question

Membranous

answer

Think lupus

question

crohn's disease

answer

cholesterol gall stones.

question

peptic stricture

answer

slowly progressive dysphagia to solid foods w/o anorexia and weight loss. can block reflux. symmetric, circumferential narrowing. GERD --> barrett's --> erosive esophagitis and peptic stricture.

question

adenocarcinoma

answer

GERD >20 years. weight loss, asymmetric narrowing of lumen of esophagus

question

hiatal hernia

answer

may present with GERD.

question

Achalasia

answer

esophageal motility disorder. bird's beak at GE jcn, dilation of prox. esophagus.

question

vascular rings

answer

congenital anomaly. aortic vessels encircle trachea or esophagus. airway obstruction, dysphagia in adults.

question

IBD

answer

can present around age 60. high WBC and ESR. ulcerated mucosa, neutrophilic cryptitis.

question

epithlial necrosis

answer

ischemic colitis.

question

pseudomembrane

answer

pancolitis.

question

Polyarteritis nodosa

answer

looks like IBD, but is much less common.

question

celiac's

answer

damages small intestine, impairing D-xylose absorption.

question

D-xylose

answer

absorption is abnl in both bacterial overgrowth and celiac disease. w/ bacterial overgrowth, the test becomes normal after antibiotic tx. look for mucosal impairment if not absorbed.

question

terminal ileal disease

answer

bile salts decreased.

question

Bacterial overgrowth

answer

impaired fat absorption due to bacterial deconjugation of bile salts and decreased excretion of xylose.

question

pellagra

answer

abd pain + watery diarrhea + depressed mood + bad memory + pigmented scaly rash.

question

seborrheic dermatitis

answer

scaly erythematous rash (face, chest, back, groin)

question

Ulcerative colitis

answer

bloody diarrhea, arthritis, uveitis, erythema nodosum, pyoderma gangrenosum

question

Acute intermittent porphyria

answer

abd pain, N&V, diarrhea, sweating, agitation, anxiety, paresthesia, confusion, absense of photosensitivity

question

achalasia

answer

dx: endoscopy. tx: pneumatic dilation.

question

Zenker's

answer

lateral neck mass. becomes larger when drinking fluids. motor dysfcn. b/w fibers of cricopharyngeal muscle. usu > 50. tx: excision, cricopharyngeal myotomy.

question

Esophageal webs

answer

sometimes iron def.

question

celiac's

answer

intermittent abd distention, flatulence, greasy stool. Iron def. pruritic, papulvesicular rash. IgA depositis.

question

drug-induced Pancreatitis

answer

lasix, HCTZ, sulfasalazine, 5-ASA, azathioprine, L-asparaginase, valproic acid, didanosine, pentamidine, metronidazole, tetracycline

question

pancreatitis

answer

diffuse or focal parenchymal changes edema, necrosis, liquefaction. perhaps stomach filled with air.

question

air in stomach

answer

air in stomach

question

Duodenal ulcers

answer

pain improves with food

question

gastric ulcers

answer

worsens with food

question

mesenteric angina

answer

pain exacerbated by eating

question

Mallory-weiss

answer

nonpainful. self-limited.

question

IBD

answer

significant pain, diarrhea, weight loss.

question

erosive gastritis

answer

alcoholics and NSAID use. pain immediately after eating.

question

gastric cancer

answer

melena, abd pain, weight loss, anorexia

question

steatorrhea

answer

pale, voluminous, foul-smelling stools.

question

Dyspepsia

answer

epigastric pain, postprandial fullness, early satiety. +/- abd burning, nausea, bloating. . GERD, NSAIDs, fcnal, PUD, malignancy

question

Dyspepsia alarm

answer

weight loss, persistent vomiting, dysphagia, blood loss, odynophagia, FH of GI cancer. >55 years. Endoscopy.

question

Negative H. Pyloria test

answer

4-8 wks of PPI. if fail, do endoscopy

question

Multiple myeloma

answer

severe constipation, anorexia, weakness, increased urination, increased ESR, increased Creatinine (renal tubular dysfcn.

question

chronic hepatitis

answer

conjugated hyperbilirubinemia and mild LFT elevation.

question

chronic pancreatitis

answer

lipase may be normal.

question

Hyperbilirubinemia from infiltration

answer

sarcoid, hemochromatosis, malignancy

question

Zollinger-Ellison syndrome

answer

prominent gastric folds, ulcer beyond duodenal bulb. Dx: serum gastrin levels. >1000. also, pH since acholrhydria increases gastrin.

question

cryoprecipitate

answer

factor 8, 13, fibrinogen, vWf.

question

FFP

answer

coagulopathy

question

Platelets

answer

thrombocytopenia

question

giardia

answer

chronic diarrhea. South america. Metronidazole.

question

scleroderma

answer

fewer esophageal waves and decreased LES tone.

question

Zn def

answer

alopecia, abnl taste, bullous lesions

question

chronic TPN

answer

Zn and Selenium deficiency.

question

duodenal ulcers

answer

usually H. pyori. Antibiotics + pantoprazole. or. amoxicillin + clarithromycin + PPI.

question

gastritis

answer

NSAIDs

question

VIPoma

answer

watery diarrhea, hypokalemia, leg cramps, low H+ in stomach. "pancreatic cholera" CT. Tx: IV hydration, octreotide. Then surgery

question

Glucagonoma

answer

necrotizing dermatitis, weight loss, anemia, persistent hyperglycemia.

question

gastrinoma

answer

1/4 of these in pancreas.

question

chronic pancreatitis

answer

chronic abd pain, pancreatic insufficiency. Fecal elastase test.

question

HIDA scan

answer

acute cholecystitis

question

laxaive abuse

answer

watery. 10-20 bowel movements a day. dark brown discoloration of colon w/ lymph follicles as pale patches (melanosis coli). (bisacodyl laxatives).

question

Melanosis coli

answer

laxative abuse. pale lymph follicles

question

Zenker's

answer

fluctuant neck mass. contrast esophagram. Tx: surgical.

question

cocaine in ER

answer

don't ever give beta blockers (unopposed alpha action)

question

MEN1

answer

primary hyperparathyroidism, pituitary tumors, pancreatic tumors. Zollinger ellison.

question

MEN 2

answer

MTC, Pheo

question

MEN2b

answer

neuroma + marfanoid

question

Diarrhea oocysts HIV

answer

Cryptosporidium

question

cricopharyngeal dysfcn

answer

"food sticking" dysphagia. doesn't relax. Dx: video fluoroscopic swallowing study

question

Diffuse esophageal spasm

answer

severe non-cardiac chest pain. uncoordinated contraction of esophageal body. multiple contraction on tracing from middle and lower esophagus. manometry

question

Spontaneous bacterioal peritonitis

answer

in a cirrhotic hepatic encephalopathy. MCC: e. coli and Klebsiella. Rocephin.

question

secretory diarrhea

answer

medication or hormone disturbance.

