question

From the hospital: What is a single antibiotic that can be used for colitis that covers all bacteria? It is NOT levofloxacin and metronidazole. What is a bad side effect of levo?

answer

zosyn ie. piperacillin/tazobactam QT prolongation

question

CARDIOLOGY: EKG should be obtained if CP appears cardiac in nature. CXR is initial step to rule out pneumothorax, pulmonary infiltrates, and rib fractures. ____should be done for patients w worrisome histories for aortic dissection regardless of CXR or EKG results.

answer

CT

question

_____is minimally invasive and rapid for detecting aortic dissection at the bedside.

answer

TEE - transesophageal echocardiogram

question

A ____ is used for pleuritic pain w normal CXR when a PE is suspected.

answer

V/Q scan - but not good for a small PE

question

A _____is sensitive for small PE and may detect other chest abnormalities leading to pain.

answer

helical chest CT

question

____is used when CP is esophageal in origin.

answer

Esophageal pH monitoring

question

EKG: A ______suggests underlying heart disease (ischemic, hypertensive).

answer

left bundle branch block

question

A _____may be indicative of right heart strain (as in pulmonary embolus).

answer

right bundle branch block

question

____is a term used to describe decreased perfusion and oxygen delivery to the body. This is best defined by BP = CO x SVR. What are the three main types?

answer

Shock; hypovolemic, cardiogenic, distributive

question

______shock can be from pump failure from infarction, cardiomyopathy, or tamponade, arrhythmia, valve failure, obstructed outflow from tension pneumothorax or massive PE.

answer

Cardiogenic

question

______shock can be from hemorrhage, diarrhea, heat stroke, or third spacing.

answer

Hypovolemic

question

______shock can be from sepsis, anaphylaxis, adrenal crisis, or myxedema coma.

answer

Distributive

question

The formation of _______occurs via: a. endothelial dysfunction & formation of fatty streak b. LDL enters fatty streak and attracts macrophages c. proliferating smooth muscle cells, connective tissue, & lipids become incorporated into plaque d. "fibrous cap" forms

answer

atherosclerotic plaque

question

Name some risk factors for CHD.

answer

Diabetes Mellitus Patient Age Peripheral Vascular disease Chronic Renal Failure Elevated homocysteine level elevated inflammatory markers like CRP Low Activity Level Low intake of fruits and vegetables lack of moderate alcohol intake

question

_____is insufficiently specific for assessment of patients with low (<10%) pretest probability of CHD. It is best reserved for patients with intermediate pretest probability. Sensitivity and specificity can be increased with imaging studies such as radionuclide imaging or echocardiography. What is the gold standard to diagnose coronary artery disease?

answer

Exercise stress testing; coronary angiography

question

The AHA suggests the following mnemonic for the important elements in treatment of stable angina:

answer

A: aspirin, ACEi, antianginals - nitrates/CCB B: B-blocker, bp C: cholesterol & cigarettes D: diet and diabetes E: education and exercise

question

CCB: Short acting dihydropyridine CCBs ie ____ have been shown to increase cardiac risk therefore nondihydropyridines are recommended. They are ___or___. Second generation dihydropyridines have fewer negative inotropic effects and can be used in settings of reduced ejection fraction. (ie. ___or___)

answer

Nifedipine verapamil or diltiazem amlodipine or nicardipine

question

Patients with stenosis of left anterior descending, left main coronary disease, three vessel disease, or survivors of sudden cardiac death or sustained VF/VT would benefit from _________.

answer

coronary artery bypass grafting (CABG)

question

_______can be used to relieve symptoms in patients who fail medical therapy but who do not have significant enough disease to require CABG.

answer

PCI - percutaneous coronary intervention

question

What are some physical exam findings in an acute MI?

answer

entirely normal, fourth heart sound, third heart sound, systolic murmur of acute mitral regurgitation -- physical exam should focus on signs of PVD which may increase the suspicion for coronary disease

question

What is the typical evolution of the EKG in the setting of a STEMI?

answer

1. increase in amplitude of the T wave 2. ST segment elevation 3. development of Q waves (hours to days) 4. resolution of ST-segment elevation

question

Cardiac-specific ____is drawn to detect damaged myocardium. It begins to rise is 6-9 hours, peaks at approximately 20 hours, and remains in the circulation for 7-10 days.

answer

troponin

question

For patients with UA or NSTEMI to assess risk. TIMI SCORE - 7 point system, more points, higher risk

answer

Age >65 at least 3 risk factors known coronary artery disease w at least 50% stenosis ST segment changes 2 episodes of angina in past 24 hours aspirin use in past week elevated CK-MB or troponin

question

What are the absolute contraindications to thrombolytic therapy? BHTASC

answer

BHTASC 1. active Bleeding 2. previous intracranial Hemorrhage 3. intracranial tumor 4. aortic dissection 5. stroke within 1 year 6. closed head injury within past 3 months

question

Thrombolytics should be given within ______of pain onset. PCI needs to be performed within _____ of presentation to medical provider.

answer

12 hours; 90 minutes

question

CHF: Systolic dysfunction is from decreased ____. Diastolic dysfunction is from a decrease in _____.

answer

contractility (the pump); compliance (the fill)

question

Most symptoms of heart failure are pulmonary in nature ie. dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, & wheezing. Why?

answer

because of increased LV end diastolic pressure that results in pulmonary venous and capillary congestion

question

What heart sound is indication of systolic dysfunction? diastolic dysfunction?

answer

systolic - S3 diastolic - S4

question

What are the principal diagnostic testing for CHF?

answer

chest radiograph, electrocardiogram, BNP, and echocardiogram

question

What is the acute treatment for pulmonary edema in heart failure? LMNOP

answer

L = Lasix M = morphine N = nitroglycerine O = oxygen P = positive pressure ventilation inotropic agents like dobutamine

question

In chronic CHF with systolic dysfunction, what three treatments are shown to decrease mortality? Digoxin, other inotropic agents, and loop or thiaxide diuretics are used as required for symptoms - benefit in fewer hospitalizations.

answer

ACE inhibitors, cardioselective beta blockers (carvedalol, metaprolol, bisoprolol), and aldosterone antagonists(aldactone)

question

Hydralazine and nitrates in combination when combined with standard therapy is shown to reduce mortality for what race with class III or IV CHF?

answer

African Americans

question

What treatment is used in diastolic dysfunction to improve filling? A fib often worsens with diastolic dysfunction because of elevated HR and loss of atrial kick. What two treatments are sometimes necessary?

answer

control of BP and HR; cardioversion and antiarrythmic medication

question

What treatments improve survival when EF <35% in class II/III CFH and sustained VT.

answer

Automatic cardiac defibrillators, cardiac resynchronization through biventricular pacing

question

The following are systemic causes for what? hypoxia increased intracranial pressure hypothermia hypothyroidism hyperkalemia

answer

brandyarrhythmias

question

What medications may result in bradyarrhythmias?

answer

BB, CCB, digoxin

question

Emergent treatment of bradyarrythmias is with _____for a patient with bradycardia causing hypotension, CHF, and syncope.

answer

atropine 0.5mg

question

With sick sinus syndrome or complete heart block, when is a permanent pacemaker indicated?

answer

for symptomatic patients

question

What type of block are pacemakers indicated even when the patient is asymptomatic?

answer

type II second degree AV block (Mobitz) or bifascicular block with intermittent type II second degree AV block

question

When accessing for a tachyarrhythmia, what exacerbating conditions should be evaluated?

answer

electrolyte disturbances (hypokalemia or hypomagnesemia), digoxin level, TSH, ethanol, cocaine

question

In patients with a hemodynamically _______wide QRS tachyarrhythmia/SVT, blocking the AV node with vagal maneuvers, adenosine, BB, CCB, or digoxin is done.

