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Internal Med Flashcards

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1
Q

Signs and symptoms of CVA of anterior cerebral artery

A
  • paralysis of contralateral foot and leg
  • sensory loss toes, foot, leg
  • gait/stance impairment
  • flat affect, slow, distracted
  • cognitive impairment
  • urinary incontinence
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2
Q

Myasthenia Gravis

- treatment of choice

A
  • Pyridostigmine
  • immune modulators second line
  • plasmapheresis and IVIG in crisis
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3
Q

Concussion

- sx

A
  • confusion
  • amnesia
  • +/- LOC
  • HA
  • Dizzy
  • Nausea
  • difficulty concentrating
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4
Q

Concussion

- when can return to sports

A
  • when asx and no longer taking medications for sx
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5
Q

Alzheimer treatment that is neuroprotective

A

Memantine

  • NMDA receptor antagonist. Excessinv NMDA stimulation can cause ischemia.
  • Best when used with cholinesterase inhibitor
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6
Q

Alzheimer treatment

- cholinesterase inhibitors

A
  • Donepezil, rivastigmine, galantamine

- improve cholinergic function by inhibiting esterase enzyme

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7
Q

Alzheimer treatment

- cholinesterase inhibitors

A
  • Donepezil, rivastigmine, galantamine

- improve cholinergic function by inhibiting esterase enzyme

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8
Q

MS

- pathophys

A
  • immune mediated

- destruction of myelinated axons in CNS

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9
Q

MS

- clinical

A
  • optic neuritis
  • Heat sensitivity
  • paresthesias
  • muscle cramping / spasm
  • bowel/bladder dysfunction
  • ataxia
  • tremor
  • cognitive changes
  • facial weakness
  • facial muscle twitching
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10
Q

MS

- dx

A
  • clinical manifestations
  • CSF: pleocytosis and elevated gamma globulin
  • MRI: confirmation
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11
Q

MS

- treatment

A
  • Steroids for acute attacks
  • plasma exchange
  • Disease modifying therapy
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12
Q

Sarcoidosis

- most commonly affected parts of boyd

A
  • Lungs
  • Skin
  • lymph nodes
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13
Q

Sarcoidosis

- overview

A
  • noncaseating granulomas in organs and tissues
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14
Q

Sarcoidosis

- skin manifestations

A
  • papular, nodular, plaque-like rashes
  • scarring
  • change in color
  • erythema nodosum
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15
Q

Sarcoidosis

- lung

A
  • bilateral hilar adenopathy
  • diffuse reticular or ground glass opacities
  • Sx: sternal pain, SOB, fatigue, dry cough, wheezing
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16
Q

Sarcoidosis

- lung

A
  • bilateral hilar adenopathy
  • diffuse reticular or ground glass opacities
  • Sx: sternal pain, SOB, fatigue, dry cough, wheezing
  • elevated ACE
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17
Q

Sarcoidosis

- treatment

A

steroids

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18
Q

Sarcoidosis

- treatment

A
  • no cure

- steroids

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19
Q

Chronic pancreatitis

- treatment

A
  • cessation etoh and smoking
  • small, low-fat meals
  • pain: TCAs, narcotics, occasional hospitalizations for NPO
  • pancreatic enzymes
  • medium chain TG - easily absorbed and provide extra calories if weight loss
  • malabsorption vitamins may occur but usu not clinically sx
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20
Q

Secondary prophylaxis for rheumatic fever post acute rheumatic fever with valvular effects

A
  • IM PCN G q 21-28 days until age 40
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21
Q

Heart failure

- RF

A
  • myopathy
  • familial heart dz
  • rheumatic heart dz
  • hyperthyroid
  • pheochromocytoma
  • dyslipidemia
  • DM
  • HTN
  • sleep apnea
  • PAD
  • substance abuse
  • chemo/radiation to chest
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22
Q

ABI

  • ratio of what indicates PAD
  • falsely high reading means what
A
  • <0.90

- falsely high ABI can occur when pt has severely hardened peripheral arteries which are non-compressible

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23
Q

PAD

- treatment

A
  • address underlying dz process
  • antiplatelets
  • stent or sx if severe
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24
Q

