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362 Cards in this Set
- Front
- Back
3 causes of aminotransferase values > 5000
|
Acetaminophen toxicity
Hepatic ischemia Unusual viruses (e.g. HSV) |
|
Distinguishing pseudoachalasia from achalasia
|
In adenocarcinoma, there is resistance to the scope passing thru the GEJ
|
|
Asymptomatic indirect hyperbilirubinemia with normal Hb and otherwise normal LFTs
|
Gilbert's
|
|
3 cirrhosis-like changes that are normal in pregnancy
|
Increased alk phos
Spider angiomata Palmar erythema |
|
Pain with internal rotation of the hip
|
Obturator sign
|
|
The obturator sign is associated with ?
|
Pelvic appendix
|
|
Pain in the right lower quadrant with extension of the right hip
|
Iliopsoas sign
|
|
The iliopsoas sign is associated with?
|
Retrocecal appendix
|
|
Red flags for alternative to IBS diagnosis
|
Weight loss
Nocturnal awakening Fever, onset >50yo, recent antibiotic use, FH of colon cancer or IBD |
|
Rx for IBS
|
Loperamide
|
|
Abdominal pain with leukocytosis, hyperkalemia, and metabolic acidosis
|
Acute mesenteric artery ischemia
|
|
3 most common causes of acute mesenteric artery ischemia
|
Mesenteric arterial embolism originating from the heart (often due to atrial fibrillation)
Mesenteric arterial thrombosis (due to atherosclerotic lesions) Mesenteric venous thrombosis (usually in SMV) |
|
Best diagnostic test for potential pancreatic carcinoma
|
Helical CT of the abdomen
(then an ERCP afterward) |
|
Calcium supplementation may cause this GI problem
|
Constipation
|
|
Two treatments for cholangitis
|
Empiric antibiotics
ERCP (must do as well, b/c of high mortality; may need to do ductal decompression) |
|
Gall bladder wall thickening indicates
|
Acute cholecystitis
|
|
Total bilirubin >4.0 mg/dL, elevated aminotransferase levels, diminished consciousness or shock
|
Suspect acute cholangitis
|
|
Gallbladder disease associated with ulcerative colitis
|
Sclerosing cholangitis
|
|
Test for diagnosis and treatment of sclerosing cholangitis
|
ERCP
|
|
Rx for gallstone pancreatitis
|
IVF, pain management, and laparoscopic cholecystectomy (due to high relapse rate)
|
|
Pretest odds (formula)
|
Pretest probability / 1- pretest prob
|
|
Post-test probability (formula)
|
Post-test odds/ Post-test odds + 1
|
|
A screening abdominal ultrasound is recommended to evaluate for ___ in men 65-79yo who are current or former smokers?
|
AAA
|
|
Best prophylactic measure against influenza for immunosuppresed pts?
|
Oseltamivir (pts can't respond to live or inactivated vaccine) + vaccination of all family members
|
|
Who should use the inactivated influenza vaccine vs. the live intranasal vaccine?
|
Elderly (>50yo), anyone with a chronic medical condition, pt on chronic corticosteroids, or pregnant
|
|
Systolic murmurs necessitate a TTE only when they are
|
Grade III or higher
|
|
How to differentiate vertebrobasilar TIA from carotid TIA?
|
Both have focal neurologic deficits, but vertegrobasilar usually has LOC, whereas carotid does not
|
|
Presyncopal symptoms of warmth, diaphoresis, and lightheadedness are consistent with
|
Neurocardiogenic syncope
|
|
Drug class contraindicated in cocaine-induced MI
|
Beta blockers
|
|
Should be used in place of beta blockers in cocaine-induced MI
|
Labetalol (both alpha and beta blocker)
|
|
Imaging modality of choice for potential spinal cord compression?
|
MRI (of the entire spine, not just suspect region)
|
|
Leg ischemia is likely if pt has ____ with exertion and an ankle:brachial index of ____ that ____ with exercise
|
Pain
<.9 Decreases (by at least 20%) |
|
Best intervention in pts with peripheral artery disease
|
Smoking cessation
(Best medical intervention for symptoms: cilostazol) |
|
Phosphodiesterase inhibitors are contraindicated in pts with
|
Heart disease
|
|
Gastric bypass surgery is recommended as an option for which pts?
|
patients with class III obesity, defined as those who have a Those with Class III obesity:
BMI of ≥40 who have been unable to maintain weight loss with exercise and diet with or without drug therapy, and have obesity-related comorbid conditions |
|
Mechanism of orlistat
|
Lipase inhibitor
|
|
Mechanism of sibutramine
|
Appetite suppressant
|
|
Which is contraindicated in pts with HTN, orlistat or sibutramine?
|
Sibutramine
|
|
Positive depression screening with what score on the Geriatric Depression Scale?
|
At least 2 out of 5
|
|
How to differentiate B12 and folate deficiency on lab testing
|
Folate: only homocysteine is elevated
B12: both homocysteine and methylmalonic acid are elevated |
|
Other than hereditary spherocytosis, spherocytes are seen in this disease
|
Warm antibody autoimmune hemolytic anemia
|
|
Low/normal iron, low TIBC, and increased ferritin indicate
|
Anemia of chronic disease (i.e. inflammation)
|
|
Rx for TTP
|
Plasmapheresis
|
|
Prolonged PTT time after previously normal tests indicates
|
Acquired Factor VIII inhibitor
|
|
3 associations with Factor VIII inhibitor development
|
Malignancies (esp lymphomas)
Autoimmune disorders Postpartum setting. |
|
How does a mixing study (aka inhibitor screen) differentiate between deficiency and inhibitor?
