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Flashcards in Uworld Misc. Deck (732):
1

Arrhythmia ️Assoc. With digitalis toxicity

A-tach with av block

Usually it is rare for both of these to occur at the same time so this is pretty diagnostic

2

Initial Tx for Hypovolemic Hypernatremia and correction rate

Isotonic saline

Can use hypotonic saline once the patient is hemodynamically stable and euvolemic

Correction rate: .5meq/dl/hr without exceeding 12 in 24 hrs
This is done to prevent cerebral edema

3

Hairy cell leukemia

B cell neoplasm associated with BRAF mutations

Clinical: Pancytopenia (infections, anemia, ️Bleeding)
Splenomegaly

Dx: BM biopsy

Tx: chemo

4

Isolated increased ALK phos in a patient with an enlarging cap size

Paget's disease

5

Vasospastic angina

Hyperreactivity of ️coronary smooth muscle leading to transient myocardial ischemia

Presents in young patients (<50) who are smokers but lack other RFs for heart disease; have recurrent chest discomfort
️Occurs at rest and during sleep; resolves spontaneously

Diagnosis: ST elevations with exertion however, ️coronary angiography shows no CAD

Tx: CCB (preventative), nitroglycerin (acute)

6

Earliest renal abnormality in diabetes patients

Glomerular hyper filtration

ACEIs help prevent this and therefore reduce chances of developing diabetic nephropathy

7

Warm agglutinin AIHA

Caused by drugs (usually penicillins), viral infxns, AI disorders (lupus), and immunodeficiency or Lymphoproliferative states

Ss: Normocytic Anemia with hemolysis
DAT (+) with anti-IgG or anti-C3

Tx: corticosteroids, splenectomy if necessary

8

Serum osmolality calculatio

[2 X (Na)] + [(glucose)/18] + [(BUN)/2.8]

9

Hemodynamic measurements in hypovolemic shock

RA pressure (preload) (pulmonary capillary wedge) ⬇️

Cardiac index (output) ⬇️

SVR (Afterload) ⬆️

MvO2 ⬇️

10

Cavernous sinus thrombosis

Can occur following infections of the facial skin, sinuses, and orbit ➡️ life-threatening CST and intracranial hypertension

Develop low grade fever, headache, and periorbital edema alongside CN II, IV, V, and VI pansies

Tx: Broad spectrum antibiotics and reversal of cerebral herniation if necessary

11

IgA nephropath

Gross ️hematuria following a URI that happens within 5 days of the infxn

⭐️ Common in young adult men ages 20-30

Ss: Recurrent gross ️hematuria

12

Extrarenal manifestations of ADKPD

Cerebral aneurysm

Hepatic or pancreatic cysts

Mitral valve prolapse

Aortic regurgitation

Colonic Diverticulation

Ventral or inguinal hernia

Dx: Abdominal US

13

Cauda equina syndrome

Bilateral and severe radicular pain

Saddle anesthesia

Asymmetric motor weakness

Hyporeflexia

Late onset bowel and bladder dysfunction

14

Conus medullaris syndrome

Sudden onset of severe back pain

Perianal anesthesia

Symmetric motor weakness

Hyperreflexia

Early onset bowel and bladder dysfnxn

15

Tx for tachyarrhythmia with hemodynamic instability

Synchronized cardio aversion

16

Disseminated histoplasmosis

Found in Midwestern US in soil contaminated by bird or bat droppings

S/s: Systemic (fevers, malaise, chills)
Weight loss/ cachexia
Cough, dyspnea
Mucocuatenous ulcers and papules
Lymphadenopathy, hepatosplenomegaly

Dx: Pancytopenia, increased LDH and ferritin
***Urine/serum Histoplasma antigen

CXR: Reticulonodular opacities

Tx: Ampho B in hospital

After improvement, oral itraconazole is continued for 1 year for maintenance therapy

17

Earliest finding in macular degeneration

Distortion of straight lines to where they start to appear wavy in the affected eye

18

ADKPD extrarenal complications

Hepatic cysts (most common)

Valvular heart disease (mitral valve prolapse or aortic regurg.)

Colonic diverticula

Abdominal/inguinal hernia

***INTRACRANIAL BERRY ANEURYSM

19

HIV patient with painful swallowing and substernal burning

HIV esophagitis

Occurs when CD4 <100

Etiologies: Candida, HSV, CMV

Tx: Empiric treatment with oral fluconazole; if they do not respond, THEN GET ENDOSCOPY

20

Pseudotumor cerebri

Idiopathic Intracranial HTN

Patients present with a headache that is pulsatile and awakens the patient at night, transient vision loss, pulsatile tinnitus (whooshing sound in the ears) and diplopia

S/S: Papilledema, peripheral visual field defects, CN VI palsy

RFs: Overweight
Isotretinoin, tetracyclines, hypervitaminosis A

Tx: Stop medications
Weight loss
Acetazolamide for idiopathic cases

21

Hidradenitis suppurativa

Also known as acne inversa

Occurs in intertrigous areas and is due to a chronic inflammatory occlusion of folliculopilosebaceous units preventing keratinocytes from shedding epithelium

RFs: DM, smoking, obesity, skin friction

S/s: Painful, solitary, and inflamed nodules that can progress to abscesses that open with purulent or serosanguineous drainage

Can lead to sinus tracts, comedones, and scarring with lymphedema

22

Test for lactose intolerance

Lactose hydrogen breath test

-Increased breath hydrogen level after ingesting lactose =>> POSITIVE

23

Test to always include in Hep B testing

Anti-HepBc

This is the one that is positive during the window period

24

Patient with sudden visual loss and S/s suspicious for GCA

Give High dose steroids

Wait for the temporal artery biopsy

25

Toxic Shock Syndromew

Patient who has had a tampon in OR had a recent nasal packing

Followed by:

Rash
Fever
Hypotension
Diarrhea
Thrombocytopenia
Skin desquamation including palms and soles

And 3 of the following systems:
GI involvement (vomiting/diarrhea)
Muscular (myalgia, elevated CK)
Renal (Elevated BUN/Creatinine)
Heme (Thrombocytopenia)
Liver (Elevated transaminases)
CNS (altered mentation without focal signs)

Tx: Fluids, broad-spectrum anti-Staphylococcal abs

26

Trichinellosis

Patient eats undercooked meat (usually pork) and develops acute GI illness; corresponds to larvae invading SI and developing into worms

2-4 weeks later:
Larvae encyst into muscle and cause myositis, subungual hemorrhages, periorbital edema, and eosinophilia

Classic triad: Periorbital edema + myositis + eosinophilia

27

Prevention of calcium kidney stones

Decreased sodium intake

=>> Will enhance calcium excretion

28

NMS tentrad

MSC

Rigidity

Fever

Autonomic dysregulation (tachycardia, hypertension, tachypnea)

29

Tx of uric acid stones

Hydration

Alkalinization of the urine (Potassium citrate usually)

Low-purine diet

If absolutely necessary: Allopurinol (but only helps if there's hyperuricemia)

30

Initial therapy for aortic dissection

IV BBs (labetalol, propanolol, esmolol)

Decrease the HR, contractility, and SBP

31

Wedge shaped infarct on chest CT scan

Think PE

32

Periinfarction ventricular arrhythmias

Phase 1a - Acute ischemia causing heterogeneity of conduction with areas showing marked slowing and delayed activation

Phase 1b - Occur 10-60 minutes following infarction and represent abnormal automaticity

33

Primary polydipsia

Patients present with hyponatremia, decreased serum osmolality, and decreased urine osmolality and a normal BP

Common in pts. with psychiatric conditions

34

Giant cell tumor

Eccentric and lytic area of epiphyseal bone (soap bubble)

Benigh and locally aggressive skeletal neoplasm seen in YOUNG ADULTS

S/s: Pain, swelling, decreased ROM, pathologic fracture

Tx: Surgery

35

Arsenic poisoning

Binds to sulfhydryl groups and interferes with enzyme activity regulating cellular respiration

RFs: Pesticides, contaminated well water, pressure-treated wood (antiquing)

S/s: Stocking-glove neuropathy
Hyporeflexia
Distal weakness
Hyperpigmentation of the skin
Hyperkeratosis of the soles and palms
Horizontal striation of the fingernails (DIAGNOSTIC)
Pancytopenia


Tx: Dimercaprol

36

Patient with an increased T4 but normal TSH

Suggestive of a euthyroid state; look for possible causes of increased TBG such as estrogens, hepatic dysfnxn, or tamoxifen

37

Isolated systolic hypertension

Systolic pressure >140 with a diastolic of <90

Path: Increased stiffness of the aorta and arterial walls in elderly patients reduces the abilities of the arteries to dampen systolic pressure

Tx: Lifestyle modifications and same pharmacologic therapy

38

Thyroid lymphoma

Presents as a rapidly enlarging, firm goiter assoc. with upper airway compressive symptoms; can have systemic B-sx.

***Arises w/ preexisting Hashimoto's thyroidits
-Suspect if patient has a positve TPO-antibody test

*When patients raise their arms, the mass will compress the subclavian and right internal jugular veins between the clavicle causing JVD

Dx: Core biopsy

39

Pemberton sign

Patient raises their arms up and get JVD due to compression of a lymphoma against the left subclavian and right internal jugular veins

40

Shy-Drager Syndrome

"Multiple System Atrophy"

1. Parkinsonism

2. Autonomic dysfnxn (postural hypotension, abnormal sweating, loss of bowel and bladder control, impotence, decreased salivation)

3. Widespread neurologic signs (cerebellar, LMN)

**Consider when a Parkinsonian patient has signs of autonomic dysfnxn

Tx: Salt supplementation, fludrocortisone, a-agonists

41

Painless thyroiditis

Patient has increased T4 and decreased TSH

May have positive anti-TPO

Tx: BB (just to control symptoms of hyperthyroid phase)

42

Clubbing pathology

Megakaryocytes become entrapped in distal fingertips after bypassing the lungs (due to some pathology) and released PDGF and VEGF

=>>CT hypertrophy and capillary growth

43

Scleroderma renal crisis

Increased vascular permeability, activation of the coag cascade, and increased renin secretion

=>> Malignant HTN, RF (increased labs), and microangiopathic hemolytic anemia/DIC

Typically happens within 5 years of diagnosis

44

Paroxysmal nocturnal hemoglobinuria

AI hemolytic disorder characterized by intravascular and extravascular hemolysis and hemoglobinuria

Path: Lack of glycosylphophatidylinositol anchor that connects proteins CD55 and CD59 to RBC surface which normally inhibit complement activation

Clinical: Hemolysis, cytopenias, hypercoagulability

Dx: Flow cytometry to detect CD55 and CD59

*Sx. usually appear in pts. 40s

45

Malignant (necrotizing) otitis externa

Severe infxn of the external auditory canal and base of the skull usually caused by Pseud.

Most pts. are old, have poorly controlled DM, or immunosuppressed

S/s: Unrelenting ear pain worse at night, purulent drainage, sense of fullness, conductive hearing loss, granulation tissue and edematous external canal on otoscopy

Tx: IV ciprofloxacin

46

Middle mediastinal mass

Suspect bronchogenic cysts

47

Anterior mediastinal mass

Suspect thymoma

48

Patient with pain, itching, red streaks on their left arm that are palpable

Suspect Trousseau's Syndrome

Hypercoagulable disorder associated with occult malignancy (usually pancreatic; can also be lung, prostate, stomach, colon)

Path: Tumor releases mucins that react with platelets to form microthrombi

***Patient's with this should get a CT to find malignancy

49

Patient who received topical anesthetic and becomes hypoxic

Suspect methemoglobinemia; topic anesthetics cause the iron component of Hgb to be oxidized

Patients will have O2 sats that appear normal BUT this is because the O2 sat only measures the PaO2

S/s: Headache, lethargy, AMS, seizure, respiratory depression

Tx: Methylene blue

50

RFs for acute urinary retention

Male

>80

Hx of BPH

Hx of neurologic disease

Recent surgery

Anticholinergics, opioids

Tx: Foley cath, urinalysis

51

Toxic megacolon

Caused by UC or C.diff infxn

S/s: Fever, tachycardia, hypotension, BLOODY diarrhea, abdominal distension,

Radio: Lead pipe

Tx: Supportive, Steroids if UC, surgery if unresponsive

52

Management of suspected esophageal perforation

Water soluble contrast esophogram

Suspect if recent endoscopy, esophagitis, ulcer, or heavy retching

53

Histoplasma capsulatum

Found in the Ohio and Mississippi river valleys in contaminated BAT DROPPINGS

***SUSPECT IN PTS WHO CAVE DIVE OR HAVE CHICKENS

S/s: Fever, chills, myalgias, DRY COUGH, HILAR LYMPHADENOPATHY

Dx: Histoplasma antigen urine testing; tissue diagnosis will reveal granulomas with budding yeasts

54

Botulism

Can be obtained from canned foods OR aged seafood ("cured")

S/s: Blurred vision, diplopia, facial weakness, dysarthria, dysphagia, progresses to =>>> Descending muscle weakness with possible diaphragmatic failure

Dx: Toxin in blood

Tx: Equine serum antitoxin (horse antitoxin)

55

First-time seizure in an adult

Run:

BMP, CBC, glucose, Ca2+, Mg2+, Renal and hepatic fnxn tests

AND DRUG SCREEN

-Possibly even consider an EKG

56

Patient with history of treated Hodgkin's Lymphoma presenting with cough, hemoptysis, chest pain, and dyspnea

Likely a secondary malignancy developed after chemo or radiation therapy tx

57

BB OD

Bradycardia, AV block, hypotension, diffuse wheezing***

Tx: Secure airway, IV fluid boluses, IV atropine, IV glucagon

Consider IV calcium, EPI

58

K+ sparing diuretics

Spironolactone, amiloride, triamterene

59

Associated neoplasms with Lynch Syndrome

Colorectal cancer

Endometrial cancer (prophylactic hysterectomy after childbearing is complete is recommendation)

Ovarian cancer

60

Associated cancers with FAP

Colorectal cancer

Desmoids and osteomas

Brain tumors

61

Associated cancers with vHL Syndrome

Hemangioblastomas

Clear cell renal carcinoma

Pheochromocytoma

62

Vertebral osteomyelitis

Usually chronic and insidious

Will have tenderness to percussion over affected vertebrae

***Leukocytes can be normal as well as temp

***Usually will still have increased Platelets and ESR

Tx: Long term IV abs

63

Lead toxicity (3 manifestations)

1. GI- abdominal pain, constipation

2. Neuropsych- Forgetfulness, neuropathy, weakness in a stocking-glove distribution

3. Hematologic- Microcytic anemia with basophilic stipling

*Also see HYPERURICEMIA

64

Drugs to start on RA patients

NSAIDS and MTX (or sulfasalazine, hydroxychloroquine, azathioprine)

***PTS NEED MTX to prevent progression of diseae

-Test them for Hep B, C, TB, and pregnancy

65

Dermatofibroma

Firm, small, hyperpigmented nodules that have a "dimple" when pinched

Typically follow a bug bite or minor trauma

Tx not required

66

MCC of pneumonia in IV drug abusers

Staph aureus

67

Septic embolism

Occur in pts with tricuspid endocarditis (think IV drug abusers)