question

Motor diarrhea

answer

hyperthyroidism.

question

Ulcerative colitis

answer

diarrhea & bloody stools. acute colitis: radiologic evidence of colonic dilatation. "toxic megacolon". can cause colonic perforation. Tx: IV fluids, antibiotics, bowel rest. IV corticosteroids. Last resort: subtootal colectomy w/ end-ileostomy.

question

pseudomembranous colitis

answer

due to antibiotics. (or malignancy, COPD, immunosuppressiive tx, renal failures. Diarrhea + abd pain. C. diff (gram +, spore-form). Clinda, cephalosporin, ampicillin.

question

Right sided colon tumors

answer

grow larger. .anemia

question

left sided colon tumors

answer

bowel obstruction

question

untreated peptic ulcer disease

answer

MCC: hemorrhage. Other complications: perforation, penetration, obstruction. Massive upper GI bleeding. blood or coffee-ground material on nasogastric tube lavage.

question

ascites tx

answer

1. Na & H20 restriction. 2. Spironolactone. 3. Lasix. 4. slow tapping 2-4L of ascitic fluid if normal kidneys

question

spenorenal shunting

answer

worsen ascites

question

portocaval shunt

answer

improves ascites, but worsens encephalopathy if present.

question

peritoneo-jugular shunt

answer

designed for tx of ascites only.

question

Tropical sprue

answer

puerto rico: megaloblastic anemia, fatty diarrhea, weight loss. blunting of villi, plasma cells,

question

diffuse esophageal spasm

answer

chest pain, dysphagia, simultaneous high amplitude contractions. barium swallow corkscrew

question

infectious esophagitis

answer

immunosuppression. candida, herpes, CMV. dysphagia, oral thrush, odynophagia.

question

increased BUN/Cr ratio

answer

prerenal azotemia, GI bleeding (reabsorption of blood from GI tract), steroid administration. steroids

question

High urine Na excretion

answer

acute tubular necrosis

question

carcinoidsyndrome

answer

facial flushing, JVP, expiratory wheeze, diarrhea. Surgery. if inneffective, octreotide

question

mesenteric ischemia

answer

unexplained chronic abd pain, weight loss, food aversion. bruit.

question

drug esophagitis

answer

KCl, tetracycline, ASA, NSAIDs, Alendronate, quinidine, iron. sudden onset odynophagia, retrosternal pain. Dx: endoscopy.

question

primary sclerosing cholangitis

answer

elevated alk phos in UC patient.

question

UC

answer

uveitis, PSC, toxic megacolon, bloody diarrhea, tenesmus, weight loss, anemia.

question

folate def.

answer

canned foods + tea and toast

question

gastric varicies

answer

splenectomy (spenic vein thrombosis during pancreatitis and malignancy) MCC varicies (alcoholic)

question

Cancers for hypercoagulability

answer

visceral adenocarcinomas. Gastric, pancreatic, ovarian.

question

Gastric cancer workup

answer

Endoscopy (ulcers for adenocarcinoma), CT scan (stage 3 and 4 are when they present), laparotomy

question

gastric lymphoma

answer

H. pylori eradication can cause remission.

question

Peptic Ulcer disease

answer

If at the ER for a bleed, resuscitate them, endoscopy (dx, tx, prevent future). PPI (prazole) = less recurrent rebleeding. Octreotide instead of endoscopy if unsuccessful, contraindicated, unavailable, or as an adjunct before endoscopy

question

Left infective endocarditis

answer

Emboli to brain, kidneys, spleen, liver. Possible presentation: Elevated LFTs (IVDU), 1 wk fever, chills, abd pain, diminished left breath sounds, CT: fluid collection within the spleen.

question

Right infective endocarditis

answer

More common than Left. Emboli to lungs. IVDU.

question

hepatorenal syndrome

answer

liver failure (cirrhosis) --> hypotension --> renal failure. Dx: elevated Cr, Urine Na <10, no protein or blood on urinalysis

question

Mallory-weiss

answer

Arterial, not venous! If don't stop on own, vasopressin or cautery

question

hemobilia

answer

bleeding into the biliary tree. Sx: Upper abd pain, jaundice, GI hemorrhage

question

Bacterial overgrowth

answer

Can present w/ Tetany (Ca def due to vit D def.), night blindness (vit A), neuropathy (B12), dermatitis, arthritis, hepatic injury

question

Peutz Jeghers

answer

hyperpigmentation, hamartomatous polyps (sorta premalignant)

question

carcinoidsyndrome

answer

can cause niacin def (tryptophan is common precursor)

question

Mononucleosis differential

answer

HIV

question

Elderly + Iron def. anemia

answer

Hemoccult. Colonoscopy (no mattery the hemoccult). If colonoscopy neg, get an endoscopy. . If neg, Small bowel follow-through

question

Anemia CV changes

answer

non-specific ST-T changes.

question

toxic megacolon

answer

lower abd pain, bloody diarrhea, tenesmus.

question

toxic megacolon

answer

infection + tachychardia + anemia.||||| + hypotension or electrolyte disturbance.

question

toxic megacolon

answer

IV predisone. After acute phase, sulfasalazine.

question

Minimal bright red blood through rectum

answer

anoscopy

question

Chemo + skin burning in one area

answer

shingles. pain can come before rash. immunocompromised

question

celiac's

answer

no leukocytosis

question

IBS

answer

no weight loss, anemia, or leukocytosis

question

dysphagia for liquids and solids

answer

barium esophagram

question

hydrogen breath test

answer

lactose intolerance

question

stool reducing substance

answer

lactose intolerance

question

low stool pH and increased stool osmotic gap

answer

lactose intolerance

question

autoimmune hemolytic anemia

answer

plasmapheresis

question

cryoprecipitate

answer

factor 8 & 9, fibrinogen, vWF

question

Whipple's disease

answer

arthralgia, weight loss, fever, diarrhea, abd pain. PAS-positive material in lamina propria. Tropheryma whippelii. White men 4th-6th decade. steatorrhea .migratory polyarthropathy, chronic cough, heart involvement. dementia, opthalmoplegia, myoclonus. pigmentation.

question

Complicated GERD

answer

dysphagia, odynophagia, weight loss, overt or occult bleeding, Fe-def anemia. Requires esophagoscopy.

question

Digoxin + verapamil

answer

must decrease digoxin dose. otherwise, digoxin toxicity. (anorexia, N&V)

question

Mesenteric ischemia

answer

severe abd pain out of proportion to clinical exam.

question

CMV esophagitis

answer

Ganciclovir.

question

candidal esophagitis

answer

1wk fluconazole. Then bx if nonremittant

question

aphthous ulcer tx

answer

prednisone.