|
Deficiency: coagulopathy fixed when pt's serum mixed with normal serum
Inhibitor: coagulopathy not corrected |
|
In pts with recurrent giardiasis and respiratory infections, suspect ____ and test ____
|
Common variable immunodeficiency
IgG levels |
|
Malodorous vaginal discharge without irritation, pain, or itching
|
Bacterial vaginosis
|
|
Rx for bacterial vaginosis
|
Metronidazole or clindamycin
|
|
Frothy yellow green pruritic discharge
|
Trichomonas vaginalis
|
|
Cottage cheese discharge with inflammation, irritation, and no smell
|
Candida
|
|
Two symptoms that may accompany a drug fever
|
Eosinophilia
Rash |
|
Noninfectious causes of SIRS
|
Trauma, pancreatitis, and severe burn
|
|
Which should be avoided in asthmatics, oseltamivir or zanamivir?
|
Zanamivir (can induce bronchospasm)
|
|
Rx for acute sinusitis
|
3- to 10-day course of a narrow-spectrum antibiotic (amox, Bactrim, doxy)
|
|
Pentad of TTP
|
Fever
Microangiopathic hemolytic anemia Renal failure Neurologic findings Thrombocytopenia |
|
What is the anion gap in multiple myeloma?
|
Low (e.g. around 3)
|
|
Maltese cross fat droplets of urine sediment under polarized light
|
Minimal change disease
|
|
C3 and C4 levels in SLE
|
Both low
|
|
Edema, hypoalbuminemia, hypercholesterolemia
|
Minimal change diseaes
|
|
Rx of hyperuricemia
|
Rasburicase
|
|
Increased serum uric acid, potassium, and phosphorus concentrations
|
Tumor lysis syndrome
|
|
Obesity hypoventilation syndrome causes a? (respiratory or metabolic, acidosis or alkalosis)
|
Respiratory acidosis
|
|
4 diagnostic features of delirium
|
1) acute onset or fluctuations in mental status over24hrs
2) inattention 3) disorganization of thinking 4) altered LOC |
|
What causes migraine or tension headaches to transform into chronic daily headache?
|
Excessive analgesic use
|
|
Rx for cluster headaches
|
Prednisone
|
|
5 diagnostic criteria for migraine headaches
|
POUND: pulsatile, one-day duration, unilateral, nausea or vomiting, and disabling
|
|
3 headache red flags
|
Age >50
Acute onset Hx of malignancy |
|
Fluctuating lethargy and inattention, hallucinations, and asterixis
|
Toxic encephalopathy (causing a dementia/ delirium picture)
|
|
Abrupt onset of dementia with subsequent improvement
|
Vascular dementia
|
|
Periventricular white matter ischemia on CT or MRI of the brain
|
Vascular dementia
|
|
Memantine is not useful in patients with this level of Alzheimer's dementia
|
Mild
|
|
Three cholinesterase inhibitors with efficacy in dementia
|
Rivastigmine, donezepil, galantamine
|
|
Rx for HSV encephalitis
|
Acyclovir
|
|
Poor prognostic sign for neurologic recovery in herpes encephalitis
|
Abnormality in the temporal lobe (e.g., a hemorrhagic lesion) on imaging
|
|
Rx for restless leg syndrome
|
Dopamine agonist
|
|
Check this serum measurement before beginning pharma treatment for restless leg syndrome
|
Serum ferritin: correcting iron deficiency can alleviate symptoms
|
|
Hodgkin's lymphoma survivors who receive extended-field radiation therapy have a greatly increased risk for developing
|
Solid tumors (e.g. breast cancer in young women treated)
|
|
Alkylating-agent chemotherapy treatment increases the risk of
|
AML
|
|
Best chance of cure for pts with cancer of head of pancreas?
|
Whipple procedure (pancreaticoduodenectomy)
|
|
Most common causes of malignant pericardial disease
|
Breast and lung cancers
|
|
Trastuzumab
|
Ab to HER2/Neu receptor
|
|
Rx for metastatic small cell lung cancer
|
Chemotherapy only (usually a platinum agent (cisplatin or carboplatin) and etoposide or irinotecan)
|
|
Are malignant pulmonary nodules generally spiculated or not, and calcified or not?
|
Spiculated, minimally calcified
|
|
Women at increased risk for breast cancer (>1.6% over next 5 years) can receive this therapy to decrease their risk
|
Tamoxifen
|
|
Rx for ulcerative colitis pt with low-grade dysplasia
|
Colectomy
|
|
Pain only on full elbow flexion
|
Olecranon bursitis
|
|
Extreme pain on passive joint motion
|
Acute crystalline or infectious synovitis
|
|
Pain and tenderness over the anteromedial aspect of the lower leg below the joint line of the knee
|
Anserine bursitis
|
|
Pain exacerbated by going down steps and by extended flexion at rest
|
Patellofemoral pain syndrome
|
|
Rx for patellofemoral pain syndrome
|
NSAIDs
|
|
Difference in swelling patterns for ligamentous vs. meniscal injuries
|
Ligamentous: immediate swelling
Meniscal: swelling occurs over several hours |
|
Twisting injury w/ popping or tearing sensation often felt, followed by severe pain, esp on walking (commonly up and down stairs)
|
Meniscal injury
|
|
Rx for knee sprain
|
RICE: rest, ice, compression, elevation
|
|
Knee radiograph indicated if pt has any of these features
|
1) >55yo
2) tenderness at head of fibula or patella 3) inability to flex to 90 or bear weight |
|
Subacromial tenderness and impingement; pain when reading overhead and when lying on the shoulder
|
Rotator cuff tendonitis
|
|
Decreased ROM of shoulder from stiffness rather than pain or weakness
|
Adhesive capsulitis (aka frozen shoulder)
|
|
Postmenopausal women who use diuretics have an increased risk for
|
Tophaceous gout of the DIPs
|
|
Two drugs for long-term gout management and their mechanisms
|
Probenecid: uricosuric
Allopurinol: xanthine oxidase inhibitor |
|
Two drugs for acute gout treatment
|
NSAIDs (preferred)
Colchicine (high toxicity; binds and stabilizes tubulin to prevent polymerization) |
|
Target uric acid level for pts with recurrent gout
|
<6
|
|
Abnormal LFTs, arthropathy, fatigue, impotence
|
Hereditary hemochromatosis
|
|
Morning joint pain lasting 15 minutes
|
Osteoarthritis! Only think RA if >30 minutes
|
|
Heberden's and Bouchard's nodes are on which joints and indicate?
