UWorld Flashcards
(174 cards)
1
Q
Tx for acute asthma exacerbation
A
Airway relax bronchoconstriction = b2 agonist or muscarinic antagonist or IV magnesium
Inflammation & edema = Short dose steroid (inhaled)
2
Q
Postmenopausal + UTI
A
Estrogen deficiency
3
Q
Elderly pt on alprazolam (insomnia)
- cognitive impairment
- falls
- Paradoxical agitation
A
As people age, they metabolize benzodiazepines more slowly
4
Q
Continued diarrhea
Normal
- labs = CBC + chemistry + LFTs + urine
- colonoscopy (melanosis coli = black mucosal pigment in proximal colon)
A
Facitious diarrhea = no external reward but false illness
Stool osmolarity
- hyper = high gap (osmotic lax) low gap (senna + bisacodyl)
- hypo = fluid overload
5
Q
Osmotic laxative
A
Lactulose
polyethylene glycol
1st line constipation
6
Q
Tamoxifen vs Raloxifene
A
SERM = increase risk VTE
Tamoxifen = Affects bones & uterius (endometrial + uterine sarcoma)
Raloxifene = Affects bone ONLY
7
Q
Gastroparesis vs Anorexia
A
Gastroparesis has a normal BMI
Anorexia = BMI < 18.5
8
Q
- Postprandial (after food) emesis
- Early satiety
- Weight loss
- Ab pain
- Food aversion
PMH DM2
A
Gastroparesis = disruption of neuro signaling
Dx: Gastric emptying scan + Upper endoscopy ± CT/MR enterography
Tx: diet change + gastric prokinetic (metoclopranide + erythromycin - antagonist to the inhibitory actions of dopamine)
9
Q
Age-related disorder
Reading material further distance
A
Presbyopia = decrease elasticity of lens (no accommodation)
Presby = old opia = eyes
10
Q
Bisphophonate use 5+ years
A
Atypical fracture = subtrochanteric stress fracture
11
Q
Indication for Methotrexate
A
- RA
- Etopic Prego
- Anemia of Chornic Disease (ACD)
12
Q
Anemia
Normal Lactate dehydrogenase
Subtotal gastrectomy
A
Vit B12 deficiency due to loss of intrinsic factor = impaired DNA synthesis
13
Q
when should you get
plasma metanephrines
Dexamethasone suppression test
A
HTN & increase glucose
Metanephrines =
dx: Pheochromocytoma
sx: headache + normal BMI + sweating & tachycardia
2nd = CT of ab
Dexamethasone =
dx: Cushings
sx: increase BMI + PE findings
14
Q
HTN non-pharm tx
A
Diet > smoking cessation
15
Q
- Dyspnea
- 3rd heart sounds
- bibasilar crackles
A
Dilated cardiomyopathy = dilated Left ventricle w/ ejection fraction of 25%
Systolic heart failure
Tx: STOP the EtOH
16
Q
Ankylosing spondylitis tx
A
1: Exercise + NSAIDs
2: TNFa (etanercept + infliximab) & IL-17 (secukinumab)
17
Q
Median nerve compression
wrist vs forearm
A
wrist = Motor weak thumb opposition or abduction + thenar atrophy
forearm = Sensory loss over lateral palm & thenar eminence (Palmar cutaneous branch)
18
Q
increase
- breath sounds
- femitus
A
inflammation = increases the lower frequency sounds (femitus) & less filtration increases breath sounds
Consolidation
18
Q
Difficulty driving at night
glare
halo
A
Cataracts
19
Q
indications for Leuprolide
A
endometriosis
Gonadotropin-releasing hormone agonist
20
Q
indication of Letrozole
A
ovulation induction in PCOS
aromatase inhibitor
21
Q
1st line therapy for PCOS
A
weight loss
OCP = combined (estrogen/progestin)
22
Q
Indications for Spironolactone
A
Hirsutism
K+ sparing w/ loop
HF
androgen receptor antagonist
23
Q
CHA2DS2 Score
1 point
A
HTN
DM
CHF
PAD/MI
female
2+ will require oral anticoagulant in patients w/ Atrial Fib
24
CHA2DS2 Score
2 point
Age = 75+
PMH of Stroke or TIA
25
Atrial Fib tx
1st line = BB (**metoprolol**)
Maintenance of sinus rhythm in reccurent a. fib episodes = **Amiodarone**
26
Primary prophylaxis for esophageal varices = (prevention of growth & bleeding)
Nonselective beta blockers
- nadolol
- propranolol
- carvedilol
27
- fever