answer

stable; unstable means synchronized cardioversion

question

_____toxicity can lead to paroxysmal atrial tachycardia with 2:1 block or nonparoxysmal junctional tachycardia.

answer

Digitalis

question

The ____syndrome is characterized by a short PR interval, delta wave, and AVRT. AV nodal blocking agents (BB, CCB, dig, adenosine) should be avoided when AF is present with WPW.

answer

WPW - wolfe Parkinson white

question

AVNRT and AVRT should be treated initially with _____. Radiofrequency ____should be considered for long-term management.

answer

AV nodal blocking agents; ablation

question

Torsades de pointes is a multifocal VT, associated with a long QT interval. Treatment is _______&_______.

answer

overdrive pacing and magnesium.

question

_____is the drug of choice to treat regular narrow complex tachycardias after vagal maneuvers have been unsuccessful.

answer

Adenosine, BB or CCB

question

Treatment of ___&___involves rate control, rhythm control, and prevention of thromboembolism.

answer

a fib and a flutter

question

Hypertension is defined as a blood pressure over ___. Over 95% of patients have HTN due to what cause?

answer

140/90; essential hypertension with a UNKNOWN cause

question

The initial treatment of HTN is with what medication? What is the first line agent for patients with diabetes, heart disease, or proteinuria?

answer

thiazide diuretic; ACE inhibitor

question

GO OVER MRTAPS

answer

GO OVER MRTAPS

question

Mitral Stenosis impairs diastolic LV filling. Medical therapy involves heart rate control with what meds?

answer

BB or CCB

question

Mitral Regurgitation results in left atrial enlargement and a dilated left ventricle. What meds are used for afterload reduction?

answer

ACE inhibitors, ARBs, or a combination of hydralazine/nitrates

question

Aortic Regurgitation causes left ventricular hypertrophy. Afterload reduction with ___or___may decrease regurgitant volume and delay need for surgery but studies are conflicting.

answer

ACEi or vasodilating CCB

question

There is no effective medical therapy for _______and several medications (nitrates, BB, CCB, ACEi) may precipitate hemodynamic instability in patients with severe or critical disease.

answer

aortic stenosis

question

Valve replacement: Mechanical vs. Porcine. Explain the difference

answer

Mechanical valves last forever but require lifelong anticoagulation. Porcine valves last 10-15 years and require no anticoagulation. Good for patients >75, women of childbearing age, or patients with contraindications to anticoagulation

question

Arterial disease may results from a variety of nonatherosclerotic disorders. Name some.

answer

Marfan syndrome, Ehlers-Danlos disease, bicuspid aortic valve, HTN, Takayasu arteritis, giant cell arteritis, thromboangiitis obliterans, infectious diseases - syphilis

question

Aortic aneurysms should be electively repaired at what size?

answer

>5.5 - 6cm

question

PAD is a coronary artery disease equivalent. Patients should be treated with what 3 things?

answer

aspirin, statin, and tight blood pressure control

question

Intermittent claudication can be managed medically, but ischemic rest pain requires immediate what? What are the 6 P's of acute arterial occlusion.

answer

evaluation by a vascular specialist, pulselessness, pallor, poikilothermia, pain, paralysis, paresthesia

question

What kind of disease should be considered in a young person with a thoracic aneurysm?

answer

connective tissue disease - Marfan, Ehlers-Danos, bicuspid aortic valve

question

Dilated Cardiomyopathy: most common cause is ____. Others?

answer

alcohol; may also be idiopathic, myocarditis, or drugs (doxorubicin) -- 1 in 3 cases of heart failure are caused by dilated cardiomyopathy

question

What PE and EKG changes are seen with dilated cardiomyopathy?

answer

PE: S3, JVD, crackles - possible mitral regurg EKG: nonspecific ST and T wave changes, LBBB

question

Hypertrophic cardiomyopathy: is due to hypertrophy of the _____? PE reveals mitral regurgitation, a ____heart sound, and prominent left ventricular impulse. EKG reveals LVH

answer

cardiac septum; S4

question

Restrictive cardiomyopathy: often caused by a ____process, or post-radiation or post open-heart surgery. What is the most common first symptom?

answer

--infiltrative process - amyloidosis, sarcoidosis, and hemochromatosis -- changes in myocardium --most common first symptom is exertion intolerance and fluid retention, signs of right heart failure

question

____often follows an upper respiratory infection and may present with chest pain or signs of heart failure. EKG reveals cardiomegaly and contractile dysfunction. Treatment includes antibiotics sensitive after myocardial biopsy or MRI.

answer

Myocarditis

question

____refers to the sudden, transient loss of consciousness and postural tone. What are the most common etiologies?

answer

Syncope 1. neurally mediated (vasovagal, situational - micturition, tussive, valsalva, carotid sinus hypersensitivity) 2. orthostatic hypotension (volume depletion, medications, postprandial) 3. primary cardiac causes - structural, arrhythmic, decreased cardiac output

question

____is a systemic immune process that is a sequel of beta-hemolytic strep infection of the pharynx. Diagnosed based on Jones criteria.

answer

Rheumatic fever Jones - 2 major or 1major and 2minor Major = carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules Minor = fever, arthralgia, previous Rheum fever, leukocytosis, ESR, CRP, prolonged PR

question

____ results from single or repeated attacks of rheumatic fever that produce rigidity and deformity of valve cusps, fusion of the commissures, or shortening and fusion of the chordae tendineae. The mitral valve is affected in 50-60% of cases.

answer

Rheumatic heart disease

question

Endocarditis (or infection of the endothelial surface of the heart) is most commonly caused by what bacteria?

answer

Strep Viradans, Staph Aureus, and enterococcus -- P aeroginosa and S. Marcescens with IV Drug users

question

What are some PE findings in infective endocarditis?

answer

Roth spots - small white spots on retina surrounded by hemorrhage Osler nodes - small tender lesions on fat pads of fingers and toes Janeway lesions - painless, reddish, macular lesions on hands or feet

question

Duke Criteria for dx of infective endocarditis Dx with 2 major or 1 major and 3 minor

answer

Major a. positive blood cultures b. endocardial involvelment on echo Minor a. predisposing condition: cardiac or IV drug use b. fever c. vascular phenomenon d. immunologic phenomenon

question

PULMONOLOGY: Which lung disease has an increased TLC (total lung capacity)?

answer

emphysema - remember flattened diaphragms

question

From the hospital: You normally here COPD or asthma on ____wheezing. You normally here pleural effusion or right heart failure on _____wheezing.

answer

expiratory wheezing = COPD inspiratory wheezing = pleural effusion

question

In pleural effusion, pneumothorax, neoplasm, there is ____fremitus or transmitted voice sounds. In pneumonia, there is ____fremitus or transmitted voice sounds due to increased transmission through consolidated tissue.

answer

decreased, increased

question

On percussion, _____replaces resonance when fluid or solid tissue replaces air containing lung or occupies the pleural space beneath your percussing fingers.

answer

dullness

question

______on percussion is found in hyperinflated lungs like in COPD or asthma.

answer

Hyperresonsance

question

In emphysema, chronic bronchitis, & asthma, is the RV (residual volume) increased or decreased?

answer

increased bc of air trapping

question

SPUTUM: What is the likely diagnosis if... 1. mostly WBC's 2. mostly eosinophils and mucous casts 3. mostly RBC's

answer

1. pneumonia or bronchitis 2. asthma 3. chronic bronchitis, bronchiectasis, or tumor

question

What are four physiologic changes that result from COPD?

answer

V/Q mismatches, pulmonary hypertension, abnormal ventilator responses, and right heart failure.

question

____is a complication of pulmonary hypertension. Right sided heart failure where the RV has a hard time pumping blood into the lungs. Causes: COPD, chronic PE, cystic fibrosis.

answer

Cor Pumonale

question

Explain how each of the following treatments for COPD helps to alleviate symptoms: 1. anticholinergics - ipratropium bromide, tiotropium 2. B-agonists - albuterol 3. Methylxanthines - theophylline What is the only treatment proven to improve survival and quality of life?