Imaging may show pulmonary septic emboli seen as abscesses, infarction, or cavities typically in the lung periphery

68

Extraglandular features of Sjogrens

Raynaud phenomenon

Arthralgia

Interstitial lung disease

69

Idiopathic Intracranial HTN

Classic pt is an overweight woman of childbearing age possibly on OCPs, tetracyclines, or Vitamin A

-Pts. may have an empty sella, although, this is not diagnostic

Pts have an elevated opening pressure on spinal tap

Tx: Stop offending meds; weight loss and acetazolamide for idiopathic cases

70

Ichthyosis vulgaris

Chronic, inherited skin disorder characterized by diffuse dermal scaling caused by mutations in the filaggrin gene

Skin appears as "plated" much like reptile scales

*Symptoms often worse in the winter

Tx: Lotion, coal tar, topical retinoids

71

Work up for suspected Zenker's

Contrast esophagram

72

Chronic prostatitis

Often a diagnosis of exclusion; presents as pain the perineum, pelvis, or genitalia with irritative voiding symptoms

-Urine is sterile; may have increased WBCs

Tx: Tamsulosin (a-blocker), antibiotics, finasteride

73

Tx for cutaneous larva migrans

Ivermectin (antihelminthic)

74

Patient who is vomiting up blood and you think is a risk for aspiration

INTUBATE; this will block off her airway and not allow her to aspirate while you get an upper endoscopy

75

Ludwig angina

Cellulitis of the submandibular space arising from a dental infxn; infxn is usually polymicrobial and spreads deep into the teeth roots

S/s: Fever, chills, malaise, local compressive symptoms such as drooling, mouth pain, muffled voice, and potential airway compromise

Tx: IV abxx (Bactrim, clindamycin); possible removal of tooth

76

Panendoscopy

Esophagoscopy + bronchoscopy + laryngoscopy

Also called a triple endoscopy

77

Amiodarone ADRs

Cardiac: Bradycardia, heart block, QT PROLONGATION

Pulm: Interstitial pneumonitis (infiltrates on CXR)

GI: Elevated transaminases

Ocular: Corneal microdeposits that are blue-gray; optic neuropathy

Derm: Blue-gray skin discoloration

Neuro: Peripheral neuropathy

78

Pt with signs of inferior MI and symptoms get worse with sublingual nitrogylcerin

Suspect RV MI

Give pt. IV bolus and avoid venodilation; otherwise, treat like normal MI

79

Patients who cannot produce sputum for a sample should undergo what

BAL

80

Patient who is presenting with signs of heart failure after placement of a pacemaker

Suspect tricuspid regurg. (or some other right heart problem)

-Pacemakers pass thru the SVC into the RA

81

Pneumococcal vaccines and their differences

PPSV23: capsular materials from 23 serotypes that induces a T-cell INDEPENDENT B-cell response
-Recommended to adults >65 and people <65 with predisposing conditions (IC, lung disease, cirrhosis, DM)

PCV13: Capsular polysaccharides that induces a T-cell dependent B-cell response
-Recommended for infants and children

82

EEG in cVJD

Sharp, triphasic, and synchronous discharges

Pts. present with myoclonus and rapidly progressive dementia

83

Carcinoid syndrome

Neuroendocrine tumors found in the distal SI, colon, and lung with metastasis to the liver; only become symptomatic with metastasis because histamine, serotonin, and VIP are inactivated by the liver

S/s: Flushing, cyanosis
Diarrhea, cramping
RIGHT SIDED HEART LESIONS (insufficient tricuspid)
Bronchospasm
Niacin deficiency (dermatitis, diarrhea, dementia)

Dx: Elevated 24 hour urine 5-HIAA; CT: echo

Tx: Octreotide and then surgery

84

Baker's Cyst

Occurs due to extrusion of synovial fluid from the knee into the gastrocnemius or semimembranosus bursa thru a communication typically from chronic inflammation (osteoarthritis)

***CAN RUPTURE; following strenuous exercise, pt. will present with tenderness and swelling of the calf resembling a DVT and will show ecchymosis distal to the medial malleolus

US will r/o DVT

85

Psoriatic arthritis

Presents as morning stiffness and swelling of the DIP joints; may also have dactylitis (SAUSAGE DIGITS) and nail involvement

Nails may be pitting showing onycholysis (Separation of the nail bed)

86

Low risk cardiac chest pain patients

Men <40

Women <50 with atypical chest pain and no RFs


If patient is low-risk and has a normal EKG, do not do further work up on chest pain

87

Hypokalemia

S/s: Weakness, fatigue, muscle cramps, flaccid paralysis, hyporeflexia, rhabdomyolysis, arrhthmias

EKG =>> Broad T-waves, U waves, ST depression, and PVCs

88

Putamen hemorrhage

Sudden contralateral hemiparesis and hemianesthesia with conjugate gaze deviation towards the side of the lesion

*Internal capsule containing the corticospinal and somatosensory fibers in the PLIC is damaged

89

Noninvasive Positive Pressure Ventilation

Ventilator support delivered via facemask allowing for CPAP or BiPAP

Decreases the work of breathing, improves alveolar ventilation

Indications: COPD exacerbation not responding to normal tx., cardiogenic pulmonary edema, Acute respiratory failure

CIs: ARDS, severe acidosis, cardiac arrest, encephalopathy, GI bleed, agitated, high aspiration risk

90

MC missed lesion on colonoscopy

Angiodysplasia

Think this if a patient has painless GI bleed with a recent negative colonoscopy

91

Lambert-Eaton Syndrome

S/s: Proximal muscle weakness, autonomic dysfnxn (Dry mouth), CN involvement (ptosis), diminished DTRs

92

PE Management

Step 1: Supportive care with O2 and fluids

Step 2: Assess CIs for anticoagulation (bleeding, hemorrhagic stroke)

Step 3: Wells Criteria

93

Wells Criteria for PE

+3 = Signs of DVT, alternate diagnosis less likely than PE

+1.5 = Previous PE or DVT, HR >100, Recent surgery or immobilization

+1 = Hemoptysis, cancer

>4= PE likely; Heparin BEFORE further testing

94

Causes of constrictive pericarditis

Tuberculosis (in endemic areas)

Cardiac surgery

Radiation therapy

Viral

Idiopathic

95

Constrictive pericarditis

S/s: Fatigue
Dyspnea
Peripheral edema, ascites
Increased JVP
Pulsus paradoxus, Kussmaul's sign

Dx: EKG shows low-voltage QRS
Imaging shows pericardial thickening with possible calcification
JVP tracing shows prominent x and y descents

96

Sensorimotor polyneuropathy and differences in symptoms

Small fiber injury =>> Pain, paresthesias, allodynia ("Positive sx.")

Large fiber injury =>> Numbness, loss of proprioception and vibration sense, decreased DTRs ("Negative sx.)

97

Tx for testicular tumor

Radical orchiectomy FOLLOWED by platinum based chemo if necessary

98

Mitral stenosis

Presents as dyspnea, orthopnea, and hemoptysis

May see afib, thromboembolisms, and voice hoarseness from recurrent laryngeal nerve compression after LAE

PE: Mitral facies (pink-purple patches on cheeks), LOUD S1, opening snap, mid-diastolic rumble

Dx: CXR shows pulmonary blood flow redistribution to upper lobes
EKG shos "p mitrale" (notched p wabes), RVH
Echo shows MV thickening with possible calcification, decreased mobility

99

Patient presenting with acute limb ischemia following an MI

Perform an echo; need to identify if there is a thrombus along with immediate anticoagulation

100

Pts. with candida esophagitis will also have what

Oral thrush

101

Criteria for LTOT

Pulse ox <88% on RA

Resting PaO2 <55

PaO2 <59 or SaO2<89% in patients with cor pulmonale, RHF, or Hcrt >55%

-O2 will greatly enhance these patients' survival

102

Cerebellar degeneration

Gait probs

Truncal ataxia

Nystagmus

Intention tremor

Dysmetria

Dysdiadochokinesia

103

First tx of PACs

Stop smoking, caffeine, alcohol, and stress

104

Acute interstitial nephritis

Maculopapular rash, fever, arthralgia following an acute drug exposure

Labs: AKI, pyuria, hematuria, eosinophilia, urinary eosinophils

Tx: Discontinue drug, steroids if unstable

105

Diseases leading to secondary pseudogout

Hyperparathyroidism

Hemochromatosis

Hypothyroidism

106

Renal tubular acidosis

Patients present with non-anion gap metabolic acidosis in t he presence of preserved kidney fnxn; patients may be hyperkalemic if the problem is in the collecting tubule

Seen in patients with poorly controlled diabetes due to hyporeninemic hypoaldosteronism from longterm damage to the juxtaglomerular apparatus

107

Causes of normal anion gap metabolic acidosis

Diarrhea

Fistulas

Carbonic anhydrase inhibitors

RTA

Iatrogenic

108

Patient's with a likely PE

GET A CTA; FUCK THE DDIMER

109

Bronchogenic carcinoma

Common with asbestos exposure; may see pleural plaques alongside other typical lung cancer signs

110

Intracranial HTN

Patients present with a headache worse at night, N/V, and AMS changes

Can also have focal neurologic symptoms such as vision change, unsteady gait, and seizure

Symptoms worsen with maneuvers that increase intracranial pressure such as leaning forward, Valsalva

111

Myasthenic crisis

Patient presents as a 30-40 year old woman with generalized and oropharyngeal weakness alongside respiratory insufficiency

Can be brought on by infxn, surgery, pregnancy, childbirth, aminoglycosides, FQNs, BBs

Monitor in ICU; intubate if necessary

112

Bath salts intoxication

Amphetamines

S/s: Severe agitation, combativeness, psychosis, delirium, myoclonus, increased BP and HR

***HAS A VERY LONG DURATION; can last from days to weeks

113

Pt who presents as an MI with a new onset of a holosystolic murmur at the apex

MI with papillary muscle displacement =>> acute mitral regurg.

114

Pramiprexole

Dopamine agonist used for Restless Leg Syndrome

If patients have comorbid insomnia, chronic pain, or anxiety, can try Gabapentin insetead (Ca2+ channel ligand)

115

Interstitial cystitis

"Painful bladder syndrome"

Patients present with bladder pain when it is full and relief with voiding; patient's have increased urinary frequency and urgency along with dyspareunia and pain on pelvic exam

Dx: Normal urinalysis, pelvic pain with other causes ruled out

Tx: Avoiding triggers, amitriptyline, NSAIDs

116

Differentiating ALF from acute hepatitis

Presence of hepatic encephalopathy

117

Uncommon complication of mono

AI hemolytic anemia along with thrombocytopenia

118

Hydroxychloroquine ADRs

Retinopathy

Pts. should have annual eye exam while on this drug

119

Prerenal AKI

Causes: Volume depletion, displace intravascular fluid (sepsis, pancreatitis), renal artery stenosis, afferent arteriole vasoconstriction (NSAIDs),

S/s: Increased serum creatinine, decreased UOP, BUN >20:1, FeNa <1

Tx: Fluid replacement

120

Tx of afib in stable pts.

BBs, diltiazem, digoxin to control rate

121

Acute erosive gastropathy

Development of severe hemorrhagic lesions after the exposure of the gastric mucosa to agents that reduce blood flow; decreased blood flow and mucosal injury allow acids and proteases to injure the stomach and vasculature

***Think this if a patient develops hematemesis and epigastric pain after ingesting Aspirin and Cocaine

122

Acetaminophen intoxication protocol

<4 hours since administration? =>> Administer activated charcoal while obtaining acetaminophen levels

N-acetylcysteine administered based on the nomogram

123

Hyperthyroidism

S/s: Anxiety, insomnia, palpitations, heat intolerance, increased perspiration, weight loss, goiter

PE: HTN, tremors, hyperreflexia, PROXIMAL MUSCLE WEAKNESS, lid lag, A-fib

Chronic findings can include muscle atrophy

124

Patient with bone lesion and recurrent infxn

MM

125

Alcoholic hepatitis

S/s: Jaundice, anorexia, fever
RUQ pain
Abdominal distension
Proximal muscle weakness (due to muscle wasting)
Possible hepatic encephalopathy

Labs: AST:ALT >2
Increased GGT, Br, and INR
Leukocytosis
Fatty liver
Increased ferritin

126

Ferritin as an APR

Increased

127

Membranoproliferative glomerulonephritis, Type 2

Caused by IgG abs against C3 convertase causing persistent complement activation and kidney damage

Antibodies are called "C3 convertase"

EM: Dense deposits with the glomerular basement membrane

128

Mixed cryoglobulinemia

Presents as palpable purpura, proteinuria, and hematuria

Other nonspecific symptoms: Arthralgia, hepatosplenomegaly, hypocomplementemia

Confirm with test for circulating cryoglobulins

***F/U: Test for HCV as these two usually COEXIST

129

Wallenburg Syndrome

Lateral medullary infarction possibly due to intracranial vertebral artery occlusion

Vestibulocerebellar: Vertigo, falling to side of lesion, diplopia, nystagmus, ipsilateral limb ataxia

Sensory: Loss of pain and temp. in ipsilateral face and contralateral body

Autonomic: Ipsilateral Horner's, hiccups, lack of autonomic respiration

Ipsilateral bulbar muscle weakness (dysphagia, hoarseness, aspiration)

130

First step in managing liver cirrhosis

Screening endoscopy to identify varices and determine risk

131

Management of cirrhosis

Variceal hemorrhage: BB or ligation (ligation preferred if varices are large)

Ascites: Na restriction, diuretics, abstinence

Encephalopathy: ID underlying cause, lactulose

132

Deficiency associated with carcinoid syndrome

Niacin

Increased tryptophan =>> serotonin conversion; less niacin and tryptophan

133

Disseminated MAC

Presents with fever, cough, abdominal pain, diarrhea, night sweats, weight loss, and SPLENOMEGALY AND ELEVATED AP
-indicates hepatosplenic involvement)

Tx: Azithromycin

134

TTP

ADAMTS13 deficiency leads to formation of small vessel thrombi due to long chains of vWF accumulating on the endothelial wall

Dx: Hemolytic anemia, thrombocytopenia, possible renal failure, neurologic change, and fever

Tx: Plasma exchange

135

Sporotrichosis

Infections occur in gardeners via direct inoculation; a papuler forms at the site that ulcerates and drains an odorless and nonpurulent fluid

=>>Later, several proximal lesions develop along the line of lymphatic drainage

Tx: Oral itraconazole

136

Management of stones <1cm

Hydration

Analgesics

a-blockers (Tamsulosin)

137

MCCo acute epididymitis in pts. >35 years

E. coli

138

ADRs of cyclosporine

Nephrotoxicity- azotemia, hyperuricemia, hyperkalemia

HTN- can tx w/ CCBs

Neurotoxicity- Headache, tremors, visual probs

Glucose intolerance

Infxn

Malignancy- SCC

*****Gingival hypertrophy

*****Hirsutism

GI probs

139

Autoimmune adrenalitis

Presents with symptoms of primary adrenal insufficiency (hyperpigmentation, hyponatremia, hyperkalemia, fatigue, weakness, GI probs)