question

HSV esophagitis

answer

multiple, small, well-circumscribed, volvano-like. ballooning degeneration, eosinophilic intranuclear inclusions. Acyclovir

question

candidal esophagitis nonremittant and definitely candida

answer

oral itraconazole

question

risk for GBS endocarditis

answer

DM, cancer, alcoholism, liver failure, elective abortion, IVDU

question

Staph epidermidis endocarditis

answer

prosthetic valves, NICU umbilical venous catheter infection

question

enterococcal endocarditis

answer

old men after GU manipulation or young obstetric patients

question

Pneumocystis (HIV)

answer

diffuse bilateral interstitial infiltrates. TMP-SMX. Add Prednisolone if PaO2<70

question

Pentamidine

answer

alternative to TMP-SMX.

question

Diarrhea in HIV patients

answer

salmonella, campylobacter, entamoeba, chlamydia, shigella, Giardia. CMV, cryptosporidium, isopora, blastocystis, MAC, HSV, adeno. Kaposi's, lymphoma of GI tract.

question

Diarrhea with hematochezia and cramps in HIV

answer

CMV, C diff, shigella, E. histolytica, campylobacter.

question

cryptospordiosis

answer

watery diarrhea.

question

Entamoeba

answer

bloody diarrha. Trophozoites in stool. flask-shaped colon ulcers.

question

Kaposi's

answer

watery diarrhea.

question

Disseminated MAC

answer

chronic watery diarrhea * weight loss. Bx of small intestine.

question

Nocardia

answer

crooked, branching, beaded, gram + and partially acid-fast filaments. TMP-SMX. Alternative: minocycline.

question

pulmonary nocardiosis

answer

subacute pneumonia over days to weeks. empyema in 1/3 of patients. 1/2 have extrapulmonary dissemination. brain MCC.

question

Meningitis (meningococcal)

answer

Myalgia, purpura

question

syphilis meningitis

answer

peripheral rash on hands and feet w/ generalized lymphadenopathy

question

Lyme disease meningitis

answer

late manifestation of Lyme. Erythema chronicum migrans.

question

RMSF

answer

viral

question

Turcot's

answer

FAP+ GBM or medulloblastoma

question

Peutz jeghers

answer

GI hamstrings, pigment around lips, genitals, palms, face, mouth. Intussuception

question

HNPCC

answer

colorectal cancer. Lunch I and II.

question

Lynch I

answer

Early onset CRC. Absent polyposis

question

Lynch II

answer

Multiple cancer predisposition. MCC: endometrial cancer. extracolonic.

question

Colon cancer tx

answer

Surgery plus chemo.

question

Rectal cancer tx

answer

Surgery + radiation and ?chemo?

question

Angiodysplasia

answer

>60. Sx: GI bleed. Dx: colonoscopy, Tx: colonoscopy coagulation

question

Acute mesenteric ischemia

answer

SMA. Usu. cardiac embolism. (Sudden. Painful.) arterial embolism:subacute. Less severe. Hypotensive ischemia minimal pain. Venous thrombosis days to weeks. L

question

Acute mesenteric ischemia

answer

Dx: Lactate level, mesenteric angiography, KUB, barium enema

question

Acute mesenteric ischemia

answer

Tx. Fluids. Antibiotics, papaverine vasodilator. Thromolytics. Surgery.

question

Abd angina

answer

Post-prandial. Chronic SMA occlusion.

question

Ogilvie's

answer

Recent surgery or illness. Present like large bowel obstruction Sx. Tx: fluids and electrolytes, enema,

question

Pseudomembranous colitis

answer

C diff. Complications: toxic mega colon. Perforation. Anasarca. Dx: toxin, KUB, leukocytosis

question

Volvulous

answer

Sigmoid. Chronic laxative use. Tx: sigmoidoscopy. If cecal, then surgery

question

Varices

answer

Beta blocker fluids , antibiotics, octreotide, emergent endoscopy. Long term beta blockers. Banding initial treatment

question

Paracentesis

answer

If new, worse, SOB,

question

Bacterial peritonitis

answer

E. coli, klebsiella, strep pneumo

question

Wilson's

answer

Zinc early. Add penicillamine if nonpregnant and symptomatic

question

Hydratid liver cyst

answer

Mebendazole

question

Amebic liver abscess

answer

Metronidazole

question

Conjugated bilirubin

answer

Dark urine

question

Achasia and diffuse esophageal spasm

answer

Start with nitrates and CaCB. Surgery

question

Sliding esophageal hernia

answer

GERD management

question

Para esophageal hernia

answer

Surgery

question

Restless leg Syndrome

answer

can be burning in legs relieved by movement. Ferritin <50ng/mL. NCS can be performed

question

Wilson's

answer

fatigue, anorexia, abd pain, tremors, poor coordination, spastic dystonia, psychiatric disorder

question

hypothyroid

answer

fatigue, weakness, paresthesias,

question

COPD

answer

hyperresonance. Don't give them beta blockers.

question

CHF

answer

increased JVP, crackles, S3 gallop, peripherapl edema

question

IPF

answer

diminshed lung volumes, late inspiratory velcro-like crackles, clubbing

question

Pulmonary HTN

answer

increased JVP, right ventricular heave, right-sided S3 that increases w/ inspiration, increased pulmonic sound (P2), tricuspid regurgitant murmur

question

Hemothorax

answer

trauma + difficulty breathing. dull to percussion, decerased breath sounds. can be caused by tumor, blood dyscrasia, pulmonary embolism, bullous emphysemia, necrotizing infection, TB.

question

pneumonia

answer

chest pain, fever, cough, dyspnea, orthopnea.

question

pulmonary embolism

answer

dyspea, marked hypoxia.

question

transudative pleural effusion

answer

due to CHF. orthopnea, S3, crackles, elevated JVP.

question

Chylothorax

answer

blockage of thoracic duct. NHL, usually. Cirrhosis, TB, filariasis, cardiac procedure.

question

constrictive pericarditis

answer

mediastinal radiation (NHL). Fatigue, dyspnea, peripheral edema, ascites, high JVP. CT scan shows pericardial thickening.

question

Kussmaul's sign

answer

paradoxical increase in JVP w/ inspiration. can be seen in constrictive pericarditis.

question

CF Secondary pneumothorax

answer

acute onset SOB, pleuritic chest pain, no fever. CF. more searious than spontaneous pneumothorax.

question

CF Secondary pneumothorax

answer

chest tube (thoracostomy).

question

Primary pneumothorax

answer

needle aspiration w/ minimal dyspnea, <50, small pneumothorax <2cm from lung margin. Free of lung disease

question

DLCO and TLCO

answer

diffusion capacity from alveoli to blood. INCREASED: polycythemia, asthma, increased blood volume (CHF, exercise, right to left pulmonary shunting (CHF, Alveolar hemorrhage)). DECREASED: pulmonary vascular occlusive disease, interstitial lung disease, emphysema, pulmonary edema.

question

Raynaud's and scleroderma

answer

may have pulmonary HTN.

question

interstitial lung disease

answer

crackles, velcro rales

question

mitral stenosis

answer

causes pulmonary HTN and exertional dyspnea.