- leukocytosis
- elevated liver enzymes
- right upper quadrant (RUQ) pain
- hepatomegaly
- right-sided pleural effusion
Pyogenic liver abscess = which can spread to biliary tree
## Footnote
Dx: CT scan of ab
Tx: IV abx + abscess drainage w/ cultures
28
Centor Criteria
Fever
Tender **anterior** cervical lymphadenopathy
Tonsillar exudates
**Absence** of cough
## Footnote
2-3 = Rapid strep Ag tests, if pos give penicillin
4 = give penicillin
29
* Diffused ab pain w/o rebound or guarding
* Peripheral neuropathy = UE weakness + areflexia
* Urobilinogen
* nonspecific psychiatric sx
Acute intermittent porphyria = increased prophobilinogen & aminolevulinic acid
acute intermittent neurovisceral attacks = Δ enzymes w/n heme synthesis
30
- HTN
- acute, severe headache
- Sx of meningeal irritation = N/V + photophobia
SAH = Subarachnoid Hemorrhage
Obtain CT w/o contrast
31
slow-growing,
ulcerated, pearly nodule w/ a rolled border on sun-exposed skin
[https://docs.google.com/presentation/d/1mVane77VVy3LGZtbk7ZuD7y-hkffPInXgXNOZsZqDU0/edit]
Basal carcinoma
32
- Cognitive impairment
- Urinary incontinence
- Gait abnormalities
- UMN in LE
Normal pressure hydrocephalus = Wet, Wacky, Wobbly
## Footnote
Dx: CT (ventriculomegaly) w/ normal LP
33
Paget vs osteomalacia
Paget = ↑ Alk P + **normal Ca**
Tx: bisphosphonates
Osteomalacia = ↑Alk P + **↓Ca**
Tx: Vit D & Ca
34
Long term dialysis can cause
misfolded precursor proteins = dialysis-related amyloidosis (**DRA**) --> organ dysfunction
| beta2-microglobulin (B2-m) deposition
## Footnote
**Scapulohumeral periarthritis**: shoulder pain/hypertrophy w/ increased rotator cuff thickness + hyperechogenic deposits on imaging
**Carpal tunnel syndrome**: median neuropathy thenar eminence atrophy + weakness, tingling + decreased sensation in the first 3 fingers, as well as possible flexor tendosynovitis (finger contractures)
**Bone cysts**: possible pathologic fracture
35
Complications of nephrotic syndrome
↑ susceptibility to encapsulated bacteria = vax
**Hypercoagulability** = prophylactic anticoagulation
Hyperlipidemia = statins
## Footnote
Management
- Edema = Loops
- Proteinuria = Renin blockers (ACE/ARBs)
36
PMH: Parkinson
-Night sweats
- Leukocytosis
- Wt loss
- non-productive cough → productive cough during eating
- CXR: unilateral cavitation
Lung abscess
## Footnote
Parkinson = can cause diffuilty w/ swallowing increasing risk of anaerobic bacteria entering the lungs
37
Fever
Wt loss
↑ESR
Anemia = ACD
Livedo reticularis
Asymmetric polyneuropathy
Polyarteritis nodosa
38
polysomnography
Sleep study
used to dx sleep disorder - OSA
39
Well circumscribe hypopigmented patch = **skin manifestations**
Nodular & tender nerves
Segmental demyelination = **loss of sensation & motor function**
Mycobacterium leprae = obtain full-thickness biopsy
40
**Positive**: VDRL
↓platelets & hematocrit
PTT ↑
Spontaneous abortion
Antiphospholipid-ab syndrome = false (+) VDRL
Hyper-coagulable state
41
↑ phosphate + potassium + uric acid
↓ calcium
AKI
Seizures
Arrhythmias
Tumor lysis syndrome
42
Painless lymphadenopathy = cervical/supraclavicular chain
**Mediastinal mass** = non-productive cough + SOB + retrosternal pain
B sx: fever + sweats + wt loss
Pruritus
EtOH - associated pain
Eosinophilia
↑ LDH
Hodgkin lymphoma
43
Erythematous
Oropharynx ulcerated
Drooling → difficulty swallowing secretions
Suicide
Caustic ingestion = cleaning products
44
Fever + malaise + sore throat
Pharyngeal erythema
Splenomegaly
**Morbilliform rash**
Absolute lymphocytosis
↑ LFTs
Atypical lymphocytes
CMV IgM
45
Associations w/ Multiple Sclerosis
↓ Vit. D
EBV
Hyperintense lesions MRI
Female
HLA-DRB1
