1
Q
treatment of esophageal varices
A
- volume resuscitation
- prophylactic ABx (ceftriaxone)
- octreotide (somatostatin analogue) for splanchnic vasoconstriction
- urgent endoscopy for band ligation/sclerotherapy followed by BB prophylaxis
- balloon tamponade if bleeding uncontrollable
- TIPS or shunt surgery definitive
2
Q
when to do platelet transfusion?
A
active bleeding AND platelet count <50,000
3
Q
effects of lifestyle change in HTN tx
A
- weight loss most effective
- then DASH diet
- then exercise
- decreased dietary sodium
- alcohol intake <1-2 drinks/day (women/men)
4
Q
OA - radiographs
A
- joint space narrowing
- subchondral sclerosis
- osteophytes
5
Q
OA vs RA in hand
A
- OA: DIP joints
- RA: PIP and MCP joints
6
Q
hemochromatosis arthropathy - radiographs
A
- squared off bone ends
- hook like osteophytes in 2nd and 3rd MCP jts
7
Q
untreated hyperthyroidism can cause?
A
bone loss
- thyroid hormone –> osteoclastic bone resorption
- increased serum calcium and hypercalciuria
cardiovascular: thyrotoxicosis –> tachycardia, systolic HTN, increased pulse pressure, AFib
- can unmask or worsen CAD
8
Q
pathophys of proptosis in hyperthyroid
A
- accumulation of GAGs in retro-orbital mm and tissues
- ONLY in Graves dz
9
Q
tx shingles
A
- valacyclovir is tx of choice, but acyclovir cheaper; can combine acyclovir with steroids if severe sx
- early antiviral reduces duration of rash and pain
- also reduces likelihood of postherpetic neuralgia
10
Q
tx of frostbite
A
- rapid rewarming with continuously circulating warm water
- debride only after rewarming complete
11
Q
precipitating factors for hepatic encephalopathy
A
- sedatives
- hypovolemia
- infection
- excessive N load (e.g. GI bleed)
- electrolyte disturbances (e.g. hypoK - maybe from diuretics)
12
Q
tx of hepatic encephalopathy
A
- supportive care: volume, electrolyte correction, restraints
- nutrition w/o protein restriction
- precipitating cause
- lower serum ammonia: lactulose (oral/enema) –> rifaximin if no improvement in 48 hrs
13
Q
clinical presentation of alcoholic hepatitis
A
- jaundice, anorexia, fever
- RUQ and/or epigastric pain
- abdominal distention (ascites)
- prox mm weakness
- possible HE
14
Q
lab studies in alcoholic hepatitis
A
- MODEST AST and ALT elevations ( 2 (usually ALT higher than AST in other liver dz)
- GGT and ferritin elevation
15
Q
T99 scan (sestamibi) used for what?
A
myocardial function and perfusion
- normally done at rest and exercise
- decreased at rest and at exercise = fixed defect = scar tissue
- decreased at stress only = inducible ischemia, likely CAD
16
Q
metformin given to pts with factors predisposing to hypoxia causes what?
