Medicine 2_1

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1. wegeners 1. vasculitis of the kidneys and UPPER 6. acute kidney injury 1. rapid decline in renal function, with
granulomatosis AND LOWER GI tract 1. definition increased serum creatinine (>50%
1. patho 2. upper respiratory symptoms, purulent 2. clinical pres relative inc., or absolute increase of
2. clinical pres bloody nasal discharge, oral ulcers, cough, 3. what decreases 0.5-1.0mg/dl)
3. dx/tx hemoptysis, dyspnea, glomerulonephritis, the probability of - may be oliguric, anuric, nonoliguric
conjunctivitis, scleritis, arthralgias, recovery from AKI 2. dec. urine output, weight gain,
myalgias, tracheal stenosis, constitutional 4. what is the MCC edema, due to positive water/sodium
symptoms death in AKI balance, azotemia (inc. BUN/Cr)
3. CXR, ESR, anemia, c-ANCA positive, 3. increasing age and presence of
thrombocytopenia comorbid conditions
*lung biopsy 4. infection, and cardiorespiratory
tx = poor prognosis, complications
***cyclophosphamide/corticosteroids
7. RIFLE criteria of 1. 1.5x increase in serum creatinine or
renal transplant
AKI GFR decrease by 25% or urine output
2. polyarteritis 1. HEP B*, HIV, drug reactions -> medium 1. risk <0.5 for 6 hours
nodosa (PAN) vessel vasculitis of nervous system/GI 2. injury 2. 2x inc. in serum creatinine, or GFR
1. patho tract/kidney --> PMN invasion and 3. failure decrease by 50% or urine output
2. clinical pres fibrinoid necrosis + intimal proliferation -- 4. loss <0.5ml/kg/hour for 12 hours
3. dx/tx > renal artery/AAA/nerve damage, 5. ESRD 3. 3x inc. in serum creatinine or GFR
NO PULMONARY INVOLVEMENT decrease by 75%
2. fever, weakness, weight loss, myalgias, 4. complete loss of kidney function
arthralgias, abdominal pain, (w/ dialysis) for >4 weeks
PERIPHERAL NERVES, HTN, 5. complete loss of kidney function >3
mononeuritic multiplex, livedo reticularis. months
diffuse glomerulonephritis
8. three possible prerenal, intrinsic, post-renal
3. biopsy of tissue (NO GRANULOMAS),
locations of AKI
mesenteric angiography (look for
aneurysms)** 9. what causes catabolic drugs (ie. steroids), GI/soft
ESR, p-ANCA (myeloperoxidase) azotemia tissue bleeding, dietary protein intake
FOBT 10. pre-renal failure 1. reversible dec. in arterial blood
tx = corticosteroids, cyclophosphamide 1. patho volume or renal perfusion --> dec.
3. behcets 1. autoimmune leukocytoclastic venulitis 2. causes GFR --> inc. BUN/Cr/uremic toxins
syndrome 2. recurrent oral and genital ulcers, 3. what drugs 2. hypovolemia, dehydration, excess
1. patho arthritis (knees/ankles), eye involvement should be avoided diuretics, diarrhea, burns,
2. clinical pres (uveitis, optic neuritis, iritis, in patients with hemorrhage, CHF, renal artery
3. dx/tx conjunctivitis), CNS involvement prerenal failure obstruction,cirrhosis
(meningoencephalitis, HTN) fever, weight 3. NSAIDS, ACE inhibitors,
loss, aortic disease cyclosporin
3. PATHERGY TEST - 11. monitoring patient daily weights, intake, output, BP,
elevated ESR/CRP, tissue biopsy, steroids with AKI serum electrolytes, Hb, Hct, monitor
4. buergers 1. cigarettes --> small vessel vasculitis of WBC for infection
disease arms/legs --> gangrene 12. urine 1. >500, <20, <1%, scant
1. patho 2. ischemia, cyanotic, distal extremities, osmolarity/urine sediment/hyaline casts
2. clinical pres ulceration of digits Na/FeNa/urine 2. >350, >40, >1%, full brownish
3. tx 3. tx smoking cessation sediment pigment/granular epithelial casts
5. hypersensitivity 1. penicillin/sulfa drugs/infection--> small 1. pre-renal
vasculitis vessel vasculitis 2. ATN
1. patho 2. palpable purpura, macules, vesicles,
2. clinical pres 3. tissue biopsy
3. dx/tx tx = withdraw offending agent, steroids
13. pre-renal 1. dry mucus membranes, hypotension, 21. UA : urine 1. few hyaline
failure tachycardia, dec. skin turgor, sediment/protein/blood casts/negative/negative
1. clinical pres oliguria/anuria 1. pre-renal failure 2. muddy brown casts, renal
2. dx 2. oliguria (<0.5ml/kg/hr), BUN:Cr >20:1 2. ATN tubular cells/trace/negative
urine osmolarity >500 3. acute 3. dysmorphic RBCs, RBCs with
dec. urine Na+ <20, FENA <1% glomerulonephritis casts, WBCs with casts, fatty
urine:plasma Cr >40:1 4. acute interstitial casts/4+ protein/3+ blood*
hyaline urine sediment nephritis 4. RBCs, WBCs, eosinophils/1+
5. post renal protein/2+ blood
14. intrinsic renal 1. ATN, glomerulonephritis, allergic
5. +/-
failure glomerulonephritis goodpasture's,
RBC+WBC/negative/negative
1. patho wegener's granulomatosis, post-strep
2. clinical pres glomerulonephritis, RAS, TTP, HUS 22. AKI 1. urine Na, urine Cr,
3. lab findings 2. usually edema, tea colored urine 4. urine chemistry 2. must get urine
3. BUN/Cr ratio <20:1, urine Na >40, 5. FENa electrolytes/plasma electrolytes--
FeNA >2-3%, urine osmolality <350 6. imaging >
(impaired resorption), urine:plasma Cr FENa = (UNa/PNa)/(UCr/PCr)
<20:1 ~~ <1% = prerenal failure, >1% =
ATN
15. rhabdomyolysis 1. skeletal muscle breakdown from trauma,
3. renal ultrasound - to evaluate
1. patho crush injury, prolonged immobility,
obstruction, hydronephrosis-- CT
2. lab findings seizures, snake bites, cocaine,
scan of abdomen/pelvis
statins* --> myoglobin --> ATN/AKI if
>20000 23. AKI 1. ECF volume expansion causing
2. elevated CK, hyperkalemia, 1. volume complications pulmonary edema - tx =
hypocalcemia, hyperuricemia + tx furosemide
3. IVF, mannitol (osmotic diuresis), 2. metabolic 2. hyperkalemia from dec.
bicarbonate (pushes K+ into cells) complciations excretion and shifts from
3. fatal complications intracellular
16. ATN 1. ischemic (shock, hemorrhage, sepsis,
metabolic acidosis due to dec.
1 . two types of DIC, heart failure) and nephrotoxic
excretion of hydrogen ions
ATN 2. aminoglycosides, vancomycin
hypocalcemia - loss of ability to
2. nephrotoxic radiocontrast
form vitamin D
agents NSAIDS + CHF
hyponatremia if drinking plain
myoglobinuria,
water
chemotherapeutic drugs- kappa, gamma,
hyperphosphatemia
light chains
hyperuricemia
17. ATN oliguric - 10-14 days (<400-500ml/day) 3. hyperkalemic cardiac arrest,
1. phases diuretic - >500ml/day from fluid/salt pulmonary edema
overload from oliguric phase
24. what is the uremic end products inhibit
recovery phase
pathogenesis of AKI immune functions and increased
18. tests for post- palpation of bladder related infection/sepsis susceptibility to infection
renal failure ultrasound of kidney/bladder- residual
25. 1. what drugs should be 1. NSAIDs, nephrotoxic agents
volume, hydronephrosis, obstruction
avoided in AKI (aminoglycosides, radiocontrast)
catheter insertion - voids large urine
2. treatment of fluid 2. diuresis, daily weight
volume
overload measurement, always consider
19. post renal AKI 1. urethral obstruction (BPH), kidney 3. pre-renal AKI cardiac function
1. patho obstruction, nephrolithiasis, neoplasms treatment 3. treat underlying disorder, NS
(bladder, cervix, prostate), retroperitoneal to restore euvolemia/BP, dont
fibrosis give to patinets who have
20. AKI 1. elevated BUN/Cr, electrolytes, K+, Ca2+. ascites/edema, stop ACE
1. Blood labs to PO4-, albumin, CBC inhibitors/NSAIDS
order 2. 3+ or 4+ protein suggest intrinsic renal 26. 1. intrinsic AKI tx 1. stop agent, trial of furosemide
2. UA findings failure from glomerular injury 2. post renal AKI tx for oliguria
3. how to rule 3. bladder catheterization, renal 2. bladder catheter, uro consult
out post-renal ultrasound
failure
27. CKD 1. dec. GFR <60ml/min or kidney 34. CKD 1. low protein - 0.7-0.8 g/kg body
1. definition damage 1. tx weight/day
2. MCC 2. diabetes MCC, HTN 2nd MCC, low salt diet if HTN/CHF present
3. how to measure chronic glomerulonephritis, restrict potassium, phosphate, Mg
CKD interstitial nephritis, ACE inhibitors - reduce risk of ESRD
3. Cr clearance, plasma Cr varies progression, but WATCH FOR
inversely with the GFR HYPERKALEMIA,
strict blood control with ACE +/-
28. CKD 1. HTN 2/2 water/salt retention, dec.
diuretics, glycemic control, smoking
1. clinical GFR stimulates RAAS
cessation
presentation (CV, CHF from volume overload, HTN,
GI, neuro) anemia 35. CKD calcium citrate (oral phosphate
n/v, loss of appetite, 1. how to correct the binder)
lethargy, somnolence, hyperphosphatemia 2. oral bicarb and oral D3
confusion, peripheral neuropathy, 2. hypo to correct 3. EPO
uremic seizures, weakness, asterixis hypo D3 and 4. dialysis
acidosis 5. capsaicin, cholestyramine, UV
29. radiographic rapid spasm of the afferent arteriole
3. """ anemia light
contract induced prevent with saline hydration
4. """" pulmonary
ATN pathogenesis
edema
30. azotemia vs uremia azotemia = elevated BUN 5. """" pruritis
uremia = signs/symptoms associated
36. 1. indicates for AEIOU
with accumulation of nitrogenous
emergent Acidosis - intractable metabolic
wastes - usually when BUN >60
hemodialysis acidosis
31. chronic renal patients renal function is electrolytes - hyperkalemia (refractor
insufficiency compromised but not failed - serum to other treatments)
Cr usually 1.5-3.0 I - intoxications: methanol, ethylene
32. CKD 1. normochromic normocytic anemia glycol, lithium, aspirin, magnesium
1. hematologic (dec. EPO) containing laxatives
effects bleeding 2/2 interference with O - hypervolemia
2. platelet function U - severe based on clinical
endocrine/metabolic 2. hyperphosphatemia--> dec. D3--> presentation, uremic pericarditis,
effects hypocalcemia --> secondary uremic encephalopathy
3. sexual effects hyperparathyroidism--> renal 37. vascular access in seldinger central catheter
-also pruritus osteodystrophy/bone fractures + dialysis tunneled catheter - used up to 6
calciphylaxis months
3. HPG disturbance dec. testosterone, AV fistula - for permanent access
amenorrhea, infertility,
38. 1. disadvantages of 1. hypotension from rapid removal of
hyperprolactinemia
hemodialysis intravascular volume, hypoosmolality
33. CKD 1. urinalysis, Cr clearance/GFR, CBC 2. disadvantages of from solute removal
1. dx shows anemia/thrombocytopenia, peritoneal dialysis 2. hyperglycemia,
2. radiologic dx` hyperkalemia, hypocalcemia, hypertriglyceridemia, peritonitis
hypomagnesemia,
39. 1. complications of 1. hypotension --> MI, fatigue
hyperphosphatemia, meta. acid
dialysis hyposmolality --> nausea, vomiting
2. renal ultrasound shows small
first use syndrome - cx pain, back
kidneys suggesting chronic renal
pain, anaphylaxis after using new
disease
dialysis machine
sepsis
beta 2 microglobulin amyloidosis
peritonitis, hernias, hyperglycemia
40. proteinuria 1. >150mg protein/24 hours 44. nephrotic 1. treat underlying disease (diabetes, MM, SLE,
1. definition 2. due to syndrome MCD)
2. glomerular glomerulonephritis/glomerular 1. tx ACE inhibitors/ARBs - dec. urinary albumin
proteinuria damage--> severe protein loss limit dietary protein,
3. tubular 3. small proteins filtered through treat hypercholesterolemia
proteinuria glomerulus are normally reabsorbed - vaccinate against pneumococcal/influenza
4. overflow - but with tubular damage they spill
45. Hematuria 1. hematuria, >3 erythrocytes/HPF on
proteinuria into urine-- 2/2 sickle cell, urinary
1. definition urinalysis
track obstruction, interstitial
2. 2. glomerular vs nonglomerular (ie. post-renal
nephritis
microscopic such as trauma, stones, malignancy)
4. small protein production
vs. gross 3. bladder or kidney cancer until proven
overwhelms tubules (ex. bence jones)
hematuria otherwise
41. nephrotic syndrome urine protein>3.5g/24 hours, 3. painless
1. key features hypoalbuminemia, hematuria
2. causes edema (2/2 hypoalbuminemia) - check CBC
exacerbated by inc. aldosterone, for IDA
hyperlipidemia/lipiduria - inc.
46. common cystitis, urethritis, prostatits
hepatic LDL/VLDL synthesis
causes for
hypercoagulable - loss of
hematuria
anticoagulants in urine
2. diabetes (MCC)*** membranous, 47. hematuria 1. kidney stones, infection (URI, urethritis,
membranoproliferative, minimal 1. causes pyelo), bladder or kidney cancer, glomerular
change (MCC in children), diabetes, 2. systemic disease, IgA nephropathy, trauma, strenuous
SLE, RA, polyarteritis nodosa, causes exercise (ex. marathon), cysts PCKD
henoch schonlein purpura, wegeners, 3. 2. SLE, rheumatic fever, HSP, wegener's, HUS,
amyloidosis, cryoglobulinemia, medication goodpasture's, PAN)
causes 3. NSAIDs, cyclophosphamide, analgesics
42. nephrotic syndrome 1. captopril, heroin, heavy metals,
3. what drugs cause NSAIDs, penicillamine 48. hematuria 1. urine dipstick, urinalysis
nephrotic 4. urine dipstick - >30mg/dl (>1+), 1. dx RBCs/casts ~ GN
syndrome- 4+ >500 mg/dl pyuria --> send for culture
- also infections, urinalysis - will show RBC casts, if + for blood, but no RBCs on microscopy~
MM, malignant WBC casts, fatty casts most likely hemoglobinuria, or myoglobinuria
HTN, and *urine micro-albumin - more cytology to detect cancer
transplant rejection sensitive than dipstick 24 hour urine Cr/protein
4. dx***** ~ do this Cr, BUN/Cr, CBC (anemia 2/2 renal blood tests - coags, CBC, BUN/Cr
diagnostic sequence failure), renal ultrasound, IVP IVP, CT scan, ultrasound
for hematuria as (pyelonephritis), ANA, anti-GBM, renal biopsy
well, basically any hepatitis serology, anti-streptococcal 49. glomerular 1. impairment of selective filtration results in
renal failure that antibody, complement levels, disorders excretion of blood cells/larger proteins, and
there is not a clear cryoglobulin, serum/urine 1. patho dec. GFR
etiology electrophoresis renal biopsy 2. clinical 2. isolated proteinuria, isolated hematuria,
43. urinalysis 1. avg 6.0, range 4.5-8 pres nephrotic syndrome
1. pH 2. 1.002 - 1.035-- will normally vary 50. nephritic 1. Post strep + others -->glomerular
2. specific gravity with volume status syndrome INFLAMMATION
3. protein 3. 1+ = 50-150mg/day, 2+ = 0.5- 1. patho 2. hematuria, AKI, azotemia, oliguria,
- also glucose, blood, 1.5g/day, 3+ = 2-5g/day, 4+ = 2. lab proteinuria (not nephrotic range ie.
ketones, nitrite, >5g/day findings <3.5g/24hr)
leukocyte esterase 4. look for casts , cells, bacteria, 3. clinical 3. HTN, edema
4. Microscope WBCs, RBCs, crystals findings
51. nephrotic 1. abnormal glomerular PERMEABILITY
syndrome 2. MCD, membranous, diabetes, SLE, drugs,
1. patho infection, FSGS,MPGN,
2. causes 3. urine protein>3.5g/24hr, hypoalbuminemia,
3. lab hyperlipidemia
findings 4. edema, hypercoagulability, inc. infections
52. minimal change 1. hodgkin's disease*/non- 58. post- 1. post group B hemolytic strep or impetigo --
disease hodgkin's/idiopathic/post streptococcal > 10-14 days
1. patho infectious/rifampin --> systemic T GN 2. hematuria, edema, HTN, low
2. diagnosis cell dysfunction--> nephrotic 1. patho complement***, proteinuria
3. tx syndrome 2. clinical 3. ASO titer*, anti-DNAse B titer, low C3
2. no histologic findings of light pres biopsy shows sub epithelial deposits
microscopy, foot processes fusion 3. dx 4. antihypertensives, loop diuretics, steroids
on electron microscopy, OVAL 4. tx for severe
FAT BODIES ON URINE
59. goodpasture's 1. IgG anti-GM antibody --> proliferative GN,
ELECTRON MICROSCOPY
syndrome pulmonary hemorrhage
3. 4-8 weeks of steroid therapy,
1. patho 2. rapidly progressive renal failure,
usually full recovery
2. clinical hemoptysis, cough, dyspnea
53. FSGS 1. blacks, AIDS patients*--> pres 3. renal biopsy shows linear*
1. hematuria, HTN--> renal 3. dx immunofluorescence
demographics/clinical insufficiency within 5 years 4. tx 4. plasmapheresis removes circulating anti-
pres 2. focal segmental IgG antibodies
2. dx glomerulosclerosis on light
60. HIV 1. proteinuria, edema, hematuria
3. tx microscopy
nephropathy 2. histopath resembles FSGS
3. cytotoxic agents, steroids,
1. clinical 3. prednisone, ACE inhibitors, HAART
immunosuppressive agents,
pres
ACE/ARBs
2. dx
54. IgA nephropathy 1. gross hematuria 5 days after 3. tx
1. patho upper respiratory infection or
61. AIN 1. allergy to meds - penicillin, cephalo, sulfa,
2. dx exercise -->
1. patho diuretics, anticoagulants, phenytoin
3. tx 2. IgA and C3 on electron
2. clinical infection - legionella, streptococcus
microscopy of kidney biopsy ,
pres CVD - sarcoidosis, SLE, Sjogren's
SERUM COMPLEMENT LEVELS
3. dx/tx 2. rash, fever, eosinophilia, pyuria,
ARE NORMAL
hematuria
3. steroids
3. inc. BUN/Cr, urine eosinophils,
55. membranous 1. hep C/B, syphilis, malaria, gold proteinuria, hematuria
glomerulonephritis (tx for RA) captopril, 4. remove offending agent, steroids
1. patho penicillamine, neoplasm, lupus --
62. renal 1. analgesics, diabetes, sickle, UTO/UTI,
2. clinical pres > glomerular thickening
papillary alcoholism, transplant rejection
2. dx 2. active urinary sediment,
necrosis 2. stop offending agent
hypertension, worsening renal
1. patho
function, proteinuria,
2. tx
hypoalbuminemia
3. subepithelial deposits on renal 63. type 1 RTA 1. inability to secrete H+ at distal tubule-->
biopsy, decreased C3 1. pH of urine is >6, dec. ECF volume,
patho/clinical hypokalemia, renal stones/nephrocalcinosis
56. hereditary 1. X LINKED OR AUTO DOM
pres (inc. Ca2+/phos excretion),
nephropathy (alports mutation in basement membrane
2. causes rickets/osteomalacia
syndrome) protein
3. dx 2. congeintal , MM, nephrocaclinosis,
1. patho 2. hematuria, pyuria, hearing
4. tx ampho B, lupus/sjogrens, analgesic
2. clinical pres loss, progressive renal failure
nephropathy
-no treatment
3. hypokalemic, hypochloremic, non-AG met
57. membranoproliferative 1. hep C/V, syphilis, lupus, acid
glomerulonephritis cryoglobulinemia 4. sodium bicarbonate, phosphate salts (inc.
1. patho 2. tram tracking on renal biopsy excretion of titratable acid)
2. dx with glomerular basement that
stains for C3 and not
immunoglobulins DEPRESSED
C3***
64. type 2 RTA 1. inability to reabsorb HCO3- in the 72. renal artery 1. atherosclerosis/fibromuscular dysplasia
1. patho proximal tubule* leading to inc. bicarb, K+, stenosis -->RAS causes dec. blood flow to JGA -->
2. causes Na+ in the urine, NO, BASIC URINE, 1. patho RAAS --> HTN
3. tx aminoaciduria, glycosuria, phosphaturia 2. clinical pres 2. HTN refractory to medical therapy, may
NEPHROCALCINOSIS/NEPHROLITHIASIS 3. dx/tx be malignant, abdominal bruit, dec. renal
2. fanconi's, cystinosis, wilsons, lead, MM, function
nephrotic syndrome, amyloidosis 3. renal arteriogram, BUT NO CONTRAST
3. no bicarb, sodium restriction inc. IN PTS WITH RENAL FAILURE.
sodium/bicarb reabsorbtion MRA
duplex doppler ultrasound
65. type 4 RTA 1. interstitial renal disease, diabetic
tx = revascularization, by PCI with stent
1. nephropathy, hypoaldosteronism or
ACE inhibitors, CCBs.
patho/causes resistance to aldosterone -> dec. Na
absorption, dec. H+/K+ secretion--> 73. renal vein 1. nephrotic syndrome***, RCC, trauma,
HYPERKALEMIA*, and acidic urine thrombosis preg/OCP, retroperitoneal fibrosis, aortic
1. patho aneurysm, lymphadenopathy
66. hartnups 1. AUTO RECESSIVE defect in amino acid
2. clinical pres 2. renal failure, flank pain, HTN
syndrome transporter --> dec. tryptophan absorption
3. dx/tx hematuria, proteinuria
1. patho and nicotinamide deficiency
3. renal venography, IVP
2. clinical 2. pellagra (niacin def seen in corn based
tx = anticoagulation
pres diets) - dermatitis, diarrhea, ataxia,
3. tx psychiatric 74. atheroembolic 1. showers of cholesterol crystals from
3. give nicotinamide disease of renal plaques in arteries
arteries 2. warfarin
67. analgesic nsaids, phenacetin, aspirin etc --> hematuria
1. patho 3. LIVEDO RETICULARIS, , hollenhorst
nephropathy - renal papillary necrosis***, or interstitial
2. risk factors plaques in the retina, digital cyanosis,
patho nephritis
3. clinical pres elevated creatinine, elevated ESR,
68. fanconi's 1. proximal tubule dysfunction --> defective
75. hypertensive 1. systemic HTN --> thickening of
syndrome transport of glucose, amino acids,
nephrosclerosis glomerular afferent arterioles -->
1. patho phosphate, uric acid, bicarb, sodium,
1. patho proteinuria, / ESRD
2. clinical potassium
2. clinical pres 2. proteinuria, rising Cr, dec. in renal
pres 2. impaired growth, glucosuria,
function,
3. dx/tx phosphaturia, rickets, osteomalacia,
proteinuria, 76. sickle cell 1. sickling of RBCs in microvasculature
3. phosphate, potassium ,alkali, salt nephropathy leads to infarction mostly in renal papillae
supplementation, hydration 1. patho --> nephrotic syndrome, 5% ESRD,
69. ADPKD 1. AUTODOM, AUTOREC--> renal failure 77. renovascular malignant HTN, sudden onset HTN, HTN
1. patho from recurrent pyelo/nephrolithiasis hypertension suddenly worsened HTN that does not
2. clinical 2. hematuria, abdominal pain, HTN, clinical pres respond to standard medical therapy
pres palpable kidneys,
78. nephrolithiasis 1. low fluid intake, gout, crohns,
3. 3. intracerebral berry aneurysms, renal
1. predisposing hyperparathyroid, type 1 RTA, UTIs (esp
complications failure, kidney stones, MVP/AR, cysts in
conditions proteus), low calcium, high oxalate diet
4. dx/tx liver/spleen/pancreas/brain, diverticula,
hernias 79. calcium stones 1.. calcium oxalate, or calcium phosphate,
4. US/CT/MRI 1. patho inc GI absorption, dec. renal reabsorption,
tx = not curable, treat infections/control 2. microscopic inc. bone reabsorbtion of calcium, primary
HTN findings/radio hyperparathyroidism, sarcoidsosi,
findings malingnacy
70. ARPKD 1. aka "infantile" cysts of the renal collecting
2. bipyramidal or ovals, radiodense on
1. patho ducts, and hepatic fibrosis
abdominal radiograph
2. clinical 2. portal HTN, cholangitis, pulmonary
pres hypoplasia, potter syndrome 80. causes of steatorrhea causes calcium loss
3. dx /tx 3. ultrasound during pregnancy, ultrasound hyperoxaluria small bowel disease, crohns, pyridoxine
deficinecy
71. potter oligohydramnios --> hypoplasia of the lungs,
syndrome club feet, abnormal facies
81. uric acid 1. persistently acidic* urine (<5.5), 87. UTO 1. renal ultrasound -
stones hyperuricemia (gout, chemotherapy, 1. dx urinalysis
1. patho leukemia, lymphoma [via purine release]) 2. tx KUB - shows stones
2. microscopic 2. radiolucent flat square plates IV contrast urogram
findings/radio 3. requires CT, ultrasound, or IVP for cystoscopy
findings detection CT scan
2. catheter, urethrotomy, prostatectomy,
82. struvite stones 1. UTI 2/2 urease producing bacteria
nephrostomy tube, ureteral stent,
1. patho (proteus, klebsiella, serratia, enterobacter)--
> alkalinization of urine--> ammonia 88. prostate 1. age, AA, high fat diet, family history,
combined with mg/phos-->struvite calculi cancer pesticide/herbicide exposure
1. risk factors 2. presents late- obstruction of the urethra
83. 1. what size 1. <0.5cm
2.clinical occurs, difficulty voiding, dysuria, inc.
stones can 2. sudden onset paroxysms of flank pain
pres urinary frequency,
pass that radiates anteriorly to the groin, n/v,
after mets- back pain, pelvic pain,weight loss
spontaneously hematuria***, UTI
2. clinical pres 3. urinalysis - microscopic or gross 89. prostate 1. DRE- 70% have spread if palpable
of urinary hematuria cancer - abnormal DRE --> TRUS
stone UA micro- shows crystals possibly 1. dx PSA screening/PSA velocity/ PSA density
3. dx/tx urine pH - alkaline suggests infection stone,
90. what causes prostate cancer, prostatitis
acidic urine suggests calcium oxalate or uric
an elevated prostatic massage
acid stones,
PSA needle biopsy, cystoscopy, BPH, prostatitis,
serum chemistry - BUN, Ca, Cr, oxalate,
advanced age
citrate levels
KUB- does not show cystine/uric acid 91. what 1. TRUS with biopsy
stones diagnostic 2. TRUS with biopsy
*CT scan without contrast* studies 3. annual follow up
IVP 1. PSA >10 4. TRUS with biopsy
renal ultrasound 2. abnormal
tx = analgesia - IV morphine/ketorolac DRE
fluid hydration, ABX for infection 3. PSA <4
>3 days - consider urology consult DRE negative
4. PSA 4.1-10,
84. indications pain not controlled with oral meds
DRE negative
for admission anuria
for renal renal colic 92. PSA ....
calculi stone > 1cm adjustments-
age adjusted,
85. renal calculi 2L/day of water
PSA velocity,
prevention limit animal protein intake if patient has
PSA density
hyperuricosuria
thiazide diuretics - dec. urine calcium, 93. when is TRUS PSA >10 ng/dl (50%)
allopurinol with biopsy PSA velocity >0.75/year
indicated
86. UTO 1. BPH, prostate cancer, urethral stricture,
1. lower neurogenic bladder, trauma (pelvic 94. prostate 1. contained disease - radical prostatectomy
urinary tract fracture/bladder cancer) cancer for
causes 2. kidney stones, blood clots, sloughed 1. treatment locally invasive - radiation and androgen
2. upper papilla, tumors, strictures, ureteropelvic deprivation
urinary tract dysfunction, pregnancy, tumors, AAA, metastatic - orchiectomy, antiandrogens
causes retroperitoneal fibrosis, endometriosis, (flutamide), LHRH agonists (leuprolide),
3. clinical pres crohns GnRH antagonists (degarelix)
3. renal colic/pain, oliguria, recurrent UTI, estramustine (estrogen+nitrogen mustard)
hematuria, renal failure 95. RCC 1. sporadic, or VHL
1. patho 2. lung, liver, brain, bone
2. sites of 3. cigarettes, phenacetin PCKD, chronic
mets dialysis (multicystic kidney disease), heavy
3. risk factors metals (mercury/cadmium), hypertension
96. RCC 1. HEMATURIA, abdominal/flank pain*, 102. epididymitis 1. e.coli in children/elderly, in young
1. clinical pres flank mass, weight loss, fever, 1. patho men - gonorrhea/chlamydia
2. paraneoplastic syndromes 2. clinical pres 2. swollen tender testicle, fever,
paraneoplastic 2. polycythemia (EPO), PTHrp, renin, chills, scrotal pain/mass
syndromes cortisol, gonadotropins, fever of unknown 3. r/o torsion (ultrasound), and abx
3. dx origin
103. fluids 1. 60% of body weight men, 50%
4. tx 3. CT with contrast, abdominal ultrasound
1. TBW women
4. surgery***, interferon alpha/2, sunitinib
2. ICF 2. 2/3 of TBW = 40% of body mass
(tyrosine kinase inhibitor)
3. ECF 3. 1/3 TBW = 20% of body mass
97. bladder cancer 1. typically transitional cell cancers 10% 4. plasma, 4. plasma = 1/3 ECF, 1/12 TBW
1. patho squamous and adeno (transitional cell interstitial fluid interstitial fluid = 2/3 ECF
2. risk factors cancer can occur in the bladder, renal
104. fluids 1. 800-1500 ml/day,
3. clinical pres pelvis, or ureter) spreads by local invasion
1. minimum = 500-600ml/day
2. cigarettes, aniline/azo dyes, long term
normal/minimum 2. 600-900 ml/day
cyclophosphamide treatment,
urine output 3. urine output 0.5-1.0ml/kg/hour
schistosomiasis
2. insensible loss
3. painless hematuria, irritable bladder
3. what is the best
irritation, dysuria frequency
way to assess
98. bladder cancer 1. urinalysis/urine culture, urine cytology, volume status
1. dx IVP, cystoscopy - lower extremity
2. tx 2. stage 0 - mucosal limited - intravesical edema may not be
chemo volume overload,
stage A - lamina propria - transurethral TBW may be high,
bladder resection but patient may be
Stage B - muscle invasion - radical intravascularly
cystectomy, node dissection ,removal of
105. causes of oliguria cardiac failure (low blood flow to
prostate, uterus, ovaries, anterior vaginal
kidney)
wall, urinary diversion
ATN/AIN/kidney damage
stage C - to pervesicular fat
post renal obstruction
stage D - cystectomy, systemic
chemotherapy 106. 1. what fraction of 1. 85% venous, 15% arterial
intravascular 2. liver failure, nephrotic syndrome
99. testicular 1. germ cell =
volume is in venous (hypoosmolar), left sided CHF
cancer seminomas (radiosensitive),
vs arterial system (pulmonary edema), right sided CHF
1. germ cell non-seminomas (embryonal
2. what patients (anasarca)
2. non-germ [necrosis/malig], chorio [mets quickly,
third space fluids
cell yolk sac, teratoma)
3. risk factors 2. leydig cell tumors - secrete 107. fluid replacement 1. blood loss or dehydrated, urgent
androgens/estrogens, precocious uses resuscitation
puberty/gynecomastia 1. normal saline 2. standard maintenance - glucose
sertoli cells -usually benign 2. D51/2NS + 20 spares muscle breakdown
3. cryptorchidism, klinefelter's syndrome mEq kcl/L 3. dilute powdered medicines,
4. dx - testicular exam/ultrasound, b-HCG 3. D5w hypernatremia, only 1/12 remains
(chorio/non-sem), AFP (embryonal), CT 4. lactated ringers intravascular
chest 4. intravascular volume, NOT
maintenance, trauma resuscitation,
100. penile cancer 1. uncircumcised, HSV, HPV
DO NOT USE IF PATIENT IS
1. risk factors 2. varicocele, spermatocele, hydrocele,
HYPERKALEMIC OR ESRD
2. ddx for lymphoma
testicular 108. causes of vomiting, diarrhea, NG suction,
mass hypovoluemia fistula, ascites, effusions, bowel
obstruction, burns, polyuria (ex.