question

right-sided murmurs

answer

increase w/ inspiration

question

bilateral diaphragmatic paralysis

answer

fall in FVC in supine position. poor inspiratory force.

question

pulmonary fibrosis

answer

late inspiratory crackles

question

chest tube placement

answer

pus, gram + fluid, pH<7.0

question

Thoracentesis indications

answer

>1cm free-flowing pleural fleuid in setting of pneumonia.

question

tube thoracostomy indication

answer

complicated parapneumonic effusions. (Pus, Gram stain=positive pleural fluid or pH < 7)

question

exudate

answer

plerual fluid : serum total protein ratio >0.5

question

malignant pleural effusion

answer

exudative, hemorrhagic. >100,000 RBC. WBC <4000, lymphocytic predominance. Glucose <60 = poor prognosis. pH<7.3 = poor prognosis.

question

transudative pleural effusion w/ cancer

answer

hypoproteinemia, atelectasis, concurrent CHF.

question

pleural effusion w/ esophageal rupture

answer

pH<6, exudative. high pleural fluid amylase. squamous cells in pleural fluid. Hx: vomiting w/ left sided chest pain. small effusion.

question

Beta blockers hurt asthma

answer

decreases FEV1,

question

Beta-2 selective

answer

atenolol, metoprolol. don't use high doses.

question

alpha and beta blocker

answer

labetalol, carvedilol. use cautiously in asthma

question

topical beta blockers for glaucoma in asthma patient

answer

can cause death.

question

beta-blocker indused bronchoconstriction Tx:

answer

ipratropium bromide. Also: beta2agonists, atropine, aminophylline, steroids, glucagon.

question

cough-variant asthma

answer

has no spirometry abnormalities.

question

exercise-induced asthma

answer

FEV1 decrease of 20%. chest tightness.

question

Bronchitis

answer

after spirometry, do methacholine challenge testing. Provocative concentration 16 = normal.

question

occupational asthma

answer

serioal peak expiratory flow rate.

question

status asthmaticus

answer

asthma that stops responding to albuterol. Need an ABG. If PCO2 is elevated, ominous sign.

question

exacerbation of mild asthma

answer

add po corticosteroid.

question

exacerbation of persistant asthma

answer

add a long-acting beta-agonist

question

COPD+acute bronchitis

answer

antibiotics.

question

pertussis bronchitis

answer

tx: macrolide.. barking cough.

question

End-stage COPD

answer

Pulmonary rehabilitation.

question

acute severe asthma

answer

1. systemic steroids 2. bronchodilaters 3. MgSO4, 4. intubate.

question

new onset afib <48 hrs

answer

Rate control, then can cardiovert them

question

unknown onset afib

answer

1. anticoagulate for 3 weeks, then cardiovert. 2. TEE to look for left atrial clots. if clean - cardiovert. 3. If already on warfarin, cardiovert. Cardioversion works better with new onset than old onset.

question

new onset afib <48 hrs

answer

1. Diltiazem. 2. Metoprolol. 3. Digoxin. Order Echo, EKG, TSH, Troponin.

question

post-MI meds

answer

...

question

Cholesterol emboli

answer

urine eosinophilic

question

Unstable angina (active pain)

answer

nitroglycerin sublingual, then IV.

question

Unstable agina acute

answer

Beta blockers decrease O2 demand, ASA, heparin, start a statin before discharge, run a lipid profile.

question

Non-ST elevation acute coronary syndrome

answer

With moderate to high risk. PCI.

question

Timi score

answer

1. Age >= 65. 2. Aspirin use in the last 7 days (patient experiences chest pain despite ASA use in past 7days) 3. At least 2 angina episodes within the last 24hrs 4. ST changes of at least 0.5mm on admission EKG 5. Elevated serum cardiac biomarkers- Known Coronary Arte

question

TIMI mneumonic

answer

AMERICA:Age > 65 Markers (increased serum cardiac markers) EKG (ST depression) Risk factors (3 or more CAD risk factors: patient age, family history, hypercholesterolemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle, metabolic syndrome)Ischemia

question

TIMI > 5 or STEMI

answer

PCI is superior

question

bradyarrhythmias

answer

early in the setting of an inferior wall MI (first 24 hours) may respond to atropine treatment.

question

bradyarrhythmias

answer

Later or wide QRS-complex bradyarrhythmias as well as bradyarrhythmias in the setting of an anterior wall MI usually require placement of a temporary pacemaker.

question

Unstable angina patient who has chest pain in front of you

answer

EKG, stat troponins

question

cirrhosis

answer

gynecomastia, spider angiomata, portal HTNMCC: alcohol, then viral hepatitis (C).

question

cirrhosis

answer

not considered large vessel atherosclerosis.

question

contrast nephropathy

answer

spike in Cr within 24 hrs, then return to normal renal fcn within 5 daus. . prevention: IV hydration w/ or w/o bicarb. acetylcystein can help, too. D/C all NSAIDs

question

xanthelasma

answer

cholesterol-filled yellow plaques on medial aspects of the eyelids bilaterally. Upper and lower eyelids may be affected. occurs in primary biliary cirrhosis and idiopathic reasons

question

chalazion

answer

chronic, sterile, granulomatous inflammatory lesion of the meibomiun glands

question

meibomium glands

answer

...

question

hordeolum

answer

purulent infection of one of the glands of the eyelid. usually staph.

question

molluscum contagiosum

answer

poxvirus. may occur with increased frequency in immunocompromised patients or normal healthy children

question

Stye

answer

small, external hordeolum involving Zeis's or Moll's gland

question

primary billiary cirrhosis

answer

pruritis, jaundice, steatorrheal, hepatosplenomegaly, increased Bili, alk phos, antimitochondrial antibodies. destroys intrahepatic bile ducts. causes cirrhosis. Xanthomas, xanthelasmas, osteoporosis.

question

SVT

answer

tachycardia originating above the bundle of His. Sinus tachycardia, multifocal atrial tachycardia, atrial flutter, atrial fibrillation, AV node reentrant tachycardia, AV reentrant tachycardia, junctional tachycardia.

question

SVT

answer

dizzy, light-headed, SOB, diaphroesis, chest pain, presyncome, syncope.

question

Paroxysmal SVT

answer

SVT with abrupt onset and offset. AVNRT, AVRT, atrial tachycardia, jcnal tachycardia.

question

SVT

answer

if hemodynamically stable, vagal maneuver (carotid sinus massage, valsalva, eyeball pressure or IV adenosine. all of which slow conduction via the AV node. unmask the hidden P waves in patients w/ atrial flutter or atrial tachycardia. can cause transient AV nodal block, which terminates AV-node dependent arrhythmias.

question

amiodarone / lidocaine

answer

ventricular tachycardia that is wide-complex.

question

polycystic kidney disease

answer

bilateral, non-tended, upper abdominal masses. Dx: abd US.HTN is early manifestation of the disease.

question

pheochromocytoma

answer

urine metanephrines

question

high aldo:renin ratio

answer

primary hyperaldo causing HTN.