A
lactic acidosis
17
Q
empyema
A
- result from HEMOTHORAX, parapneumonic effusions, rupture of lung abscess, penetrating trauma, thoracotomy, ruptured viscus
- dx: CT scan
- tx: recent = streptokinase/urokinase (unless recent trauma), ABx; non-complex: chest tube drainage; complex (e.g. peel, loculated): SURGERY
18
Q
malignancy induced hypercalcemia
A
- PTHrP production (80%)
- 125OH2 VitD production
- bone mets
- ectopic PTH production (very rare)
19
Q
PTHrP
A
- squamous cell cancers, renal/bladder, ovarian/endometrial, breast
- activation of PTH receptor –> excessive bone resorption
20
Q
excess 1,25OH2 Vit D production
A
- by lymphomas
- causes hypercalcemia via gut absorption
21
Q
bone mets and hypercalcemia
A
- breast ca, MM, lymphomas most common
- cause release of cytokines that stimulate bone resorption
22
Q
folic acid repletion in B12 deficient pt
A
- fixes Hgb (folate and B12 both cofactors for methionine synth)
- does not fix neurologic sx; can actually precipitate/worsen
23
Q
B6 deficiency
A
- peripheral neuropathy
- pts on INH
- rare
24
Q
adverse effects of inhaled corticosteroids
A
- most common = THRUSH
- adrenal suppression, cataract formation, decreased growth, purpura, bone metabolism issues
25
cutaneous larva migrans
- "creeping eruption"
- helminth A braziliense (dog/cat hookworm)
- sandboxes/beaches, esp in tropics/subtropics
- serpiginous lesions on skin
26
sporotrichosis
- fungal infx from sporothrix schnckii
- papule at inoculation --> ulceration/LAN
- GARDENERS
27
dx of DKA
- blood glucose >250
- blood pH < 7.3 or bicarb < 15-20
- plasma ketones
28
tx of DKA
- rapid IV admin of NS and regular insulin
- correction of electrolyte abnormalities (esp K)
- treatment of precipitating factors
- bicarb can cause cerebral edema; use only if pH < 7.1 or bicarb < 5 or severe hyperK
29
organophosphate poisoning
- blocks AChEsterase --> cholinergic toxidrome
| - give ATROPINE and remove clothes/sources of OP
30
complications of chronic GERD
- Barrett's --> adenocarcinoma
| - esophageal strictures: 5-15% of patients
31
esophageal strictures
- causes: GERD, radiation, systemic sclerosis, caustic ingestions
- cause progressive dysphagia to solid foods; can eventually block reflux
32
T gondii
- HIV+ with ring enhancing lesions
- H/A, confusion, ataxia
- usually CD4 <100
- give trimethoprim/sulfamethoxazole
33
M avium prophylaxis
- M avium complex
| - HIV+, CD4 < 50
34
acute acalculous cholecystitis
- most common in hosp pts with burns/trauma/TPN/fasting/ventilation
- RUQ pain, fever, leukocytosis, abnl liver panel
- complications: gangrene, perf, emphysematous cholecystitis
- dx: US; CT/HIDA more sensitive/specific
35
Wegener's
- systemic vasculitis
- airway granulomas
- glomerulonephritis
- onset ~40yo
- cutaneous: nodules, palpable purpura, pyoderma gangrenosum
- dx: C-ANCA to proteinase-3 and elevated CRP
- tx cyclophosphamide
36
classification of pulm HTN
- assoc with resp system d/os
- due to pulm venous HTN (LV heart dz, mitral valve dz, pulm veno occlusive dz)
- from chronic thromboembolic dz
- pulm artery HTN
- d/os of pulm vasculature
37
clinical features of pulm HTN
- dyspnea, weakness, fatigue
- chest pain, hemoptysis, syncope, hoarseness
- RV failure late in dz
- CXR: enlgmt of pulm aa with pruning and enlged RV
- EKG: R axis deviation
38
DHEA vs DHEAS
DHEA: from ovaries and adrenal glands
DHEAS: adrenals only
39
serum albumin ascites gradient
- ascites albumin - serum albumin
- if SAAG > 1.1 = transudative
- SAAG > 1.3 = portal HTN
40
Winter's formula
arterial pCO2 = 1.5[HCO3] + 8 +- 2
for appropriate resp compensation of metabolic acidosis
41
MEN 1
- primary hyperpara