101. testicular 1. twisting of spermatic cord causes
DKA), sepsis, retroperitoneal
torsion ischemia/infarction
inflammation, trauma, insensible
1. patho 2. acute severe testicular pain,
losses (skin 75%, respiratory tract
swollen/tender scrotum, elevated testicles,
25%)
3. testicular ultrasound, surgical
emergency - detorsion and orchiopexy
109. 1. clinical altered MS, sleepiness, apathy, coma 114. hypotonic 1. osmolality <280 mOsm/kg,
presentation orthostasis, dec. pulse pressure, dec. CVP hyponatremia low urine sodium <10mEq/L, due
hypovolaemia and PCWP 1. hypovolemic to extrarenal loss- diarrhea,
2. urine panel poor skin turgor, hypothermia, pale hypotonic vomiting, NG suction,
findings extremities, dry tongue, oliguria, ileus, hyponatremia diaphoresis, third spacing,
weakness, ARF (pre-renal azotemia) 2. euvolemic hypotonic burns, pancreatitis.
2. FENa <1%, BUN:Cr >20, low urine hyponatremia high urine sodium >20mEq/L -
sodium, elevated hematocrit (3% inc for 3. hypervolemic due to diuretic excesses, low
every liter of deficit) hypotonic aldosterone, ATN
hyponatremia 2. no evidence of ECF
110. 1. how does CBC 1. 3% inc. in hematocrit with each 1L of
expansion/contraction- SIADH,
change with dehydration
psychogenic polydipsia, post-op
dehydration 2. bolus LR or NS, monitor
hyponatremia, hypothyroidism,
2. how to HR/BP/UOP/weight, maintain UOP at
oxytocin, D5W, hypotonic
correct a 0.5-1ml/kg/hr, replace blood with
solution, water after intense
volume deficit crystalloid 3:1 ratio
exertion, haldol, cyclophos
Then maintenance D51/2NS with 20mEq
3. water retaining states - CHF,
KCl/L
nephrotic syndrome, liver disease
111. hypervolemia 1. iatrogenic, CHF, nephrotic syndrome,
115. isotonic hyponatremia any condition that causes inc
1. causes cirrhosis, ESRD
(pseudohyponatremia) protein/lipid levels --> inc. in
2. clinical 2. weight gain, peripheral edema, ascites,
plasma solids lower plasma
features pulmonary edema/rales, JVD, elevated
sodium concentration but the
3. tx CVP/PCWP, peripheral edema
amount of sodium is normal
3. fluid restriction, diuresis, UOP
monitor/daily weights, swan ganz 116. hypertonic osmotic substances cause water
catheter placement hyponatremia shift out of cells - hyperglycemia,
mannitol, sorbitol, glycerol,
112. Na+ 1. inc. sodium increases ECF, which inc.
maltose
concentration GFR, dec. in sodium intake causes dec.
is reflection of GFR and reduced sodium excretion 117. adjusting Na for for every 100 of glucose, serum
water 2. osmoreceptors in hypothalamus glucose sodium level decreases by 3
homeostasis stimulated by plasma hypertonicity(>295
118. diagnosis of specific BMP, plasma osmolality, assess
Na+ content is mOsm/kg), inc. ADH
type of hyponatremia volume status (hypo, eu, hyper)
reflection of production -->V2 receptors in collecting
urine osmolality
sodium ducts,
homeostasis 3. natremia- too much or too little water 119. hyponatremia 1. 120-130 hold water
1. sodium volemia - too much or too little sodium 1. treatment 110-120 - loop diuretics + saline
homeostasis <110 or symptomatic - give
2. water hypertonic saline to inc. serum
homeostasis sodium by 1-2 mEq/L/hr, DO
3. NATREMIA NOT INC. SODIUM MORE
VS VOLEMIA THAN 8mmol/L during first 24
hours- OR GET PONTINE
113. hyponatremia 1. plasma Na < 135mmol/L
MYELINOLYSIS
1. definition 2. occurs at Na <120mEq/L
2. symptomatic 3. water shifts and increases ICF volume, 120. hypernatremia 1. serum sodium >145
hyponatremia leading to cerebral edema--> HA, 1. definition 2. diuretics, osmotic diuresis
level delirium, twitching, weakness, 2. hypovolemic (glycosuria), renal failure,
3. symptoms of hyperactive DTR, seizures, coma, hypernatremia cause diarrhea, diaphoresis, respiratory
hyponatremia n/v ileus, watery diarrhea losses
CV HTN from inc. ICP 3. diabetes inspiidus, respiraotry
inc salivation/lacrimation losses
oliguria --> anuria ***** 4. iatrogenic ~ TPN, NaHCO3-,
glucocorticoids, saltwater
drowning, hyperaldosteronism
121. hypernatremia 1. neurologic symptoms - restlessness, 128. hypocalcemia 1. rickets, osteomalacia,
1. clinical pres focal neuro deficits, confusion, seizures, 1. clinical pres neuromuscular irritability- numbness,
2. dx coma 2. cardiac tingling, tetany, chvostek's sign,
3. tx tissues, mucous membranes dry, salivation manifestations trousseau's sign, grand mal seizures, basal
decreases 3. lab workup ganglia calcifications
2. urine volume low, urine osmolality 4. tx 2. LONG QT***
>800mOsm/kg 3. BUN, Cr, magnesium, albumin, ionized
3. hypovolemic - give NS to restore calcium, amylase, lipase
hemodynamics 4. IV calcium gluconate, oral calcium
isovolemic - DDAVP for DI, oral fluids, supplements, vitamin D, thiazide diuretics
D5W IV (dec. urinary calcium), magnesium
hypervolemic - diuretics, D5W, dialyze if
129. hypercalcemia 1. hyperparathyroidism(inc. Ca, dec PO4),
ESRD
1. causes pagets disease of bone, acromegaly,
122. water deficit water deficit = TBW (1-[actual 2. what drugs addisons, metastatic
calculation Na/desiredNa) cause cancer(prostate=osteoblastic,
hypercalcemia kidney=osteolytic), MM (lysis of bone
123. calcium 1. 8.5-10.5
- sarcoidosis tumor, release of OAF), PTHrp (lung
1. normal 2. corrected = total - [albumin*0.8]
-familial cancer)
range 3. high pH calcium binds albumin thus
hypocalciuric 2. milk-alkali syndrome, vitamin D
2. corrected total Ca is normal, but ionized is low
hypercalcemia intoxication, thiazide, lithium (inc. PTH)
calcium
(low urine
3. effect of pH
Ca2+
124. PTH 1. inc bone resorption, inc Ca2+
130. hypercalcemia stones -nephrolithiasis, nephrocalcinosis
1. actions reabsorption at the kidney, dec. PO4-
1. clinical pres bones - bone aches/pains, osteitis fibrosa
reabsorption, inc. gut activation of D3
2. cardiac cystica
==== inc plasma Ca2+, dec. plasma PO4-
findings ECG grunts and groans -muscle
125. calcitonin 1. dec bone resorption, dec kidney Ca2+ 3. dx pain/weakness, pancreatitis, PUD, gout,
1. actions reabsorption,inc kidney PO4- constipation
reabsorption, dec gut absorption of Ca2+ psychiatric overtones- depression, fatigue,
===== dec plasma Ca2+ and dec. plasma anorexia, sleep disturbances, anxiety,
PO4- lethargy
126. vitamin D inc. bone resorption, inc Ca2+ - other- polyuria/polydipsia, hypertension,
1. actions reabsorption, dec. PO4- reabsorption, inc. weight loss,
gut Ca2 reabsorption, inc. gut PO4- 2. SHORT QT***
reabsorption 3. same workup as hypocalcemia, +
radioimmunoassay of PTH (PTH vs
127. hypocalcemia 1. hypoparathyroidism (iatrogenic MCC),
PTHrp)
1. causes acute pancreatitis (deposition), renal
insufficiency (dec. D3 ESRD), 131. hypercalcemia 1. IV fluids
hyperphosphatemia (ESRD), 1. tx diuretics - furosemide
pseudohypoparathyroidism (resist to BISPHOSPHONATES (pamidronate)
PTH), hypomagnesemia (dec. PTH calcitonin
secretion), D3 deficiency, malabsorption glucocorticoids
(short bowel), transfusion (citrate binds hemodialysis
Ca), osteoblastic mets, hypoalbuminemia, phosphate- risk of metastatic calcification
digeorge (no thymic shadow) 132. potassium 1. intracellular
1. where is it 2. alkalosis, insulin, albuterol
located in the 3. acidosis, renal failure
body 4. kidneys, GI tract
2. hypokalemia
causes
3.
hyperkalemia
causes
4. potassium
secretion`
133. hypokalemia vomiting, NG suction (hypokalemic met 140. pseudohyperkalemia prolonged tourniquet use with or
1. causes alk), diarrhea, laxatives, enemas, diuretics, without repeated fist clenching-->
2. bartter renal tubular disease, parenchymal disease, acidosis/K+ loss from cells``
syndrome glucocorticoids, mg deficiency, insulin also hemolysis during venipuncture
administration, insufficient dietary intake
141. hyperkalemia 1. muscle weakness, dec. DTR,
2. autosomal recessive defect in salt
1. clinical pres respiratory failure, n/v, intestinal
reabsorption in thick ascending limb -
2. ECG colic, diarrhea
hypokalemia, met. alk, inc.urine chloride
3. tx 2. K+ > 6.0 tall peaked T waves,
(>20)~ key to distinguish from contraction
QRS widening, PR
alkalosis
prolongation,loss of P waves, sine
134. what acid hypokalemic non-anion gap metabolic wave pattern, vfib
base acidosis 3. IV calcium gluconate*** -
disturbance stabilizes resin myocardial
with membrane
diarrhea Glucose and insulin
sodium bicarbonate - inc. pH
135. in a patient 1. could be excess aldosterone
(emergency only)
who is 2. probably renal or GI loss
kayexalate - GI potassium exchange
hypokalemia 3. bactrim, ampho B, B2 agonists,
resin
1. what does
hemodialysis
it mean if
diuretics - furosemide
they are
hypertensive 142. hypomagnesemia 1. malabsorption, prolonged
2. what does 1. causes fasting, fistulas, TPN w/o mg,
it mean if 2. renal causes alcoholism
they are 3. clinical pres 2. SIADH, diuretics, bartter's,
normotensive 4. relationship gentamicin, ampho B, cisplatin,
3. what drugs between mg and k renal transplant
cause 5. ECG changes 3. COEXISTING HYPOCALCEMIA,
hypokalmeia - tx = oral or neuromuscular/CNS
parenteral Mg hyperexcitability, muscle twitching,
136. hypokalemia T wave flattening, T wave inversions
weakness, tremors, hyperreflexia,
ECG findings U waves
seizures, altered mental status
prolongation of the QU interval (also seen
4. when Mg or K decreases, the
with quinidine)
other ion decreases
137. what monitor K+, hypokalemia predisposes to 5. prolonged QT, T wave flattening,
electrolyte to digoxin toxicity torsade de pointes
monitor in monitor Ca, hypercalcemia predisposes to
143. hypermagnesemia 1. renal failure***, early burns,
patients on digoxin toxicity
1. causes severe acidosis, trauma/surgical
digoxin
2. clinical pres stress, adrenal insufficiency,
138. hypokalemia 1. arrhythmias (prolongs conduction), 3. ECG changes rhabdomyolysis
1. clinical weakness, fatigue, paralysis, cramping, 4. tx 2. nausea, facial paralysis, loss of
pres ileus, polyuria, polydipsia, N/V DTRs (first), somnolence, death
2. tx 2. identify cause, adjust drugs, oral KCL, 10 from respiratory failure/cardiac
mEq KCL inc. K+ by 0.1mEq/L, monitor K+ arrest
and EKG 3. hyperkalemia type changes- inc
max 10 mEq/hr in peripheral IV line PR interval, widened QRS, elevated
max 20 mEq/hr in central line T waves
add 1% lidocaine to dec. pain 4. calcium gluconate for
139. hyperkalemia 1. renal failure, addison's, K+ sparing cardioprotection,
1. causes diuretics (spirono), hyporeninemic saline/furosemide, dialysis,
hypoaldosteronism, ACE inhibitors***, intubation
transfusion, acidosis, rhabdo, hemolysis,
burns, insulin deficiency (dec. NAK ATPase
activity), bactrim
144. hypophosphatemia 1. alcohol abuse (dec. intestinal 151. 1. non-AG met 1. diarrhea (HCO3- loss), pancreatic
1. causes abs), vitamin D deficiency, acid causes fistulas, small bowel fistulas,
2.clinical pres malabsorption, excessive use of ureterosigmoidoscopy
antacids, hyperalimentation or proximal RTA (MM, cystinosis, wilsons),
starvation distal RTA (SLE, sjogrens, ampho B),
hyperglycemia, osteomalacia, ATN, acetazolamide (CA inhibitor)
RTA, hypokalemia,
152. 1. metabolic 1. hyperventilation - kussmaul respirations
hypomagnesemia
acidosis when pH <7.2,
2. encephalopathy, confusion,
clinical pres acidosis--> dec. response to
seizures, paresthesias, muscle
2. dx catecholamines***-->lactic acidosis, -->
weakness, myalgias/rhabdo, bone
dec. CO --> hypotension-->worsening
pain, rickets/osteomalacia
acidosis
hemolysis, RBC dysfunction, WBC
2. history, AG,
dysfunction, platelet dysfunction
expected PaCO2=1.5(HCO3-)+8+/-2
cardiomyopathy/myocardial
if more than expected there is also
depression
resp.acid b/c of inadequate compensation
145. hyperphosphatemia 1. renal insufficiency, ***inadequate compensation is a sign of
1. causes bisphosphonates, impending resp. failure
2. clinical pres hypoparathyroidism, D3 ***PaCO2 less than expected, patient has
3. tx intoxication, calcinosis, PO4 met acid + resp. alk
enemas, D3 overdose,
153. metabolic 1. sodium bicarbonate(but takes 24 hours
2. metastatic calcification, soft tissue
acidosis to get to brain)
calcifications,
1. tx H+ = 24[PaCO2/HCO3-] ~ so while
serum * calcium > 70 = likelihood for
patient gets bicarb, PaCO2 is still very low
precipitates to form
--> severe intracranial alkalosis
hypocalcemia --> neuromuscular
mechanical respiration for respiratory
irritability/tetany
fatigue
3. phosphate binding antacids w/
aluminum hydroxide or carbonate, 154. metabolic 1. inc. blood pH, inc. HCO3-
hemodialysis alkalosis 2. is the patient volume expanded or
1. definition contracted
146. metabolic acidosis 1. dec. pH, dec. bicarbonate conc
2. first step in 3. loss of gastric H+, ECF volume
1. criteria 2. AG = Na+ - (Cl + HCO3-)
evaluation contraction
2. anion gap - reflects unmeasured ions, proteins,
3. causes: saline sensitive- urine Cl < 10mEq/L, ECF
3. AG metabolic phosphates, organic acids, sulfates
saline contraction, hypokalemia: vomiting,, NG,
acidosis causes 3. ketoacidosis - diabetic, starvation,
sensitive diuretics, villous adenoma (high chloride
alcohol abuse
4. causes: diarrhea)
lactic acidosis -
saline 4. urine Cl>20mEq/L, ECF expansion,
renal failure- dec. NH4+ excretion,
resistant primary hyperaldosteronism, cushings, K+
retention of organic ions, sulfate,
5. how high deficiency, Bartter's syndrome, diuretic
phosphate
should abuse
147. effect of acidosis on right shift oxygen hemoglobin curve respiratory 5. PaCO2 to 50-55, if higher there is
the body depresses CNS, dec. pulmonary compensation probably resp acid as well
blood flow, arrhythmias, myocardial be
function impairment, hyperkalemia
155. metabolic 1. inc. HCO3-, inc. pH, hypokalemia,
148. effects of alkalosis dec. cerebral blood flow alkalosis PaCO2 is elevated, urine chloride (high or
on the body left shifts oxygen hemoglobin 1. dx low)
dissociation curve, arrhythmias, 2. tx 2. NS + potassium if saline sensitive, if
tetany, seizures saline resistant can address underlying
cause or spironolactone
149. how to tell if delta AG < delta HCO3- ~~ AG acid
Ammonium chloride for severe (risk of tox
met.acid is a mixed + high AG acid
in patients with liver failure)
disorder delta AG > delta HCO3- ~~ met alk +
high AG acid
150. salicylate toxicity primary resp. alk, primary met.acid `
acid/base
disturbance
156. respiratory 1. blood >40mmHg, reduced blood pH 163. after patient is found to retic, B12, folate
acidosis 2. acute - 1mmol/L for every 10mmHg have anemia what is next
1. definition PaCO2 lab test
2. pH inc. by 0.08
164. cryoprecipitate- VIII, XIII, fibrinogen, vWF-
compensation chronic - 4mmol/L for every 10mmHg
components+what is it used for hemophilia A, DIC,
3. causes PaCO2
used to treat vWD
4. clinical pres 3. COPD, airway obstruction, myasthenia,
brainstem injury, narcotic overdose, 165. how much change in CBC 1 unit or PRBCs- inc. Hb 1, inc
respiratory fatigue with 1 unit of PRBCs and Hct 3
4. somnolence, confusion, myoclonus with 1 unit of platelets 1 unit of platelets - inc platelet
asterixis, HA, confusion, papilledema count by 10,000

157. respiratory 1. patency of airway, supplemental oxygen 166. blood products for 1:1:1 - platelets:FFP:PRBCs
acidosis (if PaO2<60***can exacerbate acidosis in massive blood loss
1. treatment COPD), correct reversible causes, improve 167. hemolytic transfusion 1. ABO mismatched blood -->
alveolar ventilation, naloxone, reactions: intravascular anti-# IgM--> complement
bronchodilators intubation/mech vent (if hemolysis activation, C9 punches holes
PaCO2>60, no improvement with 1. patho in RBCs
supplemental oxygen, obtunded, 2. 2. fever, chills, n/v, flank pain,
deteriorating mental status) symptoms/complications chest pain, dyspnea,
158. respiratory 1. inc. blood pH, dec. PaCO2 3. tx hypovolemic shock,
alkalosis 2. acute: HCO3- dec by 2 mmHg for every hypotension, tachycardia,
1. definition 10 mmHg dec in PaCO2, blood pH inc by DIC, renal failure,
2. 0.08 hemoglobinuria (ATN)
compensation chronic: HCO3- dec by 5 mEq/L for every 3. stop transfusion, fluid
3. causes 10 mmHg dec in PaCO2 and blood pH dec. replacement, epinephrine,
by 0.02 dopamine/norepi for pressure
3. alveolar hyperventilation - anxiety, PE, control
pneumonia, asthma, sepsis, hypoxia, 168. hemolytic transfusion 1. minor antigen reaction -
mechanical ventilation, pregnancy (inc. reactions: extravascular occurs 3-4 weeks after
progesterone), cirrhosis, salicylates, hemolysis transfusion, previous exposure
159. respiratory 1. dec. cerebral blood flow 1. patho creates memory-B cells that
alkalosis (vasoconstriction), lightheadedness, 2. clinical pres + tx will produce Ig against antigen
1. clinical pres dizziness, anxiety, paresthesias, perioral and lead to splenic/liver/bone
2. tx numbness, tetany, arrhythmias marrow sequestration
2. correct underlying cause, inhaled CO2, 2. late onset -- fever, jaundice,
or breathing into paper bag anemia
tx none
160. anemia 1. inc. CO (HR*SV), inc. extraction ratio,
1. right shift of hemoglobin curve (via inc. 2,3 169. anemia 1. >2 excessive RBC
compensatory DPG), expansion of plasma volume 1. interpretation of destruction or blood loss with
mechanisms 2. Hb concentration<7g/dl or inc. oxygen reticulocytes bone marrow response
2. when to carrying capacity (CAD or pulmonary 2. microcytic anemia ddx <2 inadequate RBC production
transfuse disease) (take a look at slide)
3. clinical pres 3. depends on patient, they may be 2. IDA, thalassemias,
asymptomatic at Hb 7 or 8: headache, sideroblastic (lead, B6 def,
fatigue, poor conc, diarrhea, nausea, alcohol)-->accumulated
pallor(conjunctiva), hypotension, porphyrins/iron in
tachycardia, jaundice (if hemolytic, blood mitochondria
in stool
161. anemia 1. reticulocyte index (>2% impliese
1. dx excessive RBC destruction)
2. tx hb*3 = hct, iron, B12, folate, EPO (ESRD)
2
162. pseudoanemia decrease in hemoglobin/hct 2/2 dilution
acute volume infusion or overload
170. anemia 1. B12/folate deficiency, liver disease 177. thalassemia 1. heterozygous beta-chain thalassemia
1. macrocytic ddx (up to 115) due to altered lipoprotein minor 2. asymptomatic, mild microcytic
2. normocytic synthesis), stimulated erythropoiesis 1. patho hypochromic anemia
ddx (polychromatophilic RETICS), 2. clinical pres 3. dx = hemoglobin electrophoresis
myelodysplasia
178. what is next hemoglobin electrophoresis- to rule out
2. aplastic anemia, bone marrow
diagnostic test in alpha/beta thalassemia
fibrosis, tumor, AOCD, renal failure
patient who has
(inflamm/malig)
IDA, but does not
171. evaluation of first retic >2, respond to iron
suspected then check haptoglobin, LDH, bilirubin
179. alpha thalassemia 1. mutation/deletion of only one alpha
hemolytic anemia
1. one locus- asymptomatic, normal
172. microcytic 1. chronic blood loss, menstrual mutation/deletion hemoglobin/hematocrit
anemia bleeding, GI blood loss, clinical pres 2. two alpha loci mutations- mild
1. causes infants/toddlers drinking human milk 2. alpha hypochromic anemia
2. clinical pres (low iron), rapid growth in adolescents, thalassemia trait 3. hemolytic anemia, splenomegaly,
3. dx pregnancy clinical pres microcytic hypochromic anemia, HbH
4. tx 2. pallor, fatigue, generalized weakness, 3. HbH disease on gel electrophoresis
DOE, orthostasis 4. 4 alpha loci tx = PRBC transfusions
3. dec. ferritin, inc. TIBC, inc. mutations 4. hydrops fetalis fatal at birth
transferrin, inc RDW, microcytic
180. sideroblastic 1. hereditary
hypochromic RBCs on smear, stool
anemia acquired - chloramphenicol, INH,
guaiac
1. patho alcohol, lead*, collagen vascular
4. ferrous sulfate - SE = constipation,
2. dx disease, myelodysplasia
nausea, dyspepsia
3. tx 2. inc. serum ferritin**, inc. serum
iron dextran- IV or IM
iron*, BASOPHILIC STIPPLING,
173. beta thalassemia 1. deficient beta chain, excess alpha normal TIBC, TIBC saturation
(cooley's anemia) chains aggregate and damage normal/elevated
1. patho beta thal membranes ringed sideroblasts on marrow biopsy
2. demographics 2. mediterranean, middle eastern, and 3. remove offending agent, B6
3. clinical pres + indian ancestry supplementation
tx 3. severe hypochromic microcytic
181. anemia of chronic 1.chronic infection, TB, lung abscess,
anemia, hepatosplenomegaly***,
disease cancer, RA, SLE, trauma-->IL6/
marrow expansion, FTT, skull xray
1. patho cytokines + HEPCIDIN*** are
shows "crew cut"
2. dx suppressive effect on EPO (dec. retics)
4. HbF/HbA2 elevated - peripheral
3. tx and dec. iron absorption from the gut
smear shows microcytic hypochromic
2. low serum iron, low TIBC, low serum
RBCs with target cells
transferrin, INCREASED SERUM
tx = frequent PRBCs
FERRITIN, normochromic, normocytic
174. alpha 1. alpha chain decrease, beta tetramers 3. no treatment, do not give iron
thalassemia
182. aplastic anemia 1.radiation, chloramphenicol,
1. patho
1. patho sulfonamides, gold, carbamazepine,
2.
2.clinical pres parvo B19, hep C, hep B, EBV, HZV,
175. what is the iron overload and hemochromatosis HIV, benzene, insecticides--> bone
consequence of tx -= desferoxamine marrow failure-->pancytopenia
frequent 2. fatigue, dyspnea, petechiae, easy
transfusions in bruising, inc. infections (neutropenia),
beta thal patients 3. normocytic, normochromic anemia,
bone marrow shows hypocellular
176. what type of IDA
marrow, absence of progenitors
microcytic
tx = bone marrow transplant,
anemia is inc.