Classic signs of acute adrenal insufficiency

A
  • profound weakness
  • severe abd pain
  • peripheral vascular collapse
  • electrolyte abnl
  • shock
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25
Adrenal insufficiency | - labs
- hyponatremia - hypoglycemia - hyperkalemia
26
Adrenal insufficiency | - labs
- hyponatremia - hypoglycemia - hyperkalemia
27
Adrenal insufficiency | - treatment
- glucocorticoids - regulate NA and K - fludrocortisone (mineralocorticoid)
28
How to treat systemic acidosis in status epilepticus
- watchful wait for auto-correction once seizure activity is controlled - acidosis thought to have anticonvulsant properties
29
Status epilepticus | - treatment
- benzo: midazolam, lorazepam, diazepam etc - anticonvulsant: phenytoin, fosphenytoin, valproic acid, etc. - next step: barbiturate or general anesthetic like propofol
30
Hypercalcemia | - 2 common causes
- primary hyperparathyroidism | - malignancy
31
Hypercalcemia | - treatment
- bisphosphonates: zoledronic acid, pamidronate | - refractory: denosumab
32
Infective endocarditis | - best diagnostic test to confirm
- TEE
33
Infective endocarditis | - MCC organisms
- IVDA: S. aureus, tricuspid valve | - Native valve: streptococci, mitral vavle
34
Nephrolithiasis | - stone size and likelihood to pass
- <4-5 mm pass with little medical management | - >8-10 mm unlikely to pass spontaneously, may require stent, nephrostomy, lithotripsy, etc.
35
Nephrolithiasis | - when is urgent urology referral indicated
>8 mm stone
36
Kidney findings that require emergent treatment
- hydronephrosis with UTI | - ureteral obstruction in transplanted kidney
37
nephrolithiasis | - dx
- helical CT
38
Nephrolithiasis | - mc type stone
Calcium oxalate - struvite from urease predicting bacteria - uric acid: gout - cystine: metabolic dz
39
What metabolic condition does persistent diarrhea cause
- metabolic acidosis | * normal anion gap acidosis, due to loss of bicarbonate
40
Normal anion gap metabolic acidosis
- diarrhea - renal tubular acidosis - early renal failure - carbonic anhydrase inhibitors
41
Increased anion gap metabolic acidosis
MUDPILES - methanol - uremia - DKA - proplyene glycol - isoniazid intoxication - lactic acidosis - ethanol, ethylene glycol - salicylates
42
CAP - how to determine if should be hospitalized?
CURB65 - Confusion - Urea > 7 - RR >=30 - BP: <= 90 / 60 - >65 yo 0-1 point: home tx 2 point: prob admission vs. close outpatient 3+: admission, manage as severe
43
Hodgkin Lymphoma | - dx
- excisions biopsy: Reed-Sternberg cells
44
Hodgkin Lymphoma | - clinical
- lymphadenopathy - often cervical and painless - pruritis - fever - night sweat - unintentional weight loss - frequent infection -
45
Hodgkin Lymphoma | - cure rate
70-80%
46
Hodgkin Lymphoma | - remission health maintenance
- Q3 month follow up first 5 years - H&P, lab: CBC, lipid, ESR, glucose - periodic eval for long term complications: breast, lung cancer, CVD, hypothyroid
47
Screening for HCC
- liver US q 6 months
48
HCC - MCC - sx - dx
- HBV and HCV cirrhosis - rapidly increasing ascites - bloody ascitic fluid - increased AFP
49
Polyarteritis nodosa | - overview
- necrotizing vasculitis - medium sized muscular arteries - associated with HBV, HCV
50
Polyarteritis nodosa | - sx
- fatigue, weight loss, weakness, fever, arthralgia - skin: tender red nodules, purpura, jivedo reticulaire, ulcers, bullous/vesicular eruption - kidneys: HTN, renal failure - Neuro: wrist/foot drop
51
Polyarteritis nodosa | - treatment
steroids
52
Pneumocystitis pneumonia | - organisms
- fungus: pnuemocystis jirovecii
53
Pneumocystitis pneumonia | - patient most likely to get it
HIV with CD4 <200
54
Pneumocystitis pneumonia | - clinical
- DOE - dry cough - fever - elevated LDH
55
Pneumocystitis pneumonia | - treatment
- Bactrim first line | - steroids if PO2 <70
56
Sarcoidosis | - dx if suspicious CXR findings
endobronchial lung biopsy
57
Celiac dz - screening - confirmation testing
- IgA: Antigliadin antibodies - IgA: tissue transglutaminase - IgA: endomysial antibodies - duodenal biopsy confirmation
58
Celiac dz | - associated dz
- Dermatitis herpetiformis - T1DM - Other autoimmune - MC in Downs, Turner, Williams syndromes
59
Paget's disease of bone | - pathophys
- hyper vascular bone - causes osteolysis and then overactive osteoblastic activity = high bone turnover - new bone/collagen is disorganized with mosaic pattern "woven bone" - weaker, more porous, hyper vascular, prone to fracture
60
Paget's disease of bone | - sx
- warmth, tenderness pain at site - most are asx - MC locations: skull, spine, femur, pelvis**, sacrum
61
Paget's disease of bone | - dx
- XR: lytic lesions, bony enlargement, cortisol thickening, etc. - Skull has classic "cotton wool" appearance - elevated alk phos
62
Paget's disease of bone | - tx
- bisphosphonates first line - Calcitonin - Supplemental Ca and Vitamine D - NSAIDS/acetaminophen for pain
63
Side effect of sildenafil
``` cyanopsia - blue discoloration of vision - more likely with higher doses - usually temporary Also: hypotension, flushing, HA ```
64
PDE-5 inhibitors | - MoA
- inhibits PDE-5 corpus cavernosum smooth muscle relaxation = blood flow erection
65
If asthmatic needs to be intubated, what induction agent should be used
Ketamine: improves pulmonary function | - direct smooth muscle dilator and increases catecholamines which also dilate smooth muscles tc.
66
Cardiac biomarkers - Detectable time - Peak time - return to baseline * Troponin, Creatinine kinase, myoglobin
- Troponin: 3-12 hr, 34-48 hrs, 5-14 days - CK: 3-12 hrs, 24 hrs, 48-72 hrs - myoglobin: 1-2 hrs, 8-10 hrs, 1-2 days
67
type of genetic transmission of hemophilia A and B
X-linked recessive
68
Acute angle closure glacuoma | - dx
- gonioscopy: examine the angle formed between cornea's posterior surface and iris' anterior surface
69
SLE | - lab testing
- ANA (best initial, 95% sensitive) - Anti-DNA antibodies - Anti-smith antibodies
70
SLE | - sx
- fever - lymphadenopathy - weight loss - general malaise - arthritis - malar rash
71
SLE | - treatment
- NSAIDs - steroids - immunosuppresants - hydroxychloroquine
72
SLE | - drugs that induce
HIPPS - hydralazine - INH - Procainamide - Phenytoin - Sulfonamides
73
Iron deficient anemia | - sx
- koilonychia - atrophic glossitis - angular cheilosis - fatigue, weakness, HA - pallor - dry/rough skin - blue sclerae
74
Jarisch Herxheimer reaction | - explain
Classically occurs within first 24 hours after tx for spirochetal infection, syphilis
75
Jarisch Herxheimer | - clinical
- fever - chills - malaise - HA - tender lymphadenopathy - worsening infectious lesions
76
Jarisch Herxheimer | - tx
symptomatic: acetaminophen/ibuprofen
77
Best way to diagnose pneumonconiosis
CXR
78
Carcinoid tumor | - overview
- neuroendocrine tumor - usu in GI, then lungs, anywhere else - secrete hormones, often serotonin - if symptemic symptoms, then considered carcinoid syndrome
79
Carcinoid syndrome | - sx
- facial/trunk flushing - sudden/severe diarrhea - telangiectasia - wheezing - palpitations
80
Theophylline and acute exacerbation COPD
- contraindicated | - if used for chronic treatment, continue using it to maintain therapeutic serum level
81
Methotrexate | - Potential severe ADR
- hepatotoxicity - Pulmonary toxicity - infection - myelosuppression - lymphoproliferative disorders - nephrotoxicity ** check CBC and CMP 6 weeks after changing dose
82