- enteropancreatic tumors
- pituitary tumors
42
MEN 2A
AD
- medullary thyroid carcinoma
- pheochromocytoma
- parathyroid hyperplasia
dx: genetic test for ret proto-oncogene germline mutation
43
MEN 2B
AD
- medullary thyroid carcinoma
- pheochromocytoma
- marfanoid habitus, mucosal/intestinal neuromas
44
vaccines for chronic liver dz pts
- HAV
- HBV
- pneumococcal
- flu
- Td/TdaP
45
dacryocystitis
- infection of lacrimal sac
- sudden onset of pain, redness in medial canthal region
- staph aureus, GABHS
46
mild glomerulonephritis
- nephritic urine sediment alone
| - causes: IgA nephropathy, lupus nephritis
47
mod to severe glomerulonephritis
- nephritic urine sediment, decreased GFR, variable proteinuria
- causes: postinfectious, lupus nephritis, MPGN, vasculitis
48
nephrotic syndrome
- bland urinary sediment, proteinuria > 3.5g/day, microscopic hematuria possible
- causes: MCD, FSGS, diabetes, lyps, membranous nephropathy, IgA nephropathy, primary amyloidosis
49
mixed cryoglobulinemia
- usually due to Hep C
- immune complex (IgM + IgG-anti-HCV + HCV RNA + complement) deposition in small blood vessels
- skin, kidney, NS, MSK involvement possible
- dx: serology, kidney/skin biopsy
- tx: treat HCV, plasmapheresis, immunosuppressants
50
TTP
- decreased ADAMTS13
| - fever, microangiopathic hemolytic anemia, renal failure, neurologic findings possible
51
APLA
- anti cardiolipin antibodies
| - recurrent thrombosis, pregnancy loss, neurologic findings, microangiopathic hemolytic anemia
52
comm acquired PNA - tx
- CURB65: confusion, uremia, tachypnea (RR>30), hypotension (BP65yo
- CURB65 > 2 --> hosp; >=4 --> ICU
- levoflox/moxiflox OR betalactam plus macrolide (e.g. amp/sulbactam)
53
causes of avascular necrosis of femoral head
- chronic corticosteroids
- alcoholism
- hemoglobinopathies
54
best test for diabetic nephropathy?
random urine microalbumin to creatinine
55
diabetic nephropathy and Cr clearance
initially: hyperfiltration --> increased Cr clearance
- then decline in Cr
- Cr can be relatively normal for a while; low Cr clearance usually with advanced renal damage
56
excess oxygen in COPD
- baseline: hypoxic drive (instead of hypercapnic drive)
- get vasodilation --> increased perfusion of poorly ventilated areas
- worsened VQ mismatch
- decreased CO2 excretion --> hypercapnea
57
squamous cell carcinoma of lung
- PTHrP --> hypercalcemia (sCa++mous) --> anorexia, constipation, thirst, fatigue
58
CMV retinitis
- yellow-white retinal opacification
- retinal hemorrhages
- HIV+, CD4 <50
59
ocular toxo
- severe necrotizing retinochoroiditis
- white fluffy retinal lesions surrounded by edema and vitritis
- usually accomp by encephalitis
60
HIV retinopathy
- benign cotton wool spots
| - remit spontaneously
61
chronic pancreatitis
- causes: alcohol, CF, autoimmune
- epigastric abd pain, malabsorption, weight loss, T2DM
- amylase/lipase often NORMAL
- AXR or CT: pancreatic calcifications; if neg do MRCP/ERCP
- tx: pain, alcohol/smoking cessation, frequent small meals, enzyme supplementation
62
Ca 19-9
pancreatic cancer!
63
pregnant with HCV
- get HBV and HAV vaccines
- can breastfeed, have SVD, have unprotected sex
- can't have ribavirin or IFNa (teratogens!)
64
FSGS: common pt groups
- AfAm, Hispanic
- obesity
- HIV
- heroin
65
membranous nephropathy: common pt groups
- adenocarcinoma (breast, lung): most common form assoc with malignancies
- NSAIDs
- HBV
- SLE
66
membranoproliferative glomerulonephritis: common pt groups
- HBV
- HCV
- lipodystrophy
- chronic bacterial infections
67
minimal change disease: common pt groups
- NSAIDs
| - lymphoma
68
IgA nephropathy is associated with?