PRBC/platelt transfusion,
RDW
characteristic of 183. pernicious autoimmune destruction of parietal
anemia cells and intrinsic factor leads to
impaired absorption of B12 in terminal
ileum
184. B12 deficiency 1. homocysteine to methionine, methyl 192. sickle cell 1. AR - substitution of uncharged valine for
1. function of malonyl CoA to succinyl CoA anemia negative glutamic acid at 6th position of the
b12 2. meat, fish- about 3 years supply in the 1. patho beta chain
2. dietary liver 2. what 2. acidosis, hypoxia, changes in
sources/storage 3. pernicious, gastrectomy, poor diet triggers temperature, dehydration, infection
3. causes of content (vegan), alcoholism, crohns sickling 3. >3 crises/year - median age of death - 35
deficiency disease, ileal disease, diphyllobothrium 3. correlation years
latum, blind loop (bacterial overgrowth of sickle crisis 4. 2/2 parvo b19, - blood transfusion and
and age of patient recovers in 10-14 days
185. b12 deficiency 1. anemia, stomatitis, glossitis,
death
1. clinical pres neuropathy (B12*** vs folate),
4. treatment
demyelination (pos. columns,
of aplastic
corticospinal tracts, spinocerebellar
crisis
tracts), ataxia, upper motor neuron signs,
urinary/fecal incontinence, dementia 193. sickle cell 1. jaundice, pallor, gallstone disease
anemia (pigmented),
186. b12 deficiency 1. peripheral smear shows megaloblastic
1. clinical pres high output heart failure
1. dx anemia - hypersegmented PMNs, serum
2. painful aplastic crisis (parvo)
2. schilling test B12 <100 pg/ml, elevated methylmalonic
bone crisis 2. painful bone crisis - tibia, humerus, self
3. tx acid, elevated homocysteine, anti-
3. hand foot limiting in 2 -4 days
intrinsic factor
syndrome 3. painful swelling of dorsa of hands and
2. IM dose of unlabeled B12 to saturate
4. acute chest feet from avascular necrosis of metacarpal
binding sites, oral dose of radioactive B12,
syndrome and metatarsal bones
measure radio B12 in urine and plasma,
4. repeated episodes of pulmonary
repeat oral B12 with intrinsic factor- if it
infarctions- cx pain, respiratory distress,
is pernicious, adding intrinsic factor will
pulmonary infiltrates, hypoxia
increase serum conc
3. IM cyanocobalamin once/month 194. sickle cell 1. multiple splenic infarctions cause
anemia functional asplenia by age 4 years (non-
187. folate 1. raw green vegetables, 3 months worth
1. splenic palpable)
deficiency of stored folate
disease 2. most commonly in the hip and shoulder
1. 2. inadequate diet, alcoholism, long term
2. avascular 3. vasoocclusion --> erection, lasting
sources/storage oral ABX, pregnancy, hemolysis, MTX,
necrosis between 30 mins and 3 hours
2. clinical pres phenytoin, hemodialysis
3. priapism + tx = hydralazine, or nifedipine, or anti-
3. dx/tx 3. serum folate, elevated homocysteine
treatment androgen
ONLY,
4. CVAs 4. cerebral thrombosis especially occurs in
tx= dietary folic acid
children
188. causes of immune hemolysis, mechanical
195. sickle cell 1. renal papillary necrosis with hematuria,
hemolytic hemolysis (prosthetic valves, MAHA),
anemia 2. chronic leg ulcers
anemia burns, toxins (snake bites/recluse spider),
1. renal 3. abdominal crisis - mimics acute abdomen
sickle cell anemia, HbC, spherocytosis,
complications 4. functional asplenia leads to increased
PNH
2. extremity risk for - h.flu, s.pneumo, neisseria
G6PD, pyruvate kinase
complications meningitidis (encapsulated bacteria)
189. intravascular intravascular = inside circulation 3. abdominal
vs extravascular = within reticuloendothelial complications
extravascular system (spleen/bone marrow/liver) 4. infectious
190. lab studies for elevated retic, inc. LDH, dec. complications
hemolytic haptoglobin, dec. hb/hct, inc. retic count, 196. 1. sickle cell 1. anemia, sickle peripheral smear, howell
anemia schistocytes (intravascular), anemia jolly bodies hemoglobin electrophoresis
spherocytes/helmet cells (extravascular), diagnosis 2. hydration, IV fluids, morphine, keep
sickled RBCS, heinz bodies (G6PD), 2. sickle cell patient warm, supplemental O2
elevated indirect bilirubin , direct coombs pain crisis tx 3. avoid high altitudes (low O2 tension),
positive, (in AIHA) 3. sickle cell tx maintain fluid intake, vaccination against
191. smear findings schistocytes, helmet cells h.flu, s.pneumo, n.mening, hydroxyurea
for hemolytic (inc. HbF), blood transfusion , bone
anemia marrow transplant
197. hereditary 1. AUTOSOMAL DOMINANT - mutation in 202. paroxysmal 1. deficiency in proteins that link
spherocytosis spectrin--> splenic trapping and destruction nocturnal complement inactivating proteins to
1. patho (extravascular) hemoglobinuria blood cell membranes-->complement
2. clinical 2. hemolytic anemia, jaundice, 1. patho mediated intravascular lysis,
pres splenomegaly, gallstones*, hemolytic crisis 2. clinical pres hypercoagulable state, bone marrow
3. dx (2/2 parvo b19) 3. complications aplasia
4. tx 3. osmotic fragility to hypotonic saline, 4. tx 2. chronic paroxysmal intravascular
elevated retic, elevated MCHC >36%, hemolysis, inc. LDH, normochromic
spherocytes on smear, direct coombs normocytic anemia, pancytopenia,
negative venous thrombosis, abdominal, back
4. splenectomy pain, muscle pain
folate supplementation (prevents aplastic 3. aplastic anemia, myelodysplasia,
crisis) myelofibrosis, acute leukemia
4. glucocorticoids, BMT
198. causes of hereditary spherocytosis, G6PD, ABO
spherocytosis incompatibility, hyperthermia, AIHA 203. 1. HIT type 1 + tx 1. heparin causes platelet aggregation,
2. HIT type 2 + tx <48 hours after initiating heparin, no
199. G6PD 1. x linked disorder
treatment is needed
deficiency infection- G6PD cannot generated NADPH
2. heparin induces PF4 release and
1. patho + to reduce glutathione
triggers formation of heparin PF4
triggers OXIDIZING DRUGS- sulfonamides,
complexes--> IgG antibody mediated
2. clinical nitrofurantoin, primaquine, dimercaprol,
platelet activation/endothelial
pres fava beans, infection
activation and intravascular thrombin
3. peripheral 2. episodic hemolytic anemia, dark urine,
generation--> vascular thrombosis***
smear jaundice on exam,
3-12 days after starting heparin--
findings peripheral smear shows BITE CELLS,
heparin should be DC
HEINZ BODIES (Hb precipitates),
PRUSSIAN BLUE STAIN POSITIVE 204. 1. causes of bone 1. aplastic anemia, congenital aplastic
tx = avoid triggers, maintain hydration, RBC marrow failure anemia (fanconi's), congenital
transfusion 2. causes of bone intrauterine rubella
3. bite cell from removal of heinz bodies by marrow invasion 2. tumors, leukemia, fibrosis
splenic macrophages 3. causes of bone 3. gold, ethanol, cancer chemotherapy,
marrow injury benzene, chloramphenicol, radiation,
200. AIHA 1. autoantibodies against RBC membrane
infection
1. patho antigens (IgG anti-Rh) leads to destruction
2. warm of RBCs 205. paroxysmal Ham's test*** - patients cells placed in
AIHA 2. leukemias, lymphomas, CLL, collagen nocturnal acidified serum, triggering alternate
3. cold AIHA disease, alpha methyl dopa -->IgG--> hemoglobinuria complement pathway causes lysis of
extravascular hemolysis --> splenomegaly 1. diagnosis PNH cells
3. mycoplasma, infectious mononucleosis -- sugar water test- patients blood +
> IgM* binds to RBC membrane--> glucose - causes hemolysis
intravascular hemolysis flow cytometry shows low CD55, and
CD59
201. AIHA 1. fatigue, pallor, jaundice,
1. clinical 2. microspherocytes, elevated reticulocytes 206. platelet disorders 1. decreased production, increased
pres direct coombs test positive - IgG- warm 1. causes of destruction, sequestration
2. dx AIHA thrombocytopenia 2. reactive - IDA, splenectomy,
3. tx RBCs covered with complement alone - it 2. causes of rebound, inflammatory disease,
is cold AIHA thrombocytosis autonomous - myeloproliferative,
3. often self limiting 3. qualitative polycythemia vera, essential
warm - glucocorticoids, splenectomy, platelet disorders thrombocytosis, CML
azathioprine/cyclophosphamide, RBC, 4. hereditary 3. ASA, NSAIDs, antibiotics, high dose
folate supplementation platelet disorders PCN, uremia (effects vwF XIII), liver
cold - avoid cold exposure, RBC disease (TPO), marrow disorders
transfusions, chemotherapeutic, (leukemia etc), multiple myeloma, ITP,
cardiopulmonary bypass (causes
partial degranulation)
4. vWD, bernard soulier, glanzmanns
207. 1. what causes 1. ITP, infection, drug induced, HIT 212. heparin induced 1. unfractionated heparin (15%), rarely
increased platelet type 2, HIV associated thrombocytopenia LMWH--> drop in platelets a few days
destruction thrombocytopenia 1. patho after administration--> platelet
2. dilutional DIC, TTP, HIT type 1 2. dx/tx aggregation/activation+procoagulant
thrombocytopenia 2. post hemorrhage, post transfusion 3. complications release leads to venous
3. 3. incidental finding, or pre- thrombosis/DVT/PE****
thrombocytopenia eclampsia/ecclampsia, or HELLP 2. antiplatelet factor IV or serotonin
in pregnancy syndrome assay
tx= STOP HEPARIN, give direct
208. thrombocytopenia 1. cutaneous petechiae bleeding,
thrombin inhibitor to bridge to
1. clinical pres purpura, ecchymosis with minor
warfarin (lepirudin, argatroban,
trauma, mucosal bleeding, epistaxis,
rivaroxaban)
menorrhagia, hemoptysis, GI/GU
3. heparin induced thrombocytopenia
bleeding
and thrombosis (HITT)- 25% mortality
209. immune 1. acute post viral, or adult chronic--> rate
thrombocytopenic autoimmune antibody against hosts
213. bernard soulier 1. AR- Gp1bIX defect leads to platlet
purpura platelets which are then removed by
1. patho adhesion to subendothelium
1. patho splenic macrophages
2. dx dysfunction
2. clinical pres 2. petechiae/ecchymoses on the skin,
2. abnormally large platelets, mildly
3. dx minimal bleeding symptoms, mucous
low platelet count
membrane bleeding, NO
SPLENOMEGALY*** 214. glanzmann's 1. AR - GpIIb-IIIa deficiency
3. platelets <20,000, remainder of thrombasthenia 2. prolonged bleeding time, platelet
blood count normal, dec. platelets on count normal
blood smear, inc megakaryocytes on
215. von willebrand's 1. defect in factor VIII or vWF
bone marrow,
disease 2. coagulant portion, and antigenic
anti-platelet IgG.....
1. patho portion (= vWF)
210. immune corticosteroids, IVIG (saturates RES), 2. sub regions of 3. type 1 = dec. vWF, type 2 =
thrombocytopenic splenectomy, (70-80% effective), factor VIII qualitative abnormalities of vWF, type
purpura platelet transfusions 3. type 1/2/3 3 = absent vWF
1. tx romiplostim, eltrombopag- 4. clinical pres 4. cutaneous/mucosal bleeding,
thrombopoietin receptor agonists epistaxis, easy bruising, excessive
bleeding with minor trauma,
211. thrombotic 1. ADAMTS13 defect cannot break
menorrhagia, GI bleeds
thrombocytopenic down vWF multimers-->hyaline
purpura microthrombi occlude small vessels 216. von willebrand's 1. prolonged bleeding time, dec. vWF,
1. patho causing mechanical damage to RBCs disease dec. factor VIII, reduced ristocetin
2. clinical pres 2. hemolytic anemia (MAHA), 1. dx induced platelet aggregation
3.dx tx thrombocytopenia, ARF, fever, 2. tx 2. DDAVP induces endothelial release
fluctuating neurologic signs of vWF(type 1/2)
3. tx = plasmapheresis****, factor VIII concentrates, - after
corticosteroids, splenectomy, NO trauma/during surgery
PLATELET TRANSFUSION cryo - has risk of viral transmission
avoid NSAIDs/aspirin
217. hemophilia A 1. XLR - deficiency in factor VIII
1. patho 2. hemarthrosis, knees most commonly
2. clinical pres , progressive joint destruction (2/2
3. dx recurrent hemarthrosis), intracranial
bleeding,
retroperitoneal/intramuscular
hematomas
3. prolonged PTT, low VIII, normal
vWF
tx = analgesia (NOT
ASPIRIN/NSAIDS), VIII concentrate
for acute bleeding/dental work,
DDAVP for mild disease
218. treatment of IX concentrates, DDAVP doesnt do 227. antiphospholipid 1. acquired hypercoagulable
hemophilia B anything syndrome state (LUPUS) -- >
1. patho recurrent arterial/venous
219. disseminated 1. infection (gram neg sepsis)/OB/fluid
- lupus anticoagulant, thrombosis
intravascular emboli/retained fetus/abruptio placentae,
anticardiolipin, beta 2
coagulation trauma, malignancy (lung/pancreas)-->
microglobulin etc.
1. patho abnormal activation of coagulation leading
2. clinical to microthrombi formation and 228. protein C deficiency 1. auto dom- deficiency of
pres consumption of platelets, fibrin, 1. patho factor V/VIII inhibitor -->
coagulation factors --> activation of unregulated prothrombin
fibrinolytic system activation and inc.
2. superficial hemorrhage, ecchymosis, thrombotic events
petechiae, purpura, OOZING FROM
229. factor V leiden 1. protein C resistance -->
PROCEDURE SITES, thrombosis
1. patho protein C can no longer
220. disseminated 1. PT, PTT, bleeding time, TT - ALL inactivate factor V-->
intravascular INCREASED, fibrin split products unregulated prothrombin
coagulation increased, d-dimers increased, dec. activation
1. dx fibrinogen, dec. platelet count
230. secondary hypercoagulable malignancy (panc, GI,
2. tx peripheral smear - shows schistocytes
states lung, ovaries)
2. underlying cause, FFP, platelet
antiphospholipid antibody
transfusions cryo, low dose heparin, O2, IV
syndrome
fluids
pregnancy
221. what does measures fibrinogen concentration immobilization, OCPs,
thrombin postoperative (esp. ortho),
time measure nephrotic syndrome, HIT,
DIC, PNH
222. liver disease liver disease- PT and PTT elevated,
vs vitamin K TT, fibrinogen, platelets normal 231. what drug is not effective in HEPARIN
deficiency vitamin K - PT prolonged, patients with antithrombin
coagulopathy PTT, TT, platelet count, fibrinogen levels III deficiency
normal
232. heparin mechanism - potentiates
223. complications intracranial bleeding --> death 1. mechanism action of antithrombin to
of DIC thromboembolism - stroke, PE, ischemic 2. indications inhibit II and X, prolongs
colitis, ARF, arterial occlusion PTT
2. DVT, PE, ACS, unstable
224. vitamin K 1. no leafy greens, broad spectrum
angina/MI, LMWH, a.fib
deficiency abx/NPO, TPN, small bowel disease,
1. patho inflammatory bowel disease, obstructive 233. IV heparin 1. 70-80u/kg bolus, and
2. dx jaundice, warfarin dosing/monitoring/reversal then 15-18u/kg/hr infusion
2. PT prolonged first then PTT 2. monitor with PTT-
vitamin K, or FFP therapeutic = 60-90s, or
anti-factor Xa levels
225. coagulopathy 1. cholestasis/hypersplenism only vWF not
3. protamin sulfate reverses
of liver made by the liver
heparin
disease 2. prolonged PT
1. patho 234. heparin side effects bleeding, HIT,
2. poor heparin contraindications osteoporosis, transient
prognostic alopecia, rebound
indicator hypercoagulability
contraindications - previous
226. antithrombin 1. autosomal dominant antithrombin 3
HIT, active bleeding,
3 deficiency deficiency --> hypercoagulable state due to
hemophilia,
1. patho uninhibited thrombin
thrombocytopenia, HTN,
brain, eye, spine surgery
235. LMWH inhibits factor Xa, but less
IIa and platelet aggregation
236. warfarin 1. prolongs PT and INR 243. multiple myeloma 1. monoclonal plasma cell
1. monitoring 2. start patient on heparin, once PTT 1. patho proliferation --> anemia, leukopenia,
2. administration is therapeutic, switch the patient to 2. clinical pres thrombocytopenia
3. side effects warfarin, and once INR is therapeutic, 2. CRAB - hypercalcemia/bone pain-
4. reversal stop heparin 2/2 osteolytic lesions, fractures,
3. hemorrhage, skin necrosis vertebral collapse
(2/2 rapid dec. in protein C), anemia -- normochromic normocytic
TERATOGENIC, should not to give to 2/2 marrow infiltration
patients with fall risk renal failure- myeloma nephrosis
4. 5 day half life-- vitamin K infusion, immunoglobulin precipitating in
or FFP renal tubules,
BJ protein in urine
237. clopidogrel 1. ADP antagonist, inc. bleeding time
recurrent infections - MCC death
1. patho 2. ACS, NSTEMI, >1 year after stent
2. important drug placement 244. multiple myeloma 1. monoclonal M-protein Ig spike on
interaction 1. dx serum/urine protein electrophoresis
2. tx plain radiographs - lytic lesions
238. most men - prostate, lung, colon / lung,
bone marrow biopsy - >10%
common/mortality prostate, colon
abnormal plasma cells -
cancers in men vs women - breast, lung, colon / lung,
RBCs- rouleaux formation
women breast, colon
hypercalcemia, elevated ESR
239. oncologic hypercalcemia - IV fluids, diuretics, 2. hematopoietic cell transplantation
emergencies that bisphosphonates (NOT IF PATIENT HAS RECEIVED
require treatment spinal cord compression - steroids, CHEMOTHERAPY), systemic
MRI chemotherapy (alkylating agents),
pericardial tamponade - palliative radiation therapy
pericardiocentesis
245. waldenstroms 1. plasmacytoid lymphocyte
tumor lysis syndrome - IV fluids +
macroglobulinemia proliferation --> IgM paraprotein
electrolyte correction
1. path >5g/dL, bence jones proteinuria,
240. features of benign age <35 2. clinical pres 2. NO BONE LESIONS, fatigue,
breast masses fibroadenoma - round movable mass, 3. tx weight loss, anemia, abnormal
which changes based on menstrual bleeding, hyperviscosity syndrome
cycle 3. chemotherapy and plasmapheresis
cysts - benign if not bloody
246. hodgkins 1. bimodal age distribution - nodular
241. premalignant ductal CIS- lumpectomy or mastectomy lymphoma sclerosing (reed sternberg), mixed
breast cancers lobular CIS- removal of lesion does not 1. patho cellularity, lymphocyte predominant,
reduce risk of spread of the cancer 2. clinical pres lymphocyte depletion (worst)
242. monoclonal 1. IgG spike <3g and <10% plasma 2.constitutional symptoms painless
gammopathy of cells in bone marrow. BJ proteinuria lymphadenopathy, supraclavicular,
undetermined <1g/24 hours and no endo organ axillary, mediastinal nodes
significance MGUS damage (lytic lesions, anemia, 247. hodgkins disease 3. lymph node biopsy inflammatory
1. diagnosis hypercalcemia) 3. dx cell infiltrate shows B-cells, reed
2. tx 2. nothing just observe - 4. tx sternberg cell, bone marrow biopsy,
3. progression 3. 20% progress to myeloma in 10-15 leukocytosis, eosinophilia
years 4. radiotherapy for stages I/II/IIIA
stage IIIB, IV require chemotherapy
248. non-hodgkins 1. immunosuppression, EBV, HTLV 1, 256. HIV burkitts or diffuse, large cell lymphoma -
lymphoma helicobacter pylori gastritis, autoimmune associated very poor prognosis
1. risk factors disease (hashimoto's, sjogrens, MALT) lymphomas
2. clinical pres 2. lymphadenopathy (painless, firm,
257. CHOP cyclophosphamide, hydroxydaunomycin
mobile), palpable cervical,
therapy (doxorubicin), oncovin (vincristine),
supraclavicular, axillary nodes, B
prednisone
symptoms, HSM, recurrent infections,
anemia symptoms, SVC obstruction, 258. AML 1. radiation, myeloproliferative syndromes,
respiratory involvement, bone pain, skin 1. risk factors downs syndrome, chemo (alkylating agents)
lesions 2. 2. t(15;17), pancytopenia/DIC, all trans
promyelocytic retinoic acid
249. epidemiological burkitts lymphoma, HIV associated
clinical
associations lymphomas, adult T-cell lymphoma in
pres/tx
with NHL japan and caribbean
259. ALL 1. early lymphocytic malignancy
250. non-hodgkins 1. lymph node biopsy - any node >1cm for
1. patho 2. <15
disease >4 weeks
2. age 3. age <2 / >9, WBC >15, CNS involvement,
1. dx CXR - may show hilar/mediastinal
3. poor B cell phenotype, inc. LDH, rapid leukemia
2. markers of adenopathy
prognostic proliferation
tumor load CT- chest, abdomen, pelvis
indicators
3. tx ALP - elevated if bone involved
2. LDH, B2 microglobulin 260. ALL/AML 1. anemia, associated symptoms, bacterial
3. observation, chemotherapy (CHOP), 1. clinical infections, mucosal bleeding, splenomegaly,
radiation therapy, very high dose pres hepatomegaly, lymphadenopathy,
chemotherapy with BMT (last resort) 2. key classic bone/joint pain, focal neuro dysfunction
locations for (CNS invasion),
251. indolent or low 1. small lymphocytic, follicular
extranodal 2. ALL- testicles, anterior mediastinal
grade 2. elderly patients, painless peripheral
ALL/AML mass*
lymphomas lymphadenopathy,
AML - skin nodules
1. types 3. painless peripheral lymphadenopathy--
2. clinical pres > diffuse large cell with t(14;18) 261. tumor lysis chemotherapy in acute leukemia and high
3. progression 4. eventually widespread liver, spleen, syndrome grade NHL--> hyperkalemia,
4. tx bone marrow involvement- radiotherapy hyperphosphatemia, hyperuricemia,
for local disease only hypocalcemia
MEDICAL EMERGENCY
252. intermediate 1. diffuse large B cell lymphoma,
grade 2. locally invasive presenting as large 262. 1. ALL 1. full remission in 75% of children
lymphoma extranodal mass response to 30-40% of adults
1. types 3. 85% cure with CHOP treatment
2. clinical pres 263. CLL 1. >50
3. tx 1. age 2. monoclonal mature lymphocytes that are
253. high grade 1. lymphoblastic lymphoma (T cell -->T 2. patho not functional
lymphomas cell ALL), 3. dx 3. WBC 50k-200k, anemia
1. types burkitt's t(8;14) (small cell noncleaved) 4. tx (AUTOIMMUNE HEMOLYTIC),
2. tx lymphoma- jaw mass in african, thrombocytopenia, neutropenia
abdominal organ mass in americans SMUDGE CELLS - fragile leukemic cells
2. combination chemotherapy 50-60% flow cytometry
curative bone marrow biopsy - infiltrating leukocytes
4. symptomatic chemotherapy
254. mycosis 1. T cell lymphoma of skin - eczematous
fungoides skin lesions/exfoliative dermatitis, 264. myeloid cell erythrocytes, granulocytes, platelets
1. erythematous stage, plaque stage, tumors line
patho/clinical stage- disseminates to lymph nodes 265. CML 1. t(9;22) BCR-Abl chronic indolent course
pres 2. cribriform lymphocytes 1. patho then BLAST CRISIS --> blast/promyelocytic
2. dx 3. no cure, symptomatic radiation and 2. clinical production
3. tx topical chemotherapy pres 2. constitutional symptoms, fevers, nigth
255. sezary skin/blood stream involvement sweats, infections ,bruising, anemia,
syndrome splenomegaly/hepatomegaly,
lymphadenopathy
266. CML 1. marked leukocytosis 50-200k with 272. pneumonia 1. s.pneumo
1. dx left shift to granulocytes 1. most common 2. gram negative rods
2. tx BASOPHILIA community (E.coli/pseudomonas), s.aureus
low blasts/promyelocytes bacterial 3. age >65, heart disease, SCD,
LOW LEUKOCYTE ALKALINE pathogen pulmonary disease, diabetes, cirrhosis,
PHOSPHATASE ACTIVITY, 2. most common cigarette smokers***
thrombocytosis, bone marrow biopsy nosocomial
2. imatinib - targets BCR-Abl 3. indications
chemoradiation --> BMT for
pneumococcal
267. polycythemia 1. malignant hematopoietic cell
vaccine
vera proliferation --> inc. RBC mass (9-14
1. patho years survival), myelocytes and 273. community 1. s.pneumo, h.flu, moraxella, klebsiella,
2. clinical pres platelets*** acquired s.aureus 2/2 aspiration of
2. 2/2 hyperviscosity, HA, dizziness, pneumonia nasopharyngeal flora
weakness, pruritus (in the bath 2/2 1. patho 2. acute onset fever, shaking chills,
histamine from inc. basophils), 2. clinical pres cough with thick purulent sputum,
gout attack dyspnea, 3. dx dyspnea, pleuritic chest pain (with
thrombotic - DVT, CBA, MI, portal vein effusions), tachycardia, tachypnea, late
thrombosis crackles, friction rub,
bleeding - GI or GU, ecchymosis, 3. CXR - shows consolidation/infiltrates
epistaxis, splenomegaly, hepatomegaly (only way to differentiate between
HTN pneumonia and acute bronchitis)
O2 sat, BUN/Cr, BMP, pre-treatment
268. polycythemia 1. rule out secondary polycythemia
blood cultures, gram stain/culture of
vera elevated RBC, hemoglobin/hematocrit
sputum
1. dx (>50), thrombocytosis, leukocytosis
2. tx LOW EPO, elevated B12 274. atypical 1. sore throat/headache --> non-
hyperuricemia pneumonia productive cough and dyspnea, fevers,
bone marrow biopsy 1. clinical pres pulse temperature dissociation(normal
2. phlebotomy lowers hematocrit 2. patho pulse/high fever), wheezing, rhonchi,
3. dx crackles
269. myelodysplastic 1. idiopathic/radiation-> ineffective
2. mycoplasma, chlamydia pneumoniae,
syndromes hematopoiesis, apoptosis of myeloid
chlamydia, coxiella burnetii, legionella,
1. patho precursors, pancytopenia, hypercellular
adenovirus, paraflu, RSV
2. dx marrow
3. CXR - reticulonodular infiltrates,
3. tx 2. marrow biopsy shows dysplastic cells
4. progression? with ringed sideroblasts, blasts 275. what is a good >25PMNs <10 epithelial cells per high
normal MCV sputum cultures powered field
low reticulocyte count
276. pneumonia 1. klebsiella (gram negative encapsulated
Howell jolly bodies, basophilic
organisms rods, currant jelly sputum)
stippling,
1. in alcoholics 2. TB
3. EPO, G CSF, B6, B12, folate
2. in immigrants 3. upper lobes, pseudomonas
supplementation
3. in nursing 4. PJP pneumonia, mycobacterium TB
4. can become AML with very poor
home 5. legionella
prognosis
4. HIV patients
270. essential 1. platelets >600k with no cause (ie. 5. transplant
thrombocythemia non-reactive), peripheral smear shows patients/renal
1. dx irregular platelets, bone marrow shows failure/lung
2. tx inc. megakaryocytes, disease/smokers
3. clinical pres 2. antiplatelets - anagrelide, low dose
277. stains 1. myco TB
aspirin, hydroxyurea
1. acid fast 2. pneumocystis and other fungi
3. erythromelalgia - burning/pain in
2. methenamine 3. LEGIONELLA
extremities from microvascular
silver stain
occlusion , thrombosis, CVA
3. urine antigen
271. reactive infection, inflammation, bleeding, IDA assay
thrombocytosis etc.
278. community 1. <60 years of age most likely s.pneumo, 287. tuberculosis 1. droplet transmission --> multiplication
acquired c.pneumo, m.pneumo, or legionella -- 1. patho in the lymphatics/blood --> granulomas -
pneumonia azithromycin or clarithromycin, or 2. secondary TB -> immune insult --> reactivation
1. tx <60 doxycycline 3. risk factors 2. weakening of host immunity - HIV,
2. tx >60 5 days of treatment or afebrile for 48 hours for TB malig, immunosuppressants --> apical
3. tx for 2. >60 or patients or comorbidities treated posterior segment cavitary lesions,
hospitalized with abx in past 3 months, use a miliary TB
fluoroquinolone (levo or moxi), or 3. HIV, recent immigrants, prisoners,
second/third gen cephalosporin health care, close contact, alcoholics,
5 days of treatment or afebrile for 48 hours diabetics, glucocorticoid use, hematologic
3. fluoroquinolone or 3rd gen cephalo + malig, IVDU
macrolide
288. tuberculosis 1. asymptomatic, or pleural effusion, may
279. hospital gram negative rods 1. primary TB turn into progressive TB
acquired cephalosporins w/ pseudomonal coverage - clinical pres 2. constitutional symptoms, dry cough -->
pneumonia ceftazidime/cefepime 2. secondary TB purulent sputum, hemoptysis (advanced)
treatment carbapenams- imipenem "" apical rales
piperacillin tazobactam 3. radiographic 3. upper lobe infiltrates with cavitations,
findings pleural effusions
280. pneumonia pleural effusions - tx with thoracentesis
ghon complex - calcified primary focus
complications pleural empyema
with associated lymph node
acute respiratory failure
rankes complex - ghon complex
281. what to test gram stain, culture, pH, cell count, undergoes fibrosis/calcification
thoracentesis determination of glucose, protein, LDH
289. tuberculosis 1. pleura, GU tract, spine, intestines,
fluid for
1. meninges,
282. ventilator 1. new cxr infiltrate, purulent secretions in extrapulmonary
associated endotracheal tube, rising WBC count, sites
pneumonia bronchoalveolar lavage
290. tuberculosis 1. sputum culture (three morning sputum
1. dx 2. ceftazidime or cefepime or piperacillin
1. dx samples), PCR
2. tx tazobactam, or aminoglycoside or
PPD test - detects latent TB
fluoroquinolone, vancomycin or linezolid
Elevated adenosine deaminase levels in
283. likely RIGHT LUNG>LEFT LUNG pleural fluid
locations of posterior segments of upper lobes, and
291. PPD positive >15mm - no risk factors
lung superior segments of lower lobes
+ PPD, what is >10mm- high risk populations/recent
abscesses
next step in immigrants, homeless, prisoners,
284. lung abscess 1.aspiration of oropharyngeal management healthcare workers, nursing home
1. patho contents/hematogenous spread/direct >5mm- HIV, steroid, recent contact with
2. micro contact/food --> 2cm or larger suppurative TB+, organ transplant patients
cavitary lesions
292. next step = get ...