question

Cushing's

answer

24-hour urine cortisol

question

renal artery stenosis

answer

captopril renal scan for dx. refractory HTN.

question

ventricular aneurysm

answer

days to months after MI. persistent ST elevations on EKG. CHF, arrhythmia, thrombus formation, mitral regurg: (pansystolic murmur). Dx: Echo

question

interventricular wall rupture

answer

5 days after infarction. acute L to R shunt w/ right sided heart failure and new systolic murmur.

question

ventricular free wall rupture

answer

5 days. acute pericardial tamponade, rapid decompensation, pulseless electrical activity

question

pulmonary infarction secondary to pulmonary embolism

answer

dyspnea

question

papillary muscle rupture

answer

after infarct. acute mitral regurg and pulmonary edema.

question

acute pericarditis

answer

first few days after infarction. diffuse ST elevation. positional chest pain.

question

Dressler's syndrome

answer

immune-mediated pericarditis. weeks to months after infarction. Diffuse ST elevation, positional chest pain

question

crystal-induced nephropathy

answer

Indinavir (protease inhibitor. HIV drug). needle-shaped crystals. can occur in well-hydrated patients.

question

didanosine

answer

pancreatitis. life-threatening

question

abacavir

answer

hypersensitivity syndrome

question

NRTI

answer

life-threatening lactic acidosis

question

NNRTI

answer

Stevens-Johnson syndrome

question

Nevirapine

answer

Liver failure

question

Left Bundle Branch Block

answer

absent Q waves w/ large wide tombstone R waves in I, aVL, V6, wide QRS. Chest pain, elevated troponin

question

LBBB

answer

deep and wide rS pattern in V1. V6: wide and upright rS or rSR'. absent q in lateral leads

question

Right BBB (RSR' in V1,V2. Lateral slurring of S as Right slowly depolarizes)

answer

Small q and tall R in I. Small r, small S, large positive reflection (rabbit ears) in V6. ST depression and T-wave inversion in the right precordial leads.

question

RBB

answer

anteroseptal MI, PE, CHF, myocarditis, peicarditis, HTN, congenital

question

ABI

answer

* Most patients with peripheral vascular disease have an ankle-brachial index (ABI) <0.9, and those with severe disease (rest ischemia) have an ABI <0.4.

question

ABI

answer

* An ABI >1.3 indicates vascular calcification.

question

acute viral pericarditis

answer

sharp pleuritic chest pain preceded by 3 day prodrome of cold, etc. Tx: Indomethacin. if still in pain, steroids

question

flexible endoscopy

answer

coin in esophagus

question

rigid endoscopy

answer

coin in tracheobronchial tree.

question

macular degeneration

answer

scotoma

question

open angle glaucoma

answer

slow loss of peripheral vision. tunnel vision

question

central retinal artery occlusion or retinal detachment

answer

sudden loss of all vision.

question

sensorineural hearing loss

answer

aminoglycosides, chemo, ASA, loop diuretics.

question

severe asthma exacerbation

answer

respiratory acidosis due to air trapping and CO2 retention. or acutely, repiratory alkalosis from tachypnea.

question

pulmonary embolism

answer

hypoxia and respiratory alkalosis

question

excessive diuresis

answer

volume contraction metabloic alkalosis

question

alport's

answer

recurrent hematuria, sensorineural deafness, FHx of renal failure.

question

thin basement membrane disease

answer

familial. adult. microscopic hematuria without proteinuria.

question

benign recurrent hematuria

answer

asymptomatic. Bx: normal.

question

Conn's syndrome

answer

primary hyperaldo. young normal BMI, non-black patient w/ HTN, adrenal mass. mild hypernatrememia, hypokalemia, metabolic alkalosis. muscle weakness and exercise intolerance (low K)

question

hazard ratio

answer

if 1 control group is better off.

question

susceptibility bias

answer

treatment regiment is picked due to severity of disease. if they switch groups, it is called this if you put them into the new group instead of their own group, C. (A and B. A cannot go to B, but must go to C)

question

mitral stenosis

answer

diastolic rumble

question

mitral stenosis sequela

answer

atrial fib due to dilated left atrium. chronic pulmonary HTN, then right heart failure. Beta blockers, digoxin, warfarin,

question

symptomatic mitral stenosis

answer

preload reduction (diuretics, nitrates)

question

afterload reduction

answer

ACE-I

question

beta blocker intoxication

answer

bradycardia, hypotension, normal respirations, wheezing. Tx: Glucagon

question

benzo intoxication

answer

drosiness, slurred speech, unsteady gait. flumazenil.

question

metabolic acidosis

answer

methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, Ethylene glycol, Salicylates. Non-anion gap: RTA, diarrhea

question

respiratory acidosis

answer

COPD

question

sunburst periosteal reacation and codman triangle

answer

osteosarcoma. high alk phos, high LDH

question

osteolytic lesion w/ onion skin periosteum

answer

ewing sarcoma

question

sclerotic cortex lesion w/ central nidus of lucency

answer

osteoid osteoma. pain worse at night. NSAIDs work

question

orbital cellulitis

answer

pain w/ eye movements, proptosis, ophthalmoplegia, diplopia.

question

liver abscess + Mexico trip

answer

entamoeba histolytica (protozoan amoeba). RUQ pain,

question

hydatid cyst

answer

echinococcus granulosus. dogs.

question

cystic live carcinoma

answer

thick, irregular hypervascular walls, numerous septa.

question

chondrocalcinosis

answer

rhomboid-shaped, positively birefringent

question

reiter's syndrome

answer

after chlamydia. urethritis, conjunctivitis, arthritis

question

mucormycosis

answer

aggressive surgical debridement + amphotericin B.

question

mucormycosis

answer

3 days of DKA + facial pain, bloody nasal discharge, hyphae, chemosis, proptosis.

question

papillary thyroid carcinoma

answer

psammoma bodies. infiltrative.

question

follicular

answer

look for infiltration of border.

question

lidocaine

answer

good for V. Tach, Do not use post-MI.

question

Diabetic autonomic neuropathy

answer

postprandial bloating, early satiety, constipation and diarrhea. Tx: Metoclopramine, bethanechol, erythromycin

question

primary sclerosing cholangitis

answer

Ulcerative Colitis. intra- and extra-hepatic biliary ducts. p-ANCA. Tx: ursodeoxycholic, endoscopic stenting or liver transplant.

question

polyarteritis nodosa

answer

fever, malaise, weight loss, neuropathy, arthralgia, myalgia, livedo reticularis, renal disease, Gi sx, HTN, respiratory, CNS, orchitis, coronary. necrotizing vasculitis of the small and medium-sized arteries

question

microscopic polyangitis

answer

pauci-immune, necrotizing vasculitis of small vessels. p-ANCA w/o IBD. skin rash, hemoptysis, chest pain, GI bleeding, arthralgia.