|
DIP and PIP, respectively
Osteoarthritis |
|
Rx for osteoarthritis
|
Acetaminophen (NSAIDs have equal/ marginally better efficacy but more adverse effects)
|
|
Rx for refractory knee osteoarthritis
|
Intra-articular corticosteroid injections
|
|
Dermatomyositis, polymyositis, and inclusion-body myositis have an increased risk for
|
Malignancy
|
|
Ausculatory findings of COPD
|
Hyperresonance
Decreased breath sounds Prolonged expiration |
|
Chylothorax (drainage of lymphatic fluid into pleural space due to disruption/blockage of thoracic duct) is associated with
|
Malignancy (non-Hodgkin's lymphoma) or cardiothoracic procedures
|
|
Most common cause of hemothorax
|
Trauma (either blunt or penetrating, incl. iatrogenic)
|
|
Radiation-induced heart diseases
|
Myocardial fibrosis, constrictive pericarditis, early CAD, valve dysfunction
|
|
Increased JVP, fatigue, dyspnea, peripheral edema, ascites in a pt without CHF
|
Constrictive pericarditis
|
|
Which is more dangerous, primary or secondary pnuemothorax?
|
Secondary (there is already underlying lung disease)
|
|
Rx for secondary pneumothorax
|
Tube thoracostomy (chest tube placement)
|
|
Paradoxical abdominal motion on breathing, excessive decrease in FVC while supine, and poor inspiratory force
|
Neuromuscular respiratory failure
|
|
When is tube thoracostomy (chest tube drainage) indicated for a parapneumonic effusion, and why?
|
If pus or G+ pleural fluid is detected or if pleural pH is <7.0
They are complicated parapneumonic effusions, at risk for loculation |
|
Size cutoff for a pleural effusion that requires thoracentesis?
|
>10 mm in height (on lateral decubitus CXR)
|
|
Pleural fluid erythrocyte count >100,000/uL indicates
|
Pleural malignancy (if not in the setting of trauma or pulmonary infarction)
|
|
These non-selective meds can cause asthma exacerbations
|
Beta blockers
|
|
Rx for beta-blocker induced bronchocontstriction
|
Ipratropium bromide (or atropine, glucagon, corticosteroids, etc.)
|
|
3 most common causes of chronic cough
|
GERD
Cough-variant asthma Postnasal drip syndrome |
|
Diagnosis of exercise-induced asthma?
|
Exercise challenge test; post-exercise spirometry showing >20% fall in FEV1
|
|
Rx for acute severe asthma
|
1) Systemic corticosteroids
2) Inhaled bronchodilators (anticholinergic and short-acting beta-agonist) 3) Magnesium sulfate (IV or inhaled) --> bronchodilation 4) Intubation |
|
Rx for home treatment of asthma
|
1) short-acting beta agonist
2) inhaled corticosteroid 3) long-acting beta agonist 4) theophylline or leukotriene receptor antagonist 5) IgE Abs (if have elevated Ab levels) |
|
Episodic flushing, decreased BP, increased HR
|
Carcinoid syndrome
|
|
Pheochromocytomas are improved with these drugs and worsened by these drugs
|
Alpha-blockers
Beta-blockers (unless after adequate alpha blockade) |
|
In ____, hyperreninemia can cause recurrent episodes of flash pulmonary edema
|
Renovascular HTN
|
|
Scleroderma pt w/ new onset HTN, increased Cr, decreased platelets, anemia, LE edema
|
Scleroderma renal crisis
|
|
Rx for scleroderma renal crisis?
|
Short-acting ACEIs, e.g. captopril (to counteract increased renin)
|
|
Alteplase is contraindicated in pts with what BP?
|
>185/ 110 (or an MAP >135)
|
|
What types and when should anticoagulation be used in ischemic stroke?
|
LMWH and antiplatelet agents, 24-48 hrs after alteplase
|
|
Test used for suspected subarachnoid hemorrhage in pt with normal head CT?
|
Lumbar puncture to look for xanthrochromia
|
|
3 types of events that can precede Guillain-Barre syndrome?