answer

1. bronchodilation - helps with bronchospasm 2. additional bronchodilation 3. infrequently used -- in some cases, it is useful for nocturnal symptoms OXYGEN

question

_____is an episodic disease characterized by abnormally heightened responsiveness of the tracheobronchial tree, leading to expiratory airflow obstruction.

answer

Asthma

question

Meds to treat asthma: 1. inhaled corticosteroids 2. cromlyn & nedocromil - blunt effects of bronchospastic triggers 3. theophylline - useful for nocturnal symptoms 4. leukotriene modifier - modify inflammatory mediators 5. po steroids

answer

Asthma is treated depending on frequency of exacerbations. >2x/month - one med >1 x/week - two meds frequent - 3 meds are referral

question

If a patient with a DVT has active internal bleeding, uncontrolled HTN, CNS tumor, recent trauma or surgery, or recurrent DVT despite anticoagulation, what alternative treatment should be considered?

answer

IVC filter

question

What is the most common EKG changes in a PE? Other classic EKG changes?

answer

sinus tachycardia and nonspecific ST-segment and T-wave changes - S1Q3T3

question

What are the two signs of PE on CXR?

answer

Westermark's sign - area of decreased pulmonary vascularity with a cutoff sign Hampton's hump - shadow or density in contact with one or more pleural space corresponding to lung segment involved

question

What is the criteria for the PERC SCORE????? HADCLOTS This is used to rule out the need for further imaging.

answer

H - hormone/estrogen use A - age>50 D - dvt/pe history C - coughing up blood L - leg swelling disparity O - O2 sat100 S - surgery/recent trauma

question

A newer modality for the noninvasive diagnosis of PE is the use of _______. What is the gold standard for diagnosis of PE?

answer

helical chest CT; pulmonary angiogram

question

Morbidity from pulmonary emboli are best avoided by preventing the development of DVT's with subcutaneous heparin. What are some indications for prophylaxis with heparin bridge to warfarin?

answer

major surgery, stroke, acute MI, prolonged immobility

question

_____refers to a group of disorders characterized by inflammation of the alveolar and perialveolar structures. The cardinal features are a history of progressive dyspnea on exertion accompanied by nonproductive cough. Fine crackles, reticular or reticulonodular infiltrates on CXR.

answer

Interstitial lung disease

question

____are a group of disorders characterized by pulmonary exposure to inorganic and organic dusts and gases (asbestos, coal, rock, metals, graphite, cotton, grain, acid fumes, chlorine, nitrogen dioxide, phosgene). Chronic inflammation, mucous hypersecretion, scarring, and fibrosis.

answer

Pneumoconioses

question

_____is a condition in which lung inflammation is immunologically mediated. Deposition of antigen in the alveoli results in the formation of antigen-antibody complexes. Curable and reversible!

answer

Hypersensitivity Pneumonitis from aspergillus, botrytis cinerea, bird proteins, animal fur dust, wood dust, etc.

question

____is a well defined disease in which there is typical immunologic damage to the lung without identification of a causative agent as in HP. RA, SLE, Polymyositis, Good pasture, Wegener etc.

answer

Idiopathic Lung Disease

question

_____is a systemic disease of unknown etiology characterized by granulomatous inflammation of the lung. S/S related to the lung, skin, eye, peripheral nerves, liver, kidney, heart, and other tissues. Biopsy demonstates noncaseating granulomas (not-necrosis or "cheese like). Tx??

answer

Sarcoidosis; tx - corticosteroids

question

What does CXR show with pleural effusion? What is the tx?

answer

blunting of costophrenic angle - free pleural fluid on lateral decubitis film; thoracentesis

question

Pleural Effusion Transudates vs. Exudates: ______occur when systemic factors that control formation and absorption of pleural fluid are altered. Left sided heart failure/cirrhosis, PE. ______occur when there is a loss of integrity of the pleural membrane and/or disruption of the lymphatic drainage - pneumonia, malignancy, viral infex, PE

answer

Transudates; Exudates

question

Transudates can be distinguished from exudates by measuring the __&__contents in the pleural fluid and comparing them with serum values.

answer

protein and LDH

question

The mainstay of treatment for transudates in with ____treatment. For complicated effusions, tube thoracostomy or surgical decortication may be required.

answer

diuretic

question

Management of an exudate requires local control of the effusions via drainage or sclerosis as well as correction of the _________.

answer

underlying disorder

question

_____presents with distended neck vein, indistinct heart sounds, narrow pulse pressure, and pulsus paradoxus. Tx: pericardiocentesis and treat underlying cause.

answer

Cardiac tamponade

question

Hypotension, tracheal deviation, and elevated jugular venous pressure indicates that a simple pneumothorax has progressed to what? What does CXR show for this?

answer

a tension pneumothorax; lack of lung vascular markings at periphery

question

Where is the needle decompression performed for a tension pneumothorax?

answer

second intercostal space, mid clavicular line

question

What are the physical exam findings with signs of consolidation?

answer

bronchial breath sounds, egophony (E to A changes), dullness to percussion, increased tactile fremitus

question

Explain how the CURB65 score should be used?

answer

C - confusion U - BUN >20 R - RR>30 B - bp Systolic <90, diastolic65

question

Pneumonia CXR findings and associated bacteria: 1. Strep Pneumo, H Flu, and Klebsiella have ____consolidations. 2. Staph Aureus, Legionella, and Mycoplasma appear ___. 3. Pneumocystitis jiroveci is common in AIDS patients and appears _____.

answer

lobar; patchy; diffuse interstitial and alveolar infiltrates

question

Pneumonia treatment inpatient vs. outpatient?

answer

Inpatient: --3rd generation cephalosporin - ceftriaxone --macrolide - azithromycin --vancomycin - if MRSA is a concern Outpatient: --macrolide - azithromycin --Fluoroquinolone - levofloxacin

question

A ____is a round opacity outlined by normal lung and not associated with infiltrate, atelectasis, or adenopathy. Often asymptomatic or present w s/s of underlying malignancy. Monitor closely. >35yo, consider potentially malignant and resect.

answer

solitary pulmonary nodule

question

Lung Cancer: Small cell - 100% associated with smoking. Consider metastatic at time of diagnosis. Metastasizes rapidly. Where are mass usually found first?

answer

centrally

question

Lung Cancer: Non small cell - discrete masses that can spread to regional lymph nodes and metastasize to distant sites. What are the three types?

answer

Squamous - central airways Large cell - central or peripheral Adenocarcinoma - periphery

question

Lung cancer is more likely to produce active substances that result in a variety of paraneoplastic syndromes. Give some examples of some.

answer

hypercalcemia, SIADH, hypercoagulable state, superior vena cava syndrome, Horner's syndrome, Pancoast's tumor

question

A ____is a low-grade malignant neoplasm that is slow-growing and rarely metastasize. symptoms include hemoptysis, cough, wheezing, and recurrent pneumonia. ___syndrome of flushing, diarrhea, and hypotension. Surgery is treatment of choice.

answer

Carcinoid tumor; carcinoid syndrome

question

____is abnormal dilation of the large conducting airways often due to cystic fibrosis or alpha-1 antitrypsin deficiency. Treat underlying disorder.

answer

Bronchiectasis

question

____is when often obese patients fail to breath rapidly or deeply enough resulting in low oxygen or high carbon dioxide levels.

answer

Hypoventilation syndrome

question

GI: The abdominal plain film may show free intraperitoneal air, seen under the diaphragm on an upright film, indicating what?

answer

perforation of a hollow viscus

question

Hyperkalemia is seen in bowel infarction and represents what?

answer

tissue necrosis

question

LFT's show marked elevations in ______in hepatitis and elevation of _____in cholecystitis. LFTs may be normal in biliary colic.

answer

amylase; alkaline phosphatase

question

Osmotic diarrhea usually ____(improves or worsens) with fasting whereas secretory diarrhea ____(improves or worsens) during fasting.