What vitamin should be started with methotrexate?
folic acid - it is a folate inhibitor
83
What med for rheumatoid arthritis is safe while trying to conceive?
hydroxychloroquine | - should stop all RA meds when pregnant but is best option if have to use something
84
What testing should be done for methotrexate ADR?
annual ophthalmic exam | - can cause corneal and macular toxicity
85
RA | - serologic tests
- RF | - anti-cyclic citrullinated peptide ab
86
Sjogren's | - best med for dry mouth
Sevimeline | - cholinergic agent
87
Sjogren's | - overview
- destruction of exocrine glands (salivary and lacrimal) | - dry mouth and eyes
88
Sjogren's | - lab findings
- Anti-Ro/SSA or anti-La/SSB - RA - hyperglobinemia
89
Sjogren's | - dx
Schirmer test
90
Polymyositis | - what muscle is bx for confirmation
- Quadriceps femoris - proximal muscle and big - can bx deltoid if want UE
91
what drug can be added to statin to further reduce cardiovascular risk?
Ezetimibe: the only non-statin lipid-lowering drug that has proven to have addictive effects on prevention of CV adverse effects
92
TSH goal for patient post thyroidectomy
0.1-2.0 | normal 0.5 - 5.0
93
Most common type of thyroid cancer
papillary
94
Pheochromocytoma | - meds that should be dc on diagnosis
meds that stimulate pheo activity: - BB (without alpha blocking agents) - glucagon - metoclopramide - histamine
95
When to start lipid screening - male - female * with and without RF
- Male >= 35 - male 20-35 with RF - Female >= 45 - Female 20-45 with RF
96
What HF patients need hospitalization?
- dyspnea at rest - ACS - hemodynamically sig dysrhythmias - acute decompensation: low bp, AMS, worsening renal function - new onset HF with congestion
97
Outpatient med treatment of HF
- diuretics - ACEi - positive inotropes - BB
98
Myocarditis | - causes
- infection - autoimmune - cardiotoxic drugs - systemic inflammation - radiation - idiopathic
99
Myocarditis | - s/sx
- asx - HF, sudden cardiac death - fatigue, exercise intolerance - chest pain, pericarditis - Nonspecific ST changes - ECHO: nl or wall motion defects - cardiac enzyme elevations
100
Myocarditis | - Dx
- clinical presentation - Cardiac cath and cardiac MRI to differentiate from MI - endomyocardial bx for definitive dx but usually not done
101
Myocarditis | - tx
- usually supportive bc MCC is viral - DC drug if cause - steroids
102
Cause of jaundice in thyroid storm
hepatic tissue hypoxia due to increased peripheral consumption of O2
103
PTU and Methimazole MoA
- Both: block synthesis of thyroid hormone | - PTU: also inhibits conversion of thyroxine to triiodothyronine
104
Thyroid storm treatment
1. BB 2. PTU (or methimazole) 3. Iodine 4. Steroids 5. Bile acid sequestrant
105
Polycystic kidney disease | - genetics
- Autosomal dominant | - Cyst formation and kidney enlargement
106
Polycystic kidney disease | - Clinical
- abdominal, flank, back pain - HTN (usu diastolic elevation) - palpable bilateral flank mass, nodular hepatomegaly, sx related to renal failure
107
Polycystic kidney disease | - Dx
US test of choice
108
Polycystic kidney disease | - management
- blood pressure control: ACEi/ARB - electrolyte management - UTI prevention/tx - pain management - nephrectomy
109
Polycystic kidney disease | - complications
ESRF by age 60 = dialysis or kidney transplant
110
Renal cell carcinoma | - incidence
MC type kidney cancer adults
111
Renal cell carcinoma | - RF
cigarette smoking** - obesity - chemical exposure - HTN
112
Renal cell carcinoma - classic sx triad - other sx
- flank pain - hematuria - flank mass * * few actually present this way - weight loss - fever - HTN - hypercalcemia - night sweats - malaise - L varicocele in men
113
Renal cell carcinoma | - dx
- UA: abnl cells - CBC: anemia/infection - Electrolytes: eval kidney function - CT, PET, US, MRI
114
Renal cell carcinoma | - managemetn
surgical resection
115
Antiphospholipid syndrome | - overview
- hypercoagulable state | - recurrent venous/arterial thrombosis at early age
116
Antiphospholipid syndrome | - who should be tested
- thrombosis with no RF - miscarriage - esp late trimester or recurrent - heart murmur or valvular vegetation - heme abnl - pulm htn
117
Antiphospholipid syndrome | - testing
- lupus anticoagulant - anticardiolipin - anti-beta 2 glycoprotein I ab
118
Antiphospholipid syndrome | - management
- Low dose ASA for primary prevention of thrombotic events | - Warfarin for recurrent thrombotic events
119
Pulmonary Fibrosis | - overview
- fibrosing interstitial pneumonia - MC in M > 50 - linked to cigarette smoking
120
Pulmonary Fibrosis | - pathophys
- epithelial cell damage - impropre repair - chronic/progressing sx
121
Pulmonary Fibrosis - Sx - PE
- chronic nonproductive cough - gradual DOE - bibasilar crackles, digital clubbing
122
Pulmonary Fibrosis | - Dx
CT: structural change t lung parenchyma, honeycombing
123
Hyponatremia | - three types
- isotonic / pseudohyponatremia - hypertonic - hypotonic / True hyponatremia (MC)
124
Hyponatremia | - MCC
disordered renal excretion of water
125
Hyponatremia | - hypertonic
- increased conc serum solutes - increased tonicity draws water into serum = dilution of serum concentration - ex. hyperglycemia, IVIG, mannitol administration
126
Hyponatremia - hypotonic - associated diseases, etc.
- renal failure - CHF - liver failure - SIADH - hypothyroid - GI fluid losses - Drugs: thiazide, ecstacy
127
Hyponatremia - correction rate - to avoid what
- <8 mEq/L in 24 hours | - avoid osmotic demyelination syndrome
128
Diabetes insipidus | - two types
- Central: MC, deficient secretion of ADH by posterior pituitary - Nephrogenic: kidney's resistant to ADH
129
Diabetes insipidus | - Central causes
- idiopathic - head trauma - pituitary sx - encephalopathy
130
Diabetes insipidus | - presentation
- polyuria - polydipsia - hypernatremia if impaired thirst drive
131
Diabetes insipidus | - lab
- low specific gravity urine - low urine osmolality - high plasma osmolality
132
Diabetes insipidus | - dx
Water restriction test | - positive if continue to produce dilute urine with low osmolality and spec gravity
133
Diabetes insipidus | - test to differentiate between central and nephrogenic
Desmopressin stimulation test - Central: urine osmolality will increase dt response to ADH - nephrogenic: dilute urine continues, no response to ADH
134
Diabetes insipidus | - management
desmopressin acetate
135
Histoplasmosis - location - associated with what
- Ohio and Mississippi River valleys | - spelunking, caves, bats, bird droppings
136
Histoplasmosis | - sx
- asx - mild influenza-like illness - 103 days - cough, chest pain - often dx as atypical PNA
137
Histoplasmosis | - sx of progressive disseminated
- HIV | - fever, weight loss, cough, dyspnea, oropharyngeal ulcers, etc.
138
Histoplasmosis | - management
- itraconazole | - amphotericin B for severe
139
Scleroderma | - overview
- autoimmune dz - vascular damage and excess production and deposition of collagen - Almost 100% skin involvement
140
Scleroderma | - common early sx
- skin tightening around fingers | - pitting of fingertips
141
Scleroderma | - two main kinds
- localized | - systemic
142
PAD | - core treatment
- ASA - statin - smoking cessation - structured exercise - Cilostazol
143
WPW | - EKG findings
- slurred upstroke QRS (delta wave) - Wide QRS (>120 msec) - short PR (<120 msec)
144
WPW | - treatment
- ablation | - procainamide/quinidine
145