UMN
46
- Painless penile chancre (nonexudative)
- inguinal lymphadenopathy
- rapid plasma reagin (RPR) test (**positive**)
Syphilis
## Footnote
1st line: Penicillin G IM
Alternative: Doxycyclin
47
Neurosyphilis
- meningitis
- ocular
Tx
1st line: IV Penicillin G - 10 days
Alternative: IV Ceftriaxone
48
Vascular occlusion
Hyperviscosity = blurred vision + vertigo + ataxia
Rheumatoid factor
**↑LFTs**
**Immune complexes = ↓ C3/C4**
**Purpura**
**Glomerulonephritis = ↑ blood + protein + dysmorphic RBC**
**Arthralgias**
Chronic C = cryglobulinemia
49
Sterile pyuria =+ leukocyte esterase & - nitrite
**LLQ pain**
N/V
**Δ in BM**
↑ urinary urgency & frequency
Acute diverticulitis
50
Embolic occlusion of the Anterior spinal Artery
Loss at pain & temperature
51
Transverse myelitis vs Cauda equina
Transverse myelitis = **distinct sensory level**
- UMN = ↑ reflexes
- incontinence/ retention
- sexual dysfunction
- sensory dysfunction = pain + paresthesia + numbness
Cauda equina = **severe back pain**
- UMN = ↑ reflexes
- incontinence/ retention
- sexual dysfunction
- sensory dysfunction = pain + paresthesia + numbness
52
Transverse myelitis
Segmental inflammation of the spinal cord = immune mediated
53
Actinomyces Tx
1st: Penicillin
2nd: surgery
54
Pt on Chornic Phenyotin
Gingival hyperplasia
Macrocytic anemia
Folic Acid defiency
55
Managment of HIT
Stop heparin & start Argatroban (increase risk of thrombosis with HIT)
55
what is required to dx HIT
Heparin exposure 5+ days
thrombocytopenia >50%
Arterial + venous thrombosis
56
Sx anemia
fatigue
exertional dyspnea
Low Hgb
57
# Anemia + high reticulocyte count
CLL or SLE or Lymphoma
or
Penicillins or methyldopa
IgG = Autoimmune Hemolytic Anemia
## Footnote
Corticosteroids 1st line
Splenoectomy for refractory
If rx induced = STOP the drug
58
# Anemia + high reticulocyte count
Mycoplasma or EBV
Lymphoproliferative disorder
IgM = autommune hemolytic anemia
59
why does haptoglobin decrease w/ hemolysis
Haptoglobin binds free Hbg & when hemolysis occurs it results in increased free Hbg which then binds to haptoglobin decreasing serum levels
60
vWF vs Vit. K definency
vWF = prolong bleeding time + increase **PTT**
Vit. K = prolong bleeding time + increase **PT**/INR
61
Lab findings in pts w/
Polycythemia Vera
↑ Hgb
↑ platelets
↑ WBC
↓ EPO
## Footnote
Clonal proliferation of myeloid cells
JAK2 mutation
62
Intermittent
- headache
- dizziness
- nausea
- Polycythemia
Lab
- ↑ Hematocrit
- ↑ BUN
- ↓ Ca++
Carbon Monoxide poisoning
63
Warfarin causes defiencies in
Protein C & S
Vit. K
64
Pruritus + jaundice
**Antimitochondrial Ab**
**Xanthomas**
**Osteomalcia = Osteoporosis**
1 Biliary cholangitis
## Footnote
Pruritus + jaundice = biliary
65
Fecal calprotectin
Stool maker for inflammatory diarrhea = ↑in IBD (Crohn or ulcerative colitis)
66
IBD
Watery vs bloody diarrhea
Watery = crohns
Blood = UC
67
Low FODMAP diet = fermentable oligosaccharides disaccharides monosaccharides & polyps
IBS
68
Metabolic syndrome = DM + HLD +↑BMI
↑LFTS (AST>ALT)
Nonalcoholic fatty liver Disease = unregulated triglyceride synthesis → elevated LFTs = hyperechoic liver
69
Shock
AST>ALT
Right uper lobe infiltrate
Leukocytosis
Fever
Ischemic hepatic injury
70
epigastric pain
intermittent melena
Duodenal Ulcer
71
Esophageal varices workup & tx
Endoscopic surveillance in all pts w/ cirrhosis
Prophylaxis: nonselective BB or band ligation
Tx: endoscopy w/ band or sclerotherapy
TIPS in refractory cases
72
# Management
>60
wt loss
GI bleeding = + guaiac
dyspepsia = epigastric discomfort + postprandial fullness + early satiety + bloating
GET
H. pylori = Urease+
EGD
73
Spiculated