URI
69
crescentic glomerulonephritis
- AKI, hematuria, HTN
| - assoc with AI disorders
70
opioid withdrawal
- sx w/in 6-12 hrs of last dose; peak at 24-48 hrs
- sx: N/V, cramps, diarrhea, dysphoria, restlessness, rhinorrhea, lacrimation, myalgias, arthralgias
- PE: mydriasis, piloerection, hyperactive bowel sounds
- tx: methadone replacement (NEVER IV MORPHINE)
71
cirrhotic stigmata
loss of liver function:
1) synthetic: clotting factors, cholesterol, proteins --> edema, hypocoagulability
2) metabolic: drugs, steroids --> hyperestrogenism: gynecomastia, palmar erythema, spider angiomas, testicular atrophy, decreased body hair in males
3) excretory: bile and ammonia secretion --> asterixis
also ascites, portal HTN
72
most common causes of chronic cough
1) post nasal drip
2) asthma
3) GERD
73
chlorpheniramine
H1 antihistamine
- blocks histamine release from mast cells, limits response to inflammatory cytokines
- decreased nasal discharge and cough
74
acute mesenteric ischemia: presentation
- rapid onset periumbilical pain
- pain out of proportion to exam
- hematochezia
75
acute mesenteric ischemia: risk factors
- age
- atherosclerosis, Afib, CHF, peripheral artery dz
- hypercoagulable disorders
76
acute mesenteric ischemia: lab findings
- leukocytosis
- elevated lactate
- elevated amylase and phosphate levels
- metabolic acidosis
77
acute mesenteric ischemia: diagnosis
- early mesenteric angiography
| - --- multidetector-row CT angiography if not avail
78
acute mesenteric ischemia: tx
- resuscitative
- broad-spectrum ABx
- NG tube for decompression
- surgery for infarction/perforation
79
therapies proven to prolong survival in COPD
- smoking cessation
- supplemental O2
- lung reduction surgery
80
mainstays of sx reduction in COPD
aims: decreasing resp sx, improving QOL, decreasing hospitalizations
- inhaled anti-cholinergics
- can add short acting beta-ag, inhaled steroids, long acting beta ag
81
should you give beta blockers to pts with reactive airway disease?
- probably not!
| - may exacerbate pulmonary sx if dz is severe
82
dermatitis herpetiformis
- papules/vesicles/bullae
- B/L, symmetric, grouped
- EXTENSOR surfaces, upper back, buttocks
- IgA deposits, circulating anti-endomysial Abs
- commonly assoc with CELIAC DZ
- tx: dapsone + gluten free diet
83
common causes of priapism
- sickle cell dz
- leukemia
- perineal/genital trauma: laceration of cavernous artery
- neurogenic lesions: spinal cord injury, cauda equina
- medications: trazodone, prazosin
84
middle mediastinal masses
- bronchogenic cyst
- tracheal tumor
- pericardial cyst
- lymphoma
- LAN
- aortic aneurysms of arch
85
anterior mediastinal masses
- thymoma
- retrosternal thyroid
- teratoma
- lymphoma
86
posterior mediastinal masses
- meningocele
- enteric cysts
- lymphomas
- diaphragmatic hernias
- esophageal tumors
- aortic aneurysms
87
CEA in pancreatic cancer
- can be useful as marker for response to therapy
| - not useful as screening test
88
isoniazid and liver injury
- idiosyncratic injury: not dose-dependent, variable latency periods
- causes hepatitis morphology on biopsy
89
medications causing liver cholestatic picture
- chlorpromazine
- nitrofurantoin
- erythromycin
- anabolic steroids
90
mx causing fatty liver morphology
- tetracycline
- valproate
- anti-retrovirals
91
mx causing hepatitis picture
- halothane
- phenytoin
- isoniazid
- alpha-methyldopa
92
mx causing toxic/fulminant liver failure
- carbon tetrachloride
| - acetaminophen
93
mx causing granulomatous liver picture
- allopurinol
| - phenylbutazone
94
lateral epicondylitis
- repeated forceful wrist extension and supination
- pain near lateral epicondyle, worsened by use
- degeneration of ECRB tendon
95
posterior interosseus nerve entrapment
weakness of extrinsic extensors of hand and fingers
96
management of hypercalcemia
- asyx/mild: avoid thiazides, Li, volume depletion
- moderate (12-14): no tx unless sx
- severe (>14): short term: NS + calcitonin, avoid loop diuretics; long term: bisphosphonate
97
sx of hypercalcemia
- anorexia
- nausea
- constipation
- polyuria/polydipsia
- dehydration
- if severe: neurologic - lethargy, weakness, confusion, stupor, coma
98
how to treat hypercalcemia in chronic granulomatous disorders
- corticosteroids!