PNA - treatment outpt - treatment inpt
- macrolide or doxy | - FQ or ceftriaxone/cefotaxime + macrolide X 5D or until afebrile 48-72 hrs
146
Acute exacerbation chronic bronchitis | - tx
- 2nd gen ceph | - macrolide or bactrim
147
Medical management of COPD
- anticholinergics - ipatropium and tiotroprium - SABA for acute exacerbation dyspnea - Oral abx for infections
148
PE | - dx
- spiral CT - ABG: resp alkalosis secondary to hyperventilation - EKG: S1Q3T3 - VQ - D-dimer: can rule out if negative and had low pre-test probability - Angiography is definitive test of choice
149
PE | - Management
- anticoagulation: heparin for acute, LMWH or warfarin after acute phase - Factor Xa inhibitors and direct thrombin inhibitors alt options - min 3 months - vena cava filter: helpful if high risk recurrance
150
Pulmonary Hypertension | - s/sx
- dyspnea - angina-like retrosternal pain - waekness - fatigue - edema - ascites - cyanosis - effort syncope - narrow splitting/accentuation of second heart sound and systolic ejection click
151
Pulmonary Hypertension | - Dx
- CXR: enlarged pulm arteries - EKG: RVH, atrial hypertrophy, RV strain - Echo: estimate pulm arterial pressure - Right heart cath: precise hemodynamic monitoring. >= 25 mmHg is dx
152
Pulmonary Hypertension | - management
- oral anticoagulant - CCB: lower systemic arterial pressure - treat underlying disorder
153
Idiopathic pulm fibrosis - overview - RF
- C dx among pt with interstitial lung dz - Men 50-75 - RF: smoking, wood/metal dust, virus, DM, GERD
154
Idiopathic pulm fibrosis | - S/Sx
- insidious dry cough, exertional dyspnea, constitutional sx | - clubbing of fingers, inspiratory crackles
155
Idiopathic pulm fibrosis | - dx
- CXR: progressive fibrosis over several years - CT: diffuse, patchy fibrosis with honeycombing - PFT: restrictive (dec lung volume, normal/increased PEV1/FVC)
156
Pneumoconioses | - overview
- chronic fibrotic lung dz | - inhalation dusts, lots of kinds
157
Pneumoconioses | - Asbestosis: occupation, dx, complications
- insulation, demolition, construction - CXR: linear opacities at bases, pleural plaques - Bx: asbestos bodies - complications: lung cancer, mesothelioma (esp if smoke)
158
Pneumoconioses | - Coal workers: occupation, dx, complications
- coal mining - CXR: nodular opacities upper lung fields - progressive massive fibrosis
159
Pneumoconioses | - Silicosis: occupation, dx, complications
- mining, sand, stone, quarry - CXR: nodular opacities upper lung fields - Inc risk TB, progressive massive fibrosis
160
Pneumoconioses | - Berylliosis: occupation, dx, complications
- high tech: aerospace, nuclear power, ceramics, etc. - CXR: diffuse infiltrates and hilar adenopathy - requires chronic steroids
161
Pneumoconioses | - management
- supportive: O2, vaccinations, rehab | - smoking cessation
162
ARDS | - clinical setting
- Sepsis - severe multiple trauma - aspiration of gastric contents
163
ARDS | - pathophys
- increased permeability of alveolar capillary membranes = protein rich pulmonary edema
164
ARDS | - clinical
- rapid onset profound dyspnea 12-24 hours after precipitating event - PE: tachypnea, frothy pink/red sputum, diffuse crackles - cyanosis, severe hypoxemia refractory to O2
165
ARDS | - mgmt
- Tx underlying condition - supportive: O2 via intubation with Positive pressure ventilation and PEEP ** high rate of mortality!!
166
Pneumonia | - MC org in children >5
- mycoplasma pneumonia | - strep pneumonia
167
Pneumonia | - treatment for atypical CAP
macrolide - azithromycin
168
What is used to determine if pleural effusion is exudative or transudative
Light Criteria - pleural:serum protein - pleural:serum LDH - pleural fluid LDH
169
``` Light criteria (pleural fluid) - Transudate ```
- pleural:serum protein <0.5 - pleural:serum LDH <0.6 - pleural fluid LDH <2/3 upper limit nl - HF, cirrhosis, nephrotic syndrome, PE
170
``` Light criteria (pleural fluid) - Exudate ```
- pleural:serum protein >=0.5 - pleural:serum LDH >=0.6 - pleural fluid LDH >2/3 upper limit nl - malignancy, pneumonia, TB, PE, pancreatitis, etc
171
who should be screened for lung cancer
- adults 55-80 | - 30 year smoking history and currently smoke or quit within the last 15 years
172
Carcinoid syndrome | - treatment
octreotide
173
Solitary pulmonary nodule | - risk by size and follow up
- <6 mm - low risk - no follow up necessary - 6-8 mm: follow via CT - >8 mm: serial CT if low to intermediate risk - if high prob of malignancy, bx and excision should be considered
174
Lofgren syndrome
- acute presentation of sarcoidosis - hilar adenopathy, erythema nodosum, polyarthralgia - MC in women
175
Carcinoid syndrome | - dx
24-hour excretion of 5-hydroxyindoleacetic acid (5-HIAA), the end product of serotonin metabolism
176
Pneumonia | - MC bacteria infection sp influenza
- staph aureus - necrotizing pneumina - gram positive cocci in clusters
177
Causes of acute cor pulmonale
- PE - ARDS **usually chronic (COPD)
178
common side effect of SABA
- tremor - tachycardia - hypokalemia (inc activity Na-K-ATPase pump)
179
Sarcoidosis | - MC lab abnormality
hypercalcemia
180
What meds are used to rate control a fib.
- CCB: diltiazem or verapamil | - BB: metoprolol
181
Congenital long QT syndrome | - treatment
propranolol
182
Medication of choice to treat a. fib with RVR in patient who also has compensated systolic HF
carvedilol
183
Supraventricular tachycardia | - treatment
- vagal maneuver: cold face, blow through straw, gag reflex | - Meds: adenosine, procainamide, amiodarone, BB
184
When is verapamil CI
- <1 years old - children with HF - suspected WPW syndrome - wide QRS complex
185
what med can be used in patients with chronic stable angina who remain symptomatic?
ranolazine
186
EKG findings in hyperkalemia
- peaked T wave - prolonged PR - wide QRS - eventually sine wave
187
What tachydysrythmythia is MC with sick sinus syndrome
atrial fibrillation
188
Stable pt with ventricular fibrillation - medication of choice
procainamide
189
Min recommended anticoagulation after cardioversion for a fib
30 days
190
MCC tricuspid valve stenosis
rheumatic heart dz
191
Polyarteritis Nodosa | - overview
- autoimmune dz | - necrotizing vasculitis of small and medium muscular arteries and renal and visceral arteries
192
Polyarteritis Nodosa | - presentation
- cutaneous manifestations - constitutional: fever, asthma, myalgias - nodules: painful violacious plaques surrounded by lived reticularis "starburst". Classically on lower legs
193
Polyarteritis Nodosa | - Untreated =
- CV involvement - bowel infarction and perforation - renal failure * * high morbidity and mortality
194
Polyarteritis Nodosa | - Dx
deep wedge biopsy of suspicious nodules
195
Polyarteritis Nodosa | - Treatment
steroids
196
What cholesterol medication can exacerbate gout and elevate blood sugar?
Niacin
197
DMARDS ADR
- Common: nausea, vomiting, diarrhea, rash | - bone marrow suppression
198
Methotrexate | - common ADR
hepatitis and hepatic toxicity
199
Polymyositis | - overview
idiopathic inflammatory myopathy | - common F >50
200
Polymyositis | - presentation
- proximal myalgia/weakness - pharyngolaryngeal weakness: dyspnea, pysphagia, pysphonia - Classic findings: heliotrope rash (eyelids), cloak-like/cape rash on neck shoulders and chest, Gottron's papules (scaly purple thick knuckle skin)
201
Polymyositis | - Treatment
- steroids
202
What common medication can cause gout