question

obesity hypoventilation syndrome

answer

pulmonary HTN w/ cor pulmonale, secondary erythrocytosis, hypoxia, chronic hypercapnia, respiratory acidosis, high bicarb, low Chloride

question

SVC syndrome

answer

think lung cancer or NHL

question

adrenal insufficiency w/ adrenal calcification

answer

adrenal Tb.

question

autoimmune adrenalitis

answer

MCC of primary adrenal insufficiency. no calcification

question

HIV adrenal insufficiency

answer

CMV, mycobacteria, fungi, TB, ketoconazole

question

Adrenal hemorrhage

answer

sudden onset. imaging shows blood

question

adrenoleukodystrophy

answer

VLC fatty acid accumulation. enlarged adrenals. no calcifications

question

digitalis toxicity

answer

atrial tach w/ variableblock. Tx: antibody

question

atrial tach

answer

long RP tach

question

risk factors for digitalis toxicity

answer

hypokalemia, hypomagnesemia, hypercalcemia, renal insufficiency, hypothyroid, pulmonary disease, coadministration w/ verapamil, quinidine, amiodarone

question

p wave taller than 2.5 mm

answer

right atrial enlargement

question

p wave wider than 3 small boxes

answer

left atrial enlargement

question

aortic dissection Dx

answer

contrast-enhanced CT of the chest, transesophageal echocardiography, and thoracic magnetic resonance angiography have similar accuracy

question

Pericarditis

answer

: diffuse ST-segment elevations that are concave upward and in no particular anatomic distribution and PR-segment depression, especially in leads II and III.

question

STEMI

answer

downwardly concave as opposed to other reasons for ST elevation, such as pericarditis.

question

IPF

answer

basilar infiltrates on chest radiograph, restrictive physiology, and evidence of impaired gas exchange. Most patients with this disorder are more than 50 years old and develop progressive dyspnea and nonproductive cough, with many patients reporting symptoms of more than 6 months' duration before medical evaluation. velcro quality

question

Sarcoid

answer

skin, eyes, joints, or lungs. Ocular involvement typically presents as uveitis; however, any part of the eye or orbit may be affected. The patient's skin lesions are most likely erythema nodosum. More than 90% of patients with sarcoidosis have lung involvement. Pulmonary function tests usually demonstrate restrictive disease, although airway obstruction is seen in some patients. Chest radiograph results are staged as follows: stage 0, normal; stage I, hilar lymphadenopathy alone; stage II, lymphadenopathy plus infiltrates; stage III, infiltrates alone; and stage IV, fibrosis. As in this patient, sarcoidosis may present acutely with bilateral hilar lymphadenopathy, polyarthralgias, and erythema nodosum. This triad of symptoms, known as Löfgren's syndrome, is seen in 25% to 50% of patients, primarily women, with acute sarcoidosis. In addition to recognition of the typical clinical or radiographic findings of sarcoidosis, the diagnosis requires histologic evidence of noncaseating granulomas as well as exclusion of infection.

question

centrilobular emphysema

answer

upper lung,

question

panlobular emphysema

answer

lung bases.

question

COPD

answer

FEV1/FEV <0.75.

question

Pink puffers

answer

thin, lean forward, barrel chest, accessory muscles

question

blue bloater

answer

overweight, cyanotic, chronic cough, cor pulmonale, no apparent distress or use of accessory muscles.

question

COPD/ Acute exacerbation

answer

systemic glucocorticoids.

question

Continuous O2 for COPD

answer

PaO2 55 OR O2 sat <88% at rest or during execise of PaO255-59 + polycythemia or co pulmonale. despite optimal medical therapy

question

COPD acute exacerbation

answer

beta agonist, anticholinergic, systemic corticosteroids, zithromax or levofloxacin, O2 for sp02 < 90, CPAP or BPAP, intubation if severe respiratory acidosis.

question

asthma exacerbation

answer

if CO2 is normal or high, intubate.

question

bronchiectasis MCC

answer

CF.

question

bronchiectasis

answer

chronic cough w/ large amounts of mucopurulent foul-smellig sputum, dyspnea, hemoptysis, recurrent pneumonia.

question

bronchiectasis Dx

answer

High-res CT. obstructive PFTs, CXR abnl,but nonspecific, bronchoscopy possibly

question

bronchiectasis Tx

answer

antibiotics,hydration, bronchodilators

question

CF

answer

pseudomonas, pancreatic insufficiency

question

CF Tx

answer

pancreatic enzyme replacement, DEAK supplement, flue and pneumonia vacines, antibiotics, inhaled human deoxyribonuclease. Death at 30

question

superior vena cava syndrome

answer

more common in small cell

question

pancoast tumor

answer

C8-T2 nerves. shoulder pain radiating down the arm. Squamous cell. also, Horner's syndrome 1/2 the time

question

flexible bronchoscope

answer

central lung nodule

question

lung nodule

answer

flexible bronchoscope, needle biopsy, PET scan

question

exudative effusion

answer

cell count, glucose, pH, amylase, triglycerides, microbiology, cytology. Protein >-.5 or LDY pleural / LDH serum >0.6, LDH > 2/3 upper limit of normal serum LDH)

question

transudative effusion Tx

answer

diuretics and Na restriction. thoracentesis if massive w/ dyspnea

question

Exudative effusion Tx

answer

Treat underlying cause

question

Parapneumonic effusion

answer

effusion w/ pneumonina. pH<7.2. Tx: antibiotics. if complicated: chest tube, intrapleural streptokinase/urokinase, possibly surgical lysis of adhesions

question

Empyema

answer

exudative effusions untreated. Thoracentesis and antibiotics.

question

small spontaneous pneumothorax Tx

answer

observation. resolves in 10 days. +/- chest tube

question

larger spontaneous pneumothorax

answer

supplemental O1, chest tube insertion

question

secondary pneumothorax (lung disease)

answer

Chest tube drainage due to lack of reserve.

question

tension pneumothorax

answer

hypotension, distended neck veins, tracheal shift, decreased breath sounds, hyperresonance to percussion. large bore needle. 2nd or 3rd intercostal space, midclavicular line, then chest tube.

question

asbestos ancer

answer

mesothelioma. a few month survival' and bronchogenic carcinoma

question

interstitial lung disease

answer

fatigue, SOB, cugh, rales at bases, digital clubbing, pulmonary HTN,

question

honeycomb lung

answer

scarred, shrunken lung. ILD.

question

ILD Dx

answer

cxr, pft, biopsy, urinalysis

question

Sarcoid

answer

CN 7 involvement or optic nerve.

question

sarcoid dx

answer

CXR hilar adenopathy, ACE high, hypercalciuria, hypercalcemia,

question

sarcoid Tx

answer

steroids or MTX

question

Histiocytosis X

answer

tobacco smoker. dyspnea, nonproductive cough, spontaneous pneumothorax, lytic bone lesions, dibetes insipidus. honeycomb X-ray, cystic lesions. Tx: steroids or lung transplant

question

Wegener's

answer

necrotizing granulomatous vasculitis. lung and kidney. tissue biopsy. cANCA.