- reduce calcitriol production by mononuclear cells
- not useful in acute management
99
causes of normal anion gap met acidosis
- diarrhea
- fistulas
- carbonic anhydrase inhibitors
- RTA
- ureteral diversion
- iatrogrenic
100
hyperkalemic RTA
- type 4 RTA (non-anion gap met acidosis)
- elderly pts with poorly controlled diabetes
- damage to juxtaglomerular apparatus
- mild to mod renal insufficiency
101
CML: stages
- chronic
- accelerated
- blast crisis
102
CML peripheral smear
- increased immature myelocytes
- basophilia and eosinophilia
- platelet count normal/elevated
- patients commonly anemic
bone marrow: hypercellularity with prominent granulocytic hyperplasia
103
auer rods
- seen in M3 subtype of APL
104
AML vs CML
- no fever in AML unless infx
- splenomegaly uncommon in AML
- peripheral blood smears: myeloblasts
105
vaccines for pts with HIV
- HiB (anatomic/functional asplenia)
- HAV, HBC
- HPV
- flu
- meningococcus
- pneumococcal conjugate (1x)
- pneumococcal polysaccharide (Q5)
- Tdap, Td
106
live vaccines in HIV pts
- MMR, varicella, zoster
| - CONTRAINDICATED if CD4<200
107
risk factors for NASH
TOP 3
- obesity
- DM
- hyper TGs
others: steroids, amiodarone, dilt, tamoxifen, HAART, TPN, endocrinopathies
108
NASH
- impaired responsiveness of fat cells to insulin --> accum of fat in liver
- steatosis can progress to steatohepatitis and fibrosis
- hepatomegaly WITHOUT stigmata of chronic liver dz
- mild ALT and AST elevation
- dx: percutaneous liver biopsy
- tx: ursodeoxycholic acid
109
PBC
- jaundice, pruritus
- positive AMAbs
- portal tracts infiltrated by lymphocytes, macrophages, plasma cells, eos
- can eventually cause portal tract scarring and bridging fibrosis --> cirrhosis
110
test of choice for dx rotator cuff tear
MRI!
111
test of choice for shoulder fx/disloc/calcific tendonitis
XR!
112
what do you use bone scans for?
dx of: osteomyelitis, fx, metastatic dz
113
pemphigus vulgaris
- blistering of skin and mucous membranes
- FLACCID BLISTERS
- unknown etiology
- positive Nikolsky sign
- IgG deposits in epidermis
- tx: steroids, azathioprine, methotrexate
114
bullous pemphigoid
- benign pruritic disease
- TENSE BLISTERS
- IgG and C3 deposits at dermal/epidermal jct
115
bullous impetigo
- caused by Staph
- honey color!
- red denuded areas when removed
116
common causes of steatorrhea
- panc insufficiency
- bile salt-related
- impaired intestinal surface epithelium
- rare: Whipple dz, Zollinger-Ellison, medication-induced
117
Nocardia
- gram pos, PARTIALLY acid fast, filamentous branching rods
- immunocompromise; systemic sx, lung nodules, brain abscess
- tx for pulm nocardia: BACTRIM
- if brain involved: ADD CARBAPENEM
- long tx
118
Waldenstroms macroglobulinemia
- rare chronic plasma cell neoplasm
- abnl plasma cells invade BM, LNs, spleen
- excessive IgM production --> hyperviscosity (e.g. retinal v engorgement)
119
tx of acute exacerbation of COPD
- O2: target sat 88-92
- inhaled bronchodilators and anticholiergics
- systemic glucocorticoids
- ABx IF: 2/3 cardinal sx, mod-to-severe exacerbation, mechanical ventilation
- non-invasive pos pressure ventilation/intubation
120
acetylcysteine
- mucolytic
| - useful in CF
121
Wilson's dz
- AR
- copper in liver, basal ganglia, cornea
- liver disease in children/adols
- neuropsych dz in young adults
- low ceruloplasmin + high copper; increased urinary Cu excretion, KF rings
122
Mallory hyaline on biopsy
- alcoholic liver injury
| - wilson dz also
123
Osler Weber Rendu syndrome
- hereditary telangiectasia
- AD
- diffuse telangiectasia, recurrent epistaxis, widespread AVMs (mucus membranes, skin, GI, liver, brain, lungs)
124
lung AVM
- shunt blood from R to L heart
- chronic hypoxemia and reactive polycythemia
- massive hemoptysis
125
most common locations of ischemic colitis
- splenic flexure
- recto-sigmoid junction
(both watershed areas)
126
mechanical ventilation in ARDS
- improves O2 and prevents alveolar collapse (via PEEP)
- arterial pO2 = measure of oxygenation
- pCO2: affected by RR and TV
- goal: decrease FiO2 to under 60, make sure PaO2>60
127
can pancreatitis cause ARDS?