eccentric
lung mass
Carcinoma
74
Round opacity
< 3 cm in diameter
Surrounded by lung parenchyma = w/n periphery
Solitary Pulmonary nodule (SPN)
75
Solitary Pulmonary nodule (SPN) workup
1st: Compare previous CXR = checking for stable in size
2nd: CT scan = size + border + density
76
In pts w/ asthma exacerbation
- Normal pH
- normal PaCO2 (ABG)
Suggest impending respiratory collapse
77
Painless
blanching
purple or erthyematous mottling skin
Livedo reticularis = spasming vessels
78
HTN + HLD + DM
Peripheral angiography or intervention
Nephritic sx
Systemic atheroembolism = cholestrol crystal embolism
## Footnote
disruption of atherosclerotic aortic plaque
79
# Cirrhosis + AKI
Bland UA = no cast, protein, cells
Low urine Na+ = < 10mEq/L
Hepatorenal Syndrome (HRS)
## Footnote
Tx: vasocontriction = increase MAP
80
When is Ca++ gluconate given
W/ K+ > 6.5
81
Cor pulmonale vs cardiac tamponade
- ↑JVP
- muffled heart sounds
Cor pulmonale = peripheral edema + enlarge pulmonary vessels + HTN
Cardiac tamponade =↓BP
82
how to differentiate btw Asthma & COPD
Bronchodilator response **> 12%** = Spirometry before & after bronchodilators
DLCO decrease in Emphysema = increase surface area
83
Central cancer lesion w/n lung
Shoulder pain
ptosis
constricted pupil
Facial edema
Small cell carcinoma = Pancoast (Superior Sulcus Syndrome)
84
- Splenomegaly
- +Family History
- bilirubin gallstones
- **↑MCHC**
Hereditary spherocytosis
85
Dark urine in AM/late at night
Budd-Chiari syndrome = clots in IVC
Paroxysmal Nocturnal Hemoglobinuria = immune system attacks + damages your RBCs + platelets
- Defect in PIG-A = protective shield
- Lysis by complement
- ↑ risk for aplastic anemia
86
Dumping Syndrome?
Issues with gastric motility → Rapid stomach emptying = hyperosmolar contents poured into small bowel
## Footnote
early satiety
colicy ab pain
nausea/ vomiting
**explosive diarrhea**
bloating
Malabsorption (rapid emptying → malabsorption)
87
Kartagener syndrome (KS) vs Cystic Fibrosis (CF)
Kartagener syndrome (KS) = **lower** lobe bronchiectasis → impaired mucociliary clearance of secretions and chronic infections
Cystic Fibrosis (CF) = **upper** lobe bronchiectasis → (AR) CFTR gene mutation affecting Na/Cl secretion
88
Anterior cord syndrome (ACS) vs Central cord syndrome (CCS)
- impaired pain and temperature sensation
- B/L weaknes
Anterior cord syndrome (ACS) = B/L weakness is UE = LE
Central cord syndrome (CCS) = B/L weakness is UE > LE
89
- refractory epigastric pain
- thickened gastric folds
- diffuse duodenal (± jejunal) ulcers on endoscopy
Gastrinoma (Zollinger-Ellison syndrome)
**gastrin level > 1000 pg/mL** & **gastric pH ≤ 4**
| Management = serum gastrin concentration
## Footnote
high-dose PPIs
Octreotide = somatostatin analog
Surgical resection
90
nephrotic-range proteinuria = 3+
Congo red–positive glomerular deposits
AA (secondary) amyloidosis
## Footnote
association with other inflammatory conditions = RA
91
central ulceration w/n lesser curve =
Gastric adenocarcinoma (adeno = glands and glands are columnar cells)
92
- Dietary salt craving
- Reduced secondary sexual characteristics = decrease axillary hair or pubic hair
- Depression
Primary adrenal insufficiency (PAI) = Addison disease
autoimmune destruction of the B/L adrenal cortex
| Dx: cosyntropin stimulation test = a synthetic form of ACTH
## Footnote
**Mineralocorticoid deficiency** = renal salt wasting + hypotension + wt loss + hyponatremia + hyperkalemia + dietary salt craving
**Glucocorticoid deficiency** = fatigue + anorexia + irritability + depressed mood + hypotension
**Androgen deficiency** = loss of libido + suppression of secondary sexual characteristics (eg, reduced pubic hair) -- only seen in women b/c testes produce androgen
93