Can occur as an isolated disorder or in association with other AI syndromes

140

S3 sound

ken-tuc-KY

Typically a sign of Left Ventricular failure

141

Senile purpura

Ecchymosis, skin fragility, and consistent bruising due to loss of elastic fibers in the perivascular CT

Minor abrasions can rupture superficial vessels and lead to large ecchymoses

-Labs normally appear normal

142

Best test to diagnose brain tumors

MRI with gadolinium

143

Double duct sign

CT finding with a carcinoma of the head of the pancreas in which we see compression of the pancreatic and common bile duct

=>>Intra and extrahepatic biliary duct dilatation with a nontender, distended gallbladder

144

Complications of primary biliary cholangitis

Xanthelasmas (due to hyperlipidemia)

Malabsorption (fat-soluble deficiencies)

Hepatocellular carcinoma

Osteoporosis, osteomalacia (not due to deficiencies; Ca and Vit D can be normal so pathophysiology is unknown)

145

Tx of bacterial endocoarditis w/ acute stroke

Just IV fluids and antibiotics; do not anticoagulate

146

Leukomoid Reaction

Reactive process to acute infxn

LAP score: High (>20)

PMN precursors: Late phases

Basophilia: Not present

147

Exam for suspected chronic pancreatitis

Abdominal CT

148

Raynaud's Phenomenon workup

CBC

Metabolic panel

Urinalysis

ANA, RF
-If positive for ANA, get antitopoisomerase-1 abs for systemic sclerosis

ESR and C3, C4 levels

149

Zinc deficiency

Alopecia

Pustular skin rash (perioral region and extremities)

Hypogonadism

Impaired wound healing

Impaired taste

Immune dysfnxn

Causes: Malabsorption, bowel resection, poor intake, paraenteral nutrition

150

Patient who has just gotten out of ophthalmic surgery and presents with a fever, swollen eyelid, edematous conjunctiva, and exudates in the anterior chamber

Postoperative endophthalmitis

Occurs within six weeks of surgery and is due to an infection of the eye; viterous humor can be sent for gram stain and culture

Tx: Intravitreal antibiotics

151

MCC of gross painless lower intestinal bleeding in adults

Diverticulosis

152

Hyponatremic patients who are presenting with severe neurologic manifestations

Treat with hypertonic saline; still correct at <8meq/L for first 24 hours to prevent osmotic demyelination syndrome

153

Hallmark of prolonged and recurrent seizures

Cortical laminar necrosis; MRI shows cortical hyperintensity suggestive of infarction

154

Tumor lysis Syndrome

Patients present with N/V, diarrhea, muscle cramps, seizures, tetany, CARDIAC ARRHYTHMIA, and AKI

HAllmarks: Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

Tx: IV fluids (flush kidneys), allopurinol

155

Mechanism of ACEI dry cough

Inhibits the metabolism of kinins and substance P

=>> Kinins irritate bronchi with increased prostaglandin production

Also, inhibition of ACE activates the arachidonic acid pathway
=>>Increased thromboxane =>> Bronchoconstriction

156

Clinical features of multiple sclerosis

Optic neuritis

Internuclear opthalmoplegia

Fatigue

Heat sensitivity

Numbness, parasthesia

Paraparesis, spasticity

Bowel, bladder dysfnxn

MRI: Lesions disseminated in space and time (usually found in periventricular, juxtacortical, intratentorial, or spinal cord areas)

CSF: Oligoclonal IgG bands

157

CSF in MS pts

Oligoclonal bands

158

S4 Sound

TEN-nes-see

Indicates a stiff, left ventricle which occurs in the standing of longstanding hypertension or restrictive cardiomyopathy

Sound is made by blood striking a stiffened left ventricle

159

Mechanical Complication of acute MI timeline

Acute: RV failure (Kussmaul's sign)

3-5 days: Papillary muscle rupture (severe pulmonary edema, new holosystolic murmur)

3-5 days: Interventricular septum rupture (shock, chest pain, new holosystolic murmur, biventricular failure)

5 days-2 weeks: Free wall rupture (shock, chest pain, JVD, distant heart sounds)

160

Disseminated gonoccocal infxn

Presents as a purulent monoarthritis OR

Triad: Tenosynovitis, dermatitis (erythematous papules/pustules), and asymmetric MIGRATORY POLYARTHRALGIAS

Dx: Blood cultures can be negative, synovial fluids show PMNs

Tx: IV ceftriaxone, empiric azithromycin/doxy, joint drainage for purulent arthritis

161

Reactive arthritis

Cant' see, can't pee, can't climb a tree

Look for STD history

Tx: NSAIDs

162

Patient who has arthritis of the hands, wrists, and knees with joint effusion BUT also has kids

THINK ABOUT PARVOVIRUS B19

163

MCC of primary adrenal insufficiency

Autoimmune adrenalitis

164

Pulmonary empyema

Patients have frank pus or bacteria in a cavitary space; usually an IC pt.

Pleural fluid: ph<7.2, decreased glucose, WBC >50,000

Tx: Abs and drainage

165

Anserine burisitis

"Pes anserinus"

Localized pain and tenderness over the anteromedial tibia distal to the joint line

Patients are usually fat and obese diabetic females

Tx: NSAIDs, symptoms usually go away in a few weeks

166

Amyloidosis

Can be primary or secondary to chronic inflammation (RA, TB, osteomyelitis, IBD, malignancy, vasculitis)

S/s: Proteinuria, nephrotic syndrome
Restrictive cardiomyopathy (heart is concentrically thickened)
Hepatomegaly
Peripheral neuropathy/Autonomic neuropathy
Organ enlargement (macroglossia)
Waxy, thickened skin that easily bruises**

167

Extrahepatic manifestations of chronic HCV

Mixed cryoglobulinemia syndrome

Membranoproliferative glomerulonephritis

Porphyria Cutanea Tarda (photosensitive vesicles and bullae erupt on skin with sun exposure, lesions scar forming hyperpigmented areas)
****Always order HCV testing if a pt. has this

Lichen planus

168

Highest RF for stroke

HTN

169

Patients with steatorrhea may present with what deficiencies

Fat soluble vitamin deficiencies

Vit D= Low Ca2+, Low PO4, and increased PTH

170

Best tests for Cushing Syndrome

Low-dose dexamethasone suppression test

171

RBC transfusion thresholds

<7 = always

<8= Cardiac sx., oncology patients in treatment, heart failure

8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery

172

Complication of aortic dissection

Cardiac tamponade

173

Acromegaly effects

Local tumor effect: Visual field defects, headache, cranial nerve defects

MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome

Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg,

Pulm/GI: OSA, colon polyps, diverticulosis

Enlarge organs = Tongue, salivary glands, liver, spleen

Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia

**Effects are due to increased IGF-1

174

Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.

Suspect pheochromocytoma

BBs can also cause these exacerbations

175

Epidermal Inclusion Cyst

Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening)

Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop

176

Characteristics of uncomplicated parapneumonic effusion

Caused by movement of fluid from pneumonia into visceral pleura

Fluid analysis: ph>7.2
Decreased-normal glucose
WBC <50,000
Gram stain (-)
EXUDATIVE

-Differs from empyema because no bacteria are present

177

Tx for acute sciatica

1. Trial of NSAIDs

2. Muscle relaxant/short-term opioid

*Don't need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)

178

Aspirin allergy

ALSO GOES FOR NSAIDs

179

Globus sensation

Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety

Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat

180

Crescendo-decrescendo murmur along the left sternal border with no radiation

HCOM; indicates the presence of interventricular septal hypertrophy

S/s: Syncope, dyspnea, chest pain

181

Spinal cord compression management

Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus)

Emergency MRI

Neurosx. consult

182

Patients with steatorrhea may present with what deficiencies

Fat soluble vitamin deficiencies

Vit D= Low Ca2+, Low PO4, and increased PTH

183

Best tests for Cushing Syndrome

Low-dose dexamethasone suppression test

184

RBC transfusion thresholds

<7 = always

<8= Cardiac sx., oncology patients in treatment, heart failure

8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery

185

Complication of aortic dissection

Cardiac tamponade

186

Acromegaly effects

Local tumor effect: Visual field defects, headache, cranial nerve defects

MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome

Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg,

Pulm/GI: OSA, colon polyps, diverticulosis

Enlarge organs = Tongue, salivary glands, liver, spleen

Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia

**Effects are due to increased IGF-1

187

Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.

Suspect pheochromocytoma

BBs can also cause these exacerbations

188

Epidermal Inclusion Cyst

Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening)

Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop

189

Characteristics of uncomplicated parapneumonic effusion

Caused by movement of fluid from pneumonia into visceral pleura

Fluid analysis: ph>7.2
Decreased-normal glucose
WBC <50,000
Gram stain (-)
EXUDATIVE

-Differs from empyema because no bacteria are present

190

Tx for acute sciatica

1. Trial of NSAIDs

2. Muscle relaxant/short-term opioid

*Don't need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)

191

Aspirin allergy

ALSO GOES FOR NSAIDs

192

Globus sensation

Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety

Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat

193

Crescendo-decrescendo murmur along the left sternal border with no radiation

HCOM; indicates the presence of interventricular septal hypertrophy

S/s: Syncope, dyspnea, chest pain

194

Spinal cord compression management

Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus)

Emergency MRI

Neurosx. consult

195

Patients with steatorrhea may present with what deficiencies

Fat soluble vitamin deficiencies

Vit D= Low Ca2+, Low PO4, and increased PTH

196

Best tests for Cushing Syndrome

Low-dose dexamethasone suppression test

197

RBC transfusion thresholds

<7 = always

<8= Cardiac sx., oncology patients in treatment, heart failure

8-10= Symptomatic anemia, ongoing bleeding, ACS, noncardiac surgery

198

Complication of aortic dissection

Cardiac tamponade

199

Acromegaly effects

Local tumor effect: Visual field defects, headache, cranial nerve defects

MSK: Gigantism, protruding jaw, arthralgia, myopathy, skin tags, carpal tunnel syndrome

Cardiac: Concentric hypertrophy, HTN, mitral/aortic regurg,

Pulm/GI: OSA, colon polyps, diverticulosis

Enlarge organs = Tongue, salivary glands, liver, spleen

Endocrine: Galactorrhea, decreased libido, DM, hyperparathyroidism, hypertriglyceridemia

**Effects are due to increased IGF-1

200

Patient with periodic headaches and HTN who presents with severe HTN after anesthetic admin.

Suspect pheochromocytoma

BBs can also cause these exacerbations

201

Epidermal Inclusion Cyst

Dome-shaped, firm, freely movable cyst or nodule with a central punctum (pore-like opening)

Represents epidermis lodging in the dermis; can intermittently produce discharge; only needs tx. if signs of infxn develop

202

Characteristics of uncomplicated parapneumonic effusion

Caused by movement of fluid from pneumonia into visceral pleura

Fluid analysis: ph>7.2
Decreased-normal glucose
WBC <50,000
Gram stain (-)
EXUDATIVE

-Differs from empyema because no bacteria are present

203

Tx for acute sciatica

1. Trial of NSAIDs

2. Muscle relaxant/short-term opioid

*Don't need MRI unless patient has progressive deficits, cauda equina, or signs of epidural abscess (IV drug use, fever)

204

Aspirin allergy

ALSO GOES FOR NSAIDs

205

Globus sensation

Sensation of foreign body in the throat; occurs when swallowing saliva and is assoc. w/ anxiety

Patients do not have pain, dysphagia, or dysphonia; just the sensation of something in their throat

206

Crescendo-decrescendo murmur along the left sternal border with no radiation

HCOM; indicates the presence of interventricular septal hypertrophy

S/s: Syncope, dyspnea, chest pain

207

Spinal cord compression management

Immediate IV glucocorticoids (decreased vasogenic edema caused by an obstructed epidural venous plexus)

Emergency MRI

Neurosx. consult

208

Effect modification

External variable positively or negatively impacts the effect of a risk factor on a disease of interest

*However, if you remove the variable, there is still risk in the group with one factor

209

Confounding

Exposure-disease relationship is obscured by an extraneous factor associated with exposure and disease

*If you remove the RF, there is no difference between two groups

210

Lacunar stroke

Occlusion of the deep penetrating arteries of the brain; particularly susceptible to HTN, DM, hyperlipidemia, and smoking

Path: Microatheroma formation and lipohyalinosis leading to small vessel occlusion

211

Erlichiosis

S/s: Flu-like illness, neurologic symptoms (confusion)

"RMSF without the spots"

Labs: Leukopenia, thrombocytopenia, elevated LFTs, elevated LDH

Dx: Intracytoplasmic morulae in monocytes

Tx: Doxycycline

212

First line tx. of chemotherapy-induced nausea

SSRI

213

Caustic ingestion

S/s: Hoarseness, stridor (laryngeal), dysphagia, odynophagia (esophageal), epigastric pain, bleeding (gastric)

Tx: Secure airway, remove contaminated clothing, CXR if respiratory probs, EGD

214

Systolic anterior motion of the mitral valve

Associated with HCOM; contacts the thickened interventricular septum causing LVOT obstruction

215

Patient who recently had a drug eluting stent placed and has an MRI

Think medication noncompliance

216

Cardiac myxoma

S/s: Constitutional (fever, weight loss, Raynaud's),Heart failue, arrhythmia, embolization

Dx: Echo

Tx: Surgery soon (decrease risk of embolus)

217

Tubulointerstitial nephritis

Usually due to analgesic use

Patients may have poluria and steril pyuria

218

Glucocorticoid-induced myopathy

Patients have proximal muscle weakness and atrophy but no pain due to inflammation caused by catabolic breakdown

Will also see signs of glucocorticoid excess

219

Felty Syndrome

Advance RA with splenomegaly and neutropenia

220

Pleural effusion exam findings

Decreased breath sounds

Decreased tactile fremitus

Dullness to percussion

May be a mediastinal shift away from effusion

221

Pt with an acute STEMI and pulmonary edema

Make sure to give Lasix

222

Tophaceous gout

Tumors in the soft tissues that can ulcerate and drain a chalky material

Patients don't even need microscopic examination for gout crystals; this is pathagnomic

223

Most common glomerulopathy with HIV

Focal segmental glomerulosclerosis

224

Bilateral trigeminal neuralgia

Think MS as this is usually a unilateral condition

225

Bethanechol

Cholinergic agonist used to treat urinary retention

226

Hyposthenuria

Found in patients with SCD OR Sickle Cell Trait; presents as a patient who cannot concentrate urine or reabsorb water; usually will be young in the question stem

-RBCs get caught in the vasa recta impairing countercurrent exchange

227

Tx for syphilis patients who have SEVERE penicillin allergies

Doxycycline

228

Supravalvular aortic stenosis

Congenital LVOT obstruction causing a systolic murmur; usually heard in the first intercostal space

**Patients have differential blood pressures in the two arms

229

Hypertensive nephropathy

2nd leading cause of ESRD

Decrease in renal blood flow and GFR =>> hypertrophy and intimal medial fibrosis of the renal arterioles

Can see microscopic hematuria and proteinuria

230

Patient with renal issues who suddenly develops severe retroperitoneal pain, fever, and gross hematuria

Think RVT due to antithrombin III loss

231

HIV screening indications

Once between the ages 15-65
Treatment for TB
Treatment for another STD

Annual: IVDU, MSM, prostitutes, partners of HIV positive, homeless, prison

Additional: Pregnancy, exposure

232

Solitary brain mass in HIV patient

CNS lymphoma; is usually ring-enhancing

233

Multiple ring enhancing lesions in HIV pt.

