Term
| autoimmune inflammation and destruction of the medium sized bile ducts resulting in cholestasis is AKA |
|
Definition
| Primary biliary cirhhosis |
|
|
Term
| what lab values will be elevated in PBC? |
|
Definition
anti-mitochondrial antibodies
ALT and AST mildly elevated or normal
AP very high |
|
|
Term
|
Definition
|
|
Term
| physical findings and presentation of PBC |
|
Definition
fatigue
severe pruritis
hepatosplenomegaly
xanthomatous lesions on eyelids/tendons/skin
jaundice, steatorrhea
portal htn
osteopenia |
|
|
Term
| what diseases are assocaited with PBC |
|
Definition
scleroderma, sjogren, reynauds, autoimmune thyroid stuff, celiacs
there is also increased risk for hepatobiliary cancer |
|
|
Term
|
Definition
ursodeoxycholic acid #1
methotrexate
colchicine
liver transplant last |
|
|
Term
| what do antismooth muscle Antibodies indicate? |
|
Definition
| acute and chronic hepatitis |
|
|
Term
| what do anti ANA antibodies indicate |
|
Definition
SLE
collagen vascular diseases
primary autoimmune hepatitis |
|
|
Term
| what do anti LKM antibodies indicate |
|
Definition
| acute and chornic hepatiis (like anitsmooth mm antibodies) |
|
|
Term
| what are anti smith Abs specific for? |
|
Definition
| very specific for SLE but only found in 30-50% (not very sensitive) |
|
|
Term
| what is P-ANCA associated with? |
|
Definition
Churg-Strauss syndrome
microscopic polyangitis |
|
|
Term
| What is secondary bacterial pneumonia? |
|
Definition
when a person gets a pneumonia after having a less complicated viral URI.
seen mostly in old people |
|
|
Term
| what pathogens are mostly assocaited with secondary bacterial pneumonia? |
|
Definition
|
|
Term
| What is unique about staph secondary bacterial pneumonia? |
|
Definition
| causes a necrotising pneumonia that can cavitate and cause small abscesses that look like thin-walled cavities on CXR |
|
|
Term
| when do you investigate a murmur found incidentally |
|
Definition
ALWAYS look into diastolic murmurs
soft midsystolic murmurs in healthy ppl are ok to just ignore |
|
|
Term
| features of vitreous hemorrhage of the eyeball |
|
Definition
-sudden loss of vision
-floaters
-fundus is hard to see |
|
|
Term
| who gets a vitreous hemorrhage |
|
Definition
|
|
Term
| what does retinal detachment look like on fundoscope |
|
Definition
| elevated retina with folds/tears |
|
|
Term
| what does macular degeneration present with |
|
Definition
| progressive painless loss or blurring of CENTRAL vision |
|
|
Term
|
Definition
|
|
Term
|
Definition
"Hairy CAT goes numb"
Hyperreflexia
Convulsions
Arrythmias
Tetany (chvosteks, trousseaus)
numbness (paraesthesias) |
|
|
Term
| when can hypocalcemia occur? |
|
Definition
after surgery
after getting lots of blood transfusions |
|
|
Term
| drugs used for treating Hep B |
|
Definition
"Bud LITE"
1. Lamivudine
2. interferon
3. Tenofovir
4. Entecavir |
|
|
Term
| When do you use interferon? |
|
Definition
| in younger pt with compenstaed liver disease, short term use |
|
|
Term
| when do you use lamivudine? |
|
Definition
either never, or maybe if they have HIV
not used much anymore |
|
|
Term
| when do you use entecavir |
|
Definition
in decompensated cirrhosis
if drug resistant |
|
|
Term
| when do you use tenofovir |
|
Definition
| used in most all patients if not drug resistant |
|
|
Term
| you don't always treat pt with HBV initially. What are the indications for medically treating someone who is hep B positive? |
|
Definition
1. acute liver failure
2. clinical complications of cirrhosis
3. cirrhosis + hi HBV DNA in blood
4. pts with HBeAg, hi HBV DNA and ALT 2x greater than normal
5. in immunocomprimised or cancer patients |
|
|
Term
| most common cause of anemia in alcoholics |
|
Definition
| folate def > B12 deficiency |
|
|
Term
| treating pts with a-fib based on CHADS2 score |
|
Definition
CHADS=0 = nothing
CHADS=1= anticoagulant or ASA
CHADS=2= must use anticoagulant |
|
|
Term
|
Definition
|
|
Term
|
Definition
| factor Xa inhibitor, can be used in pt with Afib |
|
|
Term
|
Definition
| hyperthyroid can cause rapid bone loss due to inc metabolism |
|
|
Term
| in pt with frost bite how do you rewarm their fingers |
|
Definition
|
|
Term
| what is the lab test used to see if someone is HER2 positive |
|
Definition
| oncogene amplification by FISH |
|
|
Term
| What are the live vaccines you have to be careful with in HIV pts? Which are contraindicated? Which can you give sometimes? When can you give them? |
|
Definition
NEVER GIVE: BCG, Anthrax, oral typhoid, oral polio, intranasal flu.