2.prevotella, peptostrepto, fuso, bacteroides,
CXR
s.aureus, s.pneumo, aerobic gram negative
bacilli 293. tuberculosis 1. pos. PPD - negative CXR - INH +
1. treatment for pyridoxine (to prevent neuropathy)
285. lung abscess 1. alcoholism, drug addiction, CVA, seizure
latent TB OR pyrazinamide + rifampin or rifabutin
1. risk factors disorders, general anesthesia, NG or ET
2. treatment for for 2 months
2. clinical tube
active TB 2. 2 months of 4 drugs (isoniazid,
pres 2. fever, chills, foul smelling breath,
rifampin, pyrazinamide, ethambutol or
shortness of breath, weight loss
streptomycin)
3. CXR - thick walled cavitation with air
then 4 months of 2 drugs (isoniazid and
fluid levels
rifampin)
CT scan
cultures with bronchoscopy 294. TB treatment 1. monitor liver transaminases and
1. toxicity discontinue if they rise to 3-5x the upper
286. lung abscess 1. gram pos - ampicillin, or
limit of normal
1. tx amoxicillin/clavulanic or
ampicillin/sulbactam or vancomycin
anaerobes - clindamycin or metronidazole
gram neg- fluoroquinolone or ceftazidime
295. 1. flu epidemic vs 1. epidemic from minor genetic
pandemic reassortments
pandemic is from major genetic
recombination
296. influenza 1. rapid onset fever, chills,
(orthomyxovirus) malaise, headache, non-
1. clinical pres productive cough, sore throat,
+/- nausea
2. supportive,
zanamivir/oseltamivir
297. meningitis 1. hematogenous CNS seeding,
1. patho retrograde nerve transport,
2. bacterial pathogens contiguous spread (via
neonates + tx sinus/OM/surg/trauma)
3. "" children+ tx 2. GBS, e.coli, listeria
4. adults + tx monocytogenes- cefotax + amp +
5. elderly >50+ tx vanc + aminoglycoside
6. 3. n.meningitidis, s.pneumo,
immuo/hospitalized+tx h.flu - cefotaxime or ceftriaxone
+ vanc
4. s.pneumo, n.meningitidis,
h.flu - cefotaxime or ceftriaxone
+ vanc
5. s.pneumo, n.mening,
l.monocyto- ceftriaxone or
cefotax + vanc + amp
6. l.monocyto, gram negative
bacilli, s.pneumo
ceftazidime + vancomycin
298. chronic meningitis mycobacterium, fungi, lyme
causes disease, parasites
299. meningitis 1. seizures, coma, brain abscess,
1. complications deafness, brain damage,
hydrocephalus
300. aseptic meningitis 1. non-bacterial pathogens -
1. patho HSV, enterovirus, echovirus
2. treatment 2. treat as bacterial until certain
of diagnosis
301. meningitis 1. triad - fever, nuchal rigidity,
1. clinical pres change in mental status
headaches, n/v, malaise,
photophobia
papilledema, seizures *inc. ICP
cranial nerve palsies
kernig's sign - cannot fully
extend knees when patient
supine and hips at 90'
brudzinski's sign - flexion of
legs/thighs caused by passive
passive flexion of the neck
302. meningitis 1. CT scan BEFORE CSF
1. dx EVALUATION
2. tx CSF examination - cloudy, inc.
opening pressure
examine for cell count,
protein/glucose, gram stain,
culture (+AFB), crypto
antigen/india ink
303. CSF findings: WBC 1. <5/lymphos or mono/50-
count/diff/glu/protein 75/<60
1. normal 2. >1000/PMNs/low/high
2. bacterial meningitis 3. <1000/lymphos or mono/50-
75/moderate elevation
304. encephalitis 1. viral origin --> diffuse
1. patho inflammation of brain
2. causes parenchyma +/- meningitis
3. risk factors 2. HSV (MCC), arbovirus (EEE,
WNV), polio (enterovirus),
measles, mumps, EBV toxo,
aspergillosis, metabolic, T cell
lymphoma, rabies
3. AIDS CD4 <200,
underdeveloped country travel,
exposure to vectors, exposure to
wild animals (bats)
305. encephalitis 1. prodrome - headache, malaise,
1. clinical pres myalgias
headache, photophobia, nuchal
rigidity, confusion, delirium,
disorientation
hemiparesis, aphasia, CN deficits
306. altered mental status sepsis, UTI, urosepsis,
ddx pneumonia, bacterial meningitis,
subdural empyema
NMS (haloperidol)
delirium tremens
thyroid storm
307. encephalitis 1. CXR, urine/blood cultures,
1. dx urine tox screen,
2. tx LP (after CT) - lymphocytosis >5
with normal glucose (similar to
viral mening)
CSF PCR - diagnosis for many
viral causes
MRI - r/o focal cause (ie.
abscess), inc. T2 signal in
frontotemporal (=HSV)
EEG - unilateral or bilateral
temporal lobe EEG discharges
2. HSV - acyclovir 2-3 weeks
CMV - ganciclovir or foscarnet
anticonvulsants for seizures
cerebral edema - hyperventilation,
osmotic diuresis, steroids
308. vasculitis associated hep B - PAN 314. botulism 1. preformed toxins from c. botulinum
with hep B/C hep C - cryoglobulinemia 1. patho - spores inactivated by 100C for 10
2. clinical pres minutes
309. hep B vs hep C 1. 70% vs 75%
3. dx wound contamination
1. what percent have 2. 10% vs 90%
4. tx 2. SYMMETRIC DESCENDING
clinical hepatitis 3. 25% vs 20%
FLACCID PARALYSIS - starts with
after exposure 4. 40% vs 25%
dry mouth, diplopia, dysarthria
2. what percent have
diarrhea, n/v
chronic hepatitis
3. stool toxin, serum or gastric
after clinical
bioassays
hepatitis
4. watch RESP STATUS***, gastric
3. what percent of
lavage, antitoxin, penicillin for
chronic hepatitis
wounds
develop cirrhosis
4. what fraction 315. ddx in foodborne guillain barre, eaton lambert
develop HCC "botulism" syndrome, myasthenia gravis,
diphtheria, tick paralysis
310. mechanism of 1. fecal oral
transmission 2. parenterally or sexually 316. UTI 1. ascending infection from the
1. hep A/E 3. coinfection with hep B or 1. patho urethra- e coli, s.sapro, enterococcus,
2. hep B superinfection in chronic hep B 2. risk factors klebsiella, proteus, pseudomonas,
3. hep D carrier enterobacter, yeast
4. hep C 4. parenteral (most commonly in 2. female, sex, pregnancy, catheters,
IVDU) DM, spinal cord injury,
immunocomp, incomplete voiding,
311. hepatitis 1. transaminases >500 jaundice,
neurogenic bladder, BPH
1. clinical pres dark urine (direct bili), RUQ pain,
uncircumcised males, anal
2. fulminant n/v, fever/malaise, hepatomegaly
intercourse
hepatitis clinical 2. same as regular + hepatic
features encephalopathy (asterixis/palmar 317. non-infectious cytotoxic agents - cyclophosphamide
3. dx erythema), hepatorenal syndrome, causes of cystitis pelvic radiation
bleeding diathesis dysfunctional voiding
3. hepatitis serologies interstitial cystitis
hep C- viral PCR
318. UTI 2. dipstick analysis- positive urine
312. what is only hepatitis IgM anti-HBc 1. dx leukocyte esterase, positive nitrites
B marker that can be HBsAg is earliest* detectable (enterobacteriaceae),
detected during the marker but disappears during urinalysis- clean catch (no squamous
period window period (1-2 weeks) cells) or straight cath-- >1
TEST FOR BOTH IN SCREENING bacteria/HPF, >10 leukocytes/ul,
hematuria, proteinuria
313. hepatitis B serologies 1. early detection 1-2 weeks,
urine gram stain - >10^5 organisms
1. HBsAg indicates chronic hepatitis if
urine culture* - only if >65yo,
2. HBeAg persistent
diabetes, recurrent UTI, >7 days
3. anti-HBsAg 2. reflects active viral replication,
symptosm
4. anti-HBcAg detectable soon after HBsAg
5. diagnosis of hep C 3. after vaccination or clearance of 319. UTI 1. dysuria, frequency, urgency,
HBsAg indicates immunity 1. clinical pres suprapubic tenderness, gross
4. only marker present during 2. what diagnostic hematuria
window period, indicates tests for suspected 2. IVP, cystoscopy, excretory
INFECTION (does not distinguish structural urography
acute vs chronic) abnormalities
5. anti-HCV - may not be detectable
320. complicated UTI 1. any UTI past the bladder (pyelo,
for months
1. definition prostatitis, urosepsis)
HCV PCR viral load - detectable 1-2
2. what risk factors 2. men, diabetes, renal failure,
weeks after infection
pregnancy, history of pyelo, resistant
organisms, immunocomp
(HIV/transplant)
321. UTI 1. bactrim 3 days, nitrofurantoin 5-7 days 325. prostatitis 1. acute - urinalysis shows sheets of WBCs
1. (for pregnant***), fosfomycin 1 dose 1. dx acute vs in acute, urine cultures positive
uncomplicated fluoroquinolones - 3 days cipro chronic chronic - DRE boggy tender prostate, WBCs
cystitis phenazopyridine - urinary analgesic 2. tx acute vs in expressed prostatic secretions
treatment 2. ampicillin, amoxicillin or oral chronic 2. acute - hospitalize and IVabx, mild
2. UTI in cephalosporins 7-10 days (NO CIPRO - tends to outpatient bactrim or fluoro or doxy 4-6
pregnant CAUSES FETAL ARTHROPATHY) recur weeks
patient tx 3. same as women but 7 days chronic - fluoroquinolone long course
3. UTI in men 4. treat for 2 more weeks + urine culture
326. genital warts HPV - mos common STD
tx 5. chemoprophylaxis- single dose bactrim
patho
4. treated UTI after intercourse, or low dose bactrim for 6
that relapses months 327. chlamydia 1. intracellular pathogen STD, coinfection
5. > 2 1. patho with gonorrhea common
UTI's/year 2. clinical 2. asymptomatic (80% women), dysuria,
pres purulent discharge, scrotal pain/swelling,
322. pyelonephritis 1. vesicoureteral reflux + risks for
3. dx post-coital bleeding
1. patho complicated UTI --> ascending infection to
4. tx 3. enzyme assay, PCR
2. organisms kidney
5. 4. azithro 1x, doxy 7 days
3. 2. Ecoli, proteus, klebsiella, enterobacter,
complications 5. epididymitis/proctitis in men
complications pseudomonas, enterococcus, s.aurues
women - PID, salpingitis, tubo ovarian
3. sepsis in up to 25%, emphysematous
abscess, ectopic preg, fitz hugh curtis
pyelonephritis (in diabetics), chronic
syndrome
pyelo/scarring
328. gonorrhea 1. gram negative diplococcus
323. pyelonephritis 1. fever, chills, flank pain, cystitis
1. patho 2. often asymptomatic in women , males
1. clinical pres symptoms, n/v, diarrhea
2. clinical have purulent discharge, erythema/edema
2. dx 2. urinalysis - pyuria, bacteriuria, leukocyte
pres of urethral meatus, urinary frequency, also
3. tx casts
3. pharynx, conjunctiva, and rectum infection
urine cultures, blood cultures, CBC
complications 3. PID, epididymitis, prostatitis,
(leukocytosis/left shift)
tuboovarian abscess, salpingitis, fitz hugh
renal ultrasound, CT, IVP, retrograde
curtis syndrome, disseminated disease
urethrogram
3. single dose of ceftriaxone or gentamicin 329. what cancer cervical cancer
before bactrim or fluoroquinolone 10-14 associated
days with
ampicillin for gram positive cocci (s.sapro) chlamydia
very ill - hospitalize + parenteral - amp + 330. gonorrhea 1. fevers, arthralgias***, tenosynovitis,
gent or cipro use IV abx until patient 1. migratory polyarthritis/septic arthritis,
afebrile, then 14-21 day PO abx course disseminated endocarditis,
urosepsis - IV abx 2-3 wks disease rash on distal extremities (discrete purpuric
324. prostatitis 1. ascending infection from the urethra and clinical pres or pustular lesions with central
1. acute reflux of infected urine, s/p catheterization 2. dx necrosis/hemorrhage)
bacterial - e coli, klebsiella, proteus, enterobacter, 3. tx 2. gram stain of urethral discharge, culture,
prostatitis serratia 4. tx for syphillis and HIV, blood cultures
patho 2. more common, often diagnosed disseminated 3 cetriaxone one dose + azithro one dose or
2. chronic incidentally doxy (for coexisting chlamydia)
bacterial 3.acute- fever, chills, toxic appearance, 4. hospitalize and IV or IM ceftriaxone for 7
prostatitis dysuria, frequency, urgency, lower back days
patho pain 331. HIV 1. when HIV viral load is >1000
3. clinical pres chronic - asymptomatic, afebrile, recurrent 1. when is 2. primary infection, asymptomatic,
UTIs, irritative voiding and obstructive cesarean symptomatic, and full blown AIDS
symptoms delivery 2. opportunistic infections, wasting, cancer
DRE indicated
2. phases of
HIV
3. cause of
death
332. HIV/AIDS 1. mononucleosis syndrome that lasts 2-4 336. AIDS nervous 1. 33% of patients, early memory
1. primary weeks - fever, sweat, malaise, lethargy, system loss/cognitive deficits, later mental status,
infection headaches, arthralgias complications aphasia
2. 2. CD4 >500- 4-7 years, seropositive, but no 1. AIDS 2. reactivation of latent disease- symptoms
asymptomatic clinical evidence dementia of a mass (deficits/headache) and
infection 3. 1-3 years, persistent generalized 2. encephalitis (fever, altered MS)- dx =
3. lymphadenopathy, localized fungal toxoplasmosis contrast enhancing lesions in basal
symptomatic infections, recalcitrant clinical pres + ganglia/subcortical white matter
HIV (pre- vaginal/trichomonas infections oral hairy dx
AIDS) leukoplakia, seborrheic dermatitis,
337. AIDS nervous 1. stains with india ink, culture positive of
4. AIDS psoriasis, molluscum, warts, constitutional
system CSF fluid
symptoms
complications tx = amphotericin B 10-14 days then 8-10
4. CD4 <200 and disseminated
1. cryptococcal weeks PO fluconazole, lifelong fluconazole
opportunistic infections and malignancies
meningitis + maintenance
333. HIV/AIDS 1. CD4 tx 2. bacterial meningitis, histo, CMV, PML,
1. best 2. 50/year 2. other CNS HSV, neurosyphilis, TB
indicator of 3. 200-500 - HZV, TB lymphoma, infections
immune pneumonias, kaposi's
338. AIDS GI 1. e.coli, shigella, salmonella,
status/risk of <200 get more opportunistic infections
complications campylobacter, CMV, giardia, crypto,
infection
1. diarrhea isospora, MAC
2.
2. oral lesions 2. candida thrush, HSV/CMV ulcers, oral
progression
3. esophageal hairy leukoplakia (EBV), kaposi
of CD4 decline
3. candidiasis, dysphagia/odynophagia
3. at what CD4
most commonly candida, but CMV/HSV
do
(CD4 <100)
opportunistic
infections 339. AIDS skin kapsosi sarcoma - raised
occur complications brown/black/purple papulse of face, chest,
genitals, oral cavity
334. HIV/AIDS 1. viral load
HSV, warts, shingles, syphillis, warts,
1. best 2. when viral load is >50 after 4 months of
indicator of treatment, NEVER STOP TREATMENT 340. AIDS 1. disseminated GI, pulmonary, retinitis,
effectiveness opportunistic colitis, esophagitis
of infections tx = ganciclovir or foscarnet
antiretroviral 1. CMV + tx 2. wasting syndrome, lymphadenopathy,
therapy 2. MAC + tx anemia, diarrhea, weight loss
2. when does 3. HIV 3. involuntary loss of >10% of body weight
medication wasting + chronic diarrhea fever, persistent
regimen syndrome weakness
- measure 4. 4. kaposi, NHL (rapidly growing), primary
CD4 and viral malignancies CNS lymphoma
load every 3-4 341. HIV/AIDS 1. PCR RNA viral load test (also measures
months 1. dx therapy effectiveness)
335. AIDS 1. <200 2. tx p24 antigen assay
pulmonary 2 .fever, non-productive cough, SOB ELISA- positive 1-12 weeks after infection
complications w/exertion-->rest, d (99% sensitive)
1. CD4 count x = diffuse interstitial infiltrates, western blot confirmation
2. PJP clinical methenamine silver stain tx = 3 wks bactrim 2. antiretrovirals CD4 <500, and
pres and dx +steroids symptomatic
3. other prophylaxis bactrim 1x/day 2NRTI + either NNRTI or protease inhibitor
pulmonary 3. TB (may be PPD neg), CMV/MAC continue in pregnant patients
infections (CD4<50), crypto, histo, kaposi
342. pneumocystis 1. <200 348. HSV 1. stress, fever, infection, sun exposure
pneumonia 2. dyspnea, dry cough, fever 1. what 2. HSV infection from inoculation of finger,
1. CD4 3. CXR (bilateral interstitial causes painful vesicular lesion, treat with acyclovir,
2. clinical pres infiltrates), LDL (elevated), ABG (inc. recurrences do not I&D
3. dx A-a + hypoxia), bronchoscopy/BAL 2. herpetic 3. encephalitis, meningitis, keratitis***,
4. tx ***methenamine silver stain whitlow chorioretinitis, pneumonitis
4. tx = bactrim + steroids 3. 4. may be disseminated and fatal
prophylaxis with bactrim, atovaquone disseminated 5. congenital malformations, IUGR,
or pentamidine HSV chorioamnionitis, neonatal death
4/ HSV in 6. keratitis, blepharitis, keratoconjunctivitis
343. MAC prophylaxis prophylaxis with azithromycin or
pregnant
in AIDS clarithromycin or rifabutin with CD4
women
<50
5. neonatal
344. toxoplasmosis prophylaxis with bactrim when CD4 HSV
prophylaxis + <100 6. ocular HSV
treatment in AIDS tx = sulfadiazine and pyrimethamine
349. HSV 1. tzanck smear - swab base with wright's
345. AIDS vaccinations pneumovax every 3-5 years 1. dx stain (shows multinucleated giant cells)
influenza yearly 2. tx culture***
hep B ELISA
346. genital ulcers 1. single raised painless clean ulcer, 2. no cure, oral/topical acyclovir 7-10 days,
1. syphilis firm painless bilateral valacyclovir, famciclovir, acyclovir
2. primary HSV lymphadenopathy prophylaxis, foscarnet in
3. chancroid 2. grouped painful vesicles immunocompromised
4. pustules/ulcers, painful firm bilateral 350. syphilis 1. treponema pallidum spirochetes via sexual
lymphogranuloma lymphadenopathy 1. patho contact
venereum 3. purulent ulcer with shaggy border 2. primary 2. chancer painless ulcer with clean base 3-4
5. granuloma (progressive, multiple in women), 3. secondary wks after exposure, highly infectious,
inguinale fluctuant unilateral painful fistulizing 4. latent painless inguinal adenopathy
lymphadenopathy 5. tertiary 3. maculopapular rash includes palms/soles,
4. painless papule, vesicle, ulcer, flu like illness, condyloma lata**
painful unilateral fluctuant fistulizing 4. positive results, no active symptoms
lymphadenopathy 5. cardiovascular, neurosyphilis (dementia,
5. nodules coalescing into personality changes, tabes dorsalis),
granulomatous ulcers, suppurating gummas,
pseudobubo lymphadenopathy
351. syphilis 1. dark field microscopy, RPR, VDRL (70%
347. HSV 1. lives in dorsal root ganglia where it 1. dx specific), FTA-ABS, MHA-TP more specific
1. patho can reactivate at any time 2. tx 2. abx - benzathine penicillin G one dose or
2. HSV 1 clinical 2. asymptomatic, fever, malaise, oral oral doxy, or oral azithromycin, or
pres lesions, vesicles on patches of tetracycline
3. HSV 2 clinical erythematous skin, herpes labialis, latent/tertiary syphilis - penicillin 3 doses
pres bells palsy IM once per week
3. longer primary infection up to 3
352. chancroid 1. gram negative rod h.ducreyi via sexual
weeks, recurrent episodes shorter,
1. patho contact
constitutional symptoms, genital
2. clinical 2. painful genital ulcers with unilateral
vesicles, pustules
pres tender adenopathy
3. dx 3. clinical after syphilis/HSV rule out
4. azithro 1x, ceftriaxone 1x, or oral azithro
erythro cirpro
353. lymphogranuloma 1. c.trachomatis STD 358. necrotizing 1. s.pyogenes or c. perfringens deep soft
venereum 2. painless ulcer at inoculation, tender fasciitis tissue infection that spreads rapidly along
1. patho unilateral adenopathy and 1. patho fascial planes
2. clinical pres constitutional symptoms --> 2. risk factors 2. surgery, DM, trauma, IVDU
3. dx proctocolitis, stricture, elephantitis of 3. clinical pres 3. fever, pain out of proportion, crepitus,
4. tx genitals , 4. tx discoloration, cutaneous anesthesia -->
3. serologic compliment fixation, sepsis/TSS, multiorgan failure
immunofluorescence 4. prompt surgical exploration + antibiotics
4. doxy 21 days
359. differentiating erythema, warmth, tenderenss in both
354. pediculosis pubis 1. phthirus pubis STD, fomites DVT from DVT typically in posterior calf
(capitis,corpora) 2. regional pruritus cellulitis homans sign not sensitive
1. patho 3. examination of hair shows nits or VENOUS DOPPLER MUST BE USED TO
2. clinical pres` lice DISTINGUISH THE TWO CONDITIONS
3. dx 4. 1% permethrin shampoo for pt and
360. necrotizing 1. broad spectrum ABX, rapid surgical
4. tx sexual partner, combs, cloths and bed
fasciitis exploration and excision of devitalized
linens washed or thrown away
1. tx tissue
355. cellulitis 1. breaks in skin, catheters, incisons,
361. lymphadenitis 1. inflammation of a lymph node from strep
1. patho bites, venous stasis, lymphedema,
1. patho or staph infection
2. most common diabetic ulcers--> inflammation of
2. clinical pres 2. fever, tender lymphadenopathy, red
pathogens skin/subcutaneous tissue
streaking, thrombosis, sepsis
3. clinical pres 2. strep A, or s.aureus
3. penicillin G, anti-staph penicillins,
4. dx/tx 3. erythema, warmth, pain, swelling,
cephalosporins, warm compresses
+/-fever
4. clinical, blood cultures if fever 362. tetanus 1. deep punctures/bites/necrotic wounds-->
present 1. patho c. tetani gram negative anaerobic bacillus
tx = oxacillin, IV nafcillin (highest 2. clinical pres produces exotoxin in contaminated wounds
risk AIN), cephalosporin IV until signs 3. dx/tx --> blocks inhibitory transmitters at NMJ
improve then PO abx 2 weeks 2. hypertonicity, trismus (lockjaw),
generalized muscle contractions, risus
356. cellulitis 1. strep pyogenes
sardonicus (grin), opisthotonos (arch
pathogens 2. s.aureus
back), sympathetic hyperactivity
1. local 3. pseudomonas, aeromonas, vibrio
3. clinical dx + wound cultures
trauma/skin vulnificus
tx= ICU, respiratory support, diazepam for
breaks 4. haemophilus influenzae
tetany, single dose tetanus immune
2.