YES! up to 15% of patients
128
three major mechanical complications of MI
- MR due to papillary mm rupture
- LV free wall rupture
- interventricular septum rupture
129
malaria
CYCLICAL FEVER - correlates with RBC lyses
- cold phase --> hot phase --> sweating stage
- anemia and splenomegaly
130
when to get EGD in GERD
- alarm sx (dysphagia, odynophagia, weight loss, anemia, bleeding, vomiting)
- or age > 50 with >5 yrs sx and cancer risk factors
131
when to get H pylori testing
- active or past PUD
| - pts with dyspepsia but NOT GERD
132
cat scratch disease
- localized cutaneous and LN disorder
- rare involvement of liver/spleen/eye/CNS
- tx: azithromycin
133
cholestasis: lab findings
elevated direct bili + elevated alk phos
134
amebic liver abscess
- hx of travel to endemic area
- dysentery and RUQ pain
- single cyst in R lobe of liver
- E histolytica!
135
hydatid cyst
- E granulosus infection
| - from intimate contact with dogs
136
common causes of hematuria
- neoplasm
- infection
- trauma
- nephrolithiasis
- glomerulonephritis
- prostatic dz
137
risk factors for urinary tract malignancy
- age >35
- smoking
- occupational hx
- drug exposure (cyclophosphamide)
bladder cancer most common
138
medications that cause ototoxicity
- aminoglycosides
- chemo drugs
- aspirin
- loop diuretics
139
aspirin SEs
- tinnitus
| - hearing loss at higher doses
140
EPO therapy SEs
- worsening of HTN: more common in IV vs subQ
- headaches
- flu-like syndrome
- red cell aplasia
141
smudge cells on smear
CLL!
| - get flow cytometry to confirm
142
JAK2 mutation
- myeloproliferative dz
| - esp POLYCYTHEMIA VERA
143
what does a positive hepatojugular reflux test mean?
- reflection of failing RV
| - cannot accommodate increased venous return
144
most common causes of hepatojugular reflux
- constrictive pericarditis
- RV infarction
- restrictive cardiomyopathy
145
TMJ
- pain often reported as from ear
- pain worsened with chewing
- audible clicks/crepitus possible
- radiology studies limited use
- tx: conservative --> surgical
146
comedonal acne
- closed or open comedones on forehead, nose, chin
- may progress to inflammatory pustules or nodules
- TX: topical retinoids, salicylic/glycolic acid
147
inflammatory acne
- inflamed papules and pustules
- erythematous
- TX: inflammatory: topical retinoids + benzoyl peroxide (+ topical/oral ABx if mod/severe)
148
nodular (cystic) acne
- large nodules, can appear cystic
- nodules may merge to form sinus tracts
- possible scarring
- TX: mod: topical retinoid + benzoyl + topical ABx; severe - add oral ABx;
- unresponsive severe cases: add oral isotretinoin
149
indomethacin contraindicated in?
- renal failure
| - hx of GI bleeding
150
Beck's triad?
assoc with cardiac tamponade
- hypoT
- distended neck vv
- muffled heart sounds
151
cardiac tamponade pathophys
- increased pericardial P > diastolic ventricular P
- -> decreased venous return --> decreased preload
- -> decreased SV and CO
- worsened by inspiration: increased R venous return --> septum shifted to left --> LV filling further decreased --> PULSUS PARADOXUS
152
HSV keratitis
- freq cause of corneal blindness
- pain, photophobia, blurred viison, tearing, redness
- recurrences precip by sun exposure, outdoor work, fever, immundef
DENDRITIC ULCERS and CORNEAL VESICLES
- clinical dx
- epithelial scrapings --> multi-nuc giant cells
- tx: oral/topical antiviral
153
Well's criteria
3 pts: clinical signs of DVT, alternate dx less likely
1.5 pts: previous PE/DVT, HR >100, recent surg or immobilization
1 pt: hemoptysis, cancer
score > 4: PE likely
154
nafcillin and renal failure
- causes acute interstitial nephritis (eos and WBC casts in urine)
155
aminoglycosides: uses and SEs
- usually for serious G-neg infections
| - nephrotoxic!