|
Infection, immunization, surgery
|
|
Rx of Guillain-Barre
|
IV Ig or plasmapheresis
|
|
Symmetric proximal and distal muscle weakness, decreased DTRs, and distal loss of vibration and position senses
|
Chronic inflammatory demyelinating polyneuropathy
|
|
Rx for chronic inflammatory demyelinating polyneuropathy
|
Immunosuppressants (steroids, IV Ig, plasmapheresis)
|
|
Preventive therapy for prostate cancer
|
Finasteride (5-alpha reductase inhibitor)
|
|
Lateral compression of this lesion will produce a depression, or dimple, that helps distinguish it
|
Dermatofibroma
|
|
This skin lesion develops quickly and spontaneously resolves over 4-6mo
|
Keratoacanthoma
|
|
Migratory arthralgia in one inflamed joint and tenosynovitis (wrist or ankle) and/or tender necrotic pustules on an erythematous base, especially on the distal extremities
|
Gonococcal arthritis
|
|
Rx for septic arthritis
|
IV antibiotics (not oral b/c is a closed space, need penetration)
Daily drainage |
|
How to differentiate diffuse and limited systemic sclerosis?
|
Location of skin thickening
Limited: distal to elbows & knees Diffuse: proximal to elbows & knees |
|
Positive findings on pathergy test (development of an erythematous papular or pustular lesion >5 mm 24 to 48 hours after skin prick by a needle)
|
Behçet's disease
|
|
Recurrent aphthous oral ulcers +/- recurrent genital ulcers, inflammatory eye disease, cutaneous lesions
|
Behçet's disease
|
|
Scalp tenderness, carotidynia, and jaw claudication
|
Giant cell arteritis
|
|
Acute onset of asymmetrical weakness and sensory loss associated with severe pain
|
Vasculitic neuropathy
|
|
Thyrotoxicosis, a nontender thyroid gland, absent radioiodine uptake, and no visualization of tracer on the thyroid scan
|
Thryoiditis
|
|
Rx for thyroiditis
|
Beta-blockers
|
|
Which hyperthyroid states cause increased radioiodine uptake vs. decreased?
|
Increased: Graves', toxic multinodular goiter, autonomous thyroid nodules
Suppressed: Sporadic, postpartum, or subacute thyroiditis |
|
Differentiate bone mineral density in osteoporosis vs. osteopenia
|
<-2.5 in osteoporosis
Between -1 and -2.5 SD below the mean is osteopenia |
|
Which calcium channel blocker can be used in heart failure?
|
Amlodipine (2nd generation): more vasoselective, less cardiodepressant
CanNOT use nifedipine, diltiazem, or verapamil (1st generation): cause a reactive increase in sympathetic vasodilation due to peripheral vasodilation and negative ionotropic effects |
|
Tuberculin skin testing cut-offs
|
>15mm of induration
> 5mm if immunosuppressed, close contacts, or + CXR > 10mm for immigrants, IVDU, HCWs, prisoners |
|
Rx for outpatient CAP?
|
Macrolide or doxycycline
|
|
Rx for hospitalized CAP?
|
IV fluoroquinolone or
IV Beta-lactam + macrolide or doxy |
|
Rx for ICU CAP?
|
IV Beta-lactam + macrolide or fluoroquinolone
|
|
Bronchiectasis is a risk factor for the development of what pneumonia?
|
Pseudomonas aeruginosa
|
|
IV drug use, soft S1, muffled S2, heart block
|
Aortic valve perforation and paravalvular abscess
|
|
Best drug for antibiotic prophylaxis before dental procedures?
|
Amoxicilllin 1 hr beforehand
|
|
Osteomyelitis in sickle cell disease: 3 causative agents and appropriate antibiotics
|
Staph, strep, salmonella
Vanc + ceftriaxone |
|
Anti-TNF-alpha therapy (e.g. infliximab) increases the risk for what infection?
|
Reactivation TB
|
|
Bone xray showing marginal erosions and juxta-articular osteopenia
|
Rheumatoid arthritis
|
|
Rx for gonococcal arthritis
|
Ceftriaxone
|
|
Empiric meningitis Rx, and the bugs they cover
|
Ceftrixone and vancomycin (for S. pneumoniae and N. meningitides)
|
|
Risk factors for Listeria meningitis
|
Immunosuppression, extreme ages, alcoholism, malignancy, DM, hepatic failure, renal failure, iron overload, collagen vascular disorders, HIV
|
|
Intracerebral hemorrhage w/ subarachnoid hemorrhage is the hallmark of a
|
Ruptured arteriovenous malformation
|
|
Contralateral visual field deficit is due to a stroke in which artery?
|
Posterior cerebral artery
|
|
Contralateral leg weakness is due to a stroke in which artery?
|
Anterior cerebral artery
|
|
Contralateral arm>leg weakness, sensory loss, visual field deficit and aphasia or hemi-neglect is due to a stroke in which artery?
|
Middle cerebral artery
|
|
Left MCA stroke causes ___ vs. right MCA stroke, which causes ____?
|
Aphasia from left, hemi-neglect from right
|
|
Horner's syndrome, dysarthria, dysphagia, and alternating signs (contralateral body, ipsilateral face) is due to a stroke in which artery?
|
Vertebral artery (brainstem lesion)
|
|
Rx for ischemic stroke pts outside of the tPA window?