Toxoplasma

234

Patient who becomes alkalotic after being treated for fluid overload

Think loop diuretics

The increased Na+ delivery to the DCT causes K+ and H+ to be secreted

235

Pt with AKI due to postrenal causes

Catheterization

Do bladder scan first to see but if it's inconclusive, jump to this

236

Medications associated with SIADH

Carbamazepine

SSRIs

NSAIDs

237

Pt. with COPD exacerbation and has a seizure

Due to acute cerebral vasodilation

Use O2 with a goal of 90-93%

238

NaHCO3 mechanism in TCA OD

Na+ increases the serum pH and extracellular sodium =>> decreased avidity of TCA for cardiac sodium channels

-This helps to prevent QRS widening

239

Charcot joint

"Neurogenic arthropathy"

Presents as patients with large, deformed joints that lack sensation and have lost neurologic input; patients can have DJD and loose bodies on joint imaging

-Patients only have mild pain tho due to the loss of neurologic input

Causes: Diabetes, syringomyelia, spinal cord injury, B12 deficiency, tabes dorsalis
=>>Patients damage feet unknowingly

Tx: Manage underlying conditions; weight bearing assistance

240

Secondary amyloidosis

Seen with chronic inflammation, chronic infections, IBD, malignancy, and vasculitis

S/s: Proteinuria w/ nephrotic syndrome possible
Cardiomyopathy
Hepatomegaly
Peripheral neuropathy
Macroglossia
Waxy thickening and easy bruising of skin

241

Management of frostbite

Rapid rewarming in 37-39 degree water

Analgesia and wound care

Thrombolysis in severe, limb-threatening cases

242

"Water hammer pulse"

Aortic regurgitation

243

Vasovagal syncope

"Neurocardiogenic syncope"

Triggered by emotional or painful stimuli and is associated with prodromal sx. (dizziness, nausea, pallor, diaphoresis); pts. rapidly regain consciousness

Tx: Reassurance, avoidance of triggers, ***Counterpressure maneuvers (leg crossing, tensing arm muscles) that involve raising the SVR

244

CT imaging on pyelonephritis

Persistent clinical symptoms after 48-72 hours of therapy, history of kidneys tones, or unusual findings (gross hematuria, obstruction)

245

Pressure ulcers

Suspect over any bony prominences (sacrum, ischia tuberosities, malleoli, heels, 1st or 5th metatarsal heads)

246

Serous otitis media

Conductive hearing loss that presents with a dull tympanic membrane that is hypomobile

247

Aspirin Toxicity

RESPIRATORY ALKALOSIS

THEN

ANION GAP METABOLIC ACIDOSIS

pH is relatively normal, however, the pCO2 and HCO3 will both be decreased

248

Vessel that supplys the inferior wall of the heart

RCA

249

Protein C resistance

Factor V Leiden



250

Splenic abscess

Patients present with fever, leukocytosis, and LUQ pain; possibly can have left-sided pleuritic chest pain with a left sided effusion

RFs: Infxn, hemoglobinopathy, IC, IV drug use, trauma

Tx: Abs and splenectomy

****HIGHLY ASSOC. W/ LEFT-SIDED ENDOCARDITIS

251

Meniere Disease

Increased volume and pressure of endolymph in the inner ear due to defective resorption

Triad: Low frequency tinnitus w/ a feeling of fullness
Episodic vertigo (may have N/V, lightheadedness)
Sensorineural hearing loss (usually worsens with time)

Tx: Restrict Na+, caffeine, nicotine, alcohol
Benzos or antiemetics for acute sx.
Diuretics for long term management

252

Management of hypercalcemia

1. Normal saline

2. Calcitonin

3. (Long term) bisphosphonates

253

Hepatic hydrothorax

Pleural effusion due to small defects in the diaphragm that occurs when PERITONEAL FLUID passes thru

***MORE COMMON ON THE RIGHT

S/s: Dyspnea, cough, pleuritic chest pain, hypoxemia

Tx: Na+ restriction, diuretics

254

Prevalence studies are what kind of study?

Cross-sectional

255

Pneumonia breath sounds

Represents consolidation of a lung

Increased crackles

Increased tactile fremitus

Dullness to percussion

No mediastinal shift

256

Cyanide toxicity

Causes: Combustion of carbon and nitrogen material (wool, silk), industrial exposure (mining metals), or sodium nitroprusside

S/s:
Skin- Flushing, cyanosis
CNS- Headache, AMS, seizure, coma
CV- Arrhythmia
Respiratory- Tachypnea followed by respiratory depression, pulmonary edema
GI- Pain, N/V
Renal- Metabolic acidosis (LA), RF

257

Type of cardiomyopathy assoc. w/ amyloidosis

Restrictive cardiomyopathy

258

Antiparkinsonian drug that is dangerous in pts. w/ glaucoma

Anticholinergics (trihexyphenidyl)

These can ppt. ACG

259

Granulomatosis with polyangiitis Diagnostic findings

anti-PR3, anti-MPO

Biopsy:
Skin-leukocytoclastic vasculitis
Kidney- Pauci-immune GN
Lung- granulomatous vasculitis

Tx: Corticosteroids and immune modulators (MTX, cyclophosphamide)

260

Pancoast tumor

S/s: Shoulder pain
Horner cyndrome
C8-T2 neurologic involvement (weakness of intrinsic hand muscles)
Weight loss
Enlarged supraclavicular lymph nodes
SVC syndrome

261

MS

S/s: Fatigue
Episodes of numbness, paresthesia, bowel/bladder dysfnxn, heat sensitivity, optic neuritis

Symptoms may worsen when a patient moves to a hotter area

262

Uhthoff phenomenon

MS patients experiencing increased frequency of episodes after they move to a hotter region

263

Adhesive capsulitis

"Frozen shoulder"

Patients have decreased passive and active ROM in the shoulder joint with a gradual increase in severity but NOT a lot of pain

-Can be due to chronic inflammation, fibrosis, or contracture of the capsule

264

Felty Syndrome

(triad)

RA
-including vasculitis with necrotizing skin lesions

Neutropenia

Splenomegaly

*Also have anti-CCP, elevated ESR

265

Mechanism of cyanide poisoning

Inhibits cytochrome oxidase a3 in the mitochondrial electron transport chain blocking the production of ATP

=>>Increase in anaerobic metabolism and metabolic acidosis

266

Follow-up of a CXR with a new mass

Chest CT

267

Hypertrophic Osteoarthropathy

Digital clubbing accompanied by sudden-onset arthropathy affecting the wrist and hand joints

-Can be due to underlying lung disease (cancer, TB, bronchiectasis, COPD)

Initial study: CXR (rule out cancer)

268

Things to rule out in patients presenting with pseudogout

1. Hyperparathyroidism

2. Hypothyroidism

3. Hemochromatosis (get iron studies)

269

Progressive Multifocal Leukoencephalopathy

JC virus reactivation typically in an IC host

S/s: Slowly progressive confusion, paresis, ataxia, and seizure

Dx: MRI of brain shows multiple white matter lesions with NO enhancement or edema

-Virus lies dormant in kidneys and lymphoid but reactivated w/ CD4 <200; moves to CNS and lyses oligodendrocytes

270

Medications to hold prior to cardiac stress test

48 hrs: BBs, CCBs, Nitrates

-If vasodilator, dipyramidole as well

12 hrs: Caffeine

271

Chikungunya fever

Patient who is from Central or South America (or recently traveled) and presents with high fever, SEVERE ARTHRALGIA, lymphopenia, thrombocytopenia, and increased LFTs

Other S/s: Headache, myaglia, conjunctivits, maculopapular rash

Tx: Supportive

272

Anemia that develops with antiepileptics

Folic acid; due to impaired absorption

273

Tx for hepatic encephalopathy

Lactulose

274

Tx for Lyme Disease in kids and pregnant women

Amoxicillin

275

Treatment of cachexia

Progesterone analogues (megestrol acetate)

Corticosteroids

-These increase appetite, cause weight gain, and improve well being

-Megestrol acetate preferred due to decreased side effects

276

Takayasu Arteritis

Asian female who presents with constitutional signs of fever and weight loss as well as with arterio-occlusive sx. (Claudication, ulcers in the upper extremities)

PE: Blood pressure discrepancies
Pulse deficits
Arterial Bruits, especially in the upper extremities

Dx: elevated ESR, CRP
CXR: widened mediastinum, aortic dilatation
Ct/MRI: thickening of aortic walls and narrowing of vessel lumen

Tx: Glucocorticoids

277

Invasive aspergillosis

Triad of fever, chest pain, and hemoptysis in an IC pt.

⭐️CXR: Pulmonary nodules with halo sign

Can also have cell wall bio marks (Galactomannan, beta-D-glucan)

Tx: Voriconazole plus caspofungin

278

Post-streptococcal AGN

Preiorbital edema, hematuria, and oliguria

Patient will have ️Decreased c3

279

Systemic sclerosis subtypes

Limited cutaneous:

Scleroderma on the head and distal upper esophagus

Vascular manifestation (Raynauds, cutaneous Telangiectasia, pulmonary hypertension)

CReSt

Anti-centromere abs

DIFFUSE CUTANEOUS:

More internal organ involvement as well as the skin (renal crisis, myocardial ischemia and ️fibrosis, interstitial lung disease)

Anti-Scl-70 (anti-topoisomerase-1) and anti-RNA polymerase III


280

Tx for variceal hemorrhages

Volume resuscitation

IV octreotide

Antibiotics

Urgent endoscopy to evaluate for balloon tamponade

281

First thing to do with hyperkalemia

STABILIZE THE MYOCARDIUM

Give calcium gluconate

282

Patient who has had a gastrectomy years ago and is now presenting with signs of anemia

IF deficiency; suspect Vitamin b12 deficiency

283

Most common vaccination to give to people traveling abroad

Hepatitis A vaccine

284

Patient who still has a tick attached and it just happened recently

Remove tick; follow-up closely

285

Evaluation of hyperthyroidism

1. Measure TSH, T3, and T4

2. If primary, evaluate for signs of Graves (goiter, ophthalmopathy)

3. If none, do a radioactive iodine uptake scan

4. If it is low, evaluate serum TBG

High? =>> Thyroiditis, iodide exposure

Low? =>> Exogenous

286

Cervicofacial actinomyces

Patient with dental infxn or facial trauma who is IC, DM, or malnourished

S/s: Nonpainful, indurate mass; sinus tracts with SULFUR-LIKE GRANULES
-typically affects the mandible

Dx: FNA; culture shows GPR that are slightly branching

Tx: Penicillin; surgery if invasive

287

Management of cancer pain

Mild= NSAIDs

Moderate= Weak opioids and NSAIDs
-Codeine, hydrocodone, tramadol

Severe = Strong, short-acting opioids
-morphine, hydromorphone
-consider adding long acting if this does not provide relief

288

pH effects on Ca2+

Increased= dissociation of H+ from albumin =>> increased calcium binding to albumin =>> decreased serum level

Decreased ph= association of h+ to albumin =>> decreased calcium binding to albumin =>> increased serum level

289

Ice pack test

Ice pack applied over eyelid that is droopy =>> relief in ptosis CONFIRMS MG

*Cold temperature inhibits the breakdown of Ach in the NMJ

290

Ventilation goals with ARDS

Low-tidal volume ventilation to decrease the likelihood of overdistending the alveoli
-decreases the work on the lungs

Provide oxygenation by increasing the FiO2 and PEEP
-prevent SpO2 <88%

291

Patient who presents with widespread molluscum contagiosum

Test for HIV or other immunodeficiency

292

Tx for variceal hemorrhages

Volume resuscitation

IV octreotide

Antibiotics

Urgent endoscopy to evaluate for balloon tamponade

293

First thing to do with hyperkalemia

STABILIZE THE MYOCARDIUM

Give calcium gluconate

294

Patient who has had a gastrectomy years ago and is now presenting with signs of anemia

IF deficiency; suspect Vitamin b12 deficiency

295

Most common vaccination to give to people traveling abroad

Hepatitis A vaccine

296

Patient who still has a tick attached and it just happened recently

Remove tick; follow-up closely

297

Evaluation of hyperthyroidism

1. Measure TSH, T3, and T4

2. If primary, evaluate for signs of Graves (goiter, ophthalmopathy)

3. If none, do a radioactive iodine uptake scan

4. If it is low, evaluate serum TBG

High? =>> Thyroiditis, iodide exposure

Low? =>> Exogenous

298

Cervicofacial actinomyces

Patient with dental infxn or facial trauma who is IC, DM, or malnourished

S/s: Nonpainful, indurate mass; sinus tracts with SULFUR-LIKE GRANULES
-typically affects the mandible

Dx: FNA; culture shows GPR that are slightly branching

Tx: Penicillin; surgery if invasive

299

Management of cancer pain

Mild= NSAIDs

Moderate= Weak opioids and NSAIDs
-Codeine, hydrocodone, tramadol

Severe = Strong, short-acting opioids
-morphine, hydromorphone
-consider adding long acting if this does not provide relief

300

pH effects on Ca2+

Increased= dissociation of H+ from albumin =>> increased calcium binding to albumin =>> decreased serum level

Decreased ph= association of h+ to albumin =>> decreased calcium binding to albumin =>> increased serum level

301

Ice pack test

Ice pack applied over eyelid that is droopy =>> relief in ptosis CONFIRMS MG

*Cold temperature inhibits the breakdown of Ach in the NMJ

302

Ventilation goals with ARDS

Low-tidal volume ventilation to decrease the likelihood of overdistending the alveoli
-decreases the work on the lungs

Provide oxygenation by increasing the FiO2 and PEEP
-prevent SpO2 <88%

303

Patient who presents with widespread molluscum contagiosum

Test for HIV or other immunodeficiency

304

Renovascular HTN S/s

Severe HTN after the age of 55

Recurrent flash pulmonary edema or resistant HF

Unexplained rise in serum Cr

Abdominal bruits (can be periumbilical)

305

ADRs of EPO therapy

Worsening of HTN

Headaches

Flu like syndrome

Red cell aplasia (rare)

306

CYP 450 inhibitors

ACETAMINOPHEN, NSAIDs

Metronidazole, antifungals

Amiodarone

Cimetidine

Cranberry juice, Ginkgo bilboa, Vitamin E

Omeprazole

SSRIs

307

2 most common orgs that can cause direct extension to the brain from sinusitis

Strep viridans and Staph aureus

308

Organisms associated with contact lens keratitis

Psuedomonas and Serratia

309

MC source of pulmonary embolus

Femoral vein

310

Empiric tx for meningitis

Cefepime/Ceftazidine
+
Vancomycin
+
Ampicillin (covers Listeria monocytogenes)