globulin
wounds/abscesses
3. water 363. when to give Td for clean wounds and Td+TIG for dirty
immersion tetanus wounds IF : <3 doses, unknown status or
4. acute sinusitis immunization >10 years since last booster
for wound
357. erysipelas 1. Group A strep infection confined to
management
1. patho dermis and lymphatics
2. clinical pres 2. fiery red painful lesions of the lower 364. osteomyelitis 1. hematogenous, direct spread (ulcers,
3. risk factors extremities and face 1. patho trauma, PVD) of s.aureus and coagulase
4. complications 3. lymphatic obstruction, local trauma, 2. risk factors negative staph --> infection of long bones
5. tx abscess, fungal infections, DM, 3. clinical pres (tibia, humerus, femur), foot/ankle, and
alcoholism vertebral bodies
4. sepsis, local spread, nec. fascitis 2. open fractures, DM, IVDU, sepsis
5. IM or oral penicillin or erythromycin 3. pain over area of affected bone, systemic
symptoms, draining sinus (chronic)
365. osteomyelitis 1. s.aureus 372. acute 1. oxacillin or 1st gen cephalo x4 weeks
organisms 2. coagulase negative staph bacterial add vancomycin if MRSA
1. catheter 3. polymicrobial arthritis 2. 3rd gen cephalo or aminoglycoside 3-4
septicemia 4. pseudomonas treatments weeks, use aminoglycoside + extended
2. prosthetic 5. fungal species, pseudomonas 1. s.aureus spectrum penicillin for pseudomonas
joint 6. salmonella 2. 3. IV 3rd gen cephalosporin then oral agent
3. diabetic immunocomp for 3-10 days once clinical improvement
foot ulcer or risk for
4. gram negative
nosocomial 3. high risk
infections for
5. IVDU gonococcal
5. sickle cell
373. lyme disease 1. ixodidae tick carries borrelia burgdorferi
366. osteomyelitis 1. +/-WBC count, ESR/CRP, 1. patho 2. erythema migrans (enlarging bulls eye
1. dx needle aspiration + culture 2. stage 1 rash)
2. tx plain radiograph - only + after >10 days clinical pres 3. intermittent flu like symptoms, headache,
radionuclide bone scans - + after 2-3 days 3. stage 2 stiff neck, fevers, meningitis, encephalitis,
MRI is most effective imaging study clinical pres cranial nervitis (BL bells palsy), cardiac (AV
2. oxacillin, first gen cephalosporin, 4. stage 3 block, pericarditis)
aminoglycoside and beta lactam if gram clinical pres 4. arthritis, chronic CNS disease -
negative encephalitis, transverse myelitis
surgical debridement* acrodermatitis chronica atrophicans
367. potts disease TB osteomyelitis of the vertebral column 374. lymes disease IgM 3-6 weeks
serology IgG remains elevated if patient has
368. acute 1. hematogenous/contiguous
disseminated disease
infectious /traumatic/iatrogenic --> microorganisms
IgG may remain elevated even though
arthritis invade the joint space --> cytokine release
adequate abx treatment
1. patho and and destruction of the joint
VDRL may be positive
2. pathogens 2. s.aureus,
n.gonorrhoeae in young sexually active 375. lymes disease 1. history, serologic studies - ELISA,
adults 1. diagnosis western blot
salmonella - sickle cell disease or 2. tx 2. 10 days antibiotic therapy
immunodeficiency spread beyond skin 20-30 days antibiotic
therapy
369. acute 1. warm, swollen, painful, limited
doxycycline, amox or cefuroxime (preg),
infectious active/passive range of motion, palpable
erythromycin (preg)
arthritis effusion, constitutional symptoms common
30-60 days for facial nerve palsy, arthritis,
1. clinical
or cardiac disease
pres
376. rocky 1. tick bites feeds on mammals - rickettsia
370. gonococcal 1. MONO/OLIGO arthritis that progresses in
mountain rickettsii then multiplies in vascular
arthritis a migratory additive pattern
spotted fever endothelium
1. clinical tenosynovitis of hands/feet
1. patho 2. sudden onset fever, chills, malaise, n/v,
pres 2. antibiotics to cover gonorrhea and
2. clinical myalgias, photophobia papular rash that
2. tx chlamydia
pres starts peripherally@wrists/ankles (5 days
371. acute 1. joint tpa WBC>50k 80% PMNs, gram 3. dx/tx after fever) and spreads centrally
infectious stain of fluid, culture, crystal analysis, PCR of (INCLUDES PALMS/SOLES)
arthritis synovial fluid 3. clinical, immunoassay
1. dx blood cultures- positive in 50% of cases tx = doxycycline for 7 days, use IV if patient
2. tx leukocytosis, inc. ESR/CRP vomiting
CT or MRI CNS/pregnant - give chloramphenicol
2. immediate empiric antibiotics, daily
aspiration of joint (only shoulder/knee)
377. malaria 1. falciparum (most dangerous), ovale, 382. aspergillus 1. spores inhaled into lung
1. patho vivax, malariae- via mosquito vector 1. patho 2. type 1 hypersensitivity reaction -
2. clinical pres 2. fever, chills, myalgias, headache, n/v, 2. allergic presents as asthma and eosinophilia
3. dx diarrhea bronchopulmonary 3. history of sarcoid, histo, TB,
4. tx falciparum - constant fever aspergillosis bronchiectasis--> chronic cough,
ovale/vivax - 48 hour spikes 3. pulmonary hemoptysis
malariae - 72 hour spikes aspergilloma 4. hyphae invade lung vasculature
3. peripheral smear, giemsa stain 4. invasive and cause thrombosis/infarction->
4. tx chloroquine, quinine + tetracycline, aspergillosis fever, cough, respiratory distress,
atovaquone proguanil, mefloquine 5. tx diffuse bilateral pulmonary infiltrates
IV quinidine + doxy for falciparum 5. ABPA- corticosteroids
2 week primaquine for vivax/ovale relapse massive hemoptysis - lobectomy
mefloquine for traveler prophylaxis invasive aspergillosis- ampho B,
voriconazole, caspofungin
378. rabies 1. bite or scratch or corneal transplant -->
1. patho 3 month incubation - 383. cryptococcus 1. budding yeast with thick
2. clinical pres 2. prodrome including headache, sore 1. patho polysaccharide capsule - assoc. with
3. dx/tx throat, encephalitis 2. clinical pres pigeon droppings -
then hydrophobia, combativeness, 3. dx 2. meningitis/meningoencephalitis-
hypersalivation, ascending paralysis headache, fever, irritibaliity,
3. virus or viral antigen in tissues, serum dizziness, confusion, also pulmonary
antibody titers, negri bodies in tissues, infection
PCR detects viral RNA 3. LP if suspect meningitis, latex
tx = clean wound, capture animal, human agglutination, india ink smear shows
rabies immunoglobulin in wound and yeast
gluteal region tx= ampho B with flucytosine for 2
3 antirabies vaccines over a 28 day period weeks then PO fluconazole
379. other zoonosis dfasfasfasldjflasdjkfk 384. page 403 for ergwregtrwaefsdz
page 400, blastomyces, histo,
review this cocci, sporo
pg 404 for
380. candidiasis 1. antibiotics, immunosuppression,DM,
parasites
1. risk factors immunocompromised
2. clinical pres 2. yeast infection - thick white cottage 385. fever of unknown 1. fever 38.3 (101) on several
cheese like vaginal discharge- painless, origin occasions for at least 3 weeks no
pruritic 1. definition diagnosis despite 1 week of inpatient
oral thrush - thick white plaques (suggests or 3 outpatient visits
HIV) 2. TB, occult abscess, endocarditis,
cutaneous - erythematous eroded patches sinusitis, HIV, mono, malaria or
with satellite lesions parasite , occult neoplasms
GI tract - esophagitis (odynophagia), (hodgkins, leukemia, solid tumors),
collagen vascular disease, sarcoid,
381. candidiasis 1. KOH preparation demonstrates yeast,
crohns , drug fevers (penicillin,
1. dx blood or tissue culture
sulfonamides, quinidine,
2. tx 2. remove catheters,
barbiturates), PE, hemolytic anemia
clotrimazole troches 5 times/day
nystatin 3-5x/day 386. 1. fever of unknown 1. CBC, UA, pan culture, complement
miconazole or clotrimazole cream for origin diagnostic assay, PPD, LFTs, ESR, ANA, RA,
vaginal candidiasis workup TSH, CXR, tagged WBC, MRI, node
ampho B, voriconazole, caspofungin for 2. tx biopsy
systemic candidiasis 2. antibiotics empirically
387. toxic shock 1. menstruating women with tampon use, 394. infectoius 1. monospot test - detects heterophile
syndrome surgical wounds, insect bites mononucleosis antibodies (sheep red cells) will be
1. patho 2. flu like symptoms, diffuse macular 1. dx undetectable 6 months after infection,
2. clinical pres erythematous rash,hyperemic mucous 2. tx (not present in CMV mono)
3. lab findings membranes, strawberry tongue, warm EBV - specific antibody testing
skin, n/v, thrombocytopenia, peripheral blood smear - lymphocytes
cardiopulmonary disease, confusion, with large atypical lymphocytes
disorientation, rash that desquamates on throat culture to rule out group A strep
PALMS AND SOLES 2. rest, fluids, avoid strenuous activities,
3. increased PTT, elevated BUN/Cr, short course of steroids for
hyponatremia, hypocalcemia, airway/thrombocytopenia/hemolytic
hyperbilirubinemia, elevated ALT anemia
388. fever vs fever - there is elevation of hypothalamic 395. infectious hepatitis, meningoencephalitis, guillain
hyperthermia set point - treat when >105, preg, mononucleosis barre, bells palsy, splenic rupture,
hyperthermia - no alteration of 1. complications airway obstruction, AIHA,
hypothalamic set point - tx = external thrombocytopenia
cooling or dantrolene for malignant
396. rosacea 1. erythema telangiectasisa, papules, no
hyperthermia
1. clinical comedones, rhinophyma
389. toxic shock 1. hemodynamic stabilization- aggressive findings 2. topical metronidazole, systemic
syndrome fluid, pressors if needed 2. tx antibiotics, isoretinoin, avoid
1. tx remove source alcoholic/hot beverages
anti-staph therapy - nafcillin, oxacillin, or
397. keratoacanthoma 1. epithelial tumors that resemble SCC,
vanc, clindamycin
lesions grow very quickly and progress
390. catheter 1. s.aureus, s. epidermidis - THERE MAY to a dome with central crater
related sepsis BE NO SIGNS OF INFECTION AT THE
398. tinea versicolor 1. superficial infection with malassezia
1. CATHETER SITE
1. patho furfur, hot humid weather excessive
causes/clinical
2. clinical pres sweating, skin oils
pres
3. dx /tx 2. hyper/hypopigmented lesions most
391. neutropenic 1. bone marrow failure, bone marrow commonly of the trunk
fever invasion, from hematologic malig, 3. KOH prep shows spaghetti and
1. causes hypersplenism, SLE, AIDS, drug reactions, meatballs pattern, woods lamp
2. dx chemotherapy tx = oral or topical ketoconazole,
3. tx 2. CXR, pan culture, CBC, CMP, selenium sulfide lotion
3. isolation (positive pressure), broad
399. common dry scales and erythema:
spectrum abx (with antipseudomonal
locations of scalp, behind ears, external ear canal,
covg), antifungal agents, GCSF
seborrheic eyebrows, armpits, under breasts
392. neutropenia neutrophil <1500/mm3 dermatitis tx = sunlight exposure, dandruff
definition ANC <500 is at risk for severe infection tx shampoo, topical ketoconazole, topical
corticosteroids
393. infectious 1. EBV, CMV, HIV, strep, toxo
mononucleosis 2. HIV, CMV, toxo - risk of harming fetus 400. contact 1. chemical or physical insult to skin -
1. causes 3. fever up to 104, sore throat, malaise, dermatitis no previous sensitizing event
2. what should myalgias, lymphadenopathy***, 1. irritant type 2. delayed type 4 hypersensitivity
be tested for in splenomegaly (AIHA, thrombocytopenia), 2. allergic type reaction - with or without atopic history
pregnant maculopapular rash, hepatomegaly 3. clinical pres ex. poison ivy, poison oak, iodine,
woman 4. dx/tx nickel, rubber
3. clinical pres 3. acute stage - erythematous
papules/vesicles oozing edema, pruritus
only in areas of contact
4. patch testing, avoid allergen, cold
water, topical corticosteroids, systemic
corticosteroids
401. pityriasis 1. HSV7 - herald patch ==> christmas tree 409. molluscum curretage, podophyllin, cantharidin,
rosea distribution of oval lesions (with fine contagiosum cryosurgery
1. collarette of scale) on trunk upper arms and tx
patho/clinical thighs, not on face
410. herpes zoster local injection of triamcinolone in
pres 2. antihistamines, spontaneously remits in
treatment lidocaine, antiviral agents, corticosteroids,
2. tx 6-8 weeks
live vaccine
402. erythema 1. hypersensitivity vasculitis - red subQ
411. dermatophytes 1. superficial fungi - trichophyton,
nodosum elevated nodules typically over anterior tibia
1. organisms microsporum, epidermophyton
1. patho (shins)--- caused by strep infections*,
2. dx 2. KOH stain to see fungus
2. dx sarcoid, IBD, behcets, fungal infections,
pregnancy, meds (OCP, sulfa, amiodarone, 412. scabies 1. sarcoptes scabiei var hominis
abx), syphilis, TB 1. patho 2. severe pruritis worse at night, burrows,
2. CXR (for sarcoid/TB), ASO titer, VDRL, 2. clincial pres dark dot is female mite, excoriations,
CBC, ESR, cultures, skin biopsy 3. tx eczematous plaques
3. permethrin 5% cream left on overnight
403. erythema 1. erythematous macules that resemble
lindane - y benzene hexachloride - 2nd line
multiforme target lesions, may be pruritic and painful
treatment - risk of seizures
1. patho -- caused by medications (penicillin, sulfa
topical corticosteroids/oral anti-
2. tx drugs, phenytoin, allopurinol, barbiturates),
histamines to control pruritis
post - HSV
2. acyclovir, antihistamines, analgesics 413. dermatophyte 1. direct microscopy with KOH prep -
infections topical antifungals -
404. SJS and TEN 1. sulfonamides, NSAIDs, phenytoin,
1. tinea ketoconazole/miconazole
1. patho barbiturates-->most dangerous forms of
corporis dx/tx 2. woods lamp - if lights up its
2. clinical erythema multiforme
2. tinea capitis microsporum, if not its trichophyton - tx =
pres 2. mucocutaneous lesion >@ sites, lesions
dx/tx ORAL** griseofulvin
appear targetoid, fever, tachycardia,
3. tinea 3. nail scrapings - ORAL griseofulvin
hypotension,
unguium dx/tx 4. direct microscopy - topical antifungals,
2. admit to ICU/burn unit
4. tinea pedis 5. """""
405. lichen planus 1. pruritic, polygonal, purple, flat topped dx/tx
1. clinical papules - of unknown cause - commonly on 5. tinea cruris
pres wrists, shings, oral mucosa, and genitals dx/tx
406. bullous 1. triggers - UV light, NSAIDs, antibiotics 414. actinic 1. small rough scaly lesions 2/2 sun
pemphigoid NO acantholysis, IgG anti basement keratosis exposure
1. patho membrane (anti BP230, anti-BP180) and C3 1. patho 2. erythematous papules with a central
2. clinical deposits at the dermal epidermal junction 2. dx/tx scale, hyperkeratotic, cutaneous horns
pres 2. TENSE blistering lesions at extensor 2. biopsy to exclude SCC
2. tx areas, POSITIVE NIKOLSKY'S SIGN bx shows acanthosis (thickening of
subepithelial blisters of abdomen, groin, epidermis), parakeratosis (nuclei in
extremities, LESS easily ruptured than corneum), dyskeratosis, hyperkeratosis
pemphigus vulgaris (thickening of stratum corneum)
2. systemic or topical glucocorticoids,
415. basal cell 1. basal cells of the epidermis
azathioprine for severe
carcinoma 2. pearly smooth papule with rolled edges
407. pemphigus 1. autoimmune blistering due to IgG 1. patho and surface telangiectasias (3Ps pearly,
vulgaris desmoglein INTRACELLULAR in the lower 2. dx pink papule)
1. patho epidermis 3. tx 3. surgical resection
2. clinical 2. FLACCID blistering lesions on oral
416. squamous cell 1. skin sun exposure, actinic keratosis,
pres mucus membranes that become erosive
carcinoma of skin damage
3. tx rupturing blisters, NIKOLSKY POSITIVE
skin 2. crustin ulcerated nodule or erosion
tx = glucocorticoids, azathioprine,
1. patho 3. biopsy shows invasive cords of
methotrexate
2. clinical pres squamous cells with keratin pearls
408. genital warts 1. liquid nitrogen freezing, salicylic acid*, 3. dx/tx complete excision
1. treatment 5FU, surgical excision or laser therapy,
417. marjolin's SCC arising from a chronic wound such as
podophyllin for genital warts
ulcer a previous burn scar
418. melanoma 1. depth of invasion 425. hypersensitivity 1. IgE -anaphylaxis/asthma
1. most 2. asymmetry, border irregularity, color types 2. IgG or IgM cytotoxic - good
important vairation, diameter >6mm, elevation - pastures.pemphigus
prognostic 3. antigen antibody complexes - SLE,
factor arthrus reaction, serums sickness
2. features 4. T cell mediates - allergic contact
of dermatitis , tuberculosis, transplant
melanoma rejection
419. stages of 1. skin intact, non- blanching erythema 426. anaphylaxis 1 type 1 IgE reaction
decubitus 2. partial thickness skin loss 1. patho 2.pruritus, erythema, urticaria,
ulcers 3. full thickness skin loss into subQ tissue 2. clinical pres angioedema
4. full thickness extending into 3. tx dyspnea, respiratory distress, asphyxia
muscle/bones/joints/tendons etc hypotension, shock, arrhythmias
abdominal pain, n/v, severe diarrhea
420. psoriasis 1. abnormal proliferation of skin cells,
3. ABCs, epinephrine immediately IV if
1. patho improves in summer, worst during winter,
severe, subQ if less severe,
2. clinical exacerbated by trauma
antihistamines, corticosteroids IV fluids,
pres 2. koebner's phenomenon
oxygen
3. tx well demarcated erythematous
plaques/papules with thick silver scaling 427. amoebic liver 1. travel to endemic area --> entamoeba
auspitz sign - removal of scale -->pinpoint abscess histolytica --> hepatic abscesses
bleeding 1. patho 2. RUQ pain,
extensor surfaces 2. clinical pres 3. indirect hemagglutination assay,
pitting of nails/onycholysis 3. dx/tx ultrasound will show abscess with well
arthritis - pencil in cup deformity of the DIP defined margins, blood cultures
3. topical corticosteroids, tx = metronidazole, no aspiration
calcipotriene/calcitriol, tars, tazarotene necessary
(vitamin A derivative), anthralin,immune
428. ecoli 0157:H7 1. contaminated ground beef, raw milk,
modulating therapy (MTX, cyclosporine),
1. sources fecal oral
TNF blockers
2. clinical 2. mild diarrhea, hemorrhagic colitis,
phototherapy, acitretin, UV light
presentation acute renal failure, HUS
421. seborrheic 1. autosomal dominant - harmless growths
429. parvo b19 1. erythema infectiosum - fever like illness
keratosis 2. dark elevated plaques appear suck on the
1. clinical pres with a slapped cheek rash
1. patho skin
in children 2. viral arthritis *** - pain lasts about 30
2. clinical 3.cryotherapy or curettage
2 clinical pres minutes, no symptoms, no systemic
pres
in adults symptoms
3. tx
diffuse lace like rash, polyarthropathy,
422. vitiligo 1. autoimmune depigmentation condition of aplastic crisis (in G6PD or sickle cell
1. patho the skin patients), spontaneous abortion, hydrops
2. clinical 2. DM, autoimmune hypothyroidism, fetalis
associations pernicious anemia, addison's disease,
430. target O2 88-92%, overly aggressive O2 will
3. tx alopecia areata, hypopituitarism
saturation in increase PaCO2
3. glucocorticoids, phototherapy
COPD patients
423. urticaria 1. inflammatory mediators released by mast
431. meperidine metabolized to normeperidine inc. risk of
1. patho cells in response to foods, drugs, latex,
side effects CNS toxicity, sedation, seizures, resp.
dander, pollen, dust, plants
depression
2. edematous wheals and hives that disappear
and reappear elsewhere, intense pruritis 432. septic arthritis 1. hematogenous spread by staph aureus,
1. patho or beta hemolytic strep is most common.
424. hereditary autosomal dominant C1 esterase inhibitor
gonorrhea in sexually active young adults
angioedema deficiency
433. p-anca anti - myeloperoxidase
434. microscopic 1. pauci immune necrotizing small 443. fenfluramine/phentermine PPH in people who take
polyangiitis vessel vasculitis--> clinical association these drugs as appetite
1. patho 2. glomerulonephritis, pulmonary suppressants
2. clinical pres hemorrhage, fever
444. workup of suspected venous carboxyhemoglobin
3. dx 3. P-ANCA positive
carbon monoxide poisonin CXR
435. cryoglobulinemia 1. small vessel vasculitis, assc. with hep then start supplemental O2
1. patho C--> renal involvement, alveolar
445. what drugs will increase cimetidine, erythromycin,
2. clinical pres hemorrhage, arcuate artery aneurysms
theophylline levels ciprofloxacin, allopurinol,
3. dx 2. palpable purpura*** (think of adult
and zafirlukast
HSP), arthritis, glomerulonephritis,
livedo reticularis, abdominal pain, 446. what murmurs are VSD, mitral regurgitation
3. low complement increased by by exercise,
and decreased by amyl
436. tarsal tunnel posterior tibial nerve entrapment
nitrate
syndrome between medial malleolus and flexor
clinical pres retinaculum--- pain in the ankle/heel 447. digoxin specific symptomatic systolic
and numbness of sole of foo at night indications dysfunction
atrial flutter, atrial
437. hypertrophic intrathoracic malignancy, suppurative
fibrillation
osteoarthropathy lung disease, congenital heart disease
clinical 448. treatment for atrial warfarin INR to 2-3,
associations fibrillation medical/electrical
cardioversion after 3 weeks
438. exudative pleural ...
of anticoagulation
effusion fluid lab
findings 449. AAA risk factors smoking, hypertension

439. complicated vs total pleural protein:serum protein>0.5 450. indications for ventricular v.fib, or hypotensive v.tach
uncomplicated LDH pleural fluid:LDH serum >0.6 fibrillation
LDH pleural fluid >2/3 upper limit of 451. EKG findings right peaked P waves II, III, aVF,
normal ventricular hypertrophy tall R waves V1-V3,deep S in
440. complicated - ... V6, right axis deviation
pH<7.2, glucose 452. acute coronary syndrome 1. initial - morphine, oxygen,
<60, positive 1. tx nitro, anticoag/aspirin
gram beta blocker
stain/culture clopidogrel
441. pulmonary 1. 80% deep veins of the legs admission - trend cardiac
embolism 2. unilateral leg pain/swelling, then enzymes,
1. sources tachypnea*, tachycardia*, pleuritic 453. supraventricular adenosine - 6mg, then 12mg
2. clinical pres chest pain (indicates pulmonary tachycardia SVT treatment if necessary
3. dx infarction), hemoptysis, wheezing. JVD verapamil - 2.5-5mg
4. tx 3. D-dimer (90% sens, not specific), CT If adenosine/verapamil fail
pulmonary angiogram (PE protocol) can try procainamide
ABG - hypocapnia*, hypoxia* DC cardioversion
respiratory alkalosis, inc. A-a gradient immediately if
ECG- sinus tachy, atrial fibrillation, HEMODYNAMICALLY
pseudoinfarction (inferior leads) UNSTABE
new pleural effusion exudative
>transudative 454. treatment for idiosyncratic amiodarone + beta blocker
VQ scan, S4, new RBBB* ventricular rhythm in the
4. immediate IV heparin or LMWH if context of acute MI
there are no contraindications 455. what kind of murmurs right sided heart murmurs
thrombolytics only if hemodynamically worse with inspiration
compromised
456. romano ward syndrome congenital QT prolongation,
442. recommended PE warfarin titrated to INR 2-2.5 and deafness--- family
prophylaxis or LMWH BID history of sudden cardiac
during hip death
replacement
457. treatment of graduated exercise regimen, 465. 1. best test for scintigraphic gastric emptying study
symptomatic cilostazol - PDI - decreases platelet diabetic 2. glycemic control, small frequent
claudication aggregation and causes gastroparesis meals, dopamine antagonists
vasodilitation improves exercise 2. treatment (metoclopramide), bethanechol,
tolerance erythromycin (motilin interaction),
cisapride
458. 1 . vitamin D elevated iPTH, normal ionized
deficiency lab calcium, elevated alk phos 466. 1. how to serum albumin - ascitic fluid albumin
findings 2. normal iPTH, normal ionized determine if = >1.1
2. postmenopausal calcium, normal alk phos ascitic fluid is
osteoporosis from portal
findings hypertension
459. pagets disease 1. bone pain, thickening of 467. c.difficile best c.diff stool toxin assay, or colonoscopy
(osteitis deformans) calvarium, hearing loss***, bone diagnostic test showing pseudomembranes
1. complications deformity, congestive heart failure
468. disease associated autoimmune hepatitis
2. dx (acoustic meatus/VIII),
with chronic viral hepatitis
3. treatment hypercalcemia
microvesicular fat
2. normal calcium, normal
(micronodular
phosphate, elevated alk phos***,
sclerosis
elevated urinary: hydroxyproline,
deoxypyridinoline, n-telopeptide, c- 469. 1. how to dec. GI 1. cotreat with misoprostol
telopeptide Side effects with 2. inc. cardiovascular events, also
tx:asymptomatic - NO TREATMENT chronic NSAID same degree of renal dysfuntion
symptomatic - bisphosphonates use
Xray - shows resorption/sclerosis 470. bleeding propranolol (non-specific beta
especially in the skull, femur, axial prophylaxis for blockers)
skeleton cirrhotic patients octreotide
subcutaneous injections of with varicies
calcitonin if cannot tolerate
471. intermittent 1. atherosclerotic obstruction of
bisphosphonates
mesenteric visceral arteries
460. struma ovari ectopic thryoids ischemia
461. 1. effect of HRT on 1. dec. LDL, inc. HDL, inc. TG 1. patho
lipid panel 2. inc. risk of breast cacner 2. post-prandial
2. adverse effects of abdomina
HRT used for post- pain/weight loss
menopausal 472. lab findings in hyperkalemia, hyperuricemia,
osteoporosis rhabdomyolysis hyperphosphatemia, hypocalcemia,
462. cushing disease vs exogenous glucocorticoid use does ARF elevated creatinine
exogenous not cause hirsutism. high RBCs on urine dipstick
glucocorticoid but few RBCs on urine microscopy
difference in clinical 473. acute uric acid chemotherapy tumor lysis associated
presentation nephropathy renal damage
463. prolactinoma galactorrhea (non-preg), irregular 474. osmolar gap 1. 2Na+BUN/28+glu/18
clinical pres menses, amenorrhea, bitemporal 1. calculation 2. patients have toxic ingestion of
hemianopsia methanol, ethylene glycol, paint
464. empty sella 1. enlargement of the sella turcica thinners
syndrome from CSF pressure compressing the 475. ethylene glycol key hypocalcemia, high anion gap, high
1. patho pituitary gland lab findings osmolar gap*
2. chronic headaches, or
asymptomatic, rim of pituitary tissue
is fully functional
476. hyponatremia 1. heart failure, cirrhosis, 487. transfusion related 1. antibodies in donor blood that
1. with inc. ECF fluid nephrotic syndrome, renal acute lung injury bind to HLA on recipients WBCs -
overload insufficiency 1. patho > WBC agglutination and trapping
2. normal volume 2. SIADH 2. clinical pres in the lungs
status 3. plasma osmolality - 2. appears like volume overload on
3. low volume (ie low hypoosmolar = low plasma CXR
blood pressure/high osmolality
488. ABO or Rh mismatch leads to recipient Ig binding to
pulse) high plasma osmolality =
reaction donor RBCs and then complement
4. when see hyperglycemia
fixation and intravascular
hyponatremia then normal plasma osmolality -
hemolysis
evaluate volume status hypoproteinemia, hyperglycemia
THEN WHAT 489. delayed hemolytic antibodies to minor antigents
transfusion reaction antigenic memory cells response
477. 1. analgesic 1. high level analgesic use causes
within several days to a week and
nephropathy renal colic/papillary necrosis
make antibodies against
2. protease inhibitor 2. can cause obstructive renal
transfused cells
effect on GU stones
490. hypercoagulable prothrombin G202
478. refeeding syndrome hypophosphatemia, hypokalemia
states factor V leiden,
due to intracellular shifts after
OCPs
feed starving person or alcoholic
pregnancy
479. alcoholic with 2/2 hypomagnesemia decreases Protein C, S and ATII deficiencies
hypocalcemia end organ PTH response lupus
cancer
480. hyporeninemic 1., old patients, CHF - beta
hypoaldosteronism blockers, ACE inhibitors, 491. antithyroid leukopenia
1. patho spironolactone --> life medications (PTU, rare agranulocytosis
threatening hyperkalemia methimazole)
complications
481. cause of postoperative nausea, pain, and anesthetic
hyponatremia agents causes potent release of 492. 1. where in the brain 1. in the central structures of the
ADH by neurohypophysis do hypertensive brain (thalamus, basal ganglia,
hemorrhages occur cerebellum)
482. testicular cancer 1. solid mass from the testis
2. where in the brain 2. lobar hemorrhages in the
1. patho metastasizes to the
does cerebral amyloid elderly
retroperitoneal/para aortic nodes
angiopathy
(stage 2)
hemorrhage occur
483. key clinical feature splenomegaly seen in sickle SC
493. restless leg syndrome 1. dopamine enhancing drugs -
distinguishing sickle
1. tx pramipexole, ropinirole
SS from sickle SC
disease 494. what imaging MRI
modality is best for
484. myeloproligerative polycythemia vera, essential
spinal cord and
disorders thrombocytosis, CML,
posterior fossa
myelofibrosis
495. carotid sinus 1. baroreceptors of carotid sinus
485. gaisbock syndrome erythrocytosis with normal red
hypersensitivity are activated sending impulses
blood cell mass from decreased
1. patho through glossopharyngeal nerve
plasma volume.
2. clinical pres to medulla
486. breast cancer 1. post menopausal = hormonal - 2. syncope from turning head or
1. adjuvant for tamoxifen (ER antagonist) or wearing collared shirt or shaving
pre/post menopausal anastrozole** (aromatase 3. ECG carotid massage, or duplex
women inhibitor) doppler if bruit is heard
premenopausal - oophorectomy,
496. what can cause coma severe metabolic disturbances-
tamoxifen
hypoglycemia, hyponatremia,
intoxication
brainstem dysfunction - RAC or
pons
bilateral hemispheric insults
497. parkinsons disease 1. levodopa- dopamine precursor 506. CYP450 inhibitors VICK'S FACE All Over GQ stops
1. treatment carbidopa - dopa decarboxylase ladies in their tracks.