answer

improves; persists

question

____is defined as a syndrome characterized by chronic abdominal pain and altered bowel habits (can be either diarrhea or constipation). Treat w diet modifications, addition of fiber, antispasmodics, stress reduction

answer

Irritable bowel syndrome Rome Criteria - pain at least 3 days over the last 3 months w 2 or more of the following: 1. relieved w defecation 2. associated w change in frequency of stool 3. associated w change in form of stool

question

Infectious gastroentiritis: ____ is usually caused by contaminated eggs, dairy products, or poulty. ____is usually spread by the fecal-oral route. _____is acquired from eating undercooked poultry or contaminated natural water sources.

answer

Salmonella - use abx when signs of systemic illness Shigella - abx Campylobacter jejuni - abx

question

Infectious gastroenteritis: _____is an enterotoxin that causes profuse watery diarrhea; fecal/oral spread often from water contamination ____is most commonly acquired from eating undercooked beef. Can cause hemolytic uremic syndrome and thrombotic thrombocytopenic purpura. A protozoa, _______, is one of the principal agents of traveler's diarrhea.

answer

Vibrio Cholerae - tx: doxycycline E Coli - no treatment - treatment of diarrhea can increase risk of TTP/HUS Giardia lamblia - metronidazole

question

PUD includes: ____ulcers which entails increased acid production and ____ ulcers which have normal or even reduced gastric acid.

answer

duodenal, peptic

question

What infection appears to be associated with most duodenal and peptic ulcers? How is this treated?

answer

H Pylori; amoxicillin, omeprazole, clarithromycin

question

Gastritis is commonly due to direct mucosal injury. What are common agents that cause this?

answer

NSAIDs, ethanol, steroids, and strong alkali and acid agents

question

What is the most common cause of esophagitis? What is H Pylori's role in this?

answer

GERD; role is controversial, some say causative, some say protective

question

Treatment of dyspepsia involves inhibiting and neutralizing gastric acid. What meds are commonly used?

answer

H2 receptor antagonists, antacids, proton pump inhibitors, sucralfate (mucosal protectant)

question

_____disease effects the entire GI tract; mostly small intestine and colon. Rectum spared. "cobblestone mucosa" Tx: is metronidazole and immunomodulators. Complications are bowel obstruction and fistulas

answer

Crohn's Disease

question

_____disease is limited to the colon, rectum involved. Blood diarrhea. Tx: Sulfasalazine or 5-ASA drugs, immunomodulators. Complications are toxic megacolon, colon carcinoma.

answer

Ulcerative Colitis

question

In addition to hepatitis viruses, what other viral infections and drugs can cause acute hepatitis?

answer

Viruses: CMV, HSV, Coxsacke Drugs: APAP, halothane, isoniazid, methyldopa, azole antifungals ALCOHOL

question

Diagnoses of hepatitis is done via looking at the ___and___. How is alcoholic vs. acute viral hepatitis lab values different.

answer

AST and ALT Alcohol: AST>>ALT Acute viral: Both AST & ALT together are greater than alcoholic

question

Which Hepatitis can become chronic?

answer

Hep B, C, D

question

What does it mean if a patient has the 1. HepB surface antigen/HBsAg 2. HepB surface antibody/ANTIHBs 3. Hep B antibody to core antigen/ANTIHBc

answer

1. HBsAg - patient has Hep B infection 2. ANTIHBs - patient has been immunized or has recovered from acute infection 3. ANTIHBc - indicates an acute infection

question

What drugs are used to treat chronic viral hepatitis (HBV and HCV)?

answer

interferons and antivirals HCV - ribavirin (terratogenic) HBV - lamivudine, adefovir, entacvair

question

Prophylaxis against which forms of viral hepatitis are available?

answer

Hep A vaccine and Hep B vaccine

question

____is defined as irreversible hepatic injury, characterized by fibrosis that distorts hepatic architecture and the presence of regenerative nodules.

answer

Cirrhosis

question

Names some underlying causes of cirrhosis.

answer

Alcohol, chronic Hep B&C, biliary disease, cardiac disease, Nonalcoholic fatty liver disease

question

The serum ascites-albumin gradient is the most specific test to differentiate between the causes of ascites. A gradient >1.1g/dL usually means ascites caused by ____. <1.1g/dL means ascites caused by __,__, or __.

answer

cirrhosis; malignancy, pancreatitis, and tuberculosis

question

Laboratory findings seen in cirrhosis are:

answer

low Na, low BUN, low albumin, low platelets; high bilirubin and high PT, MCV>100

question

In cirrhosis, ___develop from portal vein hypertension that is transmitted to system collateral veins in the gastroesophageal junction. Tx: vassopressin analogues (octreotide), sclerotherapy, band ligation

answer

esophageal varices

question

What are the laboratory findings in cholestatic liver disease?

answer

increased alkaline phosphatase with normal to slightly elevated transaminases

question

Intrahepatic Duct Obstruction can cause either primary biliary cirrhosis or primary sclerosing cholangitis.

answer

1. Primary biliary cirrhosis usually occurs in middle aged women and presents with pruritis or asymptomatic elevations in Alk Phos 2. Primary sclerosing cholangitis is usually in association w inflammatory bowel disease and patient present with ascending cholangitis

question

____is the consequence of inappropriate activation of enzymatic precursors (zymogens) in the pancreas. Activation leads to autodigestion of the organ. What are the two most common causes?

answer

Pancreatitis; most common causes are alcohol and gallstones, less common causes are direct injury, viral infections, and metabolic abnormalities

question

Blue periumbilical discoloration or _____sign and bruising of the abdominal flanks or ____sign both suggest necrotizing disease in pancreatitis.

answer

Cullen; Grey Turner

question

In pancreatitis, when the diagnosis is uncertain, is clinically severe, the patient appears septic, or the patient fails to improve, what diagnostic study is indicated? What lab value is most sensitive to pancreatitis?

answer

Abdominal CT; amylase - lipase and amylase

question

The development of ____is a major cause of morbidity and mortality in pancreatitis. Empirical antibiotic use in cases of documented severe necrosis is advocated by some, nut not all experts. Abscesses require drainage.

answer

infection

question

_____cancers are believed to arise from malignant transformation of benign adenomatous polyps. Risk factors are: high fat diet, low fiber, obesity, ethanol, refined sugar, smoking

answer

Colorectal

question

Colorectal screening for no risk factors starts at age ___with annual fecal occult blood test, DRE, & flexible sigmoidoscopy every 3-5 years or what other option?

answer

age 50 - colonoscopy every 10 years

question

Invasive cancer involving the ___differs from other colon cancers in that local recurrences after resection are more common.

answer

rectum

question

In ____cancer, most frequently they are metastatic tumors. Poor prognosis, mean survival 6 months. Prevention is most important.

answer

liver -- most common primary malignancy is hepatocellular carcinoma - causes include Hep C infection, alcohol, hemochromatosis

question

What are the three types of esophageal strictures?

answer

esophageal webs, lower esophageal ring (Schatzki's ring), Zenker's diverticulum

question

The two types of hiatal hernias are paraesophageal and sliding. Which is treated surgically?

answer

paraesophageal sliding are only treated surgically if persistent or recurrent symptoms

question

_____is due to an abnormal immune response to gluten. Laboratory tests reveal the presence of antigliadin and antiendomysial antibodies. Abnormal immune response to gluten.

answer

Celiac disease

question

Rheumatology: Risk factors for ____include DM, HTN, obesity, hyperlipidemia, alcoholism, and thiazide use.

answer

gout

question

For acute monoarticular arthritis, ____is the definitive diagnostic procedure.

answer

arthrocentesis

question

On crystal examination, ____shows needle shaped negative bifringent crystals and ____shows rhomboid or weakly positive birefringence.

answer

gout; pseudogout

question

Bacterial infection in joint: suspicion is high when ____is >100, 000.