|
Aspirin
|
|
Major contributor to progression to ESRD
|
Uncontrolled HTN
|
|
Elevated leukocyte count and increased numbers of granulocytic cells in all phases of development
|
CML
|
|
Increased leukocyte count and increased numbers of mature lymphocytes and “smudge” cells (lymphocytes that appear flattened or distorted)
|
CLL
|
|
Elevated leukocyte count, anemia, thrombocytopenia, and blasts
|
AML
|
|
CAD equivalents for lipid goals
|
CAD, PAD, AAA, DM, Framingham score >20%
|
|
Mechanism of hypercalcemia in sarcoidosis
|
PTH-independent extrarenal production of 1,25-dihydroxyvitamin D3 by activated macrophages in the lungs and lymph nodes, which results in excess calcium absorption from the gut leading to hypercalciuria, hypercalcemia and hyperphosphatemia
|
|
Rx for ITP
|
Prednisone, followed by splenectomy if refractory
|
|
Achalasia is a risk factor for this type of esophageal cancer (vs. Barrett's, which is a risk for this type)
|
Squamous cell and adenocarcinoma, respectively
|
|
2 CXR findings in aortic coarctation
|
Rib notching (from erosion by collateral arteries formed in response to flow resistance) and a figure 3 sign (dilation before and after coarctation)
|
|
Alternative to an ACEI in pts with heart failure who develop hyperkalemia
|
Hydralazine and a nitrate
|
|
EF, K+, and Cr criteria for using spironolactone
|
EF < 35%, K+ <5, Cr < 2.5
|
|
Rx for hemoynamically unstable V-tach
|
Direct-current cardioversion
|
|
Rx for hemodynamically stable but symptomatic V-tach
|
IV lidocaine, procainamide, or amiodarone
|
|
Murmors of pulmonary stenosis and regurg ___ and ___ w/ inspiration
|
Increase for both
|
|
Rx for herpes zoster
|
Famciclovir or valacyclovir, ideally w/in 72hrs
|
|
Rx for onychomycosis
|
Terbinafine, griseofulvin, or itraconazole
|
|
Where are the lesions in inverse psoriasis?
|
Flexural sites, e.g. azillae and antecubital fossa
|
|
Guttate psoriasis often occurs after?
|
Beta-hemolytic strep infection
|
|
Which form of psoriasis can affect up to 100% of the skin?
|
Erythrodermic psoriasis
|
|
Erythematous lesions w/ central clearing and peripheral scale
|
Dermatophyte infection
|
|
Effect of sun on psoriasis?
|
Improves it
|
|
Ringworm like patch on trunk 1-2wks after viral infection
|
Pityriasis rosea (herald patch, followed by other scaly lesions)
|
|
Rx for pityriasis rosea
|
Topical cortisones and antihistamines
|
|
Papules that are sharply demarcated on yellowish-red skin and may be greasy or dry
|
Seborrheic dermatitis
|
|
Rx for tinea versicolor
|
Topical ketoconazole
|
|
Rx for common wart
|
Topical salicylic acid for 6-12wks (cryotherapy if persistant)
|
|
Multifocal atrial tachycardia is often associated w/ this lung disease
|
Hypoxic COPD
|
|
Risk factors for osteoporosis
|
Personal fracture Hx, Hx in family member, smoking, oral corticosteroids in last 3mo, weight <127lbs
|
|
When should screening for osteoporosis start?
|
DEXA scan at 65yo, or younger in women with risk factors
|
|
Possible underlying endocrine cause of hyperlipidemia
|
Hypothyroidism
|
|
Subclinical hyperthyroidism increases the risk for this cardiac condition
|
Atrial fibrillation
|
|
Rx for hyperglycemic hyperosmolar syndrome
|
Normal saline first, then insulin (maintaining volume is most imp)
|
|
Sodium correction for hyperglycemia
|
Increase by 1.6 for every 100 of glucose over normal (100)
|
|
Most sensitive physical exam finding to exclude aortic stenosis
|
Physiologically split S2
|
|
HCOM murmur ___ with Valsalva and ___ with stand-to-squat maneuver, passive leg raises, and handgrib
|
Increases (decreased preload --> smaller chamber size --> more obstruction)
Decreases (increased preload --> opposite) |
|
Ecchymosis of the flanks indicates?
|
Pancreatic hemorrhage due to pancreatic necrosis (rare presentation of acute pancreatitis)
|
|
Cigarette smoking is a risk factor for this pancreatic condition
|
Cancer (NOT pancreatitis)
|
|
4 signs of glucagonomas
|
4 Ds
DM, dermatitis (necrolytic migratory erythema), depression, DVT |
|
Rx for H. pylori
|
Triple therapy for 10-14 days:
- Acid suppression (PPI or bismuth subsalicylate) - Clarithromycin - Amox or metronidazole |
|
Med to give for acute esophageal variceal bleeding
|
Octreotide
|
|
Sign of fulminant acute hepatitis that is an indication for liver transplantation?
|
Encephalopathy/ declining mental status
|
|
Incubation period for HBC
|
1-4mo
|
|
When should you biopsy patients with NAFLD?
|
When you suspect fibrosis (and therefore want to know if need to screen for cirrhosis): >45, obese, DM, AST/ALT >1, low albumin
|
|
Rx for primary biliary cirrhosis
|
Ursodeoxycholic acid (improves pruritis, liver chemistries, decreases progression to cirrhosis)
|
|
Pts with this underlying disease are the only ones who should be given antibiotics for acute bronchitis
|
COPD
|
|
A type of sarcoidosis with bilateral hilar lymphadenopathy, polyarthralgias, and erythema nodosum
|
Lofgren's Syndrome
|
|
Which pts need LMWH instead of warfarin for long-term anticoagulation?
|
Pts w/ acute venous thromboembolism in association w/ metastatic cancer
|
|
Acidosis with increased osmolar gap and calcium oxalate crystals in the urine?
