triggered by diuretics)
Check plasma renin activity and aldosterone levels
```
95
TCA overdose - clues?
| Give what IV?
QRS prolongation, seizures, possible arrythmias, hyptoension and anticholinergic sx.
Sodium bicarb
96
HPV warts can be found which 3 places?
| In which 2 demographics?
Genital, palmar, plantar
| In young adults and immunocomprimised
97
Giardia tx?
Metro
98
If back pain radiates BEYOND the thigh/buttock to the calf/foot - think what?
And treat?
Lumbosacral radiculopathy 2/2 herniated disc
| Trial NSAIDs, most recover spontaneously
99
Housefire toxicities? Treat?
Cyanide and CO
| For CO - O2, and for cyanide give hydroxocobalamin or sodium thiosuflate or nitrites to induce methemoglobinemia
100
Cyanide tox causes acidosis how?
Reduced O2 tissue utilization - lactate buiildup
101
Most common asbestos linked cancer - especially in smokers?
Bronchogenic carcinoma
| Pleural plaques are sign of asbestos exposure
102
What is hyposthenuria in sickle cell?
| Does it occur in trait or just sickel cell DZ?
Inability to kideny to concentrate urine
| In trait too
103
sinus bradycardia in adults - first and second line?
IV atropine
| Then pacing wire
104
steatorrhea - think?
due to?
tx?
chronic pancreatitis
EtOH
stop boozing and supplement pancreatic enzyems
105
3 most common causes of aortic stenosis?
Bicuspid aortic valve (majority of cases <70 yo)
Rheumatic heart dz
Calficified aorta
106
Painful but benign tumor in young women on OCPs?
Hepatic adenoma
107
ELevated alk phos and GGT suggest?
Biliary construction or obstruction
108
Osteomyeleitis from a deep pucnture wound (esp on plantar foot) - bug?
Pseudomonas (even if a rusty nail)
109
What happens if you give folic acid and its actually B12 defic?
Megaloblastosis resolves but neuro sx rapidly get worse
110
Most common cause of rapid worsening in underlying lung DZ?
| And most common cause of that
secodnary spontaneous pneumothorax
| rupture of alveolar bleb
111
Disseminated gonococcal infx triad?
polyarthralgia, tenosynovitis, painless vesiculopustular skin lesions (2-10)
WITH venereal sx often absent
112
Hypocalcemia - if normal serum albumin check these three before advancign to PTH?
```
Low Mg (causes decr PTH release and resistance to PTH)
Drugs
Recent transfusion (incr citrate)
```
113
Transaminitis, exposure to dirty water, fever and RUQ pain, and diarrhea: Imaging: single cystic lesion in RIGHT lobe - THINK?
Treat?
Entamoeba histolyic
| Metro or intraluminal ABX (eg paromomycin)
114
Drop in PLT post AC - which drug?
UF Hep (increases apTT)
115
CHF that is unexplained, proteinuria, LV hypertrophy, but NO HTN?
amyloidosis
116
parvvorisu causes 5th dz in kids but in adults manisfested as what?
acute viral arthritis
117
paradoxical hyperkalemia in DKA is caused by ?
extracellular shift
118
2nd agent to metformin esp if weight loss if desired?
GLP-1s
119
Immunicompromisied with Fever, pleuritic chest pain, hemoptysis - halo sign (many nodules surrounding ground glass on imaging - think?
Treat?
Aspergillosis
| treat with voriocnazole and caspofungin
120
Cirrhosis - first screening when diagnsoed?
endoscopy for varcies
121
Varices - medical accompaniment or alternative to banding? (ie prophylaxis for hemorrhage)
Nonselective BB - (nadolol or propanolol)
122
Midwest fungus causing disseminated infx in HIV patients with CD4 <100?
How to test for it?
Treat?
Histoplasma - urine or serum
| Amphotericin with antiretrovirals
123
Exogenous insiulin - c peptide level?
low
124
insulinoma - 3 signs?
elevated c-protein
proinsulin >5
hypoglycemia
125
Cause of gallstones in TPN?
Galbaldder stasis
126
What can happen to cartilage in psuedogout?
Calcification
127
Beck's triad - tamponade?
| What happens to septum?
Muffled heart sounds, JVD, hypotension
| Shifts toward LV cavity leading to LV preload reduction, decr SV and CO
128
Most important factors for survival in out of hospital cardiac arrest?
Adequate bystander CPR
| Prompt rhythm analysis and defibrillation
129
Hard unilateral lymph nodes, esp if pt is smoker think?
squamous cell carcinoma if in neck, or metastatic cancer if elsewhere
130
Metabolic acidiosis (low pH and low bicarb) - next ste p in diagnosis?
Calc anion gap
131
Varicella vaccine in HIV?