-Pts. should also receive dexamethasone to prevent complications of S. pneumoniae meningitis (deafness, focal probs) until it is ruled out

311

Small intestinal bacteria overgrowth

Causes: Anatomic abnormalities (surgery, strictures)
Motility disorders (DM, scleroderma)
ESRD, AIDS, cirrhosis

S/s: Abdominal pain, diarrhea, bloating, malabsorption, weight loss, anemia, nutritional deficiencies

Dx: Endoscopy (shows >10^5 organisms), glucose breath hydrogen testing (shows rapid increase in lactulose)

Common orgs: Strep, bacteroides, E. coli, lactobacillus

Tx: 7-10 day course of rifaximin or Augmentin, avoid antimotility agents, high fat diet, metoclopramide (promotes motility)

Normal protection comes from gastric acidity, peristalsis, intact ileocecal valve preventing retrograde travel of bacteria from the colon

312

Tx for vitiligo

Topical or systemic corticosteroids

Can try topical calcineurin inhibitors but the answer is probably steroids

313

Characteristics of benign renal cysts

Thin, smooth, regular wall

Unilocular

No septae

Homogenous content

Absence of contrast enhancement on CT/MRI

Asymptomatic

*Do not need follow-up unless there are changes

314

Tetanus prophylaxis

ALWAYS JUST GIVE TDaP UNLESS THEY ARE IC

=>>THEN ALSO GIVE TIG

315

Patient with TB who is presenting with fatigue, weakness, borderline hypotension, and electrolyte abnormalities

Suspect chronic primary adrenal insufficiency due to TB

316

FAP screening guidelines

Annual sigmoidoscopies starting at age 10-12

Annual colonoscopies once colorectal adenomas are detect or at the age of 50

Proctocolectomy if the patient presents with carcinoma or adenomas with high-grade dysplasia

317

Less known RFs for Toxic Shock Syndrome

Recent surgery

Sinusitis

Nasal surgery

Skin lesions/burns

318

Primidone

Used as a treatment for essential tremor alongside BB

*BB is still first line

319

TX FOR PARKINSON'S

Trihexiphenidyl (anticholinergic)

320

Enthesitis

Pain at sites where tendons and ligaments attach

Common in AS, psoriatic arthritis, and reactive arthritis

321

Patient with meningococcal meningitis

ISOLATE THEM; even if it's against their wishes

322

Riluzole

Glutamate inhibitor used in patients with ALS

Prolongs survival time and the time towards necessary tracheostomy

323

Alveolar infiltrates with several thin-walled cavities

Can be a finding in normal, uncomplicated pnemonia

324

Patient who presents with skeletal deformities, bone and joint pain, and fractures

-May possibly also have headache or hearing loss

Paget's Disease

325

First order test for suspected SLE

ANA

326

Babesiosis

S/s: Flu-like sx.,
Severe (CHF, DIC, splenic rupture)

Dx: Anemia, thrombocytopenia, increased bilirubin, LDH, and LFTs
-Findings due to intravascular hemolysis

****Intraerythrocytic rings on peripheral smear

Tx: Atovaquone + Azithromycine
Quinine + clindamycin (if severe)

327

Occupational HIV postexposure prophylaxis

Tenofovir + emtricitabine (two NRTIs) + Raltegravir (integrase inhibitor), protease inhibitor, or NNRTI

328

Cocaine toxicity tx

IV Benzos and O2

-Also consider CCBs, nitrates, and aspirin if their is CA vasoconstriction

329

Rotor's Syndrome

Defect in the hepatic secretion of bilirubin; consider this when the patient has normal LFTs and AP but has hyperbilirubinemia

330

Patient who has a negative IgA anti-tissue transglutaminase deficiency but the biopsy still shows villi blunting

This is still Celiac's!

Many patients have selective IgA deficiency; if your assay is negative, measure total IgA

331

Juvenile Idiopathic Arthritis

Symmetric arthritis for at least six weeks

Lab findings:

Increased ESR, CRP

Hyperferritinemia

Hypergammaglobulinemia

Thrombocytosis

Anemia

332

Patients who have been longtime vegans and are alcoholics

Likely BOTH folic acid and B12 deficiencies

On administration of folic acid, megaloblastosis will resolve, however, the pt. will still have neurologic sx.

333

Vertebral compression fracture

Clinical:

Chronic: Progress kyphosis and loss of statue; can even be painless

Acute: Low back pain with decreased spinal mobility, pain increasing with standing, walking, and lying on the back; tenderness at the affected level

****Patients CAN have neuro sx. BUT if they have shooting pains down their spine, THEN you should think maybe a herniation

-Pts are at increased risk for future fractures and development of hyperkyphosis =>> protuberant abdomen, early satiety, weight loss, and decreased respiratory capacity

334

Cryoglobuinemia Type 1 (not mixed)

Pts. may have hyperviscosity (blurry vision), thrombosis, livedo reticularis, purpura

-Pts. have normal complement levels (unlike in mixeD)

Assoc. w/ lymphoproliferative conditions or hematologic probs

335

Suppurative thyroiditis

High grade fever and pain at the thyroid due to infxn; can be enlarged due to abscess formation

*Pts. are EUTHYROID

336

de Quervain thyroiditis

"Subacute thyroiditis"

Pts. present with prominent fever and hyperthyroid sx. as well as a painful, tender goiter

***Likely a postviral etiology

Dx: Elevated ESR and CRP, low radioiodine uptake

337

"Ostetitis deformans"

Paget's

338

Symptomatic sarcoidosis tx

Glucorticoids

339

Milk-alkali syndrome

Pts. have excessive intake of calcium and absorbable alkali (usually calcium carbonate in pts. w/ osteoporosis)

=>>Renal vasoconstriction and decreased glomerular blood flow

=>>Renal loss of Na+ and H2O, increased resorption of HCO3-
-due to inhibition of the Na-K-2Cl transporter and impaired ADH

Sx: N/V, constipation, polyuria, polydipsia, neuropsychiatric sx.
-"Hypercalcemia + extra pee

-Increased risk w/ ACEIs, Thiazides, and NSAIDs

Lab: Hypercalcemia, hypophosphatemia, hypomagnesemia
Metabolic alkalosis
AKI
Decreased PTH

Tx: Discontinue causative agents, IV saline + furosemide

340

SCD pt. with decreased internal rotation and abduction of the hip with normal x-rays and inflammatory markers

Think aseptic necrosis; occlusion of end artery by sickle cell

341

Warfarin skin necrosis

Warfarin administration causes immediate DECREASE in Protein C and S

=>>Transient hypercoagulable state

Tx: Protein C concentrate and cessation of warfarin

342

TSH in prolactinoma

To assess whether you think it might be low or normal, look at the patient's sx. cause it could be either

343

Lab findings in VIPoma

Hypokalemia (increased intestinal secretion)

Hypercalcemia (increased bone resorption)

Hyperglycemia (increased glycogenolysis)

Stool osmolality studies show decreased gap and increased Na

344

Methods to control confounding

Design: Matching, restriction, and RANDOMIZATION

Analysis: Stratified; statistical monitoring

345

Saline-resistant and saline-responsive Metabolic alkalosis

Saline-responsive: Due to vomiting, diuretics, laxative, decreased oral fluids

Saline-resistant: Primary hyperaldosteronism, Cushing's, severe hypokalemia

Urine chloride can differentiate if the history does not (it is <20 in saline-responsive)

346

Nocardia

Partially acid-fast branching, GPR

Presents in IC pts. with systemic symptoms, possible lung nodules, and possible lung abscesses

Tx: Bactrim

347

Phosphorus levels in tertiary hyperparathyroidism

High; kidney is not able to excrete it

348

Factorial design

Study that is designed to have 2 or more interventions with 2 or more variable endpoints

-Like studying BP endpoints on different antihypertensives

349

Morton neuroma

Numbness or pain between the 3rd and 4th toes

**Clicking sensation when palpating space between 3rd and 4th toes while squeezing the metatarsals

**Common in runners

Path: Mechanically induced neuropathic degeneration of the interdigital nerves

Sx. can be worse when walking in high heeled shoes

Tx: Metatarsal support with inserts

350

Leprosy

S/s: Anesthetic, macular skin lesions with raised borders
-Nerves nearby can be painful or also have a loss of sensory

-Patients present as immigrants or long travel history

Dx: Full-thickness biopsy of the skin lesion

Tx: Dapsone; rifampin; possible clofazimine if there are extensive lesions

351

MC nephrotic syndrome in pts. with Hodgkins

Minimal change disease

-Resolves with successful treatment of the lymphoma

352

Type of reaction that aspirin-exacerbated respiratory disease is

Pseudoallergic rxn

Production of leukotrienes via lipooxygenase and decreased anti-inflammatory prostaglandins due to COX inhibition

Tx: Leukotriene inhibitors (zileuton) or antagonists (montelukast) for acute sx.

353

Patient presenting with chest pain not related to exertion and has a chronic history

This shit dont sound like cardiac CP

354

Reason alcohol is bad for acetaminophen related liver failure

Depletes glutathione levels preventing the liver from glucuronidating NAPQI, the toxic metabolite of acetaminophen

355

Patient who has a syncopal episode and starts jerking

Do not rule out other causes; any case of cerebral hypoxia can cause jerks

356

Asymptomatic range of carotid artery blockage that indicates surgery

>60%

Symptomatic? >50%

357

Total body K+ in DKA or HHS

Decreased; elevated plasma levels but osmotic diuresis causes excessive loss

358

NF1

CFs: Cafe-au-lait spots
Neurofibromas
Lisch nodules
Optic gliomas (lead to decreased visual acuity, optic nerve atrophy, and proptosis)

-Defect in NF1 TSG neurofibromin on Cr. 17

359

D-xylose test

D-xylose is absorbed in the proximal SI; patients will absorb this after administration and increased levels are detected in the urine

ABNORMAL TEST: No increase in D-xylose in the urine

=>>SUSPECT CELIAC

False positives can be seen with impaired glomerular filtration or delayed gastric emptying

360

Thalamic pain syndrome

Weeks after suffering a stroke of the penetrating branches of the PCA (supplies the ventral posterolateral and ventral posteromedial nuclei of the brain); patients will have paroxysmal burning over the affected areas of their body and allodynia (pain with light touch)

-These nuclei transmit sensory info from the contralateral side of the body in all modalities

361

Pulmonary physiology with pneumonia

Inflammation =>> impaired alveolar ventilation =>> RIGHT-TO-LEFT SHUNT

-Also described as a V/Q mismatch (decreased)

362

Hepatorenal syndrome

Significant decrease in renal fnxn in the absence of any causes of renal dysfnxn

***As cirrhosis progresses, patients get splanchnic vasodilation and renal vasoconstriction

Precipitating factors: GI bleed, vomiting, sepsis, spontaneous bacterial perotonitis, NSAID use

Dx: Renal hypoperfusion
FeNa <1%
Absence of signs of tubular injury
No casts in the urine
No improvement in renal fnxn with fluids

Tx: Stabilize; give splachnic vasoconstrictors (octreotide, midodrine, norepinephrine); transplant

363

Significant complication of pseudotumor cerebri (idiopathic intracranial HTN)

Blindness

IF necessary, can perform shunting or optic nerve sheath fenestration to prevent

364

Young Patient with chronic low back pain that improves with activity and has an elevated ESR

AS

Pain may also be worse at night; sacroiliitis on radiographs

365

Tx for acute pericarditis

NSAIDs

366

Sick sinus syndrome

Symptomatic bradycardia without signs of heartblock

367

Tx of torsades du pointes

MgSo4 if hemodynamically stable

If not =>> Defibrillation

368

Postpartum endometritis tx

Clindamycin + gentamicin

369

Odds ratio

Measures the odds of exposure among individuals with the disease to the odds of exposure among individuals without the disease

370

Rare disease assumption

A rare disease that has a low incidence and allows for the OR to be approximately equal to the RR

371

Atropine

Dilates the eye; avoid in AACG

372

Pilocarpine

Topical agent that rapidly reduces intraocular pressure by opening the canals of Schlemm and drain aqueous humor

373

Lymphocytes with vacuolated cytoplasm

Atypical lymphs; probably Mono

374

Heterophile antibody test

Negative during first week of mono; may want to repeat after a while

TL:DR = NEGATIVE TEST DOES NOT RULE OUT MONO

375

Pts who have a CN III palsy but preserved pupillary dilation (control of the iris and ciliary muscles)

Acute ischemia of the fiber (outer fibers control pupillary dilation; inner fibers control EOMs)

-IF they have both, it is likely a lacunar stroke

376

CMV-related HIV

Frequent, small volume diarrhea

Hematochezia

Abdominal pain

Low-grade fever

Weight loss

Dx: Colonoscopy with biopsy; shows eosiniophilic intranuclear and basophilic intracytoplasmic inclusions

Tx: Ganciclovir; eye exam to rule out retinitis

377

Central retinal artery occlusion

Painless monocular vision loss that persists for serveral hours

Fundoscopy reveals a whitened retinal and a cherry red macula

Patients may have a defect in the afferent pupillary reflex

Tx: Attempt at revascularization; follow-up with carotid imaging and atherosclerosis tx

378

Gonococcal pharyngitis

Inoculation of the pharynx with pharyngeal erythema and NONTENDER cervical lymphadenopathy

379

Treatment with radioactive iodine for Grave's disease

Give glucocorticoids with treatment; otherwise pt. can get worsening of ophthalmopathy

This is because titers of anti-TSH antibodies typically increase after therapy

380

Bicuspid valve

Actually causes aortic regurgitation in young patients

381

Pt with bright red blood on the toilet paper and is under the age of 40

Get an anoscopy; colonoscopy if they are older than age 50 or have risks for colorectal cancer

382

ACTH levels in pts. with secondary adrenal insufficiency

Decreased; the HPA is what gets suppressed with chronic steroid use

383

Delayed sleep phase syndrome

Circadian rhythm sleep-wake disorder characterized by sleep-onset insomnia and excessive morning sleepiness

Occurs when internal clock is misaligned with a persons desired sleep time

-Pts. describe themselves as "night owls"

-Sleep normally when allowed to set their own schedule

384

Treatment for febrile neutropenia

Monotherapy Pip-tazo, cefepime, meropenem

Just make sure there is Pseudomonas coverage

385

Cryptosporidium

Possible in healthy adults, however, it should resolve in 10-14 days

386

Coccidiodes

PT DOES NOT HAVE THIS IF THEY DO NOT LIVE IN THE SOUTHWESTERN US

387

Thiazide diuretic effect on glucose

Increases blood levels

-Impairs insulin release and glucose utilization in the peripheral tissues

388

Pt with heat stroke and red urine

Rhabdomyolysis can occur when body temp is >105

389

Trimethoprim effects on kidney

Increases serum K+ by blocking the epithelial sodium channels in the CT (like amiloride)