answer

WBC count

question

______lumbar discs radiate pain to anterolateral leg and great toe and affect dorsiflexion. ______lumbar discs radiate pain to posterior leg and lateral toes and affect plantar flexion.

answer

L4-L5; L5-S1

question

____is a symmetric inflammatory peripheral polyarthritis characterized by lymphocytic infiltration of the synovial joints and granulomatous extra-articular nodules.

answer

Rheumatoid arthritis

question

Name some criteria for the diagnosis of RA.

answer

--morning stiffness >1hr for at least 6 weeks --arthritis of 3 or more joint for 6 weeks --Arthritis in wrist, MCP, or proximal intraphalangeal joints --symmetric arthritis --rheumatoid nodules --elevated RF --hand or wrist films showing erosions or periarticular osteopenia

question

The RF factor can be positive in other conditions like older age, SLE, sarcoid, endocarditis, chronic infections, hyperglobulinemic states. What other lab test is more specific to RA? What is drawn for inflammatory markers?

answer

anti-CCP; ESR and CRP

question

____syndrome in RA is the combination of RA, splenomegaly, and leukopenia.

answer

Felty Syndrome

question

Treatment of RA consists of analygesia and early institution of DMARDs. Name some and their side effects.

answer

DMARDs Methotrexate (bone marrow toxicity, pneumonitis, stomatitis, hepatic fibrosis, Sulfasalisize (rash), Hydroxychloroquine (retinopathy), leflunomide (diarrhea, rash), minocycline (hyperpigmentation), azathioprine (immunosuppression)

question

If first-line treatment in RA fails, then biologic agents are used. Name some.

answer

infliximab, rituximab, ehtanercept, anakinra, adalimumab

question

____presents with pain in 11+ pressure points, no abnormal labs. Treatment is exercise and behavioral therapy then TCA's, gabapentin, and anxiolytics.

answer

Fibromyalgia

question

What two rheumatoid diseases are more prevalent in men than women?

answer

anklyosing spondylitis & reactive arthritis

question

For the treatment of spondyloarthropathies which are an interrelated group of inflammatory disorders affecting the psine, joints, and periarticular structures, what is treatment focused on?

answer

treatment of underlying disease

question

______arthritis appears to be precipitated by enteric infection caused by Salmonella, Shigella, Campylobacter, Yersinia, or CHLAMYDIA.

answer

Reactive

question

In ______, can include heel pain, uveitis or conjunctivitis, sausage digits, and positive HLA-B27 (not recommended for screening). Skin involvement with circinate balanitis and/or keratoderma. Labs show a elevated CRP and ESR.

answer

reactive arthritis "Can't see, can't pee, can't climb a tree"

question

________diseases are characterized by alterations in immune function often leading to the production of autoantibodies.

answer

Connective tissue 1. immune complex deposition 2. vascular damage 3. overproduction and accumulation of extracellular matrix 4. altered immune responses

question

What diseases have increased ANA ie. are the connective tissue disease?

answer

SLE - lupus schleroderma polymyositis, dermatomyositis sjogren syndrome

question

____presents with myalgias, arthralgias, fever, malar rash, photosensitivity, and alopecia. Tx: NSAIDs, prednisone, immunosuppressants. What specific labs are positive?

answer

SLE; ANA, anti-Sm & anti-dsDNA

question

Scleroderma presents with the CREST syndrome. What does CREST stand for? Tx: ACEi for renal crisis, MTX possible help in early disease.

answer

C - calcinosis R - Raynaud's phenomena E - esophageal hypomotility S - sclerodactyly T - telangectasias

question

______presents with proximal limb muscle weakness and _______presents with proximal limb muscle weakness and heliotrope rash and gottron papules. Tx: prednisone

answer

polymyositis; dermatomyositis

question

___presents with dry eyes and dry mouth. No specific treatment other than treating the symptoms.

answer

Sjogren syndrome

question

____is inflammation of the synovial lining of the bursa and joints -- often in shoulder, neck, and hips. Tx: NSAIDS and prednisone cornerstone.

answer

Polymyalgia Rheumatica

question

_____is a vasculitis disease of the medium-sized arteries. Middle aged men. Palpable purpura, High ESR, leukocytosis, anemia, thrombocytosis, urine positive protein and blood if kidney involved.

answer

PAN - polyarteritis nodosa

question

____is a systemic disorder characterized by extracellular deposition of an amorphous eosinophillic protein that stains positive with Congo red stain. How is diagnosis made?

answer

Amyloidosis, abdominal fat pad aspirate -- treatment is supportive and prognosis is poor

question

ENDOCRINOLOGY: Involuntary weight loss of 5% or more of body weight in <12 months should prompt medical evaluation. What level/lab test can evaluate the degree of malnutrition?

answer

albumin

question

Hyperthyroidism is diagnosed by the presence of increased ____. TSH is suppressed in primary hyperthyroidism and increased in secondary hypothyroidism (rare). An exception is is T3 thyrotoxicosis.

answer

free T4

question

_____disease is an autoimmune thyroid disease caused by production of antibodies to the thyroid gland's TSH receptor. DeQuervain or painful thyroiditis is most likely viral in origin, following a flulike syndrome.

answer

Graves -s/s are proptosis and pretibial myxedema

question

The treatment of hyperthyroidism includes radioactive iodine, antithyroid drugs which are:_____which is TID and ____which is qd and not safe in pregnancy, and surgery.

answer

prophylthiouracil, methimazole

question

Hypothyroidism is characterized by low ___and high ___. Hashimoto's thyroiditis (MC!) is an autoimmune disease that is the most common cause of hypothyroidism in the US. Most patients have _____antibodies.

answer

low T4 and high TSH; anti-TPO

question

Replacement of thyroid hormone in patient with central hypopituitarism or myxedema coma may cause ____by increasing the metabolism of cortisol.

answer

adrenal crisis

question

To diagnose DMI or II, a fasting glucose should be _____or a random or OGTT reading should be _______.

answer

>125; >200

question

1. Firstline tx is with metformin, a biguanide which should not be given in what instances? 2. _____are secondline and squeeze pancreas -- s/s are hypoglycemia and weight gain - not w renal failure. 3. Meglitinides are newer ______that are not renally secreted.

answer

renal or hepatic failure; sulfonylureas; sulfonylureas

question

1. TZD's (pioglitazone, rosiflitazone) have _____negative side effects and should only be used for patients refusing insulin. 2. Alpha-glucosidase inhibitors (acarbose) have the side effect of __. 3. DDP-4 inhibitors or ____ are limited to combination therapy.

answer

cardiac; flatulence/bloating; sitagliptine

question

The two most common etiologies of hypercalcemia are primarily ____&_____.

answer

hyperparathyroidism and malignancy (lung, renal, breast, MM)

question

The simple mnemonic for hyperparathyroidism is what? What cardiac manifestations are present with hypercalcemia?

answer

stones, bones, growns, physic overtones; shortened QT interval

question

Treatment of hypercalcemia consists of hydration with IV normal saline and long term control using ____. Primary hyperparathyroidism is treated ____most commonly by resection of a solitary parathyroid adenoma.

answer

bisphosphonates; surgically

question

Primary adrenal insufficiency is usually _____in etiology. It may be associated with other diseases like T1DM and hypothyroidism as part of type II polygland autoimmune syndrome.

answer

autoimmune

question

Adrenal insufficiency (Addison's disease) presents how?

answer

weakness, weight loss, abdominal pain, hyponatremia, and hyperkalemia ACUTE presents with h/a, n/v, diarrhea, and abdominal pain

question

Diagnosis of adrenal insufficiency is confirmed with 1 hour cortisol response to cosyntropin with level ____. Treatment consists of hydrocortisone replacement and stress doses used for illness or stress.

answer

<20mg/dL

question

____is a rare form of thyrotoxicosis which occur with stressful illness, thyroid surgery or radioactive iodine. High mortality rate. Marked delirium, tachycardia, vomiting, diarrhea, dehydration, high fever, high T4, low TSH.