|
Ethylene glycol poisoning
|
|
Common cause of mixed anion gap metabolic acidosis and respiratory alkalosis
|
Salicylate toxicity
|
|
Things to rule out before diagnosing SIADH
|
Volume depletion, adrenal insufficiency, congestive heart failure, hypothyroidism, cirrhosis, and/or renal impairment
|
|
2 causes of pseudohyponatremia (normal serum osmolality)
|
Marked elevation of plasma lipids, proteins, or both
Hyperglycemia (or high concentration of another solute) |
|
Hypercalcemia with hypophosphatemia
|
Primary hyperparathyroidism
|
|
Hyperphosphatemia is most commonly caused by
|
Chronic kidney disease
|
|
Hypomagnesemia in an alcoholic can mimic ____, causing ____ and ____
|
Hypoparathyroidism (b/c is suppresses PTH), causing hypocalcemia and hyperphospatemia
|
|
Fever, chest pain, shortness of breath, hypoxia, and a pulmonary infiltrate in a patient with a sickling disorder
|
Acute chest syndrome
|
|
Leading cause of death in pts with sickle cell anemia?
|
Acute chest syndrome
|
|
Rx for acute chest syndrome?
|
Blood transfusion
|
|
When is daily hydroxyurea indicated?
|
SCA pts with 3+ hospitalizations requiring opioids
|
|
This lab value is elevated in TTP
|
LDH
|
|
Rx for TTP
|
Plasma exchange
|
|
Best OCP for a woman with an inherited thrombotic disorder?
|
Progestin-only
|
|
Factor V Leiden and prothrombin gene mutations are common in this population and very rare in these populations
|
White
Black and Asian |
|
2 agents for AML induction chemo
|
Cytarabine and an anthracycline
|
|
Where does recurrent HSV1 usually present?
|
Lips (vermillion border), as opposed to in the mouth
|
|
When do recurrent aphthous ulcers usually begin to occur, and what is their cause?
|
Teenage years
Unknown |
|
Rx for poison ivy (or other contact dermatides)
|
Topical corticosteroids
|
|
Rx for severe poison ivy, esp if involves face, neck, or intertriginous areas, or if has edema/blisters (and why)?
|
Oral corticosteroids (these areas are more prone to corticosteroid-induced atrophy w/ topicals)
|
|
How fast should you taper oral corticosteroids for contact dermatitis?
|
Slowly (2-3wks) b/c of risk of rebound dermatitis
|
|
Hypokalemia, HTN, and metabolic acidosis
|
Hyperaldosteronism
|
|
Target BP for pts with DM or renal failure
|
<130/80
|
|
Rx for HTN in pregnancy (2 drugs)
|
Methyldopa or labetalol
|
|
What is erysipelas?
|
Type of cellulitis w/ inflammation of superficial dermis --> prominent swelling, usually w/ fever and chills, commonly from S. pyogenes
|
|
Similarities/ differences btwn retinal emboli (amaurosis fugax), CRAO, and CRVO
|
All cause sudden, painless, unilateral vision loss
Emboli shows a whitened, edematous retina on exam CRAO shows pallor of optic disk and cherry red fovea CRVO shows disk swelling, venous dilation/ tortuosity, cotton wool spots |
|
Weakness, fatigue, depression, irritability, hypotension, lymphocytosis, eosinophilia
|
Glucocorticoid deficiency
|
|
What does skin pigmentation indicate about the cause of a pt's adrenal insufficiency?
|
It is primary adrenocortical deficiency (due to increased ACTH); secondary deficiency (hypothalamic or pituitary) has decreased ACTH, so no pigmentation
|
|
Primary problem in Klinefelter's
|
Seminiferous tubule dysgenesis --> increased LH and FSH but hypogonadism/ fibrotic testicles
|
|
Diuretic used for hypercalciuric renal stones vs. diuretic that can predispose to calcium stone formation
|
HCTZ (Rx) vs furosemide (stop)
|
|
Which stones are radiolucent?
|
Uric acid stones
|
|
Rx for uric acid stones
|
Hydration
Alkalinization of urine w/ potassium citrate or potassium bicarb (to pH >6.5) Low purine diet |
|
Vitiligo, hyperpigmentation, hypotension, dehydration
|
Addison's
|
|
Flushing, valvular heart disease, and diarrhea
|
Carcinoid syndrome
|
|
2 complications of bronchiectasis
|
Hemoptysis
Right-sided heart failure |
|
Choledochal cysts are at risk for degenerating into this malignancy
|
Chlangiocarcinoma
|
|
Most pts with Paget's disease of the breast have this underlying condition
|
Adenocarcinoma
|
|
Most common side effect of digoxin?
|
GI (anorexia, nausea, diarrhea, etc.)
|
|
Pts with this lab value are unlikely to respond well to HBV Rx (lamivudine or interferon)
|
Normal ALT
|
|
Post-exposure prophylaxis for HBV
|
HBIG and the HBV vaccine
|
|
Five signs of acute limb ischemia
|
5 Ps
Pain, pulselessness, paresthesias, poikilothermia (cold), pallor |
|
Dysphagia, regurgitation, foul-smelling breath, aspiration, palpable neck mass in an elderly male
|
Zenker's Diverticulum
|
|
Best diagnostic test for Zenker's diverticuli
|
Contrast esophagram
|
|
Most common kidney disease in Hodgkin's pts
|
Minimal change (can also get FSGS, but is almost always nephrotic syndrome)
|
|
Most common nephropathy associated with carcinoma?
|
Membranous nephropathy
|
|
Why is there increased work of breathing in COPD?
|
Increased lung volumes --> flattening of diaphragm --> difficulty decreasing intrathoracic pressure during inspiration
|
|
Rx for unmetastasized gastric MALT lymphoma?