Toxic adenoma vs Graves
Radioiodine uptake =
- diffuse ( homogenously distributed throughout the thyroid gland) = Graves
- focal = toxic adenoma
Graves also has extrathyroidal manifestations = exophthalmos + pretibial myxedema
94
Antithyroid Agents
Thioamides: mild
◦ Propylthiouracil (PTU)
◦ Methimazole
Potassium Perchlorate (KClO4)
Potassium Iodide (KI)
Radioactive Iodine (131I): severe
| **Adjunct therapy**: β-adrenergic blockers (e.g. propranolol)
## Footnote
Graves Disease
95
Stem = pt w/ increase Ca++ next step
Look for PTH levels or answer get PTH
increase Ca++ **w/ elevated PTH** = primary hyperparathyroidism
increase Ca++ **w/o elevated PTH** = malignancy
96
Best screening for pts w/
- low K+
- HTN
Plasma renin activity & aldosterone concentration
## Footnote
Dx: Primary aldosteronism
97
Fibromusclar Dysplasia vs Renal Artery Stenosis
- elevated creatinine = kidney dysfunction
- Pulmonary edema = elevated RAAS
FMD = younger pts
RA Stenosis = older pts w/ PMH of smoking
98
Carcinoid Syndrome vs VIPoma
- Carcinoid syndrome = SI involvement
- VIPoma = pancreatic tail
99
* **Pancreatic tail tumor**
* Watery diarrhea = tea colored stools + odorless
* Achlorhydria = stomach does not produce hydrochloric acid
* flushing
* lethargy
* N/V
* muscle weakness/cramps
VIPoma = Vasoactive intestinal polypeptide (VIP) neuropeptide → **vasodilator** = regulates smooth muscle activity + epithelial cell secretion + blood flow in the gastrointestinal tract
## Footnote
MEN1
100
Rotterdam criteria
- Oligomenorrhea
- Hyperandrogenism = acne + alding + hirsutism + increase Testerone (**get testosterone and DHEAS levels**)
- Polycystic ovaries on TVUS
## Footnote
Dx PCOS
101
What is milk-alkali syndrome (MAS)
excessive intake of Ca++ & absorbable alkali = taking calcium bicarbonate for osteoporosis or antacids → vasoconstriction → decrease GFR
Increases when combo w/ Loops, ARBs, ACEi
1. hypercalcemia = sx of constipation + headache + nausea + neuromuscular irritability + arthralgias + weakness + lethargy
2. AKI
3. Alkalosis
102
# Immunoecompromised
- Dyspnea
- hypoxia
- dry cough = non-productive cough
- fever
- ↑ Lactate dehydrogenase level
- **B/L diffuse interstitial infiltrates**
AIDS → Pneumocystis jirovecii
## Footnote
Pneumocystispneumonia (PCP) is an opportunistic infection
103
CSF = ↑ protein, normal leukocytes
LE progressive weakness
Guillain-Barré syndrome
## Footnote
Tx: IV Ig
104
Maculopapular rash = sun-exposed areas
- Face
- Upper back
Flu-like illness = constitiutional sx
Joint pain
Diatolic murmur
Splenomegly
lymphadenopathy
Hemolytic anemia = normocytic anemia
SLE
105
CCB vs BB
Overdose
- bradycardia
- hypotension
CCB = **hyperglycemia** (decreases insulin release)
BB = **hypoglycemia** (direct inhibition of hepatic glucose production + pancreatic glucagon release) + reduced pulse ox + AMS (altered mental status)
106
Venous thrombosis vs Arterial thrombosis vs Arterial emboli
Venous = dull/achy pain + swelling
Arterial thrombosis = claudication + decrease pulse in unaffected limbs
Arterial emboli = pulseless + cool + weak + numb
107
U/L flank pain
Decrease urine output
K+ wasting → dehydration + weakness
Urinary Outflow Obstruction
108
small, painful papules in the beard area consistent w/
**Pseudofolliculitis Barbae (PB)** = caused by penetration of the hair shaft into interfollicular skin, either through the lateral wall of the follicle (transfollicular penetration) or by curving back down into the skin after exiting the follicle (extrafollicular penetration).