Increases creatinine by competitively inhibiting its secretion (although GFR is unchanged)

390

Patient who has a high fever, VS instability, agitation/delirium, lid lag, tremor, warm skin

Thyroid storm

Give propanolol, PTU, and glucocorticoids (decreases peripheral T4=>T3)

-This can be triggered by surgery, trauma, infxn

391

Testing to do on all ITP pts

HIV, Hep C

Bone marrow bx. if you still dont have an answer

392

Metabolic syndrome triad

HTN

Dyslipidemia

Impaired glucose tolerance

393

Metabolic syndrome diagnostic criteria

Abdominal obesity (Men: >40; Women: >35)

Fasting glucose >100-110

BP >130/80

TGL >150

HDL (Men: <40; Women: <50)

Must have 3/5 of these

394

Hemodynamic measures in septic shock

RA pressure (preload): Normal or decreased

PCWP (preload): Normal or decreased

CI (pump fnxn): Increased

SVR (afterload): Decreased

MvO2: Increased

395

Differentiating HG from normal N/V during pregnancy

Urinary ketones are (+) in HG

396

FiO2 in ARDS

Start off high; however, it should be decreased to <60% to keep PaO2 in the 50-80 range

397

Flow-volume loop in fixed upper airway obstruction

Looks pretty egg shaped

398

Recurrent pneumonia in the same location of the lung

Can be due to localized airway obstruction =>>impaired bacterial clearance

Causes: External bronchial compression (neoplasm, lymphadenopathy, vascular irregularity)
Intrinsic obstruction (bronchiectasis, foreign body)

-Get a CT to eval

399

Complication of GCA

Aortic aneurysm

400

treatment for refractory c dif

Fidaxonycin

If all else fails, fecal transplant

401

Toxins that can cause ATN

IV contrast

Myoglobin

It's also caused by ischemia

402

Tx of prerenal AKI

IVF

Or

Diuretics if they are in a volume overload state

403

Indications for hemodialysis

Acidosis

Electrolytes ( particularly potassium and calcium)

Intoxication

Overload

Uremia

404

Common confections with gonorrhea

Chlamydia, hiv, hep b, and syphilis

Test for all of these

405

Rivaroxaban

Direct Xa inhibitor used for DVT prevention and has no increased risk for ️Bleeding

Can additionally be used for acute DVT as long as the patient is hemodynamically stable

406

Ekg finding in PE

New onset bundle branch block

407

Hypercalcemia of immobilization

Increased osteoclastic resorption after increased periods of time being nonambulatory

Worse with renal insufficiency

408

Polymyositis

Patients have symmetrical proximal muscle weakness with possible Mild muscle tenderness

Dx: AAs (anti-Jo-1)
Elevated CK
Muscle biopsy shows endomysial mononuclear infiltrate

Can be associated with Cancer, myocarditis, and lung disease

Tx: Systemic glucocorticoids

409

What should you do at stage IV CKD?

Place an av fistula in to prep for dialysis need

GFR= 15-29

410

Treatment of severe hypernatremia

D5W

411

Hyponatremia workup

1. Serum osmols
2xNa+gluc/18+BUN/2.8= approx. 280

Normal? =>> isotonic (pseudohyponatremia)

Abnml =>> Hypertonic hyponatremia
-Hyperglycemia (For every 100g starting at 200= +1.6)

Hypotonic hyponatremia
-Diuresis
-SIADH (euvolemic)
Renal tubular acidosis
Addison's
Thyroid Disease


412

First thing to check on a sample with hyperkalemia

Evidence of hemolysis in the tube

413

Barrter's disease

Looks like Loop diuretics

hypoglycemia, hypocalcemia

414

Gittelman's Syndrome

Looks like thiazide diuretics

hyperglycemia, hypercalcemia

415

IV K+ replacement

IV replacement can not go faster than 10meQ/hr

10meQ =>> Change of 0.1

416

Initial eval of adrenocortical insufficiency

8AM serum cortisol and ACTH stimulation test

417

Crystal-induced AKI

Causes: Acyclovir (especially if IV)
Sulfonamides
Methotrexate
Ethylene glycol
Protease inhibitors

S/s: Elevated Creatinine, possible hematuria, pyuria, crystals

Tx: Discontinue drug; IV fluids


****IF YOU GIVE PLENTY OF FLUIDS WITH ADMINISTRATION OF DRUG; YOU CAN PREVENT IT FROM EVER HAPPENING

418

Patient who has a popping sensation in their kneww and has a rapid onset of hemarthrosis

Probably ACL tear

419

Pt. with thrush and signs of pneumonia

Probably still PCP

420

Pt. who has decreased proprioception and a pupil that does not constrict with light

Probably tabes dorsalis

Tx: IV penicillin

421

Complications with SAH

Rebleeding (think this if in 24 hrs)

Vasospasm (think this if in 3 days)

Hydrocephalus/Increased ICP

Seizure

Hyponatremia due to SIADH

422

Familial hypocalciuric hypercalcemia

Mutation of the Calcium-sensing receptor that leads to increased reabsorption of calcium in the tubules

423

Causes of Wernicke's encephalopathy

Chronic alcoholism

Malnutrition (anorexia)

Hyperemesis gravidarum

424

Pneumonia vaccine everyone should get

PPSV23

425

MCC of resistant HTN

Renal artery stenosis

These pts. will be on 3 or more antihypertensives with consistently high readings

PE: Can hear abdominal bruits, asymmetric renal size, rise in serum Cr after starting ACEIs

426

Patient with a nonpalpable point of maximal impulse and dyspnea

Consider pericardial tamponade

427

Reason pts. with Crohn's get kidney stones

Hyperoxaluria

428

Bacillary angiomatosis

Arises w/ CD4 <100

S/s: Vascular cutaneous lesions resembling Kaposi's sarcoma
-Papular, nodular, peduncular
B-sx.

Dx: Lesional biopsy

Tx: Doxycycline or erythromycin

429

Pts. with malabsorption issues and now have bone pain

Osteomalacia

May also see muscle cramps or a waddling gait

Dx: Increased AP, increased PTH, decreased Ca2+ and PO43-, decreased urinary Ca2+

X-ray shows thinning of the cortex and reduced BMD

Bilateral and symmetric pseudofractures can be found

430

Intraocular inflammation in HIV patients

Actually caused by HSV or VZV; called bilateral necrotizing retinitis
-keratitis, conjunctivitis, eye pain, rapid vision loss

*CMV retinitis is painless and has hemorrhages and retinal lesions

431

MRI of metastatic brain lesions

Multiple-well circumscribed lesions with vasogenic edema at the gray and white matter jnxn

Lung cancer and melanoma most commonly have multiple brain mets

432

Tx for Eikenella corrodens

Augmentin

433

Pt treated with antiarrhythmic and later develops pulmonary sx.

Probably amiodarone toxicity; develops months after treatment

434

Pt. with abdominal pain right after eating that is not localized

Suspect chronic mesenteric ischemia

435

Most effective way of improving communication of relevant patient transfers

Implementing a signout checklist

436

Volume responsive metabolic alkalosis

Diuretics, dehydration, enuresis

Pts will have a urinary Cl of less than 10

437

RTA urine anion gap

Increased

438

CT in acute pancreatitis

Swelling with peripancreatic fluid and fat stranding

Fluid does NOT appear enhanced

439

Tx of acute MS exacerbation

Corticosteroids

If no improvement =>> Plasmapheresis

440

Tx of bony mets in prostate cancer

Radiation

441

Salvage therapy

Therapy when standard treatment for a disease fails

Ex: Radical prostatectomy performed but months later the pts. PSA begins to rise again

442

Adjuvant therapy

Tx given in addition to standard therapy

443

Consolidation therapy

Given after induction therapy with multidrug regimens to further reduce tumor burder

444

Induction therapy

Initial dose of tx. to rapidly kill tumor cells and send a patient into remission

445

Maintenance therapy

Given after induction and consolidation therapies to kill any residual tumor cells and keep the pt. in remission

446

Neoadjuvant therapy

Tx give before the standard therapy for a particular disease usually used to decreased the size of a tumor before a resection or some shit like that

447

G6PD activity test during an acute hemolytic episode

Useless

448

Signs of severe aortic stenosis

Diminished and delayed carotid pulse
"pulsus parvus and tardus"

Mid-to-late peaking systolic murmur

Present of a single and SOFT S2

449

Tx for Central Retinal Artery Occlusion

Hyperbaric O2 and ocular massage

450

Tx of elevated homocysteine levels and hypercoagulability

Pyridoxine

-This will help to active cystathionine B-synthase to eventually convert homocysteine to cysteine

451

Initial work-up of HTN

BMP, CBC, urinalysis, lipid profile, and EKG

-These are done to evaluate for any high risk comorbidities made worse by HTN

452

Tx for HIT

Stop heparin; start argatroban (diretct thrombin inhibitor) or fondaparinux

453

Assist control mode of respirator

Delivers a preset tidal volume that the patient can initiate with a breath but if they fail to breathe, then the respirator maintains a minimum breathing rate

If the respirator is on this setting, consider adjusting the respirator rate with undesirable CO2 and O2 levels

454

Most frequent location of ectopic foci that cause a-fib

Pulmonary veins

455

PPD treatment protocols

>5: HIV, recent TB contact, nodules or fibrotic changes on CXR, organ transplant, immunosuppresion

>10: Recent immigrant, injection drug users, high risk settings (homeless, prison, hospital), prolonged corticosteroids, diabetes, ESRD, children 15: Everybody

456

HHV-8

Kaposi's Sarcoma

457

Charcot-Bouchard aneurysms

HTN causing small ruptures and bleeds into the deep brain structures

Locations: Basal ganglia (putamen), cerebellar nuclei, thalamus, pons

458

MCCo lobar or cortical hemorrhage

Cerebral amyloid angiopathy

459

MCCo nephrotic syndrome in adults

FSGS

-Assoc. w/ being black, using heroin, having HIV, and being fat

460

Patient who presents with signs of B12 deficiency but doesn't have classic RFs for nutritional deficiencies

Pernicious anemia

***Monitor these pts. for gastric cancer because they typically have atrophic gastritis from the anti-IF abs

461

HIV pt with diarrhea

Non-bloody? =>> Stool exam for ova/parasites, C. dif ag, and acid-fast stain for Cryptosporidium

Nloody? =>> CMV colitis or other typical infectious cause

462

Hyperextensive injury in pt. with degenerative changes in the cervical spine

High RF for central cord syndrome

S/s: Weakness in upper extremities w/ possible loss of pain and temp up here too

463

Primary intervention to control GFR decline once azotemia is present

Intensive BP control

Target= 130/80

464

Patient with an autoimmune condition and it asks what other disease they might have

PICK THE AUTOIMMUNE CONDITION

465

Lab findings in Paget's

Calcium- Normal

PO43- Normal

AP- Increased

Urine hydroxyproline- Increased

Urine Calcium- Increased

466

Ulnar nerve syndrome

Entrapment of the ulnar nerve in the medial epicondylar groove

Commonly caused by prolonged, inadvertant compression of the nerve by leaning elbows on a desk or table

S/s: Numbness in 4th and 5th digits; weakened grip

467

MTX ADRs

Hepatotoxicity

Stomatitis

Cytopenias

-Try to prevent by giving the pt. folic acid supplementation

468

Sulfasalazine ADRs

TNF and IL-1 suppressor

ADRs are hepatotoxicity, stomatitis, and hemolytic anemia

469

Pt who receives blood and shows signs of tetany and carpopedal spasm

Hypocalcemia

470

Prevention of recurrent nephrolithiasis

Increase fluids

Reduce sodium and protein

Thiazide diuretics

471

Test used to compare two means

Two sample t-test

472

Test used to compare 3 or more means

ANOVA

473

Best survival chance for renal failure pts.

Renal transplantation from a living related donor

474

Hawthorne effect

Subjects are aware they are being studied and then they alter their behavior

475

Isoniazid toxicity

Peripheral neuropathy and hepatotoxicity

476

Post-ictal pt. who is acidotic

Just wait; this is temporary lactic acidosis caused by skeletal muscle hypoxia

477

Lupus nephritis abs

anti-dsDNA

478

Drug induced lupus abs

anti-histone ab

479

PBC antibodies

anti-mitochondrial abs

480

Pseudogout flare tx

Colcichine, NSAIDs

Steroids if absolutely necessary

Colcichine can cause diarrhea so be careful

481

Causes of gout

Increased production:

Tumor lysis syndrome
Chemotherapy for leukemia
Renal Failure

Decreased excretion:

Probenecid
CKD
EtOH
HCTZ

482

"Periarticular osteopenia"

RA

483

DMARDS for RA

MTX

Leflunoamide

Sulfasalazine

Hydroxychloroquine

484

CREST syndrome

Calcinosis
Raynauds (tx. w/ CCB)
Esophageal dysmotility (tx. w/ PPI)
Sclerodactyl (tight and no wrinkles) (tx. w/ penicillamine)
Telangectasia

485

Tx for renal failure in sclerotic crisis

ACEI

Usually you give steroids w/ ARF but not in this case

486

Lymphoplasmacytic infiltration of the exocrine glands

Sjogren's Syndrome

487

Stasis dermatitis

Patients have peripheral edema that leads to chronic stretching presenting as erythematous and dark skin

Tx: Diuretics; compression stalkings; leg elevation

Can progress to ulcers on the medial malleolus (stasis ulcer)

488

Hand dermatitis

Chronic hand-washing =>> dermatitis

Found in health care workers and food preparers

Tx: Conservative

489

Tinea versicolor

(Malasezzia sp.)

Fungal infxn presenting as scaly macules of varying color

****There are areas of the body that DO NOT TAN

Dx: KOH prep =>> Spaghetti and meatballs

Tx: Selenium shampoo; ketoconazole

490

Diagnosing and treating vitiligo

Dx: Wood's lamp; biopsy shows lack of melanocytes

Tx: High potency topical steroids; extensive UV light

491

Tyrosinase deficiency

Albinism

492

Ash Leaf spot

Found in TS

***LOOK FOR SHARGREN PATCHES (elevated patches of fleshy blood vessels)

F/u: CT scan to ID brain lesions

493

"eggshell calcification"

Hyatid cyst

494

Ototoxic drugs

AGCs, chemo, LOOP DIURETICS, and aspirin in high doses

495

Things you can still see after brain death

Spinal reflexes (anything that doesn't require input to the brain)

496

MCCo elevated AP in an asymptomatic elderly pt.

