contraindicated
1. benzos*, nitrates, aspirin 2. they lead to unopposed cocaine mediated alpha vasoconstriction' *choose a CCB insted to control vasospasm
861.what is the cause of inc. orthostatic hypotension with increased age
+ what other changes to the heart with age
progressively decreasing baroreceptor sensitivity * 862.worsening diastolic function, dec. resting/maximal CO. dec. # of myocytes ...
863.how does the kidney adapt to respiratory alkalosis
excreting bicarbonate in the urine
864.what are poor prognostic
indicators during an asthma attack
NORMAL PaCO2 - because it should be low 2/2 hyperventilation
865.others - speech difficulty, diaphoresis, altered sensorium, cyanosis, silent lungs ... 866.what decreases mortality in COPD home oxygen smoking cessation
867.indication for NIPPV respiratory distress
pH <7.35, PaCO2>45, RR>25/min
868.complete
opacification of a SINGLE lung with shifted mediastinum
indicates a collapsed lung, should look for bronchial lesion with bronchoscopy -- causes include mucus plugging, tumor, foreign body
869.reyes syndrome 1. patho
2. tx
hepatic encephalopathy in children associated with viral infections and salicylates
- mitochondrial injury --> extensive fatty vacuolization of the liver without inflammation 2. glucose, FFP, mannitol (for cerebral edema)
870.legionella pneumonia 1. clinical pres 2. treatment 3. dx
1. refractory to beta lactam (also mycoplasma), HYPONATREMIA CONFUSION, ABDOMINAL PAIN, DIARRHEA acute onset fever, malaise, headache, non-productive cough, dyspnea,
2. erythromycin or azithromycin 3. HYPONATREMIA, organism negative smear (only polymorphs)
871.hypoventilation syndrome
consequence of severe obesity and untreated OSA, chronic
hypercapnia/hypoxic resp. failure, secondary erythrocytosis, low serum Cl, hypertension, cor pulmonale
872.aspirin sensitivity syndrome
pseudo allergic reaction - 2/2 aspirin induced prostaglandin/leukotriene imbalance
* tx = leukotriene receptor antagonist
873.what
conditions will increase fecal fat
bacterial overgrowth, pancreatic insufficiency, celiac disease, crohns disease
874.D-xylose test simple sugar that does not need to be
digested to be absorbed tests for INTACT MUCOSA OF PROXIMAL SMALL BOWEL ONLY ONLY
- THUS if pancreatic insufficiency is present D-xylose absorption/excretion will not be effected
875.acid fast oocysts
cryptosporidium parvum - chronic diarrhea in HIV patients with CD4<180
876.also may be isospora ... 877.when to order EGD for patients with GERD n/v
weight loss, anemia, melena/blood long duration of symptoms >1-2 years failure to respond to PPI
878.^ALARM SYMPTOMS ... 879.GI bacterial overgrowth nutrient defiencies Vitamin D
Vitamin A - night blindness B12 - neuropathy
880.what vitamin deficiency in carcinoid syndrome
niacin - used to synth seratonin/5HIAA metabolites
881.which type of polyps are most likely to
progress to malignancy
villous adenoma, sessile adeoma, size >2.5cm
882.what GI pathology is often associated with elevated BUN
upper GI bleeding
883.two situations where you can see elevated BUN without elevated Cr upper GI bleeding steroids 884.1. vitamin E deficiency clinical pres 2. Vitamin C """
1. RBC fragility, hyporeflexia, muscle weakness, blindness
2. perifollicular hemorrhage, swollen gums, poor wound healing
885.most common complication in UC
colon cancer (1% per year)
886.gallstone risk factors
caucasian race, obesity, female, OCP, DM, hypomotility of gallbladder (preg), ileal disease, clofibrate, octreotide, ceftriaxone
887.pancreatic pseudocyst treatment
<5cm observe for 6 weeks if persistent then drain *no ABX necessary >5cm - drain
888.liver histo findings 1. balloon degeneration with inflamm cells 2. panlobular mononuclear inflammation 3. piecemeal necrosis
1. acute alcoholic hepatitis 2. acute viral hepatitis, bridging necrosis (confluent hepatic necrosis between adjacent lobules)
3. inflammatory cells extend between portal ducts with periportal bridging fibrosis 889.how to evaluate liver damage in acute vs chronic hepatitis acute - LFTs
chronic - liver biopsy
890.causes of liver biliary ductopenia
PBC, transplant rejection, hodgkins disease, GVHD, sarcoid, CMV/HIV
891.entamoeba histolytica 1. patho 2. clinical pres 3. dx/tx
1. contaminated water in endemic region (south america)
2. bloody diarrhea, RUQ pain 3. THIN WALLED CYST IN RIGHT LOBE OF LIVER, sterile aspirate, stool exam shows trophozoites tx = metronidazole -- DO NOT DRAIN (compare to echinococcus)
892.What should all cirrhotic patients be screened for
esophageal varices HCC - (AFP)
893.what is the risk associated with porcelain gallbladder
894.risk is cancer of the gallbladder
...
895.when to give hep A Ig vs hep A vaccine
give immunoglobulin if travel will occur in less than 4 weeks
896.otherwise give vaccine ... 897.uric acid stones
1. dx 2. tx
1. radiolucent stones on KUB, acid urine pH <5,
2. hydration, sodium bicarb or sodium citrate dissolves the stones
898.varicoceles that fail to empty in the
recumbent position
RCC
diagnose with CTA
899.what should be first diagnostic test for patient with BPH symptoms and elevated Creatinine
kidney, ureter, bladder ultrasound
900.amikacin aminoglycoside
901.causes of priapism sickle cell/leukemia, trauma,
spinal cord/cauda equina, trazodone/prazosin
902.erythropoietin side effects
worsening hypertension (30%), flu like symptoms
903.1. hypertensive nephropathy histological progression
1. dec. in blood flow,
Nephrosclerosis - hypertrophy and intimal medial fibrosis of afferent and efferent arteries Glomerulosclerosis - progressive loss of glomerular capillary surface area with
glomerular/peritubular fibrosis 2. glomerular
hyperperfusion/renal hypertrophy and INC. GFR GBM thickening, glomerular hypertrophy mesangial expansion, GFR NORMAL microalbuminuria and progressive glomerular sclerosis/fibrosis (kimmelstiel wilson) 904.causes of kidney transplant rejection + tx
acute rejection, cyclosporine toxicity, vascular obstruction, ATN
tx = IV steroids
905.1. risk
most common cause of death in dialysis patients
cardiovascular disease hyperphosphatemia, inc. PTH, inc. homocysteine, accelerated atherogenesis 2/2
uremia/dialysate oxidative stress, inc. calcium intake
906.what kind of urine sediment seen in chronic kidney disease
broad casts, waxy casts
907.urine sediments 1. muddy brown casts 2. RBC casts
3. WBC casts