- diuretics: loop or thiazide | - decrease rate excretion
203
Rheumatoid Arthritis | - overview
- chronic, inflammatory - autoimmune - symmetric destructive polyarthropathy - incidence inc 25-55 years - F>M
204
Rheumatoid Arthritis | - clinical
- Pain worse in am, better with activity - insidious onset - swelling - usu peripheral joints - polyartricuar - ulnar deviation - flexor tenosynovitis - boutonniere deformity and swan-neck deformity
205
Scleroderma | - MC lab finding
ANA +
206
What medication helps with drymouth
Pilocarpine | Sjogrens
207
Raynaud's | - medical treatment
- ASA - Prostaglandins - vasodilators - CCB
208
Infections that MC cause reactive arthritis
- enteric: c. jejune and shigella dysenteriae | - GI: chlamydia
209
Cholchicine toxicity
severe GI distress first 24 hours
210
Polymyalgia Rheumatica | - clinical
- symmetrical aching and stiffness - shoulders, hip, neck, torso - worse in AM - >50
211
Polymyalgia Rheumatica | - tx
steroids
212
Major ADR of long term use of hydroxychloroquine
retinal toxicity | - ophthalmologic exam q 6-12 months
213
What med can be used for gout if colchicine and NSAIDs are CI
corticosteroids
214
Esophageal cancer | - types
1. Squamous cell | 2. adenocarcinoma
215
Esophageal cancer | - squamous cell RF
Tobacco | Etoh
216
Esophageal cancer | - adenocarcinoma
- Barrett's metaplasia (chronic untreated GERD) | -
217
Esophageal cancer | - presentation
- progressive dysphagia | - weight loss common
218
Esophageal cancer - dx - location of each type
- EGD w/ bx - SCC: middle thoracic esophagus - Adeno: distal esophagus and GE junction
219
Schatzki Ring
- MC esophageal structural abnl - fibrous esophageal ring leads to esophageal stenosis - dysphagia
220
Achalasia | - overview
- MC dysmotility disorder - dysphagia - often pt <50
221
Achalasia | - pathophys
- loss of Auerbach's plexus in esophagus - narrowing of lower esophageal sphincter (LES) - "bird beak" appearance
222
Achalasia | - clinical
- dysphagia to solids and liquids. Liquids often most problematic - difficulty belching - chest pain - regurg undigested food - dyspepsia - aspiration
223
Achalasia | - Dx
- barium esophagram = birds beak | - confirm with esophageal manometry
224
Achalasia | - mgmg
- balloon dilation of LES | - myotomy with fundoplication
225
Mallory-Weiss Syndrome | - pathophys
- laceration to gastric cardia due to forceful vomiting - often also have hiatal hernia - longitudinal mucosal lacerations
226
Mallory-Weiss Syndrome | - RF
- forceful vomiting or other causes of intra-abdominal pressure increase: cough, strain, etc. - Etoh - ASA - bulimia
227
Mallory-Weiss Syndrome | - Dx
- upper GI bleed with hx of vomiting or retching | - Upper endoscopy to confirm
228
Mallory-Weiss Syndrome | - mgmg
- supportive - endoscopic treatment if active bleeding - Acid suppression if no active bleeding
229
Esophageal varices | - cause
- cirrhosis > portal hypertension > varices
230
Esophageal varices | - acute mgmg
- hemodynamic resuscitation - octreotide - banding/sclerotherapy - prophylactic abx
231
Esophageal varices | - chronic mgmt
- BB | - endoscopic variceal ligation
232
Esophageal varices | - Dx
- upper endoscopy: dilated submucosal gastric veins
233
Gastric cancer | - Overview
- MC adenocarcinoma - mean age dx 70 - M>F
234
Gastric cancer | - RF
- nitrates - h. pylori - tobacco use
235
Gastric cancer | - clinical
- upper abd pain: vague or severe - postprandial fullness - early satiety - nausea - weight loss - recurrent vomiting
236
Gastric cancer | - PE
- palpable enlarged stomach | - enlarged liver
237
Gastric cancer | - mgmt
- chemo - resection - radiation
238
Gastric cancer | - dx
EGD
239
Benign esophageal stricture | - Causes
- Chronic reflux esophagitis - medications - Radiation - Eosinophilic esophagitis
240
Benign esophageal stricture | - Sx
- MC: progressive solid food dysphagia - liquid dypshagia - heartburn - odynophagia - weight loss - chest pain - et.
241
Benign esophageal stricture | - Dx
- Barium esophagram - endoscopy - esophageal manometry - 24 hour ph monitoring
242
Benign esophageal stricture | - MC initial treatment
- balloon dilation | - PPI
243
Trousseau's syndrome - associated with what - describe
- pancreatic cancer | - migratory thrombophlebitis
244
Courvousier's sign - associated with what - describe
- pancreatic cancer | - palpable, contender gallbladder
245
Primary adrenal insufficiency | - overview
- MCC autoimmune adrenalitis | - loss of glucocorticoids, mineralocorticoids, adrenal androgens
246
Primary adrenal insufficiency | - clinical
- hyperpigmentation - fatigue - anorexia - orthostasis - n/v/d - abdominal pain - muscle and joint pain - salt craving
247
Primary adrenal insufficiency | - dx
- serum morning cortisol level first - confirm with ACTH stimulation test - ACTH to differentiate between causes
248
Primary adrenal insufficiency | - mgmt
- hydrocortisone | - supportive
249
Primary adrenal insufficiency | - labs
- reduce sodium and glucose | - increased potassium
250
Thyroid storm | - RF
- sx - trauma - infectin - acute iodide load - parturition
251
Thyroid storm | - clinical
- tachycardia >140 - HF - Hypotension - Dysrhythmia (a. fib) - Hyperpyrexia - Agitation - Psychosis, stupor - Coma
252
Thyroid Storm | - Labs
- Low TSH | - High FT3,4
253
Thyroid STorm | - Mgmg
- BB: propranolol - Thionamides (PTU) - Iodine (after thionamide) - Steroids - Bile acid sequestrants
254
Diabetes | - diagnostic criteria
- Sx + random glucose >200 - Fasting >126 on two occasions - Plasma glucose >200 2 hours after 75 glucose load OGTT - A1C > 6.5% (adults)
255
Hashimotos' thyroiditis | - ab
- anti-thyroid peroxidase ab | - anti-thyroglobulin ab
256
Diabetes insipidus | - overview
- disorder of ADH fn - central: production - nephrogenic: action at the kidney
257
Diabetes insipidus | - clinical
- polyuria | - polydipsia
258
Diabetes insipidus | - labs
- UA without glucose or protein - UA with low specific gravity, low osmolality, dilute color - Increased serum osmolality
259
Diabetes insipidus | - dx
- UA | - desmopressin stimulation test to determine type
260
Diabetes insipidus | - mgmt
- central: DDAVP | - Nephrogenic: hctz, amiloride, indomethacin
261
Acromegaly | - clinical
- insidious onset - enlarged supraorbital ridges, mandible - widened nose - arthralgia, fatigue, hA - increased ring/shoe size, visual field defects - weight gain - bone growth - glucose intolerance
262
Acromegaly | - pathophys
- growth hormone secreting pituitary adenoma
263
Acromegaly | - dx
- Initial: serum IGF-1 - GH blood test - MRI to confirm
264
Acromegaly | - mgmt
transsphenoidal sx to remove adenoma
265
Graves | - which medication best during pregnancy
- PTU 1st and 2nd trimester | - Methimazole 3rd trimester
266
What medication blocks the release of stored thyroid hormone
Iodine
267
Major ADR of GLP-1 medication
pancreatitis
268
TIA | - medication mgmt
ASA | also clopidogrel and combo therapy
269
Guillain-Barre | - overview
- acute immune-mediated polyneuropathy
270
Guillain-Barre | - related to what infection
Campylobacter jejuni
271
Guillain-Barre | - clinical
- progressive, ascending, symmetric muscle weakness | - absent or depressed DTR
272
Guillain-Barre | - Dx
- clinical | - Lumbar puncture: albuminocytologic dissociation: elevated protein with normal/mild pleocytosis
273
Guillain-Barre | - mgmt
- supportive - measure vital capacity and negative inspiratory force - plasmapheresis - IVIG
274