Ostetitis deformans

497

Tx for renovascular HTN

ACEIs

498

Renal stenting indications

Pts who cant tolerate medical therapy, develop recurrent flash pulmonary edema and/or refractory CHF, and pts. who fail to reach adequate BP control after a long time of medical therapy

499

Best preventative measure for pressure ulcers

Pressure redistribution

500

Tx for SVT

Adenosine; lowers automaticity of the SA node

ADRs: Headache, flushing, SOB, chest pressure, nausea

501

Prevention of SVT

Digoxin

BB or Verapamil are 2nd line

502

WPW drug tx

Type 1A or 1c antiarrhythmics

Although definitive tx is radioablation

503

Torsades de pointes tx

IV magnesium

504

Tx of Vtach

Stable =>> IV amiodarone or sotalol

Unstable =>> Cardioversion followed by amiodarone

505

Patient who has sharp chest pain and it is the worst of their life with a widened mediastinum

Aortic dissection

Probably caused by systemic HTN

506

Tx of hyperthyroidism

Mild =>> Antithyroid med alone

Moderate to severe =>> Antithyroid med, BBs, radioactive iodine

507

Tinea corporis

Scaly, erythematous, pruritic patch with centrifugal spread and central clearing with a raised, annular border

Skin scraping w/ KOH would show segmented hyphae and arthrospores

Tx: Topical clotrimazole or terbinafine

Second line: Oral griseofulvin or terbinafine

508

Cyclophosphamide ADRs

Acute hemorrhagic cystitis, bladder cancer, sterility, and myelosuppression

Prevent by drinking plenty of fluids or taking MESNA******

509

Follow-up of positive stress test

Coronary angiography on pts. with high risk findings

OR

Have a high pre-test probability (typical angina in men >40 or women >60)

510

Bronchiectasis

Pts have repeated pulmonary infxn plus defective bacterial clearance; could also be caused by airway obstruction (cancers) immunodeficiencies, CR, a1-antitrypins deficiency

PE: Crackles, wheezing, fever, dyspnea, increased sputum

Dx: CT scan of the chest (shows bronchial dilation and wall thickening)
-May also consider IG quantification, CF testing, and PFTs

511

Tx of diabetic gastroparesis

Increased fiber, small and frequent meals

Metoclopromide

Erythromycin is second line

512

Anemia that pyridoxine deficiency produces

Acquired sideroblastic anemia

Increased serum iron and decreased TIBC

513

Euthyroid sick syndrome

Normal TSH And T4 but decreased T3 caused by decreased deiodination to T4

Typically occurs in pts. w/ exacerbation of illnesses and thyroid hormone supplementation is NOT recommended

514

Severely ill pts. who on CXR have pneumonia

Still get a sputum culture before empiric antibiotics because the antibiotics can produce a false negative

515

Extramuscular findings of dermatomyositis

Interstitial lung disease

Dysphagia

Myocarditis

MALIGNANCY (must screen pts.)

516

Follicular thyroid cancer

Biopsy shows follicular cells clustered together and INVADE THE TUMOR CAPSULE and possibly a blood vessel

***Spreads hematogenously

517

Drug that acts on B1-receptors

Dobutamine

Used for severe left ventricular systolic dysfnxn and cardiogenic shock

=>>Decreased LVESV

518

First thing to do in someone SUSPICIOUS for pneumonia

CXR YOU DUMB FUCK

519

Postviral thyroiditis

Likely subacute thyroiditis; hyperthyroid sx. and fever alongside elevated ESR and CRP

520

RA leads to an increased risk of what bone conditions?

Osteoporosis and bone fractures

521

Extension of the knee while compressing the patella

Patellofemoral compression test

522

Dermatitis herpetiformis

Intensely pruritic papules, vesicles, and bullae that occure symmetrically in clusters on the elbows, knees, back, and butt

AI rxn to gluten; ASSOC. W/ CELIAC

Skin biopsy: Microabscesses at the tips of the dermal papilla and anti-epidermal transglutamase IgA

Tx: Dapsone; long-term is gluten free diet

523

Recurrent cataracts

NOT A THING

524

Pt recovering from a viral uri who is having episodic dizziness and hearing loss

Vestibular neuritis

Tx: Steroids

525

MAO-b inhibitor

Selegline

526

COMT inhibitor

Entacapone

527

Major interactions of levothyroxine

Decreased absorption: Bile acid binders, iron, calcium, AlOH, PPIs, sucralfate

Increased TBG conc: Estrogen, tamoxifen, raloxifene, heroin, methadone

Decreased TBG conc: Androgens, glucocorticoids, anabolic steroids

Increased thyroid hormone metabolism: Rifampin, phenytoin, carbamazepin (CYP-inducers)

528

Drug-induced acne

Monomorphic papules without comedones

Lesions are found in the same stage of development; does not respon to typical tx.

Causes: Steroids, androgens, azathioprine, anticonvulsant, antipsychotics, isoniazid

529

pH disorder with adrenal insufficiency

Normal anion gap metabolic acidosis

Due to decreased aldosterone

530

Tx for cervicofacial Actinomyces

Penicillin

531

DOC for primary biliary cholangitis

Ursodeoxycholic acid

532

Measurement bias

Results from poor data collection with inaccurate results

533

STI that cannot be seen on gram stain

Chlamydia

534

Imaging for obstructive urolithiasis

Abdominal US or noncontrast spiral CT

535

IE from streptococcus sp.

IV penicillin or ceftriaxone

536

Biopsy in Histoplasmosis

Granulomas with narrow-based budding yesasts

537

Confirming a diagnosis of primary sclerosing cholangitis

Can be done with an ERCP

Bx would show intrahepatic ductular obliteration with lymphocytic infiltration and periductular "onion-skin" fibrosis

538

CHADS-VASc score

Congestive heart failure
HTN
Age >75 (+2)
DM
Stroke/TIA/Thromboembolism hx. (+2)
Age 65-74
Sex category (female)

539

Naloxone OD in homeless person

AMS, hypothermia, bradypnea, and hypoxia

540

Tx for hypertensive emergency

IV nitrates, CCBs, and BBs

Drop the BP by 25% in 2-6 hrs; get it to normal in 24

541

Tx for hypertensive emergency

IV nitrates, CCBs, and BBs

Drop the BP by 25% in 2-6 hrs; get it to normal in 24

542

Acute, monocular vision loss, "washed-out" colors, afferent pupillary defect, and pain with eye movement in a woman

Optic neuritis

Immune-mediated inflammatory demyelination of the optic nerbve

543

Chronic cirrhosis effects on thyroid hormone

Lowers total T3 and T4

Free T3 and T4 are normal as well as TSH

544

Blastomycosis

Found in the Mississippi and Ohio River valleys as well as the Great Lakes region

S/s: Pneumonia, wartlike lesions, skin ulcers, violaceous skin lesions, possible osteomyelitis and prostatits

545

Amitriptyline in old people

Dont do this, you'll trigger urinary retention and then have to cath them

546

Patient who receives nitroprusside for a long time

Look for signs of cyanide toxicity

547

Signs of secondary syphilis

Diffuse rash

Lymphadenopathy *epitrochlear*

Condyloma lata

Grey mucous patches

Hepatitis

548

Repaglinide, nateglinide

Glinides

Weight gain; mostly targets postprandial glucose

Binds to sulfonylurea receptor and stimulates insulin release

549

Pioglitazone, rosiglitazone

Thiazolidinediones

PPARy activators that increase peripheral tissue sensitivity to insulin

ADRs: HF, weight gain, minor infarction risk

550

Exenatide, liraglutide

Incretins

Activates GLP-1 receptors increasing glucose-dependent insulin secretion and decreasing glucagon secretion

****ALSO DELAYS GASTRIC EMPTYING AND INCREASES EARLY SATIETY

ADRs: N/V; rare pancreatitis

551

Sitagliptin, saxagliptin

DDP-4 inhibitors

Inhibit degradation of GLP-1

ADRs: Urticaria

552

Dapagliflozin, canagliflozin

SGLT2 inhibitors in the proximal renal tubules to reduce renal reabsorption of filtered glucose

ADRs: Genital yeast infxns and UTIs

553

Elderly pt. with history of chronic falls and progressive dementia

Think chronic subdural hematoma before vascular dementia

554

RVMI leads

V4r-V6r

555

Pneumomediastinum

Esophageal perforation related to Boerhaave syndrome, instrumentation, esophagitis, or ulcer rupture

556

CRVO tx

No macular edema? =>> Conservative

Macular edema? =>> Intravitreal injxn of anti-VEGF

557

Indications to treat subclinical hypothyroidism

Symptomatic

Pregnancy

TSH >10

Anti-TPO abs

558

Acute cystitis tx options

Nitrofurantoin for 5 days (avoid in suspected pyelonephritis or CKD)

Bactrim for 3 days

Single fosfomycin dose

FQNs if primary tx. fails; also get a urine culture

559

Pt. who is on a ventilator and develops signs of pneumonia

VAP; typically caused by Psed. E. coli, or K. pneumoniae (gram negs) or gram pos bacteria

Management:

1. Get CXR

2. Sputum culture

3. Abs

560

Pts. who are on EPO but remain anemia

Give iron supplementation due to rapid depletion

561

First thing to do in suspected stroke

Non-contrast CT

562

Coverage for HCAP

Vance and zosyn

563

F/u on pulmonary cavitary lesion on CXR

CT

564

Improvers of mortality in copd

O2

Smoking cessation

565

Treatment of hypernatremia

Dextrose in water

566

Confounding factors

Things that partially explain an association

I.e. - People who smoke are also more likely to drink

567

Tx for severe hypovolemic hypernatremia

Normal saline

568

Patients with mild hypovolemic hypernatremia

Dextrose in saline

569

Patients with hypervolemic hypernatremia

Dextrose in 1/2NS

570

Patient who has a viral illness but then a cough productive of sputum that sticks around for a while

Acute bronchitis

571

Initial step in confirming hypercortisolism

EITHER A 24 HOUR URINE FREE CORTISOL MEASUREMENT AND/OR OVERNIGHT LOW-DOSE DEXAMETHASONE SUPPRESSION TEST

YA DUMB FUCK

572

Comps of acute pancreatitis

ARDS

ARF

GI bleed

Necrotizing pancreatitis

Peripancreatic fluid collection

Pseudocyst

Pathophys: Release of inflammatory mediators cause widespread vasodilation, capillary leak, shock, and end organ damage

573

Miliary TB x ray

Diffuse reticulonodular patter (millet seed)

Make sure to be on the look out for predisposing factors

574

Tx for single brain mets

SURGERY

575

Tx for multiple brain mets

Whole Brain Radiation or supportive care

576

Wernicke Encephalopathy features

Encephalopathy (confusion)

Oculomotor dysfnxn (horizontal nystagmus, bilateral abducens palsy)

Postural and gait ataxia

577

Pt with aortic stenosis and under the age of 70

Bicuspid valve

578

S4 associated conditions

Young adults/children

Ventricular hypertrophy

MYOCARDIAL INFARCTION (EARLY)

579

Acute GVHD

Donor T-lymphocytes react with host minor HLA-antigens and produce a cell-mediated response

=>>Maculopapular, pruritic rash, bloody diarrhea, and abnormal LFTs with jaundice are common manifestations

580

HIT antibodies

Heparin produces a change in platelet surface protein 4 causing the formation of AAs

=>>Platelet aggregation, thrombocytopenia, skin necrosis at abdominal injection site

581

Papillary muscle displacement but not rupture of the mitral valve

Increased left ventricular pressure due to the regurgitation

582

Patients to screen for fibromuscular dysplasia

Women <50 with one of the following:

Severe or resistant HTN

Onset of HTN before 35

Increase in Cr after starting an ACEI or ARB

Epigastric bruit

Screen with CT scan or US

583

EKG showing LVH

High voltage QRS complexes, lateral lead ST segment depression, lateral lead T wave inversion

584

Renal vascular lesions with chronic HTN

Arteriosclerosis of the afferent and efferent arterioles and glomerular capillary tufts

Eventually hypertrophy and intimal fibrosis of the arterioles

585

Pronator drift

Patient whose hand drifts downward when they hold their arms straight out with their palms up and eyes close

****SIGN OF PYRAMIDAL OR CORTICOSPINAL TRACT LESION

-UMNs cause more weakness in supinator muscles

586

Patient with a stone 5mm or less

DRINK LOTS OF FLUIDS YOU DUMB FUCK

587

Flank pain, RCC, palpable renal mass

RCC triad; pt. needs a CT scan

***Scrotal varicies can be seen on the the left side due to tumor obstruction of the gonadal vein entering the renal vein

588

Pt with bone mets from prostate cancer

TX WITH RADIATION YA DUMB FUCK

589

Chronic pancreatitis

Can occur with prolonged consumption of socially acceptable amounts of alcohol; pain can radiate to the back and be relieved by sitting up or leaning forward

Pts typically also have steatorrhea, weight loss, glucose intolerance

590

Does prostate cancer go to the liver?

No, colon cancer does ya dingus

591

New onset of urinary incontinence in an elderly patient

UTI= MCC

Could also include meds, CHF, DM, alcohol, stool impaction

592

Initial workup of any blood disorder q

CBC

ya dingus

593

What should be done after a diagnosis of cancer?

CT scan

Stage disease and look for mets

594

New lung mass found on CXR, what do you do next?

CT scan

595

Patient with back pain that improves with movement who is >50

Probably spinal stenosis

AS presents in pts. from 15-30

596

Confirmatory test for spinal stenosis

MRI

597

Young patient presenting with restrictive lung disease signs but also improves with exertion

Probably AS

Restrictive signs are due to chest wall motion restriction

598

PT with acutely elevated serum creatinine

Get a renal US

Want to rule out hydronephrosis

599

Causes of increased peak pressure on a ventilator

Normal plateau pressure: Bronchospasm, mucus plug, biting ET tub

Increased plateau pressure: PTX, edema, pneumonia, atelectasis

600

Seborrheic keratosis locations

Face, trunk, upper extremities

601

Initial test for a positive cervical lymph node for cancer

Panendoscopy

602

Contact dermatitis

Encompasses both allergic and irritant (acids, soaps)

603

Tx of uric acid stones

Hydration, alkalinization, and low-purine diet

Prevention: Potassium citrate (citrate reduces crystallization)

Allopurinol if this fail

604

Follow up test for a positive Hep C antibody

HCV viral load (confirmatory)

605

Pt who is started on a BB and develops SOB a couple days later and wheezing

Guess what happened?

Pt probably has a history of rhinitis and eczema meaning undiagnosed asthma

606

Pt with amoxicillin and develops anemia later

Warm AIHA

607

Positive urine urobilinogen

Sign of INTRAVASCULAR hemolysis

Unconjugated hemoglobin is converted to this and excreted in the urine and feces

608

Megacolon in someone who is from SA

Still consider chagas

609

Pt with alcohol abuse who develops mouth swelling from the floor of the mouth

Ludwigs angina

610

TTP

Hemolytic anemia with possible renal failure, neurologic manifestations, and fever

Tx: Plasma exchange

611

Most effective nonpharmacologic measure to decrease BP in overweight individuals

Weight loss

612

Asking about hypertensive emergency criteria

Pick end organ damage over BP

613

Cauda equina syndrome is primarily an issue with what?