MC in black men due to tightly curled facial hair
Trigger: Shaving with **multiblade razors** which cut hair below the skin surface and leave an angled tip to the hair shaft
109
# In HIV+ pts
C. neoformans vs JC virus
C. neoformans = normal MRI, Ag testing + CSF india ink + Culture (Sabunraud agar)
JC = patchy white matter = demylination on MRI, PCR
110
pt w/ MS & new inflammatory plaque tx
GC is 1st line
Plasmapheresis = pt w/ MS flare who are refractory to corticosteroid therapy
111
Peripheral vs Central lung cancers
**Peripheral** =
1. **Andenocarinoma** = nonsmoker + pneumonia
2. **Large Cell Carcinoma** = cavitation
**Central** =
1. **Squamous Cell Carcinoma** = PTHrP (Ca++ & kidney stones)
2. **Small cell** = Superior sulcus Syndrome - Pancoast (Shoulder pain + horner syndrome) + LES (upward gaze) + SIADH (salty pee) + Cushing
112
Ventilation Management
**TV** = 250-600 (pH - should **keep low to prevent alveoli overinflate**)
**Rate** = 12-16 (pH - help lower PaCO2)
**FiO2** = 25%-100% (O2 sat -- increase w/ PaO2 90+)
**PEEP** = 5-12cm (O2 sat)
113
First-line empiric treatment options for UTI
- trimethoprim-sulfamethoxazole
- nitrofurantoin
- fosfomycin
## Footnote
Recently rx abx (used in the past 3 months) should be avoided
114
ACEi & ARBs are 1st line therapy for
**Renal Artery Stenosis** = decrease MI + stroke + ESRD
DM
## Footnote
U/L RAS is compensated by the unaffected kidney
115
# Female pt
Epigastric pain, often accompanied by N/V
Acute Coronary Syndrome (ACS) = ECG
116
Hypertensive encephalopathy vs Wernicke encephalopathy
Hypertensive encephalopathy = gait ataxia + AMS + ocular dysfunction (Thiamine)
Wernicke encephalopathy = 180/120 + headache + N/V + confusion (Labetalol)
117
Workup of iron deficiency anemia
1. **CBC** - characterize the anemia
2. **Iron studies** = TIBC (transferrin saturation level) & ferritin
3. **Upper/Lower endoscopy** = GI tract bleeding
118
What happens to SVR w/ thyrotoxicosis
↓
119
* Increase indirect bilirubin
* Normal reticulocyte count
* normal Hgb
* Stress = Fasting or dehydration or surgery + menstration
Gilbert Syndrome
## Footnote
CBC & LFTs
Reassurance
120
when do you use KOH (Potassium hydroxide) prep
UTI
Fungal **SKIN** infection (ex: feet)
121
Tx of Tinea pedis = Trichophyton rubrum
empirically with topical antifungals
- miconazole
- tolnaftate
122
Work up:
- painless
- U/L testicular swelling
- dull ache = dragging sensation
- in the lower ab
1. transillumination/US
2. CT/XR
123
_______________________ = testis to become smaller in the recumbent position
Varicocele
124
Pain behind heel
aggrevated by activity
gradual burning pain
Achilles Tendinopathy
125
Acute cystitis vs Acute prostatitis vs Acute pyelonephritis
- Urinary frequency & urgency
- Fever
Cystitis = Suprapubic pain
Prostatitis = during rectal exam → anterior tenderness
Pyelonephritis = costovertebral tenderness/flank pain
126
- hyperthermia
- altered mental status (AMS)
- severe muscle rigidity
Neuroleptic Malignant Syndrome (NMS) = hypermetabolic syndrome associated with some **antipsychotic agents**
- Ziprasidone
- Olanzapine
- Quetiapine
- Risperidone
## Footnote
Tx: Dantrolene
127
# DM pt w/
- loss of fundal details + dark red glow = **hemorrhage**
- floating debris = blood clots
- Acute vision loss = Intravitreal blood prevents light from reaching the retina
vitreous hemorrhage (VH) = Proliferative diabetic retinopathy in pt w/ chronic DM
128
- Floaters
- Acute vision loss
- Photopsia = flashes of lights
Retinal Detachment = retina w/ folds and/or a tear
129
- Ruby-colored papules that blanched = diffuse telangiectasia
- recurrent epistaxis → anemia =↑hct
- Arteriovenous malformations (AVM)