answer

Thyroid storm

question

Thyroid cancer always manifests as a palpable ____. Cause unknown. Papillary most common and least aggressive. How is it diagnosed?

answer

thyroid nodule; iodine scan (cold is positive) or ultrasound

question

__disease is a disorder of bone metabolism. Most common in pelvis, lumbar spine, and femur. High alkaline phosphate, treat with calcitonin and bisphosphonate.

answer

Pagets disease of the bone

question

____syndrome is caused by excess levels of circulating cortisol. Names some PE findings

answer

Cushings; truncal obesity, moon face, purple striae, muscle atrophy, hypertension

question

Excess cortisol production in Cushings can be ACTH dependent/high which is a ___or____source or ACTH independent which is a ____source.

answer

pituitary or ectopic; adrenal

question

Diagnostic work up of Cushings includes measurement of __, __, or __ to measure cortisol. If hypercortisolism is determined, high dose dex suppression test is done to determine source. If suppressed, then source is ____.

answer

urine free cortisol, late night salivary cortisol, or overnight dexamethasone suppression test; pituitary

question

___is effective in remission in 60-80% of cases of Cushings.

answer

Surgery

question

Name the anterior and posterior pituitary hormones.

answer

FLATPIG - anterior, FSH, LH, ACTH, TSH, PL, ignore, GH posterior oxytocin, vasopressin

question

The most common pituitary adenomas are ____followed by adenomas producing GH causing ___, and those that produce ACTH causing ____.

answer

prolactinomas, acromegaly, Cushings

question

In prolactinomas, ____is elevated. In acromegaly, GH is pulsatile and can't be reliably measure, therefore, ___ is measured. In Cushings, ___is completed after high cortisol is found. ____is the test of choice for pituitary adenoma.

answer

prolactin, IGF-1, dexamethasone suppression test, MRI

question

____(loss vasopressin/ADH) is suggested by low urine osmolality in the setting of high serum osmolality. Treatment is fluid restriction until urine osmolality is >295. Administration of ____confirms central etiology.

answer

Diabetes Insipidus; vasopressin

question

Symptomatic ____are treated with dopamine agonists ie. bromocriptine or cabergoline. Surgery is required with refractory disease.

answer

pituitary adenoma

question

If pituitary adenomas are secreting hormones other than prolactin, surgery is indicated. Has radiation been effective? What is a side effect for most patients?

answer

no; panhypopituitarism

question

____ is a tumor of the medulla of the adrenal glands. Secretes norepi and epinephrine. Treatment is usually surgical resection.

answer

Pheochromocytoma

question

Alcoholics are susceptible to deficiencies of ___, ___, and ___.

answer

thiamine, folic acid, and vitamin B12

question

At what age does dyslipidemia become a risk factor for disease?

answer

Men greater than 45 or women older than 55

question

Levels of LDL at which to begin dietary or drug therapy treatment: 0-1 risk factor? 2+ risk factor, CHD risk 20%

answer

1. 0-1 risk factor dietary >160, drug >190 2. 2+risk factor, CHD130, drug >160 3. 2+risk factor, CHD >10% dietary >130, drug >130 4. CHD risk >20% dietary >100, drug >130

question

Drugs: 1. ___are firstline, s/s myalgias. 2. ___previously firstline - s/s flushing 3. ____, s/s bloating/constipation, LDL lowering and TG raising 4. ____, s/s/ GI, increase gallstones 5. ____, lower LDL, s/s myalgias

answer

Statins, Niacin, Bile Acid sequestrants, fibric acid derivatives, ezetimibe

question

When combination therapy is required in dyslipidemia, which meds are best to add to statins because of side effect profile?

answer

bile acid resins or ezetimibe

question

NEUROLOGY: ___is an acute and fluctuating state of impaired cognition and consciousness. Common precipitants are medication side effects, drug-drug interactions, medication withdrawal, and illicit substance use.

answer

Delirium

question

In delirium, what medications can be used in low doses only when necessary for patient safety.

answer

Haldol, respiridone, olanzapine

question

In BPPV, on the Dix-Hallpike maneuver, the patient will exhibit a ____&____nystagmus with the upper pole of the eye beating toward the dependent/affected ear.

answer

horizontal and torsional

question

For the diagnosis of ____, both memory loss and one other cognitive impairment must be present ie. agnosia, aphasia, or loss of executive function.

answer

dementia

question

The most common form of dementia is ___ Its short term memory loss insidiously progresses to severe dependency for ADLs in about 10 years. Tx: cholinesterase inhibitors (donepazile) and NMDA receptor blocker (memantine.

answer

Alzheimer's disease

question

Dementia with _____results in cognition fluctuations, hallucinations, and parkinsonism. Cholinesterase inhibitors should be tried before antipsychotics to treat hallucinations in order to avoid worsening parkinsonism.

answer

Lewy bodies

question

____causes of dementia such as normal pressure hydrocephalus, depression, hypothyroidism, and vitamin B12 deficiency should be assessed and treated.

answer

Reversible

question

What meds should be avoided in patients with dementia?

answer

anticholinergic

question

____is a dilation of cerebral ventricles and secondary to a prior CNS insult. The tx is a VP shunt.

answer

Normal pressure hydrocephalus

question

Stroke: Which vascular supply is affected with the following common manifestations? 1. contralateral extremity weakness - lower > upper; altered reasoning; bowel & bladder incontinence 2. contralateral face and arm weakness greater than leg; contralateral sensory deficits; dysphasia 3. contralateral visual field deficits; altered mentation; cortical blindness 4. vertigo/nystagmus; dysarthria; dysphagia; contralateral pain and temperature sensory deficits; syncope

answer

1. anterior cerebral artery 2. middle cerebral artery 3. posterior cerebral artery 4. vertebrobasillar arteries`

question

___should be rapidly performed in all patients suspected of stroke. Thrombolysis within _____ of symptom onset. No tPa if risk of intracranial or life-threatening bleeding. BP should be <_____.

answer

non-contrast CT, 3 hours, <185/110

question

Longterm treatment of stroke includes what three treatments?

answer

statin and aspirin qd, carotid Doppler screening

question

____is a focal neurologic deficit of acute onset, resolves in 24 hours, patient has risk factors of vascular disease - which are often present.

answer

Transient ischemic attack

question

_______seizures have preserved consciousness and may have prior "aura", and present as diverse as repetitive muscular activity, speech difficulty, or distortions of sound perception.

answer

Simple partial

question

_______seizures present with impaired consciousness and automatisms (facial movements, repetitive speech etc.), and patient may appear awake but does not respond appropriately.

answer

Complex partial

question

_______seizures have impaired consciousness, staring episodes, often pediatric population.

answer

Generalized absence

question

_______seizures often have "yell" at onset, initial tonic clonic back arching, cyanosis, tongue biting, loss of bowel/bladder control.

answer

Tonic Clonic/Grand Mal seizure

question

____levels are often elevated within 30 minutes and normalized after 6 hours. Head CT, MRI, lumbar puncture, and EEG are used to assess patient. Which is the most definitive test for detection of epileptic activity?

answer

Prolactin, EEG

question

_____presents with seventh (facial) cranial nerve palsy, loss of taste on the anterior 2/3 of tongue, and hyperacusis. Dx of exclusion. Rule out Ramsay Hunt syndrome.

answer

Bells Palsy

question

_____is an acute or subacute polyradiculoneuropathy most likely due to an immune-mediated mechanism. Typically follows a type of infection such as Campylobacter, mononucleosis, CMV, herpes, and Mycoplasma, weakness is ascending pattern. Tx: plasmapheresis and human immunoglobulin.

answer

Guillain-Barre syndrome

question

____is an autoimmune disorder that causes a decrease in acetylcholine receptors -- patients have trouble combing hair, climbing stairs, lifting overhead. Tx: anticholinesterase - pyridostigmine bromide, neostigmine bromide.