2. SE of parkinsons inhibitor Valproate
treatment direct dopamine agonists- Isoniazid
ropinirole/pramipexole Cimetidine
anticholinergics - benztropine Ketoconazole
mesylate dec. degree of tremor Sulfonamides
2. limb/facial dyskinesias Fluconazole
Alcohol (acute)
498. paraneoplastic 1. small cell lung, breast, female
Chloramphenicol
cerebellar genital, lymphomas
Erythromycin (macrolides)
degenerations 2. anti- Hu/Ri/Yo/Tr - neuronal
Amiodarone
1. associated antigens
Omeprazole
cancers 3. encephalopathy with sensory
Grapefruit juice
2. patho neuropathy, opsoclonus myoclonus
Quinidine
3. other syndrome, lambert-eaton
paraneoplastic myasthenic syndrome 507. 1. joint complications of 1. hyperuricemia and gout
neuronal syndromes diuretics attacks
2. what type of beta 2. non-cardioselective - should
499. hypertension DO NOT AGGRESSIVELY TREAT
blocker should be used choose metoprolol or esmolol
management in the <185/110 is acceptable
in COPD/asthma 3. ACEs/ARBs
context of acute
3. what anti- 4. inc. risk of congestive heart
cerebral
hypertensives are failure (orthostatic hypotension
ischemia/stroke
contraindicated in in the short term)
500. medication overuse >2x weekly headache medication pregnancy
headache use--> 4. alpha blockers long
501. complex partial 1. psychomotor seizures - complex term risk
seizures auras, abnormal motor behaviors, 508. cardiac risk index ischemic heart disease, CHF,
impaired consciousness cerebrovascular disease, insulin
502. vascular dementia 1. stepwise neurological defects therapy, pre-op Cr>2.0
resulting from bilateral cerebral 509. common variable 1. T cell abnormalities and
infarcts, hemiparesis, extensor immunodeficiency hypogammaglobulinemia
plantar responses, pseudobulbar 1. patho 2. 2nd decade of life onset of
palsy 2. clinical pres recurrent diarrhea (GIARDIA
503. treatment for a immediate anti-platelet therapy LAMBLIA) and respiratory
patient who had a carotid doppler infections
TIA 510. nasal turbinates in allergic - pale and boggy
504. diffuse itchiness polycythemia vera, lymphoma, allergic vs infectious infectious - red and inflamed
associated with thyroid disorders rhinitis
what condition 511. how to deal with premedicate with
505. CYP450 inducers BullShit CRAP GPS induces my rage! administering contrast antihistamines and
Barbiturates to a patient with corticosteroids-- don't need to
St. John's wort contrast allergy avoid altogether
Carbamazepine 512. IgA deficiency 1. severe blood product allergic
Rifampin 1. clinical pres reactions, inc. incidence of
Alcohol (chronic) sinopulmonary infections ``
Phenytoin inc. risk for giardia lamblia ***
Griseofulvin
513. ataxia telangiectasia 1. ATM gene mutation
Phenobarbital
1. patho abnormal DNA repair
Sulfonylureas
2. lymphomas, cerebellar
ataxia, immunodeficiency,
ocular/facial telangiectasias
514. postprandial just what it sounds like
hypotension
515. what increases the hypertension, smoking, elevated 530. 1. pulsus tardus et 1. pulse is weak and late - aortic
risk of cholesterol CRP parvus stenosis
embolization 2. pulsus 2. >10mmHg drop in BP with
paradoxus inspiration - cardiac tamponade,
516. pulmonary loud S2, prominent a waves, right
3. hyperkinetic pericarditis, OSA, COPD, tension
hyptension physical ventricular heave, ejection click,
(bounding) pulse PTX, severe asthma
examination right ventricular fourth heart sound
4. bisferiens pulse 3. high pulse pressure or low
findings
peripheral resistance - fever, anemia,
517. pacemaker persistent bradycardia, new LBBB, AV fistula, aortic regurgitation
indicatiosn new mobitz type 2, symptomatic 4. double peak per cycle - aortic
wenckebach type 2 regurgitation, HCM
518. why are ace cause renal dysgenesis and 531. 1. dicrotic pulse 1. systolic percussion wave and
inhibitors oligohydramnios 2. pulsus alternans prominent dicrotic wave in diastole -
contraindicated in 3. pulsus dilated cardiomyopathy, low CO, high
pregnancy bigeminus SVT - sepsis
519. contrast medium contrast induced nephropathy (see 2. alternating strong/weak beats -
side effects risk factors), n/v, anaphylaxis, aortic and mitral valve stenosis,
hives, itching, angioedema pericarditis
3. two heartbeats close together
520. what is latent ischemic heart disease
followed by longer pause, large QRS
electrocardiography
followed by a smaller one - HCM,
useful to detect
digitalis tox,
521. treatment of atrial diltiazem/verapamil, beta blockers,
532. JVP findings 1. inc. filling resistance - TS,
flutter digoxin
1. large a waves pulmonary hypertension, complete
522. what cardiac defects VSD*** 2. kussmaul's sign heart block (right atrium contracts
increase risk for mitral prolapse, mitral stenosis, 3. slow y descent against tricuspid closed by right
infectious asymmetric septal hypertrophy, 4. prominent v ventricular systole
endocarditis Low risk = ASD wave 2. inc. in JVP during inspiration -
523. what clincal scenario normal BP, with moderate 5. prominent x from right heart failure or constrictive
is nitroglycerine pulmonary congestion descent pericarditis
used for a heart --- when BP is low, must give 6. prominent y 3. obstruction of right ventricular
failure patient inotropic agents descent filling - atrial myxoma or tricuspid
stenosis
524. AV dissociation independent beating of 4. accentuated atrial filling - tricuspid
atria/ventricles regurgitation,
fixed P-P, fixed R-R, variable P-R 5. cardiac tamponade, restrictive
525. causes of coronary atherosclerosis, trauma, cardiomyopathies
artery aneurysm angioplasty, atherectomy, 6. constrictive pericarditis
vasculitis, mycotic emboli, 533. JVD waveform 1. atrial systole
kawasaki syndrome, arterial 1. a wave 2. atrial relaxation during ventricular
dissection 2. x descent systole
526. what is the cause of ventricular aneurysm 3. v wave 3. rising atrial pressure from
ST elevation >2 weeks look for calcified bulge on CXR 4. y descent increased atrial filling,
after an infarct 4. tricuspid opens
+ CXR finding 534. 1. which murmurs 1. mitral regurgitation, VSD, aortic
527. clinical presentation AUTOSOMAL DOMINANT are increased by regurgitation
of familial tendon xanthomas, xanthelasma, handgrip/pressure 2. HOCM, MVP
hyperchoesterolemia arcus senilis cuff
2. which murmurs
528. hypertension effect cotton wool spots, hemorrhage,
are increased by
on the eyes papilledema
valsalva/standing
fibrinoid necrosis
- most murmurs
529. left ventricular high voltage QRS in V5/B6, deep S decrease with
hypertrophy EKG in V1/V2, prolonged QRS in valsalva/standing
findings precordial leads
535. how to differentiate constrictive pericarditis has 543. zinc deficiency abnormal taste*, impaired wound
constrictive pericarditis kussmaul's sign clinical healing, dermatitis around the mouth
vs cardiac tamponade on presentation with acral involvement, then to hands,
physical exam scalp, trunk, feet, alopecia,
seen in chronic malabsorption states -
536. 1. best antihypertensive 1. beta blockers
bypass surg, IBD, alcoholism
for those with CAD 2. ACE
2. best antihypertensive 3. ACE 544. what type of nodular melanoma
for patients with left melanoma is
ventricular dysfunction invasive early
or multiple
545. sezary syndrome T cell lymphoma - HTLV1- malignancy
cardiovascular risk
of helper T cells
factors
3. what type of anti- 546. cutaneous urticarial eruption within days
hypertensive is reactions of TMP morbilliform reaction within weeks
contraindicated in SMX especially in AIDS patients
patients with bilateral 547. tetracycline photosensitivity, mottling of teeth in
renal artery stenosis dermatologic children
537. carcinoid syndrome fibrous plaques on the changes
effect on the heart endothelium on the right side 548. what drugs cause OCPs, sulfonamides, penicillins
of the heart--> tricuspid erythema - panniculitis tender subcutaneous
regurgitation, distorted cardiac nodosum erythematous nodules classically on
valves, pulmonic stenosis the anterior portion of the legs
538. treatment for bullous wet dressings several 549. chloroquine polymorphous light eruption
stage of contact times/day with burow's dermatologic side exacerbation of porphyria cutanea
dermatitis solution or boric acid, baths effect tarda
oral corticosteroids for severe black pigmentation of the face, mucous
cases membranes
539. clinical associations with visceral carcinomas - GI and 550. dermatologic side stomatitis, alopecia
acanthosis nigricans GU, especially stomach effects of anti- dystrophic nail changes (bleomycin,
diabetes, obesity, acromegaly neoplastics hydroxyurea, 5FU)
cushings syndrome cellulitis, ulceration, urticaria
540. urticaria/pruritic bullous pemphigoid - IgG anti 551. erythroderma 1. drugs - sulfa, penicillins, gold,
erythematous lesions basement membrane without 1. causes allopurinol, captopril, phenytoin,
progressing to nikolsky's acantholysis 2. clinical pres carbamazepine
negative bullous lesions
552. 2. diffuse rash, ...
541. keratoacanthoma grows on exposed hairy skin fever,
grows rapidly then involutes eosinophilia,
more common on white interstitial
skinned males nephritis
telangiectasias with a central
553. what drugs cause captopril
keratotic plug
pemphigus penicillamine
542. atopic dermatitis 1. erythematous excoriated vulgaris
1. clinical pres papules/plaques that weep and
554. treatment for pain oral phenothiazines, narcotics,
2. management become secondarily
in patients with NSAIDs
impetiginized
acute intermittent DO NOT USE: barbiturates,
2. change in environment
porphyria sulfonamides, alcohol, carbamazepine,
topical steroids
valproate, estrogen/progestin
adequate humidity
555. what lipid hypertriglyceridemia
disturbance is
seen in patients
with insulin
resistance
556. in adrenocortical low aldosterone decreases 569. type 1 deficiency of lipoprotein lipase
insufficiency what circulating volume (via inc. hypolipoproteinemia presents as eruptive xanthomas,
occurs with water natriuresis) leading to inc. ADH acute pancreatitis
balance production and hyponatremia
570. familial combnined autosomal
557. hyperparathyroidism 1. hyperlipidemia
1. effect on bones
571. what is the most ...
558. what is role of FSH in stimulates sertoli cells and then important factor in diet
men spermatogenesis induced cholesterol
elevation
559. androgen 1. X linked androgen receptor
insensitivity defect leads to XY and female 572. """" in diet induced total amount of fat and saturated
1. patho genetalia triglyceride elevation fat consumed
560. treatment for beta carotene 573. total amount of calories ...
erythropoietic
574. causes of secondary DM, hypothyroidism, renal
protoporphyria
dyslipidemias disease, alcoholism, anorexia
561. vitamin A toxicity ... Drugs - estrogen,
clinical pres glucocorticoids
562. what vitamins magnesium, folate 575. osteomalacia vitamin D deficiency leads to
classically deficient in bowing of long bones, and wide
alcoholics osteoid borders on bone surfaces
563. 1. causes of 1. alcoholism, milk diet in infants, 576. vitamin D resistant 1. X linked recessive end organ
hypomagnesemia chronic diuretic use, acute rickets insensitivity to vitamin D -->
2. clincal pres of pancreatitis, 1 patho renal phosphate wasting
hypomagnesemia 2. anorexia, n/v, tremor, altered 2. clinical pres 2. alopecia and vitamin D
mental status 3. dx deficiency - ie.
564. cystinuria 1. autosomal dominant defect in osteomalacia/rickets despite
1. patho proximal tubule reabsorption of vitamin D supplementation
2. clinical pres cystine, ornithine, arginine, lysine 3. normal serum calcium,
2. ureterolithiasis with radiopaque normal alk phos, normal levels
stones of vitamin D, symptoms of
rickets
565. mcardles disease 1. glycogen storage disease- defect
1. patho in glycogen phosphorylase 577. hormone replacement 1. dec. vaginal atrophy, incr.
2. clinical pres 2. cramps/muscle pains, inc. CK, therapy bone mineralization
inc. Lactate with exercise 1. advantages 2. inc. risk of venous
thromboembolism
566. gauchers disease 1. autosomal recessive deficiency inc risk of breast cancer
1. patho in glucocerebroside -->
2. clinical pres accumulation of glucosylceramide 578. when should a patient weight <75% expected
in lysosomes with an eating disorder severe electrolyte disturbances
2. hepatosplenomegaly, be hospitalized
neurologic/mental retardation, 579. failure of detumescence sickle cell anemia
bone lesions (erlenmeyer flask associated with what CML
femur), severe bone disease, lipid conditions
laden macrophages (gaucher cells)
580. 1. niacin deficiency 1. pellagra (seen in corn based
567. tay sachs disease 1. hexosaminidase A deficiency --> clinical pres diets)- diarrhea, dermatitis,
1. patho accumulation of GM2 ganglioside 1a. niacin excess dementia
2. clinical pres in lysosomes clinical pres 1a. flushing, hepatotoxicity
2. mental retardation, seizures, 2 .thiamine deficiency 2. beriberi - high output cardiac
blindness, cherry red macula clinical pres failure, peripheral vasodilation,
568. type 3 homozygous Apo-E defect --> water retention
hyperlipoproteinemia raised yellow plaques on
palms/fingers,2/2 abnormal
accumulation of chylomicrons and
VLDL
581. 1. vitamin A excess clinical
pres
1a. vitamin A deficiency
clinical pres
2. selenium deficiency
582. 1. vitamin C deficiency
clinical pres
583. what decreases lower
esophageal sphincter tone
584. dumping syndrome
1. patho/clincal pres
585. what patients is a low salt
diet recommended for
586. whipples disease
1. patho
2. dx
587. what vitamin deficiency
associated with celiac
disease
588. what tumors are most
common in the distal ileum
589. what kind of cancer is
more common in celiac
disease, regional enteritis,
congenital immune
disorders, organ
transplant, AIDS
590. lab characteristics of
cirrhotic ascitic fluid
591. afferent loop syndrome
1. patho
2. clinical pres
592. what is the most common
site for colon cancer.
1. abdominal pain, n/v,
headache, dizziness,
papilledema
1a. night blindness, vision
loss, dry skin, impaired
immunity
2. cardiomyopathy
1. perifollicular
hyperkeratotic papules,
tendency to hemorrhage
chocolate, ethanol, caffeine,
tobacco
1. postgastrectomy, DM -
simple sugars --> vasomotor
palpitations, tachycardia,
lightheadedness,
diaphoresis, dizziness,
confusion, syncope
hypertension, CHF, CKD
1. infection with gram
positive bacilli - tropheryma
whippelii --> GI, arthritis,
CNS, eye
2. small intestine biopsy
shows PAS positive
macrophages with non-acid
fast gram positive bacilli
iron deficiency
lipomas and carcinoid
tumors
primary small bowel
lymphoma
SG <1.016, protein <25g/L,
low WBCs
1. distention and incomplete
drainage of the afferent loop
with bacterial overgrowth
2. nausea/vomiting/bloating
30-40 minutes after eating +
postprandial pain, bloating,
diarrhea, fat and B12
malabsorption
rectosigmoid
593. 1. which hepatitis has 1. hep b
very high chronic
infection if transmitted
vertically
594. what increases the risk steroid use, h.pylori infection,
for NSAID GI ulcerse smoking, alcohol
595. mentriers disease 1. large gastric mucosal folds --
1. patho > protein malabsorption
2. clincal pres 2. abdominal pain, n/v,
3. dx/tx anorexia, --> pedal edema from
protein malnutrition
3. mucosal biopsy to rule out
cancer/lymphoma
tx =high protein diet, anti-
cholinergic drugs, H2 blockers
596. why does the sclera stain high elastin content
first with bilirubin
597. 1. rotors syndrome 1. defect of hepatic storage of
2. dubin johnson conjugated bilirubin resulting
leaking into plasma
2. conjugated
hyperbilirubinemia, diagnosis
is elevated urinary
coproporphyrin I(>80% of
total)
grossly black liver
dense granular pigments of
epinephrine metabolite*** (not
seen in rotor)
598. what noncardiac diffuse esophageal spasm
condition presents like
angina and is relieved by
sublingual nitro
599. how to diagnose osmotic stool osmotic gap
diarrhea
600. secretory diarrhea large volume, painless, watery
clinical pres
601. hepatic complications of cholestasis/jaundice without
anabolic steroids inflammation
peliosis hepatis (blood in the
liver)
602. hemoglobin C disease 1. lysine substitution for
1. patho glutamic acid
2. clinical findings 2. targetoid RBCs,
splenomegaly, less
symptomatic than HbS,
intracellular HbC CRYSTALS
603. what is is the cause of patients antibodies react to
febrile transfusion donor leukocytes in PRBCs
reaction usually after about 7
transfusions patients are
sensitized--- must filter/wash
the RBCs to remove the WBCs
604. bone marrow finding in
hemolytic anemia
605. causes of anemia in
preganncy
606. what kind of bone
abnormalities seen with
sickle cell anemia
607. fish oils effect on
coagulation
608. when does post radiation
cancer occur
609. what is the most
important prognostic
factor in colon cancer
610. also young age, male
gender, and rectal location
are poor prognostic
factors
611. what decreases risk of
breast cancer in women
612. what is the most
important prognostic
factor in bone tumors
613. Adult T cell
leukemia/lymphoma
1. patho
2 . tx
614. most common clinical
pres of hodgkins
lymphoma
increased erythroid to
myeloid ratio
folate deficiency
(megaloblastic)
dilutional anemia -
disproportionate increase in
plasma volume
IDA
bone infarction- can look like
osteomyelitis
AVN of femoral head
prolong bleeding time- by
reducing platelet arachidonic
acid, and competing with
COX
increased frequency of cancer
at the same age that you
would expect the cancer to
occur
leukemia has the lowest
latency at 5-7 years post
exposure
DEPTH OF TUMOR
PENETRATION (DUKES
STAGE)
...
late menarche, early
menopause, early first
pregnancy
more distal tumors have
better prognosis
ex - pelvic girdle is worse
than femur, and femur is
worse than tibia.
1. HTLV 1 or other retrovirus
---> fulminant leukemia with
skin involvement
2. not responsive to
treatment, but helps to
control symptoms
enlarge cervical or
supraclavicular lymph nodes
615. chemotherapy side 1. hemorrhagic cystitis - tx =
effects mesna + hydration
1. cyclophosphamide 2. cardiomyopathy/CHF
2. doxorubicin 3. lung injury, skin reactions
3. bleomycin 4. liver toxicity,
4. MTX myelosuppression, GI mucositis
5. cisplatin 5. renal, ototoxicity,
myelosuppression, peripheral
neuropathy
616. paraneoplastic 1. small cell lung
syndromes associated 2. small cell lung
cancers 3. small cell lung
1. eaton lambert 4. squamous cell lung (
2. SIADH
3. cushings syndrome
4. non-metastatic
hypercalcemia (PTHrP)
617. what type of cancers nasopharyngeal carcinoma,
occur among chinese liver cancer
americans at a higher
than normal rate
618. poor prognostic factors >60 years of age, high serum
for patients with non LDH, poor performance status,
hodgkin's lymphomas ann arbor 3 or 4
619. what increases risk for clonorchis, ulcerative colitis
cholangiocarcinoma
620. 1. how to treat brain 1. steroids
metastases pain 2. leukopenia,
associated with inc. ICP thrombocytopenia
2. limitation of
carbamazepine for use
in neuropathic cancer
pain
621. posterior circulation 1. tinnitus, vertigo, diplopia,
TIA ataxia, hemiparesis, bilateral
1. clinical pres visual impairment
2. what structures does (homonymous hemianopsia)
the basilar artery supply 2. pons, midbrain, cerebellum
622. acoustic neuroma -- develop from schwann cells
clinical presentation deafness, headache, ataxia,
tinnitus, diplopia
623. subdural hematoma venous origin 2/2 head injury-
esp. in elderly
clinical pres - fluctuating LOC,
altered mental status, seizures,
papilledema
624. wernicke korsakoff 1. infarction of mamillary bodies 636. cavernous sinus 1. 2/2 trauma, neoplastic, or
1. patho 2. confusion, ataxia, nystagmus, thrombosis infectious
2. clinical pres ophthalmoplegia (6th nerve) 1. patho 2. papilledema, hemorrhages of
3. tx korsakoff = irreversible amnesia, 2. clinical pres orbital veins, headache, diplopia,
confabulation, apathy sensory loss of face (3,4,6,V1/V2)
3. THIAMINE BEFORE
637. 1. oculomotor palsy 1. ipsilateral no response to light, no
GLUCOSE
clinical consensual light response
625. benign paroxysmal 1. calcium debris (loose presentation 2. small irregular pupils, impaired
positional vertigo otoconia) in semicircular canals 2. argyll robertson light response, accomodation intact
1. patho 2. sudden onset of brief vertigo pupil 3. parasympathetic lesion @ or distal
2. clinical pres episodes, dix hallpike maneuver 3. tonic pupil to ciliary ganglion - large unilateral
positive (holmes-adie pupil, no light response (shy drager,
syndrome) amyloid, diabetes, healthy)
626. what to start treatment diazepam, thiamine, magnesium
with for a withdrawing 638. 1. horners 1. constricted on affected side, intact
chronic alcoholic syndrome pupil light reaction, no reaction to darkness
627. what is a key feature of tinnitus and deafness is found in 639. seizure treatments 1. lorazepam or diazepam
peripheral vertigo vs peripheral vertigo 1. status 2. phenytoin, carbamazepine,
central vertigo peripheral vertigo tends to epilepticus 3. phenytoin, carbamazepine,
relapse and remit whereas 2. partial seizures valproic acid
central is more constant 3. tonic clonic 4. valproate
seizures 5. ethosuximide, valproate
628. hypokalemic periodic 1. familial/thyrotoxicosis -->
4. myoclonic
paralysis hypokalemia after large
seizures
1. patho carbohydrate meals/stress
5. absence seizures
2. clinical pres 2. recurrent attacks of weakness,
3. tx loss of DTR, paralysis 640. phenytoin side gum hyperplasia, hirsutism, SJS/TEN
3. potassium supplementation, effects
low carbohydrate,
641. long term seizure phenytoin, carbamazepine
acetazolamide, imipramine
prophylaxis
629. arteriovenous symptoms start between ages 10-
642. 1. hyperuricemia 1. urate crystals in the medulla or
malformation clincial 30, headaches similar to
renal effect pyramids with mononuclear or giant
pres migraines, seizures, or rupture
2. sickle cell cell
630. hypertensive 1. cerebellum, pons, thalamus anemia renal effect 2. ischemic injury leads to functional
encephalopathy tubule defect and concentrating
1. locations of defect, papillary necrosis, FSGS
hemorrhage
643. what drugs should NSAIDs and ACE
631. cerebellar hemorrhage 1. headache, vomiting, gait be avoided in
1. clincal pres ataxia, dizziness, vertigo, eyes patients with renal
deviate away from hemorrhage impairment
possible ipsilateral 6th nerve
644. post-strep diffuse mesangial proliferation, IgG
palsy
glomerulonephritis and C3 granular subepithelial
632. pontine hemorrhage impaired oculocephalic reflexes, 1. microscopic deposits
key clinical findings small reactive pupils, coma, findings
quadriplegia
645. what is key urine red cells/red cell casts indicate that
633. PML pathogen JC virus (papovavirus) in the finding indicating the glomerulus is bleeding
immunosuppressed glomerulonephritis - granular casts, protein will also be
present but this is not specific
634. which vaccines are smallpox or rabies
associated with ADEM 646. glucocorticoid metabolic alkalosis because
drug acid base glucocorticoids have some
635. which vitamin B12
disturbance mineralocorticoid activity
deficiency can cause
demyelination 647. hepatic cirrhosis respiratory alkalosis - 2/2 elevated
acid base progestins stimulate respiratory drive
disturbance
648. henoch schonlein 1. URI, drugs, foods, insect bites- 661. marfans syndrome 1. cystic medial degen of aorta leads
1. patho -> immune complex vasculitis of 1. heart lesions to aortic dilatation and mitral
2. kidney injury type the skin, GI tract and kidneys 2. body features insufficiency
2. diffuse proliferative 2. chest deformities (pectus), long
glomerulonephritis limbs, high arched palate, high
pedal arches, pes-planus
649. polycystic kidney renal/hepatic cysts, intracranial
disease clinical pres aneurysms, colonic diverticula 662. what heart lesion aortic stenosis (1-6%)
most common in
650. why do osteophytes stretching of periosteal nerve
HLA B27+ patients
cuase pain in endings
osteoarthritis 663. where do rheumatoid olecranon bursa, proximal ulna,
nodules typically achilles tendon, occiput
651. what cardiac aortic insufficiency (4%)
occur
complication of
ankylosing spondylitits 664. caplans syndrome diffuse nodular fibrosis that occurs
when rheumatoid nodule occur in
652. side effect of aplastic anemia
the lungs of patients with
phenylbutazone (an
pneumoconiosis
NSAID used to treat
joint pains) 665. most common eye sjogrens
manifestation in RA
653. what to think in a secondary hypertrophic
patient with new onset osteoarthropathy - next step 666. anti-RNP associated polymyositis, scleroderma, lupus,
clubbing of the distal should be a chest x ray diseases mixed connective tissue disease
extremities
667. what serologic anti-dsDNA
654. blood count findings in leukopenia (2/3 of patients) or marker correlates
SLE pancytopenia with disease activity
in lupus
655. what is the best high IgG anti Fc Ig (RA factor)
predictor of likelihood titers 668. what kind of crystal hydroxyapatite (small non-
for extraarticular arthropathy birefringent crystals)
manifestations of RA characteristic of END
STAGE renal failure
656. most common anterior uveitis - pain,
extraarticular photophobia, inc. lacramation 669. CPPD prophylaxis colchicine
manifestation of
670. clinical presentaion old age, pre-existing joint disease,
ankylosing spondylitis
that favors knee involvement
657. rheumatoid arthritis early = NORMAL pseudogout over gout
radiographic findings late = bony erosions and loss of
671. measels 1.cough/fever/coryza--> koplik
early vs late cartilage, periarticular
1. clinical pres spots, fever, rash that starts at the
osteopenia, joint margin erosions
2. complications head and DESCENDS
(narrowing of joint space)
3. treatment CONFLUENTLY (compare to
658. ehlers danlos 1. skin hyperextensibility rubella)
1. clinical pres /fragility/ bruisability, habitual 2. otitis media (most common),
dislocation of joints bronchitis, lymphadenitis
659. relapsing 1. auricular/nasal chondritis that pneumonia, encephalitis
polychondritis relapses and remits (sclerosing panencephalitis that
1. clincial pres 2. SLE, RA, sjogren's, vasculitis leads to death by 1 year)
2. associated 3. aerosolized ribavirin for
underlying conditions pneumonia

660. rheumatoid arthritis CD4+ T cells inc. IL2 672. mumps clinical pres bilateral parotitis, oophoritis,
cellular/molecular mumps treatments orchitis, meningitis,
mechanism hyperamylasemia (from parotid
inflammation) fever
tx = symptomatic,
673. treamtent for oral hydration
diarrhea loperamide or bismuth
fluoroquinolones or TMP SMX
674. HIV 1. EIA - 99.5% sensitive, 691. aspirin allergy pseudoallergic reaction due to the
1. detection NOT SPECIFIC AT ALL mechanism enhanced leukotriene synthesis
LOTS OF FALSE
692. HLA associations 1. B27
POSITIVES
1. ank spondy 2. DR4
Western blot - more specific
2. juvenile arthritis, 3. DR3
`
rheumatoid arthritis 4. B27
675. treatment of tetanus penicillin or metronidazole, 3. type 1 DM
respiratory support 4. reiters syndrome
676. heterophil negative mono CMV 693. ant/middle/posterior posterior mediastinal masses
mediastinal masses include neurogenic tumors,
677. physical manifestations of hutchinsons teeth, saddle
meningocele,meningomyelocele,
congenital syphilis nose, saber shins
gastroenteric cysts, and esophageal
678. prophylactic antibiotic ciprofloxacin inf symptoms diverticula.
choice for travelers develop anterior mediastinal masses
diarrhea include thymomas,
679. treatment for legionella macrolides - azithromycin lymphomas,teratomas, and thyroid
fluoroquinolones - masses.
levofloxacin or Middle mediastinal masses include
moxifloxacin vascular lesions,lymph nodes, and
pleuropericardial and
680. hospital acquired s. aureus, gram negatives, bronchogenic
pneumonia organisms or s.pneumo cysts.