156
loop diuretics: effects
- increased Na, H, K secretion in urine
| - volume contraction, increased aldosterone
157
drugs that cause folic acid deficiency
- phenytoin, primidone, phenobarbital
- trimethoprim
- methotrexate
--> megaloblastic anemia
158
MC site of mets for CRC
liver!
159
treatment for torsades?
MG! (if conscious, stable)
if unstable, defibrillate
- if TdP due to quinidine use: give sodium bicarb
160
treatment for PSVT?
adenosine
161
tx of hyperkalemia
- if EKG changes: calcium gluconate
- rapid intracellular shifts: beta2 agonists, insulin with glucose, sodium bicarb
- removal of K: diuretics, cation exchange resins, hemodialysis
162
XR findings in gouty arthritis
punched out erosions with rim of cortical bone
163
XR findings in RA
periarticular osteopneia
| joint margin erosions
164
common causes of megaloblastic anemia
- folate deficiency
- B12 deficiency
- myelodysplastic syndrome
- AML
- drugs: hydroxyurea, zidovudine, chemo
- liver dz
- alcohol abuse
- hypothyroidism
165
pernicious anemia
- MCC of B12 defic in white people
- assoc autoimmune dz common (thyroid, vitiligo)
- shiny tongue, ataxia, loss of position/vibration
166
common arrythmias in post MI period
- ventricular premature beats
- VT
- Vfib: most freq cause of sudden cardiac arrest in setting of acute MI
w/in 10 minutes: immediate arrythmia, ischemia --> reentrant arrhythmia
delayed (10-60 min): from abnormal automaticity
167
giant cell tumor of bone
benign and locally aggressive neoplasm in young adults
- pathologic fx common
- XR: epiphyses of long bones - soap bubble appearance
- patho: sheets of giant cells
- tx: surgery!
168
glucocorticoids and immune effects
- diminish circulating eos
- lymphopenia
- increase BM release of neutrophils --> neutrophilia
169
MCC of epiglottitis
- HiB
| - Strep pyogenes
170
post cholecystectomy syndrome
- persistent abd pain or dyspepsia following chole (can be years after)
- biliary or extra biliary causes
- lab: high alk phos, abnl AST/ALT, dilated common bile duct on abd US
171
PPD: treat or not?
- if PPD > 5mm: treat HIV+, recent contacts of TB+, XR changes consistent with previous TB, immdef
- PPD > 10mm: recent immigrants, IVDU, high-risk setting employees/residents, higher risk for TB reactivation, children 15 mm: treat EVERYONE
172
treatment for latent TB
- INH + rifapentine weekly for 3 mos (not for HIV)
- INH monotherapy for 6-9 months
- rifampin for 4 months
- INH + rifampin for 4 months
- add pyridoxine to prevent neuropathies if taking INH
173
tx for active TB
- INH, rifampin, ethambutol, pyrazinamide for 8 weeks
| - INH + rifampin for another 4 months
174
tx of open angle glaucoma
- BB eye drops (e.g. timolol)
- laser trabeculoplasty as adjunct
- if continues to increase, surgical trabeculectomy
175
CREST
- calcinosis cutis
- Raynaud
- esophageal dysmotility
- sclerodactyly
- teleangiectasias
176
ideal tidal volume
6 ml/kg
177
SEs of beta2 agonist tx
- hypokalemia --> mm weakness, arrhythmia, EKG chg
- tremor
- HA
- palpitations
178
lab findings suggestive of alcoholism
- TCP
- macrocytosis
- elevated transaminases
179
indications for O2 therapy in COPD
PaO255
| evidence of cor pulmonale
180
bruit in renal artery stenosis
- 85% of pts with RAS have bruit
| - systolic-diastolic common
181
mx that cause hyperkalemia
- BBs
- ACEi, ARB, K-sparing diuretics
- digitalis
- cyclosporine (blocks aldosterone production)
- heparin (blocks aldosterone production)
- NSAIDs
- succinylcholine
- trimethoprim (block ENaC)
182