Yes if CD4 >200, no if <200
132
When to use D-dimer in PE assessment?
If PE unlikely (via Wells) - get a d-dimer and if it is >500 get a CTPE, if PE likely go straight to CTPE
133
Who gets HIV screening?
| What method?
Everyone 15-65 regardless of risk factors
plus pregnant women, MSM, IVDU, unprotected sex or other STDs
p24 Ag and Ab testing
134
HTN and hypokalemia exposed by diuretics (also mild hypernatremia and low plasma renin activity) - think?
Primary hyperaldosteronism
135
Vasovagal (neurocardiogenic) syncope - tx?
Reassurance and counterpressure maneuvers during prodrome
| If exam and EKG suggest cardiac then investigate with Holter or TTE
136
```
Analgesic nephropathy (from eg combined NSAID and ASA) manifests as?
Sx as progresses?
```
Papillary necrosis
Tubulointerstitial nephritis
1. Polyuria and sterile pyuria (WBC casts)
2. microscopic hematuria
3. HTN, mild proteinuria, and impaired urine conc
137
Nasal crease, cobblestone throat, nasal d/c?
| Tx?
Allergic rhinitis
| Glucocorticoid nasal spray
138
Acute Liver Failure triad?
| What setting should you suspect?
Elevated AST/ALT
Hepatic encephalopathy (asterixis, somnolence, confusion)
INR >1.5
SUSPECT in aceta use on top of EtOH
139
B12 and folate cause macrocytic anemia with what kind of neutrophils?
HYPERsegmented
140
What is elevated in BOTH B12 and folic acid defic?
| And what ONLY in B12?
Homocysteine in both
| MMA only in B12
141
Odynophagia in HIV pts? Three causes and tx?
1) thrush, give fluconazole
If persists either:
2) HSV (ovoid ulcers and inclusions) - acyclovir
3) CMV (long ulcers on esophagus) - gancyclovir
142
Refracteory duodenal ulcers and/or chronic diarrhea/steatorrhea - THINK? Dx?
Mech of malabsorption?
Zollinger Ellison S (gastrin producing tumor)
Dx with gastrin >1000 and gastric pH <4
Malabsorption due to inactivation of pancreatic enzymes by stomach acid
143
Prevention of PE in pts contraindicated (eg bleeding) or failed ant-coag?
Place retrievable IVC filter
144
Causes of hypokalemia? (3)
1) Increased intracellular entry
(eg insulin, B-agonists, hematopoesis)
2) GI losses
3) renal wasting (hyperaldosteronism or diuretics)
145
Hemolytic anemia after sulfa drugs or primiquine - think?
| Why can the lab test be normal?
G6PD defic
| Reticulocytes are abnormally high
146
BPH - first line? Then?
a-blockers
| 5-a-reductase inhibs as alternative or additional but slower onset
147
Ventilator - goal for PaO2 is?
Start FiO2 high and try to reduce to what if blood gases OK?
To maintain adequate oxygenation do what to PEEP?
55-80
<60%
Increase PEEP
148
Anemia of chronic dz/inflammation - what labs would you see?
| And tx by?
Normocytic with decr serum iron, decr TIBC, decr Fe sat and normal to elev ferritin
Treat the underlying condition
149
In true iron def anemia - labs/studies would show?
| And thalassemia?
Microcytic with low iron, low ferritin, low Fe Sat but HIGH TIBC
VERY microcytic, HIGH iron and ferritin and low TIBC
150
Facial plethora, vision disturbances, pruritus, thormobosis, splenomegaly with eryhtocytosis - think?
Tx?
Polycyhtemia vera
| Phlebotomy and add hydorxyurea (or other bone marrow suppressant) if high risk of thrombosis
151
Fever, hemolysis, DIC, within an hour of transfusion. Oh shit .. . it's?
If it were just fever and chills, 1-6 hours, it would be?
Acute hemolytic transfusion mismatch (eg ABO mismatch)
| Febrile nonhemolytic reaction due to cytokines in blood product
152
Odd thromboses presenting in arms or chest and other places - think?
Likely accompanied by?
Trousseau's
Cancer somewhere, most likely pancreatic
Also stomach, lung or prostate
153
Ascending aortic aneurysms due to (2)?
| Descending due to?
Connective tissue dz or cystic medial necrosis
| Athersclerosis
154
Graft vs Host is due to T-cells from donor or recipient?
| Organs often effected?
```
Donor
Skin (macukpapular rash), intestine (bloody diarrhea), liver (LFTs and jaudice)
```
155
Euvolemic hypERnatremia - diagnx is? What psych med causes it?
DI
| Lithium
156
3 meds that decrease response to anti-hypertensives?