681. empiric treatment for broad gram negative/gram 694. what lung disease bilateral upper lobe
neutropenic fever positive coverage for a associated with fibrosis/fibrocavitary disease
bacteria ankylosing
682. - dont need to treat for ... spondylitis
fungal/viral unless there is 695. hypoxemia while right to left shunt (atelectasis,
an indication recieving 100% vascular abnormalities, ARDS,
683. EBV associated anaplastic nasopharyngeal oxygen congenital cardiac malformations)
malignancies carcinoma (US) ~~ compare to VQ mismatch which
burkitts lymphoma (Africa) is easier to correct with oxygen
HIV associated CNS therapy
lymphomas 696. lab findings for elevated ACE, ESR,
684. native valve endocarditis strep viridans > s.aureus > sarcoidosis hyperglobulinemia, hypercalcemia
caues enterococcus (elevated D3)
falsely positive ANA and RF
685. multiple myeloma defect in humoral immunity
infectious risk - susceptibility to 697. causes of pulmonary Allergic bronchopulmonary
encapsulated organisms eosinophilia aspergillosis (in asthmatics),
s.pneumoniae and parasitic reactions, and drugs
klebsiella loeffler's syndrome - benign
idiopathic pulm. eosinophilia
686. what kind of infections are candida/fungal and viral
churg-strauss
associated with cell infections -
mediated immunity defects 698. side effects drug/platelet complex
associated with thrombocytopenia* , hepatitis,
687. congenital toxoplasmosis chorioretinitis, strabismus,
quinidine bone marrow suppression, lupus
epilepsy, hydrocephalus
syndrome, GI side effects,
688. what antibiotics potentiate sulfonamides by displacing
699. LSD clincial pres sympathomimetic effects - pupillary
phenytoin phenytoin from albumin
dilitation, piloerection,
689. what antibiotic potentiates sulfonamides hypothermia, tachycardia,
the effects of oral dizziness, weakness, drowsiness,
hypoglycemics nausea, paresthesias
690. best diagnostic test for T candida infection
cell defect positive reaction means
intact T cell response
700. folate deficiency chronic alcoholism, small bowel 714. statin side effects elevated liver enzymes
causes disease, inadequate intake, MTX, myopathy - HMG CoA
diagnostic tests includes serum reductase inhibitors dec.
folate or RBC folate (will detect mevalonate which is also
rapid changes in intake) used to synth CoQ10
701. perchlorate and anti hyperthyroid drugs, both 715. how to differentiate HCM has septal thickening
thiocynaate inhibit iodide transport, work by restrictive cardiomyopathy restrictive has symmetric
preventing thyroid gland from from HCM on echo ventricular thickening
concentrating iodide
716. theophylline toxicity headache, insomnia, GI
702. which all of them except moxifloxacin disturbance, arrhythmias
fluroquinolones need (liver met), or pefloxacin ciprofloxacin and
renal adjustment erythromycin both inhibit
P450 and inc. theophylline
703. ampicillin vs acid resistant, better PO
levels
penicillin absorption, very high bio
availability PO 717. flow loop for upper airway flow limitation in both
obstruction ex. laryngeal inspiratory and expiratory
704. ADH effects inc. water permeability of the
edema limbs
distal collecting duct,
bradycardia, inc. RR, suppression 718. flow loops 1. scooped out appearance
of fever 1.obstructive disease 2. small volume restrictive
processes pattern
705. what patients should unstable angina, STEMI,
2. restrictive lung disease 3. blunted
get treated with NSTEMI, post PCI
3. upper airway obstruction inspiratory/expiratory flow
clopidogrel
loops
706. what is the treatment vagal maneuvers - carotid
719. aspergilloma 1. radiolucent mass that
for SVT massage, immersion in cold
1. CXR changes position
water, valsalva
adenosine, beta blockers, CCBs 720. what is the most likely iliofemoral veins
location of formation of a PE ~ calf veins less likely to
707. neurocardiogenic vasovagal syncope - occurs in
clot make it to the heart
syncope (situational response to pain, body actions
syncope) (urination), coughing fits 721. auscultatory findings in prolonged expiratory
nausea, diaphoresis, tachycardia, emphysema phase, end expiratory
pallor preceding syncope wheezing
708. what viral infection coxsackie b 722. treatment for inpatient vs inpatient - levofloxacin
associated with adeno, cmv, echo, hep c, outpatient community outpatient azithromycin, or
dilated acquired pneumonia (not doxycycline
cardiomyopathy ICU, not intubated)
709. isolatd systolic cuased by dec. elasticity of arterial 723. right heart cath findings of elevated pulmonary artery
hypertension wall which causes inc. systolic BP PE pressure (normal is 25/15),
+ TX OF CHOICE elevated right atrial
pressures
710. treatment of choice is ...
hypotension and shock
HCTZ
724. most fatal complication of life threatening hemoptysis
711. most common cause tuberculosis
bronchiectasis
of constrictive
pericarditis in 725. hypertrophic digital clubbing,
developing countries osteoarthropathy clinical **sudden onset**
pres arthropathy of the wrist
712. what is the only HCM
and hands
murmur that will ie. during valsalva, or standing
- first diagnostic test is a
increase with
chest x ray
decreased preload
726. what is the cause of bronchiectasis, bronchial
713. which murmurs ie. handgrip or squat
bronchial obstruction stenosis, foreign body
inc/dec. with inc. dec - AS, HCM
causing recurrent
afterload inc - MS
pneumonia
727. what is the functional increased work of breathing 739. what is common non- GERD - up to 75% of
consequence of pulmonary comorbid patients
diaphragmatic condition in asthmatics
flattening in COPD
740. what kind of MI presents with posterior and inferior
728. ddx of unilateral leg muscle strain, bakers cyst, abdominal pain MIs
swelling/pain DVT, cellulitis ECG should be first
diagnostic chest for
729. diagnostic steps for DVT low pretest probability - D-
abdominal pain
dimer - if negative don't
anticoag, if positive, 741. factitious diarrhea diagnosis melanosis coli -
compression US and then colonoscopy shows
anticoag if necessary darkening of colon, and
lymphoid nodules
730. high pretest probability ...
2/2 laxative abuse
- do compression
ultrasound first 742. right sided vs left sided colon right sided anemia, left
caner clinical pres sided obstruction
731. auscultatory findings of dullness to percussion
lobar pneumonia bronchial breath sounds with 743. constipation, back pain and multiple myeloma
prominent expiratory renal impairment in an constipation is 2/2
component elderly patient suggests what hypercalcemia
E-->A egophony condition renal impairment is 2/2
whispered pectoriloquy BJ proteinuria
crackles
744. celiac disease 1. bulky foul smelling
732. interstitial lung disease resonant to percussion, 1. clinical pres floating stool, loss of
auscultory findings vesicular breath sounds muscle mass/fat
FINE END INSPIRATORY Dermatitis herpetiformis
CRACKLES - subclinical gluten
enteropathy (sub
733. distinguishing clinical indolent course, higher
cutaneous IgA)
features of atypical incidence of extrapulmonary
pallor from IDA
pneumonia manifestations (HA, sore
(duodenum)
throat, erythema multiforme or
bone pain from
other rash)
osteomalacia
734. chronic bronchitis- 1. 1. productive cough 3 months easy bruising (K
definition, 2. patho per year for 2 years, prominent deficiency)
bronchovascular markings, hyperkeratosis (A
normal DLCO, right heart deficiency)
failure, profound O2 desat
745. most common complication of hemorrhage
2. destruction of airspaces distal
PUD
to terminal bronchioles, dec.
pulmonary vascular markings, 746. treatment of ascites sodium and water
dec. DLCO, moderate O2 desat restriction
spironolactone
735. complications of PEEP alveolar damage, tension
(aldosterone blocker)
pneumothorax, hypotension
loop diuretic - with
736. differentiation of CXRs are UNRELIABLE - spironolactone
asthma and COPD airway expansion in COPD is a frequent paracentesis (2-
LATE finding 4 L/day) if renal function
737. best way to distinguish ... intact
is FEV1 before and after
bronchodilatory
expecting >15%
response in the
asthmatic
738. causes of post normal gestation, molar
choriocarcinoma pregnancy, abortion
747. drug induced furosemide, thiazides 756. In someone with a solitary liver most likely mets
pancreatitis IBD drugs - ASA, sulfasalazine mass and no history of chronic colonoscopy, CT
immunosuppression - liver disease what is the first abdomen, AFP
azathioprine, L-asparaginase diagnostic test that should be
valproic acid performed
AIDS drugs - didanosine,
757. hepatotoxic drugs 1. acetaminophen,
pentamidine
1. hepatitis causing drugs tetracycline,
antibiotics - metronidazole,
2. cholestatic drugs isoniazid,
tetracycline
chlorpromazine,
748. what does migratory chronic DIC and malignancy - halothane,
thrombophlebitis and next diagnostic test should be antiretroviral therapy,
atypical venous pan CT scan 2. chlorpromazine,
thrombosis suggest nitrofurantoin,
clinically and what is erythromycin
the next diagnostic test anabolic steroids,
colestipol
749. chronic pancreatitis fecal elastase study*** diagnoses
best diagnostic test the pancreatic exocrine 758. why is AST>ALT in alcoholics they have deficiency
insufficiency of pyridoxal 6
serum lipase and amylase may phosphate which is
not be reliable and only mildly ALT cofactor
elevated
759. alcohol hepatitis histologic ballooning of
750. lactose intolerance 1. H+ breath test, or lactose findings cytoplasm, PMN
1. dx tolerance test infiltration, fibrosis,
necrosis, mallory
751. gallstones 1. calcium bilirubinate - from
hyaline
1. pigment stones hemolysis (black) or chronic
2. treatment for non- biliary tract infection (brown) 760. alpha 1 antitrypsin deficiency PAS positive
surgical candidates 2. ursodeoxycholic acid histologic findings of liver/lungs hepatocyte
granules***
752. hepatitis B 1. interferon, lamivudine (reverse
Panacinar
1. chronic treatment transcriptase inhibitor)
emphysema
2. post exposure 2. HBIG and hepatitis B vaccine
prophylaxis 761. emphysematous changes of the ...
lower lobes
753. diagnostic test for ERCP
recurrent pancreatitis 762. indications for TIPS refractory cirrhotic
with no identifiable hydrothorax
cause refractory ascites
recurrent variceal
754. hepatitis C 1. cryoglobulinemia (renal/GI),
bleeding
1. extrahepatic b cell lymphoma, autoimmune
patients waiting for
manifestations (sjogrens/thyroiditis), lichen
liver transplant and
planus, ITP, porphyria cutanea
needing portocaval
tarda
shunts
755. non alcoholic fatty liver 1. obesity/type 2 dm --> insulin
763. pancreatitis hypotension inflammatory effects
disease resistance/inc lipolysis and fat
pathogenesis from pancreatic
1. patho accumulation in hepatocytes -->
enzyme release inc.
2. biopsy findings proinflammatory
vascular permeability
3. top 3 risk factors cytokines/oxidative stress -->
4. tx inflammation, fibrosis, cirrhosis 764. also systemic hypotension occurs ...
2. macrovesicular fat deposition from endothelial injury
in hepatocytes
765. acute hepatic failure vs fulminant includes
(indistinguishable from alcohol)
fulminant hepatic failure hepatic
3. obesity, diabetes mellitus,
encephalopathy
hypertriglyceridemia
4. underlying conditions, 766. acute/fulminant both have liver ...
ursodeoxycholic acid synthetic failure within 8 weeks
of injury onset
767. what lab value will non-bloody, SAAG>1.1 778. initial tests for patient with DRE
indicate that ascites suspected BPH urinalysis, serum
is from portal creatinine - to rule out
hypertension infection
768. complications of pancreatitis, perforation, biliary 779. what is important rule out for bladder cancer
ERCP enteric fistula, biliary peritonitis, patient with voiding systems do repeat prostatic
sepsis, hemorrhage, contrast related and negative prostatic culture cultures and
complications cystoscopy
769. hemolytic reactions\ 1. coombs test positive, plasma free 780. acyclovir renal side effect crystalluria with renal
1. diagnosis of ABO hemoglobin, pink plasma, plasma tubular obstruction
mismatch hemoglobin >25, hemoglobinuria - avoid with good
2. complications of 2. DIC, ARF, shock hydration when using
ABO mismatch 3. reactions to cytokines released by IV acyclovir
3. febrile transfusion leukocytes in storage
781. renal vein thrombosis in loss of antithrombin
reaction
nephrotic syndrome 3/S/C leads to
770. factors that increase male sex 1. patho hypercoagulable state
the probability of age of infection >40 2. clinical pres in the renal vein
progression of longer duration of infection 3. most common nephrotic 2. sudden onset
hepatitis C coinfection with HIV syndrome associated with RVT abdominal pain, fever,
immunosuppression hematuria
liver comorbidities 3. membranous
glomerulonephritis
771. hepatic adenoma benign epithelial tumors found in
1. definition right lobe 782. fibromuscular dysplasia 1. hypertension,
2. associated assc. with anabolic steroids, 1. dx string of beads on
conditions glycogen storage disease, angiography
3. histological pregnancy, diabetes, OCPs hum or bruit in the
findings 2. enlarged adenoma cells with costovertebral angle
glycogen and lipids
783. progression of diabetic kidney inc. GFR
772. focal nodular non-malignant tumor, hyperplastic disease GBM thickening
hyperplasia response to hyperperfusion mesangial expansion
biopsy shows sinusoids and kupffer nodular sclerosis
cells
784. how to avoid urate nephropathy allopurinol pre-
773. what primary GI, lung, breast, skin (melanoma) in patients who will start treatment
malignancies chemotherapy for lymphoma
metastsize to the and leukemia
liver
785. drugs that cause interstitial penicillins, PPIs,
774. when should ACE proteinuria >300mg in a diabetic (it nephritis NSAIDs
inhibitors not be is irreversible)
786. sulfonamides, rifampin, ...
used for renal
phenytoin, allopurinol
protection
787. medullary cystic kidney 1. recurrent UTI and
775. creatinine >3-3.5 ~ ...
1. clinical pres renal stones
will worsen the renal
2. dx/tx 2. contrast filled cysts
failure
3. acquired cystic kidney disease on IVP,
-
tx = same as normal
776. initial hematuria initial = urethral source person with renal
terminal hematuria terminal = bladder or prostatic stones
total hematuria cause 3. occurs in dialysis
total = bladder or kidney cause patients
777. incontinence 1. anticholinergics, antipsychotics,
1. what medications TCAs, sedative hypnotics
associated with
overflow
incontinence
788. cyclosporine 1. nephro, renal 797. broad categories of ketoacidosis - alcoholic,
1. toxicity vasoconstriction/HTN, causes of metabolic diabetic, starvation
2. mechanism hyperkalemia, acidosis intoxications - methanol,
3. advantage/disadvantage of neurotoxicity/tremor formalin, salicylate, ethylene
tacrolimus gingival hypertrophy, glycol, INH, metformin
hirsutism* tissue hypoxia
infection, SCC, anorexia, renal failure
n/v, diarrhea
798. cause of hypocalcemia in chronic pancreatitis leads to
2. calcineurin inhibitor
an alcoholic ADEK insufficiency and thus
(thus no transcription of
inability to absorb calcium
IL2 via NFKB)
from the gut
3. no hirsutism or gum
hypertrophy - higher 799. alcoholism electrolyte hypomagnesemia,
incidence of neurotoxicity imbalance hypokalemia,
diarrhea hypophosphatemia

789. azathioprine 1. purine analog 800. what kind of acid base progesterone stimulates the
1. mechanism metabolized to 6-MP disturbance seen in DRG of medullary respiratory
2. SE 2. diarrhea, leukopenia, normal pregnancy center --> chronic resp.
hepatotoxic alkalosis

790. mycophenolate 1. reversible inosine 801. aspirin toxicity 1. stimulates respiratory center
1. mechanism monophosphate 1. patho (resp.Alk) and it is a acid so
2. SE dehydrogenase inhibitor 2. clinical pres also met. acid
~ rate limiting purine 2. fever, tinnitus, tachypnea
synthesis step 802. postictal acid base transient anion gap metabolic
2. bone marrow disturbance acidosis that resolves without
suppression treatment 60-90 minutes after
791. what drugs cause ACE inhibitors, NSAIDs, seizure activity
hyperkalemia spironolactone, amiloride 803. avascular necrosis of the 1. corticosteroids, alcoholism,
792. serum osmolality 1. hyperglycemia, hip hemoglobinopathies, lupus
1. high >295 radiocontrast, mannitol 1. causes (antiphospholipid)
2. clinical pres 2. progressive hip or groin
793. SIADH lab diagnosis serum osm <270,
3. dx pain without restriction of
Uosm>Sosm
range of motion
UNa >20
3. MRI
Uosm >100-150
804. what must be ruled out in septic arthritis- these patients
794. blind loop syndrome acid excess production of D-
any patient with RA, fever are at a higher risk for septic
base disturbace lactate caues
and a new inflamed red arthritis usually with staph
hypochloremic met. acid
joint aureus
795. chloride sensitive vs resistant sensitive - Urine Cl <20
805. what is important test kidney biopsy to determine the
met. alk 2/2 volume contraction -
before starting therapy degree of impairment
diuretics/vomiting - urine
for lupus patient with
796. resistant - urine Cl>20 and ... renal impariment
volume expansion - primary
806. most common cause of PAGETS DISEASE OF BONE
hyperaldosteronism, bartter,
isolated elevated ALP in
gitelman, black licorice
the elderly
**wont respond to NS
infusion 807. viral arthritis 1. post parvo, hepatitis, HIV,
1. patho mumps, rubella
2. dx 2. positive ANA (weak),
3. tx rheumatoid factor positive
3. NSAIDs, will resolve with
time
808. what fraction of patients 10% - breast, lung, ovarian,
with dermatomyositis urogenital
will develop cancer
809. what inflammatory
diseases associated with
aortic aneurysms
810. - unrelated - also marfan's,
ehlers danols, syphilis
811. what inflammatory
diseases associated with
renal failure
812. what inflammatory
diseases associated with
alveolar hemorrhage
813. what inflammatory
diseases associated with
depositional disease and
carpal tunnel syndrome
814. key characteristic of lupus
arthritis
815. key clinical feature of back
pain 2/2 metastasis
816. lesch nyhan syndrome
1. patho
2. clinical pres
817. vertebral compression
fractures
1. risk factors
2. clinical pres
818. what is the cause of kidney
damage in lupus
819. which organ is most likely
to be damaged when using
hydroxychloroquine for
lupus
820. degenerative joint disease
Xray findings
821. what physical exam
findings suggests lumbar
disk herniation
822. rheumatoid arthritis
increases risk of
osteopenia/osteoporosis
behcets, takayasu, giant cell 823. what part of the
arteritis, ank spondy, RA, spine is most likely
psoriatic arthritis, reiters effected by RA
arthritis
... 824. normal pressure
hydrocephalus
1. patho
SLE, wegener's, PAN, churg
2. clinical pres
strauss, behcets
3. tx
goodpasture, wegener's,
825. metoclopramide
PAN, churg strauss, behcets,
1. mechanism
antiphospholipid syndrome
2. side effects
RA, sarcoid, amyloidosis,
hypothyroidism (myxedema)
826. features of
cerebellar
it is NON-DEFORMING disorders
827. best drug for
pain that is worse at NIGHT parkinson's
patients younger
1. hypoxanthine guanine than 70 years and
phosphoribosyltransferase with minimal
deficiency --> elevated uric bradykinesia
acid 828. familial
2. self mutilation, neurologic dysautonomia
disabilities in childhood (riley day)
1. demineralization/trauma 829. pseudotumor
- osteomalacia, cerebri
osteoporosis, 1. risk factors
2. intense focal pain, worse 2. clinical pres
when lying down 3. dx/tx
immune complex deposition
and activation of
complement (-->low C3 in
the blood)
RETINA
narrowing of joint spaces,
subchondral cysts/sclerosis,
heberdens nodes, bouchers
nodes, osteophytes
830. anticholinergic
straight leg raise symptoms
yes it does indeed
cervical spine -- MUST EVALUATE
FOR SUBAXIAL SUBLUXATION
(ATLANTOAXIAL INSTABILITY)
PRIOR TO SURGERY
1. impaired CSF absorbtion leads to
ventricular dilatation
2. slow broad based shuffling gait,
urinary incontinence, memory loss
3. serial lumbar punctures, VP shunt
(if LPs are helpful)
1. dopamine ANTAGONIST - used to
treat nausea, vomiting, gastroparesis
2. dystonic reactions - tardive,
dystonia, parkinsonism, NMS, neck
stiffness
ipsilateral - nystagmus, hypotonia,
dysarthria, incoordination,
dysdiadokinesia
benztropine (anticholinergics)
ashkenazi jewish ancestry - gross
autonomic dysfunction, severe
orthostasis
1. corticosteroids, OCPs, trauma
2. presence of inc. ICP features, no
focal signs except 6th nerve palsy,
elevated opening pressure, normal
CSF micro, only vent. enlargement on
imaging,
seen in young obese females,
headaches and memory impairment,
neck pain, n/v, double vision
3. CT/MRI to rule out space occupying
lesion, empty sella from downward
herniation of arachnocele, increased
opening pressure on LP, papilledema-
see shrunken ventricles on MRI
4. acetazolamide***, lumbar
punctures, lumboperitoneal shunting
optic nerve sheath fenestration
ie. from benztropine or
trihexyphenidyl overdose
*red as a beet
dry as a bone,
hot as a hare
mad as a hatter
full as a flask
- flushing, anhidrosis, hyperthermia,
mydriasis, delirium, urinary retention,
831. side effects of nausea and vomiting because of GI 841. what is the treatment for thiamine, supplemental
levodopa effect of dopamine patient who is suspected O2, naloxone, dextrose
~ avoid with carbidopa intoxication and cannot give
good history
832. MAOI + what other TCAs or SSRIs
drugs precipitate 842. absence seizures EEG 3 hz spike and wave
serotonin syndrome finding tx = ethosuximide or
valproic acid
833. propranolol used to portal hypertension
specifically treat essential tremor 843. what patients are at a elderly and alcoholics -
which conditions hyperthyroidism (symptoms only) higher risk for subdural both have brain atrophy
hemorrhage
834. aminoglycoside ototoxicity, nephrotoxicity
toxicity 844. waterhouse friderichsen bilateral hemorrhage of
syndrome adrenal glands 2/2 DIC
835. what electrolyte SIADH --> hyponatremia
during neisseria meningitis
abnormality
results in acute adrenal
associated with
insufficiency
intracerebral
hemorrhage 845. antiarrythmics 1. antiarrhythmic used to
1. procainamide + SE treat both supraventricular
836. 1. medial medullary 1. occlusion of vertebral or a branch
2. synchronized DC and ventricular
syndrome - contralateral hemiparesis/sensory
cardioversion arrhythmias
2. lateral medullary loss, and tongue deviation to the side
3. lidocaine + SE SE= drug induced lupus,
syndrome of the lesion
agranulocytosis, QT
(wallenberg) 2. ipsilateral horners, sensory loss
prolongation
2. lateral pontine on face, palate/pharynx/vocal,
2. used to treat afib/aflutter
syndrome ataxia, contralateral body sensory
3. ventricular arrhythmias
loss
in ACS patients,
2. contralateral hemiparesis/sensory
****increases risk of
loss, ipsilateral CNV sensory loss,
asystole
ipsilateral limb ataxia
SE = confusion, seizures,
837. mid pontine 1. ipsilateral limb ataxia, resp. depression
syndrome contralateral eye deviation,
846. tetralogy of fallot MCC cyanotic heart
face/arm/leg paralysis
disease,dyspnea, growth
838. creutzfeldt jakob 1. prion disease retardation, clubbing,
disease 2. rapidly progressing dementia, polycythemia
1. patho myoclonus, periodic high EEG Tet-spells - patient squats
2. clinical pres voltage showing sharp triphasic to inc. SVR
pattern CXR shows boot shaped
839. 1. picks disease 1. frontotemporal dementia- heart
2. lewy body disease personality changes 847. stab wounds and arterial AV fistulas leading to high
3. multi infarct (euphoria/disinhibition), catheterization is output heart failure
dementia compulsive behaviors, hyperorality, associated with what site
impaired memory complication
2. fluctuating cognitive impairment,
848. av fistula clinical pres widened pulse pressure,
bizarre visual hallucinations***,
strong peripheral arterial
parkinsonism that is poorly
pulsations
responsive to therapy
3. cognitive/motor dysfunction, 849. situational syncope LOC immediatly after
stepwise loss of function (autonomic dysreg syncope) urination or other activity
840. carotid artery 1. >60% regardless of symptoms, 850. how to distinguish septic septic shock has high
stenosis 2. aspirin for life shock vs MVO2 from hyperdynamic
1. when to operate hypovolemic/neurogenic circulation and improper
2. medical therapy shock distribution of CO
851. hypovolemic and ... 861. what is the cause of progressively decreasing
neurogenic inc. orthostatic baroreceptor sensitivity *
shock have dec. hypotension with
MVO2 from inc. increased age
oxygen + what other changes
extraction to the heart with age
852. how do OCPs inc. angiotensinogen by the liver in 5% 862. worsening diastolic ...
cause of users function, dec.
hypertension resting/maximal CO.
dec. # of myocytes
853. amyloidosis 1. MM (AL), RA, IVDU other chronic
1. causes inflammatory conditions 863. how does the kidney excreting bicarbonate in the urine
2. clinical pres 2. restrictive cardiomyopathy, easy adapt to respiratory
bruisability (liver involvement), renal alkalosis
impairment/nephrotic range
864. what are poor NORMAL PaCO2 - because it
proteinuria, hepatomegaly,
prognostic should be low 2/2 hyperventilation
cardiomyopathy, pseudohypertrophy,
indicators during an
peripheral neuropathy
asthma attack
854. in what specific pulmonary edema
865. others - speech ...
situation is beta
difficulty,
blocker
diaphoresis, altered
contraindicated
sensorium, cyanosis,
in MI
silent lungs
855. endocarditis 1. non-specific symptoms - fever,
866. what decreases home oxygen
1. clinical pres malaise,
mortality in COPD smoking cessation
2. complications 2. mycotic aneurysm, abdominal
abscesses*, septic PE, renal abscess, 867. indication for NIPPV respiratory distress
conjunctival hemorrhage, janeway pH <7.35, PaCO2>45, RR>25/min
lesions, (erythematous macules) oslers 868. complete indicates a collapsed lung, should
nodes (nodules on fingers/toes), opacification of a look for bronchial lesion with
856. why is causes vasodilatation and reflex SINGLE lung with bronchoscopy -- causes include
nifedipine tachycardia shifted mediastinum mucus plugging, tumor, foreign
contraindicated body
STEMI 869. reyes syndrome hepatic encephalopathy in children
857. - diltiazem and ... 1. patho associated with viral infections and
verapamil dont 2. tx salicylates
help either - mitochondrial injury --> extensive
fatty vacuolization of the liver
858. amiodarone side pulmonary (cumulative) fibrosis,
without inflammation
effects elevated LFTs, corneal deposits, blue
2. glucose, FFP, mannitol (for
gray skin discoloration,
cerebral edema)
hypothyroidism*
859. slows SA/AV ...
node conduction
thus can cause
bradycardia
860. cocaine 1. benzos*, nitrates, aspirin
mediated 2. they lead to unopposed cocaine
cardiac mediated alpha vasoconstriction'
ischemia *choose a CCB insted to control
1. tx vasospasm
2. why are pure
beta blockers
contraindicated
870. legionella 1. refractory to beta lactam (also 882. what GI pathology upper GI bleeding
pneumonia mycoplasma), HYPONATREMIA is often associated
1. clinical pres CONFUSION, ABDOMINAL PAIN, with elevated BUN
2. treatment DIARRHEA acute onset fever, malaise,
883. two situations upper GI bleeding
3. dx headache, non-productive cough,
where you can see steroids
dyspnea,
elevated BUN
2. erythromycin or azithromycin
without elevated Cr
3. HYPONATREMIA, organism negative
smear (only polymorphs) 884. 1. vitamin E 1. RBC fragility, hyporeflexia, muscle
deficiency clinical weakness, blindness
871. hypoventilation consequence of severe obesity and
pres 2. perifollicular hemorrhage, swollen
syndrome untreated OSA, chronic
2. Vitamin C """ gums, poor wound healing
hypercapnia/hypoxic resp. failure,
secondary erythrocytosis, low serum Cl, 885. most common colon cancer (1% per year)
hypertension, cor pulmonale complication in UC

872. aspirin pseudo allergic reaction - 2/2 aspirin 886. gallstone risk caucasian race, obesity, female, OCP,
sensitivity induced prostaglandin/leukotriene factors DM, hypomotility of gallbladder
syndrome imbalance (preg), ileal disease, clofibrate,
* tx = leukotriene receptor antagonist octreotide, ceftriaxone

873. what bacterial overgrowth, pancreatic 887. pancreatic <5cm observe for 6 weeks if
conditions will insufficiency, celiac disease, crohns pseudocyst persistent then drain
increase fecal disease treatment *no ABX necessary
fat >5cm - drain

874. D-xylose test simple sugar that does not need to be 888. liver histo findings 1. acute alcoholic hepatitis
digested to be absorbed tests for INTACT 1. balloon 2. acute viral hepatitis, bridging
MUCOSA OF PROXIMAL SMALL degeneration with necrosis (confluent hepatic necrosis
BOWEL ONLY ONLY inflamm cells between adjacent lobules)
- THUS if pancreatic insufficiency is 2. panlobular 3. inflammatory cells extend between
present D-xylose absorption/excretion mononuclear portal ducts with periportal bridging
will not be effected inflammation fibrosis
3. piecemeal
875. acid fast cryptosporidium parvum - chronic
necrosis
oocysts diarrhea in HIV patients with CD4<180
889. how to evaluate acute - LFTs
876. also may be ...
liver damage in chronic - liver biopsy
isospora
acute vs chronic
877. when to order n/v hepatitis
EGD for weight loss, anemia, melena/blood
890. causes of liver PBC, transplant rejection, hodgkins
patients with long duration of symptoms >1-2 years
biliary ductopenia disease, GVHD, sarcoid, CMV/HIV
GERD failure to respond to PPI
891. entamoeba 1. contaminated water in endemic
878. ^ALARM ...
histolytica region (south america)
SYMPTOMS
1. patho 2. bloody diarrhea, RUQ pain
879. GI bacterial Vitamin D 2. clinical pres 3. THIN WALLED CYST IN RIGHT
overgrowth Vitamin A - night blindness 3. dx/tx LOBE OF LIVER, sterile aspirate,
nutrient B12 - neuropathy stool exam shows trophozoites
defiencies tx = metronidazole -- DO NOT
DRAIN (compare to echinococcus)
880. what vitamin niacin - used to synth seratonin/5HIAA
deficiency in metabolites 892. What should all esophageal varices
carcinoid cirrhotic patients HCC - (AFP)
syndrome be screened for
881. which type of villous adenoma, sessile adeoma, size 893. what is the risk 2/2 chronic cholecystitis
polyps are most >2.5cm associated with
likely to porcelain
progress to gallbladder
malignancy
894. risk is cancer of the ... 906. what kind of urine sediment broad casts, waxy casts
gallbladder seen in chronic kidney
disease
895. when to give hep A Ig vs give immunoglobulin if travel will
hep A vaccine occur in less than 4 weeks 907. urine sediments 1. ATN
1. muddy brown casts 2.glomerulonephritis
896. otherwise give vaccine ...