Hereditary hemorrhagic telangiectasia = osler Weber rendu syndrome
130
# Young pt ED
HTN + Tachycardia
CAD sx = ST elevations & CP
Dilated pupils
Acute cocaine intoxication
| C/I: BB → unopposed alpha receptors
## Footnote
Tx: IV Benzodizapine
131
- tachycardia
- tachypnea
- hypoxemia
- decreased or absent breath sounds
Pneumothorax
132
- periorbital erythema = heliotrope sign
- erythematous rash chest = v sign
- erythematous rash upper back + shoulders + back of the neck = shawl sign
- scaly flat MCP/PIP + elbows + knees = gottron sign
- scaly raised MCP/PIP + elbows + knees = gottron papules
- ↑CPK
- ↑ anti-Mi 2 & anti-Jo-1
Dermatomyositis
↑ risk of malignancies
133
Cirrhosis vs Hashimotos
Similar sx:
gynecomastia + decrease Libio + testicular atrophy
- Cirhosis = exess estrogen
- Hashimotos = increase prolactin
Cirhosis = wt loss + anorexia + **normal TSH**
Hashimotos = wt gain + **high TSH**
134
Renal infarction
Renal vein thrombosis
No hydronephrosis
U/L flank pain
Infarction = cardiembolic disease (a fib)+ Ab pain w/ flank pain
Thrombosis = pancreatic cancer
135
- intensely pruritic
- serpiginous
- reddish-brown cutaneous tracks
Cutaneous larva migrans
136
GC for long period of time →
- mood & anxiety sx
- sleep disturbances
- restlessness
- memory loss
137
LE swelling
Loop vs Elevation/exercise/stockings
LOOK at JVD
Loop = 8+ JVD + SOB
Elevation = normal JVD + PE
- venous dilation = telangiectasia + varicose veins)
- skin discoloration
- lipodermatosclerosis
- skin ulceration
138
# Older
Erythematous scaly papules/plaques
rough/dry
face/scalp/dorsum of hands = sunexposed area
+/- stinging sensation
Actinic keratosis = precursor to squamous cell carcinoma
## Footnote
Tx: 5-fluorouracil + imiquimod
139
Acute pain in joint + rash
Sexual active
fever
disseminated gonococcal infection (DGI)
- Polyarthralgia migrating = asymmetric small & large joint pain
- dermatitis = pustular/vesiculopustular lesions in distal extremities
- Tenosynovitis
140
PE managment
## Footnote
Acute dyspnea
tachypnea
tachycardia
hypoxemia
elevated JVD
1. Anti-coagulation - HEPARIN
2. Diagnostic imaging = D-dimer + CTA or V/Q scan + contract MRI + echo-TEE
3. Start Warfain (vit k antagonist)
IVC filter = active bleeding or C/I anticoagulation
| Wells score
141
RBC casts
glomerulonephritis
142
Waxy/Broad cast
Chronic Renal Failure
143
Granular cast
degraded cells + aggregation of proteins
- chronic renal failure = muddy brown cells
***ATN***
144
Fatty cast
fat bodies = Nephrotic
145
Hyaline cast
Concentrated urine
exercise + diuretics
146
WBC cast
Intersitial nephritis (NSAIDs + Tylenol)
pyelonephritis
147
Back pain
OTC use
Kidney issues
Acute: tubulointerstitial nephritis
chronic interstitial nephritis (CIN)
148
- a widened mediastinum
- enlarged aortic knob
- tracheal deviation
thoracic aortic aneurysm (TAA) = degenerative aortic disease
149
Joint fluid characteristics
Normal: <200
OA: <2,000
crystals +RA: <100,000
Septic: 500,000+
150
Bronchoscopy vs CT scan
Bronchoscopy = focal bronchiectasis - obstructive
CT = diffuse bronchiectasis
151
COPD exacerbation management
1. PEEP
2. Mechanical vent = pH <7.1
152
Severe physiologic stress (sepsis) → a catecholamine (epi) surge =
which stimulates = **hyperglycemia**
- hepatic glycogenolysis
- hepatic gluconeogenesis
153
Severe physiologic stress (sepsis) → hypoglycemia =
- increase use of glucose in tissue = ↑ cytokines
- Suppression of gluconeogensis
154
# Immuno-comp - HIV/Transplant pt
- **Hemoptysis**
- **Fever**
- **Pruritic Chest Pain**
- productive cough
- halo sign = nodular lesions w/ surrounding ground-glass opacities
Invasive pulmonary aspergillosis
| Dx: galactomannan assay + sputum stain/culture