Steroids, NSAIDs, decongestants
157
Drooling, dysphagia, mouth pain, with edema in the mouth and possibly neck, poss airway compromise - think?
Tx?
Ludwig angina (a cellulitis from teeth infection)
Give IV abx - amp/sulbactam or clinda and pull teeth
(deal with airways too!)
158
Bilateral nasal obstruction, anosmia (can't taste), plus nasal discharge - esp in setting of chronic rhinosisuitis, asthma or ASA or NSAID induced bronchospasm (AERD) - THINK?
Nasal polyp
159
Home O2 indications for chronic COPD?
| In setting of RHF or hematocrti >55?
PaO2 <55 or SaO2 <88
| PaO2 <59 or SaO2 <89
160
Advantage of DOACs over warfarin?
Fast onset, no monitoring needed
161
Indications thrombolytics in PE.DVT?
HD unstable PE (massive), massive proximal DVT with significant symptomatic swelling (not just pretibial edema) or ischemia
162
Hemolytic anemia, cytopenia, hypercoagulable state (thrombosis seen), presenting with abd pain and dark urine? THINK?
If WITHOUT the hematologoic abnormlaities and thromboses?
Paroxysmal nocturnal hemoglobiuria
| Acute intermittent porphyria
163
Recurrent kidney stones from childhood, fam hx
Hard, radioopaque stones and hexagonal crystals on UA
Diagnx?
Dz process?
What test is positive?
Cystinuria
Process: imparied amino acid transfer
Urine cyanide nitroprusside in positive
164
Inferior MI think what chamber of heart and vessel?
Sx?
Preload or afterload dependent?
RV, proximal RCA
Hypotension, clear lungs, JVD, chest pain and vomiting
Preload so give fluids not nitrates or diuretics
165
PE ECH findings? (4)
sinus tachy
non-specifc St or T wave changes
new RBBB
S1Q3T3
166
Women 15-50 with HTN (nonathlerosclerotic and nonflammatory), poss nonspecific sx or poss TIA/brian sx - think?
And it effects what?
Fibromuscular dysplasia
| Renal arteries
167
LIfestyles mods that reduce PACs?
| When would you use BBs in PACs?
Stop smoking and drinking
| BBs only if symptomatic
168
IBD: noncaseating granulomas on biopsy? Which dz?
Pseudopolyps?
Perianal dz?
Crohn's
UC
Crohn's
169
Woman with prolonged PTT and low PLT, and possible false positive VDRL - think?
Treat with? To avoid?
APS (anti phospholipid Ab syndrome)
| Give ASA and LMWH for prophylaxis of miscarriage
170
1st degree heart block - when to observe and when to get EP study?
ONly get EP study if QRS is widened (>120) - likely to have conduction delay below the AV node (rather than at the Av node with normal QRS)
171
Cancer with hypERcalcemia?
Squamous cell (SCa++umous cell) (PTHrP assoc)
172
Syndromes assoc with small cell lung cancer?
SIADH, ACTH production
173
Adenocarcinoma, squamous cell - lung locations?
Adeno - outer, squamous - central
174
Epipdidymitis - unilateral scrotal pain, TTP, erythema - bugs for <35 and >35?
>35 e coli (from bladder obstruction or infx)
| <35 chlamydia or gonorrhea (from STD)
175
Acromegaly - for diagnosis check what?
IGF1, less likely to fluctuate than GH
176
"Oh shit" in acute asthma exacerbation?
Normal or elevated PaCO2 and normal pH
| You would expect to see lower PaCO2 due to hyperventilation, if not then impending respiratory failure
177
Fever, maculopapular rash, renal failure post ABX (bactrim, PCNs, rifampin, cephs) - think?
What do you see on UA?
(acute) interstitial nephritis
| on UA: WBC casts and sometimes eosinophils
178
Type 1 vs Type2 HIT?
Type 1 is nonimmune PLT aggregation , usually mild so <100, usually withn 2 days
Type 2 is Ab mediated and usually halves PLTs, 5-10 dyas or earlier
179
MALT without mets - tx?
Treat the H. pylori with PPI, clarithro and amoxi
180
Aspiration presenting hours vs days after event?
Hours: pneumonitis (gastric acid)
Days: pneumonia (upper ariway or stomach mircobes)
181
GI sx that resolve spontaneously then progress to myositis, eosinophila and periorbital edema (can also have splinter hems) - dx?
Trichinellosis
| round worm from undercooked meat
182
Stable angina - first line meds?
Beta blocker
| Alternaitves would be CCBs or long acting nitrates, or in addition
183
Acute limb ischemic (6 Ps)
| If sudden most likley due to ?