2. RBC casts 3. interstitial
897. uric acid stones 1. radiolucent stones on KUB, 3. WBC casts nephritis/pyelo
1. dx acid urine pH <5, 4. Fatty casts 4. nephrotic syndrome
2. tx 2. hydration, sodium bicarb or 5. Broad and waxy casts 5. CRF
sodium citrate dissolves the
908. why not to do a prostatic risk of urosepsis
stones
massage and culture of just get a midstream urine
898. varicoceles that fail to RCC prostatic secretions for sample/culture and treat
empty in the diagnose with CTA suspected prostatitis empirically pending
recumbent position culture results
899. what should be first kidney, ureter, bladder ultrasound 909. best test for osteomyelitis MRI of spine
diagnostic test for
910. causes of restrictive lung ILD, neuromuscular
patient with BPH
disease disease, alveolar edema,
symptoms and elevated
pleural fibrosis, chest wall
Creatinine
abnormalities
900. amikacin aminoglycoside
911. how does alcohol precipitate ethanol metabolized to
901. causes of priapism sickle cell/leukemia, trauma, gout lactate which competes
spinal cord/cauda equina, with urate for renal
trazodone/prazosin excretion
902. erythropoietin side worsening hypertension (30%), 912. serum sickness like reaction 1-2 weeks after a drug
effects flu like symptoms fever, urticarial rash,
903. 1. hypertensive 1. dec. in blood flow, polyarthralgia,
nephropathy Nephrosclerosis - hypertrophy lymphadenopathy
histological and intimal medial fibrosis of 913. methotrexate side effects dihydrofolate reductase
progression afferent and efferent arteries inhibitor
Glomerulosclerosis - progressive macrocytic anemia*
loss of glomerular capillary nausea, stomatitis, rash,
surface area with hepatotoxicity, ILD,
glomerular/peritubular fibrosis alopecia, fever
2. glomerular
914. cyclosporine side effects viral
hyperperfusion/renal
infections/lymphoma,
hypertrophy and INC. GFR
nephrotoxicity
GBM thickening, glomerular
hypertrophy mesangial 915. azathioprine side effects pancreatitis, and dose
expansion, GFR NORMAL dependent bone marrow
microalbuminuria and suppression
progressive glomerular 916. what drugs associated with beta blockers and
sclerosis/fibrosis (kimmelstiel raynauds phenomenon ergotamine
wilson)
917. how to diagnose rotator cuff neer test positive (passive
904. causes of kidney acute rejection, cyclosporine tendinitis motion above head)
transplant rejection + toxicity, vascular obstruction, injection of lidocaine
tx ATN improves range of
tx = IV steroids motion/pain relief
905. 1. risk cardiovascular disease 918. adhesive capsulitis aka frozen shoulder
most common cause of hyperphosphatemia, inc. PTH, pain/contracture due to
death in dialysis inc. homocysteine, accelerated fibrosis of the shoulder
patients atherogenesis 2/2 capsule
uremia/dialysate oxidative stress, lidocaine injection does
inc. calcium intake not help pain
919. lateral epicondylitis 2/2 forceful wrist extension
degenerates extensor carpi
radialis brevis tendon (aka tennis
elbow), pain near lateral
epicondyle worse with use,
supination, extension
920. anserine bursitis 1. nighttime pain from knees
1, clinical pres hitting each other, pain over the
medial tibial plateau below the
joint line- valgus stress does not
exaggerate pain (compare to MCL
tear)
921. prepatellar bursitis pain directly above the patella
wtih cystic swelling
922. pagets disease of bone 1. inc. bone turnover due to
1. patho osteoclast dysfunction and
increased bone breakdown with
compensatory deposition
923. hypervitamin D granulomatous disease - sarcoid,
causes TB
924. tick borne paralysis 1. rapidly ascending paralyisis
1. clinical pres over hours to days (vs GBS), CSF is
2. tx normal
2. remove the tick
925. progressive multifocal 1. JC polyomavirus reactivation in
leukoencephalopathy immunocompromised patients.
1. patho causes destruction of white matter
2. hemiparesis, disturbance in
speech, vision, gait
926. causes of enhancing toxoplasmosis (strongly
lesions in the brain of enhancing) - MCC - avoid with
immunocompromised bactrim prophylaxis
patients primary CNS lymphoma (weakly
enhancing) - check for EBV DNA
in CSF
927. 1. anterior vs 1. ant= internal carotid supplies
posterior circulation ant/mid cerebral arteries
of the brain pos = paired vertebral arteries
supplies basilar and paired
posterior cerebral arteries
928. 2. ACA stroke clinical 2. contralateral motor/sensory
pres deficits more pronounced in the
3. MCA """" lower limbs, urinary
4. PCA """" incontinence, primitive reflexes
5. lacunar infarcts 3. contralateral motor/sensory
deficits more pronounced in the
upper limbs and homonymous
hemianopsia
4. homonymous hemianopsia,
alexia without agraphia,
sensory symptoms, third nerve
palsy with vertical gaze, motor
deficits (cerebral peduncle and
midbrain)
5. pure motor, pure sensory,
dysarthria clumsy hand, ataxic
hemiparesis- most common
location is the putamen (very
close to internal capsule)
929. glioblastoma multiforme 1. n/v, headaches worse with
1. clinical pres position changes, coughing,
sneezing
2. butterfly appearance with
central necrosis and
serpiginous contrast
enhancement
930. stroke aspirin and statin
primary/secondary
prevention
931. sumatriptan/ergotamine pregnancy, familial hemiplegic
contraindications migraine, uncontrolled
hypertension, CAD***,
prinzmetal, ischemic stroke,
basilar migraine
932. restless leg syndrome 1. uncomfortable sensation to
1. clinical pres move legs, worse during sleep,
2. risk factors alleviated by movement
3. tx 2. iron deficiency, elderly, CKD
3. dopamine agonists*-
pramipexole, ropinerole,
levodopa
933. lewy body disease vs both involve alpha synuclein
parkinsons disease inclusions
934. lewy body has early onset ...
dementia
935. parkinsons has early ...
onset motor
936. most common sites of lateral striate arteries - supply
migration of the internal capsule, caudate,
cardioembolic stroke putamen, globus pallidus
- high risk of hemorrhagic
conversion
937. atherothrombotic occur at rest, gradual onset, 949. most common cause complex ventricular arrhythmias -
strokes successive strokes with of death in patients from a ventricular reentrant
increasing frequency with acute MI arrhythmias around the area of
infarction ex. v.fib
938. upper thoracic spinal paraplegia, bowel/bladder
cord lesion clinical pres incontinence, anesthesia from 950. treatment of beta blockers
the nipples down congenital long QT
syndrome
939. what is best FVC
measurement of 951. what electrolyte serum sodium level
respiratory function in abnormality indicates (hyponatremia) - when low it is
GBS the severity of heart associated with overactive
failure neurohumoral axis- high renin,
940. atrial fibrillation 1. aspirin alone
aldosterone, vasopressin,
treatment 2. warfarin
norepinephrine
1. lone afib
2. afib + risk factors 952. why are CCBs and the cause peripheral
vasodilators not vasodilatation, reflex tachycardia
941. what conditions in ACS **right ventricular
indicated in aortic increasing sheer stress
are nitrates infarction/inferior wall
dissection ***beta blockers are treatment of
contraindicated MI**DO NOT WANT TO DEC.
choice
PRELOAD TREAT WITH IV
FLUIDS 953. in what medical if patient is on diuretics
aortic stenosis, recent context is FeNA
phosphodiesterase use, useless to determine
volume status
942. what is the next step for dobutamine and dopamine to
someone with inc. CO 954. pneumoconiosis PFTs restrictive pattern with reduced
hypotension does not DLCO
respond to fluid
955. acute massive PE hemodynamic instability
hemodynamics
echo/EKG findings echo - RV dilatation
943. what patients have a very spina bifida ekg - RV strain/ right axis
high incidence of latex deviation
allergy
956. this is an indication ...
944. five p's of acute arterial pain, pulselessness, pallor, for thrombolytics
limb ischemia paresthesias, paralysis
957. what is suggested by occult malignancy - probably
945. how to treat a new antibiotic prophylaxis with new clubbing in a hypertrophic osteoarthropathy
diagnosis of rheumatic penicillin first, then COPD patient
heart disease anticoagulate
958. how does PND differ chronic bronchitis - cough occurs
946. chagas disease 1. t.cruzi protozoa in a patient with at the same time every night from
1. patho 2.megacolon, megaesophagus, chronic bronchitis vs mucus buildup
2. clinical pres dilated cardiomyopathy LV failure LV failure - occurs whenever the
patient lays down
947. antiarrhythmics 1. atrial arrhythmias
1. quinidine + SE SE= tinnitus, QT, hemolytic 959. what is key asthma shows inc. FEV1 with
2. digoxin + SE anemia, thrombocytopenia distinguishing feature bronchodilator
2. inotrope and treats atrial between asthma and
arrhythmias, especially in the COPD on PFTs (both
context of systolic dysfunction have dec. FEV1:FVC)
SE= nausea, anorexia, AV
960. COPD shows no ...
block,
change in FEV1 with
ventricular/supraventricular
bronchodilator
arrythmias
961. what is key feature ILD will have decreased DLCO
948. what electrolytes hypokalemia,
distinguishing chest chest wall will have normal DLCO
abnormalities hypomagnesemia, and
wall vs ILD (both have
associated with loop potentiate digoxin toxicity
normal FEV1:FVC)
diuretics
962. what cancers have bronchogenic carcinoma, 973. causes of TIA blood vessels - atherosclerosis,
higher than normal mesothelioma inflammation, dissection
incidence in asbestos embolism disease
exposure vasculitis, dissection,
hypercoagulable states
963. what is target PaO2 >60 ~ adjust with FiO2 before
when patient is on PEEP 974. what pathologic nerve ischemia
ventilator processes is
responsible for
964. blastomycosis clinical recent travel to great lakes,
diabetic
pres and treatment mississippi river and ohio river
mononueropathies
basins
skin, bone and pulmonary 975. cerebellar ipsilateral ataxia, nystagmus,
symptoms lesions/tumors intention tremors, loss of
itraconazole or amphotericin B clinical pres coordination, broad based gait,
dysmetria, dec. rapid alternating
965. what is best treatment fluticasone nasal spray and H1
movements, nystagmus
for a cough caused by blockers
post nasal drip 976. HSV encephalitis 1. HSV virus causes destruction of the
1. patho temporal lobes
966. how to follow low serial CT scans
2. dx 2. CSF - lymphocytic pleocytosis,
probability for
ERYTHROCYTOSIS, elevated protein
malignancy
levels, normal glucose
pulmonary nodules
MRI- shows temporal lobe
967. CHF exacerbation hypoxemia from effusions abnormalities
blood gas findings hypocapnia and resp. alk from EEG = slow intermittent high
tachypnea amplitude waves
968. pickwickian 1. extreme obesity, thick neck, 977. TB and fungal markedly elevated proteins
syndrome (obesity hypersomnolence, distant heart meningitis low glucose
hypoventilation sounds, low voltage EKG, poor lymphocytic pleocytosis
syndrome) CXR
978. most common aerobic and anaerobic
1. clinical pres 2. hypercapnia, hypoxemia,
organisms in brain streptococci/bacteroides
2. ABG findings alveolar hypoventilation during
abscesses
wakefulness -- due to increasing
of CNS chemoreceptor set-point 979. what is most hypertension
for CO2 important risk CHADS2 - CHF, hypertension,
factor for stroke age>75, diabetes, previous stroke
969. ABG findings for 1. PaCO2 elevated, normal A-a
different types of 2. normal PaCO2, normal A-a 980. stroke clinical pres 1. motor impairment without cortical
hypoxemia gradient 1.posterior limb of or visual abnormalities
1. hypoventilation 3. normal PaCO2 and elevated A-a IC 2. contralateral hemiplegia,
2. low inspired oxygen gradient that DOES NOT 2. MCA hemianopia, aphasia OR hemineglect
content CORRECT WITH 100% OXYGEN 3. ACA 3. contralateral weakness of lower
3. shunting 4. normal PaCO2 and elevated A-a 4. vertebrobasilar extremity, abulia, akinetic mutism,
4. VQ mismatch gradient that DOES CORRECT system emotional disturbances, eyes deviate
WITH 100% OXYGEN toward lesion, sphincter incontinence
4. many different brainstem
970. if patient is overly adjust the RR first, not the TV
syndromes with contralateral
ventilated on a because decreasing TV can trigger
hemiplegia and ipsilateral cranial
mechanical ventilator increased ventilatory rate
nerve involvement
what should be
adjusted first 981. what is the major vasospasm with symptomatic
cause of mortality ischemia and infarction - usually
971. what is the effect of see neutrophilia 2/ mobilizing the
in SAH occurs about 7 days after SAH
glucocorticoids on the marginated neutrophil pool, and
CBC bone marrow release 982. complications of seizures, ARDS, DIC, hepatic/renal
heat stroke failure
972. list the causes of asthma, GERD, CHF, OSA
repeated nocturnal
awakenings
983. pathogenesis of end organ fibrinoid necrosis of small 995. which antihyperthyroid radioactive iodine -
damage in malignant arterioles treatment can actually cause because it destroys
hypertension atrial fibrillation follicular cells which
transiently elevates serum
984. three uses for n- prevents contrast induced
thyroid hormone levels
acetylcystine nephropathy
mucolytic (CF) 996. in a patient which has elevated testosterone -
acetaminophen overdose rapidly progressing ovarian source
symptoms of androgen DHEAS - adrenal source
985. niacin flushing non-hypersensitivity
excess how to differentiate
mechanism + how to avoid histamine/prostaglandin
ovarian vs adrenal source
release
997. effect of hyperthyroidism ' 1. rapid bone loss because
986. take with a low dose ...
1. bones thyroid hormones
aspirin 30 minutes before
2. heart stimulate osteoclastic
taking the niacin
3. eyes resorption
987. which antihypertensive beta blockers 2. hyperdynamic
should be avoided in circulation - tachycardia,
asthmatics systolic hypertension,
988. why does renal perfusion activation of the RAAS inc. pulse pressure, atrial
decrease in CHF system causes fibrillation
afferent/efferent 3. infiltrative
vasoconstriction and ophthalmopathy with
enhanced sodium accumulation of
reabsorption to increase total glycosaminoglycans in
body volume retro orbital muscles

989. what needs to be ruled out hypothyroidism, adrenal 998. vitamin D toxicity clinical inc. calcium absorption -
before a diagnosis of insufficiency pres hypercalcemia
SIADH can be made constipation, abdominal
pain, polyuria, polydipsia
990. hypertension/hypokalemia primary hyperaldo
possible casues renovascular HTN 999. most common thyroid papillary carcinoma
renin tumor malignancy
SAME 1000. trichinella spiralis clinical initial invasion into
CAH pres intestinal wall - n/v,
glucocorticoid suppressible diarrhea, abdominal pain
hyperaldosteronism systemic hypersensitivity
991. which hypoglycemics lead insulin, TZDs, sulfonylureas - splinter hemorrhages,
to weight gain metformin causes weight periorbital edema*,
loss! retinal hemorrhage,
chemosis
992. metabolic syndrome abdominal obesity (>40 M,
muscle aches/pains*
(uworld) >35F)
from larvae entering
fasting glucose >100-110
skeletal muscle
BP>130/80
TG>150 1001. most common cause of GBS, ecoli
HDL (<40M, <50W) osteomyelitis in sickle cell
disease patients
993. most common causes of ***#1 subacute lymphocytic
thyrotoxicosis with dec. thyroiditis 1002. what kind of prophylaxis oral TMPSMX - PCP,
radioiodine uptake also- subacute appropriate for transplant toxo, nocardiosis
granulomatous (dequervain's recipients oral valganciclovir - CMV
pain), levothyroxine vaccinate against
overdose, iodine induced influenza, pneumo, hep B
thyrotoxicosis 1003. infectious causes of bloody EHEC, shigella,
994. causes of primary adrenal TB, fungal, CMV diarrhea salmonella,
insufficiency campylobacter
1004. side effect associated biliary sludging 1016. bacillary bartonella henselae in
with ceftriaxone angiomatosis immunosuppressed patients
large pedunculated exophytic
1005. anti-pseudomonals cefepime
papule with collarette of scale
piperacillin-tazobactam
looks like large cherry angioma
ciprofloxacin
****careful before biopsy because
aztreonam
these lesions hemorrhage
imipenam/cilastatin
tx = azithromycin**
tobramycin
gentamicin 1017. treatment for albendazole, mebendazole, or
amikacin enterobius pyrantel pamoate
1006. coronary artery symptomatic carotid disease 1018. babesiosis 1. NO RASH - jaundice,
disease equivalents PVD 1. clinical pres hemoglobinuria, renal failure,
AAA 2. dx death
DM 3. tx 2. giemsa thick/thin blood
framingham >20% smears, intravascular hemolysis,
anemia, thrombocytopenia,
1007. infectious screening hep A/B, PPD, toxo serology,
atypical leukocytes (maltese
after patient is VDRL
cross)
diagnosed with HIV
3. quinine-clindamycin,
1008. empiric treatment for piperacillin and tobramycin atovaquone-azithromycin
pneumonia in CF (antipseudomonal penicillin and
1019. treatment for bone orchiectomy androgen ablation
patient aminoglycoside/fluoroquinolone)
pain/hypercalcemia acute pain - radiation therapy for
1009. why should causes cartilage destruction and due to osseous new mets
fluoroquinolones not growth retardation metastasis or PTHrp zoledronic acid - bisphosphonate
be used in children
1020. lead poisoning 1. non-specific complaints,
1010. management of start empiric fluconazole 3-5 days 1. clinical pres peripheral neuropathy, microcytic
suspected if no response do esophagoscopy 2. tx anemia, renal damage/interstitial
esophagitis in an HIV with biopsy nephritis
patient 2. succimer, or EDTA chelators
1011. pulmonary cavitary mycobacterium TB 1021. why should folate not replacing folate in the context of
lesion in an HIV atypical mycobacterium be replaced alone B12 deficiency can cause
patient possible Nocardia - gram + weakly acid without checking B12 peripheral neuropathy
causes fast branching rods- tx = bactrim
1022. 1. acute monocytic 1. alpha naphthyl esterase
gram negative rods
special diagnostic test positive, peroxidase negative (no
anaerobes
2. acute auer rods)
1012. human bite/dog bite amoxicillin clavulanate lymphoblastic 2. PAS positive, TdT positive
antibiotic treatment leukemia diagnostic (specific for immature T/B)
1013. treatment of amphotericin B followed by test
histoplasmosis in an lifelong treatment with 1023. metastatic brain 1. grey white junction
HIV patient itraconazole tumors 2. surgical resection + whole
1014. what kind of staphylococcus aureus pneumonia 1. location brain radiotherapy
pneumonia post 2. treatment
influenza 1024. what conditions leukemoid reaction - high
1015. actinomycosis high dose IV penicillin 6-12 weeks should leukocyte Polycythemia vera - high
dx/treatment dx = anaerobic gram positive alkaline phos be used CML - low
branching bacteria with yellow to confirm a
sulfur granules diagnosis
1025. hyposthenuria inability to concentrate urine from
sickling in the vasa recta
impairing countercurrent
exchange and free water
reabsorbtion
1026. what drugs cause phenytoin, primidone, phenobarbital, 1037. 1. chalazion 1. sterile granulomatous inflammatory
folate deficinecy trimethoprim (inhibits DHFR), MTX 2. hordeolum lesion of meibomian glands
3. stye 2. purulent infection of an eyelid
1027. why must temporary increase in risk of DVT,
gland (staph)
warfarin always be venous limb gangrene or skin
3. external hordeolum involving zeis
bridged necrosis
or molls glands
due to loss of protein S/C (HL only 9
hours vs 60 hours for other factors) 1038. immune 1. recurrent pyogenic infections
leading to temporary hypercoagulable deficiency 2. neisseria infections
state associations 3. hereditary angioedema (unopposed
1. C3 deficiency C2b and bradykinin production).. not
1028. what tumors never non-melanoma skin cancer
2. C5-C8 infection...
metastasize to the oropharyngeal cancer
deficiency 4. bacterial infections
brain esophageal cancer
3. C1 inhibitor 5. systemic lupus erythematosus
prostate cancer
deficiency
1029. graft vs host 1. donor T cells recognise host 4. phagocytosis
disease minor/major HLA antigens 5. C1q deficiency
1. patho 2. skin, intestine, liver
1039. scarlet fever 1. streptococcus pyogenes infection
2. organs effected
1. patho 2. higher fever, sandpaper rash,
1030. mycobacterium 1. hypopigmented patches with areas 2. clinical pres exudative pharyngitis, rash
leprae of anesthesia desquamates
1. clinical pres
1040. eczema HSV infection associated with atopic
1031. contact dermatitis 1. type 4 hypersensitivity herpeticum dermatitis
1. what kind of urushiol, nickel, formaldehyde, life threatening
reaction certain fragrances, preservatives, start acyclovir
rubber, chemicals
1041. felon needle injury (ie. tailors) causes
2. calamine lotion, topical
bacterial infection of distal volar
antihistamines, topical
space --> tense abscess, intermittent
corticosteroids, oral steroids
throbbing pain
1032. prophyria cutanea 1. uroporphyrinogen decarboxylase
1042. what patients at those who are in contact with
tarda deficiency in heme synth path
high risk for orotracheal secretions - ex. dentists
1. patho triggers - ethanol/estrogens
herpetic whitlow
2. painless blisters,, skin fragility,
facial 1043. rubella 1. fever/malaise, suboccipital adenitis
hypertrichosis/hyperpigmentation 1. clinical pres polyarthralgia, maculopapular face
3. elevated urinary porphyrin rash that spreads to involve trunk and
tx = phlebotomy, extremities
hydroxychloroquine, interferon alpha
1044. dermatitis dapsone - both therapeutic and
1033. treatment for moisturizers, topical antifungals, herpetiformis diagnostic
seborrheic anti-dandruff shampoos, topical treatment
dermatitis steroids
1045. vancomycin side nephrotoxicity, ototoxicity, red man
1034. ichthyosis gradual scaling of dry skin effects syndrome
progressing to horny plates over the
1046. delirium tremens 48-96 hours after last drink
extensor surfaces worsens during the
hypertension, hyperthermia,
winter
agitation, hallucinations (tactile),
1035. 1. cherry 1 .appear in 3rd or 4th decade, do not death
hemangiomas regress spontaneously tx= benzodiazepines
2. strawberry 2. grow rapidly and regress by 5-8
1047. how does bicarb aspirin - alkalinizes the urine and
hemangioma years of age
treat aspirin enhances excretion
1036. what skin seborrheic dermatitis overdose vs TCA TCA - narrows the QRS complex by
conditions overdaose alleviating the cardio-depressant
associated with action on sodium channels
parkinsons
disease
1048. treatment of dantrolene 1056. ethylene glycol 1. ethylene glycol metabolized by
neuroleptic bromocriptine (dopamine agonist) poisoning ADH to oxalic acid*** (binds
malignant amantadine (antiviral with 1. patho calcium causing
syndrome dopamine agonist properties) hypocalcemia/calcium oxalate
crystals) and glycolic acid (damages
1049. what is the most bradypnea
renal tubules)
reliable indicator of - not miosis becuase there are often
opioid intoxication coingestions 1057. phencyclidine haloperidol and calm setting, urine
intoxication acidification
1050. iron toxicity clinical 5 phases
treatment
presentation 1. GI phase - first 6 hours - nausea,
vomiting, hematemesis, melena, 1058. beta blocker toxicity bradycardia, AV block,
abdominal plain clinical pres/ hypotension, diffuse wheezing***
latent phase - 24 hours - treatment tx = atropine, IV fluids, calcium,
asymptomatic glucagon** (inc. cAMP and inc.
metabolic acidosis/shock - 72 hours Calcium levels --> improved cardiac
hepatotoxicity - 96 hours contractility)
mucosal scarring and bowel
1059. digoxin toxicity blurred vision, disturbed color
obstruction weeks to months post
clinical pres perception, fatigue, headache,
ingestion
abdominal pain
1051. TCA overdose anticholinergic - dilated pupils,
1060. acetaminophen 1. activated charcoal within 4 hours
clinical flushed dry skin, ileus
toxicity rumack-matthew nomogram -
presentation EKG- dec. myocardial conduction
1. treatment measure at 4 hours and decided
velocity and widening of QRS- tx =
whether or not to give N-
bicarb
acetylcysteine
1052. torsade de pointes 1. malnourished, familial long QT,
1061. carbon monoxide carboxyhemoglobin levels
1.risk factors hypomagnesemia, TCA,
poisoning diagnosis tx = hyperbaric oxygen
2. tx amiodarone, sotalol,
fluoroquinolones, fluconazole 1062. cyanide poisoning 1. burning rubber or plastic
2. magnesium sulfate 1. patho 2. headaches, n/v abdominal
discomfort, confusion, coma,
1053. 1. methanol 1. anion gap metabolic acidosis,
BITTER ALMOND BREATH
overdose clinical disc hyperemia, n/v, abdominal
pres pain 1063. methemoglobinemia 1. cyanosis, blue discoloration of
2. ethylene glycol 2. similar to methanol except it 1. clinical pres the skin/mucus membranes
clinical pres damages the kidneys 1064. organophosphate cholinergic excess - bradycardia,
3. aspirin overdose 3. anion gap met. acid, tinnitus, poisoning miosis, fasciculations, salivation,
clinical pres fever, hyperventilation (resp alk.) 1. clinical pres lacrimation, urination, defecation
4. lithium "" 4. hyperreflexia, ataxia, seizures 2. tx 2. tx = atropine, pralidoxime
1054. how to differentiate benzodiazepine intoxication does 1065. when to screen for patients who are at higher than
alcohol from not have nystagmus ovarian cancer average risk - screen with CA125
benzodiazepene and transvaginal ultrasound
intoxication
1066. what kind of T cell independent B cell response
1055. poisoning 1. sodium bicarb immune response because it is a polysaccharide
treatments 2. mgSO4 from pneumococcal vaccine
1. aspirin/TCA 3. hemodialysis vaccine
overdose 4. succimer, calcium EDTA
1067. what CD4 count >200
2. torsades 2/2 5. N-acetylcysteine
needed to give a live
prolonged QT 6. deferoxamine
vaccine
3. lithium 7. ethanol, fomepizole (ADH
4. lead poisoning inhibitor), sodium bicarbonate, 1068. what drugs are best fibrates
5. acetaminophen hemodialysis for raising HDL
6. iron 8. atropine, pralidoxime 1069. CRAO vs CRVO CRAO - pallor of the disk, cherry red
7. ethylene glycol 9. physostigmine fovea, boxcar segmentation of blood
8. organophosphate in both retinal arteries and veins
9.
diphenhydramine
1070. CRVO - disk swelling, ... 1082. most common serous otitis media - due to auditory
venous dilatation, middle ear tube dysfunction from HIV
tortuosity, retinal pathology in HIV lymphadenopathy, or obstructing
hemorrhages, cotton patients lymphomas
wool spots
1083. cholesteatoma 1. chronic middle ear disease leads
1071. CRAO treamtent ocular massage and high flow 1. patho to formation of a retraction pocket in
oxygen the tympanic membrane that fills
with granulation tissue
1072. trachoma 1. follicular conjunctivitis,
2.
1. clinical pres pannus neovascularization of the
cornea, 1084. aspirin asthma, nasal polyps, chronic
2. oral tetracycline or exacerbated rhinosinusitis, bronchospasm
erythromycin respiratory disease following NSAIDS
1073. 1. HSV retinitis 1. widespread pale peripheral 1085. peritonsillar uvular deviation, hot potato voice,
2. CMV retinitis lesions and central necrosis of abscesses clinical lymphadenopathy
3. toxo retinitis the retina - rapid vision loss pres
"acute retinal necrosis"
1086. allergic rhinitis clinical history, eosinophils on
2. painless, yellowish white fluffy
diagnosis nasal cytology
or granular retinal lesions near
retinal vessels, retinal 1087. cause of ascending ascending - cystic medial
hemorrhages vs descending degeneration
3. necrotizing retinochoroiditis - aortic aneurysms descending - atherosclerosis
fluffy white lesions surrounded by 1088. PTU/methimazole agranulocytosis - look for sore
retinal edema and vitritis side effects throat
1074. sympathetic 2/2 damage to an eye via and discontinue medication
ophthalmia penetrating injury leads to immediately
immunologic reaction to hidden 1089. hypercalcemia of 2/2 activation of osteoclasts causing
antigens- anterior/panuveitis, bedrest increased bone turnover
papillary edema tx = bisphosphonates
1075. retropharyngeal 1. fever, neck pain, trsimus, 1090. why must beta beta blocker leads to unopposed
abscess limited cervical extension blocker not be given alpha and a sudden rise in blood
1. clinical pres alone in pressure
1076. diphtheria 1. pseudomembranous pheochromocytoma
1. clinical pres pharyngitis, low grade fever, 1091. ***give alpha ...
nasal discharge, cervical blocker first THEN
adenopathy beta blocker
1077. otitis externa 1. pseudomonas>staph infection
1. patho of the external ear - causes severe
2. treatment ear pain/drainage, can progress
to skull base or TMJ, destruction
of VII
2. topical neomycin, or systemic
ciprofloxacin if severe
1078. key distinguishing orbital cellulitis - has
features of orbital proptosis/dec. visual acuity
cellulitis vs preseptal
cellulitis
1079. ***both may have pain ...
with eye movement
1080. ACE inhibitor side cough, hyperkalemia,
effects angioedema
1081. beta blocker side bradycardia, inc. airway
effets resistance, fatigue, depression,
sexual dysfunction