What anticonvulsant is highly teratogenic?
valproic acid
275
Trigeminal neuralgia | - medication
Carbamazepine
276
Migraine | - Acute exacerbation
- Triptans - Ergots - NSAIDs - Acetaminophen - Antiemetics
277
Migraine | - prophylaxis
- Propranolol - verapamil - Amytriptyline - Valproic acid, topiramate - Botox
278
Intracranial neoplasm - MCC - other common casues
- metastases (lung, breast) - Meningioma MC primary - Glioma MC malignant
279
HA from brain tumor are classically worse during what time of day
morning - intracranial pressure highest after night of recumbent posture
280
Huntington's Disease | - genetics
- autosomal dominant | - CAG trinucleotide repeats
281
Huntington's Disease | - pathology
- neuronal loss - astrogliosis - atrophy of caudate nucleus and pitman (basal ganglia) and cerebral cortex
282
Huntington's Disease | - 3 main sx
- movement disorder: chorea, ballism, dystonia, parkinsonian features - cognitive: dementia - mood/behavior: depression, bipolar, psychosis, personality, sex/sleep disturbance
283
Chorea
- excessive, spontaneous and abrupt movements or irregular frequency and random distribution - Ex: restlessness, fidgeting, gesture and facial expression alterations and dancelike gait
284
choreathetosis
slow distal writhing movements | - milder form chorea
285
Ballism
gross, proximal, flinging movements of the extremities
286
Athetosis
contorted, twisting movements
287
Huntington's Disease | - Mgmt
- benzos - dopamine-depleting meds - dopamine-antagonist meds
288
Subdural hemorrhage | - chronic vs. acute
- acute within 3 days of presentation | - chronic: >3 weeks old
289
Chronic Subdural hemorrhage | - who is at elevated risk
- elderly | - alcoholic
290
Chronic Subdural hemorrhage | - clinical presentation
- insidious onset HA - cog impairment - somnolence - occasional seizures
291
Chronic Subdural hemorrhage | - imaging
- CT: hypodense (dark) crescent (isodense compared to cerebrospinal fluid)
292
Epidural vs. subdural hematoma
Epidural - artery (middle meningeal): rapid expansion - skull fracture - dura pushed inward (convex) Subdural - bridging veins: slow expansion - does not cross falx, tentorium bc dura attached to the skull
293
Epidural vs. subdural hematoma
Epidural - artery (middle meningeal): rapid expansion - skull fracture - dura pushed inward (convex) Subdural - bridging veins: slow expansion - does not cross falx, tentorium bc dura attached to the skull
294
Caloric testing
- tests oculovestibular reflex of eye - intact brain stem will = nystagmus - truly comatose = no response * * COWS: cold opposite (fast portion will beat towards opposite ear) and warm same
295
Increased intracranial pressure | - triad of sx
Cushing Triad: - bradycardia - HTN - irregular breathing * sign of impending brain herniation...
296
Parkinson's Disease | - MC medication
L-dopa: carbidopa/levodopa - Levodopa converted to dopamine in brain - carbidopa prevents conversion in peripheral circulation - Con: increased dose required over time, does not slow dz progress, causes tardive dyskinesia
297
Parkinson's Disease | - med for motor abnl
dopamine agonists - bromocriptine - pramipexole - ropinirole * less benefit but less side effects than L-dopa
298
Parkinson's Disease | - med for motor abnl
dopamine agonists - bromocriptine - pramipexole - ropinirole * less benefit but less side effects than L-dopa
299
Parkinson's Disease | - pathophys
- lewy bodies (intracellular cytoplasmic inclusions) - dopaminergic neuron loss in substantia nigra - depigmentation
300
Meningitis - MCC for all ages - 2nd MCC
- Streptococcus pneumonia | - Neisseria meningitidis: older children/young adults (dorm, military)
301
Which infectious org is most commonly associated with meningitis with petechiae?
N. meningitidis
302
Meningitis | - empiric treatment
- Ceftriaxone + vancomycin | - add ampicillin if >50 or etoh (listeria)
303
Meningitis | - empiric treatment
- Ceftriaxone + vancomycin | - add ampicillin if >50 or etoh (listeria)
304
Classic triad of bacterial meningitis
- fever - AMS - nuchal rigidity
305
Meningitis - Brudzinski - Kernig
- Neck flexion = hip/knee flexion | - Flex hip and knee to 90, pain if extend the knee
306
Dystonic reaction | - medication to tx
- benztropine - diphenhydramine (anticholinergics)
307
Alzheimer Disease | - memory loss
- remote memory preserved better than recent memory
308
Alzheimer Disease | - progression
- ST memory loss - Language difficulty, disorientation, mood swing, loss motivation, self care - withdrawal - loss bodily fn - death
309
Glasgow Coma Scale | - Eye
4 spontaneous 3 opens to verbal 2 opens to pain 1 none
310
Glasgow Coma Scale | - Verbal
``` 5 oriented 4 confused 3 inappropriate response, discernible words 2 incomprehensible 1 none ```
311
Glasgow Coma Scale | - motor
``` 6 obeys commands 5 purposeful movement from pain 4 withdraws from pain 3 flexion/decorticate 2 extension/decerebrate 1 none ```
312
Glasgow Coma Scale | - motor
``` 6 obeys commands 5 purposeful movement from pain 4 withdraws from pain 3 flexion/decorticate 2 extension/decerebrate 1 none ```
313
Acute myasthenic crisis - cause - clinical - mgmt
- infection, medication - respiratory failure - mechanical ventilation - plasma exchange, IVIG
314
MCC acute onset altered consciousness in pediatric population
toxic ingestion
315
SAH | - classic signs
- Sudden onset worst HA of life - n/v - impaired consciousness > coma
316
SAH | - RF
- recent head trauma - HTN - tobacco - heavy Etoh * * females of advanced age greatest risk
317
SAH | - dx
- CT w/o contrast - CTA - LP if suspect but negative CT
318
SAH | - LP findins
- red | - yellow (xanthochromia)
319
SAH | - mgmt
- admission - cerebral angiography - Sx clipping/endovascular tx
320
Cryptococcus meningoencephalitis
- opportunist infection, usually CD4 <100 - progressive hA< nausea, malaise, fever (can be subtle) - CT > LP (elevated WBC with lymphcytosis, dec glucose, mild elevated protein) - IV amphotericin B
321
Vascular dementia | - RF
- hyperlipidemia - HTN - DM
322
Vascular dementia | - clinical
- patchy cog impairment - focal neuro s/sx - abrupt or stepwise onset
323
Vascular dementia | - mgmt
- prevent further strokes: antiplatelet drugs, control RF
324
Herpes simplex encephalitis | - Clinical
- rapid onset fever - HA - seizure - focal neuro sx - impaired consciousness - personality change
325
Herpes simplex encephalitis | - LP
- lymphocytic pleocytosis - inc RBC - inc protein - normal glucose
326
Herpes simplex encephalitis | - Mgmt
- IV acyclovir
327
Common side effect topiramate
CNS: - paresthesias** - nervousness - fatigue - ataxia - drowsy - dizzy, confusion
328
Common side effect topiramate
CNS: - paresthesias** - nervousness - fatigue - ataxia - drowsy - dizzy, confusion
329
Brain herniation - Cause - MC type - presenation
- ICP - uncle transtentorial - compression of parasympathetic fibers running with CN III = fixed and dilated pupil (unopposed sympathetic tone)
330
Brain herniation - Cause - MC type - presenation
- ICP - uncle transtentorial - compression of parasympathetic fibers running with CN III = fixed and dilated pupil (unopposed sympathetic tone)
331
Putamen hemorrhage | - signs
``` Rapid progression: - hemiplegia - n/v - HA Then: - ipsilateral deviation of eyes, stupor, coma, mydriatic pupils ```
332
Thalamic hemorrhage | - signs
- complete hemisensory loss | - aphasia and hemiparesis also common
333
Thalamic hemorrhage | - signs