Pain, Pallor, Paresthesias
Pulselessness, Poikilothermia, Paralysis
Arterinal emoblic occlusion
184
Dietary recs for people who get kidney stones? (3)
Increased fluids
Low sodium
Normal calcium
185
Autoimmune hemolytic anemia vs hereditary spherocytosis as a cause of hemolytic anemia (FamHx and Coombs test)?
What is common to both?
AIHA - neg FamHx, pos Coombs
HS - pos FamHx, neg Coombs
Common: spherocytes without central pallor
186
Bright flashes of light, floaters, "curtain coming down over eye" - dx?
Retinal detachment
187
What on the BMP increases with GI bleed?
| Why?
BUN and so BUN/Cr ratio
Increased urea production from breakdown of HgB
and increase urea absorption due to hypovolemia
188
Hep B serology: vaccinated vs resolved infx?
Vaccinated: just anti-HBs
| Resolved infx: anti-HBs and anti-HBc
189
Infective endocarditis from Eikenella - source?
| Gram status?
Poor dentition, oral
| Gram negative anaerobe
190
Uric acid stones (needle shaped crystals) - next step?
Abd CT
191
Suspicion for foreign body in eye. Penlight exam shows nothing, next step?
Fluoroscein examination
192
Plasma aldosterone/renin activity ration in primary hyperaldosteronism?
>20
193
White tongue, salivations, dysphagia - GI pain - after ingestion. Suggests?
Caustic poisoning
194
post-transfusion electrolyte abnormality?
hypocalcemia
195
Mitral stenosis presentation?
Common arrythmia?
Underlying dz?
Progressive dyspnea and orthopnea
A-fib
Rheumatic fever
196
Drugs causing acute pancreatitis (6 classes)
```
AEDs (depakote)
Diuretics (lasix, thiazides)
IBD drugs (5-ASA, sulfasalazine)
Immunosuppressives (azathioprine)
HIV meds
ABX (metro, TCNs)
```
197
3 causes that account for 90% of chronic cough in nonsmokers w/o chronic lung dz
PND (tx empiric with oral antihistamine, first gen)
GERD
asthma
198
Why do empyemas (exudative effusions) have low glucose?
Metabolic activity of leukocytes and bacteria in the pleural fluid
199
Raynaud's medical tx?
CCBs
200
Acute pancreatitis etioligies (6)
Gallstones, EtOH, TGs
Drugs, infx (legionella, CMV, aspergillus), iatrogenic (post-ECRP)
and SCORPION BITES!
201
Mixed resp alklosis and metabolic acidosis - think?
ASA intox
202
In addition to hypokalemia, 2 other side effects of loop diuretics in the kidney?
metabolic alkalosis and prerenal kidney injury
203
Metaoblic alkalosis - saline responsive vs saline unresponsive?
```
Saline responsive (low urine Cl and volume contraction)
Saline unresponsive (urine Cl >20)
```
204
Corneal vesicles and dendritic ulcers in the eye?
HSV keratitis
205
WBC upper limit for osteoarthtitis on joint tap?
2000
206
Lactose intolerance dx?
```
Positive hydrogen breath test
Increased stool osmotic gap
Positive stool for reducing substances
Low stool pH
NO steatorrhea
```
207
Wide complex tachy - shock if AMS, unstbale etc. but if stable give what?
Anti-arrythmics, i.e. amiodarone, lidocaine, procainamade, sotalol)
208
Effect of squatting on preload/afterload?
| And effect on mitral prolapse/regurg murmurs systolic murmurs?
Increases preload and thus LV volume
| Decreases them
209
Hypocalcemia, hyperphosphatemia, with an increased PTH is likley due to ?
Renal failure (secondary hyperparatyroidism)
210
Can diabetic neuropathy affect bladder and cause incontinence?
YES
211
Hyperinflation in COPD causes flattening if diaphragm which causes?
Hyperinflation itself is caused by?
Increased work of breathing
| Decreased alveolar elasticity
212
Cause of pancytopenia in lupus?
Peripheral immune destruction of blood cells
213
Thyroid storm sx?
Fever, HD instability, CHF, arrhythmais, triggered by specific event (trauma, childbrith, surgery, iodine contract etc.)
214
Fatigue, fever, weight loss, cough, in setting of incarceration or IVDU?
TB, miliary or otherwise
215
Pericarditis weeks after MI - dx?
| Tx?
Dressler's
NSAIDs, then steroids if refractory
(No AC)
216
```
Hookworm larvae (cutaneous larva migrans) , very itchy- how do you get it'?
Treat?
```
Walking on sand or soil barefoot
| Treat with ivermectin
217
Abd pain, fever, gross hematuria in setting of neprhotic syndrome?
Dz most assoc with?
Renal vein thrombosis, due to losing antithrombn III in urine
Most assoc with membranous glomerulopathy