answer

Myasthenia gravis

question

The cause is unknown for an _____, can be inherited in an autosomal dominant pattern. Typically involves hand or head. No hypokinetic features or rigidity of PD. Tx: BB and modest doses of alcohol.

answer

essential tremor

question

_____disease is a genetic disorder characterized by choreiform movements, mental status decline, and personality changes. Insidious onset of clumsiness and random, brief, fidgety movements. Gait is dancelike.

answer

Huntington's MRI shows cerebral atrophy death in 15 years

question

____is a progressive degenerative disease resulting from loss of dopaminergic neurons in the substantia nigra. Pill-rolling tremor, cogwheel rigidity, bradykinesia, shuffling gait.

answer

Parkinson's disease

question

_____ generally presents with fever, headache, and signs of meningeal irritation. What is the essential diagnostic tool? What should be administered IMMEDIATELY if LP is delayed?

answer

Meningitis; LP; antibiotics

question

Which clinical features of CSF are AVM, which are ABM? A. WBC 200-10,000, PMN mostly; 100-500 protein; 200 opening pressure; winter months; age - older adults and infants B. WBC 25-100; lymphocyte mostly; 50-100 protein; >40 glucose; <180 opening pressure; summer months; children and young adults

answer

bacterial meningitis; viral meningitis

question

What is the classic antibiotic treatment for meningitis? Length of course?

answer

14 day course 1. 3rd generation cephalosporin - ceftriaxone or cefotaxime - covers Strep pneumo, N meningitis 2. Vancomycin - covers MRSA 3. Ampicillin - Listeria monocytogenes

question

____sign refers to pain in the neck or back that occurs when a pt with meningitis attempts to extend the leg at the knee while the thigh is held in 90 degrees of flexion. ____sign refers to spontaneous flexion of the hips during attempted passive flexion of the hips during attempted passion flexion of the neck.

answer

Kernigs; Brudzinski

question

Concussion grading - American Academy of Neurology: ____=confusion but no LOC for 15 minutes. ____=LOC either brief or prolonged.

answer

Grade I, Grade II, Grade III

question

It is vital to make sure the symptoms of the first concussion have subsided because of the gloomy possibility of ________ ie. when the brain swells catastrophically - patient either dies or is left severely disabled

answer

second impact syndrome

question

GLASCOW COMA SCALE Severe, with GCS < 8-9 Moderate, GCS 8 or 9-12 Minor, GCS ≥ 13.

answer

EYE OPENING 4 - spontaneous 3 - open to speech 2 - open to pain 1 - no response VERBAL 5 - alert and oriented 4 - disoriented conversation 3 - inappropriate words 2 - nonsensical sounds 1 - no response MOTOR 6 - spontaneous 5 - localizes pain 4 - withdraws to pain 3 - decorticate posturing 2 - decerebrate posturing 1 - no movement

question

____is infection of the brain parenchyma. CSF: Gram stain usually negative, WBC majority is mononuclear leukocytes, protein >100, CRP normal, glucose normal to slightly decreased.

answer

Encephalitis

question

The most common cerebral aneurysm is a ____aneurysm that is typically located on the circle of Willis or major branches. Treated is surgical clipping.

answer

berry DX of aneurysms with CT, MRA, or angiography

question

What are the common causes of anion gap acidosis? MUDPILES

answer

M, Methanol. U, Uremia. D, Diabetic Ketoacidosis. P, Paraldehyde. I, Infection. L, Lactic Acidosis. E, ethylene glycol. S, salicylates

question

A ____aneurysm is an elongated dilation of large arteries, associated with atherosclerosis, typically develop in basilar artery. Frequently multiple and found in the distal cerebral arteries. Treated with total occlusion.

answer

fusiform

question

KIDNEY: Some causes of _____which is an excess of water relation to total solute is volume depletion, edematous states, euvolemic hypo-osmolar states, hyperglycemia, hyperlipidemia, hyperproteinema. S/S = lethargy, confusion, coma, hyperexcitality.

answer

hyponatremia ---serum osmolality ---

question

The causes of ____are pure water deficits, water loss, and sodium overload. S/S = CNS dysfunction.

answer

hypernatremia

question

As a rule of thumb, only ___ of the free water deficit should be replaced in the first 24 hours, and the remainder of the deficit over the next 24 to 48 hours.

answer

half

question

Hypokalemia causes ____waves on EKG and ____waves with hyperkalemia.

answer

U waves; peaked T waves

question

Emergent treatment of hyperkalemia is via ____administration. Intracellular shift of potassium is accomplished by __&__ administration. Elimination of K is by use of potassium-binding resins, diuretics/saline infusions, or via dialysis.

answer

Calcium; insulin and bicarbonate

question

The etiologies of ARF are divided into three major groups based on the anatomic nature of the lesion. What are they?

answer

Prerenal, Intrinsic, or postrenal

question

_____etiologies could be hypovolemia, decreased cardiac output, renovascular disease, systemic vasodilation, renal vasoconstriction, impairment of renal autoregulation of blood flow (caused by drugs like ACEi or NSAIDs)

answer

Prerenal causes

question

_____etiologies are vasculitis or microangiopathy, glomerulonephritis, acute tubular necrosis (caused by ischemic insult or nephrotoxic drugs), interstitial nephritis, or tubular obstruction.

answer

Intrinsic

question

_____etiologies are ureteral obstruction, bladder neck obstruction, or urethral obstruction.

answer

Postrenal

question

Chronic kidney disease is defined as a GFR below ____ and end stage kidney disease is defined as a GFT below ____. What is seen on urinalysis?

answer

<60; 90 Stage II - 60-89 Stage III - 30-60 Stage IV - 15-29 Stage V - <15 broad waxy casts

question

___&____are the most common complication that causes CKD. 70%

answer

Diabetes and hypertension

question

The ____ syndrome is a constellation of symptoms and PE findings that result from the accumulation of toxins normally handled by the kidney pericarditis, dyspnea on exertion, anorexia, n/v, fatigue/weakness, AMS, SOB, pruritis and easy bruising..

answer

uremic

question

_____casts are seen in interstitial nephritis. _____casts are seen in acute tubular necrosis

answer

white cell casts (WBC's), muddy brown casts

question

The ____are disorders characterized by direct injury to the glomerulus. Because the glomerulus provides primary filtration for the urinary system, disease should be suspected when urine contains findings consistent with abnormal filtration ie. dysmorphic red cells, red cell casts, significant proteinuria, or lipiduria

answer

glomerulopathies -- TEA COLORED URINE

question

Glomerulonephritis is an uncommon cause of acute renal failure. Titers: Poststreptococcal = high _____titer IGa nephropathy = elevated ____ levels Wegeners = ____positive Goodpasture's = ____positive Lupus nephritis = ____positive

answer

Poststreptococcal = ASO titer IGa = elevated IGa levels Wegener's = ANCA positive Goodpasture's = Anti-GMB positive Lupus = ANA positive

question

Causes of glomerular injury can be divided into those that cause inflammation or ____ and those that alter the permeability of the glomerular membrane (_____).

answer

Nephritis; Nephrosis

question

Nephrotic syndrome has proteinuria greater than what? Edema and ascites!!!! What about fat in urine?

answer

>3.5 grams/day; fatty casts, oval fat bodies, Maltese crosses

question

Nephritic syndrome has what color urine? Protein <3.5g/day, and what about the red cells?

answer

tea colored urine, dysmorphic red cells and red casts

question

Acute _____is an acute injury - either ischemic or toxic, you see muddy brown casts. Pigmented granular casts and/or epithelial cells.

answer

tubular necrosis

question

What dietary factors increase the risk for nephrolithiasis?

answer

low fluid intake, grapefruit juice, high sodium intake, high protein intake, low dietary calcium intake, hyperparathyroidism, obesity, gout, DM, renal tubular acidosis

question

_______is the most common type of kidney stone. What are the other three less common types of kidney stones.

answer

Calcium (hypercalciuria, hypocitruria, hyperoxaluria, hyperuricosuria); uric acid, struvite, cystine

question

Which stone is radiolucent? Which stones have an increased pH?