- complete hemisensory loss | - aphasia and hemiparesis also common
334
What level does spinal cord terminate in adults
L1-L2
335
Median nerve - test motor - test sensation
- opposition of thumb and pinky | - tip of index finger
336
Radial nerve - test motor - test sensation
- wrist/finger extension | - sensation of first webspace dorsum
337
Ulnar nerve - test motor - test sensation
- 5th finger abduction | - 5th finger sensation
338
Carotid artery dissection | - how common
- common ischemic stroke in young patients | - may have underlying connective tissue disorder
339
Carotid artery dissection | - clinical
- abrupt severe neck, facial, retroorbital pain - Partial horner: mitosis and ptosis - carotid bruit
340
What test should be done on a patient who presents with stroke sx such as acute onset focal weakness?
finger stick glucose to rule out hypoglycemia
341
Myasthenia gravis | - overview
- autoimmune: ab vs. acetylcholine receptors | - muscle weakness and fatigue, worse with use
342
Myasthenia Gravis | - clinical
- ptosis - diplopia - blurred vision
343
Myasthenia gravis | - what improves the sx
cooling - "ice test" for ptosis
344
Myasthenia Gravis | - clinical
- ptosis - diplopia - blurred vision - normal DTR
345
Fell asleep on chair after night of drinking is what nerve
Radial: wrist drop | "Sat night palsy"
346
MCC spontaneous intracerebral hemorrhage
- HTN vasculopathy
347
Lidocaine OD | - sx
- dizzy - HA - tingling - tinnitus - sedation - tremor - seizure - bradycardia - Heart block - dysrhythmias
348
Lidocaine OD | - sx
- dizzy - HA - tingling - tinnitus - sedation - tremor - seizure - bradycardia - Heart block - dysrhythmias
349
Optic neuritis
- acute monocular loss of vision - dt focal demyelination of optic nerve - usually normal fundoscpic exam - pain with movement, afferent pupillary defect, loss of color vision (red) - related to MS
350
Optic neuritis
- acute monocular loss of vision - dt focal demyelination of optic nerve - usually normal fundoscpic exam - pain with movement, afferent pupillary defect, loss of color vision (red) - related to MS
351
Testicular cancer - dx tests - definitive diagnosis
- scrotal US, CT scan | - Radical inguinal orchiectomy
352
MC type testicular cancer
seminoma | 95% germ cell
353
Testicular cancer | - tumor marker
Serum alpha-fetoprotein
354
Prostatitis | - clinical
- fever, chills, perineal/back pain, dysuria, urinary retention - warm, exquisitely tender and boggy prostate
355
Prostatitis | - Mgmt
< 35: ceftriaxone and doxy | > 35: cipro or bactrim
356
Prostatitis | - Mgmt
< 35: ceftriaxone and doxy > 35: cipro or bactrim **4-6 weeks treatment
357
Prostate cancer | - Dx
- PSA - DRE - transrectal US guided bx
358
Prostate cancer | - screening
> 50 with life expectancy >10 years: - DRE - serum PSA
359
Prostate cancer | - screening
> 50 with life expectancy >10 years: - DRE - serum PSA
360
Nephrolithiasis | - stone composition
- calcium oxalate (MC) - uric acid - cystine - struvite
361
Nephrolithiasis | - dx
- poss leukocytosis - UA: hematuria, culture to r/o infection - CT without contrast - IV pyelogram: rare
362
BPH | - clinical
- hesitancy - Intermittence, incontinence - frequency, fullness - urgency - nocturia
363
BPH | - mgmt obstruction
- Foley cath | - suprapubic cath if foley placement fails
364
MC type prostate cancer
adenocarcinoma
365
Prostate cancer | - tx after prostatectomy
Leuprolide
366
Bladder cancer | - most definitive test
cystoscopy
367
Bladder cancer | - clinical
- dysuria - frequency, hesitancy - hematuria - sx of obstruction
368
Bladder cancer | - RF
- cigs | - industrial dye
369
Acute pyelonephritis | - Outpatient treatment
- Cipro, levo | - Bactrim
370
Acute pyelonephritis | - inpt treatment
- ceftriaxone - cipro/levo - aztreonam Severe: - cefepime - pipercillin-tazobactam - meropenem
371
Epididymitis | - clinical
- dull, unilateral scrotal pain - red, painful, swollen scrotum - relief with elevation
372
Epididymitis | - cause <35 and >35
<35 chlamydia and gonorrhea | >35 e. coli
373
Epididymitis | - mgmg
< 35: ceftriaxone and doxy | > 35: bactrim, FQ
374
Epididymitis | - dx
- clinical signs | - increased flow on doppler US
375
BPH | - medical mgmt
- alpha blockers (prazosin and tamsulosin) to relax bladder neck and improve urination - 5-alpha reductase inhibitors: block conversion testosterone, decreases size of prostate
376
Hodgkin Lymphoma - incidence - Assoc with what
- Bimodal: 20s and >50s, MC males | - Epstein-Barre virus
377
Hodgkin Lymphoma | - Clinical
- Painless lymphadenopathy - alcohol may induce lymph node pain - Advanced: night sweats, weight loss, cyclical fever
378
Hodgkin lymphoma | - Dx
- Reed Sternberg cells (owl eyes) large cells with bilobed or multi lobar nucleus - mediastinal lymphadenopathy (PET/CT)
379
Non-Hodgkin lymphoma - Overview - Risk factors
- lymphocyte neoplasm - MC >50 yo - ** peripheral lymph nodes - RF: age, immunosuppression (HIV)
380
Non-Hodgkin lymphoma - clinical manifestations - subtype name and sx
- Local painless lymphadenopathy (Gi, skin, CNS MC) | - Burkitt lymphoma: abd pain, jaw involvement, starry sky histology
381
Non-Hodgkin lymphoma | - managment
- unpredictable course | - rituximab
382
Multiple Myeloma | - pathophys
- proliferation of a single clone of a plasma cell - monoclonal ab (IgG and IgA MC) - ab accumulate in bone marrow, interrupt nl cell production
383
Multiple Myeloma | - Risk Factors
- >65 yo - AA - Men
384
Multiple Myeloma | - Clinical manifestations
BREAK - Bone pain (MC spine and ribs): osteolytic, destructive lesions - Recurrent infection dt leukopenia - Elevated calcium - Anemia - Kidney failure
385
Multiple Myeloma | - Dx
- Serum protein electrophoresis: monoclonal protein spike** - Urine protein electrophoresis: Bence-Jones proteins** - CBC: Rouleaux formation, increased ESR - Skull xray: punched out lesions - Bone marrow bx: plasmacytosis
386
Acute Lymphocytic Leukemia (ALL) - pathophys - distribution - RF
- malignancy of lymphoid stem cells - MC childhood (3-7 yo) - RF down syndrome
387
Acute Lymphocytic Leukemia (ALL) | - clinical
- Pancytopenia --> Fever (MC) | - CNS: HA, stiff neck, vision
388
Acute Lymphocytic Leukemia (ALL) - PE - DX
- hepatosplenomegaly, lymphadenopathy | - Bone marrow: hyper cellular >20% blasts
389
Acute Lymphocytic Leukemia (ALL) | - Tx
chemo
390
Chronic Lymphocytic Leukemia (CLL) - pathophys - Clinical
- B cell clonal malignancy | - Most asx, incidental finding on CBC, fatigue MC
391
Chronic Lymphocytic Leukemia (CLL) | - Dx
- well differentiated lymphocytes with "smudge cells" | - Pancytopenia
392
Acute Myeloid leukemia (AML) | - common population
MC acute leukemia in adults (>50)
393
Acute Myeloid leukemia (AML) | - Clinical
- pancytopenia: anemia, splenomegaly, gingival hyperplasia | - Leukostasis: WBC>100,000
394
Acute Myeloid leukemia (AML) | - Dx
Bone marrow bx: - Auer Rods - >20% blasts
395
Chronic Myelogenous Leukemia (CML) - pathophys - age - clinical
- granulocyte proliferation - Usu >50 yo - most asx until blastic crisis, splenomegaly
396
Chronic Myelogenous Leukemia (CML) | - Dx
- Philadelphia chromosome (tx with imatinib) | - Very high WBC counts
397
TTP | - classic pentad
1. fever 2. thrombocytopenia 3. renal failure 4. neuro findings 5. anemia: microangiopathic, hemolytic
398
Botulism | - types
- infant MC: floppy baby - Food-borne - Wound
399
Botulism | - clinical