|
H. pylori treatment (omeprazole, clarithromycin, amoxicillin)
|
|
Best Rx for hypersensitivity pneumonitis
|
Avoidance of antigen trigger
|
|
Rx for primary biliary cirrhosis
|
Ursodeoxycholic acid
|
|
HTN, hypokalemia, metabolic alkalosis, low renin (mostly from adrenal adenomas)
|
Primary hyperaldosteronism
|
|
Diagnosis of primary hyperaldosteronism
|
AM plasma aldosterone to plasma renin activity (PA/PRA) ratio > 30
|
|
Muscle cramps, polyuria, high glucose
|
Hypokalemia
Resistance to ADH --> polyuria Impaired insulin secretion --> high glucose |
|
Hypokalemia, HTN, and high plasma renin (2 causes)
|
Atherosclerotic renal artery stenosis
Fibromuscular dysplasia |
|
Butterfly appearance of brain tumor
|
GBM
|
|
Lactic acidosis in pt with atherosclerosis and atrial fibrillation
|
Bowel ischemia
|
|
Chronic pressure overload --> ___ hypertrophy
vs. Chronic volume overload --> ___ hypertrophy |
Concentric for pressure
Eccentric for volume |
|
Flushing, diarrhea, cyanosis
|
Carcinoid syndrome
|
|
BP goal during fibrinolytic therapy for acute stroke
|
<185/110
|
|
When to start ASA in pt with acute ischemic stroke?
|
If giving fibrinolytics, hold for 24hrs
Otherwise, immediately |
|
Ataxia, broad-based gait, dysmetria, intention tremor, difficulty with rapid alternating movements, and nystagmus are indicative of dysfxn where?
|
Cerebellum
|
|
What does albumino-cytologic dissociation mean, and what disease does it point to?
|
Elevated protein w/ normal cell count in CSF
Guillain-Barre |
|
What valve disease classically presents in women during pregnancy?
|
Mitral stenosis
|
|
Acute onset dyspnea in pt with food allergies and urticaria is due to?
|
Laryngeal edema (obstructing the upper airway)
|
|
Back pain, anemia, renal dysfunction
|
Multiple myeloma
|
|
Severe constipation may be from an abnormality in this electrolyte
|
Calcium
|
|
Rx for CMV retinitis
|
Ganciclovir or foscarnet
|
|
3 most common causes of death in dialysis pts
|
CVD (50% of deaths), withdrawal from dialysis, infection
|
|
Stroke localization: motor impairment + visual field abnormalities w/o cortical dysfxn
|
Lacunar infarction
|
|
Stroke localization: "alternates" w/ contralateral hemiplegia and ipsilateral CN involvement
|
Brain stem
|
|
Stroke localization: contralateral LE weakness, emotional disturbances
|
ACA occlusion
|
|
Stroke localization: contralateral hemiplegia, conjugate eye deviation toward lesion, hemianesthesia
|
MCA occlusion
|
|
Stroke localization: aphasia if in dominant hemisphere, hemineglect if in non-dominant hemisphere
|
MCA occlusion
|
|
Rx for severe hypovolemic hypernatremia
|
Isotonic 0.9% saline; .45% saline once volume deficit is restored
|
|
Rx for euvolemic hypernatremia or hypervolemic hypernatremia
|
5% dextrose in water (D5W)
|
|
Fever, severe jaundice, and RUQ abdominal pain
|
Charcot's triad of acute ascending cholangitis
|
|
Fever, jaundice, RUQ pain, confusion, hypotension
|
Reynold's pentad of suppurative cholangitis
|
|
Rx for acute ascending cholangitis
|
Supportive care, broad spectrum Abx
20% of pts have persistent pain: then do ERCP |
|
Glutamic acid decarboxylase Abs may be seen in this disease
|
Type I diabetes
|
|
Distinguishing benzo from opioid toxicity
|
Both present with sedation; opioid intoxication also has respiratory depression and miosis
|
|
Overdose w/ tremor, hyperreflexia, ataxia, and seizures
|
Lithium
|
|
Overdose w/ horizontal nystagmus, cerebellar ataxia, confusion
|
Phenytoin
|
|
Management of solitary brain met w/ stable extracranial disease
|
Surgical resection followed by whole brain XRT
|
|
Management of multiple brain mets
|
Palliative whole brain radiation
|
|
Pts with long-term (>2 decades) ankylosing spondylitis are at risk for
|
Vertebral fractures
|
|
Rx for diphenhydramine overdose
|
Physostigmine (cholinesterase inhibitor)
|
|
Overdose w/ tinnitus, N/V, fever, AMS
|
Salicylates
|
|
Test for paroxysmal nocturnal hemoglobinuria
|
Sugar water test
|
|
Test for hereditary spherocytosis
|
Osmotic fragility test
|
|
Cause of bleeding in a dialysis pt
|
Platelet dysfunction 2/2 uremia
|
|
Rx for coagulopathy in uremic pts
|
DDAVP, cryprecipitate, conjugated estrogens
|
|
Dry cough, exertional dyspnea, and fever in an HIV pt (+ bilateral interstitial infiltrates, significant hypoxia, elevated LDH)
|
PCP
|
|
Bilateral arthralgias in PIP, MCP, and wrists in a day care worker
|
Parvovirus B19 viral arthritis
|
|
This joint is usually affected by psoriatic arthritis
|
DIP (usually with dactylitis)
|
|
Differentiate orbital cellulitis from preseptal cellulitis
|
Orbital involves fat and muscles, not just superficial tissue
Orbital has proptosis and decreased visual acuity (and has pain w/ eye movement more commonly than preseptal) |
|
Differentiate orbital cellulitis from anterior uveitis
|
Both have painful red eyes; anterior uveitis does not involve eyellid
|
|
Differentiate orbital cellulitis from cavernous sinus thrombosis
|
CST is usually bilateral, causes ptosis, and causes rapid visual loss
|
|
What is enthesitis and what disease does it implicate?