## Footnote
Tx: IV voriconazole w/ echinocandin (eg, caspofungin)
155
# Immunocompromised pt
- dyspnea
- nonproductive cough = dry cough
- low-grade fever
- patchy or diffuse ground-glass opacities on CT
CMV
156
Polycystic kidney disease - AD = adult Association
Cerebral aneurysm = intracranial bleeding
157
Transplant 3 weeks
Crampy ab pain + diarrhea
Maculopapular rash
Liver inflammation
GVHD = CD8+ t-lymphocyte mediated injury (donor t-cells)
Biopsy - dx after testing C. diff & CMV
158
Diving 12 hr ago
Skin = extremities
- Pruritus
- Mottling
- ischemia
Confusion
Gait ataxia
Dysarthria
Vascular air embolism → decompression sickness = nitrogen gas bubbles → pulmonary cap via R-L shunt = patent foramen ovale
Complications:
- Respiratory distress
- Pulmonary edema
159
↑K+
↓Na+
Hypotension - can be orthostatic
Hyperpigmentation = ACTH + melanocyte-stimulating hormone
↑Cl- acidosis
Postpartum
Addison disease = autoimmune adrenalitis
160
Primary vs Secondary Adrenal insuff
1: hypotension +↑(K+) +↓Na+
2: ONLY GC (hyperpigmentation) + ↓adrenal androgens secretions
161
EtOH disorder tx
Acamprosate = glutamate modulator receptor 5 - 1st line for pt w/ liver issues BUT not CKD
Naltrexone = mu receptor (opioid) antagonist - 1st line - good for CKD
Disulfiram = inhibits aldehyde dehydrogenase - 2nd line
- flushing + headache + vomiting + palpitations + SOB
162
Fomepizole
EtOH dehydrogenase inhibitor = Tx methanol + ethylene glycol poisoning
163
Parkinson disease
Lightheadedness or syncope
Orthostatic hypotension
Autonomic insufficiency → Neurogenic Orthostatic Hypotension =↑ release of NE → vasoconstriction + ↑ HR
Result of degenerative Δ to autonomic ganglia + CNS nuclei
164
↑ serum gabapentin
↓ Renal clearance → Medication -induced myoclonus
↑ GABA = neurotoxicity
165
Nocturnal diarrhea indicates
Secretory etiologies
- chronic infection - bacterial toxin
- microscopic colitis
- bile salt diarrhea
- hormone secreting tumor = gastrinoma + VIPoma
166
Prophylaxis against toxoplasma
CD4 <100 w/ trimethoprim-sulfamethoxazole
167
Prophylaxis CMV
Used in some organ transplantation
168
Male secondary hypogonadism
↓ testosterone & LH
Gynecomastia + testicular atrophy
1. Serum prolactin
2. MRI
3. Testosterone therapy
169
# Transplant which Rx causes these ADR
- **Nephrotoxicity**: vasoconstrictive properties → reversible AKI + ↑K+ + hyperuricemia → gout
- **HTN**: vasoconstrictive properties → ↑ Na+ retention by the kidneys + ↑ arteriolar peripheral resistance b/c ↑ RAAS
- **Neurotoxicity**: vasoconstrictive cerebellar or cerebral ischemia → Tremor + visual disturbance _ seizures
- **Glucose intolerance**: inhibitors impair the secretion of insulin from pancreatic b islet cells → hyperglycemia
- **Cosmetic effects**: Gingival hypertrophy + hirsutism + alopecia
- **Gastrointestinal disturbance**: mild anorexia + N/V + diarrhea
Calcineurin inhibitors (tacrolimus + cyclosporine) = inhibit the transcription of **IL-2** → ↓ T-cell activity + chronic immunosuppression following solid-organ transplantation
170
**Vessels** = Raynaud phenomenon
**GI tract** = esophageal dysmotility & reflux
**Lungs** = interstitial fibrosis (decrease vol) + pulmonary htn (lumen narrowing pulmonary arteries)
**Kidneys** = scleroderma renal crisis
CREST syndrome
C = calcinosis - anti-centromere
R = Raynaud phenomenon
E = Esophageal dysmotility
S = Sclerodactyly
T = Telangiectasias
171
mottling skin is linked to
embolism
172
Skin leison + lymphadenopathy
**G(-) coccobacilli**
- Francisella = 1 ulcer: Tularemia
- Baronella henselae = Cat scratch + flea bite (Fastidious + faculitive + intracellular)
**Fungi**
- Sporotrichosis = no fever + purulence