question

Wegener's tx

answer

immunosuppressants and steroids

question

Churg-strauss

answer

granulomatous vasculitis in asthma patients. plmonary infiltrate, rash, eosinophilia. bood eosinophilia. pANCA. Tx: Steroids

question

pleural plaques

answer

asbestos

question

egg shell calcificaion

answer

silicosis

question

asbestos ancer

answer

linear opacities and hazy infiltrates

question

silicosis

answer

peribronchial fibrosis

question

Berylliosis

answer

acute: pneumonitis. chronic: granulomas, skin lesions, hypercalcemia. lymphocyte proliferaiton. Steroids.

question

hypersensitive pneumonitis

answer

acute: fever, chills, cough, dyspnea. pulmonary infiltrates. Chronic: tougher.

question

hypersensitive pneumonitis Tx

answer

remove offending agent. glucocorticoids

question

Goodpasture

answer

lung + Kidney. hemoptysis and dyspnea. Dx: biopsy. Tx: plasmapheresis, cyclophosphamide, steroids

question

Pulmonary alveolar proteinosis

answer

surfactant-like protein, phospholipids in the alveoli. Tx: GCSF

question

IPF Tx

answer

oxygen, steroids, cyclophosphamide, lung transplant

question

Cryptogenic organizing pneumonitis

answer

flu-like Sx. patchy infiltrates. Tx: steroids

question

radiation pneumonitis

answer

pulmonary fibrosis.cough, fever, chest fullness, dyspnea, pleuritic chest pain, hemoptysis, ARDS. CT: diffuse infiltrates, effusions. Tx: Steroids.

question

Acute respiratory failure

answer

inadequate oxygenation of blood or inadequate ventilation.

question

hypercapnia

answer

increases ICP

question

V/Q mismatch

answer

Tx: oxygen.

question

intrapulmonary shunt

answer

no ventilation due to collapsed alveoli. Cause; atelectasis, fluid buildup in alveoi, direct right-to-left intracardiac blood flow. NO oxygen

question

Increased CO2 production

answer

sepsis, DKA, hyperthermia

question

ARDS

answer

shunting due to alveoli collapse. interstitial pneumonia, sepsis, trauma, pancreatitis, transfusions, intracranial HTN, heart bypass

question

ARDS

answer

dyspnea, tachypnea, tachycardia. no response to O2. diffuse pulmonary infiltrates.

question

ARDS Tx

answer

O2, PEEP. PCWP of 12-15

question

Mechanical ventilation

answer

high RR or respiratory arrest, impaired consciousness, absent gag, metabolic acidosis, respiratory muscle fatigue, PaO250, pH<7.2

question

assisted control ventilation

answer

1st line in respiratory failure. same predetermined tidal volume. all breaths by ventilator. Patient can go over the line.

question

Synchronous intermittent mandatory ventilation

answer

breath over hte line, but if you do, tidal volume is whatever the patient requires. good for weaning.

question

CPAP

answer

0-20cm pressure during inspiration and expiration. patient breathes on his own.

question

Pressure-support ventilation

answer

weaning trial. pressure with an initated breath to assist breathing. pressur not continuous. enhances respiratory effors. PEEP may be added.

question

Pulmonary HTN

answer

>25-30 mm Hg. mitral stenosis, atrial myxoma, VSD, ASD, PDA, PE, CREST syndrome, COPD, OSA,

question

Primary pulmonary HTN

answer

Cardiac cath, CXR: larger arteries, RV, and clear lung feals. restrictive PFT, Right axis deviation and RVH. Tx trial: inhaled NO, IV adenosine, CaCb before longterm Tx: prostacyclin: epoprostenol and CaCB + warfarin and lung transplant

question

Cor pulmonale

answer

RVH w/ RV failure from pulmonary HTN due to pulmonary disease.

question

Cor pulmonale

answer

right axis deviation, peaked P waves, RVH. Echo: RVH. Tx: diuretics, O2, digoxin if also LV failure.

question

pulmonary embolism

answer

Respiratory alkalosis, high A-a gradient, high V/Q

question

pulmonary embolism

answer

D-Dimer if unlikely. if likely, spiral CT. if inconclusive or cannot be done: Leg US. if no DVT: V/Q scan

question

pulmonary embolism Tx

answer

O2, heparin for 5-10 days, warfarin, +/-streptokinase or TPA if large or Right heart failure. IVC placement.

question

aspiration pneumonia

answer

PCN G or clindamycin,

question

massive hemoptysis

answer

bronchiectasis, bleeding diathesis. intubate, possibly. bronchoscope, balloon tampoade, bronchial artery embolization.

question

hemoptysis

answer

bronchitis, lung cancer, TB, bronchiectasis, pneumonia, goodpasture's, PE, aspergilloma, mitral stenosis, hemophilia

question

HITT DVT prophylaxis

answer

Intermittent pneumatic compression is effective prophylaxis in patients at moderate to high risk for venous thromboembolism in whom heparin and low-molecular-weight heparin are contraindicated.

question

active cancer prophylaxis

answer

low-molecular weight heparin

question

lung

answer

A FEV1/FVC ratio <70% is indicative of obstructive lung disease.

question

PAO2 alveolar

answer

150-(CO2*1.25)

question

PAO2 alveolar example

answer

150 - (37*1.25) = 104

question

A-a gradient

answer

PAO2 - PaO2. 104-60=44

question

4 categories of hypoxemia

answer

hypoventilation, low inspiredO2, Shunting, V/Q mismatch

question

V/Q mismatch

answer

pulmonary embolism

question

shuntin

answer

pulmonary edema, pneumonia, vascular shunt.

question

pulmonary edema risk factors

answer

HTN, DM, CAD, blood loss/surgery.

question

bronchiectasis

answer

linear atelectasis. diffuse rhonchi and wheezes w/ crackles at base

question

bronchiectassis

answer

cough, mucopurulent sputum, hemoptysis, responsive to antibiotics.

question

ventilator management

answer

decrease ventilator FiO2 once PaO2>60. PaCO2 is normal, minute ventilation is appropriate. don't change tidal volume or respiratory rate.

question

IPF

answer

progressive dyspnea, nonproductive cough, digital clubbing. end-inspiratory crackles

question

CHF

answer

Kerley B lines

question

lupus

answer

pneumonitis

question

laryngeal edema

answer

limitation of both inspiration and expiration

question

aspergillosis

answer

asthma/CF patients. Fever, malaise, productive cough, eosinophilia, hemoptysis

question

pulmonary embolism sequela

answer

pleural effusions.

question

bronchoalveolar lavage

answer

malignancy and opportunistic infection

question

hypertrophic osteoarthropathy

answer

digital clubbing + sudden-onset arthropathy wrist and hand due to lung disease (cancer, TB, bronchiectasis, emphysema).