|
Inflammation and pain at site of tendon and ligament attachment to bone; ankylosing spondylitis
|
|
Pts at increased risk for acalculous cholecystitis?
|
Extensive burns
Severe trauma Prolonged TPN or fasting Mechanical ventilation |
|
Inferior wall MI is caused by an occlusion in this artery
|
RCA
|
|
Inferior wall MI is caused by an occlusion in this artery
|
RCA. No really. Don't **** this up.
|
|
Rx for herpes zoster ophthalmicus
|
Acyclovir
|
|
What does dullness to percussion of the lung indicate?
|
Consolidation (or pleural effusion, though the former has increased breath sounds and the latter has decreased)
|
|
Four signs of consolidation on lung exam
|
Egophany
Dullness to percussion Bronchial breath sounds (louder and with pronounced expiratory phase) Crackles |
|
Latex allergy is particularly common in pts with this disease
|
Spina bifida
|
|
Rx for cocaine-associated myocardial ischemia (not infarction, which requires cardiac cath)
|
Benzos (also aspirin and nitrates)
|
|
Complement deficiency predisposes to infection with
|
Neisseria
|
|
HIV pts should get these two vaccines annually
|
Influenza and pneumococcal
|
|
Who should get the HAV vaccine?
|
Pts with HBV, HCV, preexisting liver disease, IV drug users, and MSM
|
|
DDx for normotensive pts with hypokalemia and metabolic alkalosis
|
Diuretic use, surreptitious vomiting, Gitelman Syndrome, Bartter Syndrome
(latter two have elevated urine chloride (>20) b/c is defective Na and Cl reabsorption --> RAA system activation) |
|
Indications for immediate treatment of hyperkalemia
|
Cardiac toxicity (EKG changes), muscular paralysis, K+ > 6.5
|
|
Three drug classes that cause hyperkalemia
|
K+ sparing diuretics, ACEIs, NSAIDs
|
|
Rx for subconjuctival hemorrhage
|
Observation
|
|
Mechanism of QRS prolongation in TCA poisoning
|
Inhibition of cardiac fast sodium channels
|
|
Rx for acute QRS prolongation
|
Sodium bicarb (reverses prolongation by increasing extracellular sodium concentration)
|
|
Rx for IV drug associated endocarditis
|
Vanc (b/c is often staph, so can't just use Amoxicillin-sulbactam like you can for most strep or enterococci endocarditis cases)
|
|
Common finding in exfoliative dermatitis
|
Gynecomastia
|
|
Common adverse effect with hydroxychloroquine
|
Retinopathy (need eye exams q 6mo)
|
|
Most common site of lacunar infarct, and what it causes
|
Posterior internal capsule
Pure motor stroke |
|
Pathophys of lacunar stroke
|
Small vessel hyalinosis
|
|
Test used to confirm diagnosis of primary hyperaldosteronism (given high aldosterone to renin ratio)
|
Aldosterone suppression test (failure to suppress after loading with IV saline)
|
|
CHF with proteinuria and easy bruisability
|
Amyloidosis
|
|
Necrotizing dermatitis, weight loss, anemia, and persistent hyperglycemia
|
Glucagonoma
|
|
Severe watery diarrhea, hypokalemia --> muscle cramps, dehydration
|
VIPoma
|
|
Visual defect in which straight lines look wavy
|
Macular degeneration
|
|
B12 and folate deficiencies both cause increased ___ and decreased ____
|
Homocysteine
Methionine |
|
B12 and folate deficiencies can be differentiated by the presence of increased ____ in B12 deficiency
|
Methylmalonic acid
|
|
Rx for amebic liver abscess
|
Metronidazole
|
|
Rx for variant angina (vasospasm)
|
CCBs or nitrates
|
|
How can alkalosis cause paresthesias and cramps?
|
Increased pH increases affinity of serum albumin to calcium, decreasing the levels of ionized calcium; hypocalcemia --> paresthesias/ cramps
|
|
Rx for symptomatic sinus bradycardia
|
IV atropine (long-term might need pacemaker)
|
|
Gummas indicate what stage of syphilis?
|
Tertiary
|
|
Tick bite and hemolysis
|
Babesiosis
|
|
Tick bite with leukopenia and thrombocytopenia
|
Erlichiosis
|
|
Why is amitryptyline useful in fibromyalgia?
|
Increases amt of restorative phase 4 sleep
|
|
Causes of osteonecrosis (also known as aseptic or avascular necrosis)
|
Corticosteroids, chronic alcohol use, trauma, antiphospholipid syndrome
|
|
Ring-shaped scaly patches w/ central clearing and distinct borders
|
Tinea corporis
|
|
Familial colon cancer + brain cancer
|
Turcot's Syndrome
|
|
Familial colon cancer + skin/bone cancer
|
Gardner's Syndrome
|
|
Calcium, phosphate, alk phos, and urinary hydroxyproline measurements in Paget's
|
Normal Ca and PO4
High alk phos and urinary hydroxyproline |
|
Bilirubin encephalopathy indicates this disease
|
Crigler-Naajar Type 1
|
|
Rx for Crigler-Naajar Types 1 and 2
|
1: Phototherapy and plasmapheresis, though only liver transplant is curative
2: none/ occasional phenobarbital or clofibrate |
|
Rx for CRAO
|
Ocular massage and high flow oxygen
|
|
Asymptomatic but with black liver
|
Dubin-Johnson Syndrome
|
|
Rx for PCP
|
Bactrim + oral prednisolone if PaO2 < 70
|