A1AT
- bullous changes of lungs
- emphysematous chg in lower lobes
- can also cause liver dz: neonatal hepatitis, cirrhosis, liver failure
183
PSVT
- re-entry in AV node is most common mechanism
- abrupt attacks, HR 160-220
- vagal maneuvers increase vagal tone and decrease AV conduction
- can also use adenosine
184
Wegener's
- granulomatosis with polyangiitis
- upper airway: nasal discharge, oral ulcers, sinusitis
- lower airway: dyspnea, cough, hemoptysis
- renal: insufficiency, micro hematuria, RBC casts
- systemic: fever, weight loss, fatigue
- CXR: nodular densities, alveolar/pleural opacities
- test for ANCA
185
aortic dissection
- risks: HTN, Marfan, cocaine
- > 20 mmHg BP variation bw arms
- complications: stroke, AR, Horner's, MI, pericardial effusion/tamponade, hemothorax, lower-extremity weakness, abdominal pain
- dx: CXR - mediastinal widening; best test is chest CT or TEE
- tx: labetalol (if HTN)
- ascending aorta: need surg; descending aorta: medical management only
186
flash pulm edema
- usually 2ary to acute MI
| - give furosemide: decrease preload and increase venodilation
187
common causes of aortic regurg
- Marfan, syphilis --> aortic root dilation
- post-inflammatory: rheumatic heart dz, endocarditis
- congenital bicuspid valve
188
clinical features of aortic regurg
- diastolic decrescendo murmur
- widened pulse pressure
- collapsing/water hammer pulse
- heart failure signs/sx
- increased LV size --> apex close to chest wall --> uncomfortable awareness of heartbeat
189
amiodarone and lungs
- pulmonary toxicity!
- chornic interstitial pneumonitis, organizing PNA, ARGDS
- related to cumulative dose
190
CHADS2 score
for anticoag in Afib
- CHF, HTN, Age>75, DM, stroke/TIA (2 pts)
- score 0: no anticoag or aspirin
- score 1: anticoag or aspirin
- score 2+: anticoag
191
AAA risk factors
- age, smoking, family hx, white, atherosclerosis
| - risk factors for expansion/rupture: large diameter, rate of expansion, current cig smoking (biggest
192
massive PE
- PE complicated by hypoT and/or acute RH strain
- syncope possible
- JVD and RBBB possible
- causes cardiogenic shock and CNS effects
- can confirm with CT pulm angio if time allows
- give resp, hemodynamic support; fibrinolysis
193
tx for stable angina
- BB
- CCB (addl to BB or alternative)
- nitrates (acute or long-acting)
preventive: aspirin, statin, smoking cessation, exercise/wt loss, BP and DM control
194
lidocaine
- 1B anti-arrhythmic drug, good for variety of ventricular arrhythmias
- DON'T use as prophylaxis for Vfib in MI pts -- increases risk of asystole!
- decreases freq of ventricular premature beats and risk of Afib
195
complications of PEEP
- alveolar damage
- tension PTX
- hypoT (if high P)
196
PEEP in ARDS
- mainstay of therapy
| - levels up to 15 may be needed
197
pulsus parvus et tardus
assoc with aortic stenosis
198
Light criteria for pleural effusion
exudative pleural effusion IF 1+ of:
- p/s protein ratio >0.5
- p/s LDH ratio >0.6
- pleural LDH >2/3 ULN for serum LDH
199
causes of primary adrenal insuff
- autoimmune
- infections (TB, HIV, fungal)
- hemorrhagic infarction
- metastatic ca
200
dx of primary adrenal insuff
- ACTH and cortisol with high dose ACTH stim test
- primary: low cortisol, high ACTH
- 2ary/3ary: low cortisol, low ACTH
201
MC 2ary tumors in HL patients
18. 5x risk of 2ary malignancy
- lung, breat, thyroid, bone, GI
- if got radiation/chemo tx: increased risk of leukemia or non-HL
medicine
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