question

Wegener's

answer

cANCA, hemoptysis, high Cr, sinusitis

question

AFP cancers

answer

hepatocellular, testicular.

question

aspergillosis CXR

answer

solid mass w/ radiolucent crescent.

question

candida

answer

esophagitis, endocarditis, endopthalmitis, hepatosplenic disease, meningits

question

laryngeal edema

answer

acute-onset dyspnea, usually due to allergy. stridor.

question

eosinophilic pneumonia

answer

gradual onset, asthma-like sx for several days. diffuse wheezes and fine inspiratory crackles. bronchial and interstitial involvement. Peripheral eosinophilia present.

question

Leukocytoclastic vasculitis

answer

skin + lung infiltrates ,

question

nocturnal asthma

answer

think GERD

question

high suspicion of PE

answer

O2, IV fluids, heparin, CT.

question

Contraindication to spiral CT

answer

iodine dye allergy, kidney issues.

question

klebsiella

answer

encapsulated gram (-) mucoid colony growt. upper lobe. currant jelly sputum. pneumonia in an alcoholic.

question

e. coli pneumonia

answer

nosocomial.

question

legionella

answer

gram-negative bacillus. from water. not encapsulated. occurs in alcoholics.

question

mycoplasma

answer

sparse bacteria, PMNs + monocytes + desquamated respiratory epithelial cells

question

pseudomonas

answer

encapsulated gram (-) bacillus. nosocomial. cystic fibrosis, neutropenia, advanced AIDS, bronchetasis, ICU pneumonia.

question

recurrent pneumonia in same location

answer

bronchogenic carcinoma until proven otherwise. Order CT.

question

chlorpheniramine

answer

like benadryl

question

asymptomatic pulmonary asthma + Mississippi

answer

histoplasmosis. fungus vird and bat. spore inhalation

question

blastomycosis

answer

3-month low-grade fever, night sweats, productive cough, weight loss. ulcerated skin involvement, lytic bone lesions, Ohio, wisconsin.

question

Coccidiodomycosis

answer

fever, cough, night sweats, skin, meninges, skeleton. Southwest.

question

mycoplasma

answer

headache, sore throat, erythema multiforme, few cells, indolent.

question

legionella Dx

answer

urine legionella antigen test

question

plumber exposure

answer

asbestos. bronchogenic carcinoma is more common than mesothelioma, which is only in the pleura.

question

theophylline

answer

headach, insomnia, palpitations, vomiting

question

albuterol S/E

answer

arrhythmia, nervousness, tremor

question

theophylline

answer

cipro and erythrmocyin decreases its clearance and raises plasma concentration.

question

secondary pneumothorax (lung disease)

answer

due to expansion of dilated alveolar blebs.

question

amp + gent

answer

gram negative aerobes. abdominal infections if added to flagyl

question

cipro

answer

gram negative coverage

question

doxycycline

answer

outpatient pneumonia w/ suspected macrolide resistance.

question

active intracranial neoplasm

answer

no anticoagulation

question

kartagener's

answer

no pancreas involvement

question

CF

answer

pancreas involvement.

question

empyema

answer

intrapleural pus due to bacteria from parapneumoinc effusion in pneumonia.

question

wegener's

answer

vasculitis, upper and lower airway granulomas, nasal cartilage destruction, cutaneous lesions. Skin + sinuses + lung

question

pulmonary tb

answer

facial lupus vulgarus, scrofuloderma

question

mintral stenosis

answer

hemoptysis, dyspnea, fatigue, orthopnea, paroxysmal nocturnal dyspnea

question

Nasal septum perforation

answer

Pain, crusting, bleeding

question

Inverted nasal papilloma

answer

Nasal obstruction, epistaxis

question

Pyodermal germinoma

answer

Pregnant women get these. Cause nosebleeds.

question

Angle closure glaucoma

answer

Tx: IV acetazolamide, then po, then surgery

question

corneal abrasion

answer

pain and photophobia. slit lamp w/ fluorescein.

question

uveitis

answer

pain, blurred vision, anterior chamber: flare and cells on slit lamp. constricted pupil. poor light response

question

PCP

answer

pupil dilation, hallucinations, nystagmus

question

marijuana

answer

tachycardia, high BP, paranoia

question

aldo-deficiency

answer

hyperkalemic hyponatremic normal anion-gap metabolic acidosis. can occur in TB.

question

neuroleptic malignant syndrome

answer

rigidity, fever, high CK,

question

Tetanus

answer

similar to NMS + muscle spasms.

question

lithium intoxication

answer

tremors, ataxia, AMS, N&V, hypotension

question

drug-induced parkinsonism

answer

no fever

question

conductive hearing loss

answer

...

question

amiodarone

answer

use for PVCs if Beta Blockers don't work.

question

New clubbing in COPD

answer

malignancy until proven otherwise

question

Pulmonary HTN

answer

>25-30 w/ exercise

question

hemochromatosis + cirrhosis

answer

increased risk of LIsteria, Yersinia, Vibrio vulnificus. due to iron overload

question

UCcolonoscopy schedule

answer

8 years after onset, repeatcolonoscopies every 1-2 years.

question

Colectomy for UC

answer

only if colonoscopy shows dysplasia.

question

hepatic adenoma

answer

check AFP

question

hydatid cyst

answer

cystic echinococcosis in immigrants or SW. Tapeworm to liver cysts. RUQ pain, N&V. encapsulated, calcified cyst. budding cells

question

graves

answer

increased iodine uptake

question

thyroiditis

answer

decreased iodine uptake

question

struma ovarii

answer

ovarian teratoma. hyperthyroid

question

toxic multinodular goiter

answer

older patients. hot nodules w/ decreased uptake in the rest of the thyroid gland

question

mid=diastolic rumble

answer

mitral stenosis or atrial myxoma

question

endocarditis

answer

regurgitant murmur

question

myxomatous valve degeneration

answer

causes mitral valve prolapse. midsystolic click.

question

polymyalgia rheumatica (PMR)

answer

pain and stiffness in neck, shoulder, pelvic girdle. >50yo, elevated ESR, morning stiffness >1hr. Tx: low-dose prednisone.

question

PMR+temporal arteritis

answer

biopsy + high dose prednisone to prevent blindness.

question

ARDS

answer

non-cardiogenic pulmonary edema. sepsis, severe bleeding, pneumonia, toxins, burns.

question

PCWP

answer

>18 = cardiogenic. <18 = non-cardiac.

question

iatrogenic fluid overload

answer

PCWP>18

question

PEEP

answer

mild hypoxemia, respiratory alkalosis, FiO2 of 70%. add peep.

question

legionella

answer

Pneumonia, fever, GI symptoms. Dx: urine antigen or charcoal agar culture

question

pleural effusion Dx

answer

thoracentesis unless clear evidence of CHF.

question

COPD exacerbation

answer

O2, B2 agonist, anticholinergic, broad-spectrum antibiotics, 2-week steroid taper

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