- descending, symmetric, flaccid paralysis - decreased DTR - normal sensation - CN deficits: diplopia, ptosis, pupillary dilation, etc. - parasympathetic blockade: dec salvation, GI ileus, urinary retention
400
Botulism | - mgmt
- Supportive - respiratory support - antitoxin if >1 - IV botulism Ig if <1 - abx for wounds
401
TB - mc org - transmission - s/sx - CXR
- mycobacterium tuberculosis (acid fast bacilli) - aerosolized droplets - fatigue, weight loss, fever, night sweats, productive cough - CXR: caseating granuloma formation, pulmonary opacities (MC apical)
402
PPD results
Positive: - induration >15 mm and no risk factors - induration >10 mm and high risk (high prevalence area, homeless, immigrant in 5 years, prisoner, health care, nursing home, contact, etoh, DM) - induration >5 mm and very high risk (HIV, steroid, organ transplant, TB contact, CXR with cavitation)
403
TB treatment | - latent
(negative CXR, sputum, or both) | 9 months INH
404
TB Treatment | - active
- droplet precautions until sputum negative AFB - 2 months 4 drug RIFE tx then 4 months INH and rifampin - if isolate is INH and rifampin sensitive, can use 2 drug regimen - treat 3 months past negative culture
405
Tetanus | - clinical
- descending paralysis - Muscle rigidity starts in jaw and facial muscles and descends to limbs - opisthotonos (bridge back) - risus sardonicus (facial expression) - trismus - dysphagia - diaphoresis, HTN, tachycardia
406
Tetanus | - mgmt
- supportive: benzo, opioids - low stimulation - clean wound - metronidazole - tetanus IVIG
407
SIRS criteria
- HR >90 - Resp >20 - Temp >100.4 (38) - WBC >12k or <4k or >10% bands
408
Sepsis criteria
SIRS + suspected or present infection
409
Severe sepsis
Sepsis + lactic acidosis or low bp (<90 or drop >40)
410
Rocky Mountain spotted fever - Org - clinical presentation - Tx
- rickettsie rickettsii - Tick bite (dog or wood ticks) - abrupt onset sx - Fever, HA, myalgias, Rash (palms and soles to trunk) * * Petechiae formation after blood pressure cuff inflation - Doxy
411
Rheumatic fever | - Major jones criteria
- carditis - erythema marginatum - subcutaneous nodules - chorea - polyarthritis *JONES: joints, oh my carditis, nodules, erythema marginatum, sydenham chorea
412
Rheumatic fever | - minor jones criteria
- fever - polyarthralgias - reversible prolonged PR interval - rapid ESR - CRP
413
Rheumatic fever | - management
- bed rest - IM penicillin (erythromycin if PCN allergic) - antipyretics and steroids to reduce joint sx
414
Shigellosis - sx - lab - mgmt - complications
- fever, bloody/mucoid diarrhea, seizures - fecal RBC and WBC - azithromycin or cipro - HUS, reactive arthritis
415
Abx vs. MRSA
- Bactrim - Rifampin - Clindamycin (GI ADR) - Tetracyclines - LInezolid
416
Cholera | - mgmt
- fluid resuscitation - doxy, cipro - azithromycin for kids/preggo
417
Malaria | - dx
thick and thin smear
418
Malaria | - mgmt
- chloroquine - atovaquone-proguanil - Quinine + doxy/tetra/clinda - others
419
Syphilis tx if allergic to PCN
oral doxy
420
What drug is used to treat Lyme disease in kid <8 yo
amoxicillin
421
Mumps | - MC anatomical structure affected
- parotid glands
422
What is a common chronic medication for angina
beta blocker
423
Hypertrophic cardiomyopathy | - meds to use with caution
- Digoxin, nitrates, diuretics - dig: up contractility - nitrates/diuretics: reduce LV volume
424
HF | - meds taht decrease mortality
- ACE/ARB - BB - Nitrate/hydralazine - spironolactone * ICD if EF < 35%
425
Loop diuretics | - ADR
- volume depletion - hypo K, Na, Ca - Hyper lycemia and hyperuremia
426
HF | - role of digoxin
use when HF and A.fib | - no mortality benefit
427
CHF | - mgmt
LMNOP - lasix - morphine - nitrates - O2 - position - upright
428
Endocarditis | - valves
- MC mitral valve | - exception: IVDU, then tricuspid valve
429
Endocarditis | - blood culture
must get 3, 1 hour apart
430
Endocarditis treatment
- empiric - native valve: vanc +/- cefazolin - Ill with HF: gentamicin + cefepime + vanc - Valve replacement if refractory or abscess
431
Endocarditis - criteria for dx name - criteria
- Duke Criteria | - 2 major, 1 major and 1 minor, 5 minor
432
Endocarditis | Major criteria
- two + blood cultures with typical org | - echo with new valvular regurgitation
433
Endocarditis | minor criteria
- predisposing factor - Fever >100.4 (38) - vascular phenomena (embolic dz or pulmonary infarct) - Immunologic phenomena (glomerulonephritis, osler node, roth spot) - + blood culture not meeting major criteria
434
Pericarditis | - EKG
- diffuse ST elevations | - PR depressions
435
Pericarditis | - heart sounds
- acute/restrictive: friction rub | - constrictive: pericardial knock
436
HTN goals
< 60: 140/90 | > 60: 150/90
437
First line HTN med - non AA - AA - BPH - Gout
- thiazide, ACE/ARB, CCB - thiazide, CCB - alpha-blocker - CCB, losartan
438
Hypertensive urgency | - mgmt
- reduce MAP 25% 24-48 hours - ORAL agents - Clonidine, captopril, furosemide, labetolol, nicardipine
439
Hypertensive emergency | - mgmt
* * usu >180/120 - reduce BP 25% first HOUR - reduce BP 5-15% next 23 hours - IV agents
440
1st line med to tx: - LDL - triglycerides - HDL
- statins - fibrates - niacin
441
Niacin medication - main effect - ADR
- vitamin B3 - increase HDL - flushing, HA, warm sensation, itching - hyperuricemia (gout) - hyperglycemia
442
Statins - aka - main effect
- HMGcoA reductase inhibitors - inhibits rate-limiting step in hepatic cholesterol synthesis and increases LDL receptors so more LDL removed from blood
443
Statin - ADR - when to give
- myositis, myalgia, rhabdomyolysis - Hepatitis: LFTs first 3 mo - bedtime
444
Fibrates | - ADR
- myositis, myalgias * esp with concomitant statin us - gallstones
445
Ezetimibe
zetia - inhibits cholesterol absorption in intestine - lowers LDL - increased LFTs, esp with statin use
446
What is the only lipid lowering agent that is safe in pregnancy
bile acid sequestrants
447
MCC bronchitis
adenovirus
448
bronchitis | - mgmt
- fluid - rest - bronchodilators - antitussive * *abx: elderly, COP, immunocompromised, cough >7-10 days
449
Bronchiectasis | - PFTs
- obstructive
450
FEV1/FVC - obstructive - restrictive
- obstructive: reduced ratio dt reduced FEV1 | - restrictive: normal ratio with reduced FEV1 and FVC
451
classic presentation of sarcoidosis
young patient with respiratory and constitutional sx, blurred vision, erythema nodosum
452
pulmonary nodule | - size
<3 cm
453
Non-small cell carcinoma
85% lung cancer - MC adenocarcinoma: peripheral - Squamous cell: central - large cell: very aggressive
454
Non-small cell carcinoma | - Squamous cell
Cs - Centrally located - Cavitary lesion - hyperCalcemia - panCoast syndrome
455
Small cell carcinoma
- very aggressive - usually met early - centrally located
456
Pancoast
1. shoulder pain 2. Horner's syndrome 3. hand/arm atrophy
457
pulmonary HTN | - MCC secondary
COPD
458
pulmonary HTN | - heart sounds
- fixed, paradoxically split S2 | - accentuated S2 (bc P2)
459
Cor pulmonale
RV failure due to pulmonary HTN (MCC COPD)
460
Dysphagia to both solid and liquid
achalasia
461
Dysphagia to solids and then fluids
esophageal neoplasm
462
Diffuse esophageal spasm
- stabbing chest pain worse with hot/cold food/liquid - corkscrew esophogram - CCB or nitrates
463
Nutcracker esophagus
- excessive contractions during peristalsis - dysphagia and chest pain - CCB, nitrates, botox, sildenafil
EORs
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