answer

uric acid; calcium & struvite

question

If ______predominates the picture, renal malignancy, pyelonephritis, glomerulonephritis, or trauma should be considered.

answer

gross hematuria

question

What is the diagnostic test of choice for nephrolithiasis? Stones that are smaller than ____usually pass on their own.

answer

helical CT - IVP used to be but dye has decreased its use; 5mm

question

Systemic conditions often predispose to nephrolithiasis. ___stones may be caused by hyperparathyroidism, sarcoidosis, or Cushings. _____stones are associated with myeloproliferative disorders, chemotherapy/tumor lisis, or gout. Patients w intestinal malabsorption and ileal disease usually have ______stones.

answer

Calcium; Uric acid; calcium oxalate stones

question

_____of urine using potassium citrate and allopurinol reduce recurrence of uric acid stones.

answer

alkalinization

question

The presence of _____indicates a renal origin for hematuria.

answer

RBC casts

question

RBC's originating from glomerular disease are often ____in shape.

answer

dysmorphic

question

Men over age 50, smokers, people treated with cyclophosphamide, and those using high dose analgesics are at increased risk for ________.

answer

urinary tract malignancy

question

What is the first imaging technique used to detect a urinary malignancy? If nonglomerular bleeding persists, what test is typically performed?

answer

helical CT; cytoscopy

question

UTI's are usually caused by _________ie. E Coli, Enterobacter, Klebsiella, Proteus, and Pseudomonas.

answer

gram negative Gram positive: Staph saprophyticus and enterococci Yeast: Candida

question

What are the standard oral drugs to treat UTI's?

answer

Bactrim, quinolones, or beta lactams azo/phenazopyridine for symptomatic relief

question

PSA is a serine protease produced by the prostate and a value ____ug per mL are highly suspicious for prostate cancer.

answer

>10ug/mL

question

A Gleason score from 1 as well differentiated to 5 as poorly differentiated are added together to 1 through 10. What scores have the worst prognosis?

answer

scores from 8-10

question

_______carcinoma presents with flank pain, abdominal mass, and hematuria. The most common type is clear cell. Tx: surgical removal or immunomodulatory therapy with interleukin-2 for metastatic disease

answer

Renal cell

question

HEMATOLOGY: General criteria for anemia are a hemoglobin level of <____in men and <____in women.

answer

<13 in men; <12 in women

question

____is caused by either increased destruction (hemolysis), decreased production (low retic count), or blood loss.

answer

Anemia

question

If microcytic (MCV<100), what are possible dx?

answer

iron deficiency, thalassemia, anemia of chronic disease, or sideroblastic anemia

question

If MCV is low and RDW is low but RBC is high, what is the diagnosis? What is it?

answer

thalassemia - decreased production of globin chain --Mediterranean, ME, or Southeast Asian for Beta --those plus AA for alpha

question

With liver disease, thalassemia, and hemolysis, what kind of cells might you see?

answer

target cells

question

Iron deficiency anemia has MCV<100 and ____ferritin and ____RDW.

answer

low ferritin and high RDW

question

If MCV is >100, what levels should you check first?

answer

Vitamin B12 and folate deficiency

question

Megaloblastic anemias include B12 and folate deficiencies and on smear what might you see?

answer

hypersegmented PMN's and ovalocytes

question

Myelodysplastic syndrome, MCV>100 is a stem cell disorder characterized by an arrest in maturation of all blood cells, usually presenting as pancytopenia. Often occurs in the elderly. What do you often see on the peripheral smear?

answer

bilobed PMNs

question

Anemia of chronic disease presents with ____MCV and is most commonly caused by infection, inflammation, cancer, ESRD, or liver disease.

answer

normal

question

______is an autosomal recessive disease the results in production of hemoglobin S that leads to vaso-occlusion in the microvasculature that causes pain and organ dysfunction.

answer

Sickle cell disease

question

An oxidative stress often precedes the hemolysis in _____. Stress, ingestion of fava beans or certain drugs causes this ie. Sulfonamides, Nitrofurantoin, Methylene blue, Dapsone, or Primaquine

answer

G6PD deficiency

question

__________states include the postpartum period, malignancy, oral contraceptives, deficiencies of protein S, protein C, and antithrombin III, lupus anticoagulant, activated protein C resistance, prothrombin gene mutations, hyperhomocysteinemia.

answer

Hypercoagulable

question

Hemophilia A has a factor ____deficiency. Hemophilia B has a factor ____deficiency. vonWillibrand disease has a deficiency of factor ____and platelet aggregates. What about Vitamin K?

answer

Hem A - factor VIII Hem B - factor IX vW disease - factor VIII and platelet aggregates Vitamin K - factor II, VII, IX, and X

question

_____is an autoimmune disorder in which patients develop antibodies against their own platelets. Superficial bleeding of skin, mucous membranes, and GI tract. Chronic disease will need high dose steroids and possible splenectomy.

answer

Idiopathic thrombocytopenia purpura (ITP)

question

_____is comprised of microangiopathic hemolytic anemia, thrombocytopenia with normal coagulation, and CNS symptoms. Renal failure and fever compose the pentad of symptoms.

answer

Thrombotic thrombocytopenia purpura schistocytes

question

Leukemia can be either acute or chronic. 1. ____- most common leukemia, smudge cells! "mature appearing lymphocytes". Can live for decades without treatment. 2. ____ - high WBC, bcr/abl gene, Philadelphia chromosome 3. ___ - is acute, blasts! cytophenia! 4.___ - is acute, hallmark is Auer rod

answer

CLL, CML, ALL, AML

question

A decreased anion gap in the presence of anemia, proteinuria, leukopenia, hypercalcemia, and renal failure suggests ____, "Rouleux formations".

answer

multiple myeloma

question

Lymphoma is divided into Hodgkin lymphoma or non-Hodgkin's lymphoma. Which one is characterized by the presence of Reed-Steinberg cells? What diseases are highly associated with NHL?

answer

Hodgkin's lymphoma; HIV or immunosupression

question

INFECTIOUS DISEASE: HIV is considered AIDS once the ___is <200 and a patient has at least one AIDS defining illnesses.

answer

CD4 count AIDS defining illnesses: Pneumococcal Pneumonia, Kaposi's sarcoma, lymphoma, TB, toxoplasmosis, HSV, candida esophagitis, wasting syndrome, CMV, PML

question

____is the most common fungal infection. Oropharyngeal, Vulvovaginitis, Cutaneous. KOH/gram stain shows budding yeast.

answer

Candidiasis

question

____is common in the immunosuppressed. Pigeon droppings, Meningismus, fungus. Tx: Amphotericin B

answer

Cryptococcus

question

____is the MC case-defining illness in AIDS, hacking non-productive cough, fever, dyspnea, interstitial infiltrates, butterfly pattern.

answer

Pneumocystis

question

____is common in Mississippi and the Ohio River Valley. Patchy, multilobal infiltrate. Immunocompromised. Intraconazole or Amphotericin B.

answer

Histoplasmosis

question

_____is a bacterial infection common in food borne, canned goods, wounds contaminated with soil, or in infants that ingested soil or honey.

answer

Botulism

question

_____can cause trachoma/conjunctivitis, cervicitis, epididymitis/salpingitis, or atypical pneumonia.

answer

Chlamydia

question

_____causes rice water diarrhea from Vibrio Cholerae most commonly from ingesting food or water from an endemic area.

answer

Cholera

question

_____causes tonsillopharyngitis/laryngitis due to Cornebacterium diptheriae. Sore throat, grayish pseudomembrane. Tx: immunization!!

answer

Diptheria

question

____is a parasitic infection often acquired after eating undercooked meat, an opportunistic infection in HIV.

answer

Toxoplasmosis

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