Spinal nerve roots

Causes: Disc herniation, spinal mets, spinal stenosis, infxn, hemorrhage

***Spinal cord ends at L1-L2 and cauda equina begins below this

***Only causes LMN signs as opposed to conus medullaris

614

Classic clinical criteria for ARDS

Hypoxemia refractory to O2 therapy

Bilateral diffuse pulmonary infiltrates on CXR

No evidence of CHF

615

Tx of ARDS

Mechanical ventilation w/ PEEP; increases lung volume by opening collapsed alveoli

Avoid volume overload

616

Synchronous intermittent mandatory ventilation

Like assist control BUT the tidal volume is not precontrolled by the ventilator

***AC is much more commonly used



-This mode is good for weaning patients off the ventilator tho BUT I WOULD STILL USE CPAP

617

Ventilator to adjust to achieve baseline PaCO@

Minute ventilation

618

I:E ration on a vent

Usually uses 1:2

If you increase one, the other goes down

619

ADRs of high levels of PEEP

Barotrauma with possible PTX

Low CO due to decreased VR

620

Comps on ventilators

Sedation with benzos as anxiety and agitation are common

Suction trachea

Nosocomial pneumonia if >72 hrs

Accidental extubation

Barotrauma

Tracheomalacia (you know who)
-If she would have gotten a tracheostomy after 2 weeks on the vent; none of that would have happened

621

Tx for primary pulmonary HTN

Prostacyclin; CCBs (pulmonary vasodilators)

Anticoagulation

Lung transplantation if possible after evaluation

622

Peaked p waves

P pulmonale

623

Manifestations of Grave's Disease

Gen: Heat intolerance, weight loss, sweating

Eyes: Lid lag, proptosis, DIPLOPIA, DECREASED CONVERGENCE

Skin: Hair loss, infiltrate dermopathy

CV: Tachycardia, HTN, a-fib

Nails- Onycholysis, clubbing

Endo: Hyperglycemia, hypercalcemia, bone loss, menstrual irregularities

GI: Diarrhea

Neuro: Tremors, hyporreflexia, proximal muscle weakness

624

Ventricular aneurysm

Commonly occurs 5 days-2 weeks after an MI

EKG: persistent ST-segment elevation after a recent MI and deep Q waves in the same leads

-HF, refractory angina, arrhythmia, mural thrombus with possible embolization, mitral annular dilatation with regurgitation

Dx: Echo shows dyskinetic LV portion in same area of previous MI

625

Indications for testing for someone for an inheritable hypercoagulopathy

Age <45

Recurrent DVT

Multiple or unusual sites of thrombosis

FH of VTE

626

Where is Broca's area located?

Frontal lobe

627

Where is Wernicke's area located

Temporal lobe

628

Thyrotoxicosis with normal or decreased iodine uptake

Painless (Silent) thyroiditis; assoc. w/ anti-TPO and is a variant of chronic lymphocytic (Hashimoto's) thyroiditis

Subacute thyroiditis

Amiodarone-induced thyroiditis

Excessive intake

Struma ovarii

Iodine-induced

Cancer met s

629

Study of choice for Aortic Dissection of unstable pt.

Transthoracic echocardiography

CT if stable (Don't do with kidney disease)

630

Tx for acute back pain

NSAIDs; moderate activity

NOT PT YOU IDIOT

631

Therapy for chronic back pain

PT

632

Pts loss to follow-up in a prospective study is what type of bias?

Selection bias
-Study winds up with inaccurate estimate of disease exposures and relevance

633

Pt who is given amoxicillin for sore throat and develops a rash 24 HOURS after administration

Probably has mono

***If the rash immediately develops, it is hypersensitivity

634

Riley-Day Syndrome

"Familial dysautonomia"

Jewish kid with gross dysfnxn of the autonomic nervous system with severe orthostatic hypotension

635

Attributable risk percent

Represents the excess risk in a population due to exposure to an RF

ARD= (risk in exposed-risk in unexposed)/risk in exposed

636

Factors found in Cushing Syndrome but not in PCOS

Skin atrophy

Muscle weakness

Bruisability

637

Patient who develops an infxn after being treated for hyperthyroidism

THINK ABOUT AGRANULOCYTOSIS

STOP PTU

638

Chronic bronchitis

Can progress to hemoptysis

Don't automatically think of cancer or bronchiectasis

639

Polymositis vs/ hyperthyroidism

Does not present with any other sx. than muscle weakness

IF patients have tachcardia, weight loss; think hyperthyroidism

640

Patient who is on an antipsychotic and has elevated prolactin

Check other pituitary hormones; they should not be suppressed

If they are =>> suspect adenoma

641

Hypothyroid myopathy

Muscle weakness; elevated CK; fatigued woman with decreased DTRs

642

Pt in the hospital for 2 days with hallucinations, HTN, hyperthermia, tremors, and diaphoresis

Delirium tremens

Give benzos because they act as GABA agonists like alcohol

643

Differences between strokes caused by amyloidopathy and HTN

Amyloidopathy =>> Lobar and CORTICAL

HTN=>> Charcot-Bouchard aneurysms and deep structures

644

Lab findings in anemia of chronic disease

Iron: Decreased

TIBC: Decreased

Ferritin: Normal-increased

Transferrin saturation: Decreased-normal

MCV: Decreased-normal

645

Patient with signs of RA and splenomegaly

Felty Syndrome

646

Bullous pemphigoid tx

Topical clobetasol

647

"Carboxyhemoglobinemia"

Refers to CO poisoning

NOT CO2 you dipshit

648

Other sign of a STEMI

New onset of LBBB

649

Psoriasis treatment

Calcipotriol

Steroids

Combo is best

650

Where is the fluid in Angioedema?

The subcutaneous layer, unlike with urticaria

Can also be found in the hands, feet and genitalia

651

Pleural effusion lung sounds

Percussion: Dull

Tactile fremitus: Decreased

Breath sounds: Decreased

652

Lung consolidation sounds

Percussion: Dull

Tactile fremitus: Increased

Breath sounds: Decreased

653

Mechanical obstruction abdominal x-ray appearance

Air through the entire GI tract with dilated and scattered loops stacked on top of each other

"Bag of sausages"

654

Ileus abdominal x-ray appearance

Dilated loops that are scattered and lack organization

"Bag of popcorn"

655

Patient who has a central line placed and then has sudden onset of dyspnea

Consder PTX or venous air embolism

656

Patient who was given an antibiotic for let's say endocarditis and develops a diffuse, red rash

Probably vancomycin

"Red Man Syndrome"

S/s: Fever, nephrotoxicity, ototoxicity

Tx: Slow the infusion; give antihistamines

657

Drug you should always give with imipinem

Cilastatin; prevents renal toxicity

658

Drug used for GNR sepsis

CArbapenem

659

Tx of chlamydia in a pregnant woman

Erythromycin

660

Only FQN with anaerobic coverage

Moxifloxacin

661

TB therapy

4 drug therapy for two months

Rifampin and INH for 4 months

662

Prophylactic for pts. with contact for menigococcal meningitis

Rifampin

663

Pt treated for vaginal discharge and has vomiting after going out one night

Disulfarim rxn due to metronidazole

664

Pt who is in a car accident and has weakness that is more pronounced in the upper extremities than the lower

Central cord syndrome

-This is because the motor fibers serving the arms are closer to the central part of the corticospinal tract

-Pt. does not necessarily have to have loss of pain and temp

665

Patient who has signs of a heart attack and then has a syncopal episode shortly after to the ER

PRobably due to a reentrant arrhythmia

If it happens 10-60 minutes later, it is due to abnormal automaticity

666

Pt who has a chronically progressive cough and comes to the ER with upper lobe consolidation with possible cavitation

Mycobacteria

Remember, aspiration pneumonia typically affects the lower lobes

667

PT. who has malaria-like sx. but lives in New York

Babesiosis

668

Hypovolemic shock hemodynamic parameters

RA pressure: Decreased

PCWP: Decreased

CI: Decreased

SVR: Increased

MvO2: Decreased

669

Study in which population is randomly selected and then determined if they have the disease and marker or not

Probably a cross-sectional study

****ANY STUDY THAT LOOKS AT PREVALENCE, GUESS THIS*****

670

Tx for patients with symptomatic hypercalcemia

Parathyroidectomy

671

Causes of 1st time seizure

Vitamins
Infxn
Trauma
Autoimmune
Metabolic
Ingestion/Withdrawal (benzos and alcohol)
Neoplasm
pSych

672

Tx for myoclonic seizures

Valproic acid

No loss of tone

673

Tx for atonic seizure

Valproic Acid

Loss of tone

674

Paradoxical splitting of S2

Narrowing of normal S2 split

Occurs due to LBBB, aortic stenosis, and HTN

675

Rales

Same thing as crackles!

Due to excessive fluid in the lungs

676

Positive babinski

EXTENSION

677

Observational studies

Case-control studies

678

Study that observes subjects at a specific point in time

Cross-sectional

"Snapshot of a population"

679

Patients are selected because they have a certain outcome and their history is reviewed for any exposures

Case-control

ALWAYS RETROSPECTIVE

*Good for rare diseases and diseases with long latent periods

680

Studies are selected according to exposure and are followed over time to determine the development of disease

Cohort study

681

Type I error

(alpha error)

Same thing as a p-value

Null hypothesis is rejected even though it's true

682

Type II error

Null hypothesis is accepted even though it is not true

*Determines the statistical power of a study

Usually, 20% is accepted

Factors that affect it: Sample size, p-value, variability of data, effect size chosen by researcher

683

PErformance bias

Subjects in comparison groups are given different care other than the intervention being studied

Example: One group receives interventional counseling in addition to the treatments that both groups get

684

Attrition bias

Drop-outs from a study

685

Intent-to-treat analysis

Analyzes drop outs from a study in groups to which they were initially assigned

Helps prevent attrition bias

686

Studies that suffer from bias lack what type of validity?

Internal

687

Studies that cannot be generalized to a larger and more complex population lack?

External validity

688

Pt presenting with upper abdominal pain with nausea and vomiting and a history of diabetes

Still get EKG first; need to rule out ACS

689

Pt who has HIV and CXR suggestive of pneumoniae but CD4>200

NOT PCP; PROBABLY ONE OF THE NORMAL BUGS

690

COPD respiratory findings

Bilateral wheezing

ABG shows respiratory acidosis and hypoxia

691

Pt who has either liver disease or nephropathy and presents with hypocalcemia

Consider hypoalbuminemia as the cause

692

Should you give someone bitten by a pet rabies prophylaxis

Nah just observe the pet for 10 days

693

Tx for cocaine OD even if it is presenting with coronary vasospasm

IV benzodiazepines

694

Does thyroid hormone increase production of catecholamines?

No; it increases sensitivity to them

695

Best medication reconciliation to reduce adverse drug events in patients

Pharmacist-directed interventions

696

Ventilation-perfusion scans that show perfusion defects

SUSPECT SOME SORT OF EMBOLI

-Could be recurrent if the pt is not currently symptomatic

-Pt will probably have evidence of venous disease

697

Bone scan showing multiple dark areas that are well circumscribed and not diffuse

Think mets

698

Fluffy bilateral interstitial and alveolar infiltrates

Think pulmonary edema

=>>Pts. will have alveolar-arteriolar mismatch

699

Severe umremitting chest pain radiating to the arm and back

Aortic dissection

Pt can have small left pleural effusion

700

Type I diabetic who collapses while exercising. What is your immediate treatment?

Dextrose

Probably a hypoglycemic episode

701

Pt with epigastric tenderness, itching, increased bilirubin, and a history of having her gallbladder removed

CT to r/o pancreatic cancer

You know it cant be gallstones

702

Healthcare proxy who insists that you do something that is medically contraindicated for a patient

Nah don't do it what does he know

703

Cause of dehydration in HNNC

Osmotic diuresis

704

Most effective therapy to prevent an asthma exacerbation following an illness

Oral corticosteroids

705

Indications for a court order

Patient has no capacity to make a decision, there is no living will or proxy, and the family cannot decide

706

Drug to use when statins can't be used

Fibrates

Can cause same ADRs tho

707

Ezetemibe ADR

Diarrhea; consider this if pt. just started

708

Drug to give w/ niacin

Aspirin

Will prevent the flushing

709

Vasovagal syncope causes

Visceral organ stimulation (excessive coughing, urination)

Carotid bodies (increased sensitivity to pressure =>>vagal response)

Test: Tilt-table if you want but DX IS USUALLY DETERMINED BY HISTORY

****USUALY A PRODROME

Tx: BB

710

Dx of orthostatic hypotension

Systolic change of 20

Diastolic change of 10

HR change of 15

Tx: Give fluids or treat any loss of fluids or neuropathic disease

711

Test done for pain sensation

Pinprick yah dingus

Remember that the nerves come from 1-2 levels higher

712

Causes of pulsus paradoxus

Cardiac tamponade

Severe asthma

COPD

definition: drop in systolic bp >10 on inspiration

713

Indications for splenectomy

Hereditary spheroctosis

Warm AIHA if severe

Massive splenomegaly w/ B-thalassemia major or Hgb H disease

714

ANYTIME IT TELLS YOU ABOUT A PACEMAKER AND HEART FAILURE OR MURMUR

DO NOT RULE OUT RIGHT SIDED CAUSES

715

Pt who has a nighttime dry cough with a history of seasonal allergy; what is probably causing it?

Post-nasal drip yah dingus

716

Pt who has aortic stenosis at age 70 or greater

Age-related change

717

Pt with IV drug abuse and they also have TB but have rapid signs of decompensation

I would look more towards a problem with the IV drug use

718

INITIAL TREATMENT FOR FEBRILE NEUTROPENIA

Pip-tazo

-This is going to cover gram negs (including pseud) and many gram positives as well

719

Pt with hypernatremia with neurologic manifestations

Normal saline

then switch to D5W later

720

Initial treatment for Chronic Venous Insufficiency

Leg Elevation

Followed by compression stockings

721

Hyperkalemia EKG

Tall peaked T-waves

PR prolongated

QRS widened

Disappearance of p wave

Conduction blocks, sine wave pattern

722

Meningococcal meningitis

Sudden onset of fever, headache, myalgia, and vomiting alongside nuchal rigidity, AMS, and petechial rash

Differentiate this from RMSF because RMSF has CSF findings similar to VIRAL MENINGITIS

723

Old patient on NSAIDs and/or aspirin who is anemic

IDE most likely cause

724

Can osteoarthritis cause anemia of chronic disease?

No; but lupus and RA can

725

Treatment for CML

Imatinib; A TK INHIBITOR

726

RApid reversal of warfarin bleed

Prothrombin complex concentrate

or

FPP

along with

Vitamin K

727

Degenerative changes in Alzheimer's

Diffuse cortical and subcortical atrophy mostly in the temporal and parietal lobes

728

Persistent Vegetative State

Similar to coma but there is NO ACTIVITY ON EEG

Both still have brainstem activity; therefore there is reflexes, they may swallow, have that cold water eye reflex, corneal reflex, and other shit ya feel

729

Virchow's triad

1. Venous stasis

2. Endothelial injury

3. Hypercoagulable state

730

Likely ABG on PE

Decreased pO2

-Due to decreased perfusion and it is DIFFUSION limited

Decreased pCO2

-Due to increased CO secondary to hypoxemia

Overall will show respiratory alkalosis

731

Test to get in pt with possible PE but history of CKD

V/Q scan

732

Massive PE tx

tPA

Do this if the pt. has PE with pulmonary hTN and overall hypotension