GIVE WHEN CD4>200:
MMR, varicella, zoster (age>60) |
|
|
Term
| What vaccines do you ALWAYS give HIV pts? |
|
Definition
Tdap
pneumococcus
flu
hepA
hepB
menigogoccal
HPV
Hib
"HHHHTMPF" |
|
|
Term
| radiolucent stones are made of? |
|
Definition
|
|
Term
| what are the three possible causes of renal colic pain in a pt who shows no stones on xr |
|
Definition
1. radiolucent stones (from uric acid)
2. calcium stones (1-3 mm too small to see on xr)
3. non-stone cause of pain (tumor, blood clot) |
|
|
Term
| how do uric acid stones occur? |
|
Definition
pts have low urine pH
maybe bc defect in ammonia secretion
maybe bc of hyperuricosuria |
|
|
Term
| how do we tx uric acid stones |
|
Definition
hydrate
alkalinize urine to >6.5pH with K bicarb or K citrate
low purine diet
+- allopurinol if pt has hyperuircosuria |
|
|
Term
|
Definition
| auditory tube dysfunction from HIV lymphadenopathy or obstructing lymphomas |
|
|
Term
| what are the major characteristics of serous otitis media> |
|
Definition
middle ear effusion without evidence of acute infection
conductive hearing loss
dull tympanic membrane that is hypomobile |
|
|
Term
| How do you differentiate between B12 and folate def? |
|
Definition
both have elevated homocysteine levels
but B12 will also have hi methymalonic acid |
|
|
Term
| pneumonia sx with target shaped skin lesions |
|
Definition
mycoplams pneumoniae
(erythema multiforme) |
|
|
Term
| management of goodpastures disease? |
|
Definition
| must rpaidly do plasmapheresis to mimimize kidney damage |
|
|
Term
| most common cause of calcium kidney stones |
|
Definition
| idiopathic hypercalciuria |
|
|
Term
| management of pt with stones due to idiopathic hypercalciuria |
|
Definition
inc fluids
sodium restriction
thiazide or amiloride diuretic |
|
|
Term
| how do thiazides dec calcium |
|
Definition
1. they cause a mild volume depletion
2. this leads to inc in proximal reabs of Na and Ca
3. less reabs of Ca means less Ca passing thru kidneys to make stones |
|
|
Term
| DM + hypogonadism + hepatic cirrhosis |
|
Definition
| hereditary hemochromatosis |
|
|
Term
| most sensitive test to screen diabetic nephropathy |
|
Definition
| random urine for microablumin/cr ratio |
|
|
Term
| rapidly developing virilization in a female pt |
|
Definition
| ovarian or adrenal tumor secreting androgens |
|
|
Term
| best test for rapidly developing virilization in female pt |
|
Definition
|
|
Term
| What is the major murmur heard at the aortic area? |
|
Definition
| systolic murmur from aortic stenosis |
|
|
Term
| What are the major murmurs heard best at the pulmonic area? |
|
Definition
1. Systolic mumur: pulmonic stenosis, flow murmur, ASD
2. Systolic click: pulmonic stenosis |
|
|
Term
| What are the major murmurs heard best at the tricuspid area? |
|
Definition
1. Holosystolic: tricuspid regurg, VSD
2. Mid/Late Diastolic:Triscuspid stenosis, ASD |
|
|
Term
| What are the major murmurs best heard at the mitral area? |
|
Definition
1. Holosystolic: mitral regurg
2. Mid/Late diastolic: mitral stenosis
3. Systolic click: MVP |
|
|
Term
| What are the major murmurs best heard at the left sternal border? |
|
Definition
1. Systolic: Hypertrophic cardiomyopathy
2. Early Diastolic: Pulmonic regurg, Aortic regurg |
|
|
Term
| partially acid fast bacteria with branching filamentous rods |
|
Definition
|
|
Term
| cervicofacial actinomyces |
|
Definition
usually after dental surgery or procedure.
usually in the mandibular region.
slow growing nontender mass that can form abscess, fistula, or sinus tracts |
|
|
Term
| tx cervicofacital actinomyces |
|
Definition
1. penicillin
3. clindamycin if penicillin allergy |
|
|
Term
| What acid base change does persistant vomitting cause? |
|
Definition
| hypokalemic, hypochloremic metabolic alkalosis |
|
|
Term
| what is calcium gluconate used for |
|
Definition
| cardio protective in hyperkalemia |
|
|
Term
| what does hyperkalemia present as on EKG |
|
Definition
1. starts with peak T waves
2. PR and QRS start to prolong
3. sine wave eventually |
|
|
Term
| what do TCA overdose and aspirin overdose have in common? |
|
Definition
| give sodium bicarb in both |
|
|
Term
|
Definition
ppl with prolonged QT inverval
1. malnourished/etoh --> hypomagnesium
2. familial long QT syndrome |
|
|
